bluuebunny/crossref_metadata_2025 huggingface dataset:
The Value of the Evidence Integration Triangle
Authors: Resnick Barbara
Published: December 2021

The Evidence Integration Triangle involved engaging stakeholders in the 12 month FFC-AL-EIT activities including identifying community specific goals, supporting the staff implementing the intervention, and intervening when champions or staff were not engaged in intervention activities. Ongoing participation of the stakeholder team occurred through monthly meetings. Evaluation of implementation was based on the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) Model. Reach was based on 85 of 90 communities participating and 794 residents recruited. Effectiveness was supported based on less functional decline and more function focused care performed by residents. Adoption was based on evidence that monthly meetings were held, 77% of settings engaged as, or more than expected, and caregivers increased the amount of function focused care provided. The intervention was implemented as intended, knowledge was received, and environments and policies supporting function focused care were maintained. The Evidence Integration Triangle is an effective implementation approach for assisted living.
Audiometric Age-Related Hearing Loss and Cognition in the Hispanic Community Health Study
Authors: Golub Justin , Brickman Adam , Ciarleglio Adam , Schupf Nicole , Luchsinger José
Published: December 2021

Studies associating age-related hearing loss (HL) with cognition have been limited by non-Hispanic cohorts, small samples, or limited confounding control. We overcome these limitations in the largest study of formal, audiometric HL and cognition to date using the multicentered Hispanic Community Health Study (n=5,277, mean age=58.4 [SD=6.2]). The main exposure was audiometric HL. The main outcome was neurocognitive performance. Adjusting for demographics, hearing aid use, and cardiovascular disease, a 20-dB increase (one-category worsening) in HL was cross-sectionally associated with worse performance in multiple neurocognitive measures: -1.53 (95% CI = -2.11, -0.94) raw score point difference on Digit Symbol Substitution Test, -0.86 (-1.23, -0.49) on Word Frequency Test, -0.76 (-1.04, -0.47) on Spanish-English Verbal Learning Test (SEVLT) 3 trials, -0.45 (-0.60, -0.29) on SELVT recall, -0.07 (-0.12, -0.02) on Six-Item Screener. Because HL is common and potentially treatable, it should be investigated as a modifiable risk factor for neurocognitive decline/dementia.
A Stakeholder-Based Study Improving Resident and Family Engagement in the Safety of Assisted Living
Authors: Beeber Anna , Anderson Ruth , Schwartz Lindsay
Published: December 2021

Assisted living (AL), is a long-term care service that provides housing and care for over 800,000 older adults in 30,000 residences. AL culture and operations have been transforming to enhance resident personhood and increase autonomy, however, these practices are balanced with the need to minimize safety issues (e.g., medication errors, infections, falls, and in cases of dementia, elopement and injuries). In this stakeholder-based study, we are translating existing strategies for improving patient safety to AL residences and developing an evidence-based tool for implementing these engagement strategies in AL. This symposium presents the methods and findings from a federally-funded mixed methods study including qualitative interviews with 105 AL residents, staff and family caregivers, and a series of focus groups with an AL stakeholder group to develop a toolkit to improve resident and family engagement in AL safety. The first paper outlines our methodological approach, including our efforts to work with stakeholders throughout the research process. The second paper reports findings from a scoping review of existing tools to support resident and family engagement in the safety of AL. The third paper presents the findings from our interviews with AL residents, families and staff exploring their safety priorities, and how they differ across stakeholder groups. The fourth paper presents the findings from our qualitative interviews exploring the challenges and promising practice to resident and family engagement in AL safety during the COVID-19 pandemic. All four presentations in this symposium illustrate important issues for future practice, policy, and research.
Tools to Enhance Resident and Family Engagement in Assisted Living Safety: A Scoping Review.
Authors: Vu Thi , Leeman Jennifer , Baernholdt Marianne , Kistler Christine , Moreton Elizabeth , Ottosen Terri , Dardess Pam , Beeber Anna
Published: December 2021

This presentation reports the results of a scoping review which identified and evaluated existing engagement strategies, tools, and interventions for their fit with assisted living (AL). Using the PRISMA criteria, we evaluated 54 empirical studies in assisted living/residential care or nursing homes (NH) for how they engaged families and residents, promoted person-centered and/or safety in AL/NH care, and assessed relevant outcomes (safety, experience, service use, satisfaction with care, health behaviors, and quality of life). The strategies, tools, and interventions aimed to improve residents’ activities of daily living, function, and quality of life. Studies also targeted staff and family caregivers to increase knowledge, improve relationships, and decrease caregiving stress. Overall, the studies reported statistically significant changes in resident quality of life, agitation, antipsychotic use, staff knowledge and job satisfaction. Results from this systematic review will inform the development of a testable toolkit to increase engagement and improve safety in AL.
Integrating the GSA KAER Toolkit Into Practical Training for Primary Care Clinics
Authors: Gaster Barak , Raetz Jaqueline , Belza Basia , Suchsland Monica Zigman , Illes Judit , Olivari Benjamin , McGuire Lisa , Fitzpatrick Annette
Published: December 2021

Education is central to driving change in clinical practice. First, primary care providers and their clinic team members need to understand why detecting cognitive impairment is important, how it can be done efficiently, and what the next steps in referral and management are. To engage primary care clinics in this change process, we developed a continuing education intervention, based on the KAER Model, using a live video format. Four evidence-based, 45-minute training modules presented core knowledge skills, including how to have difficult conversations, which are essential to diagnosing cognitive impairment. To overcome the obstacles to doing so in primary care, our team relied on a deep understanding of busy primary care practice. With a combined 35 years of direct experience in primary care, our collaborative interdisciplinary team was able to use the KAER Model to develop a highly acceptable intervention for primary care.
Implementation of the GSA KAER Toolkit in a Large Clinic System: Workflow Modifications and EMR Tools
Authors: Raetz Jaqueline , Gaster Barak , Belza Basia , Suchsland Monica Zigman , Illes Judit , Olivari Benjamin , McGuire Lisa , Fitzpatrick Annette
Published: December 2021

We implemented the KAER toolkit in the University of Washington primary care clinics. In this session we share the workflows implemented to promote the KAER model and share the tools we developed within EPIC, the system's electronic medical record (EMR). We collaborated with clinic staff to develop interdisciplinary workflows including: training patient service representatives, social workers, nurses, and medical assistants (MAs) about 'red flags;' training medical assistants to complete the Patient Health Questionnaire (PHQ-9) and Montreal Cognitive Assessment (MoCA); and assuring they are appropriately entered into flowsheets in EPIC. We created a checklist (EPIC 'SmartPhrase') and educated the clinics' interdisciplinary teams to utilize it within their scope of practice. Additionally, we created an order set (EPIC 'SmartSet') of commonly ordered tests and referrals to expedite evaluation of patients with suspected cognitive impairment. Lastly, we created a direct link from our EMR to our website containing community resources.
Chronic Inflammation and the Acceleration of Chronic Disease States
Authors: Walston Jeremy
Published: December 2021

The chronic activation of the immune system is commonly observed in older adults, and is highly associated with multiple chronic disease states and Geriatric syndromes including physical frailty, sarcopenia and mild cognitive impairment. Chronic inflammation is multifactorial, and the individual inflammatory mediators that drive the development and propagation of disease states impact normal tissue homeostasis as well as stem cell vitality. This session will discuss age-related etiologies of chronic inflammation and specific inflammatory mediators and their measurement, including Tumor Necrosis Factor (TNF) alpha and its receptors. Inflammation-driven molecular pathways that most impact relevant chronic disease states such as the tryptophan degradation pathway, and its relationship to pathophysiological changes, will also be considered. Finally, discussion of potential treatment modalities, including several emerging from Geroscience research, will be described as will their impact on chronic disease states.
Neighborhood Cohesion and Mobility Limitations Among Older Americans: The Roles of Depressive Symptoms and Mastery
Authors: Wang Fei , Qin Weidi , Yu Jiao
Published: December 2021

Neighborhood environment has been playing an important role in late-life health; yet, the social aspect of neighborhood environment and its impact on mobility limitations have been rarely examined. This study examines the relationship between neighborhood social cohesion and mobility limitations and the potential mediators (i.e., depressive symptoms, mastery) of this relationship. A total of 8,317 Americans aged 65 and older were selected from the Health and Retirement Study. Using ordinary least squares (OLS) regressions, this study shows that neighborhood social cohesion is negatively associated with mobility limitations, and this association is mediated by depressive symptoms and mastery respectively. Specifically, neighborhood social cohesion can reduce mobility limitations through mitigating depressive symptoms and increasing mastery. The findings have implications for developing community measures to promote neighborhood social cohesion and applying psychosocial interventions to reduce depressive symptoms and improve mastery among older adults.
Healthy Lifestyle Does Matter for Community-Dwelling Adults Pursuing Quality of Life
Authors: Liu Li-Fan
Published: December 2021

It has been well documented that socioeconomic factors influence lifestyle behaviors and all the physical and mental status at the individual level do matters for elderly people experiencing healthy aging. This study aimed to explore to what extent the healthy lifestyle including exercise and social participation influence on the health status of the community dwellings and their quality of life in Taiwan. Using a cross-sectional survey design, 1032 adults, aged ≥ 50 years, were interviewed with complete data from four communities in southern Taiwan. The results showed that for older community dwellings adults, doing exercise was significantly associated with feeling less stress, less depress, higher life satisfaction and higher quality of life (p<0.001). Being volunteers was found to be significantly associated with better quality of life (p<0.001). In the aging society, it is necessary to apply multifaceted approaches extending from individual solutions to public policy efforts in promoting healthier lifestyles.
Policy Series: Congressional Update
Authors: Lindberg Brian
Published: December 2021

This popular annual session will provide cutting-edge information on what the 117th Congress has and has not accomplished to date, and what may be left for end of the First Session. Speakers will discuss key issues such as pandemic relief, Social Security, Medicare, Medicaid, and the Older Americans Act.
Age Differences in Preparedness for the Continuation of COVID-19: Important Roles of Social Support
Authors: Chen Zhirui , Cong Zhen , Liang Daan , Cao Guofeng
Published: December 2021

This study examined the association between age and preparedness for the continuation of COVID-19. The moderation effects of three types of social support, namely, emotional, financial, and instrumental assistance were also tested. Using a sample of 443 adults in Dallas county which has the most confirmed cases in Texas, results of multiple linear regressions showed that compared to those aged between 18 and 64, older adults aged 65 and reported better preparedness for the continuation of COVID-19. Receiving emotional, financial, and instrumental assistance were respectively more important for older people to get better prepared than for younger adults, which is consistent with the socioemotional selectivity theory. Our findings directed attention to the strengths and resilience of older adults during COVID-19 from a life course perspective and highlighted the importance of social support and social relationship in their post-disaster recovery and ongoing preparedness.
Physical Distancing and Social Connectedness Among Older Adults
Authors: Lutz Julie , Bower Emily , Beckwith Ellen , Choi Julie , Van Orden Kim
Published: December 2021

The COVID-19 pandemic has significantly impacted older adults; due to elevated risk, many older adults have followed physical distancing guidelines. These efforts, while critical to public health, have also impacted the social interactions and connectedness of older adults. In this mixed-methods study, we conducted qualitative interviews and administered questionnaires to 23 adults age 60 and older to examine how physical distancing has affected their social connectedness; what strategies and supports they have utilized to maintain or improve social connectedness despite physical distancing; and what types of supports, programs, and interventions they feel could promote and foster social connectedness among older adults during physical distancing. The results may have implications not only for the pandemic, but also for older adults who cannot leave their homes or experience barriers to typical social activities for any reason (e.g., being homebound, having functional impairments).
Using Visual Demonstrations of Learning to Promote Age-Integrated Problem Solving
Authors: Borrero Lisa
Published: December 2021

Working to dismantle the “othering” of older adults requires active effort to reverse deeply ingrained cultural perceptions and attitudes. As gerontology educators, we are uniquely positioned to “move the needle” on this issue by providing students with the opportunity to engage with older adults in meaningful ways and to see the world from their perspective. In this presentation, visual demonstrations of student learning will be shared that allow students to demonstrate their mastery of course concepts in a creative way and to problem-solve a particular issue by engaging with their own future selves. This approach also allows for a deviation from the routine of written demonstrations of learning by appealing to a different set of student skills. Approaches discussed will include concept maps to deconstruct community collaboration; book bentos to explore optimal aging; multimedia presentations on meaning-making in older adulthood; and a photo elicitation project to address outdoor fall hazards.
Utilization of Home and Community-Based Resources by Family Caregivers in a Native American Community
Authors: Wyman Mary , Miller Debra , Wheelock Sunshine , Petri Florence , Metoxen Elijah , Lambrou Nickolas , Gleason Carey
Published: December 2021

Family caregiving is uniquely significant for elder care within American Indian/Alaska Native (AI/AN) communities. Compared to other populations, AI/AN older adults are disproportionately impacted by chronic conditions and AI/AN are more likely to be family caregivers. However, AI/AN are underrepresented in aging research. We describe a successful research partnership with the Oneida Nation of Wisconsin and report results of a recent survey of tribal members and affiliates (N=405), covering demographics of caregiving, awareness and use of home and community-based resources, and perceptions of factors impacting service use. Approximately 42% of respondents were current caregivers; of these, roughly one-third knew how to access various resources. Most common sources of knowledge were a health care/social worker or finding information on their own. Traditional cultural values were viewed as variably supportive of resource utilization, depending on service type. Implications for efforts to address disparities for AI/AN aging and support caregivers will be discussed.
Association Between Advance Care Planning for Older Adults and Family Caregivers’ Sense of Security
Authors: Shinohara Masumi , Sakka Mariko , Inagaki Asa , Yasaka Taisuke , Fukui Chie , Noguchi-Watanabe Maiko , Igarashi Ayumi , Yamamoto-Mitani Noriko
Published: December 2021

Family caregivers’ (FCs’) sense of security benefits older adults who receive homecare. Advance care planning (ACP) is reported to have positive effects on FC’s experience, but it might differ depending on FCs’ kin relationships with the older adults. We examined whether ACP for older adults in homecare settings is associated with FCs’ sense of security. Further, we assessed whether such an association depends on their status as spouses or as adult children. We conducted a secondary analysis of data from a prospective cohort study in Japan. The participants were older adults who used home-visit nursing services, their FCs, and the nurses who cared for them. The FCs were asked to answer a sense of security questionnaire, and nurses were asked whether ACP was conducted. Multivariate logistic regression analyses were performed to examine the association between ACP implementation and positive changes in the sense of security scores after three months. Data from 169 cases were analyzed. Of the FCs, 28.1% were men and 55.6% were spouses. ACP was performed in 53.8% of the cases. The results of the multivariate analyses showed an interactive effect between ACP implementation and FC kin relationships. For spouses, ACP was significantly associated with a positive change in their sense of security. For adult children, such an association was not found. ACP might have a positive effect on caregiving spouses’ sense of security. Adult child caregivers, who often have multiple responsibilities and have difficulties facing their parents’ physical decline, may need support, in addition to ACP.
The Burden of Having to Wonder: Minority Stress Experiences of LGBTQ+ Hospice Family Caregivers
Authors: Cloyes Kristin , Jones Miranda , Vega Marilisa , Hebdon Megan Thomas , Thompson Casidee , Rosenkranz Susan J , Reblin Maija , Ellington Lee
Published: December 2021

Home hospice care relies heavily on informal caregivers, often patients’ family and close others. Hospice family caregivers report stress, burden, and unmet support needs associated with poor health and bereavement outcomes. These outcomes are sensitive to the quality of interactions with professional hospice providers, especially for historically marginalized groups, yet little research examines experiences of LGBTQ+ hospice family caregivers. Informed by minority stress theory, we conducted in-depth interviews with LGBTQ+ home hospice family caregivers across the U.S. (N=20). Participants reported demographics and described their caregiving experiences including interactions with hospice providers. Interviews were audio-recorded, transcribed, and content-analyzed. Participants were mostly white (n=15, 75%), non-Hispanic (n=19, 95%), cisgender (n=19, 95%), gender binary (n=19, 95%), lesbian (n=10, 50%), women (n=12, 60%); average age was 52.3 (range 25-67, SD=13.84). Along with known end-of-life caregiving stressors, participants experienced minority stress that complicated caregiver-provider communication. Distal stressors included lack of LGBTQ+ competent resources, inadequate legal protections, providers’ assumptions about relationships, and difficult dynamics with unaccepting relatives. Proximal stressors included perceived risks of disclosure, expectation of poor treatment, feeling the need to modify presentation of self or home, and wondering whether negative provider interactions were due to being LGBTQ+. This generated a background level of uncertainty, caution, and concern that was particularly distressing in the home setting. Minority stress affects LGBTQ+ people across the lifespan and generates added burdens and support needs for hospice family caregivers. Providers who understand these effects are better positioned to deliver safe, effective care to all families at end of life.
Working Family Caregiver Well-Being: Work Impact, Workplace Supports, and Family Discord
Authors: Xu Jiayun , Liu Pi-Ju , Peng Yisheng , Beach Scott
Published: December 2021

A recent study by our team showed that family discord about care provision among multiple family caregivers was a significant predictor of caregiver burden, anxiety, depression, and activity restrictions. This study examined the combined effects of family discord, work impacts (missed work, caregiving affects work), and workplace supports (flexible hours, caregiver benefits) on caregiver well-being. We conducted a secondary analysis using cross-sectional survey data from the Western Pennsylvania Family Caregiving Project 2017-2018. Participants were family caregivers who worked outside the home and shared older adult (i.e. over age 50) caregiving responsibilities with family (n=364, mean age: 52.59 years, female: 71.7%, White: 79.7%, cared for a parent: 69.5%, mean work hours/week: 37.30). Hierarchical regression analyses were conducted testing for main effects of family discord, work impacts, and workplace supports; and interactions between discord and work impacts/workplace supports. The presence of family discord negatively impacted all caregiver well-being outcomes (p<0.05). Having more work impacts increased the risk for anxiety (p<0.04), activity restrictions (p<0.01) and burden (p<0.01). No main effects were found for workplace support. Moderating effects were found, such that anxiety was high when family discord and work impacts were higher (p=0.025). Additionally, more activity restrictions occurred when caregivers had low workplace support and higher family discord (p=0.020). Results suggest having less family discord, more workplace support, and less negative work impacts may improve caregiver well-being. Future work is needed to determine which work supports are most beneficial to this population and how family discord and negative work impacts can be reduced.
Friendship and Loneliness Among People Living With Dementia: Social Practices and Identity
Authors: Saunders Pamela , Gan Daniel R Y , Swinton John
Published: December 2021

More people living with dementia (PLWD) are aging in place in the community. The number of PLWD aging in community is estimated to comprise 61-81% of the total number of PLWD in North America. Since most PLWD do not drive (Foley et al., 2000), many may (or may not) spend much of their time closer to home, barring occasional visits out of town. Yet, one’s everyday environment may not always provide “ways of being in the world that are more accepting and embracing” (Hillman & Latimer, 2017) and kind, to the varied socio-cognitive struggles of PLWD. Meaningful relationships are required to support continued social participation and citizenship (Bartlett & O’Connor, 2007; Swinton, 2020). In addition to dementia diagnosis, these everyday experiences in community may significantly alter PLWD’s self-perception and confidence. PLWD may feel more or less comfortable forging relationships depending on their past experiences. In other words, the identity of PLWDs are often challenged and (re)constructed (Saunders et al., 2011). Amid persistent power imbalances, malignant social practices may reshape one’s identity such that social isolation, whether self-imposed and/or due to restrictions from others, appear the best way to tide over overwhelming loneliness. This symposium explores how community and friendships may intercept the formation of such lonely self-identity among PLWD. We use advanced qualitative methods to elucidate the varied experiences and challenges of PLWD in community. Findings from three perspectives, namely sociolinguistics, sociology, and social work, will be discussed identify new social practices to undo stigma and support PLWD in community.
Tips for Timely (and Positive) Reviews: The International Journal of Aging & Human Development
Authors: Patrick Julie Hicks
Published: December 2021

For more than 40 years, under the leadership of four editors and two publishers, The International Journal of Aging and Human Development (IJAHD) has featured multidisciplinary scholarship related to aging processes and older adults. With the publication of eight issues a year, with over 800 pages of scientific content, the IJAHD places emphasis upon psychological and social studies of aging and the aged. However, the Journal also publishes research that integrates observations from other disciplines that illuminate the "human" side of gerontology. A more recent focus includes midlife development, as well. About half (47%) of the publications in the IJAHD are from international colleagues. This presentation will discuss tips for both international and US-based scholars for ensuring timely reviews and positive decisions for manuscript submissions, including such areas as key words, suggesting unbiased reviewers, formatting, writing mechanics, clearly-articulated methods, and a sound theoretical basis.
They Have the Ability to Say Yes or No: Providers' Perspectives on Veterans' Service Refusal as a Cause of Readmissions
Authors: Hicks Nytasia , Noel Polly , Penney Lauren , Pugh Jacqueline
Published: December 2021

Service refusal, where patients actively refuse clinicians’ recommendations for additional services needed to achieve safe and full recovery after discharge, is a key but often overlooked cause of readmissions. There is a dearth of literature on the extent of service refusal and providers’ (e.g. clinicians, nurses, social workers) observations regarding how to deal with these situations. As part of a larger, 10 VA site organizational case study of readmission, semi-structured interviews exploring causes of readmission were conducted with 21-41 staff members at each site (n=314). 41 providers identified Veteran service refusal and decision-making as causes of readmission. Providers acknowledged the need to honor patient autonomy/self-determination in decisions while at the same time worrying about potential adverse outcomes. Incongruence between Veterans’ and providers’ perceptions (especially for capacity for self-care), goals, and discharge plans was also cited as a factor in service refusal. Frustration was also raised about initial acceptance of service followed by refusal at time of service delivery. Providers also felt readmissions increased even further when combined with lack of or inadequate caregiving arrangements/family support, lack of cognitive capacity, homelessness, or home care affordability. Findings point to the need for interventions to evaluate congruence between provider and patient assessment of self-care capabilities and provide more in-depth goal setting and motivational interviewing techniques to help patients reach more realistic post-discharge care goals.
Using Implementation Science Strategy Mapping on the Age-Friendly Health System's 4Ms Journey
Authors: Dolansky Mary , pohnert Anne , Greenberg Sherry
Published: December 2021

Background: Implementation science is the study of methods to promote the adoption and integration of evidence-based practices into routine health care to improve the quality of care. The purpose of this study was to use Implementation Mapping to guide the implementation of The John A. Hartford evidence-based Age-Friendly Health Systems (AFHS) 4Ms Framework: What Matters, Medications, Mentation, and Mobility. Methods: Implementation Mapping, a systematic process for planning implementation strategies, guided the 9-month integration of the 4Ms Framework in the 1,100 MinuteClinics across the US. Implementation Mapping includes five tasks: (1) conduct an implementation needs assessment and identify program adopters and implementers; (2) state adoption and implementation outcomes and performance objectives, identify determinants, and create matrices of change objectives; (3) choose theoretical methods (mechanisms of change) and select or design implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. Results: The implementation plan, developed by the implementation mapping method, was carried out over 9-months. Seven implementation strategies were identified from the Expert Recommendations for Implementing Change (ERIC) project including the provision of education, electronic health record integration, internal champion facilitation, cues to action, and a dashboard to monitor progress. To date, the implementation mapping has resulted in the adoption of the 4Ms by 1145 providers (37%). Monitoring of the adoption of the 4Ms Framework and consideration of future implementation strategies is ongoing. Conclusions: Implementation Mapping provided a systematic process to develop strategies to improve the adoption, implementation, sustainment, and scale-up of the evidence-based 4Ms Framework.
Social Isolation and Well-Being Among Middle-Age and Older Adults: Before and During the COVID-19 Outbreak
Authors: Li Lydia
Published: December 2021

This symposium brings together five studies that examined the relationship between social isolation and well-being. Two used pre-COVID data from the Health and Retirement Study (HRS). One aimed to identify patterns of social isolation trajectory in a 9-year period, where social isolation was conceptualized as a multidimensional construct. It identified four distinct patterns, and the pattern had a gradient relationship with health outcomes. Another examined the association between self-perceptions of aging (SPA) and social well-being among older adults. It found that positive SPA predicted increased social connectedness and reduced loneliness in four years. Two other studies were based on a longitudinal survey (COVID-19 Coping Survey) that began in April 2020. One reports that adults 55+ with comorbidity at pandemic onset had persistently elevated depressive symptoms in a 6-month period, regardless of their social isolation level. Another paper suggests that physical isolation at pandemic onset was associated with elevated symptoms of depression, anxiety, and loneliness throughout the following six months. The fifth paper was based on two-wave data—2019 survey and 2020 COVID supplement—from the National Aging and Health Trend Study (NAHTS). It found that older adults who were very socially isolated and completely homebound before the pandemic experienced less psychological distress during the outbreak than those who were very socially integrated and not homebound. The five studies highlight the multiple dimensions of social isolation, their antecedents and development over time, and their role in shaping mental health in a pandemic context.
Government and University Partner for Virtual Service-Learning to Support Intergenerational Social Interaction
Authors: Kemeny Betsy , Williams Adelle , Cole Stephanie
Published: December 2021

Pre-pandemic, evidence existed that intergenerational service-learning programs support knowledge of aging and positive attitudes and perceptions (Monahan et al., 2020). As spring 2020 COVID-19 lock downs and public health warnings urged physical distancing of community dwelling older adults, growing concern about the unintended consequences of increased social isolation on mental and physical health prompted the Secretary’s Office of Pennsylvania Department of Aging to design a pilot project with university faculty for virtual intergenerational social interaction. The Department identified older adults at the highest risk for social isolation (live alone, in poverty, with a disability). The resulting pilot project is fully integrated as a high impact practice into eight sections of recreational therapy and gerontology courses with participation by 210 undergraduate students and 210 older adults for 9 weeks of both the fall and spring semesters. Students, who received extensive classroom instruction aimed at avoiding negative stereotypes of older adults as helpless and dependent, called their assigned partner several times a week for at least an hour of communication. Using the UCLA loneliness scale, community-dwelling older adults reported frustration with isolation due to the pandemic. Those with low and moderate loneliness reported positive feelings about program and looking forward to interactions with students. Students gained virtual communication skills that may contribute to telehealth competencies, intervention skills such as assessment, life review/reminiscence, mindfulness techniques, and leisure education. Moreover, an analysis of student reflections revealed positive changes in attitudes toward older adults and the ability to enjoy common interests despite age differences.
Social Isolation Patterns and Health Outcomes in Midlife and Later Life
Authors: Luo Meng Sha
Published: December 2021

Conceptualizing social isolation as a multidimensional construct encompassing social networks, social contacts, perceived support and loneliness, this research aims to: (1) identify patterns of social isolation trajectory among middle-aged and older adults in the U.S.; (2) investigate how different patterns of social isolation trajectory are related to adults’ physical, mental, cognitive, and overall health. Latent class growth modeling was used to examine social isolation trajectory patterns over nine years in a national sample of 6,457 adults aged 51+. Four patterns of social isolation trajectory were identified: severely isolated, moderately isolated, subjectively integrated, and objectively integrated. The objectively integrated group reported the best physical, mental, cognitive, and overall health, whereas the severely isolated group reported the worst. The moderately isolated and subjectively integrated groups fell in between, with the latter displaying relatively better health outcomes. Findings support a close relationship between poor health and long-term social isolation.
Adapting to Create Innovative Virtual Falls Prevention Programs for at Risk Older Adults During a Global Pandemic
Authors: Pidgeon Dawna , Dobert Rebecca , Brennan Maura
Published: December 2021

Baystate Health’s Geriatrics Workforce Enhancement Program (GWEP) postponed implementation of Group Medical Visits focused on falls reduction for older adults in Springfield, Massachusetts due to COVID-19 and quickly shifted efforts to participate in Dartmouth’s Falls Prevention Training Program. Long standing GWEP Community Based Organizations (CBOs) were consulted, and all believed that the virtual Tai Ji Quan Moving for Better Balance® (TJQMBB) program would combat social isolation and improve older adults’ comfort with technology in addition to reducing falls during the COVID-19 pandemic. Baystate’s GWEP was able to reallocate grant dollars to support the purchase of equipment for CBOs to deliver TJQMBB virtually. While many challenges continue to arise, the innovative and collaborative approach between the two GWEPs and Baystate’s CBOs leveraging Administration for Community Living falls prevention funding has led to high level engagement and rapid implementation. Dartmouth’s model capitalizes on and strengthens existing GWEP partnerships with its CBOs.
Does Long-Term Care Policy Enable or Limit Volunteers’ Roles in Enhancing Resident Quality of Life?
Authors: Hubley Emily , Hande Mary Jean
Published: December 2021

This paper examines how volunteer roles are represented in Canadian long term care (LTC) policy in four Canadian jurisdictions, attending to how these regulated roles might impact resident quality of life. Overall, we found that policies define volunteer roles narrowly, which may limit residents’ quality of life. This happens through (1) omitting volunteers from most regulatory policy, (2) likening volunteers to supplementary staff rather than caregivers with unique roles, and (3) over-emphasizing residents’ safety, security and order. We offer insights into promising provincial policy directions for LTC volunteers, yet we caution against further regulating volunteers. Instead, we argue, addressing the cultural, social and structural changes required for volunteers to enhance LTC residents’ quality of life effectively.
Cortico-Striatal Functional Connectivity Reflects Changes in Subjective Energy and Tiredness
Authors: Hengenius James , Ehrenkranz Rebecca , Huppert Theodore , Rosano Caterina
Published: December 2021

Subjective feelings of energy and tiredness may reflect different neural processes. Functional connectivity (FC) was measured in 272 HealthABC participants via resting state functional MRI in striatal-associative, striatal-limbic and striatal-sensorimotor networks. Subjective energy level (scored 1-10) and tiredness (tired/not-tired) during the prior month were collected via self-report from year 2 to year 10 (mean energy follow-up=8 years, tiredness follow-up=7 years). Participants who never reported being tired during follow-up (N=119) had significantly lower FC in the striatal-limbic network (mean difference [95%CI]: -0.055 [-0.1020,-0.00879], p=0.02). Participants with stable energy level over time (N=94, defined as decline <1.0 SD below the mean) had significantly higher FC in the striatal-associative network (mean difference [95% CI]: 0.041 [0.00192,0.0807], p=0.04). Associations were similar when adjusted for brain atrophy, demographics, and education. Although based on subjective measures, the distinct spatial patterns of these associations support our hypothesis that neural basis of energy and fatigue may differ.
Exercise-Associated Pathways as Novel Neuroprotectants Against CNS Aging and Alzheimer’s Disease
Authors: Cortes Constanza
Published: December 2021

Skeletal muscle has recently arisen as a novel regulators of Central Nervous System (CNS) function and aging, secreting bioactive molecules known as myokines with proteostasis and metabolism-modifying functions in targeted tissues. We have recently generated a novel transgenic mouse with enhanced muscle proteostasis via moderate overexpression of Transcription Factor E-B (TFEB), a powerful master regulator of cellular clearance and proteostasis. We have discovered that the resulting enhanced skeletal muscle proteostasis function can significantly ameliorate proteotoxicity in the aging CNS and improve cognition and memory in aging mice. These neuroprotective benefits are markedly reminiscent of those observed in the aging CNS post-exercise, suggesting enhancing muscle proteostasis may be sufficient to replicate the local and systemic effects of exercise. Identification of pathways regulating crosstalk between skeletal muscle and CNS may yield targets with high therapeutic potential for diseases of the aging CNS.
The Preparedness for Caregiving Scale in African American and White Caregivers of Hospitalized Persons With Dementia
Authors: Kuzmik Ashley
Published: December 2021

This study evaluated the Preparedness for Caregiving Scale (PCS) upon discharge from the hospital. The caregivers reported a mean age of 60.5 years (SD=13.9). The majority of caregivers were female (72%), married (59%), non-Hispanic/Latino (98%) and either white (52%) or African American (48%). Fifty percent were employed outside of the home and averaged 40.7 (SD= 14.4) hours of outside work per week. The average PCS was 24.4 (SD=6.9, 0-32). One-factor structure of the PCS and measurement invariance by race was fully supported. Predicative validity revealed significant association between the PCS and anxiety (β =-.41, t = -7.61(287), p <.001), depression (β =-.44, t =-8.39 (287), p <.001), and strain (β =-.48, t =-9.29(287), p <.001). The PCS is a valid and meaningful tool to measure preparedness in African American and white family caregivers of persons with dementia during post- hospitalization transition.
Physical Isolation and Mental Health Among Older U.S. Adults in the COVID-19 Coping Study
Authors: Joseph Carly , O'Shea Brendan , Finlay Jessica , Kobayashi Lindsay
Published: December 2021

The ongoing COVID-19 pandemic has set an urgent need to understand the impact of physical isolation on mental health. We aimed to investigate the relationships between physical isolation during the period when many US states had shelter-in-place orders (April-May 2020) and subsequent longitudinal trajectories of mental health in middle-aged and older adults (aged 55+, N=3,978) over a six-month follow-up (April to October 2020). We used population and attrition-weighted multivariable linear mixed-effects models. At baseline, 7 days/week of physical isolation (vs. 0 days/week) was associated with elevated depressive symptoms (β=0.82; 95% CI: 0.04-1.60), and all of 1-3, 4-6, and 7 days/week of physical isolation (vs. 0 days/week) were associated with elevated anxiety symptoms and loneliness. Physical isolation was not associated with changes in mental health symptoms over time. These findings highlight the need to prioritize opportunities for in-person connection for middle-aged and older adults when safe to do so.
Pre-Pandemic Social Isolation: Protection or Vulnerability in the Time of COVID?
Authors: Li Lydia
Published: December 2021

How do older adults at risk of social isolation before the pandemic fare during the COVID-19 outbreak? Using data from two waves (Round 9 [2019] and COVID-19 Supplement) of the National Health and Aging Trend Study (NHATS), we examined the relationship between pre-pandemic social isolation and psychological distress during the outbreak among community-living older adults (age 65+). Results show that the most socially integrated respondents had more PTSD (β=1.47, SE=.37, p<.001) and depression/anxiety (β=.34, SE=.11, p=.002) symptoms than the most isolated. Older adults who were not homebound had more PTSD (β=2.0, SE= .76, p=.01) and depression/anxiety (β=1.05, SE=.20, p<.001) than the completely homebound. With shelter-in-place and social distancing requirements, older adults who have been socially active and integrated may experience high-stress levels and may need extra support to adjust to the changes. Relatively, those who have been very isolated and homebound may experience fewer changes in their lives.
Social Determinants of Cognitive Health: Studies on Physical and Social Environments and Cognition
Authors: Yu Kexin , Ng Ted , Heyn Patricia
Published: December 2021

Living environments profoundly influence the aging process. This symposium presents research on two main aspects of the living environment and their relationships with cognitive health. The living environment is broadly defined, including both physical and social aspects. The physical environment is the characteristics of the built environment, such as tripping hazard in the home, cleanness of the community streets, and presence of deserted buildings, etc. The social environment is the cohesiveness with other people living in the neighborhood. Living environments have multiple layers; the physical environments encompass both in-home and in-community domains, whereas the social environment can be categorized as domestic versus community cohesiveness. This symposium includes studies with investigation scopes spanning from the micro to mezzo levels. The first presentation scrutinizes the buffering effect of marital relationships, as a form of domestic social environments, on cognition among older adults with vision and hearing impairments. Using the NHATS dataset, the second presentation examines social isolation as a potential mediator for the association between physical, social environments and global cognitive functioning. The third presentation evaluates the impact of living environments on cognition among Canadian older adults with multimorbidity. The last presentation examines how the physical environment affects sleep quality and thus influences older adults’ cognition. All four presentations are closely linked to the overarching theme of evaluating the environmental impact on cognition and provide possible explanations mediating the association observed. This symposium contributes to advancing gerontological knowledge by offering new perspectives on the social determinants of cognitive health.
Marital Quality as a Moderator of the Association Between Sensory Impairments and Cognitive Functioning
Authors: Yorgason Jeremy , Tanner Corinna , White Avalon , Richardson Stephanie , Hill Melanie , Bench Shaylee , Stagg Brian , Ehrlich Joshua
Published: December 2021

Research suggests that marital quality may buffer the impact of sensory impairments in later life, and that marital quality relates to cognitive functioning. This study explored how marital quality moderated links between sensory impairments and cognitive functioning. We used data from 723 paired marital dyads from two cohorts in the NHATS and NSOC studies across three-year periods (n=340 dyads from waves 1, 2, 3; n=383 dyads from waves 5, 6, 7). Growth curve models of executive functioning indicated that marital quality moderated effects of both hearing and vision impairment on changes in cognitive functioning longitudinally. Specifically, higher marital quality was associated with higher executive functioning across time. Results suggested no improvement in executive functioning among those with average or lower marital quality. Although cognition declines with advanced age and with sensory impairments, results suggest that older adults with higher marital quality may improve in some aspects of cognition longitudinally.
Comparison of Different Approaches to Operationalize Fried’s Phenotypic Frailty in the NuAge Cohort
Authors: Turcot Valerie , Cohen Alan , Gaudreau Pierrette , Legault Véronique , Morais José , Presse Nancy , Chevalier Stéphanie
Published: December 2021

Many operationalization approaches were proposed to identify frailty in older adults. The common use of Fried’s original criteria or other cut-offs based on cohort distribution may not apply in every cohort leading to potential bias in the identification of frail individuals. We thus aimed to apply different Fried’s phenotypic frailty operationalization approaches in the Quebec NuAge cohort of generally healthy community-dwelling older adults (n=1,753; aged 67-84 years), and longitudinally compare prevalence, incidence and predictive strength on outcomes, such as functional autonomy, falls, hospitalization and mortality. Significant variability in prevalence, classification agreement and predictive strengths were observed between approaches, notably using different types of distribution cut-offs, variables, or ways to handle missing data. This strategy helped us to prioritize a specific Fried’s phenotypic frailty operationalization in NuAge, which could then be used in secondary research projects aiming to study determinants of Fried’s phenotypic frailty and its role in health outcomes.
Irving S. Wright Award: Cellular recycling in aging and disease: The importance of taking out the trash
Authors: Hansen Malene
Published: December 2021

Aging is greatly influenced by quality-control processes that keep the materials inside our cells in proper shape and function. One of these processes is called autophagy, which means "self-eating". This cellular recycling process can digest damaged components to provide new and better parts for the cell. Autophagy plays important roles in many age-related diseases and has been directly linked to aging. In our laboratory, we use the microscopic soil-dwelling round worm C. elegans to understand how autophagy is linked to aging and disease. In this Wright Award seminar, I will discuss our progress on understanding how autophagy is regulated during normal aging and how it may promote a long and healthy lifespan.