bluuebunny/crossref_metadata_2025 huggingface dataset:
Adapting the Environmental Scan for Gerontology Graduate Students’ Career Exploration
Authors: Sadeq Nasreen , Stanback Brianne
Published: December 2021

Environmental scanning is a process that provides organizations with information about their internal and external strengths, challenges, and opportunities. Although traditionally used in business and strategic planning, environmental scanning is now being utilized in health care to evaluate currently available programs and services, identify gaps in patient care or research, and make educational, organizational, and policy recommendations. The current study explores adapting the environmental scan for students enrolled in a gerontology graduate program as a tool to facilitate career exploration. Students learned about environmental scanning and were instructed to perform an environmental scan on an important issue, program, or service relevant to their overall career goals. Because students completed their environmental scan while enrolled in an Alzheimer’s Disease Management course, they were encouraged to factor in the increasing prevalence of Alzheimer’s disease into their project. Students’ environmental scan projects spanned several timely topics, including an evaluation of the services currently offered in assisted living facilities from the perspective of a geriatric social worker, a review of memory training interventions and a proposal for a new research study, and preliminary plans for opening an assisted living facility catering to older adults in the LGBTQ community that outlined financial considerations, staff training goals, and patient care plans. Completing the environmental scan project gave students an opportunity to investigate the current state of the career field they are planning to enter, and provided them with a product that they can build upon as they complete the graduate program and begin their careers.
Multi-method Examination of Elder Mistreatment in the Age of COVID-19
Authors: Salari Sonia , Talboys Sharon , Fukushima Annie Isabel , Melton Heather , Michelle Seage , Petersen Megan
Published: December 2021

A multi-method study exposed COVID-19 influence on the pre-existing epidemic of elder mistreatment in Utah. We found changes in 1) abuse types, 2) service responses, 3) firearm access and 4) policy implications. Gun sales were tracked by news surveillance and FBI National Instant Criminal Background Check System (NICS) for pre-pandemic (2018/2019) and pandemic years (2020/2021). New requests for permits skyrocketed during the pandemic. The 2021 Utah State Legislature loosened restrictions on concealed permits. Domestic violence (DV) Fatality Tracker Data in pre-covid years were compared to 2020-2021. A figure illustrates the prevalence of DV fatalities, ages of victims by year and methods used. We conducted 15 in-depth interviews of stake holders who serve DV victims (shelters, police, etc.). DV shelters had a relative lack of children during the pandemic, but increased use by older persons 60+. Susceptibility to chronic respiratory distress syndrome, required social distance for older persons. DV shelters obtained CARES Act funds to adapt solutions, like placing victims in hotel rooms. Most victims stayed at home, confined with abuser(s), some without technology, so isolation decreased their safety. Evidence suggests some fatalities among elder adults. A case study during the pandemic described a 73-year-old mother’s suspicious bank account activity. Bank employees sent police to her home. She was missing, but her co-resident adult son was in possession of her bank cards. She was later found in a shallow grave. Utah households have increased risks of DV fatalities in the wake of the pandemic and for years to come.
Age Group Differences in Response to Repeated Exposure to Laboratory Stress Tasks
Authors: Miller James , Luong Gloria
Published: December 2021

Research examining age differences in affect reactivity (i.e. how much affective experiences change in response to stressors) has produced mixed results, suggesting that there are areas of relative strength and weakness in regulatory processes across age-groups. The present study’s goals were to examine potential age-group differences in affect reactivity and subjective task-appraisals across repeated exposures to a psychosocial laboratory stressor. In the Health and Daily Experiences (HEADE) study, younger (18-35 years old; n=107) and older adults (60-90 years old; n=90) were exposed to the Trier Social Stress Test on three occasions in a laboratory setting over a five-day period. Current affective experiences and task-appraisals were assessed at each session using validated self-report scales, with current affective experiences measured at baseline and task periods to determine affect reactivity. Repeated measures ANOVA analyses were conducted to examine age-group differences in affect reactivity and task-appraisals across sessions. In support of our hypotheses, younger adults showed greater reductions in their negative affect reactivity over time compared to older adults [F(2, 390)= 8.18, p<.001]. Additionally, younger adults’ appraisals of task-difficulty decreased [F(2, 384)= 14.79, p<.001] and appraisals of task-performance increased [F(2,384)= 13.39, p<.001] across sessions, while older adults’ task-appraisals remained stable. Age-group differences in negative affect reactivity and task-difficulty appraisals were not evident for the first session and only emerged after repeated exposure to the stressors. These results highlight the importance of identifying age-related vulnerabilities in adapting to repeated stressors, with implications for designing effective interventions aimed at improving health and well-being for older adults.
Facilators and Barriers to Advance Care Planning Engagement among Chronic Kidney Patients in Taiwan
Authors: Wang YuHsuan (Olivia) , Enguidanos Susan
Published: December 2021

End-Stage Renal Disease (ESRD) patients experience high rates of cognitive impairment and lower quality of life at end of life. Having an advance care planning (ACP) conversation is associated with better care at end of life and improved care consistency with patient preferences. Taiwan ranks highest in ESRD and dialysis incidence worldwide, highlighting the importance of ACP among this population. Since 2019, the Patient Autonomy Act entitled Taiwanese to engage in ACP, but strategies to promote its uptake and the role of healthcare providers and caregivers in ACP conversations remains unclear. This study aimed to investigate facilitators and barriers to ACP engagment among Taiwanese with kidney disease and their caregivers. In 2020, we recruited 18 adults with stage 3—5 kidney disease and their caregivers. We conducted semi-structured interviews to elicit knowledges and perspectives on ACP. A grounded theory approach was used to guide the analysis of primary themes. Two researchers independently coded the transcripts and met to reconcile codes. The primary barrier to ACP was the misconception that it equated to funeral arrangements. Themes related to ACP facilitators included: trust in the nephrology care team (especially in case managers); straighforward communication; and in-person consultations. Additionally, transplant patients were more likely to have ACP discussions with their loved ones. While kidney disease patients preferred straightforward communication, caregivers preferred indirect communications. These findings emphasize the critical role of the nephrological care team members. Improving knowledge of ACP and facilitating communication between caregivers and kidney disease patients in Taiwan is needed.
Pre-Statistical Harmonization of Behavioral Instruments Across Eight Surveys and Trials
Authors: Chen Diefei , Jutkowitz Eric , Iosepovici Skylar , Lin John , Gross Alden
Published: December 2021

Data harmonization methods facilitate further use of existing studies and research resources. Most statistical harmonization methods require pooling data across studies, which is complex and requires careful scrutiny of source data. Most methods (e.g., item response theory) require datasets to have common items for linking a common construct across studies: this necessitates the qualitative process of pre-statistical harmonization. Here, we document pre-statistical harmonization of items measuring behavioral and psychological symptoms (e.g., agitation, wandering, etc.) which represent problematic behaviors among people with dementia administered in a national survey (ADAMS), evaluations conducted at Alzheimer’s Disease Research Centers (NACC), and in six randomized trials (COPE, TAP, ALZQOL, ACT, REACH, ADSPlus). We describe our approach to review question content and scoring procedures to establish comparability across items prior to data pooling. We identified 327 items from 15 instruments across these eight studies. We found considerable cross-study heterogeneity in administration and coding procedures for items that measure the same domain. For example, eight items were coded as count variables in some studies but as categorical variables in others. Moreover, of the 359 items, 191 are conditionally dependent on values of another item. These issues around item response heterogeneity and conditional dependency needed to be resolved prior to estimation of item response theory models for statistical co-calibration. We leveraged several rigorous data transformation procedures to address these issues, including re-coding and winsorization. This study provides guidelines for how future research may acknowledge and address similar issues in pooling behavioral and related instruments.
A qualitative analysis of family caregiver perspectives from the Caregiving Transitions Study
Authors: Blinka Marcela , Liu Chelsea , Sheehan Orla , Rhodes J David , Roth David
Published: December 2021

As people live longer, informal caregiving for family and friends is becoming increasingly common. Caregiver satisfaction with their role is now of greater importance to an increasing proportion of the U.S. population. Most research on caregivers has studied convenience samples, often restricted to caregivers of people with dementia. Various studies have examined the impact of caregiving on caregivers’ health but to our knowledge there are no qualitative studies of caregiving experiences from caregivers in population-based samples. This study investigated the impact of caregiving on participants who transitioned into a caregiving role while participating in a national population-based study. Participants were from the Caregiving Transitions Study, which is ancillary to the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. We thematically analyzed responses from 150 caregivers providing care for multiple different conditions to an open-ended question asked at the time of enrollment and designed to encourage caregivers to share additional details about their caregiving experience. Four major themes were identified: cultural/family expectations; growth opportunities and reciprocity; stressors and challenges; and recommendations. Participants shared both positive and challenging experiences in their role as a family caregiver as well as the impact that these experiences had on their lives. Caregivers shared that one of the most important motivations for taking on this role was their sense of duty toward family. Caregivers also highlighted the positive impact of caregiving on their lives such as opportunities for personal growth, acquisition of new skills, and finding a sense of fulfillment and gratitude.
Research Participation among Community Dwelling Dementia Caregivers: Reflections and Suggestions
Authors: Cruz Kiana , Joshi Sama , Park Taeyoung , Reid M Carrington , Herr Keela , Pillemer Karl , Riffin Catherine
Published: December 2021

Clinical trials for dementia caregivers have suffered from small sample sizes that lack adequate power to detect treatment benefits. Addressing these methodological shortcomings is contingent upon successful recruitment and enrollment of caregiver participants, but major barriers impede their participation in research. This presentation describes the lessons learned from recruiting and enrolling dementia caregivers into a pilot randomized controlled trial designed to help caregivers recognize and communicate about pain in dementia care recipients. Using Bronfenbrenner’s ecological model, we organize our discussion of challenges and opportunities into three levels: community (ecosystem), institution (microsystem), and individual. A key challenge at the community level was gatekeeping by organization leaders, including those from support groups, senior centers, and congregate living facilities. At the institutional-level, challenges included an absence of administrative mechanisms for identifying caregivers and a lack of caregiver research expertise on the Institutional Review Board. At the individual-level, challenges included time constraints and varying motivations for participating in research. Strategies for overcoming these challenges spanned the three levels and included establishing trust and rapport with various constituencies; adapting our recruitment approaches to meet the specific motivations of prospective participants; and refining recruitment scripts to allow for greater personalization. Employing these strategies, which can be generalized to recruit other hard-to-reach populations, helped to overcome recruitment challenges and expedite enrollment of caregivers from a diverse range of sociodemographic backgrounds. Further improvement will require coordinated changes at the institutional and community levels, including the development of central research registries and administrative mechanisms for identifying caregivers.
Prolonged Mechanical Ventilation At Home Versus Long Term Care: Caregiver Characteristics And Strain
Authors: Marcus Esther-Lee , Jacobs Jeremy , Stessman Jochanan
Published: December 2021

Although the number of Prolonged Mechanical Ventilation (PMV) patients and their informal caregivers (CGs) is rising both at Home or Long Term Care (LTC), little is known concerning CG characteristics or strain. We enrolled 120 patients and 106 informal CGs: 34/46 and 72CGs/74 PMV patients from Home Hospital and LTC respectively. CGs were married (82%), female (60.4%), mean age 59 ±14 years; spouses (29%) or children (40%) of the PMV patient. The 13-item Modified Caregiver Strain Index (MCSI) (Maximum severity=26) was 13.6± 6.5, similar at Home vs. LTC (14.3±7.5 vs. 13.3±6.0, p=0.9). Most frequent complaints were distress concerning patient’s changes (93%) or upsetting behaviours (82%), feeling overwhelmed (82%), sleep disturbance (69%) and emotional adjustments (67%). Home CGs reported significantly more physical and financial burden, confinement, and need for work adjustment, while LTC CGs reported greater emotional disturbance and upsetting patient behaviours. Hierarchical clustering identified three clusters of CG strain: burden (physical/time/financial), emotional (upsetting adjustment/ behaviours/overwhelmed) and disturbance (work/plans/confinement). Emotional strain was most frequent, irrespective of site of care; however CGs at Home vs. LTC experienced significantly higher burden and disturbance vs. higher emotional strain respectively. In multivariate models, after adjusting for numerous patient and CG variables, increasing CG strain was consistently associated with rising patient symptomatology. This relationship was pronounced among CGs of Home PMV patients, with a significant interaction variable of Home*Patient symptomatology. Our findings identify specific patterns of strain among caregivers of PMV patients whether at home or LTC, and highlight the importance of addressing their unique needs.
Learning Needs of Dementia Family Caregivers during the Pandemic
Authors: Clevenger Carolyn , Epps Fayron , Hepburn Kenneth , Perkins Molly , Glasgow Glenna Brewster
Published: December 2021

The COVID-19 pandemic has dominated and transformed all caregiving contexts and situations. In a time of COVID-19, caregivers now have to learn how to take all of the complicated precautions to keep themselves and their persons from being exposed to the virus given their population’s mortality rate from COVID-19 infections exceed 40%. As part of a larger initiative to develop an asynchronous online education program for family caregivers of persons living with dementia illnesses (PLWD) to prepare them to master the new demands of their caregiving role in this extraordinary circumstance of the COVID-19 pandemic, we conducted three focus groups with 13 dementia family caregivers to inform the structure, content, and “feel” of the course. Focus groups were conducted with a lead interviewer, via Zoom, audio and video recorded and transcribed for analysis. Participants were asked two groups of questions: their lived experience over the past year and course content for caregiving during crisis. Caregivers identified 4 themes regarding their lived experience of caregiving during the pandemic: (a) mixed feeling about the stay-at-home orders; (b) positive adaptation to telemedicine, (c) vaccine risks and benefits; and (d) impact of social isolation on the PLWD. The groups also recommended specific course content based on their experiences. Participants recommended specific course content based on their experiences, such as health system navigation and the logistics of what to do following the death of a PLWD. Results from these groups have been incorporated into an asynchronous online course to be pilot tested in coming months.
A Scoping Review of Youth Caregivers: Addressing the Needs of This Growing Population
Authors: Doshi Heena , Chen Gracie , Bostarr Norma , Cherry Debra , Mittelman Mary , Satyadev Nihal
Published: December 2021

Generation Z, those who are born in 1997 or thereafter, account for six percent of the estimated 53 million family caregivers in the US – and this percentage is growing, especially given the health impacts of the pandemic. This review focuses on caregiving youth (ages 0-18) and young adult caregivers (ages 18-25) who assist household members who need regular assistance with ADLs and IADLs. This presentation will analyze key trends in the literature of this demographic and identify gaps in research. Our review broadens the knowledge base of how caregiving done by this population impacts brain development, and hence their long term physical, emotional, and mental health. In spite of the significant number of caregiving youth and young adults, current publications on these demographics remain sparse, with most studies being conducted on spousal and adult caregivers. Our group found that the existing literature reviewed the adverse implications on the health and education outcomes for young adult caregivers. This included increased anxiety/depression compared to non-caregivers and for those in post-secondary education, the contribution of caregiving to college incompletion. There are no known studies on this population who have entered the workforce and who also continue their caregiving role. Adequate understanding and characterization of caregiving youth and young adult caregivers will inform better interventions and future policy for them. Support for this demographic, in turn, may improve health outcomes for older adults, who are the majority of those in their care.
Innovations on Dementia Advocacy among Students of a Medical University in Taiwan
Authors: Kuo Tsuann
Published: December 2021

In 2017, Taiwan established Dementia Action Plans 2.0 to respond to the World Health Organization's call to increase dementia awareness and support for dementia carers. However, efforts have not yet been made to educate and increase dementia literacy on the younger generations. This paper addressed the outcomes to increase knowledge and information about dementia and caregiver resources to university students. 93 students participated in a two-day workshop on dementia literacy, followed by two months of advocacy in Taichung City, Taiwan. Students were divided into 14 advocacy groups and the outcome reports were categorized qualitatively using content analysis. The results showed that students were from nine departments and over one-quarter having a dementia loved one in the family. Four innovative categories were developed, including (1) dementia literacy for students and the public; (2) dementia friendly action plans; (3) dementia caregiver’s advocacy and (4) reducing dementia stereotypes. Highlights included students using social media to promote dementia literacy, face-to-face experiences to inform public education, dementia education on early onset dementia and using diverse bio-psycho-social angels to evaluate dementia. Students expanded advocacy to many social media, innovations and target areas, including Facebook, Instagram, Google spreadsheet, stickers, postcards, illustration of children’s books and public announcement. This paper revealed that younger generations used many advocacy methods that were thinking outside of the box. In conclusion, dementia is no longer an elder’s business but young adults can bring technological, inter-generational and cultural innovations into fulfilling the goals of Dementia Global Action Plans.
PPA Tele-Savvy: Developing an Online Intervention with Caregivers of Persons with Primary Progressive Aphasia
Authors: Morhardt Darby , Roberts Angela , Penn Alyssa , Lindauer Allison , Rogalski Emily , Weintraub Sandra , Hepburn Kenneth
Published: December 2021

Primary progressive aphasia (PPA) typically results from a neurodegenerative disease such as frontotemporal lobar degeneration or Alzheimer’s disease and is characterized by a progressive loss of specific language functions with relative sparing of other cognitive domains until later stages when widespread cognitive decline consistent with generalized dementia is more prevalent. PPA tends to appear earlier than most dementias, in late middle-age, and can result in a high degree of psychological and economic burden for the family. Thematic analysis of PPA caregiver studies reveal families are learning to adapt to not only declining language across communicative contexts and domains, but concomitant behavioral, social communication and personality changes over time. While there are several evidence-based dementia caregiver interventions, none are specifically designed for the PPA family caregiver. This pilot project, funded by the Emory University Roybal Center is the adaptation of an evidence-based on-line psychoeducation program (Tele-Savvy) to address the unique challenges facing informal caregivers of those living with PPA and to help these caregivers achieve mastery within this context. PPA caregivers have been engaged through focus groups to identify their most pressing caregiving challenges and how the existing Tele-Savvy curriculum should be adapted to meet their needs. Synchronous and asynchronous video modules have been designed to address: PPA education, the impact on dyadic connection and caregiving challenges and communication strategies specific to PPA. The Tele-Savvy central processes of coaching and de-briefing will also be pilot tested and refined.
Frailty and Functional Status improvement after Skilled Nursing Facility based Post-Acute Care
Authors: Shi Sandra , Olivieri-Mui Brianne , McCarthy Ellen , Kim Dae Hyun
Published: December 2021

People admitted to a skilled nursing facility (SNF) for post-acute care undergo comprehensive evaluation and rehabilitation, potentially enabling prediction of future functional recovery. We identified the first SNF admission per beneficiary (n=250,159) between 07/01/2014 – 06/30/2016 in a 5% Medicare sample, using the Minimum Data Set (MDS) and the Outcome and Assessment Information Set (OASIS). Episodes were excluded for non-community discharge (n=43,397) or no OASIS admission assessment within 14 days of SNF discharge (n=77,989). A deficit accumulation Frailty Index (FI) was measured on admission MDS assessment and categorized into robust (MDS-FI<0.15), pre-frailty (MDS-FI0.15-0.24), mild frailty (MDS-FI0.25-0.34), and moderate or worse frailty (MDS-FI≥0.35). Outcomes were functional decline obtained from OASIS, readmission, or death after initiation of home care. Functional status was measured by activities of daily living from OASIS assessments. A total of 135,310 SNF episodes were matched to OASIS episodes. Of these, there were 6,472 (4.8%) robust patients, 38,923 (28.8%) pre-frail, 63,727 (47.1%) mildly frail and 26,053 (19.3%) moderately frail or worse. In a logistic regression after adjustment for OASIS admission function, compared to robust status, frailty was associated with hospital readmission or death within 30 days of OASIS admission, (mild frailty OR1.33 [95%CI 1.23-1.45] and moderate or worse OR1.81 [95%CI 1.66-1.97]). Frailty was also associated with functional decline at OASIS discharge, after adjustment for OASIS admission function (mild frailty OR1.50 [95%CI 1.38-1.63] and moderate or worse OR2.30 [95%CI 2.11-2.50]). Among those discharged from SNF with home services, a SNF-based MDS-FI is associated with increased likelihood of poor community outcomes.
Physical Frailty is Correlated with Worse Quality of Life in Older Adults with Hypertension
Authors: Liu Pan , Zhang Yaxin , Li Shijie , Li Ying , Chen Yumeng , Zhao Ou , Li Yun , Ma Lina
Published: December 2021

Background: Hypertension is one of the commonest chronic cardiovascular diseases in older adults. Frailty and hypertension often coexist in older people, but few studies have explored frailty in older hypertensive adults. We aimed to explore the correlation of frailty with quality of life in older hypertensive adults. Method: We enrolled 291 patients with hypertension aged ≥60 years. Ambulatory blood pressure monitor was performed. Physical frailty was assessed by Fried phenotype. Quality of life was assessed by SF-36. Results: Forty-eight (16.5%) patients were frail. Compared with non-frail older hypertensive patients, frail patients were older, had lower education levels, a higher rate of living alone, and a longer duration of hypertension. Moreover, they had lower diastolic blood pressure (DBP) and mean arterial pressure (MAP), and higher pulse pressure, more chronic diseases, a higher proportion of calcium channel blockers (CCBs) usage, and worse quality of life. Frailty scores were positively correlated with pulse pressure, and negatively correlated with DBP and MAP. The SF-36 score was negatively correlated with frailty scores and positively correlated with grip strength and walking speed. After adjusting for age, the SF-36 score was negatively correlated with frailty and positively correlated with walking speed. Frailty, when adjusted for age, duration of hypertension, DBP and comorbidity, had a significant effect on the SF-36 score. Conclusion: Frailty was associated with worse quality of life of older adults with hypertension. Frailty prevention and intervention may help improve the quality of life of older hypertensive adults. Keywords: frailty, older adults, hypertension, quality of life
Skeletal Muscle Quality Of Nonagenarians And Centenarians
Authors: Miljkovic Iva , Sterczala Adam , Barinas-Mitchell Emma , Cvejkus Ryan , Feitosa Mary , Thyagarajan Bharat , Wojczynski Mary , Zmuda Joseph
Published: December 2021

Skeletal muscle adipose tissue infiltration is hypothesized to lead to poorer muscle quality and function with aging. Indeed, skeletal muscle adiposity has emerged as a consistent, independent predictor of skeletal muscle strength, mobility, metabolic disorders, and survival among older adults. However, phenotypic features of skeletal muscle among the oldest-old remain poorly characterized. Herein, we evaluated the skeletal muscle characteristics of 54 nonagenarians and centenarians (mean age 98 years, range 90-110 years; 63% women) and 25 middle-aged individuals (mean age 54 years, range 40-59 years; 36% women) belonging to the Long Life Family Study (LLFS), an international, multicenter cohort of families with a clustering of longevity. Ultrasonography was used to measure echo intensity of the sternocleidomastoid muscle, which has a similar fiber type distribution to the rectus femoris. Greater echo intensity is indicative of lower muscle quality (greater adipose and fibrotic tissue). Current smoking, alcohol intake, and BMI were similar between the age groups. Nonagenarians and centenarians had lower grip strength (16.3 vs. 39 kg) and were less physically active (22.2% vs 66.7% exercised 1+ times per week) compared to younger individuals (P<0.001 for all). Mean±SE echo intensity, adjusted for gender, field center, BMI and physical activity was 52.1±1.7 among nonagenarians and centenarians compared to 44.2±2.4 among younger individuals (P=0.0098). Our preliminary findings suggest that nonagenarians and centenarians may have substantially lower skeletal muscle quality and strength compared to their younger aged counterparts. Additional research is needed to better understand the mechanisms leading to poorer muscle characteristics of the oldest-old.
Appendicular Lean Mass Loss Does Not Impact Physical Performance Change During Caloric Restriction in Older Adults
Authors: Beavers Daniel , Miller Ryan , Beavers Kristen , Nicklas Barbara
Published: December 2021

Data from 11 six-month randomized controlled trials were pooled, with 902 participants randomized to caloric restriction (CR; n=762) or Non-CR (n=140) to determine if CR-induced appendicular lean mass (ALM) loss was associated with change in physical performance among older adults. After adjusting for age, sex, race, body mass index, exercise assignment and baseline value of the outcome, CR had significant ALM loss [-0.77 kg (95% CI: -0.89, -0.65)], while Non-CR had ALM gain [+0.28 kg (0.08, 0.49)]; p<0.001. Both groups experienced similar improvements in the Short Physical Performance Battery (SPPB) score [CR: +0.45 (0.35, 0.55) vs Non-CR: +0.50 (0.30, 0.69); p=0.63] and sit-to-stand time [CR: -1.42 s (-1.81, -1.03) vs Non-CR: -1.85 s (-2.49, -1.21); p=0.19]. Change in SPPB score and sit-to-stand time was not associated with change in ALM (both p>0.15). In spite of significant ALM loss, CR resulted in overall improvements in physical performance in older adults.
Geriatric Knowledge Gaps of Community-Based Providers: A National Study of Asked Questions
Authors: Lindquist Lee , Madore Aylin , Miller Stephanie , Kerr Alice , Bradley Sara
Published: December 2021

Primary care providers (PCP) - internists, family practitioners, nurse practitioners, physician assistants - play an integral role in the care of older adults, although many receive limited geriatrics education. We sought to examine what questions community-based PCPs had about geriatrics and clinical care of older adults. As part of large clinical continuing medical education (CME) conferences across 12 states (FL,GA,CA,IL,NY,MA,DC, PA,AZ,TX,TN,WA), PCPs attended a live in-person 60-minute geriatrics-focused lecture and entered questions into a mobile application. Questions were then qualitatively analyzed using constant-comparison and tie-break methodology. At all sites, 103 questions were asked with 158 upticks (PCPs could check off that they had similar question) with a range of 3-18 questions per lecture. PCPs asked questions on the following common themes: 1.) Medication-related (e.g. discontinuing medicines in asymptomatic patients, optimizing pain relief), 2.) Dementia (e.g. prevention, nutraceuticals, agitation) 3.) Medicare Coding 4.) Falls 5.) Weight loss, and 6.) Insomnia. There were a number of questions referencing incorrect practices (e.g. prescribing inappropriate medications such as benzodiazepines for sleep, placement of gastric tubes in late-stage dementia, antibiotics to treat asymptomatic bacteria). In conclusion, community-based PCPs nationally experience gaps in geriatric knowledge and several utilize practices that could jeopardize older adult health. While attending CME-based lectures is one means of overcoming these gaps, some PCPs may not find time or realize geriatrics as an educational need. PCPs need to be better supported with opportunities to ask geriatric care-related questions in order to improve the care of older adults.
Using the 4 M of the Age Friendly Health System to improve MIPS documentation in Primary care: A Feasibility study
Authors: Tewary Sweta , Kruszynski Denise , Pandya Naushira , Cook Nicole , Damier Sashah , Twahir Assma
Published: December 2021

Age Friendly Health Systems (AFHS) commit to evidence-based, low-risk, coordinated care that is centered on what matters most to older adults, their families and caregivers. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) has partnered with multiple primary care clinics to provide dedicated AFHS training and support to increase AFHS transformation in Broward and Miami-Dade Counties. As part of the initiative, SFGWEP provide didactic training, clinic on-site brief demonstration, and infographic guidance for EHR documentation. NSU SFGWEP activities are conducted through training surveys, provider feedback, and e-clinical measures that align with CMS MIPS measures. Three participating health systems report annually on seven e-clinical measures that, collectively, provide indicators of the 4Ms of AFHS (what matters, medication management, mentation and mobility.) From baseline to Year 1, NSU SFGWEP saw improvement in controlled hypertension (54% to 94%), opioid screening (<1% to 11%), advance care planning (21% to 35%) and falls risk assessment (45% to 59%). Results demonstrate the need to continue and expand AFHS interventions for sustainability. In Year 2, SFGWEP will continue to expand awareness of best practices and benefits of the AFHS through education and training at NSU and at the various primary care sites. As mutual collaboration and implementation methods are shared among participating members, the expectation is that quality healthcare of our elder community adults will measurably improve.
Age, Sex, and Cerebral Microbleeds Affect White Matter Integrity Across Adulthood After Mild Traumatic Brain Injury
Authors: Robles David , Dharani Ammar , Chaudhari Nikhil , Rostowsky Kenneth , Wehbe Layal , Ha Michelle , Ngo Van , Irimia Andrei
Published: December 2021

The contributions of age, sex, and cerebral microbleeds (CMBs) to WM changes after mild traumatic brain injury (mTBI) have not been studied. We used diffusion tensor imaging (DTI) to map WM fractional anisotropy (FA) changes across the first ~6 months post-mTBI in 109 subjects aged 18-77 (46 females; age µ: 40 y, σ: 17 y) imaged within ~1 week post-injury and ~6 months later. After partialing out age, sex, and CMB counts, significant mean FA decreases were found in the anterior body, posterior body, and splenium of the corpus callosum (CC; p = 0.003, 0.009 and 0.015, respectively), left superficial frontal fasciculus (p = 0.008), and left branch of the corticospinal tract (CST; p = 0.007). Age contributed to mean FAs measured acutely in the CC body (p = 0.04), and chronically in the CC genu (p < 0.001), CC body (p = 0.01), and middle longitudinal fasciculi (p = 0.04), older adults exhibiting larger decreases. CMB counts were positively associated with mean FA decreases in the CC body (p = 0.04) and middle longitudinal fasciculi (p = 0.04). Significant age-by-sex and CMB count-by-age interactions mediated FA decreases in the CC genu (p = 0.02 and p = 0.03, respectively), older males exhibiting larger decreases. Thus, the CC, longitudinal fasciculi, superficial frontal WM and CST are particularly vulnerable to post-traumatic neurodegeneration moderated by age, sex and CMB count, men and older adults being at highest risk for adverse effects. Future research should investigate our findings relative to cognitive function.
Centenarians in the Global South: A View from Ethiopia
Authors: Chane Samson , Adamek Margaret
Published: December 2021

As global aging advances, the number of centenarians worldwide is greatly increasing. Most of what is known about centenarians comes the Global North. It is not clear what factors contribute to longevity of centenarians in impoverished, mostly rural areas of Global South nations that still lack basic amenities. Cultural differences in the profile, lifestyles, and needs of centenarians in Africa have yet to be documented. Using a case study design, this descriptive inquiry investigated the profiles of centenarians in Ethiopia including religion, marriage, education, occupation, income, and living arrangement. Data were generated through in-depth interviews with nine centenarians (1 woman, 8 men) and were analyzed using descriptive narrative analysis. Respondents were between 100 and 108 years old. All nine were adherents of Orthodox Christianity, had been married, and were great-grandparents. Their adult lives were marked by both residential and marital stability. The Ethiopian centenarians persevered through many losses and hardships with the help of strong community-based social networks. Unlike studies of centenarians in the Global North, most respondents were male and had strict religious upbringings. Understanding the unique profiles of centenarians in the Global South will help to inform research and practice with this growing population of the oldest-old.
Understanding Global Deprescribing Policy: Opportunities and Challenges
Authors: Kim Catherine , Thompson Allison , Kim Grace , Marcum Zachary , Keller Michelle , Sorensen Andrea , Brandt Nicole
Published: December 2021

The landscape of deprescribing, the planned process of dose reduction or stoppage for medications which are no longer of benefit, has been rapidly expanding with global efforts and the formation of regional and national deprescribing networks. The purpose of this qualitative study is to describe successes and challenges about deprescribing from thought-leaders across the world to inform future policy initiatives. We aim to conduct at least 15 key informant (KI) interviews; we have completed 13 to date. Codes were constructed to identify themes that depict the perspectives regarding deprescribing policy across the globe. The KIs primarily represent the fields of pharmacy and medicine from four global regions with years of deprescribing experience ranging from 5 to > 20. We identified two emerging overarching themes through our qualitative analysis: Regional Organization Support and Evidence & Knowledge gaps. Within these overarching themes, we further identified sub-themes and their representative quotes: Network Structure: “idea of the network was threefold: 1) To try and figure out what we need to activate healthcare providers to deprescribe; 2) To do work with community-dwelling seniors to motivate them and give them opportunities to deprescribe; 3) ...getting pharmacists to provide the education to the patients.” Cost-effectiveness: “If we can show that it is cost-effective to deprescribe, that there is actually a return here, not just in health terms but in monetary terms, I think that would really push it along.” This research will help to advance global efforts to optimize medication management.
Is Age Just a Number? Influence of Caregiver Age on Injuries of Children Raised by Grandparents
Authors: Lopez Acacia , Scott Rachel , Nadorff Danielle
Published: December 2021

Unintentional injuries are the most common cause of death for children in the United States. One factor linked to their occurrence is parenting style (i.e., a collection of factors such as physical health, mental health, and possible cohort differences in parenting role expectations). Differences in parenting behaviors may be evident in grandparents caring for their grandchildren, due to cohort differences and age-related declines in cognitive and physiological processes. This may impact their abilities to monitor, supervise, and respond to children. Further, Hayslip & Kaminski report custodial grandparents are less likely than parents to understand and respond to the psychological and emotional needs of children but are more likely to enforce discipline. This study sought to explore the ways in which parenting styles are associated with unintentional injury behaviors in children (via caregiver age) for grandchildren raised by grandparents. Participants were grandparents raising their grandchildren, recruited via Qualtrics Panel Service (N = 323). Conditional process analyses were conducted using Model 1 of SPSS PROCESSv3.5. Age moderated the relation between consistency of discipline and child unintentional injury (F (1, 231) = 12.67, p <.001) as well as level of supervision and child unintentional injury (F (1,146) = 6.23, p = .01). Age did not moderate the relation between positive parenting and unintentional injuries. These results imply that children being raised by older grandparents were especially at risk for increased injuries when their grandparents used less consistent discipline or lower rates of supervision. Pathways are suggested for age-specific psychoeducation interventions for custodial grandparents.
Using Life Story Techniques with Diverse Communities: Lessons Learned from a Focus Group Study
Authors: Wilk Christa , Cordell Ashlee , Orsulic-Jeras Silvia , Powers Sara , Ejaz Farida , Sanders Lisbeth
Published: December 2021

Providing high quality, cost-effective dementia care remains a major health challenge. Life story work, used in residential care settings, helps engage persons living with dementia (PWD) at a low cost with minimal staff burden. LifeBio, one such intervention, is designed to elicit life history data and care preference information through comprehensive life story interviews. LifeBio Memory, an adaptation of LifeBio, utilizes novel speech-to-text technology to process life story data more efficiently. Seven focus groups were conducted to evaluate the acceptability and feasibility of LifeBio Memory. Three types of focus groups were held (n=35) and audio recorded: 1) One group of early-stage PWDs (n=5); 2) Two groups of current and former users of original LifeBio (n = 12); and 3) Four groups of residential care staff and directors (n=18). Sessions were transcribed and thematic analyses were conducted. Findings indicated high levels of acceptability and feasibility of LifeBio Memory. Further, a secondary theme emerged signaling the need to prioritize the emotional safety of PWDs participating in life story work. This poster will discuss: 1) the life story interview process, 2) identifying PWDs who would most benefit from a life story program, 3) involving family and staff care partners to identify sensitive topics, 4) interview question design, selection and order, and 5) expanding life story work across diverse communities. Discussion will highlight the importance of protecting the emotional well-being of marginalized communities by identifying potential underlying traumas that could impact the safe delivery of otherwise effective life story interventions.
Multiple Streams Analysis of the Long-Term Care Insurance in South Korea: Understanding Policy Changes (2008 - 2014)
Authors: Jeong Mijin
Published: December 2021

The Long-Term Care Insurance (LTCI) Act in South Korea was enacted in 2008 to improve the quality of life of older adults by promoting better health and to mitigate the burden of care on family members. In 2014, the Enforcement Decree for the LTCI Act was revised to broaden criteria for eligible recipients of LTCI-related services and care. This policy analysis seeks to explore the political circumstances under which the Act was formed and how social environmental factors had evolved to revise the LTCI Act using a multiple streams policy analysis framework. A combination of factors influenced the status of LTCI policy agenda, including shifts in aged demographic structure and increasing medical expenditures. From the Korean National Dementia Plan, a pilot project of dementia care was conducting to prove the efficiency of dementia care service. While the Korean Senior Citizens Association (KSCA) was less successful gaining press attention around dementia care, the presidential election and candidates’ election pledges were key factors to suddenly open the opportunity to extend the recipients for dementia care. The process through which the LTCI Act was revised and expanded showed the importance of the political environment associated with the election. Based on the recognition of LTIC policy agenda and already testing the efficiency of dementia care services, the election leaded to revision of LTCI Act and it quickly diffused by the new administration. From the revision of LTCI, international policymakers and scholars should recognize how the political events might use the policy for older adutls.
The Influence of COVID-19 on Retirement and Longevity Planning: A Multigenerational Perspective
Authors: Miller Julie , Raue Martina , D'Ambrosio Lisa
Published: December 2021

For many, the COVID-19 pandemic has painted a new economic picture of longevity. Results from the series demonstrated that younger generations surveyed—Gen Xers, Millennials, and Zoomers— generally reported elevated levels of worry about how the pandemic would affect their long-term finances. Baby Boomers, by comparison, evinced significantly less worry. And, although the pandemic has had a disproportionate economic impact on lower-income individuals, a higher income did not appear to confer freedom from worry. When it comes to planning for longevity, worry can be paralyzing. Zoomers were the generation most likely to agree that the future is too uncertain for them to even think about planning financially for retirement, and this sentiment applied for other generations as well. This presentation will also describe other ways in which the COVID-19 pandemic had influenced respondents’ perceived longevity preparedness and attitudes across a variety of demographic and socio-economic characteristics.
Effects of Participating in a Volunteer Driving Program on Mental Health in Service Recipients and Volunteers
Authors: Tomita Machiko , Bhattacharjya Sutanuka
Published: December 2021

Objectives: To assess the effects of a volunteer transportation program on mental health in riders and volunteers. Methods: A cross-sectional study (N=133, age ≥60) compared pre- and existing (≥2 years) riders, pre- and existing (≥2 years) volunteer drivers, and riders (Rs) and pre-volunteers (PreVs), representing general older adults. The cohorts belonged to a large, community volunteer organization. Outcome measures, depression and quality of life, were analyzed using ANCOVA. Percentages of people who wanted to go to specific destinations with available transportation were identified for pre-riders (PreRs) and Rs. Results: Rs had better depression scores (p<.001), no longer exhibited depressive symptoms (p=.005), and were better in quality of life (p=.002) than PreRs. Rs were similar to PreVs. PreRs’ major needs were going to medically related places (doctors’ offices – 74.4%, drug stores - 44.2%, hospitals – 37.2%) and basic living (grocery – 60.5%, clothing -37.2%). In Rs, these had significantly lowered, but still 40% wanted to go to doctors’ offices and 30%, grocery stores. Volunteer driver's (Vs)' depression (p=.009), health (p=.006), and social relationships (p=.004) were significantly better than PreVs'. Discussion: Although the use of free transportation up to four times a month may not be enough to improve perceived health for Rs, it was beneficial to prevent depression and increase quality of life. Since many PreVs were doing volunteer work other than driving, the type of volunteer work matters. Regularly helping people, in person, with their core needs for living resulted in positive outcomes for Vs.