bluuebunny/crossref_metadata_2025 huggingface dataset:
Caring for a Family Member With Mild Dementia: Perceptions, Connections, and Relational Dynamics With the Sacred
Authors: McGee Jocelyn , Myers Dennis , Meraz Rebecca , Morgan Davie
Published: December 2021

Researchers define spirituality as the search for or connection with the “sacred”, which is transcendent and considered blessed, holy, or revered. For some, the sacred is connection with a divinity (e.g., God, gods) and for others, a close relationship with something else bigger than themselves (e.g., the Universe, Nature, a life philosophy). Current research reports that family caregivers with a strong connection to the sacred, as compared with those who do not, have fewer symptoms of depression, more positive perceptions of the caregiving experience, improved coping, and bolstered resilience. However, there is limited research on the impact of spirituality on the perceptions of familial caregivers whose loved ones have recently been diagnosed with dementia. In this study, 27 family caregivers of persons with mild dementia (CDR=1) were interviewed using the Dimensions of Caregiving Interview (DCI, McGee & Carlson, 2013). The DCI identified positive psychological aspects of the caregiving experience, including spirituality. Three heuristic themes emerged from Directed Content Analysis: perceptions about the sacred reflect variability in the early part of the caregiving journey; specific characteristics, traits, and functions of the sacred shape caregiver coping and adjustment; and the relational dynamics between caregivers and the sacred inform adaptation. Recommendations for clinical practice and additional research are provided.
Give Thanks in All Circumstances? Gratitude Toward God and Health in Later Life After Major Life Stressors
Authors: Upenieks Laura , Ford-Robertson Joanne
Published: December 2021

Gratitude is foundational to well-being throughout the life course, and an emerging body of work suggests that older adults may be more inclined to attribute gratitude to a non-human target (God). Drawing on life course theory and Erikson’s lifespan development framework, we use data from a national sample of Christian older adults from the United States (N = 1,005) to examine whether gratitude towards God buffers the noxious health effects of the death of a loved one or personal illness. Results suggest that gratitude towards God tends to predict better age-comparative and global self-rated physical health in the aftermath of stress, a moderation effect which is partially mediated by stronger beliefs in God-mediated control (that God is a collaborative partner in dealing with problems). We conclude by proposing some interventions for clinicians and counselors centered around gratitude and religiosity that may assist older adults in coping with major life stressors.
Use of Telehealth to Support Family Caregivers of Hospice Patients During the COVID-19 Pandemic
Authors: Demiris George , Oliver Debra Parker , Washington Karla
Published: December 2021

Family caregivers of hospice patients faced additional challenges in the context of the COVID-19 pandemic where social isolation and loneliness that are often observed among those taking care of a loved one at the end of life, were exacerbated by social distancing rules and workflow changes introduced by hospice agencies. The use of telehealth technologies has the potential to facilitate the delivery of supportive services for family caregivers. We conducted a study examining the use of telehealth for the delivery of a supportive intervention based on problem solving therapy and positive appraisal theory designed specifically to support family caregivers of hospice patients during the COVID-19 pandemic. We recruited 248 caregivers who each participated in three telehealth sessions over a month; caregivers reported higher levels of quality of life and lower levels of anxiety post intervention. Specific recommendations for inclusive telehealth design are discussed based on lessons learned.
Technology Is out There for the Betterment of Us: African American Family Caregivers and COVID-19
Authors: Hazzan Afeez , D'Agostino Carol , Jackson Phyllis
Published: December 2021

Unpaid family caregivers are mostly responsible for bearing the costs associated with caring for older adults with dementia. Importantly, the ongoing COVID-19 pandemic has created unforeseen challenges for many family caregivers. Specifically, the restrictions put in place to limit the spread of the coronavirus may be exacerbating the challenges faced by these caregivers as they try to navigate the system. Further, studies have shown that family caregivers who are members of a racial or ethnic minority group such as African-Americans or Hispanics face unique challenges when caring for their loved ones. Additional challenges may include socioeconomic disadvantages, health disparities, and language barriers that make it more difficult to access healthcare and social services. In this study, we examined the perspectives of African-American family caregivers of older adults on the feasibility of utilizing technology as a coping strategy (including for research participation) during the ongoing COVID-19 pandemic. The research question was: What are the perspectives of African-American family caregivers of people with dementia on the feasibility, opportunities, and challenges of technology as a means to engage family caregivers during a pandemic? In-depth one-on-one interviews were conducted with 12 African-American/black family caregivers. Thematic analysis of the qualitative data yielded the following three themes: (1) Acceptance that technology will play a greater role in the world going forward, and family caregivers need to adapt; (2) Opportunities to avoid social isolation while maintaining links with critical community resources; and (3) Challenges due to possible loss of privacy and lack of physical interactions
Annual Review of Gerontology and Geriatrics Symposium: Black Older Adults in the Era of Black Lives Matter
Authors: Kelley Jessica , Thorpe Roland , Chatters Linda
Published: December 2021

Our renewed urgency and engagement in a national dialogue on issues of systemic racism and racial justice provides a much-needed opportunity to expand the discourses, perspectives, and practices used in the study of aging. This symposium features contributions from the 2021 (Vol 41) Annual Review of Gerontology and Geriatrics focusing on the continued development and maturation of scholarship on the lives of older Black Americans. Building on the scholarship and research contributions of prior generations of eminent African American gerontologists, the volume asks: “What do we know about the lived experience of Black older adults and what is there still to be learned?” The contributing authors continue a tradition of research that examines the life histories and contemporary experiences of older Black adults within their relevant social and personal contexts. Symposium presenters from a range of social science fields (sociology, psychology, social work), explore aspects of physical health, stress, cognition, and social well-being in the context of intersecting social dimensions of marriage, family, gender, and neighborhood.
Neighborhood Physical Environment and Cognition in Later Life: A Cross-Sectional Study in Hong Kong
Authors: Chan On Fung , Liu Yuqi , Guo Yingqi , Lu Shiyu , Chui Hiu Kwan , Chiu Lai Har , Webster Chris , Lum Terry Y S
Published: December 2021

This study examined the association between neighbourhood physical environment and cognition among community-dwelling older people and identifies whether this association varies among different older age groups. Data came from a cross-sectional survey data with 2,081 older people living in 12 public housing estates in Hong Kong. We merged individual data with neighbourhood physical environment data from community audit and GIS. Multivariable linear regression model was used. Young-old who resided in neighbourhoods with a higher land use mix and more public transport terminals, were associated with better cognition. Only the number of community centres was positively associated with the cognition for old-old. A curvilinear association was found between cognition and the number of active leisure facilities in the overall sample and young-old. Our findings could inform urban planners and policymakers on planning community facilities and physical environments based on the needs of older people in different age groups.
Community-Engaged Strategies for Recruitment of Korean Americans in Community-Based Research Studies
Authors: Han Haera , Lee Hochang , Kim Miyong
Published: December 2021

With increasing numbers of researchers targeting ethnic minorities to address health disparities, it is important to address the unique needs of Korean American (KA) older adults—a “hard to reach” yet one of the most rapidly increasing ethnic and age groups in the nation. The purpose of this paper is to describe the main barriers to research participation and to identify facilitators for recruitment of older KAs. We have analyzed recruitment data pertaining to more than 10 community-based KA research studies we have conducted for the last ten years. There were a number of unique recruitment challenges in regard to the culture, language, and sociodemographic characteristics of the participants. Examples of effective recruitment strategies included: aligning the research agenda with the priorities of the community; establishing collaboration with ethnic churches and ethnic media; recruiting and training bilingual volunteers and community health workers; and placing liaison research staff in the community.
Successes and Lessons Learned in Moving All Education and Service Activities to Virtual Learning and Services
Authors: Cotton Sam , Faul Anna , Yankeelov Pamela , Gordon Barbara , D'Ambrosio Joseph
Published: December 2021

Despite technology challenges, the UofL GWEP was able to provide access to quality care during the pandemic by pivoting all health and behavioral health patient appointments to telehealth. We found being flexible and using technology patients were most familiar with, was the most successful way easing into telehealth. We trained providers in a variety of technology tools and modalities to support this flexibility. We implemented a remote patient monitoring program and a virtual friendly visitors’ program for our most vulnerable patients. Our workforce development focus supported us in teaching our 60+ interdisciplinary interns how to conduct telehealth visits, how to collaborate as an interdisciplinary team in managing the remote patient monitoring program, and how to do virtual case conceptualization and care planning meetings. To re-create the dynamic atmosphere of an interprofessional learning experience, we have paired students together in teams, and provide them with regular opportunities to meet and engage.
The Intersection of Dementia-Friendly Initiatives and Age-Friendly Environments: The Integration Models
Authors: Sun Fei , Kim Ha Neul , Prieto Lucas , Fréel Stéfanie , Seeher katrin , Wang Huali
Published: December 2021

While age friendly city (AFC) initiatives aim to build supportive physical and social environments for older adults, dementia-friendly initiatives (DFI) see the critical need of persons living with dementia (PWD) to be included in society. Given the close relationship between advanced age and dementia risk, communities facing challenges of aging and dementia will benefit from the integration of DFI and AFC. This study aims to summarize the differences between AFC and DFI practice and to identify integrative models for DFI and AFC based upon cases in the U.S.A and China. Qualitative interviews with 11 stakeholders from Massachusetts and Michigan of the U.S.A. and Beijing and Shanghai in mainland China were recorded via Zoom and transcribed for analyses in order to identify different integration models. A summary of differences and commonalities between AFC and DFI core values, key players, major activities, and outcomes is reported. Four practice models of AFC and DFI based upon case analyses were described as sequential integration, concurrent integration, sequential separation, and concurrent separation. Massachusetts’ model is unique in the support from the state government to integrate both from the beginning, and Michigan witnessed separate efforts between grassroots-based agencies and the state government. Shanghai model represents a sequential integration that includes DFI in local government’s long-term aging policy plan, while AFC and DFI in Beijing have a loose connection despite progress made for each initiative. Communities need to develop a practice model considering its local community needs, policy support, and sustainable resources available.
When Strangers Become Family: The Role of Civil Society Organizations in the Care of Older People
Authors: Angel Ronald , De Oca Veronica Montes
Published: December 2021

As in other nations, the aging of the population of Mexico presents many challenges specially in dependence. These social and political changes occur in the context of a series of interacting political, social and demographic transformations. At the end of the 20th and beginning of the 21st Centuries civil society organizations have begun to define a third sector. A growing desire of individuals to exercise more direct democracy, has accompanied the growth of identity politics and the rise of groups representing women, indigenous populations, racial and religious minorities, environmental interests, older persons, and others. These groups have changed public discourse and today give individuals greater capacity to demand their basic human and social rights. This paper reviews the impact of these changes on older people and multidimensional care.
Prevalence of Dementia Among the Elderly in Latin America and the Caribbean: A Systematic Review and Meta-Analysis
Authors: Ribeiro Fabiana , Teixeira-Santos Ana Carolina , Leist Anja
Published: December 2021

Background: Over the last decades, life expectancy in Latin America and the Caribbean showed a rapid increase, which led to a significant increase in the number of people with dementia. Moreover, 9% of the population in this part of the world are aged 65 or older, and by 2050 this percentage is projected to at least double. For this reason, it is essential to estimate the prevalence of dementia in LAC countries with the aim to determine suitable actions to enhance the quality of life of those affected. Methods: Database searches for articles were conducted September 2020 throughout Pubmed, Web of knowledge, Scopus, Lilacs, and SciELO. The inclusion criteria comprised population- or community-based studies, published in English, Spanish, or Portuguese, reporting data on the prevalence of dementia collected in LAC countries. The complete data search retrieved 1719 non-duplicates. Results: A total of 58 studies met the high-quality inclusion criteria, published 1991-2020, including participants in the following countries: Brazil, Mexico, Argentina, Colombia, Peru, Cuba, Dominican Republic, Venezuela, Ecuador, Trinidad and Tobago, and Jamaica. The most common form of dementia studied was Alzheimer’s disease with prevalence ranging from 5.9% to 23.4%. Estimates differed by age, gender, and education, with oldest, women, and lower-educated adults living in rural areas presenting higher dementia prevalence. Conclusion: This is the first study giving a comprehensive overview of dementia prevalence in LAC countries, which is relevant to estimate care needs and economic costs related to dementia treatment and care.
COVID-19 Pandemic-Related Distress and Self-Efficacy to Manage Dementia Care Among Family Caregivers
Authors: Thompson Lena , Schneider Haley , Donohoe Maria , Saathoff Elizabeth , Hossain Lubna , Ashida Sato
Published: December 2021

The COVID-19 pandemic posed numerous challenges to persons with dementia (PWD) and their caregivers. To better understand these challenges, we conducted a mixed methods study analyzing data from interviews with family caregivers participating in an ongoing intervention study. Telephone interviews were conducted with 58 family caregivers of PWD diagnosed within the past two years. Participants reported self-efficacy (SE) using a 5-item scale (e.g. handle problems with memory, keep PWD at home) and rated pandemic-related distress on a 1-10 scale. They also qualitatively described effects of the pandemic on care recipients and themselves. Qualitative data were coded and organized by concepts from the Stress Process Model. Distress level ranged from 1-9 and was negatively associated with SE to manage dementia care (r=-316, p=0.036). Caregivers described distress related to primary stressors such as loss of services (respite care, assistance with daily tasks) and resistance to mask wearing by PWD due to behavioral symptoms. Secondary stressors included managing work or supervising children’s schoolwork at home while providing care. Caregivers most often expressed distress related to inability to access coping resources such as family or friends, and worried that PWD were not able to rely on their support systems. At all reported levels of distress, inability to interact with members of support networks (e.g., family, friends, service providers) was identified as most distressing. This was compounded by lower self-efficacy to manage dementia care. Efforts to decrease pandemic impacts must consider strategies to safely keep PWD and caregivers connected with family, friends, and service providers.
Applying Principles of Implementation Science to Aging Programs and Policies
Authors: Hughes Jaime , Morrow-Howell Nancy
Published: December 2021

Implementation science, defined by NIH as “the scientific study of the use of strategies to adopt and integrate evidence-based health interventions,” continues to grow within research, education, and practice-based settings. Building on principles from organizational psychology, intervention science, health economics, and health services research, implementation science aims to explore how, and under what conditions, evidence-based interventions are successfully implemented and sustained in real-world settings. Applying implementation science to aging programs and settings may help to accelerate the translation of effective programs and policies into practice. This interdisciplinary symposium will provide an introduction to key principles and applications of implementation science. The first three presentations will focus on largescale spread of interventions while the last two presentations will focus on broader applications of implementation science. The first two presentations will focus on adapting interventions from delivery in one setting or population to another. The third presentation will discuss the role of implementation strategies in scaling an intervention from a controlled research setting into a large integrated healthcare system. The third presentation will focus on the intersection of implementation science and policy. The final presentation will discuss the role of implementation science in alleviating health disparities and advancing health equity. Each presentation will utilize examples from ongoing research studies to demonstrate principles. The session will close with an interactive discussion on the role of implementation science within aging, including challenges and considerations for aging programs, policies, and populations as well as opportunities for further training and education.
Adapting Montessori Programming for Aging and Dementia With Implementation Strategies
Authors: Douglas Natalie
Published: December 2021

There is a need to translate research findings to support the wider adoption of person-centered care into typical long-term care environments across the world. Montessori for Aging and Dementia is one mechanism to support person-centeredness, dignity and autonomy of older adults living in long-term care environments. In this presentation, strategies used to support the implementation of Montessori for Aging and Dementia in a long-term care community of 20 people living with severe dementia will be highlighted. Implementation support was provided through capturing and sharing local knowledge, ongoing training and consultation, and tailoring communication supports. Through the use of these iterative strategies, the program was successfully adapted to include people living with severe dementia. While key findings of the project included improvements on a variety of observational and staff administered measures, the focus of this presentation will be on the relationships between the Montessori program’s fidelity, local needs and implementation strategies.
Examining the Efficacy and Results of a Short-Form Alzheimer's Survey With College Students
Authors: Valencia-Laver Debra , Buchanan Brooke , McPheron Chelsea , Rogers Anna , DeTurck Alex , Shapiro Jasmine , Laver Gary
Published: December 2021

College students are important stakeholders in addressing the significant costs of Alzheimer’s disease in their future roles as caretakers, health care consumers, taxpayers, and as individuals in the workforce whose careers may interact with and impact those with Alzheimer’s and their caregivers. To assess their knowledge of Alzheimer’s, a 10-item True/False on-line quiz was presented to 912 students in Introductory Psychology classes. Participants were 61% white, 13% Asian/Asian American, and 10% Latinx, with 14% reporting other racial and ethnic groups, including that of mixed heritage; 59% of the sample self-reported as female. The quiz was counterbalanced such that items appearing in one format (e.g., True) appeared in the other format (e.g., False) across the two forms of the quiz. A significant difference was found for percent correct in Form A (61.4%) versus Form B (59.3%). In order to prompt participants to consider the ways the disease may impact their own lives, additional questions examined students’ own experience with Alzheimer’s, their interest and willingness to take action towards supporting Alzheimer’s research, and their perceptions about how Alzheimer’s would impact their lives personally, financially, and in their career pursuits. The research extends the findings of earlier research on student knowledge of Alzheimer’s (e.g., Bailey, 2000; Eshbaugh, 2014) by allowing the results to be broken down by gender, race/ethnicity, and student major. It also expands upon those findings by identifying how college students project the societal effects and costs of Alzheimer’s to their own lives and livelihoods.
Implementation Strategies for Widespread Scaling of Effective Programs into Healthcare systems
Authors: Hughes Jaime
Published: December 2021

Translation of effective evidence-based programs into practice is critical to promoting and preserving older adults’ function and independence. This presentation will provide an introduction to implementation strategies, defined as the “methods or techniques used to enhance the adoption, implementation, and sustainability of a clinical program or practice.” Some examples of implementation strategies include education and training, stakeholder engagement, patient and/or consumer involvement, adaptation, and technical assistance. Application of these implementation strategies will be illustrated using examples from local and national scale out of evidence-based health promotion programs for older adults within the VA Healthcare System. This presentation will close with guidance on how to select, track, and evaluate implementation strategies.
Childhood Disadvantage and Later-Life Multimorbidity: Demonstrating Robustness Under Imperfect Identification
Authors: Seixas Brayan , Macinko James
Published: December 2021

This study assesses the relationship between indicators of early childhood disadvantage and later-life multimorbidity within a nationally representative sample of Brazilians aged 50 and over (n = 9,412). Data come from the baseline assessment (2015/2016) of the Brazilian Longitudinal Study of Aging (ELSI). We employed survey-weighted Ordinary Least Squares regression to estimate the effects of individual and combined measures of childhood disadvantage on the total number of chronic conditions in later life. Mediation analysis assessed whether adult socioeconomic status (SES) mediated the relationship between childhood disadvantage and chronic conditions. We found that individual and combined measures of childhood disadvantage were associated with the total number of chronic conditions, even after controlling for potential confounders. Mediation analysis suggested that part of the effect of childhood adversity is mediated by higher SES in adulthood (~10%). A formal strategy of sensitivity analysis showed that omitted variable bias is extremely unlikely. To rule out the observed effect, an unobserved hypothetical confounder would need the explanatory power of the residual variance of both the independent and the dependent variables that is at least 30 times larger than that of BMI or 5 times larger than the explanatory power of age. Results should inform efforts to strengthen interventions targeting early childhood development and to improve other key inputs (such as education) to enhance adult SES and lessen the impact of early life stressors on health in older adulthood.
Food Insecurity, Food Environments, and Disparities in Diet Quality and Obesity
Authors: Choi Yeon Jin
Published: December 2021

Food insecurity is a public health concern that is associated with poor diet and obesity. Poor food environments with low access to healthy, affordable food may amplify the negative impact of food insecurity on diet and obesity. This study aims to investigate whether food insecurity and food environments are jointly associated with an increased risk of poor diet quality and obesity. We used data from a nationally representative sample of 6,395 older adults in the Health and Retirement Study Health Care and Nutrition Survey and the National Neighborhood Data Archive. Weighted regression models were estimated to examine the relationship between food insecurity and food environments with diet quality and obesity. Both food insecurity and poor food environment were associated with lower healthy eating index scores, indicating poorer quality diet. Food insecure older adults were more likely to be obese than food secure older adults and poor food environments exacerbate the negative impact of food insecurity on obesity risk. However, there was no statistical difference in obesity risk by food environment among food secure respondents. Findings from this study highlight the negative impact of limited access to healthy food due to financial difficulties and/or poor food environments on diet quality and obesity risk. Providing financial or nutritional supports along with efforts to promote healthy food environment may reduce disparities in diet quality and obesity. Special support should be provided to food insecure older adults with poor food environment, those at the greatest risk of poor diet quality and obesity.
Interpreting the Emerging Discourse Around Elderhood: Life Stage, Anti-Ageism Strategy, or Something Else?
Authors: Inker Jenny
Published: December 2021

The emerging discourse around elderhood hints at the possibility of a later life stage characterized by a focus on balancing development and decline, with potential to empower elders. However, little agreement exists about whether elderhood is a valid and useful construct. The first presenter questions the aging “mystique” through an analysis of the concepts of elderhood, sageing, croning, and eldering in popular and academic literature, underscoring the importance of avoiding othering and critically thinking beyond labels, even if positive. The second presenter explores the concept of agency in later life through a feminist philosophical lens, arguing that confrontations with one’s existential vulnerability need not be an obstacle to agency in elderhood, but rather can inspire alternative conceptualizations of it. The third presenter contrasts his personal and professional experiences of studying cultural aspects of aging, concluding that elderhood is neither a stage of a life nor a rite of passage but rather an individual, voluntaristic process. The fourth presenter explores 943 texts written by Finnish older adults, finding that the writers creatively position themselves as a group of older persons with a special contribution to make to society, even where elderhood is not explicitly mentioned, and potentially offer an alternative view to countering ageism. The fifth and final presenter explores a novel elderhood video intervention among first-year medical students (N = 585). Thematic findings of neutrality, elderhood as development, elderhood as othering, and elderhood as an opportunity to reframe stigma suggest that elderhood may be a viable and productive anti-ageism strategy.
TBD
Authors: Sierra Felipe
Published: December 2021

Chair: Lori Simon-Rusinowitz;Panelists: Representatives of GSA Sections - Phillip Rozario (SRPP), Stephen Helfand (BS), Tamara Baker (BSS), Cynthia Brown (HS), Judith Howe (AGHE), Darina Petrovsky (ESPO); Discussant: Brian Lindberg. This interactive session is an interdisciplinary look at policy issues in aging with the speakers representing views from their sections. This session, organized by the GSA Public Policy Panel, will provide both GSA section leadership and attendees an opportunity to have an open dialogue on important public policy issues of significance in the field of aging. Presentations will likely address the COVID-19 pandemic, how GSA, each section and its members, and the federal government responded during the past year; how the policy work has been influenced by the increased acknowledgement of institutional and societal racism; and member experiences with the influx of additional economic relief, research funding, and funding for aging supports and services programs.
Typology of Family Relationships and 6-Year Mortality Risk
Authors: Li Mengting , Dong XinQi
Published: December 2021

Durkheim’s “family protection” thesis indicated that family could protect individuals from death. However, there are heterogeneities in family types. It remains unclear whether all family types play a protective role in older adults’ later life. This study aims to test the relationship between family types and 6-year mortality. Data were derived from a prospective cohort study from 2011 to 2017 of 3,018 U.S. Chinese older adults in Chicago. Family typology was clustered by Latent Class Analysis, including tight-knit (high solidarity and low conflict), unobligated ambivalent (high solidarity and high conflict), commanding conflicted (low solidarity and high conflict), and detached (low solidarity and low conflict). Cox model was used. The result showed that older adults in detached type have higher mortality risk than those in tight-knit type after controlling age, gender, education, income, and medical conditions. Future study could explore the mechanisms through which family types affect mortality risk.
Impact of Economic Shocks on Cumulative Advantage Processes: Recession, Recovery, and Trajectories of Inequality
Authors: Crystal Stephen
Published: December 2021

This study compares the effect of the 2008 recession and subsequent recovery across generational cohorts by evaluating age-cohort trajectories of income inequality. Using data from the 2007 to 2016 waves of the Survey of Consumer Finances, we examine the trajectory of inequality for the overall population and by cohort in years spanning the Great Recession and subsequent recovery. We find that increases in per-capita income and wealth observed at the population-level during the recovery were not reflected among households below the median, leading to increasing inequality. Within cohorts, we observe growing inequality within cohorts in their primary working years. Findings are consistent with a model of integrative cumulative dis/ advantage, which predicts increasing within-cohort inequality over the life course influenced both by persistent micro- and macro-level processes of increasing heterogeneity. Our analyses highlight the potential role of extreme business cycle fluctuations, booms and busts, to exacerbate this underlying process.
Associations Between Ultra-Processed Food Intake and Cardiometabolic Health Among Diverse U.S. Adults 50 or Older
Authors: Elfassy Tali , Juul Filippa , Mesa Robert , Palaniappan Latha , Srinivasan Malathi , Yi Stella
Published: December 2021

Asian American (AA) diets are naturally adapted to the NOVA dietary recommendations, favoring minimally processed foods. Yet the relationship between dietary intake and metabolic health, among AAs is largely unknown. We examined the association between ultra-processed foods and cardiometabolic health (obesity, hypertension, high cholesterol, and diabetes), among US adults 50 or older reporting a single ethnicity, using the National Health and Nutrition Examination Survey (2001-2018). From multivariable adjusted logistic regression models, the highest compared to the lowest quartile of ultra-processed food intake was associated with obesity only, among AAs (OR: 2.15, 95% CI: 1.04, 4.45), followed by non-Hispanic blacks (OR: 1.73, 95% CI: 1.40, 2.14), non-Hispanic whites (OR: 1.41, 95% CI: 1.19, 1.68), and Hispanics (OR: 1.34, 95% CI: 1.08, 1.65). AAs are more likely than other ethnic/racial groups to be obese when consuming ultra-processed foods. Cultural adaptation of current North American-focused dietary recommendations should drive AA preventive dietary recommendations.
Race Differences in COVID-19 Stress and Social Isolation: Implications for Depressive Symptoms
Authors: Birditt Kira , Oya Akari , Turkelson Angela , Polenick Courtney , Fingerman Karen
Published: December 2021

The experience of the COVID-19 pandemic may vary widely by race. This study examined race differences in pandemic-related stress, social isolation and the implications for well-being. Participants included 1260 adults (45% women) ages 18 to 97 from the May and June 2020 nationally representative Survey of Consumers and 562 who completed a 6 month follow up in November/December. A total of 76% were White, 10% were Black, 3% were Asian, and 11% were Hispanic. Participants reported experiences of pandemic-related stress, social isolation and depressive symptoms in the last month. Analyses showed that minority groups reported greater pandemic related stress that had negative implications for depressive symptoms over time. The implication of social isolation for the stress-depressive symptoms link also varied by race. Overall this study showed racial inequities in the implications of COVID-19 pandemic and that reducing social isolation may only be beneficial for certain racial/ethnic groups.
Developing, Testing, and Implementing a Falls Prevention and Healthy Aging App (Keep-On-Keep-Up) for Older Adults
Authors: Stanmore Emma
Published: December 2021

Falls are a common and costly concern for older adults. Digital technologies can offer new, inexpensive approaches to increase access and engagement with falls prevention programmes. Keep-On-Keep-Up is a personalised, falls prevention App with strength and balance exercises plus health literacy games. This study reports on the user-centred design, usability testing and implementation of the KOKU App. Older adults aged 55 years and older in the UK were invited to take part in the study. Data collection included focus groups; baseline and 6 week questionnaires and assessments; semi-structured interviews and one focus group with falls prevention therapists to explore App usability. Thirty older adults were invited to use KOKU unsupervised, 3 times a week for 6 weeks. Data were analysed using thematic content analysis. Focus groups (n=11) with 66 older users and 11 therapists informed development. Thirty older adults (mean age = 75) were recruited for the in-depth testing. Mean SUS score was 71 indicating high usability. Qualitative themes included: ease of use (app usability; iPad properties; exercise presentation), usefulness (physical/psychological benefits; falls education), attitude towards the App and intention to use (technological barriers; flexibility of use; exercise class versus App). Therapists (n=6) viewed the KOKU platform positively and suggested extensions for further progression. No adverse events were reported during the study. This research demonstrates that KOKU is an acceptable and easy to use falls prevention intervention that facilitates older adults’ ability to access falls prevention training at a time, and in a location, that suits them.
My Faith Gives Me Strength: Black Churches Supporting Dementia Care Partners
Authors: Sloan Danetta , Cotter Valerie , Samus Quincy , Spliedt Morgan , Means Samuel , Bowie Janice , Gaskin Darrell
Published: December 2021

Inequities in dementia care require an in depth understanding of dementia care partner life experiences, care needs, sources of support and ways to improve those experiences at the community level. In partnership with Black Churches in Baltimore, MD and rural Pennsylvania, we facilitated three focus groups (n=30) with Black dementia care partners to understand: 1) unique dementia care-related needs and challenges, and 2) how the church can be a supportive care partner. Participants noted three overarching themes related to challenges and needs: 1) unique challenges in caregiving - assuming various roles to provide comprehensive care, working within policies of support services, environmental challenges (neighborhood safety), and family conflicts; 2) lack of dementia education and educational materials; and 3) unmet needs of the care recipient – lack of dementia friendly neighborhoods, lack of meaningful activities, and undiagnosed dementia. Regarding the supportive role of the church, the theme of perceived role of the church included providing emotional and social support for care partners and recipients, reducing burden through providing respite, support groups, networking/ connections to resources, and promoting health events.
Transcending Inequities in Dementia Care in Black Communities: Lessons From the MIND Care Coordination Program
Authors: Sloan Danetta , Johnston Deirdre , Fabius Chanee , Antonsdottir Inga , Spliedt Morgan , Pyatt Tabitha , Reuland Melissa , Samus Quincy
Published: December 2021

Resolution of ongoing inequities in dementia care requires careful examination of how care is delivered to ensure we are aware of, and meeting needs for all people affected, especially those most vulnerable and in under-resourced communities. Maximizing Independence at Home (MIND) is a multicomponent, home-based dementia care program designed to provide high quality, wholistic care coordination for to persons and families living with dementia. Program goals are to delay transition from home, improve life quality, and reduce unmet care needs. We completed three focus groups (n = 25) with Black (e.g., African American) dementia caregivers who received the intervention to understand (1) the unique dementia related needs of Black dementia caregivers and barriers and challenges to caregiving experienced within the Black community , (2) perceived benefits of MIND, and (3) ways to improve the MIND intervention. Participants noted three overarching themes related to needs and challenges in dementia care in the Black community: difficulty finding and accessing dementia information, help, and related services; familial conflict/lack of sibling and familial support; and lack of effective communication about dementia within Black Communities. Regarding benefits of the program, four themes emerged including that the program helped find resources (formal and informal); provided caregivers an opportunity for socialization and interaction; included comprehensive assessments and helpful linked information; and resulted in a “much needed break.” Increased diversity of MIND personnel and greater clarity and consistency in MIND program promotion and communications were themes for how the program could be improved.
Cumulative Stress Burden and Cognitive Function in African American Adults Living in Low-Income Neighborhoods
Authors: Fan Erica , Dubowitz Tamara , Troxel Wendy , Weinstein Andrea , Gary-Webb Tiffany , Butters Meryl , Ghosh-Dastidar Bonnie , Rosso Andrea
Published: December 2021

African Americans (AA) are more likely to experience stressors due to racial discrimination and segregated neighborhoods, potentially contributing to higher risk for dementia. We investigated the association between stressors and cognitive function in older AA adults through cumulative stress burden (CSB) indices. Stressors and cognitive domains were measured in 253 participants >50 years, recruited from primarily AA neighborhoods in Pittsburgh, PA. CSB included perceived and psychological distress, unfair treatment, post-traumatic stress disorder, and neighborhood-level stressors such as walkability, safety, satisfaction, and social cohesion. Indices were formed by dichotomizing stressor scores and summing. Cognitive domains were z-scores adjusted for age, sex, and education. Adjusted generalized linear models assessed the relation between CSB indices and cognition, and between specific stressors and cognition. Interactions with age were tested. Greater individual-level CSB index was associated with lower language (□= -0.11, p= 0.03) and executive function (□= -0.087, p=0.04). The neighborhood-level CSB index was not associated with any cognitive domain. The combined index was marginally associated with language in adjusted models (□= -0.07, p= 0.05). There were no significant associations between specific stressors and cognition, except for neighborhood safety with 3MS (□= -0.28, p= 0.001) and language (□= -0.16, p= 0.02). Age interactions indicate that findings were stronger for younger participants. Greater cumulative stress is associated with poorer cognitive function in some domains in older AA. A comprehensive assessment of cumulative stress is vital in understanding the dimensionality of racialized stress for older adults potentially experiencing cognitive decline.
COVID-19 Mortality In Adult Congregate Living Settings Across Five U.S. States
Authors: Rein David , Shapiro Lindsey , Mancino Mairin , Pearson Caroline
Published: December 2021

The magnitude of COVID-19 mortality in adult congregate living settings other than nursing homes (NH) is unknown. To address this, we created an individual property level dataset for five U.S. states (Colorado, Connecticut, Florida, Georgia, and Pennsylvania) using multiple public and private sources. The data included information on each observation’s state and county, level of care (LOC), the estimated number of residents, COVID-19 deaths through December 31, 2020, and county-level cases of COVID-19 per 100,000. We restricted our sample to market grade properties with 25+ residents, for which we able to estimate resident and LOC information. We defined LOC as County, non-congregate (CN), Independent Living (IL), Assisted Living (AL), Memory Care (MC), and Nursing Home (NH). We used multilevel, multivariable logistic regression models to estimate the expected death rate for each LOC controlling for differences in reported COVID-19 infections and county and state reporting differences. We identified 3,059 properties that met our inclusion criteria (69 CN, 477 IL, 1,118 AL, 179 MC, and 1,216 NH). We estimated deaths per 1,000 persons of 4.4 (95% CI: 4.0-4.8) for CN, 4.4 (3.9-4.9) for IL, 16.2 (14.7-17.9) for AL, 50.3 (44.4-56.8) for MC, and 32.0 (29.3-34.9) for NH. The order of death rate severity was the same in each state, except MC in Georgia. Additional research is needed to evaluate whether death rate differences resulted from congregate living risks, from COVID mortality risk factors at each LOC, or a combination of factors.
Relation Between Volunteering and Suicidal Ideation Among Older Adults
Authors: Fenstermacher Erika , Owsiany Montgomery , Fiske Amy , Van Orden Kim
Published: December 2021

Suicide disproportionally affects older adults, necessitating further investigation into potential protective factors for suicide in late life. Volunteering is associated with psychological well-being in older adults. However, there is scant literature examining the association between volunteering and suicidal ideation or behavior in this age group. The present study involved a cross-sectional examination of volunteering and suicidal ideation using baseline data from the Helping Older People Engage study. This sample (N = 245, 88% White, 68% female, 60-92 years old) was recruited from primary care practices. Inclusion criteria included clinically significant loneliness (UCLA loneliness scale M = 49.5; SD = 5.7). Forty-three percent of the sample reported engaging in recent volunteer activity. Passive and active suicidal ideation in the past month were endorsed, respectively, by 20% and 9% of the sample. Results of hierarchical linear regression analyses examining the association between volunteering and suicidal ideation, controlling for covariates, will be discussed.
Metabolomics-Based Biomarkers for Frailty in Chinese Older Adults
Authors: Pan Yiming , Liu Pan , Li Yun , Ma Lina
Published: December 2021

Background: Frailty is a clinical state characterized by decline in physiological function, and increased vulnerability to adverse outcomes. The biological mechanisms underlying frailty have been extensively studied in recent years. Advances in the multi-omics platforms have provided new information on the molecular mechanisms of frailty. Thus, identifying omics-based biomarkers is helpful for both exploring the physiological mechanisms of frailty and evaluating the risk of frailty development and progression. Objective: To identify metabolomics biomarkers and possible pathogenic mechanisms for frailty with untargeted-metabolomics profiling. Methods: LC-MS-based untargeted metabolomics analysis was performed on serum samples of 25 frail older inpatients and 49 non-frail older controls. The metabolomics profiling was compared between the two groups. Results: We identified 349 metabolites belonging to 46 classes, in which 2 were increased and 3 were decreased in frail older adults. Citrate cycle (with up-regulated cis-Aconitic acid, Fumaric acid, L-Malic acid, and Isocitric acid), fatty acid metabolism (with up-regulated Palmitic acid and L-Palmitoylcarnitine) and tryptophan metabolism (with up-regulated 5-Hydroxy-L-tryptophan, L-Kynurenine, Kynurenic acid, and 5-Hydroxyindoleacetic acid) were significantly associated with frailty phenotype. Conclusions: Our results revealed characteristics of metabolites of frailty in Chinese older adults. The citrate cycle related metabolites (Isocitrate, (s)-Malate, Fumarate and cis-Aconitate), saturated fat (Palmitic acid), unsaturated fatty acid (Arachidonate and Linoleic acid), and some essential amino acid (Tryptophan) might be candidate biomarkers for early diagnosis of frailty. Disorders of energy metabolism, lipotoxicity of saturated fatty acids, disturbances of unsaturated fatty acid metabolism, and increased degradation of tryptophan were potential mechanisms and therapeutic targets of frailty.