bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPLEMENTING A HEALTHY BRAIN INITIATIVE IN THE NATION’S LARGEST COUNTY JURISDICTION
Authors: Kuo Tony , Barragan Noel , Reyes Mariana , Thomas Ariane
Published: December 2022

In 2019, there were an estimated 166,857 Los Angeles County (LAC) residents living with Alzheimer’s disease. By 2040, this number is expected to rise by 150% to 405,382, with 152,980 and 35,341 of them, respectively, being Black and Latinx. Locally, there is special interest in reducing dementia risk among the two communities, as modifiable risk factors such as untreated hypertension, diabetes, and smoking are disproportionately higher in these groups (e.g., hypertension – Black, 35.9% vs. White, 27.3%; diabetes – Black and Latinx, 14.4% and 13.6%, respectively, vs. White, 8.8%). In LAC, considerable investments have been made to help create and implement the local arm of the California Healthy Brain Initiative (Healthy Brain Initiative: Los Angeles or HBI-LA). Launched in 2019, HBI-LA utilized a multi-level, multi-sector approach to expand the breadth and quality of tools available to the Black and Latinx communities and key stakeholders who work with these communities. The initiative set out to complete the following State-approved objectives: (i) educate the public and health professionals about dementia care and prevention; (ii) develop policies that improve access to health, aging, and prevention services for those with cognitive decline; and (iii) disseminate reliable, culturally sensitive information and tools to promote best practices on brain health. The present investigation examines the stepwise process that LAC took to achieve these objectives, including the development of two culturally tailored educational workshops (one for community members, one for healthcare and social services professionals) and how a U.S. Congressperson and County Supervisor supported dissemination efforts.
AGING IN COMMUNITY: LESSONS LEARNED IN THE FIRST YEAR OF DEVELOPING A GRASSROOTS, RURAL PROGRAM
Authors: Kinkade Emily , Hajdar Melisa , Fuller Heather
Published: December 2022

The North Dakota Aging in Community project has an overarching goal of creating programs that improve the quality of life of rural older adults by increasing community-level support to help them age in place in two rural communities. The progress of program development and implementation was assessed across the project’s first year through program data and steering committee surveys. Program data, including steering committee meeting minutes and monthly activity reports completed by program staff, were qualitatively analyzed for successes, challenges, and lessons learned by finding common themes within these data. Successes included the use of an apprenticeship/mentorship model utilizing consultants from similar grassroots, rural organizations, recruitment of an optimistic, enthusiastic, and collaborative steering committee, and employing patience to develop community-led efforts based on unique community needs. Challenges included hiring qualified staff in rural communities, limitations in infrastructure opportunities, and need for creative marketing strategies. Survey results aligned with these conclusions, yet demonstrated the strengths and challenges related to incorporating the ideas and needs of diverse stakeholders. These findings highlight the unique challenges in developing programs to support rural aging-in-place, yet also highlight unique strategies that leverage rural strengths. Based on the findings of this first-year evaluation, future directions include conducting needs assessments to identify new avenues for program development, ensuring local program ownership through continued development of local steering committees, and continuing the mentorship/apprenticeship model while creating strategies to successfully foster independence. By sharing lessons learned, this program may serve as a replicable model to foster rural aging-in-place.
UNDER THE SAME ROOF: GRANDPARENTAL CO-RESIDENCE AND CO-PARENTING PATTERNS IN MODERN CHINESE FAMILIES
Authors: Zhou Shuai , Liu Chang , Bai Xue
Published: December 2022

This study aimed to examine the role of grandparental co-residence in shaping coparenting patterns in the Chinese family context. Using a sample of 5,795 children (Mean age = 6.74 years; SD = 3.82) from the China Family Panel Studies 2012-2018, we offered a novel typology of six coparenting patterns based on daytime and nighttime childcare information: a) grandparental care only (15.4%); b) grandparent-parent coparenting (10.9%); c) parental care only (44.5%); d) grandparent-private coparenting (4.2%); e) parent-private coparenting (16%); and f) private care only (e.g., paid nanny, nursery schools/kindergartens, and others, 9.1%). Fixed-effects multinominal logistic regression was applied to investigate the effects of grandparental co-residence on daytime and nighttime childcare, and on daily coparenting patterns over time, controlling for a set of child and parental characteristics and family conditions. Grandmother co-residence contributed to both daytime and nighttime grandparenting, while grandfather co-residence increased the likelihood of grandparenting and private care during the daytime. In terms of daily coparenting, grandmother co-residence was associated with increased probability of grandparent-parent coparenting as well as grandparent-private coparenting, while grandfather co-residence merely increased the likelihood of parent-private coparenting. It also found that child’s experience of separation with mother during the last year and mother’s employment were two key determinants of coparenting behavior in Chinese families. Findings suggest that co-residing grandparents, particularly grandmothers, may function as a kind of supplementary care resource in response to the lack of maternal childcare resulted from migration and labor force participation.
OPENING THE DOOR TO AGING IN PLACE: FINDINGS FROM THE INTERGENERATIONAL TORONTO HOMESHARE PROGRAM
Authors: Hsieh Jessica , Mirza Raza , Tanner Jackie , Bull Amanda , Gardiola Andrea , Moore Carley , Kelly-Adams Deirdre , Klinger Christopher
Published: December 2022

Older adults prefer to live in their own homes for as long as possible — to 'age in place' — but for myriad reasons, may be unable to do so. To address this, a number of housing alternatives have been explored, including homesharing, or homeshare, an exchange-based shared housing approach with the potential to empower older adults to age in place by enabling them to obtain additional income, companionship, and assistance with completing household tasks in exchange for renting out a room in their home.An intergenerational homesharing pilot program in Toronto matched older adults (55+) with postsecondary students. With limited research in the area, a mixed methods research study was embedded within the pilot project with the goals of: 1) conducting a scoping review to map and synthesize the literature related to outcomes of homeshare participation for this population, 2) conducting in-depth interviews with homeshare participants (N=22) to learn about their experiences, and 3) conduct a full evaluation and exit survey to better understand the implications of the project. Results were organized around the following themes: (1) benefits and challenges of participating in homeshare for older adults; (2) intergenerational engagement as social exchange; and (3) the key role of agency facilitation as a determinant of the experience of homesharing for older adults. Results spoke to the unique benefits and challenges of participating in homeshare for this population. Findings were used to derive implications for policy and practice, as well as highlight areas for future research.
CHARACTERISTICS OF LONG-TERM HOME CARE PATIENTS WITH DEMENTIA
Authors: Yamanaka Takashi , Mizuki Maiko , Kidana Kiwami , Yamaga Ryonosuke , Akishita Masahiro
Published: December 2022

This study aimed to clarify the characteristics of older adults with dementia receiving physician home visits. We prospectively registered 179 patients aged ≥65 years, estimated to receive physician home visits for over 6 months, in a clinic in Chiba, Japan, in 2020–2021. The patients’ mean (±SD) age was 85.1±7.4 years and ranged from 68 to 102 years. Out of the total patients, 57.5% were men. We collected clinical information; employed the Dementia Assessment Sheet in Community-based Integrated Care System 21 items (DASC-21) and EuroQOL five dimensions 5-level (EQ-5D-5L) every 6 months; and calculated the incidence of death. Eighty-two patients (45.8%) were diagnosed with dementia at the commencement of physician home visits. The characteristics of older adults diagnosed with dementia (D+ group) were compared with the characteristics of those who were not (D- group). The D+ group was older than the D- group (86.4±6.6 years vs. 84.1±8.0 years, p=0.04118). Total cholesterol levels and DASC-21 scores were higher in the D+ group compared to the D- group (180.2±41.7 vs. 163.7±51.2, p=0.04091; 62.3±14.5 vs. 50.2±16.2, p=0.00004, respectively). The EQ-5D-5L was not significantly different between the groups (0.439±0.255 vs. 0.397±0.267, p=0.32409). The proportion of those living in assisted living facilities or fee-based homes for the elderly was higher in the D+ group (χ2=8.5177, df=2, p=0.01414, V=0.2258). The mortality rate after 6 months was 20.7% in the D+ group and 16.5% in the D- group (χ2=0.5305, df=1, p=0.46641). In conclusion, the characteristics of patients with dementia should be further elucidated to provide better care.
TYPES OF ATTENDEES IN COMMUNITY SPACE IN JAPAN: TOWARD DESIGNING AN ENVIRONMENT FOR SOCIAL PARTICIPATION
Authors: Takase Mai , Ogino Ryogo , Nitanai Ryoichi , Nakayama Riko , Kim Hongjik , Kazembe Neo , Goto Jun , Iijima Katsuya
Published: December 2022

Introduction

Designing community space for social participation of older adults is essential for healthy aging. The behavioral characteristics of the attendees have much to offer as they relate to social settings designed in the space. This study aims to elucidate the basic typology of the attendees considering their motivation for attendance and state of social connection.

Methods

Semi-structured interviews targeting attendees of Chiiki-Katsudokan, a space designed for social participation in a larger aging estate in Japan, were conducted in December 2021 (N=16, 16% male). Attendees were asked about their reasons for attending events at Chiiki-Katsudokan, interaction levels with other attendees, and levels of social participation during the COVID-19 pandemic.

Results

Based on the interviews, attendees were classified into three types: Seeker, Hobbyist, and Socializer. First, Seekers (n=3) used Chiiki-Katsudokan as the primary means of preventing social isolation. Amongst the three types, the social interaction level of Seekers was the lightest, and the opportunity decreased when Chiiki-Katsudokan closed during the quarantine. Second, the main motivation for Hobbyists (n=5) was the event contents which matched their interests. Hobbyists were also likely to engage in hobby networks, which continued privately during the pandemic. Finally, Socializers (n=8) attended Chiiki-Katsudokan to communicate with friends. Many were initially socially active and engaged in social interaction outside Chiiki-Katsudokan, e.g., teatime with friends, during the quarantine.

Conclusion

This study suggested that designing community space for social participation requires defining the varying levels of engagement and expecting relationships outside the space based on the behavioral characteristics of the attendees.
MEANINGFUL ACTIVITY ENGAGEMENT AND WELL-BEING AMONG DISABLED OLDER ADULTS: THE MODERATED ROLE OF ENVIRONMENT
Authors: Tung Yi-Hsuan , Chi Iris , Wu Shinyi , Chao Shiau-Fang
Published: December 2022

Engaging in meaningful activities has been seen as an important way to sustain the well-being of older adults with disabilities and to achieve person-centered care. Yet, it is still unclear whether and to what extent meaningful activity engagement promotes well-being for community-dwelling older adults with disabilities, and how the environmental factors could affect these relationships. This study aims to investigate the relationship between meaningful activity engagement and psychological well-being, and to explore the moderated role of environmental factors (physical, attitudinal, service/support, policy). Survey data conducted in Taiwan between April and July of 2018 were analyzed by using multiple regression (N=1,244). Three types of meaningful activities (instrumental, social, and leisure) were identified based on a self-rated activity meaningfulness measure. Findings showed that higher levels of engagement in three types of meaningful activities were associated with better quality of life (QOL), but only engaging in meaningful leisure was associated with less depressive symptoms while adjusting functional status. Perceived better policy-related environment (e.g., long-term care services) could reinforce the positive effects of three types of meaningful activity engagement on QOL and depressive symptoms. Findings also indicated perceived attitudinal environment moderated the association between meaningful leisure activity engagement and QOL. These results established the influences of meaningful activity engagement on the well-being of community-dwelling older adults with disabilities and highlight the importance of age-friendly environment in supporting meaningful activity engagement and older adults’ well-being.
EVALUATING IMPLEMENTATION FIDELITY TO A NURSE-LED CARE MODEL IN NURSING HOMES: A MIXED-METHODS STUDY
Authors: Guerbaai Raphaelle Ashley , De Geest Sabina , Simon Michael , Popejoy Lori , Wellens Nathalie , Denhaerynck Kris , Zúñiga Franziska
Published: December 2022

Implementation fidelity assesses the degree to which an intervention is delivered as intended. Little is known about how it acts as a moderator between an intervention and its intended outcome(s) and which factors affect the fidelity trajectory over time. We exemplify implementation fidelity in INTERCARE, a nurse-led care model implemented in eleven Swiss nursing homes (NH) successfully decreasing unplanned hospital transfers. A mixed-methods design was used, guided by the Conceptual Framework for Implementation Fidelity. Fidelity to INTERCARE’s core components was measured with 44 self-developed items at 4-time points (baseline, 6, 12 months after intervention start, 9 months post-intervention; fidelity scores were calculated for each component and overall. Structured notes from NH meetings were used to identify moderators affecting the fidelity trajectory over time. Generalized linear mixed models were computed to analyze the quantitative data. Deductive thematic analysis was used for the qualitative analysis. The quantitative and qualitative findings were integrated using triangulation. A higher overall fidelity score showed a decreasing rate of unplanned hospital transfers (OR: 0.65 (CI=0.43-0.99), p=0.047). Higher fidelity score to advance care planning was associated with lower unplanned transfers (OR= 0.24 (CI 0.13-0.44), p= < 0.001) and a lower fidelity score for communication tools (e.g., ISBAR) to higher rates in unplanned transfers (OR= 1.69 (CI 1.30-2.19), p= < 0.003). High implementation fidelity to INTERCARE was necessary to achieve a reduction in unplanned transfers. In-house physicians with a collaborative approach and staff’s perceived need for nurses working in extended roles were important factors for high fidelity.
RESULTS OF A PILOT IMPLEMENTATION OF AN ADL GUIDELINE FOR NURSING PROFESSIONALS IN THE NETHERLANDS
Authors: Cremer Svenja , Bleijlevens Michel , Metzelthin Silke , de van Ginkel Janneke de Man-van , Zwakhalen Sandra
Published: December 2022

Nursing care in activities of daily living (ADL), such as washing, dressing, or eating is frequently provided while being poorly informed by scientific evidence. To address nursing professionals’ need for guidance we developed a practice guideline on ADL-care. This guideline comprises eleven core recommendations on involving care receivers and informal caregivers in ADL-care, identifying ADL-care needs, and effective ADL-interventions. Since the success of this guideline hinges on its actual use by nursing professionals, we assessed the use and determined influencing factors to guide targeted strategies for future implementation in different nursing care settings. In a mixed-method study, nursing professionals documented the number of core recommendations applied over three weeks using recording forms and a self-administered questionnaire to identify barriers and facilitators. In addition, we conducted focus groups to capture team experiences in applying the 11 core recommendations and clarifying survey results. Seven nursing care teams participated from various settings: hospital (n=1), rehabilitation (n=2), home-care (n=1), and long-term care (n=3). Preliminary results reveal that participants consider the core recommendations compatible with and adaptable to current practices, and their care settings. Participants experienced advantages over existing practices. However, core-recommendation usage and perception of influencing factors appeared to be highly context-dependent, especially regarding the involvement of informal caregivers in ADL-care. Limited knowledge on the application of interventions to improve ADL limited the use of some recommendations. Our results underline the necessity of careful selection of targeted strategies for each setting tailoring the core recommendations to the different qualifications and roles of nursing professionals.
WHAT MATTERS TO OLDER SURGICAL PATIENTS AND THEIR CARERS DURING THEIR HOSPITALIZATION?
Authors: Thillainadesan Janani , Box Helen , Kearney Leanne , Naganathan Vasi , Cunich Michelle , Aitken Sarah , Monaro Sue
Published: December 2022

Older adults account for a growing proportion of the surgical population. We investigated patient- and carer-reported experiences of hospitalization in this group. A mixed-methods study using telephone and postal surveys of recently hospitalized vascular surgical patients aged ≥ 65 years at an acute care academic hospital. Qualitative data were thematically analyzed using a framework approach. In total 46 patients (mean age 77 years, 78% male) and nine carers were surveyed. Nine (20%) patients were frail (Clinical Frailty Scale score >4). The majority of patients reported overall they felt their views were listened to (n=42, 89%), were kept informed (n=39, 83%) and were asked about their pain level (n=37, 79%). Among the nine carers, seven reported overall they felt their views were listened to (n=42, 89%) and were kept informed (n=39, 83%). Thematic analysis of responses to open-ended survey questions about their experience of hospitalization revealed four key themes: receiving fundamental care including hygiene and nutrition, importance of the hospital environment such as sleep and meals, being informed and involved in health care decision-making, and treating pain and deconditioning to help recovery. Findings from this study identified that older adults admitted to hospital for surgical care, and their carers, highly value care that meets fundamental needs and involves them in decision-making and recovery. These priorities can be addressed through Age-Friendly Health System initiatives such as the implementation of the “4Ms” of geriatrics care: what matters, medication, mobility and mentation.
A SUCCESSFUL EDUCATIONAL INTERVENTION LINKING DEMENTIA PATIENTS AND FAMILIES WITH COMMUNITY RESOURCES
Authors: Barnes Stacy , Duthie Edmund , Denson Kathryn , McAlister Jennifer , Betley Wendy , Szymkowski Amanda , Malone Michael , Simpson Deborah
Published: December 2022

Unpaid caregivers provided approximately 83% of the care for the 6.2 million Americans aged 65+ who were living with Alzheimer’s dementia in 2021. Physicians and other health professionals are not well informed about dementia-related community resources and rarely refer patients/families despite strong evidence which supports incorporating community services as part of an ongoing treatment plan. To bridge this gap, partnership with community agencies is essential. The Alzheimer’s Association’s “Direct Connect” referral program is provider-initiated and connects patients/families with disease information, care consultations, support groups, a 24/7 Helpline, and other resources. As part of the Wisconsin Geriatric Workforce Enhancement Program award from HRSA (U1QHP28712) 1,023 health professionals working in Wisconsin hospitals and primary care clinics were trained to use Direct Connect. Our educational intervention re-framed dementia from a hopeless disease to a chronic condition requiring supportive services as a necessary component of the disease management plan. Results of a paired-samples t-test (n=675) indicated our educational intervention had a significant impact on trainees' self-reported pre/post-test knowledge in both hospitals [t(444) = -34.67, p < 0.001, d = 1.64] and primary care [t(229) = -24.63, p < 0.001, d = 1.62]. By the end of the 5-year project period, Direct Connect referrals totaled 1,352 and the program grew from less than 50 referrals to 290 annually. While these results are promising, Direct Connect remains underutilized and initiatives to further increase referrals from providers must be expanded.
STRONGER MEMORY: EXPERIENCES OF OLDER ADULTS AND CAREGIVERS IN AN INTERVENTION PROGRAM FOR COGNITIVE PERFORMANCE
Authors: Kang Hyun , Tompkins Catherine , Barrett Kendall , Keesee Francesca , Magee Catherine , Lauber Mckenzie , Ihara Emily , Fredericksen Jessica
Published: December 2022

Subjective cognitive decline (SCD), defined as self-reported memory issues that have worsened over the past year, can be one of the first indications of Alzheimer’s disease and related dementias. SCD affects nearly 9% of Virginians aged 45 or older, and 31% of these individuals live alone. A practice-based intervention is essential to addressing the challenges associated with cognitive impairment. This study examined the effect of StrongerMemory program, which involves a series of cognitive exercises. The StrongerMemory program provides a 12-week curriculum designed to stimulate the brain’s prefrontal cortex, which governs the ability to retrieve memories. Participants are encouraged to spend 20 to 30 minutes a day reading aloud, writing or journaling and completing simple math problems. The Mason Gerontology Research Team investigated the pre- and post-cognitive outcomes among 43 participants who participated in the StrongerMemory program to determine the effectiveness of the program. The cognitive outcomes were evaluated using the Mini Montreal Cognitive Assessment 2.1 (Mini MoCA). The mean (SD) scores in Mini MoCA evaluated in the participants were 12.60 ± 2.1 (pre-test) and 13.53 ± 1.9 (post-test). The mean difference was statistically significant. Our results indicate that the StrongerMemory program is beneficial for cognition. The premise around the StrongerMemory program is that prior to a diagnosis or even with a diagnosis of mild cognitive impairment, a decline can be slowed and possibly prevented by participating in a program like StrongerMemory. The Mason Gerontology Research Team continues to evaluate the StrongerMemory program to examine its impact on SCD.
SELF-CARE AND QUALITY OF LIFE IN PEOPLE WITH PARKINSON’S DISEASE AND THEIR CAREGIVERS
Authors: Kim Eunyoung , Lee JuHee , Chung Misook , Yoo Subin
Published: December 2022

Objective

To examine associations of self-care and the quality of life (QOL) in patients with Parkinson's disease (PD) and their caregivers dyads.

Background

Patients with PD engage in self-care with motor and non-motor symptom experiences. There is insufficient knowledge about associations of self-care and QOL in patients with PD and their caregivers though PD patients and family caregivers are interdependent. Method: A total of 73 PD patients and primary family caregivers from the Korean Parkinson's Disease Association or who visited outpatient clinics of the tertiary hospitals in Korea participated in this study. Dyad members completed the survey of the self-care (the Self-Care of Chronic Illness Inventory and Caregiver Contribution to Self-Care of Chronic Illness Inventory) and QOL (Parkinson’s Disease Quality of Life Questionnaire and The Parkinson’s Disease Questionnaire-Care). The comparisons of self-care and quality of life within two dyad members were conducted via paired t-test and Pearson's correlation using SPSS 26.0 Result: PD patients reported significantly higher levels of self-care maintenance (78.34 vs. 70.21, patients vs. caregiver respectively, p<.001) and management (65.9 vs. 60.49, p=.029) than caregivers. Patients’ self-efficacy was significantly correlated with their QOL (r=.270, p=.021). Caregiver contribution to self-care management was significantly correlated with their own QOL (r=.365, p=.001) and patients’ QOL (r=.234, p=.047).

Conclusion

The self-care efficacy of patients and the contribution of caregivers to self-care management can affect the QOL of both patients and caregivers. A dyadic approach for the intervention of self-care management is crucial to improve the QOL of patients with PD and caregivers.
UNDERSTANDING THE CHARACTERISTICS AND WELL-BEING OF AMERICAN INDIAN AND ALASKA NATIVE GRANDPARENT CAREGIVERS
Authors: Danielson Ramona , Davis Shelly , Adamsen Collette
Published: December 2022

Background

American Indian/Alaska Native (AI/AN) grandparents have always had an important role in their grandchildren’s lives. Grandparents being the primary caregiver of their grandchildren has become a more pronounced occurrence in AI/AN populations in recent years and warrants review.

Methods

Data come from the National Resource Center on Native American Aging’s 2017-2020 needs assessment of AI/AN adults ages 55+. Analysis explored demographic and well-being indicators by caregiving status (N=19,855): not a caregiver of a grandchild (non-CG; 71%); part-time caregiver (PT-CG; 18%); and primary caregiver (PR-CG; 11%).

Results

Caregivers were more likely to be younger, be married, have higher education and incomes, and live with family in a single-family residence than non-CG. PR-CG were more likely to be female, employed full-time, and live with family on reservation/trust land than PT-CG and non-CG. Regarding indicators of well-being, caregivers were more likely to participate in cultural practices than non-CG. PT-CG were more likely to socialize and have recently participated in vigorous exercise, were less likely to have fair/poor health, and had fewer daily self-care restrictions than PR-CG and non-CG. PR-CG were more likely to be obese and daily smokers and had a higher measure of mental health concern, but were less likely to have recently binge drank or mainly eat alone than PT-CG and non-CG.

Conclusions

The demographics reviewed were all significantly different. PT-CG had better outcomes, pointing to a potential protective benefit, while PR-CG had more mental health strain. Further research is needed to better understand the interconnectedness of the indicators analyzed.
CAREGIVER SINGING VERSUS MUSIC ACTIVITIES IN DEMENTIA CARE: DIFFERENT BENEFITS IN DIFFERENT OCCASIONS
Authors: Hammar Lena , Lövenmark Annica , Swall Anna
Published: December 2022

Music has been used in the care of persons with dementia (PWDs) in decades, and research show that music activities such as background music, music listening, sing-along activities and playing instruments have positive effects on mood, emotions and interaction. However, Caregiver Singing (CS)- when caregivers are singing for or together with PWDs during care activities, are commonly in literature mixed up with other music activities. CS is a care intervention aiming to facilitate care situations and has shown to be useful to increase interaction and cooperation in care activities. This study aimed to describe caregivers’ experiences of the differences between using CS compared to music in the care of persons with dementia.Data was three focus group interviews with 12 professional caregivers and residential facilities for PWDs. Data was analyzed with qualitative content analysis. Results revealed that CS are a successful tool to communicate, cooperate and bring out the PWDs hidden resources during care activities. The PWDs were told to be more adequate even thou the caregivers sings instead of speaking. Music activities were described to increase moods and socialization and are important part to increase a nice atmosphere. However, it does not increase cooperation in the way CS does. As interventions to facilitate caring situations with PWDs are needed, and CS has shown to be effective and should therefore be seen as an intervention not mixed up with traditional music activities. It is an important contribution in the education for staff in dementia care to include training in CS.
THE ROLE OF CAREGIVING IN COGNITIVE FUNCTION AND CHANGE: A REGARDS STUDY
Authors: Elayoubi Joanne
Published: December 2022

Caregiving is often associated with elevated levels of stress and depressed mood. There is some evidence that higher caregiving strain is associated with worse cognitive functioning, however, findings are mixed. The current study examined the relationship between caregiving and cognitive functioning, and the potential mediating effects of depressive symptoms and high-sensitivity C-reactive protein (hsCRP). We identified participants in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study who were family caregivers at baseline assessment (n=3,118), and then used propensity matching on 14 sociodemographic and health variables to identify 3,118 non-caregivers. Participants completed repeated assessments of global cognitive functioning, learning and memory, and executive functioning and processing speed. Our results showed caregivers and non-caregivers did not differ on cognitive functioning at baseline or in rate of change in cognition over time. Caregivers had higher baseline depressive symptoms than non-caregivers but depressive symptoms and hsCRP did not mediate the relationship between caregiving strain and cognition. The present study, using several methodological advances not found in most previous papers on caregiving and cognition (large sample size, propensity matching of caregivers and non-caregivers, longitudinal methods) found no evidence that caregiving or caregiving strain significantly influenced cognitive performance. Results are consistent with recent research demonstrating that, while caregiving can be highly stressful, many caregivers are resilient and do not show marked declines in cognition and health, or higher mortality. A more balanced narrative of caregiving, emphasizing resilience and both the problems and benefits of caregiving, is indicated.
AGE-RELATED DIFFERENCES IN THEORY OF MIND: A TIME-VARYING FUNCTIONAL CONNECTIVITY APPROACH
Authors: Rincon Samuel Naranjo , Betzel Richard , Krendl Anne
Published: December 2022

Theory of Mind (ToM) refers to the act of inferring someone’s inner state, such as their emotions and thoughts. Previous work also demonstrated that ToM performance declines across age, but the mechanisms underlying this are not well-understood. The brain regions underlying ToM are generally in the default mode network (DMN) – a group of brain regions particularly vulnerable to pathological aging. Recent work suggests that declines in functional connectivity (FC; correlations between brain regions) during resting state (a period of undirected thought) predict age deficits in ToM. However, these findings come from aggregated FC, ignoring potentially informative details of dynamic changes during resting state. Researching these details may provide more specificity related to social cognitive aging. To test this, 35 older adults (OA; M = 75.61; 22 female) and 40 young adults (YA; M = 21.58; 25 female) underwent resting state and task-based fMRI. During the task, they completed a standard ToM task. We conducted time-varying functional connectivity analyses in the DMN to identify dynamic changes over time. Overall, OA had more variability than YA, but variability benefitted YAs, and not OAs. This occurred specifically in a DMN subnetwork associated with contextual information in memory. These results suggest that variability is useful, but only to an extent. With respect to ToM, variability may promote how YA integrate contextual information to memory, but is ineffective for OA.
NEUROPSYCHIATRIC SYMPTOMS AND MORTALITY FOR COGNITIVELY NORMAL OLDER MEXICAN AMERICANS
Authors: Cantu Phillip , Snih Soham Al , Markides Kyriakos
Published: December 2022

Objectives

Neuropsychiatric symptoms (NPS) present in older adults with Alzheimer’s disease (AD) and other dementias are related to mortality. Research on the relationship between NPS and mortality in a non-dementia population has not been conducted. This study examines NPS as a predictor of six-year mortality among community dwelling Mexican Americans aged 80 years and older.

Methods

Data included 466 cognitively normal participants from wave 7 of the Hispanic Established Population for the Epidemiologic Study of Elderly. NPS were measured using the Neuropsychiatric inventory (NPI). Cox proportional hazard modes were used to estimate the hazard ratio (HR) of mortality.

Results

The hazard ratio death at six years was 1.02 (95 % CI, 1.00-1.04) as a function of having any NPI score and 1.09 (95% CI 1.02-1.17) for number of NPI conditions, controlling for demographic and health characteristics. Apathy, irritability, and aberrant motor behavior were all independently predictors of mortality.

Conclusions

NPS may be modifiable risk factors to increase survival time or may by indicative of underlying healthy problems. NPS may be related to underlying health conditions among older adults with normal cognitive functioning.
WEALTH INEQUALITIES IN PHYSICAL AND COGNITIVE IMPAIRMENTS AMONG OLDER ADULTS ACROSS EUROPE AND JAPAN
Authors: Quashie Nekehia , Le Dung D , Ibuka Yoko , Brandt Martina
Published: December 2022

Although prior research has provided insights on the association between country-level factors and health inequalities, key research gaps remain. First, most previous studies examine subjective rather than objective health measures. Second, the wealth dimension in health inequalities is understudied. Third, a handful of studies explicitly focus on older adults. To bridge these research gaps, this study aims to: i) measure wealth-related health inequalities in physical and cognitive impairments; and ii) examines the extent to which welfare states moderate wealth inequalities in physical and cognitive impairments among older people across Japan and Europe. We utilized harmonized data of non-institutionalized individuals aged 50-75 for physical and cognitive impairments from the Japanese Study of Aging and Retirement (JSTAR) and the Survey of Health, Ageing and Retirement in Europe (SHARE), for (n= 31,969 and 31,348, respectively). We applied a concentration index to quantify the degree of wealth inequalities in impairments. Our multilevel linear regression analyses examined whether national public health spending and healthcare access resources explained cross-country differences in wealth inequalities in physical and cognitive impairments. Findings indicated that inequalities in both impairment outcomes favored wealthier individuals in all countries, but the magnitude of inequality varied across countries under examination. Furthermore, a higher share of public health spending, lower out-of-pocket expenditures, and higher investment in healthcare resources were associated with lower wealth inequalities especially for physical impairments. Our findings suggests that different health interventions and policies may be needed to mitigate specific impairment inequalities.
INFORMAL CAREGIVING NETWORKS FOR PERSONS WITH DEMENTIA SUPERIMPOSED ON COMPLEX MULTIMORBIDITY
Authors: Song Mi-Kyung , Paul Sudeshna , Happ Mary Beth
Published: December 2022

Informal caregiving research has focused on the primary caregiver and caregiver-patient dyad. Thus, we know little about caregiving beyond the dyadic relationship. This study was to gain a comprehensive understanding of informal caregiving networks for individuals with dementia superimposed on complex multimorbidity. We used egocentric social network analysis to obtain caregiving information of 46 patients with moderate to severe cognitive impairment, 5 chronic conditions on average, and undergoing hemodialysis (4.3 mean years). Most patients (n=35, 77.8%) were Black, 22 (47.8%) male, and mean age of 73.9 years. Starting with the primary family caregiver (FCG), up to 2 additional FCGs were recruited for each patient, totaling 76 FCGs (46 primary, 30 non-primary). Most were a child of the patient (n=39, 51.3%), female (n=57, 75%), and 54.2 years of age. Of the 46 networks, 16 (35%) included only one FCG (singletons). Multimember networks (n=30, 65%) provided longer caregiving than singletons (7.7 vs 3.8 years, p=0.008). Average network size was 2.8, and 26 (54.5%) networks had at least one male caregiver. Among the 30 multimember networks, average size was 3.8, density (proportion of possible ties) was 0.9, and mean degree and maximum degree (number of ties per member to other network members) were 2.5 and 2.8, respectively. Higher mean and maximum degrees were associated with fewer 12-month patient hospitalizations (r=-0.47, p=0.01; r=-0.43, p=0.02, respectively). Including additional caregiver informants significantly increased network size, ties and maximum degree centrality compared to those based on primary caregiver only, allowing for fuller network description.
UNDERSTANDING THE IMPACT OF CARE LITERACY ON PREVENTATIVE CARE: EVIDENCE FROM FAMILY CARERS IN JAPAN
Authors: Costantini Hiroko
Published: December 2022

To address the importance of family carers’ understanding of care, encompassing their own care as well as the broader care and health social systems, this paper leverages the notion of ‘care literacy’. The aim of this study is to understand the variation in care literacy and the impact of care literacy on preventative care. The empirical focus is on working family carers for older relatives in Japan, through a cross-sectional online survey that includes a novel operationalization of care literacy, established measure of health literacy, assessment of information used to understand care, and measures of preventative care. The participants’ (n = 292) mean age was 53, with 44% women, and an average of 8.3 hours per week caring for their parent(s). The measure of care literacy is shown to be correlated, as expected, but distinct to health literacy (correlation 0.60). Based on regression analysis of care literacy, significant explanatory variables are health literacy (p< 0.001), gender (p=0.044), number of sources of information on care (p=0.029), and care hours (p< 0.001). In contrast, proximity in living arrangements of carer and care receiver, and severity of care needs were not significant predictors. Turning to the impact of care literacy, care literacy is a significant explanatory variable for use of preventative measures (p=0.002), in particular related to nutrition (p< 0.001), frailty (p=0.028), dementia (p=0.090) and general home renovations (p=0.018). The pattern of results from this cross-sectional analysis indicates the importance of understanding the potential for improved care literacy as an enabler of better care.
MENTAL HEALTH AND WELL-BEING OF OLDER CARERS DURING THE COVID-19 PANDEMIC: EVIDENCE FROM ENGLAND
Authors: Gessa Giorgio Di , Price Debora
Published: December 2022

Older people caring at home or in the community play a vital role in supporting population health and wellbeing and in protecting health and care systems, often at cost to their own health. Yet there has been very little research or policy attention given to this group of carers during the pandemic. Exploiting longitudinal data from Wave 9 (2018/19) and the first two COVID-19 sub-studies (June/July 2020; November/December 2020) of the English Longitudinal Study of Ageing, we use logistic and linear regression models to investigate associations between changes in provision of informal care and mental health during the pandemic, controlling for socio-demographic characteristics, pre-pandemic physical and mental health, and social isolation measures. During the first months of the pandemic, about a quarter of older people provided informal care (with ~10% caring for members living in the same household). Those caring in the household experience worse mental health during the pandemic. Even controlling for prior characteristics and lack of social interactions, those caring for family members in the household had higher odds of reporting elevated depressive symptoms (OR=1.67, 95%CI=1.07;2.62), poor self-rated health (OR=1.73, 95%CI=1.09;2.73), anxiety (OR=2.21, 95%CI=1.20;4.06) as well as lower quality of life (B=-0.85, 95%CI=-1.66;-0.05) and life satisfaction (B=-0.43; 95%CI=-0.78;-0.09) than those who were caring for friends and family outside the household. As we aim to build back society and restore the wellbeing of our populations, policies and services should be better directed to support those people who during the pandemic struggled to cope while caring for their family members.
EMPOWERING BEHAVIOR CHANGE TO SUPPORT BRAIN HEALTH AMONG OLDER ADULTS
Authors: Lock Sarah , Han Duke
Published: December 2022

This symposium will provide highlights from the Global Council on Brain Health’s (GCBH) body of work on behavior change. This work is focused on developing a better understanding of (a) how to persuade and motivate people to engage in sustained healthy behaviors, (b) how to change policies within local communities to support individuals’ ability to make healthy choices, and (c) how to optimize conditions for brain health so all can thrive. The GCBH is an independent collaborative of scientists, clinicians, scholars, and policy experts convened by AARP to provide evidence-based advice on what people and professionals can do to maintain and improve brain health. The Council translates scientific research into actionable recommendations aimed at helping to drive behavior change in individuals across communities and cultures. Experts were brought together to build consensus around a range of factors at the individual and societal level that influence individual behavior and decision-making. This presentation will also draw upon lessons learned from the field of health promotion and examples from communication campaigns around heart health will be discussed as they relate to brain health. Nationally representative surveys, fielded by AARP Research including diverse respondents of adults 40+ and health care professionals diagnosing and treating dementia, found that misperceptions and stigma about dementia are commonplace and hinder efforts to address brain-healthy behaviors. Physicians who used to treat dementia patients, now themselves living with dementia, discuss how championing change, providing hope and refuting stigma can even help those living with a dementia diagnosis.
CLINICAL TRIAL OF METFORMIN FOR FRAILTY PREVENTION IN COMMUNITY-DWELLING OLDER ADULTS WITH PRE-DIABETES
Authors: Espinoza Sara , Wang Chen-pin , Michalek Joel , MacCarthy Daniel , Cortes Tiffany , Powers Becky , Musi Nicolas
Published: December 2022

Background

Metformin may reduce frailty through improving insulin resistance and inflammation, aging mechanisms known to increase frailty risk. We describe a randomized clinical trial of metformin for frailty prevention in community-dwelling older adults with pre-diabetes and provide baseline characteristics of randomized participants.

Methods

Older adults (65+ years) are studied in this randomized, double-blind, placebo-controlled trial of metformin (max 2,000 mg/day). Pre-diabetes, required for inclusion, is assessed by 2-hour oral glucose tolerance test (OGTT). Individuals with glomerular filtration rate < 45 mL/min and frail individuals (Fried criteria) are excluded. The primary outcome, frailty, is assessed by both Fried criteria and frailty index. Secondary outcomes are physical function (short physical performance battery), lower extremity strength (Biodex), 6-minute walk, inflammation (systemic and skeletal muscle tissue), muscle insulin signaling, insulin sensitivity (insulin clamp), glucose tolerance (OGTT), and body composition (dual-energy x-ray absorptiometry). Subjects are followed for 2 years with safety assessments every 3 months and frailty assessment and OGTT every 6 months.

Results

145 participants (49% female, 35% Hispanic) are randomized. Mean age is 71.8 ± 5.4 years (range: 65-88), body mass index is 30.8 ±6 kg/m2, and Hemoglobin A1c is 5.6 ±0.4%. Using Fried criteria, 63.4% have frailty score of 0, 30.3% a score of 1, and 6.2% a score of 2.

Conclusion

Metformin is being examined as a potential therapeutic agent to prevent frailty in older adults with pre-diabetes. Findings from this trial may have future implications for screening and treatment of pre-diabetes in older adults for the prevention of frailty.
HEART-HEALTHY LIFESTYLES REDUCE THE RISK OF COGNITIVE DECLINE
Authors: Lock Sarah , Yaffe Kristine
Published: December 2022

The Global Council on Brain Health (GCBH) convened experts from around the world to examine the impact of cardiovascular risk factors on brain health. GCBH issue experts carefully considered how high blood pressure, diabetes and stroke, as well as lifestyle choices such as diet and exercise, influence brain health in adults age 50 and over. The GCBH concluded that the best evidence to date shows us “what’s good for the heart is good for the brain.” Their consensus puts powerful tools in the hands of adults wanting to protect their brain as they age. The GCBH adopted 10 recommendations for individuals to incorporate into their lives to keep heart and blood vessels healthy and reduce the risk for cognitive decline and dementia. These recommendations and 16 practical tips are provided in the final report. Liaisons from numerous civic and nonprofit organizations with expertise in heart and brain health helped develop these recommendations for adults 50+ and their health care providers.
RISK OF FRAILTY ASSOCIATED WITH COGNITIVE DECLINE, SENSORY IMPAIRMENTS, AND FUNCTIONAL LIMITATION IN OLDER ADULTS
Authors: Shin Jinhee , Kim Gwang Suk , Afaya Agani
Published: December 2022

The purpose of this study was to examine the effects and risk factors of cognitive decline, sensory impairment, and functional limitation associated with frailty among older adults. We conducted secondary data analysis using data from the Korean Longitudinal Study of Aging (2006–2018). The participants of this study consisted of 1,789 older adults over the age of 65 in South Korea who had never experienced frailty at the beginning of the survey (2006). Participants were classified into two groups, frailty and non-frailty, based on frailty events over time. We used Kaplan–Meier analysis to determine the effects of frailty-related group differences on cognitive decline (K-MMSE), sensory impairment (visual and hearing), and functional limitation (K-ADL) from 2006 to 2018. To determine the risk factors associated with frailty, the Cox regression analysis was performed. This study established that over time, approximately 71.2% of the older adults (n = 1,274) developed frailty. The study also revealed that over time, both physical (sensory impairment and functional limitation) and psychological factors (cognitive decline) could lead to frailty. We also identified that demographic (age, female), physical (BMI, chronic disease, hearing, vision, and K-ADL), and psychological (K-MMSE) factors were associated with frailty. This study provides an opportunity for healthcare professionals and policymakers to implement intervention programs tailored to ensure regular monitoring prevention and among of these risk factors.