bluuebunny/crossref_metadata_2025 huggingface dataset:
A Path Analysis of Agitation in Persons with Alzheimer Disease
Authors: Kero Katherine , Yarandi Hossein , Schutte Debra
Published: December 2021

This study tested a theory-driven path model of predictors and outcomes of agitated behavioral symptoms in persons with Alzheimer Disease (AD) guided by the Nursing Theory of Unpleasant Symptoms. This secondary analysis included data from 48 persons with AD from institutional residences in Midwestern United States. Data included measures of physical, psychological, and situational antecedents of agitation, the symptom of agitation, and functional outcomes of agitation with 15 instruments and subscales. The data were a good fit for the empirical path model (χ2 = 1.049, df = 2, p = .592). Statistically significant paths were found from measures of physical, psychological, and situational antecedents to agitation (B = 0.58, 0.446, and 0.51; p ≤ .001) which explained 63% of the variance in agitation. Functional performance was influenced only by physical antecedents, which explained 66% of the variance in functional performance. While physical and psychological states may be comorbid to the AD disease process and therefore less modifiable, the situational measure was primarily defined by measures related to caregiver burden. Therefore, future agitation interventions should target strategies to improve caregiver burden.
Estimating Dementia from Self-Reports of Diagnoses Among Adults Aged 65 and Over: United States, 2019
Authors: Kramarow Ellen
Published: December 2021

Prior research shows that, overall, about 10% of the population aged 65 and over in the U.S. has dementia. Estimating the prevalence of dementia from nationally representative surveys can be accomplished by asking respondents about a diagnosis, by administering a cognitive assessment, or, if available, by examining linked medical claims data. In 2019 for the first time, the National Health Interview Survey (NHIS) added “dementia, including Alzheimer’s disease” to the questions asking about doctor-diagnosed health conditions. Although estimates derived from doctor-diagnosed questions usually underestimate the true prevalence of a condition, and estimating dementia from self-reports presents additional challenges, they are still useful for many surveillance and research objectives. Early diagnosis of dementia is encouraged to allow patients and their families to plan for future needs. The objective of this research is to describe the noninstitutionalized population aged 65 and over who have a dementia diagnosis, by selected socio-demographic, health, and healthcare utilization characteristics. Point estimates, standard errors, and 95% confidence intervals for percentages are calculated using NHIS adult sample weights and adjusted for the complex sample design of NHIS. Preliminary analyses show that, overall, 4% of the 65 and over noninstitutionalized population has a diagnosis of dementia. About 8% of respondents with less than a high school education reported a dementia diagnosis compared with 2% of those with more than a high school education. Those with a dementia diagnosis were more likely to report depression than those without a dementia diagnosis (44% vs. 14%).
Understanding Driving Avoidance Among Older African Americans And Whites With Diabetes
Authors: Armah Henrietta , Martin Maya , Browning Wesley , Atkins Ghislaine , Clay Olivio
Published: December 2021

Diabetes mellitus is one of the most common chronic diseases with half of the new diagnoses affecting adults aged 60 years and older. Although African Americans are more likely to develop the disease, they are also less likely to receive healthcare. Importantly, living with diabetes is likely to negatively impact mobility for aging adults as the disease is associated with lower physical functioning (e.g., ability to maintain one’s balance). Further, diabetes could pose a significant threat to a person with diabetes’ ability to drive and remain in the community. This study examines the relationships and influences of social determinants of health (e.g., race, gender, socioeconomic status) and cognition on avoiding driving maneuvers such as driving at night and in rush hour traffic among older adults with diabetes. Data from the University of Alabama at Birmingham (UAB) Diabetes and Aging Study of Health (DASH) were analyzed and of the 224 participants, 193 (86.16%) were current drivers. There was a gender difference with 94.12% of males and 79.51% of females being current drivers, p < .01. Within the sample of current drivers, 45% were African American and being female, not married, lower levels of education and cognition, low income, and being African American were associated with higher scores on driving avoidance. Cognition explained 30.44% of the racial difference in driving avoidance. Findings from this study will help identify individuals who are at-risk for reduced mobility and identify those who may need to be intervened upon to support a better quality of life.
Characteristics of Older Adults who Receive Assistance with Management of Multidrug Regimens
Authors: O'Conor Rachel , Benavente Julia Yoshino , Eifler Mogan , Opsasnick Lauren , Curtis Laura , Lindquist Lee , Wolf Michael
Published: December 2021

Many older adults manage multiple chronic conditions requiring adherence to multidrug regimens, yet half are non-adherent, increasing their risk of hospitalization for poorly controlled chronic conditions. Few studies have investigated whether caregivers support medication-related behaviors of community-dwelling older adults. We interviewed 97 patient-caregiver dyads participating in a cognitive aging cohort study to identify factors associated with caregiver assistance in managing multidrug regimens. Patients completed a neuropsychological battery covering five cognitive domains. Health literacy and patient activation were measured using the Newest Vital Sign and Consumer Health Activation Index, respectively. Caregivers reported their medication-related involvement. Predictors of involvement in medication-related tasks were examined using logistic regression models. Patients were on average 71 years old, managing 4 comorbidities and prescribed 5 medications. The majority were female (73%) and identified as Black (46%) or White (47%). Caregivers’ mean age was 65 years; half were female (53%), were predominantly spouses (57%) or children (26%), and lived with the patient (61%). 31% of caregivers ordered patients’ prescribed medications, 40% helped manage their medications, and 50% spoke with the patient’s clinician about their clinical care. Cognitive impairment (OR 2.60, 95% CI 1.08-6.25), limited health literacy (OR 2.97, 95% CI 1.26-6.97), and ≥3 comorbidities (OR 2.14, 95% CI 1.06-9.30) were associated with medication management assistance. Patient activation, gender, cohabitation, or relationship were not associated. These findings suggest that caregivers are assisting with older adults’ medication management and should be included in clinical discussions about medication management, especially among patients with cognitive impairment, low health literacy or multimorbidities.
Simulating Treating in Place in Long-Term Care: Interprofessional Team Care Video Case for Nurse Practitioners
Authors: Kennedy-Malone Laurie
Published: December 2021

As a means of enhancing clinical simulation opportunities for adult-gerontology nurse practitioner students, a series of video simulations were created for use for nurse practitioner education. With funding through the Health Resources and Service Administration (HRSA) Advanced Nursing Education Workforce grant and partnering with nurse practitioner clinical educators from Optum Health Care, a video simulation focused on the concept of treating an older veteran within a long-term care facility rather than transferring to the acute care setting was developed. The case Treating in Place: Nurse Practitioner-Led Team Management of a Long-Term Care Patient Video involved a nurse practitioner collaborating with a physician, a registered nurse, a social worker, and a family member. The interactive simulation video was developed using the eLearning authoring tool H5P to create learning experiences for students that can be used either in face-to-face classroom experiences or embedded in learning management systems. H5P is a web-based authoring tool that helps faculty build interactive course content. H5P activities provide instant feedback to students, allowing them to self-assess their understanding of the dynamic video simulation case. A faculty handbook that describes the case scenario with the interactive questions and suggested discussion questions is available. The adult-gerontology primary care nurse practitioner competencies addressed for this case are identified in the faculty handbook. These videos have been widely disseminated and are being included in nurse practitioner curriculum across the country. A QR code with access to direct viewing of the video will be included in the presentation.
Elder Abuse Victims During the COVID-19 Pandemic: Administrative Data From San Francisco Adult Protective Services
Authors: Liu Pi-Ju , Wang Aining , Schwab-Reese Laura , Stratton Sara
Published: December 2021

This study examined elder mistreatment victims’ experiences at the beginning of the COVID-19 pandemic. San Francisco Adult Protective Services (APS) caseworkers conducted phone interviews to inquire about clients’ awareness of COVID-19 and unmet needs. Nine-hundred-and-thirty-four (71%) of 1,313 APS’ past clients or their collaterals were interviewed, with 741 (79%) responding positively to COVID-19-awareness questions, and 697 (75%) having no unmet needs. Binary logistic regression with Firth adjusted maximum likelihood estimation method revealed that older persons (p < .05), self-neglectors (p < .05), and victims of neglect (p < .05) were less aware of COVID-19. Unmet needs varied by mistreatment type. Victims of isolation were more likely to have medical needs (p < .05), while victims of emotional abuse were more likely to report loneliness (p < .001). Collaboration between service providers is key in assisting victims experiencing unmet needs to live safely in a public health crisis.
Susceptibility to COVID-19 Scams: Does Age Matter?
Authors: Nolte Julia , Hanoch Yaniv , Wood Stacey , Hengerer David
Published: December 2021

The COVID-19 pandemic has lead to a worldwide surge in COVID-19 related mass marketing scams. While COVID-19 poses higher health risks for older adults, it is unknown whether older adults are also facing higher financial risks as a result of such scams. Thus, the present study examined age differences in vulnerability to COVID-19 scams and factors that might help explain them. In June 2020, 68 younger (18 – 40 years, M = 25.67, SD = 5.93), 79 middle-aged (41 – 64 years, M = 49.86, SD = 7.20), and 63 older adults (65 – 84 years, M = 69.87, SD = 4.50) were recruited through Prolific. Participants responded to five COVID-19 solicitations, psychological measures, and demographic questions. Across solicitations, older adults perceived COVID-19 solicitations to offer significantly fewer benefits than both younger and middle-aged adults did. However, age groups neither differed in their perception of the solicitations’ risks and genuineness nor in their willingness to act in response to COVID-19 solicitations. Overall, intentions to respond to COVID-19 solicitations were positively predicted by higher levels of educational attainment, a previous history of fraud victimization, and higher levels of positive urgency. As expected, stronger genuineness and benefit perceptions positively predicted action intentions, whereas stronger risk perceptions negatively predicted action intentions. Older adults did not exhibit greater vulnerability to COVID-19 solicitations: If anything, they were more skeptical of the benefits associated with these solicitations. Irrespective of age, risk, benefit, and genuineness perceptions were the key factors associated with intention to respond to solicitations.
Immoral Intentions vs. Accidental Actions: Age Differences in Endorsements of Anger and Disgust
Authors: Minton Alyssa , Snyder Jason , Young Nathaniel , Graupmann Verena , Mikels Joseph
Published: December 2021

Given that older adults value social harmony and selectively avoid negativity (Carstensen & Mikels, 2005), we investigated whether older and younger adults differentially react to scenarios in which someone intends to harm others compared to someone who accidentally harms others. Younger (n = 112, M = 26.23) and older (n = 113, M = 66.42) adults read 8 scenarios in which a perpetrator intentionally acts to harm someone else but is unsuccessful (Desire condition) or a perpetrator accidentally harms someone else (Consequence condition; Giner-Sorolla & Chapman, 2017). Endorsements of anger and disgust toward the perpetrators were measured on 7-point scales (1 = Not at all, 7 = Extremely). Emotion endorsements were submitted to 2 (age) x 2 (condition) ANOVAs. Anger (M = 4.81, SD = 1.58) and disgust (M = 4.82, SD = 1.54) endorsements were higher in the Desire relative to Consequence condition (M = 2.64, SD = 1.33; M = 2.49, SD = 1.29, respectively), F(2, 221) = 124.03, p < .001; F(2, 221) = 156.31, p < .001, respectively. Moreover, older (M = 5.17, SD = 1.61) relative to younger (M = 4.45, SD = 1.37) adults were disproportionately disgusted in the Desire condition, t(102) = 2.45, p = .016, but no age differences emerged in the Consequence condition. Results indicate that older (relative to younger) adults are disproportionately disgusted when judging a person who intends to harm others. Older adults may respond more strongly than younger adults to malicious perpetrators, as they intentionally upset social harmony.
Marital Conflict, Anger Expression, and Marital Instability: Associations by Age and Culture
Authors: Witzel Dakota , Nichols Madeline , Stawski Robert
Published: December 2021

Positive social relationships, such as high-quality marriages, are associated with better health, especially among older adults. Moreover, negative components in marriages (i.e., disagreements and associated emotional responses) are linked to negative outcomes such as marital disruption (McGonagle et al., 1993) and divorce (Markman et al., 2010). Factors such as marital conflicts and emotion expression threaten marital stability and health and have been shown to decrease with age and in collectivist cultures (i.e., Japan compared to U.S.; Kitayama et al., 2015; Matsunaga & Imahori, 2009). While anger has featured as a specific emotion associated with compromised health and marital quality (Carrère et al., 2005), less is known about how marital conflict and the expression of anger may contribute to marital instability in later life, or differences in these links across age and culture. Using data from married respondents participating in the second wave of the Midlife in the United States (MIDUS, n=750, Mage=55.18, SD=11.5, %Female=50.13%) study or first wave of the Midlife in Japan (MIDJA; n=706, Mage=55.26, SD=13.68, %Female=47.73%) studies, we examined associations between disagreements, anger expression, and marital risk. Preliminary analyses revealed that marital disagreements and anger expression were each associated with increased marital instability in both the MIDUS and MIDJA samples (ps<.05). Additionally, the effects of marital disagreements and anger expression did not differ between the two samples or as a function of age. Discussion will focus on the relevance of expression and regulation of emotions for understanding marital (in)stability in midlife and aging and across cultures.
The Effect of Everyday Stressors and the Perceived Stress Reactivity Scale on Variability in Sympathetic Arousal
Authors: Hughes MacKenzie , Hertzog Christopher , Neupert Shevaun , Moffat Scott
Published: December 2021

This ecological momentary assessment study examined the effect of naturally occurring stressors and perceived stress reactivity on alpha-amylase, a proxy of sympathetic nervous system arousal. There are age-related changes in physiological systems sensitive to stress, so the sample included 174 adults ages 20-78 (M=48.65, SD=19.28). At the beginning of the study, participants completed the Perceived Stress Reactivity Scale (PSRS; Schulz et al., 2005). For 10 consecutive days, participants were prompted five times per day to report exposure to stressors. During the same 10-day period, participants provided seven saliva samples per day, assayed for alpha-amylase. Multilevel modeling was used to examine daily and momentary associations between stressors, the PSRS, and alpha-amylase activity. On a daily basis, stressors did not predict changes in the diurnal alpha-amylase pattern, but higher perceived stress reactivity predicted steeper diurnal slopes and lower total daily output. A significant cross-level interaction emerged showing people higher in perceived stress reactivity had steeper awakening responses on days they experienced more stressors than usual. On a momentary basis, alpha-amylase levels were higher on occasions when participants reported stressors. In addition, higher levels of perceived stress reactivity predicted lower overall alpha-amylase levels. Findings suggest that 1) stressors are associated with elevations in momentary but not daily aggregate levels of alpha-amylase, and 2) the PSRS has prospective validity as a predictor of stress-related fluctuations in diurnal alpha-amylase patterns. Age was not a significant moderator of the relationship between stressors and alpha-amylase, potentially suggesting the effect of stressors on alpha-amylase activity is age invariant.
A Case Study On Anticipated End-of-Life Caregiving Among The Millennial American Born Chinese
Authors: Li Tongtong , Zhang Aileen , Liu Ruotong , Chi Iris
Published: December 2021

Millennial American Born Chinese (ABCs) are in a double jeopardy position with end-of-life (EOL) care for their immigrant parents, because of both cultural and generational clashes. There is no existing empirical study about the millennial ABCs’ attitudes or behaviors towards EOL caregiving. Our study is the first one to explore the millennial ABCs’ anticipated EOL caregiving behaviors, support and resources needed, attitudes towards terminal illness disclosure and advance care planning (ACP) discussion with their parents, and how acculturation influences. A qualitative in-depth phone interview using a case study approach, with a scenario of caring for parents with Parkinson’s disease and stage IV lung cancer, was adopted. Participants were recruited via convenience sampling, and a total of 27 (18 females and 9 males with an average age of 25) passed the screening and completed the interviews. Using the directed content analysis, researchers identified two themes: EOL caregiving and EOL decision making, which included five sub-themes: caregiving behaviors, needed supports and resources, care arrangement decision, terminal illness disclosure, and ACP. Both traditional Chinese culture of familism and filial piety, and western culture of autonomy and patients’ rights to know were exhibited in every theme. Most participants did not fully understand ACP concept, but they were willing to initiate ACP conversation after comprehending ACP concept. This study constitutes an essential step towards understanding the millennial ABC EOL caregivers’ financial, physical, and emotional needs from family, community and government, better establishing corresponding policies, and promoting public education in ACP to benefit this minority group.
Hospice Care for Veterans: A Community Education Program
Authors: Kresevic Denise , Heath Barbara , Pallaki muralidhar
Published: December 2021

The impact of trauma on care at end of life and the social isolation of the COVID-19 pandemic highlighted a critical gap in care of terminally ill veterans. It is estimated that 30% of Vietnam Veterans suffer from PTSD, suicide rates are 49% higher in older veterans than nonveterans, and 41% of veterans surveyed report post traumatic guilt. A survey of non-VA hospice agencies revealed many do not screen for PTSD, but desired training in this area. The VA responded to these challenges implementing an initiative to educate community caregivers on PTSD, suicide, and moral injury with expanded tele mental health services. Several VA sites were supported to participate in training focusing on PTSD, suicide, and moral injury and Telemental health. In Northeast Ohio, from 2019-20, 11 community hospice agencies participated in training, including 283 providers,120 (42%) nurses, 100 (35%) social workers, 29 (10%) volunteers, and 34 (12%) other. A majority of participants post-training (n=160) (84%-94%) reported enhanced knowledge, skills, or attitudes related to resources, education, and communication. Participants rated changes for assessment skills lowest for moral injury (34%), PTSD (41%), and suicide (56%). An analysis of telemental health visits (N=50) revealed that, 56% addressed spiritual support, (22%) family support, (10%) resources/referrals, and (8%) confusion. The majority of telehealth visits were VA initiated (84%), and 10% were hospice initiated Continued education regarding PTSD, suicide, and moral injury assessment skills is still needed for hospice care providers of veterans. These findings support the use of telemental health for care and consultation.
Intention to Communicate End-of-Life Wishes among Rural African Americans: Is Awareness of Hospice Care Important?
Authors: Luo Yan , Noh Hyunjin , Lee Lewis , Lee Hee
Published: December 2021

The intention to communicate end-of-life wishes and its related factors among adults in the southern rural region of the US has not been studied. This study aims to: (1) assess the intention to communicate end-of-life wishes among rural residents living in the Black Belt Region; (2) controlling for demographics and social determinants of health (SDH), examine the relationship between awareness of hospice care and the intention to communicate end-of-life wishes. A convenient sample living in rural Alabama was collected to complete a cross-sectional survey (N=182, age=18-91). Univariate analyses were conducted to assess participants’ intention to communicate end-of-life wishes, demographic characteristics, and SDH. Binary logistic regressions were used to examine the relationship between awareness of hospice care and the intention to communicate end-of-life wishes while controlling for demographics and SDH. The majority of participants were willing to communicate end-of-life wishes to their family (77.5%) or doctors (72.5%). Participants who were aware of hospice care were more likely to be willing to communicate end-of-life wishes to both their families (OR=10.08, p<0.01) and doctors (OR=7.20, p<0.05). Moreover, participants who were older were less likely to communicate end-of-life wishes to their doctors while participants with higher social isolation scores had lower intention to communicate end-of-life wishes to their families (OR=0.53, p<0.05). This is the first study assessing the intention of communicating end-of-life wishes among residents living in the Black Belt Region. This study demonstrated that awareness of hospice care is positively associated with the intention to communicate end-of-life wishes to both families and doctors.
Post-Recession Housing Insecurity and Physical and Mental Health of Midlife and Aging Adults
Authors: Bhat Aarti , Almeida David , Santos Alexis
Published: December 2021

Housing insecurity, or limited/unreliable access to quality housing, is a powerful chronic stressor that can negatively affect individual health and well-being. This study extends prior research by examining the effect of multiple forms of housing insecurity on both the mental and physical health of aging adults using the Midlife in the United States study (MIDUS; N = 2532; M age = 63.42; 57% women; 16% black). Participants reported on experiences of anxiety/depression in the past year, number of chronic health conditions experienced in the last year, and experiences of housing insecurity since the 2008 recession (e.g., homelessness, threatened with foreclosure or eviction, missed rent or mortgage payment). 14% of participants reported experiencing one or more housing insecurity events in the aftermath of the recession. Higher levels of housing insecurity were experienced by midlife participants (ages 46-65) and black participants. Regression results showed that, even when controlling for prior health, housing insecurity was significantly associated with higher odds of experiencing anxiety/depression and additional chronic health conditions. These results suggest that housing insecurity experiences are fairly prevalent among midlife and aging adults, and that housing insecurity experiences leave these adults susceptible to compromised mental and physical health. This work has various implications for policy around addressing housing access and affordability issues for aging adults as a public health concern. Subsequent analyses will examine age, gender, and race/ethnic differences in these associations between housing insecurity and health outcomes.
Stress, Cognition, and Minority Health
Authors: Antonucci Toni , Zahodne Laura , Gerald Melissa
Published: December 2021

This symposium examines the many factors influencing cognition and health among ethnically and racially diverse groups. Kindratt et al. use representative, national data to examine cognitive limitations and diabetes among foreign born Non-Hispanic Whites, Blacks, Hispanics, Asians and Arab Americans. Results indicate that prevalence of cognitive limitations was highest among non-Hispanic Whites and Arab-Americans, lowest among Blacks and Asians. Diminich et al. investigate the association of stressors and metabolic risk factors with cognitive/emotional functioning in a population of Hispanic/Latina(o) immigrants. They find a link between components of metabolic syndrome that are associated with domain specific deficits in cognition. These impairments are linked to posttraumatic stress, immigration related trauma and emotional health and wellbeing. Arevalo et al. examine cross-sectional and prospective associations of sleep duration and insomnia symptoms with measures of cognitive functioning among older Latinos from Puerto Rican ancestry with a longitudinal sample of older adults from the Boston Puerto Rican Health Study. Findings indicate that hours of sleep and insomnia symptoms are significantly associated with a number of global and specific cognitive factors. Finally, Munoz and colleagues, using a regional racially and ethnically diverse sample of people living in a large northeastern city, identified four stress profiles. These profiles (which focus on different types of stress) were differentially associated with working memory performance. In sum, these four papers document the experiences of stress and their association with cognitive functioning in diverse minority groups each of whom are disproportionately at risk for ADRD/RD. Gerald, from NIA, will serve as discussant.
Is a Low Intensity Walking Intervention Successful in Reducing Depression Symptoms in Middle to Older Age Women?
Authors: wu jingchuan
Published: December 2021

Depression is a common syndrome that has a strong negative impact on people’s quality of life. Women, especially in middle age, are facing a greater risk for depressive disorders. Increasing one’s physical activity level has shown great effects on reducing depression symptoms. The study evaluated the effect of a 12-week goal-directed walking intervention on walking engagement and depression symptoms among middle-aged women. A total of 55 middle to older age female participants (age range: 50–74) were included in the analysis. The 12-week intervention instructed participants to increase 15% of baseline steps every other week. Depression levels were measured pre-and post-intervention by the Center for Epidemiologic Studies Depression Revised Scale (CESD-R). A baseline measure-time structure- was considered as a possible mediator of association between walking and depression. Although no intervention effects were found in steps promotion and depression reduction in this walking program, we found that more depressed or younger participants had lower walking consistency It suggested that people with higher depression level or younger age require more instruction over time when engaging in physical activity interventions. Additionally, adherence of participants showed a over-time decreasing trend in this self-paced walking program. This inspired us to give timelier adjusts goals and exercise performance feedback to bolster participants' adherence in the future.
Piloting the Effectiveness of a Text Messaging and Fitness Tracking Intervention within Older Black Women
Authors: Clay Olivio , Mixon Veronica , Opoku-Agyeman William , Nicholson Meneka Johnson , Bowen Pamela
Published: December 2021

Physical activity (PA) can help lower risk of obesity and type 2 diabetes, reduce anxiety, and reduce risk of Alzheimer’s and other related dementias. Despite these benefits, older, obese Black women are not meeting CDC recommended PA guidelines at disproportionate rates. This study aims to identify whether a targeted intervention, Texting Older Sisters to Step (T.O.S.S.), can improve health-related outcomes within older Black women. A sample of 24 Black women (12 per group) age 60 and older who had a BMI > 30 were recruited. The treatment group received text messages previously validated to promote physical activity every day for 12-weeks and were placed in Fitbit communities. The control group received a general health or nutrition-related text message every Sunday. Participants ranged from 60 to 70 years of age with a mean of 64 and 90% had at least some college education. Overall, there was a significant reduction of 1.53 inches in waist circumference, p < .01. When the groups were compared, the treatment group showed a 2.16 inch reduction compared to a 0.91 inch reduction in the control group (Cohen’s d=0.54, a medium effect size). Similarly, the treatment group lost 2.50 pounds on average compared to 1.33 in the control group (d=0.23). When the groups were compared on HgA1c, the treatment group was stable with a reduction of 0.01 unit whereas the control group reduction was 0.15 unit (d=0.23). Findings provide initial support for the T.O.S.S. intervention and suggest a modification of including nutrition information among the intervention messages.
Silver Sneakers in Central PA: Assessment of a Community based Exercise Program in a Mixed Rural/Urban Catchment Area
Authors: Flores Eileen , Nakagawa Sage , Moyer Robinn , Bluethmann Shirley
Published: December 2021

Older cancer survivors present with unique challenges that may impact quality of life and increase physical dysfunction if not properly managed. Regular physical activity (PA) can help mitigate these effects. Silver Sneakers (SS), a free exercise program available to Medicare beneficiaries, has more than 16,000 US locations. To understand capacity of SS to serve older adults in our mixed rural/urban catchment area of Central Pennsylvania, we 1) identified all registered SS program locations in our 28-county catchment area and; 2) conducted phone questionnaires with SS program staff. Approximately 18 gyms closed during the pandemic, leaving a sample of 121 participating gyms. We talked to 80 gyms (66% response rate) to understand member and programming characteristics, training of staff and program marketing. Geographic locations of SS were mixed – 39% in rural and 61% in urban counties; the majority (43%) were located in private gyms or YMCAs. The majority of gyms reported membership was equally mixed by gender and described ages of members as 65-80 years (94%). Program staff said that many members exercised several times per week with friends/family. Program staff also reported that social opportunities (35%) were a primary reason participants remained active in SS. Most (89%) of the facilities were still able to offer SS during the pandemic, with the majority (60%) adapting format to Zoom and other video platforms to conduct classes. Overall, SS programs offer a sustainable option to facilitate access to exercise programs and reduce barriers to PA among older adults in our catchment area.
The Effect of Low-Intensity Daily Walking Activity on Cognitive and Brain Function in Older Adults
Authors: Eldreth Dana , Varma Vijay , Chuang Yi-Fang , Carlson Michelle
Published: December 2021

Physical activity is an effective intervention to prevent or delay cognitive decline and dementia in older adults; however, many have difficulty achieving recommended moderate- to vigorous-intensity guidelines. This study examined the impact of low-intensity daily walking activity on executive cognitive and brain function in 66 older adults (mean age=67.26 ; SD=6.04). Daily walking activity was measured using a step activity monitor and brain function was assessed using functional magnetic resonance imaging during the Flanker task. Analyses included whole and region of interest (ROI) in the right middle frontal gyrus (RMFG), occipital cortex (OCC) and anterior cingulate (ACC). Partial correlations were performed between step activity, behavioral performance, and ROI activation, adjusting for age and education. Most of the step activity was in the low-intensity range. No associations were observed between step activity and task performance (p>.05). Task-related activation occurred in the RMFG, lateral OCC and paracingulate (p<.01). Increased activation in the RMFG was associated with greater amount r(62)=.390, p=.001, duration r(62)=.309, p=.013 and frequency r(62)=.327, p=.007 of step activity. Stratification by sex revealed a positive association between amount of step activity and RMFG activation in women r(44)= .360, p=.014, but not men. Whole brain correlation revealed that amount of step activity was positively associated with precuneus activation (p<.01), an area impacted early in Alzheimer’s disease. These results support the benefits of low intensity daily walking activity on prefrontal function in older adults and suggest the importance of designing attainable and sustainable physical activity interventions to promote brain health in older adults.
Capturing Change in Balance Confidence over 30 Days: Insights Gained from a Micro-Longitudinal Study
Authors: Su Tai-Te , Griffin Aileen , Washington Faith-Christina , Sosnoff Jacob , Meija Shannon
Published: December 2021

Balance confidence reflects one’s estimate of their ability to maintain balance and avoid falls. Extensive literature has shown the relationships between balance confidence, functional limitations, and falls in later life. However, change in balance confidence, especially within short timescale, remains largely unknown and deserves further research. In this study, we aimed to investigate how older adults’ balance confidence would change over 30 days and explore whether baseline characteristics would explain the individual differences in change. We used data from the Daily Balance Project that employed intensive-repeated measurements to examine the dynamics of subjective and objective fall risk across a month. Twenty-one participants (age=78.6±5.8, 48%female) were enrolled, and individual characteristics were measured upon recruitment. Throughout the study, participants self-reported their daily balance confidence using the Activity-Specific Balance Confidence (ABC) Scale. We performed growth modeling techniques to examine change within a multilevel framework. Our results showed that overall, ABC scores were high (79.9±17.4) at first, but the linear change was non-significant (b=0.03, SE=0.21, p=.89) on average. However, we found that balance confidence increased in individuals with higher educational attainment (b=0.37, SE=0.13, p<.01) and decreased among those with greater physical fall risk (b=-0.18, SE=0.07, p<.01) and accurate understanding of fall risk at baseline (b=-0.24, SE= 0.12, p=.04). Although ABC scores were stable within the period of one month, our study highlights the distinction of individual characteristics in the process of balance confidence appraisal. We suggest that these nuances should be taken into account when developing more fine-grained fall risk assessments and interventions.
Sleep and Cognition: Results From a Longitudinal Cohort of Older Puerto Rican Adults
Authors: Arevalo Sandra
Published: December 2021

We examined cross-sectional and prospective associations of sleep duration and insomnia symptoms with measures of cognitive function among older adults aged 45-75 y from the Boston Puerto Rican Health Study, a longitudinal cohort of 1500 participants of Puerto Rican ancestry. We found, statistically significant cross-sectional associations of sleep duration (hours) and an executive function domain before (F=6.20; Prob>F=0.0001) and after (F=2.33; Prob>F=0.05) controlling for covariates (age, sex, education, smoking, drinking, mental and health conditions and medication use); between sleep duration and global cognition before (F=5.38; Prob>F=0.0003) and a trend after controlling for covariates (F=2.20; Prob>F=0.0669). In longitudinal associations, sleep duration (time2) was significantly associated with global condition at time3 (F=2.42; Prob>F=0.0475) after controlling for time2 global cognition. In conclusion, we found hours of sleep and insomnia symptoms significantly associated with various cognitive factors. A public health focus on sleep hygiene may improve cognitive health outcomes in older Puerto Rican adults.
Sensory Impairment is Associated With Recurrent Falls: Study of Women’s Health Across the Nation
Authors: Karvonen-Gutierrez Carrie , Hood Michelle , Ehrlich Joshua , Neitzel Richard , Ylitalo Kelly
Published: December 2021

This study evaluated the relationship between individual and combined sensory impairments (vision, hearing, peripheral nerve (PN)) with recurrent falls in the past year among 1951 women (mean age 65.6 years) from the Study of Women’s Health Across the Nation. Sensory impairments were defined as self-reported vision difficulty, hearing loss, or ≥4 on the Michigan Neuropathy Screening Instrument. Recurrent falls were defined as ≥2 self-reported falls. Hearing was the most commonly reported impairment (39.2%), followed by vision (22.1%) and PN (16.0%). Among those with any impairments, 7.0% of women reported impairments in all domains. Recurrent falls were more common among women with vision (19.4%), hearing (17.3%), or PN impairments (24.7%) as compared to women without sensory impairments (7.0%). The greatest burden of recurrent falls was among women with all three sensory impairments; one-third (34.6%) of women with vision, hearing and PN impairment were recurrent fallers. In an adjusted logistic regression model, vision, hearing, and PN impairments were associated with statistically significantly higher odds of recurrent falls in the past year (odds ratio (OR) = 1.58, 1.76, 2.11, respectively; all p<0.01), after adjustment for age, race/ethnicity, economic strain, and depressive symptoms. The presence of all three sensory impairments was associated with nearly 6-fold increased odds of recurrent falls (OR=5.65, 95% CI 3.25, 9.82) compared to women with no impairments. Sensory impairments often onset during mid-life and early late adulthood. This work demonstrates that these impairments are associated with falls and that women with impairments across multiple sensory domains are at greatest risk.
Program Practices Predict Intergenerational Interaction among Youth and Older Adults
Authors: Jarrott Shannon , Turner Shelbie , Naar Jill Juris , Scrivano Rachel , Weaver Raven
Published: December 2021

Non-familial intergenerational programs engage younger and older people in shared programming for mutual benefit, frequently involving senior centers or adult day programs and preschools. With growing interest in the potential benefits of intergenerational strategies, it is imperative to know their effects on participant interaction during intergenerational programming. To address this knowledge gap, activity leaders at five sites serving older adults and/or preschoolers received training to implement 14 evidence-based practices during intergenerational activities involving 109 older adult and 105 preschool participants over four years. We utilized multi-level modeling to test whether variations in implementation of practices were associated with variations in participants’ responses to programming on a session-by-session basis. For both preschool and older adult participants, analyses revealed that the implementation of certain practices was associated with significantly more intergenerational interaction. Specifically, when person-centered best practices (e.g., leading activities that are age- and role-appropriate for older adults) were implemented, preschoolers (estimate=5.83, SD=2.11, p=0.01 and older adults (estimate=5.11, SD=.10, p=0.02) had more intergenerational interaction. Likewise, when environmental-centered best practices were implemented, such as pairing materials between intergenerational partners, preschoolers (estimate=6.05, SD=1.57, p=0.002) and older adults (estimate=6.50, SD=1.85, p=0.001) had more intergenerational interaction. Our findings reveal session-by-session variation in intergenerational interaction that can be impacted by implementation practices, which highlights the importance of training activity leaders to implement evidence-based practices. Researchers and practitioners should consider how session-by-session variation in program implementation affects participant response.
Informal Caregivers’ Perceptions of Burdens and Benefits Predict Greater Confidence in Their Abilities
Authors: de Rosa Cristina , Lorenz Rebecca , Sullivan Suzanne
Published: December 2021

Informal caregivers experience both burdens and benefits from caregiving. This analysis aimed to determine whether caregiver perceptions of burdens and benefits predicted feelings of confidence in their abilities. In the National Study of Caregiving (NSOC) Round II (2015), we identified 1,390 caregivers as “primary” for providing the greatest number of care hours in the past month to individuals age 65 and over. Logistic regression was performed to assess the influence of primary caregivers’ gender, age, relationship to their care recipients, and self-reported indications of burdens and benefits on the odds that they would report confidence in their abilities. Caregivers were more likely to report confidence in their abilities when caregiving taught them to deal with difficult situations (OR=5.93, 95% CI [4.67, 7.54]), gave them satisfaction that their care recipient was well cared for (OR=1.97, 95% CI [1.26, 3.04]), and when caregiving brought them closer to their care recipient (OR=2.61, 95% CI [2.02, 3.36]). Caregivers were less likely to feel confident if they reported frequent changes in routine (OR=.78, 95% CI [.64, .96]). The final model predicted confidence (chi-square = 525.383 [4] p < .001) and correctly classified 78.7% of cases. All other variables were non-significant. These findings suggest that confidence in abilities is influenced by caregivers’ perception of learning to handle difficult situations, satisfaction, closeness to the recipient, and burdens associated with changes in routine. Future research should further explore burdens and benefits of caregiving. Health care providers should routinely assess caregivers and provide referrals for additional resources.
The association between caregiver education on adult T2DM and patient’s outcomes in community: A systematic review
Authors: Tark Aluem , Song Jiyoun , Kim Jeong-Yeon , Park So Yeon , Woo Kyungmi
Published: December 2021

Introduction Adult type 2 diabetes (T2DM) threatens public health and most patients manage their diabetic condition while in the community. As it is challenging for patients to properly manage diabetes alone, caregiver involvement in T2DM patient care is encouraged. This study aimed to examine the association between caregiver involvement in T2DM education within a community and the patients’ diabetes care outcomes (e.g., glycated hemoglobin (HbA1c) level, behavior, or hospitalization). Methods The available scientific literature in PubMed, Cochrane, EMBASE, and CINAHL was searched. The methodological quality of bias was assessed using the Cochrane risk of bias tool. Results A total of 13 out of 741 published studies were synthesized in this review. There is evidence that caregiver involvement in T2DM education is effective in the reduction of HbA1C and BMI, but not necessarily effective in reducing lipids. Study results indicate that caregiver related interventions can significantly improve patient diabetes knowledge, physical activity, and self-efficacy, but results were more mixed regarding medication adherence. Risk of bias analysis classified the majority of studies (77%) to be moderate or high quality. Conclusion This review aimed to explore the association between caregiver involvement in adult T2DM education in the community and patients’ diabetes care outcomes. The findings show an improvement in biological and behavioral self-management outcomes with caregivers involved in T2DM education, though no studies examined the direct association between complications or hospital readmission. Future research focused on tailored interventions and longer follow-up of patient outcomes are recommended.
“We’ve all Lost so Much”: The Experiences of Essential Family Caregivers’ Long Term Care Visitations During COVID-19
Authors: Chu Charlene , Yee Amanda , Stamatopoulos Vivian
Published: December 2021

Family caregivers are integral to the care of long-term care (LTC) residents. COVID-19 public health policies initially restricted all essential caregivers from visiting LTC homes. In lieu of in-person visitations, caregivers were allowed technology-based visits then restrictive outdoor visits, followed by indoor visitations. This study aims to illuminate the experiences of essential caregivers’ as they visited their loved ones in LTC during COVID-19’s restrictive policies. We conducted seven caregiver focus groups (N=30) from Ontario and British Columbia, Canada. Thematic analysis and line-by-line coding were completed using NVivo. We found six themes that were common to all the visitation types: 1) “LTC Home disorganization” to facilitate visits and poor communication; 2) “Lack of staffing and resources”; 3) “Mistreatment from staff and management” as caregivers were seen as inconveniences; 4) “Shock and disbelief” when family members first saw their loved ones; 5) “Significant lack of person-centered or family-centered ethos” for example the residents’ needs were ignored such that their cognitive and physical impairments sometimes made visitations impossible, as well as the burden of multiple weekly COVID-19 tests; and, 6) “Collateral damage” in the form of trauma and irreparable harm to the relationships between residents and families. These results emphasized caregivers who ultimately felt betrayed and ignored by the broader healthcare system. Our findings provide an in-depth understanding of how COVID-19 public health policies have impacted the essential caregivers and the long-lasting impacts on residents and caregivers alike. Understanding caregiver’s experiences can inform future pandemic response policies and encourage more person-centered protocols.