bluuebunny/crossref_metadata_2025 huggingface dataset:
QUALITY OF LIFE IN OLDER ADULTS RECEIVING IMMUNE CHECKPOINT INHIBITOR THERAPY
Authors: Hoogland Aasha I , Eisel Sarah L , Irizarry-Arroyo Nathaly E , James Brian , Mansfield Jori , Lafranchise Elizabeth A , Jim Heather S
Published: November 2019

Immune checkpoint inhibitors (ICIs) have generated significant excitement for their ability to extend survival in patients with lung, head and neck, and other cancers. In older adults with cancer, emerging research suggests that ICIs improve overall and progression-free survival, but few studies have reported on quality of life (QOL). The goal of this study was to examine changes in QOL over time in older (65+ years) vs. younger (<65 years) lung and head and neck cancer patients. Eligible participants scheduled to begin ICI for lung or head and neck cancer completed the Functional Assessment of Cancer Therapy General (FACT-G) every 2-4 weeks until disease progression. Controlling for cancer site, age group differences in QOL over time were evaluated using linear mixed models. A total of 80 lung cancer (mean age=66.5, 55% female, 55% aged 65+) and 55 head and neck cancer patients (mean age=61.5, 15% female, 45% aged 65+) provided consent. At baseline, patients with head and neck cancer reported significantly lower overall QOL, physical well-being, and emotional well-being compared to patients with lung cancer (ps<.0001). Older patients had marginally higher baseline emotional well-being than younger patients (p=.07). Across groups, there were increases in social well-being (p=.04) and a trend toward decreasing physical well-being (p=.10) over time. Patients with head and neck cancer reported lower emotional well-being over time than patients with lung cancer (p<.01). There were no age differences in QOL over time. Larger longitudinal studies are needed to better understand QOL in older patients receiving ICIs.
INCREMENTAL VALIDITY OF OPTIMISM AND PURPOSE FOR PREDICTING OLDER ADULTS’ DEPRESSIVE SYMPTOMS
Authors: Mitchell Lauren L , Erbes Chris , Arbisi Paul
Published: November 2019

After age 60, depressive symptoms tend to increase slowly over time on average across the population. However, individual trajectories vary, with some increasing more steeply, and others remaining stable. A broad array of psychological constructs have been demonstrated to predict depressive symptoms, including neuroticism, extraversion, optimism, and sense of purpose in life. It is important for psychologists to understand which among these factors are the strongest and most robust predictors. A substantial body of research demonstrates that Big Five personality traits are strongly associated with depressive symptoms (e.g., Hakulinen et al., 2015). Optimism and purpose are also associated with well-being (Carver et al., 2009; Pinquart, 2002), but it is not clear whether such associations could be accounted for by Big Five traits, which are also correlated with optimism and purpose. Using data from the Health and Retirement Study (N = 14,021), we tested the incremental validity of optimism and purpose for predicting older adults’ depressive symptoms, controlling for Big Five traits and demographics. A latent growth curve modeling approach allowed us to examine associations with trajectories of depressive symptoms over six waves (approximately 10 years). Results demonstrated that both optimism and purpose are significantly associated with baseline levels of depressive symptoms, over and above the Big Five. However, only Big Five traits were associated with linear and quadratic slope in depressive symptom trajectories. These findings suggest that optimism and purpose are not redundant with Big Five traits for predicting depressive symptoms, and may be valuable targets for intervention efforts.
EVALUATION OF A TELEPHONE-BASED PROGRAM DESIGNED TO REDUCE LONELINESS IN OLDER VETERANS
Authors: Gould Christine E , Juang Christine , Huh Terri , Iyer Sowmya
Published: November 2019

We examined the benefits and challenges of implementing a program aiming to reduce older Veterans’ loneliness. The program helped connect older Veterans with others through telephone-based group activities. Thirty-four Veterans were enrolled in the program, of which 14 attendees called in to one or more activities. Data were collected at baseline, 3-months, and 6-months. Differences in baseline characteristics between attendees and non-attendees were calculated. Changes in Veterans’ perceived loneliness, depression, anxiety, and quality of life were evaluated. Client satisfaction were analyzed. Qualitative data analyses were conducted to identify perceived benefits and challenges of participating in this program. Attendees were more likely to be depressed and have limited environmental resources to promote quality of life than non-attendees. A significant decrease in loneliness was found among attendees from baseline to 3-months. Overall, Veterans were satisfied with this program and the services provided. Perceived benefits included a structured program with interesting topics to spend time on as well as the opportunity to socialize, exchange ideas, and connect with other Veterans. Perceived individual challenges (e.g., hard of hearing) and program-level challenges (e.g., complicated procedures) were observed. Results demonstrated that this telephone-based program is feasible and beneficial for older Veterans to reduce loneliness. Several barriers and challenges were noted, providing insight into ways to improve the implementation of this program.
DISCRIMINATION AND DEPRESSION IN MID- TO LATE LIFE: THE ROLE OF OPTIMISM
Authors: Perez Elliottnell , Dzierzewski Joseph , Ravyts Scott
Published: November 2019

he positive association between discrimination and depression is well-supported throughout the literature. Previous evidence exploring potential mechanisms suggest discrimination is associated with depression via changes in social cognition. The goal of the current study was to investigate whether optimism explained the relationship between discrimination and depressive symptoms in mid-to-late life. Furthermore, the study assessed whether this mediated relationship was moderated by race or sex. This study included cross-sectional and longitudinal secondary data analysis of 2453 middle-aged and older adults (M age=68.30,SD=8.93) from the Midlife in the United States study. Discrimination was measured using an 11-item count of the number of discriminatory events experienced. Optimism was measured using the 6-item Life Orientation Test. Depressive symptoms were assessed using a 7-item count of the number of symptoms experienced. Optimism mediated the relationship between discrimination and depressive symptoms cross-sectionally, 95% CI:[.012, .034], and longitudinally, 95% CI:[.008, .024]. There was no evidence of moderated mediation; however, sex did moderate the direct relationship between discrimination and depressive symptoms cross-sectionally, b=.10, 95% CI:[.001, .194], and longitudinally, b=.03, 95% CI:[.01, .05]. The current study extends the literature by providing cross-sectional and longitudinal support for optimism as a mechanism through which discrimination leads to depressive symptoms in older adults. Evidence also suggests that women experience greater depressive symptoms than men in response to discrimination. Future research may wish to examine the developmental course of observed relationships and the impact of multiple marginalized identities on these relationships.
MUSCLE WEAKNESS IS ASSOCIATED WITH DISABILITY AND CHRONIC MULTIMORBIDITY IN MIDDLE-AGED AND OLDER AMERICANS
Authors: Peterson Mark , Faul Jessica
Published: November 2019

Background: The objective of this study was to use nationally-representative data on Americans age 50+ to determine the association between grip strength and inflammation as independent predictors of incident disability, chronic multimorbidity and dementia. Methods: Older adults (n=12,618) from the 2006-2008 waves of the Health and Retirement Study with 8-years of follow-up were included. Longitudinal modeling was performed to examine the association between baseline grip strength (normalized to body mass: NGS) and high sensitivity c-reactive protein (hs-CRP) (≥3.0 mg/L) with incident physical disabilities (i.e., ≥2 limitations to activities of daily living), chronic multimorbidity (≥2 of chronic conditions), and dementia. Results: The odds of incident disability were 1.28 (95% CI: 1.19-1.37) and 1.27 (95% CI: 1.21-1.36) for men and women respectively, for each 0.05-unit lower NGS. The odds of incident chronic multimorbidity were 1.22 (95% CI: 1.06-1.18) and 1.12 (95% CI: 1.06-1.17) for men and women respectively for each 0.05-unit lower NGS. The odds of incident dementia were 1.10 for men (95% CI: 1.02-1.20) for each 0.05-unit lower NGS, but there was no significant effect for women. Elevated hs-CRP was only associated with chronic multimorbidity among women (OR=1.60; 95%CI: 1.26-2.02). Conclusions: Our findings indicate a robust inverse association between NGS and disability and chronic, multimorbidity in older men and women, and dementia in men. Elevated hs-CRP was only associated with chronic multimorbidity among women. Healthcare providers should implement measures of handgrip strength in routine health assessments and discuss the potential dangers of weakness and interventions to improve strength with their patients.
MULTIPLE CHRONIC CONDITIONS IN OLDER CANCER SURVIVORS WITH AND WITHOUT HIV
Authors: Koroukian Siran , Schiltz Nicholas , Rose Johnie , Cooper Gregory , Owusu Cynthia , Statler Abby , Moore Scott E , Markt Sarah
Published: November 2019

Background: With more effective treatment for both HIV and cancer, longevity among persons living with HIV (PLwHIV) has improved significantly. However, little is known about whether the comorbidity profile of cancer survivors differs between PLwHIV and their HIV-free counterparts. To address this critical gap in knowledge, we compared the occurrence and combination of multiple chronic conditions (MCCs) among older cancer survivors by HIV status. Methods: We used national data from the 2014 Chronic Conditions Data Warehouse (CCW) as part of the Medicare Beneficiary Summary File, which flags 66 conditions, including HIV/AIDS, and history of common cancers (colorectal, lung, prostate, and leukemias/lymphomas). We limited our study population to men age 65 years or older who were cancer survivors. In addition to descriptive analysis, we conducted association rule mining (ARM) analysis to compare the prevalence of the most common MCCs among cancer survivors, with and without HIV. Results: We identified 1.3 million individuals, of which 1,901 (0.15%) were PLwHIV. Compared to their HIV-free counterparts, PLwHIV were younger (mean of 72.5 and 77.0 years); more were non-White (41.8% vs. 13.5%); and more of them presented with anemia (44.8% vs. 35.3%), chronic kidney disease (CKD, 41.9% vs. 26.6%), depression (26.6% vs. 13.9%), viral hepatitis (20.4% vs. 0.70%), and/or liver disease (10.7% vs. 4.8%; p < 0.001 for all comparisons). ARM results showed a prominence of CKD in the most common top 5 combinations of conditions. Conclusion: Despite being younger than their HIV-free counterparts, PLwHIV with history of cancer carry a significantly greater comorbidity burden.
METABOLIC SYNDROME AND LATE-LIFE DEPRESSION AMONG MEXICAN AMERICANS: THE ROLE OF NATIVITY
Authors: Zhang Weihui
Published: November 2019

Metabolic syndrome (MS) has been reported to predict depression. However, studies evaluating if there are differences by nativity status among Mexican Americans are scarce. This study aims to examine the association between metabolic syndrome and depression among Mexican-American older adults. We also evaluated the role of nativity, sociodemographic and health risk factors. We use three waves (2006-2013) from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE; N=1,542, mean age =83.45 in 2006). MS was defined according to the National Cholesterol Education Programme (NCEP-ATP III) using abdominal obesity, use of antihypertensive medication, and insulin. Depression was ascertained by self-report of a CES-D score greater than 16. We applied random-effect logistic regression models which accounted for inter-individual correlation and adjusted for age, sex, education, smoking, alcohol use, physical performance, and self-esteem. We also tested for interaction between MS and nativity. Approximately 30% of foreign-born and 22% of US-born reported depression. The prevalence of MS was higher in the Foreign-born when compare to the US-born (5.89% vs. 5.35%). In the total sample, MS was associated with a higher risk of depression (OR=4.34, p=0.007). Foreign-born Mexican Americans were more likely to have depression (OR=1.70, p=0.002) when compared to US-born; however, foreign-born with MS reported lower depression (OR=0.26, p=0.052) after adjusting for potential confounders. Our finding adds to the concept of “metabolic depression,” and further highlights the importance of evaluating nativity to explain the differences in physical and psychological health among a sample of the Hispanic population at old age.
COHORT DIFFERENCES AND 4-YEAR CHANGE IN EVERYDAY DISCRIMINATION AMONG OLDER AMERICANS
Authors: Wheaton Felicia V
Published: November 2019

Experiences of everyday discrimination, such as being treated with less courtesy or respect, are associated with poorer mental and physical health in later life. Yet not much is known about cohort differences in experiences of everyday discrimination, nor how subjective reports of discrimination change over time among older adults. This study assessed cohort differences and 4-year change in everyday discrimination using data from the 2006 and 2010 waves of the Health and Retirement Study (HRS), a nationally-representative study of Americans 50+. In both waves, participants were asked about 5 possible experiences of everyday discrimination: for example, “In your day-to-day life, how often have any of the following things happened to you? You receive poorer service than other people at restaurants and stores” and could respond from 0=never to 5=almost every day. Average everyday discrimination was lower for older cohorts compared with younger cohorts in both 2006 and 2010. Paired-samples t-tests showed that average everyday discrimination declined significantly over the 4-year period. However, it is unclear if changes are due to period or age effects. Implications of these findings will be discussed.
RACE, BIOLOGICAL AGE, AND COGNITION: THE SYSTEMATIC ASSESSMENT OF GERIATRIC ELEMENTS IN ATRIAL FIBRILLATION STUDY
Authors: Forrester Sarah N , McManus David D , Saczynski Jane S , Kiefe Catarina I
Published: November 2019

Atrial Fibrillation (AF) is associated with dementia and cognitive decline. AF is less prevalent among Blacks than Whites, although AF-related complications are more common in Blacks. In the general population, all-cause cognitive decline and dementia are more prevalent among Blacks than Whites. Thus, studying diverse populations with AF may advance our understanding of racial disparities in cognitive functioning. We created a measure of multisystem dysregulation (weathering), which includes but is more encompassing than aging, and examined its association with racial differences in cognition using data from the SAGE-AF study, a prospective cohort of >65-year olds with AF, at high stroke risk, and eligible for anticoagulation. Biological (as opposed to chronological) age among 974 participants was calculated using the Klemera and Doubal method using biomarkers representing physiological functioning, metabolism, and blood pressure. We defined weathering as the difference between biological and chronological age (weathering >0 indicates that biological age is higher than chronological age). We measured the association between weathering and the Montreal Cognitive Assessment (MoCA) score. Mean weathering (SD) was -0.7 (11.5) and 4.3 (12.6) for whites and non-whites, respectively. There was an interaction between race/ethnicity and weathering on cognition (P=0.004). In stratified analyses, higher weathering was associated with a lower MoCA score among both Whites and non-Whites but more so among non-whites (B = -0.09, 95% CI: -0.17, -0.02) for Whites (B = -0.03, 95% CI: -0.06, -0.01) for non-whites. Aging-related multisystem dysregulation is more strongly associated with worse cognition in non-whites than in whites.
NEIGHBORHOOD SOCIAL INTEGRATION, SOCIAL NETWORK, AND COGNITION: DOES THE INTERACTION EFFECT MATTER?
Authors: Chen Jenhao , Crimmins Eileen , Li Mengting , Dong XinQi
Published: November 2019

Social integration of neighborhoods and social network properties are associated with better cognitive function but the two factors are often investigated separately. This study examines the interaction between neighborhood social integration and quantity and composition of social network on cognitive domains by analyzing Population Study of Chinese Elderly, a population-based epidemiological study of over 3000 US Chinese older adults aged 60 and above in Chicago metropolitan. Regression results show that larger network size, volume of contact and smaller proportion kin and proportion co-resident were associated with higher level of global cognition. Higher sense of community was associated with higher level of global cognition. The interaction term of volume of contact and neighborhood cohesion was negative and statistically significant, suggesting the protective effect of volume of contact may decrease in high cohesion neighborhoods. Similar moderation effects were observed in specific cognitive domains, including episodic memory, working memory and executive function.
THE ASSOCIATION OF RESILIENCE AND SOCIAL NETWORKS WITH PAIN OUTCOMES AMONG OLDER ADULTS
Authors: Musich Shirley , Wang Shaohung , Slindee Luke , Kraemer Sandra , Yeh Charlotte
Published: November 2019

Depression, stress and poor sleep are associated with increased pain among older adults with chronic pain. Positive resources may help buffer the impacts of negative attributes on pain. Our primary objective was to determine effects on pain outcomes (severity; interference) of positive resources (resilience; social networks) on negative attributes among older adults with pain. The sample (N=15,000) came from older adults≥65 years with AARP®Medicare Supplement and AARP®MedicareRx plans (insured by UnitedHealthcare Insurance Company) with diagnosed back pain, osteoarthritis and/or rheumatoid arthritis. Members received a survey assessing positive resources, negative attributes and outcomes of pain. Depression, stress, sleep, resilience, social networks, pain severity and interference were measured. Opioid and other medications were determined from claims. The population was propensity weighted to adjust for survey non-response; weighted to be generalizable to members with diagnosed pain. Multinomial logistic regression was used to determine associations of positive/negative attributes on pain. Among respondents (N=4,161; 29%), prevalence of pain severity and interference for no/mild, moderate and severe categories was 61%, 21% and 18% for severity and 67%, 16% and 17% for interference. In bivariate models adjusted for demographics/health status, negative attributes of depression, stress and poor sleep had stronger associations with pain severity and interference than moderating effects. In full multivariate models, the strongest associations with moderate and severe severity and interference remained depression, stress and sleep. Based on results, multidimensional pain management strategies should include management of depression, stress and poor sleep along with enhancement of positive resources and analgesics as needed for pain management.
HOME CARE SOCIAL WORKERS CLAIM MEDICARE IGNORES PATIENT NEEDS
Authors: Cabin William D
Published: November 2019

There is significant literature on the importance of addressing social determinants of health (SDOH) in order to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded Medicare Advantage plans ability to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 29 home care social workers between January 2013 and May 2014 in the New York City metropolitan area. Results indicate social workers believe the lack of SDOH coverage in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and re-hospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs. Policymakers are urged to consider adding coverage of SDOH to Medicare home health primarily through expanded social work coverage.
ELECTRONIC PERSONAL HEALTH RECORD USE AMONG ELDERLY CANCER SURVIVORS AND NON-CANCER SURVIVORS
Authors: Luo Yan
Published: November 2019

Background Electronic personal health records (ePHRs) are potential tools to improve clinical outcomes through increasing patients’ self-management. Although elderly people, especially elderly cancer survivors, is a growing population who can benefit from ePHRs, little is known about its utilization among the elderly, particularly among those diagnosed with cancer. Objective By applying Anderson’s Behavioral Model of Health Services Use, this study aims to examine and compare the associated factors with ePHRs use among elderly cancer survivors and non-cancer survivors. Methods The data collected from the 2018 Health Information National Trends Survey (HINTS) was analyzed. The level of access to ePHRs among the elderly were assessed. Predictors of ePHRs use among elderly cancer survivors and non-cancer survivors were compared by conducting multiple linear regression. According to Anderson’s Model, predisposing factors, enabling factors, and need factors were included in the statistical model. Results The overall use of ePHRs remained low among 577 participants (mean = .87, SD = 1.72, range from 0 to 4). Non-Cancer survivors reported lower ePHRs use (mean = .83, SD = 1.77, range from 0 to 4). Race/ethnicity, education, regular health care providers, health insurance, social support, and medical conditions were associated with ePHRs use among non-cancer survivors, while age, gender, social support, and self-reported health status were related to ePHRs use among cancer survivors. Conclusion This study suggests additional efforts to increase ePHRs utilization among the elderly, especially the elderly cancer survivors. The predictive findings reported in this study will contribute valuable implications to enhance the ePHRs use.
INTERNET USE AND NEGATIVE HEALTH PERCEPTIONS: THE MODERATING ROLES OF EDUCATION AND HEALTH LITERACY
Authors: Seckin Gul , Bell Valarie , Hughes Susan
Published: November 2019

There is a mixed support regarding the effect of Internet use on health and well-being. We estimated the extent to which e-health literacy predicted two domains of negative assessment of well-being: negative affect and self-reported experience of health problems. Respondents were randomly sampled from the largest national online probability-based research panel (N = 710). Hierarchical ordinary least squares regression analyses were employed for hypothesis testing. We computed interaction terms (e-health literacy x strain; e-health literacy x education; and education x strain) as determinants of negative subjective assessment of well-being. Older adults with higher levels of e-health literacy reported significantly more health information consumerism [(t (194) = 7.32, p ≤ .0001] but less strain in medical encounters [(t (194) = 2.92, p ≤ .004]. They reported less negative affect [(t (194) = 2.11, p ≤ .036] and more satisfaction with medical encounters [(t (194) = 4.70, p ≤ .0001]. The effect of perceived strain in medical encounters on negative affect was weaker among those with higher levels of education (β = -.314, p ≤ .01). Education had a significant moderating effect on the association between perceived strain in medical encounters and self-reported health problems, (β = -.550, p ≤ .05). Those who reported lower averages for e-health literacy but higher educational levels indicated lower averages on negative affect (β = -.597, p ≤ .05). Given that conventional methods of acquiring health-related information shift to the Internet, our study holds significant health and social implications for a rapidly growing Internet-connected older population.
CAREGIVER RESPONSES TO REMOTE ACTIVITY MONITOR ALERTS OF PERSONS WITH DEMENTIA
Authors: Zmora Rachel , Finlay Jessica M , Mitchell Lauren L , Gaugler Joseph E
Published: November 2019

The benefits of technology to alert family caregivers to the needs of persons with Alzheimer’s disease or related dementias (ADRD) are unclear. Previous research indicates that remote activity monitoring (RAM) system alerts can be alternately reassuring and highly stressful for caregivers. We conducted a parallel convergent mixed-methods analysis of 62 primary caregivers of persons with ADRD to evaluate the association between the number of alerts and caregiver outcomes after 6 months. We assessed caregiver-reported usability of the system as well as self-efficacy, sense of competence, and distress as primary outcomes. Linear regression models tested the association between the number of alerts and caregiver-reported usability and primary outcomes. The number of alerts declined over the first 6 months of system use and was not associated with a change in system usability or primary outcomes. Thematic analysis of caregiver-reported perceptions of RAM use simultaneously probed for more in-depth understanding of caregiver experiences of and feelings towards RAM. Preliminary analyses reveal that 28% of caregivers comments were positive, noting benefits such as early warning of health concerns and peace of mind. 34% of comments were neutral or mixed, and 38% were negative. Concerns included false alarms and accidental triggers, losing sleep due to alarms, and difficulties using the system. These findings help characterize the adjustment period to use RAM technology. The mixed-method results inform future research studies and applications of RAM systems so that researchers and caregivers can better understand the initial adjustment period, address concerns, and avoid discontinuing RAM use prematurely.
IDENTIFYING CARE ACTIVITIES THAT WERE SUPPORTED BY AMAZON ECHO FOR CARE PARTNERS AFTER ONSET OF COGNITIVE IMPAIRMENT
Authors: Madjaroff Galina
Published: November 2019

There are several important challenges when addressing the needs of older adults with cognitive impairment and their care partners including the potential for diminishing emotional well-being and loss of autonomy, which could potentially lead to a lower overall quality of life for both care partners (CPs). The motivation of this study was to identify the care activities that were supported by home based technology for care partners after the onset of cognitive impairment. This work was done through gathering multiple sources of qualitative and quantitative data, including mobile application dialogue history logs, pre and post interviews, user feedback groups and home visits. The technology deployed in the home of the care partners was a Voice User Interface Intelligent Agent, specifically the Amazon Echo with its intelligent agent “Alexa.” This technology was selected because it was not built from a traditional care model, yet embodies functions that could be used for all potential forms of care, including those that achieve a higher level of quality of life goals for care partners. From this study, we can further our understanding of how to deploy and design technology that shifts the perspective from “cure to care” with a focus on the older person and their lived experience, monitoring wellness, and not just addressing illness. Results and findings indicated that daily care activities of dyads that are seemingly fundamental are actually complex care activities that emerge from using the technology that support the care partners on multiple levels in satisfying multiple needs.
USE OF TECHNOLOGY BY FOUR DIVERSE COHORTS OF OLDER ADULTS: FINDINGS FROM THE CART STUDY
Authors: Wild Katherine , Mattek Nora , Sharma Nicole , Marcoe Jennifer , Wall Rachel , Kaye Jeffrey
Published: November 2019

Early studies of technology adoption and computer use identified a “digital divide” between older adults and the general population. As that gap has narrowed, other demographic variables have been identified as continuing to foster disparities in access to and use of computers and related technologies. For example, gender, socioeconomic status, education, and ethnicity have been recognized as predictors of computer use among community living older adults. The ORCATECH Collaborative Aging (In Place) Research Using Technology (CART) initiative was designed to develop and validate an infrastructure for research utilizing technologies to facilitate healthy and independent aging. The CART program tests innovative technology applications in four diverse populations: residents in low income, section 202 housing in Portland; isolated, rural veterans in the Pacific Northwest; urban African American seniors in Chicago; and socially isolated, ethnically diverse low income seniors in Miami. As part of their participation in the CART project, older adults complete an annual survey of health and technology use. A total of 214 participants were enrolled and agreed to have their homes instrumented with the CART platform of monitoring technologies. Across all four cohorts 166 answered the technology survey thus far: 82 - 97% of participants own a cell phone; 64 - 78% perform some online banking activities. There were no differences among cohorts in computer use or cell phone ownership, or in other measures of technology use. Inclusion of ethnically and economically diverse populations in future technology research will be critical in the development of effective digital health interventions.
EXAMINING DISCREPANCIES IN SOCIAL ROBOT VERSUS HUMAN ASSESSMENTS OF GERIATRIC WELL-BEING
Authors: Harrington Erin , Do Ha , Bishop Alex J , Reese-Melancon Celinda , Sheng and Weihua
Published: November 2019

Socially assistive robotic (SAR) technologies represent a viable tool for monitoring the safety and health of older adults. However, it is unclear whether SARs can comprehensively screen geriatric well-being as effectively as trained human clinicians. The purpose of this study was to compare SAR versus human assessment of geriatric well-being. Participants included 30 older adults (Mage = 73.40, SD = 7.88) who completed a robot-administered well-being assessment session during which human-administered evaluation was simultaneously performed. Standardized clinical screening assessment tools common in geriatric care were administered (e.g., Short Blessed Test (SBT), UCLA Loneliness Scale, Geriatric Depression Scale, PHQ-4, Iowa Fatigue Scale, Fall Risk). Multiple dependent sample t-tests were used to explore variability in assessment scores between SAR and human evaluation. Assessment scores significantly differed on several measures, including the SBT (t(29) = -9.33, p < .001), UCLA Loneliness scale (t(19) = 2.37, p < . 05), and fall risk assessment (t(29) = 3.03, p < .01). Specifically, the SAR indicated that older adults were significantly more cognitively impaired, less lonely, and more likely to fall compared to the human administrator. Other observed differences and hypothesized explanations will be discussed in greater detail. The current study indicates that there is a divergence in geriatric assessment outcomes based on human versus SAR administration. Findings have implications relative to further developing SAR technology to align with human-based evaluations to enhance cognitive well-being, social connectedness, and falls prevention.
CROSS-COUNTRY COMPARISON OF INTERNET USE AND DEPRESSION BY GENDER: THE ROLE OF INTERGENERATIONAL FACTORS
Authors: Shim Hyunju , Ailshire Jennifer A , Crimmins Eileen
Published: November 2019

Technology may offer one approach to reducing depression as it provides medium to maintain connections (Cotton et al., 2014). Yet, depression, internet use, gender roles, and expectation of intergenerational interaction all differ across countries. Using nationally representative data from the U.S (Health and Retirement Study: HRS) and South Korea (Living Profiles of Older People Survey: LPOPS), the study examines 1) association between internet use and depressive symptoms by gender in two countries; 2) and whether intergenerational factors moderated this association. In the U.S., more than half of men and women aged 65+ used the internet, while approximately 30% of women and 47% of men used the internet in Korea. Using the internet was associated with lower depression for those living far from the closest child for women in the U.S., and for men in Korea. The findings indicate that the association of internet use on depressive symptoms can be influenced by intergenerational factors that may differentially affect men and women depending on the sociohistorical contexts.
CALL A TEENAGER . . . THAT’S WHAT I DO!: GRANDCHILDREN HELP OLDER ADULTS USE NEW TECHNOLOGIES
Authors: Portz Jennifer D , Fruhauf Christine , Bull Sheana , Boxer Rebecca S , Bekelman David , Casillas Alejandra , Gleason Kathy , Bayliss Elizabeth
Published: November 2019

As older adults increasingly show interest in technology for their well-being, families will play an important role in promoting the adoption and use of beneficial health technologies. The purpose of this study was to conduct a sub-analysis of data collected from a large-scale qualitative project regarding older adults’ experiences using health information technology. Specifically, the sub-analysis explored older adults’ experiences with technology support from family members to inform strategies for promoting older adult engagement with new health technologies. While the primary analysis of the original study was theoretically driven, this paper reports results from the inductive, open-coding analysis. Twenty-four older patients (≥65 years) with multiple chronic conditions (Charlson Comorbidity Index > 2) participated in a focus group conducted at patients’ primary clinic. While conducting the primary theoretically-driven analysis, coders also utilized an open-coding approach to ensure important ideas not reflected in the theoretical code-book were captured. Open-coding resulted in a primary theme, “family support”, that was furthered categorized by who and how the tech-support was provided. Participants were not specifically asked about family support, yet family assistance and encouragement for technology emerged from every focus group. Participants repeatedly mentioned that they called their grandchildren and adult children for help with technology. Participants also reported that family members experienced difficulty when teaching technology use. Family members struggled to explain simple technology tasks and were frustrated by the slow teaching process. Family support, specifically via grandchildren, may have a key role in the successful adoption and use of emerging health technologies.
IT’S MY BUDDY: EXPLORING THE PERCEPTIONS OF PEOPLE WITH DEMENTIA ABOUT THE SOCIAL ROBOT PARO IN A HOSPITAL SETTING
Authors: Hung Lillian , Chaudhury Habib
Published: November 2019

New technology such as social robots opens up new opportunities in hospital settings. PARO, a robotic pet seal, was designed to provide emotional and social support for older people with dementia. This project aims to explore the perceptions of persons with dementia about PARO’s role in a hospital setting. Video-ethnographic methods were applied. We had conversational interviews with and video observations of 10 older people with dementia in the geriatric unit of a large Canadian hospital. Also, semi-structured interviews and two focus groups were conducted with 10 staff members in the local unit to gain contextual information. Thematic analysis yielded three substantive themes: (a) “it’s like a buddy”—the robot helps people with dementia uphold a sense of self in the world; (b) “it’s a conversation piece”—the baby seal facilitates social connection; and (c) “it’s all about love”—PARO transforms and humanizes the clinical setting. Our findings help provide a better understanding of the direct perspectives of patients with dementia on the use of social robots. Instead of substituting human contact, the social robot complements emotional care and supports our fundamental human need for love.
AN INNOVATIVE DATA-DRIVEN FALL PREVENTION COMMUNICATION TOOL FOR ADMINISTRATORS, NURSE MANAGERS, AND STAFF NURSES
Authors: Bjarnadottir Ragnhildur , Lucero Robert
Published: November 2019

Falls are the leading cause of injury among older adults, resulting in 3 million emergency department visits and 800,000 hospitalizations each year in the United States alone. In the hospital setting, falls are among the most common adverse events, causing longer stays and higher costs of care. Substantial efforts have been made to reduce falls in the past decade but with limited sustained effect. This may in part be due to limitations of existing tools for fall-risk assessment and evidence-based fall prevention. Therefore, there is a need to strengthen the evidence on risk factors for hospital-acquired falls and address barriers to translating the best available evidence into practice. To this end, we undertook the development of an innovative dissemination tool to implement fall-related evidence generated through state-of-the-art data science and information visualization approaches. Through a multidisciplinary academic-clinical partnership, we have developed an infographic to disseminate empirical evidence to nurses and administrators in the hospital setting. The infographic was developed based on principles of user-centered design and persuasive communication, and focuses on providing clear and accessible information about factors contributing to a patients’ risk of falling in the hospital. This innovative dissemination approach is intended to foster dialogue between administrators, mid-level nursing management and staff nurses as well as evidence-based practice at the bedside. Future use and evaluation of this fall prevention tool will focus on adapting the infographic as an interactive digital tool for education and engagement of patients and families in the hospital setting.
AGE- AND ETHNICITY-RELATED DISPARITIES IN TECHNOLOGY USE AMONG HIGH-RISK VETERANS
Authors: Muralidhar Kiranmayee , Valencia Willy Marcos , Wang Kaicheng , Ruiz Diana , Gomez-Orozco Carlos , Dang Stuti
Published: November 2019

Using predictive analytic modelling, the Veterans Affairs has identified Veterans considered to be High Need High Risk (HNHR) requiring increased support. This pilot study sent needs assessment questionnaires to 1112 HNHR Veterans to better understand gaps regarding technology use, access, physical function, and mobility. There were 341(30.7%) respondents: 270(80.4%) Non-Hispanic, 64(18.8%) Hispanic/Latino; 210(61.6%) White, 119(34.9%) Black/African Americans; and 310(90.4%) had ≥high school education. Average Barthel(ADL) score was 81.5±22.8 and Lawton(IADL) score was 5.8±2.2. Younger Veterans (age<70) were more likely able to use Internet ((117(65%) vs 74(46%)),(p≤0.01) and email (106(58.9%) vs 67(41.6%),( p≤0.01). They were also more likely enrolled in MyHealtheVet (87(48.3%) vs 58(36%),(p=0.043). Secure messaging was used by 62(34.3%) younger and 37(23%) older Veterans,(p=0.026). More higher functioning Veterans (140(55.1%)) used email than lower functioning (33(37.9%)),(p=0.018). Among higher functioning Veterans, 148(58.3%) were willing to use videoconference for care coordination and 116(45.7%) owned a smartphone or computer with camera for this; more than lower functioning Veterans (33(37.9%) and 28(32.2%)), (p≤0.01 for both). Less dependent Veterans preferred to be contacted via cellphone (88(62.4%)) or Internet (10(7.1%)) compared to the more dependent (96(48%) and 6(3%)) respectively (p=0.01). Only 71(44.1%) of older Veterans were willing to use videoconference (p≤0.01) and 54(33.5%) owned a smartphone or computer with camera,(p≤0.01). There are significant variations in technology use by age and ethnicity. However, although there are differences by functional ability, a significant number of disabled veterans are willing and able to use technology, and this may provide a way to address access barriers in this population.
WEBCAMERA-BASED VISUAL PAIRED COMPARISON AS A REMOTE COGNITIVE SCREENING METHOD
Authors: Gray Michelle , Gills Joshua , Smith Spencer A , Bates Emily , Glenn Jordan M , Madero Erica , Bott Nick
Published: November 2019

Alzheimer’s disease (AD) is a form of dementia impacting memory and cognitive function of 131 million individuals worldwide. Though early cognitive decline detection is important, cognitive screening is limited among older adults and many cases go undetected. As easy-to-use cognitive assessments are not readily available to the general population, the purpose of this investigation was to determine the ability of a 5-minute webcamera-based eye-tracking cognitive assessment to discriminate between cognitively intact adults and adults with mild cognitive impairment (MCI) or AD. This prospective study included 56 participants (age=55.9±26.8) divided into three groups: younger cognitively intact (ages 18-46 years, n=25), older cognitively intact (ages >60 years, n=20), and older cognitively impaired participants with MCI or AD (ages>60 years, n=13). All participants completed the Digit Symbol Substitution Test (DSST) and Visual Paired Comparison test (VPC) to assess cognition. One-way ANOVA detected differences in cognition between groups. A Pearson correlation determined the association between cognitive assessments. Additionally, multiple regression determined the ability of VPC and age to predict DSST scores. Results revealed significant differences between cognitively intact and cognitively impaired groups for VPC (p=.001) and DSST (p<.001). Follow-up analyses revealed significant differences between cognitively intact and cognitively impaired adults (p=.005) with no differences between younger and older cognitively intact adults (p=.34). There was a significant association between the VPC and DSST cognitive assessments (r=.54, p<.001), with VPC and age accounting for 69% of the variation in DSST. These results support the use of webcamera-based VPC as a viable option when screening tool MCI/AD.
AUTOMATIC QUANTIFICATION OF TANDEM WALKING USING A WEARABLE DEVICE: VALIDITY OF THE INSTRUMENTED TANDEM WALK
Authors: Hausdorff Jeffrey M , Ganz Natalie , Gazit Eran , Hadad Amit , Buchman Aron S , Mirelman Anat
Published: November 2019

Tandem walk (TW) is typically assessed by the time to complete the task and the number of missteps, however, these measures suffer from limitations and may not fully capture the range of performance in this task. We developed metrics of TW by using a body-fixed, wearable sensor in young and older adults. Healthy young men (n=40) and older adult men (n=362) were studied. While wearing a 3D accelerometer on their lower back, subjects performed three different tasks: TW, usual-walking, and quiet standing. The extracted measures for TW were: High-to-Low frequency band ratio from the power spectral density from the ML axis [nu], signal vector magnitude[g], step duration[s], sample entropy from ML, AP axis[nu] and CV[%]. All of the TW metrics were significantly different in the young and older men (p<0.001). Older men completed the TW with higher CV, suggesting greater stride-to-stride variability and they walked more slowly, as seen by their step duration. Additionally, the frequency ratio measure suggests that the older adults displayed less complex corrective movements in the ML axis. TW measures were modestly correlated with usual-walking (e.g., average stride time with TW step time, r=0.3; p<0.001) and with quiet standing postural control (e.g., acceleration path length in the ML and AP axis with TW sample entropy in the ML axis, r=0.13; p=0.014). Metrics derived from a wearable device complement conventional TW measures and vary with age. Further work is needed to determine if TW, gait and posture metrics are differentially associated with distinct adverse health outcomes.
VIDEO RECORDING FOR CAPTURING INTERACTIONS BETWEEN RESIDENTS WITH DEMENTIA AND STAFF: A SYSTEMATIC REVIEW
Authors: Kim Da Eun , Sagong Hae , Kim Eunjoo , Jang Ah Ram , Yoon Ju Young
Published: November 2019

The use of video-recording offers important advantages in observing and assessing the relationships between specific behaviors in health care settings. The purpose of this systematic review is to investigate and synthesize the methodological characteristics of studies using video-technology for measuring interactions between the older persons with dementia and staff in long-term care facilities. We searched Medline, Embase and CINHAL databases for published articles in English using a video-recording method for both staff and persons with dementia. Quantitative research design studies (e.g., descriptive studies or an experimental studies) were included. Among 5,605 searched papers, a total of 20 studies were selected for this review. Situations of video-recording were providing personal care (n=12), mealtime (n=6), and conversation (n=3). Concepts of measuring by video-recording were classified into two groups: 1) Staff [care practice by staff (n=13) and communication by staff (n=11)] and 2) residents [communication by resident (n=4), activities of daily life function of resident (n=8), and behavioral and psychological symptoms of dementia (n=10)]. This review demonstrates that video technologies are actively used to evaluate the relationship between quality of care and health outcomes of the elderly with dementia in many international nursing studies. This study provides the foundation for a future research using video-recording technologies to examine the interactions and relationship between staff and the residents in long-term care settings.
DESIGNING TECHNOLOGY TO SUPPORT HEALTHCARE FOR AGING ADULTS
Authors: Charness Neil H , Beach Scott R
Published: November 2019

Healthcare costs are rising in industrialized countries, partly as a function of managing costly chronic care conditions associated with aging populations. Of roughly 3 trillion USD expended in the U.S., almost 90% is spent on those with chronic conditions. Technology is touted as one tool to manage healthcare efficiently. However, human factors research has shown that technological systems that do not take human capabilities into account will fail to be adopted, or if adopted, will be abandoned by users. The Center for Research and Education on Aging and Technology Enhancement (CREATE) will describe research findings for four different facets of healthcare technology. Sara Czaja will provide an overview, describing technology for healthcare support. Caregiver needs are projected to rise rapidly, in part due to aging of the baby boom cohorts. We need new solutions for future generations of older adults as there will be insufficient numbers of caregivers to care for the increased number of older adults given changes in social structures. Wendy Rogers will discuss research on the design and use of televideo and robots to assist with healthcare. Neil Charness will discuss home monitoring technology, particularly practical issues around design, deployment, and maintenance, drawing on studies of heart failure patients and older adult controls. Walter Boot will discuss how gamification of healthcare interventions can help to address the adherence problem for behavior change. Scott Beach, Associate Director & Director of Survey Research Program, University Center for Social and Urban Research, University of Pittsburgh, will serve as discussant.