bluuebunny/crossref_metadata_2025 huggingface dataset:
RESILIENCE IN JAPANESE OLDER IMMIGRANTS AND ROLES OF COMMUNITY SUPPORT DURING THE COVID-19 PANDEMIC
Authors: Wada Mineko , Canham Sarah
Published: December 2023

The objective of this community-based study was to explore how Japanese older immigrants cultivated resilience in overcoming challenges during the COVID-19 pandemic and how Tonari Gumi, a community service agency, supported the process. As Japanese people make up a small proportion of the population in Canada, there are limited resources to meet their distinct needs. Thus, Japanese older adults were particularly affected by disrupted support and service systems when COVID-19 public health orders were implemented. In this qualitative study, seven community-dwelling Japanese older immigrants and five staff from Tonari Gumi participated in semi-structured interviews. The interviews were analyzed thematically using a conceptual lens of resilience, which refers to the ability to survive and thrive in the face of adverse life experiences. Our analysis yielded three themes: Challenges and concerns; Staying active: physically, mentally, and socially; and Creating needs-based services and programs to survive, connect, and enjoy. The initial challenge experienced by Japanese older immigrants was “a feeling of emptiness,” followed by hardships associated with digital literacy, English literacy, fear of COVID, and concerns about the future. In response to the challenges, Japanese older immigrants stayed active by rebuilding and sustaining regular exercise habits, nurturing and sustaining positive mindsets, and sustaining and expanding social connections. Tonari Gumi developed and delivered a variety of new services and programs to meet the needs of survival, social connection, and fun. We will discuss key actions that older individuals and service providers took on to facilitate resilience and implications for research, policy, and practice.
A MENDELIAN RANDOMIZATION STUDY SUPPORTS CAUSAL EFFECT OF OVERWEIGHT ON LONGEVITY
Authors: Duan Hongzhe , Holmes Rachel , Arbeev Konstantin , Bagley Olivia , Wu Deqing , Yashin Anatoliy , Ukraintseva Svetlana
Published: December 2023

Overweight was associated with better survival in some studies. This was termed “obesity paradox”; however, its mechanism is unclear. Mendelian Randomization (MR) is a common approach to uncovering causality in observational data using SNPs as instrumental variables (IVar). However, only few SNPs usually pass all the required assumptions. Here we use a new strategy of selecting IVar for the MR study of causal relationships between overweight and longevity in the Health and Retirement Study (HRS) data. We paired all SNPs in eight candidate obesity-related genes (ADIPOQ, FTO, LEP, LEPR, INSIG2, MC4R, PCSK1, PPARG) available in HRS, and used such ‘composite SNPs’ as IVar, which resulted in significantly more IVar candidates compared to single SNPs. The following variables were used in MR analysis as “exposure”: (1) ‘overweight’ BMI 25-30 vs. (0) ‘normal’ BMI 18.5-25, at ages 75-85; and “outcome”: (1) survived 85+ vs. (0) died before age 85. Inverse-Variance Weighted (IVW), and maximum likelihood (ML) from R-package MendelianRandomization were used to test causality. We found that being overweight at ages 75-85 had significant protective effect on survival at ages 85+ in both sexes, white males, and black males and females. In conclusion, pairing SNPs is a convenient simple approach to increasing numbers of IVar candidates for MR. Results of our MR study suggest that being overweight in late life causally contributes to longevity. One potential mechanism may involve larger energy reserves contributing to a better resilience of overweight people in face of an adverse health event, such as, e.g., major surgery.
OPIOID PRESCRIBING AND OPIOID USE IN OLDER ADULTS: BUILDING AND REFINING A CHANGE PACKAGE FOR PRIMARY CARE
Authors: Childs Ellen , Noel Megan , Hsu Clarissa , Parchman Michael , Hall Kendall , Shoemaker-Hunt Sarah , Keane Nicole
Published: December 2023

Opioid use is associated with increased risk of harms in older adults (≥65) due to physiologic changes, drug interactions, and comorbidities. The AHRQ Opioids in Older Adults project developed a change package based on an evidence review and expert recommendations that included nine high-leverage changes (HLCs) and related key activities to address safe opioid use in this population. We used the change package to support fourteen primary care practices participating in two fifteen-month learning collaboratives convened to implement innovations in safer opioid use in older adults. Given the nascent understanding of how practices address opioid safety among older adults, this presentation will describe the HLCs implemented by practices compared to the original change package offered to them as a way to validate and improve the change package for broad use and uptake. Of the original nine HLCs, practices implemented seven, including staff education, risk assessment, opioid use disorder assessment and treatment, processes and workflows, non-pharmacologic pain management, medication management, and using data to inform practice. All activities fit into an original HLC, however the activities that practices implemented varied from the original key activities identified by the literature review and expert panel. For example, under the using data to inform practice HLC, most practices struggled to complete chart reviews, and were unable to “review data regularly” as offered in the original change package. This presentation will describe strategies used to improve opioid safety for older adults in primary care.
DECLINE IN OBJECTIVELY MEASURED STATIC BALANCE WITH AGING
Authors: Banarjee Chitra , Choudhury Renoa , Park Joon-Hyuk , Xie Rui , Stout Jeffrey , Thiamwong Ladda
Published: December 2023

Balance performance is a key predictor of falls, contributing to an increased risk of chronic disease and future falls in older adults. In this study, we aimed to characterize the effects of age, gender, and body mass index (BMI) on changes in balance over time. BTrackS, a portable and inexpensive technology system, was utilized to objectively measure the changes in static balance with eyes closed. We assessed 70 community-dwelling older adults (Mage=74.8 years, 77% female, MBMI=26.95 kg/m2) over 2-4 longitudinal observations, with an average of 174 days between baseline and follow-up assessments to characterize the balance performance over time. The balance performance measure was computed as the average center of pressure (COP) path length (cm) across three testing trials. The balance performance measure at baseline significantly positively correlated with age (Pearson’s r=0.417, p< 0.001) and with BMI (r=0.264, p=0.029), but did not differ by gender (p=0.480). Change in balance (difference in static balance over time, cm) was correlated (r=0.393, p< 0.001) with age, such that older adults experienced a greater decline in static balance over time, however, gender (p=0.620) and BMI (p=0.709) did not show a significant correlation. Older adults with increased BMI were found to be more likely to have limitations in balance. These results suggest that clinicians and researchers need to account for the age-related effects on changes in balance performance over time. Rapid deterioration of balance with increased age also has implications for increased monitoring of balance function and further intervention in older adults as they age.
“BEYOND JUST A SINGING GROUP”: PERCEPTIONS OF PARTICIPANTS, CAREGIVERS, AND LEADERS OF PARKINSON’S SINGING GROUPS
Authors: Brown Jessy , Logue Cailie , Bartel Maya , Jordan Tera , Stegemoller Elizabeth
Published: December 2023

Parkinson’s disease (PD) is the second most prevalent neurodegenerative disease after Alzheimer’s disease, and its prevalence is increasing. There is no cure, so symptom treatment is currently the only method to decrease the disease burden for individuals diagnosed with PD. A common treatment modality option that has been shown to improve both motor and non-motor symptoms in PD is therapeutic singing, often in a group setting. Previous literature has explored perceptions of singing groups for persons with PD (PwPD) and their caregivers (CGs) and has found overall positive experiences and outcomes. No study has sought to understand the perspectives of the leaders of the singing groups. The purpose of this study was to understand the perceptions and experiences of participants in singing groups (n=31), their caregivers (n=8), and those leading the groups (n=10) across several different singing groups in the United States. A qualitative phenomenological methodological framework was used with principles of grounded theory to make meaning from the transcripts. Three main themes emerged from the data: peer support, proactive PD management, and the effects of the pandemic. These findings indicate that even during a global pandemic, all three participant groups experienced positive outcomes resulting from peer support and either experiencing or witnessing effective management of PD symptoms. All three participant groups reported similar perceptions and experiences about their involvement which reinforces the rationale to use singing as a treatment modality for PD.
INFLAMMATORY BIOMARKERS ASSOCIATED WITH BRAIN MRI MEASURES: FRAMINGHAM HEART STUDY OFFSPRING COHORT
Authors: Chen Jiachen , Doyle Margaret , Fang Yuan , Ragab Ahmed A Y , Murabito Joanne , Lunetta Kathryn
Published: December 2023

Brain MRI volumes measuring brain atrophy have been associated with risks for Alzheimer’s Disease (AD) and related dementia. Inflammatory biomarkers associated with brain MRI volumes may provide insight into the neuroinflammation associated with these diseases. The study aim is to identify circulating inflammatory biomarkers associated with total and regional brain MRI volumes in the Framingham Heart Study Offspring cohort. Participants (N=662, 52% female, mean age 62 years) free of dementia and stroke at the time of blood draw and who had MRI measures within five years were profiled using the OLINK Proteomics inflammation panel. Pairwise cross-sectional associations between 68 biomarkers and eight brain MRI volumes were investigated using linear mixed-effect models accommodating familial correlations and adjusting for covariates (age, age2, sex, time between blood draw and MRI measurement, age-sex interaction, and number of APOE ε2 and ε4 alleles), using FDR≤0.1 to declare significance. APOE genotype-stratified analyses were performed to explore effect modification. Higher levels of 8 proteins were significantly associated with smaller total brain volumes (TCBV), including CDCP1, HGF, IL6, IL8, MMP10, OPG, VEGFA, and 4E-BP1. Higher levels of SCF and TWEAK were significantly associated with larger TCBV, and higher levels of SCF were also associated with larger parietal gray matter volume. In APOE ε4 carriers, higher levels of IFNγ were associated with greater white matter hyperintensity volumes. Consistent with our findings, SCF has been shown to have neuroprotective effects in animal models. Further studies are needed to confirm these potential risk and protective factors and to elucidate mechanisms.
IMPLEMENTING AGE-FRIENDLY HEALTH SYSTEMS: SCALING 4MS CARE ACROSS VA
Authors: Solberg Laurence , Jindal Shivani , Church Kimberly , Schwartz Andrea
Published: December 2023

The U.S. Department of Veterans Affairs (VA) provides health care to 9 million enrolled Veterans across a variety of settings. Nearly 50% of enrolled Veterans are age 65 and older, compared to 16% of the U.S. population. The VA has set out to become the largest integrated Age-Friendly Health System (AFHS), using the 4Ms as a framework to improve care for older adults: what Matters, Medication, Mentation and Mobility. When implemented together, the 4Ms allow interprofessional teams and health systems to provide care consistent with what Matters to each older adult. Since joining AFHS movement in 2020, over 190 care settings at 100 VA facilities have earned recognition from the Institute for Healthcare Improvement (IHI). VA has identified key drivers to scale-up and spread 4Ms care at the national, local, and team level. Drivers include active and visible national leadership, building a coalition of local champions, and regular commmunication with teams. VA has accelerated adoption of the 4Ms by following IHI’s Action Community (AC) model. At close of registration, 145 teams from 69 VA facilities enrolled in the VA AC. The VA AC offered a series of monthly webinars and coaching calls to empower teams to create a 4Ms plan building on exisiting best practices. In addition to using evidence-based tools identified by IHI, teams may also leverage VA clinical innovations to support their 4Ms plan. Implementation of AFHS provides a framework for interdisciplinary teams to continuously improve Veteran-centered care and ultimately, fulfill VA’s mission to honor America’s aging Veterans.
IDENTIFYING SENOLYTIC TARGETS OF DIETARY FLAVONOIDS IN RENAL CELLS BY THERMAL PROTEOME PROFILING
Authors: Strassheim Quinn , Banarjee Reema , Rutherford Delaney , Dey Amit , Tsitsipatis Dimitrios , Moaddel Ruin , Gorospe Myriam , Basisty Nathan
Published: December 2023

Senescent cell accumulation is a known driver of aging and age-related pathologies. Clearance of senescent cells is a promising approach to increase longevity and reduce multiple age-related diseases in humans. Flavonoid compounds are present in fruits and vegetables, of which certain flavonoids (e.g., quercetin and fisetin) have demonstrated senolytic, or ‘senescent-cell-killing’, activity in culture and in mice. However, the cellular mechanism of senolysis and the efficacy of these compounds are not known in renal epithelial cells. Here, we combine flavonoid drug screening, targeted metabolomics, and thermal proteome profiling (TPP) with analysis by mass spectrometry (MS) to explore protein targets of senolytic drugs in senescent human renal cortical epithelial cells and human renal proximal tubular epithelial cells. Senescence was induced by exposure to ionizing radiation and the senescence phenotype was validated through a rigorous panel of senescence and viability markers. Proliferating and senescent renal epithelial cells were screened with a panel of 8 flavonoids to identify senolytic drugs and their concentrations for selectively killing senescent cells. Targeted MS assays were developed to assess intracellular drug uptake, a potential mechanism of senescent-specific killing. To identify protein targets of the senolytic flavonoids in senescent cells, we performed a variation of TPP in combination with liquid chromatography (LC)-MS/MS proteomics analysis, carefully controlling for non-senolytic interactions by excluding proteins bound by a non-senolytic flavonoid. The results of this study pave the way for the development of a more specific generation of senolytic compounds and identify novel candidate senolytic pathways engaged by dietary flavonoids.
INCONSISTENT AND UNPREPARED: HOW FAMILY CAREGIVERS AND OLDER ADULTS EXPERIENCE HOSPITAL DISCHARGE
Authors: Gale Kathy , Ruffalo Leslie , Kavanaugh Melinda
Published: December 2023

Family caregivers and older adult patients report confusion, inconsistency, and a lack of preparation for post-discharge activities after a hospital stay, leading to hospital readmissions. This multi-disciplinary research project investigated how family caregivers, older adult patients, and hospital clinical and administrative staff experienced the hospital discharge process at a midwestern hospital system. The research team brought together expertise in community-engaged research and bridged multiple specializations, including personal family caregiver experience, community service expertise, community engaged research leadership, and instruction of medical students and social work students. Together, we conducted semi-structured interviews with family caregiver, older adult patients, and hospital personnel via video conference and telephone. We analyzed the data using open coding strategies and principles of thematic analysis. Themes included the importance of the timing of discharge planning, communication between all systems and individuals included in the discharge process, a lack of clarity regarding the roles in the process, inconsistent identification of the family caregiver, conflicting priorities, and the impact of medication errors. Implications are (1) each organization within the older adult/family caregiver system must determine their role in the post discharge process including the type of services and resources that support older adults and family caregivers and (2) the current system of healthcare, public sector, and community must determine how to adapt and change to support older adults and their family caregivers during the post-discharge period.
TRENDS IN FRAILTY INCIDENCE AND THE IMPACT OF LIFESTYLE AMONG US ADULTS AGED ≥50 YEARS FROM 2004 TO 2020
Authors: Xu Hui-wen , Chen Yu-Ming , Yang Zhou , Xu Bei-bei
Published: December 2023

Few studies have estimated frailty incidence. The contribution of lifestyle to the incidence of frailty may change over time. It is necessary to quantify the impact of lifestyle on frailty incidence over time. A total of 25,639 subjects aged ≥50 years from the Health and Retirement Study (HRS) 2004-2020 were divided into seven consecutive and overlapping cohorts. Frailty was measured using the Paulson–Lichtenberg Frailty Index. Lifestyle included smoking status, alcohol consumption, physical activity, and sleep problems. The trend of frailty incidence rates was estimated by generalized estimating equation (GEE) models with a natural cubic spline. Population attributable fractions (PAFs) were calculated using hazard ratios from Cox models. Lifestyle-attributable frailty incidence rates were estimated by multiplying PAFs by the overall incidence rate of frailty. The incidence (per 1,000 person-years) of frailty showed a general trend of first decreasing and then increasing, with a peak occurrence of 22.7 (95% CI: 21.0, 24.5) in 2010–2014. Almost 20% of frailty incidence rates were attributed to current smoking, physical inactivity, or sleep problems. The incidence of frailty showed a fluctuating but decreasing trend among middle-aged and older adults in the United States from 2004 to 2020, with a peak occurrence after the Great Recession of 2007–2009. Smoking, physical inactivity, and sleep problems may have contributed importantly to the incidence of frailty. Effective and early frailty prevention strategies should be developed to reduce smoking, physical inactivity, and sleep problems, especially in the context of the global economic crisis caused by the COVID-19 epidemic.
SEX AND RACE/ETHNIC DIFFERENCES IN TERMINAL COGNITIVE DECLINE
Authors: Mejía-Guevara Iván
Published: December 2023

Background

Cognitive decline has been documented in older adults, but sex and racial/ethnic differences among decedents have not been studied. Here we investigate the relation of mortality to change in the cognitive function of older individuals by sex and race/ethnicity.

Methods

The study analyzed data from the Health and Retirement Study (HRS) between 1993 and 2018, which included information on total word recall, mental status, and total cognition of individuals aged 65 and older. The study estimated the loss of cognitive function using a multilevel random coefficient model, considering sex and racial/ethnic differences in the risk of death, age, and death status. The study also approximated terminal cognitive decline using cognitive scores reported within two years before death for decedents.

Results

On average, older women performed better than older men in word recall and overall cognition, while older White Americans performed better than African Americans and Hispanics/Latinos in overall cognition at all ages. Decedents had a similar cognitive function to survivors at age 65, but their cognition declined quickly with age, especially among older women and White Americans. Evidence of terminal cognitive decline within two years before death was significant regardless of age but less conclusive for African Americans and Hispanics/Latinos due to smaller sample sizes.

Conclusions

This paper indicated evidence of sex and race/ethnic differences in cognitive decline and terminal cognitive decline among older adults, which may have critical clinical implications directly linked to the onset and duration of dementia risk.
THE RELATIONSHIPS OF VOICE PROSODY MEASURES TO COGNITIVE CHANGES OVER 10 YEARS
Authors: Mahon Elizabeth , Lachman Margie
Published: December 2023

Voice prosody measures, especially jitter and shimmer, can differentiate cognitive impairment from healthy cognition, and may be promising early biomarkers for identifying high risk before later-life disease onset. In our past work, higher jitter and lower pulse assessed during the second cognitive assessment were associated with 10-year cognitive declines in middle-age and older adults from the Midlife in the U.S. (MIDUS) study. The current study assessed voice biomarkers taken at baseline, 10 years before the second cognitive assessment, and measured voice on speech that was independent of the cognitive assessments to address the possible influence of cognitive performance on concurrent voice prosody measures. Participants (ages 34 to 82 at the first occasion) were included if they were in the Boston Longitudinal Study (BOLOS, a subset of MIDUS) and had voice measures collected from the audio recordings of the cognitive interviews. Multilevel analyses controlled for age, sex, education, race, neurological conditions, and depressive symptoms at baseline. Higher jitter, lower shimmer, and lower pulse predicted greater 10-year declines in episodic memory. Higher pitch and lower pulse were associated with greater increases in reaction time on an executive functioning task. Thus, voice biomarkers previously associated with cognitive impairment could be useful as early indicators of later-life cognitive declines. Identifying voice biomarkers that could predict 10-year cognitive change may facilitate earlier intervention for decline through modification of disease risk factors.
EXPLORING THE EFFECT OF EXOSOMES AND RADIATION ON GLIOBLASTOMA CANCER CELLS
Authors: Hausman Hannah , Azizi Linda , Pajonk Frank
Published: December 2023

Glioblastoma is the most common and aggressive type of brain cancer, with higher incidences in aging adults over 75 and little to no long-term survival or cure. The median survival time under the current standard of care, surgical resection and chemoradiation, is 15-18 months. Glioblastoma tumors consist of multiple cell types, including mature brain cells in cell cycle arrest and cancer stem cells (CSCs) that replenish cancer cell populations. However, the cancerous non-stem cells are induced into a cell fate called glioma-initiating cells in response to radiation, where they begin to express stem-like phenotypes. Glioma-initiating cells proliferate at an aggressive rate and are the reason for cancer recurrence, making them a necessary target for new and more effective therapeutics. This research is studying the effect of exposure to exosomes, extracellular vesicles that carry proteins and RNA, on the stem-like phenotype expression of irradiated non-stem cells. Irradiated glioblastoma cells were exposed to varying concentrations of exosomes isolated from glioblastoma CSCs in vitro. The results showed a decrease in ZsGreen expression, a marker for stem-like phenotypes, as exosome concentration increased. Exposure of glioblastoma cancer cells to exosomes post-irradiation decreased the rate of transition to glioma-initiating cells. This suggests that CSC exosomes may signal that stem cells are present, decreasing the need for the formation of glioma-initiating cells. Further research is necessary to better understand the role of exosomes in glioblastoma tumors, however, this result may suggest exosomes as a potential way to delay or reduce the aggressive nature of glioblastoma cancer recurrence.
THE IMPACT OF FAR-INFRARED TECHNOLOGY ON QUALITY OF LIFE IN OLDER ADULTS
Authors: Rath Shavonnye , Guggenheimer Joshua , Homan Melanie , Myers Marcella , Hutson Jennifer , Green Ginny
Published: December 2023

Identifying methods of pain amelioration to meet the unique demands of older adults (OA) may be crucial to increasing quality of life (QOL) for this population. This study aimed to examine the effects of far-infrared heat (FIR) on pain management and QOL in OA. FIR utilizes a long light wavelength that simulates dry sauna-like conditions. Examining the relationship between FIR and pain is important due to the increased prevalence of chronic pain associated with aging and the corresponding impact it has on QOL and physical performance. Seventeen OA completed the study. Participants were randomly assigned to either a convective heat group (CON) or a convective and far-infrared heat (FIR) group, with convective heat set to 60℃ (140℉.) Participants received six, 30-minute sessions. Physical assessments were measured (range of motion, gait speed, timed up-and-go, and hand grip strength) as well as pain severity and its interference with daily life, and the impact pain had on overall QOL. T-tests were used to compare pre- and post-assessment measures. Results indicated that pain severity was significantly reduced (from 3.31 to 2.5, P < 0.05) in the FIR group and that pain interference was significantly reduced (from 1.26 to 0.43, P < 0.05) in the CON group. Findings suggest that heat therapy successfully reduced pain over time, but that FIR heat specifically was not superior to that of convective heat alone. Further research is required to correctly identify the relationship between QOL and the use of FIR.
A META ANALYSIS ON THE ASSOCIATION OF NOVEL PLASMA BIOMARKERS TESTING FOR EARLY DETECTION OF ALZHEIMER’S DISEASE
Authors: Dunnam Charles
Published: December 2023

The latest research confirms the heterogeneity of Alzheimer’s Disease Related Dementia (ADRD). This justifies a meta-analysis study on the association of novel plasma biomarkers with screening assessments for early detection of ADRD. The conceptual framework model will be analyzed from the 2020 edition of the GSA KAER Toolkit with updates. The purpose of the current study is two-fold. First, to determine the need of a universal protocol method for early assessment of ADRD by primary care teams. Second, implementation of Food and Drug Administration (FDA) approved novel plasma biomarkers testing as a follow-up protocol to a screening assessment. The two suggested protocols have recently established Medicare coverage. The study will conclude with an extensive review of the known novel plasma biomarkers that are available for testing, at present and a brief overview of available screening assessments for early detection of ADRD.
AGE BIAS IN ARTIFICIAL INTELLIGENCE (AI): A VISUAL PROPERTIES ANALYSIS OF AI IMAGES OF OLDER VERSUS YOUNGER PEOPLE
Authors: Allen Laura , Xu Wenqian , Nishikitani Mariko , Patil Vaishnavi Atul , Bradley Dana
Published: December 2023

Concerns about age-related biases in Artificial Intelligence (AI)’s design, development, and data generation raise alarms for potential social inequalities. AI art-generators like MidJourney, known for creating distinctive and artistic images, have gained attention recently. However, the critical examination of their potential biases remains limited. Our study aims to investigate age-related bias in MidJourney by comparing how older and younger individuals are visually depicted. Using 19 keywords (as text prompts) tied to domains of potential social exclusion for older adults, we automated the collection of “old person” and “young person” images in MidJourney. The text-to-image prompts yielded 456 AI-generated images that were analyzed with Amazon Rekognition image detection software to transform them to quantitative data. Data were compared statistically using STATA (version 16). The results show that the images of older people are significantly less bright (p< 0.001) and less sharp (p< 0.001) than the images of younger people. Additionally, images of older people have significantly more smile expressions (16%; p< 0.001) and are more likely to be wearing glasses (56%; p< 0.001) compared to images of younger people (6% and 12%, respectively). The findings reveal that MidJourney’s algorithm associates older people with a negative sense of antiquity, irrelevance, and dread. The findings also align with the Stereotype Content Model in which older people are seen as having warm personalities but not as competent or capable as younger people. We interpret these results as age bias that the AI art generator MidJourney has learned and in turn, creates, through image generation.
ARE OLDER ADULTS’ PERCEPTIONS OF ELDERSPEAK INFLUENCED BY SELF-REPORTED PSYCHOSOCIAL CHARACTERISTICS?
Authors: Weimar Lisa , Shaw Clarissa
Published: December 2023

PROMIS (Patient-Reported Outcomes Measurement Information System) is a system of highly reliable measures of patient-reported health status. Elderspeak is speech that sounds childish to older adults. Use of elderspeak by nursing staff can result in rejection of care. The Iowa Coding Scheme for Elderspeak (ICodE) contains 11 elderspeak attributes: diminutives, childish terms, collectives, short words, directives, reflectives, minimizers, exaggerated praise, laughter, tag questions and exaggerated prosody. Thirty-one older adults (aged 74.5±7.8 years) responded to short form PROMIS instruments measuring self-efficacy, physical function, isolation, cognitive function, depression, anxiety, and pain interference. Participants listened to 41 audio recordings of nursing staff providing care to hospitalized patients with dementia and were asked to rate each audio recording using a 5-point Emotional Tone Rating Scale for patronizing and respectful (5=very, 1=not at all). Using the ICodE, each audio recording was classified as neutral (no elderspeak), containing a single attribute, or containing an attribute combined with exaggerated prosody. Ratings for elderspeak attributes ranged from 2.1 to 2.9 for patronizing and 2.8 to 3.8 for respectful. Using the SPSS statistical package, a Spearman’s rho correlation was calculated for each elderspeak rating and health status domain identified above. Among this small, homogenous sample, no statistically significant correlation was found between participants’ self-efficacy, isolation, physical or cognitive function, depression, anxiety, or pain interference, as measured by PROMIS tools, and their rating of elderspeak attributes as respectful or patronizing. Future research should continue to explore what factors influence older adults’ perceptions of elderspeak as being respectful or patronizing.
ASSOCIATION BETWEEN LONG-TERM CARE FACILITY STAFF TRUST IN LEADERSHIP AND RECEIVING THE COVID-19 VACCINE
Authors: Li Xinjun , Gifford David , Williams Valerie
Published: December 2023

Trust in the sources recommending COVID-19 vaccine is thought to be associated with COVID-19 vaccine uptake. We compared long-term care (LTC) staff’s trust with leadership and public health organizations and their vaccination status. We administered a questionnaire to all staff in 48 long term facilities (39 Skilled Nursing Facilities (SNFs) and 9 Assisted Living (AL) facilities) to assess their overall trust level on a 5-point Likert scale with leadership and public health agencies along with their reported used COVID-19 vaccination status. We received 759 responses, with 34 were excluded due to incomplete data. Overall, 12% were not vaccinated, 25.2% completed initial series, 25.0% received one booster, and 37.8% received bivalent booster. Average trust was lowest with CDC (3.62) & CMS (3.60) and highest with leadership (Supervisor (4.07), Administrator (3.98) and DON (3.89)), which were higher than trust with the LTC organization (3.74). Trust levels increased as the staff’s vaccination status increased (p< 0.01) for each category in ANOVA tests. Building overall trust may help increase staff compliance with vaccination recommendations.
CONDITIONS ASSOCIATED WITH SUCCESSFUL IMPLEMENTATION OF AN ADVANCE CARE PLANNING INTERVENTION IN NURSING HOMES
Authors: Hickman Susan , Miech Edward , Stump Timothy , Mack Laramie , Tu Wanzhu , Unroe Kathleen
Published: December 2023

Implementing evidence-based interventions in nursing homes is challenging in part because clinical trials requiring a controlled experimental environment are difficult to sustain. In contrast, pragmatic clinical trials develop and evaluate evidence-based interventions in the “real world” with the goal of streamlining implementation after study completion. However, there is minimal information available identifying conditions associated with successful implementation of pragmatic interventions in the nursing home setting. The “Aligning Patient Preferences - a Role Offering Alzheimer’s patients, Caregivers, and Healthcare Providers Education and Support” (APPROACHES) project is a pragmatic trial designed to test and evaluate a staff-led advance care planning (ACP) intervention for residents with ADRD in 131 nursing homes (64 intervention, 67 control) between September 1, 2021 and August 31, 2022. ACP Specialists received training on ACP facilitation and implementation of the ACP program in the facility. Twenty of 65 (31%) sites successfully implemented the APPROACHES intervention and had > 75% of residents with documented ACP conversations. Using configurational analysis, we found two solutions directly linked with successful pragmatic implementation: (1) no executive director turnover during the observation period combined with site participation in monthly intervention support calls with ACP staff at other facilities; and (2) higher rates of hospitalization (3.96 – 7.2 per 1000 resident days) combined with a low number of certified beds. Findings suggest that leadership stability and engagement with peers were essential drivers of successful implementation. Having greater improvement opportunities as well as a more manageable caseload for the ACP Specialist may also help explain successful implementation.
CONDUCTING A NEEDS ASSESSMENT TO INFORM AGE-FRIENDLY HEALTH SYSTEMS INITIATIVE FOR UNIVERSITY OF UTAH HEALTH
Authors: Cadiz Ashley , Perkins Rebekah , Farrell Timothy , Edelman Linda
Published: December 2023

Today, people live longer and more productive lives than ever. The number of adults aged 65 and older is projected to nearly double 98 million by 2060 to 24% of the U.S. population (Administration on Aging & Administration for Community Living, 2018). Increased life expectancy, coupled with the exponential growth of the older adult population will create more demand for healthcare professionals to meet the care needs of older adults living with chronic conditions. Chronic conditions can lead to complex care and increase the usage of healthcare systems (Axon & Kamel, 2021). The Age-Friendly Health Systems initiative provides specific evidenced-based best-practice interventions to all older adults in a health system setting (Fulmer et al., 2022). An Age-Friendly Health System is one in which every older adult’s care is guided by an essential set of evidence-based practices known as the 4Ms framework: What Matters, Medications, Mentation, and Mobility (Institute for Healthcare Improvement, 2022). This project developed and delivered a Needs Assessment to providers practicing in the U Health Ambulatory Care Clinics to identify baseline knowledge, gaps in knowledge, and current practices related to the AFHS 4Ms Framework. The Needs Assessment consists of using online surveys and semi-structured interviews. Significant findings were that: 1) U Health ambulatory care clinic providers have very little to no baseline knowledge of the AFHS 4Ms Framework, 2) U Health ambulatory care providers are already providing care that aligns with the 4Ms framework, 3) There are barriers and challenges to providing Age-Friendly care.
CORRELATES OF MILD BEHAVIORAL IMPAIRMENT IN OLDER ADULTS WITH COGNITIVE DECLINE
Authors: Yoon Seolah , Jeong Innhee , Kim Jennifer (Jeehyun) , Kang Bada
Published: December 2023

Implementing early interventions in individuals with subjective cognitive decline and mild cognitive impairment during preclinical and prodromal stage of Alzheimer’s dementia spectrum, addresses modifiable risk factors thereby reducing potential dementia. Mild behavioral impairment (MBI) is considered as a potential predictor and prognostic marker for dementia. However, comprehensive reviews on how MBI is associated with other factors in these at-risk groups are limited. This scoping review identified and mapped associated factors of MBI on health outcomes among older adults with subjective cognitive decline and mild cognitive impairment. Following Joanna Briggs Institute methodology, we sourced studies from databases including PubMed (MEDLINE), CINAHL, Web of Science, EMBASE, PsycINFO, Cochrane, and SCOPUS, focusing on English-language publications published between January 2003 and July 2023. A total of 36 studies met the inclusion criteria. We classified MBI correlates identified from these studies into three categories: neurocognitive, physical, and psychosocial. Neurocognitive functions such as objective cognitive decline and progression to Alzheimer’s disease showed distinct health outcomes related to the MBI. Biomarkers including brain atrophy, beta-amyloid, and p-tau were found to be associated with MBI. Frailty, low gait speed, and hearing loss were physical functional outcomes associated with MBI. Studies on psychosocial aspects with MBI were limited, except one study demonstrating the relationship between caregiver burdens and MBI severity. This review underscores the importance of taking into account MBI and its correlates for developing tailored care approaches to prevent functional decline and improving health outcomes among older adults with subjective cognitive decline and mild cognitive impairment.
DEVELOPMENT OF AN AI-POWERED EMOTIONALLY INTELLIGENT, INTERACTIVE AGENT PROTOTYPE TO SUPPORT INFORMAL CAREGIVERS
Authors: Chang Yu-Ping , Dwibedi Aditya Kumar , Joshi Suryakanth , Bhattacharjee Sreyasee Das
Published: December 2023

Long-term informal caregiving for older adults with dementia is exhausting and poses risks to caregivers’ health outcomes. Most informal caregivers are not well prepared for their new role, facing various challenges and receiving limited support. With the advent of artificial intelligence (AI) and information and communication technologies (ICTs), assistive technology is increasingly useful for supporting caregivers. However, limited research assesses the potential for AI to facilitate a privacy-preserving computation environment to provide proactive assistance to caregivers. This project aims to fill this gap by leveraging the tremendous potential of Multimodal Machine Learning and Large Language Models (LLMs) to develop a prototype of an AI-powered emotionally intelligent, interactive agent for informal caregivers. We introduce an effective context-driven instruction tuning technique that enables LLMs to finetune various caregiving-related tasks (tips generation, answering questions, elaborating a specific training module) with instructions. The project will also deliver a first-of-its-kind custom dataset augmented with manualized instructions for relevant caregiving tasks, which is used for finetuning several state-of-the-art LLM models. Our intelligent interactive agent prototype currently has the ability to evaluate caregivers’ unique affective states at query times to provide personalized assistance, addressing various types of caregivers’ situation-specific queries (e.g., managing agitation, wandering, or medications). The prototype is capable of understanding and responding to the user’s natural language queries and designing short, machine-driven persuasive conversations on a pre-defined set of topics. Our prototype has the potential to provide individualized and contextualized support for caregiving tasks which in turn may greatly reduce caregiver burden.
DIETARY IMPACT ON GUT MICROBIOTA, COGNITIVE PERFORMANCE, AND HIPPOCAMPAL MARKERS IN AGING RATS
Authors: Solch-Ottaiano Rebecca , Harper Colin , Engler-Chiurazzi Elizabeth , Ismael Saifudeen , Prats Madison , Volic Milla , Bix Gregory , Maraganore Demetrius
Published: December 2023

Many patients with mild cognitive impairment have alterations in gut microbiota composition and dietary consumption directly modulates gut microbiota; therefore, the quality of a diet may impact cognitive function. Twelve-month-old male Fischer 344 rats (n=10/group) were assigned to a Mediterranean diet (MeDi), Western diet (WD), or Chow for three months to determine the effect of diet in aged animals. Animals underwent neurobehavioral assessments including the Morris water maze (MWM), and radial arm water maze (RAWM). Fecal samples were analyzed via 16S rRNA sequencing. Markers of barrier and immune function in the hippocampus were measured via qPCR. The MeDi (p=0.06) and Chow (p=0.003) groups had a trend to or swam a shorter distance compared to the WD in the MWM. There was no difference in RAWM total errors between Diets (p=0.43). Microbiota analyses exhibited differences in alpha- and beta-diversity. Chow diet had a higher Simpson and Shannon index compared to MeDi (p< 0.02) and WD (p< 0.001). The MeDi (p=0.03) and Chow (p< 0.001) groups had a higher Chao1 index compared to the WD group. Beta-diversity differed by Diet for weighted UniFrac (p< 0.03), and unweighted UniFrac (p< 0.001). For barrier integrity, there was a trend for Occludin expression to differ by Diet (p=0.07) but Claudin-5 did not differ (p=0.81). For immune function, the WD group had a trend to have a higher expression of GFAP compared to the MeDi (p=0.05) but a lower Iba-1 expression (p=0.009). A short-term diet had a subtle effect on cognitive performance but modulated microbiota compositions and hippocampal immune marker expression.
DO OLDER ADULTS BELIEVE THEY ARE AGING SUCCESSFULLY IN THE CIRCUMPOLAR NORTH?
Authors: Howell Britteny , Worthington Amber , Golden Dale , Redmond Leslie
Published: December 2023

People’s perspectives on successful aging may impact their own aging outcomes. To gain more insight, we surveyed a convenience sample of 58 adults aged 55+ years in urban Alaska about their perceptions of their own aging using Fowler’s successful aging scale. Overall, older adults rated their aging in the middle of the 1-7 scale across all three questions: how well they are aging, how “successfully” they have aged up to now, and how they rate their lives these days (M=4.17, SD=1.16, range=1-7 where 1 = not at all successful and 7 = extremely successful). Correlational analyses indicated that as perceptions of successful aging increase, self-reported good general health (M=2.90, SD=1.00, range=1=5) increases, r(56)=.499, p<.001, and self-reported disability (M=0.71, SD=0.92, range=0-3) decreases, r(56)=-.27, p<.05. Despite a small sample size, these findings that perceptions of successful aging increased as general heath increased and self-reported disability decreased, suggest that participants may perceive successful aging and good general health to be positively correlated. Perceptions of successful aging were not related to age in this sample (M=71.98, SD=8.74), r(56)=.125, p=.349. This is promising, as it may indicate that older adults recognize good health and absence of disability as integral components for successful aging regardless of chronological age providing opportunities for targeted messaging in future interventions. Future work will explore opportunities to promote successful aging and overcome some of the challenges related to healthy aging in this urban location, including the Circumpolar environment, historical trauma of Indigenous peoples, and a lack of accessible healthcare across Alaska.
ENHANCING CAPACITY OF SERVICE PROFESSIONALS TO PREVENT FINANCIAL EXPLOITATION IN RURAL OLDER ADULTS WITH DEMENTIA
Authors: Sun Fei , Zhang Zhenmei , Kim Ha Neul , Zhang Xuehan , Xiong Yuan , Yang Huiyu , Wang Xia
Published: December 2023

Cognitive impairment renders older adults more vulnerable to financial exploitation (i.e., financial abuse committed by family members, or someone known to victims, and financial fraud committed by strangers). This study developed and tested the efficacy of a community-based financial exploitation prevention model for older adults living with dementia in rural Michigan. Guided by the routine activity theory, we chose to address external risk factors for financial abuse and fraud by focusing on service professionals (i.e., social and health care providers) who are at stake for identifying and reporting abuse. Using a randomized control design, we assigned 52 service professionals in intervention groups that received training on dementia and financial exploitation and available community resources, and 39 in control groups that received community resources only. Participants were assessed at baseline and 3 months following the intervention, while 26 dropped out at 3-month follow-up. Linear mixed modeling (LMM) was used to examine time and group effects in dementia literacy, understanding of financial exploitation, and competence in handling financial exploitation. Both groups reported an increase in their knowledge of dementia and their competence of handing financial exploitation cases. Moreover, those in the intervention groups reported more understanding of risk factors for financial abuse committed by family members. Community service agencies comprise a strong safety network for vulnerable older adults at risk for financial exploitation. Policies and practice need to be in place to sustain the coordinated efforts among community service agencies and adult protective services to prevent financial exploitation.
FUNCTIONAL IMPACT ON ADULTS AND OLDER PEOPLE AFTER HOSPITALIZATION BY COVID-19
Authors: Ochiai Gabriela , De Godoy Caroline , Silva Erika Gouveia E , De Carvalho Celso Ricardo Fernandes , Fu Carolina , Tanaka Clarice , De Carvalho Carlos Roberto Ribeiro , Pompeu Jose
Published: December 2023

Cross-sectional study of 159 individuals, one month after hospitalization at the Hospital das Clínicas of the University of São Paulo for Covid-19, divided into groups: 54.7% (n=87) were adults (< 60 years), and 45.3% (n=72) were older people (≥60 years), with 43.4% (n=69) being female. Those who did not accept to participate, without availability, or without ability to understand the questionnaires were excluded. Functional capacity was assessed by the Barthel Index (BI). Statistical analysis was performed using JASP Statistics-0.15.0, considering significance level of alpha=0.05. Wilcoxon and Mann-Whitney tests were applied to compare pre- and post-Covid periods and to compare adults and older people, respectively. Data collection went from June 30, 2020, to August 24, 2021. The median length of hospitalization was 23 (15-34) days. The median total BI scores were lower one month after discharge in older people, 95 [90-100], when compared to adults, 100 [92.5-100] (p=0.001). Bladder control (p=0.009), toilet use (p=0.021), chair/bed transfers (p=0.043), ambulation (p=0.006), dressing (p=0.015), stair climbing (p< 0.001), and bathing self (p=0.006) were the activities of daily living most affected in older people. Hospitalization due to Covid-19 had functional impacts in the post-discharge period, particularly in older people, manifested by limitations in performance of daily activities with higher physical demand. These findings emphasize the need for functional capacity screening after hospitalization for Covid-19, especially in older people.