bluuebunny/crossref_metadata_2025 huggingface dataset:
HOW DO GREEN CARE FARMS FOR PEOPLE LIVING WITH DEMENTIA SUCCESSFULLY INTEGRATE OUTDOOR SPACES?
Authors: Rosteius Katharina , de Boer Bram , Verbeek Hilde
Published: December 2022

Green Care Farms (GCFs) are an innovative care environment for vulnerable groups. This study explores the design, and the successful integration of the natural environments of GCFs. By actively integrating outdoor spaces into daily care, they may encourage residents to participate in meaningful activities. A case study was conducted on a Dutch GCF using mixed ethnographic methods. 129 hours of observations of daily life were combined with 24 semi-structured interviews with residents, family, volunteers, staff and management, and a focus group with staff. The physical environment was assessed quantitatively. Data was analyzed thematically and triangulated. Results indicate that some factors supported the integration of the outdoor spaces into daily care. First, the physical environment was specifically designed to stimulate residents. Second, the outdoors was easily and openly accessible for residents. Third, residents’ security was supported in several ways. Lastly, staff members creatively motivated residents to use the outside spaces.
CREATION AND VALIDATION OF A POLYSOCIAL SCORE FOR PHYSICAL FRAILTY AMONG COMMUNITY-DWELLING OLDER ADULTS IN THE US
Authors: Wu Chenkai , Tang Junhan
Published: December 2022

The interrelatedness between social determinants of health impedes researchers from identifying important social factors for health investment. A new approach is needed to quantify the aggregate effect of social factors and develop person-centered social interventions. Data are from the Health and Retirement Study; 6,075 older adults initially not frail (non-frail or prefrail) were included. Frailty was assessed by slowness, weakness, exhaustion, inactivity, and shrinking. Persons were classified as “nonfrail” (0 criteria), “prefrail” (1–2 criteria), or “frail” (3–5 criteria). We included 24 social factors from five categories (economic stability, neighborhood environment, education, community/social context, and healthcare system) and used forward stepwise regression to screen for important ones. Polysocial score was created using 15 social factors and was classified as low (0-29), intermediate (30-42), and high (43+). We used the Poisson regression to estimate the risk of incident frailty by three polysocial score categories. We found that 444 (34.5%), 651 (17.9%), and 108 (9.4%) cases of incident frailty at the 4-year follow-up among participants with a low, intermediate, and high polysocial score, respectively. In the multivariable-adjusted Poisson model, the risk of frailty among participants in the intermediate and high polysocial score categories was 35% and 59% lower than those in the low polysocial score category, respectively. We found a universal association between polysocial scores and frailty across race/ethnicity and sex subgroups. The polysocial approach may offer possible solutions to monitor social environments and suggestions for older people to improve their social status for specific health outcomes.
DISTINCT PROFILES OF SEDENTARY BEHAVIORS IN OLDEST OLD ADULTS
Authors: Webster Katelyn , Zhou Weijiao
Published: December 2022

Sedentary behavior (SB) is a significant health risk. Emerging research suggests that mentally active SB (such as computer use and reading) were associated with better health than mentally passive SB (such as watching TV). However, this has not been examined among the oldest old (age ≥80). The aims of this study were to (1) identify distinct profiles of oldest old adults based on six domains of SB (watching TV, using a computer/tablet, talking to friends or family members, doing hobby or other activities, transportation, and resting/napping); and (2) compare health-related outcomes across identified profiles, using the National Health and Aging Trends Study (NHATS) dataset. Latent profile analysis was used to identify distinct profiles of SB. Design-based linear and logistic regressions were used to examine associations between different profiles and health outcomes, accounting for sociodemographic characteristics. We identified four profiles and named them based on total sedentary time (ST) and passive/active pattern (n=852, “Low ST”, “High ST-passive”, “Medium ST-TV”, “High total ST-mentally active”). Compared to the “High ST-passive” group, “Low ST” group was associated with fewer difficulties with activities of daily living, fewer problems limiting activities and higher cognitive function; “High ST-mentally active” group was associated with the above outcomes, as well as lower anxiety and depression. This study, with a national representative sample of the oldest old population, suggests that both total ST and SB pattern matter when evaluating health outcomes of being sedentary. Interventions should encourage oldest old adults to reduce ST and especially target mentally passive ST.
OBJECTIVELY MEASURED PHYSICAL ACTIVITY PATTERNS OVER 24-HOURS BY APOE-Ε4 CARRIER STATUS
Authors: Wanigatunga Amal , Marino Francesca , Liu Fangyu , Simonsick Eleanor , Tian Qu , Deal Jennifer , Resnick Susan , Schrack Jennifer
Published: December 2022

The Apolipoprotein-ε4 (APOE-ε4) genotype is associated with earlier onset and greater risk of β-amyloid deposition, but whether APOE-ε4 status is associated with physical activity amount or fragmentation remains unclear. In 563 BLSA participants aged 55-97 years with APOE-ε4 and ≥3 days of wrist accelerometry data, multivariable linear regression models were fitted to estimate differences in activity amount (daily or by 6-hour time blocks) or fragmentation by APOE-ε4 status and to test whether age modifies these effects. Overall, daily activity amount and fragmentation did not differ by APOE-ε4 status (p=0.28 and p=0.93, respectively). Yet, age significantly modified the APOE-ε4 effect. Per each additional year of age, APOE-ε4 carriers had less activity during early morning (12:00-6:00AM) than non-carriers (p=0.035). This association was non-significant among the oldest-old (p=0.697 at age 80 years, p=0.347 at age 90 years), suggesting possible decreases in the predictive power of APOE-ε4 with increasing age.
WHAT CAN DUAL-TASK WALKING AND TAPPING TELL US ABOUT SUBJECTIVE COGNITIVE DECLINE? AN FNIRS STUDY
Authors: Salzman Talia , Perreault Hannah , Farhat Farah , Vallejo Diana Tobon , Fraser Sarah
Published: December 2022

Older adults who pass standard cognitive tests but report subjective cognitive decline (SCD) may be identifying early changes in cognition at a stage when intervening can prevent further declines. Changes may be subtle highlighting the need for novel approaches, such as divided attention tasks, to distinguish between those with and without SCD. This pilot study examined 15 older women (9 SCD, 6 non-SCD) completing dual-task walking and tapping. Brain (cerebral oxygenation) and behavioural (gait and tap speed, accuracy, and vocal response) measures were assessed during single and dual-tasks. Older adults with SCD were marginally less accurate during dual-task tapping (p < .06) and had greater cerebral oxygenation than the non-SCD group (p = .01). SCD did not moderate gait speed from single to dual-task while non-SCD did (p = .02). Findings suggest that challenging dual-task paradigms may help identify different behavioural and brain activity markers of SCD and intervention targets.
EARLY CHARACTERISTICS AND BIOMARKERS OF COGNITIVE IMPAIRMENT AND DEMENTIA WITH PRIOR MOTOR IMPAIRMENT
Authors: Tian Qu , Resnick Susan , Ferrucci Luigi
Published: December 2022

Motor impairment is one early feature of preclinical Alzheimer’s disease and strongly predicts future dementia. Whether older persons with dementia who had prior motor impairment present specific characteristics is less clear. In the Baltimore Longitudinal Study of Aging, we compared characteristics of participants with cognitive impairment or dementia who had slow gait on average 6 years before symptom onset (<1.0m/sec)(n=65,81±7 years,35%women,25%black) to those who did not (n=93,77±7 years,61%women,16%black). Early cognition and key biomarkers on average 7 years before onset were compared between groups using multivariable linear regression, adjusted for demographics. Those with prior slow gait had early unfavorable metabolic panel (higher fasting glucose,higher 2hr-OGTT insulin,lower HDL,higher triglyceride,higher BMI and waist,higher blood pressure), lower manual dexterity and processing speed, and lower lysophosphatidylcholine 18:1 and 18:2, critical in the synthesis of cardiolipin-an essential component of mitochondrial membranes. Strategies to prevent metabolic dysfunction at an early stage may slow down dementia progression.
NURSING FACILITY QUALITY, CLOSURES, AND STAFFING
Authors: Tyler Denise
Published: December 2022

The quality of care provided in nursing facilities has long been a societal concern and an important focus of policy at the federal and state level. The COVID-19 pandemic has drawn increased attention to nursing facilities due to high infection and mortality rates as well as increased media attention on staffing shortages that have occurred in the wake of the pandemic. The Office of the Assistant Secretary for Planning and Evaluation (ASPE) and RTI International have recently completed a series of studies focused on nursing facility quality and staffing. This symposium will present the results of four of those studies. First, we will report the results of a study exploring states’ use of value-based payment (VBP) programs as part of their nursing facility Medicaid payment systems. Second, we will present the results of a study examining inappropriate discharges from nursing facilities. Third, we will report findings from a study that examined the factors associated with nursing facility closures. Finally, we will present findings from a study that explored the effect of the pandemic on nursing facility staffing. Together these studies provide important information about the state of nursing facilities in the wake of the COVID-19 pandemic and suggest key areas of focus for policymakers.
ASSESSING THE FACTORS ASSOCIATED WITH NURSING HOME CLOSURES
Authors: Hughes Kelly , Li Qinghua , Feng Zhanlian , Oliveira Iara , Dey Judith
Published: December 2022

The media has reported recent increases in nursing home closures. This study examined closures from 2011-2019, identified facility and market characteristics associated with closures, and assessed the impact of closures on quality and access. We identified closures using termination dates and gaps in certification surveys and conducted descriptive and multivariate analysis. We identified 1,220 closures, with large increases in closure rates in 2018 and 2019 and geographic clusters. Chain facilities, urban facilities and smaller facilities were more likely to close, as were facilities with higher percentages of non-white and Medicaid residents. Staffing and quality five-star ratings had a nonlinear relationship with closure, which suggests Medicaid funding may impact closures rates. We found both the number of beds per 1,000 elderly and occupancy rates decreased, including in high-quality facilities. Closures should be examined further in the context of the COVID-19 pandemic.
COMING OUT AND GOING BACK IN: AGING AND STRATEGIC IDENTITY DISCLOSURE AMONG LGBTQ ADULTS
Authors: Sweeny Brian
Published: December 2022

In addition to facing social, economic, and health disparities, LGBTQ older adults face prejudice and discrimination across various social domains, leading some to re-enter the closet. When might older adults openly identify as LGBTQ, and when might they conceal this identity? Based on participant observation and interview data collected in two naturally occurring retirement communities in New York City, this paper examines LGBTQ identity and coming out in relation to aging processes, especially changing care networks and family structures, decreasing autonomy, and increasing engagement with health and social services. The older LGBTQ adults in the study feel the benefits of broad social changes and increasing cultural competencies regarding LGBTQ issues, yet they also speak of unsafe spaces, experiences of exclusion, and uncertainties. I analyze three specific identity disclosure strategies older LGBTQ adults use as they navigate prejudice and discrimination and work to affirm identities as aging gender and sexual minorities.
SEEING THROUGH A HOUSING LENS: STUDYING HOUSING-FOCUSED RESPONSES TO THE NEEDS OF OLDER ADULTS DURING THE PANDEMIC
Authors: Berlinger Nancy
Published: December 2022

This paper draws on a study of unindexed literature produced by local and state policymakers, Area Agencies on Aging, nonprofit organizations, for-profit companies, age-friendly initiatives, affordable housing providers, and other groups responding to the needs of older adults at home during the COVID-19 pandemic. By collecting and analyzing descriptions of how service providers pivoted or improvised to meet urgent challenges, we sought to identify promising practices and policy ideas preserved in reports, newsletters, websites, and other communications. This paper reviews study methods and recommendations, and explores a concept that emerged from this research: recognizing services and support for older adults at home as “housing-focused” care that relies on the affordability, accessibility, and safety of a person’s home. The applications of the “housing lens” to future research on housing, aging, and health and to making progress on better integrating housing policy and health policy in aging societies will be discussed.
LEVERAGING THE STRENGTH OF UNIQUE PARTNERS TO IMPROVE GERIATRIC EMERGENCY CARE IN RURAL CRITICAL ACCESS HOSPITALS
Authors: Rodi Scott
Published: December 2022

Developing a level 1 accredited geriatric emergency department during the pandemic was challenging. The greater challenge has been to support rural critical access hospitals on their journey of becoming level 2 accredited geriatric emergency departments. This has been accomplished through a novel collaborative approach between the level 1 accredited emergency department, a newly established Geriatric Center of Excellence at Dartmouth-Hitchcock Health and a HRSA funded Geriatric Workforce Enhancement Program. This talk will focus on bringing together system partners and funders who have a history of success through: (a) development, testing and dissemination of tool kits and implementation guides; (b) boot camp training that includes interprofessional team training, QI and specific geriatric content training; (c) implementation support and coaching using data and QI methodology through learning collaboratives; (d) scaling successful models of evidence based geriatric care; (e) expertise in implementation science; (f) expertise in evaluation and (g) disseminating findings to achieve our goals.
IMPACT OF CAREGIVING DURING THE COVID-19 PANDEMIC: COMPARISON BETWEEN DEMENTIA AND NONDEMENTIA CAREGIVERS BY RACE
Authors: Moon Heehyul , Rote Sunshine , Sears Jeanelle , Niemiec Stacey Schepens
Published: December 2022

Despite evidence of increased caregiving intensity, stress, and burden during the COVID-19 crisis and clear racial disparities in COVID-19, there is a lack of research on the impact of dementia (vs. non-dementia) care provision on caregivers’ (CGs) quality of life by race. The current study used the National Health and Aging Trends Study COVID-19 Family Members and Friends data (N=1,462, 15% Black and 85% Non-Hispanic White CGs) to explore differences in primary stressors (changes in the provision of help with ADL and IADL tasks and emotional support) by dementia care and race during COVID-19. Most respondents were adult children. Dementia CGs in particular reported increases in stressors (ADL and IADL provision) during the pandemic. Black dementia CGs reported significantly more provision of help with ADL tasks before and after the COVID-19 onset and a significantly higher level of emotional support to their care recipients compared with the other three groups (Black non-dementia, White dementia, and White non-dementia CGs). Black dementia CGs also reported the highest care burden and worst psychological well-being and self-rated health during COVID-19. Findings revealed significant differences in the magnitude and nature of the changes in CG help provision before and amidst the pandemic, by race and dementia care status. Future studies should examine the longitudinal impact of the pandemic on the well-being of CGs from other racial and ethnic minority groups.
AGING IN PLACE: THE REALITIES OF OLDER HOMELESS WOMEN NAVIGATING URBAN STREETS AND SHELTERS
Authors: Gonyea Judith , O'Donnell Arden
Published: December 2022

Older homeless women have often been an invisible population; however, this is changing as their numbers grow. Today, women age 50 and older represent 30% of the shelter population. In this qualitative study, we explored the question, What does “aging in place” mean to women in their fifties who are navigating the urban streets and shelter system?” Our study’s purpose was to gain a deeper understanding of the impacts of daily displacement and migration and, through the women’s accounts, engage in a critical analysis of the shelter system’s practices and policies. Fifteen older chronically homeless women were recruited via a flyer posted at a city’s women’s day shelter to participate in an onsite interview about their homelessness experiences. Using a phenomenological approach, in depth semi-structured interviews were conducted, recorded and transcribed verbatim. Our analysis process was inductive and iterative with the culminating phases being theme generation and interpretation. Participants identified challenges centered on six themes: 1) loss of a sense of control, self-determination, and independence, 2) lack of physical security, 3) worsening physical and emotional health, 4) lack of comfort, familiarity, and routine, 5) weakening or loss of social connections, and 6) a diminished sense of self-worth. The findings highlight the links between place, sense of belonging, and identity. The data underscored that shelters were dehumanizing places that further diminished women’s sense of self. We discuss reforms needed to disrupt shelter and housing systems’ practices that further disempower and stigmatize the women and fail to support pathways out of homelessness.
DEEP AGING: THE CONNECTION THAT SURVIVES DEATH AND ITS ROLE IN INCREASING HUMAN–NONHUMAN RELATIONSHIPS
Authors: Park Hong-Jae
Published: December 2022

Ageing is part of life, and so is death. Although death will involve all of us over time, it is often regarded as a taboo topic, and bonds with the dead are seldom acknowledged in contemporary times. The aim of this paper is to present selected insights on the connection that survives death and its role in increasing human/non-human relationships, learned from two indigenous knowledges—whakapapa (genealogical connections in Maori) and filial piety (respect/care for parents and ancestors). Data were collected from semi-structured interviews with 49 key informants (Maori=25; Korean=24) between 2019 and 2021 in New Zealand and South Korea. A modified thematic analysis method was used to analyse the data obtained in a bilingual research context. The research findings show that the connectedness with ancestors or deceased loved ones is a significant part of the participants’ mental and social lives, emphasised in both whakapapa and filial piety/ancestor veneration traditions. Maori participants were likely to consider their natural environment (for example, land and water) as a common good for all generations, while Korean counterparts viewed it (for example, a mountain) as the place where ancestors were remembered and venerated. Participants’ awareness of the post-mortem relationships was associated with their connection with nature and spiritual practices. Overall, this study suggests that there are several possible ways that older people could do ‘something’ prior to death for their remaining families and friends, ranging from activities concerning death talk, end-of-life preparation, legacy building and after-life planning, to connectedness with nature and non-human beings.
WHAT NEEDS TO BE DONE TO PREVENT ELDER ABUSE IN JAPAN?
Authors: Kuo TsuAnn , Anetzberger Georgia
Published: December 2022

This symposium first introduces the Japanese Act on the Prevention of Elder Abuse, including its elder abuse definitions and trends in elder abuse in both institutional and domestic settings. It then describes a recent amendment to operational standards made by ministerial ordinance, which aims to reduce elder abuse. Second, it presents analysis of elder abuse data (N=497) from Matsudo-City in Chiba prefecture, which found that only about 65% of reported elder abuse cases were deemed to meet the legal definition of elder abuse and the rest were excluded due to how the law defines abusers. Findings suggest the definitions in the Act be broadened to encompass a wider set of abuse situations. Third, it presents analysis using the same data, of characteristics of abusers. Findings indicate that about 24% of abusers were caregivers with disabilities, suggesting the importance of supporting caregiver health and welfare to help prevent abuse. The symposium concludes by presenting findings from a longitudinal survey of older adults aged 75+ (N=769) indicating that physical restraints use is associated with “having been diagnosed as intractable neurological diseases,” “unstable general condition or at the terminal stage,” “higher levels of care-need,” “having medical treatment,” and “family members’ long-term care burdens.”
BEREAVEMENT ACROSS THE ADULT LIFE COURSE: VARIATIONS IN EFFECTS ON HEALTH AND WELL-BEING
Authors: Suitor J Jill , Gilligan Megan
Published: December 2022

This symposium considers the consequences of deaths of family members across the life course on psychological well-being, physical health, and mortality in the middle and later years. The first two papers focus on intergenerational losses, using data from the HRS. Donnelly, Lin and Umberson examine the ways in which the impact of parental death on adult children’s health in later life are shaped by children’s ages at loss, social isolation, and race/ethnicity. Next, Huo and Kim investigate the extent to which the effect of child loss on parents’ well-being in mid- and later-life is moderated by volunteering. The third and fourth papers focus on the role of spousal loss in health and well-being. Rodin and colleagues use HRS data to explore whether the association between widowhood and mortality differs depending on the cognitive health of the surviving spouse. Next, Vedder and colleagues provide a systematic review of variations in patterns and predictors of loneliness by marital status in middle and later life. Finally, Miles and Olsen examine the association between recent loss and binge drinking among spouses and adult children who had served as caregivers to the deceased, using data from the Georgia Behavioral Risk Factor Surveillance Survey. This diverse set of studies reveals how the impact of the death of family members on survivors’ health and well-being is shaped by a complex set of structural and socioemotional factors, shedding new and important light on health disparities by sex/gender and race/ethnicity in the middle and later years.
THE WIDOWHOOD EFFECT IN COMPLEX SERIOUS ILLNESS: THE IMPACT OF SPOUSAL DEATH ON MORTALITY IN DEMENTIA
Authors: Rodin Rebecca , Smith Alex , Espejo Edie , Boscardin W John , Gan Siqi , Hunt Lauren , Ornstein Katherine , Morrison Sean
Published: December 2022

Numerous studies suggest that there is an association between widowhood and mortality. This “widowhood effect” may be heightened in patients with dementia, who have high support needs and for whom spouses typically provide extensive caregiving support. Yet there are limited data on widowhood and mortality that account for dementia status. To determine the relative mortality risk of widowhood among those with and without dementia, we conducted a retrospective cohort study among community-dwelling, married/partnered persons, ≥65 years, enrolled in the Health and Retirement Study, 2000-2018. Among the 12,308 persons (n=390 with dementia), widowhood was not associated with increased mortality, after adjusting for age and dementia status, in men or women (adjusted HR 1.04; 95%C.I.(0.95-1.13); HR 0.96; 95%C.I.(0.87-1.95), respectively). These findings suggest that dementia, age, or other unmeasured confounding variables may account for the previous finding of increased mortality following spousal death. Further research is needed to confirm these findings in diverse populations.
THE LONG-TERM LONELINESS OF WIDOWHOOD: A SYSTEMATIC REVIEW OF MARITAL STATUS DIFFERENCES
Authors: Vedder Anneke , Stokes Jeffrey , Boerner Kathrin , Schut Henk , Boelen Paul , Schut Bibi , Stroebe Margaret
Published: December 2022

Loneliness can be prominent in bereavement, possibly leading to compromised mental and physical health. We systematically reviewed the extent of loneliness across marital status groups, examining the prevalence, intensity, risk factors, and correlates of loneliness in widowhood, compared to other marital statuses. Studies that met predefined criteria as well as investigated marital status (comparisons) were included in the review. For reporting, we followed the PRISMA statement. Thirty-eight studies were included. Widowhood was associated with a greater likelihood and intensity of loneliness when compared to other marital statuses, and especially the divorced. Widowers were on average lonelier than widows. Findings suggest that , widowed persons are uniquely vulnerable to loneliness, and that, in the long-term, loneliness may be more pronounced among the widowed than the divorced. However, methodological shortcomings (e.g., heterogenous samples, different measures of loneliness) of available studies must be considered, and future research should aim to overcome these limitations.
MENINGES HARBOR IMMUNE MEMORIES OF LIFE EXPERIENCES
Authors: Herz Jasmin , de Lima Khalil Alves , Salvador Andrea Francesca , Lemieux Mackenzie , Dykstra Taitea , Smirnov Igor , Kipnis Jonathan
Published: December 2022

The adaptive immune system relies on formation of the memory of past microbial challenges to accelerate protective immune responses in the event of reinfection. This memory is accomplished in part by the retention of antigen-specific B and T cells within barrier tissues. As the healthy central nervous system parenchyma is virtually devoid of adaptive immune cells, the meningeal spaces carry out the vital function of coping with environmental threats during aging. We conducted an extensive molecular and functional analysis of meningeal T cells to test the hypothesis that the meninges in the brain sense and respond to internal and external cues throughout life, and that alterations in the meningeal T cell repertoire alter brain function. We found presumably self-reactive tissue-resident T cells in the meninges of naive mice. Using models of pathogen exposure, we describe a neuroimmune axis in which antigen experienced resident Tcell subsets dynamically record immune perturbations, which resulted in behavioral abnormalities that were exacerbated with aging. Our findings elucidate molecular properties of T cells that survey the brain borders under both homeostatic and pathological conditions and provide insights linking CNS immune privilege with memory.
R1p Dispersion in White Matter Correlates with Cognitive Impairment in Older Adults
Authors: Adelnia Fatemeh , Davis Taylor , Acosta Lealani Mae , Puckett Amanda , Wang Feng , Zu Zhongliang , Harkins Kevin , Gore John
Published: December 2022

Alzheimer‘s disease is the most frequent form of dementia in older adults and has a total estimated worldwide cost that rises to $2 trillion by 2030. Much previous neuroimaging research in AD has focused on the roles of amyloid and tau proteins using PET, but there have also been several studies that have implicated microvascular changes as an early indicator of damage related to later dementia. Here, we developed and refined a non-invasive 3D-R1ρ dispersion imaging technique using different locking fields to quantify microvasculature changes within brain tissues in persons with mild cognitive impairment (MCI) compared to healthy controls. The fractional difference in R1ρ comparing different locking fields provides a unique way of characterizing changes in the geometry and structure of microvasculature. After providing informed consent, 40 adults aged 62 to 82 years (n=17MCI) underwent cognitive assessments and MRI scan at 3T. We found the fractional change in R1ρ of the whole brain white matter is significantly greater in persons with MCI, and the correlation remained significant (ß=-0.4, p-value=0.01) after introducing age (ß=0.2, p-value=0.2) and sex (ß=-0.1, p-value=0.5) as covariates. The white matter hypertonicity lesion volume measured from conventional MRI was also correlated with the health status (p-value < 0.05); however, the size of the regression coefficient was substantially smaller (53% lower), and it was no longer significant (p-value=0.14) after adjusting for age and sex. This work establishes a new non-invasive method that can potentially characterize changes in microvasculature anatomy with the progression of cognitive impairment regardless of an age effect.
ASSOCIATION BETWEEN EXPOSURE TO HURRICANE HARVEY AND MORTALITY AMONG NURSING HOME RESIDENTS
Authors: Hua Cassandra , Thomas Kali , Patel Sweta , Dosa David , Jester Dylan , Andel Ross
Published: December 2022

Hurricane Harvey made landfall in Southeast Texas in August 2017, causing catastrophic flooding. We examined the association between exposure to Hurricane Harvey and rates of 30-and 90-day mortality among Texas nursing home residents. Using Medicare data, we compared a cohort of residents exposed to the storm in 2017 (n= 18,693) to a cohort of residents not exposed to the storm in 2015 (n=19,688). We fit generalized estimating equations with a sandwich estimator, adjusting for resident demographic and clinical characteristics. Exposure to Hurricane Harvey was not associated with 30-day rates of mortality. However, it was associated with a 15% increase in the odds of dying at 90 days holding resident characteristics constant (adjusted odds ratio: 1.15 [95% Confidence interval: 1.06, 1.25). Health effects due to severe flooding, such as those related to decreased ability to manage chronic conditions, may not be apparent until several weeks after the storm.
TEXAS NURSING HOMES INCREASED DIRECT-CARE STAFFING LEVELS DURING WINTER STORM URI
Authors: Jester Dylan , Peterson Lindsay , Andel Ross , Dosa David
Published: December 2022

Prior work suggests that nursing homes (NHs) increase their registered nurse (RN), licensed practical nurse (LPN), and certified nursing assistant (CNA) staffing levels in anticipation of a major hurricane. However, less is known about NHs’ ability to increase staffing levels during a winter storm. We examined RN, LPN, and CNA staffing levels in 1,170 Texas NHs during Winter Storm Uri from February 13-20, 2021. This storm was characterized by cold temperatures and snow/ice accretion that affected the Texas power grid. Linear mixed effects models were adjusted for profit status, continuing-care retirement community status, resident census, overall star rating, a weighted deficiency score, number of citations for infection control, number of substantiated complaints, and county fixed-effects. After adjustment, Texas NHs decreased RN (β=-0.005;b=-0.002;p=.004) but increased LPN (β=0.022;b=0.009;p<.001) and CNA (β=0.044;b=0.026;p<.001) staffing levels. NHs face unprecedented challenges during winter storms, including maintaining adequate staffing levels to meet the needs of their residents.
USING THE INSTITUTE OF HEALTHCARE IMPROVEMENT'S 4M FRAMEWORK TO IMPROVE DISASTER PREPAREDNESS FOR NH POPULATIONS
Authors: Dosa David , Jester Dylan , Peterson Lindsay , Dobbs Debra , Brown Lisa , Black Kathy
Published: December 2022

Prior studies have repeatedly demonstrated that exposure to natural disasters such as hurricanes, earthquakes, and flooding events have profound effects on nursing home (NH) residents. Previous efforts to improve disaster preparedness have often been predicated on the decision to evacuate or shelter in place from a disaster. Unfortunately, evacuation of NH residents is often not possible and nursing homes are often required to make difficult decisions to protect the lives of their residents without data. Recognizing that healthcare systems increasingly provide care for complex individuals; the Institute of Healthcare Improvement (IHI) and the John H. Hartford Foundation introduced a framework for evaluating age-friendly healthcare systems based on 4 evidence-based core elements that matter to older adults. We believe that this 4 M’s paradigm: What Matters, Medication, Mentation, and Mobility, provides a step off point for defining a practical approach to disaster preparedness for nursing homes exposed to future disasters.
DEMOGRAPHIC DIFFERENCES IN THE LONGITUDINAL EFFECTS OF SYMPTOMS ON FALLS AND FALL-RELATED OUTCOMES
Authors: Peng Wenting , Miyawaki Christina , Mo Cen , Luo Yuqian , Tang Siyuan , Liu Minhui
Published: December 2022

Research has shown an association between symptoms and falls and fall-related outcomes among older adults. However, this association was primarily drawn from cross-sectional studies or studies with a single symptom. Using the 2011-2018 waves of the National Health and Aging Trends Study, we examined whether 1) prior-wave common co-occurring symptoms predicted later-wave fall-related outcomes and 2) demographics moderated the longitudinal effects of symptoms on fall-related outcomes among community-dwelling older adults. Falls and fall-related outcomes were self-reported falls, multiple falls, fear of falling (FOF), and FOF limiting activity. The number of symptoms (from 0 to 6) was calculated based on the presence of pain, insomnia, breathing difficulty, depressive symptoms, anxiety, and fatigue. Binomial logistic regression was used for data analyses. Our sample consisted of 9,060 participants who contributed 34,327 observations. These observations were aged between 65 and 79 years old (57.7%), female (58.4%), and non-Hispanic White (70.5%). Each additional symptom was associated with an increased risk of falls (Adjusted Odds Ratio [AOR]: 1.13, 95% CI: 1.11-1.15), multiple falls (AOR: 1.15, 95% CI: 1.12-1.18), FOF (AOR: 1.21, 95% CI: 1.18-1.24) and FOF limiting activity (AOR: 1.25, 95% CI: 1.21-1.29). Age, race/ethnicity, education, and living arrangement significantly moderated the relationships between symptoms and falls and fall-related outcomes. However, gender did not moderate the effects of symptoms on any outcomes. These findings suggest that symptoms longitudinally predict falls and fall-related outcomes. Common symptoms assessment and individual demographics should be incorporated into fall risk assessments and interventions.
GENERIC AND TAILORED INTERVENTIONS FOR COMMUNITY OLDER ADULTS WITH CHRONIC COGNITIVE COMMUNICATION DISORDERS
Authors: Saidi Ladan Ghazi
Published: December 2022

Many Community-Dwelling Older Adults (CDOA) live with debilitating chronic cognitive and communication disorders including Aphasia, Mild Cognitive Impairment, and Traumatic Brain Injury, and no longer receive healthcare services. This portion of the symposium will discuss why engaging CDOA and their caregivers with developing and selecting interventions for their cognitive communication disorders is important. Further, we discuss a community-based approach to make generic as well as tailored speech-language pathology services available to CDOA free of charge. The process of developing and using a multi-stakeholder advisory board of clinicians, researchers, CDOA, as well as a diverse advisory board of caregivers will be described, and challenges will be discussed. Further, we will present and discuss some relevant data.
RESOURCE UTILIZATION AMONG FAMILY CAREGIVERS: INDIVIDUAL AND NEIGHBORHOOD CHARACTERISTICS
Authors: Choi Hyojin , Litzelman Kristin , Harnish Autumn , Reblin Maija
Published: December 2022

Resources in the community play a pivotal role in increasing well-being of both care recipients and caregivers and ensuring equitable access to needed resources is a crucial priority for policy and practice. Drawing on the Andersen Behavioral Model, this study explored the longitudinal relationship between individual and neighborhood factors and social resource utilization (i.e., paid caregivers, respite care, support group, training, financial help, or transportation) among family caregivers. Unpaid family caregivers for community-dwelling older adults were identified using data from the National Study of Caregiving and National Health and Aging Trends Study (Time 1: 2015, Time 2: 2017; n=616). Neighborhood characteristics were indicators of the Social Vulnerability Index and provider density at the census-tract level. Poisson regression was used to assess predictors of greater resource use (interpreted as incident rate ratios [IRR] with 95% confidence intervals [CI]). Nearly two-thirds of the sample reported using one or more services at each timepoint. Enabling factors were key predictors of resource use at Time 2, including income above 400% federal poverty level (IRR[CI]=1.53 [1.11,2.09]), better self-rated health (IRR[CI]=1.11 [1.01,1.22]), and resource use at Time 1 (IRR[CI]=1.64 [1.29,2.08]). Need-based predictors included greater frequency of personal care (IRR[CI]=1.13 [1.05,1.22] and longer care duration (IRR[CI]=0.99 [0.98,1.00]). Neighborhood factors were not associated with resource use in this analysis, nor were other need factors including caregiving burden. The findings highlight potential disparities in resource use by income, health status, or experience with systems navigation, with implications for policy and outreach.
TIME-USE AND WELL-BEING IN FAMILY AND OTHER UNPAID CAREGIVERS OF OLDER ADULTS
Authors: Baik Sol , Lehning Amanda , Sacco Paul , Cagle John , Kusmaul Nancy
Published: December 2022

Due to the intensive time commitment for caregiving, caregivers report limited freedom to engage with others, participate in physical activities, pursue leisure activities, and have adequate time for sleep. Few studies have focused on caregivers’ time-use across different activities, particularly how different patterns of time-use are associated with well-being. This study aimed to: (1) identify time-use profiles of family caregivers of older adults and (2) examine associations between identified time-use profiles and caregiver well-being. We analyzed 1,640 family caregivers of community-dwelling older adults by combining secondary data from Round 7 (2017) of the National Study of Caregiving and the National Health and Aging Trends Study. We conducted latent profile analysis to estimate time-use profiles including covariates and outcomes. Three classes of caregivers emerged based on time-use patterns. The High Committed class (20%) spent the longest time in non-eldercare related committed activities, such as household activities and paid work. The High Discretionary class (49%) spent the highest amount of discretionary time, including social activities, physical activities, and other free-time activities. They also spent the least amount of non-eldercare committed time compared to the other two caregiver types. Lastly, the Balanced class (31%) allocated time relatively evenly in all activities. When comparing well-being outcomes between time-use profiles, caregivers in the High Discretionary class had worse self-rated health but lower levels of anxiety than the Balanced class. Research on time-use and caregiver well-being may help identify at-risk caregiver groups based on lifestyle profiles and develop targeted policies to promote better caregiver well-being.
PAVING THE WAY FOR AGE-FRIENDLY UNIVERSITY DESIGNATION: ACCESS AND SUPPORT FOR OLDER ADULT LEARNING INITIATIVES
Authors: Felsted Katarina Friberg , Eaton Jacqueline
Published: December 2022

Through a GSA/AARP funded grant, the University of Utah implemented an initiative to promote awareness of a state bill which provides reduced tuition for residents 62 and older. The initiative provided tuition waivers to older adult students, which enhanced enrollment and increased engagement with key age-friendly stakeholders. Implemented over four semesters, student use of tuition waivers increased 875%. This initiative was a crucial step in seeking Age Friendly University (AFU) designation, as it led to mentorship from members of the AFU global network and a partnership with our university’s Emeritus Faculty Board. Strategic planning guided the preparation of a four-step plan towards designation: 1) complete a cross-campus AFU inventory and inform campus stakeholders, 2) report progress to the Council of Deans, 3) present to Academic Vice Presidents, and 4) obtain AFU endorsement from the University President. During this presentation we will present lessons learned as we progress towards designation.
FOSTERING SOCIAL CONNECTIVITY AND RESILIENCE IN SEXUAL AND GENDER MINORITY OLDER ADULTS
Authors: Kim Hyun-Jun
Published: December 2022

While social connectedness and engagement are key aspects of well-being over the life course, sexual and gender minority (SGM) older adults are found to experience elevated risks of social isolation and limited social connectivity, which have been linked to loneliness. Social isolation and loneliness have been significant health concerns, increasing risk of premature death, cognitive decline, and poor health and well-being, yet SGM older adults are resilient populations. To address the strengths and challenges found in evidence-based intervention development, it is critical to understand how they have managed to build and maintain their social resources and reduce social isolation and loneliness. To this end, this symposium will analyze and incorporate the results using data from both Aging with Pride: National Health, Aging and Sexuality/Gender Study (NHAS), the first longitudinal study of SGM older adults in the United States and Innovations in Empowerment and Action (IDEA) Café, the first clinical trial pilot study addressing social isolation among SGM older adults living with dementia. Dr. Kim and colleagues with present a factor analysis suggesting a multi-dimensional construct of social resources unique to SGM older adults. Dr. Fredriksen Goldsen and colleagues will identify sexual and gender diverse older adults at heightened risk of loneliness and examine risk and protective factors. Dr. Emlet and colleagues will present findings from a pilot study, IDEA Café, designed to enhance social connectedness, physical functioning, and quality of life among socially isolated SGM older adults with cognitive impairment.
FRIENDSHIP IN APHASIA
Authors: Douglas Natalie
Published: December 2022

People living with aphasia (PLWA) have identified friendship as a key area of need, and any programs or interventions designed to support this priority should have the input of PLWA at the forefront. This portion of the symposium will outline steps that were taken to engage PLWA in the development of evidence-informed interventions and programming to support friendship for PLWA, despite the challenges PLWA face in communication. The process of developing and using a multi-stakeholder advisory board of clinicians, researchers, PLWA, and family members will be described. Data highlighting key themes from interviews of PLWA, their significant others, and their friends will be presented including reciprocity, persistence, and communication strategies. Finally, communication techniques to engage PLWA in research activities as informed by PLWA themselves, clinicians, and researchers will be provided.
UNDERSTANDING THE DIMENSIONS OF SOCIAL RESOURCES AMONG SEXUAL AND GENDER MINORITY OLDER ADULTS
Authors: Kim Hyun-Jun , Goldsen Karen Fredriksen , Romanelli Meghan
Published: December 2022

Despite the growing number of recent studies on the positive role of social resources on health and well-being among SGM older adults, the multi-dimensional construct of social resources has not been examined due to a lack of adequate measures and data. This study describes the rationale behind the measurements of social resources used in the National Health, Aging, and Sexuality/Gender Study (NHAS). We analyze NHAS data collected in 2014 (N = 2,450) to assess the reliability of these social resource measurements. Out of 28 indicators of social resources (α = .82), three distinct factor structures emerged: relational social connectedness (α = .71), collective social connectedness (α = .82), and perceived social connectedness (α = .79). All item-rest correlations for each scale were moderate to strong. The scales could be used to understand various aspects of social resources and its role in enhancing health and well-being in the historically marginalized populations.
MULTISTAKEHOLDER COLLABORATION TO BETTER ADDRESS MEANING IN LIFE: PARTICIPATORY ACTION RESEARCH
Authors: Bakker Franka , van Leeuwen Theo
Published: December 2022

Meaning in life of older adults is related to a good life. Health and social care professionals are expected to address tensions in finding meaning in life among their clients. From 2020 to 2022, we conducted a 24-month participatory action research to discover how professionals in spiritual care, social workers, and volunteers can collaborate to better recognize, address and support questions regarding meaning in life. Four groups of co-researchers were composed, each consisting of a social worker, professionals in spiritual care, older adult, volunteer, students and researcher. They had monthly meetings to discuss actions and findings. In-between, collaboration activities were shaped and qualitative data were gathered about e.g. experiences. Results show that collaboration can be shaped by activities like providing workshops, expert consultation, coaching-on-the-job, jointly shaped interventions for clients, dialogue sessions, and multidisciplinary meetings. Thereby, for realising sustainable collaboration and ongoing mutual learning, structural and person-independent encounters should be realised.
DOES PERTURBATION-BASED BALANCE TRAINING ON COMMERCIAL TREADMILLS IMPROVE BALANCE RECOVERY IN OLDER ADULTS?
Authors: Whitten Justin , Oleary Bryant , Tarabochia Dawn , Graham David
Published: December 2022

Background

Perturbation-based training (PBT) is a balance training method that causes a trip like event requiring a rapid step response to regain balance. There are numerous examples in the literature demonstrating the effectiveness of PBT but the need to use an expensive treadmill in a scientific laboratory limits the general applicability of PBT as a community-based intervention. A possible solution is to rapidly stop the treadmill belt during walking using the e-brake as the perturbation event. Importantly this could be performed on a commercially available, lower cost treadmill. Therefore, the purpose of this study was to evaluate the effectiveness of a commercial treadmill during PBT.

Methods

Seventeen participants completed either 9 weeks of PBT or conventional balance training based on ACSM guidelines. During an initial and final testing session participants balance recovery performance was evaluated. Participants were released from a forward static lean angle and asked to recover with a single step, during this test their movement was recorded and subsequently used to determine the Margin or Stability pre- and post-training. Participants were tracked for 6 months following the intervention and falls were recorded on a weekly basis. Results and Summary: There was no difference in balance recovery performance between groups following the training intervention and there was no difference in fall rate between groups in the 6-month follow-up period. We conclude that overall using the e-brake of a commercial treadmill is ineffective as a PBT strategy as it elicits no greater benefit than conventional exercise training.