bluuebunny/crossref_metadata_2025 huggingface dataset:
NEIGHBORHOOD HEALTH CARE FACILITIES AND INCIDENT DEMENTIA: RESULTS FROM THE EINSTEIN AGING STUDY
Authors: Hyun Jinshil , Hall Charles , Katz Mindy , Derby Carol , Lipton Richard
Published: December 2023

Though access to health care is associated with improved chronic health outcomes, data on dementia risk are limited. From the Ecological Model of Aging, limited access to health care facilities may be associated with increased likelihood of developing dementia through poor management of comorbidities. The current study aims to investigate the association between the density of neighborhood health care facilities and incident dementia. Participants were community-dwelling older adults, systematically recruited from Bronx, NY (N=1,461, mean age=78.4; mean follow-ups=4.6 years; 68% non-Hispanic White, 26% non-Hispanic Black). Density of health care facilities in each participant’s Census Tract was derived from the National Establishment Time-Series data. We used Cox proportional hazards models using age as the time scale and adjusted for sex, race, education, income, and neighborhood deprivation. Incident dementia developed in 10% of the sample. Older adults living in the areas with lower density of health care facilities, compared to those living areas with a higher density of health care facilities, were at increased risk for incident dementia (HR=1.79, 95% CI=[1.12, 2.87] for lowest vs. highest tertile; HR=1.65, 95% CI=[1.02, 2.66] for intermediate vs. highest tertile). Further controlling for cardiovascular and other comorbidities did not change the pattern of results. The current results suggest that unequal distribution of health care facilities across geographic locations may help account for cognitive health disparities among older adults. Future studies will need to identify behavioral and individual-level mechanisms (e.g., healthcare use, better treatment before disease occurs) in the association between neighborhood health care facilities and dementia.
NURSING ASSISTANT TURNOVER IN HOME HEALTH CARE AGENCIES: A SCOPING LITERATURE REVIEW
Authors: Wagner Jennifer , Miller Vivian , Maziarz Lauren , Burek Melissa , Bell Julia , Perry Kaley
Published: December 2023

Certified nursing assistants (CNAs) who work in Home Health Care (HHC) are part of the continuum of care and aid in reducing the burden to the acute care system. CNAs assist patients with their activities of daily living and provide social engagement. Since CNAs see patients more frequently, they are crucial for referral to the nursing staff in times of crisis. The Affordable Care Act was enacted in 2010 which expanded HHC services and provides consumers with more health care options. There is a projected 25 percent increase in CNAs needed in HHC between 2021 and 2031. Despite the growth in HHC, the sector has high turnover rates of CNAs. It is estimated that 35 to 65 percent of CNAs leave HHC employment annually. This scoping review utilized the Job Demands-Resource (JD-R) and the Social-Ecological (SE) models to identify trends in turnover. The JD-R can be used to understand how the demands of one’s job as well as the engagement in one’s work can affect overall work-related stress, health, and motivation, and is contrasted with available job resources. The SE framework was used to explore levels of influence, and examines how individuals, relationships, communities, and society interact to influence behavior and perceptions. By using both the JD-R and SE models, it is easier to conceptualize the interaction of factors impacting turnover and that many of these factors are unique to CNAs in HHC. The difficult nature of the work, low pay, and low autonomy mean identifying job resources is critical.
OBLIGATIONS IN JAPAN: A THREE-YEAR LONGITUDINAL STUDY OF MID-LIFE ADULTS
Authors: Oh Jeewon , Lee Han Na
Published: December 2023

Obligations embody a sense of responsibility, whether they are directed toward close relationships or the broader public community. Middle-aged adults may find themselves in increased caregiving roles, but research examining the role of their obligation on their well-being and relationships is scarce. Across studies, obligation is linked with both positive (e.g., higher well-being and relationship quality) and negative outcomes (e.g., greater burden). A previous study in the U.S. suggested that these mixed findings may be partially because there are various types of obligations that differ on the level of investment. Given the Japanese collectivistic culture that values intricate social connection, their obligation may take on a different form and play a different role. We used two waves of data from the Midlife in Japan Project (2009-2012). Participants were 371 middle-aged adults (M = 55.47, SD = 14.04, 56.02% women, 43.98% men, 71.73% married) living in Japan. We factor-analyzed the structure of obligation and found a 3-factor solution fit best (e.g., RMSEA = .06, SRMR = .01, CFI = 1.00). Obligation could be characterized by holding light and substantive obligations to close others and obligations to the public community. Results suggest differential links between the types of obligation and well-being outcomes. For instance, light obligation predicted less negative affect (β = -.24, p = .035) after three years, but otherwise, other types of obligation did not predict positive or negative affect. Links with relational outcomes (e.g., support/strain) and implications of midlife obligations will be discussed.
OLDER ADULTS’ PERCEPTIONS OF HOPE REGARDING THEIR ABILITY TO MAKE DIET AND EXERCISE CHANGES
Authors: Worthington Amber , Golden Dale , Howell Britteny
Published: December 2023

Successful aging is facilitated by healthy diet and exercise levels; however, older adults may face barriers to obtaining these. One key motivator for improving older adults’ diet and exercise may be perceptions of hope. Persuasive Hope Theory (PHT) posits that hope motivates behavior by focusing peoples’ thoughts on opportunities for actions that lead to future rewards. Research suggests hope is particularly motivational for older adults, yet little work has examined factors that lead older adults to feel hope. In line with PHT, this project examined whether older adults’ perceptions that increasing fruit and vegetable intake (FVI) and exercise are important, possible, congruent with their goals (i.e. goal congruence), and will lead to a better future (i.e., future expectation), influence feelings of hope. A convenience sample of participants (N=58) aged 57-87 (M=71.98, SD =8.74) living in urban Alaska completed a questionnaire as part of a larger study. A multiple regression analysis revealed that importance (M=4.40, SD=0.67) and future expectation (M=4.47, SD=0.66) for increasing FVI significantly predicted feeling hopeful about increasing FVI (M=4.40, SD=0.75), but perceptions that increasing FVI is possible (M=4.26, SD=0.74) and goal congruent (M=4.34, SD=0.64) did not (F(4, 53)=11.29, p<.05, R2=.46). The PHT variables for increasing exercise did not significantly predict feeling hopeful about increasing exercise. These results suggest PHT, specifically importance and future expectation, may be used to strategically design messages to increase older adults’ hopeful feelings for increasing FVI; however, more research is needed due to the limitations of the small convenience sample.
OPTIMIZING MEALTIME (OPTIMAL) IN NURSING HOME RESIDENTS WITH ADRD: A PILOT TRIAL OF A PERSON-CENTERED CARE PROGRAM
Authors: Liu Wen , Suh Heather , Williams Kristine , Galik Elizabeth , Resnick Barbara , Buckwalter Kathleen , VanHaitsma Kimberly , Rakel Barbara
Published: December 2023

Nursing home (NH) residents living with dementia (residents) commonly experience behavioral symptoms during mealtime that negatively impact nutrition and function. Residents may not receive optimal, person-centered mealtime care (PCMC) due to multilevel factors. PCMC training that teaches staff to actively engage residents in eating is a prioritized modifiable factor. We developed Optimizing Mealtime (OPTIMAL), a multifaceted, evidence-based, theoretically grounded PCMC program with five components: community stakeholder engagement, environment/policy assessment/modifications, staff education, individualized care planning, and ongoing motivation. OPTIMAL is designed to create and maintain a supportive PCMC culture/environment through appropriate assessments and modifications of factors to optimize mealtime care and outcomes. Our pilot trial (single-group repeated measures design, stakeholders’ interviews) demonstrated OPTIMAL was feasible, acceptable, and perceived useful as evidenced by high recruitment (74%, 77%) and retention (94%, 99%) rates for residents and staff, successful completion of data collection/coding and intervention delivery, and positive stakeholders’ feedback. We recruited 95 staff (age=45±12.1 years, 8.5% male, 12.3% non-white, 89% experienced mealtime care challenges) and17 residents (age=74±7.9 years, 88.2% male, 11.8% non-white) from 8 memory care units of one NH. Stakeholders perceived OPTIMAL was useful for staff who provide care to residents with and without dementia who need assistance and/or experience behavioral symptoms during mealtime. Videotaped observations of dyadic mealtime interactions (N=265) at baseline and 6- and 12-weeks following OPTIMAL showed that resident functional impairments and resistive behaviors during mealtime decreased during the study period. Findings provide preliminary evidence for feasibility, acceptability, and usefulness of OPTIMAL in NH staff and residents with dementia.
ORAL HEALTH AMONG FILIPINO OLDER ADULT IMMIGRANTS
Authors: Ea Emerson , Wu Bei , Hu Jinyu
Published: December 2023

Poor oral health has been associated with decreased quality of life, various non-communicable diseases, and a higher risk of mortality. There is also evidence that older immigrants and those who have been in the US for less than 5 years are more likely to have periodontitis, a serious gum disease and a common oral health condition. Despite this evidence, there is a paucity of studies investigating the influence of acculturation, immigration-related experiences, and resilience on oral health among older Filipino immigrants. To address this significant knowledge gap, a mixed methods study using a survey and focus group interviews was conducted among community-dwelling Filipino immigrants aged 60 years and older. This poster will present the results of the survey (N=103), which used a socio-demographic questionnaire, as well as valid and reliable instruments such as the Geriatric Oral Health Assessment Index, A Short Acculturation Scale for Filipino Americans, Everyday Discrimination Scale, and Connor-Davidson Resilience Scale. The results of the regression analysis revealed that the perception of discrimination and resilience were significantly associated with the perception of oral health among the participants surveyed [F(10,92) = 1.985, p < 0.05]; this regression model accounted for 18.6% of variance in the perception of oral health. The findings support the need for culturally sensitive interventions that could optimize oral health, including the utilization of dental care services for this underserved population.
PERCEIVED HOUSING PROBLEMS AND DEPRESSIVE SYMPTOMS AMONG MIDDLE-AGED AND OLDER AMERICANS
Authors: Lu Peiyi , Kong Dexia , Cao Feifan , Shelley Mack
Published: December 2023

Background

Housing insecurity has been shown to be associated with worse mental health. However, previous studies mostly examined one dimension of housing insecurity (e.g., affordability) and few focused on older adults. This study examined the relationship of perceived housing problems with depressive symptoms among middle-aged and older Americans.

Method

Longitudinal data from the Health and Retirement Study 2006-2018 were used. A total of 7,285 respondents (aged 50+ at baseline) were followed-up every 4 years. Respondents self-reported the status, severity, and duration of their housing problems. Depressive symptoms were assessed by the Center for Epidemiological Studies-Depression Scale (CESD). Mixed-effect models were used to examine the association between perceived housing problems and depressive symptoms, adjusting for individual-level, household-level, and housing-related confounders.

Results

About 5%-7% of respondents had housing problems during every study visit and 5.67% of them experienced persistent housing problems over the study period of 12 years. Having housing problems was associated with higher risk of depressive symptoms (IRR=1.30, 95% CI=1.23, 1.36). A dose-response relationship was observed in the severity and duration of housing problems, with greater increase of depressive symptoms risk among those experiencing more severe or longer duration of housing problems. Results were similar when modelling the risk of elevated depressive symptoms using a binary measure (CESD score ≥ 4).

Conclusion

Perceived housing problems were associated with worse mental health among middle-aged and older Americans. The dose-response pattern highlighted the importance of early intervention and consistent assistance to those experiencing housing problems.
PERCEPTIONS OF THE ROLE PLAYED BY LIVING ALONE IN PROVIDING SERVICES TO PATIENTS WITH COGNITIVE IMPAIRMENT IN THE US
Authors: Portacolone Elena , Johnson Julene , Kotwal Ashwin , Stone Robyn
Published: December 2023

Given the estimated 4.3 million older adults from diverse racial/ethnic backgrounds who are living alone with cognitive impairment in the US, the objective of this study was to identify the potential moderating role of living alone in the use of healthcare and social services for patients with cognitive impairment by eliciting providers’ perceptions of caring for diverse patients with cognitive impairment living alone, in comparison to counterparts living with others. This study used semi-structured interviews conducted between March 2021 and June 2022 with purposively sampled providers of services to patients with cognitive impairment in MI, CA, and TX. An inductive content analysis was used to analyze the data. The majority of the 76 interviewed providers cared for racially/ethnically diverse patientt. Providers represented 20 professions. Providers elucidated specific factors that made serving people living alone with cognitive impairment (PLACI) more challenging, as well as specific factors that increased their concerns when serving PLACI. Providers also elucidated reasons for systematic unmet needs of PLACI for essential healthcare and social services. The vast majority of providers underscored the critical, yet understudied, role of living alone in moderating access to essential healthcare and social services among patients with cognitive impairment. Findings suggest that living arrangement are a social determinant to health among patients with cognitive impairment because PLACI are more likely to experience gaps in services because they are more challenging to serve than counterparts living with others and the healthcare system is not equipped to address these challenges.
PHARMACOLOGIC AMPK ACTIVATION IMPROVES HEALTHSPAN AND LIFESPAN IN NORMAL AND PREMATURE AGING MODELS
Authors: Akin Ozlem Altintas , Mitchell Sarah , Sturla Shana , MacArthur Michael
Published: December 2023

Cockayne Syndrome (CS) is a rare autosomal recessive childhood disease, caused by mutations in CSA (ERCC8) or CSB (ERCC6) genes leading to defective DNA damage repair. CS characteristics include UV sensitivity and premature aging. Deficiencies in CSA or CSB may lead to impaired AMP-activated protein kinase (AMPK) activation. Notably, AMPK-activating interventions have shown promise in preclinical CS mouse models. We tested whether MK8722, an AMPK activator, could mitigate CS phenotypes in a C. elegans model. Our preliminary data show that MK-8722 increases lifespan in wild-type and CS worm model. We also tested the effect of MK-8722 on brood size as a fitness parameter and showed that it does not change the total brood size. We also showed that treating aged mice with MK-8722 improves multiple measures of healthspan including body composition, grip strength and age-associated inflammation. These data suggest that AMPK activation may be a promising therapeutic avenue for both normal and CS-associated aging phenotypes
PRESENCE OF DYSPHAGIA IN A COHORT OF PERSONS LIVING WITH DEMENTIA: OUTCOMES FROM A MULTIDISCIPLINARY CLINIC
Authors: Yee Joanne , Brates Danielle , Mackowicz-Torres Meredith , Robison Raele , Lewis Brian , Clark Lindsay , Wanninger Ellen , Rogus-Pulia Nicole
Published: December 2023

The Cognitive Care Clinic (CCC) provides evaluation for Veterans living with dementia. Speech-language pathology (SLP) is incorporated to facilitate early identification and proactive management of dysphagia. This project sought to describe dysphagia frequency in persons living with dementia (PWD) in CCC. Multidisciplinary assessments led to consensus diagnosis of dementia subtype. Stage was determined using the Functional Assessment Staging Tool (FAST). Validated dysphagia screening tools included Eating Assessment Tool (EAT-10), water swallow test (WST), and Test of Mastication and Swallowing Solids (TOMASS). Penetration-Aspiration Scale (PAS) scores were determined following videofluoroscopic swallow studies (VFSS); scores were classified as “safe” (PAS< 3) or “unsafe” (PAS>=3). Descriptive statistics were calculated for dementia subtype, stage, and dysphagia measures. 78 Veterans were diagnosed with dementia between 2017 and 2023 (mean age=77 years; 5% female) and completed dysphagia screening. The majority had Alzheimer’s disease (43%) and were in the mild disease stage (61%). 37% failed the WST, suggesting impaired safety. 49% failed the TOMASS, indicating masticatory inefficiency. 26% scored 3 or higher on EAT-10, indicating increased dysphagia risk. 22 patients completed VFSS; 55% exhibited unsafe swallows. No significant differences in EAT-10 total scores were observed between those with safe and unsafe PAS scores. Nearly half of this cohort demonstrated signs of swallowing impairment based on clinical testing and/or VFSS. Additionally, EAT-10 scores were low overall with no differences based on dysphagia status on VFSS, which suggests underreporting of dysphagia. These findings highlight the necessity of SLPs in dementia care teams to support early identification and management of dysphagia.
PREVALENCE OF METABOLIC COMORBIDITIES AMONG COGNITIVELY NORMAL AND IMPAIRED WHITE AND AFRICAN AMERICANS
Authors: Turaani Mohammad , Pal Subhamoy , Reader Jonathan , Giordani Bruno , Kavcic Voyko
Published: December 2023

Assessing comorbidities associated with a MCI diagnosis is crucial for diagnostic accuracy and for understanding the role of comorbidities in cognitive decline. In this study of amnestic (aMCI) and non-amnestic (naMCI) MCI participants and persons with normal cognition (CN), we compared the prevalence of three primary comorbidities: Hypertension (HTN), Hyperlipidemia (HLD), and Diabetes Mellitus (DM) across African American and White populations using Chi-squares. Participant data (N = 9,342, 17% African American) were available through the National Alzheimer’s Coordinating Center and included: CN (n = 5,963; MOCA mean=27), aMCI (2,694; MOCA=22), and naMCI (685; MOCA=24) with diagnosis and data per their first Uniform Data Set (Version 3) visit. Significant differences in the distribution of HTN, HLD, and DM were found among the diagnostic groups for the total cohort and racial groups, separately; however, diagnostic differences across races were not always consistent. The relative rates of DM and HLD across the diagnostic groups for both races were generally similar, though higher percentages were seen in African Americans (25% of African Americans, 10% of Whites). As for HTN (52% of African Americans, 39% of Whites), however, the distributions differ across the diagnostic groups and race (%yes for diagnosis; White Americans: CN 35%, aMCI 47%, naMCI 44%; African Americans: CN 66%, aMCI 70%, naMCI 79%, p< 0.001). These findings highlight the importance of considering the contributions of both race and diagnosis when evaluating the role of comorbid factors and metabolic disorders in NC and MCI groups, in particular when considering blood pressure-related measures.
RED BLOOD CELL DISTRIBUTION WIDTH: WHAT CAN IT TELL US?
Authors: Oberdier Matt , Zampino Marta , Shardell Michelle , AlGhatrif Majd , Lakatta Edward , Simonsick Eleanor , Ferrucci Luigi
Published: December 2023

Red blood cell distribution width (RDW), a measure of red blood cell size variability used in evaluating anemia, has been found to predict cardiovascular disease (CVD) morbidity and mortality. RDW increases with age, but the determinants of age-associated elevation in RDW independent of CVD and associated risk factors is limited. Therefore, we examined the association of RDW within the normal range (11.5-15.0%) with age, sex, race, other red blood cell properties, major cardiovascular disease risk factors, and other physiologic data. Data were from 606 men and 627 women (aged 50-95) participating in the Baltimore Longitudinal Study of Aging. Candidate correlates of RDW were included in multiple linear regression models; a reduced model was then obtained by backward selection. RDW was higher with age and female sex. Differences in RDW by sex were explained by hemoglobin, mean corpuscular hemoglobin, and mean corpuscular volume. Further, mean platelet volume (STβ=0.0779, P=0.007), interleukin-6 (STβ=0.0774, P=0.011), erythrocyte sedimentation rate (STβ=0.0746, P=0.028), institutional normalized ratio (STβ=0.0836, P=0.004), thyroid stimulating hormone (STβ=0.0653, P=0.023), and body mass index (STβ=0.1725, P=8.98E-8) were all independently associated with RDW. In the final model, age remained a strong correlate of RDW (STβ=0.2412, P=2.91E-12). In summary, inflammation, metabolic rate, and body habitus independently predict RDW, but do not completely explain its association with age. Future investigation of longitudinal change in RDW with age and its association with these and other factors is needed to advance knowledge on the timing and potential mechanisms of age-associated increases in RDW, and its implication for health outcomes.
SELF-REPORTED AND OBJECTIVE ASSESSMENT OF HEARING HANDICAP AND COGNITIVE CHALLENGES IN AGE-RELATED HEARING LOSS
Authors: Shende Shraddha , Mudar Raksha
Published: December 2023

Age-related hearing loss (ARHL) is a common condition in older adults, with most reporting challenges in recognizing speech-in-noise (SiN). Growing evidence also indicates cognitive alterations in this population. Concomitant examination of hearing and cognitive abilities using a combination of subjective and objective measures would be useful in characterizing the challenges faced by individuals with ARHL. We examined hearing abilities and cognitive functions in 15 individuals with bilateral mild-to-moderate untreated sensorineural ARHL (age: 70.4 ± 7.4 years, pure tone average: 31.0 ± 3.8 dB HL) and 15 age- and education-matched normal hearing controls (age: 65.7 ± 5.8 years, pure tone average: 15.4 ± 5.9 dB HL). We examined subjective ratings of hearing handicap (Hearing Handicap Inventory for Adults) and cognitive ability (Self-rating of Cognition in Everyday Activities), and objective measures of SiN (Quick Speech-In-Noise) and cognition (Montreal Cognitive Assessment [MoCA] and MoCA-memory index score [MoCA-MIS]). Our analysis revealed that individuals with ARHL self-reported a greater number of cognitive issues in everyday activities and had a higher hearing handicap score (p=.044) relative to controls. Additionally, the ARHL group performed significantly worse on SiN (p=.005) and cognitive screening (MoCA, p=.031; MoCA-MIS, p=.039). Taken together, these findings suggest that in addition to experiencing challenges with hearing abilities, individuals with mild-to-moderate ARHL also experience cognitive changes. Furthermore, these challenges are self-perceived as well as noticeable on objective testing. Our work points towards the consideration of self-report and objective assessment of cognition in geriatric hearing care, which can further inform the development of novel interventions.
RISK AND PROTECTIVE FACTORS OF COGNITIVE FUNCTIONING AND DEMENTIA: COMPARING MEXICAN AND NON-MEXICAN HISPANICS
Authors: Ferdows Nasim
Published: December 2023

This study investigates the cognitive functioning of Hispanic individuals aged 65 and above, focusing on the unique risk and protective factors associated with dementia in Mexican Hispanics and non-Mexican Hispanics. The study utilizes data from the Harmonized Cognitive Assessment Protocol (HCAP) subsample of the Health and Retirement Study (HRS), comprising 388 Hispanic older individuals who participated in the HCAP in 2016 (traced back to 2000), allowing for a comprehensive examination of cognitive health within this population. Cognitive function was measured using the Mini-Mental State Examination (MMSE) score and to classify dementia. The findings reveal distinct patterns in cognitive functioning between Mexican Hispanic and non-Mexican Hispanic populations. Mexican Hispanic males exhibit lower MMSE scores across all age groups, while Mexican Hispanic females show slightly higher scores compared to non-Mexican Hispanic females. Education and wealth levels do not significantly affect cognitive scores in either group. Mexican Hispanics have lower odds of dementia compared to non-Mexican Hispanics, even when accounting for sociodemographic, midlife, and late-life characteristics. Both educational attainment and wealth emerge as protective factors against dementia for both groups. Additionally, midlife obesity, hearing loss, and later-life physical inactivity are identified as specific risk factors for dementia in Mexican Hispanics but have an insignificant impact on non-Mexican Hispanics. These findings have implications for targeted interventions and policies to promote cognitive well-being and address health disparities in older Hispanics. The aim is to improve the overall quality of life and achieve equitable healthcare outcomes.
RISK FACTORS FOR FALL-RELATED MILD TRAUMATIC BRAIN INJURIES AMONG OLDER ADULTS: A SYSTEMATIC REVIEW
Authors: Okrah Prince , Tharrington Shafer , Shin Isaac , Wagoner Aaron , Woodsmall Katelyn , Jehu Deborah
Published: December 2023

Mild traumatic brain injuries (mTBI) are commonly undiagnosed, which delays treatment and recovery. About 80% of older adults’ mTBIs stem from falls, yet factors driving fall-related mTBIs are unclear. This study aimed to systematically review risk factors for fall-related mTBIs among older adults. We used the Preferred Reporting Items for Systematic Reviews with Meta-Analysis protocol and the Meta-Analysis of Observational Studies in Epidemiology guidelines (Prospero ID: CRD42023377847). Our scope included prospective studies analyzing risk factors for fall-related mTBI in adults ≥ 60 years. The primary outcome measure was the relative risk for fall-related mTBIs, and secondary outcomes were: fall rate, total falls, and the number of fallers and non-fallers in those with and without a mTBI. On November 4, 2022, we searched: CINAHL Plus, and Health Source: Nursing Academic Edition, Nursing & Allied Health Database, PubMed, SPORTDiscus, and Web of Science. We conducted a grey literature search by examining reference lists of relevant studies. Two authors screened articles, and one author adjudicated any disagreements. Two authors would have assessed the reporting quality using the Strengthening the Reporting of Observational Studies in Epidemiology checklist, and the risk of bias using the Joanna Briggs Institute Prevalence Critical Appraisal tool. The database search yielded 410 articles; after deduplication, 395 titles and abstracts were screened, and 66 articles underwent full-text review. Overall, no studies were eligible. Fall-related mTBIs can have devastating consequences. There is an urgent need to identify risk factors for fall-related mTBIs in older adults to improve screening procedures and therapeutic intervention.
SHAPING COVID-19 INTERVENTIONS THAT ADDRESS SOCIAL BARRIERS AMONG OLDER LATINOS IN ASSISTED LIVING FACILITIES
Authors: Panellas Isis , Beaulaurier Richard
Published: December 2023

COVID-19 has exposed severe gaps in our understanding of preventing infectious diseases, particularly in congregate living facilities. While the medical and public health communities developed clear insights into preventing or limiting the spread of infection, our understanding of barriers to adopting these measures has lagged, particularly in minority communities. The COVID-19 pandemic has disproportionately affected older Latino adults, particularly those living in assisted living facilities. Among this vulnerable population, older Latinos face unique social barriers such as language and communication difficulties, lack of culturally competent care, and socioeconomic disadvantages that contribute to their increased susceptibility to COVID-19 transmission and which can lead to more severe outcomes. While initial intervention strategies focused on medical interventions to mitigate the virus’s effects, there has been a gradual recognition that barriers to prevention have increasingly shifted from medical to social domains. This paper aims to document the existing knowledge and identify knowledge gaps concerning effectively managing these social barriers. Culturally sensitive approaches must consider salient features of Latino family dynamics such as allocentrism, familismo, respeto, and expected gender roles. In addition, there are often barriers related to external factors, such as a lack of Spanish language resources, community engagement, stereotypes, and racism. Prevention approaches need to identify and address these barriers to safeguard the well-being of older Latinos in assisted living facilities during the COVID-19 pandemic. This review will explore our current understanding of these social barriers, provide insights into potential strategies to mitigate their impact and identify continuing gaps in our knowledge.
STABILITY AND INTER-RELATIONSHIPS OF INFLAMMATORY MARKERS ACROSS TWO WEEKS IN OLDER ADULTS
Authors: Tennyson Robert , Wright Molly , Knight Erik , Graham-Engeland Jennifer , Engeland Christopher
Published: December 2023

The temporal stability of basal and stimulated inflammatory cytokines is unclear in older adults, despite often being used to characterize inflammatory status. Further, it is not apparent how the stability of these markers and their multi-dimensional relationships connect to healthy aging. This analysis examines these issues in 227 participants from the Einstein Aging Study [ages: 70-90 (Mean=76.7), 67% women] with blood draws ~2 weeks apart. Temporal stability was assessed by intra-class coefficients (ICCs) obtained from linear mixed models (controlling for days between measurements, age, gender) for a panel of basal and lipopolysaccharide (LPS)-stimulated cytokines (interleukin [IL]-1β, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor [TNF]-α). Sensitivity analyses compared ICCs across genders and individuals reporting high vs. low subjective health. A composite measure of basal cytokines exhibited strong reliability (ICC: 0.854), whereas individual basal cytokines exhibited moderate (>0.5) to very high reliability (>0.9). Conversely, a composite measure of stimulated cytokines demonstrated moderate reliability (ICC: 0.552), with individual stimulated cytokines having only low (< 0.5) to moderate reliability. No appreciable differences were observed by gender, but individuals reporting low (ICC: 0.457) vs. high (ICC: 0.631) subjective health exhibited considerably lower reliability for the stimulated composite measure. In sum, basal cytokines had moderate to high stability, whereas stimulated cytokines exhibited relatively low stability. Given that individuals reporting lower subjective health demonstrated greater variability in stimulated cytokines, higher fluctuations in inflammatory responsivity may reflect suboptimal health in older adults. The inter-relationships of these cytokines, explored via principal component analysis, will also be discussed.
STOPPING OLDER PERSON GENDER-BASED VIOLENCE IN WOMEN 55+ THROUGH PROMISING PRACTICES: A SCOPING REVIEW
Authors: Melissa Macri , Abbas Jihan , Hirst Sandra , Santarossa Melanie , Mirza Raza , Hsieh Jessica , MacPherson Margaret , Schoepflin Benedicte
Published: December 2023

Background

Intimate partner and family violence (IPFV) disproportionately affect women of all ages, but are often understudied in older populations. Older women also face numerous barriers to reporting these types of abuse. A scoping review was undertaken to: (1) synthesize current knowledge about the utility and suitability of screening and intervention tools for older women (55+) experiencing IPFV; and (2) identify existing policy, practice, and research gaps with regard to current screening and intervention tools.

Methods

A comprehensive search of the databases Medline, CINAHL, PsychINFO, AgeLine, ASSIA, and Sociological Abstracts was conducted. In addition, grey literature sources were searched using Google Scholar, ISI Social Sciences Citation Index, ISI Conference Proceedings Citation Index-Social Science & Humanities, Dissertations & Theses: Full Text, Canadian Institute for Health Information (CIHI), and National Institute of Health (NIH). After screening and selection, 42 documents were included for data extraction.

Results

There were five major themes that emerged: (1) older women were not the specific targets of the studies/tools; (2) screening and intervention tools should address health outcomes; (3) tools identified were used or developed for some diverse populations; (4) two or more tools were used in combination; and (5) intervention tools should focus on social support and empowerment.

Conclusions

Older women, especially those with intersectional identities, are rarely represented in studies of IPFV, and are even less frequently the primary focus. Screening and intervention tools should address health outcomes, social support, and empowerment. Effective screening and intervention may stem from utilizing multiple tools in combination.
SUCCESSFUL METHODS FOR ELICITING VIEWS OF DIRECT CARE WORKERS REGARDING NEEDS AND PREFERENCES OF HOME CARE CLIENTS
Authors: Hyde Joan , Frost Alanna
Published: December 2023

Over the past decades, as the recruitment and retention of Direct Care Workers (DCWs) has become a critical issue, numerous studies have sought to elicit workers’ views, particularly on job satisfaction, stressors, and intent to stay. This project, which includes a review of those studies, uncovered a wide variety of methods and approaches, which we are evaluating for use in future studies that would capture direct care worker’s insights regarding the needs and preferences of the people for whom they provide support. In particular, this project, in conjunction with a larger one designed to assess dually-eligible care recipients’ experiences with formal home care, explores methodologies best suited to capturing the congruence of DCWs’ views with those of recipients’ needs and preferences. It would test the hypothesis that DCWs’ assessments may supplement recipients’ insights, and may strengthen advocacy to improve home care access, policies and practices. The presentation will offer a systematic review of methods and instruments, including use of validated tools and those with face validity that addresses culturally relevant factors, as well as the use of focused and hypothesis-generating open-ended interviews that are sensitive to the power relationships and voices of those participants in the endeavor. The presenters will offer potentially innovative practices, such as observation, documentation analysis, and the use of Delphi techniques which draw on the knowledge and expertise of DCWs. The presentation will also draw on studies that utilized technology and social media to reach and engage this study population.
THE ASSOCIATION OF NON-SEVERE COVID-19 INFECTION AND PROGRESSION TO FRAILTY AMONG ROBUST OLDER VETERANS
Authors: Resendes Natasha Melo , Tang Fei , Tosi Dominique , Hammel Iriana
Published: December 2023

Background

Frailty is a multisystem syndrome characterized by vulnerability to stressors, such as the infection with COVID-19. We set out to examine if mild COVID-19 infection impacted frailty onset among older robust veterans, and whether other factors were associated with developing frailty.

Methods

Retrospective cohort study of U.S. Veterans 55 years and older who had a SARS-CoV-2 infection between 3-15-2020, and 11-30-2020, were active VHA users/and had a VA Frailty Index (VA-FI) of 0.0 at time of diagnosis. We used nationwide VHA data from the VA COVID-19 Shared Data Resource database. We excluded Veterans hospitalized after contracting COVID-19, and who died within the 25-month follow-up. Cox proportional hazard model was used to assess the association between COVID-19 infection and developing frailty or (pre-frailty + frailty), after adjusting for age, BMI, race, ethnicity, gender, smoking, and rurality.

Results

86061 Veterans aged 55 and older met inclusion criteria. Mean age was 68.4 yrs (SD=7.8) with 91.0% (78347) males. 7561 (8.8%) tested positive for COVID-19, and 78500 (91.2%) tested negative. The COVID-19 positive group had a higher percentage of black and city-dwelling Veterans than the COVID-19 negative group. After adjustments listed above, testing positive for COVID-19 was associated with an increased hazard of becoming frail (adjusted HR=1.63, 95%CI: 1.24-2.13), and pre-frail + frail (adjusted HR=1.77, 95%CI: 1.53-2.06).

Conclusion

We showed that mild COVID-19 was associated with higher incidence of frailty and pre-frailty. Follow-up post COVID-19 infection should include a comprehensive geriatric assessment for early frailty identification and intervention.
THE ASSOCIATIONS BETWEEN LUNG DISEASE, CAREGIVING, AND PSYCHOSOCIAL WELL-BEING IN OLDER US ADULTS
Authors: Bilalaga Mariah Malak , Almidani Louay
Published: December 2023

The aim of this study was to examine the association between lung disease, caregiving for adults with lung disease, and the psychological and social well-being of older adults using data from the National Health and Aging Trends Study 2021, a nationally representative sample of US adults aged ≥ 65 years. Lung disease was determined based on self-reported data regarding diagnoses of emphysema, asthma, or chronic bronchitis. The Patient Health Questionnaire for Depression and Anxiety (PHQ-4) questionnaire was utilized to assess depressive and anxiety symptoms. Social isolation was defined based on responses about living arrangements, frequency of communication with others, and participation in activities. Prevalence ratios adjusted for covariates were calculated using Poisson regression. Among adults with lung disease, the prevalence of depressive symptoms was notably higher (prevalence ratio [PR]: 1.43; 95% CI: 1.05, 1.96) compared to those without. However, the prevalence of anxiety symptoms and social isolation did not significantly differ when compared to their counterparts without lung disease (p< 0.05). Caregivers responsible for adults with lung disease had a greater prevalence of depressive symptoms (PR: 1.61; 95% CI: 1.16-2.25), but there was no notable difference in the prevalence of anxiety symptoms or social isolation (p< 0.05). We highlight that both lung disease and caregiving for adults with lung disease are significantly associated with increased prevalence of depressive symptoms, but not anxiety symptoms or social isolation, among older adults in the United States. Strategies are required to enhance the psychological well-being of individuals with lung disease as well as their caregivers.
THE FOURTH AGE IN PROSPECT: A STUDY FROM FIVE NATIONS
Authors: Ekerdt David , Marhankova Jaroslava Hasmanova , Fung Helene , Liou Shyhnan , Lessenich Stephan
Published: December 2023

Higgs and Gilleard (2015) have uniquely theorized the fourth age as a “social imaginary” of deep old age that blends notions of frailty, abjection, and the moral relations of care. This report evaluates the power, reach, and coherence of the fourth age imaginary among older adults in relative good health. In a qualitative design and within samples at five sites (in Czechia, Germany, Hong Kong, Taiwan, and the United States), 138 adults aged 70+ and still living independently discussed what it would mean to be “not independent” in later life. Replies referenced other people in general, specific people, or one’s own potential experience. Pooled across sites, the views of our participants confirm the theorized features of the social imaginary. Participants spoke readily of gateway infirmities heralding frailty and of frailty’s abjection; expressed dread and abhorrence of dependence, some saying that death would be preferable; and were anxious about nursing homes and about burdening others with an obligation to care for them. In all, the bleak but formidable reputation of the fourth age impinges on those living in the third, raising apprehensions about the future. At the same time, perhaps this prospect of unwanted old age can function as adaptive, motivating efforts to maintain bodily and cognitive integrity, to plan for the future, to cultivate support networks, or to savor the present. Fourth-age studies that document the lived experience of frailty and dependence have the potential to undermine the social imaginary and furnish new narratives for facing the future.
THE RELATIONSHIPS BETWEEN INTRINSIC CAPACITY AND FRAILTY AND DISABILITY IN OLDER OUTPATIENTS
Authors: Chang Mei-Ching , Lo Yu-Tai , Lee Wei , Fan Sheng-Yu
Published: December 2023

The ICOPE scale is developed by the WHO to assess intrinsic capacity, including cognition, mobility, nutrition, hearing, vision, and depression. However, the relationships between intrinsic capacity and frailty and disability were unknown. The purposes of this study were to explore the cut-off points of the ICOPE scale for frailty and disability in older outpatients, and the significant intrinsic capacities for frailty and disability. This study employed a cross-sectional research design. The participants were patients aged 65 and above attending the geriatric department of a medical center (n=397). The ICOPE scale, Clinical Frailty Scale (CFS), and Activity of Daily Living (ADL) scale were used. ROC curve analysis was used to determine the optimal cut-off points of the ICOPE scale for frailty and disability, and logistic regression for the significant intrinsic capacities related to frailty and disability. For frailty, the AUC value of abnormal intrinsic capacity was 0.79 (p < 0.001), with an optimal cut-off point of 2/3. For disability the AUC value of abnormal intrinsic capacity was 0.82 (p < 0.001), with an optimal cut-off point of 2/3. Logistic regression showed cognition, mobility, and nutrition related to frailty significantly; whereas cognition, mobility, nutrition, and hearing related to disability significantly. Older adults with three or more abnormal intrinsic capacities have a higher risk of frailty and disability. The problems of cognition, mobility, and nutrition were the risk factors of frailty and disability. Healthcare staff can pay attention to older outpatients with the problems of intrinsic capacities.
THE RISK OF MEDICATIONS IMPAIRING ROAD TEST PERFORMANCE AMONG COGNITIVELY INTACT OLDER ADULTS
Authors: Carr David , Beyene Kebede , Babulal Ganesh
Published: December 2023

Importance

Older adults are increasingly prescribed medications that have adverse side-effects. Prior studies have found higher risks associated with motor vehicle crashes. Objective: This 10-year study determined whether specific medication classes were associated with performance decline assessed by a standardized road test in a community-sample of healthy, cognitively-normal older adults. Design, Setting, and Participants: This was a prospective cohort study of 198 cognitively-normal older adults ≥ 65 years old with a valid driver’s license who were followed annually, with rolling enrollment. Exposure: Potentially driver impairing medications. Main outcomes and measures: The primary outcome measure was performance (pass or marginal/fail) based on the Washington University Road Test. Multivariable Cox proportional hazards models evaluated the association between PDI medication use and road test performance.

Results

Among the 198 older adults (mean [SD] baseline age, 72.6 [4.6] years; 87 females [43.9%]; and 19 Black participants [9.5%]), 70 participants [35%] received a marginal/fail rating on the road test over an average follow up of 5.70 years. Any antidepressant (HR, 2.81; 95% CI, 1.67- 4.71), SSRI/SNRI (HR, 2.73; 95% CI, 1.56- 4.77), sedatives/hypnotics (HR, 2.70; 95% CI, 1.40- 5.19), or NSAIDs/Acetaminophen (HR, 2.80; 95% CI, 1.34- 5.83) use had at least a 2.5 greater risk of receiving a marginal/fail rating on a road test compared to controls. Conclusion and relevance: In this prospective cohort study, specific medication classes increased the longitudinal risk of failing a road test. Patients should be counseled about perceived driving difficulty and risk when prescribed these medications by clinicians.
TRANSITIONS IN MEDICATION MANAGEMENT AMONG PATIENTS WITH DEMENTIA: PATIENT-CAREGIVER PERSPECTIVES
Authors: O’Conor Rachel , Russell Andrea , Oladejo Dianne , Filec Sarah , Morhardt Darby , Rogalski Emily , Lindquist Lee A , Wolf Michael
Published: December 2023

Older adults with Alzheimer’s disease and related dementias (ADRD) have higher rates of multimorbidity and polypharmacy. Medication adherence is critical to maintain health but is difficult with complex regimens. Little is known about how older adults with varying levels of cognitive impairment self-manage medications, and how responsibilities transition to caregivers. We conducted qualitative interviews with patient-caregiver dyads exploring how they managed multidrug regimens. Patients were eligible if they had 1) mild cognitive impairment (MCI), mild ADRD or moderate ADRD, 2) ≥3 chronic conditions, 3) ≥5 medicines and 4) a caregiver. Three coders applied a priori codes to transcripts and analyses followed the framework method. We interviewed 60 participants (Patients: mean age 78 years, 63% female, 50% white, 33% Black; Caregivers: mean age 65 years, 73% female, 60% spouse, 33% child). Patients took 9 medicines on average; cognitively, 36% had MCI, 40% mild ADRD and 23% moderate ADRD. Interviews revealed a tension between preservation of patient independence with early caregiver involvement. Patients and caregivers reported a strong preference towards patient autonomy in medication management, and patients with MCI and mild ADRD managed their medications independently. Among patients with moderate ADRD, caregivers assumed all medication responsibilities except when living separately. In those scenarios, caregivers set up organizers and made reminder calls, but did not observe medication intake. Transitions in medication management followed patient-driven medication errors that resulted in adverse events. These findings have important implications; clinicians should initiate conversations with caregivers and patients about early medication assistance and work to simplify regimens.