bluuebunny/crossref_metadata_2025 huggingface dataset:
New Computational Approaches to Aging Research
Authors: Levine Morgan E
Published: December 2020

Aging is associated with numerous changes at all levels of biological organization. Harnessing this information to develop measures that accurately and reliably quantify the biological aging process will require systems biology approaches. This talk will illustrate how epigenetic data can be integrated with cellular, physiological, proteomic, and clinical data to model age-related changes that propagate up the levels—finally manifesting as age-related disease or death. I will also describe how network modeling and machine learning approaches (linear and non-linear) can be used to identify causal features in aging from which to generate novel biomarkers. Given the complexity of the biological aging process, modeling of systems dynamics over time will both lead to the development of better biomarkers of aging, and also inform our conceptualization of how alterations at the molecular level propagate up levels of organization to eventually influence morbidity and mortality risk.
Sex-Dimorphism in Aging Gene Regulation: Are We Missing Half of the Picture?
Authors: Benayoun Bérénice , Lu Ryan , Sampathkumar Nirmal , Kim Min Hoo
Published: December 2020

The existence of human supercentenarians reveals a surprising predictor for exceptional longevity: being female. Not only are 33 out of 34 living supercentenarians women, women are also more resistant to most diseases responsible for age-related morbidity in the US. However, because most molecular aging studies generally opt to use only one sex, sex-driven differences in aging remain poorly understood. A key compartment that can actively respond to sex-specific inputs throughout life is the immune system. Indeed, the majority of age-related diseases share common inflammatory mechanisms, a phenomenon described as “inflamm-aging”. Macrophages play an important role in the inflammatory response throughout life, and are considered major mediators of this phenomenon. Thus, to unbiasedly dissect sex differences in immune aging, we generated ‘omics’ data from 4 and 20 months old female and male mice. Intriguingly, we found that transcriptional aging in primary macrophage populations varies strongly between sexes, with up to 20-fold more aging changes in female vs. male cells. Pathways specifically downregulated in females with aging included lysosome, inflammation and phagolysosome. We confirmed experimentally that metabolic preferences of macrophages are indeed directly modulated in this context (e.g. glycolytic preference for male-derived cells). Our results support the notion that there are functional differences in aging trajectories in the immune system of female vs. male mice. Our research could provide new insights into the molecular underpinnings of sex-dimorphism in aging and disease.
Using C. elegans to Find Genes, Mechanisms, and Drugs to Slow Cognitive Decline
Authors: Murphy Coleen
Published: December 2020

Cognitive decline is one of the most important losses of human quality of life with age. To find new treatments that might slow these declines, it is useful to have short-lived, rapidly aging models in which to identify possible treatments. We found that C. elegans also lose their ability to learn and remember with age, along with other neuronal functions (axon regeneration, motility, etc.), and these declines are staved off by reduction in the insulin signaling pathway, which also extends lifespan. Both the mechanisms that regulate neuronal functions and the mechanisms that slow decline are well conserved evolutionarily, suggesting that we can use worms to identify new genes and compounds that might slow decline. Additionally, we have developed new C. elegans models of Parkinson’s and Alzheimer’s diseases, and through genetic, genomic, and metabolic studies we have found new approaches that may slow these declines.
Modulation of the Aging Drosophila Brain and Susceptibility to Neurodegeneration
Authors: Bonini Nancy
Published: December 2020

Human neurodegenerative diseases, like amyotrophic lateral sclerosis, Alzheimer’s disease and frontotemporal dementia, are late-onset progressive neurodegenerative disorders for which few cures or treatments are available. To develop new insight, we have been using the model organism Drosophila. We can re-create disease-associated protein toxicity in the fly brain, and then take advantage of the powerful molecular genetic approaches to define pathways and mechanisms. The fly is allowing us to reveal mechanistic understanding that we can then extend to the human condition. These studies have highlighted multiple novel pathways involved in longterm integrity of the brain. Among these processes, we have defined epigenetic pathways critical for longterm brain health. These pathways typically converge on stress pathway players, highlighting that boosting the ability of the nervous system to combat stress may help promote healthful brain aging and resistance to degenerative disease pathways.
Linking Epigenetics, Metabolism and Cancer: Lessons From SIRT6
Authors: Mostoslavsky Raul
Published: December 2020

In recent years, chromatin regulators have emerged as key modulators in cancer. We discovered that the mammalian histone deacetylase SIRT6 is a key chromatin factor, modulating expression of metabolic, developmental, and ribosomal protein genes. In recent studies, we identified a loss of function mutation in SIRT6 behind a human syndrome of perinatal lethality. In the context of cancer, we found SIRT6 to act as a robust tumor suppressor, by modulating glucose metabolism. As Otto Warburg described decades ago, cancer cells exhibit glycolytic metabolism, where pyruvate, instead of contributing to ATP production in the mitochondria, is converted to lactate even under normoxia conditions. We found SIRT6 as the first chromatin factor in charge of suppressing the Warburg effect in colon and skin cancer. At the cellular level, SIRT6 inactivation leads to increased cellular glucose uptake, higher lactate production and decreased mitochondrial activity. Our results indicate that SIRT6 directly regulates expression of several key glycolytic and ribosomal genes, co-repressing Hif1a and Myc, respectively, and acting as a histone H3 lysine9 (H3K9) and lysine 56 (H3K56) deacetylase. Notably, we recently identified SIRT6 as the first deacetylase to specifically inhibit transcriptional elongation, rather than initiation, in its targets. Strikingly, we determined in new studies that such glycolytic switch provides an advantage even at the early initiating cancer stem cells stage, in what we identified as the cell-of-origin for the Warburg effect. In addition, we found SIRT6 to act as a robust tumor suppressor in the context of pancreatic cancer. However, in this case, SIRT6 did not influence metabolism, but rather silenced expression of the developmental gene Lin28b, in this way protecting against aggressive undifferentiated pancreatic adenocarcinoma. Our studies highlight the important role epigenetic factors, such as SIRT6, play in protecting against tumor progression by providing “epigenetic plasticity”, inhibiting adaptive responses in transformed cells.
Novel Roles for the Sirtuin Deacylase SIRT5 in Normal Physiology and in Cancer
Authors: Lombard David
Published: December 2020

Sirtuins are NAD+-dependent deacylases that regulate diverse cellular processes such as metabolic homeostasis and genomic integrity. Mammals possess seven sirtuin family members, SIRT1-SIRT7, that display diverse subcellular localization patterns, catalytic activities, protein targets, and biological functions. Three sirtuins, SIRT3, SIRT4, and SIRT5, are primarily located in the mitochondrial matrix. SIRT5 is a very inefficient deacetylase, instead removing negatively charged post-translational modifications (succinyl, glutaryl, and malonyl groups) from lysines of its target proteins, in mitochondria and throughout the cell. SIRT5 plays only modest known roles in normal physiology, with its major functions occurring in the heart under stress conditions. In contrast, in specific cancer types, including melanoma, we have identified a major pro-survival role for SIRT5. We have traced this function of SIRT5 to novel roles for this protein in regulating chromatin biology. New insights into mechanisms of SIRT5 action in cancer, and in normal myocardium, will be discussed.
Supporting the Transition From Hospital to Home for Older Adults: Case Study Results
Authors: Weeks Lori , Barber Brittany , MacDougall Eileigh Storey , Moody Elaine , Steeves-Dorey Lexi , Warner Grace , Macdonald Marilyn , Misener Ruth Martin
Published: December 2020

It is often during transitions between health services that many issues arise for older adults, such as care that is poorly coordinated, additional burden placed on family and friend caregivers, and inappropriate placement in nursing homes. The Home Again program delivered by the provincial health authority in Nova Scotia, Canada, provides transitional care through providing additional support beyond what is normally provided through home care services to help older adults transition home after a hospital admission. The purpose of this research was to identify what factors contribute to older adults being placed unnecessarily in a nursing home when they could receive care through the Home Again program. Through using a retrospective multiple case study design, we analyzed interviews for five cases including older adult patients, their family or friend caregivers, and healthcare professionals in each case. Results indicate all hospitalized patients experienced a major health event or rapidly declining health. All family and friend caregivers experienced burnout and frustration from the lack of sufficient home care supports and quality of services available, such as services provided throughout the night. Healthcare professionals discussed that patients were placed on a waiting list for nursing homes due to lack of home care supports and resources for caregivers. This study contributes to our knowledge about better processes to ensure that hospitalized older adults are not unnecessarily admitted to nursing homes which can result in reduced healthcare costs and improved delivery and quality of care to older adults and their family and friend caregivers.
Stem Cells: The Future Promise of Stem Cells in Healthspan
Authors: Webb Ashley
Published: December 2020

Tissue specific stem cells are critical for maintenance and repair of tissues and organs throughout life. However, during aging, the functionality of stem cells declines, contributing to tissue decline. This symposium will focus on the mechanisms underlying stem cell aging in various compartments, including muscle, brain and the hematopoietic system.
Development of the African Killifish as a New Model to Study Aging and Suspended animation
Authors: Brunet Anne
Published: December 2020

We have pioneered a new model organism for aging research, the naturally short-lived African killifish Nothobranchius furzeri. The African killifish lives in ephemeral pools of water in Africa, and has evolved a short life cycle adapted to this habitat. Its embryos can also resist drought until the next wet season in a state of ‘suspended life’. In laboratory conditions, the African killifish has a maximal lifespan of about 4-6 months, and is, so far, the shortest-lived vertebrate that can be bred in captivity. We have successfully transformed this natural short-lived vertebrate into a usable model organism for aging research, including de novo assembly of the genome and CRISPR-Cas9 mediated genome-editing. Our goal is to use this model to discover new principles underlying aging, longevity, and ‘suspended animation’ in vertebrates.
3D Team Care Management Trial: Study Design Features and Participant Characteristics
Authors: Fortinsky Richard
Published: December 2020

This clinical trial was designed in partnership with a Medicare Advantage (MA) plan, with the goal of comparing two care management approaches for its MA policyholders age >65 living with cognitive vulnerability. To test the efficacy of the 3D Team, we are using a randomized design, with the comparison group receiving telephonic care management currently offered to MA members. In this presentation, detailed aspects of the study design, characteristics of the study population, and patterns of 3D team referrals will be explained. To date, 390 older adults and 306 informal caregivers are enrolled in the trial toward a recruitment goal of 576 older adults and 380 caregivers. Among older adults, 40% have depression only, 23% have dementia only, and the rest have more than one of these conditions and/or delirium. Most common referrals by 3D Team nurse practitioners are to the community health educator and to physical and occupational therapy.
Advancing Alzheimer’s Disease Care and Services Among Racial and Ethnic Minorities
Authors: Smith Lenora , Thorpe Roland
Published: December 2020

Research shows consistent and adverse disparities among racial and ethnic minorities compared to non-Hispanic Whites in the prevalence and incidence of Alzheimer’s disease, mortality, participation in clinical trials, use of medications and other interventions, health care expenditures, and quality-of-life outcomes. The literature suggests numerous underlying causes, including factors related to measurement of the disease, genetics, socioeconomic factors, cultural differences, lack of culturally competent interventions, and discrimination in services and care. Although these disparities are well known, little is known about the effectiveness of various strategies to address these differences within the context of Alzheimer’s disease services and care. This symposium aims to contribute to this knowledge. The first presentation examines the role of race with marital status and risk for dementia using data from the Health and Retirement Study. Results suggest differences for unmarried White and unmarried older adults of color, which can inform dementia care services. The second presentation highlights the opportunities and challenges of facilitating cognitive impairment screenings among African American congregations. The third presentation introduces attitudes about brain donation among African American research participants and suggestions to increase involvement. The symposium concludes with a presentation on hearing care disparities in dementia with practical recommendations on how to close this gap in hearing care. The findings from these papers contribute significantly to the impact of ethnoracial differences in dementia and the need to include more diverse populations in ADRD research to promote equity. Alzheimer’s Disease Research Interest Group Sponsored Symposium.
Screening for Cognitive Impairment in African American Congregations
Authors: Epps Fayron
Published: December 2020

Having access to memory screenings is pivotal to early detection in the African American (AA) community. The purpose of this report is to describe the willingness and perceived barriers of AA congregants to participate in memory screenings. Out of 283 attendees to dementia-related church forums, 26% (n = 73) of the attendees participated in private memory screenings. The majority of the participants were female (88%, n = 64). Under half of the participants (37%, n = 27) scored below normal with 81% (n =22) being female. Several attendees declined the opportunity to have their memory screened for various reasons. These results support how women are disproportionately affected by cognitive impairment. Another alarming point was the low participation in memory screenings of event attendees. This report is important because it raises awareness of the need within the AA community, who are at a higher risk for memory loss, to receive screening. Part of a symposium sponsored by the Alzheimer’s Disease Research Interest Group.
Differential Association of Geographical Region of Birth With Dementia Risk Across Black Women and Men
Authors: Avila-Rieger Justina , Murchland Audrey , Seblova Nika , Glymour Maria , Brickman Adam , Schupf Nicole , Mayeux Richard , Manly Jennifer
Published: December 2020

Risk of dementia is both racially and spatially patterned. Less is known about sex/gender differences in pathways linking birth place to late-life cognitive outcomes in older non-Latino Blacks. The 1464 Black men and women included in these analyses were Northern Manhattan residents. Cox regressions revealed that Stroke-Belt South (SB) and Non-Stroke-Belt South (NSB) birth was associated with a higher dementia risk, adjusted for birth year, childhood SES, and risk of death. Compared to Northern-born (NB) men, SB men had the highest risk, followed by NSB women and SB women, while NSB men and NB women had a similar risk to NB men. The higher risk for SB men and NSB women remained after adjusting for education, adult income, and CVD burden. Future work should identify why birth in the SB is uniquely detrimental for cognitive health among Black men, while birth in NSB has the strongest impact on Black women.
Adult Children’s Support and Trajectory of Depressive Symptoms Among Disabled Chinese Older Adults
Authors: Wang Jianyun , Zhong Renyao , Pei Yaolin , Wu Bei
Published: December 2020

This study aimed to examine the trajectory of depressive symptoms among Chinese older adults with disabilities and the role of adult children’s support in predicting trajectory classes of depressive symptoms. Data were drawn from three waves of the China Health and Retirement Longitudinal Study (2011-2015). The sample included 1420 disabled older adults age 60+ at the baseline and completed all three waves of the data. Growth mixture model shows two-class depressive symptoms trajectories: the higher risk group (25.49%) and the lower risk group (74.51%). Logistic regression results showed that respondents who received a longer term of adult children’s instrumental support were more likely to be classified in a higher risk group after controlling the covariates (OR=1.184, p<0.05), while financial support and the frequency of contacts were not associated with the increased level of depressive symptoms. The policy implications were also discussed in this study.
Creating Inclusive Advance Care Planning Tools
Authors: Beringer Robert , Gutman Gloria , de Vries Brian , Kwan Helen , Jang Katrina , Vashisht Avantika , Kaur Taranjot
Published: December 2020

The cultural appropriateness of two ACP tools, My Wishes, My Care, and Conversation Starter Kit, are examined. In development by the BC Centre for Palliative Care, My Wishes, My Care was reviewed with: LGBT Non-Metropolitan Older Adults (6 focus groups, N=32); English/Chinese Speaking Older Adults (1 focus group, N=9); and English/Punjabi or Hindi Speaking South Asian Older Adults (1 focus group, N=5). The Conversation Starter Kit, developed by Ariadne Labs, was reviewed with focus groups of people whose loved one was/is in a Care Home: one LGBT group (N = 5); one South Asian group (N = 5). General feedback on both tools included: concerns over level of understanding required to use the tool; the role of family in ACP planning; cultural inclusivity (e.g., images and text) and design elements. The feedback will inform revision of these tools and assist organizations in developing inclusive ACP planning guides or educational materials.
Deprescribing and Polypharmacy for Medicare Beneficiaries Under Guardianship in Long-Term Care Facilities
Authors: Swenson Tami
Published: December 2020

Local judicial courts vary in the amount of supervision they provide guardians, which makes the practice of guardianship uneven. To begin to address the evidence gap to inform best practices for persons under guardianship care, this study examines the issues of polypharmacy and prescribing patterns for four therapeutic classes most commonly targeted for deprescribing for older adults. The Medicare Current Beneficiary Survey (MCBS) for 2015 and 2016 is used to examine facility-dwelling Medicare beneficiaries under guardianship compared with those that are not. Logistic regression is used to examine association of polypharmacy outcomes and guardianship care controlling for patient and facility characteristics. Statistical models are adjusted using Fay’s Method with replicate weights for the MCBS complex survey design. Approximately 12% of the facility-dwelling Medicare population in 2015 and 2016 are persons under guardianship care. Persons under guardianship were more likely to have polypharmacy or to be prescribed 5 or more medications (Odd Ratio (OR)=1.168, 95% Confidence Interval (CI)=1.156 to 1.180, p<0.001) than facility-dwelling Medicare beneficiaries not under guardianship care. Medicare beneficiaries under guardianship were more likely to be prescribed PPIs (OR=1.229, 95% CI=1.222 to 1.237, p<0.001) or antipsychotic medications (OR=1.240, 95% CI=1.232 to 1.247, p<0.001) but less likely to be prescribed benzodiazepines (OR=0.920, 95% CI=0.913 to 0.927, p<0.001) or antihyperglycemics (OR-0.726, 95% CI=0.721 to 0.731, p<0.001). Medical decision support services, such as guardianship care, are increasing in importance as shared decision making between patients and physicians evolves to address polypharmacy and deprescribing for older adults.
Does Long-Term Care Substitute for Hospital Care? Evidence From the China Health and Retirement Longitudinal Survey
Authors: Yang Wei
Published: December 2020

Publicly funded long-term care (LTC) support is shrinking in many countries despite continuing increases in the number of older people who need care. Evidence has shown that the LTC services have an impact on the efficient use of the resources in the health care sector by reducing rates of admission and associated costs through assisting older people with daily living. This paper seeks to examine whether and to what extent these services are substitutes. We use a fixed-effect instrumental variable GMM model to predict the effect of long-term care services on the utilisation of outpatient and inpatient care services. Data are drawn from China Health and Retirement Longitudinal Survey 2011, 2013 and 2015. Our findings suggest that LTC significantly reduces the use of outpatient care but not inpatient care. We have also found LTC use is concentrated among the rich, but the substitution effects are stronger among the poor compared to the rich. This indicates that the poor would benefit more from subsided LTC services. We urge the Chinese government to take action to develop its formal LTC system and to channel more resources to its LTC system, which will benefit the older population in general, and the poor in particular.
A Comparison of Symptoms in Hospitalized African American and White Persons With Dementia
Authors: Galik Elizabeth , Marie Boltz , Arendacs Rachel , Kuzmik Ashley
Published: December 2020

There exist significant race disparities in the prevalence of dementia, with black persons with dementia (PWD) showing higher co-morbidity and more frequent hospitalizations, yet little is known how clinical presentations compare. This study compared physical function, delirium, depressive symptoms, and behavioral and psychological symptoms of distress (BPSD) in black and white PWDs when hospitalized. A multivariate analysis of covariance showed that, controlling for age, gender, cognitive status, and comorbidities, black PWD had more delirium (mean= 3.8, SD= 2.9) as compared to white PWDs (mean=2.4, SD= 2.2, F=4.8, p =.029). Additionally, black PWD had more depressive symptoms (mean= 11.7, SD= 6.7) as compared to white PWD (mean = 9.0, SD= 5.2, F=6.6, p =.011), and less improvement in functional status admission to discharge (mean =12.4, SD= 18.9) as compared to white PWD (mean=17.8, SD=18.8, F=12.3, p=.001). There were no differences in BPSD. Continued research examining factors influencing differences in race cohorts is warranted.
Large-Scale Measurements of Physical Activity With Wearable Devices: An International Perspective
Authors: Urbanek Jacek , Schrack Jennifer , Roth David
Published: December 2020

In recent years the popularity and application of both research- and consumer-grade wearable physical (PA) activity monitors have witnessed substantial growth in large observational studies and clinical trials. For example, the NHANES and UKBiobank, have collected accelerometry data on thousands of participants contributing to the reputation of wearable technology overall as well as in aging-oriented research. As a result, more aging-focused studies including the Baltimore Longitudinal Study of Aging, Maastricht Study, Finnish Retirement and Aging study, and the National Health and Aging Trends Study, along with clinical trials have introduced accelerometry protocols into their design. The symposium focuses on challenges in the implementation of the objective measurements of PA into large studies on older adults. We will discuss the design of successful projects held and/or completed in the United States and Europe including: (1) types of devices, (2) size of datasets, (3) steps necessary for the successful device implementation, (4) data management and (5) statistical analyses. We will also present primary, PA-related findings in each study, together with funded or planned follow-up work. Collectively, these presentations will improve understanding of the technology and effort necessary for the successful application of objective PA monitoring and the resulting data analysis, providing a better context for investigators in the field of aging who want to introduce wearable devices into existing and upcoming research. The discussion will focus on the future of these technologies in the context of geriatric medicine and gerontology and the consequent steps essential for their best utilization and further expansion.
Supporting People With Dementia in the Community: Occupational Therapy Service and Reimbursement Innovations
Authors: Lepore Michael , Long Erin , Fortinsky Richard
Published: December 2020

The wide range of services needed to support a safe and quality life among people living with dementia at home is growing and extends beyond the bounds of traditional reimbursement models. Within the context of a health care system that is not designed to reimburse for these types of services, federal grants from the Alzheimer’s Disease Programs Initiative (ADPI) funded by the Administration for Community Living (ACL) have supported the delivery of home- and community-based services (HCBS) for people with dementia and their care partners with a pragmatic emphasis on sustainability, such as establishing successful reimbursement pathways. Drawing lessons from ACL’s ADPI program and from the Health Resources & Services Administration Geriatric Workforce Enhancement Program and Geriatrics Academic Career Award program, this symposium examines opportunities and strategies for providing services to people living with dementia in the community and highlights occupational therapy as a valuable dementia care service that has potential for sustainable delivery and opportunities for professional expansion. Papers address needed workforce development for delivering HCBS to diverse populations living with dementia and examine occupational therapy roles in delivering HCBS to persons with dementia and their care partners. Additionally, papers examine the implementation and outcomes of evidence-based occupational therapy and interprofessional interventions for persons living with dementia in the community. Reimbursement mechanisms for occupational therapy services delivered to people with dementia in the community are described. Discussion addresses how these innovative interventions and reimbursement mechanisms align with the recent surge of National Institute on Aging funding for pragmatic trials.
FIGS Study Outcomes: Disentangling Relationships Between Vision Loss, the Environment, Physical Activity, and Falls
Authors: Ramulu Pradeep , Gitlin Laura , Schrack Jennifer
Published: December 2020

The longitudinal relationships between various aspects of mobility (with each other and with vision loss) are important to understand for healthy aging. The Falls in Glaucoma Study (FIGS) was a three-year longitudinal study conducted in persons with a range of visual field damage from glaucoma (from normal visual fields to severe visual field damage) and evaluated several aspects of mobility: physical function (gait and balance), physical activity (annual accelerometer trials), fall rates (prospectively-collected falls calendars), environmental features (an in-home assessment), and fear of falling. In this symposium, we present data demonstrating that: (1) physical activity is altered by visual field damage - lowering the overall amount of physical activity, and also resulting in more fragmented activity (i.e. shorter activity bouts); (2) specific home environmental features, such as better lighting, are associated with lower rates of falls within the home; (3) specific gait and balance features increase the risk of falling, but do not explain the association between visual field damage and a higher rate of falls; (4) injurious falls, but not non-injurious falls, lead to future reductions in physical activity; and (5) worsening of fear of falling (FoF) leads to either a higher rate of falls (at low FoF levels) or decreases in physical activity (at higher FoF levels). Study findings will educate the audience about the types of mobility problems found in persons with visual field damage, potential methods to prevent falls in older adults, and factors likely to predict future mobility deficits in older adults.
The Relationship Between the Home Environment and Falls for Older Adults With Visual Impairments
Authors: Swenor Bonnielin , Mihailovic Aleksandra , Ramulu Pradeep
Published: December 2020

The home environment and features of the home have been identified as important risk factors for falls, and may pose particular risk for older adults with visual impairments given difficulty with hazard perception. We used data from 245 participants in the Falls in Glaucoma Study [mean age: 71 years, mean follow-up: 31 months] with homes graded using our previously validated Home Environment Assessment for the Visually Impaired (HEAVI), which quantifies the number of in-home fall-related hazards and found that neither the number of hazards nor the percentage of hazardous items were associated falls/year. However, each 10-fold increase in lighting was associated with a 35% lower rate of falls/year (RR=0.65, 95%CI=0.46 to 0.92) and there was a 50% reduction in falls/year when lighting was at or above 30 footcandles (minimum lighting level recommended by the Engineering Society of North America) compared to lighting <30 footcandles (RR=0.50, 95%CI=0.26 to 0.96).
Facilitators and Barriers to the Implementation of Function and Behavior Focused Care
Authors: Vigne Erin , Galik Elizabeth , Resnick Barbara
Published: December 2020

Function and Behavior Focused Care (FBFC) is a two tiered intervention based on the Social Ecological Model and Social Cognitive Theory that focuses on training long term care staff to cue, model, and assist residents with dementia to engage in physical activity and perform functional tasks. FBFC was implemented by a Research Nurse and a facility based Champion for 12 months and involved a four step approach: (1) Environment and Policy Assessments; (2) Staff Education; (3) Establishing Resident Care Plans; and (4) Mentoring and Motivating of Staff and Residents. Facilitators of implementation included administrative support, an identified champion, and supportive environments and policies. Challenges and barriers included the fear of falls, fear of behavioral symptom exacerbation, competing priorities, and lack of facility specific goals. Innovative approaches to overcoming these barriers will be reviewed.
ESPO/ Health Sciences Section Symposium: Leveraging Older Adults’ Perceptions of Chronic Illness to Improve Care
Authors: Prasad Anyah , Morgan Brianna , Naylor Mary
Published: December 2020

In advanced years of life comorbidity of chronic illnesses is a common phenomenon. While chronic illnesses have been documented to impact overall quality of life, morbidity, and mortality, older adults may develop psychological resources in the years of coping and managing their illnesses. These psychological resources can be influenced by individual perceptions and context as people age, and include concepts such as psychological resilience, inner strength, subjective age, and illness perception. This symposium brings together emerging health science scholars’ work on exploring and leveraging these psychological resources to improve care. Amy Ketcham will present a systematic review of psychological resilience and depression in adults with cardiac disease. Brianna Morgan will present a concept analysis exploring the nature of inner strength in people aging with serious illness and cognitive impairment. Anyah Prasad will present results examining the association between chronic illnesses and subjective age and discuss its clinical relevance. Eleanor Rivera will explore illness perception phenotypes in a longitudinal cohort study of older adults with chronic kidney disease. Together, the perspectives shared in this symposium improve understanding of and indicate ways to move toward person-centered and contextual clinical models of care in the management of chronic illnesses among older adults. In addition, the discussant will engage in a dynamic conversation about psychological resources in later life and the role these projects have played in advancing the presenters along their academic trajectories.
Characterizing Illness Perception Phenotypes in Older Adults With Chronic Kidney Disease
Authors: Rivera Eleanor , Hirschman Karen , Townsend Raymond
Published: December 2020

An individual’s understanding of their chronic illness (illness perception) is a psychological resource that has an impact on coping and self-management behaviors. Our previous study identified illness perception phenotypes (overall patterns of illness perceptions) in a sample of older adults with heart failure, COPD, and chronic kidney disease. These phenotypes were associated with perceived self-management ability (patient activation) and recent hospitalizations. To further characterize the illness perception phenotypes we focused on older adults with chronic kidney disease, analyzing illness perception data along with potential covariates from the multi-center longitudinal Chronic Renal Insufficiency Cohort study (CRIC). Covariates include sociodemographics, disease parameters, personality type, disease knowledge, and treatment adherence. While personality type was associated with illness perception phenotype, disease knowledge and treatment adherence were not. We have also conducted qualitative analyses of in-depth interviews. These results will inform the development of a pilot intervention incorporating illness perception information into the clinical setting.
Socioeconomic and Psychosocial Mechanisms Underlying Racial and Ethnic Disparities in Cognition Among Older Adults
Authors: Zahodne Laura , Sharifian Neika , Kraal A Zarina , Morris Emily , Zaheed Afsara , Sol Ketlyne , Manly Jennifer , Brickman Adam
Published: December 2020

Racial/ethnic disparities in cognitive aging are only partly attributable to socioeconomic indicators. Emerging literature highlights psychosocial factors, such as related constructs of discrimination and perceived control. Using data from 1,463 older adults (51% Hispanic, 27% non-Hispanic Black, 22% non-Hispanic White) in the Washington Heights-Inwood Columbia Aging Project, cross-sectional mediation models quantified separate indirect effects of Black race and Hispanic ethnicity on global cognitive composite scores. Socioeconomic status explained approximately 50% of Black-White and Hispanic-White disparities in cognition. Perceived control explained an additional 5-8%. Discrimination was not associated with cognition. Significant racial/ethnic disparities remained after accounting for the included socioeconomic and psychosocial factors, indicating that future studies should consider additional potential mediators. Lower perceived control, which likely reflects chronic exposure to interpersonal and institutional marginalization, may be a particularly salient psychosocial risk factor for poorer cognitive aging among certain racial/ethnic minority groups.
More Energy and Less Fatigue: Implications for Successful Brain Aging
Authors: Rosano Caterina , Glynn Nancy
Published: December 2020

Higher energy and lower fatigue are intuitively important to live independent, active lives. However, little is known about the relation between brain health, energy, and fatigue in older adults. From a neurobiological standpoint, energy and fatigue appear to rely on distinct, albeit overlapping brain networks, but most evidence is from patients with neurodegenerative conditions. These relations have not been fully examined in community older adults. In this symposium, we first present an overview of the neurobiology underlying fatigability and energy states. We will then present original unpublished data on brain health, fatigability, and energy from four well-established epidemiological studies of aging: Osteoporotic Fractures in Men Study (MrOS), Long Life Family Study (LLFS), Baltimore Longitudinal Study of Aging (BLSA), and the Health Aging Body Composition Study (Health ABC). Specifically, Ms. Allen will explore whether personality traits are related to perceived mental fatigability in MrOS. Using LLFS data, Ms. Gmelin will examine whether perceived physical fatigability is associated with global cognition, verbal fluency, memory and psychomotor speed. Dr. Schrack will share BLSA data showing cross-sectional and longitudinal associations between lower walking efficiency and reduced brain volumes. Dr. Tian will evaluate the neuroimaging signature of perceived energy levels in Health ABC. Taken together, our data indicate that higher energy and lower fatigability likely reflect overlapping but distinct aspects of brain health. The long-term effects of promoting energy and lowering fatigability on dementia should be further studied.
New Evidence on the Biobehavioral Mechanisms of Chronic Pain in Aging African Americans
Authors: Booker Staja
Published: December 2020

African American older adults are living longer with chronic pain, which presents a huge personal and societal burden. A growing group of scholars are now devoted to accurately and precisely characterizing and phenotyping the experience of pain in aging using within-group and advanced methodological designs to elucidate the biopsychosocial-behavioral responses to pain. In this symposium, five dynamic presenters present new evidence on mechanisms of pain in older African-Americans. Dr. Roach’s investigation reveals the effect of genetic alterations of sickle cell disease (SCD) on stress-related pain in younger and older adults; this scientific inquiry is especially important because there is little research on SCD in aging. Next, Dr. Terry, extends these findings by exploring the association between psychosocial factors such as experiences of discrimination, pain catastrophizing, and perceived stress on neural (brain) responses via magnetic resonance imaging. From a clinical perspective, Dr. Booker reports on the first-ever model of intra-racial differences in movement-evoked pain in older African-Americans with knee osteoarthritis and healthy controls. Our final two presenters use a translational approach to identify how older African-Americans cope with chronic pain. Dr. Robinson-Lane’s study highlights the unique experience and predictors of coping, adaptation, and self-management of chronic pain in Black dementia caregivers. Finally, Dr. Cobb’s research from a large cross-sectional study correlates social, behavioral, and health factors with opioid and psychotropic use in economically disadvantaged older African-Americans. This symposium offers novel ways of understanding social determinants of pain and assisting African-Americans and their caregivers to manage complex chronic pain in later life.
Palliative Care With Dementia and Family Caregiver Involvement (A Collaborative Symposium between the Hospice, Palliative, and End-of-Life Care and Nursing Care of Older Adults Interest Groups)
Authors: van der Steen Jenny , Johnson Christopher , Zimmerman Sheryl
Published: December 2020

This collaborative symposium offered by the Hospice, Palliative, and End-of-Life Care and Nursing Care of Older Adults Interest Groups addresses palliative care including advance care planning considerations for family caregivers and persons with dementia. Family caregivers may need information about palliative and end-of-life care that is specific to the person, the situation or the stage of dementia. This symposium shows information needs also differ by country and setting. Conversations about symptoms, and about current and end-of-life treatment preferences need support from healthcare professionals. The symposium shows results of a study on video recordings with end-of-life preferences and how, as a stand-alone, they may not inform palliative care practice, and integration of information sources for advance care planning is needed. We will also show that a question prompt list with examples of questions to encourage family caregivers to ask healthcare professionals can and should have different contents for different countries as the content reflects socio-cultural differences. In more studies, participants clearly neede information on the disease trajectory and available services. Such needs go beyond need for information on pain and other symptoms, as family caregivers often appreciate opportunities for social activities for persons with dementia. A decision aid study shows that persons with dementia and family caregivers can participate in advance care planning conversations when supported by the right tools. We argue that local client participation is important when developing tools. Overall, the symposium highlights the need for tailored tools to support face-to-face conversations with all stakeholders to encourage person-centred caregiving.
Association of the Amount and Pattern of Physical Activity With Arterial Stiffness: The Maastricht Study
Authors: Vandercappellen Evelien , Henry Ronald , Stehouwer Coen , Koster Annemarie
Published: December 2020

We examined the associations of the amount and the pattern of higher intensity physical activity with arterial stiffness. Data from The Maastricht Study (n=1699; mean age: 60±8 years, 49.4% women, 26.9% type 2 diabetes (T2DM)) were used. Arterial stiffness was assessed by carotid-to-femoral pulse wave velocity (cfPWV). The amount (hours/day) and pattern of higher intensity physical activity were assessed with the activPAL3®. Activity groups were: inactive (<75min/week), insufficiently active (75-150min/week), weekend warrior (>150min/week in ≤2 sessions), and regularly active (>150min/week in ≥3 sessions). After full adjustment, higher intensity physical activity was associated with lower cfPWV (amount: -0.35[-0.65;-0.05], insufficiently active: -0.33[-0.55;-0.11]; weekend warrior: -0.38[-0.64;-0.12] and regularly active: -0.46[-0.71;-0.21] (reference: inactive)). These associations were stronger in those with T2DM. Participating in higher intensity physical activity was associated with lower cfPWV, regardless of the weekly pattern, and may be an important strategy to reduce CVD risk, particularly in T2DM.
Reserve and Healthy Aging
Authors: Felix Cynthia , Sprague Briana
Published: December 2020

In line with the GSA 2020 Annual Scientific Meeting theme of “Turning 75: Why Age Matters”, our symposium highlights the fact healthy aging is relevant to maintaining reserve- be it brain/cognitive reserve or physiological reserve. Even among older adults 75 or older, continuing to practice healthy aging habits, helps with reserve. In this symposium, Drs. Felix and Carlson discuss how positive neuroplastic processes such as social engagement and social volunteering may aid in brain/cognitive reserve. Dr. Lin discusses how negative neuroplastic processes such as hearing loss may hamper the same. The “use-it-or-lose-it” hypothesis may be a common pathway in effecting brain reserve, regardless of whether the inputs are social or sensory stimuli. Physiological reserve is also important in aging, and Dr. Sprague talks about energy and frailty, with frailty being an accelerated decline of physiological reserve. While the studies presented are from older adult populations, reserve often takes a lifetime of effort to build and maintain. The symposium speakers present several hypotheses such as brain reserve, cognitive reserve, cognitive load, information degradation, sensory deprivation and frailty. An application of these concepts, would help older adults practice aging habits that promote reserve, into advanced old age, at individual and community levels. Brain Interest Group Sponsored Symposium
Spreading Telehealth for Older Adults in Rural Areas Through Network of Geriatric Interprofessional Teams
Authors: Barczi Steven , Gately Megan , Welch Lauren , Nearing Kathryn , Thielke Stephen , Pimentel Camilla , Previll Laura , Dryden Eileen
Published: December 2020

Older adults living in rural areas have limited access to geriatrics interprofessional team care. In the Veteran healthcare system, geriatric teams such as geriatricians, nursing professionals, social workers, pharmacists and psychologists, located in urban areas link up with rural clinics to provide geriatric consultation remotely through clinical video telehealth and other means in the project GRECC Connect. Since its inception in 2014, the service has now grown to 16 geriatric teams offering consultation to over 100 clinic sites serving older rural Veterans. GRECC Connect delivered over 2,000 consultations in 2019, meeting complex care needs by identifying and linking geriatric services and management to patients with geriatric syndromes. The network of established geriatric teams, local champions and a shared Electronic Health Record facilitated the spread, while ongoing effort to build and maintain relationships between consultants and local rural provider teams and other community based services are important for ongoing success.
The Impact of Alzheimer’s Disease and Related Dementias on Dental Care Utilization and Costs in Older Adults
Authors: Li Sam , Donkor Isaac , Hong Liang , Lu Kevin , Wu Bei
Published: December 2020

There is limited information on the impact of cognition function on dental care utilization and costs. This study used the Medicare current beneficiaries survey in 2016 and included 4,268 participants 65+. Dental care utilization and costs were measured by self-report and included preventive and treatment events. Negative binomial regression and generalized linear regression were used to examine the impact of Alzheimer’s disease (AD) and related dementia (RD) on dental care utilization and costs. We found that AD was not associated with dental care utilization, but RD was associated with a lower number of total treatment dental care visits (IRR: 0.60; 95% CI: 0.37~0.98). RD was not associated with dental care costs, but AD was associated with higher total dental care costs (estimate: 1.08; 95% CI: 0.14~2.01) and higher out-of-pocket costs (estimate: 1.25; 95% CI: 0.17~2.32). AD and RD had different impacts on different types of dental care utilization and costs. Part of a symposium sponsored by the Oral Health Interest Group.