bluuebunny/crossref_metadata_2025 huggingface dataset:
Retirement Financial Insecurity for Men and Women in Canada: The Impact of Life Course Work and Income Instability
Authors: Taylor Miles , Carr Dawn , Quesnel-Vallee Amelie
Published: December 2020

Financial security is critical to overall well-being in retirement. Life course disruptions in work due to unemployment or disability may have lasting impacts on financial security in later life, and these effects may or may not be ameliorated by old age security programs and retirement benefits. Women are known to be particularly vulnerable for financial hardship in later life, making their life course experiences especially important in understanding financial well-being in retirement. We examine the Canadian Longitudinal and International Study of Adults (LISA) to assess later life financial insecurity in retirement, including 20 years of data on labor force experiences across adulthood drawn from linked tax records (N=2,353; N=1,079 men and N=1,274 women). The Canadian context is a useful complement to studies in the US due to its diverse and relatively generous public support programs, in addition to personal savings options for retirement. We find that among men, financial insecurity is tied to years reporting unemployment, where for women this outcome is more strongly linked to reports of disability and income assistance across adulthood. Although public and private retirement benefits do not offset these associations for either gender, receipt of income supplements reduce subjective financial insecurity among women. Among men, personal savings have the most robust effect in reducing financial insecurity. Our results suggest that in Canada, with its relatively generous provision of retirement support, life course work and health instability have lasting but differential effects for men and women in retirement.
Higher Rates of Untreated Distress in Older Versus Younger Adults With Indolent Lymphoma
Authors: Trevino Kelly , Martin Peter , Leonard John
Published: December 2020

Indolent lymphomas are incurable but slow-growing cancers, resulting in a large number of older adults living with these diseases. Patients typically live with their illness for years with the knowledge that disease progression is likely. Yet, little is known about psychological distress in this population. This study examined rates of and the relationship between distress and mental health service use in older and younger adults with indolent lymphomas. Adult patients diagnosed with an indolent lymphoma (e.g., follicular lymphoma, marginal zone lymphoma) within the past six months completed self-report surveys of distress (Hospital Anxiety and Depression Scale; HADS) and mental health service use since the cancer diagnosis (yes/no). Descriptive statistics, t-tests, and chi-square analyses were used to examine study questions. The sample (n=84) included 35 patients 65 years or older. Across the entire sample, 21.4% screened positive for distress on the HADS; 58.8% of these patients did not receive mental health services. Older adults reported lower distress levels than younger adults (17.1% v. 24.5%; p=.038). Among younger adults, 50% of distressed patients received mental health services; only 20% of distressed older adults received mental health services. Distress was associated with mental health service use in younger adults (p=.004) but not in older adults (p=.17). Older adults with indolent lymphomas have higher levels of untreated distress than younger adults. Research on the mechanisms underlying these age differences (e.g., stigma toward mental health services, ageism) would inform interventions to increase rates of mental health service use and reduce care disparities due to age.
Technology Use Among Caregivers for Persons With and Without Cognitive Impairment
Authors: Lee Shinduk , Smith Matthew , Dahlke Deborah Vollmer , Shubert Tiffany , Popovich Steve , Ory Marcia
Published: December 2020

This study aims at describing technology use among caregivers for middle-aged or older adults with and without cognitive impairment (CI) and examining whether the associations between technology use, caregiver strain, and social support differ by care-recipient CI status. Online data from caregivers (n=561) for adults at aged 50 years and older were analyzed from a national caregiver and technology survey. Multiple binary items were used to indicate caregivers’ use of various devices (smartphone, computer, e-reader, and wearable activity tracker) and applications (communication, online banking, navigation, online entertainment, medication alert/tracker, and physical activity tracker). Predictors were care-recipient CI status (having been diagnosed with cognitive problems versus no cognitive problems), caregiver strain, and social support. Multivariable logistic regression models were fitted for each technology and for testing effect modification by care- recipient CI status. All models were adjusted for total caregiving hours and caregiver age, sex, race/ethnicity, financial status, and residence. Almost half (47%) reported their care-recipient was diagnosed with CI. Caregivers for those with CI were more likely to use e-readers (adjusted odds ratio (AOR) = 1.55, p=.040), wearable activity trackers (AOR=1.77, p=.013), and medication alerts/trackers (AOR=2.59, p<.001). Generally, greater caregiving strain and social support were positively associated with use of multiple technologies (p<.05). No effect modification of caregiving strain and social support by CI status was observed (p>.05). Technology use differences among caregivers of persons with CI may be driven by care recipients’ unique situations and demands. Future research should identify technology use benefits on caregiver health-related quality of life.
The Impact of Sleep Disturbance on Regional Brain Volumes
Authors: Burke Shanna , Li Tan , Grudzien Adrienne , Barnes Christopher , Hanson Kevin , DeKosky Steven
Published: December 2020

Sleep disruption has been associated with increased beta-amyloid deposition and greater risk for later development of Alzheimer’s disease. Studies indicate that sleep disturbance correlates with regional brain volumes, but data are limited. We sought to determine the effect of sleep disturbance on regional brain volumes by cognitive and apolipoprotein e (APOE) e4 status. We conducted a secondary analysis of the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set using complete structural imaging data from 1,371 participants (mean age: 70.5; SD: 11.7). Multiple linear regression was used to estimate the adjusted effect of sleep disturbance (via Neuropsychiatric Inventory Questionnaire) on regional brain volumes through measurement of 30 structural MRI biomarkers. Sleep disruption was associated with greater volumes in the right and left lateral ventricles and greater volume of total white matter hyperintensities (p<.05). Lower mean volumes in total brain, total gray matter, and total cerebrum grey matter volumes, and in 12 hippocampal, frontal, parietal, and temporal lobe volumes were observed among participants who reported sleep disturbance. Males, Hispanic participants, and those with less education were more likely to report sleep disruption. Cognitive status moderated the relationship between sleep disturbance and lateral ventricular volumes, while APOE e4 moderated the effect between sleep disturbance and parietal lobe volumes. These findings suggest that disrupted sleep is associated with atrophy across multiple brain regions and ventricular hydrocephalus ex vacuo, after controlling for intracranial volume and demographic covariates. The influence of cognition and APOE e4 status indicates that this relationship is affected by co-occurring physiological processes.
Wellness for Older Adults Living With Serious Mental Illness: A Proposed Practical Framework
Authors: Zechner Michelle , Fullen Matthew , Barrett Nora , Swarbrick Margaret , Pratt Carlos , Santos Stephanie
Published: December 2020

Multi-dimensional wellness is a holistic, person-centered clinical approach, that offers promise as a framework for improving the health and well-being of older adults. This approach can be especially helpful for older adults who are experiencing mental health conditions as it focuses on strengths, resilience and recovery comprehensively. Few clinical interventions have addressed wellness in older adults with mental health conditions (Zechner et al., 2019).The authors reviewed two existing wellness frameworks: 1) grounded in extensive practical interventions for people living with mental health conditions (Swarbrick, 1997; 2006; 2012; 2017), and 2) a theoretical framework informed by a systematic literature review (Fullen, 2019). The two frameworks were compared for usefulness in older adults living with mental health conditions using the concept analysis strategies of analyzing the overlap and contrasting characteristics of concepts with related ideas, and then proposing a merged operationalized definition and practical implementation suggestions based on the characteristics of the original dimension (Mackeroff et al., 2016). The two wellness models described similar dimensions, but also represented distinct areas. We propose a synthesized framework combining the models to best serve older persons living with mental health conditions. The framework holds eight distinct areas 1) Developmental 2) Cognitive/ Intellectual, 3) Physical 4) Emotional 5) Social/Relational, 6) Occupational/Vocational 7) Spiritual and 8) Contextual/Environmental/Financial. Inter-professional practical clinical strategies and policy suggestions will be presented for consideration. More work is underway to understand the salience of the proposed model for stakeholders and to empirically test how the proposed framework impacts outcomes.
Unraveling the Effects of Social Class and Systemic Racism on Advance Care Planning
Authors: McDonnell Jenny
Published: December 2020

While advance care planning (ACP) is recognized as a key facilitator of high-quality, goal-concordant end-of-life care, black Americans are less likely to participate in ACP than non-Hispanic whites (Carr 2011; Detering et al. 2010). There are divided explanations for why these disparities persist. Some scholars attribute racial disparities in end-of-life care to socioeconomic (SES) differences between black and white Americans citing blacks’ and whites’ differentiated access to, control over, and use of material resources (Wilson 1978; Yearby 2011). Others assert that health care preferences do not solely reflect lack of resources or health literacy, but that the larger social context frames care preferences differently across racial and ethnic groups in American society (Alegria et al. 2011; Sewell and Pingel forthcoming). By turning the analytical lens to class-privileged black Americans, I investigate whether racism overflows the margins of class disadvantage. Using data from the Health and Retirement Study, I ran logistic regression and moderation models. I found that class-privileged blacks are less likely to engage in ACP than both high-SES and low-SES whites. The interaction of race and SES was negatively and significantly associated with ACP (OR=0.91; P<0.05), indicating that SES has a stronger effect on the probability of ACP among whites than among blacks. Predicted probabilities show that 51% of low-SES whites are likely to engage in ACP compared to 32% of high-SES blacks. These findings indicate that racialized disparities in ACP exist independent of SES, and that the effects of SES and race are intersectional rather than simply additive.
Does Spouse’s Dementia Diagnosis Make Individuals Skimp on Health Care?
Authors: Chen Yi
Published: December 2020

Dementia is a costly disease that places great burden on individuals, families, and health care systems. The substantial time and financial resources taken away by living with persons with dementia (PWDs) may make their spouses forgo needed health care, thus deteriorating long-term health. To quantify the effect of dementia on spouses’ health investment, I employed a difference-in-difference approach, comparing use of preventive services and doctor visits before and after spouses’ dementia onset. Using Health and Retirement Study (HRS) with linkage to Medicare claims, I identified 650 older adults whose spouses had incident dementia during 1993 to 2007, and matched them to 1,816 controls whose spouses were dementia-free. Primary analysis reveals that individuals whose spouse had dementia did not change their use of most health services, relative to dementia-free controls. In stratified analysis, middle-class individuals skimped on flu shot and diabetes screening. Providing help for activities of daily living (ADLs) was associated with 1.9 less doctor visits, the effect of which was stronger among females (2.5 less visits). Help with instrumental activities of daily living (IADLs) was not a predictor of any utilization outcome. In conclusion, externalities of dementia imposed on family members are more profound and complex than deprivation of time. Certain subgroups were worse off in health investment when facing the trade-off between caring for spouses with dementia and caring for themselves. When understanding dementia burden, the externality imposed on spouses and its heterogeneity should be considered.
Characteristics of Older Veterans Enrolled in the Illinois Medical Cannabis Patient Program
Authors: Bobitt Julie , Kang Hyojung
Published: December 2020

Veterans often struggle with disabling conditions such as chronic pain and post-traumatic stress disorder (PTSD) that tend to worsen as they age. Common treatments for these conditions include the use of opioids and benzodiazepines, yet these medications tend to have unwanted side effects and can even result in addiction. While cannabis use in the US has increased significantly over the past decade, research regarding the risks and benefits is mixed and a growing number of research studies have highlighted the benefits of taking cannabis for medical purposes. While previous studies have looked at cannabis use in older adults and in Veterans over 18, no research has looked at cannabis use specifically in older Veterans. We surveyed adults age 60 and over who were enrolled in the Illinois Medical Cannabis Patient Program as of September 2019. We collected demographics, reason for enrolling in the medical cannabis program, history of cannabis, opioids, and/or benzodiazepines use, and health outcomes. Of 3,768 responses, 593 were Veterans. Older Veterans in our study were predominately male (92.1%), reported using cannabis primarily for pain (80.1%), PTSD or emotional health problems (50.1%) (i.e. anxiety and depression), and reported that cannabis use has positively impacted their quality of life (89.4%), health outcomes (81.9%), pain (86%), and sleep quality (77.1%). Understanding why older Veterans use cannabis and the outcomes they experience from cannabis use can inform state and federal policy makers and enhance clinical care practices.
Health Differences Among People With Varying Profiles of Awareness of Positive and Negative Age-Related Changes
Authors: Sabatini Serena , Ukoumunne Obioha , Ballard Clive , Diehl Manfred , Wahl Hans-Werner , Brothers Allyson , Clare Linda
Published: December 2020

Higher awareness of negative age-related changes (AARC-losses) is related to poorer mental and physical health whereas higher awareness of positive age-related changes (AARC-gains) is related to better mental health. Associations of health with AARC-gains and losses have been explored separately, but often people experience gains and losses concurrently. Using latent profile analysis, we identified at the cross-sectional level patterns of AARC-gains and losses and explored whether groups with distinct profiles of AARC-gains and losses differed in physical, mental, and cognitive health, and demographic characteristics. Analyses were based on the large-scale PROTECT study conducted in the UK (N= 6,192; mean age= 66.10(SD= 7.04); 76% women). A four-group solution revealed the best model fit (Akaike’s information criterion= 156,061.93; Bayesian information criterion= 156,418.67); 45% of participants perceived many AARC-gains and few losses (Group 1); 24% of participants perceived moderate AARC-gains and few losses (Group 2); 24% of participants perceived many AARC-gains and moderate losses (Group 3); and 7% of participants perceived many AARC-gains and many losses (Group 4). The four groups differed meaningfully in health; Group 1 was the most healthy, followed by Groups 2, 3 and 4. Participants in Group 1 were most likely to perceive their health as excellent, reported the lowest levels of depression and anxiety, and showed the best cognitive performance. On average participants in Group 1 were younger, and more likely to be female, employed, and married, compared to other groups. Considering the co-existence of gains and losses is important when relating awareness of age-related changes to health.
Moderating Effect of Psychological Resilience on Functional Impairment in Relation to Subsequent Depression
Authors: Choi Shinae , Namkung Eun Ha
Published: December 2020

The growing prevalence of functional impairment is a serious concern due to its relation to decreased quality of life in later life. Guided by the social convoy model and the stress process model, the present study investigated whether psychological resilience, particularly optimism and mastery moderated an association between functional impairment and subsequent depressive symptoms in later life. This study used data derived from two population-based national studies in the United States: 2012 and 2016 waves of the Health and Retirement Study (N = 5,035) and 2004 and 2013 waves of the Midlife in the United States (N = 2,476). Ordinary least squares regression was used to estimate the impact of optimism and mastery, respectively, on the associations between functional impairment (baseline measure at wave(t-1), changes over the study period from wave(t-1) to wave(t)) on subsequent changes in depressive symptoms. Across both studies, we found that having and developing functional impairment are related to increased number of depressive symptoms. Optimism independently predicted decreased depressive symptoms over the study periods and buffered the negative effects of functional impairment on depressive symptoms across the two studies. Specifically, the mitigating effects of optimism on depressive symptoms were greater for those with more numbers of functional limitations. The findings suggest that psychological resilience plays a key role in decreasing depressive symptoms, especially for midlife and older adults with functional impairment. The results also demonstrate the importance of examining both optimism and mastery when investigating psychological resilience and emotional well-being in older adults.
Stepping Out: A Novel Pilot Falls Prevention Program for Individuals With Mild Cognitive Impairment
Authors: Fischer Barbara , Midden Allison , Hoffmann Aundrea , DeWitt Lynn , Kohlman Kathryne , Clemson Lindy , Sherman Katherine , Mahoney Jane
Published: December 2020

Objectives: Falls are the leading source of accidental injury and hospitalization among adults over the age of 65. Relative to people with intact cognition, individuals with cognitive impairment are at increased risk for falls; however, few falls prevention programs exist to specifically reduce and prevent falls in this population. To address this issue, we developed a novel, multifactorial, cognitively-based falls prevention program, Stepping Out. Based on the popular and effective evidenced-based program, Stepping On, Stepping Out was modified and tailored to the learning needs of individuals with Mild Cognitive Impairment (MCI). We hypothesized that older adults with MCI would find the program understandable, and that program participants would demonstrate reduced falls. Methods: Sixteen veterans, mean age of 77.5, diagnosed with MCI and at increased risk for falls participated in Stepping Out. Falls were collected for the six months prior to intervention and the six months during and after program participation. All participants completed post-program evaluations. Falls incidence was compared using a Wilcoxon paired signed rank test. Results: Stepping Out was found to be feasible and comprehensible by all participants. Program participants exhibited significantly reduced falls, with median reduction of two falls (p = 0.0020), and a range of zero to 12 falls. Discussion: With appropriate modifications, individuals with MCI were able to benefit from a cognitively-based falls prevention program and to reduce accidental falls incidence. Falls are an important and feasible target to address among individuals with cognitive impairment.
Family Caregiver Role in the Long-Term Services and Supports of Individuals With Dementia Over Time
Authors: Reckrey Jennifer , Bollens-Lund Evan , Husain Mohammed , Ornstein Katherine , Kelley Amy
Published: December 2020

Family caregivers of persons living with dementia (PLWD) provide disproportionately high levels of care over a long and variable disease course, yet an understanding of the trajectory of care hours provided over time and the contributions of individual family members to overall care is lacking. This study used longitudinal data from the nationally representative Health and Retirement Study in order to compare the hours of care that spouses, children, and other family caregivers provide to those with and without dementia. During the last 10 years of life, family caregivers of PLWD provided nearly three times as many total care hours as compared to others (7,447 vs. 2,653 total hours). While care hours provided to PLWD increased steadily in each of the last 10 years of life (going from 4 hours/week 10 years before death to 33 hours/week the year before death, average annual increase 27%), care hours provided to others remained low and then nearly tripled in the last year of life to 22 hours/week on average. Adult children of PLWD provided 50% of total care hours, while adult children of others provided 41% of care hours. This study provides important insight into the high levels of year-over-year caregiving provided to PLWD by their family caregivers in general and by adult children in particular. Policies to support these caregivers must shift from short-term, episodic support to sustained assistance in acknowledgment of the key role family caregivers play in the long-term services and supports of PLWD.
All-cause Dementia Prediction by Machine Learning: The Health, Aging, and Body Composition Study
Authors: Wu Chenkai , Jin Xurui
Published: December 2020

There are several shortcomings of the currently available risk prediction models for dementia. We developed a risk prediction model for dementia using machine-learning approach and compared its performance with traditional approaches. Data were from the Health, Aging, and Body Composition Study, comprising 3,075 older adults (at least 70 years). Dementia was defined as (1) use of a prescribed dementia medication, (2) adjudicated dementia diagnosis, or (3) a race-stratified cognitive decline>1.5 SDs from the baseline mean. We selected 275 predictors collected from questionnaires, imaging data, performance testing, and biospecimen. We used random survival forest (RSF) to build the full model and rank the importance of predictors. Subsequently, we built parsimonious models with top-20 predictors using RSF and Cox regression. A dementia risk score was developed using top-ranked variables. We used the C-statistic for performance evaluation. Over a median of 11.4 years of follow-up, 659 dementias (21.4%) occurred. The RSF model (both including all and top-20 variables) showed a higher C-statistic than the regression model. Digit symbol score, physical performance battery, finger tapping score, weight change since age 50, serum adiponectin, and APOE genotype were the top-6 variables. We created a dementia risk score (0-10) using the top-6 variables. A 1-unit increase in the risk score was associated with an 8% higher risk of dementia. The risk score demonstrated good discrimination (C-statistic=0.75). Machine learning methods offered improvement over traditional approaches in predicting dementia. The risk prediction score derived from a parsimonious model had good prediction performance.
Building, testing, and learning from network models of human aging
Authors: Rutenberg Andrew , Farrell Spencer , Mitnitski Arnold , Rockwood Kenneth , Stubbings Garrett
Published: December 2020

We have developed computational models of human aging that are based on complex networks of interactions between health attributes of individuals. Our “generic network model” (GNM) captures the population level exponential increase of mortality with age in Gompertz’s law together with the exponential decrease of health as measured by the frailty index (FI). Our GNM includes only random accumulation of damage, with no programmed aging. Our GNM allows large populations of model individuals to be quickly generated with detailed individual health trajectories. This allows us to explore individual damage propagation in detail. To facilitate comparison with observational data, we have also developed and tested new approaches to binarizing continuous-valued health data. To extract the most information out of available cross-sectional or longitudinal data, we have also reconstructed interactions from generalized network models that can predict individual health trajectories and mortality.
Role of Genetic Interactions in Alzheimer’s Disease: Lessons from Long Life Family Study (LLFS)
Authors: Yashin Anatoliy , Wu Dequing , Arbeev Konstantin , Stallard Eric , Tan Qihua , Kulminski Alexander , Feitosa Mary , Ukraintseva Svetlana
Published: December 2020

Experimental and clinical studies of Alzheimer’s disease (AD) provide plentiful evidence of AD heterogeneity and involvement of many interacting genes and pathways in regulation of AD-related traits. However, detailed mechanisms of genetic interactions (GxG) involved in AD remain largely unknown. Uncovering hidden patterns of such interactions from human data will help better understand the nature of AD heterogeneity and find new targets for AD prevention. In this paper, we applied a newly developed method of evaluating joint GxG effects on AD to analysis of the Long Life Family Study data. The analysis included several steps: (i) selecting candidate genes from stress response pathways that are thought to be involved in AD; (ii) estimating interaction effects of SNP-pairs on AD risk, and selecting the top interacting SNPs; (iii) running GWAS-like interaction analysis for SNP-pairs, with one SNP fixed; (iv) using characteristics of the detected SNP-pairs interactions to construct the SNP-specific Interaction Polygenic Risk Scores (IPRS); and (v) evaluating the effects of IPRSs on AD. We found that SNP-specific IPRS have highly significant effects on AD risk. For most SNPs involved in the significant interaction effects on AD, their individual effects were statistically not significant. Male and female analyses yielded different subsets of the top interacting SNPs. These results support major role of genetic interactions in heterogeneity of AD, and indicate that AD mechanisms can involve different combinations of the interacting genetic variants in males and females, which may point to different pathways of resistance/response to stressors in two genders.
Feasibility of Automating Fidelity Monitoring in a Dementia Care Intervention
Authors: Hodgson Nancy , Nencova Ani , Gitlin Laura , Summerhayes Emily
Published: December 2020

Careful fidelity monitoring is critical to implementing evidence-based interventions in dementia care settings to ensure that the intervention is delivered consistently and as intended. Most approaches to fidelity monitoring rely on human coding of content that has been covered during a session or of stylistic aspects of the intervention, including rapport, empathy, enthusiasm and are unrealistic to implement on a large scale in real world settings. Technological advances in automatic speech recognition and language and speech processing offers potential solutions to overcome these barriers. We compare three commercial automatic speech recognition tools on spoken content drawn from dementia care interactions to determine the accuracy of recognition and the guarantees for privacy offered by each provider. Data were obtained from recorded sessions of the Dementia Behavior Study intervention trial (NCT01892579). We find that despite their impressive performance in general applications, automatic speech recognition systems work less well for older adults and people of color. We outline a plan for automating fidelity in interaction style and content which would be integrated in an online program for training dementia care providers.
Development of an Interprofessional Training Education Program in Geriatrics
Authors: Cotton Sam , Faul Anna , Yankeelov Pamela , D’Ambrosio Joe
Published: December 2020

This study examines the development of an interprofessional training certificate program that prepares social work learners to infuse geriatrics and behavioral health into primary care settings. Since 2018, our program has trained 31 social work learners and 16 learners from counseling psychology and nursing. At the core of the certificate program is an emphasis on developing skills focused on the integration of geriatrics, behavioral health and primary care to address the lack of workforce trained at the intersection of these areas. Each series of workshop is aligned with core competencies that address the 4-M Model of Age-Friendly Health Care and SAMSHA’s Core Competencies in Behavioral Health. Our professional certificate includes training in Motivational interviewing, as well as Cognitive behavioral therapy, Mindfulness based cognitive therapy and Problem-solving therapy, Narrative Therapy, Strategic Therapy, Systemic Therapy, Life Review and Reminiscence Therapy. Additionally, students receive professionalization trainings to help prepare them for the job market. To measure the efficacy of this curriculum program, we examined the outcomes related to student knowledge of geriatrics and behavioral health including knowledge attainment, fidelity to modalities, learner self-efficacy, and learner satisfaction. The results of this study showed that integrating interprofessional education into social work settings can lead to positive outcomes for student knowledge, self-efficacy and learning satisfaction. Additionally, we found that having a curriculum that focused on interprofessional teams contributed to higher self-efficacy in completing tasks compared to previous cohorts. This has implications for the way that we conceptualization the use of interprofessional education.
Longitudinal Relationships Between Favorite Activities and Homebound Status in Older Adults
Authors: Sun Xiaocao , Liu Minhui , Miyawaki Christina , Li Yuxiao , Hou Tianxue , Tang Siyuan , Szanton Sarah
Published: December 2020

Favorite activities are usually meaningful to older adults and may influence their homebound status and vice versa. Using Round 1 (R1, in 2011) and Round 5 (R5, in 2015) data from the National Health and Aging Trends Study, we examined the patterns of favorite activity by homebound status and investigated their relationship among community-dwelling older adults (N=3,332). Homebound status (non-homebound, semi-homebound, and homebound) was determined by the frequency, difficulty, and needing help of outdoor mobility. Favorite activities were named by participants verbatim and then were classified into two categories (active and non-active) based on the estimated energy needed to perform the activity. Logistic regression models were used to determine whether homebound status at R1 predicted the types of favorite activity in R5, and ordinal logistic regression models for predictions from the types of favorite activity at R1 to homebound status at R5, adjusting for demographics and health conditions. The sample was, on average, 76±7.23 years old, non-Hispanic White (72.9%), and female (59.7%). Regardless of the homebound status, reading and walking are the top two favorite activities. Homebound older adults enjoyed “non-active” activities (e.g., watching TV), while non-homebound counterparts preferred “active” outdoor maintenance. Being homebound at R1 predicted non-active favorite activity in R5 (OR=.257, p<0.001), and R1 non-active favorite activity also predicted homebound status in R5 (OR=1.219, p =0.039). These findings provide new information on the activity preferences of older adults with different homebound status and how their preferences may influence their future homebound status.
The Relationship Between Physical Activity Levels and Manual Dexterity in Adults Over 60 Years Old
Authors: Kim Naomi , McGraw Rachael , Thralls Katie
Published: December 2020

During aging there is a natural physiological decline that contributes to a loss of function needed for activities of daily living to maintain independence and high quality of life. Physical function needed for independence includes gross motor function (e.g., lower body strength for standing) and fine motor function (e.g., manual dexterity for dressing). Physical activity (PA) has shown to maintain fitness, such as muscular strength, to delay loss in gross motor function. However, there is limited research on the association between PA and fine motor function. The purpose of this study was to examine the relationship between meeting national Physical Activity Guidelines (PAG; >150 min./wk.) and manual dexterity in older adults (>60 years). Participants (N=45, Mean age = 80.2±8.2 years) completed an interview-assisted self-report of their PA level and an objectively measured manual dexterity assessment (i.e., Purdue Pegboard Test (PPT)). The PPT included four fine motor skill assessments. For all four PPT’s, Analysis of Variance (ANOVA) tests showed a significant main effect for PA level, a main effect for age, and an interaction effect (PA*age) on manual dexterity for all PPTs (ps<0.05). Follow-up comparisons showed a significant main effect for PA level on manual dexterity for the older group (>80yrs; ps<0.05), and not for the younger group (ps>0.05). Pearson’s r correlations showed significant moderate-positive correlations between activity level (min./wk.) and PPTs scores (r=0.45– 0.50; ps<0.005). These findings suggest that meeting PAG may be a preventative strategy to attenuate aging declines in manual dexterity to maintain hand function and independence.
Negative Marital Quality, Purpose in Life, and Depressive Symptoms Among Middle-Aged and Older Couples
Authors: Irani Elliane , Park Sumin , Hickman Ronald
Published: December 2020

Negative marital quality is associated with poor health outcomes. Purpose in life can serve as a psychological resource to buffer the stressors experienced from a negative marital relationship. Yet, the associations among negative martial quality, a person’s level of purpose in life, and depressive symptoms have not been fully explored in a dyadic context. We examined the actor (intra-individual) and partner (cross-spousal) effects of negative marital quality on depressive symptoms in couples and the potential mediating role of purpose in life. Structural equation modeling was used to analyze cross-sectional data on middle-aged and older married, heterosexual couples (N=1,235) who participated in the 2016 wave of the Health and Retirement Study. The final model had an acceptable fit to the data (TLI=.963, RMSEA=.040, SRMR=.038). At the actor level, negative relationship quality was positively associated with depressive symptom severity, and purpose in life mediated the relationship in wives and husbands. At the partner level, wives had more depressive symptoms when husbands reported higher negative marital quality. Comparatively, husbands had less depressive symptoms when their wives indicated a greater sense of purpose. Husbands also had a lower purpose in life when their wives had higher states of negative marital quality. This study highlights the psychological benefits of allaying negative perceptions of marital quality and enhancing the sense of purpose in middle-aged and older couples. The results support a focus on dyadic approaches to improve the psychological health, and potentially, the physical health status of middle-aged and older couples.
Barriers to Successful Aging Among Older Women Living With HIV: A Qualitative Study
Authors: Rubtsova Anna , Taylor Tonya , Wingood Gina , Ofotokun Igho , Gustafson Deborah , Holstad Marcia
Published: December 2020

Successful aging (SA) is the capacity of older people to thrive despite age-related changes and/or declines. Although our previous research found that older (age ≥50) women living with HIV (OWLH) can achieve SA, considerable barriers remain. The purpose of this qualitative study was to identify specific barriers to SA among OWLH. Our sample consisted of 29 OWLH recruited between October 2018 and March 2019 at two sites of Women’s Interagency HIV Study (WIHS): Atlanta, GA and Brooklyn, NY. These participants were assigned to either semi-structured interviews (N=17: 8 interviews in Brooklyn and 9 in Atlanta) or focus group discussions (FGD: 1 FGD in Atlanta with 5 participants, and 1 FGD in Brooklyn with 7 participants). Our FGD and Interview Guides included questions focused on barriers to SA. Participants were, on average, 58 years old (range 50-73), 86% Black, 83% single, and 62% with annual income ≤ $12,000. All interviews and FGD were transcribed and coded using MAXQDA software. We used thematic coding within constructivist approach. Several themes emerged identifying the following SA barriers: multiple chronic conditions and pain (e.g., arthritis, neuropathy); polypharmacy and side effects of HIV medications (“it’s wearing on me”); HIV-related stigma and loneliness (“I think my children would judge me if I would tell them I have it HIV”); substance use, giving up on yourself (“just sitting around, not doing anything”); and lack of access to resources and services (e.g., mental health providers, support groups). Our findings will help designing public health interventions promoting SA among OWLH.
The Development of a Scale to Measure HIV-Prevention Factors in Adults Age 50 and Older
Authors: Wion Rachel , Loeb Susan , Mogle Jacqueline , Fick Donna
Published: December 2020

Adults aged 50 and older are at risk for human immunodeficiency virus (HIV) infection. Currently, there are no measures specifically aimed at middle-aged and older adults to assess their HIV risk. Existing measures have been created for and mostly tested in adolescent and young adult populations. The purpose of this study was to modify and test existing instruments related to HIV prevention factors with an older adult population. Two rounds of an expert panel (N = 10) review were conducted to assess items from the Condom Use Self-Efficacy Scale and the Sexual Risks Scale for their applicability to older adults. Any items with content validity at the item level <0.78 were either discarded or modified. New items were also added. The final adapted HIV prevention scale had 31 items and was administered via an online survey. Single adults (N = 252) aged 50 to 85 who had been on at least one date over the past year participated in the study. The HIV prevention scale underwent confirmatory factor analysis. Model fit was estimated using maximum likelihood and standardized estimates were used for factor loadings. The items loaded on eight factors in three models: Model 1 (Mechanics, Advocacy, Intoxicants); Model 2 (Attitudes, Normative Beliefs, Perceived Susceptibility); and Model 3 (Intention, Expectations). There was adequate to excellent model fit. However, there were multiple correlations of error variances suggesting that while the items are appropriate for an older adult population, the scale will need adaptations prior to using for further data collection.
The Senior Sex Education Experience Study: Qualitative Data From Developing an Adult Sex Education Program
Authors: Pierpaoli-Parker Christina
Published: December 2020

Older adults (OAs) account for an unprecedented proportion of STDs but receive limited sex education. We present preliminary data from the SEXEE study developing a sex education intervention for OAs 50+. The sample consisted of 17 OAs, ages 53 to 77, (M = 65, SD = 7.6; 64.7% female; 94.1% Caucasian) and seven primary care physicians, geriatricians, and other specialists (e.g. gynecologists), sampled purposively. Physicians completed a semi-structured interview to describe their experiences discussing sexual health with OAs, identify barriers to those discussions, and elicit recommendations for an educational curriculum. OAs participated in three separate focus groups to determine their interest in and suggestions for the intervention. Qualitative data underwent thematic coding separately by two researchers, with a third researcher resolving any discrepancy. One physician (14%) reported routinely assessing adults’ sexual health; others only in the context of a specific presenting concern (e.g. ED). Though the physicians considered sexuality important component of QoL, many reported barriers to assessment and treatment, including insufficient time, training, and knowledge; concerns about personal and patient discomfort; and patient complexity. Of the OAs interviewed, 15 (88%) endorsed high interest in attending a sex education program. The most commonly recommended educational topics among physicians and OAs included: sexual changes with aging and management strategies; STDs and risk factors; tools for enlarging the sexual repertoire, myths about late life-sexuality; masturbation, and dating. Findings extend previous observations about clinical barriers to sexual health discussions and provide new insights for developing a sex ed intervention for this population.
Pathway Analysis of Leisure Activity and Cognitive Function in the Long Life Family Study
Authors: Roth Nicole , Sebastiani Paola , Cosentino Stephanie , Schupf Nicole , Perls Thomas , Andersen Stacy
Published: December 2020

Familial longevity and greater involvement in activities purported to build cognitive reserve (e.g. education, cognitively stimulating leisure activity) have both been associated with better cognitive function in later life, yet little is known about how these protective factors relate with one another. In this work, we modeled the associations among familial longevity, proxies of cognitive reserve, and cognitive function in the Long Life Family Study (LLFS). We assessed cognitive function using a comprehensive battery of neuropsychological tests (i.e. Digit-Spans, California Verbal Learning Test, Rey-Osterrieth Complex Figure, phonemic fluency, category fluency, Word Generation, DKEFS Sorting Test, and logical memory) in a subset of LLFS family members and a referent cohort (N=314, mean age 75.7±14.6 years). To model these associations, we used a series of Bayesian hierarchical regression pathways that incorporate a random effect for family relatedness, adjusted by age and sex. All continuous variables were rescaled and bounded to be approximately between (0,1) in order to standardize regression coefficients and to allow for an asymmetrical beta-distribution. Controlling for education level, age, and sex, referents had greater engagement in late-life cognitive activities compared to LLFS family members, β=0.38 (95% CI: 0.18 to 0.57). In turn, those with higher markers of cognitive reserve exhibited better neuropsychological performance. Despite LLFS family members having lower participation in cognitively stimulating leisure activities, there were no differences between LLFS family members and referents on cognitive test performance. These results suggest long-lived family members may have more unique pathways (i.e. genetic/environmental) that preserve cognition later in life.
Identification of Research Trends in Aging in Place Using Text Mining Analysis
Authors: Kim Ha Neul , Nam Seok In
Published: December 2020

Since 1980s professionals and social service providers have focused on aging at the place where people lived. This is the initial concept of the Aging in Place (AIP). Over 40 years, the topics have developed and extended to other disciplines welcoming different perspectives in the study of AIP. Therefore, this study aims to understand the overall research trends in Aging in Place (AIP) studies using text mining analysis to track the evolvement of AIP subtopics not only in Gerontology but also in various fields. To identify the topic trends, we collected the titles, abstracts, and keywords from 1,372 international articles that were published from 1981 to 2019. Then, keywords were extracted and cleaned based on precedent literature and discussions. We analyzed the keywords based on the degree of centrality and visualized the keyword-networks using VOSviewer and Pajek. Top-most popular keywords are “independent living”, “housing”, “older adults”, “home care”, “daily life activity” and “quality of life.” The change in topic trends shows that in the 1980s to early-2000s, research focused on organization and management level of intervention, home(housing) for the older adults, long term care. In the mid-2010s, health-related topics such as daily life activity, health service, health care delivery and quality of life have emerged. Recently, the topics have extended further to technology, caregiver, well-being, and environment design, environmental planning that support independent living of oneself. The research result shows that the interdisciplinary approach regarding AIP is not only inevitable but also encouraged for an in-depth discussion of the field.
High School Quality and 56-Year All-Cause Mortality Risk Across Race and Ethnicity
Authors: Seblova Dominika , Peters Kelly , Lapham Susan , Zahodne Laura , Gruenewald Tara , Glymour Maria , Chapman Benjamin , Manly Jennifer
Published: December 2020

Having more years of education is independently associated with lower mortality, but it is unclear whether other attributes of schooling matter. We examined the association of high school quality and all-cause mortality across race/ethnicity. In 1960, about 5% of US high schools participated in Project Talent (PT), which collected information about students and their schools. Over 21,000 PT respondents were followed for mortality into their eighth decade of life using the National Death Index. A school quality factor, capturing term length, class size, and teacher qualifications, was used as the main predictor. First, we estimated overall and sex-stratified Cox proportional hazards models with standard errors clustered at the school level, adjusting for age, sex, composite measure of parental socioeconomic status, and 1960 cognitive ability. Second, we added an interaction between school quality and race/ethnicity. Among this diverse cohort (60% non-Hispanic Whites, 23% non-Hispanic Blacks, 7% Hispanics, 10% classified as another race/s) there were 3,476 deaths (16.5%). School quality was highest for Hispanic respondents and lowest for non-Hispanic Blacks. Non-Hispanic Blacks also had the highest mortality risk. In the whole sample, school quality was not associated with mortality risk. However, higher school quality was associated with lower mortality among those classified as another race/s (HR 0.75, 95% CI: 0.56-0.99). For non-Hispanic Blacks and Whites, the HR point estimates were unreliable, but suggest that higher school quality is associated with increased mortality. Future work will disentangle these differences in association of school quality across race/ethnicity and examine cause-specific mortality.