bluuebunny/crossref_metadata_2025 huggingface dataset:
Salivary Cortisol Patterns in People Living With Dementia
Authors: Petrovsky Darina , Dong Fanghong , Huang Liming , Aryal Subhash , Perez G Adriana , Hodgson Nancy
Published: December 2021

Salivary cortisol has a well-documented circadian pattern in older adults. Yet, the pattern of salivary cortisol in persons living with dementia (PLWD) due to circadian rhythm disturbances is unknown. This study examined diurnal salivary cortisol patterns in 176 PLWD (mean age 73.6±8.8, 33.3% male, clinical dementia rating >=0.5) by collecting saliva at waking (AM1), 30 minutes after waking (AM2) and bedtime (PM) over two consecutive days. Cortisol awakening response (CAR) was calculated as the change between AM2 and AM1 cortisol levels. The mean baseline salivary cortisol levels (ug/dl) were 0.35 (SD:0.3) at AM1, 0.40 (SD:0.39) at AM2, and 0.19 (SD:0.4) at PM. On average, cortisol levels decreased from morning to evening, with 58% exhibiting a positive CAR (mean 0.05; SD:0.34). There were no significant associations between cortisol levels with age, sex, obesity, and comorbidities. The findings demonstrated that diurnal cortisol rhythms are maintained in PLWD with a flattened CAR.
Sensory Impairment and Beta-Amyloid Deposition in the Baltimore Longitudinal Study of Aging
Authors: Armstrong Nicole , Cai Yurun , Wang Hang , Schrack Jennifer , Agrawal Yuri , Simonsick Eleanor , Resnick Susan
Published: December 2021

Studies have demonstrated a link between sensory impairment and dementia risk, but little is known about the presence of beta-amyloid plaques in individuals with single and multisensory impairments. Sensory function (combinations of vision, hearing, vestibular function, and proprioception) and amyloid PET imaging were measured in 170 BLSA participants (age=78± 9 years; 53% women; 77% white; 28% amyloid positive) from 2012 to 2019. Log-binomial regression models were used to examine the prevalence ratios (PR) of amyloid positivity for individual sensory impairments and across categories of impairments. While crude associations indicate associations of vision impairment (PR=1.72, p=0.04) and impairments in all four senses (PR=2.38, p=0.03) with amyloid positivity, these associations were insignificant after adjusting for age, sex, race, and education. There were no other crude and adjusted associations. These results suggest sensory impairments may be related to dementia independent of AD pathology. Future studies with larger sample sizes are warranted.
How Has COVID-19 Impacted Older Adults and Their Needs for Services?
Authors: Bayne Alycia , Kennedy Mallory , Alvarez Emily , Wright Bernadette , Theilheimer Lucy , Benz Jennifer
Published: December 2021

COVID-19 has had profound effects on older adults and will have lasting impacts on their preferences and needs for services, including those offered by Meals on Wheels and other community organizations. Organizations serving older adults would benefit from insights about how to prioritize resources and services to address older adults’ needs during the pandemic and beyond. On behalf of Meals on Wheels America, NORC at the University of Chicago conducted a study to explore COVID-19’s impacts on older adults and older adults’ needs during the pandemic. We conducted two data collection activities with adults age 60 and older: a nationally representative survey with 1,535 respondents and 24 interviews. Results indicated that COVID-19 has affected older adults’ physical and mental health, social connectedness, employment, and use of services and technology. Informal networks of family members and friends are a source of assistance for 50% of older adults during the pandemic. Impacts of COVID-19 differed by income, rurality, disability status, and living situation. Findings documented the extent to which older adults had unmet needs during the pandemic, such as activities to help keep busy at home and affordable food to meet dietary needs. Survey respondents who have a lower income, are 75 and older, live alone, and who are Black were more likely to have unmet needs. Findings suggested a need to strengthen partnerships among organizations that serve older adults to address diverse needs, conduct ongoing assessments of older adults’ needs and preferences, and enhance assistance for informal support networks.
Depression and Age-Related Changes in Body Composition, Cardiovascular Function, Grip Strength, and Lung Function
Authors: Mutz Julian , Lewis Cathryn
Published: December 2021

Individuals with mental disorders, on average, die prematurely, have higher levels of physical comorbidities and may experience accelerated ageing. In individuals with lifetime depression and healthy controls, we examined associations between age and multiple physiological measures. The UK Biobank study recruited >500,000 participants, aged 37-73, between 2006–2010. Generalised additive models were used to examine associations between age and grip strength, cardiovascular function, body composition, lung function and bone mineral density. Analyses were conducted separately in males and females with depression compared to healthy controls. Analytical samples included up to 342,393 adults (mean age = 55.87 years; 52.61% females). We found statistically significant differences between individuals with depression and healthy controls for most physiological measures, with standardised mean differences between -0.145 and 0.156. There was some evidence that age-related changes in body composition, cardiovascular function, lung function and heel bone mineral density followed different trajectories in individuals with depression. These differences did not uniformly narrow or widen with age. For example, BMI in female cases was 1.1 kg/m2 higher at age 40 and this difference narrowed to 0.4 kg/m2 at age 70. In males, systolic blood pressure was 1 mmHg lower in cases at age 45 and this difference widened to 2.5 mmHg at age 65. Individuals with depression differed from healthy controls across a broad range of physiological measures. Differences in ageing trajectories differed by sex and were not uniform across physiological measures, with evidence of both age-related narrowing and widening of case-control differences.
The Kynurenine Pathway Metabolites QA and KYNA induce senescence in Bone Marrow Stem Cells through the AhR Pathway
Authors: Kondrikov Dmitry , Elmansi Ahmed , Shi Xing-ming , McGee-Lawrence Meghan , Fulzele Sadanand , Hamrick Mark , Isales Carlos , Hill William
Published: December 2021

Cell senescence is emerging as a critical factor in the pathophysiology of aging bone loss. We have shown that the essential amino acid tryptophan is metabolized by IDO-1 in the periphery to generate kynurenine (KYN), and that KYN can signal though the aryl hydrocarbon receptor (AhR) transcription factor pathway to inhibit osteogenesis in bone marrow MSCs via epigenetic regulation of osteogenic genes, while also upregulating osteoclastogenic transcription factors and genes driving osteoclast activity. Further, we recently showed that KYN acting via AhR inhibits MSC autophagy while inducing senescence. Here we demonstrate that KYN metabolites downstream from KYN act via the AhR signaling pathway to inhibit autophagy and induce SASP expression and drive senescence in murine and human bone marrow MSCs. We focused on two of these metabolites, quinolinic acid (QA) and kynurenic acid (KYNA) and investigated their effects on BMSC cellular function. We demonstrated that both kynurenine pathway metabolites QA and KYNA increase biomarkers for senescence including beta-galactosidase, p21/Cdkn1 and other SASPs such as PAI-1 and TIMP-2, as well as nuclear DNA damage leading to senescent markers like H2A Ser139 phosphorylation, and the accumulation of senescence-associated hetero chromatin foci (SAHF) with H3K9-me3 labeling. Then upon treatment with the AhR inhibitor 3’4’-DMF the disruption of autophagy and induction of senescent biomarkers was blocked. Like KYN, the effects of QA and KYNA were mediated through the AhR receptor. Therefore, this presents novel therapeutic targets linked to KYN metabolite signaling via AhR to prevent senescence and bone loss.
Reasoning About Life Transitions in Relation to Perceived Housing: In-Depth Data From Sweden
Authors: Eriksson Erik , Schmidt Steven , Kylén Maya
Published: December 2021

The accessibility and suitability of housing to improve health and well-being for the growing share of older adults in the population has important policy implications. Yet, current housing policies tend to neglect the heterogeneity of older adults housing needs which vary across age, health, and personal preferences. Little is known about how life transitions in combination with perceived housing relates to good aging. This qualitative study aims to explore the relationship between perceived housing, life transitions, well-being, health, and participation in older age. Participants were community-dwelling and aged 65-75 years. All participants reported multiple transitions considered as important for the way they viewed their housing situation and social relationships as well as for the choices they made around their housing. The findings from this project may be used to develop health promotion programs that proactively support housing decisions along the process of ageing and enable full participation in society.
How Is Daily Social Interaction Related to Loneliness in Older Adults? The Roles of Trait Loneliness and Personality.
Authors: Zhaoyang Ruixue , Scott Stacey , Harrington Karra , Sliwinski Martin
Published: December 2021

Loneliness is prevalent among older adults and is associated with increased risks for morbidity and mortality. This study examined what types of social interactions could reduce loneliness for older adults and who would benefit the most from social interactions. We used data from 312 community-dwelling older adults (aged 70 to 90 years) who completed ecological momentary assessments (EMA) five times a day for 16 consecutive days using smartphones (n=20,507 reports), as part of the ongoing Einstein Aging Study (EAS). At each EMA, participants reported their social interactions in the past 3 to 4 hours and their current feelings of loneliness. Results from multilevel models revealed that older adults reported lower levels of loneliness on occasions when they had pleasant social interactions (p<.000) or interactions with family (p=.001) in the past few hours, compared with occasions when they had no social interaction. In contrast, they reported higher levels of loneliness if they had unpleasant social interactions in the past few hours (p=.004). These within-person (WP) effects of social interactions on momentary loneliness were significantly moderated by participants’ trait levels of loneliness and neuroticism; and were significantly stronger among those with higher (vs. lower) trait loneliness (ps <.001) or neuroticism (ps <.042). Other personality traits (Extraversion, Openness, Conscientiousness, Agreeableness) did not moderate any WP association. These results highlight the importance of having pleasant social interactions and frequent interactions with family for reducing older adults’ loneliness in daily life, especially for those higher in trait loneliness and neuroticism.
Gender, Stress, and Mental Health Among Older African Americans
Authors: Erving Christy
Published: December 2021

Across studies on social stress exposure on the mental health of older African Americans, most investigate singular stress exposures (discrimination). Furthermore, this research rarely assesses gender differences in the psychological effects of specific stress exposures. I use the National Survey of American of Life to assess: (1) gendered patterns of stress exposure among older African Americans; (2) gendered nuances in the individual, collective, and cumulative effects of stress exposure on mental health. I find gender patterns of stress exposure differed by type of stressor. Women and men shared some stress predictors of mental health (everyday discrimination). Other stress predictors were specific to women (health-related mobility challenges) or to men (perceived neighborhood crime). Study findings challenge gerontologists to consider how race-gender groups are at distinct risks for stressors that elicit poor mental health and provide a call for tailored strategies for improving the psychological health of African American women and men.
Reimagining Training During a Pandemic: The Experience of Middle Tennessee GWEP
Authors: Rhodes Shana , Powers James
Published: December 2021

A major component of The Middle Tennessee GWEP involves delivery of an annual regional geriatrics update conference. Formerly in-person, the planning committee transformed the 34th Annual Update Conference to a virtual platform within a six-month period. The University partner provided a Zoom platform with licensing and training of program staff. National marketing was achieved through professional societies and purchased e-mailings. Participants numbered 79, including 8 disciplines. Presenters were instructed on platform techniques including screen sharing, polling function, and breakout rooms to enhance audience participation. REDCap registration captured demographic information and facilitated evaluations and post-attendance intention-to-change surveys. Lessons learned were shared with community partners and advisory board members who demonstrated changes in service delivery models and training of new staff to support care to greater numbers of clients and participants. Virtual platforms can extend outreach for valuable learning and service outcomes and maintain high levels of satisfaction among target audiences.
New Networks, New Connections: Geriatric Student Scholars Embrace Adaptive Learning
Authors: McAtee Robin
Published: December 2021

The Arkansas Geriatric Education Collaborative (AR’s GWEP) embraces, nurtures, and encourages students with a passion for caring for older adults. Each year five geriatric scholars are chosen from across the spectrum of health services schools (MD, RN, PT, PA, Pharm D, dental hygiene, etc.) to enhance their geriatric knowledge and experience. Requirements focus on geriatric academic and community-based opportunities. However, these opportunities drastically changed with the pandemic. Therefore, the students became very innovative as they trudged forward to meet and exceed the scholar objectives. They participated in various virtual events to fulfil their academic and community participation requirements. They worked together to develop and implement an interdisciplinary final project that marketed to and engaged rural isolated older adults in a fun educational event aimed at preventing social isolation in older adults and caregivers. Students learned how to connect to and bridge the digital divide with isolated rural older adults.
Adapting the ADS Plus Program and Study for a Spanish Speaking Population
Authors: Johnson Elma , Marx Katherine , Nkimbeng Manka , Gaugler Joseph , Gitlin Laura , Parker Lauren
Published: December 2021

While Hispanic/Latinos are at increased risk for Alzheimer’s Disease, they are often cited as a “difficult-to-reach population” to engage in community-based research or clinical trials. One reason may be that many community-based supportive interventions for dementia caregivers are not adapted for Spanish-speaking populations. The purpose of this presentation is to describe the process of adapting the Adult Day Services Plus (ADS Plus) program for this population. In addition to translating ADS Plus into Spanish, staff, familiar with the program from four sites, which serve a predominantly Hispanic population, participated in a set of three focus groups that reviewed recruitment and intervention materials. Emerging themes included, Hispanic caregivers do not refer to themselves as caregivers but as the familial relationship (e.g. daughter, son, wife), and Hispanics often view research as a waste of resources. Future studies should consider these cultural elements towards caregiving in developing programs for Spanish-speaking dementia caregivers.
Implementing Dementia Friendly Initiatives in the Community: Perceptions of Stakeholders in the USA and China
Authors: Sun Fei , Kim Ha Neul , Prieto Lucas , Conyers Christian , Opur Fredrika
Published: December 2021

To address the exclusion of persons living with dementia (PWD), Dementia Friendly Initiatives (DFI) are being launched to build a friendly and supportive environment for PWD in the U.S.A, mainland China, and Taiwan. This study aims to identify the impact of DFI, the challenges DFI encountered, and strategies used to address such challenges within the COVID-19 context in American and Chinese societies. Individual interviews via Zoom with 9 stakeholders from the U.S.A, 8 from mainland China and one from Taiwan were transcribed for analyses. DFI have shown effectiveness in raising the public’s dementia awareness and engaging PWD in the community. COVID-19 pandemic posed the challenges of serving isolated PWD due to resources and attention shifted to COVID-19 prevention. Person-centered and technology-based means were used to deliver services for PWD during the pandemic. DFI in American and Chinese societies experienced similar sustainability challenges but showed resilience during the COVID-19 pandemic.
Factors Associated With Engaging in Regular Physical Activity Among Women Family Caregivers
Authors: Keller Abiola
Published: December 2021

Regular physical activity is important for promoting the health of family caregivers. In this study, we used data from the 2015 and 2017 Behavioral Risk Factor Surveillance System Questionnaire-Caregiver module to examine factors associated with meeting physical activity guidelines among women caregivers. Meeting physical activity guidelines was defined as participating in 150 minutes (or vigorous equivalent minutes) of physical activity weekly. We used survey-weighted multivariate regression analyses to examine relationships between sociodemographic, caregiving, and health characteristics and meeting physical activity guidelines. All variables were entered into the model simultaneously. The Wald test was used to test the significance of interactions between race and ethnicity and other covariates. 50.7% of 10,542 women caregivers met physical activity guidelines. The amount of time spent caregiving each week was not associated with the odds of meeting guidelines. Caregivers in the paid workforce had decreased odds (OR=0.73, 95%CI [0.62-0.87]) of meeting guidelines. Compared to women caregiving for <6months, women caregiving for 6 months to 2 years had increased odds of meeting guidelines (OR =1.33, 95%CI [1.08-1.64]). Increasing education was associated with an increased odds of meeting guidelines, but being college educated had a more positive effect for Hispanic than white caregivers (pinteraction=0.03). Having children did not affect the odds of meeting guidelines for white caregivers, but for black caregivers having two or more children decreased the odds (pinteraction=0.03). Understanding how sociodemographic, caregiving, and health characteristics impact engagement in regular physical activity is critical to designing effective interventions and ultimately improving the health of caregivers.
Nursing Home COVID-19 Action Network: Responding With Stress First Aid and Caring for Residents With Dementia
Authors: Caprio Thomas , Ganzel Barbara , Simning Adam
Published: December 2021

The GWEP at the University of Rochester (New York) has an established network of nursing homes participating in Project ECHO. This ECHO hub includes geriatric medicine, psychiatry, pharmacy, aging services network and the Alzheimer’s Association focusing on best practices in geriatric mental health and dementia care. With the COVID-19 pandemic, this infrastructure quickly pivoted to expansion of 80 facilities and the addition of expertise in medical direction, trauma informed care, and infectious disease. A stress first aid training module was developed in partnership with Ithaca College and the National Center for PTSD to support front line nursing home workers. Dementia care experts contributed to practical problem-solving in addressing social isolation and mental health. Work now is focusing on vaccination and how to best support trauma-informed needs of residents with dementia.
What Matters Most: ACP Evolving in Practice
Authors: Valadares Kevin
Published: December 2021

The University of Southern Indiana (USI) GWEP uniquely embeds Area Agencies on Aging (AAA) care coordinators within primary care settings to invite the participation of aging patients in advance care planning (ACP), among other health interventions. Two subsequently developed features of the USI GWEP’s ACP initiative emerged to address the What Matters metric of the 4Ms: 1) Patients are invited to engage in What Matters Most conversations through multiple touchpoints that frame Medicare Wellness Visits with a Deaconess provider and introduce a free, online ACP platform, Prepare for Your Care. 2) Provider, patients and families are supported in having ACP conversations with the dedication of a new Advance Care Planning facilitator position. Certified in Respecting Choices and jointly funded by the GWEP and Deaconess, the ACP facilitator supports individuals in navigating these essential healthcare conversations about balancing quality care with quality of life.
Elderhood, Agency and Existential Vulnerability
Authors: Laceulle H E
Published: December 2021

Popular conceptualizations of elderhood often use a spiritually inspired language of personal growth and wisdom. These conceptualizations are rightly critical of the language of activity and productivity that abounds in dominant successful aging discourses. Instead, the emphasis is placed on embracing our diminishing strength and increasing dependence with an attitude of resignation and gracious acceptance. Problematically, however, this can reinforce the ageist cultural assumption that old age lacks agency. If the emerging discourse about elderhood is truly to serve as a more inspiring cultural image of late life, it requires a reconceptualization of agency in the face of existential vulnerabilities. This paper aims to present a possible philosophical outlook for such a reconceptualization. It will draw on sources from feminist philosophy to argue how confrontations with vulnerability need not be an obstacle, but rather inspire alternative conceptualizations of agency that are a welcome addition to gerontological thinking.
Elderhood as an Anti-Ageism Intervention
Authors: Gendron Tracey , Arnette Shannon , Inker Jenny , Marrs Sarah , McIntyre Maddie , Bert Waters
Published: December 2021

Ageism is a complex, multi-layered phenomenon impacting feelings, thoughts and behaviors toward self and others. Due to the complexity of ageism, evidence-based anti-ageism interventions have proved challenging and costly. To date, using the concept of elderhood as a mechanism to mitigate the negative impacts of ageism has not been explored. As an anti-ageism strategy, elderhood reframes later life as a stage that encompasses growth and development and expected loss and decline. The current study evaluated a brief video intervention among first-year medical students before participating in a year-long senior mentoring program. First-year medical students (N = 585) from 2018-2021 responded to open-ended questions after viewing the video. Thematic analysis revelated four themes: neutrality, elderhood as development, reframing stigma and elderhood as othering. Findings suggest that elderhood may be a viable and productive anti-ageism strategy.
The Effect of Medicaid Enrollment on Family Caregiving
Authors: Jutkowitz Eric , Shewmaker Peter , Lake Derek , Rahman Momotazur
Published: December 2021

Most people with long-term care needs rely on family caregivers. People with long-term care needs are also more likely to be eligible for Medicaid, which is the largest public payer of home and community based long-term care services. Whether enrolling in Medicaid compliments or substitutes for family caregiving is unknown. We linked Health and Retirement Study (HRS) respondents with their Medicaid enrollment data (2002-2012), to determine the effect of enrolling in Medicaid on family caregiving hours. We identified 130 people that participated in the HRS interview prior to enrolling in Medicaid in the same year (i.e., untreated) and 142 people that participated in the HRS interview after recently enrolling in Medicaid (i.e., treated). Untreated and treated respondents had similar demographic characteristics (age, sex, race). We estimated a series of inverse probability weighted linear regression adjusted models to determine the difference in monthly family caregiving hours between individuals that newly enrolled in Medicaid compared to people that had yet to enroll. We controlled for HRS respondents’ demographics, health care utilization, and nursing home utilization. HRS respondents interviewed after enrolling in Medicaid received 5.98 (95%CI: -27.60, 39.57) fewer monthly hours of family caregiving than respondents that had yet to enroll in Medicaid. HRS respondents interviewed after enrolling in Medicaid were not statistically more likely to receive any family caregiving (risk difference 0.05% 95%CI: -0.16, 0.06) than HRS respondents that had yet to enroll in Medicaid. Initial enrollment in Medicaid does not substitute for family caregiving.
How Long-Term Care Quality Assurance Measures Address Dementia in Australia, England, Japan, and the United States
Authors: Lepore Michael , Edvardsson David , Igarashi Ayumi , Meyer Julienne
Published: December 2021

The prevalence of people with dementia living in long-term care (LTC) is high and rising internationally, and the need to improve LTC for people with dementia is widely recognized. In some countries, LTC quality assurance programs use quantitative measures of LTC quality, and international bodies emphasize the importance of person-centered care and healthy ageing outcomes. To better understand how LTC quality assurance programs address dementia, programs were reviewed in four countries—Australia, England, Japan, and the United States. Quality measures from each program were identified (n = 38) and examined to determine how they address dementia. Most measures did not address dementia, but four risk-adjusted for dementia (antipsychotic use, fractures, falls, mobility), one was dementia-specific (dementia/delirium hospitalizations), and one excluded people with dementia (losing bowel/bladder control). The other 32 measures were calculated equally regardless of the prevalence of dementia among LTC residents. Overall, LTC quality measurement differs internationally, but few measures address dementia. When dementia is addressed in quality measure calculations, it is most often as a risk-adjustor. Risk adjustment can help with attributing performance on these measures to the LTC setting rather than to the types of residents that the setting serves, but risk adjustment factors also are highly amenable to fraud, and thus require ongoing monitoring. Although LTC quality assessment programs and measures can help ensure people with dementia have access to quality LTC, adoption of measures that are meaningful to people with dementia—including measures of person-centered care and healthy ageing outcomes—remains needed.
The Academy of Gerontology in Higher Education Perspective
Authors: Howe Judith
Published: December 2021

Chair: Lori Simon-Rusinowitz;Panelists: Representatives of GSA Sections - Phillip Rozario (SRPP), Stephen Helfand (BS), Tamara Baker (BSS), Cynthia Brown (HS), Judith Howe (AGHE), Darina Petrovsky (ESPO); Discussant: Brian Lindberg. This interactive session is an interdisciplinary look at policy issues in aging with the speakers representing views from their sections. This session, organized by the GSA Public Policy Panel, will provide both GSA section leadership and attendees an opportunity to have an open dialogue on important public policy issues of significance in the field of aging. Presentations will likely address the COVID-19 pandemic, how GSA, each section and its members, and the federal government responded during the past year; how the policy work has been influenced by the increased acknowledgement of institutional and societal racism; and member experiences with the influx of additional economic relief, research funding, and funding for aging supports and services programs.
A Multidimensional Construct of Religiosity Among Baby Boomers and Trajectories of Social Attitudes
Authors: Yoon Joonsik , Hwang Woosang , Brown Maria , Silverstein Merril
Published: December 2021

Although a number of studies have examined relationships between religiosity and social attitudes, less is known about how these relationships change over the life course using a multidimensional construct of religiosity among Baby Boomers. A multidimensional construct of religion allowed us to take a more person-centered approach to religiosity, whereby we examine the association between Baby Boomers with different types of religiosity and the trajectories of their political and gender role attitudes over a period of transition from early to later adulthood. We selected 798 young-adult Baby Boomers from the 1971 wave (mean age: 19 years) of the Longitudinal Study of Generations (LOSG) and tracked their political and gender role attitudes through until the 2016 wave (mean age: 64 years). Using latent class analysis, we identified four latent religious typologies: strongly religious, weakly religious, liberally religious, and privately religious. We found that Baby Boomers in the strongly religious class reported the most conservative political and gender role attitudes among the four classes over this period of transition. Baby Boomers in the privately religious class were conservative in their political and gender role attitudes than those in the weakly religious class. The liberally religious group generally reported the second most conservative political attitudes among the four identified groups, but reported the least conservative gender role attitudes of the four groups. Findings suggest that early religiosity may serve as a significant predictor affecting political and gender role attitudes throughout the adult life course.
The Occupational Narratives of Older Adults Participating in Music-Based Occupations
Authors: Cleveland Penelope Moyers , Beckstein Kassidy , Gartner Allie , Hay Lexy , King Mackenzie , McLeish Sammy , Romatz Courtney
Published: December 2021

The purpose of this study was to implement an occupational therapy intervention that could be used for telehealth services with an emphasis on participants learning ways to independently choose and sustain engagement in meaningful music activities, known as occupations. The researchers’ aim was to examine how music occupation interventions lower risks of occupational deprivation (i.e., prolonged restriction from participation in necessary or meaningful activities) that could occur due to the COVID-19 pandemic. Eight adults participated who were 65 years or older, lived in the community, and enjoyed music. The researchers used narrative qualitative methodology to analyze pre- and post-intervention focus group data. The participants completed seven intervention sessions designed to increase and sustain music engagement outside of the sessions. The pre-intervention focus group data resulted in an occupational pattern analysis and a single occupational narrative. Triangulation of data post-intervention included the two focus groups and their pattern analyses and narratives, field notes from each intervention session, and documents produced through group completion. The final analysis produced an occupational change pattern analysis and narrative. The focus of the change narrative was on the participant’s management or prevention of occupational deprivation. The researchers identified several common themes involving change in routines and habits to include regular engagement in meaningful music activities, skills for using occupational participation as an important method of coping with COVID-19, and developing new technological skills to access music to replace in-person participation of attending live concerts and shows when deemed unsafe because of potential for virus transmission.
Long-Term Cognitive Effects From a Real-World Multi-Skill Learning Intervention in Older Adults
Authors: Ferguson Leah , Sain Debaleena , Kürüm Esra , Strickland-Hughes Carla , Rebok George , Wu Rachel
Published: December 2021

Previous cognitive learning interventions have focused primarily on learning one or two novel real-world skills at a time, or utilizing computer-based programs to enhance specific cognitive skills (Ball et. al 2002; Park et. al, 2014). While these studies yielded immediate cognitive improvements in participants, the long-term benefits of continuing to learn several real-world skills in older adulthood is unclear. In the present two studies, the long-term (1-year post-intervention) benefits of a multi-skill learning intervention were investigated with older adult participants. Study 1 (a pilot sample) included 6 participants (67% female, M = 66.33 years, SD = 6.41, range = 58–74 years old) and Study 2 included 27 participants (67% female, M = 69.44 years, SD= 7.12, range = 58–86 years old). Following a three month intervention which entailed simultaneously learning at least three real-world skills, such as photography, drawing, and Spanish, participants’ cognitive abilities were assessed using four tasks (Flanker, Set-Shifting, Dot Counting, and N-Back), as well as RAVLT and Digit Span. Follow-up assessments were completed at three-, six-, and 12-month follow-ups after the interventions. Linear mixed-effects regression models revealed significant cognitive improvements across time points up to one year following the intervention compared to baseline assessments. These promising results support the idea that intense learning experiences may lead to considerable cognitive growth in older adulthood, as they do earlier in the lifespan.
Exploring the Experiences of Persons Living With Dementia and Their Care Partners During the COVID-19 Pandemic
Authors: Yonashiro-Cho Jeanine , Avent Elizabeth , Mosqueda Laura , Gassoumis Zachary
Published: December 2021

Public health measures implemented to mitigate the spread of COVID-19 have transformed the physical and social environments in which we live. The effects of these policies on persons living with dementia (PLWD) and their care partners (CPs) are not fully understood. This study explores the experiences, attitudes, and perceptions of caregiving dyads during the COVID-19 pandemic. Cross-sectional survey data were drawn from a larger longitudinal study examining the relationship between PLWD aged 65+ and their CPs being conducted in a metropolitan city significantly affected by COVID-19. Interviews with were conducted remotely via videoconferencing and telephone. Data on sources and types of care provided for the PLWD, relationship quality and conflict, and caregiver stress were collected and analyzed using descriptive statistics and tests of independence. Preliminary results from PLWD (n=8) and CPs (n=13) confirmed a reduction in social interaction with family members and friends. CPs reported they (n=5) or other family members (n=2) changed their schedules to provide care for the PLWD. CPs reported increased conflict with the PLWD regarding care provision, going out or welcoming visitors, and home management. In contrast, PLWD reported a lack of conflict among household members (n=6) and the perception of good changes (n=2) and increased quality time with CPs. Preliminary findings provide empirical evidence of the effects of pandemic public health policies on dyads enrolled in this study and reveal differences in perceived relational conflict between PLWD and their CPs. Further research is needed to better understand the experiences of dyads and develop supportive interventions.
Testing Online Men’s Groups to Promote Psychological Well-Being and Reduce Despair During the COVID-19 Pandemic
Authors: Heisel Marnin , Links Paul , Sarma Sisira , Flett Gordon , Wilson Kimberly , Hatcher Simon , Lapierre Sylvie , Conn David
Published: December 2021

Suicide prevention is a healthcare and social justice priority. Older adults have the highest rates of suicide and the highest COVID-19 fatality rates in North America. The combined impacts of social isolation, fear of infection, apathy, and hopelessness could amplify suicide risk among older adults, as appears to have been the case during the 2003 SARS epidemic in Hong Kong. Innovative interventions are thus needed to promote social interaction and reduce risk for suicide in these challenging times. We are currently testing an online version of our Meaning-Centered Men’s Group (MCMG; Heisel et al., 2020), an upstream psychological intervention designed to promote psychological well-being and reduce suicide risk among men struggling with the transition to retirement, in the context of pandemic-related public health restrictions. This presentation will focus on adaptations to MCMG for online delivery, and share participant experiences and findings on positive and negative psychological outcomes.
Disruption to Substance and Opioid Use Disorder: The Deep South Substance and Opioid Use Rural Training Grant
Authors: Allen Rebecca , Jacobs Lindsey , Rybarczyk Bruce
Published: December 2021

The primary objective of this symposium is to describe our integrated, interprofessional behavioral health training program in substance use and opioid use disorders (SUD/OUD) across the adult lifespan (19 to 80) within our clinical psychology graduate program in the Deep South. Due to the COVID-19 pandemic, our assessment, treatment, and prevention delivery has occurred via telehealth. The first paper describes our Clinical Training Model in two federally qualified health centers (one peri-urban and one rural) and one residential drug and alcohol rehabilitation program. Graduate and undergraduate students provide prevention, assessment, and treatment with an emphasis on 1) mindfulness-based relapse prevention, 2) literacy-adapted treatment for chronic pain, and 3) trauma and recovery. The second paper describes the participant population. Specifically, participants (N = 105) receiving prevention, assessment and treatment services report high levels of substance and opioid use and are underserved, impoverished, and have low levels of education and health/mental health literacy. The third paper explores the relation of age, adverse childhood experiences, and PTSD symptoms within the context of substantial or severe SUD/OUD. The final paper describes issues surrounding telehealth delivery in the rural south with underserved populations. The discussant, an expert in integrated, interprofessional telehealth delivery across the adult lifespan, will provide insight on program sustainability and dissemination. Given the pronounced need for SUD/OUD treatment in underserved populations with attention to the intersection of age and urban/rural residence, this project is poised to make a substantive impact across the adult lifespan.
A Typology of Health Services Regulated in U.S. Assisted Living Communities
Authors: Carder Paula , Smith Lindsey , Zhang Wenhan , Zimmerman Sheryl , Sloane Philip , Thomas Kali
Published: December 2021

State agencies regulate assisted living (AL) with varying approaches across and within states. The implications of this variation for resident case mix, health service use, and policy, are not well described. We collected health services-relevant AL regulatory requirements for all 50 states and DC and used a mixed-methods approach (thematic analysis; k-means cluster analysis) to identify six types: Housing, Affordable, Hybrid, Hospitality, Healthcare, and Hybrid-Healthcare. We stratified Medicare claims data by regulatory type, identifying variation in resident case mix and health service use. Housing and Affordable clusters have larger proportions of dual-eligible beneficiaries, Black residents, and residents of Affordable had more long-term nursing home use compared to other clusters. Dual-eligible beneficiaries account for 26.6% of Housing cluster residents compared to 8.1% of Hybrid Healthcare cluster residents. We provide other examples and explain the implications in terms of sampling AL for single and multi-state studies, racial disparities, and health-related policies.
Environmental Assessment of Housing for Older Adults Facing Housing Insecurity
Authors: Gurung Shreemouna , Elkes Shelby , Mahmood Atiya , Qureshi Muhammad , Chaudhury Habib , Canham Sarah , Weldrick Rachel
Published: December 2021

The Aging in the Right Place Environmental Audit (AIRP-ENV) and Secondary Observation (AIRP-ENV-SO) tools were developed to conduct observation-based audit of the built environment in shelters, transitional housing, independent housing with offsite/onsite supports, and permanent supportive housing with onsite medical and/or specialized services for older adults experiencing (or at risk of) homelessness. The 241 item AIRP-ENV tool is used to audit the presence/absence of exterior and interior built environmental features that support housing stability. The seven open-ended questions in the AIRP-ENV-SO tool is used to collect contextual data on function, safety and land-use of surrounding neighborhood. Data were collected at four sites of a transitional housing program in Vancouver, Canada as part of a multi-year, multi-city partnership project on aging and homelessness. Preliminary results demonstrate that built environment and urban design features (e.g., access, privacy, flexible and supportive spaces) contribute towards tenants’ residential resiliency and aging in place.
Effects of Age and Social Adversity on Immune Cell Populations in a Non-Human Primate Model of Human Aging
Authors: Sanchez-Rosado Mitchell , Snyder-Mackler Noah , Higham James , Brent Lauren , Marzan-Rivera Nicole , Pavez-Fox Melissa , Watowich Marina , Sariol Carlos A
Published: December 2021

Significant hallmarks of aging are immune function decline and rising cumulative inflammation. These immunosenescent signatures are also found in individuals who experience chronic social adversity, independently of age. However, no studies to date have examined how social adversity alters immune function across the lifespan –data that are essential to identify the molecular routes through which social adversity might lead to increased aging-related disease. Over a two-year period, we investigated how age and social adversity (quantified by low social status) affected immunity. We measured immune cell proportions at baseline and their gene regulation after in vitro stimulation with pathogen molecules that stimulated both Th1 and Th2 immune responses in a population of free-ranging rhesus macaques. We first performed flow cytometry on peripheral whole blood to quantify changes on immune cell proportions across the lifespan (n=235) and in animals of different social statuses (n=141). We found significant decreases in CD20+ B cells and CD3+/CD4+ T cell proportions with age, suggesting diminished antibody production and adaptive immune responses in older individuals. Age-associated increases in CD3+/CD8+, CD3+/CD4+/CD25+ T regulatory cells and CD14-/CD16+/HLA-DR+ non-classical monocytes indicated heightened baseline inflammation in older animals. Social adversity recapitulated the effects of aging in CD14+/CD16-/HLA-DR+ classical monocytes, indicating immune deficits in phagocytosis and pathogen clearance in older and lower status individuals. Using RNA-seq, our stimulations (n=1,320) will allow us to identify molecular immune pathways that are disrupted by age and social adversity, similarities in response between age and adversity, and how the effect of adversity varies across the lifespan.
Providers’ Perceptions of Telehealth Barriers Among Homebound Adults in in a Home-Based Primary Care Practice
Authors: Moody Kate , Kalicki Alex , Gliatto Peter , Franzosa Emily , Ornstein Katherine
Published: December 2021

The COVID-19 pandemic resulted in a dramatic shift to video-based telehealth use in home-based primary care. We conducted an online 11-item survey exploring provider perceptions of patients’ experience with and barriers to telehealth in a large HBPC program in New York City. More than one-third (35%) of patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first-time video-based telehealth encounters between April and June 2020. The majority (82%) required assistance from a family member and/or paid caregiver. Among patients who had not used telehealth, providers deemed 27% (n=153) “unable to interact over video” for reasons including cognitive or sensory ability. Fourteen percent lacked caregivers. Physicians were not knowledgeable about patients’ internet connectivity, ability to pay for cellular plans, and video-capable device access. These findings highlight the need for novel approaches to facilitating telehealth and systematic data collection before targeted interventions to increase video-based telehealth use.
Implementation Science Translation: Program Sustainment for Managing Distress Behavior in Dementia
Authors: Curyto Kim , Kolanowski Ann
Published: December 2021

Distress behaviors in dementia (DBD) are common in nursing home settings, are distressing, and result in poorer outcomes for residents and staff. We present on the implementation of STAR-VA, an interdisciplinary intervention for effective management of DBD in Veterans Health Administration (VA) nursing home settings, called Community Living Centers (CLCs). A primary focus of this symposium is the use of implementation science concepts to improve and sustain evidence-based programs through tailored implementation strategies and key partnerships. Key implementation science concepts from conceptual frameworks, including the Consolidated Framework for Implementation Research (CFIR) and the use of organizational Knowledge Reservoirs (KR) for sustaining new clinical practices, formed the basis of this work. Their application in health care practice will be discussed using STAR-VA as an exemplar. Interdisciplinary CLC staff feedback during STAR-VA implementation and sustainment is presented, including feedback regarding barriers to integrating new program interventions into usual care processes. Mapping key implementation strategies onto reported barriers informed development of implementation tools and strategies designed to guide adaptions tailored to the needs of the residents and frontline staff, increasing the chances of successful sustainment. Finally, we highlight the importance of key leadership partnerships in implementation of evidence-based programs to improve care of residents with DBD and present strategies for developing these partnerships. Discussion will include the importance of using implementation science to implement evidence-based interventions for effective management of DBD and strategies for sustainment of these effective practices into usual care.