bluuebunny/crossref_metadata_2025 huggingface dataset:
ADAMO INDOOR MOBILITY, PHYSICAL FRAILTY, AND AUTONOMY IN OLDER ADULTS: A MEDIATION MODEL
Authors: Rainoldi Alberto , Donini Lorenzo M , Brustio Paolo R , Mulasso Anna , Poggiogalle Eleonora , Zia Gianluca , Feletti Luca C , Signore Susanna Del
Published: November 2019

Physical frailty represents a clinical condition among older adults leading to adverse health outcomes, such as autonomy loss. To evaluate physical frailty in older adults, adopting information and communication technologies (ICT) may be useful. ADAMO (Caretek S.r.l.) is a care-watch accelerometer that allows to measure mobility in a non-intrusive way (Magistro et al., 2018) providing wider information on individual general health (Mulasso et al., in press). The aim of this study was to evaluate the relationship between indoor mobility, physical frailty and autonomy in a sample of Italian older adults. Methods: Thirty-two volunteers (age 65–84 years; women 56.2%) participated in the study. All wore ADAMO care-watch continuously over a 7-day period. The number of steps indoor was the main endpoint. Fragmented daily mobility was estimated. Physical frailty and autonomy were measured using the Tilburg Frailty Indicator (physical components) and the Groningen Activity Restriction Scale, respectively. Results: Significant inverse correlations were observed between number of steps and autonomy, and number of steps and physical frailty. Conversely, a significant direct correlation was observed between physical frailty and autonomy. Additionally, mediation analysis demonstrated full mediation effect of physical frailty between the number of steps and autonomy. Our results imply that high indoor mobility per se can reduce physical frailty and consequently helps to maintain autonomy. Conclusions: Indoor mobility captured by ADAMO accelerometer may be an important indicator of physical frailty and autonomy. ADAMO may be used as a non-intrusive telemonitoring solution to capture relevant information on individual general health in aged people.
A RANDOMIZED CONTROLLED TRIAL OF METFORMIN FOR FRAILTY PREVENTION: STUDY DESIGN AND BASELINE CHARACTERISTICS
Authors: Espinoza Sara E , Musi Nicolas , Wang Chen-pin , Michalek Joel
Published: November 2019

Inflammation and insulin resistance are major predictors of frailty. Here we describe the study design of an ongoing double-blind, randomized controlled trial of metformin for frailty prevention. Subjects are adults aged 65+ years with pre-diabetes assessed by 2-hour oral glucose tolerance test (OGTT). Those who are frail (Fried criteria) are excluded. Participants are randomized to metformin (maximum dose of 2,000 mg/day) vs. placebo and followed for 2 years. The primary outcome is frailty (category and score); secondary outcomes are physical performance and function (short physical performance battery, 6-minute walk, lower extremity strength), systemic and skeletal muscle tissue inflammation, muscle insulin signaling, insulin sensitivity (insulin clamp), glucose tolerance (OGTT), and body composition (dual-energy x-ray absorptiometry). Safety assessments occur every 3 months; frailty, systemic inflammation, and OGTT are assessed at baseline and every 6 months, and insulin clamp with muscle biopsies are assessed at baseline and every 12 months. To date, 51 subjects have been randomized; 120 completers are planned. Mean age is 73.4 ±5.7 years, 43% are female, and 39% Hispanic. Mean BMI is 30.5 ±5.5 kg/m2, waist circumference is 105 ±13.1 cm, fasting glucose is 102.3 ±8.8 mg/dL, Hemoglobin A1c is 5.8 ±0.3, and glucose at 2 hours during OGTT is 168.5 ±20.4 mg/dL. Metformin is being examined in this study as a potential therapeutic agent to prevent frailty in older adults with pre-diabetes. Findings from this trial may have future implications for the screening and potential treatment of pre-diabetes in older patients with metformin for the prevention of frailty.
DOES GENDER INFLUENCE RISK FOR ORTHOSTATIC HYPOTENSION IN OLDER ADULTS WITH SARCOPENIA?
Authors: Benton Melissa J , Silva-Smith Amy L , Spicher Jefferson M
Published: November 2019

Older adults with sarcopenia may be at risk for unstable postural blood pressure due to diminished lean mass that plays a role in maintaining fluid volume. Males have greater lean mass, so risk may be mediated by gender. We compared postural blood pressure changes in older men (77.1 ± 2.0 years; n = 15) and women (79.6 ± 2.0 years; n = 13) with sarcopenia before and after an overnight fast. Sarcopenia was defined using the Lean Mass Index (males ≤ 19.0 kg/m2; females ≤ 15.0 kg/m2). Body composition was measured using multi-frequency bioelectrical impedance, and blood pressure was measured lying, sitting, and standing. On Day 1 (normally hydrated) there were significant drops in systolic blood pressure, with an overall decrease of -9.1 ± 2.2 mmHg (p < 0.001) between lying and standing. On Day 2 (overnight fast), postural changes were more profound, with an overall decrease of -14.1 ± 2.8 mmHg (p < 0.001). However, when compared by gender, postural changes between lying and standing remained significant but did not differ between men and women (Day 1: men -8.9 ± 2.5 vs. women -9.3 ± 2.5 mmHg; Day 2: men -14.6 ± 4.6 vs. women -13.6 ± 3.1 mmHg). On both days diastolic blood pressure remained stable. In this group of older adults, significant decreases in postural systolic blood pressure were observed in the early morning fasted condition, increasing the risk for orthostatic hypotension (drop in systolic blood pressure -20.0 mmHg). Interestingly, gender did not influence risk.
WHEN STRANGERS BECOME FAMILY: THE ROLE OF CIVIL SOCIETY IN ADDRESSING THE NEEDS OF AGING POPULATION
Authors: Angel Ronald J
Published: November 2019

Mexico’s rapidly aging population presents serious short and long-term challenges to the state and to families, since relatively few individuals have formal retirement plans. Although health care access is formally universal, and non-contributory retirement income is provided to all elderly in need, the Mexican old-age welfare remains limited. In this study we assess the potential role of civil society organizations (CSOs), a category that includes secular non-governmental organizations (NGOs), faith-based organizations (FBOs), in advocacy for and service provision to elders in need. Social and demographic changes, including the migration of children away from their parent’s community, the need for women to work, smaller families, and more are undermining the capacity of the family to provide all of the care and support that frail aging parents need. Given the fact that the federal, state, and municipal governments are limited in what they can provide, the role of CSOs is potentially significant.
IMPACT OF HIGH BODY MASS INDEX ON FRAILTY AND MORTALITY IN MIDDLE-AGED AND OLDER ADULTS
Authors: Jayanama Kulapong , Theou Olga , Godin Judith , Cahill Leah , Rockwood Kenneth
Published: November 2019

Obesity is associated with higher risk of metabolic diseases. How body mass index (BMI) relates to mortality across frailty levels is controversial. We investigated the association of high BMI with frailty, and their effects on mortality. We included 36,583 participants aged ≥50 years from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) cohorts (7,372) and 29,211 participants aged ≥50 years from wave 1 (2004) of Survey of Health Ageing and Retirement in Europe (SHARE). BMI was categorized as: normal: 18.5-24.9 kg/m2, overweight: 25-29.9, obese I: 30-34.9 and obese II+III: >35. A frailty index (FI) was constructed excluding nutrition-related items using 36 items for NHANES and 68 items for SHARE. Mortality data were obtained until 2015. All analyses were adjusted for educational, marital, working and smoking status. In participant aged 50-65 years, higher BMI was associated with greater frailty. Being obese level II+III increased mortality risk in male participants aged 50-65 years with FI≤0.1 [NHANES (hazard ratio (HR) 2.10, 95%CI 1.17-3.79); SHARE (2.35,1.14-4.87)]. In males aged >65 years with FI>0.3, being overweight and obese (any level) decreased mortality risk. In females aged 50-65 years, higher BMI was not associated with mortality across all frailty levels. BMI and frailty were cross-sectionally associated. The subsequent mortality impact differed by age, sex, and frailty. Obesity was not associated with mortality in middle-aged females, regardless of the degree of frailty. In males, obesity was harmful in those who were fit in middle age and protective in moderately/severely frail older ones.
EFFECT OF CHAIR YOGA ON FRAILTY IN OLDER ADULTS WITH LOWER EXTREMITY OSTEOARTHRITIS: RANDOMIZED CLINICAL TRIAL
Authors: Park Juyoung , Liu Zuyun , Vieira Edgar R , Liehr Patricia
Published: November 2019

This study examined whether chair yoga (CY) could reduce severity of frailty in community-dwelling older adults with lower extremity osteoarthritis (OA). Participants were randomly assigned to CY or health education program (HEP) at each of two sites and attended twice-weekly 45-minute sessions for 8 weeks. Data were collected at baseline and 4 and 8 weeks. For primary analysis, followed by Rockwood’s suggesiton, 97 deficits/variables measuring OA symptoms, physical function, balance, fatigue, depression, social activities, and life satisfaction were used to construct a frailty index, ranging from 0 to 1. Fewer deficits/variables were used to construct three alternative versions of the index. Linear mixed-effects models with random intercept were used to analyze longitudinal repeated outcome measures. A total of 112 participants (n = 63 CY, n = 49 HEP; 75.3[7.5] years; 76% female, 46% Hispanic) completed the study. After adjusting for site, cohort effect, and baseline of frailty, there was no significantly greater decline in frailty in the CY group compared to the HEP group (between-group difference, -0.019; 95% CI, -0.063 to 0.025) or the trend of changes in the index (p for interaction = .489). Additional adjustment for baseline characteristics (age, gender, ethnicity, marital status, living alone, health status, pain medication) did not change results substantially. Secondary analysis of three alternative versions of the index indicated similar nonsignificant changes. Thus, an 8-week CY intervention did not reduce severity of frailty in older adults with lower extremity OA. A longer duration of CY with a larger sample size is needed.
THE ASSOCIATION BETWEEN LOWER EXTREMITY FUNCTION, FRAILTY, AND LOW-MILEAGE DRIVER STATUS AMONG OLDER ADULTS
Authors: Crowe Christopher L , Andrews Howard , Molnar Lisa J , Eby David W , DiGuiseppi Carolyn , Strogatz David , Li Guohua , Mielenz Thelma J
Published: November 2019

The crash rate per mile driven among older adults is higher than that of most age groups and comparable to that of the youngest, most inexperienced drivers. The low-mileage bias posits that the elevated rate among older adults results from an increased rate among those who accrue the fewest annual miles. This study evaluated whether low physical capacity among older drivers, measured by the National Health and Aging Trends Study (NHATS) Expanded Short Physical Performance Battery (SPPB) and Fried’s frailty phenotype, increases the risk of being low-mileage drivers. Data were collected for 2,990 older drivers via questionnaires and assessments in addition to 61,528 person-months of driving data. Multivariable log-binomial regression was used to estimate risk ratios. Those with fair and good function had 0.53 (95% CI: 0.40-0.69) and 0.60 (0.47-0.78) times the risk of driving fewer than 3,000 miles/year and 0.45 (0.26-0.77) and 0.48 (0.32-0.72) times the risk of driving fewer than 1,865 miles/year, respectively, compared to those with poor function. For an increase from not frail to pre-frail and from pre-frail to frail, the risk of driving fewer than 3,000 or 1,865 miles/year increased 1.36 (1.11-1.65) or 2.38 (1.63-3.46) times, respectively. Having low physical capacity is associated with an increased risk of low annual mileage. Given the known association between low-mileage driver status and increased crash rates and the modifiable nature of the risk factors examined in this study, interventions aimed at improving physical capabilities may lead to an improvement in safety among older drivers.
THE ELECTRONIC FRAILTY INDEX BASED ON THE COMPREHENSIVE GERIATRIC ASSESSMENT: DEVELOPMENT AND TESTING
Authors: Chinda Betty , Sepehri Katayoun , Zou Macy , Braley Mckenzie , Garm Antonina , Park Grace , Rockwood Kenneth , Song Xiaowei
Published: November 2019

Frailty is characterized by loss of biological reserves across multiple systems and associated with increased risks of adverse outcomes. A Frailty Index (FI) constructed using items from the Comprehensive Geriatric Assessment (CGA) has been validated in geriatric medicine settings to estimate the level of frailty. Traditionally, the CGA used a paper form and the CGA-based FI calculation was a manual process. Here, we reported building of an electronic version of the assessment on personal computers (PC), i.e., standalone eFI-CGA, to benefit frailty assessment at points of care. The eFI-CGA was implemented as a software tool on the WinForms platform. It automated the FI calculation by counting deficits accumulation across multiple domains assessing medical conditions, cognition, balance, and dependency of activities of daily living. Debugging, testing, and optimization were performed to enhance the software performance with respect to automation accuracy (processing algorithm), friendly user interface (user manual and feedback), and data quality control (missing data and value constraints). Systematically-designed simulation dataset and anonymous real-world cases were both applied. The optimized assessment tool resulted in fast and convenient conductance of the CGA, and a 100% accuracy rate of the eFI-CGA automation for up to four decimals. The stand-alone eFI-CGA implementation has provided a PC-based software tool for use by geriatricians and primary and acute care providers, benefiting early detection and management of frailty at points of care for older adults.
MIDLIFE FACTORS, GENDER, AND MIGRATION ARE KEY PREDICTORS OF COGNITIVE HEALTH IN LATE LIFE
Authors: Rote Sunshine , Angel Jaqueline L
Published: November 2019

Older Latinos are at 1.5 times greater risk for Alzheimer’s disease and other dementias than non-Latino Whites (Wu et al., 2018) and there is evidence of high levels of cognitive impairment, dementia, and dementia-related neuropsychiatric symptoms among older Mexican Americans in particular (Rote et al., 2015). We use data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE, 1993/94- 2010/11, N=2,665), a national study of Mexican American 65 years and older residing in the southwestern U.S. Older adults who were in the paid labor force, except for those who worked in the agricultural sector, exhibit lower risk for cognitive impairment. The results hold for both women and men. For family size, number of children is associated with greater risk for cognitive impairment and this is especially evident among women and immigrant men. Midlife factors, gender, and migration are key predictors of cognitive health in late life.
A GENETIC ALGORITHM-BASED APPROACH TO OPTIMIZE THE CONSTRUCTION OF A FRAILTY INDEX
Authors: Zucchelli Alberto , Marengoni Alessandra , Rizzuto Debora , Calderon-Larranaga Amaia , Onder Graziano , Fratiglioni Laura , Vetrano Davide
Published: November 2019

The frailty index (FI) is a reliable prognostic indicator based on an individual clinical and functional deficits, which is strongly associated with poor outcomes. We hypothesize that an optimization algorithm may help to select the best candidate deficits to generate a highly-predictive FI. We aimed to optimize the predictive accuracy (area under the curve; AUC) of a FI employing a “genetic algorithm”, an iterative meta-heuristic that selects and recombines the most accurate FIs among randomly-generated ones. We used data from 3363 individuals aged 60+ enrolled in the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). To avoid overfitting, the algorithm was run on a randomly-chosen subsample (70%) of 10 imputed datasets. About 825,000 FIs were built, evaluated, and recombined. The best genetic algorithm-based FI (ga-FI) was compared in terms of 3- and 6-year mortality prediction with a clinically-generated FI (c-FI) in the remaining 30% of the data. Ga-FI showed better AUCs in comparison to the c-FI, overall and in all age and sex subsamples. Several sensitivity analyses were carried out. The major AUC improvement was seen among participants aged <75 [3-year mortality AUC: 0.83 vs 0.63; p<0.001]; 6-year mortality AUC: 0.76 vs 0.63; p<0.001], while smaller differences were seen among participants aged ≥75 [3-year mortality AUC: 0.86 vs 0.84; p=0.216; 6-year mortality AUC: 0.84 vs 0.81, p=0.017]. The genetic algorithm is a feasible method to optimize the construction of a highly performant FI that might be used to assess health comprehensively both in clinical and research settings.
OPTIMAL STAFFING MODELS TO CARE FOR FRAIL ELDERLY ADULTS IN PRIMARY CARE AND GERIATRIC PRACTICES
Authors: Auerbach David I , Michael Carie , Levy Douglas , Maramaldi Peter , Dittus Robert , Spetz Joann , Buerhaus Peter , Donelan Karen
Published: November 2019

As the US population ages, primary care is expected to be the health care “home” for older adults, and several initiatives are aimed at helping to transform primary care practice to care for this population. Wide variation in staffing has been observed. Meyers et al proposed ideal models of primary care staffing for a general population and for a frail elderly population (2018). We developed the 2018 Survey of Primary Care and Geriatric Clinicians to measure optimal team configuration in clinical practices caring for older adults. A majority employed NPs, MDs and PAs, with [r = -.53] between % of clinician labor of NPs and physicians). High-NP practices are more likely located in states with full scope of practice, perform well for frail elders and are less expensive. Meyers' models, with fewer physicians, more SW and CHWs, more RNs, perform better for frail elders, and are less expensive.
PATTERN OF HEALTH-RELATED BEHAVIORS AND RESOURCES AS PREDICTOR OF MEDICAL CARE AND MORTALITY RISK AMONG OLDER ADULTS
Authors: Zuo Dongmei , Silverstein Merril D
Published: November 2019

This study investigates the patterns and consequences of a wide range of health-related behaviors and resources that include health-compromising behaviors, health-promoting behaviors, preventive health behaviors, and health risks coping resources. We aim to identify the empirically-derived subgroups of individuals with unique profiles of health behaviors and resources to determine how subgroup membership predicts health outcomes and medical care utilization four years later. Data derived from 5,067 respondents in the 2010 and 2014 waves of the Health and Retirement Study. Latent class analysis was used to define classes based on 13 indicators in the 2010 wave, which also provided sociodemographic and health-related covariates. Outcomes were measured over 4 years. Six latent subgroups were identified: “Best Behavior/Resources”, “Low Social Support “, “Low Physical Activity”, “High Substance Abuse”, “Low Preventive Tests”, and “Low Governmental Health Insurance”. Compared with the “Best” group, older adults identified as “Low Physical Activity” and “High Substance Abuse” were found to have higher mortality risks and a lower likelihood of seeing doctors and less nursing home nights; older adults with the lowest level of receiving flu shots, cholesterol and cancer screen test (“Low Preventive Tests”) reported a less likelihood of seeing doctors; respondents in “Low Governmental Health Insurance” subgroup were associated with a lower likelihood of hospital stay and more nursing home nights. Results suggest that distinct groups of older individuals characterized by their health behaviors and resources provide a basis for identifying the high-risk segment of the older population for intervention.
SOCIODEMOGRAPHIC DISADVANTAGE, LIVING WITH A SMOKER, AND OBESITY IN MIDDLE-AGED AND OLDER WOMEN
Authors: Holahan Carole K , Holahan Charles J , Lim Sangdon , Chen Yen T , Powers Daniel A
Published: November 2019

Although sociodemographic disadvantage is a recognized risk factor for obesity, the potential role of living with a smoker in this relationship has been unexamined. This study investigated: (a) the association between sociodemographic disadvantage and living with a smoker, and (b) the role of living with a smoker in partially explaining the link between sociodemographic disadvantage and obesity. The study used limited access data from the Women’s Health Initiative Observational Study obtained from NHLBI. Participants were 91,888 women ranging in age from 50 to 79; 6,527 participants reported living with a smoker. Analyses were cross-sectional. Logistic regression analyses examined paths in the proposed model; bias-corrected bootstrapped confidence intervals tested indirect effects. All analyses controlled for age, marital status, and participants’ current smoking status. Results demonstrated a significant association (p < .001) between sociodemographic disadvantage and living with a smoker across three measures of disadvantage (for low education, low income, and Black ethnicity, ORs were 1.95, 2.10, and 2.63, respectively), as well as between living with and smoker and obesity (OR = 1.71). Moreover, the unstandardized indirect effect (CIs are in brackets) from sociodemographic disadvantage to obesity through living with a smoker was statistically significant for all three measures of disadvantage (for low education, low income, and Black ethnicity, indirect effects = .05 [.04, .06], .06 [.05, .06], and .07 [.06, .08], respectively). These findings underscore the need for innovative household-level interventions for disadvantaged families living with a smoker integrating smoking- and obesity-prevention efforts. This project was supported by the NIH/NCI (R03CA215947).
OLDER ADULTS’ HEALTH AND SOCIAL ENGAGEMENT: THE MEDIATING ROLE OF SUBJECTIVE LIFE EXPECTANCY
Authors: Kim Dahee , Lee Kyuho
Published: November 2019

Older adults’ mental and physical health is likely to limit social engagement, but their perception of how much time they have left, according to the socio-emotional selectivity theory, might influence it as well. The aim of the research is to investigate the mediating effect of subjective life expectancy (SLE) on the pathways from older adults’ mental health and functional limitation to volunteering and contacts with close relationships. The current research used data of 5,285 older adults aged 50 to 75 from the Health and Retirement Study collected in 2014. Structural equation modeling was performed to investigate the direct effect of older adults’ depressive symptoms and functional limitation on volunteering and contact with close relationships. Predictors’ indirect effects via SLE was also assessed. The results indicated that older adults’ higher depressive symptoms and functional limitations significantly decreased volunteering time and frequency of contacts with close relationships. Older adults’ SLE attenuated the effects of depressive symptoms and functional limitations on their volunteering time and frequency of contact with close relationships. The findings describe the mechanism of how older adults engage in volunteering and contact with close relationships through their perception of remaining time. Further, this research highlights SLE as a motivator for encouragement of older adults’ social engagement.
FACE-TO-FACE AND FACEBOOK ACROSS THE LIFESPAN: SOCIAL INTERACTIONS BUFFER STRESS ON MOOD, BUT ONLY FOR ADOLESCENTS
Authors: Liu Yin , Fauth Elizabeth B , Maxey Myles , Beckert Troy
Published: November 2019

Social support serves as a protective factor, buffering stress in both adolescents and adults, however Socioemotional Selectivity Theory suggests developmental differences in stress reactivity and social support. It is unclear how modern forms of social contact, such as social media buffer stress, and the extent to which this differs across the lifespan. We utilized ecological momentary data to examine the moderating effects of age and two distinct types of social contacts the person had experienced in prior hours (frequency of face-to-face, or social media contacts) on the association between daily stress and momentary mood. Participants were recruited initially through Amazon.com’s Mechanical Turk (adolescents referred by a parent). A total of 119 adolescent (n = 44; Agemean= 15.73) and middle-aged/older adult participants (n = 75; Agemean= 59.67) provided momentary data three times a day, on three consecutive days, every two weeks, for up to 12 weeks. Multi-level models showed significant 3-way interactions between stress appraisal of avoiding an argument, age group, and frequency of social contact via face-to-face (β = 1.698, se = 0.542, p = .002) and social media (β = 3.341, se = 0.984, p = .001). Older adults experienced better mood than adolescents. When avoiding an argument was appraised as more stressful, both age groups displayed worse mood. Whereas high levels of recent social contact (both face-to-face and social media) seemed to exacerbate the impact of this stressor on poorer mood for older persons, high levels of recent social contact, particularly social media, had stress-buffering benefits for adolescents.
ADVANCING OUR UNDERSTANDING OF ELDERHOOD: A NARRATIVE REVIEW
Authors: Inker Jenny , Gendron Tracey , Brooks Marshall
Published: November 2019

There are relatively few explorations of later life in the peer reviewed gerontological literature that holistically embrace the duality of potential and decline. This is in striking contrast to a growing body of non-scholarly literature, frequently authored by elders, displaying deep interest in the phenomenon of elderhood, i.e. the holistic, lived experience of later life. We conducted a narrative review with the aim of describing the state of the science with regard to the bio-psycho-social-spiritual experience of elderhood. Following a search of multiple databases for English language, peer reviewed articles published from 2000-2017, we identified 24 articles in the disciplines of gerontology, anthropology, psychology, the humanities, and spirituality studies, reflecting elderhood in Eastern and Western cultures. While the articles offered no shared operational definition of elderhood, nor applied any unifying conceptual or theoretical structures, several common themes emerged. These included the description of elderhood as both inward facing (inner development) and outward facing (social contributions of elders). Numerous articles also recognized that ageism socially mediates the experience of elderhood, resulting in a failure of social systems and structures to recognize or provide opportunities for lifelong growth in later years, including a lack of mentors and role models for individuals transitioning into elderhood. This review demonstrates that there is a compelling need for the discipline of gerontology to strengthen our understanding of the phenomenon of elderhood by leading on the development and implementation of theoretically driven empirical research into the subject of the holistic, lived experience of later life.
TRAJECTORIES OF POSITIVE AND NEGATIVE AFFECT: A COORDINATED ANALYSIS OF 11 LONGITUDINAL SAMPLES
Authors: Bastarache Emily D , Graham Eileen K , Estabrook Ryne , Ong Anthony , Piccinin Andrea , Hofer Scott , Spiro III Avron , Mroczek Daniel K
Published: November 2019

This study assessed age-graded change in positive and negative affect over decades of the lifespan. We conducted a coordinated integrative data analysis (IDA) using data from 11 longitudinal samples, comprising a total of 74076 respondents, spanning the ages of 11 to 106. Positive and negative affect were measured using the CES-D in 8 studies, the PANAS in 3 studies, and the MIDI scale in the MIDUS with three to eleven measurement occasions across studies. To assess and compare the extent and nature of change in affect over time across studies, analyses were coordinated, deploying identical multi-level growth models on each dataset. The curvilinear models suggested PA was best characterized by an inverted U-shaped trajectory, peaking in the mid-to-late 50s, while change in NA was best described by a U-shaped curve, bottoming out in the late 60s. We also found measure-related differences in the proportion of variance in affect attributable to within- or between person differences; The majority of the variability in CES-D-assessed affect was attributable to within-person differences over time, while the variability in PANAS-assessed affect was predominantly attributable to between-person differences. Overall, the results did not support steady improvement of emotional experience over the entire life-course as previous studies have suggested, but show promise for midlife when PA peaks and NA bottoms out. This study demonstrates the value of coordinated conceptual replications, resolving some of the mixed findings in the literature regarding age-graded change in affect and enhancing the current understanding of the longitudinal affect phenomenon.
SOCIAL CHARACTERISTICS OF THE FOURTH AGE
Authors: Pothen John , Dore Emily C , Idler Ellen
Published: November 2019

How can we differentiate distinct phases of aging in later life? Theorizations of the third and fourth age posit that later life often involves a time of continued growth and increased opportunity (the “third age”) as well as a time marked by growing cognitive, physical, and social losses (the “fourth age”). In contrast to population-based definitions that place this transition around the age of 80, a person-based definition using frailty as a marker offers more sensitivity by focusing on ability and agency instead of age alone. In this study, we apply both definitions in order to examine the social characteristics of the fourth age. Using a nationally representative sample of adults over the age of 65 from from the National Health and Aging Trends Study (NHATS) seventh round (n=6,312) we find that the population-based definition overestimates the number of adults in the fourth age (2,834 vs 569; p<0.001). Additionally, social network patterns observed when comparing adults above and below the age of 80 - increased rates of including a daughter or son and a decreased rate of including a friend - are not seen when comparing adults who do and do not meet criteria for frailty. Our findings suggest that common understandings of the social characteristics of the oldest old - understandings with important implications for policy and the promotion of human dignity - may be biased by focusing on age alone as a marker of change instead of ability and agency.
IDENTIFYING THE TRAJECTORIES OF MULTIMORBIDITY AND THEIR CORRELATES AMONG KOREAN OLDER ADULTS
Authors: Lee Sun Ah , Jun Hey Jung , Joo Susanna , Chai Hye Won
Published: November 2019

Multimorbidity, the co-existence of two or more chronic diseases, has become prevalent among the older population. This study focused on identifying different patterns of multimorbidity trajectories across older adulthood and examining their predictors. We used six waves of the Korean Longitudinal Study of Aging (KLoSA), a nationally representative longitudinal data collected every two years from 2006 to 2016. The sample was older adults aged 65 years and older in 2006 (N=1,668). Multimorbidity was measured as the self-reported number of medically-diagnosed chronic diseases, and Growth Mixture Modeling was used to examine multimorbidity trajectories. Identified patterns of multimorbidity trajectories were then used as outcome variables in multinomial logistic regression models. Independent variables were socio-demographic, psychological, health-related behavioral and interpersonal factors at baseline. At Wave1, 76% of the sample had no or one chronic disease and 24% had two or more. At Wave6, 49% had none or one and 51% had two or more. Results identified four patterns of multimorbidity trajectory: “maintaining-low” (59.1%; reference), “maintaining-high” (7.3%), “moderately increasing”(26.4%), and “rapidly increasing” (7.2%). In terms of the correlates of these patterns, female older adults and respondents with higher depressive symptoms were more likely to be in the “maintaining-high” group. In addition, respondents who had less frequent meetings with friends, neighbors or relatives were more likely to be in the “rapidly increasing” group. The findings suggest that there are distinct patterns of multimorbidity trajectories across older adulthood, and interventions focusing on depressive symptoms or social engagement may be useful in preventing the increase in multimorbidity.
KNOWLEDGE MANAGEMENT AND THE ADOPTION OF CULTURE CHANGE INITIATIVES BY HIGH-MEDICAID-CENSUS NURSING HOMES
Authors: Hearld Larry , Ghiasi Akbar , Szychowski Jeffery , Weech-Maldonado Robert
Published: November 2019

Culture change represents an organizational transformational process to become person-centered, through staff and resident empowerment. Culture change initiatives have been associated with fewer health-related deficiency citations and better psychosocial outcomes. Knowledge management, defined as the process of creating or locating knowledge, and managing the dissemination of knowledge within and between organizations, has been shown to be associated with the adoption of innovations such as culture change initiatives. This study examines the relationship between knowledge management activities of high Medicaid census (70% or higher) nursing homes (NHs) and the adoption of culture change initiatives. This study used facility survey data from approximately 324 nursing home administrators (30% response rate) from 2017- 2018, merged with data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. Binary logistic regression models revealed that the probability of adopting a culture change initiative was 0.12 higher for facilities reporting a one-unit higher level of knowledge management activities. Additional interaction analysis revealed that knowledge management activities were associated with a greater likelihood of adopting a culture change initiative for NHs where the director had been in his/her position fewer years. Similarly, higher levels of overall knowledge management activities were significantly associated with greater adoption of culture change initiatives at intermediate levels of nurse retention. Results suggest that knowledge management activities may help high Medicaid NHs acquire and mobilize informational resources in ways that can support the adoption of patient-centered initiatives. These activities may be particularly effective in nursing homes with leadership and nursing staff instability.
ORGANIZATION OF WORK AND DECISION-MAKING OF PROFESSIONALS WORKING IN NURSING HOMES IN CATALONIA (SPAIN)
Authors: Gea-Sánchez Montserrat , Alconada-Romero Alvaro , Pastells-Peiró Roland , Bellon Filip , Teres-Vidal Lourdes , Blanco-Blanco Joan , McGilton and Katherine
Published: November 2019

The long term care environment demands specific requirements of the staff, namely that they provide a holistic approach to care. Providing holistic care leads to complex decision-making processes which go beyond just finding a solution to a specific health problem. It requires that staff are able to respond to the diverse needs expressed by the residents and which, in many cases, are only identified through the relationship that professionals have with them. However, this relationship that staff establishes with the resident often leads to burden for these professionals. The researchers sought to identify characteristics of the nursing homes that lead to positive outcomes for staff. The study involves collecting questionnaires (n=132) and conducting semi structured interviews (n=35) in 9 Catalan nursing homes with number of staff, utilizing a quantitative questionnaire and semi-structured interviews. Practices in organisations that led to positive outcomes for staff included coordinated care that includes processes of support for staff, effective communication and decision making practices, clear responsibilities for staff, and utilization of care plans. Effective long term care practices can favour both patient care and professional practice in residences for elderly.
A CASE STUDY: THE INVISIBLE LABOR OF CULTURALLY SENSITIVE CARE
Authors: Thao Mai See , Akosionu Odichinma C , Davila Heather , Shippee Tetyana P
Published: November 2019

Nursing homes are increasingly becoming more racially/ethnically diverse yet racial disparities in resident’s quality of life and quality of care continue to persist. One reason for these disparities is lack of culturally-sensitive care and racial/ethnic similarity between residents and staff. This study examines a case of a high proportion minority nursing home with racially/ethnically diverse staff to understand how shared culture among direct care staff and residents may influence care delivery. We used three months of participant observation, supplemented by in-depth qualitative interviews with 8 Hmong residents and 5 Hmong staff to explore the labor of culturally sensitive care in a large, urban NH. We discovered four themes: 1) Culturally sensitive care was often equated to fulfilling language needs for residents who didn’t speak English. 2) Hmong staff members had to take the initiative to inform non-Hmong staff members how to care for Hmong residents. 3) Hmong staff members also had to communicate the culture of NH care and its limitations to Hmong residents and their families. 4) Hmong staff members have to advocate for the culturally relevant needs of Hmong residents. The findings of this case study illuminate that having staff members from diverse cultural backgrounds and meeting language needs of residents does not reflect the everyday practices of culturally sensitive care. This type of emotional labor can also result in higher levels of burn-out for staff of color. Additional research into what constitutes culturally sensitive care to NH residents and staff is needed.
LACK OF POLICIES, TRAINING, AND SPECIAL CARE UNITS FOR OBESITY CARE IN PENNSYLVANIA NURSING HOMES
Authors: Harris John A , Castle Nicholas
Published: November 2019

It is unclear how nursing homes in the U.S. prepare for the specific needs of residents with obesity at a population level in terms of equipment availability, policies, staff training, and special care units. Using a mail survey of Directors of Nursing (DON) to 420 Pennsylvania Nursing Homes in 2017 and 2018, we examined the reported presence of obesity-specific equipment availability, organizational policies, staff training, and special care units. We compared the presence of these adaptation approaches by whether the DON strongly agreed that obesity was a problem for resident and staff safety using χ2 tests. One hundred fifty-one surveys were returned and included in the analysis (response rate of 36%). 80.7% of respondents were, on average, very concerned when asked about 11 resident medical, functional, relational, and staff-related safety outcomes (e.g., pressure ulcers, hospital readmissions, social isolation, and staff injury). DONs reported reduced equipment availability in nursing homes for obesity-specific beds (66%), walkers (34%), bedside commodes (30%), and gowns (28%). The presence of obesity-specific organizational policies (44%), staff training (26%), and special care units (7%) was limited. DON strong agreement with obesity-related resident and staff safety issues was significantly associated with obesity-specific bed availability (p=0.04) but was not significantly associated with obesity-specific organizational policies (p=0.17), staff training (p=0.51), and special care units (p=0.09). Despite a high concern for resident and staff safety related to obesity care expressed by DONs, there is little appropriate nursing home organizational response as measured by policies, staff training or special care units.
POLICY SERIES: POLICY UPDATE: OLDER ADULT NUTRITION AND MALNUTRITION
Authors: Whitmire Meredith , Blancato Robert
Published: November 2019

This symposium will provide an update on older adult nutrition policy, including background on the issues of older adult malnutrition and food insecurity. The federal policy update will include discussion of the Older Americans Act nutrition programs and their reauthorization progress, older adult programs under the US Department of Agriculture, and advances in nutrition services being made in healthcare programs such as Medicare Advantage and managed long-term care services and supports. It will also discuss funding for federal older adult nutrition programs and their sustainability moving forward.
DEMENTIA CARE FOR RESIDENTS IN ASSISTED LIVING: PERSPECTIVES OF STAFF RESPONDING TO BEHAVIORAL EXPRESSIONS
Authors: Dobbs Debra J , Zimmerman Sheryl , Beeber Anna , Carder Paula , Miller Stephanie , Hodgkinson Jennifer , Thorp Julia
Published: November 2019

Background: An estimated 42% of persons who live in assisted living (AL) have dementia. The majority of these individuals express behaviors (such as agitation, aggression, and wandering) that indicate a mismatch between their ability to cope and demands in the social and physical environment. In some cases, AL staff are able to successfully address those behaviors and in other cases they are not. This study explores behavioral expressions of persons with dementia residing in AL, strategies used to address those behaviors, and residents’ behavioral results, as reported by 251 AL healthcare supervisors across seven states. We also examine what differentiates situations deemed successful from situations that were not successful. Methods: Qualitative interviews conducted with healthcare supervisors revealed cases of successful and unsuccessful strategies for addressing severe/disruptive behavioral expressions of persons with dementia residing in AL. During initial analysis, a data-driven conceptual model was developed to identify common structural domains within and across responses, which ranged from recognizing antecedents to final discharge from the AL community. Additionally, content analysis was applied to identify themes. Results: A minority (<5%) of reports indicated that staff recognized antecedents to behaviors, or noted including residents’ families in addressing behaviors. The majority of both successful and unsuccessful cases referenced the use of medications to address behaviors, and a notable proportion (10%) referenced professional psychiatric assessment. Discussion: Findings suggest the benefit of helping staff identify antecedents of behavioral expressions, and the important role of psychiatric assessment for AL residents who experience agitation, aggression, and similar behaviors.
OLDER ADULT MALNUTRITION: A GROWING CRISIS
Authors: Whitmire Meredith
Published: November 2019

Malnutrition, a caloric or nutrient imbalance, is particularly common in the older adult population, and food insecurity is a rising concern. This paper will discuss the incidence of malnutrition and food insecurity in the older adult population. It will also discuss federal and state programs in place that work to prevent and combat malnutrition. It will provide strategies for aging network members to engage in these policy discussions.
FEDERAL NUTRITION POLICIES AND PROGRAMS
Authors: Blancato Robert
Published: November 2019

This paper will discuss the Older Americans Act nutrition programs and their reauthorization progress, older adult programs under the US Department of Agriculture, and advances in nutrition services being made in healthcare programs such as Medicare Advantage and managed long-term care services and supports. It will also discuss funding for federal older adult nutrition programs and their sustainability moving forward.
THE EFFECT OF COGNITIVE TESTING ON STATE ANXIETY AND CORTISOL REACTIVITY IN YOUNGER AND OLDER ADULTS
Authors: Hughes MacKenzie L , Pearman Ann , Neupert Shevaun D
Published: November 2019

Although it is well established that stress is negatively associated with cognitive functioning, less is known about age differences in the effects of stressors and anxiety on state anxiety and physiological reactivity (i.e., changes in cortisol). The current study examined state anxiety and cortisol reactivity during a series of cognitive tasks in a sample of younger (n=26) and older (n=29) adults. Participants completed the State-Trait Anxiety Inventory prior to cognitive testing and provided six salivary cortisol samples throughout one testing session: two cortisol samples prior to cognitive testing, three samples during testing, and one sample after testing. Six cognitive tasks were administered that measured attention span, declarative memory, and processing speed. Results indicated a significant interaction effect of age by time with younger adults’ cortisol linearly decreasing during the testing session and older adults’ cortisol showing a quadratic trend. A second interaction was found between age and state anxiety whereby older adults who reported more anxiety had higher cortisol levels during the cognitive testing session than both the older adults who reported low levels of anxiety and the younger adults. Only age (not cortisol or anxiety) was significantly related to cognitive performance. Results from this study suggest that standard cognitive testing could be anxiety producing for older adults, particularly for those who are already anxious. Future investigations should examine age-related differences in the processes linking anxiety and cortisol to specific types of performance, such as memory and attention.
THE OPIOID EPIDEMIC IN LONG-TERM CARE: A STAFF PERSPECTIVE
Authors: Hemmert Rachael , Dull Gabriella E , Edelman Linda S
Published: November 2019

Opioid-based analgesic therapy is a common treatment for moderate to severe pain among long term care (LTC) residents. It has been estimated that 60% of LTC residents have an opioid prescription. Of these, 14% use opioids as part of a long term pain management strategy. LTC residents are particularly vulnerable to opioid misuse, exhibiting higher rates of adverse drug events. However, addressing pain, polypharmacological needs and resident well-being in the LTC setting is challenging. More research and education regarding opioid use in LTC is needed. The Utah Geriatric Education Consortium conducted interprofessional focus groups with LTC partners to 1) determine educational needs of staff regarding opioid use, and 2) gather qualitative data about the pain management experiences of staff when working with residents and families. Staff identified the following training needs: pain manifestation and assessment; certified nurse assistant education on opioid use; non-pharmacological options for pain management. Review of staff’s perception of the intersection of opioids, family and staff in a LTC setting revealed that 1) family is concerned about opioid use; 2) conversely, staff may not see opioid use as a problem; and 3) non-pharmacological options for pain management are often costly and unavailable to those in LTC. Identifying educational needs of LTC staff will help guide the development of educational materials and provide baseline data for future assessments of the impact of opioid education on long-term care patient outcomes.