bluuebunny/crossref_metadata_2025 huggingface dataset:
TRENDS IN OPIOID USE IN LONG-TERM CARE NURSING HOME RESIDENTS WITH DEMENTIA
Authors: Mehta Hemalkumar B , Kuo Yong-Fang , Westra Jordan , Raji Mukaila , Goodwin James S
Published: November 2019

We examined opioid use in long-term care nursing home residents with dementia. This retrospective cohort study used Minimum Data Set linked Medicare data, 2011-2016, and included long-term care episodes for residents 65+ years who survived 100+ days each year (592,211 episodes for 256,207 residents). Cognitive status at first annual assessment was classified as none/mild, moderate and severe impairment. Overall opioid use, prolonged opioid use (prescription supply 90+ days) and long-acting opioid use were identified from Medicare part D. Descriptive statistics were used to describe opioid use by cognitive impairment. Cochrane Armitage trends test was used to determine trends in opioid use. 114,622 (19%) patients had severe and 129,257 (22%) had moderate dementia. Overall opioid (none/mild=15.4%, moderate=13.9%, severe=9%), prolonged opioid (none/mild=5.2%, moderate=4.5%, severe=3.2%) and long-acting opioid use (none/mild=1.1%, moderate=0.9%, severe=0.3% ) were lower in patients with advanced dementia. Opioid use was significantly higher in females and Whites and varied by states. Substantial increase was found in overall opioid and prolonged opioid use from 2011 to 2016, with greater increase in none/mild and moderate dementia patients. For example, prolonged opioid use increased by 69% in none/mild and 71% in moderate dementia patients compared to 52% in severe dementia patients (p<0.0001). Long-acting opioid use decreased, with a greater decline in none/mild (69%) and moderate (71%) dementia patients compared to severe dementia patients (58%) (p<0.0001). Contrary to decreasing opioid use in community setting, overall and prolonged opioid use increased in nursing home residents. Future studies should identify the reasons behind increased use.
AN EXPLORATION OF HOME CARE NURSES’ EXPERIENCES IN DEPRESCRIBING OF MEDICATIONS FOR OLDER ADULTS IN THE COMMUNITY
Authors: Sun Winnie
Published: November 2019

The aim of this study is to explore the barriers and enablers of deprescribing from the perspectives of home care nurses, as well as to conduct a scalability assessment of an educational plan to address the learning needs of home care nurses about deprescribing. This study employed an exploratory qualitative descriptive research design, using scalability assessment from two focus groups with a total of eleven home care nurses in Ontario, Canada. Thematic analysis was used to derive themes about home care nurse’s perspectives about barriers and enablers of deprescribing, as well as learning needs in relation to deprescribing approaches. Home care nurse’s identified challenges for managing polypharmacy in older adults in home care settings, including a lack of open communication and inconsistent medication reconciliation practices. Additionally, inadequate partnership and ineffective collaboration between inter-professional healthcare providers were identified as major barriers to safe deprescribing. Further, home care nurses highlighted the importance of raising awareness about deprescribing in the community, and they emphasized the need for a consistent and standardized approach in educating healthcare providers, informal caregivers, and older adults about the best practices of safe deprescribing. Nurses in home care play a vital role in medication management and, therefore, educational programs must be developed to support their awareness and understanding of deprescribing. Study findings highlighted the need for the future improvement of existing programs about safer medication management through the development of a supportive and collaborative relationship among the home care team, frail older adults and their informal caregivers.
PATTERNS OF PSYCHOACTIVE MEDICATION USE IN COMMUNITY-DWELLING OLDER ADULTS IN THE UNITED STATES IN 2015
Authors: Bajracharya Rashmita , Qato Danya
Published: November 2019

Per the 2015 Beer’s Criteria, most psychoactive medications are identified as potentially inappropriate for use in older adults as this population is especially vulnerable to the potential adverse effects associated with psychoactive medications, including sedation, anticholinergic effects, and falls. Past studies found increasing use of psychoactive medications in community-dwelling older adults; however, patterns of use by other sociodemographic, socioeconomic, and clinical subgroups have not been explored. This is a cross-sectional analysis of 2015 Medical Expenditure Panel Survey in a sample of 6122 older adults (60-85 years). We utilized Andersen’s Behavioral Model of Health Services Utilization to guide logistic regression model development and estimated odds ratios (OR) with 95% confidence intervals (CI) to quantify the association between psychoactive use and predisposing(sex and race); enabling(marital status, education, poverty, insurance); and need-based[multi-morbidity and activities of daily living (ADL) limitations] factors. Over 30% of older adults in the U.S. reported taking a psychoactive medication in 2015. Prevalence of use was significantly higher in women (35.9%), the unmarried(34.1%), low-income(35.7%), white(34.0%), multimorbid (32.0%), and ADL limitation groups (45.9%) compared to men, married, high-income, other races, not multimorbid, and no ADL limitations groups, respectively. Female sex [OR=1.62(1.38-1.91)], low-income [OR=1.30(1.04-1.6)], multimorbidity [OR=3.2(2.6-3.9)], and ADL limitations [OR=2.2(1.7-2.8)] were identified as independent predictors of psychoactive use. There is differential use of psychoactive medications by sociodemographic, socioeconomic, and clinical factors. Given the increased complexity of pharmacotherapy regimens, especially in those with multimorbidity and ADL limitations, improved efforts aimed at prudent use of psychoactive medications should be intensified.
DIABETES, SELF-EFFICACY TOWARD DIABETES PREVENTIVE BEHAVIORS, AND DEPRESSIVE SYMPTOMS AMONG KOREAN AMERICANS
Authors: Cho Soyeon
Published: November 2019

Type 2 diabetes is a largely preventive chronic disease, which requires persevering self-management by maintaining healthy life style. Prevalence of Type 2 diabetes among Asian Americans are rapidly increasing, yet little is known about Asian Americans’ self-efficacy towards diabetes preventive behaviors. Thus, the present study examined self-efficacy on diabetes preventive behaviors (DPB) as a potential mediator in the association between diabetes and depressive symptoms among older Korean Americans. Data were driven from a cross-sectional study of 235 community-dwelling Korean American older adults (aged 60 and older) in 2013. The direct significant relation between diabetes and depressive symptoms became insignificant after self-efficacy on DPB was introduced, which demonstrates a full mediation effect of self-efficacy on DPB. Results suggest that even in the presence of diabetes, mental well-being such as depression of older adults can be maintained by having competence in self-management of their own health.
AGE, EXPERIENCE OF RACIAL MICROAGGRESSIONS, AND DISTRESS
Authors: Thompson Shayla , Sawyer Broderick , Meeks Suzanne
Published: November 2019

Racial microaggressions are a common form of racial discrimination consisting of subtle or interpersonal slights. Racial microaggressions are linked to various kinds of psychological distress in younger adults, but have not been studied across the lifespan. We examined the relationship of racial microaggressions with psychological distress and anger rumination among younger and older adults identified as racial or ethnic minorities. We hypothesized that age would moderate the relationship between racial microaggressions and psychological distress and anger rumination, that is, the relationship would be weaker for older than for younger adults. Participants were recruited from Amazon Mechanical Turk and were compensated $1 for their participation. Preliminary tests of the hypotheses (N=220), using multiple regression analyses to test for moderation, failed to support the hypothesis that age would mitigate the impact of microaggressions on symptom severity. Both age and microaggressions were related to psychological distress and anger rumination, but contrary to prediction, older adults showed more exacerbation of distress in the face of microaggressions than younger adults. The results also differed by gender and ethnic groups, suggesting the importance of examining intersectional experiences of race, gender, and age in response to discrimination. These cross-sectional findings lend support to the importance of considering both subtle and overt discriminatory experiences in understanding the mental health challenges for minority groups in the U.S., but more work is needed to examine the intersection of ethnicity with other demographic variables, and to understand how the lifelong experiences of discrimination may shape older adults’ vulnerability, well-being, and resilience.
A 20-YEAR COHORT STUDY OF LIVING ARRANGEMENTS AND COGNITIVE DECLINE IN THE MEXICAN AMERICAN POPULATION
Authors: Cantu Phillip A
Published: November 2019

Backgrounds/Objectives: The prevalence of dementia in the elderly Latino population is expected to significantly increase from around 200,000 cases in 2000 to as many as 1.3 million cases in 2050. This demographic trend has important consequences for options in care and living arrangements. Very little is known about how of cognitive impairment trajectories co-vary with support available to Mexican Americans. We examine the relationship between living arrangements and the social support of individuals with dementia. Methods: Using data from nine waves from the 23 years of the Hispanic EPESE (n=3,952), we examine trajectories of cognitive functioning and family and social support. We first describe the change in Mini Mental Status Examination (MMSE) scores for survivors from Wave 1 (1993/1994) to Wave 9 (2015/2016), n=255. Growth Mixture Modeling (GMM) is then used to assess how changes in MMSE scores are distributed among living arrangements for individuals living independently compared to household extension (living with others) using the full sample. Results: Analyses reveal different trajectories in MMSE score. 12% (n=27) of the sample had no decrease, while the remaining (88%) were split between moderate decline (60% n=136, 1-10 point decline in MMSE) and severe decline (28% n=62 >10 point decline In MMSE). Changes in living arrangement over the same period show that 89% of individuals who move from independent living into extended household experienced cognitive decline. Conclusions: This study provides new information on how cognitive trajectories are associated with living arrangements. We discuss implications for improving community-based interventions for Latino family caregivers.
TóMALO SUAVE (TAKE IT EASY): HOW LATINO OLDER ADULTS PERCEIVE OF POSITIVE AGING
Authors: Piedra Lissette M , Howe Melissa , Ridings John , Montoya Yadira , Conrad Kendon
Published: November 2019

With the help of the Positive Aging of Latinos Study (PALS) steering committee (N = 20), we used concept-mapping methods to learn what Latino older adults (N = 101) consider important for aging well, positively, and successfully. We used data from nine focus groups (six Spanish, three English) to generate an unabridged list of 171 statements that described what positive and successful aging meant to participants. The PALS steering committee reviewed the statements, assisted with the translation and back translation of items in Spanish, eliminated vague and duplicate statements, and approved a final list of 85 statements. Next, Latino older adults thematically sorted (n = 35) and rated (n = 93) the 85 statements (using a 1-5 scale; higher values indicate greater importance). These data were used to produce a concept map for how participants conceptualized positive and successful aging. The final map consisted of 11 clusters nested within 4 overarching regions. Region 1 [Self-Sufficiency] contains clusters of items which address “Stability” and “Independence.” Region 2 [Healthy Behaviors] includes clusters with items related to “Staying Healthy” and “Avoiding Trouble.” Region 3 [Perspectives on Life] encompasses four clusters of items that address mindsets: “Tómalo Suave (Take it Easy),” “Outlook on Life/Self-Care,” “Emotional Well-being,” and “Maturing.” Region 4 [Convivir (To coexist)] features indictors of interrelatedness such as “Social & Community Engagement,” “Coping & Adjustment,” and “Family Relationships.” These findings provide insights into how Latino older adults conceive of positive aging, which could be useful when designing culturally sensitive programming for Latino seniors.
UNIMAGINED FUTURES: THE PARADOX OF FAMILISM AND ELDERCARE AMONG AGING LATINOS IN THE CHICAGOLAND AREA
Authors: Howe Melissa , Howard Alexis , Hsieh Wendy , Piedra Lissette M
Published: November 2019

Scholars of gerontology highlight the ways aging varies cross-culturally. Whereas North Americans tend to describe “successful aging” as the maintenance of social and physical independence, Latin Americans tend to view aging as a natural process of social transition. In this study, we conducted a content analysis of nine focus groups (N =101) and 20 interviews with Latino older adults in the Chicagoland area to examine how they characterize successful aging and view the health declines that accompany aging. We found that Latino older adults often used rhetoric associated with “successful aging,” which tended to emphasize the maintenance of independence and physical functioning. Even immigrant respondents employed this language, suggesting that descriptions of “good old age,” may be more culturally transferable than previously thought. At the same time, the cultural values of respeto and familismo also emerged. Regardless of the participant’s nativity status, centrality of family and the importance of respect represented constant sources of support. Still, adherence to these values came with considerable drawbacks for those intensely focused on self-sacrifice for the sake of their families. Taken together, “successful old age” was defined by the participants as one in which a person maintains physical independence in the context of an interdependent, kin-focused, social life. This paradoxical combination of valuing independence and familial interdependence produced a number of benefits and challenges for Latino adults as they transitioned into to older adulthood.
PAIN AND DEPRESSION AFFECT SELF-REPORTED STRESS RATINGS IN ADULTS WITH AND WITHOUT FIBROMYALGIA
Authors: Nguyen Ha M , Phillips Kristen , Cherry Barbara J , Zettel-Watson Laura
Published: November 2019

Fibromyalgia (FM) is a chronic pain condition characterized by tenderness, fatigue, stiffness, joint pain, and physical and emotional distress. Depression is common, as well, and stress may be perceived as more severe. The current study examines perceived stress in adults ages 50 and older with and without FM. It was hypothesized that individuals with FM and/or depression would subjectively rate stressors as more severe compared to those without. Ninety-four participants (53% with FM, 78% female) aged 50 to 93 (M = 67.72, SD = 9.26) were administered an updated version of the Social Readjustment Rating Scale (SRRS) to assess amount of stress experienced in the past year. The difference between the SRRS pre-determined values and participants’ subjective ratings was calculated. Lower difference scores indicated that self-reported severity exceeded standardized values. Hierarchical linear regression analyses revealed that older adults and men were less likely to report exaggerated stressor severity (p < .05). Controlling for age and gender, individuals with FM were significantly more likely to report stressor severity far above standardized severity scores (p < .05). Results also revealed that both depression and chronic pain impact stress ratings, but impact is significantly greater for depression (p < .001). When controlling for depression, FM impact is no longer significant, suggesting that depression is a stronger predictor of subjective stress. The findings emphasize the importance of stress management and lifestyle changes to reduce the likelihood of depression and stress perception in individuals experiencing chronic pain.
NUTRITIONAL RISK IS ASSOCIATED WITH LOW BACK PAIN AMONG OLDER ADULTS: RESULTS FROM THE UAB STUDY OF AGING
Authors: Buys David R , Evans Marion W , Kennedy Richard E , Locher Julie , Buys Katie , Brown Cynthia J
Published: November 2019

Poor nutritional status is associated with adverse health outcomes across the life course, affecting older adults’ ability to maintain overall well-being, limiting physical strength, and affecting mobility. International research has demonstrated associations between nutritional risk and general musculoskeletal pain; however, no research has explored relationships between nutritional risk and low back pain. Using the University of Alabama-Birmingham Study of Aging, we examined this relationship among 1000 community-dwelling older Alabamians (65+years). We used the DETERMINE Checklist, a well-validated nutritional risk assessment and assessed presence and severity of low back pain over the past 4 weeks. We completed univariate and bivariate analysis and multivariate logistic regression, adjusting for factors significant in the bivariate analyses: sex, body mass index, depression, and co-morbidities. More than half of the participants were at nutritional risk (55.2%). In multivariate analyses, one point increases in nutritional risk were associated with a 14% increase in the likelihood of low back pain 95% CI (1.087,1.213); in categorical analyses, moderate nutritional risk and high nutritional risk were associated with an increase in likelihood of low back pain [46% (95% CI 1.07,2.02) and 164% (95% CI 1.80,3.94), respectively]. While this cross-sectional analysis should be interpreted cautiously, it further emphasizes the importance of nutritional health for older adults. Clinicians treating patients with low back pain or nutritional risk may consider assessing for the other condition. When nutritional risk is detected, clinicians should refer to services such as counseling with a registered dietitian or to a social worker for assistance identifying community-based nutritional supports.
NOVEL METHIONINE-RELATED INTERVENTIONS THAT CONFER HEALTHSPAN BENEFITS TO YEAST AND RODENTS
Authors: Johnson Jay E , Plummer Jason D , Postnikoff Spike D , Tyler Jessica K , Johnson Jay E
Published: November 2019

Methionine restriction (MR) is one of only a few dietary manipulations known to robustly extend healthspan in mammals. Methionine-restricted rodents are up to 45% longer-lived than control-fed littermates and a number of studies suggest that humans may also benefit from MR. While a methionine-restricted human diet is technically feasible, compliance to such a regimen might not be practical or desirable. Therefore, an important goal is to identify and/or develop more facile dietary interventions, or preferably, pharmacological agents that mimic MR. Towards this end, we have made use of the yeast chronological lifespan and replicative lifespan assays, which serve as models of aging in quiescent and mitotic cells, respectively. Importantly, our lab and others have demonstrated that MR dramatically extends yeast lifespan. Here we show work aimed at developing novel MR-like interventions that extend yeast lifespan, as well as preliminary data demonstrating that such interventions significantly improve the healthspan of mice.
A MEDITERRANEAN DIET INTERVENTION ALTERS AGE-ASSOCIATED PHYSIOLOGY IN A NOVEL NON-HUMAN PRIMATE MODEL
Authors: Snyder-Mackler Noah , Shively Carol , Johnson Corbin , Michalson Kristopfer , Appt Susan , Belsky Daniel , Register Thomas
Published: November 2019

Diet modifications are some of the most well-established aging interventions. For decades we have known that caloric restriction can dramatically increase lifespan and healthspan in organisms ranging from yeast to primates. More recently, other dietary modifications, including varying nutrient composition, have been experimentally shown to alter healthspan and lifespan. However, limitations inherent in human trials, such as diet adherence and heterogeneity of other lifestyle factors, mitigate our ability to identify the mechanisms through which diet alters healthspan and lifespan. Here, we conducted a randomized, long-term, whole-diet manipulation in a nonhuman primate, where cynomolgus macaques consumed either a Mediterranean or Western diet for 15 months. We hypothesized that individuals fed a Western diet would exhibit accelerated rates of cellular and physiological aging relative to their Mediterranean-fed counterparts. Indeed, we found that Western diet-fed animals exhibited increases in physiological measures that also increase with age, including body weight, fasting insulin, and triglycerides. Animals eating a Mediterranean diet, on the other hand, had a more sensitive and tuned autonomic response, and reduced HPA responses to an acute stress challenge. Probing further, we found that diet strongly affected monocyte function, altering the expression of 40% of expressed genes, leading to a more proinflammatory monocyte phenotype in Western diet fed animals. Experiments are underway to explore effects of diet on other markers of biological aging. Together, these data provide the first controlled evidence that Western and Mediterranean diets can alter aging-associated function in a species with clear biological similarity and relevance to humans.
SENIOR MODELS: SUCCESSFUL AGING AND SERIOUS LEISURE
Authors: Lee Sanghee , Bae Jaeyoon , Im Sua , Heo Jinmoo
Published: November 2019

Serious leisure involves productive engagement and commitment in leisure activities. Literature shows that participating in serious leisure is associated with physical and mental health benefits of older adults. The behavior of senior modeling reflects serious leisure engagement that might offer a new insight useful in understanding successful aging. We explored the experience of senior models as a form of serious leisure. Using selective optimization with compensation as well as serious leisure framework, we attempted to identify how senior modeling activity contributes to successful aging. This study used in-depth interviews using purposeful sampling, and data were collected over two months in 2019. The participants were 31 senior models (average age = 67). The analysis resulted in three themes which contained characteristics of serious leisure as well as selective optimization with compensation: identifying new possibilities, serious engagement, and rewards from meaningful experiences. This study demonstrated various experiential characteristics associated with modeling as a form of serious leisure. Through selection, optimization, and compensation process, the participants seemed to achieve successful aging. We found that senior model experiences promoted active lifestyle, health benefits, and interpersonal relationships. To our knowledge, this is the first exploration of the experience of senior modeling activity. Consistent with existing literature, our study provides evidence of the significant role of serious leisure in later life. We suggest that senior modeling program holds promise as an effective way for older adults because it can be used as a self-care approach and community programs not only in Korea, but at various locations.
DISCRIMINATION, STRESS, AND MORTALITY AMONG BLACKS AND WHITES
Authors: Choun Soyoung , Kang Sungrok , Lee Hyunyup , Aldwin Carolyn M
Published: November 2019

Mortality rates have declined significantly in the past decades. However, Case and Deaton (2015) showed that middle-aged white Americans with lower education levels have increasing mortality rates. Although some have suggested that stress is an important factor in both this and in racial/ethnic disparities in mortality, relatively few studies have examined vulnerability to stress and mortality, and typically have examined only one type of stress. We examined racial/ethnic and gender differences in different types of stressors, from everyday discrimination, to lifetime trauma, as well as differential mortality risk due to stress vulnerability. Using data from the Health and Retirement Study (HRS), the sample consisted of 6,810 (Mage=68.9 years, SD=10.1) who completed the Psychosocial Questionnaire (PQ) in 2006; mortality was assessed to 2014. Blacks were higher on most stressors except for lifetime trauma. Women reported higher level of financial strain but lower levels of everyday discrimination and lifetime trauma than men. Controlling for demographics and self-rated health, Cox proportional hazard models revealed that everyday discrimination, financial strain, SLEs, lifetime trauma were significantly associated with the risk of mortality. There were no significant racial/ethnic differences in mortality risk. However, interaction effects showed that whites had higher mortality risk with lifetime trauma than Blacks, while those with lower education had higher mortality risk for SLEs. This supports the idea that lower education whites may be more susceptible to some types of stressors, providing a possible mechanism for Case and Deaton’s finding (2015) of increasing mortality risk in this group.
PREDICTORS OF MORTALITY RISK AMONG MEDICARE ADVANTAGE ENROLLEES
Authors: Choun Soyoung , Doan Lan , Govier Diana J , Hooker Karen , Mendez-Luck Carolyn , Turner Shelbie , Irvin Veronica L
Published: November 2019

Overall all-cause mortality rates have declined significantly in past decades among individuals aged 65 and above in every racial and ethnic group. We explored demographic, overall health, and disability development as predictors of mortality in Medicare beneficiaries enrolled in Medicare Advantage plans. We used data from the 2014-2018 Medicare Health Outcomes Survey, a nationally representative panel survey with a two-year follow-up, administered by the Centers for Medicare and Medicaid Services. Our sample consisted of 1,273,494 community-dwelling adults aged 65 and older (Mage = 74.5 years, age range: 65-109 years) enrolled in Medicare Advantage plans. Mortality was assessed over a 2-year follow-up period. We used Cox proportional hazards regression analysis to predict risk of all-cause mortality by demographics, self-rated health, chronic health conditions, smoking status, and activities of daily living (ADLs). Among all participants, the mortality rate was 7.0% (n = 88,058) at 2-year follow-up. Advanced age and being male were significantly associated with greater risk of mortality, while higher levels of education and income were inversely associated with mortality. Controlling for other factors, white adults had higher mortality risk than black or African American, Hispanic, and Asian older adults. Individuals who were unmarried, had lower self-rated health, had more chronic health conditions, smoked, and had more ADL limitations had higher mortality risk. Our findings suggest that sustained health and better functional capacity are important elements in decreasing the risk of mortality in older adults.
TACKLING THE OPIOID EPIDEMIC: A STATE-WIDE INITIATIVE TO DECREASE OPIOID PRESCRIBING
Authors: Chahal Jasleen K , Northrip Kimberly
Published: November 2019

More than 500,000 preventable deaths annually have been attributed to the growing opioid epidemic and increased opioid prescribing rates by providers (CDC, 2016). A report by the American Medical Association (AMA) found that only 50% of physicians have taken continuing professional development (CPD) activities on managing pain with opioid alternatives (2016). In 2012, Kentucky passed a comprehensive law regulating the prescribing of controlled substances and requiring ongoing CPD in opioid prescribing and abuse. UK HealthCare CECentral partnered with the Kentucky Office of Drug Control Policy (KODCP) to provide CPD training. This study utilized retrospective learner data collected from CECentral between 2012 – 2017. Since the initiative began in 2012, CECentral has provided this training to 8,893 individuals: 5,877 physicians, 1,527 APNs, and 831 other health professionals. This initiative has resulted in more than 6,000 total participants committing to various forms of clinical practice change to help combat the opioid crisis. Between 2012 and 2016, these commitments resulted in an increase in Buprenorphine/Naloxone prescriptions and prescribers requesting controlled substance reports on their patients. An overall decrease in opioid prescriptions was also shown to be a result of this Kentucky opioid initiative. Results of the study indicate that partnerships between state agencies and CPD providers can lead to practice improvements that address public health concerns. Future research should focus on the efficiency and effectiveness of CPD training and such collaborations as public health initiatives.
THE SAGE SYMPOSIUM: A MODEL FOR HANDS-ON INTERACTIVE CONTINUING EDUCATION
Authors: Powers Becky
Published: November 2019

Current graduate and postgraduate medical education has minimal geriatric and palliative care curricular requirements, leaving Continuing Education (CE) programs poised to fill a critical educational niche. The San Antonio Geriatric and Palliative Education (SAGE) Symposium was a 3 day long interprofessional CE conference for providers caring for older adults. SAGE addressed geriatric knowledge, skill, and attitude deficits in practicing providers by incorporating: 1) a community and provider based needs assessment, 2) active skills sessions culminating in a health fair, and 3) multimedia based reflective exercises. Needs Assessment (Knowledge): A video needs assessments of older adults were performed using a convenience sampling methodology in 13 non-healthcare public locations in each quadrant of the city. 23 respondents were interviewed before reaching thematic saturation with 3 main themes: geriatric syndromes, patient-provider relationships, and support. Content areas for the course were derived from the needs assessment. Skills Sessions (Skills): In addition to standard plenary sessions, multiple active breakout session taught attendees common geriatric skills. On the last day of the conference, attendees applied these skills under supervision at a senior community health fair. Reflective Exercises (Attitudes): Videos, poems, and artwork with themes on aging were displayed during conference breaks. Attendees received CE credit for electronically submitting short reflections to each multimedia piece. Reflections were compiled and reported back to the group at the end of the conference. By changing the traditional CE conference format to an interactive experience, the SAGE Symposium was able to address knowledge, skills, and attitudes towards aging in its attendees.
PROMOTING SUCCESSFUL CHRONIC DISEASE SELF-MANAGEMENT THROUGH COMMUNITY-BASED INTERVENTIONS
Authors: Washington Tiffany R , Gitlin Laura N , Smith Matthew L
Published: November 2019

Persistent chronic conditions are among the top leading causes of death in the U.S. The majority of older adults live with two or more chronic conditions. When poorly managed, chronic conditions can result in negative psychosocial and health outcomes such as low quality of life, diminished mood, workforce withdrawal, high healthcare utilization, and disability. Fortunately, chronic disease self-management interventions show promise in reducing the negative impact of chronic conditions on health status. This symposium will highlight formative work and recent findings of community-based interventions that promote successful self-management. To start, presenter one will describe findings from four studies that constitute the formative work necessary to inform implementation of self-management interventions in community and healthcare settings. Next, presenter two will report findings from an effectiveness trial of a technology-based intervention to support hypertension self-management. Then, presenter three will describe findings on the feasibility of a Health Passport tool to promote self-health management among individuals with physical limitations. Finally, presenter four will describe factors affecting attendance among African Americans with arthritis who participated in a national dissemination of Chronic Disease Self-Management Education programs. Collectively, these presentations will provide practical evidence and science-based recommendations for ways to increase successful chronic disease self-management and ultimately improve population health among older adults.
THE USE OF CREATIVITY WITH CLIENTS WITH DEMENTIA TO ENHANCE STUDENT LEARNING AND POSITIVE PERCEPTIONS
Authors: Foti Megan , Ghaul Michelle
Published: November 2019

Funding and productivity demands combined with curative approaches of medicine can make working with older adults less appealing to health professionals (Samra et al, 2013 George et al, 2013). It is essential to recognize and address such perceptions to promote the provision of quality, humanistic healthcare. Educators can impact perceptions by facilitating innovative opportunities for interaction with older adults, especially those in dementia care. Creative therapies, such as art, music, and storytelling provide opportunities for reminiscence and self-expression and have been proven to yield potential psychosocial benefits for people with dementia including enhanced well-being, lessened cognitive decline, decreased anxiety and depression, and improvements in memory, social interaction, orientation, and cognitive functioning. (Phillips et al, 2010; Subramanium, Trentham, n.d.; Woods, & Whitaker, 2013). Similarly, these interventions yield benefits for facilitators such as increased comfort and higher levels of humanistic care for clients with dementia (George et al, 2013, & 2014). The proposed presentation will provide evidence related to the benefits of creative therapies for people with dementia and highlight methods for integrating this into healthcare curricula in addition to supporting evidence and positive outcomes.
KNOWLEDGE OF END-OF-LIFE CARE, LIFE-SUSTAINING TREATMENT, AND ADVANCE DIRECTIVES IN NURSING STUDENTS
Authors: Cheon Jooyoung
Published: November 2019

Knowledge of end-of-life (EOL) care and being able to make the appropriate decisions for patients who are dying is important for nursing students, who will soon play a critical role in EOL decision-making among patients and their caregivers. Accordingly, the purpose of this study was to examine the level of knowledge of EOL care, life-sustaining treatment, and advance directives among nursing students in South Korea. This cross-sectional descriptive study was conducted from December 2017 to February 2018. Data were collected from 220 undergraduate nursing students and analyzed using descriptive statistics, t-tests, one-way ANOVA, and a post hoc test with the SPSS 19.0 program. The score for knowledge of EOL care was 7.8 out of 11 points, for knowledge of life-sustaining treatment was 4.6 out of 6 points, and for knowledge of advance directives was 7.0 out of 9 points. There were significant differences in knowledge of EOL care scores by year of study, experiences in clinical practicum education, and experiences of caring for dying patients. Knowledge of life-sustaining treatment significantly differed by year of study, experiences in clinical practicum education, experiences of caring for and observing dying patients during clinical practicum education, and perceived self-rated health. There were significant differences in knowledge of advance directive scores by year of study, satisfaction with nursing major, experiences in clinical practicum education, and experiences of caring for and observing dying patients during clinical practicum education. Further studies should develop educational intervention programs that improve knowledge of EOL care, life-sustaining treatment, and advance directives.
IMPROVING COLLEGE STUDENTS’ ATTITUDES TOWARD AGING POPULATIONS: USING CBT-BASED GERONTOLOGICAL PEDAGOGY
Authors: Li Qiwei , Harllee Heath , Knight Becky P
Published: November 2019

The U.S. is facing a shortage of aging-related professionals. Lack of positive attitudes among undergraduate students towards the older population may restrict them from participating as aging professionals. However, research majorly focused on the attitudes among students already in the medical training fields instead of improvement of the attitudes among undergraduate students who potentially will devote themselves to be aging professionals. We seek to enhance attitudes toward the aging population through gerontological coursework at the undergraduate level. The introductory course is based on Cognitive Behavioral theory (CBT) which emphasizes to unlearn false concepts. Therefore, the class exposes students to positive aging images in contemporary films and literature demonstrating concepts such as successful aging, retirement, gender issues, and aging as minorities, etc. Students review their perceptions of the aging population at the beginning and end of the semester, presenting five words that best describe the aging images. The variances of occurrence of negative to positive descriptions are analyzed as an evaluation of the class. The class also stimulates civic responsibilities of the students toward the aging population with concepts such as generational equities by conducting team-based discussions. The results report increased positive words and improved attitudes on in-class team projects and post-class evaluations. The implication of the course outcomes is that discussing and exposing the positive images, and justifying typical aging-related behaviors significantly improves students’ attitudes toward the aging population, and may encourage undergraduate students to select an aging profession. Qualitative evaluation of the course will be conducted in future semesters.
RESIDENTIAL HOMES FOR THE DYING: AN UNTAPPED RESOURCE FOR TEACHING PATIENT- AND FAMILY-CENTERED END-OF-LIFE CARE
Authors: Sharpe Chantelle , Weisse Carol
Published: November 2019

Clinical training opportunities in end-of-life care are lacking, especially in home settings where death is expected and supported as a natural process. The Community Action, Research and Education (CARE) program provides students who are interested in healthcare a better understanding the challenges of providing end-of-life care. Over 8 weeks, undergraduate students serve as surrogate family members providing care to hospice patients in residential homes for the dying. Additionally, students engage with a formal curriculum by completing online learning modules each emphasizing different skills for providing end-of-life care. This study analyzed data from three cohorts of undergraduate students (n = 21) who participated in the CARE Program. Analyses from assessment surveys revealed that students reported improved knowledge and skills, including enhanced bedside education and training and increased ability to care for someone at the end-of-life after completion of the program. Also, 95% (n = 20) of students over the three cohorts reported that the formal coursework enhanced skills and training related to bedside care. Previous research has examined end of life training in a professional school setting, but the focus was on care in an institutional or facility setting (Billings et al., 2010; Supiano, 2013). The CARE program is a model for experiential learning in a home setting that provides a special lens to the dying experience in a holistic, patient and family centered way.
THE EFFECT OF PERCEIVED APPRECIATION ON CAREGIVER WELL-BEING: A TEST OF EQUITY THEORY
Authors: Meyer Kylie , Puga Frank , Pickering Carolyn E
Published: November 2019

Equity theory suggests that equal (reciprocal) exchange of support in social relationships leads to better outcomes for members. However, in caregiving, exchange of support may become unbalanced due to heightened instrumental support from caregivers (CG). Imbalance may be exacerbated in dyads where the care recipient (CR) has dementia, since cognitive changes can attenuate expression of social support. One way social support is demonstrated in through show of appreciation. We used data from National Study on Caregiving (NSOC) to test whether CGs who did not feel appreciated by CRs were more likely to experience depression in the future. To accomplish this, we applied lagged dependent variable (LDV) models to the 2011 and 2015 NSOC waves (N=150). CGs who felt appreciated by the CR in the 2011 wave had 0.22 times the odds of being depressed in 2015 as those who did not feel appreciated by the CR (CI 0.07 to 0.68). This effect appears to exist primarily among CGs to people with dementia. In stratified models, we found CGs to people with dementia in 2015 had 0.04 times the odds of being depressed in 2015 if they previously felt appreciated by the CR (CI 0.003 to 0.40). A statistically significant effect was not observed among those assisting someone without depression (OR=0.65, CI 0.22 to 1.91). Results suggest that CGs to people with dementia who feel appreciated have less risk of experiencing depression. Findings have applications for future interventions for caregiver wellbeing, such as enhancing perceived appreciation (e.g., cognitive restructuring, communication training).
BEING RESPECTED AND ADMIRED IN OLD AGE: DYNAMICS OF SOCIAL STATUS AND AGING
Authors: Weiss David , Bellingtier Jennifer A , Diehl Manfred
Published: November 2019

Social status - the standing of a person or group in the social hierarchy - is part and parcel of social life and a significant determinant of cognition and behavior. Status hierarchies are basis of virtually all human and primate societies and assign different roles and privileges to its members. However, the dynamic nature of social status and the underlying mechanisms in old age are not well understood. Therefore, this symposium addresses questions of how social status is influenced by aging-related changes in roles, life events, self-concept, and images of aging and how social status shapes in response personality, subjective age, prosocial behavior, performance, and well-being in old age. Bellingtier and colleagues examined objective and subjective social status and their connections to subjective age, attitudes towards aging, and awareness of age-related changes. Zhang shows paradoxical association between aging stereotypes and prosocial behaviors toward older adults. Barber and Hamel investigated how stereotypes of reduced physical competence in old age affect the gait performance on easy and difficult tasks. Weiss and colleagues take a cross-cultural perspective on the different sources of social status in China, Germany, and the US showing that generations in contrast to age groups represent a source of high social status in later life. Finally, Kornadt investigates the dynamic interplay of changes in social roles and personality in old age. Together, these presentations enlarge our understanding of the dynamics of social status in old age.
CELL NON-AUTONOMOUS MECHANISMS OF AGING
Authors: Leiser Scott
Published: November 2019

It is now recognized that biological aging can be affected both positively and negatively by intercellular communication. This symposium will focus on recent discoveries related to cell non-autonomous mechanisms of aging.
CELL NON-AUTONOMOUS SEROTONIN SIGNALING MEDIATES STRESS RESISTANCE AND LONGEVITY
Authors: Leiser Scott , Miller Hillary , Huang Shijiao
Published: November 2019

The ability of organisms to perceive and respond to their environment is crucial to their long-term survival. Recent studies in model organisms identify signaling pathways that perceive environmental stress and cell non-autonomously modify systemic physiology. These pathways often originate in the neurons, where key cells monitor the external environment for changes including food availability, air-quality, and the presence of dangerous toxins. Our previous work identified a key role for serotonin signaling in the induction of flavin-containing monooxygenase-2 (fmo-2) downstream of hypoxic signaling. fmo-2 expression is necessary and sufficient to promote stress resistance and longevity downstream of multiple genetic pathways, making it a useful tool for identifying key components of these pathways. Our current data defines environments, pathways, and signaling molecules that induce fmo-2 and subsequently increase lifespan. Our resulting data define key roles for serotonin signaling and fmo-2 that rely upon the perception of oxygen and food.
RESTORATION OF HYPOXIA SIGNALING IMPROVES AGING-ASSOCIATED LOSS OF SKELETAL MUSCLE REGENERATIVE POTENTIAL
Authors: Udeh Kodi , Li Bin , Endo Yori , Panayi Adriana , Sakthivel Dharaniya , Neppl Ron , Wagers Amy , Sinha Idranil
Published: November 2019

Skeletal muscle retains the ability to regenerate throughout life, but this decreases significantly with aging. The present study investigates whether aging-associated loss of muscle hypoxia signaling limits regenerative potential. Utilizing young (3 months) and old (22-24 months) mice, skeletal muscle from old mice exhibited a 40% decline in the cross-sectional area (CSA) of newly regenerating fibers following cryoinjury at day 10 (p < 0.01) post-injury as compared to young. Focused PCR array demonstrated a greater than 3-fold decline in expression of the majority of hypoxia signaling genes. In particular, aryl hydrocarbon receptor nuclear translocator (ARNT), which is required for downstream hypoxia signaling and the transcription of hypoxia response genes, is 5-fold lower for both gene expression (p < 0.01) and protein levels (p < 0.01) in old versus young mice. To determine the effects of ARNT on muscle regeneration, we utilized a genetically modified mouse which results in an 80% decrease in ARNT gene expression following activation, specifically in skeletal muscle. Compared to littermate controls, mice with a muscle specific knockdown of ARNT (mKO ARNT) exhibit a 30% decline in regenerating fiber sizes at day 10 (p < 0.01) following cryoinjury, without any loss of regenerative potential in FACS isolated satellite cells ex vivo. Administration of a pharmacologic hypoxia activator, ML228, induced a 30% increase in regenerating fiber CSA in both old mice and mKO ARNT mice (p < 0.01) as compared to treatment with vehicle control. These data suggest hypoxia signaling declines with aging in skeletal muscle and activation of hypoxia signaling may promote regeneration.
CHRONIC DISEASE SELF-MANAGEMENT PROGRAM ATTENDANCE AMONG AFRICAN AMERICANS WITH ARTHRITIS AND COMORBIDITIES
Authors: Mingo Chivon A , Washington Tiffany R , Smith Matthew L
Published: November 2019

African Americans (AA) are 17% less likely to be diagnosed with arthritis compared to Whites, yet disproportionately burdened by arthritis symptoms. AA are overrepresented in the diagnosis and burden of other chronic conditions (diabetes, heart disease), highlighting the need to engage them in evidence-based Chronic Disease Self-Management Education (CDSME) Programs. This study examines how disease profiles may influence program attendance. Using a multinomial logistic regression, data were analyzed from AA with arthritis (N=20,541) who attended CDSME programs in 48 states. Relative to those with only arthritis, participants with more complex disease profiles were less likely to attend an arthritis-specific program (P<0.001) and more likely to attend a diabetes-specific program (P<0.001). Those with more complex disease profiles were more likely to attend programs at healthcare organizations and residential facilities, and less likely to attend in faith-based organizations (P<0.001). Understanding barriers and facilitators to program attendance have policy and public health implications.