bluuebunny/crossref_metadata_2025 huggingface dataset:
Modes of Transportation to Medical and Primary Care Among Older Adults
Authors: Suntai Zainab , Kubanga Kefentse , Adanu Emmanuel , Lidbe Abhay
Published: December 2021

Transportation is an increasingly meaningful concern for older adults as physical, cognitive, and psychological changes in older adulthood impact mobility and accessibility. While several studies have examined the modes of transportation used among older adults, few have explored specifically how older adults are accessing primary care/medical care services. As such, this study aimed to determine the specific modes of transportation used among older adults for primary care visits. Data were derived from the 2018 National Health and Aging Trends Study (NHATS), an annual longitudinal panel survey of older adults aged 65 and older living in the United States. Descriptive analyses were conducted to examine the prevalence of several modes of access and logistic regression models were used to predict the likelihood of using the two most prevalent transportation modes, based on sociodemographic and socioeconomic factors. Results showed that 70% of older adults drive themselves to their doctor, 34.8% rely on a family member, friend, or paid person, 2.4% have a home visit, 2.1% use public transportation, 1.5% walk to their doctor and 1.1% use a taxi. Additionally, having higher income, being of younger age, being White, and having post-secondary education was associated with driving oneself to the doctor. These results indicate that while most older adults are still self-reliant on transportation to medical providers, those with lower socioeconomic status are particularly at risk of losing driving independence. Transportation-related interventions should therefore consider targeting individuals with lower economic capital by proving financial assistance, ride-share programs, and other innovative approaches.
The Promising Impact of a Virtual Music Intervention for Persons With Dementia
Authors: McDowell Cynthia , Walton Jannell , Sheets Debra , Smith Andre , Stawski Robert , MacDonald Stuart
Published: December 2021

This study examines the within-person association between negative affect and global cognitive function for persons with dementia. Participants (n=33) engaged weekly in the Voices in Motion (ViM) sociocognitive choral intervention spanning up to 18-months and 9 individual assessments. Results revealed a significant time-varying association whereby within-person improvements in negative affect dynamically covaried with improvements on the Mini Mental State Examination (p<.05) across months of participation. These findings imply that, within-persons, reducing comorbidities associated with dementia (e.g., elevated negative affect) through participation in a lifestyle intervention, may facilitate increases in cognitive function. During the current pandemic, ViM transitioned to an online choir allowing for individuals to continue participating in the intervention and to maintain necessary social connections. The discussion focuses on the implications of this virtual choral intervention and the importance of modifiable risk factors such as negative affect and social isolation on the maintenance of cognitive health.
Modulators of Caregiver Distress and Corresponding Impacts on Persons With Dementia
Authors: Trites Michaella , Santana Sebastian , Sheets Debra , Smith Andre , Stawski Robert , MacDonald Stuart
Published: December 2021

Extensive literature documents the detrimental effects of caregiver distress (CD) for caregivers. Less is known about the impact that CD exerts upon their care recipients, particularly persons with dementia (PwD). Using multilevel modeling, this study employed dyadic data from the Voices in Motion study to examine time-varying within-person associations between key caregiver and care recipient indicators of psychosocial function. An initial dyadic coupling model indicated that cognitive functioning for PwD and caregiver well-being significantly predicted shifts in CD. A second time-varying dyadic model found that, within dyads, high levels of CD predicted lower positive affect and increased depression scores in PwD. Most sociocognitive interventions target a sole member of a dyad; our results suggest that both dyad members are impacted simultaneously. Caregiver well-being impacts CD, which in turn, impacts well-being in PwD. The symbiotic relationship between care partners and PwD is nuanced, with further research required to understand the interdependencies.
Coping With Uncertainty: Use of Contemplative Practices Amid a Pandemic
Authors: Lekhak Nirmala , Bhatta Tirth , Goler Tim , Kahana Eva
Published: December 2021

Contemplative practices have been used as coping resources to reduce the negative influences of adverse life situations on mental health. The COVID-19 pandemic has disproportionately impacted older adults, causing immense uncertainty, stress, and anxiety. By using data from our “Coping with Pandemic” nationwide web-based survey (n=1861), we examine the utilization of practices such as meditation, prayer, and yoga across social, economic, and health status during the pandemic. Consistent with studies conducted before the pandemic, we find significantly greater utilization of meditation and yoga among women and higher educated individuals. Findings showed significantly greater usage of prayer among women and Blacks. Unlike previous studies, we documented greater usage of meditative practices among Blacks than Whites. Older adults with higher anxiety were significantly more likely to practice meditation and yoga. Our study offers much needed guidance for future intervention studies aimed at improving mental health among diverse groups of older adults.
An Evolving Inquiry of Monastic Spiritual Care for Aging Inmates
Authors: Bishop Alex , Randall Kevin
Published: December 2021

This investigation involved focus-group inquiry of the Oblates in Prison Program, a faith-based ministry founded on monastic principles in the Rule of St. Benedict. Data from a Benedictine Order monk and program coordinator, ordained prison minister, and lay ministry volunteer were collected. Participants were asked a series of questions regarding the spiritual care of aging prisoners. Responses were coded and cross-compared for thematic content. Of central thematic importance was implementation of a spiritual care model using traditional monastic rules for daily living. A second theme centered on purposeful rebuilding of self-renewal through stability and obedience. A final emergent theme encompassed institutional acceptance in the provision of religious sacraments, sacred texts, and artifacts. Results highlight the broader implications of providing spiritual care and outreach to aging prisoners. The role of restorative justice for successful delivery of faith-based spiritual care for improved rehabilitation of aging inmates will be further addressed.
Advance Care Planning in the Context of COVID-19: Complexities Across a Range of Constituents
Authors: Carpenter Brian , Hirschman Karen
Published: December 2021

The COVID-19 pandemic brought serious illness and death into close proximity for a large number of people, whether through personal experience, infection in family members or friends, or unremitting media coverage on the effects of the virus and widespread mortality. Because of a collective vulnerability to illness and the heightened possibility of death, more people began to contemplate what kinds of medical care they would want if they ever became seriously ill. In other words, more people began the process of advance care planning (ACP). This symposium explores how the COVID-19 pandemic shifted interest in and execution of ACP across a range of groups. The first presentation reviews survey data from a large, community-based sample of older adults about their ACP conversations before and after the start of the pandemic. Shifting to the experience of clinicians, the second presentation summarizes a survey with multidisciplinary healthcare professionals about ACP conversations in their personal lives during the pandemic and how their observations of patients influenced their own plans. The third presentation describes the reactions of undergraduate students to an ACP class exercise, including COVID-19 as a motivating factor for pursuing ACP. The final presentation concludes with a review of two clinical cases that illustrate how COVID-19 has upended traditional ACP and highlighted the need for new policies and processes, with a particular focus on ethics and equity. Together, these presentations offer diverse insights into how ACP may shift in a post-pandemic world.
A New Normal? Continued Impact of COVID19 on Alzheimer’s Clinical Trials Research
Authors: Rhodus Elizabeth , Gibson Allison , Bardach Shoshana , Abner Erin , Jicha Gregory
Published: December 2021

The COVID-19 pandemic has led to unprecedented challenges in Alzheimer’s disease and related dementias (ADRD) clinical trials research. Scientists continue to grapple with the potential and multifaceted consequences of COVID-19. This presentation will discuss strategies used at a U.S. Alzheimer’s Disease Research Center to implement virtual methods to counter COVID-19’s impact on safety for continued research engagement; address the disparate impact by age, race, and ethnicity for online accessibility; and plans for virtual engagement in future research. As scientists navigate lasting implications of COVID-19, future study planning, design, and management will likely be altered. Specifically, increased awareness of participant-centered approaches, inclusion of psychosocial implications, and focus on ways to meet older adults’ unique needs of virtual accessibility will be needed. We must be intentional to counter COVID-19’s lasting impact on ADRD clinical trials research while maintaining rigor and reproducibility to uphold and progress advances toward treatment and cures for ADRD.
STAR Caregivers: Virtual Training and Followup: Implementation
Authors: Penfold Robert , Ramirez Maggie , McCurry Susan , Terry Linda , Ralston James , Hansen Kelly
Published: December 2021

STAR Caregivers is an evidence-based intervention designed to reduce caregiver burden for caregivers of people living with dementia. This study translated the paper-based, face-to-face intervention into a 6-session, self-directed online learning program supported by 6, 30-minute telephone calls with a clinically trained coach. Our approach is designed to overcome issues of access to training. Eligible caregiver-patient dyads at Kaiser Permanente Washington were identified automatically via electronic health records. Qualitative interviews were conducted with a sample of patients to elicit information about their needs and preferences for training. We developed a “learning management system” (analogous to compliance training modules) complete with slides, voice-over narration, and testing. The training sessions are mounted on the KP Learn site and accessible to anyone. Baseline and outcomes data on standardized instruments are collected remotely via REDCap. Recruitment for the study is ongoing and initial participant feedback on the program is very positive.
The Positive Impact of a Novel Air Purification Technology on Environmental and Clinical Outcomes
Authors: Schlener Susan , Worrilow Kathryn
Published: December 2021

Reducing sources of illness improves resident care. An advanced air purification technology (AAPT) was designed to destroy the DNA and RNA of all bacteria, fungi and viruses, rendering them non-infectious and to remediate volatile organic compounds (VOCs). This study compares the biological, fungal and VOC loading using the AAPT to standard high efficiency particulate air (HEPA) filtration. It was hypothesized that the AAPT would be associated with reductions in airborne and surface pathogens, VOCs and improved clinical metrics. A control floor with HEPA filtration and study floor with AAPT remediation were studied. Measurements of total VOCs and airborne and surface bacteria and fungi were measured in five locations on each floor. The facility acquired infection (FAI) rate, the number of infections divided by total patient days, showed a 57% difference between the control floor (2.33 FAIs/month) and the study floor (1.00 FAIs/month) and a decrease of 39.75% pre-installation (1.66 FAIs/month) to post-installation (1.00 FAIs/month). The viable pathogen loading measured on the study floor was reduced from an average of 483.8 colony forming units (CFU)/m3 pre-installation to an average of 56 CFU/m3 post-installation. VOCs were reduced from an average of 641.66 parts per billion (PPB) to 64.96 PPB and viable surface bacteria from an average of 110.6 CFU/m3 to 97.2 CFU/m3. The AAPT significantly reduced levels of infectious airborne and surface pathogens and VOC levels. As a result, residents on the AAPT floor demonstrated significant improvements in FAI rates. The findings support the hypothesis that environmental factors impact resident wellness.
Clark Tibbitts Award and Hiram J. Friedsam Mentorship Award Lectures
Authors: Dassel Kara
Published: December 2021

The Clark Tibbitts Award lecture will feature an address by Debra Dobbs, PhD, FGSA in memory of the 2021 award recipient, Kathryn Hyer, PhD, FGSA. AGHE's Clark Tibbitts Award was established in 1980 and named for an architect of the field of gerontological education. The award is given each year to an individual or organization that has made an outstanding contribution to the advancement of gerontology and geriatrics education. The Hiram J. Friedsam Award lecture will feature an address by the 2021 award recipient, Pamela Elfenbein, MSW, PhD, FAGHE, HS-BCP. Hiram J. Friedsam was the professor, co-founder, and director of the Center for Studies in Aging and dean of the School of Community Service at the University of Northern Texas. Dr. Friedsam was an outstanding teacher, researcher, colleague, and mentor to students, faculty, and administrators, as well as a past president of AGHE. The purpose of this award is to recognize those who emulate Dr. Friedsam's excellence in mentorship.
Hiram J. Friedsam Award: Reflections of Mentors and Mentorship
Authors: Elfenbein Pamela
Published: December 2021

Being honored with the AGHE Hiram J. Friedsam Mentorship Award brought into sharp focus the mentors who have guided my journey and a desire to share this moment with them. Preparation for this session provided the opportunity to reach out to those who have shaped my path and share memories of our journeys. Lesa Huber, when awarded the Hiram Friedsam Mentorship Award in 2013, wrote “those of us who have had great mentors know it is not so much what is said, but how it is said that is at the core of effective mentorship.” This presentation reflects on relationships built, wisdom shared, guidance offered, lessons learned by design and unintentionally, and passed on in my own way to the next generation.
Childhood Adversity Across the Lifespan: Assessing the Relationship Between ACEs and Subjective Cognitive Decline
Authors: Avent Elizabeth , Yonashiro-Cho Jeanine , Peterson Roberta , Mosqueda Laura , Gassoumis Zachary
Published: December 2021

Adverse childhood experiences (ACEs) have long-term impacts on health throughout the life course. Emerging research found that 3+ ACEs are associated with increased risk of cognitive impairment, nearly 11 times more than those who have not experienced childhood adversity. This study further investigates the ACEs-SCD relationship using data from the 2011 Behavioral Risk Factor Surveillance System (BRFSS). Seven ACE questions were asked of respondents in California, Washington, and Wisconsin (n=5,898, aged 55+); SCD was measured as experiencing progressive confusion or memory loss in the last 12 months. A series of logistic regressions were run to separately model the presence of ACEs and ACE score on SCD. Fourteen percent reported SCD, with 65.4% of those reporting 1+ ACE. More SCD respondents reported 4+ ACEs (10.8%) than non-SCD respondents (4.8%). The most frequently reported ACEs among those with SCD were psychological abuse (34.9%) and substance abuse in the household (30.5%). Regression results showed greater SCD risk with increased ACE scores, up to 2.90 odds of SCD for 4+ ACEs compared to 0 ACEs (p<.0001). Those reporting physical abuse and sexual abuse had the greatest odds (1.75 & 1.70, p<.0001) of SCD. Findings demonstrate a strong association between childhood adversity and SCD, with physical and sexual abuse placing individuals at greatest risk. Results show possible pathways to which ACEs can lead to cognitive impairment. Findings implicate the importance of considering a lifespan perspective in childhood adversity and family violence work and the importance of considering early-life adversity when assessing risk for cognitive impairment.
Education, Occupation, and the Cognitive Performance Distribution of South Korean Older Adults
Authors: Ford Katherine , Leist Anja
Published: December 2021

Earlier research suggests that educational attainment up to early adulthood are crucial for the development of cognitive reserve, while intellectually stimulating activities later in the life course are of limited impact. We sought to explore the effects of educational attainment and occupational factors (occupation type and currently having work) across the distribution of cognitive performance for adults aged 45-65 years in South Korea. We analysed scores from the Korean Mini Mental State Exam (MMSE) provided in the 2006 wave of the Korean Longitudinal Study of Aging. We used quantile regressions to both investigate relationships across the distribution and to reduce bias for measures of the central tendency as the MMSE is known for its ceiling effects. The quantile function at the lowest conditional decile of MMSE scores suggested that education level was the dominant significant factor for adult performance on the MMSE (lowest MMSE decile, primary education: β = 6.11 points, p < 0.001; secondary education β = 9.56 points, p < 0.001). All occupational factors were non-significant. Further factors with a significant association with the MMSE were hearing loss, the log-transformed household income, and age squared. With the conditional median function, occupational factors became significant in the middle of the distribution but remained much less important than education levels. In summary, educational levels were more important to explain variation in cognitive functioning than occupational factors, echoing studies with Western samples. We discuss the findings with regard to the historically gender unequal educational and occupational opportunities in Korea.
Laying Down the Groundwork for an International Measurement Infrastructure
Authors: Chu Charlene , McGilton Katherine , Zúñiga Franziska , Lepore Michael , Corazzini Kirsten
Published: December 2021

The COVID-19 epidemic has brought to light the significant problems in the long-term care (LTC) sector, specifically the lack of an infrastructure to collect and aggregate data between LTC sectors in different countries. This talk will briefly describe goals of the WE-THRIVE initiative, and focus on exploring the development of “workforce and staffing” common data elements for LTC. We will describe how the subgroup is “laying down the groundwork” within this domain with various methodologies to develop CDEs related to workforce and staffing. The CDEs aim to measure staff retention and turnover, evaluating nursing supervisor effectiveness, and staff training in LTC. Anticipated challenges of this international work will also be highlighted. International research on LTC can valuably inform LTC policy and practice, and the proposed CDEs can facilitate data sharing and aggregation internationally, including low-, middle-, and high-income countries.
Challenges in the Measurement of Staffing: A Review of Reviews
Authors: Zúñiga Franziska , Osinska Magdalena , Blatter Catherine , Simon Michael
Published: December 2021

The question concerning the relationship of staffing and quality of care of residents in residential long-term care (LTC) has been explored extensively; however, no consistent evidence has been brought forth so far. Inconsistent measurement of staffing might hinder this research field to move forward. We assessed its measurement in a narrative review of reviews that explore the staff – quality of care relationship. We identified 12 systematic reviews, covering 1960 to May 2018. Most studies included had a cross-sectional design, were performed in the USA and worked with secondary, administrative data (e.g., OSCAR). Comparability of studies was limited by diverse definitions and measurement methods for staffing, including data about grade-mix, number of staff, and staff-resident ratios. We suggest performing international multi-case studies to compare and contrast LTC staffing and develop appropriate international common data elements. Logic models support the description of the expected relationship between staffing aspects and quality.
An International Perspective on the Impacts of COVID-19 on Adult Education and Training
Authors: Dikhtyar Oksana , Helsinger Abigail , Cummins Phyllis , Hicks Nytasia
Published: December 2021

The COVID-19 pandemic has caused one of the worst economic crises since the Great Depression and the current recession has been more detrimental to older workers compared to other age groups. Not only has it forced more older workers out of their jobs, but it has also made it much harder for jobless older workers to find a new job. Furthermore, due to increased automation and digitalization in the workplace, older workers will likely need upskilling or reskilling to improve their employment prospects in the changed labor market. This situation brings the importance of offering training and continuous education programs that target older workers to the forefront of adult education policy and practice. This qualitative study examines measures taken in response to COVID-19 in adult education and training (AET) in seven countries including Sweden, Norway, the Netherlands, Australia, Singapore, Canada, and the United States. The findings are based on key informant interviews with international policy experts and scholars in the field of AET in addition to information gathered from written materials (e.g., government and organizational reports). To expedite their economic recovery and improve labor market outcomes for their workers, some countries have increased government funding for vocational and continuing education or offered financial support for post-secondary students while others have provided funds to employers to offer training and retraining for their employees. Some of these measures have the potential to expand adult educational opportunities in the post-pandemic world. Implications for policy and practiced are discussed.
COVID-19 Vaccination in Home Health and Hospice: Barriers to Vaccination and Results From a Home Vaccination Program
Authors: Rosati Robert , Landers Steven , Videon Tami
Published: December 2021

Little is known about vaccination rates in home health and hospice populations. Results draw upon two separate data sources from The Visiting Nurse Association Health Group (VNAHG). Among VNAHG patients surveyed between February 2 and March 1, 202, 24% had received at least one COVID-19 vaccine. Among vaccinated patients, roughly one quarter did not travel to get the vaccine (received inpatient vaccination). They mostly traveled by car (88%), and 70% received help from a family member. Of patients who had not received a vaccine (76%), 81% were pursuing or planning to pursue obtaining a vaccine. Additionally, of those not pursuing a vaccine, 30% indicated it was because they could not get to a vaccine site. 44% of patients in the VNAHG “in home” vaccination pilot were bedbound, and 100% of patients had ambulation difficulties that make it impossible for them to leave home. All (100%) had a health care provider(s) recommended they get the vaccine. Only 38% have internet access. A quarter tried to call to schedule a vaccine, but only one was able to speak to someone. 40% of the patients attempted to get a COVID-19 vaccine prior to enrollment in the program. Most patients (81%) did not have someone available to assist with their transportation to get vaccinated, and most indicated difficulty securing an appointment. Many indicated severe traveling difficulties (requiring oxygen, needing ambulance transport). These findings highlight the high barriers for homebound patients, and the need and value of clinicians traveling to provide in-home vaccines.
Perceptions of Family Caregivers of People With Dementia Regarding Symptom Management and the COVID-19 Pandemic
Authors: Harris Melissa , Titler Marita
Published: December 2021

Nearly 98% of older adults with Alzheimer’s disease and related dementias (ADRD) experience behavioral and psychological symptoms of dementia (BPSD). Although BPSD are linked to caregiver burden, perceptions of family caregivers on the impact of BPSD and their experiences addressing them in the home are unclear, and little is known about the impact of the pandemic on these experiences. Study aims were to explore: 1) the experiences of family caregivers of community dwelling older adults with ADRD regarding BPSD and how they manage BPSD in the home, and 2) how the pandemic impacted family caregivers’ experiences, BPSD of their relatives, and BPSD management. A qualitative, exploratory approach was used; 21 family caregivers were interviewed virtually. Content analysis and constant comparative methods were used. Ten major themes emerged: 1) Emotional and psychological responses of caregiver, 2) Loss, 3) Anticipation, 4) Reliance, 5) Learning to caregive, 6) Rewarding, 7) Emotional and psychological responses of care recipient 8) Cognition of care recipient, 9) Care strategies, 10) Caregiver perspectives. Caregivers did not use terms “behaviors” or “symptoms”, instead they described their relatives’ and their own experiences interdependently. Caregiving challenges presented before the pandemic (e.g. equivocal effects of medications, increasing care demands), many of which were compounded by the pandemic. Future research should explore the experiences of caregivers from a range of backgrounds. Findings illustrate communication barriers exist between clinicians, community services, people with ADRD and their families which may be addressed through clinician education, family-centered care planning, and policies to expand support service access.
Facilitators and Barriers to Implementation of the EIT-4-BPSD Intervention
Authors: Behrens Liza , Riley Kiernan , Boltz Marie , Kolanowski Ann , Van Haitsma Kimberly
Published: December 2021

This study aimed to explore the perceptions of stakeholders (site champions, administrators, and front-line, social service, and activity staff) regarding the EIT-4-BPSD implementation strategy, including its utility, and the barriers and facilitators to implementation in real-world settings. A process evaluation included qualitative data from focus groups conducted with 93 stakeholders of 21 nursing homes (NHs) that implemented the EIT-4-BPSD strategy. Data were analyzed using a conventional content analysis. Emerging codes were sorted into categories then organized in meaningful clusters based on the domains of the RE-AIM framework. Challenges, facilitators, and contextual factors explain variability in implementation of EIT-4-BPSD strategy among NHs in six key categories: multi-stakeholder engagement, multi-level outcomes, process adaptations, uptake and utility of EIT resources, adoption barriers and facilitators, and future planning. Overall, stakeholders reported that the EIT-4-BPSD strategy can be successfully implemented in NHs and is helpful in improving staffs’ approach to BPSD.
Hearing and Vision Impairment in Older Adults: Implications for Cognitive, Mental, and Brain Health
Authors: Deal Jennifer , Lin Frank , Swenor Bonnielin
Published: December 2021

Sensory impairment impacts over 55% of Americans aged 60 years or older and may have important downstream consequences for the cognitive health of older adults. This session will present evidence for a relationship between sensory impairment and accelerated cognitive decline, increased risk of incident dementia, and increased mental and physical fatigability from two observational cohort studies. Additionally, this session will investigate the possible nature of these relationships. It may be that sensory impairment is a marker of dementia-related pathological changes in the brain, with potential ramifications for risk prediction and stratification. Alternatively, sensory impairment may have a direct impact on the aging brain, a potential causal mechanism liking sensory impairment and brain health, with implications for disease prevention. As part of this session, we will present evidence for associations between central auditory processing, a potential risk marker, and brain volumes measured with structural magnetic resonance imaging (MRI), and retinal vasculature density, as measured with optical coherence tomography. We will conclude by describing associations between age-related macular degeneration, a leading cause of blindness, and neurocognitive test performance and regional changes in brain atrophy and connectivity.
State-Level Health Care Expenditures Associated With Disability
Authors: Anderson Wayne , Khavjou Olga , Honeycutt Amanda , Bates Laurel , Hollis NaTasha , Grosse Scott , Razzaghi Hilda
Published: December 2021

This study updated prior (2003) state-level estimates of disability-associated health care expenditures (DAHE). We combined 2013-2015 data from three national data sets to estimate using multivariate regression all state-level DAHE for US adults in total, by payer, and per adult and per (adult) person with disability (PWD). In 2015, DAHE were $868 billion nationally (State range, $1.4 billion to $102.8 billion) accounting for 36% of total health care expenditures (range, 29%-41%). From over a decade ago, total DAHE increased by 65% (range, 35%-125%). DAHE per PWD was $17,431 (range $12,603 to $27,839). From over a decade ago, per-PWD DAHE increased by 13% (range, –20% to 61%). In 2015, Medicare DAHE per PWD ranged from $10,067 to $18,768. Medicaid DAHE per PWD ranged from $9,825 to $43,365. DAHE are substantial and vary by state and payer. Stakeholders can use these results to develop public health programs to support people with disabilities.
Motor Skill Training Effect on Real-Time Prefrontal Cortex Activation During Walking
Authors: Rosso Andrea , Chen Nemin , Perera Subashan , Huppert Theodore , VanSwearingen Jessie , Brach Jennifer , Rosano Caterina
Published: December 2021

We aimed to test the effects of motor skill training (MST) on gait automaticity measured by changes in prefrontal cortex (PFC) activation during actual walking. We used data from a 12-week trial of older adults (mean age=75.5, 60.5% women) randomized to standard physical therapy and standard+MST in a 1:1 ratio. Functional near infrared spectroscopy (fNIRS) measured PFC activation during simple and dual task walking. We will apply linear mixed models to assess effects of task, time, and MST on PFC activation. We will compare the PFC activation 1) during dual task walking compared to simple walking; 2) across visits after intervention; and 3) between participants receiving MST compared to standard physical therapy. These results will demonstrate whether gait automaticity, as evidenced by PFC activation during walking, is affected by MST.
Molecular Resiliency and Aging
Authors: Salmon Adam
Published: December 2021

Resilience is described as the ability to respond to acute forms of stress and recover to normal homeostasis. There is growing evidence that biology of resilience is entwined with the biology of aging. With increasing age, resilience decreases and is a likely contributor to increased morbidity, frailty and susceptibility to death with age. Conversely, increased resilience across numerous physiological markers of function is associated with longevity and healthy aging. The variation in resilience in populations suggests biological and molecular regulatory mechanisms that might provide insight into interventions to improve resilience, healthy aging and longevity. In this session, speakers will provide insight regarding short-term assays of resilience in animal models that prove useful both in delineating these biological mechanisms as well as inform on potential translational models to better understand biological resilience in human populations. The sessions focus is on defining these assays and discussion of the biological relevance each resilience assay in terms of the regulation of aging. The goals of these studies range from identifying potential predictors of individual lifespan within markers of functional resilience to leveraging geroscience to define whether markers of resilience can be modified through interventions to the aging process. Moreover, better understanding of the biology of resilience could assist in defining novel interventions that improve resilience and thereby enhance longevity.
Providing Care for Older Residents With Dementia in Nursing Homes in China: Through the Lens of Adaptive Leadership
Authors: Wang Jing , Bian Xueli , Anderson Ruth , Beeber Anna , Wang Junqiao
Published: December 2021

This study aims to understand staff’s experiences of providing direct care for older residents with advanced dementia in long-term care facilities through the lens of Adaptive Leadership Framework for Chronic Illness (ALFCI). Semi-structured interviews were conducted with health care aides (N=35) from 2 government-owned and 2 private long-term care facilities in urban China. Directed and conventional content analysis were used, drawing upon core constructs of ALFCI. We found that health care aides are confronted with multiple challenges such as high intensity of work, stress from managing older residents’ behavioral and psychological symptoms of dementia (BPSD), a lack of access to on-the-job dementia-specific training, and a lack of support from nurses and managing team. Some of the health care aides demonstrated use of their strengths and doing adaptive work to improve work life and care for older residents by using communication cues, enhancing person-centeredness in their care, and facilitate peer interactions.
Sexual Expression, Policy, and Practices in Skilled Nursing Facilities: An Updated Assessment in the State of Kansas
Authors: Jen Sarah , Jeong Mijin
Published: December 2021

Prior studies have reported barriers to meeting the sexual needs of older adults within skilled-nursing facilities, such as a lack of privacy, lack of supportive practices and policies, and judgement or discomfort on the part of the staff (Doll, 2013; Hajjar & Kamel, 2003). In 2008, Doll and colleagues assessed the scope of sexual behaviors, staff perceptions of and responses to such behaviors, and whether facilities had a sexual policy in place in SNFs in the state of Kansas (Doll, 2013). In the present study, an online survey was distributed to the same population to provide an updated assessment of sexual behaviors, policies, and practices. Of 60 survey respondents, 62.7% reported knowledge of individual sexual acts (e.g., masturbation) within the past year and 34.5% reported interactional (between two or more residents) sexual acts. When encountering a sexual event, staff were most likely to report the incident to an administrator (76.7%) and treat residents with respect (70.0%), while 35.0% and 41.7% were expected to respond with embarrassment and discomfort, respectively. Only 40% of administrators reported having a policy related to sexual expression. Findings indicate that staff are likely to respond differently to LGBTQ residents due to discomfort and those living with cognitive impairment due to concerns related to consent. The proportion of facilities in Kansas with policies related to sexual expression has increased from 26% to 40% in the past 12 years, but there remains a need for greater specificity of sexuality-related policies and trainings.
Recruiting Older Adults in a Medicare Supplement Population for Wellness Intervention Pilot Studies
Authors: Ungar Rachel , Zaidel Catherine , Tkatch Rifky , Wu Lizi , Albright Laurie , McGinn Michael , Yeh Charlotte
Published: December 2021

Older adults are often underrepresented in the health promotion literature, in part due to challenges in recruiting older adults for such studies. Aging Strong 2020 was specifically designed to address the health needs of older adults. A subset of adults aged 65 and older with an AARP Medicare Supplement plan insured by UnitedHealthcare were recruited for participation in one of eight interventions. Recruitment lists for each program were drawn from a pool previously screened for loneliness, purpose in life, optimism, and resilience, administered by an interactive voice response (IVR) telephone survey. Recruitment efforts were multifaceted and included emails, direct mailers, and phone calls. Incentives ranging from $25-$100 for completing surveys did not correspond with higher recruitment rates. Overall, recruitment phone calls reached 28,058(32%) individuals on the recruitment lists; a total of 1,766 participated, demonstrating that targeted efforts to recruit older adults for research opportunities can be successful.
Improving Resilience, Optimism, Purpose, and Loneliness Among Older Adults
Authors: Tkatch Rifky , Wu Lizi , Albright Laurie , Ungar Rachel , Zaidel Catherine , Cheng Yan , Schaeffer James , Yeh Charlotte
Published: December 2021

Aging Strong 2020 was developed to promote health and well-being and increase resilience by focusing on the pillars of enhanced purpose in life, social connectedness, and optimism. A series of eight interventions over three years tested the feasibility of enhancing these pillars. Interventions included: 1) An expressive writing program, 2) Animatronic pets, 3) A telephonic reminiscent program, 4) An online self-compassion mindfulness program, 5) A technology-based behavior change tool, 6) An online and workbook tool for purpose, 7) An online happiness program, and 8) A peer-to-peer support program. Each program demonstrated efficacy dependent on the pillar targeted and the population sampled. Overall, some improvement was found among participants in resilience (47%), purpose (49%), optimism (44%), and loneliness (48%). Further, participant satisfaction improved in each program with Net Promoter Scores increasing between 7-19 points. Results demonstrate that Aging Strong 2020 was successful, contributing to a holistic model of healthy aging.
Improving Usefulness of Cognitive Decline Population Measures in Predicting Future Dementia Burden
Authors: Olivari Benjamin , Taylor Christopher , McGuire Lisa
Published: December 2021

Alzheimer’s disease and related dementias begin with mild early symptoms of memory loss, progressing to more severe cognitive and functional impairment. Reports of worsening memory and subjective cognitive decline (SCD) are often the earliest possible signs of dementia onset. The trajectory of certain types of dementia may require early detection of worsening memory in the disease progression for successful interventions. However, the predictive value of subjective measures of cognitive decline is limited; the majority of those who report subjective symptoms do not progress to diagnosed cognitive impairment or dementia. These two realities create a significant challenge in confronting the growing dementia crisis. Population-level data can be beneficial in tracking trends in SCD. Data from the Behavioral Risk Factor Surveillance System (BRFSS) core questions related to chronic diseases and from the SCD optional module from survey years 2015-2019 were aggregated across the participating 50 states, D.C., and Puerto Rico for this analysis. Among 181,097 U.S. respondents aged ≥45 years, 11.3% (95% CI=10.9-11.6) reported SCD; among 20,424 with SCD symptoms, 39.4% (37.6-40.6) reported functional difficulties associated with SCD symptoms and 33.9% (32.4-35.5) needed assistance with day-to-day activities resulting from symptoms. Studies suggest persons experiencing SCD symptoms and associated functional difficulties are at increased risk for dementia compared with those with SCD without functional difficulties. Combining responses about SCD with associated functional difficulties, anxiety, and other measures might help to better inform the future burden of more severe cognitive impairment than SCD status alone.
Lessons on Learning in Later Life With the MIT AgeLab 85+ Lifestyle Leaders
Authors: Patskanick Taylor , Miller Julie , Yoquinto Lucas , D'Ambrosio Lisa , Coughlin Joseph
Published: December 2021

Previous research has established the role of lifelong learning in promoting psychological wellbeing and active aging. Population aging necessitates an understanding of the unique opportunities and challenges around formal and informal learning in later life. This paper will share findings from a mixed methods study with the MIT AgeLab 85+ Lifestyle Leaders, a panel comprised of octogenarians and nonagenarians from across the United States. Drawing on an online survey and virtual focus groups with 29 Lifestyle Leaders from January 2021, findings suggest the Lifestyle Leaders most often learned new things from talking with others (46%) and reading print (54%) or online (54%) sources. The majority were familiar with attending in-person lectures or classes (89.7%) and were now using videoconferencing to do these (78.6%). A majority (56.7%) had or are currently participating in a lifelong learning program. Most consider themselves lifelong learners and described this around remaining curious and engaged with life, choices around what one learns, and greater enjoyment of learning. In the survey, a plurality of Lifestyle Leaders indicated the top two challenges affecting their ability to learn were sensory burdens (e.g., hearing loss, declining eyesight) (35%) and their energy level (32.4%); focus group data revealed that recall also is a barrier. Focus group data further highlighted generational experiences around early life learning and career paths, specifically how gender roles, diagnoses of learning disabilities, and evolving digital technology have affected these and changed over the course of their lifetimes.
Country Differences in Financial Preparation: What Do People Expect From the State?
Authors: Nikitin Jana , de Couto Maria Clara P Paula , Graf Sylvie , Rothermund Klaus
Published: December 2021

A considerable gap between one’s pension and living expenses in old age exists in almost all developed countries, making savings and financial preparation for old age inevitable. Nevertheless, financial preparation for old age substantially differs across countries. Using the data from the AAF project, we investigated what motivates people in different countries (USA, Germany, Czech Republic, Hong Kong, and Taiwan) to financially prepare for old age. Financial preparation was the highest in the USA, followed by Germany and the Czech Republic. The lowest levels of financial preparation were found in Hong Kong and Taiwan. These differences were explained by age-related expectations on a “paternalistic” role of the state: Greater endorsement of the idea that the state should provide financial support to older citizens led to less preparation. These findings are in line with the idea that individuals’ beliefs and expectations regarding the role of institutions shape personal actions.
Older Adults Pursue More Autonomy During Pandemic: An Explanation by Social Obligation
Authors: Tsang Hiu Ling Vivian , Mai Chunyan , Fung Helene
Published: December 2021

Older adults are considered more vulnerable under the COVID-19 pandemic. Nevertheless, the pandemic also highlights the social obligation of all individuals, young and old. We investigated whether older adults pursued more autonomy during the pandemic than did middle-aged adults, and the moderating effect of perceived social obligation. One hundred and twenty-three Hong Kong citizens (62 females, Mage=60.59±13.28 years old) participated in this study in 2018 (before pandemic) and 2020 (during pandemic). Comparing these two waves, the results showed a larger increase of perceived importance of independence and autonomy among older adults than among middle-aged adults. Moreover, the age difference became stronger with a higher increase in expectation on social obligation, suggesting that the pandemic might make older adults feel more socially obligated to be independent and autonomous, so as not to be a burden on others. Future ageism-related studies should take the social obligation of older adults into consideration.
Everyday Needs Assessment for Cognitive Tasks: Challenges for Persons With Cognitive Impairment
Authors: Rogers Wendy , Mudar Raksha , Harris Maurita , Lydon Elizabeth , Ramadhani Widya , Czaja Sara , Boot Walter , Charness Neil
Published: December 2021

ENACT (Everyday Needs Assessment for Cognitive Tasks) is an exploration and discovery project to gather information on challenges in daily and community living experienced by individuals aging with compromised cognition due to mild cognitive impairment, traumatic brain injury, or post-stroke. We are exploring their challenges through a longitudinal needs assessment study involving interviews with older adults with cognitive impairment and their care partners. We will describe the study development process wherein we interviewed subject matter experts, including persons with professional (neurology, rehabilitation, gerontology) or personal experience with individuals who have cognitive impairment. Based on their collective insights, we selected the following categories of activities for the ENACT in-depth interviews: health, social engagement, transportation, domestic life, and leisure/recreation. The ENACT longitudinal data will provide insights to guide development of adaptive, context-sensitive technology-based supports for the AUGMENT, DREAM, and STRUMM projects described in this symposium, as well as other initiatives.
Social Support, Coping Behaviors, and Resilience Among African Americans During COVID-19
Authors: Park Sung
Published: December 2021

Enduring structural inequalities in the United States by race have only become more apparent during COVID-19, as African Americans experienced significant health and economic challenges that far exceeded those observed among other racial and ethnic groups. Relying on multiple nationally representative surveys, this study examines the diversity of ways in which middle-aged and older African Americans’ managed the stress and pressures associated with the pandemic. I summarize the inequities faced by African Americans before and during COVID-19, as well as trends in the utilization of social support, coping behaviors, and degree of resilience. Furthermore, this study investigates the relationship between social support and coping strategies to multiple health outcomes over time. When appropriate, comparisons to other racial and ethnic groups are made. This research underscores the importance of considering social relationships and modifiable coping behaviors when studying African American aging and well-being during times of crisis.
GSA Managing Editors’ Perspective on Submission Dos and Don’ts
Authors: Jackson Kathleen , Jung Karen
Published: December 2021

In this presentation, the managing editors of GSA’s peer-reviewed journals will discuss how the editorial offices operate and their roles in the publishing process. The topics will include how to navigate the ScholarOne submission system, why it is important to read the Instructions to Authors, and how authors can work with the editorial offices to increase the visibility and impact of their published articles.