bluuebunny/crossref_metadata_2025 huggingface dataset:
PREDICTORS OF LONGITUDINAL COGNITIVE DECLINE AMONG COMMUNITY-DWELLING KOREAN OLDER ADULTS
Authors: Shin Jinhee , Cho Eunhee
Published: November 2019

Objective This study aims to explore predictors to longitudinal decline of cognitive function in old adults in Korean. Methods The data were derived from the information system of the Korean Longitudinal Study of Aging (KLoSA) which performed nationwide aging panel survey for adults aged over 45 years between 2006 and 2016. The sample consisted of 1,262 older adults who completed K-MMSE. Of the total 1,262 participants, 752 had normal cognition, 243 had mild cognitive impairment, and the rest 267 had dementia. Variables from diverse dimensions were derived from the KLoSA. The linear mixed models were used to predict and explain predictors affecting cognitive function decline over time. Results The ADL and IADL, depression, exercise, and social activity were time-varying variables significantly related to the cognitive function of the older adults. Over time, difference in change of the K-MMSE score between three groups was significant. Conclusions This study identified predictors influencing decrease of cognitive function over time in older adults in Korea. Tailored intervention needs to be developed and implemented in order to delay the cognitive function decline. Improving physical function through regular exercise, increasing social activity, and managing depression by early detection and treatment are recommended according to the cognitive function status. Keywords: old adults, cognitive function, K-MMSE, predictor
OPTIC FLOW IMPROVES SPATIAL GAIT FUNCTIONING ESPECIALLY IN MEDIOLATERAL DIRECTION
Authors: Fallahtafti Farahnaz , Kim Hyeon Jung , Yentes Jennifer M , Venema Dawn , Boron Julie Blaskewicz
Published: November 2019

Instances where multiple tasks are completed simultaneously are considered high cognitive load situations (HCLS, also called dual-task), potentially affecting gait performance in older adults. Walking while talking is a common HCLS that requires additional cognitive resources. Optic flow (OF) provides visual information about speed and direction of self-motion, and thus, may ameliorate gait deficits under HCLS. This study aimed to identify the effect of HCLS, as well as OF, on gait performance in older adults. The HCLS included walking while talking on the phone, compared to walking alone. Fifteen older adults (70.86±4.7yrs) underwent four experimental conditions: walking alone with(1) and without OF(2), as well as walking while talking with(3) and without OF(4). Step width, step length, and double support time were measured and examined with 2(HCLS) x 2(OF) repeated-measures ANOVAs. There was a main effect of OF; step width was narrower with OF compared to without OF (p=0.048). For step length, there was a significant interaction between HCLS and OF (p=0.045). Without OF, there were no differences in step length; however, with OF step length was significantly longer when walking alone compared to when walking while talking (p=0.002). Double support time was not affected by HCLS or OF. Considering younger adults have longer and narrower steps compared to older adults, OF may have enhanced step width regardless of HCLS and step length when walking only. Using OF in training programs designed for older adults, could be a potential factor to improve spatial gait function, more so in the mediolateral direction.
NEIGHBORHOOD CONTEXT AND LATER-LIFE WELL-BEING: OBJECTIVE AND SUBJECTIVE INDICATORS
Authors: Webster Noah J , Mair Christine , Cutchin Malcolm
Published: November 2019

Neighborhoods are known to shape well-being across the life course, particularly in later life. Yet, neighborhoods remain an underutilized focus in public health interventions due to lack of measurement specificity and understanding of mechanisms across well-being outcomes. This symposium brings together four complementary papers from social work, sociology, and psychology that incorporate multiple (objective and/or subjective) indicators of neighborhood context from national to locally-based samples to predict diverse forms of well-being. Lehning and colleagues use objective (Census) indicators of neighborhoods from the National Neighborhood Change Database, combined with data from the National Health and Aging Trends Study (N=7,197), to explore links between changing neighborhood age composition and older adults’ self-rated health.. Sharifian and colleagues examine the associations between perceived neighborhood characteristics (social cohesion, physical disorder) and cognition directly and indirectly through mental health pathways (depressive symptoms, anxiety) using the Health and Retirement Study. Webster and colleagues examine links between objective (Census) and subjective (perceived safety) neighborhood indicators and social well-being using data from the Detroit-based Social Relations Study (N=259). Mair et al. combine objective neighborhood-level data with individual-level data from the Healthy Aging in Neighborhoods of Diversity across the Life Span dataset to examine direct and indirect effects of neighborhood context on obesity risk among N=2,707 middle-age and older Baltimore City residents. These papers will be discussed by Malcolm Cutchin, a health geographer and social gerontologist, who will provide an interdisciplinary reflection of neighborhood measurement and use neighborhoods as a platform to promote diverse forms of well-being in later life.
REAL-WORLD REPRESENTATIVENESS OF CANADIAN RESEARCH SUBJECTS WITH MILD COGNITIVE IMPAIRMENT
Authors: Huang Vivian , Hogan David B , Ismail Zahinoor , Maxwell Colleen J , Smith Eric E , Callahan Brandy L
Published: November 2019

Studies of mild cognitive impairment (MCI) utilize stringent inclusion/exclusion criteria which may impact the generalizability of findings to the broader clinical population. We compared characteristics of MCI patients in a Canadian memory clinic in Calgary to MCI research participants in published Canadian studies to assess the representativeness of research samples. Clinic participants included 555 MCI patients from the Prospective Study for Persons with Memory Symptoms registry. Research participants included 4,981 individuals with MCI retained from a systematic literature review of 112 peer-reviewed empirical Canadian studies. Clinic patients and research participants were diagnosed with MCI using similar diagnostic criteria (i.e., from the NIA-AA, or Petersen criteria). Both samples were compared on baseline demographic variables, medical and psychiatric comorbidities, and global cognitive performance using chi-square tests and t-tests with weighted means. Diverse presumed causes were noted among clinic patients. Clinic patients were younger, more likely to be male, and more educated than research participants (ds: 0.22-0.98). Psychiatric disorders, traumatic brain injury, and sensory impairments were common in clinic patients (up to 83%), but participants with these conditions were excluded from approximately 80% of studies in the systematic review. Clinic patients performed significantly worse on two global cognitive assessments (ds: 0.53 – 1.27). Stringent eligibility criteria such as used in Canadian MCI research studies would exclude a considerable subset of MCI patients seen in our referral clinic. This may have contributed to the disparities between the clinical and research cohorts in the cognitive measures examined. The implications of these findings will be discussed.
FACTORS PROMOTING CONTINUED LIFELONG LEARNING: FOCUS ON THE PERSON-ENVIRONMENT FIT IN JAPAN
Authors: Yasuzato Chiharu , Katagiri Keiko
Published: November 2019

Lifelong learning of older people is categorized as social participation. Most studies on social participation have examined the motivation to start; however, those on continuing participation are few. This study aimed to identify the factors promoting continued lifelong learning among older adults, focusing on both personal and socio-relational factors. To do this, in-depth semi-structured interviews were conducted with 20 Japanese citizens, aged 60-75, with a learning experience of more than 3 years. Results showed that both personal and socio-relational factors matter. First, personal factors include older adults’ past learning experience, access to learning in the present, and work status. Past learning experience relates to their perception as students and their memories of learning during school age. Regarding accessibility, classes within walking distance, for example, would help in continuation of learning, especially for people with health problems. People may choose to become involved in learning activities after retiring from the workforce and they have time to spend. Second, the importance of socio-relational factors was evident in how family supported older people by accepting how important learning was for them and offering them rides to the classes. Within the class, they can share information about the happenings and activities in their community, become mentors, and stimulate each other. The instructor enhances their enthusiasm to learn and provides a comfortable learning space. Therefore, the findings of this study suggest that while there is no single condition, a person-environment fit promotes older adults continued learning.
NEIGHBORHOOD ENVIRONMENTS AND OBESITY: EXPLORING PATHWAYS TO RISK OF CARDIOVASCULAR DISEASE
Authors: Mair Christine , Lehning Amanda , Mattocks Nicole , Kim Kyeongmo , Millar Roberto , Evans Michele K , Zonderman Alan B , Waldstein Shari
Published: November 2019

Modifying neighborhood environments to target well-established risk factors for cardiovascular disease may reduce health disparities by complementing clinical services. Prior research, however, includes limited measures of neighborhoods and does not adequately account for individual-level processes known to mediate health outcomes. We combine baseline data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) dataset with neighborhood-level data to yield a diverse sample of Black and white middle-aged and older residents of Baltimore City (N=2707). We use structural equation modeling to examine associations between neighborhood environments and obesity (BMI>=30), focusing on individual-level mediators. Initial direct associations between neighborhoods and obesity (e.g., presence of businesses, β=-0.062) are mediated by healthcare access and health behaviors. Additional indirect pathways exist through health behaviors (e.g., neighborhood disorder, access to parks). These findings highlight the importance of considering indirect pathways to cardiovascular health promotion among aging adults in different neighborhood contexts.
ANXIETY AND DEPRESSIVE SYMPTOMS MEDIATE THE LINK BETWEEN PERCEIVED NEIGHBORHOOD CHARACTERISTICS AND COGNITION
Authors: Sharifian Neika , Sharifian Neika , Zaheed Afsara B , Spivey Briana N , Zahodne Laura B
Published: November 2019

Although prior research has linked perceived neighborhood characteristics to cognition, scant research has investigated underlying mechanisms regarding how neighborhood characteristics impact cognition. One pathway, in particular, may be through mental health outcomes. Poorer neighborhood characteristics have been independently linked to greater depressive and anxiety symptoms, which may, in turn, be risk factors for cognitive decline in later life. The current study examined direct and indirect effects of perceived neighborhood characteristics (social cohesion, physical disorder) on cognitive functioning (episodic memory, executive functioning) through anxiety and depressive symptoms using longitudinal data from the Health and Retirement Study (2010–2014). Results revealed that higher social cohesion was associated with better memory and executive functioning through lower anxiety and depressive symptoms. Physical disorder was associated with worse episodic memory and executive functioning through greater anxiety symptoms. These findings highlight the importance of neighborhood context for promoting both mental and cognitive health outcomes in older adulthood.
ARE FAMILY RELATIONSHIPS A PROTECTIVE RESOURCE AMONG ADULTS WITH FUNCTIONAL IMPAIRMENT?
Authors: Chunga Richard E , Wang Haowei , Carr Deborah
Published: November 2019

Health-related declines that affect physical functioning are a common stressor among older adults. Functional impairment can take a toll on older adults’ psychological well-being as it limits one’s capacities to independently carry out meaningful daily activities. The extent to which impairment affects mental health may vary based on the levels of support and strain in one’s personal relationships. Stress buffering perspectives suggest that support mitigates the detrimental psychological consequences of impairment, whereas stress amplification perspectives predict that strain will amplify these consequences. We use data from 2012 and 2016 waves of the Health and Retirement Study (N=3800) to explore: (a) the direct effects of functional limitation on depressive symptoms (CES-D); (b) the extent to which these associations are moderated by spouse, child, other relative, and friend support/strain; and (c) gender and marital status differences therein. Using lagged endogenous regression models, we find that impairment significantly increases depressive symptoms among men and women, and these effects are intensified by marital strain for both married men and women. However, buffering effects are found for women only, such that marital support mitigates against depressive symptoms in the face of current impairment. These results may reflect the gendered nature of marriage, where men with impairment uniformly benefit from marriage although women may experience protective effects of only in highly supportive unions. Results for other strain and support moderators also reveal gender differences, reflecting the distinctive ways that men and women interact with kin and friends over the life course.
GRANDPARENTS’ PERSPECTIVES ON A MULTIGENERATIONAL DIGITAL HEALTH PHYSICAL ACTIVITY INTERVENTION
Authors: Kobayashi Marissa , Leite Rafael O , Lugo Isabella , Wetstone Rachel , Vanegas Dario , George Sara M St , Czaja Sara J
Published: November 2019

Studies examining associations among grandparents’ involvement and grandchildren’s lifestyle behaviors have been largely mixed or negative highlighting the need for interventions that help grandparents promote grandchildren’s healthy behaviors. The current study explored older adults’ interest in participating in a digital intervention with their grandchildren. As part of the intervention, grandparents and grandchildren would engage in weekly walks and use a mobile application to track their steps, photos and conversations. Twelve grandparents (63±6.5yrs; 75% female; 50% Hispanic) participated in qualitative interviews. Researchers asked open-ended questions to assess grandparents’ relationships with their grandchildren, motivation to participate, and feedback on prototypes. A 10-item systems usability questionnaire was also administered. Three researchers independently analyzed interview transcripts using a rapid assessment approach and reached consensus on key themes. Grandparents described having positive relationships with their grandchildren and used texts to schedule time with them; family dynamics (conflicts, divorce) influenced the amount of time they spent together. Grandparents’ motivation for participating in the intervention included the opportunity to enhance their relationship with their grandchild and improve their own health. Grandparents noted weekly walks would feasibly occur on the weekends given their grandchildren’s competing activities. They were receptive to proposed weekly session topics (e.g., sports/hobbies, ancestry, humor) and suggested other topics to discuss during weekly walks, such as faith/religion, morality, safety, and nutrition. They strongly agreed or agreed that they would use the prototypes frequently and found them easy to use (83% and 92%, respectively). Results from this study will inform the next iteration of intervention prototypes.
OLD AND FORGOTTEN? CARE FOR ELDERS IN MEXICO AND THE U.S.
Authors: Aguila Emma , Angel Jaqueline L , Markides Kyriakos
Published: November 2019

The United States and Mexico differ greatly in the organization and financing of their old-age welfare states. They also differ politically and organizationally in government response at all levels to the needs of low-income and frail citizens. While both countries are aging rapidly, Mexico faces more serious challenges in old-age support that arise from a less developed old-age welfare state and economy. For Mexico, financial support and medical care for older low-income citizens are universal rights, however, limited fiscal resources for a large low-income population create inevitable competition among the old and the young alike. Although the United States has a more developed economy and well-developed Social Security and health care financing systems for the elderly, older Mexican-origin individuals in the U.S. do not necessarily benefit fully from these programs. These institutional and financial problems to aging are compounded in both countries by longer life spans, smaller families, as well as changing gender roles and cultural norms. In this interdisciplinary panel, the authors of five papers deal with the following topics: (1) an analysis of old age health and dependency conditions, the supply of aging and disability services, and related norms and policies, including the role of the government and the private sector; (2) a binational comparison of federal safety net programs for low-income elderly in U.S. and Mexico; (3) when strangers become family: the role of civil society in addressing the needs of aging populations; and (4) unmet needs for dementia care for Latinos in the Hispanic-EPESE.
A HOME-VISIT PILOT INTERVENTION TO PROMOTE COMMUNICATION SKILLS AND WELL-BEING FOR DEMENTIA FAMILY CAREGIVERS
Authors: Lee Jung-Ah , Kehoe Priscilla , Gibbs Lisa
Published: November 2019

Dementia takes a significant toll on caregivers resulting in their suffering from chronic stress and depression due to responsibility for care for persons with dementia (PWD). Behaviors of PWD could be aggravated by inappropriate responses by family caregivers such as correcting PWD’s memories. The study purpose is to examine the feasibility of a home-visit-based intervention designed to promote communication skills with PWD and well-being in family caregivers. This pilot study used a single-arm experimental pre-post design to test the feasibility of 4 weekly home visits for 13 female family caregivers in Southern California (spouse, n=7; adult children, n=6; mean age=64.3, ranging 46-82). Trained home visitors used video scenarios for behavioral education for caregivers. All caregivers completed the entire home visit program. Significantly caregiver burden was decreased from baseline (M(SD)=51.38(4.58)) to follow-up at 5 weeks (M=43.31(5.67), Wilcoxon signed rank test: p=.04). Additionally, caregiver-reported PWD’s negative behaviors were reduced from baseline to follow-up (Mbase=22.31(3.52), Mfolllowup=19.31(4.4), p=.13). There were other improvements (non-significant) in greater caregiver self-efficacy and less depressive symptoms from baseline to follow-up. Caregiver satisfaction with the intervention was high (M=4.6(0.65) of 5). Qualitatively, participants appreciated the home visits for educational sessions and welcomed the empathy provided. Caregivers expressed better communications and responsiveness to the PWDs. The results showed the home-visit-based caregiver intervention was feasible and had a potential effectiveness on reduction of caregiver burden and possibly on self-efficacy and well-being. A larger-scale study will be needed to demonstrate long term positive effects on caregiver interactive skills and their well-being.
PERCEIVED AVAILABILITY OF CARE AND SUPPORT AMONG OLDER ADULTS IN BANGLADESH
Authors: Luna Farhana Ferdous
Published: November 2019

Care for older adults is most precarious in developing countries where poverty and weak state support systems have put the well-being of their older populations at risk. Bangladesh is one such nation characterized by excess poverty, poor health, high mortality rates, and illiteracy among its older adults. The lack of elder-friendly infrastructure presents another problem for aging well in Bangladesh. This study examined perceptions about the adequacy of care and support received by older Bangladeshis. A cross-sectional survey collected data from 100 older people who were purposively sampled. Results revealed that older people generally are not satisfied with support services from the government and feel that old-age care has historically declined. Inadequate care and support was cited both at family and state levels. Respondents expressed concern that earlier generations of older people were better taken care of than the present generation, and that the former received more respect than the latter. Factors related to perceived support deficits included poverty, widowhood, and migration of sons. In this patrilineal culture, widowed women in particular perceived themselves as disadvantaged in terms of care availability. We conclude by recommending that policies be designed to enhance care and support services for older people in Bangladesh, particularly the most vulnerable and marginalized among them.
DECISION-MAKING AND DISPARITIES IN QUALITY OF CHOSEN PLANS AMONG RACIAL-ETHNIC GROUPS IN MEDICARE ADVANTAGE
Authors: Rivera-Hernandez Maricruz , Blackwood Kristy L
Published: November 2019

Limited research regarding decision-making in Medicare Advantage (MA), which now disproportionally serves racial and ethnic minorities (~45% Hispanics and 30% African-Americans), has been conducted. Without understanding the extent to which vulnerable groups select low quality plans with high out-of-pocket costs (OOPC) and what factors influence this selection, these beneficiaries could continue to be adversely affected. The objective of this study is to understand plan choice decision-making process and differences in quality and OOPC of chosen plans between racial and ethnic minorities enrolled in MA. We used 2015 national data from Medicare and conducted in-depth interviews with 25 MA enrollees. African-Americans were enrolled in plans with higher drug deductibles and lower OOPC. In addition, Hispanics and African-Americans enrollment in high quality plans were lower by 10% and 5%, respectively, regardless whether mean OOPC were 100 or 1000 (P<.05). Our interviews highlighted issues regarding financial literacy, choice overload and complexity. These seniors did not use Plan Finder from Medicare and obtained information from insurance companies. Most seniors were confused about insurance terminology and expressed poor computer literacy. Among them, there was a prevailing sentiment that more expensive plans are better. Our findings could inform the Medicare program, and vulnerable populations who would benefit from plans that maximize quality of care with lower out-of-pocket spending. Finally, this information could contribute to state organizations’ future efforts such as ensuring quality of health services for older adults including. Overall, this research provides new evidence about an increasingly important part of our publicly funded health system.
PROVIDER-IDENTIFIED BARRIERS TO PALLIATIVE CARE FOR MEDICAID PATIENTS
Authors: Enguidanos Susan , Rahman Anna , Hoe Deborah , Meyers Kate
Published: November 2019

In January 2018, California enacted Senate Bill 1004, which requires Medicaid (or Medi-Cal in California) managed care providers to offer home-based palliative care (HBPC) to their seriously ill patients. Since then, enrollment in HBPC has been lower than projected, which means many across the state continue to suffer without the pain and symptom management and psychosocial support available from a palliative care team. This study elicited clinician-perceived barriers to access to HBPC by Medi-Cal patients. We conducted a qualitative study comprising 25 individual interviews with a range of healthcare leaders and practitioners. Interviews were audio-recorded and transcribed verbatim. Using a grounded theory approach, we analyzed transcripts to determine primary themes. Our findings identified a myriad of access barriers to HBPC for the Medi-Cal population, including lack of physician knowledge about HBPC programs and benefits, a physician office structure that hampers the provision of HBPC education (i.e., one physician per office), cultural and language barriers among both physicians and patients, physicians’ lack of time, and competing demands on physicians. Providers also identified patient-related barriers, including cultural mismatch between HBPC providers and patients, trust issues related to the health-care system, and the complex challenges facing some patients such as lack of adequate and safe housing, behavioral health problems, and limited access to services that meet basic needs. These findings underscore the need for multiple approaches to increase physician education and awareness of HBPC and HBPC Medi-Cal benefits, develop culturally appropriate HBPC services, and develop programs that improve patients’ palliative care health literacy.
EXAMINING LONGITUDINAL HEALTHCARE UTILIZATION, OUTCOMES, AND SATISFACTION IN PRE-FRAIL OLDER ADULTS
Authors: Vaughn Ivana A , Marlow Nicole M , Sonawane Kalyani , Fillingim Roger B , Beyth Rebecca J
Published: November 2019

Frailty is a medical syndrome occurring in nearly 60% community dwelling older adults and could have insidious origins in middle-adulthood that manifest predominantly as decline and multi-morbidity. Identification of pre-frail states in adults could potentially reduce its impact in late-life. The study used data from the Health and Retirement Study (HRS) to: 1) compare long-term healthcare utilization between pre-frail and non-frail patients, 2) compare risk of pain progression, functional decline, and mortality between pre-frail and non-frail patients, and (3) compare satisfaction with healthcare, self-perceptions of aging and satisfaction with life between pre-frail and non-frail patients. The primary predictor, pre-frailty phenotype, was based on the Paulson-Lichtenberg Frailty Index (PLFI), a validated HRS-version of the Fried criteria. Additional covariates included sociodemographics, comorbidities, smoking status, sleep quality, health status, and body mass index. Statistical analyses consisted of descriptive statistics, univariate analysis, negative binomial regression with log-link function, logistic regression, generalized linear modeling and Cox regression. Pre-frailty status increased the incidence of hospitalizations (IRR: 1.23; 95%CI: 1.18-1.28) and doctor’s visits (IRR: 1.18; 95%CI: 0.15-1.22); increased the risk of pain progression (HR: 1.61, 95%CI: 1.53-1.69), functional decline (HR: 1.77, 95%CI: 1.67-1.87), and all-cause mortality (HR: 1.09, 95%CI:1.03-1.16); lowered odds of healthcare satisfaction (OR: 0.79, 95%CI: 0.62-0.99) and lowered satisfaction with aging ((β: -0.23 95%CI: -0.36- (-0.10)) and satisfaction with life (β: -0.27 95%CI: -0.44- (-0.11)). Frailty syndrome is highly prevalent and having a better understanding of its influence on health outcomes at intermediate pre-frail states could provide insight into reducing manifestations in later life.
MULTIDIMENSIONALLY HETEROGENEOUS HEALTH LATENT CLASSES AND HEALTHCARE UTILIZATION FOR OLDER CHINESE
Authors: Ye Linglong , Luo Jiecheng , Shia Ben-Chang , Fang Ya
Published: November 2019

Objectives: Based on a multidimensional perspective, this study aimed to assess the heterogeneous health latent classes of older Chinese, and further examined the effects of health latent classes and associated factors on healthcare utilization. Methods: Data came from the Chinese Longitudinal Healthy Longevity Survey in 2014. Latent class analysis was adopted to identify heterogeneous health latent classes by health indicators of physical, psychological, and social dimensions. Two-part models were used to evaluate the impact of health latent classes and socio-demographic factors on outpatient and inpatient utilization. Results: Among 2,981 participants aged 65 and over without missing health indictors, four health latent classes were identified and labeled as “Lacking Socialization” (10.4%), “High Comorbidity” (16.7%), “Frail Group” (7.7%), and “Relatively Healthy” (65.1%). Among 1,974 participants with complete information, compared with the Relatively Healthy group, those in the Lacking Socialization group costed more inpatient expenditure (p-value =0.02). Those in the High Comorbidity and Frail groups tended to use healthcare services and costed more outpatient expenditure (all p-value <0.01). After controlling for health latent classes, the effects of age, gender, marital status, education, residence area, occupation, and health insurance on healthcare utilization were significant. Conclusions: Four heterogeneous health latent classes were identified by multidimensional health, and had significant effects on healthcare utilization. After controlling for health latent classes, different effects of socio-demographic factors on healthcare utilization were found. It enhances our understanding of heterogeneous health and complex healthcare demands in older Chinese, and is valuable for improving healthcare resource allocation targeted for healthy aging.
HOME AND COMMUNITY HEALTHCARE FOR FRAIL OLDER ADULTS: A PATIENT, CAREGIVER, AND PRACTITIONER PERSPECTIVE
Authors: McDonald Andrew , Rizzotti Rowena , Rivera Joanna , Park Grace , Garm Antonina , D’Arcy Ryan , Song Xiaowei
Published: November 2019

Frailty and the decline in ability to maintain independent living may be forestalled through discussions with healthcare providers and seniors about managing health at home. In addition, the use of technology in supplementing doctors’ visits to assess frailty progression may be easily adopted by some but not others. We conducted this qualitative study to elucidate the context in which seniors access care at home and current barriers to independent living, from the perspectives of both seniors and practitioners. Pre-approved discussion questions were administered to two audio-recorded focus group sessions of 14 participants. The first group were community-dwelling older adults and informal caregivers, while the second consisted of healthcare practitioners. Group members were sampled to include a range of health backgrounds and levels of technological expertise. Thematic analysis with NVivo Software was used to parse out key discussion topics from the audio transcripts. The caregiver/patient group emphasized the stigma of frailty and age-related isolation, desiring transparency and advocacy from care teams. Practitioners/researchers discussed the importance of a holistic biopsychosocial approach to frailty management and the need for standardized frailty measurement. Patients/caregivers used health-tracking devices at home and were more optimistic about telehealth/video-conferencing than practitioners. Awareness of contextual factors surrounding “aging in place” and what aspects of care are valued by patients and practitioners is key to advancing home health and paving the way for new evidence-based services in the home.
PERCEPTIONS OF EMPOWERMENT AMONG HOME CARE AIDES
Authors: Butler Sandra S , Kusmaul Nancy
Published: November 2019

Workforce issues in eldercare are of growing concern with the dramatic aging of our population and the growing need for personal care assistance. Due to difficult job conditions, recruitment and retention of direct care workers have presented challenges throughout the country both in facility-based and community-based care. The empowerment of workers has been theorized as one vehicle for improving job satisfaction among healthcare workers. Models of structural and psychological empowerment have been explored as factors to reduce job strain among healthcare workers in institutional settings, but have not been well examined in the home care setting. This paper will report on an exploratory study of perceptions of empowerment among home care aides (HCAs) in two states. In-person and telephone semi-structured interviews were conducted with 12 HCAs ranging in age from 20 to 64; eight were white and U.S. born and four were black and African born. All 12 study participants reported positive aspects of empowerment in their home care work (e.g., receiving information and good support, feeling competent, having an impact on their clients’ lives, and finding the work meaningful), and most felt autonomous in their work and believed they had the resources they needed to do the job. Nonetheless, negative aspects of empowerment were also frequently described (e.g., poor support, constrained information and resources, limited autonomy due to regulations, and few opportunities for advancement). This paper will explore and interpret these seemingly contradictory findings, with a discussion of implications for recruitment and retention of this valuable workforce
REACTIVITY TO THE MEASUREMENT OF PSYCHOLOGICAL WELL-BEING IN OLDER ADULTS
Authors: Amireault Steve , Friedman Elliot M , Huffman Mary K
Published: November 2019

Although it is known that measurement reactivity can yield medium-sized effects (Cohen’s d = .50) on anxiety, its effects on psychological well-being (PWB) measures (e.g., purpose in life, personal growth) are unknown. The aim of this study was to evaluate reactivity to the measurement of PWB in older adults. Ninety-four adults aged 60 ≥ years (mean = 75) were recruited from a fitness center, retirement home and community center in Indiana. All participants received a questionnaire via postal mail at baseline (T1) and 2-3 weeks later (T2). Using block randomization (block size = 16), older adults were randomly allocated (1:1 ratio) to one of two conditions: PWB measures assessed at T1 and T2; and PWB measures were at T2 only. Purpose in life and personal growth were assessed using Ryff’s PWB scales. Multiple imputation analysis was conducted to account for attrition at T2 (18%), and all participants were analyzed according to the condition they were originally assigned. ANCOVA, controlling for recruitment sites, revealed that purpose in life (p = .03), but not personal growth (p = .08), T2 scores were on average lower when PWB was measured twice compared to those when PWB was measured once. The detected difference in purpose in life T2 scores was of medium size (d [95%CI] = - .50 [-.95, -.04]). This finding suggests that initial or later scores might be biased – a problematic finding because if ignored, measurement reactivity has the potential to affect conclusions drawn from gerontological research that focuses on PWB.
THE INFLUENCE OF THE UNIVERSAL TWO-CHILD POLICY ON CHINA’S FUTURE AGING AND POPULATION
Authors: Jia Can , li Handong
Published: November 2019

China’s aging situation is becoming more and more prominent, and both the people and the government are facing unprecedented pressure of providing for the aged. For this reason, the Chinese government began implementing a new family planning policy for couples to have two children since 2016 (referred to as “universal two-child policy”). In order to explore the impact of the newly released policy, our research is based on the sixth census of China. And first, we use the cohort-component method and a Leslie matrix to construct the population prediction model. Considering some certain unique factors in China, such as the significant urban-rural dual structure and the household registration system and so on, we divide the total fertility rate into urban and rural areas which fully reflects the characteristics of China’s family planning policy. Then we predict and analyze the number and structure of China population between 2011 and 2050 based on the three scenarios of high, medium and low. And the results show that the Chinese population will present an inverted pyramid structure, and the population structure will continue to deteriorate. Besides, we adapt three indicators to analyze the aging trend in China, namely, the old-age coefficient, the population aging index, and the social dependency ratio. And the three indicators of China will continue to grow under the universal two-child policy with different changing rate, which means, the newly released policy will not change China’s aging population growth trend and the severity of China’s aging.
THE TRUTH ABOUT AGE DIFFERENCES IN PERFORMANCE ON VARYING LENGTHS OF LIKERT-TYPE TEST ITEMS
Authors: Lutz Julie , Metzger Aaron , Turiano Nicholas A , Spalding Rachael , Katz Emma , Edelstein Barry
Published: November 2019

Guidelines for self-report assessment with older adults emphasize the use of shorter Likert-type or agree/disagree response formats to reduce cognitive load (e.g., Yesavage et al., 1983). However, these suggestions are not founded on empirical studies directly comparing younger and older adults’ responses on different scales. Thus, the current study tested differential responding on varying Likert-type response scale lengths between younger, middle-aged, and older adults. Participants completed three versions of the International Personality Item Pool (IPIP) Neuroticism scale with 3, 5, and 7 Likert-type response scale lengths in counterbalanced orders with other questionnaires between versions. Six multi-group confirmatory factor analyses (CFAs) assessed measurement invariance across scale lengths and age groups. Invariance of convergent validity networks was also assessed with multi-group CFAs of the associations between the IPIP and measures of depression, anxiety, anger, worry, and affect. The final sample consisted of 835 adults (327 18-44; 279 45-64; and 229 65 or older) via Amazon Mechanical Turk. Measurement invariance was supported in analyses by age within each scale length and by scale length within each age group, indicating that response patterns across all scale lengths and age groups did not significantly differ. Analyses of convergent validity also supported invariance, suggesting that responses across all scale lengths and age groups reflect the same underlying construct. This study indicates that, among community-dwelling adults, shortened response scale lengths do not yield significantly different or more valid responses for older adults compared to younger adults.
CHRONIC PAIN AND ASSOCIATED RISK OF COGNITIVE IMPAIRMENT AMONG MIDDLE-AGED AND OLDER ADULTS
Authors: Hu Yi-Han , Lin Hsien-Chang
Published: November 2019

Chronic non-cancer pain (CNCP) is an emerging health issue among the older population. Not only did the CNCP prevalence increase gradually in past decades, but also it may cause difficulties in cognitive processing and social and emotional functioning. However, evidence for the associations between CNCP and incident mild cognitive impairment (MCI) and Alzheimer’s disease and related dementias (ADRDs) is inconsistent and insufficient. Using the administrative claims data from health insurance companies from January 2007 to December 2017, this prospective cohort study investigated the impact of CNCP on the risks of developing MCI and ADRDs among adults aged 50 and older. To reduce potential selection bias, the propensity-score matched cohort design was applied for selecting comparable CNCP and non-CNCP patients at the beginning of the follow-up. Time-dependent Cox proportional-hazards regression models were conducted to estimate the hazard ratios (HRs) of incident MCI/ADRDs, adjusting for baseline sociodemographics and time-dependent medical conditions. Of 236,782 patients with/without CNCP, 342 individuals (0.14%) developed MCI and 1,183 patients (5.0%) had been diagnosed with one type of ADRDs during the follow-up. After adjusting confounders, CNCP patients had a 42% increased MCI risk (HR=1.42; 95% CI=1.14-1.76) and a 20% increased ADRDs risk (HR=1.20; 95% CI=1.07-1.34) relative to non-CNCP patients. Our findings indicate that CNCP is associated with incidences of MCI and ADRDs. Early diagnosis of CNCP and CNCP management may prevent cognitive impairment among middle-aged and older adults. Future studies are warranted to explore the potential effects of pain treatments on restoring cognitive function of CNCP patients.
ROLE MODEL OF AGING AND ATTITUDES TOWARD AGING IN ASIAN AMERICANS
Authors: Jung Seojung , Jopp Daniela
Published: November 2019

While having a role model for successful aging may have a beneficial influence and promote successful aging throughout the course of one’s life, very little empirical research has examined role models for successful aging, particularly among Asian Americans. The current study examined Asian Americans’ role models for successful aging and their link with attitudes toward own aging with a sample of 135 individuals aged 18 to 74 years (Mage = 36.76, SD = 14.73; female, 71.9%). Participants were asked whether they had a specific role model for successful aging and, if they had, the reasons why the role models were chosen. Participants’ open-ended answers were then analyzed using qualitative content analysis using a coding scheme drawn from a prior study on role models for successful aging (Jopp et al., 2016). The categories most often mentioned were public figures, followed by parents, other relatives, non-specific persons, grandparents, non-family acquaintances, and self. Participants with at least one family role model were more likely to have positive attitudes toward aging, and this effect was strong even after controlling for ethnic identity, filial obligation, self-rated health, and other demographic variables. The present study suggests that Asian Americans identify role models for successful aging both within their immediate families and among public figures, while family role models are more likely to promote the development of positive attitudes toward own aging. The implications for understanding Asian Americans’ role models on motivating, promoting, and facilitating positive aging processes will be discussed.
MEDICATION DISCREPANCIES AND COMMUNICATION ERRORS DURING NURSING HOME INTAKE: A MIXED-METHODS ANALYSIS
Authors: Patterson Mark E , Bollinger Sandra , Foust Janice
Published: November 2019

Older adults experience high medication discrepancy rates during transitions from inpatient to nursing home settings. Dosage changes and multiple prescribers increases the risk of inaccurate handoffs and creates challenges for medication reconciliation at nursing home intake. Our objectives were to 1) Characterize medication discrepancies occurring at nursing home intake and 2) Identify resident and medication related factors associated with medication discrepancies. Demographics, comorbidities, medications, discrepancy types and location were prospectively collected over 9-months. Chi-square tests were used to determine factors associated with discrepancies. A focus group of nurse practitioners, pharmacists, and administrators from four long-term care facilities was convened to discuss medication reconciliation challenges at resident intake. Thematic analysis was used to determine key themes. 22%, 12%, and 3% of residents experienced one, 2 to 5, or six or more discrepancies, respectively. The most prevalent discrepancies were omission (34%), frequency (20%), and therapeutic duplication (13%) occurring in analgesics, respiratory and genitourinary medications. 44% of discrepancies occurred between nursing homes and hospitals and 39% involved the community pharmacy. The most significant risk factors for discrepancies included age over 70, Charlson comorbidity indices over 7, readmission to nursing homes, or the prescribing of at least 17 medications. Staff faced challenges of delayed and/or inaccurate data, incompatible documentation forms and inefficient workflows for resolving discrepancies. Residents at greatest risk for medication discrepancies require additional attention during admission medication reconciliation to prevent errors. Nursing home intake and medication reconciliation workflow needs to be improved with data sharing technology to increase accuracy and efficiency.
THE IMPACT OF MUSIC AND MEMORYSM ON RESIDENT MOOD, BEHAVIORS, AND USE OF MEDICATIONS IN NURSING HOMES
Authors: Bakerjian Debra , Bettega Kristen , Marin-Cachu Ana , Azzis Leslie , Taylor Sandra
Published: November 2019

The numbers of Americans with dementia are projected to increase by 44.8% by 2025. Many of these patients are cared for in nursing homes (NH), 70% of NH residents with dementia have been reported to have significant behavioral or psychiatric symptoms (BPSD) that are often challenging to manage. Historically, the first lines of treatment for BPSD has been antipsychotic medications; however, serious adverse effects have been associated with these drugs. Our main aim was to study the effects of Music and MemorySM (M&M), a personalized music program, on improving behaviors and reducing antipsychotics and other medications in residents with dementia in participating NHs. This 3-year, quasi-experimental, mixed methods study used a cluster, randomized design in three phases. We used the Qualtrics Research Suite to create and disseminate a baseline survey and a 4-part quarterly survey thereafter. The quarterly survey collected select resident MDS data including diagnoses, medication use, pain, falls, mood and behaviors; how M&M was being implemented; resident use of M&M; organization level information. We also downloaded NH 5-Star quality rating quarterly. A total of 265 NH and 4,109 residents participated in the study. We found the odds of antipsychotic use declined by 11%, antianxiety medications by 17%, and antidepressants by 9% per quarter. The odds of residents exhibiting aggressive behaviors declined by 20% per quarter, depressive symptoms by 16% and residents reporting pain by 17%. Our findings indicate that M&M provides substantial benefit to NH residents, particularly in reduction of psychoactive medications and improving mood and behaviors.
TRANSITIONAL CARE OUTCOMES IN VETERANS RECEIVING POST-ACUTE CARE IN A SKILLED NURSING FACILITY
Authors: Burke Robert , Canamucio Anne , Glorioso Thomas , Baron Anna , Ryskina Kira
Published: November 2019

More than 200,000 Veterans transition between hospital and skilled nursing facility (SNF) annually. Capturing outcomes of these transitions has been challenging because older adult Veterans receive care at VA and non-VA hospitals, and four different kinds of SNFs: VA-owned and -operated Community Living Centers (CLCs), VA-contracted community nursing homes (CNHs), State Veterans Homes (SVHs), and non-VA community SNFs. We used a novel data source which concatenates VA, Medicare, and Medicaid data into longitudinal episodes of care for Veterans, to calculate the rate of adverse outcomes associated with the transition from hospital to SNF in all enrolled Veterans age 65 and older undergoing this transition 2012-2014. The composite primary outcome included Emergency Department (ED) visits, rehospitalizations, and mortality (not in the context of hospice) within 7 days of hospital discharge to SNF. We used multivariable logistic regression to adjust for Veteran and hospital characteristics and hospital random effects. In the 388,339 Veterans discharged from 1502 hospitals in our sample, we found more than 4 in 5 Veteran transitions (81.7%) occurred entirely outside the VA system. The overall 7-day outcome rate was 10.7%. After adjustment, VA hospitals had lower adverse outcome rates than non-VA hospitals (OR 0.80, 95% CI 0.74-0.86). VA hospital-CLC transitions had the lowest adverse outcome rates; in comparison, non-VA hospital-CNH (OR 2.51, 95% CI 2.09-3.02) and non-VA hospital-CLC (OR 2.25, 95% CI 1.81-2.79) had the highest rates. These findings raise important questions about the VA’s role as a major provider and payer of post-acute care in SNF.