bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Neighborhood-Level Socioeconomic Disadvantage and Older Americans’ Cognitive Functioning
Authors: Settels Jason , Leist Anja
Published: December 2020

Most studies of later life cognitive functioning have focused on individual-level variables. While some studies have examined neighborhood-level variables as influences upon older adults’ cognitive functioning, this scholarship has neglected to consider neighborhoods in a dynamic context. The present study helps fill this research gap by considering how changing extents of neighborhood-level socioeconomic disadvantage cause changes in older residents’ cognitive functioning. We employ waves 2 (2010-2011) and 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP) as our source of individual-level variables and the American Community Survey as our source of neighborhood-level variables. Our analytical sample includes 1,989 respondents who participated in both waves and were 50 to 90 years in age at wave 2 of the NSHAP. Through structural equation modelling, we find that rising neighborhood-level socioeconomic disadvantage significantly decreases older residents’ cognitive functioning, both without and after controlling for baseline neighborhood-level socioeconomic disadvantage and cognitive functioning. Furthermore, approximately 7.2% of this effect is mediated through decreases in the sizes of networks of close confidants, and roughly 8.5% of this effect occurs through increased depressive symptoms. Our findings suggest that older adults’ cognitive decline can be slowed down or prevented through improvements in their living environments. In particular, policies and programs that improve living spaces while also facilitating older residents’ development of close and supportive confidant ties are likely to be particularly effective. Our study encourages further research on how neighborhood dynamics affect older persons’ cognitive functioning.
Addressing Under-Detection in Minimum Data Set Behavioral Measures Using NIH Stage III/IV Embedded Trial Design
Authors: McCreedy Ellen , Gutman Roee , Rudolph James , Baier Rosa , Thomas Kali , Dvorchak Faye , Ogarek Jessica , Mor Vincent
Published: December 2020

Using the National Institutes of Health (NIH) Stage Model framework, we are conducting a Stage III/IV embedded trial to evaluate the effects of personalized music on agitated behaviors in nursing home (NH) residents with dementia under two research conditions--less pragmatic, more researcher involvement (Stage III) and more pragmatic, less researcher involvement (Stage IV). We are conducting a three-year trial in 81 NHs, with 27 NHs receiving the intervention per year. Behavior frequency is assessed via resident MDS assessments, staff interviews, and direct observations of residents. During the first year, researchers interview NH staff and observe residents with dementia in 54 randomly selected NHs (27 treatment and 27 control, parallel design). MDS assessments are available for all 81 NHs throughout the three-year study (stepped-wedge design). In the 54 NHs in the parallel design, we compare staff interview and NH-conducted resident assessments and, using multiple imputation methods, we impute staff interview data for eligible residents of all 81 NHs in order to estimate the effect of the intervention under the step-wedge design. There are four key features of this trial: 1) combination of parallel and stepped-wedge designs; 2) equilibrating researcher-collected behavior data to NH-collected behavior data to impute research-collected behavior data for some residents; and 3) simulated resident selection process in control facilities to improve comparisons of effects across treatment groups. This design has the potential to shorten the research timeline by iteratively assessing real-world efficacy and large-scale effectiveness. Our design will inform pragmatic testing of other interventions with limited efficacy evidence.
Functional Neural Underpinnings of Increased Falls Risk
Authors: Ai Meishan , Hsu Chun-Liang , Liu-Ambrose Teresa
Published: December 2020

Impaired cognition, especially in the domain of executive functions, is a major risk factor for falls in older adults. However, the underlying neural mechanism of the association between cognitive function and falls risk remains unclear. The current study compared the performance on mobility and cognitive assessments, and brain activation under Stroop task between fallers (>=2 falls in the past year) and non-fallers (0 or 1 fall in the past year). We found that during the incongruent condition of Stroop task, higher activation in precuneous, frontal and temporal areas was observed in fallers, while they showed comparable task performance as non-fallers. In addition, the contrast between congruent and incongruent conditions showed fallers exhibited increased activation in middle frontal region (z>1.7, P<0.05). Further, through mediation analysis, our data revealed that brain activation in temporal and frontal-paracingulate regions mediated the relationship between Montreal Cognitive Assessment and number of falls (confidence interval = 95%), after controlling for age and sex. Overall, our findings suggested that lower neural efficiency may be an underlying mechanism by which cognitive function is associated with falls risk.
Loss of ARNT Limits Improvement in Physiological Performance Following Aerobic Exercise in Aging
Authors: Endo Yori , Zhang Yuteng , Li Bin , MacArthur Michael , Sinha Indranil
Published: December 2020

Hypoxia signaling is essential for angiogenesis and metabolic regulation during exercise. Our previous study has demonstrated an age-related loss of ARNT resulting in limited muscle regeneration. To explore the role of hypoxia signaling in physiological performance in relation to aging, we generated a mouse model with skeletal muscle-specific knockout of ARNT (ARNT mKO). ARNT mKO and ARNT WT mice were subjected to a sedentary activity or treadmill running exercise regime at an increasing speed of 8-12 m/min for 40 minutes, three times weekly over the course of 8 weeks. ARNT levels was 3-fold lower in old mice compared to young. The exercised WT mice exhibited 52% greater increase over the sedentary group in exercise endurance as measured by the maximum running distance (490.92±154.28 vs 237.76±135.19m, p＜0.01). In contrast, ARNT mKO mice did not benefit from exercise (231.85±198.61 vs 167.27±136.56m, p=0.41). The maximum running speed was severely restricted in the trained ARNT mKO mice versus WT (16±1.63 m/min vs 26.67±2.45 m/min, p＜0.001). Cross-sectional area of myofibers increased significantly following exercise in WT mice (2270 vs 2960 □m2, p=0,015) indicating muscle hypertrophic response, while no change was observed in the ARNT mKO group (2101 vs 2378□m2, p=0,21). Further, exercise increased femoral artery blood flow by 41% in ARNT WT mice, but not in ARNT mKO mice (898.96±52.33 vs 802.86±48.43, p=0.20). These data suggest that ARNT is essential for physiological response to exercise
P300 Amplitude in Relation to Age, Neuropsychological Performance, and Genetic Risk for Alzheimer’s Disease
Authors: Sheffler Julia , Hajcak Greg , Vied Cynthia , Meynadasy Melissa , Mach Russell
Published: December 2020

The P300 event-related potential (ERP) is associated with aging and risk for Alzhiemer’s disease (AD) and mild cognitive impairment (MCI). Our study sought to replicate previous findings regarding P300 amplitude, age, and neuropsychological outcomes. We also sought to fill gaps in the literature by assessing associations in a primarily healthy sample of older adults (aged 60-75) and through use of comprehensive assessment procedures for ERPs, neuropsychological outcomes, and a genetic risk score (i.e., BDNF, APOE, and PSEN1 mutations). Approximately 25% of our total sample (N=72) met criteria for possible or probable mild cognitive impairment. We assessed whether the P300 elicited by auditory (oddball) and visual (go/nogo) paradigms were associated with performance across neuropsychological tests commonly used in clinical settings, which include cognitive domains of semantic, episodic, and visual memory, executive functioning, language (confrontation naming), abstract reasoning (visual and verbal), and attention. Further, we examined associations between P300 and multiple genetic risks for AD. Our findings demonstrated differences in outcomes between audio and visual tasks of P300, with visual tasks tending to show stronger relationships with neuropsychological and genetic factors. Neuropsychological measures of memory and executive functioning were most closely related to visual P300 amplitude. P300 amplitude was also significantly associated with a genetic risk score for AD, despite the sample generally performing in the normal range on most neuropsychological tasks. Overall, our study has implications for use of the P300 for early detection of risk for AD and for improving our understanding of the P300 as a cognitive biomarker.
Canadian Consensus Conference on Psychological and Non-Pharmacological Interventions for Dementia
Authors: Sheets Debra , Clare Linda , Sivananthan Saskia , Vedel Isabelle , Liu-Ambrose Teresa , Brodaty Henry , Mann Jim , McAiney Carrie
Published: December 2020

Psychological and non-pharmacological interventions that could have a positive effect on outcomes important to persons living with dementia are essential to identify given the the limited efficacy of dementia medications and the diverse needs of persons living. In 2019, for the first time the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD) created a working group to develop recommendations related to a broad range of psychosocial and non-pharmacological interventions exist, typically aimed at improving cognition, symptoms, or well-being, as well as improving caregiver well-being and coping. The recommendations, primarily intended for primary care physicians, may also allow clinicians, organizations, and communities and help to better meet the needs of people living with dementia and their caregivers. A group of 11 experts, including persons living with dementia and informal caregivers, as well as clinicians and researchers from various organizations both nationally and internationally were invited to participate. A rapid review of meta-analyses and literature reviews on psychological and non-pharmacological interventions was conducted. The synthesized results were submitted for a consensus building approach using a Delphi method, involving a panel of more than 50 Canadian participants. Recommendations with a positive vote of 80% or more were considered to have reached consensus. All proposed recommendations reached consensus using the Delphi process. Details of the recommendations are presented. Five recommendations are made: group or individual physical exercise, group cognitive stimulation therapy, psychoeducational interventions for caregivers, dementia friendly organizations/communities, and case management.
Nurse Visits, Site of Care, and Hospitalization Among Hospice Patients With Dementia
Authors: Luth Elizabeth , Russell David , Prigerson Holly , Bowles Kathryn , Ryvicker Miriam
Published: December 2020

Persons with dementia comprise up to 50% of hospice patients and face an increased risk of burdensome, disruptive, and costly discharge from hospice due to hospitalization. The relationship between timing, dose and site of hospice care provided, all modifiable factors, and risk of hospitalization is poorly understood. We use a retrospective cohort analysis of 2,692 electronic health records of hospice patients with dementia who received care from a large hospice agency in New York City between 2013-2017 to determine the relationship between hospice service delivery (e.g., number and timing of nurse visits, home vs. facility-based) and risk of hospitalization (vs death). We control for demographic and clinical characteristics of patients. 9.36% of patients with dementia were hospitalized. Hospice service delivery factors were significantly associated with risk of hospitalization. Each additional nurse visit was associated with a 5% decrease in risk of hospitalization (AOR: 0.95, 95% CI: 0.92-0.98). Each additional day between last nurse visit and discharge was associated with a 7% increase in risk of hospitalization (AOR: 1.07, 95% CI: 1.04-1.11). Home hospice was associated with 97% higher odds of hospitalization (AOR: 1.97, 95% CI: 1.19-2.09). Hospice patients with dementia who receive services at home, receive fewer nursing visits, and have increased time between nursing visits are at increased risk for hospitalization. Research is needed to determine if increasing the number and timing of nursing visits can reduce risk of hospitalization in this population.
Implementing Changing Talk Online Training: A Pragmatic Trial to Improve Dementia Care Communication in NHs
Authors: Coleman Carissa , Williams Kristine , Perkhounkova Yelena , Hein Maria , Beachy Tim , Shaw Clarissa
Published: December 2020

The Changing Talk (CHAT) training effectively reduces elderspeak and subsequent behavioral challenges in residents with dementia in nursing homes. The Changing Talk: Online (CHATO) training was developed to increase staff access to education using a new online format. A pilot test was conducted to confirm the feasibility and effects of CHATO on training outcomes. In the initial nursing home, twenty-three direct care staff members in a small Midwestern nursing home enrolled in the course including 12 CNAs, 4 RNs, 2 LPNs, 2 CMAs, 1 Dietary Aide, 1 Social Worker, and 1 in Transportation. Two forms of a 13-item scenario-based test to measure knowledge gain were developed and tested. Of the 23 staff, 18 (78%) completed the post-test and 83% of completers achieved a post-test score of 70% or greater. Scores on the test improved from M=69% correct (SD=11.7) at pretest to 86% correct (SD=10.6) on posttest demonstrating knowledge gain (p=.024). Participants improved their recognition of elderspeak (21%) and person-centered communication (24%) in a video vignette and 86% self-reported improvement in their abilities to recognize ineffective communication and to apply more effective communication strategies in practice. A randomized control trial enrolled staff (N=187) in eight additional nursing homes. Preliminary results confirm improvements in test scores from M=70.6% correct (SD=15.8) at pretest to 77.2% correct (SD=14.1) on posttest and increased elderspeak recognition (p=.004). Relationships between nursing home characteristics, implementation strategies, and culture change measured by the Artifacts of Culture Change Tool and their relationship to communication outcomes will be presented.
Improving Dementia Capability Among Law Enforcement: Evaluation of Dementia Education Training in San Diego County
Authors: Powers Sara , Orsulic-Jeras Silvia , Empeno Jessica , Lagasca Regina , Abrams Amy , Barker Sarina , McDaniel Rebecca , Hanna Marcie
Published: December 2020

As the number of Alzheimer’s disease and related dementia (ADRD) cases grow, first responders will have more frequent interactions with individuals living with ADRD within the community. Recognizing the lack of dementia training among first responders and through the support of an Administration for Community Living grant, Alzheimer’s San Diego partnered with local law enforcement to support and educate first responders on local ADRD resources, referral systems for families and caregivers, and disease-related information, in hopes of building stronger dementia capable services within San Diego County. To date, 249 first responders have participated in dementia education trainings and completed the related evaluations that aimed to understand their experiences with and knowledge of dementia. On average, participants were 44.74 years old (SD=18.45) and served 8.72 years (SD=7.99) on their job. Majority were male (n=189), had some college education (n=94), and identified as White/Caucasian (n=105) or Hispanic/Latino (n=92). Although objective knowledge (as measured by a shortened version of the Alzheimer’s Disease Knowledge Scale [ADKS]) did not significantly differ from pre- to post-test, participants’ perceived subjective knowledge about dementia significantly increased from pre-test (M=1.17, SD=0.77) to post-test (M=1.89, SD=0.66); t(141)=10.56, p<.001. Encouragingly, participants who reported receiving prior training on dementia had significantly higher ADKS scores at both pre- and post-test compared to those who did not have prior training. Results highlight the need for ongoing dementia-related training for law enforcement and the importance of evaluation requirements. Discussion will focus on policy implications and how communities can support dementia capability among first responders.
Initial Results From an Everyday Memory and Metacognitive Intervention for Older Adults
Authors: Pearman Ann , Hertzog Christopher , Lustig Emily , Hughes MacKenzie
Published: December 2020

We report results from a new intervention study implementing an Everyday Memory and Metacognitive Intervention (EMMI). This intervention trains older adults on self-regulatory procedures for achieving everyday life goals by implementing a metacognitive perspective where participants learn mindful control over life tasks that place demands on planning and memory (e.g., learning new names and managing prospective memory demands). Fifty-three participants, age range 65 to 83, were assigned to either the EMMI treatment group (n = 32, mean age = 70.13, SD = 3.2) or a waitlist control group (n = 21, mean age = 71.76, SD = 4.7). Individuals with probable memory impairments, as indexed by low MOCA scores, were excluded from the study. Outcomes included daily diary reports of everyday memory errors and a prospective memory telephone task. EMMI participants had fewer reported memory errors per day (M = 0.42) than controls (M = 0.64), one-tailed p = .03. EMMI participants also performed better than controls on the telephone task outcome variables: total number of phone calls completed and mean absolute deviation of call times from scheduled times for successfully completed calls (ps<.001). Subjective outcomes, including personal memory beliefs, life satisfaction, and perceived stress, showed greater pretest-posttest improvement in the EMMI group compared to the control group. This study is a successful initial demonstration of the efficacy of our intervention for improving everyday cognition in older adults and highlights the possibility of improving success in memory-demanding everyday life contexts, thereby contributing to resilient aging in an older population.
Age and Daily Positive Events Moderate the Link Between Depressive Symptoms and Inflammation
Authors: Wen Jin , Almeida David , Sin Nancy
Published: December 2020

Inflammation is a pathway underlying numerous aging-related conditions. Depression is related to elevated inflammation, whereas daily positive events have been linked to lower inflammation; these psychological experiences may interact with age to predict inflammation. The purpose of this study was to examine whether daily positive events moderate the association between depressive symptoms and inflammation in an adult lifespan sample. A sample of 343 adults ages 25-75 (55% women, 83% white) in the Midlife in the United States Refresher Study completed daily diary interviews for 8 evenings about their daily positive events. Depressive symptoms were assessed with the 20-item Center for Epidemiological Studies Depression scale, and blood samples were assayed for inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP). On average, depression scores ranged from 0 to 44 (mean = 9.31, SD = 7.80), and participants reported 1.25 (SD = .70) positive events per day (range = 0–5). Depressive symptoms and daily positive events were separately associated with higher and lower log IL-6 and CRP, respectively. Depressive symptoms, daily positive events, and age interacted such that daily positive events predicted lower IL-6 (but not CRP) among midlife and older adults who reported lower depressive symptoms, whereas positive events were not related to inflammation among younger adults. Thus, these findings suggest that the protective association between daily positive events and inflammation was blunted when depressive symptoms were elevated and for younger adults. This work has implications for understanding age variations in the role of positive experiences in depression and inflammation.
East and West Ethnography in Adult Day Services: Lessons From Taiwan and the United States
Authors: Liou Chih-ling , Salari Sonia
Published: December 2020

Adult Day Services (ADS), an alternative to institutionalization, offer daytime programs for those with physical and/or cognitive impairments. ADS have grown rapidly in Taiwan and the U.S., to improve quality of life (QOL) and provide respite for caregivers. ADS researchers have focused primarily on caregiver outcomes, with less emphasis on consumers. Our study is among the first to examine these issues in a cross-cultural context. Surveys are insufficient for ADS attendees, since many have diminished capacity. We use ethnographic methods to more fully understand the life of clients in ADS in two countries. The focus is on clients and staff, while including the physical and social environments. Data were collected over 820 hours of observation and 77 interviews with key ADS stakeholders, including clients, for insider perspective. Comparisons between the two countries, found that infantilization (e.g., baby-talk, child-oriented activities and decor) occurred in all 10 settings to varying degrees and outcomes were shaped by culture. In Taiwan, infantilization embedded within a cultural tradition of respecting elders and exhibited as a parent-child role reversal, where staff played the adult-child role. Their over-helping and over-controlling were aimed to ‘benefit’ clients, who were seen as incompetent aging parents. In the U.S., infantilization resembled a primary school environment with elementary décor. Aides used baby-talk and ‘taught’ compulsory child-oriented songs and games. This effect was exacerbated when preschool-aged children were added, and all generations were treated similarly. Results can be translated to implement age-appropriate care environments across cultures to improve QOL in ADS.
Goals-of-Care Consult and Future Costs, Acute Care and Hospice Use in Matched Cohorts of African Americans and Whites
Authors: Starr Lauren , Ulrich Connie , Appel Scott , Junker Paul , O’Connor Nina , Meghani Salimah
Published: December 2020

African Americans receive less hospice care and more aggressive end-of-life care than Whites. Little is known about how palliative care consultation to discuss goals-of-care (“PCC”) is associated with future acute care utilization and costs, or hospice use, by race. To compare future acute care costs and utilization and discharge to hospice between propensity-matched cohorts of African Americans with and without PCC, and Whites with and without PCC, we conducted a secondary analysis of 35,154 seriously-ill African American and White adults who had PCC at a high-acuity hospital and were discharged 2014-2016. We found no significant difference between African Americans with or without PCC in mean future acute care costs ($11,651 vs. $15,050, P=0.09), 30-day readmissions (P=0.58), future hospital days (P=0.34), future ICU admission (P=0.25), or future ICU days (P=0.30), but found greater discharge to hospice among African Americans with PCC (36.5% vs. 2.4%, P<0.0001). We found significant differences between Whites with PCC vs. without PCC in mean future acute care costs ($8,095 vs. $16,799, P<0.001), 30-day readmissions (10.2% vs. 16.7%, P<0.0001), future days hospitalized (3.7 vs. 6.3 days, P<0.0001), and discharge to hospice (42.7% vs. 3.0%, P<0.0001). Results suggest PCC decreases future acute care costs and utilization in Whites and, directionally but not significantly, in African Americans; and increases discharge to hospice in both races (15-fold in African Americans, 14-fold in Whites). Research is needed to understand how PCC supports end-of-life decision-making and hospice use across races and how systems and policies can enable effective goals-of-care consultations across settings.
Age-Related Variation in Cardiovascular Risk Associated With Red Cell Distribution Width
Authors: Dalton Jarrod , Zidar David , Al-Kindi Sadeer , Krieger Nikolas I , Perzynski Adam
Published: December 2020

We previously showed that routine indicators of immune-hematologic function are strongly associated with all-cause and cardiovascular mortality, especially among older adults, in whom traditional atherosclerotic cardiovascular disease (ASCVD) risk factors predict poorly. The objective of this study was to quantify differences in the relationship between red cell distribution width (RDW) and 5-year risk of ASCVD events (stroke, myocardial infarction or cardiovascular death) as a function of age and the area deprivation index (ADI). We analyzed electronic health records of 76287 Cuyahoga County, Ohio residents who were over age 40 and who visited Cleveland Clinic Health System and/or MetroHealth System in two consecutive years between 2005 and 2015, the latter of which served as the index/baseline. Multivariable Cox regression was used, adjusting for sex, race/ethnicity, diabetes, systolic blood pressure and antihypertensive use. Generally, RDW levels in disadvantaged neighborhoods corresponded to people 15-20 years older from affluent neighborhoods. In a main-effects-only model, we found higher ASCVD event rates associated with age (hazard ratio [95% confidence interval] per 10 year increment: 1.34 [1.32–1.35]), ADI (top vs. bottom quintile: 1.30 [1.24–1.36]) and RDW (>16% vs ≤13%: 2.03 [1.94–2.12]). Age and RDW exhibited a synergistic interaction (χ2 = 17.7 on 2 df, p<0.001), with slightly larger RDW effects associated with increasing age, while evidence of differential RDW effects across ADI quintiles was weak (χ2 = 12.9 on 8 df, p=0.11). We conclude that RDW effects on ASCVD event risk are large, independent from traditional ASCVD risk factors and increase with advancing age.
Assessment of Appropriateness of Cardiovascular Preventive Medication in Adults ≥ 75 years
Authors: van der Ploeg Milly , Poortvliet Rosalinde , Gussekloo Jacobijn , Drewes Yvonne
Published: December 2020

Physicians are confronted with dilemma’s on cardiovascular preventive medication for older people with complex health problems. With accumulation of diseases, limitations and shortening life expectancy, questions arise for whom cardiovascular preventive treatment is still appropriate (the expected benefits of treatment exceeds the negative consequences by a sufficiently wide margin resulting that treatment is worth doing). There is a need for more guidance in clinical situations. With the RAND/UCLA appropriateness method (RUAM), we investigated the appropriateness of cardiovascular preventive medication in adults ≥ 75 years. The RUAM is a systematic, formalized method, to combine available scientific evidence with the collective judgment of experts. Fourteen interdisciplinary panelists (9 physicians representing 6 medical disciplines, 1 medical ethics expert, 1 pharmacist and 3 older adults [lay man]), discussed and rated the appropriateness of starting and stopping of three medication groups (cholesterol lowering, blood pressure lowering and thrombocyte aggregation inhibitors) for different clinical scenarios (combinations of cardiovascular history, systolic blood pressure, complexity of health problems, age, life-expectancy, side-effects). Depending on the medication group, different patterns of appropriateness judgments across the clinical scenarios were found. In general, absence of cardiovascular disease, presence of complex health problems, a short life-expectancy or hindering side-effects were important factors to judge cardiovascular preventive medication as inappropriate. Results were summarized into colored reading maps. These findings can offer more guidance in clinical decision making about cardiovascular preventive treatment for adults ≥ 75 years.
The Model of Empathic Pain Assessment and Treatment in Persons With Dementia
Authors: Starr Lauren , Magan Kristin Corey
Published: December 2020

There are 5.8 million people with Alzheimer’s dementia in the United States—81% are 75 years or older. Although half of persons with dementia regularly experience pain, their pain is underrecognized and undertreated, partly because clinicians experience challenges assessing pain in persons with dementia who cannot self-report. Evidence suggests clinician empathy is involved in pain assessment and treatment. Conceptual models guiding Alzheimer’s research are lacking in the literature. To create an interdisciplinary, evidence-based model for understanding clinical empathy’s relationship with the assessment and treatment of pain in persons with advanced dementia, we conducted a literature review of relevant manuscripts from 2000-2019 across disciplines and countries, emphasizing dementia studies and research conducted in the last decade. After performing quality appraisal using the Oxford Centre for Evidence-based Medicine’s levels of evidence, we synthesized findings from 38 qualifying studies and developed a new conceptual model driven by observation of behaviors indicating pain in persons with dementia unable to self-report. The model represents the cognitive, affective, ethical, and behavioral components of clinical empathy involved in assessing and treating pain, relevant patient outcomes, and contextual factors influencing empathy and outcomes; and provides a framework for testing clinical empathy interventions to improve adverse outcomes in persons with advanced dementia. Understanding the relationship between clinician empathy and the assessment/treatment of pain in persons with dementia may improve care quality and help reduce pain behaviors in this population. This model may be used to inform pain research in persons with dementia and develop clinical interventions and clinician education programs.
Unpacking “OK, Boomer”: Using Lifespan Concepts to Ease Intergenerational Conflict
Authors: Graf Allyson , Bartlett Robin
Published: December 2020

With the “OK, Boomer” media exchange in late 2019, intergenerational conflict is touted as existing at an all-time high. Although the age diversity of today’s workforce is unprecedented, spanning nearly five generations of workers, generational stereotyping and its influence on the identities and experiences of those individuals is not new. In this talk, we will advocate for the role that lifespan developmental psychology can play in preparing students to enter a sometimes contentious, misrepresented multigenerational workforce. We will demonstrate the value of helping students distinguish normative age-graded, normative history-graded, and non-normative influences to better understand individual similarities and differences in developmental experiences. We will discuss research on age identity and generational identity as distinct and self-enhancing life-span processes. Finally, we will highlight the developmental barriers that must be navigated in order to foster intergenerational cohesion.
Having a Casino in the Community: Implications for Older Residents
Authors: Bui Cindy , Coyle Caitlin
Published: December 2020

Casino-going has been acknowledged as a common leisure activity for older adults, but what having a casino in the community means for the local older population has been understudied. Previous research has focused on problem gambling among older adults, but little is understood about how older residents perceive having a casino nearby and further how it impacts relevant senior services. This mixed-methods study gathered perspectives from 14 senior center directors and older residents (N = 411) of communities in Massachusetts that surround Plainridge Park Casino, the first casino that opened in the state in 2015. We conducted qualitative interviews with senior center directors and distributed a quantitative survey to older residents of the surrounding communities and those who visited the casino during the study period. We found that while most senior centers did not engage in trips to this “hometown” casino, many had other creative interactions with the casino, such as using casino space to host senior center events or seeking funding support from the casino. Older residents exhibited low rates of problem gambling risk, preferred to go to casinos outside of the state as an excursion, and attributed their reasoning to go to casinos to socializing rather than gambling aspects. While we must be aware of risks for problem gambling, this study also highlights the possibility of reframing a local casino as a potential asset that could contribute back to the community by providing resources for senior service providers and expanding social engagement opportunities for the older population.
GSA and AGHE: 75 Years of Leading Innovative, Interdisciplinary, Intergenerational, and Engaging Education
Authors: Howe Judith , Bernard Marie
Published: December 2020

The AGHE Symposium will highlight the many ways that education has advanced interdisciplinary work, innovative programs, intergenerational services and community engagement in the field of aging over the last decades. Presenters will reflect on how these educational modalities can inform the future of gerontology education. Educators have innovated over decades to develop a field characterized by a diversity of programs, including internships, applied learning experiences in research, policy and practice, and leadership. The history of AGHE and interdisciplinary education are linked, with AGHE serving as an incubator for the advancement of change in this area. Over the course of the last five decades, funding from federal and foundation initiatives have resulted in multi-disciplinary university based centers, interprofessional team training programs, and workforce development initiatives. These efforts have improved the health and well-being of older adults and contributed to the development of new collaborative care systems. AGHE members have also long been involved in intergenerational teaching and learning strategies, including service-learning and community activities. Intergenerational work in the field of aging has helped to shape the Age-Friendly University initiative which calls for colleges and universities to promote intergenerational learning through reciprocal sharing of expertise among learners of all ages. Finally, the AGHE community has long promoted engaged learning with opportunities for students to interact with community partners through programs such as community-based research and clinical experiences and local policy efforts. The ideas presented in the symposium will lead to reflection on how AGHE can expand its value as GSA’s educational arm.
Older Adults as Citizen Scientists and Policy and Planning Voices in Higher Education
Authors: Kaye Lenard , Burby Sarah
Published: December 2020

The University of Maine is embarking on achieving AFU status. In addition to maximizing older adult participation in all facets of campus life (education, recreation, culture, etc.), their presence in nontraditional sectors of university activity will be emphasized. Building on the principles of community-based, participatory research, focal points of UMaine’s AFU strategy will be to ensure that age-specific, engagement mechanisms are created and maintained that ensure older citizens play an influential role in guiding and interpreting academic research and development and curricula innovation across multiple professions and disciplines. Using a state-wide, older adult research registry, and co-design, community test-beds in partnership with continuing care retirement communities, older adults will serve as citizen scientists. Other empowerment strategies for maximizing elder voice include expanding the number of departments that incorporate life span perspectives in their mission statements and expanding the number of older adult advisory bodies that inform university policy and practice.
The Age-Friendly University Umbrella: New Synergies for Gerontology Programs, Aging Centers, and Health Systems
Authors: Schumacher John
Published: December 2020

Higher education has a tentative relationship with gerontology programs and research centers. Despite demographic shifts, academic gerontology serves a modest student body and attracts limited research/scholarly interest. Our new Age Friendly University (AFU) designation served to motivate our university leaders and faculty to re-imagine how aging issues are fundamental to our mission framed by: 1) Interdisciplinarity; 2) Intergenerational relations; and 3) Inclusiveness of the life course. Additionally, the AFU initiative energized the relationships among our health professions schools, academic departments, and research center to collaborate on grant opportunities. Our AFU also started collaborating with a local health system seeking Age Friendly Health System status. Finally, our AFU designation raised visibility with our three local county governments who had just received Age Friendly Community status. Our AFU efforts have served as an inclusive umbrella to attract new, interested partners in our shared effort to improve the lives of older adults. Part of a symposium sponsored by Directors of Aging Centers Interest Group.
The Contribution of Geriatric Educators to Public Policy
Authors: Faul Anna , Severence Jennifer , Waters Leland
Published: December 2020

Despite the current pressure to reduce state and federal spending, policymakers must find ways to address the challenges of a growing population of older adults with complex health care problems. There is an increased need for the health professions workforce to have collaborative care skills and geriatric clinical competencies. Therefore, programs like the Geriatric Workforce Enhancement Program (GWEP) and the Geriatric Academic Career Awards (GACA) are important in strengthening the workforce and supporting policy development that addresses increased demands on the health care system. In 2019, the Bureau of Health Professions, under the Health Resources and Services Administration, provided 48 GWEP awards and 26 GACA awards in 37 states and 2 territories. These programs play an important advocacy role to improve on and expand geriatric education. This symposium provides an overview of these programs and their role in advancing geriatric care and in shaping policy.
Engaging Older Adult Learners Through Intergenerational Learning Opportunities
Authors: Leedahl Skye , Clark Phillip , Leconte Beth
Published: December 2020

The University of Rhode Island became a part of the AFU network in 2018, and much of our rationale for joining the network was based on our strengths and growing interest in intergenerational programs and learning. The URI Osher Lifelong Learning Institute (OLLI) currently has over 1,300 members, and a large aspect of their strategic plan and current efforts are focused on increasing intergenerational learning opportunities due to interest and successes in these areas. Some of the successful strategies that have been used include an intergenerational classroom of OLLI member and university students designed within a traditional college class, a matching program where students are partnered with OLLI members, intergenerational service learning opportunities for students to engage with OLLI members in different ways, and question and answer sessions with OLLI members within college classes. This presentation will highlight these efforts, lessons learned, and efforts to track participation and outcomes.
Older Adults’ Adherence to Technology-Based Intervention: The Role of Messaging and Individual Differences
Authors: Boot Walter , Roque Nelson , Harrell Erin , Charness Neil
Published: December 2020

Adherence to health behaviors is often poor, including adherence to at-home technology-based interventions. This study (N=120) explored adherence to a cognitive training intervention delivered via computer tablet, assessed adherence over a 4.5 month period, explored how individual difference factors shaped adherence, and tested the efficacy of message framing manipulations (positive vs. negative framing) in boosting adherence. Individual difference factors predicted adherence, including variations in self-efficacy and belief in the efficacy of cognitive training. Overall message framing had little impact. However, during the final portion of the study in which participants were asked to play as much or as little as they wanted instead of following a schedule, participants who received positively framed messages engaged with the intervention more. Implications for predicting and boosting adherence to home delivered technology-based interventions will be discussed.
Aging and Gaming: The Science and Promise of Technology-Based Leisure Activities and Interventions
Authors: Kerssens Chantal
Published: December 2020

Much research has focused on technology to support older adults in basic and instrumental activities of daily living. Much less is known about technology supports of hobbies and leisure later in life. Physical, cognitive and social activities potentially delay the onset and progression of disease, including dementia. Older adults are interested in digital games, applications (apps) and social technologies, and will use technology provided their needs, preferences and goals are met. Moreover, video games can be designed to promote satisfying social experiences between players of differing capabilities. More work, however, is needed to understand older adults’ interactions and engagement with game-based interventions. This symposium presents cutting-edge research findings and design recommendations for technology-based leisure activities and interventions in older adults. Yow et al. present data from a large, touch-screen dual language intervention program with cognitive training tools aimed at slowing down the rate of cognitive decline in older adults with dementia. Boot et al. present longitudinal data from the Center for Research and Education on Aging and Technology Enhancement (CREATE) with a focus on leisure and videogames; Freed et al. present older adults’ attitudes and experiences with an exercise videogame (exergame). Lin et al. discuss the early effects of an exergame involving real-world physical activity on activity, social contact and stress levels in dementia caregivers. Kerssens et al. discuss the creation and testing of an adapted, accessible version of beloved board games for people with mild cognitive impairment (MCI) and a care partner without MCI. Technology and Aging Interest Group Sponsored Symposium.
The Role of Midlife Occupational Factors for Trajectories of Cognitive Change
Authors: Hueluer Gizem , Siebert Jelena , Wahl Hans-Werner
Published: December 2020

Cognitively enriching environments are usually related to higher levels of cognitive performance, while associations with longitudinal change are less clear. In the present study, we used 20-year longitudinal data from the German Interdisciplinary Longitudinal Study of Adult Development and Aging (ILSE) to examine the role of occupational factors for longitudinal trajectories of cognitive function in midlife. To do so, we used data from 374 participants in the ILSE midlife cohort (born in 1950-52; mean age at baseline = 44 years; 44 % women). Our findings showed that cognitively enriching work environments were associated with higher levels of cognitive function at baseline; however, these associations were not independent of control variables including education. There was no evidence that enriching work environments were related to the maintenance of cognitive abilities. In sum, our findings are in line with notions of “preserved differentiation”. We discuss potential mechanisms underlying these findings.
Bidirectional Longitudinal Associations Between Cognitive Abilities and Social Relationships in Old Age
Authors: Luo Minxia , Edelsbrunner Peter , Siebert Jelena , Martin Mike , Aschwanden Damaris
Published: December 2020

Individuals’ social connections can both shape and be shaped by cognitive abilities in aging process. This study examined bidirectional longitudinal associations between cognitive abilities and social relationships using 12-year longitudinal data (3 waves) from 499 German older adults who were born between year 1930 and 1932. Cognitive abilities were assessed as a latent construct consisting of five cognitive tests, i.e., picture completion, block design, information, similarities, and word finding. Social relationships were assessed by the self-reported number of free time partners and scales of perceived social relationships. Using a random-intercept cross-lagged panel model, we focused on within-person causal relations. Results showed that higher cognitive abilities predicted higher number of free time partners over four years and that more positive perceived social relationships predicted higher cognitive abilities at four-year follow-up. In sum, the bidirectional longitudinal associations indicate social relationships and cognitive abilities mutually maintain each other in old age.
Multiple Dimensions of Perceived Discrimination, Race-Ethnicity, and Mortality Risk Among Older Adults
Authors: Cobb Ryon
Published: December 2020

The present study utilized data from the Health and Retirement Study (N=12,988) to investigate the joint consequences of multiple dimensions of perceived discrimination on mortality risk. Perceived discrimination is based on responses from the 2006/2008 HRS waves and included everyday discrimination, the number of attributed reasons for everyday discrimination, and major lifetime discrimination. Vital status was obtained from the National Death Index and reports from key household informants (spanning 2006–2016). Cox proportional hazard models were used to estimate the risk of mortality. During the observation period, 3,494 deaths occurred. Only the number of attributed reasons for discrimination predicted mortality risk when all discrimination measures were estimated in the same model (Hazard Ratio [HR]=1.09; 95%, Confidence Interval [CI]=1.05 - 1.14), holding all else constant. Overall, the number of attributed reasons for everyday discrimination is a particularly salient risk factor for mortality in later life.
Diverse Approaches to Assessing What Matters to Older Adults
Authors: Emery-Tiburcio Erin , Golden Robyn
Published: December 2020

Asking older adults What Matters to them and assuring that care plans are aligned with these preferences is the cornerstone of an Age-Friendly Health System (AFHS). Health systems have struggled to identify clear ways to ask this question and meaningfully utilize the responses. Both simple and complex options for addressing this challenge have been developed at Rush University Medical Center. At Rush, nurses began asking every inpatient What Matters and placing the response on the white board in the patient’s room. Results of this practice include increased awareness of staff and significant increases in patient satisfaction. Qualitative analysis of responses yields increased awareness of patterns that the hospital can more systematically address. The Rush Center for Excellence in Aging hosts Schaalman Senior Voices, in which older adults from diverse backgrounds are given the unique opportunity to offer their perspectives on life, health and aging related to “What Matters” to them. The films have been used effectively to stimulate conversations among older adults and families in the community and in health professions courses, and with health systems executives. The Rush College of Medicine has integrated AFHS training into communication skills for medical students. Faculty introduce the 4Ms and demonstrate methods for having What Matters (WM) conversations. Students then practice WM conversations with simulated patients; some have had the opportunity to practice with real patients in preceptorships. Implications for the health system and community will be discussed as Rush builds an Age-Friendly Health Community.
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Authors: Irani Elliane
Published: December 2020

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