bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECT OF SELF-PACED WALKING ON REDUCING COGNITIVE DEMANDS OF WALKING WHILE TALKING
Authors: Kim Hyeon Jung , Fallahtafti Farahnaz , Yentes Jennifer M , Venema Dawn , Boron Julie Blaskewicz
Published: November 2019

Although walking is considered an automated process, internal and external factors can alter gait performance. Fear of falling leads to walking with a wider base of support and decreased walking speed, due to a combination of shorter stride lengths and/or stride time. Exacerbation of gait deficits have been reported under high cognitive load situations (HCLS, also known as dual-tasks). Talking on a phone is considered an increased HCLS over talking in-person due to visualization of the individual on the phone. The purpose of the study was to explore the added effects of walking while talking on a phone compared to talking in-person. Fifteen healthy older adult subjects (70.86±4.7yrs) performed three conditions while walking on a self-paced treadmill for ten minutes: (1)walking alone, (2)walking while talking in-person, (3)walking while talking on a phone. Mean stride length(SL), stride time(ST), and step width(SW) were compared using one-way, repeated-measures ANOVAs (p=0.10). Dual-task cost of walking while talking in-person and on a phone was calculated for each gait variable and compared with t-tests. Mean gait variables did not differ between conditions (SL p=0.95, ST p=0.77, SW p=0.57). Dual-task costs were not significantly different between talking conditions (SL p=0.99, ST p=0.54, SW p=0.14). Use of a self-paced treadmill allowed the subjects to perform in their “comfort zone”, however, walking on a set-speed treadmill may force walking speed outside of the comfort zone, pushing one’s “reserve”, and revealing differences. Use of a self-paced treadmill better approximates daily life by providing the opportunity to make adaptations under HCLS.
THE AGING BRAIN AND MOTOR LEARNING
Authors: Tian Qu , Mullins Roger , Corkum Abby , Reiter David , Pupo Daniel , Simonsick Eleanor M , Kapogiannis Dimitrios , Studenski Stephanie
Published: November 2019

The effect of aging on motor learning is poorly understood. This study investigated response time and patterns of brain activation induced over the course of a bimanual motor learning task in three age groups. Twenty-two cognitively unimpaired participants (32%women) were grouped into Young (<35,n=6), Middle-Age (36-59,n=10), and Old (60+,n=6). A self-paced bimanual motor learning task was performed during fMRI. The task consisted of using 2 capital and 2 lower case letters in strings of 16 cues with 6 novel alternating with 6 repeated sequence blocks. To assess learning, a repeated measures ANOVA tested whether average time per slide differed over time between novel and sequence conditions. Voxel-wise changes in brain activation between novel and sequence conditions over time were examined using a within-subject repeated measures model. Faster initial time per slide was associated with younger age (p0.05). Old had increased brain activation in repeated sequence than novel conditions in right postcentral and superior parietal regions during the early half of the task compared to the second half (p0.05). We found behavioral evidence of motor learning in Middle-Age and Old, but not Young, perhaps because younger individuals performed quickly and learned sequence almost immediately. Among older individuals, sequence-specific learning in parietal regions challenges the view that it is mediated by only motor areas.
QUADRICEPS STRENGTH IS ASSOCIATED WITH COGNITION IN OLDER ADULTS WITH CHRONIC STROKE
Authors: Bennett Kimberly , Crockett Rachel A , Brinke Lisanne F ten , Davis Jennifer C , Liu-Ambrose Teresa
Published: November 2019

Individuals who have suffered a stroke are at risk for developing cognitive impairment and dementia. Thus, it is important to identify modifiable risk factor for cognitive decline in this population. Among older adults without a history of stroke, greater muscle strength is associated with better cognitive function. Whether this relationship also exist in older adults with a history of stroke is not known. Thus, we aimed to examine whether cognition, as measured by both the Montreal Cognitive Assessment (MoCA) and the 13-item Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog 13), is associated with lower extremity muscle strength in adults with chronic stroke (> 1 year post stroke). Ninety-one community-dwelling adults, aged 55 years and older, with chronic stroke were included in this analysis. Isometric strength of the quadriceps was measured bilaterally in kilograms. Two linear regression models were constructed to determine the independent association of quadriceps strength (mean kilograms of both legs) with: 1) MoCA; and 2) ADAS-Cog 13, after controlling for age, sex, and mood. Mean quadriceps strength was independently associated with both MoCA and ADAS-Cog scores, after accounting for age, sex, and mood. Specifically, quadriceps strength explained an additional 5.6% of the variable in MoCA scores; total variance explained by the model was 12.0%. For ADAS-Cog 13, quadriceps strength explained an additional 5.4% of the variance; total variance explained by the model was 16.5%. Our current cross-sectional results suggest that the maintenance of muscle strength may be important for cognitive health in older adults who have suffered a stroke.
ASSOCIATIONS BETWEEN COGNITIVE FUNCTION AND BIOACTIVE FOOD COMPOUNDS IN 100% WATERMELON JUICE
Authors: Ellis Amy , Hansen Ann Bradford , Baidwan Navneet , Nagabooshanam Vinoth Aryan , Crowe-White Kristi
Published: November 2019

Objectives: Decline in cognitive function and increases in inflammation and oxidative stress are part of normal aging. Watermelon contains numerous bioactive compounds including lycopene, arginine, and citrulline that exhibit both anti-inflammatory and antioxidant functionality. Thus, the objective of this study was to examine the effect of 100% watermelon juice supplementation on cognitive performance. Methods: A placebo-controlled, randomized, double-blind, crossover trial was conducted with postmenopausal women (n = 16, 60 + 4.1y). Participants initiated a low-lycopene diet during a one-week run-in period and adhered to this diet throughout the study. For four weeks, participants were randomized to consume either two 360 mL servings of pasteurized 100% watermelon juice or a placebo beverage. Following a two-week washout period, participants received the opposite beverage for an additional four weeks. Pre/post each intervention arm, fasting blood samples were collected, and cognitive tests were administered to assess various neurocognitive domains. Statistical analyses included mixed models and Spearman correlations. Results: Serum lycopene exhibited a significant treatment effect (p=0.002); however, lycopene was not correlated with any cognitive test. In contrast, no significant treatment effect was observed for serum arginine or citrulline, yet arginine was significantly inversely correlated with Digit Span Forward (p = 0.005, r = -0.547) and Letter Fluency (p = 0.024, r = -0.507). Conclusion: Despite research supporting the relationship between lycopene and enhanced cognition, lycopene was not related to improvements in cognitive performance in this study. Nevertheless, consumption of 100% watermelon juice may be beneficial for increasing circulating levels of this antioxidant.
A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS OF COGNITIVE TRAINING INTERVENTIONS IN OLDER ADULTS
Authors: Malatyali Ayse , Reive Carol , Williams Christine
Published: November 2019

There has been a growing interest in cognitive training interventions for their potential effect of maintaining and promoting cognitive functioning in older adults. Rapid and significant changes in technology has had a significant impact on the design and assessment methods of cognitive training interventions. Investigating changes in brain networks and blood markers are relatively new approaches and sparsely examined in the literature. The purpose of this systematic literature review is to analyze the effect of cognitive training interventions on brain networks, blood markers and associated cognitive performance of healthy older adults. We conducted a comprehensive literature search on four databases, following PRISMA guidelines. Initially, 2426 citations were retrieved, and 251 full-text publications were evaluated in detail for eligibility. Fourteen randomized control trials were included in this review. Functional imaging analysis of brain networks showed significant activity changes primarily in the Default Mode Network. These changes were associated with improvement in memory, learning, attention, and affective performances. Also, there were activity changes in the Central Executive Network that were associated with improvement in reasoning, attentional control, innovative thinking, and processing speed. Training-induced changes have been observed in the brain-derived neurotrophic factor levels and the markers of antioxidative and anti-inflammatory regulatory mechanisms. Improvement in attention and memory performances were significantly related to these changes. Limitations of the studies included methodological inconsistencies, sampling issues, and the lack of long-term follow up assessment. Cognitive training appears to promote improvement and maintenance of cognitive functioning in healthy older adults.
REDUCING OPIOID OVERDOSE RISK IN A COMMUNITY CARE COORDINATION CLINIC: RICHMOND HEALTH AND WELLNESS PROGRAM
Authors: Zanjani Faika A , Brooks Marshall , Waters Leland , Parsons Pamela , Slattum Patricia
Published: November 2019

Objective Opioid safety is increasingly important in the care of older adults due to higher risk for negative opioid-related outcomes related to higher prevalence of chronic pain, multimorbidity, polypharmacy, and age-associated changes in drug metabolism and elimination. Evidence-based practices for screening and safe opioid use for older adults are needed. Our project aims to develop, implement, and evaluate a care-coordination workflow and interprofessional clinical opioid misuse screening, support, and referral training to support older adult care. Methods Our research occurs in context of the Richmond Health and Wellness Program (RHWP), a community-based interprofessional care coordination initiative, with interprofessional faculty and students providing on-site integrated care to residents in low-income senior housing communities. Curriculum development, and interprofessional clinical faculty, peer support, and health professions student training have been conducted. Results will discuss the findings from the health professions student training. Findings The Opioid Overdose Risk Reduction Curriculum was delivered via Blackboard and in-person during student orientation. Pre (n=66)/Post (n=59) assessment indicated that after the training, there was an increase in knowledge, specifically change from 50% at baseline, 60% recognized Tramadol as an opioid, change from 80% to 97% understanding that MME represents Morphine Milligram Equivalent, and change from 62% to 93% understanding that 50 MME level greatly increases overdose risk. Only 20%, change from 60%, reported not being able to calculate MME. Conclusions Our findings indicate that opioid safety training within community care coordination is feasible. Future works needs to explore the impact on resident health as the workflow is implemented.
THE ROLE OF IMPROVED SOCIAL SUPPORT FOR HEALTHY EATING IN A LIFESTYLE INTERVENTION: TEXERCISE SELECT
Authors: Yoshikawa Aya , Smith Matthew L , Lee Shinduk , Towne Jr. Samuel D , Ory Marcia G
Published: November 2019

Healthy diet is essential to the management of chronic conditions such as cardiovascular disease and diabetes. Research suggests an association between social support and dietary behavior, yet the relationship is not fully explored. The role of social support in nutrition consumption was examined among older participants in a group-based lifestyle enhancement program (Texercise Select) designed to improve dietary behaviors and physical activity and related supports. Factor analysis and structural equation modeling were performed using secondary data from a quasi-experimental study of participants who completed a baseline survey and three-month follow-up (Intervention group N = 211, comparison group N = 175). The majority of participants were age 70 years or older (Mean = 74.30, SD = 8.54), female (82.1%), and had at least two chronic conditions (63.5%). The two groups did not differ in baseline levels of nutrition intake or social support. Program participants improved in terms of intake of water and fruits/vegetables as well as social support. Structural equation models adjusting for the effect of baseline scores indicated that the intervention effect on fruits/vegetable intake (β = 0.19, p < 0.001) was partially mediated (β = 0.03, p = 0.021) by social support for planning and keeping dietary goals and reducing barriers to healthy eating (X2/df = 1.89; RMSEA = 0.04; CFI = 0.99; TLI = 0.99; SRMR=0.02). Findings suggest that programs designed to enhance social support may be effective in improving dietary behaviors among older adults. Future research should investigate various types of social support for promoting healthy diets.
CNA WORK IS BETTER LEARNED HANDS-ON: TRAINING CERTIFIED NURSING ASSISTANTS TO FEED RESIDENTS WITH DEMENTIA
Authors: Douglas Joy W , Jung Seung Eun , Noh Hyunjin , Ellis Amy , Ferguson Christine
Published: November 2019

In nursing homes across the United States, Certified Nursing Assistants (CNAs) provide essential mealtime assistance to residents with dementia who have difficulty feeding themselves. However, dementia-related training content in CNA programs can vary. In this qualitative study, we sought to understand the training provided to CNAs in Alabama, and to identify the ideal training modality for content related to feeding residents with dementia. Nine focus groups were conducted with 53 CNAs. Each participant had at least one year of working experience as a CNA caring for older adults. Focus groups were audio recorded and transcribed verbatim. Data were analyzed using the directed content analysis approach. Analyses revealed several key themes related to training CNAs to feed residents with dementia. Across focus groups, CNAs agreed that they needed additional training about feeding residents with dementia. They unanimously agreed that the best person to provide such training should be an experienced CNA, not a nurse or other healthcare provider. In terms of delivery, they preferred hands-on training and role playing. CNAs also emphasized that while some learning takes place in a didactic setting, the most valuable learning moments involve on-the-job experience in feeding residents, where they are mentored by seasoned CNAs. Findings from this study revealed the need for providing CNAs training on feeding residents with dementia. CNA training programs that includes hands-on activities mentored by seasoned CNAs could increase CNAs’ ability to provide optimal meal assistance to nursing home residents with dementia.
EDUCATIONAL CHALLENGES OF CHILDREN IN SKIPPED GENERATION HOUSEHOLDS IN NIGERIA
Authors: Popoola Bayode I , Togonu-Bickersteth Funmi , Aransiola Joshua O , Akintomide Akinjide , Ekundayo Opeyemi
Published: November 2019

The paper examined the challenges of accessing education by Nigerian children raised in an unusual family context, the skipped generation households. Specifically, it determined the proportion of Nigerian school-age children in skipped generation households enrolled in the formal school system and investigated the children’s perception of the effect of living in skipped generation household on their education. The paper also ascertained regional differences in education challenges experienced by children in skipped generation households. The study adopted the descriptive survey design. The research procedure involved the collection of primary data through the administration of a survey questionnaire on 2144 indexed children from three purposively selected states representing the three major ethnic groups in Nigeria. The results showed that 88.2% of Nigerian children in skipped generation households were enrolled in the formal school system, and that significant regional variations existed in school attendance by children in skipped generation households. Also, a substantial majority (74.1%) of grandchildren reported that living in SGHs had no negative effect on their academic performance. The specific education challenges of school-going children in skipped generation households included having to do assignment alone, not getting enough time to study, and difficulty in paying school fee. The results further indicated that the education challenges experienced by children in skipped generation households were significantly different across the selected states which constitute the study area. The paper highlighted the need for government to improve the welfare of older adults in Nigeria, especially those who serve as custodial grandparents for their grandchildren.
WHAT IT TAKES TO COMBAT DECLINE: LEARNING THROUGH AN INTERPROFESSIONAL STUDENT SENIOR PARTNERSHIP
Authors: Katz Anne D , Axonovitz Judy
Published: November 2019

Healthcare is in need of a workforce with the knowledge and skills to meet the needs of our aging population. Seniors face social, mental, and physical issues as they move into the later stages of life. The Student Senior Partnership Program (SSPP) connects teams of students with healthy senior volunteers in the community. Through this partnership, students learn the strategies seniors implement to stay engaged and maintain their activities of daily living to combat decline and frailty. The SSPP focuses on increasing student’s capability to assess older adults, and learn from their senior within an interprofessional team. Faculty provided training to the senior volunteers so they were prepared to function in a role as “teachers” to students from six professional disciplines (Medicine, Social Work, OT, PT, Dentistry, Pharmacy) through meaningful dialogue focused on physical well-being, relationships with family, friends, community, memory and cognition . Evaluation was performed using the Geriatrics Attitudes Scale (GAS). The pre and post survey (n=72) measured the reported capability to assess older adults and evaluate their attitudes toward the elderly. There were statistically significant improvements in six of nine assessment topics. The largest improvements were in the capability to assess resource gaps (mean=2.79 to 3.44 on a 5-point scale, p<0.001), mental status (3.03 to 3.57, p<0.001) and fall risk (2.99 to 3.50, p<0.001). Attitudes toward the elderly were measured using the Geriatrics Attitudes Scale (GAS). Overall, students improved during the program (mean=3.88 to 4.05 on a 5-point Likert scale, p<0.001).
EDUCATION AND TRAINING ELECTRONIC NAVIGATION SYSTEMS’ IMPACT ON OLDER DRIVER PERFORMANCE AND TRAINING TO OVERCOME UNFAMILIARITY
Authors: Dickerson Anne E , Thomas F Dennis , Graham Lindsay , Coleman M Chandler , Blomberg Richard , Wright Tim
Published: November 2019

Technology may assist older adults in improving their driving performance and therefore driving safety. However, it is sometimes a distraction and some older adults avoid its use due to the complexity of learning the systems. This study examined how older drivers interacted with an electronic navigation system (e.g., GPS) and the extent to which it impacted driving performance on unfamiliar routes. It also examined three approaches to training older adults how to program the devices. In Phase 1, 80 older drivers navigated unfamiliar routes using a GPS or paper directions and completed destination entry tasks. In Phase 2, 60 older drivers completed one of three training conditions (video, video with hands-on, placebo) to examine the impacts of training on destination entry performance. Driving performance was improved with GPS over paper directions (p = .025), as evaluated by a driver rehabilitation specialized on counterbalanced standardized routes. Analyses also showed significant effects for familiarity for use of GPS (p=.035) and age group (60’s versus 70’s) (p<.001), but many drivers had difficulty entering destinations. In Phase 2, a main effect of training was found (p=.02) with using video and one-on-one training showing the best performance. This study demonstrates older drivers could benefit from the use of such devices when driving to unfamiliar destinations, but training is needed with hands-on training with a live instructor being the best.
TWO STEPS FORWARD AND THREE STEPS BACK: STUDENTS’ PERSPECTIVES ON LIVING AND WORKING WITHIN AN AGING SOCIETY
Authors: Tompkins Catherine J , Ihara Emily S , Bittinger Katelyn
Published: November 2019

Each day, 10,000 Americans celebrate a 65th birthday, but there are still many young adults not choosing to enter a field that focuses on working with the older population. As part of a continued effort to understand low enrollments in a minor in aging studies and a graduate certificate program in gerontology, focus groups were held with students to explore why they are not choosing to learn more about one of the fastest growing sectors of the U.S. population. A total of 21 students participated in two focus groups. Students’ majors varied but included social work, public health, nursing and communications. All of the students were between the ages of 18 and 22 except for one student who was 68 years old. Only 6 students had taken an aging class, but every student indicated that they were close to a family member, 60 years old or older. Two researchers coded and analyzed the focus group data for themes. Examples of the themes about older adults included being unwilling to change, having negative views toward millennials, and being hampered by technology. Themes relative to student perspectives included needing empathy and patience to work with older adults, assuming decline and lacking opportunities within their majors to take gerontology courses. Comparing views and perspectives of older adults decades ago by traditional college-aged students to current day perspectives resulting from this data will be discussed as well as successful strategies for increasing enrollments in gerontology programs.
DEVELOPMENT OF AN OPIOID EDUCATION RESOURCE FOR OLDER CANCER PATIENTS
Authors: Manna Ruth , Moryl Natalie , Gangai Natalie , Malhotra Vivek , Wang Jennifer , Korc-Grodzicki Beatriz
Published: November 2019

Pain is a common problem in older cancer patients, estimated to affect 70% of those with advanced disease. As older adults live longer after diagnosis, the use and misuse of opioids will continue to rise. Gaps in available age-friendly opioid resources for patients were identified at a Comprehensive Cancer Center. An interprofessional team worked to develop a resource to educate older cancer patients and their caregivers regarding safe opioid use. Expert clinical opinions from Supportive Care, Anesthesia Pain, Nursing, and Geriatrics Services as well as patient observations informed drafts of the resource. A total of 22 older patients in three geriatric clinics were approached for a short interview (8 open questions) surrounding opioid understanding and concerns. The most stated concerns were fear of addiction, concern about the opioid epidemic, and potential unwanted side effects. There was an evident lack of awareness of what an opioid was or which one of the medications in their list was an opioid. The interviews underscored the need for the education resource to include names of opioids, address concerns about the opioid epidemic and signs of addiction. Language was added to describe safe use, storage and disposal of opioids. Special considerations in the older adult were emphasized. Links to additional information were provided. Finally, patient education experts reviewed the draft to adapt the language to be patient-friendly. Opioids are often effectively used in cancer pain management and older cancer patients warrant proper education. Patient perspectives are critical in the development of relevant patient education resources.
ADVANCING PROGRAM REACH BY TAKING TRAINING ONLINE
Authors: DeMott Andrew , Hughes Susan , Spencer-Brown Lesha
Published: November 2019

The National Recreation and Park Association (NRPA) is one of four national organizations to receive funding from CDC to disseminate arthritis-appropriate evidence-based interventions (AAEBIs). NRPA has partnered with Fit & Strong!, a CDC-approved AAEBI and National Council on Aging falls prevention program, to disseminate through local park and recreation agencies across the country. To meet the needs of this dissemination effort, Fit & Strong! adapted its in-person instructor training into an online curriculum which became available March 2018. After initial pilot-testing, Fit & Strong! created a five-module training curriculum using Moodle teaching software. The training curriculum uses slides, graphics, videos, and interactive questions to assess mastery. After completing the training, fidelity checks are performed on all instructors by having them video record a class session and share it with the Fit & Strong! team for review. After evaluating the videos, the team meets with the instructors by phone to debrief and advise on any needed improvements. Through this partnership, Fit & Strong! trained an initial cohort of 39 instructors across 18 states within a month’s time. Training evaluation results have been positive. To date, over 900 participants have been reached. A second cohort of approximately 40 new instructors will be trained in Spring 2019. This presentation will review the processes of creating and executing the online training, potential cost and time-saving benefits to CBOs, instructor feedback, and the ease with which instructors can complete the training and offer the program anywhere across the country.
STRENGTHENING A COMMUNITY HEALTHY AGING EDUCATION PROGRAM THROUGH CBO PARTNERSHIPS AND RCQI
Authors: Graupner Jeffrey P , Molony Jason , Kelemen Leah , Ding Kedong , Thompson Katherine
Published: November 2019

The SHARE Network (Supporting Healthy Aging Resources & Education) is a Geriatrics Workforce Enhancement Program serving older adults in a large urban, underserved community. For 4 years, one objective of the SHARE Network has been to increase health literacy while fostering positive change in older adults through “Healthy Aging” presentations. Led by geriatrics subject experts, these presentations cover a wide range of important health topics for older adults at a variety of community-based organization (CBO) partner locations. Rapid Cycle Quality Improvement (RCQI) efforts to enhance this programming include surveying audience members after a presentation, then sharing results with CBO partners at monthly meetings to review popular topics, participant demographics, quality of presentations, suggestions for improvement, etc. These recurring RCQI meetings have proven critical to maintaining a robust healthy aging curriculum and network engagement across a variety of organizations and interests. Analysis of participant survey data demonstrates the strength of QI efforts and includes a qualitative analysis of open-ended responses. To date, 153 presentations have been held with 2,704 attendees and 1,470 respondents, 86.3% of whom planned to make a health change after attending the presentation. Qualitative analysis of these behavior change plans reveals that 82.6% are proactive behaviors versus restrictive behaviors, and that diet, exercise, and lifestyle changes are most common. This program, and its RCQI approach, serves as a successful model for aligning the educational objectives and priorities of network partners, while ensuring relevancy and cultural competency in promoting positive healthy behaviors in the older adult community.
IMPROVING THE PERSONAL CARE ASSISTANT WORKFORCE THROUGH TRAINING, DATA, AND TECHNOLOGY
Authors: Abujarad Fuad , Swierenga Sarah J , Luz Clare , Hanson Katherine , Curtin Chris , Luo Zhehui , Swanson-Aprill Lauren A
Published: November 2019

Ensuring a quality personal care aide (PCA) workforce is critical to meeting the needs of an aging population. The Integrated Model for Personal Assistant Research and Training (IMPART) program is a PCA training and advocacy model designed to increase the number of qualified PCAs. A core component is an evidence-based, comprehensive PCA training program, Building Training…Building QualityTM (BTBQTM), supported by a robust data platform. This online system was designed to register, train and certify PCAs and Trainers, maintain a qualified PCA workforce database, and enhance the capacity to track IMPART process, performance, and impact measures. This innovative system was developed using a User-Centered Design approach, which includes four main user interfaces: Administrator, PCA, Trainer, and Public. It automates central administration functions, tracking, and reporting of training events, and standardizes and consolidates all training activities on a scalable and usable web-based technology platform. User acceptance testing of the tool and a usability evaluation with representative PCAs and trainers has been completed. Over 50 PCAs have completed BTBQTM modules and 22 new trainers have completed a new BTBQTM Trainer Certificate program during the tool development phase. The PCAs are already reporting substantially higher wages. Launching the new web-based data platform in April 2019 will make it possible for these programs to scale up for wide distribution. As more PCAs and trainers graduate, the number of qualified PCAs will increase exponentially. The data collected with this technology can inform responsible fiscal and policy decisions about resource allocation to support a stronger PCA workforce.
END-OF-LIFE SERVICES IN TRIBAL COMMUNITIES
Authors: Jervis Lori L , Cox Derrell W
Published: November 2019

Terminally ill American Indians/Alaska Natives (AI/ANs) are less likely to receive hospice and palliative care than other racial/ethnic groups, with fewer than 1/3 receiving these services compared to over 45% of EuroAmericans (Johnson, 2013; NHPCO, 2017). While some AI/ANs believe that End of Life (EoL) services will hasten their deaths (Colclough & Brown, 2014), claims that Natives reject EoL services due to death taboos are likely overgeneralizations. Rather, extant studies point to barriers to access resulting from lack of financial resources and inadequate service infrastructure, especially in rural areas (Jervis, Jackson, & Manson, 2002; Kitzes & Berger, 2004; Kitzes & Domer, 2004; Weech-Maldonado et al., 2003). While these factors undoubtedly play a role in underutilization, our preliminary research suggests that other factors—such as a lack of tribally based EoL programs and the cultural mismatches that occur when non-Native programs attempt to deliver hospice services to Native clients—may discourage AIANs from seeking and/or retaining these services. In this presentation, we report on results from a nationwide telephone survey of the availability of EoL care across AIAN tribes. We also present findings from in-depth interviews with local service providers on the challenges and successes they experienced in providing EoL care to their AI clients in one tribal community. Together, these findings will add to our growing understanding of the factors that inhibit and facilitate EoL service utilization, and suggest possibilities for improving access.
STRENGTHENING OLDER INDIGENOUS NEW ZEALANDERS AT END OF LIFE: WHAT ROLE DO HEALTH SERVICES PLAY?
Authors: Moeke-Maxwell Tess H , Mason Kathleen R , Gott Merryn
Published: November 2019

Older indigenous people and their families draw on specific tribal care customs to support end-of-life care as these help to fortify and strengthen older people. New Zealand’s health and palliative care services can either help or hinder families to utilise their care customs. The aim of the Pae Herenga study was to investigate the specific traditional care customs employed by older New Zealand Māori. This involved 60 face-to-face interviews with participants who had a life limiting illness (majority aged over 65), family carers, indigenous healers, spiritual practitioners, and health and palliative care professionals across four key geographical sites. Three digital story workshops involving 16 participants were also included. The study findings show that no matter what the older person’s illness was, their cultural customs and protocols helped to fortify them and kept them spiritually safe at end-of-life. Hospitals and hospices helped families to action their customs by providing rooms large enough to host gatherings of thirty or more people; prayers, songs, speechmaking and communal sharing of food took place. However, incidences of racism, a lack of space, and a lack of support for indigenous plant medicines prevented the use of ancient traditional end-of-life care customs for older people. The findings suggest that health and palliative care services can help older indigenous people maintain their spiritual strength by providing them with culturally supportive care and environments equipped to host the dying and their families.
PREVALENCE AND CORRELATES OF SYMPTOMS OF ANXIETY AND DEPRESSION AT THE VERY END OF LIFE
Authors: Kozlov Elissa K , Phongtankuel Veerawat , Reid Cary
Published: November 2019

Rates of psychological symptoms for patients with serious illness is high, but there has been limited research investigating psychological symptoms at the very end of life. The aim of this study was to better understand the prevalence, intensity and correlates of psychological distress at the very end of life. This cross-sectional study utilized caregiver proxy interviews. Caregivers were contacted after their loved one recently died after being on home hospice and invited to participate in a brief interview with a trained research assistant. Patient, caregiver and hospice utilization data were also abstracted from electronic medical records. N = 351 caregivers were included in the study. According to caregivers, 46.4% of patients had moderate to severe anxiety, as assessed with a score of ≥4 on the Edmonton Symptom Assessment Scale (ESAS) and 43% had moderate to severe symptoms of depression in the last week of life. Symptoms of anxiety and depression were significantly associated with caregiver burden scores and inversely associated with the age of the patient. Psychological symptom management at the very end of life is essential to providing comprehensive hospice care. Our study revealed that nearly half of patients die with moderate to severe symptoms of anxiety and/or depression. Future research is needed to improve psychological symptom management at the very end of life in order to improve the quality of life for both patients and their families.
THE PERSISTENCE OF TRADITIONAL VALUES: GRANDPARENTS REARING GRANDCHILDREN
Authors: Edwards Anne B , Henderson Tammy L , Niemeyer Crystal , Stanley Jessica L
Published: November 2019

The goal of this study is to examine how cultural values are preserved and transmitted by grandparents rearing grandchildren in one community in the southeast region of the Yukon-Koyukuk Census Area in Alaska. The eight participants (six females and two males) lived in a community in the Kusilvak Census Area, with ages ranging from 47 to 73 years old. Participants’ took part in a semi-structured interview, which were then transcribed and coded into larger themes of 1) loss of traditional values, 2) continuing traditional values, 3) practicing traditional values, and 4) transmitting traditional values. The participants provided examples of how the cultural values that were strong at one point in their lives, were no longer exemplified in their community, and, in fact, behaviors that went against accepted values were seen. Participants spoke most often of how community members were cared for, how the community was valued over the individual, and the connections within families. The GRGs practiced those traditional values by caring, supporting, and loving the people in their families and communities, and by practicing humor and sharing with others. While this community has been influenced by modern ways of living currently found in the United States and Canada, it still remains relatively isolated from the technological and social influences that dominate what is considered “typical, modern” family life. The findings from this study illustrate the important roles that GRGs play in the persistence of cultural values, and the importance of incorporating these values in programs to assist this community.
CARE DEPENDENCY IN OLD AGE IN MEXICO: SITUATIONAL ANALYSIS, IMPLICATIONS, AND RECOMMENDATIONS
Authors: López-Ortega Mariana , Gutiérrez Robledo Luis Miguel F
Published: November 2019

The demographic transition, population aging, and the epidemiological transition in Mexico have modified the burden of the disease profile, and impose important economic, social, and health care challenges, particularly old-age and disability-related care dependency. We describe old age health and dependency conditions, and analyze the supply of services to dependent population, including aging and disability norms and policies, the role of the government and the private sector (profit & non-profit) in the provision of related services. Based on the analysis, it is clear that public strategies for care dependency are practically non-existent and that policies aimed at these populations focus on guaranteeing access to basic health services, an economic income, and social integration. Also, there are no support strategies for family caregivers who currently carry most of the care work. Care dependency strategies to support those who need them as well as those who currently provide them are urgently needed.
PATIENTS’ PAIN AND THEIR SPOUSAL CAREGIVERS’ NEGATIVE AFFECT: THE MODERATING ROLE OF SELF-EFFICACY
Authors: Nah Suyoung , Martire Lynn , Marini Christina
Published: November 2019

Spousal caregivers of chronic pain patients may experience high levels of negative affect, perhaps in part because they regularly witness patients’ suffering. Yet, few studies have examined the relation between patients’ chronic pain and spousal caregivers’ negative affect. According to social cognitive theory, individuals’ self-efficacy may modulate how much negative affect they experience in response to stressful situations. The purpose of this study was to test the hypothesis that spousal caregivers would report higher levels of negative affect on days when patients experienced higher levels of knee pain. We also tested the hypothesis that patients’ and spouses’ self-efficacy for managing pain would each buffer this positive association. A total of 144 knee osteoarthritis (OA) patients and their spouses completed baseline interviews and a 22-day diary assessment. Multilevel models indicated that patients’ self-efficacy, but not spouses’ self-efficacy, moderated the positive association between patients’ pain and their spouses’ negative affect, even after controlling for spouses’ gender, age, and depressive symptoms. That is, spouses reported higher levels of negative affect on days when patients experienced more pain, but only among patients whose self-efficacy for managing pain was low. These findings suggest that patients’ self-efficacy for managing pain may serve as a protective factor for their spousal caregivers’ daily negative affect. Interventions targeting patients’ self-efficacy for managing pain may be beneficial for couples coping with knee OA.
LONG-TERM OUTCOMES OF THE BENEFIT-FINDING GROUP INTERVENTION FOR ALZHEIMER’S FAMILY CAREGIVERS: A DOUBLE-BLIND RCT
Authors: Cheng Sheung-Tak
Published: November 2019

This study examines the long-term effects of benefit-finding on caregivers’ depressive symptoms (primary outcome), and global burden, role overload, and psychological well-being (secondary outcomes). 96 Hong Kong Chinese caregivers of relatives with Alzheimer’s disease were randomly assigned to receive the benefit-finding intervention (BFT) or one of two control conditions, namely, simplified psychoeducation (lectures only; SIM-PE) or standard psychoeducation (STD-PE). Caregivers received four biweekly one-to-one interventions of three hours each at their own homes. Participants and raters were blind to experimental assignment. We focused on outcomes measured at 4- and 10-month follow-ups. The trajectories of intervention effects were modeled by BFT x time and BFT x time2 interaction terms. Mixed-effects regression showed significant BFT x time2 interaction effects on depressive symptoms against both control conditions, suggesting diminishing BFT effects over time. Z tests showed that, compared with controls, BFT participants reported substantial reductions in depressive symptoms at 4-month follow-up (d = -0.85 and -0.75 vs. SIM-PE and STD-PE respectively). At 10-month follow-up, BFT was indistinguishable from STD-PE whereas a moderate effect was observed in the comparison with SIM-PE (d = -0.52). In addition, some inconsistent effects on role overload were observed but no effect was found for the other outcome variables. It is concluded that benefit-finding is an efficacious intervention for depressive symptoms in Alzheimer caregivers, with strong effects in the medium-term post-intervention and possible moderate effects in the long-term.
THE MODERATING EFFECT OF RAISING ONE’S GRANDCHILDREN ON THE RELATION BETWEEN SLEEP AND DEPRESSION
Authors: Stearns Melanie , Nadorff Danielle K
Published: November 2019

Recent evidence has shown that poor quality sleep is associated with depression, particularly among older individuals (Bao et al., 2017; Nadorff, Fiske, Sperry, & Petts, 2012). Moreover, given the high prevalence of depressive symptoms among older adults, it is important to identify possible risk factors of poor sleep quality. One possible risk factor is being a custodial grandparent (raising one’s grandchildren), as increased caregiving responsivities are associated with increased depressive symptoms (Brand-Winterstein, Edelstein, & Bachner, 2018). Based upon these previous findings, the current study examines the effect of custodial status on the relation between sleep quality and depressive symptoms. The sample (N = 466) was a subset of individuals recruited in the second wave of the MIDUS biomarkers project completed in 2009 who answered the sleep, caregiving, and depressive symptoms variables of interest. Measures included the Center for Epidemiological Studies Depression Scale (CESD), the Pittsburgh Sleep Quality Index (PSQI), and a question regarding custodial grandparent status. The current study aimed to examine whether poor sleep quality might serve as a risk factor for experiencing depressive symptoms and how custodial grandparents might differ from other older adults. Moderation analyses were conducted using SPSS’ Process macro on the sample. The interaction between global sleep quality and custodial grandparent status was significant in predicting depressive symptoms, t (1, 465) = 3.90, p = .04, such that custodial grandparents reported a stronger positive correlation between greater global sleep problems and depressive symptoms than non-custodial grandparents. Implications, future directions, and limitations are discussed.
IMPROVING SUPPORT FOR CAREGIVERS OF SERIOUSLY ILL OLDER VETERANS: STEPS TOWARD LAY NAVIGATION
Authors: Boucher Nathan A
Published: November 2019

This session will discuss mid-stage findings from a five-year, federally-funded study to develop lay navigation supporting informal caregivers, often family/friends, of older Veterans with advanced stage illness. Caregivers of Veterans report numerous burdens in their caregiver role related to food, clothing, shelter, utilities, and transportation. Current programs focus on Veterans’ needs rather than caregivers’ needs. Few programs focus on practical needs that can be met with VA and community-based supports. Lay navigator programs may be used to support caregivers’ social/practical needs. Lay navigation is used with patient populations, but models focused on caregivers do not readily exist. Dr. Boucher will discuss establishment of and input from the study’s Stakeholder Advisory Board and data from sample of caregiver and Veteran interviews informing a lay navigation training curriculum and pilot intervention. Feedback from audience members will be encouraged in this session exploring quality improvements in caregiver support applicable to multiple health systems.
SCREENING FOR LOW SHORT PHYSICAL PERFORMANCE BATTERY SCORES: CAN GRIP STRENGTH AND SINGLE CHAIR STAND BE USEFUL?
Authors: Chaves Paulo H
Published: November 2019

The clinical value of low Short Physical Performance Battery (SPPB) scores for identification of older adults at-disability-risk who may benefit from structured intervention is well-established. Feasibility concerns – e.g., time, space constraints – are factors that often preclude SPPB implementation in clinical settings. We assessed whether grip strength (GS) and/or single chair stand (SCS), simple and highly feasible tests, could be useful for clinical identification of older adults with poor SPPB performance. Cross-sectional study using most recent data (Round 7) from the National Health and Aging Trends Study, which enrolled a large U.S. representative sample of Medicare beneficiaries 65 years and older (baseline round: 2011; yearly follow-ups). Nursing home residents were excluded. Sample size was 4,612. Outcome: poor SPPB performance (score <8). Low GS: <20 Kg (women) or <30 Kg (men), and able to do a SCS without use of arm (yes/no) were predictors. Logistic regression, areas under the curves (AUC), and accuracy statistics were computed. AUC for low GS was 0.66, and SCS inability was 0.68; when both tests were considered together, AUC increased significantly: 0.76. Among those SCS-unable (n=752), 95.6% had SPPB<8. A two-stage screening approach; i.e., detection of SCS inability first, followed by low GS in those SCS-able resulted in a net-sensitivity of 75.3%, and net-specificity of 83.5%. Sequential screening with SCS and GS testing might offer a case finding screening approach appealing to busy clinical settings from feasibility, accuracy, and/or efficiency perspectives for identification of older adults with low SPPB who may benefit from established interventions.
OPERATIONALIZING THE FRAILTY INDEX BASED ON WEARABLE SENSOR TO ASSESS FUNCTIONAL PERFORMANCE IN OLDER ADULTS
Authors: Nguyen Hung , Yang Jacqueline , Zahiri Mohsen , Najafi Bijan
Published: November 2019

Frailty status is a well-known predictor of adverse health outcomes and functional performance. An assessment tool based on a wearable sensor was developed to quickly assess frailty using an upper extremity flexion and extension test. However, the current tool has relied on conventional frailty assessment to classify the frailty status of the participant. The aim of this study is to operationalize the frailty index based on wearable sensor to classify frailty status of older adults. 104 older adults were recruited for the study (age=78.6 ±9.7 years old). Participants were asked to perform a quick 20-second upper flexion and extension task while wearing a gyroscope on the wrist. A sensor-based frailty index (FI) was derived using parameters extracted from the sensor. Participants were also assessed using the Fried Phenotype Criteria (FC) and were classified into three groups: robust, pre-frail, and frail. Mean-shift clustering algorithm was used to operationalize the FI by identifying the cut-off point for each group. Grip strength and physical activity level were used as functional outcome measures. Regression analysis (r) was used to compare the correlation of the FC and FI with the identified metrics. Bivariate analysis show that grip strength was highly associated with the sensor-based frailty classification (r=-0.547) and FC (r =-0.503). The sensor-based classification was significantly associated with walking activity (r=-0.355). The results showed that the sensor-based frailty assessment tool could be used to quickly classify frailty status in older adults and eliminated the need for subjective and time-consuming evaluation.