bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers and Facilitators of Pain Management in Persons With Dementia in Long-Term Care: A Scoping Review
Authors: Liao Yo-Jen , Jao Ying-Ling , Berish Diane , Kitko Lisa
Published: December 2021

Approximately 50% of individuals with dementia regularly experience moderate to severe pain, which is largely undermanaged. Several studies have explored the barriers and facilitators of pain management for persons with dementia; yet the evidence has not been systematically reviewed. This review aimed to synthesize current evidence on the barriers and facilitators of pain management in persons with dementia in long-term care. A PRISMA guided literature search was conducted in PubMed, CINAHL, and PsycINFO. Titles, abstracts, and full texts were screened. Included articles were original research examining the barriers or facilitators of pain assessment and treatment in individuals with dementia in long-term care. Quality assessment was conducted using the Risk of Bias tool and Johns Hopkins Level of Evidence. Ten studies were identified, including four quantitative studies, five qualitative studies, and one with both quantitative and qualitative research. Barriers of pain management identified include residents’ ability to self-report pain, pain medication side effects, need discrepancy among residents and their families, reluctance in administering analgesics, lack of pain assessment tools, lack of guidance in providing nonpharmacological interventions, and lack of clinical guidelines. Facilitators of pain management include clinicians with caring and enthusiastic characteristics, clinicians’ knowledge of residents, positive relationships among clinicians, good communication skills, using validated pain assessment tools, understanding pain indicators, clinical experience, and need-driven continuing education. These results can guide clinical practice in long-term care. Interventions should be developed to target these barriers and facilitators and improve pain management in persons with dementia.
The Sex Difference in Gait Speed: How Do Sociodemographic, Lifestyle, Social, and Health Determinants Contribute?
Authors: Sialino Lena , Schaap Laura , van Oostrom Sandra , Picavet Susan , Twisk Johannes , Verschuren Monique , Visser Marjolein , Wijnhoven Hanneke
Published: December 2021

This study explores whether a sex difference in sensitivity to (strength of the association) and/or in exposure to (prevalence) determinants of gait speed contributes to the observed lower gait speed among women compared to men. Data from the Longitudinal Aging Study Amsterdam (LASA) were used. In total 2407 men and women aged 55-81 years were included, with baseline measurements in 1992/2002 and follow-up measurements every 3-4 years for 15/25 years. Multivariable mixed model analysis was used to investigate sex differences in sensitivity (interaction term with sex) and in exposure to (change of the sex difference when adjusted) for socio-demographic, lifestyle, social and health determinants of gait speed. On average, women had a 0.054 m/s (95%CI:0.076-0.033, adjusted for height and age) lower mean gait speed compared to men. Higher BMI and lower physical activity were more strongly associated with lower gait speed in women compared to men (i.e. higher sensitivity). Lower educational level, living alone and having more chronic diseases, pain and depressive symptoms among women compared to men also contributed to observed lower gait speed in women (i.e. higher exposure). In conclusion, both a higher sensitivity and higher exposure to determinants of gait speed among women compared to men contributes to the observed lower gait speed among women aged 55 years and older. The identified (modifiable) contributing factors should be taking into account when developing prevention and/or treatment strategies aimed to enhance healthy physical aging. This might require a sex-specific approach in both research and clinical practice.
Intergenerational Relationships During the COVID-19 Pandemic: Challenges and Opportunities of Data Collection
Authors: Suitor J Jill , Gilligan Megan
Published: December 2021

Family scholars experienced numerous unique challenges and opportunities when studying intergenerational relationships during the COVID-19 pandemic. In this presentation, we draw examples from the Within-Family Differences Study to highlight some of the ways in which respondents’ patterns of study participation, reports of their relationships with their late-life parents and their own young adult children, and their psychological well-being, subjective physical health, and health behaviors reflected the fluctuating waves of the pandemic. Among the patterns we discuss are systematic variations in the intensity of respondents’ answers to both open and closed-ended items, respondents’ expressions of concern regarding choosing the “right” answers to questions, and their attempts to negotiate their responses with interviewers. Our observations led us to conclude that measures family gerontologists use to capture many constructs central to the field are subject to different “meanings” by respondents in the face of disaster.
Comparison of Two Surveys Using the Sexuality Assessment Tool (SexAT) in Flanders
Authors: Messelis Els , Bauer Michael , Stichele Elisabeth Vander , Elaut els
Published: December 2021

From 2015 it is mandatory in Flanders, Belgium, to develop a policy to deal with sexual abuse in elderly care. Residential Aged Care Facilities (RACF'S) try to focus on this mandatory, but should also pay attention to implement an overall Sex and Intimacy Policy. This study contains a Comparison of two surveys (Messelis & Bauer, 2020 and Vander Stichele, e.a. 2020) in Flanders, Belgium, both using the Sexual Assessment Tool (SeAT, Messelis & Bauer, 2017). Both studies aimed to assess how supportive residential aged care facilities are of residents' sexual expression. In the survey of Messelis & Bauer 750 aged care facilities were contacted in 2017-2018 and 69 (9,2%) completed the SexAT survey after three reminders. Vander Stichele e.a. contacted 100 aged care facilities managers in 2019. Twenty of them (20% response rate) completed the SexAT after three reminders. Findings of the Messelis & Bauer survey indicate that 70% of the facilities rated 'very good' to 'good' (score between 21-59/69), while Vander Stichele e.a. found a prevalence of 76% of this score. Both found no facilities were rated 'excellent' (score greater than 60/69). In the category 'improvement needed' (score less than 20/69), percentages were 30% and 23%; a difference of 7% (CI95% of difference in percentage includes zero, not significant). There is room for improvement in residential aged care facilities for the support of sexual expression of residents. The more recent study confirms results of the previous one, and no significant evolution was observed in two consecutive cross-sectional surveys.
Efforts by the National Academy for State Health Policy
Authors: Fox-Grage Wendy
Published: December 2021

The National Academy for State Health Policy hosts both the RAISE Act Family Caregiving Resource and Dissemination Center and the Hub for State Strategies to Build and Support Palliative Care, with generous funding from The John A. Hartford Foundation. The value of supporting individuals with serious illness and complex conditions as well as their family caregivers through telehealth, care management, advance care planning, and other added family caregiver supports has been especially evident during the COVID-19 pandemic. Policymakers are now grappling with how to restructure hard-hit health care and long-term services and supports systems to better support these individuals and their family caregivers. The State Hub provides concrete resources for states working to implement and expand high-quality palliative care, and the RAISE Center is assisting the Family Caregiving Advisory Council with creating the country’s first national Family Caregiver Strategy.
Caregiver Stress and Empathy: Neural and Hormonal Correlates
Authors: Mirajkar Shalmali , Warren David , Beadle Janelle
Published: December 2021

Providing care to older adults with chronic conditions can be emotionally meaningful and stressful. The tend-and-befriend theory highlights the role of affiliation/empathy in stress reduction, but it has not been established whether this theory extends to caregivers for older adults. Addressing this gap, we assessed caregiver empathy and stress through behavioral, hormone, and neuroimaging measures. In Experiment 1, we compared 19 caregivers (Mage=67.1) to 24 non-caregivers (Mage=72.6), and found that caregivers with a greater reduction in cortisol to an empathic context showed greater prosocial behavior (r2=0.3). In experiment 2 (N=32), we examined differences between caregivers and non-caregivers in whole brain resting-state functional connectivity (RSFC) with seed regions of interest (posterior cingulate cortex (PCC); amygdala), and covariation of RSFC with empathy (α=0.05). For emotional empathy, caregivers had stronger connectivity between the PCC seed, medial prefrontal cortex, and right supramarginal gyrus, and between the amygdala seed and the right middle frontal gyrus.
Safety Considerations of Adaptive Horseback Riding Program for Adults With Dementia and Their Families
Authors: Oestreich Alicia , Fields Beth
Published: December 2021

Human-animal interactions, including equine-assisted services, are becoming increasingly popular to enhance the quality of life of adults with dementia and their families. However, there is a lack of knowledge on safety considerations when serving this population. The purpose of this qualitative descriptive study was to explore the safety perspectives of key stakeholders involved in an adaptive horseback riding program for adults with dementia and their families. Ten, 30-minute semi-structured interviews and two, 60-minute focus groups were conducted with horseback riding program instructors and staff, dementia specialists, and adults with dementia and their families. Thematic analysis of data were guided by the Professional Association of Therapeutic Horsemanship International’s Core Safety Standards and completed using NVivo 12. Stakeholders described two central themes to consider when offering equine-assisted services at therapeutic horseback riding centers to adults with dementia and their families 1) dementia and horse training parameters, and 2) enrollment procedures. Stakeholders recommended that training should encompass “how to interact and communicate in a positive way with the adult with dementia…redirect if a behavior comes up”, and horses should be specially selected to “tolerate standing in a ramp during a difficult mount”. Stakeholders also shared that enrollment in the program should include learning the adult’s health and prior horse experience, precautions and contraindications, horseback riding readiness, and availability of and support from family. Information gleaned from this study may help researchers, instructors, and staff develop policies that demonstrate optimal safety practices when delivering equine-assisted services to adults with dementia and their families.
Multiple Chronic Condition Combinations, Affect, and Memory Among Black and White Older Adults
Authors: Ogletree Aaron , Cooke Steph , Katz Benjamin
Published: December 2021

Research demonstrates the adverse effects of coexisting multiple chronic conditions (MCCs) on older adults’ health and wellbeing. While most research relies on total counts of chronic conditions, little work explores how specific MCC combinations may have compounding effects on depression and memory. Furthermore, no published research explores differences in the prevalence and correlates of MCC combinations between Black and White older adults. The current study assesses within- and between-group heterogeneity in the prevalence and correlates of MCC combinations to advance health equity research. We utilize a sample of 16,757 Black and White older adults drawn from the 2014 wave of the Health and Retirement Study. Respondents were categorized into one of 32 MCC combination groups. Depressive symptoms and self-rated memory were calculated separately for Black and White respondents across each of the 32 groups. Chi-square tests, t-tests, and ANCOVAs were used to compare differences. Black and White respondents differed significantly in the prevalence of 14 out of 32 MCC combinations. Within-group differences were found such that 45% of Black respondents experiencing only Lung Disease met criteria for clinical depression; this rate is similar to Black respondents experiencing Diabetes + Heart Condition + Hypertension + Lung Disease (44.5%). Between-group differences revealed that Black respondents experiencing Arthritis + Diabetes + Hypertension had worse self-rated memory than White counterparts (MB = 3.24, MW = 3.13; two sample t[1139]= -2.04, p < .05; Cohen’s d = 0.13). Additional findings are presented, and theoretical and practical implications for this work are discussed.
Early-Life Racial Discrimination, Racial Centrality, and Adult Allostatic Load Among African American Older Adults
Authors: Tobin Courtney Thomas , Gutierrez Angela , Thorpe Roland
Published: December 2021

This study evaluated the life course processes through which early life racial discrimination (ELRD) and racial centrality (i.e., the importance of Black identity to one’s sense of self) interact to shape allostatic load (AL) among African American (AA) adults aged 50+ in the Nashville Stress and Health Study (N=260). Adolescent ELRD was associated with greater racial centrality in adulthood and conferred 35% greater risk of high adult AL; greater centrality was also linked to high adult AL. Centrality accounts for 24% of the association between ELRD and AL. ELRD and centrality interact to shape adult AL, such that racial centrality is protective against high AL for adults who experienced racial discrimination as children or adolescents. Findings highlight the multiple pathways through which race-related stressors and psychosocial resources interact to shape physiological dysregulation in later life and underscore the health significance of racial identity for older AAs.
Retrospective Perceptions of Changes in Well-Being: The Impact of Age, Culture, and Aging Attitudes on Accuracy
Authors: Park Jeongsoo , Lothary Allura , Hess Thomas
Published: December 2021

Aging attitudes have important consequences on functioning in later-life. A critical question concerns whether such attitudes may bias perceptions of one’s own aging, with potentially negative effects on important outcomes. Using data from adults aged 30 – 85 in the US (n=315), Hong Kong (n=317), and Germany (n=623), we examined the impact of age and aging attitudes on accuracy of perceptions of change in well-being over five years in different domains of functioning. Across contexts, comparisons revealed good correspondence between retrospective reports and actual change. However, older adults and those with negative attitudes retrospectively reported less positive change over this period. Accuracy of perceived change was affected by aging attitudes, with positive attitudes being associated with greater accuracy across most domains, although culture moderated these effects. The results highlight the complex relationship between culture and perceptions of well-being, as well as the potentially insidious effects of attitudes on their accuracy.
STRUMM: An Intelligent, Adaptive Software Package for Older Adults With a Cognitive Impairment
Authors: Czaja Sara , Ceruso Marco , Boot Walter , Charness Neil , Rogers Wendy
Published: December 2021

Many older adults have a cognitive impairment (CI), which negatively impacts on their quality of life and threatens their independence. In this presentation, we provide an overview of the conceptual framework, structure, and processes of our multi-site Center, ENHANCE, which is focused on developing technology support for aging adults with a CI. ENHANCE has two cross-site research projects, two cross-site development projects, training, and dissemination components. A core battery of measures is collected across all projects. We also discuss the Supportive Technology Resources through Usability & Machine-learning Methods (STRUMM) research project, which focuses on an innovative intelligent adaptive software package aimed at providing cognitive and social support, and support for resource access to aging adults with a CI. STRUMM is designed to meet the user’s varying cognitive needs. Finally, we present preliminary data regarding the perceived usability and value of STRUMM from our clinical partners and potential user groups.
The Devastating Economic Impact of COVID-19 on Older Black and Latinx Adults: Implications for Health and Well-Being
Authors: Garcia Marc , Thierry Amy
Published: December 2021

The ongoing COVID-19 pandemic and subsequent economic recession have wreaked havoc on the United States’ economy and brought to the forefront stark racial and ethnic inequalities in our society. Older Black and Latinx adults are particularly hard hit by the pandemic as they have relatively lower levels of income and wealth to protect against crises. This study used data from the 2020 COVID-19 module of the Health and Retirement Study, to highlight how the COVID-19 pandemic has economically impacted older Black, U.S.-born Latinx and foreign-born Latinx adults. Results show the pandemic has economically devastated older Black and Latinx adults across a host of economic factors, with foreign-born Latinx experiencing greater economic hardships relative to other groups. Our findings document stark inequalities that are being exacerbated by the pandemic. We discuss the implications of the economic shocks of the pandemic for the health and well-being of older Black and Latinx adults.
Systemic Mechanisms of Brain Rejuvenation
Authors: Villeda Saul
Published: December 2021

Aging drives cellular and cognitive impairments in the adult brain. It is imperative to gain mechanistic insight into what drives aging phenotypes in the brain in order to maintain, and even restore, functional integrity in the elderly. We, and others, have shown that systemic manipulations - such as heterochronic parabiosis (in which a young and old circulatory system are joined) and administration of young blood or exercise induced blood factors - can reverse age-related impairments in regenerative, synaptic and inflammatory processes, as well as rescue cognitive faculties in the aged brain. These studies have revealed an age-dependent bi-directionality in the influence of the systemic environment indicating pro-youthful factors in young blood elicit rejuvenation while pro-aging factors in old blood drive aging. It has been proposed that introducing pro-youthful factors or mitigating the effect of pro-aging factors may provide effective strategies to rejuvenate aging phenotypes in the brain. Despite this potential, much is unknown as to the systemic and molecular mechanisms regulating pro-youthful and pro-aging effects of blood-borne factors. I will discuss work from my research group that begins to provide mechanistic insight into the systemic and molecular drivers promoting rejuvenation in the aging brain.
Targeting Anticipatory Neurogenesis to Maintain Cognitive Reserve
Authors: Sahay Amar
Published: December 2021

Memory imprecision is a hallmark of age-related cognitive decline and mild-cognitive impairment (MCI) and is characterized by increased memory interference and decreased stability of memory representations. Evidence from humans, non-human primates and rodents demonstrate reduced hippocampal neurogenesis, excitation-inhibition imbalance and inflexible hippocampal remapping during age-related cognitive decline and MCI. Developing strategies to reverse cognitive decline during aging and Mild Cognitive Impairment necessitates an understanding of molecular, cellular, circuit and network mechanisms that support memory functions of the hippocampus. Over the last decade we have built a multifaceted program grounded in basic neuroscience that is aimed at improving memory in aging and MCI. We have demonstrated how we can Rejuvenate the aged hippocampus by selectively increasing neurogenesis and how we can Re-engineer connectivity of aged inhibitory microcircuits to improve memory precision in aging. Ongoing efforts include strategies to Repairing neurogenic niche fitness by targeting intercellular communication in the aging hippocampus. In today’s talk I will present a fourth approach catalyzed by our discovery of the first transcriptional regulator of neural stem cell expansion in the adult hippocampus. We will present data in support of this claim and convey how this discovery may guide strategies to maintain cognitive reserve embodied in the pool of neural stem cells in the adult hippocampus.
The Impact of Diabetes and Edentulism on All-Cause Mortality: Racial and Ethnic Disparities
Authors: Tan Chenxin , Luo Huabin , Sloan Frank , Plassman Brenda , Adhikari Samrachana , Schwartz Mark , Qi Xiang , Wu Bei
Published: December 2021

This study examined the relationships between the concomitance of diabetes mellitus (DM) and edentulism and mortality among Black, Hispanic, and White older adults in the US. We used data from the 2006-2016 Health and Retirement Study with 2,108 Black, 1,331 Hispanic, and 11,544 White respondents aged 50+. Results of weighted Cox proportional hazards models showed that the concomitance of DM and edentulism was associated with a higher mortality risk for Blacks (Hazard Ratio [HR] = 1.58, p < 0.01), Hispanics (HR = 2.16, p < 0.001) and Whites (HR = 1.61, p < 0.001). Findings also indicated that DM was a risk factor for mortality across all racial/ethnic groups, but edentulism was a risk factor only for Whites (HR = 1.30, p < 0.001). This study revealed that the risk of DM and edentulism on mortality varied among racial/ethnic groups. Our study gives alternative explanations for the observed findings.
Disparities in Dental Service Use Among Adult Populations in the United States
Authors: Wu Yan Yan , Zhang Wei , Wu Bei
Published: December 2021

This paper aimed to examine disparities of dental service utilization for younger (20-49), middle-aged (50-64), and older adults (65+), among Whites, Hispanics, Blacks, Asians, American Indians or Alaska Natives (AIAN), and Native Hawaiian or other Pacific Islanders (NHOPI). Weighted logistic regression models were conducted to analyze nine waves of data (2002-2018) from the Behavioral Risk Factor Surveillance System. Results show that the all-wave average prevalence was 71% and racial/ethnic disparities increased with age. Black older adults had the lowest level of dental service utilization (65%), comparing to the two highest groups: White older adults (79%) and Asian older adults (76%). The younger adult populations had low prevalences with the lowest among Asians (65%). The AIAN and NHOPI all age groups tended to have average or below average prevalences. Health policy, federal funding, and community-based programs should address needs of dental service utilization for racial/ethnic minorities including Blacks, AIANs, and NHOPIs.
Fatigability: An Early Marker of Diminished Renal Function?
Authors: Simonsick Eleanor , Moore Ann , Shardell Michelle , Kuo Pei-Lun , Karikkineth Ajoy , Ferrucci Luigi
Published: December 2021

Renal function declines markedly with age due to normal aging and/or disease processes and impacts multiple systems. Diminished renal function may manifest as low exercise tolerance and fatigue threshold. Using data on 951 well-functioning (usual gait speed >.67m/s and no difficulty walking ¼ mile) men and women (51%) aged 60-89 years in the Baltimore Longitudinal Study of Aging, we evaluated the cross-sectional association between perceived fatigability (Rating Perceived Exertion after 5-minute treadmill walk at 1.5mph) categorized as 6-7, 8-9, 10-11 and 12+ and GFR using Cockcroft-Gault. For each fatigability increment, likelihood of suboptimal (GFR=75-89, 21%), diminished (GFR=60-74, 26%) and poor renal function (GFR=15-59, 30%) relative to GFR≥90 was respectively OR(95%CI)p-value 1.51(1.16-1.96).002, 1.38(1.04-1.83).027 and 1.68(1.22-2.31).002 adjusted for demographics, weight, height, smoking, exercise and anemia. Findings were similar for men and women. Perceived fatigability may facilitate identification of apparently well-functioning older adults on the precipice of suboptimal to poor renal function.
Trends of ARNI and Other Heart Failure Medication Use in Older Adults
Authors: Lee Yu-Chien , Patorno Elisabetta , Gopalakrishnan Chandrasekar , Kim Dae
Published: December 2021

In 2015-2017, we identified 276,679 to 315,788 Medicare beneficiaries with HFrEF (mean age 76.6-76.7 years, 75.0-76.2% male, 82.0-83.4% Whites, and 44.8-50.9% frail). Since its approval in July 2015, ARNI use increased from 0.3% to 5.7%. ARNI uptake was lower in patients with older age (6.6% for 65-74 years vs 3.4% for ≥85 years), non-Hispanic race (7.3% for Hispanic vs 5.6-6.6% for other race), no dual eligibility (6.4% for dual eligibility vs 5.5% for no dual eligibility), frailty (5.1% for frailty vs 6.1% for non-frailty) and dementia (3.8% for dementia vs 6.1% for no dementia). Frail patients were less likely than non-frail patients to receive disease-modifying treatments, such as angiotensin-converting enzyme inhibitors (32.4% vs 38.9%), angiotensin receptor blockers (14.5% vs 17.5%), aldosterone antagonists (20.8% vs 23.4%), and beta-blockers (65.1% vs 68.3%), but more likely to receive symptomatic treatment with loop diuretics (56.4% vs 48.0%).
Recruitment, Enrollment, and Retention: Creative Techniques to Overcome Obstacles
Authors: Sefcik Justine , Petrovsky Darina
Published: December 2021

The process of recruiting, enrolling, and retaining older adults in research studies has been challenging, even prior to the COVID-19 pandemic. This symposium presents research conducted and lessons learned on recruiting, enrolling, and retaining older adults, including those with cognitive impairment. Insights are provided on what techniques are most beneficial for improving rates of research participation, spanning time prior to and during the pandemic. The first presentation reports on qualitative perspectives of persons living with dementia and their caregivers as to what helped them decide to enroll into a clinical trial together. The second presentation speaks to how variations in incentive payment allocations played a role in consent decisions of patients with amnestic mild cognitive impairment and their study partners. The third presentation discusses the effectiveness of an adapted framework and strategies to increase the recruitment and retention of older Latinos with Alzheimer’s Disease and Related Dementias (ADRD) into a clinical trial. The fourth presentation shares techniques for recruiting older adults for a survey study during the pandemic. The fifth presentation defines challenges during a longitudinal study when the pandemic and other natural disasters occurred and strategies for success. Taken together, these presentations will inform researchers on techniques that could be used to improve recruitment, enrollment, and retention of older adults in clinical research.
Variations in Payment Allocation to Persons Living With Cognitive Impairment and Study Partners
Authors: McPhillips Miranda , Li Junxin , Sefcik Justine , Petrovsky Darina , Brewster Glenna , Hodgson Nancy , Gooneratne Nalaka
Published: December 2021

There is a paucity of research focused on monetary incentives for recruiting dyads (participants with cognitive impairment and study partners) into research. Our objective was to evaluate if two different variations in allocating compensation among dyads changed consent rates in one clinical trial, Memories2. This trial is evaluating cognitive and functional outcomes of obstructive sleep apnea treatment in patients with amnestic mild cognitive impairment (aMCI). Prior to phone screening, participants were randomly assigned to one of two groups (1) $200 to participant with aMCI or (2) $100 to participant with aMCI and $100 to study partner at consent visit. Allocating all the payment to the participant with aMCI yielded a 2.6% consent rate, while splitting the payment yielded at 1.7% consent rate. We will also discuss how demographic factors affected consent decision by group. This study provides insight into novel strategies that may enhance enrollment of dyads into clinical trials.
Adult Children’s Education and Older Mothers’ Health: Are Offspring’s Problems Mediators or Moderators?
Authors: Frase Robert , Bauldry Shawn , Suitor J Jill , Gilligan Megan
Published: December 2021

Despite the growing body of literature documenting positive effects of adult children’s education on older mothers’ health outcomes there is limited research exploring the mechanisms that underlie and influence this relationship. This lack of knowledge limits our understanding of how or under what conditions older mothers benefit from their offspring’s resources. In this paper, we draw from theories of the life course, cumulative inequality, and the social foreground to explore how adult children’s problems (physical and emotional, personal and financial, and deviant behaviors) mediate and moderate the effect of adult children’s education on older mothers’ self-rated health and depressive symptoms. To address this question we use data collected from 420 mothers aged 75-85 reporting on their 1,514 adult children, as part of the Within Family Differences Study. Theoretically, this project adds to existing scholarship on intergenerational support in later-life families by identifying the conditions under which adult children’s resources improve parents’ well-being. Preliminary findings reveal that less educated adult children experience more problems, which in turn, negatively impact mothers’ health. Additionally, when adult children experience problems in their own lives, mothers receive less care and financial support from their offspring, even from those who are well-educated and would otherwise have been expected to have shared resources. The findings will have implications for practice by increasing health care providers’ awareness that older parents may be at risk for unmet needs for care even when adult children have resources that would have been expected to serve as a safety net.
Early Trauma and Later Health: Examining the Mediation of Social Relationships in Adulthood in HRS
Authors: Liu Yin , Chopik William , Leggett Amanda , Kong Jooyoung , Polenick Courtney
Published: December 2021

Early trauma is associated with compromised health and well-being in later life, but whether social functioning mediates the association is unclear. Participants in the Health and Retirement Study (n = 15,946) had baseline surveys in years 2006 and 2008 (T1), and were followed up twice (T2-3) every 4 years. Health outcomes included depressive symptoms, chronic health conditions, and subjective memory complaints. Social relationships were measured by contacts, relationship strains, and feelings of loneliness. Early trauma was measured by parental physical abuse and alcohol and drug problems in the family before the age of 16. Social contacts decreased over time, while relationship strains and loneliness increased especially for older adults with early trauma, which in turn mediated the associations between early trauma and poorer health in later life. The findings suggested that maintaining positive social relationships are beneficial for better health in late life, especially for individuals with early trauma exposures.
Daily Social Interactions as a Route to Purposeful Days in Older Adulthood
Authors: Pfund Gabrielle , Allemand Mathias , Hofer Matthias
Published: December 2021

Sense of purpose predicts slower cognitive decline, reduced risk for health issues, and greater longevity (Pfund & Lewis, 2020). However, work is limited regarding how we can help older adults maintain purposefulness in daily life. The current study explored positive daily social interactions as a route to daily purposefulness in older adults, using a measurement burst design. Older adults completed surveys for five-day bursts spread six months apart (Mean age = 70.75, SD = 7.23; n = 104). Multilevel models demonstrated that on days when individuals reported more positive social interactions, they reported feeling more purposeful (b = 0.39, 95% CI [0.28, 0.51]) when accounting for health, employment, and relationship status. Employment status moderated this association, as daily social interactions were more strongly associated with daily purpose for unemployed/retired individuals (b = -0.23, 95% CI [-0.38, -0.08]). Positive social interactions thus may help older adults maintain purposefulness, particularly after retirement.
The Wisconsin Longitudinal Study: Overview, Data Linkages, and Future Plans
Authors: Engelman Michal
Published: December 2021

The WLS is a study of Wisconsin high school class of 1957 graduates, with follow-ups in 1964, 1975, 1993, 2004, 2011, and 2020. The data reflect the life course of the graduates (and their siblings), initially covering education, switching to family, career, and social participation in midlife, and physical and mental health, cognitive status, caregiving, and social support as respondents age. The WLS is linked to multiple administrative data sources including: parent earnings from state tax records (1957-60) and Social Security earnings and benefits for respondents; 1940 Census data; characteristics of high schools and colleges, employers, industries, and communities of residence; voting records from 2000-2018; Medicare claims; and the National Death Index. Efforts are underway to expand the racial/ethnic and educational composition of the WLS by supplementing the original sample with a new cohort of age-matched adults drawn from Wisconsin’s Black, Hispanic, Asian-American, and Native American communities.
How to Access and Use Data From the Wisconsin Longitudinal Study
Authors: Roan Carol
Published: December 2021

With over 27,000 analysis variables covering more than 60 years of participants’ lives, the WLS data can be overwhelming to new users who are looking for the measures they need to answer their research questions. Core WLS survey data is free and easy to download from our website. As we add new types of measures and new waves of data, we refine our data sharing methods to balance our need to make the data easily available with the need to protect the confidentiality of participants. This presentation will teach users how to access to the data files they need for their research and how to use our online documentation of survey instruments and data files. Symposium attendees will also receive a USB drive with the publicly available data and complete documentation.
A Toolkit for Advancing Age Inclusivity in Higher Education
Authors: Montepare Joann , Farah Kimberly
Published: December 2021

The pioneering Age-Friendly University (AFU) initiative, endorsed by GSA’s Academy for Gerontology in Higher Education (AGHE), calls for institutions of higher education to respond to shifting demographics and the needs of our aging populations through more age-friendly programs, practices, and partnerships. Over 70 institutions have joined the AFU global network and adopted the 10 AFU guiding principles. In support of the initiative, a GSA-AGHE-AFU workgroup was organized to develop strategies to help GSA members and their campuses explore how they can be more age-inclusive and create pathways to joining the AFU network. One outcome of the workgroup’s efforts was the creation “Tools for Advancing Age Inclusivity in Higher Education”, designed with support from AARP. In this symposium, workgroup members describe this suite of tools which can be used by faculty, students, administrators, and other campus leaders. Montepare will introduce the symposium with an overview of the AFU network and the workgroup’s goals. Morrow-Howell and Schumacher will discuss tools for “Making the Case” with examples from efforts on their campuses. Porter and Bergman will describe tools for “Getting Started” and how campuses can begin to mobilize age-friendly efforts. Andreoletti and June will share tools for “Gaining Momentum” with tips for creating age-friendly campus connections and collaborations. Silverstein and Gugliucci will describe tools for “Assessing and Tracking Success” that can be used at any stage of the process for exploring a campus’s age-friendliness. Information about joining the AFU network will be provided.
Gaining Momentum Around Advancing Age Inclusivity
Authors: Andreoletti Carrie , June Andrea
Published: December 2021

Have you already experienced some success with age friendly initiatives at your institution but are wondering how you might broaden your reach? Fostering connections across disciplines and units on your campus as well as with organizations in your community is the key to gaining momentum and advancing age inclusivity. This presentation will discuss strategies for connecting and engaging faculty, staff, students, and community members in age friendly programs and practices. We will share examples and tips for supporting others to be more age inclusive in their teaching, research, and community engagement. We will share ideas from the AFU toolkit for creating learning groups, collaborative community events, and intergenerational exchange as well as our own experience which has demonstrated that many smaller efforts over time can go a long way toward building momentum and creating a more age inclusive campus.
Facility Characteristics Associated With Intensity of Care of Nursing Home Residents With Advanced Dementia
Authors: Hendricksen Meghan , Mitchell Susan , Lopez Ruth , Mazor Kathleen , McCarthy Ellen
Published: December 2021

Profound variations in care intensity of nursing home (NH) residents with advanced dementia exist for NHs within and across hospital referral regions (HRRs). Little is known about how these levels of influence relate. Nationwide 2016-2017 Minimum DataSet was used to categorize NHs and HRRs into 4 levels of care intensity based on hospital transfer and tube-feeding rates among residents with advanced dementia: low intensity NH in low intensity HRR; high intensity NH in low intensity HRR; low intensity NH in high intensity HRR; and high intensity NH in high intensity HRR. We used multinomial logistic regression to identify NH characteristics associated with belonging to each of 4-levels of intensity as compared to low intensity NH in low intensity HRRs (reference). We found high intensity NHs in high intensity HRRs were more likely to be in an urbanized area, not have an dementia unit, have an NP/PA on staff, have a higher proportion of residents who were male, age <65, of Black race, and had pressure ulcers, and relatively fewer days on hospice. Whereas in low intensity HRRs, higher proportion of Black residents was the only characteristic associated with being a high intensity NH. These findings suggest potentially modifiable factors within high intensity HRRs that could be targeted to reduce burdensome care, including having a dementia unit, palliative care training for NP/PAs, or increased use of hospice care. This study underscores the critical need to better understand the role race plays in the intensity of care of NH residents with dementia.
Developing Educational Materials to Support Older Adults With Hypertension Management
Authors: Rogers Wendy , Nie Qiong , Harris Maurita , Al-Saleh Stacy , Floresca Ysabel Beatrice
Published: December 2021

A comprehensive approach to hypertension management requires medication adherence as well as more general health behavior changes. Our primary objective is to provide evidence-based and tailored education about hypertension, medications, and health self-management strategies with consideration for different stages of behavior change, health literacy, education, disease knowledge, and experience. To facilitate health behavior change, enable information seeking, and increase engagement, the educational materials provide different layers of information, including tips and information in the MEDSReM app, as well as more detailed educational content on the web portal. We will present examples of the materials in different formats to show how they are tailored to ease comprehension, support adherence, and influence behavior change. These educational materials will have broad utility outside of the MEDSReM system, and will also serve as the education-only comparison condition for the randomized controlled trial.
Usability Evaluation Methods Used to Ensure the Usability of the MEDSReM-2 System
Authors: Hale Timothy , Smith Carson , Trinh Mimi , Rogers Wendy
Published: December 2021

A key objective of the MEDSReM-2 study is to promote medication taking decisions and improve adherence to hypertensive medications for older adults. New functionalities include enhanced decision-support algorithms for missed medications, automated entry of blood pressure measurements, improved data visualizations, and an easy-to-use online web portal. In support of these enhancements, the User Testing subteam is tasked with providing ongoing evaluation and feedback on the usability of early design concepts, prototypes, beta software, wireless blood pressure monitors, and instructional materials. The overall project comprises multiple working teams, whose efforts must be coordinated. We will describe the challenges of working with these interdisciplinary teams and the usability evaluation methods used to support the needs of each team in creating the enhanced MEDSReM-2 system that is easy-to-use and effective in helping older adults improve their hypertension medication adherence. These processes inform the research and design efforts of other technology interventions.
Tailored Music Listening to Improve Sleep in Older Adults With Dementia: A Randomized Clinical Trial
Authors: Petrovsky Darina , Gooneratne Nalaka , Bradt Joke , McPhillips Miranda Varrasse , Etokebe Ime , Gitlin Laura , Hodgson Nancy
Published: December 2021

Sleep disturbances in persons living with dementia (PLWD) contribute to reduced well-being. Music has shown promise to improve sleep among older adults, but there is limited evidence of music interventions improving sleep specifically in PLWD. The purpose of this wait-list RCT was to examine the i) feasibility; ii) acceptability and iii) preliminary efficacy of tailored music listening intervention in community-dwelling PLWD and their caregivers (dyads). Thirty consented dyads out of 33 (91%) completed the RCT. Tailored music for sleep was feasible based on screening (26%), enrollment (89%), and recruitment (3 dyads/month) rates. The intervention was found acceptable, as evidenced by post-intervention interviews. Compared to controls, PLWD in the intervention group reported greater global sleep quality improvement post-intervention (PSQI mean change -0.08 vs -1.65; p=0.06). The results from this feasibility RCT have informed the development of a music mobile application that will be tested in a future clinical trial.
Strengthening Anti-Racist Gerontology Research: Does One Size Fit All?
Authors: Holley Lyn
Published: December 2021

This paper is based on a scoping review and conceptual analysis of research literature about incorporating anti-racism into social science research practices. In his examination of how anti-racist research can effectively borrow key concepts such as “validation and “reliability” from traditional social science research, Dei concludes that these concepts must be reconsidered to addresses the main issues of anti-racism. (2005). A further critique of these concepts is that they do not account for differences among racism as it is applied to different minoritized groups. Public Health Nurses and other practitioners have long recognized the importance of understanding and taking these differences into account in their “culturally competent” practice. (Lipscomb, Culture Care) Although there is some literature about de-centering whiteness in research (e.g., https://libguides.umn.edu/antiracismlens ), little is available to guide research that acknowledges and addresses overlapping yet differing contours of racism as experienced by different “races”, e.g., Black-Americans, Native American Indians”.
Biological Pathways Underlying the Longitudinal Association Between Loneliness and Cognitive Decline
Authors: Yu Kexin , Ng Ted
Published: December 2021

Loneliness has been recognized as a risk factor for cognitive decline (CD) in older adults. However, how loneliness “gets under the skin” to influence CD has been conceptually proposed but rarely empirically examined. The purpose of this study is to investigate whether cardiovascular and kidney biomarkers mediate the longitudinal association between loneliness and CD. We used the cross-lagged panel model (CLPM) to examine the hypothesized relationships with 2006, 2010 and 2014 waves of data from the Health and Retirement Study (HRS). Loneliness is measured with 3-item UCLA loneliness scale. Cognitive health was assessed using the total cognition score. Biomarkers considered including HbA1C, total cholesterol, HDL cholesterol, CRP, and Cystatin C. Among all five biomarkers examined, HbA1c significantly mediated the longitudinal association between loneliness and CD. The other biomarkers examined did not mediate the relationship between loneliness and CD. The study findings show loneliness might affect CD through elevating HbA1C levels.
A Public Health Analysis of the Relationship Between Loneliness, Isolation, and Dementia
Authors: Victor Christina
Published: December 2021

Loneliness and isolation are now characterised as major public health problems largely because of reported associations with negative health outcomes including dementia. We adopt a public health perspective and review the relationship between loneliness/isolation and dementia focussing on how these concepts are defined, measured, and reported. We identified community based longitudinal studies which measured loneliness/isolation at baseline and dementia at follow up (minimum 12 months) published up to February 2021. We identified 12 papers for loneliness and 15 for isolation which demonstrated substantial heterogeneity in how exposure (loneliness/ isolation) and outcome (dementia) were measured and reported. For example, dementia was measured in 5 different ways: death, hospitalisation, clinical diagnosis, dementia screening tools or cognitive function. Evidence to support a relationship between loneliness/isolation and dementia is inconclusive largely because of this methodological heterogeneity. Using consistent exposure and outcome measures is a prerequisite for determining the health consequences of loneliness and isolation.
How Biomarker-Based Diagnosis and Treatment Affect Alzheimer’s Stigma: Results of a Randomized Trial
Authors: Stites Shana , Gill Jeanine , Largent Emily , Harkins Kristin , Krieger Abba , Karlawish Jason
Published: December 2021

Alzheimer’s disease (AD) causes progressive disability and, ultimately, death. Currently no therapy can delay or slow cognitive and functional decline. This prognosis contributes to the general public’s negative reactions—discrimination, pity, and social distance—toward individuals with AD and their families. But what if, using AD biomarker tests, diagnosis was made earlier and treatment was available? Stigma of AD might change. This project aimed to discover how diagnosis and treatment of AD before the onset of cognitive impairment would change public stigma, and how these effects might differ in ethnoracial populations. Comparisons of 12 experimental conditions (i.e., 2 (biomarker test result) x 2 (treatment availability) x 3 (cognitive impairment: none, mild, moderate)) are conducted in two independent samples of self-identified White (N=800) and Black (N=800) Americans. Findings anticipate the translation of the preclinical AD construct into care and will inform public policies and interventions to mitigate public stigma of AD.