bluuebunny/crossref_metadata_2025 huggingface dataset:
INFLAMM-AGING IS ASSOCIATED WITH PRO-INFLAMMATORY PROGRAMMING OF INNATE IMMUNE CELLS IN THE COLON
Authors: Noh Ji Yeon , Wang Hongying , Farnell Yuhua , Tan Xiao-Di , Wright Gus , Hillhouse Andrew , Sun Yuxiang
Published: December 2022

Chronic low-grade inflammation is prevalent in aging, which is called inflamm-aging. Immune cells are important mediator of inflammatory state of host and the innate immunity is the first responder to various insults. Gastrointestinal track, especially colon, is the site where immune cells are abundant. Aging is associated with increased gut dysbiosis and functional decline. We hypothesize that colonic innate immune cells contribute to the age-associated inflammation in the colon. We found that macrophages in colon mucosa are elevated in aging, and it is accompanied by pro-inflammatory cytokine expression and increased gut permeability. Specifically, we used flow cytometry to assess colonic innate immune cells collected from 5-, 7-, 14-, 19-, 24-, and 28-month-old mice. Aging significantly increased the populations of pro-inflammatory cytokine producing innate immune cells in the colon, including neutrophils, dendritic cells, monocytes and macrophages. Interestingly, the infiltrating Ly6Chi macrophages and pro-inflammatory CD11c+ macrophages were much higher, while anti-inflammatory CD206+ macrophages were decreased in colon of the aged mice. In line with the immune profile, aged mice showed increased gut permeability tested by fluorescein isothiocyanate-dextran, and the gene expressions of gap junction proteins in the colon were decreased, supporting increased gut permeability in the aged mice. Collectively, our results suggest that innate immune cells play an importance role in age-associated gut inflammation; targeting the innate immune cells in the colon may present a novel therapeutic strategy for prevention and treatment of aging leaky gut.
GERIATRIC AND EXTENDED CARE TRAJECTORIES AND TRANSITIONS AMONG VETERANS WITH LONG-TERM CARE NEEDS
Authors: Bouldin Erin , Brintz Benjamin , Hansen Jared , Rupper Randall , Brenner Rachel , Intrator Orna , Kinosian Bruce , Pugh Mary Jo
Published: December 2022

We aimed to identify clusters of geriatric and extended care services used by Veterans, describe transitions between clusters, and identify factors influencing transition. We explored services across the continuum of care from clinic to home-based and institutional care services. Analyses include 104,837 Veterans Health Administration (VHA) patients 65 years and older, and used VHA and Centers for Medicare & Medicaid Services (CMS) data from FY15-FY17. Using latent class and latent transition analyses, we identified 5 latent classes: 1) No Services, 2) CMS Services, 3) Home-Centered Interdisciplinary Care, 4) Personal Care Services, and 5) VHA-CMS Care Continuum. Veterans most commonly transitioned from the CMS Care Continuum class to No Services. Veterans also frequently transitioned into the VHA-CMS Care Continuum class over time. Identifying service patterns can inform service delivery, program development, and future resource allocation to better meet aging Veterans’ needs.
ETHNICITY-SPECIFIC EXTREME LONGEVITY VARIANTS IN A CONSORTIUM OF FOUR CENTENARIAN STUDIES
Authors: Bae Harold , Gurinovich Anastasia , Song Zeyuan , Giuliani Cristina , Nygaard Marianne , Barzilai Nir , Puca Annibale , Sebastiani Paola
Published: December 2022

It has been shown that some longevity variants including the APOE variants have ethnicity-specific effects on EL within European ethnicities. The goal of the present study is to identify genetic variants whose effects vary by ethnicity by conducting a genome-wide association study of extreme longevity (EL: defined as living past the age at which less than 1% individuals from the 1900 - 1920 birth year cohorts survived) that includes the SNP-by-ethnicity interaction terms using a consortium of four centenarian studies: the New England Centenarian Study, the Long Life Family Study, the Southern Italian Centenarian Study, and the Longevity Gene Project. We used the Uniform Manifold Approximation and Projection (UMAP), a non-linear dimension reduction technique, to identify distinct ethnic clusters. The UMAP analysis revealed four distinct ethnic groups (Danish, Italian, Ashkenazi Jewish, and middle European) in the aggregated data set with 2223 cases and 5673 controls. Using a mixed effects logistic model with SNP-by-ethnicity interaction terms, we found 29 loci, in which the test of any interaction effect produced p< 10-5. The results showed that some variants had ethnicity-specific effects on EL. We sought for replication in two independent studies of longevity: the Danish Longevity Study and the Italian Longevity Study. In the Italian Longevity Study, rs7907949 (PFKP), rs11667516 (intergenic: RAB11B;MARCHF2), rs13245505 (intergenic: ZC3HC1;KLHDC10) replicated with a nominal significance level of 0.05. In the Danish Longevity Study, rs79853795 (PLCB1) and rs4072601 (SLC39A11) replicated. Future drug development should account for ethnic-specific differences in the genetic effects for higher efficacy for more diverse populations.
MEDICAL MORBIDITY RISK IN A SAMPLE OF OLDER WOMEN WITH BINGE EATING
Authors: Hooper Savannah , Marshall Victoria , Bridges Preston , Espinoza Sara , Keel Pamela , LaCroix Andrea , Musi Nicolas , Kilpela Lisa
Published: December 2022

Binge eating (BE; consuming an abnormally large amount of food in one sitting while feeling out of control) is the most common form of disordered eating among older women, and aging may confer greater risk for medical morbidities. While the clinical phenotype of older women with BE is unknown, understanding health impacts of BE on the aging process is important. The objective of this study was to describe physiological characteristics of older women (aged 60+) with clinical levels of BE (i.e., ≥weekly episodes). Participants (N = 21; M age = 66.0±4.59) underwent a DEXA, indirect calorimetry, anthropometric measurements, and fasting blood labs. 76% of participants reported a BE age of onset in midlife or later (age 42+); the sample mean BMI was 35.08±8.64, with an average waist-to-hip ratio of 0.90±.047. DEXA scans indicated 90.48% were classified as overweight or obese. Using age- and gender-matched norms, mean fat percentile was 84.75±17.43; mean total body fat percentage was 47.0±4.5. Mean Resting Energy Expenditure (kcal/lean mass) was 34.2±3.71; average respiratory quotient was 0.81±0.06. HbA1c values indicated that 61.90% had pre-diabetes or diabetes; 47.61% had high fasting blood glucose and 76% had high LDL cholesterol. Mean bone mineral density (BMD) fell within a healthy range (1.11 g/cm2±.14); 33.33% had a BMD z-score of less than zero. Cardiovascular comorbidities were rare in this sample (9.5% had standard hypertension). Overall, metabolic disturbances were prevalent, while a minority had cardiovascular or skeletal morbidities. Findings suggest that BE may interfere with healthy aging predominantly through metabolic morbidities.
INVESTIGATING LINKS BETWEEN CHILDHOOD HEALTH AND FAMILY LIFE AND ACCELERATED BIOLOGICAL AGING
Authors: Larkina Marina , Smith Jacqui
Published: December 2022

An epigenetic clock measure, DNA methylation (DNAm) PhenoAge, differentiates individual aging trajectories and has been shown to predict mortality and morbidities. Despite suggestions that early-life experiences may shape epigenetic aging, little is known to date about specific risk and protective factors. We use data from Health and Retirement Study (HRS) to investigate the role of childhood factors, including health and family financial situation, in epigenetic age acceleration. The sample (N = 3952, M age = 64, range 50-100) included participants from the HRS 2016 Venous Blood Study and those, who reported about their childhood health and family. Using logistic regression, we predicted DNAm PhenoAge acceleration, calculated as the residuals resulting from regressing DNAm PhenoAge on chronological age and coded as 0 or 1 (1 = positive values, faster epigenetic aging rate). Participants with more years of education were less likely to have accelerated epigenetic aging (OR: 0.963, 95%CI[0.941-0.985], p < .001). However, self-reported chronic illnesses before age 16 (15 possible conditions), self-rated childhood health, and family financial situation before age 16 were not associated with accelerated aging. In addition, men had higher likelihood of accelerated aging than women (OR: 1.145, 95%CI[1.007-1.301], p < .05). Race/ethnicity and age cohort (e.g., being younger or older age 65) were not significant predictors. Our results highlight that investigation of relation between childhood disadvantages and DNAm PhenoAge acceleration might need to include other indicators (e.g., residential history). Future work is needed also to identify life course moderators of the clock efficacy.
GENETIC ARCHITECTURE OF SUBJECTIVE HEALTH: RELATIONSHIP WITH PHYSICAL HEALTH, COGNITION, AND DEPRESSION
Authors: Finkel Deborah , Gatz Margaret
Published: December 2022

The fact that self-rated health (SH) predicts mortality and a variety of other health outcomes independent of objective health measures generates questions about mechanisms and etiologies. SH can be considered an indicator of physical health, per se, resulting from active cognitive processing of explicit information about one’s own health and intuitive knowledge of symptoms and physical sensations. The extent to which SH taps shared cultural ideas about health should be reflected in estimates of the shared environmental component of variance (C). SH has also been associated with emotional health measures, such as neuroticism and depression. Previous analyses have been limited by sex (only women), sample size, age (range = 63-76), and failure to include cognitive function. The current analysis used data from 8291 adults ranging in age from 22 to 102 from the international Interplay of Genes and Environment Across Multiple Studies (IGEMS) consortium to investigate the genetic architecture of SH. Genetic influences on self-rated health (SRH) were investigated in the context of CIRS (Cumulative Illness Rating Scale), MMSE (Mini-Mental Status Exam), and depression (CES-D or CAMDEX). Independent pathways modeling indicated that all genetic variance for SRH was shared with CIRS, MMSE, and depression. Comparison of groups older and younger than 74 indicated age differences in genetic architecture of SRH. Evidence suggests that the discordance between objective and subjective health increases in late adulthood, possibly as a result of greater emphasis on psychological rather than physical components of subjective health assessments by older adults.
PLACE OF DEATH FOR PEOPLE WITH DEMENTIA: EVIDENCE FROM THE CDC WONDER MORTALITY DATA
Authors: Amano Takashi
Published: December 2022

Previous studies have found that patients with dementia experience poorer end-of-life care compared to patients with cancer. Dying in the preferred place has become a common measure of the quality of end-of-life care, and it has been consistently reported that the majority of people prefer to die at home. Thus, this study examines whether dying from dementia is a significant determinant of the place of death in mortalities among older adults. The Mortality Data on Center for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) between 2010 and 2019 were utilized. This study examined whether dying from dementia was associated with place of death (hospital, home, hospice facility, nursing home/long-term care facility) among deaths at 65 years or older. A multinomial logistic regression analysis was performed to estimate the association adjusted for covariates. We analyzed a total of 15,855,034 death records of which 12.34% were dementia deaths. The percentage of deaths at nursing homes was higher in deaths from dementia (56.5%) than other deaths (21.85%), whereas percentages of death at home were similar (20.7% for dementia death and 29.1% for other deaths). Multinomial logistic regression revealed that dementia deaths were 2.74 times more likely to occur at nursing homes than at hospitals compared to other deaths. Results suggest that dementia deaths are more likely to occur at nursing homes/long-term care facilities than other deaths. Further research should investigate the ways to improve the quality of end-of-life care for people with dementia in nursing homes/long-term care facilities.
CORRELATIONS OF GPS-BASED COMMUNITY MOBILITY METRICS BETWEEN PERSONS WITH DEMENTIA AND FAMILY CAREGIVERS
Authors: Chung Jane , Boyle Joseph , Wheeler David
Published: December 2022

Currently, the majority of dementia care is provided at home by informal caregivers. Most informal caregivers share a routine with their loved ones and change their activity patterns to adapt to a new routine of persons with dementia (PWDs). Given the dementia caregiving context, caregivers’ mobility behaviors and PWDs’ mobility may be positively associated. This study aimed to characterize patterns of GPS-derived community mobility in dementia dyads and examine relationships between PWDs’ and caregivers’ mobility patterns. Six dyads wore a GPS data logger inside and outside the home for 8-11 days. Twelve participants generated valid GPS track files (N=110). Four temporal and spatial mobility metrics were derived from GPS data (total distance, time use, median speed, and convex hull area). Then we calculated Pearson correlation coefficients between PWDs and their caregivers over all tracks. All dyads made active out-of-home trips, indicated by mean daily distance (range: 6,198 - 115,592m for PWDs; 5,125 - 108,857m for caregivers). Median speed of movement ranged from 0.09 to 1.29 km/hour for PWDs, and from 0.21 to 0.97 km/hour for caregivers. The mean size of convex hull over the monitoring period indicates a limited space usage level in both PWDs and caregivers, meaning restricted community mobility despite relatively large distance trips. The correlation coefficient was positive and significant for each metric (r = 0.70-0.97, p < .001). These results suggest substantial agreement in the mobility metrics between PWD and their caregivers, indicating a high level of dyadic effects of a partner’s experience of community mobility.
EXAMINING SUBJECTIVE BURDEN AMONG SPOUSAL CAREGIVERS OF PARTNERS WITH DEMENTIA: THE IMPACT ON MARITAL QUALITY
Authors: Yorgason Jeremy , White Avalon
Published: December 2022

Although sometimes caregiving is associated with closeness in marriage, at other times the stresses may affect marriage relationships negatively. In the current study we explore how caring for a partner with dementia, and subjective burden are associated with marital quality. We further explore how dementia care and subjective burden might interact (suggesting a pileup of stress) to affect marital quality. Using data from 1,066 spousal caregivers that participated in the NSOC study and their corresponding care recipients from the NHATS study, the current analysis explored cross-sectional associations between spousal caregiving (primary vs. Secondary caregiver, subjective burden, gender, age, education) and partner care recipient characteristics (dementia classification, household income) predicting positive and negative marital quality. Results suggested that dementia classification and subjective burden were associated with lower positive marital quality and higher negative marital quality. The relationship between subjective burden and positive marital quality was moderated by whether or not the care recipient had dementia. Specifically, when dementia was present, the negative association between subjective burden and positive marital quality was stronger. Spousal caregivers often carry substantial burden to help their partners with activities of daily living. Care provision can alter the marriage relationship in negative ways when perceived burden is high. The current study suggests that the negative association between burden and positive marital quality is even stronger when caring for a spouse with dementia. Gender differences need further exploration, as well as how these patterns play out in early vs. later stages of dementia and across time.
DEVELOPING A MUSIC PROGRAM ON ZOOM FOR OLDER ADULTS WITH DECLINING COGNITION: A PROGRAM DEVELOPMENT REPORT
Authors: Dorris Jennie , DiCicco Heather , Becker James , Rodakowski Juleen
Published: December 2022

The coronavirus pandemic upended in-person programming for older adults with cognitive decline, presenting an urgent need to explore options to offer virtual programming. This program development report describes the adaptation of a music program for older adults with memory loss from in-person to a digital format. The objective was to develop a music program that was both engaging for the older adults, acceptable for the music instructor, and clearly defined for future research and implementation. This report describes the content of the music program and the systematic process of its development, including stakeholder interviews, acceptability surveys, fidelity reviews, and the developed instructor manual. With these structures in place, future research could begin to discern if digital music programming can support older adults in the same way that has been demonstrated in-person, potentially offering a new way to support the cognitive and social needs of a vulnerable population.
A MOBILE MUSIC APPLICATION FOR CAREGIVERS OF PERSONS WITH DEMENTIA: A USABILITY TESTING STUDY
Authors: Doyle Cassidy , Dobbs Debra , Wiechart Kelly , Wadhwa Rohan , Meng Hongdao
Published: December 2022

More than 11 million Americans spend an average of 26.3 hours caring for a person with dementia (PWD). Managing behavioral and psychological symptoms of dementia (BPSD) is a significant source of caregiver stress. Music-based interventions (MBIs) have been shown to be a pleasant activity enjoyed by both PWD and their caregivers, with the potential to help alleviate BPSD. However, current commercial music streaming services are not designed for families coping with dementia due to subscription and/or network connection requirements. This mixed-methods usability study tested caregivers’ experience with an open-source Android application (MUsic to Support Engagement and Resilience, or MUSER) as a potential platform for home-based MBI delivered by caregivers of PWD. In-lab and in-home testing sessions were conducted with 6 caregivers (2 former and 4 current caregivers, 1 male and 5 females). Semi-structured interviews were conducted before and after the in-home testing period between July and November 2021 to better understand User Experiences (UX). Family caregivers had a mean age of 57.8 (SD=26.2, range 20-77). The main themes identified from the interviews included ease of use, device and music preferences, and prior experience with technology. Overall, users reported high satisfaction and would recommend the application to other caregivers. Users reported that listening to music on the app elicited positive emotional effects (e.g., calmness and relaxation). The MUSER mobile music application can be used by caregivers to deliver MBI in the community. Future research should test whether a caregiver-delivered MBI would be efficacious in reducing BPSD among PWD.
EXERCISE BEHAVIOR IS DETERMINED BY PANDEMIC DISTRESS AND TASK BURDEN AMONG CAREGIVERS OF OLDER ADULTS
Authors: Nemati Donya , Keith NiCole , Kaushal Navin
Published: December 2022

Background

Caregivers who have dependents with dementia are at a much higher risk of heart disease and mental illnesses compared with non-dementia caregivers. Consequently, these outcomes have been exacerbated by societal barriers that resulted from the pandemic. Engaging in regular physical activity at a moderate-to-vigorous level (MVPA) is beneficial for caregivers has it has been shown to prevent several adverse health outcomes. However, pandemic-related (COVID-19) distress likely worsened caregiver burden which in turn compromised their MVPA levels. The purpose of this study was to understand how caregiving burden impacts MVPA when accounting for physical activity determinants from an augmented Theory of Planned Behavior (TPB) model.

Methods

Participants (n=127) were caregivers for older adults (65+) who have dementia. Participants completed measures of MVPA (behavior), TPB, pandemic-related distress (COVID Caregiver Risk Index) and burden scale for family caregivers. The study was investigated using a structural equation model.

Results

Participants were 45.5 (SD=3.4) years old, 76.4% female. Attitudes (β=.22, p=.012) and perceived behavioral control (β=.19, p<.001) predicted intention. Attitudes and perceived behavioral control mediated the relationship between past behavior and intention (β=.17, p=.02). Covid distress predicted caregiver burden (β=.35, p<.001), and caregiver burden mediated the effects between distress and behavior (β=-.12, p=.01).

Conclusions

Caregiver burden findings suggest that societal changes and demographic-specific burdens related to caregivers need to be considered for caregivers with dependents who have dementia. Taken together, exercise programs that focus on traditional behavioral determinants also need to include specific approaches to buffer caregiving burden experienced in this demographic.
REMOTE ELECTRONIC DATA CAPTURE OF MEDICATION USE AND AGITATION SYMPTOMS IN OLDER ADULTS WITH MCI OR DEMENTIA
Authors: Au-Yeung Wan-Tai , Miller Lyndsey , Gothard Sarah , Lindauer Allison , Kaye Jeffrey
Published: December 2022

Timely and objective knowledge regarding behavioral and psychological symptoms (BPS) in older adults with cognitive impairment or dementia residing in the community setting is challenging to obtain. The Monitoring Dementia-Related Agitation using Technology Evaluation (MODERATE) Study aims to identify longitudinal changes of agitation and related symptoms for dyads living at home with dementia. To date, MODERATE has enrolled seven dyads (a person living with MCI or dementia and a spousal caregiver). The mean age of the participants is 75.7 (8.5) years, the age of the spousal caregivers is 71.0 (6.0) years, and 5 out of 7 of the participants with MCI or dementia are male. We created an online survey, which is sent weekly to the caregivers, to inquire of any changes in medication and frequency of symptoms of agitation experienced by the persons with MCI or dementia in the past week. As of 02/22/2022, 102 weekly surveys (mean per participant = 14.6) were sent out via email; 99 responses were returned (response rate of 97.1%). One caregiver used a personal computer (PC) only, 2 used smartphone only and 4 used both PC and smartphone to complete the surveys. The median time to complete the online survey was 3.83 minutes with IQR 1.72 – 9.14 minutes. “Complaining, negativism, refusal to follow directions” were the most commonly reported agitated behaviors reported (43% of surveys). Caregivers can provide regular detailed symptom profiles and medication reports online. This approach may be used for more timely and informative management of BPS in dementia.
DECLINE OF AN ONLINE COGNITIVE COMPOSITE ASSOCIATED WITH MODIFIABLE LIFESTYLE FACTORS
Authors: Wu Chao-Yi , Wright Kirsten , Hantke Nathan , Kaye Jeffrey
Published: December 2022

Voluntary, self-administered online assessment platforms have gained popularity in monitoring cognition and lifestyle behaviors. This study used the AARP Staying Sharp online brain health assessment platform to estimate the progression of a cognitive composite and correlate it with six modifiable lifestyle behaviors (physical activity, diet, sleep, stress, social activity, and brain engagement) in 147,939 participants (68.6 ± 7.0 years old; 70% female). A cognitive composite was created using attention, immediate and delayed recall, and working memory tasks and lifestyle behaviors were collected by self-report. A lower frequency of exercise (p=0.01), a higher frequency of sitting (p=0.03), a lower frequency of getting in touch with family and friends (p=0.04), and the inability to manage stress (p=0.02) were associated with a decline in the online cognitive composite. A self-administered online assessment platform may be useful in informing lifestyle modification interventions for risk reduction of cognitive impairment and dementia.
WHAT DO LONG-TERM CARE LEADERS SAY ABOUT THEIR PREPAREDNESS FOR COVID-19? A QUALITATIVE STUDY
Authors: Liu Darren , Lane Sandi , Burston Betty , Rados Robert
Published: December 2022

The post-acute and long-term care (PALTC) sector has, in some respects, served as the epicenter in the U.S. during the COVID-19 pandemic. Many decisions were carried out by administrative and/or clinical leaders during this pandemic. The decisions were made based on their professional experiences, and recommendations by the Centers for Medicare & Medicaid Services (CMS). However, little research has reported on the perspective of those administrators who took the lead during this most difficult time. This study aims to understand how responses and decisions were formed during COVID-19 to ensure resources were available protect staff and residents. Accordingly, this study tried to answer two key questions: 1) What did the PALTC administrative and clinical leaderships learn? 2) What can we do better not if, but when COVID ever “…hits again?” We interviewed nursing home and/or assisted living administrators in two conveniently selected states: Pennsylvania and North Carolina. These interviews (each of which took about 30 minutes) were conducted over Zoom using structured and open-ended questions. The transcripts were entered and analyzed using NVivo – a qualitative data analysis software. The results revealed several themes including communications, relationship building, experience as an administrator, fears and resilience, as well as successful activities to support their staffs such as recognition, bonuses, and food bags prepared for their family. The findings highlight some important administrators’ thoughts which recommend key future strategies. These include whether preparedness assets, knowledge, resources, and policies were adequate and where the future efforts should focus.
IMMUNE RESPONSES TO MODERNA COVID-19 MRNA VACCINE IN FRAIL NURSING HOME PATIENTS
Authors: Semelka Charles , Sanders John , Alexander-Miller Martha
Published: December 2022

Prior COVID-19 mRNA vaccine trials included healthy older adults, but mRNA vaccine responses were not studied in frail older adults. We postulated that frailty was associated with immune responses of reduced quality and quantity following mRNA vaccination. A cohort of 15 older adults in a retirement facility were followed from the first Moderna mRNA-1273 vaccine dose in February 2021 with blood collections at baseline and weeks 4 (boost), 6, 18 and 28. Outcomes were IgG titers to SARS-CoV-2 Spike protein with secondary outcomes of T cell responses. Statistical analysis used log transformed geometric mean antibody titers in multivariable regression models with clinical predictors including, age, sex, prior infection status, and clinical frailty scale (CFS) score. Cellular immune response analysis used multivariable regression for function and phenotyping of T cell subsets. All participants with median (IQR) age: 90 years (84, 96) and CFS score: moderately frail 6 (5, 7) generated robust antibody responses with mean peak titer levels 10-fold higher than baseline. In the adjusted model, individuals with severely frail scores CFS=7 had lower antibody levels compared to mildly frail CFS=5, OR: 0.55 (0.35, 0.87) p=0.017. Both chronological age and sex had non-significant relationships with antibody titers. Spike peptide specific CD4 cells and T follicular helper cells were significantly decreased in more frail individuals (p=0.011 and p=0.008 respectively), though the relationship with antibody titers was non-significant. Frailty scores were a better predictor than age for serologic and cellular immune responses to COVID-19 mRNA vaccination in very old adults.
FRAILTY TRAJECTORIES AMONG WORLD TRADE CENTER GENERAL RESPONDERS
Authors: Ko Fred , Ornstein Katherine , Pedretti Nicolo Foppa , Colichino Elena , Bello Ghalib , Hung William
Published: December 2022

As the WTC cohort ages, it is important to examine whether there are differences in frailty trajectories over time in the cohort and examine clinical risk profiles of subpopulations with different trajectories. We used longitudinal data collected annually from the WTC data center and included all individuals with 3+ Clinical Frailty Index (FI) measurements after 9/11 to examine frailty trajectories using latent class growth mixture models. These patterns of change of Clinical-FI all showed an increasing trend over time, but there were three distinct patterns with different rates of increase. These were associated with distinct profiles of characteristics including sociodemographic, occupational and exposure level. WTC responders with higher age, working in construction, and higher-intermediate WTC level of exposure had higher rate of increase of Clinical-FI over time. While WTC responders with younger age, working in protective environment, and with higher education had lower rate of increase of Clinical-FI over time.
ANXIETY IN COMMUNITY-DWELLING OLDER ADULTS AND ITS RELATED FACTORS DURING THE COVID-19 PANDEMIC
Authors: Ma Yu , Greiner Chieko , Ryuno Hirochika
Published: December 2022

The rate of infection and magnitude of the effects of the coronavirus disease 2019 (COVID-19) pandemic has far exceeded the realm of what most people had previously experienced in their lives. There is an urgent need to ensure that strategies are in place to prevent and reduce anxiety in older adults. The present study aimed to assess anxiety in community-dwelling older adults and the related factors during the COVID-19 pandemic in Japan. A community-based cross-sectional study was completed in July 2021. The Japanese version of the Geriatric Anxiety Inventory was used to screen for anxiety symptoms. Demographical data and data for the following five other factors were collected: loneliness, mental well-being, perceived social support, coping behaviors to COVID-19, and fear of COVID-19. The association between anxiety and potential predictors was analyzed using binomial logistic regression. A total of 385 participants aged 65 to 86 years were included in the present study. 17% developed anxiety symptoms. Factors associated with anxiety were age, living alone, loneliness, significant people support, fear of COVID-19, and health monitoring as a COVID-19 coping behavior. Older age, living alone, and significant people support were associated with lower anxiety, and loneliness, fear of COVID-19, and health monitoring as a COVID-19 behavior were associated with higher anxiety in community-dwelling older adults during the COVID-19 pandemic. These findings can help to develop effective measures for reducing anxiety and will support the development of a psychological intervention for tackling the mental health of community-dwelling older adults during the COVID-19 pandemic.
SHOT ON THE SPOT VACCINATION COMMUNITY OUTREACH
Authors: McIntyre Alissa , Allen Rebecca , Cox Brian , Wilson Loretta , Payne-Foster Pamela , Oliver JoAnn S , Luo Yan , Lee Hee
Published: December 2022

Due to the COVID-19 pandemic disproportionately affecting Black communities, The University of Alabama (UA) partnered with the Rural Alabama Prevention Center (RAPC), a community-based healthcare organization to improve the vaccination rate from 34% vaccinated Alabama Black Belt residents to 70% over a year. Health literacy training is provided to community health workers and students who, along with the team members, volunteer at pop-up Shot on the Spot vaccination sites to administer surveys collecting demographics and vaccine hesitancy data. Team members provide health literacy information and answer questions non-vaccinated individuals have. This vaccination intervention has led to drastic rate increases, such as, Choctaw County having a 36.6% increase since the beginning of the project in August (30.7% to 67.30%). However, some counties have low vaccination rate changes, such as, Crenshaw County with a rate change of 15.4% (19.5% to 34.90%). Notably, the Alabama Black Belt currently stands at a higher vaccination rate compared to Tuscaloosa County (UA’s location), only having a rate of 44.3%. Within one year, there have been a total of 44 administered first and second vaccine doses and 435 booster doses, resulting in 50.24% vaccinated Black Belt residents. As the virus evolved into different variants, team members were able to observe an increase in administered booster doses in congruence with the rise of a new coronavirus variant. The partnership formed between RAPC and UA scientists and students is an important step in improving vaccination rates and building community research on minority and diverse populations.
FRAILTY AND AGE-RELATED CONDITIONS AMONG WORLD TRADE CENTER GENERAL RESPONDERS
Authors: Ornstein Katherine , Ko Fred , Park Amy , Sabra Ahmad , Ferreira Katelyn , Hung William , Lucchini Roberto , Thanik Erin
Published: December 2022

As WTC exposure may precipitate frailty, we examined patterns of frailty in the general responders cohort. We used two methods to assess frailty: a Clinical Frailty Index (FI) developed using a deficit accumulation approach utilizing clinical assessments performed during routine annual visits to a WTC clinical program in New York City; and a frailty questionnaire (5-point FRAIL scale) collected from a subsample of responders. Using a Clinical FI cutoff score of 0.25, over 25% of the 7,679 participants, median age 58.3 years (IQR 9.3), who had any visit to the WTC clinical program from 2017 to 2019, were frail. In a subsample of 100 participants with additional frailty assessment (FRAIL scale), we found that 27% were pre-frail, 5% were frail, 14% had recent falls, 9% had ADL dependencies; 34% had mild cognitive impairment. These data suggest that frailty and its related conditions are prevalent among the cohort despite younger age.
THE RISK OF DEMENTIA AMONG INDIVIDUALS WITH DEPRESSION AFTER A TRAUMATIC BRAIN INJURY
Authors: Ashby Joan , Nuno Miriam , Ugiliweneza Beatrice , Deshmukh Maya , Boakye Maxwell
Published: December 2022

Although traumatic brain injury (TBI) has been found to be associated with dementia and depression, large-scale studies of US non-Veteran populations are limited. This study assesses the role of depression on dementia risk after TBI. Data was analyzed from 80,423 individuals with TBI age 55+ in the IBM MarketScan Commercial Claims and Encounter Database and the Medicare Supplemental Database between January 1, 2000 and December 31, 2019. Dementia diagnosis was captured from inpatient or outpatient visits with a “wash out” period of one year. Depression was defined based on documented diagnosis and/or the prescription of antidepressants. The median age was 69 years, 51% female, with a majority covered by Medicaid (51%). 62% of TBIs were moderate/severe and 16% mild. 44,234 (55.1%) individuals were diagnosed with depression with a median of 2.1 months after TBI and 24.4 months prior to dementia. Depression rates differed by sex (female: 54%, male: 44%, p< 0.0001) and insurance (Commercial: 36%, Medicaid: 49%, p< 0.0001). The median time to dementia was 158 months. The median time to dementia was 128 months among those with depression, while patients without depression did not reach this estimate within 250 months of follow-up (p< 0.0001). The risk of dementia increased significantly over time after depression among patients with TBI. This study provides evidence to support that depression after TBI represents a symptom of TBI rather than a prodrome of dementia. Future research will investigate the role of depression in the risk of dementia by race/ethnicity, insurance status, and TBI severity.
TAI CHI OR CONVENTIONAL EXERCISE ON PHYSICAL PERFORMANCE, SLEEP, AND QUALITY OF LIFE IN OLDER PEOPLE WITH DEMENTIA
Authors: Gao Ran , Greiner Chieko , Ryuno Hirochika , Ｇao Shuhong
Published: December 2022

Aims

This study was to compare the therapeutic efficacy of Tai chi and conventional exercise on physical performance, sleep efficiency and quality of life among older people with dementia.

Methods

Eighty-one elderly mild to moderate older people with dementia living in a nursing home in China were screened and randomized to three groups. The intervention groups received a 12-week Tai chi or conventional exercise intervention. Participants were assessed at baseline, week 6, and week 12 between December 2020 and July 2021. The primary outcome was short physical performance battery, secondary outcomes including the sleep efficiency and quality of life. Generalized estimating equations and one-way analysis of variance were the main statistical tests.

Results

The mean age was 80.7 (SD 7.7) years and 74.1% of participants were women. Analysis indicated that there was a significant difference in both intervention groups in short physical performance battery, sleep efficiency and quality of life relative to control from 0-12 weeks, and the Tai chi group had a substantial advantage over the conventional exercise group.

Conclusions

Tai chi and conventional exercise could improve physical performance, sleep efficiency and quality of life in older people with dementia. Furthermore, Tai chi could be a more effective approach to improve physical performance.
REJECTION OF CARE AND AGGRESSION AMONG OLDER VETERANS WITH DEMENTIA WITH AND WITHOUT POSTTRAUMATIC STRESS DISORDER
Authors: Kang Bada , Pan Wei , Karel Michele , Corazzini Kirsten , McConnell Eleanor
Published: December 2022

Veterans with co-occurring dementia and posttraumatic stress disorder (PTSD) living in residential long-term care encounter a range of physical and social stimuli, which may trigger trauma-related distress that can be exacerbated and manifested with care rejection and aggression. Yet, it is largely unknown how PTSD influences manifestation of care rejection and aggression in older veterans with dementia. Guided by the need-driven dementia-compromised model, this study examined the moderation effect of PTSD on pathways from background factors, and interpersonal triggers to care rejection and aggression among veterans with dementia with and without co-occurring PTSD. In this secondary analysis study, a multi-group structural equation modeling was conducted using program evaluation data of 315 veterans with dementia from the STAR-VA behavioral intervention implemented in 76 Veterans Health Administration-operated nursing homes. Although no moderation effect of PTSD on the overall model was found, findings revealed distinct patterns of relationships among background factors, interpersonal triggers, and care rejection and aggression between veterans with dementia with and without PTSD. The magnitude of the direct effects of interpersonal triggers on care rejection was greater in veterans with PTSD. Findings on the indirect effect of depression via interpersonal triggers on care rejection and direct effect of functional status on aggression only in veterans with PTSD implies that different mechanisms may underlie distressed behavior depending upon whether or not a veteran has PTSD. This study also underscores the importance of an enhanced focus on trauma-informed care, and individualized multi-component symptom management approach for veterans with dementia and PTSD.
RETURN MIGRATION AND AGING OF JAPANESE INDIVIDUALS LIVING IN GREATER NEW YORK: A QUANTITATIVE ANALYSIS
Authors: Toyama Itsuko , Nakashima Taeko
Published: December 2022

Our previous quantitative research studies have revealed that large numbers of older Japanese individuals living in overseas communities either maintain hope of receiving culture-oriented care or harbor aspirations of returning to Japan to live out their final days. Presently, by analyzing a quantitative research study on older Japanese individuals living in Greater New York in 2018, we clarify the characteristics of those individuals who have decided to return to Japan. In the research study, 2,057 questionnaires were distributed, and the overall return rate was 29.7%. Respondents were divided into three groups based on their answers regarding their intentions for the location of their final abode: the United States, Japan, or indecisive. We performed a multinomial logistic regression analysis based on age, gender, immigration status, having children in the United States, and academic background. The following is a summary of the findings: (1) as participants aged, the ratio of selecting either “Japan” or “indecisive” as opposed to “the United States” decreased, (2) compared to those holding citizenship, individuals with permanent residence selected both “Japan” and “indecisive” at greater rates (by approximately 3 times and 8.7 times, respectively); (3) compared to those having children in the United States, individuals without children in the United States selected both “Japan” and “indecisive” at greater rates (by approximately 1.8 times and 2.2 times, respectively); (4) individuals with a graduate career displayed a tendency to select “the United States,” and (5) gender and language proficiency were not critical attributes in determining the likelihood of selecting “Japan.”
BUILDING CAPACITY FOR PATIENT-CENTERED OUTCOMES RESEARCH IN THE AGING RESEARCH COMMUNITY
Authors: Gray Taylor , Webber Sophia , McGaffigan Erin
Published: December 2022

Patient-centered outcomes research (PCOR) models are increasingly used to ensure stakeholders inform evidence-based systems of care. Unfortunately, older adults, especially those of low income, frailty, and color, are often left out of PCOR, leading to continued health and service disparities. The Aging PCOR Learning Collaborative was funded by the Patient-Centered Outcomes Research Institute in 2020 to conduct a series of multi-media education, training, and mentoring activities to change how older adults are viewed and engaged in research. This project was strongly guided by multiple advisory structures, including two stakeholder advisory boards, two older adult paid advisors, and two student advisors, all of whom assumed an integral role in the design and implementation of project activities, dissemination of products, and analysis and reporting of evaluation methods. Project staff applied a multi-domain evaluation framework to analyze data relevant to these activities, which demonstrated the effective role of advisory structures and the project’s reach to over 300 older adults, researchers, funders, and academic leaders. This session will review the steps required to implement these activities as well as our project reach, outputs, and mid-term outcomes, providing one of the first glimpses into how to measure this significant shift in research paradigm.
EXPERIENCE OF UNFAIR TREATMENT IN HEALTHCARE SETTING AND RELATED STRESS AMONG OLDER AMERICANS: RACIAL/ETHNIC GAPS
Authors: Yi Eun-Hye , Hong Michin , Bolton Cherish
Published: December 2022

Guided by the intersectionality framework, this study examined the experience of unfair treatment in healthcare settings over lifetime and related stress. A subsample drawn from the California Health and Interview Survey 2017, including residents age 55 or higher, was used (N=12,261). Significant differences existed in unfair treatment and corresponding stress among racial/ethnic groups, including Whites, African Americans (AA), Hispanics, and Asian Americans (AS). Using weighted chi-square tests, we found that most Whites (75.99%) never experienced unfair treatment, while around 60% of AA answered never. Whites tended to feel extreme stress more when mistreated (23.47%) than Hispanics (14.83%) and AS (15.69%). Weighted logistic regression analyses revealed that younger older adults with lower mental health were more likely to experience unfair treatment across all race/ethnic groups. Intersectional factors contributing to unfair treatment experience were identified for each race/ethnic group. Being a female, living in poverty, poor health, being a naturalized citizen, and living in an urban area were factors for Whites while having higher education was a factor for AA. Mental health was associated with extreme stress for the unfair treatment in all racial/ethnic groups. Different contributors to the stress were found by race/ethnicity. Gender, poverty, citizenship, and length of staying in the U.S. were significant for Whites. For AA, poverty, healthcare insurance, and obesity were significant, and for AS, physical health and obesity were. This study highlights the importance of culturally/ethnically sensitive approaches shaping interventions and policies to enhance awareness about unfair treatment and preventing discrimination toward diverse older adults.
ACCEPTABILITY AND FEASIBILITY OF A CAREGIVER FINANCIAL PREPAREDNESS PROGRAM
Authors: Stratton Lauren , Grant Claire , Moreno Monica , Lanigan Kerry , Judge Katherine , Fazio Sam
Published: December 2022

Caregivers are often financially impacted, through health care costs, long-term care costs, and decreased income. A financial literacy program, Managing Money: A Caregiver’s Guide to Finances, was developed to provide information on financial impacts in caregiving. The virtual program was delivered synchronously with a live presenter through an online platform and was rated with high acceptability. The virtual program was then shifted to an online format. Changes included removing the live presenter and group format in favor of a voiceover and self-paced movement, the addition of videos, and online resources. The asynchronous, self-paced online delivery of the program was evaluated through a survey of 146 caregivers. Participants had a mean age of 45.85 (SD=5.65); 55% female; 75% White; 46% cared for their grandparent and 45% to their parent. A Likert scale was utilized to indicate satisfaction with the program (1=strongly disagree, 5=strongly agree). Overall, participants indicated that the program provided important information on managing money (M=3.97, SD=.83); helped to understand the content (M=3.89, SD=.91); was easy to read and understand (M=3.99, SD=.90); and would recommend the program (M=3.91, SD=.84). The explanation of content areas were rated on a Likert scale (1=poor, 4=excellent); participants rated areas including having conversations about finances (M=3.05, SD=.80); avoiding financial fraud and abuse (M=2.98, SD=.81); covering care costs (M=2.98, SD=.81); and organizing legal plans (M=3.09, SD=.80). Participants reported no difficulties that needed to be resolved when moving through the program. Overall, both the virtual and online formats were acceptable and feasible to caregiving populations.