bluuebunny/crossref_metadata_2025 huggingface dataset:
PHYSICAL ACTIVITY, SEDENTARY BEHAVIORS AND MYOSTEATOSIS IN AFRICAN CARIBBEANS
Authors: Bessette Lily , Cvejkus Ryan , Acevedo-Fontanez Adrianna , Kuipers Allison , Zmuda Joseph , Wheeler Victor , Miljkovic Iva
Published: December 2023

Skeletal muscle fat infiltration (myosteatosis) leads to poorer muscle quality and function with aging, and is emerging as a predictor of skeletal muscle strength, mobility, and metabolic disorders. Few studies investigated the association of physical activity (PA) and sedentary behavior (SB) with myosteatosis, especially in African Caribbeans, a vastly under-studied, rapidly growing population. We examined the associations of objectively measured PA and SB (Bodymedia SenseWear Armbands) worn over 7 days with calf muscle density (mg/cm3), a marker of intra-muscular fat (Stratec XCT-2000), in older adult African Caribbean men (N=355, mean age 62 years) and women (N=682, mean age 59 years) of the Tobago Health Study. Compared to men, women were younger with higher BMI, more SB, less light (LPA) and moderate to vigorous PA (MVPA), and lower muscle density (p< 0.05, age-adjusted). Meeting MVPA guidelines (150 min MVPA/week) was associated with greater muscle density in obese men and women (p=0.03, p=0.09 respectively, age-adjusted). Adjusting for age, BMI, smoking, diabetes, hypertension, and lipid-lowering treatment, we assessed sex stratified partial spearman correlations between PA and SB and muscle density. MVPA was more strongly correlated with greater muscle density in men (r=0.15, p=0.01) than in women (r=0.07, p=0.09), while SB was associated with lower muscle density in women (r=-0.08, p=.044), but not significantly in men (r=-0.10, p=0.12). Our novel findings indicate that the association between PA and SB with myosteatosis may differ by sex. These findings may have important implications for sex specific activity guidelines related to skeletal muscle health in African Caribbeans.
PREDICTORS OF FINANCIAL BURDEN IN TWO SAMPLES OF ADULTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Clayton Jordana , Iacob Eli , Aruscavage Nancy , Utz Rebecca , Supiano Katherine , Bybee Sara , Dassel Kara
Published: December 2023

Compared to other older adults with chronic illness, individuals diagnosed with Alzheimer’s disease and related dementias (ADRD) incur much higher care costs at the end of life. The financial strain created by these high costs is experienced unevenly, as individuals who are low-income and minorities may have difficulty meeting out-of-pocket costs of care. Our objective was to examine the relationship between reported concern about being a financial burden to others and socioeconomic and demographic variables. To accomplish this, we conducted a mixed-methods study of two samples of individuals diagnosed with ADRD aged 31-89 (mean 63, n = 44) and 50-89 (mean 66, n=38) using two ordinal logistic regression models and qualitative analysis. The ordinal regression models indicate that the probability of reporting higher financial burden increases with lower age, higher education, and being widowed. One model shows income and employment as significant predictors of financial burden, particularly for the “forgotten middle” who have a high enough income not to qualify for social support programs but low enough income to experience strain from high out-of-pocket costs. In the qualitative analysis, we categorized 309 free responses from the second sample using the Financial Hardship Typology into concerns of material conditions / ability to pay (n=40), psychological distress about being a financial burden (n=28), and coping behaviors / limiting care to reduce costs (n=20). These results point to ways that social programs need to be improved to better support individuals with ADRD who are experiencing financial strain during the end-of-life.
PRESSURED TOUCH FOOT CARE TO RELIEVE CHRONIC PAIN AND IMPROVE QUALITY OF LIFE
Authors: Clayton-Jones Mary
Published: December 2023

Background

Chronic pain affects many older adults and is a leading cause of disability. It is often treated pharmacologically, but evidence indicates touch therapy modalities are beneficial. Purpose: To implement a therapeutic touch program for adults enrolled in a Program of All-Inclusive Care for the Elderly (PACE) to help reduce chronic pain and improve quality of life for those patients enrolled in this project.

Method

Twelve participants in an assisted living facility with chronic foot pain were initially selected by the PACE Family Nurse Practitioner (FNP) for home visits with this Doctor of Nursing Practice (DNP) student for a foot care and pressured touch intervention to occur once a month for 3 months. The McGill Pain and Quality of Life Scores questionnaires were administered before each intervention.

Results

Four participants completed all three interventions. Every participant experienced a decrease in pain pre- and post-intervention and month-to-month of 15% or more. Three participants had experiences of complicated grief and had a decrease in quality-of-life scores over the 3 months. The participant without complicated grief had an improvement in the quality-of-life scores with pain reduction.

Conclusions

This small home intervention project for chronic foot pain demonstrated that foot care and pressured touch may be a cost-effective adjunct therapy for reducing pain. Chronic pain can be complicated by grief, which must be considered when looking to support elder wellness and quality of life. Keywords: Chronic pain, therapeutic touch
PROFILES OF DIGITAL LITERACY AMONG COMMUNITY-DWELLING KOREAN OLDER ADULTS: A LATENT PROFILE ANALYSIS
Authors: Shin Jiyoung , Kang Hun , Choi Seongmi , Choi JiYeon
Published: December 2023

Digital divide exists among not only between older and younger generations but also within the older adult population. Understanding digital literacy profiles among older adults is important to identifying strategies for reducing digital divide among this population. This study aimed to identify profiles of digital literacy among community-dwelling older adults and examine associated factors. Data were collected from a national survey of 1016 community-dwelling older adults in Korea (average age 68.0±6.5 years, 47.8% male). Digital literacy was evaluated across three domains: ’Information and Communication’ (9 items), ’Contents Creation and Management’ (4 items), and ’Safety and Security’ (9 items). Latent profile analysis and multinomial logistic regression yielded three digital literacy profiles: “Low-level” (35.7%, n=363), “Middle-level” (39.2%, n=398), and “High-level” (25.1%, n=255). Compared to the low-level group, a higher likelihood of belonging to the middle level group was associated with younger age, higher education level, higher dependence on instrumental activities of daily living, longer digital device use, and participating in offline social activities. Similarly, a higher likelihood of belonging to the high-level group was associated with younger age, higher education level, higher dependence on instrumental activities of daily living, longer digital device use, better physical well-being, doing daily physical exercise, and greater social support. These findings suggest characteristics associated with lower digital literacy, including older age, lower education level, and reduced functional independence. To promote digital literacy in older adults, potential strategies encompass tailored access and guidance for digital device use specifically tailored to older adults, alongside efforts to nurture social connectedness.
PSYCHOMETRIC PROPERTIES OF THE KOREAN VERSION HOSPITAL SURVEY ON PATIENT SAFETY CULTURE IN HOME HEALTHCARE
Authors: Lee Kayoung , Lee Soohee , Woo Seoyoon
Published: December 2023

Patient safety culture is essential for quality care in healthcare organizations. Instruments for patient safety have been developed and widely implemented in hospital settings. The revised hospital survey on patient safety culture (HSOPSC) is one of the representative instruments for evaluating patient safety culture. In 2021, the Korean version of the HSOPSC 2.0 (K-HSOPSC 2.0) was developed. However, there is a lack of evidence to examine the validity of the instrument in home healthcare settings. This study aimed to test the psychometric analysis of K-HSOPSC 2.0 in home healthcare settings in South Korea. We collected 215 certified advanced practice nurses (APNs) and nurse managers from 163 out of 175 home healthcare institutions in South Korea. We conducted the confirmation factor analysis (CFA) to examine the existing 10 dimensions of K-HSOPSC 2.0. Statistical analyses were performed with Stata 17.0, and the Satorra-Bentler (SB) method was used to adjust the standard error. The construct validity demonstrated an acceptable fit (RMSEA_SB=0.061, CFI_SB=0.912, TLI_SB=0.889). The K-HSOPSC 2.0 demonstrated high reliability (Cronbach’s α=0.90), except for teamwork (α=0.52) and staffing and work pace (α=0.39) among 10 dimensions. The validity of the measurement of patient safety culture was supported in home healthcare settings. However, further evaluation is needed for the two dimensions of ’teamwork’ and ’staffing and work pace’. In home healthcare settings, it is crucial to consider the role of patients and caregivers in teamwork and different home healthcare working environments in staffing that reflects unique home healthcare settings.
PURPOSE PROMOTES MENTAL HEALTH FOR RETIREES, BUT THEY NEED TO HELP FINDING IT
Authors: Best Rachel , Ogliore Anthony , Rule Payton , Hill Patrick
Published: December 2023

Previous research shows that sense of purpose is significantly related to mental health outcomes, including depression and anxiety (Crego et al., 2021; Dixon, 2007). Retirees are at higher risk for having a lower sense of purpose (Hill & Weston, 2019; Pinquart, 2002). Accordingly, helping retirees increase their sense of purpose may be a good way to also improve their mental health. First, research is needed to understand the relationship between sense of purpose and anxiety and depression in retirees. The current study uses cross-sectional data from 1975 adults (516 retirees and 1459 non-retirees; mean age = 49.23, SD = 18.29 ). Pearson r correlations were run between sense of purpose (Life Engagement Test), depression (PHQ-9) and anxiety (GAD-7) in retirees and non-retirees. T-tests were run between retirement status, sense of purpose, depression, and anxiety. As expected, sense of purpose was associated with lower depression (retirees r = -.33, p <.001 ; non-retirees r = -.28, p <.001) and anxiety (retirees r = -.32, p <.001 ; non-retirees r = -.29, p <.001) for both retirees and non-retirees. Results also showed that retired older adults had lower sense of purpose than older adults who are still working (t(1090) = -4.8778, p < .001). These data suggest that targeting sense of purpose in retirees is a worthwhile goal that may also indirectly improve mental health outcomes.
QUALITY OF LONG-TERM CARE FACILITIES AND COVID-19 OUTCOMES: A SYSTEMATIC REVIEW
Authors: Wang Xiaochuan , Eyler Gabriella
Published: December 2023

U.S. long-term care facilities (LTCFs) have been disproportionally and negatively impacted by the COVID-19 pandemic, reporting high shares of COVID-19 cases and deaths. It is critical to understand whether and how quality of these facilities is related to COVID-19 outcomes, to inform policy and practice to better protect the vulnerable LTCF residents and prepare for future outbreaks. Yet, research on this topic has primarily focused on nursing homes which has yielded inconsistent findings, and less is known in the assisted living care setting. To help address this gap, we systematically reviewed existing literature describing quality indicators and examining their impacts on COVID-19 outcomes in LTCFs. Using PRISMA guidelines, we searched electronic databases (e.g., PubMed) for peer-reviewed articles published in English between 2020 and 2023. The search yielded 1,487 unduplicated publications. After screening articles for relevance based on titles and abstracts, 123 were reviewed in full text. A total of 25 articles were included in this review. The included articles examined a range of quality indicators, such as CMS overall and sub-domain 5-star ratings and previous infection prevention and control deficiencies. Overall, the studies revealed mixed results regarding the association between quality and COVID-19 outcomes in LTCFs. Most studies found that higher quality is generally indicative of better COVID-19 outcomes, and some further suggested that the association varied across pandemic phases. Whereas another 7 studies found no significant relationship. This systematic review highlights the need for future research and evidenced-based policy and practice to better protect the at-risk LTCF resident population.
RACIAL DISCRIMINATION TRAJECTORIES AND MULTIMORBIDITY BURDEN AND CHANGE AMONG MIDDLE-AGED AND OLDER BLACKS
Authors: Whilby Kellee White , Robinson-Ector Kaitlynn , Quiñones Ana
Published: December 2023

Racial discrimination is a chronic psychosocial stressor that can accelerate aging. Characterizing longitudinal patterns of racial discrimination may provide greater precision in predicting health risk particularly for outcomes such as multimorbidity that is considered a proxy of multisystem dysregulation and a marker of cumulative disease burden. However, longitudinal patterns of racial discrimination and its relationship with multimorbidity has received limited attention. We investigate the association between racial discrimination trajectories (RDT) and multimorbidity among a subsample of middle-aged and older Black adults from the Health and Retirement Study (2006–2020, N = 2,167, 50+). RDTs were constructed based on the Everyday Discrimination Scale using repeated measures latent profile analyses. Multimorbidity was operationalized using the multimorbidity weighted index (MWI) score. Linear mixed models, adjusted for sociodemographic, behavioral, and clinical covariates, estimated the association between RDT and MWI score and change in score over time. Average MWI scores varied across RDT classes: low (5.9), moderate (6.5), and high (5.9). Individuals characterized in the moderate RDT had the highest multimorbidity burden (3.03; 95% confidence interval [CI]: 1.46, 4.58) and was the only group that experienced an accelerated rate of multimorbidity accumulation, as measured by change in MWI score over time. This relationship was not observed among respondents in the persistently high RDT. Our findings suggest that there are differences in the relationship between RDT and multimorbidity burden. Uncovering specific characteristics associated with the profiles of RDT may advance our understanding of healthy aging processes.
RACIAL REPRESENTATIVENESS AND AFFORDABLE HOUSING DISPARITIES: A NATIONAL STUDY OF NURSING ASSISTANTS
Authors: Holmes Sarah , Gurlu Merve , Zhu Shijun , Murray Briana , Lepore Michael
Published: December 2023

Occupational racial representation is increasingly recognized as a health equity issue. In the US, racial unrepresentativeness in the healthcare workforce, including nursing homes (NHs), is a pervasive aspect of economic inequality: racially minoritized women are disproportionately overrepresented among nursing assistants (NAs) in NHs, and racially minoritized NAs commonly live in poverty and lack affordable housing. Despite evidence of associations between occupational racial representation and affordable housing, there is limited research on these associations among NAs in NHs. We examined how state-level racial representativeness of NAs in NHs relates to housing affordability using data from the PHI Workforce Data Center, LTCFocus, and US Census. Racial representativeness was calculated as the difference between the percentage of racial group (Black, White) in NA workforce in the state and the percentage of racial group in state working-age population. Multivariable linear regression was used to examine associations between housing affordability and racial representation. The national sample included 527,480 NAs. Results showed overrepresentation of Black NAs (M=17.5%, SD=.166) and underrepresentation of White NAs (M=-18.2%, SD=.127) in most states. Controlling for NH primary payer source and NA education level, lack of affordable housing was associated with higher representation of Black NAs in the workforce (b=1.78, p<.001, R2=.66) and lower representation of White NAs in the workforce (b=-1.45, p<.001, R2=.61). These findings indicate racial disparities in NA access to affordable housing and highlight the need for additional research on these associations and related outcomes to develop equity-centered strategies in the NH workforce that will address housing affordability.
RECRUITMENT LESSONS LEARNED FROM A RANDOMIZED PSYCHOEDUCATIONAL TRIAL FOR DEMENTIA FAMILY CAREGIVERS
Authors: Aranda Maria
Published: December 2023

Family caregivers/care partners are the backbone of long-term services and support on behalf of persons living with memory loss such as Alzheimer’s and related dementias. Although there has been increased attention on family caregivers overall, documented recruitment strategies to participate in research—and clinical trials in particular—are lacking. This paper addresses the individual and system-level factors addressed in order to reach target recruitment goals in a community-based dementia caregiver trial conducted online with a racially- and ethnically-diverse cohort of mostly spousal/partner and adult children caregivers. Based on a sample of 231 trial participants and 105 focus group interviewees, we drew from our theoretical model—the Micro-Meso-Macro Framework—to elucidate factors that facilitated or impeded diverse cohort recruitment. We analyzed data from two data sources: a) source of referral and reason for contacting the recruitment team; and b) content analysis from focus group interviews. Based on our multi-level analysis we documented the following factors that facilitated trial participation: 1) MICRO: prior encounters with the research enterprise; educational attainment and occupational status; sense of altruism and beneficence; monetary incentivization; comfort with disclosure of private matters; starting from ground zero; and addressing gender issues; and 2) MESO/MACRO: assembling a proactive scientific team; leveraging logos and reputation; training trial staff and community partners; writing project budgets that incentivize diverse trial recruitment; making inroads with community partners; navigating technological challenges; and tapping into resources to alleviate barriers. In our paper, we will discuss lessons learned, and address future research directions including recruiting underrepresented groups.
REDEFINING OBESITY: A RATIO OF FAT AND MUSCLE MASS COMPARED TO BODY MASS INDEX IN OLDER ADULTS
Authors: Lafontant Kworweinski , Thiamwong Ladda , Stout Jeffery , Park Joon-Hyuk , Xie Rui , Fukuda David
Published: December 2023

Body composition is an important determinant of physical fitness and overall health in older adults. Body mass index (BMI) is currently the standard used to categorize clinical thresholds for body composition (underweight, normal weight, overweight, obese). However, BMI does not account for key aspects of body composition like skeletal muscle mass (SMM) and fat mass (FM). This can lead to misclassification and inaccurate inferences about metabolic health. A FM/SMM ratio may better capture age-related changes in body composition like sarcopenia and obesity, but it is unknown whether FM/SMM correlates more closely with muscularity and adiposity than BMI. This cross-sectional study assessed 103 older adults (16 men, 87 women; mean age 75.7 ± 7.19 years; BMI 26.8 ± 5.22 kg/m2) for SMM, FM, and body fat percentage (BF%) using bioelectrical impedance analysis (InBody S10). BF% was more highly correlated with FM/SMM (r = 0.979, p < 0.001) than BMI (r = 0.702, p < 0.001), and a Fisher’s R-to-Z analysis indicates that the difference is significant (95% CI [0.826, 0.926], z = 12.217, p < 0.001). However, SMM showed weak correlation with both FM/SMM (r = -0.306, p = 0.002) and BMI (r = 0.349, p < 0.001). FM/SMM may better detect changes in adiposity compared to BMI, suggesting utility as an obesity measure. Further research should examine the longitudinal validity of FM/SMM in older adults and its ability to predict metabolic and musculoskeletal health.
TELEWORKING TO SUPPORT ACCOMMODATION, INCLUSION, AND HEALTH OF OLDER WORKERS: ISSUES FACED BY MANAGERS
Authors: Lecours Alexandra
Published: December 2023

Telework is increasingly present and has the potential to be used as an accommodation modality to facilitate inclusion and healthy participation in the workplace for older workers (i.e. aged 55 and over). However, there is a need for a practical tool to guide the application of telework with this population. This poster presents the first stage of a study aiming to develop a reflective guide for applying telework to support the accommodation, inclusion, and health of older workers. Following a three-stage developmental research design, this first stage consists in conducting individual interviews with older teleworkers and managers to gather qualitative data on their experience. During the second stage, the issues, considerations, and good practices that emerged from the first stage are compiled into a guide. In the third stage, this guide will be validated by workers and managers to ensure its acceptability and applicability. Preliminary results from the first stage allowed to identify issues faced by managers concerning accommodation (n=8, e.g. ensuring that accommodating older workers does not add extra pressure on colleagues), inclusion (n=5, e.g. difficulty to mobilize older teleworkers for face-to-face social gatherings), and health (n=2, e.g. managers feel powerless to manage older teleworkers’ emotions). Managers play a key role in implementing practices that promote the accommodation and inclusion of older workers through teleworking, but they have few tools to support them. The reflective application guide that will be created during this study represents an innovative tool likely to have positive impacts at individual, organizational and societal levels.
REMOTE FAMILY CAREGIVERS: INVISIBLE YET INDISPENSABLE DURING HOSPITALIZATION OF OLDER ADULTS
Authors: Tonkikh Orly , Johnson Yuuko , Young Heather , Siegel Elena O
Published: December 2023

Limited research has addressed the interplay between the roles of nursing staff and families of older adults in acute care settings, including those families involved in-person and those who are unable to be physically present (remote). This descriptive qualitative study explores nurses’ and family members’ perspectives on the roles and engaging family members or friends during an acute hospitalization in medical-surgical units. Semi-structured interviews were conducted via Zoom or phone with a convenience sample of 19 nurses and families between February and August 2023. Thematic analysis inductively captured key patterns in data. Nurses proactively engaged family members who were present in the hospital, while they engaged with remote family members in a more limited way, mostly during discharge planning. Nurses describe making decisions about including families based on their presence (e.g., education about medications, encouraging to engage the patient in the recommended care, ask to support with ADLs). In contrast, families describe providing support regardless of physical presence, including socio-emotional support, help with medical/nursing tasks, encouragement to recover, mediation of information provided by staff, learning to perform medical-nursing tasks and communication and interpretation of the information with other family members. The findings reveal a gap in nurses and family’s perspectives about the feasibility and contribution of remote family involvement during an acute hospitalization. This provides direction for further exploration of acute care structures and nursing care processes needed to support the preferred mode for family involvement.
RESEARCH BEST PRACTICES TO SUPPORT RESILIENCE IN EYE STROKE VISION REHABILITATION
Authors: Hreha Kimberly , Boucher Nathan , Whitson Heather
Published: December 2023

While effective rehabilitation exists to promote independence and community participation for age-related vision impairment, no rehabilitation program has been developed specifically for eye stroke impairment. We are adapting a macular degeneration self-management program using input from key partners to inform future intervention. The pilot phase objective was to inform future study design for eye stroke survivors. We conducted semi-structured interviews, and applied the 5T Framework (Target population identification, Team composition, Time considerations, Tips to accommodate older adults, and Tools for inclusive enrollment of older adults) to develop the interview guide. Twenty-five people recruited from clinical settings were consented/interviewed over six months. This included 10 stroke survivors (M age= 66 years; 70% male--90% visual field defect), 4 care partners (M age= 57 years; 100% female--1 mother, 1 sister and 2 spouses), and 11 providers (M age= 37 years; 54.5% female--3 occupational therapists, 4 ophthalmologists, 2 optical technicians, 1 optometrist, 1 physical therapist). The most meaningful outcomes identified were driving and returning to full independence. The most frequently identified “facilitator of recovery” after eye stroke was family support. The most frequently identified barriers to participation in intervention research were lack of accessibility of the research building and transportation. Optimal lighting and scanning strategies were identified as key elements of any future intervention as well as approaches to support enrollment and retention in study activities. Interview data are now being used to inform phase two: adaptation of the self-management program and design of the study that will evaluate its effectiveness.
RESILIENCE AND PSYCHOLOGICAL DISTRESS IN GENETIC TESTING FOR ALZHEIMER’S DISEASE
Authors: Burgei Alicia
Published: December 2023

This research project examines the relationship between resilience and psychological distress resulting from genetic testing for Alzheimer’s disease among individuals who are non-cognitively impaired. Preventative genetic testing is increasingly important to determine the likelihood of developing or passing on genetic disorders. However, receiving genetic information, especially regarding incurable diseases like Alzheimer’s disease, can lead to significant psychological distress. Resilience, the ability to cope with adversity and recover quickly, is considered a protective factor against psychological distress. The purpose of this study is to investigate whether higher levels of resilience are associated with lower psychological distress from genetic testing for Alzheimer’s disease. A cross-sectional survey was conducted online using the Impact of Genetic Testing for Alzheimer’s Disease (IGT-AD) scale and the Brief Resilience Scale (BRS), along with a question about family history of Alzheimer’s disease. The results indicated a significant negative correlation between resilience and psychological distress, suggesting that individuals with higher resilience experienced lower distress related to genetic testing. However, family history did not moderate the relationship, meaning the protective effect of resilience was consistent regardless of familial risk. These findings have implications for developing targeted support services and resilience-based interventions to help individuals cope with the emotional impact of genetic testing for Alzheimer’s disease. Further research could explore other potential protective factors and examine the long-term impact of genetic testing results on psychological well-being and behavior.
RETIRING AFTER A JOB WELL DONE: HOW SUBJECTIVE CAREER EVALUATIONS IMPACT RETIREMENT ADJUSTMENT
Authors: Tunney Orlaith , Henkens Kène , van Solinge Hanna
Published: December 2023

An individual’s past, and how they reflect on it, may influence current and future well-being, with recent qualitative studies suggesting retirees’ reflections on their careers may relate to well-being in retirement. Establishing factors that may promote successful transition to retirement is vital. Particularly in light of population ageing and the subsequent increase in both the number of retirees and the length of retirement. The aim of our study was to investigate the impact subjective career evaluations on retirement adjustment at follow-up. Using data from across three waves of the NIDI Pension Panel Study, (conducted in 2015,2018, and 2023) we examined the pre-retirement career evaluations of a sample of Dutch older workers (N= 3566), factors associated with these evaluations, and the impact of subjective career evaluations on retirement at five or eight-year follow-up. The results of our ordinal logistic regression models showed that how individuals evaluated both the work (b= 0.15 p=.001) and family (b= 0.12 p=.001) domain of career was positively associated with retirement adjustment, with those who evaluated their careers more favorably reporting fewer problems adjusting to retirement. Our results demonstrate the long-term impact of subjective career evaluations and highlight the need for additional research evaluating their predictive utility for other important outcomes in older adulthood such as life satisfaction and health. These findings could also be applied to identify and deliver interventions for those at risk of less favorable retirement outcomes.
SEDENTARY BEHAVIOR DIFFERENTIALLY INFLUENCES COGNITIVE HEALTH IN OLDER ADULTS AT DIFFERENT TIMESCALES
Authors: Qiu Tian , Elbich Daniel , Alwerdt Jessie , Hakun Jonathan
Published: December 2023

The negative health effects of sedentary behavior have received increased attention over the past decade. Whether sedentary behavior negatively influences cognitive health at any timescale remains poorly understood. Our study sought to determine whether sedentary behavior negatively affects cognitive health throughout the adult lifespan at multiple timescales (acute within-day, day-to-day, cross-sectionally). We examined ambulatory assessment data generated by an adult lifespan sample (N=161; age range:19-88 years; 84% F) where cognition was repeatedly assessed via ultra-brief cognitive assessments of processing speed and working memory in an ecological momentary assessment (EMA) framework (6 assessments/day for 14 days). Activity was measured continuously via thigh-worn ActivPAL monitors. ActivPAL and EMA data were combined and modeled in a multi-level (3-level; moments within days within persons) isotemporal substitution modeling framework. Increased sedentary behavior was associated with acute decreases in processing speed for older participants (65+ years of age) and substitution modeling indicated that exchanging bouts of walking or standing for sedentary time would result in short-term improvements. In contrast, a consistent result across younger and older adults indicated that days with generally more sedentary time (as well as lying and standing) were associated with overall better processing speed and working memory capacity. No cross-sectional associations were observed. A lack of cross-sectional associations between sedentary behavior and cognitive performance was consistent with previous studies. Our current results extend previous findings by showing that sedentary behavior might influence cognitive performance differently at different timescales in younger and older adults.
SENIOR TECHNOLOGY ACCEPTANCE, FEAR OF FALLING AND FALL RISK ASSESSMENT IN COMMUNITY-DWELLING OLDER ADULTS
Authors: Ojo Eunice Oladepe , Ng Boon Peng , Thiamwong Ladda
Published: December 2023

The use of technology, such as the BTrack balance system (BBT) for fall risk assessment and the Senior Technology Acceptance (STA) survey is important for understanding technology-based fall prevention efforts for at-risk older adults. The purpose of this study was to examine the relationship between technology-based fall risk assessment and STA among community-dwelling older adults aged 60 years and older (n=124). Descriptive statistics, bivariate analysis, and multiple linear regression adjusted for socio-demographics were performed. The STA tool was used to obtain information about older adults’ acceptance of technology. The STA consists of four domains and 14 items. The Short Fall Efficacy Scale International (FES-I) and the BBT were used to measure fear of falling and balance performance, respectively. Of the study population, 77.4% were female, 22.6% were non-white, 8% reported financially inadequate, 46% had low BBT scores and low FES-I scores, whereas 33.9% had high BBT and high FES-I scores, and 20.2% had low BBT and high FES-I scores. For the bivariate analysis, we found a statistically significant difference in the STA scores based on age (p=0.006) and education (p=0.032). In the adjusted analysis, only age was negatively associated with the STA (p=0.004); fall risk assessment using the BBT and FES-I were not significantly associated with STA. With a small study population, readers should be aware of this limitation to our findings. Further studies are needed to address this issue and to identify effective strategies to encourage older adults to use technology to improve their well-being.
SEQUENTIAL ANALYSIS OF DEMENTIA FAMILY DYADIC COMMUNICATION: EFFECT OF CAREGIVER DISABLING COMMUNICATION
Authors: Kim Sohyun , Chen Will , Sun-Mitchell Shan
Published: December 2023

This study examined temporal relationships between antecedent family caregiver disabling communication and subsequent care recipient (persons living with dementia) communication during 75 in-home care video observations. Secondary analysis of 5-, 10-, 15-, 20-, 25-, and 30-second timed-window analysis was conducted. 95% confidence intervals, p-values, and Yule’s Q statistics were used. The results showed that care recipient engaging, challenging, and neutral communication occurred at differing frequencies within each time window following disabling communication by family caregivers. Care recipient challenging verbal communication was more likely to occur within all time widows after caregiver challenging verbal communication preceded (OR = 1.51 – 1.77, p <.001, Yule’s Q = 0.204 – 0.277). Care recipient engaging verbal communication was more likely to occur with weaker chance within all time widows except 30-second window after caregiver disabling verbal communication preceded (OR = 1.11 – 1.17, p = .001 - .028, Yule’s Q = 0.151 – 0.080). Care recipient neutral communication was more likely to occur within all time widows after caregiver disabling verbal communication preceded (OR = 1.34 – 1.39, p <.001, Yule’s Q = 0.144 – 0.162). Care recipient neutral communication more likely occurred within all time widows except 5-second and 10-second windows after caregiver disabling nonverbal communication preceded (OR = 1.28 – 1.34, p =.009 - .029, Yule’s Q = 0.123 – 0.144). Caregiver disabling communication was associated with more likely subsequent care recipient communication. Future research can further explore how participant characteristics and types and frequencies of caregiver communication influence care recipient communication.
SEVERE ALZHEIMER’S DEMENTIA ALTERS THE RELATIONSHIP BETWEEN EXECUTIVE FUNCTION AND FALLS
Authors: Delgado Ferdinand , Yu Fang , MacKinnon David , Peterson Daniel , Ofori Edward , Beach Thomas , Adler Charles , Der Ananian Cheryl
Published: December 2023

Falls are a public health concern for older adults, particularly those with cognitive impairments, like mild cognitive impairment (MCI) and Alzheimer’s disease (AD) dementia. Executive function (EF) is linked to falls in older adults, but little is known about the relationship between individual EF assessments and falls in individuals with varying cognitive statuses. Using cross-sectional secondary data analyses with binary logistic regression, we examined the associations between EF assessments (Trail Making Test (ΔTMT), Digit Span (DS), Stroop test, Clock Drawing Test, and phonemic/semantic fluency tests) and falls (fall history and subsequent falls) in 466 participants (aged 66-103) with either intact cognition, MCI, or AD dementia. Surprisingly, a significant interaction effect emerged with AD dementia and EF assessments (ΔTMT, DS, and semantic fluency), revealing that individuals with AD dementia with worse EF had a lower probability of prior fall history. These findings were influenced by a low percentage of reported falls in people with severe AD dementia. Further stratified analysis of the interaction effects showed that DS and semantic fluency were significantly associated with fall history in people without AD dementia. While some EF assessments were individually associated with falls, interpretations should be made cautiously, especially considering the appropriateness of the assessments for specific populations. The counterintuitive result may stem from factors specific to severe AD dementia. In conclusion, this study uncovers complex interactions between cognitive status, EF assessments, and fall history, and the potential for further investigation to enhance our understanding of falls in individuals with severe AD dementia.
SEX DIFFERENCES IN EMPLOYMENT HISTORY AND LATE-LIFE COGNITION AMONG OLDER CHINESE
Authors: Lu Peiyi , Yin Hongyu , Li Chihua
Published: December 2023

This study characterizes the employment history of older Chinese men and women and examines the associations between employment trajectories and late-life cognition. Individuals aged 60+ in the 2011 China Health and Retirement Longitudinal Study were included (2,733 men and 2,363 women). Multiple waves of surveys were conducted to assess their cognition in 2011, 2013, and 2015. Sequence analysis identified employment trajectories among men and women separately based on self-reported employment history of whole working age (15-60 years). Mixed-effect models examined the relationship between employment trajectories and cognition. Three distinctive employment trajectories were identified for men and women, separately. Among men, 45% men was consistently agriculture employed, 26% were consistently non-agriculture employed and retired at age 60, and 29% had fluctuating employment featuring in agriculture and early-retirement. Among women, 70% women was consistently agriculture employed, 15% were consistently non-agriculture employed and retired at age 55, and 14% had fluctuating employment featuring unemployment, home, and early-retirement. Compared to the consistently agriculture employed, the consistently non-agriculture employed group reported better cognition for both men and women (men: β=1.26, 95%CI=0.81, 1.66; women: β=1.63, 95%CI=1.09, 2.30). Men with fluctuating employment trajectory also had 0.62 points higher cognition (95%CI=0.27, 0.96) than men who were consistently agriculture employed. Older Chinese experienced distinct life-course employment trajectories reflecting the economic and historic development in China. The sex difference was evident as women were more involved in agricultural work and working at home. Non-agricultural employment was associated with better cognition, highlighting the disadvantaged health status of Chinese farmers.
SLEEP DISORDERS AND MUSCLE STRENGTH IN OLDER MEXICAN AMERICANS: SEX DIFFERENCES
Authors: Okada Jamil , Snih Soham Al
Published: December 2023

We used data from the Hispanic Established Population for the Epidemiological Study for the Elderly to examine sex differences in the relationship between sleep duration and handgrip strength (HGS) among Mexican Americans aged ≥ 77 years with normal or high HGS (≥ 17 in women and ≥ 27 in men) at baseline over a 9-year period (2007/08 to 2012/13; N=1542). Measures included socio-demographics, sleep duration, HGS (Kg), body mass index, medical conditions, depressive symptoms, physical function, cognitive function, disability, and pain. We categorized sleep duration as ≤ 7, 8, 9, and ≥ 10 hours/night and used linear mixed models to estimate the changes in HGS as a function of sleep duration by sex, adjusting for covariates. Both men and women in the highest sleep duration group (≥10 hours/night) had on average the greatest decline in HGS (1.54 kg and 0.95 kg, respectively) compared to those who slept 8 hours/night, after controlling for all covariates over the follow-up period. Older age, time (years), depressive symptoms, one or more falls in the last year, and low physical function were associated with greater decline in HGS among women. Older age and time (years) were associated with greater decline in HGS among men. In conclusion, longer sleep duration was associated with greater loss of HGS over time in older Mexican Americans. Sleep health promotion and sleep behavioral interventions may reduce the risk of decline in HGS, which has been associated with disability, institutionalization, and mortality in this population.
SOCIAL DETERMINANTS OF DEPRESSION AMONG OLDER ADULTS IN THE UAB STUDY OF AGING: THE ROLE OF RACE-BASED DISCRIMINATION
Authors: Buys Katie , Buys David , Bowen Pamela , Kennedy Richard
Published: December 2023

Mental health is known to be influenced by social determinants of health (SDoH). However, little is known about how racial discrimination, in the context of other social factors, impacts the mental health of older adults. The focus of this research is specifically on the different effects of racial discrimination in that broader context on depression diagnosis vs. symptomology. Using the UAB Study of Aging’s cohort of 1000 Alabamians 65+ balanced on rural/ urban status, sex (men/women), and race (Black/white), we evaluate the impact of SDoH, including race-based discrimination, on clinically verified depression diagnosis and on depressive symptomology using the Geriatric Depression Scale. Other independent variables include environmental factors (eg: neighborhood disadvantage), status and assets, interpersonal factors, and fixed demographic characteristics. Using generalized estimating equations, we found that experience of racial discrimination is associated with a depression diagnosis (OR: 2.33) independent of race and other factors. Other variables that were significant predictors of having a verified depression diagnosis include life-space mobility and race. Factors associated with depressive symptomology include fear of crime, financial difficulty, social support, life-space mobility, race (Black), and sex (female). While demonstrating that experience of race-based discrimination was associated with depression diagnosis is not surprising, finding in an otherwise identical model, that it was not associated with symptomology was unexpected. Authors will discuss some potential reasons for this counterintuitive outcome and future directions for better understanding this inconsistency.
STAKEHOLDER INSIGHTS: STANDARDIZING END-OF-LIFE CARE TRANSITIONS FOR NURSING HOME RESIDENTS WITH DEMENTIA
Authors: Beltran Susanny , Chisholm Latarsha , Jaijairam Emily
Published: December 2023

Sixty-seven percent of dementia patients die in nursing homes (NHs), where end-of-life care is often suboptimal, and hospice not accessed in a timely manner. The eligibility criteria for the Medicare Hospice Benefit (< 6 months prognosis) poses challenges for patients with Alzheimer’s disease and related dementias given the variable disease progressions that characterize most dementias. This study describes current NH processes used to identify dementia residents to refer to hospice, and stakeholders’ input into the design of a standardized process for clinical decision-making, using the Mitchell Index, a dementia mortality prediction tool. Individual interviews and focus groups were conducted with NH administrators, medical directors, directors of nursing, MDS coordinators, and social workers (N=11). Participants completed an online survey including facility (e.g., size, profit status) and individual demographics (e.g., years of experience), then participated in an interview that involved a brief presentation of the proposed standardized process using the Mitchell Index. Qualitative data analysis followed a deductive approach, guided by constructs from the Consolidated Framework for Implementation Research (CFIR). Preliminary analyses indicate providers believe the Mitchell Index can be successfully adapted for NH use. Participants stated the tool added something to current processes (CFIR relative advantage), would be easy to use (CFIR complexity), and pointed to external influences (i.e., regulations; CFIR domain 2: outer setting) which would be important to consult in later stages of intervention development. Overall, nursing home stakeholders endorse the potential for a standardized process using the Mitchell Index to be acceptable and feasible in high-Medicaid nursing homes.
SUCCESSFUL CARE CONFERENCES: NURSING HOME STAFF, PERSONS WITH DEMENTIA AND CAREGIVER PERSPECTIVES
Authors: Towsley Gail , Edelman Linda , Montez Shelby
Published: December 2023

Work demands of the care team, time constraints, and a lack of guidance from the regulatory environment often result in short, perfunctory mandated quarterly care conferences (e.g., care plan meetings) that lack focus on resident preferences. Me & My Wishes is a video recording approach for documenting, viewing, listening, and discussing nursing home (NH) residents’ living with dementia preferences for daily and end-of-life in care conferences. As part of a study adapting Me & My Wishes for remote delivery, we used a qualitative descriptive design to conduct focus groups (February – June 2023) with experts representing persons living with dementia (PLWD) (n=6), informal care partners (CPs) (n=8), and NH staff (n=9) to inform us of what comprises a successful care conference. We coded and analyzed audio-recorded transcripts, resolved coding discrepancies in team meetings, and derived domains from finalized codes. All groups discussed three primary domains characterizing a successful care conference: 1) resident- engagement; 2) key staff and CPs identified and engaged to support the resident perspective; and 3) structured meetings led by trained facilitators for resident-centered discussion and problem-solving. NH Experts noted that a facilitator who anticipates and mitigates potential barriers (e.g., conflicting discourse) is key for a successful care plan meeting. PLWD identified providing technology assistance for the resident and CPs as important. Care conferences that allow virtual attendance of staff and CPs who know the resident well, are resident-driven, and are well organized can facilitate communication and problem solving resulting in improved resident-centered care.