bluuebunny/crossref_metadata_2025 huggingface dataset:
Caregiver Knowledge of Long-Term Services and Supports: Effects of Rurality and Support
Authors: Stratton Lauren , Richter Nichole , Shelley Mack , Margrett Jennifer
Published: December 2020

Caregivers often lack knowledge regarding available long-term services and supports (LTSS). Certain barriers, such as rurality and levels of social support, may contribute to a lack of knowledge and accessibility of LTSS. The Caregiver Beginnings Workshop, held in 12 communities throughout 11 counties in Iowa, was a one-time educational session created to increase knowledge and awareness of LTSS. Data were collected from pre- and post-tests completed during the workshop (N = 98). To assess caregivers’ initial knowledge of LTSS, a hierarchical regression model was estimated to examine knowledge of LTSS in caregivers as predicted by caregiver education, number of health problems in care recipient, relationship type, feelings of social support, and rurality. Results showed that rurality (β = 0.33, p = 0.047) and infrequent or no support (β = -0.30, p = 0.02) were significant predictors (R2 = 0.21), indicating that caregivers living in rural areas reported higher knowledge of LTSS and those who reported infrequent or no support reported less knowledge. Additional analyses examined county-level data to better understand the availability of community resources in rural areas. County-level variables (e.g., number of home healthcare services, education level, income, health status) were included in a regression model to predict knowledge of LTSS. The results indicated that median income (β = -0.32, p = 0.002) and an educational attainment of an associate’s level degree or higher (β = -0.30, p = 0.004) were significant predictors. Discussion focuses on the importance of support and accessible resources for caregivers in all geographic areas.
Challenges of Recruiting Caregiver and Care Receiver Dyads for a Randomized Clinical Trial
Authors: Fruhauf Christine , Schmid Arlene , Prabhu Neha , Swink Laura , Portz Jennifer , Leach Heather , Hidde Mary , Van Puymbroeck Marieke
Published: December 2020

The recruitment of participants for chronic disease clinical trial research is often challenging. Further complicating participant recruitment occurs when the intervention is dyadic (i.e., simultaneously includes both care receivers and caregivers or recruiting pairs of people). Despite the strong support in favor of dyadic interventions for certain chronic diseases (e.g., among cancer and stroke survivors and their caregivers), researchers have not systematically shared challenges and opportunities for dyadic recruitment. During the recruitment for a yoga and self-management education intervention for people with chronic pain and their caregivers, several steps were taken to recruit and screen potential participants for the study. In this presentation, we will provide an overview of common recruitment challenges for physical activity and chronic disease self-management studies as well as the actual challenges encountered and our procedures for overcoming these obstacles. We will present our consort figure with attention toward inclusion and exclusion criteria of both care receivers and caregivers. Additional discussion will include specific challenges encountered when recruiting and screening caregivers (i.e., after the care receiver has been screened). The need for innovative clinical trial research with caregivers and care recipient dyads is essential as new care practices continue to evolve and demands on health care utilization increase. Lessons learned from this study may prove useful for future researchers as they embark on developing and testing dyadic interventions among adults with chronic disease and their caregivers.
Do the Reasons Emerging Adults Become Informal Caregivers Relate to Future Willingness to Care? A Mixed-Methods Study
Authors: Canell Anastasia , Bashian Hannah , Caskie Grace
Published: December 2020

Approximately 12-18% of family caregivers to older adults in the U.S. are emerging adults (aged 18-25), yet minimal research focuses on this subgroup of caregivers (Levine, 2005). Although several theories have developed to explain the growing number of emerging adults assuming informal caregiving roles (e.g., alleviating burden on middle-aged caregivers, family obligation; Dellmann-Jenkins & Brittain, 2003), the reasons why emerging adults become caregivers have not been studied. In the current study, a sample of 248 emerging adult caregivers were asked to describe the circumstances that led to providing unpaid care to an older adult. Using discovery-oriented coding methodology, 11 themes emerged within participants’ responses: care-recipient illness (35.5%), familial relationship (35.5%), care-recipient became dependent (23.8%), proximity (13.7%), only option (10.1%), reciprocal care (8.9%), availability (8.5%), age-related decline (6.9%), monetary restrictions (6.9%), care-recipient desire (6.0%), and community service (4%). Follow-up analyses found that participants who identified familial relationships (e.g., “They are my parents so I felt obligated...”) were less likely to endorse willingness to provide nursing care in the future compared to those who did not identify familial relationships (p=.032). Participants who identified care-recipient dependency as a circumstance leading to caregiving (e.g., “My grandmother fell and was in rehab...”) were more likely to endorse willingness to provide instrumental (p=.034) and emotional (p=.047) care in the future than those who did not identify care-recipient dependency. These results demonstrate the unique reasons that may lead emerging adults to begin caregiving and how these reasons relate to future willingness to care for an older adult.
Does Instruction Improve Older Adults’ Knowledge of Memory Aging?
Authors: Turner Rachael , Reese Celinda , Brigman Susan , Cherry Katie E
Published: December 2020

Memory loss happens in later life. For cognitively healthy older adults, deficits in memory in everyday life may be frustrating, but are less severe compared to the memory dysfunction observed in persons with progressive dementia syndromes, such as Alzheimer’s disease (AD). Normal memory aging has been defined as benign memory deficits due to genuine maturational processes in otherwise healthy older adults. Pathological memory aging has been defined as memory dysfunction due to non-normative factors such as disease or trauma to the brain (Cherry & Smith, 1998). In the present research, we examined the effects of instruction on knowledge of memory aging issues among community-dwelling older adults. Participants ranged in age from 59 to 94 years. All were enrolled in a six-week lecture series on cognition in later life. They completed the Knowledge of Memory Aging Questionnaire (KMAQ: Cherry, Brigman, Hawley, & Reese, 2003) before and after the series. Results indicated that their knowledge of pathological memory aging was greater than their knowledge of normal memory aging, as expected. Importantly, both normal and pathological types of knowledge were impacted by instruction, as post-test scores were higher than pre-test scores for both scales. In addition, a select set of items reflecting ageist views were also impacted by instruction; scores on this subset were significantly improved (less reflective of ageist stereotypes) at the end of the lecture series. Implications for the design of educational programs on adult cognition for community-dwelling older adults are considered.
Heart and Mind: Essential Components in Sound Decision-Making
Authors: Clark Michaela , Patrick Julie Hicks , Reardon Michaela
Published: December 2020

Consumer tasks permit an ecologically-valid context in which to examine the contributions of affective and cognitive resources to decision-making processes and outcomes. Although previous work shows that cognitive factors are important when individuals make decisions (Patrick et al., 2013; Queen et al.), the role of affective components is less clear. We examine these issues in two studies. Study 1 used data from 1000+ adults to inform a cluster analysis examining affective aspects (importance, meaningfulness) of making different types of decisions. A 4-cluster solution resulted. In Study 2, we used affective cluster membership and cognitive performance as predictors of experimental decision-making outcomes among a subset of participants (N = 60). Results of the regression (F(2, 40) = 6.51, p < .01, R2 = .25.) revealed that both the affective clusters (b = .37, p = .01) and cognitive ability (b = -.30, p = .04) uniquely contributed to the variance explained in decision quality. Age did not uniquely contribute. Results are discussed in the context of developing measures that enable us to move the field forward.
Movement Therapy and Cognitive Function in Middle-Aged and Older Adults: A 10-Year Study
Authors: Bhattacharyya Kallol Kumar , Meng Hongdao , Hueluer Gizem , Hyer Kathryn
Published: December 2020

Cognitive function is an important component of healthy aging and physical activities have been shown to support late life cognitive function. However, it is unclear whether non-traditional physical activities provide additional benefits for cognitive function above and beyond traditional leisure physical activities. This study examines the associations between movement therapy and cognitive function in the US population. We used data from the waves 1, 2 and 3 (1995-2014) of the Midlife in the United States (MIDUS) study. MIDUS included a national probability sample of community-living adults aged 25-75 years old in 1995 (wave 1) and added the wave 2 cognitive functioning tests of executive function and episodic memory. We applied multivariate linear regression models to estimate the effect of movement therapy (wave 2) on the cognitive episodic memory and executive function (wave 3) while controlling the covariates (wave 2 sociodemographic factors, health, and cognitive function). A total of 2097 individuals aged 42-92 years (mean 64.4, sd 10.9, 55.6% women) were included in the analysis. Movement therapy was independently associated with better episodic memory (beta=0.117, p=0.02), but not with executive function (beta=0.039, p=0.14), after including control variables. The results suggest that movement therapy may be an effective non-pharmacological intervention to attenuate age-related cognitive decline in middle-aged and older adults. Future research should test whether these findings can be replicated in similar populations and if confirmed, interventions should incorporate a wider range of physical activities in community-living older adults with the goal of maintaining and improving physical and cognitive health.
Retirement Planning: Reimagined and Revamped for Successful Aging
Authors: Nagaich Rajiv , Redfield Carol , Harvill Ben , Schill Scott
Published: December 2020

What grade should current retirement planning programs receive in which thousands of Americans participated in for their third segment of life? If success is measured by basic goal achievements that most desire (i.e. financial security, not be a burden, and avoiding institutional living), then we have failed significantly. Ninety percent of the population want to age in their own home, yet, only 30% get to. Sixty-six percent report that their employers did “nothing” to help with retirement transition; another 16% state “not sure” to what employers actually did. Seventy percent will travel through Long Term Care services in their lifetime, yet only 8% have LTC insurance. Only one-fourth of Baby Boomers are confident that they will have enough money to last through retirement. Retirement contribution starts with the first paycheck followed by 3-4 decades of employment with possible access to retirement preparedness counsel. Why, then, has planning fall short of being adequate? Are individuals too trusting of the programs from their employers or financial advisors that they don’t question completeness? Are professionals practicing in siloed spaces that they fail to realize their services may impact client’s other areas of life, especially, last years of life? Why is there a lack in a multi-disciplinary team approach which can ensure better predictability of outcomes? We propose a multi-pronged, integrated program: LifePlanning Model, which includes a coordinated, multi-disciplinary approach with a pull-it-together focus for the emerging retiree. The wholistic-based framework guides people through issues in the health, housing, financial, legal and family domains.
Mediating Role of Trait Mindfulness on the Relationships Between Age and Both Depressive and Anxiety Symptomology
Authors: Howard Scotti , Allard Eric
Published: December 2020

Previous research has shown that despite experiencing more negative life events, older adults maintain relatively high levels of well-being compared to their younger counterparts. This effect appears to be at least partially mediated by trait mindfulness in older adults (Raes et al., 2013). The current study expanded into an investigation as to how trait mindfulness might intervene on the relationship between age and other well-being indicators: anxiety and depressive symptomology. Participants included 30 older adults (aged 60-83) and 41 young adults (aged 18-35). Trait mindfulness was examined using the Mindful Attention Awareness Scale (MAAS), while depressive symptoms and trait anxiety were measured using the Center for Epidemiological Studies Depression Scale (CES-D) and the State-Trait Anxiety Inventory (STAI), respectively. Two separate mediated multiple regression models were conducted using Hayes’ PROCESS Macro in SPSS. Trait mindfulness exhibited a significant indirect effect on the relationship between age and depressive symptoms (β = -2.27, p < .005), which was also seen for the relationship between age and trait anxiety (β = -4.17, p < .001). Older age predicted higher trait mindfulness, which in turn predicted diminished self-reported anxiety and depressive symptomology. Controlling for mindfulness in these models reduced the direct effect of age on depression and anxiety to non-significance. These findings imply that the relationship between age and trait mindfulness can be extended to alternative markers of well-being.
The Effect of Anxiety on Regional Brain Volumes in the National Alzheimer’s Coordinating Center Uniform Data Set
Authors: Burke Shanna , Li Tan , Grudzien Adrienne , Barnes Christopher , Hanson Kevin , DeKosky Steven
Published: December 2020

Anxiety has been associated with greater risk of Alzheimer’s disease (AD) and existing research has identified structural differences in regional brain tissue in anxious compared to healthy samples, but results have been variable and somewhat inconsistent. We sought to determine the effect of anxiety on regional brain volumes by cognitive and apolipoprotein e (APOE) e4 status using data from a large, national dataset. A secondary analysis of the National Alzheimer’s Coordinating Center Uniform (NACC) Data Set was conducted using complete MRI data from 1,371 participants (mean age: 70.5; SD: 11.7). Multiple linear regression was used to estimate the adjusted effect of anxiety (via the Neuropsychiatric Inventory Questionnaire) on regional brain volumes through measurement of 30 structural MRI biomarkers. Anxiety was associated with lower total brain and total cortical gray matter volumes and increased lateral ventricular volume (p<.05). Lower mean volumes were also observed in all hippocampal, frontal lobe, parietal lobe, temporal lobe, and right occipital lobe volumes among participants who reported anxiety. Conversely, greater ventricular volumes were also correlated with anxiety. Findings suggest that anxiety is associated with significant atrophy in multiple brain regions and ventricular enlargement, even after controlling for intracranial volume and demographic covariates. Anxiety-related changes to brain morphology may contribute to greater AD risk.
An Examination of the Meikirch Model’s Multidimensional Definition of Health and Aging
Authors: Dorman Hillary , Allen Rebecca , Parmelee Patricia , McGuire Lisa
Published: December 2020

The present study used the CDC’s 2017 Behavioral Risk Factor Surveillance System and Structural Equation Modeling (SEM) to test the Meikirch model’s theoretical definition of health and aging. This biopsychosocial and ecological framework considers the dynamic interplay between an individual’s biology, health behavior and health potential, social surroundings, physical environment, and demands of living on both mental and physical health outcomes. A total sample of 96,568 adults were included with a mean age of 66.05 years (SD = 9.91). Individuals were classified in the following age groups: 43% middle-aged (45-64 years), 33% young-old (65-74 years), and 25% old-old adults (75+ years). The sample was largely female (61%), Non-Hispanic White (86%), and urban (67%). A CFA and WLSMV estimation was used to assess each latent construct. The overall SEM model was found to be a good fit (RMSEA=0.05, CFI=0.94, TLI=0.90), explained a significant portion of the variance in the health outcome (65%), and appeared to mimic prior literature on health variable relationships. An important finding within this study suggests the significant relationship between education, personally acquired potential, and health outcome variables. Underscoring health education and health literacy interventions may positively promote a person’s health behavior, resource access, and health outcomes across the lifespan. The Meikirch model can be used as a framework in public health interventions to better understand health adaptation, as well as behavioral risks and systematic hurdles. Overall, the study emphasizes how understanding health is not exclusively an individual hurdle to tackle, but a communal goal.
Food Insecurity Among Older Adults: A Transprofessional, Community-Based Collaboration
Authors: Girouard Shirley , Solloway Michele
Published: December 2020

To address inequities related to food insecurity among older adults, a better understanding of the phenomenon was needed. An innovative screening tool to distinguish among high, medium and low risk and that considers cultural preferences related to food acquisition and related behaviors was developed and piloted. Screenings and healthy eating education were offered at health fairs and other community events. Information about food insecurity and healthy eating as well as resources, such as food maps, guidelines, and food preparation materials were disseminated. Preliminary findings suggest that over half of those screened have high levels of food insecurity. Approximately 37% have five or more comorbidities that combined with food insecurity, represent a significant threat to health and well-being. Elected officials and community leaders soon learned about this initiative and sought education and screening for their constituencies. The research and project evaluation will be used in collaboration with these leaders to identify polices at the local, state and federal level to promote health equity and reduce food insecurity disparities. Efforts are under development to integrate the new screening and referral mechanisms in community-based primary care practices.
Associations Between the Five Factor Model of Personality and Dementia-Related Anxiety
Authors: Yun Stacy , Stone Lisa , Furr Evan , Maxfield Molly
Published: December 2020

The Five Factor Model (FFM) of normative personality is predictive of long-term outcomes, including well-being and anxiety. For example, people with anxiety disorders often report high Neuroticism and low Conscientiousness (Kotov et al., 2010). Dementia-related anxiety (DRA) is concern about developing dementia that can occur in individuals of any age and cognitive status (Kessler et al., 2012). This study assessed associations between the FFM and DRA and the extent to which other factors, such as demographics and variables related to DRA (i.e., external locus of control and lacking knowledge of dementia), contributed to relationships. Participants (N = 664; aged 18 to 81; M = 30.24) completed measures of the FFM, DRA, locus of control, and dementia knowledge. Hierarchical regression (block 1: basic demographics, block 2: DRA-related variables, and block 3: FFM) was computed. The set of predictors explained 17.9% of the variance in DRA, F(14, 623) = 9.69, p < 001. Being older, partnered, low on Conscientiousness and Openness, and having greater external locus of control and less dementia knowledge predicted higher DRA (p-values < .05). Surprisingly, Neuroticism was not predictive of DRA after controlling for demographic and DRA-related factors, indicating that the trait-like tendency towards emotional instability does not explain DRA. Longitudinal research can explore the course of relationships among Conscientiousness, Openness, and DRA over time to further examine significant effects of age, as expressions of personality change across the lifespan. Research targeting potentially modifiable factors (i.e., dementia knowledge) could help identify methods of reducing DRA.
Childhood Socioeconomic Status, Adult Personality, and Cognition: Early Indicators of Cognitive Impairment in Old Age
Authors: Sesker Amanda , Strickhouser Jason , Súilleabháin Páraic Ó , Terracciano Antonio , Sutin Angelina
Published: December 2020

This study investigated the association between childhood socioeconomic status (cSES) risk of cognitive impairment but not dementia (CIND), cognitive impairment (dementia or CIND), and dementia and whether adult personality mediated this association. A sample of 10,289 participants (aged 50 and older) from the Health and Retirement Study (HRS) were followed across 2-year periods between 2006 - 2018. Estimates of mediation effects in Cox Proportional Hazards regressions were conducted using Mplus software to approximate the total effects of cSES on the cognitive outcomes and the natural indirect effects and natural direct effects derived when personality causally mediated this outcome. cSES was associated with increased risk of all three cognitive outcomes. Conscientiousness partially mediated the relationship between cSES and dementia, CIND, and cognitive impairment risk while neuroticism partially mediated dementia and impairment, but not CIND. Personality improved the overall model fit between cSES and both CIND and impairment, and conscientiousness was specifically associated with significantly lowered cognitive impairment risk over time. Conscientiousness and neuroticism substantially mediated the relationship between cSES and risk of impairment in old age. This research adds to lifespan models and suggests that distinct personality traits attenuate early childhood factors that contribute to lifespan development and cognitive aging. Conscientiousness in particular may act as a protective buffer mediating risk factors associated with cognitive impairment in old age.
Convergence Between DSM-5 Section II and III Models of Personality Disorders Among Older Adults
Authors: Stone Lisa , Segal Daniel
Published: December 2020

Introduction: The Personality Inventory for DSM-5 (PID-5) is a measure of the alternative model of personality disorders (PDs), proposed in Section III of the DSM-5, but the PID-5 has limited evidence of validity for use among older adults. This study examined the validity of the alternate model through associations with the 10 traditional PDs in DSM-5. It was hypothesized that the PID-5 would relate to the traditional PDs in patterns predicted by the alternate model. Method: Older adults (N = 202) completed the PID-5 and the Coolidge Axis II Inventory (CATI), a measurement of the 10 PDs. Results: Correlations were computed between the PID-5’s 25 facets and the CATI’s 10 PD scales. All facets were found to significantly (p < .001) and positively correlate with all 10 PD scales, with large effect sizes (> .30). Next, regressions were conducted, with the PID-5 facets predicting each PD scale. Overall, across the 10 regression analyses, the PID-5 facets accounted for significant variance in the CATI PD scales, ranging from 64% (Avoidant) to 71% (Obsessive-Compulsive). Discussion: Although some DSM-5 hypothesized facets were significant predictors, many unexpected significant relationships were also detected. Of the 10 PD models, seven models included more unpredicted significant traits than predicted ones; two models included more significant predicted traits than unpredicted ones; one model included an equal number of predicted and unpredicted significant traits. We found substantially more overlap between the PID-5 and CATI than anticipated in unpredicted directions, suggesting that the PID-5 has good specificity but lacks sensitivity.
Personality and Well-Being in Old Age
Authors: Paul Constanca
Published: December 2020

Personality is a controversial issues in Geropsychology. It is generally accepted that personality is relatively stable through life and plays a relevant role in life style and wellbeing. We assessed Personality with NEO (Neuroticism, Extroversion and Openness) in a community sample of 1322 individuals 55+ years, mean age 70.4 (sd=8.6) years, 71% women. The means were: Neuroticism 34.06(sd. 5.1); Extroversion 41.25(sd. 4.05), Openness 37.37(sd. 3.82), around 10 points higher than the normative Portuguese data. Considering the highest values of the 3th tertil in each domain, women have higher Neuroticism differing from men (p=0.001), and values raise with age along 3 age groups (p=0.001); Neuroticism has significant positive correlations (p<0.01) with loneliness, sleep problems, psychological distress, difficulties in ADL and IADL and self-perception of health, and negative correlations with social network, happiness and cognitive capacity. Extroversion do not differ between gender and varies by age group (p=0,04) in U inverted form. Extroversion is positively correlated with happiness and negatively with loneliness, self-perception of health, psychological distress, difficulties in ADL and IADL. Openness does not differ by gender but differ between age groups (p=0.18) in U shape and correlates negatively with cognitive capacity, and social network. Personality traits appear very relevant for successful aging as facilitators or risk factors of physical and mental health, and should be addressed to foster adaptation in old age.
Age-Related Social Selection and Its Associated Emotional and Cognitive Costs Across Adulthood
Authors: Liao Hsiao-Wen , Carstensen Laura
Published: December 2020

Socioemotional selectivity theory maintains that goal prioritization differs across adulthood as a function of future time horizons. To prepare for a long and nebulous future, young adults prioritize learning and exploration over emotional meaning. Relieved from the burden to prepare, older adults prioritize emotionally meaningful goals. In the context of social relationships, younger adults include proportionally fewer familiar social partners in their social networks, whereas older adults’ social networks encompass proportionally fewer unfamiliar social partners. Although social selection is considered adaptive, it inevitably involves gains and losses. The current study examined whether age-related selectivity correlates with (1) greater concurrent negative emotions in younger people, and (2) poorer cognitive performance in old age. A life-span sample (N = 258) completed a social networks questionnaire and cognitive tests. Daily emotional experience was assessed using experience sampling. A subset (N = 119) completed the cognitive tests again five years later. Results of multiple regression analysis, controlling for physical health and trait neuroticism, indicate that smaller proportions of familiar social partners in one’s social network correlated with more frequent experience of negative emotions. Age moderated this association with a stronger association in younger than older people. Results of separate multiple regression analysis, controlling for baseline cognition, physical health, age, SES, and trait openness, indicate that a smaller proportion of social partners in one’s outer social circle negatively predicted older adults’ Digit Span Backward performance assessed five years later. We discuss our findings within the framework of gains and losses in life-span development.
Effectiveness of Nutritional Education for Obese Older Adults With Frailty: A Systematic Review and Meta-Analysis
Authors: Yin Yue-Heng , Justina Liu Yat
Published: December 2020

Obesity has been shown to intensify the decline of physical function and lead to frailty. Nutrition is an important method in managing obesity and frailty, while seldom reviews have ever explored the effects of nutritional education interventions. We conducted a systematic review (PROSPERO: CRD42019142403) to explore the effectiveness of nutritional education interventions in managing body composition and physio-psychosocial parameters related to frailty. Randomized controlled trials and quasi-experimental studies were searched in CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed and Scopus from 2001 to 2019. Hand search for the reference lists of included papers was conducted as well. We assessed the quality of included studies by Cochrane risk of bias tool. Meta-analyses and narrative synthesis were used to analyse the data. Two studies with low risk of bias were screened from 180 articles, which involved 177 older people with an average age of 69.69±4.08 years old. The results showed that nutritional education was significantly effective in reducing body weight and fat mass than exercises, and it was beneficial to enhancing physical function and psychosocial well-being. But the effects of nutritional education in increasing muscle strength were not better than exercises. The combined effects of nutritional education and exercises were superior than either exercises or nutritional education interventions solely in preventing the loss of lean mass and bone marrow density, and in improving physical function. Due to limited numbers of relevant studies, the strong evidence of effectiveness of nutritional education interventions on reversing frailty is still lacking.
Exploring the Motivators and Barriers of Older Adults Participating in an Interactive Exergame Intervention
Authors: Crane Breanna , Drazich Brittany , Moored Kyle , Carlson Michelle
Published: December 2020

Cognitive and physical activity are important to maintaining daily functioning in older adults. While bidirectional associations between cognitive and physical activity magnify with increasing age, elucidating shared benefits has been difficult as few interventions explicitly train on cognition and mobility simultaneously. We conducted focus groups among 14 older adults residing in an independent-living center who participated in an interactive video game study called Bandit the Dolphin, where participants simultaneously incorporated cognitive exercise and physical activity while navigating within a complex spatial environment to help Bandit jump, eat fish, and stun sharks. Using ‘sneaky exercise’ tactics, participants utilized upper extremities in conjunction with slight lower extremity movement to move Bandit within a 3-D oceanic environment. We conducted 3 semi-structured focus groups and analyzed the data using the “Sort and Sift, Think and Shift” method to assess general likes and dislikes as well as the primary motivators, barriers, and reasons for remaining in the study. Participants enjoyed the immersive nature, challenge, and “fun factor” of the game. Primary motivators for joining were generativity/helping others, self-improvement, from peer referrals, and because the study looked interesting. Key barriers reported in the study were exhaustion from standing, learning how to play in 3-D space, and frustration from lack of level advancement. Reasons for retention were due to the game being fun, a sense of duty, and fulfilling commitments. This information will guide ongoing research efforts to design interactive video game interventions that are enjoyable for older adults and maintain high retention rates.
Gender and Age Moderate the Effects of Partner Substance Use on Problem Drinking in Adulthood
Authors: Miller Sara , Almeida David , Maggs Jennifer
Published: December 2020

The current study examined whether partner substance use problems predict problem drinking and how gender and age moderate this relationship. Problem drinking refers to alcohol use resulting in alcohol dependence or health and social consequences. Participants were adults (n=2142, 53% female, mean age=54, range= 33-83) from Wave 2 of the Midlife Development in the United States (MIDUS) Study. Participants reported on both past 12-month problem drinking (e.g., emotional problems from drinking, urges to drink, month or “much time” drinking, drinking more to get effects, drinking more than intended, and alcohol-related role interference) and partner substance use problems. Results indicated that 22.2% of the sample reported at least one problem drinking behavior in the past year. Multiple linear regression analysis revealed a significant interaction between gender and partner substance use problems (b=0.05, p=0.01) such that for males having a partner with substance use problems was a risk factor for their own problem drinking. However, a three-way interaction with gender, age, and partner substance use problems (b=-0.41, p<0.01) indicated that partner substance use problems might have both gender and age-specific effects on problem drinking. Exploratory analyses of this interaction indicated that with age partner substance use problems might no longer promote risk for male problem drinking. Older adults are especially sensitive to the effects of alcohol for reasons such as lower tolerance, medication interaction, and health conditions. There is thus a need for identifying age-relevant factors associated with these drinking behaviors for intervention and prevention efforts.
Innovative Experiences at Work Support Hippocampal Maintenance in Late Life
Authors: Odd Kaleena , Boron Julie Blaskewicz , Burzynska Aga , Santo Jonathan , Robinson Paul , Willis Sherry , Schaie K Warner
Published: December 2020

Prior research has demonstrated the positive impact of occupational complexity on cognitive aging, however, neural underpinnings remain unclear. There is emerging evidence linking midlife managerial experience to slower hippocampal atrophy (Suo et al., 2012, 2017), supporting the brain maintenance model (i.e. preservation of young-like brain structure). However, occupational complexity, along with education, is known to be a proxy of cognitive reserve (i.e. mind’s resistance to brain aging). The current study examined the influence of midlife work environment factors (i.e., autonomy, control, and innovation; Work Environment Scale, Moos, 1981) on change in hippocampal thickness, while controlling for education and age. We studied 150 participants (60-78 years, M = 66.27, SD = 5.20, 61% female) from the Seattle Longitudinal Study who had at least one MRI scan and remained cognitively normal between 2006 and 2014. Hypotheses were tested using multilevel modeling in Mplus; gender differences were examined. There was no substantial drop in model fit as a result of adding any of the significant effects. Innovation at work slowed the decrease in hippocampal thickness over time demonstrating the protective effect of more novelty, variety and change in work activities. There was a significant age by gender interaction, such that the decrease in hippocampal thickness was stronger for older women. Together, findings suggest that long-term impact of work environment on the hippocampus extends beyond the effects of education, particularly in men, supporting the brain maintenance hypothesis. Innovation at work should be considered in understanding protective/risk factors in hippocampal atrophy in older age.
Social Network Types and Health Among Older Singaporeans
Authors: Malhotra Rahul , Sung Pildoo , Chan Angelique W M
Published: December 2020

Little is known about the heterogeneity and dynamics in older adults’ social networks and their bidirectional relationship with health in Asian societies. We investigate (1) social network types, (2) how network types predict health, and (3) whether health influences network types over time among older Singaporeans. We use data from Transitions in Health, Employment, Social engagement and Inter-Generational transfers in Singapore Study (THE SIGNS Study), a national longitudinal survey, collected in 2016-2017 (wave 1) and 2019 (wave 2). Latent class analysis is applied to identify distinct social network types and how they affect self-rated health after two years. Latent transition analysis is then employed to examine the pattern of change in network types between waves, and the relationship between baseline self-rated health and transition in network types. We identify six social network types: diverse, diverse but less socially engaged, immediate family, extended family, living alone yet diverse, and restricted (proportion at baseline: 7.2 %, 38.2 %, 14.1 %, 27.1 %, 7.0 %, and 6.4 %, respectively). Older adults in the ‘living alone yet diverse’ network type are less likely to report poor self-rated health after two years than those in the restricted and extended family network types. Additionally, we find that good health is related to more diversified network types—‘diverse’ and ‘diverse but less socially engaged’—at baseline, and network types are relatively stable over two years. These findings contribute to the literature by capturing complexities in the reciprocal relationship between social network types and health in later life.
Digital Health Information as Friend or Foe: The Question of (Mis)Trust Among Older Internet Users
Authors: Seckin Gul , Campbell Patricia , Lawson Megan
Published: December 2020

Gathering health information is among the major motivations for getting online among older adults who want to be better prepared with knowledge to manage their health and personal care. Prior research also showed significant gender differences in health-related use of the Internet. This research examined the effect of Internet use for health information on (a) mistrust of physician, (b) empowerment, (c) self-care, and (d) worry and/or anxiety. The sample (N=710; Mean= 48.82, SD=16.43) was randomly drawn from a national probability-based online panel. We performed gender-stratified sub-sample analyses of older respondents (age ≥60, N= 194). Hierarchical linear regression analyses showed that there is a negative association between older age and feeling empowered because of using the internet for health information (β = -.23, p < .05) and a positive association between older age and mistrust of diagnosis and/or treatment of physician (β = .19, p < .05). Study respondents did not report better self-care as a result of obtaining information from the Internet (β = -.15, p > .05). Lastly, older adults reported less worry and/or anxiety because of information stumbled upon the Internet that may not be accurate (β = -.25, p < .05). Sub-sample analyses showed that there are gender differences. Particularly, older men reported greater mistrust (β = .32, p < .05), and less worry (β = -.44, p ≤ .01) while these associations were not significant among older women. Results call for examination of the synergy of age and gender in perceived benefits of health-related Internet use.
Give People What They Want, Feedback: Older Adult Perceptions on Cognitive Training Features to Increase Engagement
Authors: Roque Nelson , Harrell Erin
Published: December 2020

According to Temporal Self-Regulation Theory (TST; Hall & Fong, 2007), adherence motivation can be driven by both positive and negative emotional reactions in which adherence is viewed in relation to gains versus losses. In a sample of 100 older adults (ages 64+), we explored participant-provided feedback related to intervention and game elements participants perceived would increase their adherence across five domains: (1) ability to adjust difficulty; (2) ability to change game design (from the preprogrammed American Western theme); (3) cognitive performance feedback; (4) ability to unlock extra game features (e.g., more levels); and (5) other elements. Ranked in order of frequency of endorsement, 53% endorsed: cognitive performance feedback; 47%: ability to adjust difficulty; 28%: ability to unlock new features; 27%: the ‘Other’ option; and 20% endorsed changing the game’s theme. This work has implications for models of adherence, specifically, the role that expectations of later cognitive feedback might play.
A Video Decision Aid for the West Virginia POLST: A Randomized, Controlled Trial
Authors: Heard Cherish , Pino Emma , Gallegos Jarred V , Edelstein Barry , Moss Alvin
Published: December 2020

Patients with serious medical conditions are faced with making decisions about treatments related to end-of-life care. The Physician Orders for Life Sustaining Treatment (POLST) is a document that allows patients to express preferences for four medical decisions including cardiopulmonary resuscitation, level of medical intervention, and medically administered fluids and nutrition. The purpose of the study was to develop and evaluate a video decision aid for the West Virginia POLST form. Sixty-four community-dwelling adults (50+) were recruited to participate. Participants were randomized to active control (exercise video) or intervention group (POLST video). Knowledge and decisional conflict were measured pre- and post-intervention. Participants were given a hypothetical vignette with medical information for the purpose of completing study measures. Separate MANCOVAs were conducted to explore the relation between treatment group and decisional outcomes at post-intervention for each medical decision, while controlling for numeracy and pre-intervention ratings of knowledge and decisional conflict. Results identified significant main effects of treatment group for each of the four medical decisions. Participants who viewed the video were more knowledgeable regarding CPR F(1,59) = 42.844, p<.001, medical interventions F(1,59) = 20.475, p<.001, and medically administered fluids F(1,59) = 31.004, p<.001, compared to participants assigned to the control group. Additionally, participants who viewed the video had less decisional conflict related to CPR F(1,59) = 17.892, p<.001, medical interventions F(1,59) = 31.017, p<.001, medically administered fluids F(3,56) = 11.718, p=.001, and nutrition F(1,59) = 16.411, p<.001, compared to participants in the control group. Conclusions and practical implications will be discussed.
Factors Predicting Short Length of Stay in Hospice Patients With a Primary Diagnosis of Stroke
Authors: Marino Victoria , Templeman Maureen , Schonwetter Ronald , Dobbs Debra , Haley William
Published: December 2020

Stroke is the second leading cause of death globally among people aged 60+, yet only 9% of hospice decedents have a primary diagnosis of stroke and little research has examined their end-of-life care experiences. Late referral and admission to hospice is an indicator of poor end of-life-care quality. This project identified factors predicting short stays in hospice, defined as a length of stay (LOS) of 14 days or less, via chart review of 100 hospice patients with a primary diagnosis of stroke. Of the 98 patients with complete data, 89% died in hospice; 11% were live discharges. Most patients were female, married, and referred to hospice from a hospital. Only 21% of patients entered hospice with a completed advance directive. Approximately 75% (n=73) of patients had a short LOS. Binary logistic regression indicated that gender, race, marital status, and having an advance directive at hospice admission were unassociated with LOS. Controlling for demographics, patients referred from home were 74% less likely to have a short LOS (OR=.26, CI=.08-.83) compared to those referred from a hospital, with a mean LOS of 44 and 13 days, respectively. Including Palliative Performance Scale (PPS) score in the model attenuated the effect of referral location. For every ten percent increase in PPS, participants were 85% less likely to have a short LOS (OR=.15, CI=.07-.32). Advance care planning should be more widely promoted among patients at high risk for stroke. There are opportunities for earlier referral to hospice for patients with a diagnosis of stroke.
Who Prepares More for End of Life? The Factors Associated With End-of-Life Planning Among Older Adults
Authors: Park Hayoung , Jun Hey Jung , Joo Susanna , Lee Sun Ah
Published: December 2020

Being an “aged” society, only recently in Korea have there been growing interests in well-dying and end-of-life planning. Therefore, the purpose of this study was to investigate the factors associated with the level of end-of-life planning among Korean older adults. For the analyses, 2017 National Survey of Older Koreans was utilized and the sample was 10,073 older adults aged 65 and above. The independent variables were age, gender, employment, education level, marital status, household income, religion, number of children, and life satisfaction. The dependent variable, the level of end-of-life planning, was measured as the sum of five items of the question asking whether they have prepared the following items in preparation for end-of-life: shroud (8.3% prepared), cemetery/charnel house (25.1% prepared), mutual aid society (13.7% subscribed), will (0.5% prepared), lectures in preparation for end-of-life (0.4% participated). The results from multiple regressions using STATA 15.0 indicated that the level of end-of-life planning was significantly associated with age (b=.02, p<.001), gender (b=-.07, p<.001), education level (b=.02, p<.01), household income (b=2.56, p<.001), religion (b=.06, p<.001), number of children (b=.04, p<.001), and life satisfaction (b=.17, p<.001). That is, they have planned more for their end-of-life when older in age, female, more educated, wealthier, with religion, had more children, and more satisfied with life. The findings from this study suggest that political interventions are required to promote end-of-life planning education especially for less educated older adults with low income for their “well-dying”. Further researches are needed to explore other personal/interpersonal factors associated with end-of-life planning.
Generativity Among Japanese Elderly: Its Association With Demographic Characteristics and Health Indicators
Authors: Murayama Sachiko , Kobayashi Erika , Kuraoka Masataka , Nonaka Kumiko , Tanaka Motoki , Nemoto Yuta , Murayama Hiroshi , Fujiwara Yoshinori
Published: December 2020

Generativity is defined as concern and activity dedicated to contributing to the welfare of others, especially younger generations. Although generativity is postulated to be an important developmental task in old age, there are few reports of its related factors in Asian countries. The purpose of our study is to examine the gender difference of generativity and to explore the defining factors among Japanese elderly. During August to September 2016, we conducted a questionnaire survey for randomly selected 1,187 people aged 65–84 years in the Tokyo area (527 males, 660 females, mean age 72.6 years±5.5), and measured the following variables: generativity, gender, age, length of residence, parental status (having children or grandchildren), working status, commitment to child-rearing activities, mental health (WHO-5 scores), and Instrumental Activities of Daily Living (IADLs). As a result of Student’s t-test, we found that males scored significantly higher on generativity than females (t=2.678, df=1067.097, p<.01). Moreover, we carried out multiple regression analysis, separated by gender. The results showed that, only among males, generativity was positively related to age (β=.096, p<.05) and having children (β=.148, p<.001). In addition, we found that generativity was positively associated with the following variables in both genders: having jobs, commitment to child-rearing activities, mental health, and IADLs (β=.081–.318, p=.000–.032). Among them, mental health and IADLs especially had strong effects on generativity (β=.188–.318, p<.001). We have concluded that the related factors of generativity differ between males and females, but regardless of gender, health indicators are strongly associated with generativity in old age.