bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EFFECT OF SHORT DURATION BED REST AND TYPE 2 DIABETES MELLITUS ON ARTERIAL STRUCTURE AND FUNCTION IN OLDER ADULTS
Authors: Masterova Kseniya , Moro Tatiana , Volpi Elena
Published: December 2022

Type 2 diabetes mellitus (T2DM) and inactivity individually accelerate changes related to vascular aging. These changes increase cardiovascular risk and contribute to morbidity and mortality in the elderly. It is unknown if T2DM and bed rest have an additive, deleterious effect on vascular structure and function in older adults. The objective of this study is to determine the magnitude of the effect of bed rest on vascular structure in older adults with T2DM compared to healthy controls and determine if resistance exercise is protective of this effect. So far, we have recruited T2DM (n=9) and healthy control (n=17) subjects (age: 67.0 ± 6.7 years) to undergo five days of bed rest. During bed rest, subjects were randomized to receive intensive bedside resistance exercise physical therapy or standard of care in-bed passive physical therapy. On bed rest days 1 and 5, popliteal artery diameter, area, blood velocity, and blood flow were measured using Doppler ultrasonography. Our preliminary data show that the T2DM, non-exercise group had significantly greater decreases in popliteal artery diameter (-0.59 mm ± 0.18) than the control, non-exercise group (-0.17 mm ± 0.11). Resistance exercise did not prevent artery size changes in either controls or T2DM. Resistance exercise showed a trend in preventing blood velocity and flow reduction in both T2DM and control groups. These preliminary data suggest that older adults with T2DM had greater structural popliteal artery changes compared to controls. Resistance exercise appears to help maintain blood flow by maintaining/increasing popliteal artery blood velocity, but not size.
UNTREATED OBSTRUCTIVE SLEEP APNEA INCREASES HOSPITALIZATION RISK IN MEDICARE BENEFICIARIES 65+ WITH HEART DISEASE
Authors: Kirk Jennifer , Wickwire Emerson , Somers Virend , Albrecht Jennifer
Published: December 2022

Cardiovascular disease (CVD) is a leading cause of death and disability in the United States and worldwide. Untreated obstructive sleep apnea (OSA) is common among older adults with CVD and may increase their risk of hospitalization. However, prior research has been limited by smaller samples of participants undergoing diagnostic sleep testing. Our objective was to estimate the effect of untreated OSA on the risk of hospitalization among older Medicare beneficiaries with CVD age 65+. Using a 5% sample of Medicare administrative claims data from 2006 to 2013, beneficiaries were identified as cases diagnosed with OSA or controls without any sleep-related diagnoses. Then, we restricted only to beneficiaries with a CVD diagnosis by the index date (i.e., OSA diagnosis date or matched date in controls). Next, we assessed the risk of hospitalization, counting only one per beneficiary, during the year before the index date. Because OSA is typically present long before it is diagnosed, the year before OSA diagnosis was assumed to represent a period of untreated OSA. Covariates were balanced between cases and controls using inverse probability of treatment weighting (IPTW). Then using logistic regression, we estimated the risk of hospitalizations the year prior to the index date. Of the 142,893 beneficiaries with CVD, only 19,390 were diagnosed with OSA. In the IPTW model, beneficiaries with untreated OSA were more likely to be hospitalized (odds ratio, 1.82; 95% CI 1.77–1.87). Results suggest screening for OSA among Medicare beneficiaries with CVD may identify older adults at increased risk of hospitalization.
HEALTHCARE UTILIZATION IN OLDER ADULTS (≥70 YEARS) UNDERGOING CELLULAR THERAPY FOR HEMATOLOGIC MALIGNANCIES
Authors: Snider Christina , Budhwani Hina , Logue Melissa , Goyal Parul , Pugh Kelly , Murff Harvey , Kassim Adetola , Jayani Reena
Published: December 2022

Increasingly, older adults are receiving hematopoietic cell transplant (HCT) and chimeric antigen receptor T-cell therapy (CAR-T), intensive therapies for treatment of hematologic cancers which typically require prolonged hospital admissions. Older adults are at high risk of increased healthcare utilization and complications of prolonged hospitalization [Mudge, J Am Geriatr Soc, 2019]. We identified patients age ≥70 years who received HCT or CAR-T in a primary outpatient transplant program at Vanderbilt University Medical Center between 1/1/19 and 12/31/20. Healthcare utilization, including all visits and admissions, was captured from the start of conditioning chemotherapy through early post-therapy. Thirty-eight patients met inclusion criteria; 26 (68%) received autologous HCT (autoHCT), 7 (18%) allogenic HCT (alloHCT), and 5 (13%) CAR-T. Twenty-four patients (63%) had high HCT-Comorbidity Index (HCT-CI). Eighteen (69%) autoHCT, 6 (86%) alloHCT, and no CAR-T patients had at least one unplanned admission. The median number of total hospital days (LOS) was 7.5 (2-14), 8 (4-62), and 9 (7-9) days, respectively. One-year mortality was 12% (3) in autoHCT, 43% (3) in alloHCT, and 0% in CAR-T. Low performance status and high HCT-CI did not correlate with LOS (p=0.58 and p=0.16, respectively) or number of outpatient visits (p=1, p=0.19). In conclusion, most patients who received auto- or alloHCT in a planned primary outpatient setting experienced at least one unplanned admission. LOS duration varied widely with shorter LOS among autoHCT patients. Further research is needed to identify factors among older adults (≥70 years) at risk of increased healthcare utilization during HCT or CAR-T.
OLDER DYADS USING A WEARABLE PERSONAL SLEEP MONITORING DEVICE FOR SLEEP SELF-MANAGEMENT
Authors: Jacelon Cynthia , Torrisan Maral , Fiske Sarah
Published: December 2022

Normally occurring changes in sleep patterns can affect behavior, safety, and function in older individuals. In addition, altered sleep of one partner can affect the functioning of the other. We tested a novel intervention using an off the shelf, wrist-worn actigraph as a personal sleep monitoring device (PSMD) with dyads comprised of individuals who were 70 years old or older, and slept in the same house. Aims included: 1) Establish the feasibility of sleep self-monitoring using PSMDs, as a self-management strategy. 2) Establish the feasibility of PSMD data sharing among members of the dyad to improve sleep self-management and improve sleep quality; and 3) Evaluate the usability of PSMDs and data sharing for dyads of older individuals. Over the course of a five-week trial, we used a mixed methods approach. Data were comprised of daily sleep diaries, data from the PSMD, weekly questionnaires regarding sleep patterns and function, and qualitative interviews focused on sleep, self-management within the dyad, and the usability of the PSMD. Data were analyzed using qualitative or statistical methods. The use of the PSMD increased awareness of sleep patterns at the individual and dyadic levels, but the limitations of the PSMD were frustrating. Participants valued having a graphic image of how their daily activities affected their sleep patterns. The dyadic approach was effective in improving sleep patterns for older individuals, and using over the counter activity monitoring devices provide a relatively inexpensive way to assist older adults to improve their sleep self-management.
CHANGES IN PATTERNS OF FORMAL AND INFORMAL HELP AND UNMET NEEDS AMONG KOREAN OLDER ADULTS
Authors: Lee Seoyeon , Cha Seung-Eun , Kim Kyungmin
Published: December 2022

Despite the consistent expansion of social long-term care insurance (LTCI), informal care by family members is still dominant in Korea. This study aims to examine how older adults in need utilized formal and informal sources of help and how patterns of help and unmet needs changed over time, since LTCI has been introduced in 2008. Community-dwelling older adults (65+) from the Korean Longitudinal Study of Ageing (N = 2,501) reported their I/ADL limitations and who helped them—if they are in need in 2010 and 2018. We grouped older adults’ sources of care into (a) no help, (b) informal help only, and (c) any formal help, and examined the patterns by wave and gender. Among older adults with I/ADL limitations, formal help use increased between waves (1% to 12%), suggesting the impact of LTCI expansion. Changes in the patterns of help and unmet need differed by gender. The proportion of older men with no help dramatically decreased (41% to 27%); more men received informal or formal help in 2018. In contrast, the proportion of older women who did not receive any help remained similar (33% to 34%); thus, although more women received formal help, less women relied on informal help in 2018. Within the context of LTCI expansion, older men may mobilize support from their family further, which contributes to lowered unmet needs. However, older women’s unmet need did not decrease, while reduced use of informal help. These findings highlight the importance of considering gendered long-term care resources in Korea.
EFFECTS OF PARENTING STYLE IN CHILDHOOD ON MENTAL HEALTH OUTCOMES OF CAREGIVING IN ADULTHOOD: A QUALITATIVE ANALYSIS
Authors: Baumbach Abby , Hughes M Courtney , Derain Lily , Liu Yujun
Published: December 2022

The life course perspective suggests that caregivers of aging parents bring their histories of relationships with aging parents, such as childhood maltreatment, to the care environment. These histories would then impact the dynamics and consequences of caregiving. However, there is a lack of research on the impact of childhood parental interactions on adult relationships with aging parents, particularly in the context of caregiving. The study aims to understand how relationships with caregivers while growing can impact an individual's role as a caregiver later in life. The qualitative study included 47 adult family caregiver survey respondents who care for their parents, with a mean age of 46.7, ranging from 20 to 79 years old. The respondents were asked to reflect on their recent experience of providing care for their loved ones and how experiences with their caregiver growing up may have influenced their current relationship dynamic. The researchers used Dedoose V.9.0.17 to perform a codebook thematic analysis. Themes from the survey analysis linking childhood to current experience included reciprocating good care, performing obligatory care, and stopping the generational transference of negative care. When focusing on specific parental genders when receiving care in childhood, levels of presence and affection stood out as important aspects of their father’s caregiving. Themes associated with maternal caregiving included good relationships, strained relationships, and nurturing. Knowledge about the impact of childhood experiences can help program designers develop interventions to help lessen caregiver burdens that consider childhood care receiving experiences and the challenges and opportunities they present.
IMPACTS OF CAREGIVING ON WELL-BEING AMONG SPOUSAL CAREGIVERS TO OLDER ADULTS USING COARSENED EXACT MATCHING
Authors: Liu Ruotong , Chi Iris , Wu Shinyi
Published: December 2022

Spousal caregivers to older adults may be at increased risks of negative health outcomes because they are also dealing with their own aging and health issues. Estimating the impacts of caregiving without controlling for caregivers’ own aging and aging-related health decline could exaggerate the negative health consequences of caregiving, whereas focusing on caregivers only could face the risk of selection bias where healthier individuals enter and/or remain in caregiving. In this study, we used coarsened exact matching to compare outcomes in wellbeing between spousal caregivers and spousal non-caregivers. Pooled panel data from Wave 8 to Wave 13 in the Health and Retirement Study was utilized with two consecutive waves of data for each spousal caregiver. The sample included 203,162 person-wave observations from 5,162 unique individuals, among whom 3,577 were spousal caregivers. Variables used for matching were classified into three categories: care obligations, the willingness to provide care, and the ability to provide care. Outcome of interest was depressive symptoms measured by CES-D 8. A total of 2,741 (81.01%) spousal caregivers were matched with 18,043 observations of spousal non-caregivers. Regression analysis indicated that being a spousal caregiver was statistically significantly associated with a 0.27 unit increase in depressive symptoms in the subsequent wave, after controlling for other potentially confounding variables such as caregiver’s race/ethnicity, length of current marriage, etc. Our results highlighted the elevated needs to address mental health among spousal caregivers, and indicated that long-term care program and policy should take into consideration the mental health among spousal caregivers.
MEANING FOCUSED COPING: IMPLICATIONS FOR FAMILY CAREGIVER BURDEN AND POSITIVE ASPECTS OF CARE
Authors: Dieker JoAnna , Qualls Sara
Published: December 2022

The Stress Process Model (Pearlin et al., 1991) posits that different styles of coping influence both positive and negative psychological outcomes in family caregivers. Meaning-focused coping is hypothesized to promote positive psychological experiences, but presently it is unclear how meaning-focused coping is related to caregiver burden. The present study tested the associations among meaning-focused coping, indicators of burden, and positive aspects of care in adult child and spousal caregivers of older adults with dementia. An online sample of caregivers ranging in age from 30-68 (n = 219) completed a measure of meaning-focused coping (COPE-PRG; Carver et al., 1989) and the Caregiver Reaction Scale (CRS; O’Malley & Qualls, 2016) which assessed overload, role captivity, personal growth, and competence. Regression analyses indicated that meaning-focused coping predicted less role captivity and predicted greater personal growth and competence. However, meaning-focused coping did not account for significant variance in perceived overload. The findings extend prior research by demonstrating that meaning-focused coping strategies may faciliate positive aspects of care during chronically stressful experiences such as caregiving. Findings highlight that meaning-focused strategies may be more helpful for coping with role captivity (e.g., feeling unable to participate in work or family roles outside of caregiving) and less helpful for coping with subjective overload (e.g., a sense of overwhelm) in caregivers. Results inform clinical interventions that promote meaning and reduce burden in caregivers.
INFLUENCES ON CUSTODIAL GRANDCHILDREN'S RECEIVING TREATMENT FOR DISTRESS
Authors: Hayslip Bert , Montoro-Rodriguez Julian
Published: December 2022

Little work exists regarding the difficulties facing grandchildren raised by their grandparents, where previous research suggests such children to be especially at risk for psychological difficulties and that they often have limited access to potentially efficacious psychosocial interventions. The present study integrates these two perspectives in examining multiple sociodemographic, family-related, and grandchild-specific factors differentiating custodial grandchildren who were being treated for a variety of emotional and behavioral difficulties (N = 80) and those who were not (N = 157), as reported by the custodial grandparent. A MANOVA (F 23, 176 = 9.74, p < .01, eta2 = .56) indicated that custodial grandchildren who were receiving treatment came from larger grandfamilies, were older, were having a greater variety of grandparent reported psychosocial difficulties, and were experiencing more emotional, behavioral, attentional, and relationship problems. The grandparents of such grandchildren experienced more parental strain, reported less social support, were less resilient, were less satisfied with the grandparent role, and reported poorer health. They also reported being less strongly attached to the grandchild and expressed more negative affect toward him/her. However, they also reported more openness regarding a variety of difficulties that might be addressed by mental health professionals. A subsequent discriminant analysis reflecting a weighted linear combination of the above factors (X2 19 = 132.09, p < .01, Wilks’ Lambda = .498) correctly classified 86.1% of cases based upon treatment status. These findings provide a basis for understanding the determinants of custodial grandchilden’s receiving needed psychosocial interventions crucial to their well-being and adjustment.
WAYFINDING DESIGN IN LONG-TERM-CARE COMMUNITIES: EVALUATION OF COMPLEXITY
Authors: Davis Rebecca , Calkins Margaret
Published: December 2022

Wayfinding, the ability to find one’s way, is a significant problem for many older adults; especially those with cognitive impairment. Long term care communities (LTCC) are often fraught with challenges for wayfinding. Those who cannot find their way are at risk for decreased engagement and loss of independence. A critical need is to assess architectural and design features that promote effective wayfinding in an objective way. This study describes the results of a wayfinding design evaluation of 12 LTCC (4 Assisted living; 2 Independent Living; and 6 mixed residency). We measured space syntax axial integration (SSAI; a measure of the visual connectedness) and a Revised Wayfinding Checklist. The results showed low integration values in all communities, ranging from an R3 of 1.43-2.03, indicating low connectedness (and increased wayfinding complexity). The Checklist score totals ranged from 23 – 34 (M = 27.45) out of a possible total of 17 – 51. Results showed that the buildings were overall complex, all had long corridors (>100 feet), over half used multiple elevators to get to common areas; and over 60% had complex, multi-building layouts. Design wise, visibly accessible restrooms were not present; over half of the LTCC had insufficient lighting; and signage color/contrast and letter size was less than recommended. All sites had few directional signs at decision points. Thus, the review of these LTCC showed that most buildings were very complex, with low connectedness, and had room to improve design features like signage and lighting to support wayfinding ability for the residents.
INVOLVEMENT IN CARE DECISION-MAKING AND ADVERSE OUTCOME ONSET IN COMMUNITY-DWELLING CARE RECIPIENTS IN JAPAN
Authors: Komatsu Ayane , Nakagawa Takeshi , Noguchi Taiji , Saito Tami
Published: December 2022

The involvement of older adults in care decision-making may enhance their daily life motivation and quality of life. Furthermore, it could contribute to their better prognosis in long-term care. We examined the association between decision-making involvement and the onset of adverse outcomes, such as institutionalization and death, among older adults under long-term care. This study used two-year longitudinal survey data of Japanese community-dwelling care recipients aged 65 and above. The participants were followed regarding the onset of institutionalization and deaths. The status of involvement in decision-making was assessed based on one item and the selection among the following response options: “very much involved,” “fairly involved,” “not very involved,” “never involved,” “unclarified wishes,” and “absence of person supporting decision-making.” A multivariable logistic regression analysis estimated the odds ratios (OR) and 95% confidence intervals (CI) for the onset of adverse outcomes, composite of institutionalization and death. A total of 707 participants with no severe cognition disabilities (MMSE>12) and no missing variables at the baseline were included and responded to the follow-up survey. At the baseline, 36.5% reported being very much involved in decision-making. The onset of adverse outcomes was observed in 17.5% of participants (institutionalization, 5.1%; death, 12.4%). Compared to those with very high involvement in decision making, those who were not involved were more likely to have adverse events, even after adjusting for covariates (OR=2.86 [95% CI: 1.21-6.76], p=0.016). Our findings show the importance of decision-making involvement in daily care regarding better prognoses in long-term care.
FAMILY MEMBERS’ COMMUNICATION WITH LONG-TERM CARE PROVIDERS AND ITS INFLUENCE ON RESIDENT WELL-BEING
Authors: Falzarano Francesca , Cimarolli Verena , Siedlecki Karen
Published: December 2022

Considerable research has examined communication dynamics among family members and staff in nursing homes (NHs) and has demonstrated that better communication is associated with more optimal psychosocial outcomes in both family caregivers and formal care providers. However, the literature on how communication dynamics influence resident functioning is limited, and it has yet to be determined how communication impacts residents across other care contexts, such as Assisted Living Facilities (ALFs). Thus, using data from the National Health and Aging Trends Study and the National Study on Caregiving, the purpose of this study was to examine family perceptions of communication with formal care providers (i.e., frequency, availability, and helpfulness of communication) and its influence on resident outcomes in two samples of long-term care residents (n=337 in ALFs, n=112 in NHs) and their family caregivers, and to compare how results differ across care setting. When examining the full sample of long-term care residents, findings showed that better communication was associated with lower depressive symptoms and negative affect. When investigating differences across care settings, we found that those residing in NHs exhibited higher levels of depressive and anxiety symptoms compared to ALF residents. Further, better communication was associated with lower levels of depressive symptoms only among ALF residents. Our findings provide insights into how interpersonal dynamics between family and formal care providers influence resident functioning and underscores the importance of enhanced communication among all members of the primary care team – that is, healthcare providers, residents, and their family members.
BETTER NP PRACTICE ENVIRONMENTS REDUCE HOSPITALIZATION DISPARITIES AMONG DUALLY ENROLLED PATIENTS
Authors: Nikpour Jacqueline , Brom Heather , Mason Aleigha , Chittams Jesse , Poghosyan Lusine , Carthon Margo Brooks
Published: December 2022

Adults dually-enrolled in Medicare and Medicaid experience twice as many hospitalizations and higher rates of ambulatory care-sensitive conditions (ACSCs) – such as coronary artery disease [CAD] and diabetes, compared to Medicare-only patients. Nurse practitioners (NPs) are well-positioned to address care needs of dually-eligible patients, yet NPs often work in unsupportive clinical practice environments. The purpose of this study was to examine the association between the NP primary care practice environment and disparities in all-cause hospitalizations between dually-eligible and Medicare-only patients with ACSCs. Using linked secondary cross-sectional data from the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ) and Medicare claims files, we examined 189,420 patients with CAD and/or diabetes (19.1% dually-eligible, 80.9% Medicare-only), cared for in 470 practices employing NPs across four states (PA, NJ, CA, FL) in 2015. After adjusting for patient and practice characteristics, dually-eligible patients in poor practice environments had the highest odds of being hospitalized compared to their Medicare-only counterparts (OR 1.60, CI: 1.49-1.71). In mixed practice environments, dually-eligible patients had approximately 48% higher odds of a hospitalization (OR 1.48, CI 1.31-1.68), while in the best practice environments, dually-eligible patients had approximately 37% higher odds (OR 1.37, CI 1.21-1.57, p < .001). As policymakers look to improve outcomes and reduce costs among dually-eligible patients, addressing a modifiable aspect of care delivery in NPs’ clinical practice environment is a key opportunity to reduce hospitalization disparities. Yet further efforts are needed to address remaining disparities by meeting patients’ health-related social needs, such as poverty and access to care.
AGE-RELATED DIFFERENCES IN HEALTH-RELATED QUALITY OF LIFE AMONG WESTERN CANADIAN NURSING HOME RESIDENTS
Authors: Shieu Bianca , Schwartz Todd , Hoben Matthias , Toles Mark , Beeber Anna , Anderson Ruth
Published: December 2022

Nursing homes (NHs) typically focus on health-related quality of life (HRQoL) among residents aged 65 and over despite approximately 7% of NH residents are younger (aged 18-64). Research suggests that the needs of younger NH residents are not being met and they may have low HRQoL. However, differences in HRQoL of younger and older NH residents may not be apparent in studies that use HRQoL measures designed for research with older NH residents. We hypothesized that the younger residents would have lower HRQoL mean scores than the older (aged ≥ 65) residents using a HRQoL measure based on the HRQoL score derived from Resident Assessment Instrument – Minimum Data Set 2.0 items. The measure uses items that emphasize physical aspects of quality of life rather than social aspects. In a sample of 21,129 residents from 94 NHs in Western Canada, we performed descriptive analyses, t-test, chi-square test, and an adjusted propensity score (PS) analysis through retrospective cohort study from years 2016 to 2017. The HRQoL index score ranged from -.351 to .996 (Mean= 0.693, SD=0.265). In the PS model, the adjusted mean score for younger was higher than for older adults with a mean difference at 0.061 (95% CI 0.031, 0.091) (p<.001). Other domains such as mental health condition of quality of life must be examined in younger NH residents because it is a crucial factor influencing their daily lives, thereby we can explore a more complete set of HRQoL domains of them and redesign care for their unique needs.
CHRONIC DISEASE AND LIFE EXPECTANCY DISPARITIES OF OLDER ADULTS IN SINGAPORE
Authors: Guo Xueying , Wee Hwee lin , Chen Cynthia
Published: December 2022

Singapore is one of the countries with longest life expectancy, also one of the most rapidly ageing societies in the world. This study investigates the future demographic transitions in Singapore, focusing on the life expectancy disparities of the older adults. We developed a dynamic Markov microsimulation model based on the Singapore Multi-Ethnic Cohort study. The model was adapted to project future trends of chronic diseases, mental illnesses as well as hospitalisation costs of Singapore older people from 2020 to 2050. The prevalences of diabetes, heart disease, hypertension, stroke, disability, dementia and depression of people aged 51 and above was projected to be increasing. Overall projected life expectancy at age 51 for male is 27.8 years, and for female is 34.5 years. Moreover, for older people with secondary or upper education, the overall projected life expectancy at age 51 is 34.1 years, active life expectancy at age 51 is 28.6 years. For older people with primary or lower education, the overall life expectancy at age 51 is projected to be 27.9 years, and active life expectancy projected to be 23.9 years. Our study has significant social and economic implications for policymakers in the way that it demonstrates disparate trends in aging and costs among different education groups in Singapore.
HOME-BASED EXERCISE PROGRAM WITH MEAL DELIVERY INCREASES DAILY STEP COUNT IN HOMEBOUND OLDER ADULTS
Authors: Kaur Harmanpreet , Lee Jessica
Published: December 2022

The United Nations projects adults aged 60 and older will reach 2.1 billion by 2050. With this trend, there will be an increase in older adults who are homebound, leading to more frailty with increased healthcare utilization and institutionalization. Improvements in frailty and homebound status may occur through increased physical activity, which has been shown in multiple randomized controlled trials to improve frailty. Our study aims to evaluate the effects of a home-based exercise program, administered through Meals on Wheels, on gait speed and frailty status in sixty-four homebound adults age 60 and older. All participants receive meal delivery for 12 weeks and half are randomized to receive an exercise kit with weekly exercise handouts. All participants are asked to wear an activity tracker with an additional longitudinal measure at 6 months. We now have 6 participants who have completed the study. Preliminary analysis was conducted on step count between the exercise and non-exercise group using two-sample t-tests. Average daily step count in the exercise group (n=3) was 2656 compared to 813 in the non-exercise group (n=3), p< 0.00001 during the first 12 weeks. The step count in the exercise group did decrease during the weeks after the intervention stopped, however they remained more active than the non-exercise group, 1112 vs 548, p< 0.0001. No adverse events were noted. As we continue to enroll participants, we are encouraged that the home-based exercise program with meal delivery appears to be a safe and effective way to increase physical activity in homebound older adults.
HEALTHY AGING TALK AROUNDS: NEAR AND FAR
Authors: Mullins Lindsay
Published: December 2022

BackgroundLoneliness and chronic health conditions are the two most cited ailments among older adults (OAs) that deter independent living. Community-tailored health programs increase feelings of connectivity to neighbors and link OAs to healthcare resources. MethodsDesign. The Healthy Aging Talk Around program is product of CAB formation, input, and a series of talks in-person (near) and virtually (far). Using qualitative methods, data was collected to determine significant health issues for OAs and qualitative data were collected through surveys to evaluate knowledge, access, and feelings of connectivity related to series gatherings. Setting and Population. Inner-city and rural OAs in the deep south from various communities (2 FBOs, 1 Assisted Living, 2 neighborhood groups). Series was held in community and later online. Attendance ranged between 75-130 OAs. Measures. Qualitative measures included pre and post series surveys (n=110; n = 91) with questions to determine the impact of the series. Analysis. Content analysis was conducted with the qualitative data to determine the impact of the series on 1.) knowledge of health issue(s), 2.) likelihood of accessing health resources, and 3.) feelings of connectivity and isolation. ResultsThe qualitative data analysis suggested the series as relatable because information was tailored linked to local community resources. Discussion of independent living challenges fostered connectivity with neighbors. Once virtual, knowledge and access were similar, feelings of connectivity were less prevalent. ConclusionA community-tailored health program series can increase knowledge of health issues, access to resources, and create neighborly connectivity potentially influencing ability to age in place.
PERSPECTIVES OF UNDER-RESOURCED PATIENTS ABOUT THE MEDICARE ANNUAL WELLNESS VISIT
Authors: Ferrone Christine , Goldman Roberta , Wilkinson Joanne , Borkan Jeffrey , Clark Phillip
Published: December 2022

The Medicare Annual Wellness Visit (AWV) involves a personalized risk assessment and prevention plan to help prevent disease and disability among older adults. Though studies have shown that AWV uptake is suboptimal, little is known about the perspectives and experiences of patients completing it. Family medicine physicians are conducting AWVs at a Rhode Island pilot teaching clinic participating in the GWEP's Age-Friendly Health Systems Initiative. To evaluate perspectives of the clinic's under-resourced patients, 20 qualitative telephone interviews were conducted following their AWV. Interview recordings were analyzed for content and themes. Few patients recognized the term ‘Annual Wellness Visit’ or recognized it was significantly different from other visits: “I noticed it was a bit different, but not that different. I’m usually not covered for a visit like that by Medicare.” Mental health, mobility and medications were discussed at most of the AWVs. Some patients noticed that a physician did the medication review instead of the nurse. Patients had varying experiences of how advance directives were discussed, and some thought it unnecessary since a family member knows their preferences. A few patients were dissatisfied that their physician did not focus on their chronic or acute health problems. However, most patients “trusted” their physicians to do “whatever is necessary” for them, and were glad to have had the AWV because “instead of talking about being sick all the time, talking about how to stay well”. Recommendations for patient education to improve understanding and the experience of the AWV will be offered.
HEALTH PROFILES OF OLDER NURSING HOME RESIDENTS BY SUICIDAL IDEATION: A LATENT CLASS ANALYSIS
Authors: Yuan Yiyang , Barooah Adrita , Mack Deborah , Lapane Kate , Ulbricht Christine
Published: December 2022

In US nursing homes, 2% of residents have documentation of suicidal ideation (SI). Whether older residents’ health profiles differ by SI is unknown. Using the 9th Patient Health Questionnaire-9 (PHQ-9) item on Minimum Data Set 3.0, we identified 15,277 older residents with and 562,184 without SI. Latent class analysis using frailty, cognitive impairment, palliative care index, pain, and remaining PHQ-9 items as indicators identified health profiles by at-admission SI and estimated the association between profiles and SI at 90 days. In residents with at-admission SI, four profiles emerged: (1) frail, intact/moderate cognitive impairment, all depressive symptoms (prevalence: 22.8%); (2) frail, moderate/severe pain, depressed mood, sleep problems, fatigue (32.2%); (3) frail, severe cognitive impairment, depressed mood, fatigue, feelings of worthlessness (22.9%); (4) pre-frail, moderate/severe cognitive impairment, depressed mood (22.0%). Compared to the residents in profile 4, those in profile 1 [adjusted OR (aOR): 1.24; 95% Confidence Interval (CI):1.11-1.37] and those in profile 2 [aOR: 1.11; 95% CI: 1.01-1.22] were more likely to continue reporting SI at 90 days. In residents without at-admission SI, three profiles emerged: (1) frail, depressed mood, fatigue (33.9%); (2) frail, severe cognitive impairment (38.1%); (3) prefrail/frail (28.0%). Residents in profile 1 were more [aOR: 2.80; 95% CI: 2.60-3.00] while those in profile 2 were less [aOR: 0.79; 95% CI: 0.71-0.86] likely profile 1 residents to report SI at 90 days. Findings indicate substantial heterogeneity in the health profiles between and within older residents with and without self-reported SI.
“I EAT TO NOT DIE”: DIET AND EXERCISE EXPERIENCES OF OLDER ADULTS LIVING ALONE
Authors: Choi MoonKi , Bae Juyeon
Published: December 2022

Living alone is a critical health risk factor among older adults. Regular exercise and a balanced diet are important for maintaining an independent and healthy life. However, it can be more difficult for older adults living alone to maintain healthy exercise and dietary habits due to the lack of social support. This was a qualitative descriptive study to explore the life changes that accompany living alone, focusing on exercise and diet and the need to improve the nutrition and physical activity of older adults living alone. Thematic analyses were applied to analyze the qualitative data collected from semistructured in-depth interviews. Fifteen subjects, including 5 men and 10 women, participated in the interviews. The mean age was 77.73 ± 7.37 years, and the mean duration of living alone was 17.73 ± 12.89 years. Six main themes were developed: unavoidable difficulties of living alone (lack of someone to depend on and loneliness), just eating “to not die”, exercise that is good for health but hard to do alone, conflict between maintaining independence and dependence on others, coping with available resources, and resources needed for regular exercise and a balanced diet. Living alone led to poor dietary habits, such as skipping meals or insufficient food intake. Food security should be ensured through the reinforcement of social support, financial assistance, and the operation of public cafeterias. In addition, a tailored group exercise program that can meet the need for social interaction and improve self-efficacy would help older adults living alone maintain regular exercise habits.
CURRENT PRACTICE PATTERNS IN HOME HEALTH OCCUPATIONAL THERAPY
Authors: Liu Chiung-ju , Burch Hannah , Glover Sabrina , Donofrio Abigail , Oliveros Gianna , Demeo Gianna
Published: December 2022

Occupational therapy practitioners are essential members of the home health rehabilitation team to support patients transitioning from acute care to home. However, home health occupational therapy services have been underutilized, in part, due to limited understanding of services that the profession provides. Improving this understanding is necessary to help patients receive timely services. The purpose of the study was to describe the current practice patterns in home health occupational therapy. Fifty home health occupational therapy practitioners from 27 states completed an electronic survey between May and June 2021. The survey consisted of questions about assessment and treatment, communication with physical therapy colleagues, and the impact of the Patient-Driven Grouping Model and the coronavirus disease 2019 pandemic on service delivery. Results showed that occupational therapy assessments focused on personal care activities, mobility and balance, and cognition. The treatment content usually included training in activities of daily living, functional mobility, the application of compensatory strategies (e.g., home adaptations), and fall prevention strategies. Most respondents communicated with their physical therapy colleagues at least once a week on topics related to scheduling, changes in a patient’s condition, and falls and safety concerns. Seventy percent of respondents experienced a reduction of home visits during the recent Medicare payment reform and the pandemic. These practitioners felt that some patients might be discharged prematurely because of this reduction. The survey results highlight the pertinence of occupational therapy services to support patients’ independence and safety at home and the need to increase these services for home health patients.
FREQUENT USERS OF EMERGENCY MEDICAL SERVICES IN A METROPOLITAN CITY: INDIVIDUAL- AND SYSTEM-LEVEL CONSIDERATIONS
Authors: Martinez Beatrice , Aranda Maria , Aguilar Iris , Sanko Stephen , Vega William
Published: December 2022

Frequent 911 calls from older adults place a significant burden on emergency response systems. Drawing from key informant interviews, we explore factors implicated in repeated Emergency Medical Services (EMS) among older people in the City of Los Angeles and provide system and policy recommendations to mitigate overuse of EMS 911 calls. Los Angeles Fire Department (LAFD) dispatch call records documented 370,016 EMS encounters from 202,471 unique individuals over 50 from 2012 to 2016. Frequent 911 callers over the age of 50 (n=8), family members (n=6), Los Angeles Fire Department (LAFD) personnel (n=10), and community service providers (n=3) participated in in-depth, qualitative interviews to understand individual- and system-level factors that increase the likelihood of repeated calls. All interviews were audio recorded, transcribed, and analyzed thematically. Guided by Grounded Theory, two themes emerged across all interviewee groups pointing to factors that contributed to 911 calls: 1) The Nature of 911 Calls; 2) Barriers to Access. Patients and family members were aligned on a third theme: 3) Previous Encounters: Interactions with emergency care providers, while LAFD and service providers were in agreement on a fourth theme: 4) The Role of EMS Responders and Community Providers. All groups provided recommendations for the theme, 5) Change the System so that 911 calls do not serve as the default choice. Findings demonstrate the need to improve coordination between LAFD, medical and human service providers. Care coordination can support individual- and system-level supports for patients and families to address their needs and reduce repeated EMS use.
SKELETAL MUSCLE HEALTH AND LOWER URINARY TRACT SYMPTOMS IN OLDER ADULTS
Authors: Cawthon Peggy , Bauer Scott , Parker-Autry Candace , Lu Kaiwei , Cummings Steven , Hepple Russell T , Scherzer Rebecca , Covinsky Kenneth
Published: December 2022

Lower urinary tract symptoms (LUTS) are associated with increased risk of mobility limitations among older adults. Our objective was to evaluate the association of muscle (D3Cr muscle mass, MRI total thigh muscle volume, Keiser extensor power, grip strength) and physical performance (400m walk, SPPB) measures with LUTS severity and bother among adults age >70 years in the Study of Muscle, Mobility and Aging (SOMMA). We used data from the first 132 women and 103 men to complete their baseline visit where LUTS were assessed using the LURN Symptom Index-10 (SI-10) plus a global urinary bother question. We calculated Spearman correlation coefficients and chi-square tests as appropriate, stratified by sex. Among women, LURN SI-10 scores were inversely correlated with D3Cr muscle mass/body weight (ρ=-0.217, P=0.01), peak leg power/body weight (ρ=-0.179,P=0.04), and SPPB (ρ=-0.173,P=0.047), but not 400m walk, MRI thigh muscle volume, or grip strength (P>0.1 for all). 46% of women in the lowest tertile of % muscle mass versus 38% in the highest tertile reported they were at least “somewhat bothered” by urinary symptoms (P=0.04). Among men, no muscle or physical performance measures were significantly associated with LURN SI-10 or urinary bother (P>0.2 for all). In conclusion, older women with greater muscle mass, leg power, and SPPB scores had reduced LUTS severity whereas LURN SI-10 was not significantly correlated with muscle and physical performance measures in older men. Older women with higher D3Cr muscle mass were also less bothered by urinary symptoms, supporting muscle health as a novel female LUTS mechanism.
ASSOCIATIONS BETWEEN POSTURAL SWAY AND GAIT DOMAINS DURING WALKING WHILE TALKING
Authors: Jayakody Oshadi , Blumen Helena , Ayers Emmeline , Wang Cuiling , Verghese Joe
Published: December 2022

Poor gait performance during walking-while-talking (WWT) is associated with an increased falls risk. Whether this association between WWT and falls is moderated by balance is not known. To address this, we examined 1) cross-sectional associations between postural sway and gait domains during WWT and, 2) whether postural sway moderated the effects of gait domains on falls. Gait (using a computerized walkway) and postural sway in anteroposterior (AP) and mediolateral (ML) directions (using the SwayStar™ system) during WWT were assessed in 357 community-dwelling older adults (M Age 77.9 years; 55.5% female). Principal component analysis was used to derive distinct gait domains: pace (speed, step length), rhythm (swing, stance, step time) and variability (step length variability, double support time variability). Falls incidence over 12 months were ascertained using bi-monthly calls. Multiple linear regression (adjusted for age, sex, and education) was used to examine the associations between postural sway and gait domains. Poisson regression was used to examine the associations of number of falls with gait domains and postural sway. Greater AP- and ML-sway were associated with slower pace, greater rhythm, and greater variability (p< 0.005). Slower pace (not rhythm or variability) was associated with falls incidence (n=95) and the effect of pace on falls (although p>0.005) was reduced by the ML-sway (β for interaction between pace and sway -0.001 95%CI -0.002, 0.0001). These findings suggest that greater sway during WWT is associated with poorer gait performance. Interventions to maintain ML-sway during WWT may assist with reducing the effects of pace on falls risk.
EFFECTS OF RESISTANCE EXERCISE ON MOBILITY AND LIFE SATISFACTION AMONG OLDER CHINESE AMERICANS
Authors: Chen Mei-Lan , Gardenhire Douglas , Wu Ying-Jung , Lee Mi-Jung
Published: December 2022

Physical activity interventions have shown to be potentially effective for preventing mobility impairment and improving life satisfaction in older adults. However, few studies investigated the effect of resistance exercise training on mobility and life satisfaction in older Chinese Americans. The purpose of this study was to test the effect of a 12-week resistance exercise intervention (two times weekly) on mobility (balance, gait speed, and chair stand performance) and life satisfaction in a sample of community-dwelling older Chinese Americans aged 60-89 years (N = 30; mean age 77.9 ± 5.0 years). The study was a two-group randomized controlled trial (RCT). All participants were randomly assigned into either the resistance exercise group or the wait-list control group (15 participants in each group). Participants’ balance, gait speed, chair stand performance, and life satisfaction were assessed at baseline and 12 weeks. Descriptive statistics and t tests were used for data analysis. The results indicated that older adults participated in the resistance exercise program had significant improvements in balance, gait speed, chair stand performance, and life satisfaction at the end of the trial. Compared to the control group, the resistance exercise group had significantly greater improvements in balance, gait speed, chair stand performance, and life satisfaction at 12 weeks follow-up. The findings suggest that resistance exercise has beneficial effects in improving mobility and life satisfaction for older adults. This resistance exercise program provides a basis for developing larger RCTs for further determining the efficacy of resistance exercise among older Chinese Americans.
DAILY EXERCISE DOES NOT ALTER CEREBRAL BLOOD FLOW REGULATION DURING TILT IN OLDER ADULTS AFTER TWO WEEKS OF BEDREST
Authors: Robertson Andrew , Hedge Eric , Mastrandrea Carmelo , Unger Federico Granados , Hughson Richard
Published: December 2022

Bedrest is associated with cardiovascular and cerebrovascular changes that are linked to a greater prevalence of orthostatic intolerance; however, much of what we know from bedrest trials comes from young adults. How older adults respond to extended periods of activity restriction is not well understood. The current work tested the hypothesis that impaired control of cerebral blood flow in older adults following bedrest could be attenuated by regular exercise. Twenty-two older adults (55-65 years, 11 women) participated in a randomized controlled trial involving 14 days of continuous 6-degree head-down bedrest. The cohort was randomized to an exercise intervention (EX), involving daily aerobic, high-intensity interval, and resistance training, or a control group (CON), involving passive manual therapy. Cerebral blood flow velocity, cardiac output, and arterial blood pressure were measured continuously during a passive 80-degree head-up tilt protocol for up to 15 minutes. Responses in the cerebral and peripheral vascular beds were quantified by vascular resistance (cerebral: resistance area product (RAP); peripheral: total peripheral resistance (TPR)). Following bedrest, both supine RAP and TPR were elevated (p< 0.01), with no effect of exercise training. In addition, the number of participants who could not complete 15 minutes of tilt increased from 3 to 15 (8 EX, 7 CON). In these non-finishers, RAP dropped ~20% and TPR dropped ~15% during the final 2 minutes of tilt, with no difference between groups. These data suggest that multimodal exercise training is insufficient to prevent changes in cardiovascular and cerebrovascular regulation in older adults observed during 14-day bedrest.