bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Isolation and COVID-19 Mitigation: Perspectives of Key Informants in the United States and Japan
Authors: Ihara Emily , Inoue Megumi , Rinker Cortney Hughes , Koizumi Naoru
Published: December 2021

The deleterious health effects of social isolation and loneliness among older adults have been well-established and were exacerbated by the forced separation for those at health risk of contracting the COVID-19 virus. Both the United States and Japan are experiencing phenomenal growth of the older adult population; Japan is considered a “super-aged” society, with the highest proportion of people aged 65 and older in the world. This study examined how COVID-19 and mitigation measures may have affected services for older adults. We conducted key informant interviews with specialists in aging and older adult care in both Japan (n=5) and the United States (n=14). All interviews were conducted over Zoom and lasted 30-60 minutes. The research team transcribed and checked the interviews for accuracy and conducted multiple coding sessions to identify, sort, and consolidate the codes using Atlas.ti. Key themes in both countries that emerged included the many cracks in the system of programs and services for older adults, the inaccessibility to technology and the internet, and the particular difficulties of socioeconomic inequities, especially for those living alone. Older adults were motivated to become more technologically proficient and local communities came forward to help provide support. One key informant from the U.S. noted that their organization experienced a 600% increase in interest among volunteers as a result of the pandemic. Despite the many challenges of the pandemic, many silver linings emerged. One participant poetically stated, “I think that's human nature – when you have no other choice, you find a way.”
Ways Community-Based Organizations Enhance Late-Life Depression Care in Partnership With Clinics
Authors: Hoeft Theresa , Gosdin Melissa , Wagner Jenny , Henderson Stuart , Vredevoogd Mindy , James Katherine , Unutzer Jurgen , Hinton Ladson
Published: December 2021

Late-life depression is a serious public health concern in the U.S., especially as the population ages. To improve care coordination and increase the number of providers working to improve depression outcomes, primary care clinics and community-based organizations (CBOs) can partner and improve care. Addressing social determinants of health is one area CBOs can help respond to but there are other ways CBOs can bring value to these partnerships with primary care clinics. As part of a qualitative evaluation of the Care Partners Project, 84 key informant interviews and 20 focus groups were conducted over five years with selected primary care physicians, care managers, administrators and psychiatric consultants. These data were coded and organized using an inductive and deductive thematic analysis approach. CBOs contributed to care through 1) adding new services that focus on clients’ social needs (e.g., assistance locating affordable housing, reliable transportation, applying for social security benefits) that were foundational to effective depression care; 2) strengthening core aspects of existing care; 3) incorporating a lay health workforce to enhance care; and/or 4) adding home visits that supported deeper understanding of patient’s life context, enhanced trust and improved access to care. CBOs can enhance depression care through increasing access and quality of care. Findings can inform conversations about the value CBOs offer when partnering with health care systems and improve partnership efforts. Such conversations are worth revisiting as organizations deepen their connections and work together over time.
Relative Vigorous-Intensity Physical Activity Predicts Brain Microstructural Changes in Older Adults
Authors: Tian Qu , Schrack Jennifer , Landman Bennett , Wanigatunga Amal , Resnick Susan , Ferrucci Luigi
Published: December 2021

Physical activity especially at moderate-to-vigorous intensity may preserve brain structure in old age. However, current findings are cross-sectional and rely on absolute intensity. This study aimed to examine whether relative or absolute vigorous-intensity physical activity (VPA) predicts brain microstructural changes. We analyzed 260 initially cognitively normal and well-functioning participants(age=70.5yrs) who had VPA data via ActiHeart and longitudinal brain microstructure by DTI(follow-up=3.7yrs). Associations of VPA with microstructural changes were examined using linear mixed-effects models, adjusted for demographics. Each SD higher relative VPA defined by heart rate reserve (i.e. 21 min/day) was significantly associated with less decline in memory-related microstructural integrity, including mean diffusivity of entorhinal cortex and parahippocampal gyrus and fractional anisotropy of uncinate fasciculus and cingulum-hippocampal part, and not executive/motor-related microstructure. Absolute VPA was not associated with microstructural markers. Among well-functioning older adults, participating in VPA defined by heart rate reserve may predict less brain microstructural decline in memory-related areas.
Symptoms Contributing to Mobility Limitations and Fear of Falls in Older Adults.
Authors: McKay Michelle , Mensinger Janell , O'Connor Melissa , Costello Alexander , Leveille Suzanne
Published: December 2021

Mobility limitations in older adults are associated with negative outcomes including fear of falls (FOF) and poorer quality of life. However, self-reported symptoms contributing to mobility difficulty have not been fully explored as an area for intervention. The study aimed to identify the prevalence of self-reported symptom causes of difficulty walking and stair-climbing. In addition, we examined associations between symptoms and FOF in a population-based cohort of community-dwelling older adults in the MOBILIZE Boston Study. Of the 243 older adults who reported difficulty with walking one quarter of a mile or climbing stairs, 67% were women, 72% were white, average age=79.4y (SD=5.7). FOF was measured with the Tinetti Falls Efficacy Scale. Pain was most commonly reported as the primary symptom responsible for mobility difficulty (38.4%) followed by endurance (21.1%), multiple symptoms (15.6%), weakness (13.2%), balance (8.7%), other symptoms (2.9%). Factorial ANCOVA determined gender differences in associations between symptoms and FOF, adjusting for age. In pairwise comparisons, women who identified balance as their primary symptom had higher FOF than women identifying endurance (p=.017), pain (p=.015), other (p=.017), or multiple (p=.050) symptoms. There were no FOF differences for women identifying balance compared to weakness as the primary issue (p=.395). Men who identified balance as their primary symptom had higher FOF than those who identified pain (p=.036); no other FOF differences were noted in men identifying balance compared to other symptoms. Understanding common symptoms experienced by older adults, and symptoms associated with greatest FOF, will assist in developing tailored interventions for mobility improvement.
Pandemic Deployment of a Smarthealth Technology to Improve Stress in Dementia Family Caregivers
Authors: Ko Eunjung , Rose Karen , Gordon Kristina , Schlegel Emma , McCall Matthew , Gao Ye , Jabbour Jason
Published: December 2021

Caregiving stress from repetitive and heavy caregiving workloads can trigger poor emotional health, such as stress, anxiety, and depression, leading to higher caregiver mortality rates. Interest in technology-based interventions for this population has increased among researchers due to availability, acceptability, and flexibility compared to in-person services, especially now, during an unprecedented pandemic. Our study focuses on in-home SmartHealth technologies for caregivers of persons with Alzheimer’s Disease and related dementias, delivered using Ecological Momentary Assessment and a novel acoustic monitoring, mood recognition, and self-learning recommendation system. The system provides mindfulness-based stress management in response to interpersonal conflict in real-time. We will report challenges and solutions of creating and deploying a SmartHealth system for older adults in their home during the COVID-19 pandemic. Potential effects of this system on caregivers' emotional health are also examined. Findings suggest SmartHealth technologies may assist caregiving populations adapt and thrive in a new, more isolated normal.
Psychological Correlates of (Non)Use of Formal Resources by Family Caregivers of People With Dementia
Authors: Gallego-Alberto Laura , Cabrera Isabel , Márquez-González María , Chaparro María del Sequeros Pedroso , Mérida-Herrera Laura , Huertas Cristina , Losada-Baltar Andrés
Published: December 2021

Caring for a relative with dementia is a stressful task characterized by a high number of demands extended in time. Therefore, caregivers frequently report the need for assistance to cope with the situation. However, formal resources use is low among that population. The objective of this study was to explore the correlates of (non)use of formal resources (day care center and home care) by family caregivers of people with dementia. Participants were 225 dementia family caregivers that were individually assessed in a) use of formal resources, b) sociodemographic variables, c) stressors (frequency and reaction to behavioral problems), and d) psychological variables (depression, anxiety, and dysfunctional thoughts about caregiving). A logistic regression was done comparing those who used formal resources with those who did not use them. Caregivers who did not use formal resources were younger (OR = .95; 95% CI [.92 - .98]), devoted more daily hours to caring (OR = 1.07; 95% CI [1.02 - 1.11]), reported higher levels of dysfunctional thoughts about caregiving (OR = 1.07; 95% CI [1.04 – 1.10]) and higher anxiety levels (OR = 1.07; 95% CI [1.00- 1.13]), and their care-recipient had a higher functional autonomy (OR = 1.04; 95% CI [1.02 – 1.05]). Higher levels of anxiety and dysfunctional thoughts in caregivers may be act as barriers to seek for formal support. Targeting these variables may help to increase the use of formal resources by family caregivers of people with dementia.
Age of Migration and the Health Status of Older Latinos: Findings From the Health and Retirement Study
Authors: Kemp Blakelee , Garcia Marc
Published: December 2021

Life course research emphasizes the importance of considering how early life experiences set individuals on specific trajectories over time with implications across multiple health domains. Life experiences of older Latinos are shaped by where they were born and, for the foreign-born, when they immigrated to the United States. Prior research examining the extent to which age of migration is associated with health has largely been limited to regional studies. To address this gap in knowledge, we use nationally representative data from the Health and Retirement Study to examine associations between age of migration and multiple physical health outcomes among older Latinos residing in the United States. We examine 2010 prevalence and follow-up incidence to 2016 of cardiovascular issues, diabetes, one or more activities of daily living (ADLs), one or more instrumental activities of daily living (IADLs), cognitive issues, and mortality incidence. Preliminary results indicate similar health profiles across Latinos who migrated in early life (<18), during adulthood (18-34), and during later adulthood (35+). Most health profiles were similar among Latino men and women except for prevalence and incidence of experiencing difficulties with at least one ADL. Latino women who migrated in later-adulthood have higher prevalence of ADLs and women who migrated early in life (>18) have higher ADL incidence than Latino men who migrated during the same life course periods. A greater understanding of the how immigrant experiences influence physical health outcomes offers important insights into the development of actionable and culturally appropriate social and health policies.
Where to Retire? Experiences of Older African Immigrants in the United States
Authors: Nkimbeng Manka , Akumbom Alvine , Granbom Marianne , Szanton Sarah , Shippee Tetyana , Thorpe Roland , Gaugler Joseph
Published: December 2021

The needs and conceptualization of age-friendliness likely vary for immigrant older adults compared to native-born older adults. For example, Hispanic immigrant older adults often return to their home country following the development of ill health. Doubling in size since the 1970’s, the aging needs of African immigrants are not fully understood. This qualitative study examined experiences of aging and retirement planning for African immigrant older adults in the United States (U.S.). Specifically, it explored the factors, processes, and ultimate decision of where these older adults planned to retire. We analyzed semi-structured interviews with 15 older African immigrants in the Baltimore-Washington Metropolitan area. Data were analyzed using thematic analyses in NVivo. The majority of participants were women, with a mean age of 64. We identified three overarching themes with ten sub-themes. The themes included: 1) cultural identity: indicating participant’s comfort with the U.S. society and culture; 2) decision making: factors that impact participants' choice of retirement location, and 3) decision made: the final choice of where participants would like to retire. Age-friendliness for immigrant older adults in the U.S. is complex and it includes the traditional domains such as physical and sociocultural environment (e.g. housing, transportation, and income). However, immigrant age-friendliness also needs to include wider contextual aspects such as political climate in their country of origin, immigrant status, family responsibilities, and acculturation in the U.S. More research is needed understand and facilitate age-friendly environments for transnational immigrant older adults.
I Didn’t Really Fully Understand Until I Came Into the States: African Immigrants’ ADRD Introduction and Awareness
Authors: Nkimbeng Manka , Akosah Kwame , Shippee Tetyana , Rosebush Christina , Russell Wynfred , Gaugler Joseph
Published: December 2021

Most African immigrants report that they had never heard about dementia until their arrival in the United States. Conversations and insights from project advisory board meetings of the African Immigrant Memory Loss and Dementia Education projects (5 conversations and 8 meetings in the Minneapolis area) reveal unique cultural and immigrant characteristics surrounding dementia terminology and awareness. Dementia is often lumped together with mental illness which is associated with stigma. In addition to the fear of bad news and death, mental health issues are often considered a result of witchcraft, spiritual attack or punishment. Additionally, there are no traditional or cultural words for dementia in many African languages and current terms used are related to mental illness and all have negative connotations. There is a need to identify appropriate words for dementia in many tribal and immigrant dialects that can facilitate dementia awareness and education programs in African communities.
Spiritual Experience in Dementia From the Health Care Provider Perspective: Implications for Intervention
Authors: Palmer Jennifer , Hilgeman Michelle , Balboni Tracy , Paasche-Orlow Sara , Sullivan Jennifer
Published: December 2021

Spiritual care seeks to counter negative outcomes from spiritual distress and is notably needed in dementia. Such care needs disease-appropriate customization. Employing “cognitive apprenticeship” theory’s focus on learning from contrast, we explored spiritual needs salient within dementia as related to other disease states; we aimed to inform future dementia-focused spiritual care design. Accordingly, we conducted semi-structured qualitative interviews with 24 providers who serve older adults inclusive of persons with dementia. We sampled participants purposively by discipline (chaplains, nursing staff, social workers, activities professionals) and religious tradition (for chaplains). Our interview guide inquired about the nature of spiritual needs in dementia and stakeholders’ roles in addressing them. Hybrid inductive/deductive thematic analysis was employed. A thematic structure emerged with two themes: 1) spiritual experience in dementia compared to other medical conditions (sub-themes: the salience of (a) fear; (b) loss of self; (c) dementia’s progressive and incurable nature; (d) dementia’s impact on accessing faith); and 2) the need for spiritual intervention at the mild stage of dementia (sub-themes: (a) awareness in mild dementia and its influence on spiritual distress; (b) a window of opportunity). These findings pointed to possibilities for the “what” of spiritual needs and the “who” and “when” of implementing spiritual care. Implications included the imperative for dementia-specific spiritual assessment tools, interventions targeting fear and loss early in the disease, and stakeholder training. Researchers should study the “how” of dementia-appropriate spiritual care given recipients’ cognitive and linguistic challenges. Conjointly, these efforts could promote the spiritual well-being of persons with dementia worldwide.
Telehealth as a Resource for Continuity of Care in the Face of Disaster
Authors: Boot Walter , Phillips Judith Robertson
Published: December 2021

This symposium co-sponsored by the Disasters and Older Adults and the Technology and Aging special interest groups of GSA aims to highlight the promise of, and barriers to, the use of telehealth to support continuity of care in the face of disasters and crises, such as the ongoing COVID-19 pandemic. M. Mattos will showcase a home-based medical care (HBPC) program to address chronically ill and homebound persons living with dementia and caregivers’ needs during the pandemic. T. Wyte-Lake will present the results of a national survey on how changes were made to the Department of Veterans Affairs (VA) HBPC programs in response to the pandemic. G. Demiris describes a large caregiver study in which problem solving therapy and positive appraisal theory interventions designed specifically to support family caregivers of hospice patients during the COVID-19 pandemic were implemented via telehealth. D. Lindeman will specifically discuss challenges and implementation strategies for telehealth solutions applied to low-income older adults living in affordable housing communities. Finally, H. Xu will present the results of an analysis examining the effectiveness of telehealth in reducing readmissions among heart failure patients during the COVID-19 pandemic. While the COVID-19 pandemic has especially impacted older adults and those who care for them, these talks highlight the potential of telehealth services and interventions to provide support and facilitate the continuity of care during times of crisis.
Telemedicine Use Among Older Adults During the COVID-19 Pandemic
Authors: Szerszen Anita , Kogan Yulia , Burns Edith
Published: December 2021

Objective: Although technology adoption among older adults is improving, ethnic minorities and those with socioeconomic disadvantages may have lower utilization of telemedicine. Here, we evaluate telemedicine uptake amongst community-based older adults. Materials and Methods: Using a retrospective cohort design, we examined electronic medical records (EMR) for documentation of telemedicine use among patients > 65 years old at Geriatric practices in the New York metropolitan area from January-November 2020. Demographic details and insurance payer were captured for telemedicine visits and compared to in-person encounters. Multivariable regression was used to evaluate the association of demographic, socioeconomic factors and visit type. Results: A total of 712 patients (32.3%) engaged in 1,085 telemedicine visits. Telemedicine represented 80% and 66% of all encounters during April and May, respectively and averaged 11.8% between June and November. Use was similar across age groups, gender, race and insurance payer status between telemedicine versus in-person encounters. Patients with greater number of comorbidities were more likely to use telemedicine-. Medicaid recipients had preference for video visits. 47.5% of patients who engaged in video visits had another person/family member present during an encounter. Conclusions: Telemedicine augmented access to health care for older individuals during the peak of the COVID pandemic and continues to be utilized to improve access to care for older Americans. Given the distinct preference for video visits among patients with multiple medical conditions and those who have Medicaid, telemedicine has potential to serve as a tool to reduce enduring health care disparities beyond the pandemic.
Sex-Specific 25-Hydroxyvitamin D Threshold Concentrations for Functional Outcomes in Older Adults
Authors: Shardell Michelle , Guralnik Jack , Simonsick Eleanor , Kritchevsky Stephen , Cawthon Peggy
Published: December 2021

25-Hydroxyvitamin D [25(OH)D] has extra-skeletal effects, but it is not known whether the minimum sufficient serum levels for such targets, like muscle, differ from those for bone health (typically recommended at 20 or 30 ng/dL). Therefore, we derived and validated sex-specific thresholds for serum 25(OH)D predictive of poor physical function using 5 cohorts comprising 16,388 community-dwelling older adults (60.9% women). Using a cohort-stratified random two-thirds sample, we found incident slow gait was best discriminated by 25(OH)D<24.0 versus 25(OH)D>=24.0 ng/mL among women (Relative Risk=1.29; 95% CI 1.10-1.50) and 25(OH)D<21.0 versus 25(OH)D >=21.0 ng/mL among men (RR=1.43; 95% CI 1.01-2.02). Estimates from the remaining one-third validation sample were similar. Empirically identified and validated sex-specific 25(OH)D thresholds from multiple well-characterized cohorts of older adults may yield more biologically meaningful definitions in important sub-populations. Such thresholds may serve as candidate reference concentrations or inform design of vitamin D intervention trials in older adults.
Well-Being Among Aging Women: Observations From the Women’s Health Initiative Study (WHI)
Authors: Cochrane Barbara , Cochrane Barbara
Published: December 2021

Previous efforts to assess well-being in relation to health have relied on descriptive analyses of hedonic or eudaemonic well-being indicators. Factor scores from principal components analysis offer a summary measure of well-being, but limited interpretability in epidemiologic analyses, e.g. estimated risk ratios. Use of latent class analysis to identify groups differing by levels of both hedonic and eudaemonic indicators preserves information about both dimensions while supporting interpretation of well-being effects on health indicators important for studying older women’s health. For this symposium, we report on analyses to: (1) Develop a multidimensional profile of well-being that would preserve the individual dimensions of well-being (hedonic, eudaemonic) using latent class analysis; and (2) Support epidemiologic analyses of well-being as both an outcome and a predictor of health outcomes, enhancing interpretability of levels of well-being across various dimensions. Data on well-being in over 80,000 older women in the Women’s Health Initiative Study were obtained in 2011-2012, along with their baseline demographic characteristics in 1993-1998. All-cause mortality included death from any cause occurring from 2012-2020. Four classes of well-being were identified: (1) lowest hedonic and eudaemonic well-being scores; (2) higher hedonic/lower eudaemonic scores; (3) lower hedonic/higher eudaemonic scores; and (4) highest hedonic and eudaemonic scores. Results will be presented in three papers addressing the development of the well-being profile; relationships of the profile with predictors of well-being; and the relationship of the profile to all-cause mortality. The discussion will focus on future research questions, such as likely factors mediating well-being and health outcomes.
Cancer and Caregiving Among Older Black Americans and Families
Authors: Ellis Katrina
Published: December 2021

Cancer disproportionately affects Black Americans and consequently, their families. In addition, cancer is often just one of the significant health concerns facing Black families at any one time. Research on family support after an adult cancer diagnosis overwhelmingly focuses on a single (i.e., primary) caregiver and spousal family caregivers, limiting understanding of the complexity of caregiving within family systems facing multiple health challenges. This presentation presents a framework for a broader focus on the role of family systems in providing cancer care, highlighting both the unique strengths and challenges facing Black families who provide care. A family comorbidity lens is used to underscore the need to better understand the nature and impact of concurrent health challenges within families. Ultimately, this perspective reflects the lived experiences of older Black adults and their families after a cancer diagnosis and has implications for future research and interventions to address health issues interdependently.
Inhibitory Control in Age-Related Hearing Loss
Authors: Shende Shraddha , Nguyen Lydia , Rochford Grace , Mudar Raksha
Published: December 2021

Inhibitory control involves suppression of goal irrelevant information and responses. Emerging evidence suggests alterations in inhibitory control in individuals with age-related hearing loss (ARHL), however, few have specifically studied individuals with mild ARHL. We examined behavioral and event related potential (ERP) differences between 14 older adults with mild ARHL (mean age: 69.43 ± 7.73 years) and 14 age- and education-matched normal hearing (NH, mean age: 66.57 ± 5.70 years) controls on two Go/NoGo tasks: a simpler, basic categorization task (Single Car; SC) and a more difficult, superordinate categorization task (Object Animal; OA). The SC task consisted of exemplars of a single car and dog, and the OA task consisted of exemplars of multiple objects and animals. Participants were required to respond to Go trials (e.g., cars in SC) with a button press, and withhold responses on NoGo trials (e.g., dogs in SC task). Behavioral results revealed that ARHL group had worse accuracy on NoGo trials on the OA task, but not on the SC task. ARHL group had longer N2 latency for NoGo compared to Go trials in the simpler SC Task, but no differences were observed on the OA task between Go and NoGo trials. These findings suggest that more prolonged neural effort in the ARHL group on the SC task NoGo trials may have contributed to their ability to successfully suppress false alarms comparable to the NH group. Overall, these findings provide evidence for behavioral and neural changes in inhibitory control in ARHL.
Carer Café in Taiwan: An Innovative Model Providing Caregiver Support for Older Adults
Authors: Hou Su-I , Kuo Tsuann
Published: December 2021

Physical places and environments play critical roles in shaping how people interact. This paper introduces an innovative Carer Café model in Taiwan with social infrastructure support and services for family caregivers caring for older adults. Carer cafés are community-based initiatives of Taiwan Association of Family Caregivers (TAFC), aiming to help carers recognizing their own needs and increase awareness of long-term care resources available. Through partnerships with local coffee shops, respite-focused services are provided. The “free coffee for two” campaign encourages family members and friends taking a caregiver out for a “respite coffee”. Carer Café has also become an important “third place” hosting respite programs and the “a shop within a shop” style creating designated space to build a sense of community. Pilot survey (n=375) showed 77% perceived reduced stress, 83% appreciated services provided, and 250% increased referrals within one year. Implications on impact and future opportunities will be discussed.
Community-Based Brain Health Promotion During the COVID-19 Pandemic: Efforts of AARP in the USA
Authors: Lock Sarah , Chura Lindsay , Lazarus Rachel
Published: December 2021

The pandemic has created new barriers for the delivery of healthcare resources and information, as well as in-person delivery of health care, caregiving, and social engagement. AARP created trainings designed for volunteer-led community-based brain health promotion. Due to the COVID, we have had to convert them to virtual presentations, distributed through technology. Staying Sharp is AARP’s online platform that educates users about integrated, holistic, lifestyle-based approaches for maintaining brain health as we age. This platform was created for convenience and scalability – we currently have over 800,000 users. During a period of necessary isolation, this platform has performed as an ideal way to get helpful information about maintaining brain health to our consumers, who are now stuck at home without access to in-person (e.g., community-based) alternatives. We will discuss lessons learned from these two different approaches along with preliminary data on behavior change based on these engagements.
Discrimination in Long-Term Care Facilities: Legal Consciousness and Problem-Solving Among Staff
Authors: Perone Angela
Published: December 2021

Over half of direct care workers in long-term care facilities are women of color. Building on legal consciousness theory–which explains how individuals invoke legal principles to define everyday experiences–this study examines how staff understand and resolve discrimination between residents and staff and among staff. This study employs a multi-method qualitative extended comparative case approach. Data includes in-depth semi-structured interviews (n=80) and participant and non-participant observation (n=8 months) at two facilities that vary in staff racial composition. Findings reveal rampant unreported instances of race and sex discrimination toward Black staff by white staff and residents. Black staff at all levels did not invoke rights or discrimination rhetoric when they experienced overt race discrimination by residents but engaged in significant emotional labor to respond to race discrimination by residents. Black staff, however, perceived microaggressions and unequal treatment by white staff as discrimination. At both facilities, floor staff and management adopted diverse team approaches across race and staff hierarchy for responding to race discrimination by residents toward Black female staff. These findings suggest the need for new and targeted policy and practice approaches that recognize extensive emotional labor expended by staff of color when addressing discrimination by residents and challenges from white staff when addressing race discrimination by staff. These findings have theoretical implications by extending legal consciousness theory to multi-level staff understandings of discrimination. Findings also provide useful tools and case examples for policymakers and practitioners interested in racial justice, particularly given how COVID has exacerbated racial inequities in long-term care.
The Effects of Assets and Debt on the Depression Trajectory of Low-Income Older Adults in South Korea
Authors: Woo Jihee , Choi Hyojin
Published: December 2021

Evidence suggests that assets and debt are among the most significant factors affecting older adults’ mental health. This study focuses specifically on South Korea, where the poverty rate of older adults is the highest among all OECD countries. Given that low-income older adults with fewer assets and more debt may be at greater risk for depression, we investigated how assets and debt affected the depression trajectory of low-income older adults in South Korea. We used the six most recent waves of data from the Korean Welfare Panel Study (2014-2019) to estimate the longitudinal effects of assets and debt on depression in low-income older adults. Our sample was restricted to low-income Korean heads of household aged 55 and above (N=2,832). Using latent growth curve modeling, the unconditional model revealed decreasing trends in depression over time, while the conditional model, controlling for sociodemographic variables (i.e., age, gender, education, general health, marital status, employment status, income), suggested that assets and debt had contrasting impacts on depression. Specifically, although it did not impact the depression trajectory, debt did have a positive impact on depression at baseline. Most notably, assets negatively affected both depression at baseline (B=-1.911, SE=0.284, p<.001) and its trajectory (B=-0.235, SE=0.081, p<.01). These findings highlight the importance of holding assets over time as a protective factor against depression and thus the need for interventions such as savings programs and financial education for low-income older adults.
Hmong Older Adults’ End-of-Life Care Preferences: Physical, Psychosocial, Cultural, Religious, and Spiritual
Authors: Her-Xiong Youhung
Published: December 2021

As the Hmong community continues to grow and age in the United States (US), mainstream healthcare providers may encounter Hmong older adults who prefer their cultural end-of-life (EOL) care. The challenge for these providers is to offer culturally sensitive EOL care to Hmong older adults within the realm of the Western healthcare system. One factor contributing to this challenge may be the lack of knowledge regarding Hmong older adults’ EOL care preferences. Another is Hmong EOL care is interwoven with care from domains such as culture, religion, and spirituality. The purpose of this study is to garner an understanding of the care preferences of Hmong older adults during the dying process. A qualitative study using inductive content analysis was conducted. Thirty Hmong older adults who reside in Wisconsin participated in semi-structured interviews that were audio recorded and transcribed. Data was analyzed using inductive content analysis by Elo & Kyngäs (2008). The findings revealed that participants preferred care at EOL in the domains: physical, psychosocial, cultural, religious, and spiritual. Physical care included ADL’s while psychosocial care related to communication and companionship. Cultural care included children as caregivers and decision-makers. Religious and spiritual care surrounded Animism and Christian beliefs such as soul calling and prayers. Findings also suggest Hmong older adults’ care preferences as heterogenous and holistic. The findings have implications for the Hmong community and formal care services to collaborate on how culturally sensitive care can be provided to Hmong older adults at end of life.
Establishing a Dementia-Inclusive Community: The Evaluation of Dementia Friends in Cleveland Heights
Authors: Bibbo Jessica , Cardellini Jennifer , Nicolay Sarah
Published: December 2021

Cleveland Heights, in northeast Ohio, is currently working towards becoming a member of the Dementia Friendly America National Network. Utilizing the Dementia Friends curriculum to raise community members’ awareness of issues related to dementia is a key component of this initiative. Our initial efforts toward this goal targeted two sectors, namely community member and libraries. Participants completed on-line surveys at the beginning and end of each session. The surveys include the Brief Tool for Dementia-Friendly Education and Training Sessions developed by the Administration for Community Living. Of the 22 participants, nine had not previously attended a Dementia Friends session and completed both pre- and post-session surveys. Results indicated participants felt more confident interacting with people living with dementia at post-session compared to pre-session (t = -2.83, p=.022). Changes at the individual level may create more inclusive communities for people living with dementia and those who care for and about them.
Improving Staff-Family End-of-Life Communication at Israeli Geriatric Facilities by Using a Mobile App
Authors: Cohen Rinat , Maydan Gal , Brill Shai , Cohen-Mansfield Jiska
Published: December 2021

Family caregivers (FCs) of persons institutionalized at geriatric facilities present significant unmet communication needs regarding receiving regular updates about their loved one’s condition and having available healthcare professionals (HPs) to approach when needed. We developed and tested a mobile-app for staff-family communication with both parties having active roles in app planning to tailor it to their needs and abilities. The app includes a daily-update module for FCs and a chat option for FCs and HPs. App use was piloted at one geriatric-medical-center for 15 months (unit-level randomization resulted in one complex-care and one assisted-ventilation unit in each group- intervention and control) and one single-unit nursing-home for three months. Personal interviews were conducted with 55 FCs (28 from intervention-group and 27 FCs from control-group) before-and-after app use (with mean duration of use 1.6[S.D.=.6] months. Most participants were women and the children of the patients; their mean age was 55.9 years (S.D.=12.4). Repeated-measures Analysis-of-Variance for the end-of-life communication sub-scale on the Quality-of-communication questionnaire yielded a main effect for time (F(1,53)=8.31, p=.006) with both groups’ ratings increasing over time and an interaction effect (F(1,53)=4.78, p=.033) with a greater increase for intervention-group compared to control-group. Intervention-group participants rated the app as convenient to use. Qualitative data revealed that FCs perceived app use as improving quality of communication with the HPs who used it and improving their own well-being. The app offers a feasible and an effective mode of communication that incorporates technology in daily communication between FCs and HPs while addressing FCs’ unmet needs.
Text-Mining in Long-Term Care: Exploring the Usefulness of Computer-Aided Analyzing Methods
Authors: Aarts Sil , Hacking Coen , Verbeek Hilde , Hamers Jan , Sion Katya
Published: December 2021

In nursing homes, narrative data are collected to evaluate quality of care as perceived by residents or their family members. This results in a large amount of textual data which exceeds the capability of humans to analyse it. This study aims to explore the usefulness of text-mining approaches regarding narrative data gathered in a nursing home setting. Data has been collected as part of the project ‘Connecting Conversations’: assessing experienced quality of care by conducting individual interviews (n=125) with residents of nursing homes, family members and care professionals. Several pre-processing steps were applied to the textual data. Finally, a variety of text-mining analyses were conducted: individual and bigram word frequencies, correlation analysis and sentiment analysis. A survey was conducted to establish a sentiment analysis model tailored to text collected in long-term care for older adults. Residents, family members and care professionals uttered respectively 285, 362 and 549 words per interview. Word frequency analysis showed that words that occurred most frequently in the interviews are often positive. Although there are some differences in wording such as the use of ‘mother’ and ‘breakfast’, correlation analysis displayed that similar words are used by all three groups to describe quality of care. The majority of interviews displayed a neutral sentiment. Care professionals are more diverse in their sentiment than residents and family members: while some express a more positive sentiment, others express more negativity. This study demonstrates the usefulness of text-mining to extend our knowledge regarding quality of care in a nursing home setting.
The Dual-Language Semantic Computerized Program (DISC) Maintained Local Switch Costs in MCI Older Adults
Authors: Yow W Quin , Chen Hui-Ching , Lokanathan Tharshini
Published: December 2021

It has been proposed that switching cost deficit in executive control (Velichkovsky et al., 2020) could be used as an early marker for abnormal aging processes. Although research with technology-based intervention has shown benefits in improving cognitive performance with older adults, the overall results are mixed (Ge et al, 2018). This study aims to investigate whether computerized intervention program (e.g., DISC) would help to reduce the switching costs deficits in mild-to-moderate cognitively-impaired older adults (MCI-OA). Fourteen MCI-OA (79.75±6,94) and 9 cognitively-healthy OA (age 77,25±6,9) were randomly assigned to an experimental group or a control group (a final sample size of 30 MCI and 40 cognitive-healthy older adults would be ready by conference time). All participants first completed a set of cognitive tasks as part of a larger study (i.e., pre-tests) (e.g., MMSE, Ravens, cued-base Task Switching Task). The experimental group then played cognitive games on a touch-screen tablet for about 30-40 minutes per session with a total of 24 sessions over 8-12 weeks. The control group continued their daily activity as per usual for 8-12 weeks. Participants were then asked to complete the same set of cognitive tasks again post-test. Control group MCI-OA performed worse for the local costs in the cued Task Switching task (p<.05), whereas experimental group MCI-OA maintained their performance (p=.40) post-test compared to pre-test. All cognitively-healthy OA did not show any difference in performance irrespective of condition. This suggests that the DISC program could be an effective tool in slowing down the abnormal accelerated aging process.
Age, Childhood Trauma, Post-Traumatic Stress Disorder, and Substance Use Disorder in the Deep South
Authors: Reel Candice , Allen Rebecca
Published: December 2021

We examined the relationship of reported childhood trauma and PTSD symptoms in a sample (N = 105) of individuals aged 19 to 80 receiving treatment for substance use and opioid use disorders in federally qualified health centers. Fifty-two percent of the sample was age 39 or younger, 30% were in their 40s and 18% were aged 50 and older. Thirty-two percent did not graduate high school and 36% had a high school education or equivalent. Seventy percent reported experiencing adverse childhood experiences (ACES). Although harmful alcohol use was low, 83% of the sample reported substantial or severe substance use, with 41% of the total reporting opioid use. ACES predicted current PTSD symptoms. Telehealth treatment considerations include: 1) internet access, 2) health and mental health literacy, and 3) monitoring for dissociation when using mindfulness-based relapse prevention treatment.
Inter- and Intrastate Variation of Mental Health Requirements for Assisted Living in Seven States
Authors: Dys Sarah
Published: December 2021

Little is known about states’ approaches to regulating mental health (MH) services in assisted living (AL) settings. Yet, one in nine AL residents are diagnosed with serious mental illness (Hua et al, 2020). This study describes the MH regulatory requirements in AL regulations within Arkansas, Louisiana, New Jersey, New York, Oklahoma, Pennsylvania, and Texas. Using health services regulatory analysis (Smith et al, 2021), we reviewed 2018 regulations for the 45 identified AL licenses within these states sourced from Nexis Uni. We summarize 16 MH requirements related to admission, care transitions, resident assessment, third-party services access, and staff training. Each state explicitly addressed at least one of the identified MH requirements, though few states have consistency across all AL types within a state. The most commonly addressed requirements related to admission limitations, assessment, and transfer to psychiatric units. Understanding these requirements promotes a holistic approach to practices that meet residents' needs.
We Should Have Talked About Hospice: Transforming Communication With Bereaved LGB Aging Women
Authors: Valenti Korijna , Janssen Leah
Published: December 2021

Because of historical discrimination, discomfort disclosing information, and differing definitions of family, lesbian, gay, bisexual, and transgender (LGBT) older adults with serious illness need both improved palliative and end-of-life (EOL) care communication with clinicians and recognized inclusion of spouses/partners. Communicating about palliative and EOL care may improve the care goals and emotional trajectory for patients and significant others. Using a descriptive qualitative approach, this study’s aim was to analyze the communication experiences during a spouse’s/partner’s EOL care for bereaved LGB women (n=16) 60 and older. Drawing on queer gerontology, issues relating to access to resources and information and the systemic silencing of older LGB women illuminate areas where policy and practice may be improved. Semi-structured, one-on-one interviews were used to provide deep and meaningful information about palliative and EOL care communication between participants, their spouse or partner, and clinicians. While results reflect certain outcomes found in prior studies with non-LGBT adults, thematic analysis revealed three main findings with evidence specific to this population: 1) avoiding deep discussions about EOL; 2) lack of understanding about palliative or EOL care; and 3) limited communication with clinicians. Findings illuminate the need for better understanding among clinicians regarding palliative and EOL communication with LGBT dyads as well as communication strategies based on recognition and acceptance. Further dyadic communication research may improve care goals for LGBT older adults. Understanding couples’ interactions and examining different communication behaviors may lead to improved palliative and EOL care goals for older LGBT adults with serious illness and their spouses/partners.
Metabolic Adaptations to Aerobic Exercise in Aged Mice
Authors: Marx Tyler , Vasileva Anastasiia , Hutchison Stephen , Stern Jennifer
Published: December 2021

Aerobic exercise training is a potent intervention for the treatment and prevention of age-related disease, such as heart disease, obesity, and Type 2 Diabetes. Insulin resistance, a hallmark of Type 2 Diabetes, is reversed in response to aerobic exercise training. However, the effect of aerobic exercise training on glucagon sensitivity is unclear. Glucagon signaling at the liver promotes fatty acid oxidation, inhibits De novo lipogenesis, and activates AMP Kinase, a key mediator of healthy aging. Like humans, aging in mice age leads to a decline in physical and metabolic function. To understand the role of glucagon signaling in exercise-induced improvements in physical and metabolic function in the mouse, we implemented a 16-week aerobic exercise training protocol in young and aged mice. 16 weeks of exercise training initiated at 6 months of age increased markers of physical function (P<0.01) and attenuated age-related weight gain (P<0.05) and fat mass (P<0.0001). Additionally, exercise training improved glucose clearance (P<0.01), enhanced glucose-stimulated insulin secretion (P<0.01) and decreased hepatic lipid accumulation (P<0.05). Importantly, exercise training decreased hypoglycemia stimulated glucagon secretion (P<0.01), with no effect on hepatic glucagon receptor mRNA expression or serum glucagon. Thus, we propose that aerobic exercise training enhances glucagon sensitivity at the liver, implicating glucagon as a potential mediator of exercise-induced improvements in aging. Studies initiating the same aerobic exercise training intervention at 18 months of age in the mouse are currently underway to establish the role of glucagon receptor signaling in exercise-induced improvements in aging.