bluuebunny/crossref_metadata_2025 huggingface dataset:
Loneliness and Cognitive Functioning Over Time: Using Ambulatory Cognitive Assessment
Authors: Kang Jee-eun , Harrington Karra , Sliwinski Martin
Published: December 2020

Loneliness has been investigated as a risk factor for cognitive health, but results were inconsistent. This study used three measurement bursts of ambulatory cognitive assessment to determine whether loneliness affects longitudinal changes in cognitive functioning in daily life. At each burst, participants performed cognitive assessment five times a day for 14 days. 138 adults (Mage=49.4) who completed all three bursts were included in this study.

Growth curve modeling showed that, on average, scores of cognitive functioning were improved across a 2 year period (p<.001). The chronic lonely group (in the highest tertile at all 3 bursts) showed less improvement in scores compared to non-lonely people (p<.01), although there was no difference in cognitive functioning at the baseline between two groups. This study indicates that we need a repeated measurement of cognitive functioning and longitudinal approach to detect the effect of chronic loneliness on the rate of cognitive change. Part of a symposium sponsored by the Measurement, Statistics, and Research Design Interest Group.
Building National Capacity for Dementia Caregiving Research: The NIA Edward R. Roybal Centers
Authors: Davidson Karina , Onken Lisa
Published: December 2020

More than 5.8 million Americans are currently living with Alzheimer’s disease and related dementias, and they are cared for by over 16 million people at an estimated annual cost of $290 billion. The need for innovative, evidence-based interventions to support these patients and caregivers is critical to addressing this problem. The goal of the NIA Edward R. Roybal Centers for Translational Research in the Behavioral and Social Sciences of Aging is to translate and integrate basic behavioral and social research findings into interventions aimed at innovatively improving both the lives of older people and the capacity of institutions to adapt to societal aging. The Roybal Centers will develop research within the conceptual framework of the multidirectional and translational NIH Stage Model to produce these implementable, principle-driven behavioral interventions. The program has now funded new Centers, and each has a unique focus. Areas of concentration include promoting caregiving mastery (Emory University), integrating the use of technology in care support to improve assessments and interventions in care provision (Oregon Health & Science University), developing behavioral interventions to reduce isolation and promote social connectedness in caregivers (University of Rochester), promoting health in racial/ethnic minorities (University of Illinois at Chicago), and using insights from data science and behavioral economics to improve palliative care delivery and long-term support facilities for persons with dementia and their caregivers (University of Pennsylvania). Center leaders will present an overview of their cutting-edge, early-stage research projects and discuss implications for improving care of caregivers and patients.
Forgotten Variables and Incarcerated Males
Authors: Randall George , Bishop Alex
Published: December 2020

Religiosity tends to mitigate mental health challenges for incarcerated males. Further, negative life events experienced during childhood tend to exacerbate young adult challenges, resulting in incarceration. The current study, based on Koenig (2015) and the Developmental Adaptation Model (DAM; Martin & Martin, 2002), used self-report data from 261 older male inmates, ages 45-82 (M=57.59; SD =8.41) to test a path analytic model regressing religiosity (public religious attendance and private activities) on to known correlates and antecedents. Nested model testing found that the association between self-reported life events experienced as a child and later life religiosity was mediated by forgiveness of self and social provisions, controlling for age, race, and education (IE = -.014; p=.03, one-tail). Distal and proximal assessments influenced religiosity in this sample. Future research will want to explore assessing religiosity and possible therapeutic interventions relative to childhood difficulties and forgiveness of self for incarcerated males.
Exploring Spirituality as a Forgotten Variable in the Contexts of Communities of Faith and Education
Authors: Manning Lydia
Published: December 2020

The purpose of this investigation was to describe the lived experience of aging in communities of faith, more specifically how older adults experienced social support. Semi-structured interviews were conducted with 15 older adults ranging in age from 63 to 84 years of age. Grounded Theory coding techniques were applied to identify themes. Findings include people feeling supported by community, connections, and beliefs, but also failed regarding opportunities for elder ministry or other types of worship. Participants expressed wanting more intentional opportunities for engagement. Many participants described the desire for an “expert” in their communities of faith. We consider the culture of support and how communities of faith may need to reconsider traditional ways of meeting the needs of people as they age. Furthermore, we explore the creation of educational tools that may allow for the emergence of an aging specialist in communities of faith.
Creating Inclusive Design Experiences Through Engaging Seniors With Disabilities in Student Hackathons
Authors: Sanford Jon
Published: December 2020

Although voice-activated assistants (e.g., Amazon Alexa) have become smarter, faster, more personalized, and more ubiquitous, little is known about their potential to promote aging in place for people with disabilities. Partnering with Amazon’s Alexa team, a 2-month long design competition and hackathon was conducted to inspire college students to develop innovative voice-activated solutions to support successful aging with disabilities. This presentation will cover the specific inclusive experiences used to immerse student teams in the daily lives of the target population to ensure that design solutions responded to real needs of real people in real environments. These included: lectures on current research findings about the everyday needs and challenges of the target users as well as universal design approaches to solving those problems; a survey of individuals currently using voice-activated assistants to understand their benefits and potential uses; and providing target with Alexa-enabled devices and embedding them into the hackathon teams.
Chronic Condition Discordance and Physical Activity: Longitudinal Associations Among Older Couples
Authors: Polenick Courtney , Birditt Kira , Turkelson Angela , Kales Helen
Published: December 2020

Chronic condition discordance (i.e., the extent that two or more conditions have non-overlapping self-management requirements) is detrimental for functional health but little is known about mechanisms accounting for these associations. We examined links between chronic condition discordance at both the individual level and the couple level (i.e., between spouses) and physical activity over time. Participants included 1,095 couples from five waves (2006-2014) of the Health and Retirement Study. Dyadic growth curve models showed that greater individual-level discordance was associated with lower baseline physical activity among individuals and their partners. When husbands had greater individual-level discordance, wives and husbands had faster declines in physical activity. The findings highlight the importance of considering both members of a couple when examining the implications of chronic illness for physical activity in middle and later life.
Improving Respect and Dignity of Older Lesbian Adults: Interprofessional Approaches for Specialized Care
Authors: Rowan Noell , Smith Stephanie , Arms Tamatha , Hohn Kris
Published: December 2020

Interprofessional research pertaining to LGBTQ older adult cultural sensitivity training for social workers and nurses is often missing in the empirical literature. Members of the LGBTQ communities become increasingly vulnerable to health disparities as they age and treating clients with respect and dignity is at the forefront of this study. Students and faculty engaged in an interprofessional simulation project with older members of the LGBTQ community to learn health knowledge and applied assessment and brief intervention skills. Quantitative findings (N=58; 23 social work; 35 nursing) indicated increased student health knowledge. Reflection and qualitative findings are included with four primary themes: (a) bias of health care providers, (b) access to quality care, (c) specific health care needs, and (d) health risks of LGBTQ older adults. Specific emphasis is given to reflection and insight of the older lesbian participants about access to care, recognition of significant relationships, and marriage equality.
How Active Older Adults Manage Their Mobility Needs: Transportation Insights From a Panel of Adults Ages 85+
Authors: D’Ambrosio Lisa , Rudnik John , Lee Chaiwoo , Patskanick Taylor , Miller Julie
Published: December 2020

Research suggests that adults experience tremendous transportation challenges at ages 85 and over. As mobility has been tied to overall health and wellbeing, the implications are dire. In this study, the Lifestyle Leaders were surveyed to understand their experiences with different modes of transportation. Responses to a questionnaire (N = 18) and focus groups (N = 18) indicate that many of the Lifestyle Leaders are still driving and report satisfaction with their ability to get around. However, over the past 10 years, many participants have changed their attitudes toward driving and transportation in general. Some panelists cite issues of physical discomfort, increased time and energy spent planning trips, and an increased sense of dependence. Additional data suggest that decision making processes for selecting transportation modes have changed over time. This presentation will discuss policy and practice implications for older adults, caregivers, and transportation professionals.
Ideal Levels of Prosocial Involvement in Relation to Momentary Affect and Eudaimonia: Exploring the Golden Mean
Authors: Finley Kelsey , Axner Maria , Vrooman Katherine , Tse Dwight
Published: December 2020

Aristotle believed that happiness and success result from cultivating virtue at the mean between deficiency and excess - the golden mean. Some evidence suggests there is a golden mean of hours spent volunteering, where well-being benefits are maximized. Our study examined potential linear and nonlinear functions in the amount of time spent in prosocial work (PSW) in a day on the outcomes of eudaimonia, high arousal negative affect, and high arousal positive affect in a sample of high-commitment volunteers and prosocial leaders. In addition to nonlinear functions, interactions were explored. For example, we found that those who spend less time per week in PSW experience less negative affect when they spend more hours per day in PSW; however, those who spend more time per week in PSW experience more negative affect when they spend more hours per day in PSW. Additional findings for positive affect and eudaimonia will be discussed.
Sounds of Healthy Aging: Assessing Everyday Cognitive Activity From Real-Life Audio Data
Authors: Demiray Burcu , Luo Minxia , Grilli Matthew
Published: December 2020

The healthy aging model of the World Health Organization (2015) highlights the value of assessing and monitoring everyday activities in understanding health in old age. This symposium includes four studies that used the Electronically Activated Recorder (EAR), a portable recording device that periodically collects sound snippets in everyday life, to assess various real-life cognitive activities in the context of healthy aging. The four studies collected over 100,000 sound snippets (30-seconds long) over a few days from young and older adults in the US and Switzerland. Participants’ speech in the sound snippets were transcribed and coded for different cognitive activity information. Specifically, Haas and Kliegel have investigated the “prospective memory paradox” by examining the commonality and differences in utterances about retrospective and prospective memory failure in young and older adults’ everyday conversations. Demiray and colleagues investigated the relation between autobiographical memory functions and conversation types in young and older adults in relation to well-being. Luo and colleagues have identified the compensatory function of real-world contexts in cognitive aging: Their study showed that older adults benefited from talking with their spouse in producing complex grammatical structures. Finally, Polsinelli and colleagues found robust associations between language markers (e.g., prepositions, more numbers) and executive functions, highlighting the potential use of spontaneous speech in predicting cognitive status in healthy older adults. Finally, Prof. Matthew Grilli will serve as a discussant and provide an integrative discussion of the papers, informed by his extensive work on clinical and cognitive neuroscience of memory in relation to real-life contexts.
Real-World Language Use With Familiar Versus Unfamiliar Interlocutors in Young and Older Adults
Authors: Luo Minxia , Debelak Rudolf , Schneider Gerold , Martin Mike , Demiray Burcu
Published: December 2020

Real-world contexts may compensate for age-related changes in language production. We compared age effects on vocabulary richness (i.e., entropy) and grammatical complexity (i.e., clause length) in conversations with familiar interlocutors (i.e., significant other, friends, family members) versus with strangers. We collected thousands of 30-seconds speech samples from 61 young and 48 healthy older adults across four days using a portable audio recording device — the Electronically Activated Recorder (EAR). Bayesian multilevel analyses showed that participants used richer vocabulary and more complex grammar with familiar interlocutors than strangers. Young adults used richer vocabulary than older adults. Furthermore, older adults produced equally complex grammar with the significant other as young adults did, but simpler grammar with friends and family members. We found no age group differences in grammatical complexity with strangers (lacking statistical power). In sum, familiarity with the significant other may benefit older adults in producing complex grammar in real-world conversations.
Mind Your Language: New Insights on Memory and Cognitive Aging Research Through Real-Life Methods
Authors: Haas Maximilian , Hering Alexandra , Kliegel Matthias
Published: December 2020

In the past decades, the so-called “age - prospective memory paradox”– a phenomenon comparing prospective memory (PM) performance in and outside the lab – has challenged the classical assumption that older adults necessarily evidence a marked decline in PM functioning. In our study, we want to extend established methods for measuring memory through arising technologies, such as the Electronically Activated Recorder (EAR; Mehl, 2017). Over the course of three days, 60 younger adults (18-32 years) and 45 older adults (60-82 years) completed an ambulatory assessment with the EAR in order to detect spontaneous speech production related to memory and memory failures. Results reveal that younger and older adults do not differ in the total number of utterances related to different facets of memory and cognition. However, when it comes to failures, older adults talk significantly less about PM failures than younger adults. Possible explanations for these findings will be discussed.
The Bright Sides of Sadness in Late Life
Authors: Haase Claudia , Wu Deborah , Lwi Sandy , Verstaen Alice , Levenson Robert
Published: December 2020

Sadness is often thought of as unpleasant and dysfunctional. Yet, evolutionary-functionalist approaches and discrete emotional aging frameworks suggest that sadness is an emotion that helps us deal with loss and thus may become particularly salient and adaptive in late life. This talk presents findings from a multi-study, multi-method research program using age-diverse samples and experimental and longitudinal study designs. Findings show (1) intact or elevated levels of sadness responding in late life (i.e., higher sadness expressions in response to distressing film clips; higher coherence between sad facial expressions and autonomic physiology in response to film clips depicting loss; stability in sadness behaviors in marital conflict interactions). Moreover, (2) higher levels of sadness responding are linked to adaptive outcomes in late life (i.e., higher social connectedness, higher compensatory control strategies) with some effects generalizing across age groups (i.e., links between sadness coherence and well-being). Implications for future research are discussed.
Correlates of Loneliness in Older Korean Americans: Interactive Effects of Negative Family Interactions
Authors: Park Nan Sook , Jang Yuri , Chiriboga David , Chung Soondool
Published: December 2020

This study examined factors affecting the feelings of loneliness among older Korean Americans. Data were drawn from a survey with older Korean Americans aged 60 or over (N = 2,150) in five states (California, New York, Texas, Hawaii, and Florida), conducted during 2017−2018. In hierarchical multiple regression models, loneliness was regressed on five blocks of variables: (1) demographic/health (age, gender, education, financial status, chronic conditions, and physical disabilities); (2) immigration-related (length of stay in the U.S., and acculturation); (3) social engagement (having meals alone, family network, friend network, activity participation, and community engagement); (4) negative family interactions; and (5) interactions of negative family interactions with social engagement variables. A significant interaction was found in the relationship between friend network and negative family interactions: the impact of negative family interactions on loneliness was buffered by friend network. Implications of findings were discussed regarding working with older immigrants with limited social networks.
Exploring the Relationship Between Day-to-Day Care and Caregiver Vigilance
Authors: McCann Brandy Renee , Roberto Karen , Blieszner Rosemary , Savla Tina , Hoyt Emily , Knight Aubrey
Published: December 2020

A demanding aspect of caregiving for a relative with dementia is need for constant vigilance of their behavior and well-being. Vigilance is associated with higher quality of care, but can take a toll on caregivers who have few opportunities for respite. Home- and community-based services have the potential to offer caregivers relief from constant vigilance. Using in-depth interviews with 30 rural caregivers, we found that service use did not necessarily provide relief from constant vigilance. Caregivers typically needed to monitor aspects of home- and community-based services and care facilities such as scheduling and quality of care from CNAs. In contrast, some caregivers found respite from constant vigilance when they used formal services—typically in extreme situations such as when a husband with dementia became violent and moved temporarily to a long-term care facility. Findings connect caregiver needs and concerns related to vigilance with availability, quality, and use of formal services.
Alcohol Consumption and Blood Pressure Among Older Couples: Negative Implications of Drinking Concordance
Authors: Birditt Kira , Turkelson Angela , Polenick Courtney , Cranford James , Blow Frederic
Published: December 2020

Couples who are similar in their drinking behaviors (i.e., concordance) often report better quality and longer marriages. These patterns of drinking may have negative implications for blood pressure, however, as individuals age. The present study examined the effects of alcohol use on blood pressure among couples and whether the associations varied by age. Participants included 2311 married/cohabiting couples (4487 individuals; aged 52 to 92) followed from 2006 to 2014 in the Health and Retirement Study who reported their average drinks per week and had their blood pressure measured. Multilevel models revealed older men (aged 60+) who drank more had higher blood pressure irrespective of wives drinking whereas for younger men the link between their own drinking and increased blood pressure was greater when wives drank more. Although concordance may be beneficial for marriage, there may be a downside to drinking concordance for health especially among middle aged men. Part of a symposium sponsored by Dyadic Research on Health and Illness Across the Adult Lifespan Interest Group.
High Stressor Exposure and Low Stressor Diversity Are Linked to Higher Blood Pressure Across Age
Authors: Koffer Rachel , Dickman Kristina , Kamarck Thomas
Published: December 2020

Stress exposure is linked to elevated blood pressure, which increases risk for cardiovascular disease (Spruill, 2010; WHO, 2013). Stress exposure may be especially harmful when concentrated in one particular domain (i.e., low stressor diversity) (Koffer, et al., 2016). Using a diversity index, we test whether high stressor exposure and low stressor diversity is associated with high resting blood pressure. Participants (N=391, aged 40-64 years) completed four days of hourly self-report of stressful experiences (e.g., work task demand, non-work task demand, arguments, interpersonal tension), with clinic blood pressure separately assessed. Linear regression results indicate older adults experienced lower stressor diversity (B = -0.003, p =.003). Further, higher stressor exposure with lower stressor diversity related to higher diastolic blood pressure (B= -7.21, p=.046). Experiencing high stress concentrated in one domain may increase risk of high blood pressure. We discuss how low stressor diversity may help explain age-related risk of cardiovascular disease.
The Role of Leisure Activities as Markers of Cognitive Reserve on Dementia Risk in English Older Adults
Authors: Meza Pamela Almeida , Steptoe Andrew , Cadar Dorina
Published: December 2020

We examined the frequency of participation in cognitive and social type of leisure activities in association with dementia risk over 15 years of follow-up in 12,280 participants aged 50+ from the English Longitudinal Study of Ageing. Cox proportional hazards regression models were used to estimate the hazard of dementia in relation to the cognitive and social type of leisure activities as well as their interactions with sex and marital status. Medium and higher levels of engagement in cognitive leisure activities were associated with a lower risk of dementia. An analysis of the social type of leisure activities showed a similar pattern with protection for higher levels of engagement in a model adjusted for sex and marital status but further explained by wealth. This study shows a reduced risk of dementia for individuals with higher levels of engagement in cognitively stimulating activities, that may preserve cognitive reserve until later in life.
Physical Restraint Use in Swiss Nursing Homes: Two New National Quality Indicators
Authors: Favez Lauriane , Zúñiga Franziska , Blatter Catherine , Sharma Narayan , Simon Michael
Published: December 2020

Quality indicators are used in nursing homes to assess physical restraint use. Switzerland introduced two publicly reported indicators measuring the use of 1) bedrails and 2) trunk fixation or seating that prevent standing up. Whether these indicators show good between-provider variability is unknown. The study aimed to measure the prevalence of physical restraint use and assess their between-provider variability using a cross-sectional, multicentre study of a convenience sample of nursing homes. The between-provider variability of the indicators was assessed with intraclass correlation 1 and with caterpillar plots based on Empirical Bayes estimates. We included 11,412 residents from 152 nursing homes. Prevalence rates were 13.5% (n=1’433) for bedrails and 3.6% (n=411) for trunk fixation / seating that prevent standing up. For the first indicator, intraclass correlation 1 was 0.245 (95%-CI 0.197-0.286), for the second 0.343 (95%-CI 0.235-0.405). The two indicators showed good between-provider variability and can be recommended for public reporting. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.
Arcs and Stages: Retrospectively Conceptualizing a Gerontological Career
Authors: Hepburn Kenneth
Published: December 2020

The arc of a gerontologist’s career is that of a “work in progress,” work unlikely to be completed. Early efforts might develop interdisciplinary collaborations and establish the principles and mechanisms of a central line of work and inquiry. Mid-stage work may entail expansion and adaptation of preliminary efforts and identification of exciting areas of exploration that both fit within the gerontologist’s overall thematic trajectory and extend beyond the reasonable scope of pursuit. In late stage, the most pressing concern is to sustain, but not constrain, the work’s trajectory. This may best be accomplished by identifying and supporting students and early career researchers who are passionate about the work and who are likely to move it forward and expand it in their own unique and divergent ways. Emeriti gerontologists may seek to remain generatively engaged in ways that both contribute to and let go of the continuing arc of the work.
Places Visited, Maintained, or Abandoned Outside Home: A Community Mobility Need of Older Adults With Dementia
Authors: Margot-Cattin Isabel , Gaber Sophie , Kuhne Nicolas , Malinowski Camilla , Nygard Louise
Published: December 2020

For older adults to “age in place”, they need to keep engaged and mobile in their communities, whatever their health condition. The impact of age and cognitive decline on community mobility is a growing problem in Europe and worldwide. Engaging in occupations outside home implies being able to get to those places where activities are performed. Yet little is known regarding the types of places visited, maintained or abandoned for older adults with/without dementia. This study addresses community mobility needs through the places people visit, maintain or abandon. People with and without dementia, aged 55+, were interviewed using the Participation in ACTivities and Places OUTside the Home (ACT-OUT) questionnaire across Switzerland (n=70), Sweden (n=69) and the UK (n=128). Results show that people with dementia experience a higher rate of abandonment for more places than regular older adults. Insights about driving cessation and access to travel passes will be presented.
Implementing Psychosocial and Environmental Practices for Persons With Dementia in Assisted Living
Authors: Schwartz Lindsay , Zimmerman Sheryl , Wretman Christopher , Prizer Lindsay , Sloane Philip
Published: December 2020

Assisted living (AL) provides care for a large proportion of residents with dementia. Coincident with the increased focus on reducing off-label use of antipsychotics for people with dementia, providers are encouraged to turn to non-pharmacological practices to address behavioral expressions. This analysis used data from 250 AL communities in seven states, and examined familiarity, use, and practicality of twelve evidence-based practices, including music, pets, and social contact. Although a high percentage of staff reported familiarity and use of some of the practices, interviews with staff indicated that administration was not always consistent with evidence on implementation. Familiarity, use and practicality were associated with AL communities that had more residents with dementia, training on antipsychotics and non-pharmacological practices, policies on gradual dose reduction of psychotropics, and leadership that supported use of practices (p<.05 to <.001). Opportunities and barriers to implementation of these practices will be discussed.
Addressing Longevity Risk: How Best to Annuitize Defined Contribution Assets?
Authors: Munnell Alicia , Wettstein Gal , Hou Wenliang
Published: December 2020

Unlike defined benefit pensions, 401(k) plans provide little guidance on how to turn accumulated assets into income. The key risk that retirees face is outliving their assets. Insurance against such risk is available through several routes, including immediate annuities, deferred annuities, and additional Social Security through delayed claiming. Under this Social Security bridge option, participants would tap their 401(k) for payments equal to their Social Security to delay claiming. This paper compares these three options in simulations against a baseline in which no assets are used to obtain lifetime income. In each option, assets not allocated to purchasing lifetime income are consumed following the Required Minimum Distribution rules. The analysis finds that, when market and health shocks are included alongside longevity uncertainty, the Social Security bridge option is generally the best for households with median wealth. Wealthier households can benefit from combining the bridge option with a deferred annuity. Part of a symposium sponsored by the Economics of Aging Interest Group.
Unmet Needs of Families of Adults With Intellectual and Development Disabilities on Waiting Lists
Authors: Heller Tamar
Published: December 2020

Most adults with intellectual and developmental disabilities live at home with their aging parents. Given the large waiting lists for residential and home-based services, families face many unmet service and support needs. The author will present results of a study that examined the impact of a Medicaid waiver program that provided either home-based or residential placements to 444 families of adults with IDD who were living at home at baseline through surveys at baseline and two years later. Families who did not receive the waiver services still had high unmet needs for person-centered planning training, networking with other families, respite, advocacy services, assistive technology, and home modifications at follow up. Regardless of services received, class members from minority backgrounds had more unmet needs than white class members, indicating the need for more targeted efforts to reach minority families.
Effective Communications Techniques for Communities to Reach Older Adults in a Natural Disaster
Authors: Fletcher Patricia
Published: December 2020

Framing timely messages during an emergency is often underestimated but is vitally essential and necessary, especially for the older population. While there is existing research on disaster and older adults, there is a gap in the literature that focuses on a 21st-century communication model that reaches at-risk populations. This presentation explores how practitioners can inspire change in the delivery of an emergency message to communities. Appropriately designed health communications will provide extensive knowledge about the health crisis and improve public health literacy among older adults in disaster preparedness, response, and recovery, creating messages that influence necessary behavior change during the emergency. Additionally, recognizing how collaborative partnerships with Federal, Local, State government, trusted relief agencies, and community groups benefit from designing an organizational structure to disseminate information to the community. Part of a symposium sponsored by Disasters and Older Adults Interest Group.
The CoGenT3 Study: Examining Gender’s Impact on Education and Cognition Trends in Three American Generations
Authors: Stites Shana , Cao Hannah , Gill Jeanine , Harkins Kristin , Rubright Jonathan , Flatt Jason
Published: December 2020

How older adults protect their cognitive health, reduce their risk for cognitive decline, and manage cognitive changes vary for men and women. To advance what is known about these differences and to promote inclusion of sexual and gender minorities in research, we are developing an empirically-informed research framework for studying gender effects in aging and Alzheimer’s research. In this presentation, we describe the framework informing our approach and present results from analyses of gender effects in The Health and Retirement Study that examine gender differences in the associations observed between education and cognitive measures in older adults. Our findings show gender’s effects on education vary in direction and magnitude as gender norms changed over time. Although college education serves as a factor protective against cognitive decline, characteristics of who achieves a four-year college degree change over time. We discuss the implications of our results for aging and Alzheimer’s disease research.
Psychoactive Prescribing in Assisted Living
Authors: Zimmerman Sheryl , Sloane Philip
Published: December 2020

More than 800,000 older adults reside in almost 30,000 assisted living (AL) communities across the country, 42% of who have moderate or severe dementia. As many as 97% of persons with dementia display symptoms of distress such as agitation or anxiety, and 69% of AL communities provide medications to treat this distress. Unfortunately, the psychoactive medications that are prescribed are often ineffective, contraindicated, and may cause serious adverse events including mortality. Especially concerning is the use of antipsychotic medications, which carry a black-box warning for persons with dementia. This symposium will present data from a seven state study of 250 AL communities and the 13,600 individuals who reside there. The first speaker will discuss the prevalence of psychoactive prescribing in AL overall and by medication type, and community characteristics that relate to use (e.g., staffing, resident case-mix). The second presentation will focus on the use of pro re nata (PRN) psychotropic medications, to examine the extent to which use is situational. The third speaker will address the use of off-label antipsychotic medications, and typologies of AL communities that differentiate use. The fourth speaker will discuss the prevalence of potential antipsychotic side-effects and adverse events, and also family member knowledge of medication use. The final speaker will compare the use of antipsychotic and antianxiety prescribing in proximate AL communities and nursing homes, to examine the extent to which local prescribing patterns may influence use. All five presentations of this symposium convey important issues for practice, policy, and future research.
Pro Re Nata Use of Psychotropic Medications in Assisted Living
Authors: Carder Paula , Zimmerman Sheryl , Wretman Christopher , Dys Sarah , Sloane Philip
Published: December 2020

This study examined the use of pro re nata (PRN, or as needed) psychotropic medications among assisted living (AL) residents. We examined prescriptions and administrations, and compared use based on dementia diagnosis. Data sources included interviews with administrators of 250 AL communities in 7 states and medication administration record review for the prior 7 days; analyses were weighted to the entire state. The percent of all residents prescribed a PRN psychotropic medication was 10.3%. However, residents with a dementia diagnosis were twice as likely to have a PRN psychotropic prescription (15.2% versus 7.2%; p<.001). The majority of psychotropic medications prescribed and administered were for anxiolytics/hypnotics rather than antipsychotics. Additional resident-level factors significantly associated with higher PRN prescribing included psychiatric diagnosis, incontinence, hospice use, confusion/disorientation, and agitation. We summarize these and other findings in the context of state regulatory requirements for staffing, chemical restraints, and dementia care.
Local Nursing Home Prescribing Patterns and Psychoactive Prescribing in Assisted Living
Authors: Thomas Kali , Wretman Christopher , Sloane Philip , Beeber Anna , Carder Paula , Schwartz Lindsay , Zimmerman Sheryl , Silbersack Johanna
Published: December 2020

Because prescribing practices in long-term care settings may reflect regional influences, we examined how potentially inappropriate antipsychotic and antianxiety medication prescribing in assisted living (AL) compared to prescribing in nursing homes (NHs) based on their proximity, using generalized linear models adjusting for facility characteristics and state fixed effects. Data were derived from a seven state sample of AL communities and data for the same seven states drawn from publicly available data reported on the Nursing Home Compare website. In adjusted analyses, AL rates of antipsychotic use were not associated with the rates in the nearest or farthest NHs. However, AL communities that were affiliated with a NH had lower rates of potentially inappropriate antipsychotic use (b=−0.27[95%CI=−0.50,−0.04]). In a separate model, antianxiety medication prescribing rates in AL were significantly associated with neighboring NHs’ rates of prescribing (b=2.65[95%CI=1.00,4.29]). Findings suggest efforts to change prescribing in NHs may influence prescribing in AL.
Social Isolation and Loneliness: The Pros and Cons of Technological Interventions
Authors: Demiris George
Published: December 2020

A variety of technologies have been proposed, tested, and used to reduce social isolation and loneliness [SIL]. Furthermore, information technology may offer a way to detect or predict patterns of SIL. In this paper, the range of technology tools for assessment (e.g., passive monitoring, tracking data patterns, electronic health records) and intervention (e.g., social robots, social media, virtual reality) are reviewed for evidence of impact, and consideration is given for related ethical issues. The role of technology in relation to the report’s recommendations is discussed, including assessment and testing of new technological interventions for their potential benefits and harms, consideration of contextual issues such as broadband access, and the role of technology in education and training. Finally, gap areas of research are explored, such as the impact of the use of technology among current younger adults as they age. Part of a symposium sponsored by Loneliness and Social Isolation Interest Group.
Title I: Modernizing Definitions and Programs Under the Administration on Aging
Authors: Gualtieri Marie
Published: December 2020

The recent reauthorization of the Older Americans Act adds language and definitions to current issues facing the aging population. Specifically, Title I includes definitions related to program adaptation and coordination, workforce and long-term care issues, nutrition and social isolation, as well as family caregivers. Different from the last authorization, these definitions span beyond the individual experience to include other entities impacted by an aging society, such as the workforce and families. Overall, the Title I reauthorization seeks to modernize policy to reflect the current influx of the older adult population and its consequences.
The Aging Enterprise: A 40-Year Retrospective
Authors: Polivka Larry , Estes Carroll
Published: December 2020

Dr. Carroll Estes has long been recognized as one of our most influential social gerontologists beginning with the publication of the Aging Enterprise over 40 years ago. This book quickly achieved iconic status among gerontologists and other social scientists as one of the founding texts in critical gerontology, which Dr. Estes has played a leading role in developing with numerous publications over the course of her illustrious career. The panelists will focus on Dr. Estes’ application of the theoretical frameworks offered by the social construction of reality and the political economy of aging to a critique of federal and state policies designed to improve the quality of life of older Americans. Many of the programs and policies included in Dr. Estes’ critique are still in place, including the Older Americans Act and the nonprofit aging network. On the other hand, much about the aging enterprise has changed since 1979. The panelists, Drs. Chris Phillipson, Pamela Herd and Larry Polivka, will discuss the value of and challenges to these theoretical and empirical perspectives within the current contemporary neoliberal political economy that has gradually displaced the welfare state capitalism of the postwar period. As this shift has occurred in the political economy, a neoliberal policy agenda featuring for-profit privatization of public services, including aging services, has become dominant at the federal and state levels. Dr. Estes will respond to the panelists’ presentations and discuss the future of critical gerontology. Women's Issues Interest Group Sponsored Symposium.
The BOLD Public Health Response to Alzheimer’s Disease and Related Dementias: Past, Present, and Future
Authors: McGuire Lisa , Reed Nia
Published: December 2020

Achieving meaningful progress against Alzheimer’s disease and related dementias (ADRD) requires an urgent public health response. Since 2005, the Alzheimer’s Association, Centers for Disease Control and Prevention (CDC), and other public health partners collaborated on the Healthy Brain Initiative (HBI). HBI seeks to advance public health awareness of and action on ADRD as a public health issue. The HBI Road Map Series, State and Local Public Health Partnerships to Address Dementia: The 2018–2023 Road Map (S&L RM) and Road Map for Indian Country, provide the public health with concrete steps to respond to the growing burden of ADRD in communities, consistent with the aim of the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act (P.L. 115-406). This series of RMs for state, local, and tribal public health provide flexible menus of actions to address cognitive health, including ADRD, and support for dementia caregivers with population-based approaches. The purpose of this session is to illustrate public health’s role with ADRD—past, present, and future. An overview of the evolution of HBI RM series will be provided (McGuire) and preliminary evaluation data of 24 actions from S&L RM will be presented (French, Shean, Beatty). Holt, Reed, & McGuire will share lessons learned and next steps from CDC’s Regional Action Institutes designed to facilitate implementation of the RM series across the US. The intersection between the RM series and Age-Friendly Public Health Systems will be described as a starting point for public health (Wolfe, French, Shean).
Start at the Center: Age-Friendly Public Health Systems and Healthy Brain Initiative Frameworks
Authors: Wolfe Megan , French Molly , Shean John
Published: December 2020

SIGNIFICANCE. Older adults can contribute wisdom, skills, and time to communities. The public health sector has unique capabilities for creating conditions that promote health, foster community connections, and quality of life. METHODS. Two frameworks provide public health (PH) with core strategies to improve outcomes for all older adults. The Framework for Creating an Age-Friendly Public Health System (AFPHS) supports the PH role, as demonstrated by 37 of Florida’s 67 county health departments that are piloting the AFPHS Framework. The Healthy Brain Initiative’s (HBI) State and Local Public Health Partnerships to Address Dementia is a framework for action used by PH to promote cognitive health, improve care for cognitive impairment, and increase caregiving supports. Both frameworks call for utilizing regional data and cross-sector partnerships. IMPLICATIONS. PH can contribute to community-wide initiatives to promote well-being and community connections for older adults. Cross-sector partnerships can start by using available tools and planning guides.
Policy Series: The Impact of Ageism on Health and Efforts to Address It Through Reframing Aging
Authors: Solway Erica
Published: December 2020

Ageism can manifest in a variety of ways including in institutional policies and practices, interpersonal interactions, older adults’ internalization of ageist stereotypes, and through the media. While major incidents of age-based discrimination and their negative effects on health are more recognized, older adults also experience less momentous, but still harmful ageism in their day-to-day lives. These types of everyday ageism are also harmful to health. This symposium will highlight recent research from the University of Michigan National Poll on Healthy Aging on self-reported experiences of everyday ageism among a nationally representative sample of U.S. adults age50-80 and its connections to physical and mental health outcomes. Next, another researcher also using data from the National Poll on Healthy Aging will explore the prevalence of positive attributes of aging, its relationships to health, and ways in which it may buffer older adults from the adverse health consequences of ageism. Then speakers will highlight the Reframing Aging initiative and the ways in which GSA and other organizations are leading a national effort to address ageism through education and dissemination of research-based resources. This session will feature research, education, and advocacy efforts and will focus on the policy implications of efforts to better understand the prevalence of and strategies to counter the effects of ageism.
Advance Care Planning Engagement and End-of-Life Preference Among Older Chinese Americans
Authors: Pei Yaolin , Zhang Wei , Wu Bei
Published: December 2020

The study aimed to examine how immigrant status and family relationships are associated with advanced care planning (ACP) engagement and end-of-life (EOL) preference over burial plan among older Chinese Americans, the largest subgroup of Asian Americans. Logistic regressions were used to analyze data from a survey of 430 older Chinese Americans aged 55 and older living in a Honolulu, Hawai’i. Results show that U.S.-born Chinese Americans were more likely to engage in ACP, including willingness thought of EOL care, and discussion about EOL care, and having preference over burial plan, than the foreign-born Chinese American. Family cohesion was not associated with ACP engagement and EOL preference over burial plan. Family conflict increased the possibility of ACP engagement, indicated by willingness thought of ACP, willingness discussion on ACP, and EOL preference over burial plan. The culturally sensitive educational intervention is needed to increase ACP engagement among older Chinese Americans.
Catechol-O-Methyltransferase Genotype, Frailty, and Gait Speed: The Cardiovascular Health Study
Authors: Mance Shannon , Rosso Andrea , Bis Joshua , Studenski Stephanie , Bohnen Nico , Rosano Caterina
Published: December 2020

The association of COMT with gait speed varies across studies; frailty, a condition increasing vulnerability to stressors, may influence this association. Cross-sectional data was obtained in 3,744 participants (71 years, 82% white, 39% male) for gait speed, frailty (Fried definition), and COMT. Multivariable regression models of COMT predicting gait were adjusted for demographics, chronic conditions, and locomotor factors. Interactions of COMT by frailty and by race predicting gait speed were p=0.03 and p=0.02, respectively. Compared to Met/Met, the Val/Val group walked marginally more slowly in the full cohort (0.87 vs 0.89 m/sec, p=0.2); differences were significant for those with frailty (n=220, 0.55 vs 0.63m/sec, p=0.03), but not for those with moderate (n=1691, 0.81 vs 0.81m/sec, p=0.9), or no frailty (n=1833, 0.98 vs 0.97 m/sec, p=0.7). Associations were similar by race, but significant for whites only. Studies should assess the influence of dopaminergic signaling on gait slowing due to frailty.