bluuebunny/crossref_metadata_2025 huggingface dataset:
Geographic Disparities in County-Level Prevalence of Alzheimer’s Disease Across the United States
Authors: Fowler Mackenzie , Crowe Michael , Kennedy Richard
Published: December 2020

While national and state estimates of the prevalence and incidence of AD are available, estimates across finer geographic regions offer an opportunity to tailor programs to the needs of the local population. Previously, we estimated prevalence and incidence of AD at the county level across the continental United States and found that estimated prevalence of AD varied more than threefold across counties, predominantly in the Southeastern and Midwestern United States. We also observed “islands” of low AD within regions with high AD, and vice versa. We update these findings by examining changes in projected prevalence of AD over time, and comparing projected prevalence of AD to prevalence of AD diagnoses in Medicare. We also examine regional variation in provider specialty patterns and racial differences across counties as possible explanatory factors. Understanding small-area geographic disparities in prevalence will be critical for addressing practice variation in the prevention and diagnosis of dementia.
Geriatrics Clinic Primary Care: Screening for Mental Health and Psychological Flexibility
Authors: Scicolone Monica
Published: December 2020

At baseline assessment, average level of symptoms for both depression (M = 3.75) and anxiety are low (M = 1.65). OLS regression analyses at baseline revealed psychological inflexibility (β = .474, p < .001) and anxiety symptoms (β = .334, p < .001) were significantly associated with depressive symptoms, and psychological inflexibility (β = .331, p = .002) and depression symptoms (β = .381, p < .001) were significantly associated with anxiety symptoms. These associations remained at year two in data collection. As of March 2019, there are 88 individuals with time two data for depressive symptoms (M = 2.99), and 79 individuals with time two data for anxiety symptoms (M = 1.34). Repeated measures ANOVA revealed that neither mean scores for depression nor anxiety changed significantly from time one to time two. As data collection continues into year three, multilevel modeling will be used to analyze longitudinal data. Part of a symposium sponsored by the Mental Health Practice and Aging Interest Group.
Heterogeneity of Aging: Implications for Team Care and Team Science
Authors: Kuchel George , Fortinsky Richard , Ferrucci Luigi
Published: December 2020

Increasing heterogeneity with aging is a deeply held belief in gerontology often used to combat generalizations and ageist stereotypes regarding older adults. Nevertheless, the vast majority of published studies do not report or discuss variability in their findings with aging, instead focusing on average differences between age groups. Yet, when data diversity is examined, most studies do find increased heterogeneity with aging across all domains – biological, immunological, behavioral, social, clinical, and population. Although heterogeneity has been described across the aging literature, including most GSA journals, little or no effort has been made to define and better understand the very nature of heterogeneity as a conserved feature of aging evident across all of its varied dimensions. It is well established that multidisciplinary team-based approaches are essential to clinical care of older adults, to research efforts in aging, and to the training of future generations of scientists, clinicians, educators and others in the aging field. Over the last 75 years, GSA has been a leading and unique vehicle for the development of multidisciplinary and interdisciplinary dialogue and collaborations involving its six membership sections. This symposium will provide a unique opportunity to begin a multidisciplinary dialogue designed to engage the broader GSA community in determining shared, as well as distinct, features of heterogeneity as they are manifested in terms of biology, immunology, behavioral and social considerations, and clinical and population issues, with ultimate impact on health policy and practice.
Urban-Rural Mental Health Disparities in China: The Neighborhood Effects
Authors: Han Chengming
Published: December 2020

This paper intended to explore the neighborhood effects on mental health disparities of urban and rural residents in Mainland China. Data were drawn from the CHARLS baseline (2011). The sample included 450 neighborhoods, with 3907 urban residents and 13,391 rural residents older than 45 years old. Multilevel model was used to determine the neighborhoods’ effects and individual effects on depressive symptom scores (CES-D). Independent variables included social activities, health status, and demographic characteristics. The result reveals three context effects of urban-rural neighborhoods: first, people living in urban communities reported better physical health, higher educational levels, and lower depressive symptoms than their rural counterparts. Second, people living in urban communities are more engaged in social activities than people living in rural villages. Third, the urban neighborhoods present more variations in depressive symptoms and social activities than the rural neighborhoods.
Long-Term Adherence to Physical Activity Among Older Veterans
Authors: Brown Candace
Published: December 2020

The benefits of physical activity (PA) are well-established and it is recommended that older adults achieve at least 150 to 300 minutes of moderate intensity PA and strengthening activities weekly. However, only 54.0% and 23.2% of older adults achieve these recommendations for endurance and strengthening (respectively), and 48% dropout within the first 6-months. Most PA research focuses on the 6-month initiation phase leaving a gap regarding long-term adherence. We explored predictors of long-term adherence (>2-years) to PA from 97participants at 6-month follow-up and yearly surveys. Variables examined included age, race, gender, body mass index (BMI), and self-reported comorbidities, symptoms, physical function, and barrier-specific self-efficacy scale (α-level 0.05). Lower BMI (29.1±5.1 versus 31.6±6.5, p=0.047) and higher self-efficacy to overcome environmental barriers (p=0.016) and social isolation (p=0.05) were associated with long-term adherence. Self-efficacy to overcome environmental and social barriers should be addressed to promote long-term adherence to exercise among older adults
Introducing the ENHANCE (Enhancing Neurocognitive Health, Abilities, Networks, & Community Engagement) Center
Authors: Boot Walter , Czaja Sara , Rogers Wendy , Charness Neil
Published: December 2020

Cognitive impairment (CI) refers to changes in cognition that result in difficulties remembering, learning new things, concentrating, making decisions important to everyday life, responding to environmental demands, or understanding social cues, and these difficulties can result in disability (limiting one or more major life activities). Existing and emerging technology applications hold promise for providing everyday support for older adults with CI, promoting independence and community living. However, these solutions will only be viable if they consider the needs, preferences, and abilities of older adults experiencing cognitive impairment. This talk introduces a new center, funded by the National Institute on Disability, Living, and Rehabilitation Research (NIDILRR), with the aim of supporting older adults with CI (MCI, CI as a result of traumatic brain injury or stroke) through adaptive and individualized technology solutions.
Irving S. Wright Award of Distinction Lecture
Authors: Barzilai Nir , Lederman Stephanie
Published: December 2020

The Irving S. Wright Award of Distinction Lecture will feature an address by the 2020 recipient James L. Kirkland, MD, PhD. This award is given by the American Federation for Aging Research, Inc.
Maxwell A. Pollack Award Presentation and Lecture
Authors: Harootyan Bob
Published: December 2020

The lecture will feature an address by the2019 Pollack Award recipient, Karen Lincoln, PhD, FGSA of the University of Southern California. The2020 Pollack Award recipient is Karl Pillemer, PhD, FGSA. The Maxwell A. Pollack Award for Productive Aging Award recognizes instances of practice informed by research and analysis, research that has directly improved policy or practice, and distinction in bridging the worlds of research and practice. Supported by The New York Community Trust.
How Covid Flipped the Classroom: Learning from the Next Generation of Gerontologists
Authors: Carter Mary
Published: December 2020

Covid laid bare the structural inequities and systemic challenges facing LTC, both in terms of risk and neglect. Lost in the daily tally of new cases and mortality rates are the stories of essential workers who have neither degree nor stature in the field, yet who fulfill an awesome responsibility—caring for older adults no longer visible behind locked doors. Suddenly, these full-time students and part-time workers found themselves employed in one of the most dangerous occupations in the country—providing direct care in nursing homes and assisted living communities. This award lecture highlights their voices and lessons learned.
Aging in place among adults with traumatic personal experiences and the community’s role: A scoping review
Authors: Danielson Ramona , Ray-Degges Susan
Published: December 2020

We propose that trauma history is important context for understanding the adaptive capacity of aging adults to achieve a suitable person-environment fit. We conducted a scoping review using bibliographic databases to identify studies focused on aging in place, vulnerability and traumatic personal experiences, and aging adults’ maladaptive behaviors. Our review showed little research directly exploring the connection between trauma-related needs and aging in place and limited research about the community’s role in supporting those needs. Literature about the impacts of trauma revealed that trauma could stem from adverse childhood experiences (e.g., abuse, neglect, household dysfunction) and adult adverse experiences (e.g., domestic violence, substance use disorder, military trauma). Adults who have experienced trauma may have increased physiological (e.g., sensory sensitivities) and psychological (e.g., post-traumatic stress disorder) conditions. Sensory sensitivities in the home environment—including sounds (e.g., air conditioners), air quality (e.g., pollutants), and lighting (e.g., flickering lights)—can substantially decrease quality-of-life. Strong emotional reactions can make interpersonal relationships, such as those with a landlord or neighbors, difficult and increase the likelihood of eviction. Aging adults with trauma histories also experience greater poverty rates, increasing the likelihood of substandard housing (e.g., mold, rats). Because the housing environment is a significant aspect of overall well-being, challenges to aging in place for adults with trauma histories warrants further research, as does the role of community supports in mitigating housing-related stressors. Examples may include trauma-informed approaches in universal design, the availability of safe affordable housing, community education, and funding for intermediaries who can support aging adults.
Acarbose suppresses symptoms of mitochondrial disease in a mouse model of Leigh Syndrome
Authors: Bitto Alessandro , Grillo Anthony , Kaeberlein Matt
Published: December 2020

Mitochondrial diseases are pathologies characterized by impairment in mitochondrial function. Mitochondrial dysfunction is also a hallmark of the aging process. Rapamycin, a drug that increases lifespan and reduces the incidence of age-related pathologies in multiple models, increases survival and reduces the impact of neurological symptoms in a mouse model lacking the complex I subunit Ndufs4. Here we show that acarbose, another drug that extends lifespan in mice, suppresses symptoms of disease and improves survival of Ndufs4-/- mice. Unlike rapamycin, acarbose rescues disease phenotypes independently of mTOR inhibition. Furthermore, rapamycin and acarbose have additive effects on clasping and maximum lifespan in Ndufs4-/- mice. Acarbose rescues mitochondrial disease independently of glycolytic flux and Sirt3 activity by potentially remodeling the microbiome. This study provides the first evidence that the microbiome may rescue severe mitochondrial disease and proof of principle that biological aging and mitochondrial disorders are driven by common mechanisms.
Pick Your Poison Carefully: How Alcohol Consumption and Serum Biomarkers Influence Body Fat – A UK Biobank Study
Authors: Larsen Brittany , Klinedinst Brandon , Le Scott , Pappas Colleen , Meier Nathan , Lim Ye-Lim , Wolf Tovah , Willette Auriel
Published: December 2020

Aging is characterized by physiological alterations in body composition, such as increased visceral adiposity accumulation and bone loss. Alcohol consumption is thought to partially drive these associations, but findings have been mixed. To clarify inconsistent findings, different types of alcohol--beer, liquor, and wine--may show different association patterns with body composition. Our longitudinal U.K. Biobank study leveraged 1,874 White British participants (aged 40-79 years; 58.9% male). Participants self-reported demographic, alcohol and dietary consumption patterns, and lifestyle factors using a touchscreen questionnaire. Anthropometrics and serum for proteomics were collected and body composition was obtained via dual-energy X-ray absorptiometry (DEXA). Structural equation modeling was used to probe direct and indirect associations between adiposity and bone, alcohol types, and cardiometabolic biomarkers. Over a mean duration of four years, greater consumption of beer and liquor were significantly associated with more visceral adiposity (β=.069, p<.001 and β=.014, p<.001, respectively); these associations were driven by dyslipidemia and insulin resistance. In contrast, greater red wine consumption predicted less adipose mass (β=-.023, p<.001), and this association was mediated by reduced inflammation and higher high-density lipoproteins (HDL) cholesterol. White wine consumption did not influence visceral adiposity but did predict greater bone mineral density (BMD) (β=.051, p=.003). Taken together, these data suggest that beer and liquor may drive the “empty calorie” hypothesis related to adipogenesis, while red wine may be protective due to anti-inflammatory and eulipidemic effects. Furthermore, white wine may benefit bone mineral density in older adults.
Dynamics of Multimorbidity Resilience and Health Outcomes Over Time in Community-Residing Older Adults
Authors: Xu Yingzhi , Rahmaty Zahra , McConnell Eleanor , Xue Tingzhong (Michelle) , Kang Bada , Corazzini Kirsten
Published: December 2020

Multimorbidity resilience may mitigate the adverse effects of multiple chronic diseases on older adults’ health. Wister et al.’s (2018) multimorbidity resilience index was developed and tested in a cross-sectional sample of older adults in Canada. Building on these findings, we examined the reciprocal relationships of resilience on outcomes to test these potentially mitigating effects in a community-based, U.S. sample of older adults over time. The study sample includes 1,054 older adults from waves 2 and 3 of the National Social Life, Health, and Aging Project (NSHAP) study (Waite et al 2020). Wister et al.’s (2018) index was mapped to NSHAP measures, and reciprocal relationships of multimorbidity resilience and health outcomes over a 5-year period was tested using structural equation modeling (SEM). Results indicated significant effects of multimorbidity resilience on self-rated physical health and pain. Interestingly, a better functional resilience at baseline conferred better self-rated physical health at follow-up, while better psychological resilience predicted lower pain level. By contrast, the influence of health outcomes on any domain of multimorbidity resilience was not detectable at all, supporting the direction of these associations from resilience to outcomes. The study systematically investigated the dynamic hypotheses between multimorbidity resilience and health outcomes. That is, whether they are determinants or consequences, or both. Our findings suggest multimorbidity resilience predicts subsequent 5-year change in health outcomes, especially self-rated physical health and pain level, but not vice versa, strengthening the evidence of the importance of resilience in the health of older adults.
Can Light Physical Activity Improve Cognition Among Older Adults? A Scoping Review
Authors: Erlenbach Emily , McAuley Edward , Gothe Neha
Published: December 2020

Although the physical and cognitive benefits of moderate-vigorous intensity physical activity (MVPA) for older adults is well documented, this population often faces age-related functional and physical limitations impeding recommended MVPA participation. Recently, there has been a surge of interest in the independent health benefits of light-intensity physical activity (LPA) and its association with morbidity and mortality risk. LPA is the most common form of activity among older adults and its potential to combat cognitive aging needs to be investigated. The purpose of this scoping review was to catalog existing evidence on the association between device-based or technologically measured LPA and cognition among healthy older adults, identify trends in the literature, and pinpoint future areas of research. Six electronic databases were searched between January and August 2020. Eighteen published studies met the inclusion criteria: one acute exercise study, two randomized control trials (RCTs), twelve cross-sectional studies, and three longitudinal studies. Overall, n=9 studies (n=1 RCT, n=7 cross-sectional, and n=1 longitudinal) reported a significant, positive relationship between LPA and one or more cognitive outcomes including memory, attention, executive function and global cognition (MMSE/MOCA). These heterogeneous findings can largely be attributed to the diverse study designs, inconsistent definitions of LPA and numerous assessments used to test the cognitive domains. Collectively, these findings suggest LPA may be a potential lifestyle intervention to improve cognition among healthy older adults. However, the inconsistent approaches used among these studies suggests a more concerted, unified scientific approach and rigorous methodology are needed to further understand the LPA-cognition relationship.
A Longitudinal Analysis of the Association Between Subclinical Hearing Loss and Cognition
Authors: Irace Alexandria , Armstrong Nicole , Deal Jennifer , Chern Alexander , Ferrucci Luigi , Lin Frank , Resnick Susan , Golub Justin
Published: December 2020

Several studies have demonstrated that age-related hearing loss (defined as >25 dB pure tone average [PTA]) is longitudinally associated with worse cognition. We aimed to investigate whether subclinical hearing loss (SCHL), or imperfect hearing traditionally categorized as normal (PTA ≤25 dB), may be similarly linked to cognitive decline. Subjects included cognitively normal adults ≥50 years old in the Baltimore Longitudinal Study of Aging with PTA ≤25 dB measured between January 1991 - September 1994 who had repeated cognitive assessments from January 1991 - November 2019 (n=263). The exposure was hearing based on the better ear PTA. The outcomes were standardized test scores in the following domains: learning/memory, mental status, executive function, visuospatial ability, and language. Multivariable linear-mixed effects models with random intercepts and slopes and unstructured variance-covariance structure were used to model the association between hearing and change in cognition over time, adjusting for baseline age, sex, years of education, and race. Mean age was 68.3 years (standard deviation [SD]=8.9) and follow-up ranged from 0-27.7 years (mean=12.5, SD=7.9). A 10-dB worsening in hearing was longitudinally associated with an annual decline of 0.016 SDs (95% confidence interval [CI]: 0.0002, 0.033) in California Verbal Learning Test (CVLT) short-delayed recall, 0.019 SDs (95% CI: 0.002, 0.036) in CVLT long-delayed recall, and 0.017 SDs (95% CI: 0.006, 0.028) in letter fluency after covariate adjustment. Poorer hearing among those with SCHL was associated with steeper declines in memory and verbal fluency scores. This relationship may begin at earlier levels of hearing loss than previously recognized.
Early Indicators of Cognitive Decline in Online Financially Active Older Adults
Authors: Mattek Kimberly Grzesek Nora , Sharma Nicole , Wild Katherine
Published: December 2020

As access to computers and use of technology becomes more common in older adults, the incidence of online financial fraud increases. Law enforcement officials and fraud experts predict this trend to continue as aging baby boomers increasingly become targets. One reason this population might be at risk for financial fraud is due to subtle, undetected decline in cognitive abilities that have been associated with decline in financial capacity. Many cases of incipient cognitive decline go undetected. Further, those with early cognitive decline often have poor insight to its potential impact on daily functioning. Assessment of Activities of Daily Living Skills (ADLs) is paramount to determine early decline in daily activities. The ORCATECH Life Lab was designed to evaluate subtle neurological and other health changes and their relation to changes in daily functioning. Older adults participating in the Life Lab complete annual ADL and neurocognitive assessments. Additionally, 97 participants completed an online technology questionnaire where 64 participants reported participating in online financial activity. Results revealed that within the online financially active group, some assistance in ADL’s was required. However, inconsistencies in ADL change over time highlight the challenges of screening for early signs of mild cognitive impairment (MCI) in patients that fall between normal cognition and MCI. In-home information technology may help overcome these challenges. Defining subtle changes in ADLs is a crucial step to enable early diagnosis of neurocognitive disorders and assist health care providers in improving disease management and to prevent incidents of financial fraud in this vulnerable population.
An Analysis of the Impact of Sexual Orientation on Longitudinal Depression
Authors: Thompson Anna , Wardecker Britney
Published: December 2020

Research suggests that mental health and well-being improve as we age, and this trend is dubbed “the paradox of aging” (Charles & Carstensen, 2010). However, little is known about whether this trend happens for individuals who may experience lifelong disadvantage, such as those who identify as lesbian, gay, or bisexual. We used data from the Midlife in the United States Study (MIDUS) to examine lesbian/gay, bisexual, and heterosexual adults’ changes in depression from 1995 to 2014. Participants identified as lesbian/gay (n = 46), bisexual (n = 37), and heterosexual (n = 3030) and 45.1% identified as female. Participants’ ages ranged from 20-74 years (M = 45.61, SD = 11.41) in 1995 and 39-93 years (M = 63.64, SD = 11.35) in 2014. We analyzed our data using a repeated measures ANOVA and our results indicate that depression decreased on average from 1995 to 2014 for heterosexual [Wilk’s Lamda = .996, F (1, 3029) = 12.23, p < .001] and lesbian/gay adults [Wilk’s Lamda = .848, F (1, 45) = 8.08, p = .007]. However, bisexual adults did not experience this decrease in depression [Wilk’s Lamda = .990, F (1, 36) = 0.36, p = .550] and their depression remained relatively stable. Our results are consistent with previous studies that indicate bisexuals experience poorer mental health when compared to lesbian/gay and heterosexual adults (Bostwick, Hughes, & Everett, 2015). The current research highlights depression as a condition that may not decrease universally over time. We discuss implications for bisexuals’ health and well-being.
Delivery of Community Support Services for Older Adults in Social Housing
Authors: Yau Matthew , Sheppard Christine , Charles Jocelyn , Austen Andrea , Hitzig Sander
Published: December 2020

Community support services are an integral component of aging in place. In social housing, older adult tenants struggle to access these services due to the siloed nature of housing and health services. This study aims to describe the relationship between community support services and social housing for older adults and examine ways to optimize delivery. Data on government-funded community support services delivered to 74 seniors’ social housing buildings in Toronto, Ontario was analyzed. Neighbourhood profile data for each building was also collected, and correlational analyses were used to examine the link between neighbourhood characteristics and service delivery. Fifty-six community agencies provided 5,976 units of services across 17 service categories, most commonly mental health supports, case management and congregate dining. On average, each building was supported by nine agencies that provided 80 units of service across 10 service categories. Buildings in neighbourhoods with a higher proportion of low-income older adults had more agencies providing on-site services (r = .275, p < .05), while those in neighbourhoods with more immigrants (r = -.417, p < .01), non-English speakers (r = -.325, p < .01), and visible minorities (r = -.381, p < .01) received fewer services. Findings point to a lack of coordination between service providers, with multiple agencies offering duplicative services within the same building. Vulnerable seniors from equity-seeking groups, including those who do not speak English and recent immigrants, may be excluded from many services, and future service delivery for seniors should strive to address disparities in availability and access.
Sensory Loss and Cognitive Decline among Older Adults: An Analysis of Mediation and Moderation Effects of Loneliness
Authors: Ge Shaoqing , Pan Wei , Wu Bei , Plassman Brenda , Dong XinQi , McConnell Eleanor
Published: December 2020

Multiple studies have reported that hearing and vision loss are linked to cognitive decline. Yet little is known about factors that may influence the association between sensory loss and cognitive decline. This study examined if loneliness mediates or moderates the impact of sensory loss on cognitive decline as individuals age. This was a longitudinal study using data (N = 243) from the Health and Retirement Study (HRS) (2006 – 2014) and its supplement: The Aging, Demographics, and Memory Study (ADAMS) (Wave C). Hearing loss was defined by an inability to hear pure-tone stimuli of 25 dB at frequencies between 0.5 – 4.0 kHz in either ear. Vision loss was defined as having corrected binocular vision worse than 20/40. Loneliness was measured by the 3-item UCLA Loneliness Scale. Longitudinal parallel-process (LPP) analysis was conducted at a significance level of α = .05 (one-tailed). Loneliness moderated but did not mediate the associations between vision loss and the rate of cognitive decline (standardized β = -.108, p < .05). No moderation or mediation effect of loneliness was found for the association between hearing loss and cognitive decline. Both hearing and vision loss were significantly associated with increased severity of loneliness. Vision loss combined with an elevated level of loneliness may produce a more synergistic, deleterious impact on older adults’ cognitive function than vision loss alone. This study highlights the importance of promoting a healthy social and psychological status for older adults with vision loss.
Alcohol use and mental health among older American adults during the early months of the COVID-19 pandemic
Authors: Eastman Marisa , Kobayashi Lindsay , Finlay Jessica
Published: December 2020

We investigated the association of self-reported changes in alcohol consumption with the prevalence of anxiety, depression, and loneliness in the early months of the COVID-19 pandemic among middle-aged and older US adults. Between April and May 2020, 6,938 US adults aged 55+ completed online questionnaires in the COVID-19 Coping Study, a national cohort study of older adults’ mental health and well-being. Multinomial logistic regression estimated self-reported changes in the frequency of alcohol consumption relative to before the pandemic, according to anxiety (5-item Beck Anxiety Inventory), depression (8-item Center for Epidemiologic Studies Depression Scale), and loneliness (3-item UCLA Loneliness Scale). All models were population-weighted and adjusted for confounders. Nearly half (46%) of adults reported drinking 1-7 drinks/week prior to the pandemic, 12% reported drinking 8+ drinks/week, and 42% reported not drinking. One in five adults (21%) reported a change in their alcohol consumption since the start of the pandemic, while 38% indicated they were drinking the same amount, and 42% reported not drinking alcohol. Older adults who screened positive for each of anxiety, depression, and loneliness reported drinking more than usual (OR=1.92; 95% CI: 1.92–1.93 for anxiety; OR=2.67; 95% CI: 2.67–2.68 for depression; OR=2.46; 95% CI: 2.45–2.46 for loneliness), compared to drinking the same as before the pandemic. These results demonstrate potentially negative changes in alcohol intake among middle-aged and older adults experiencing mental health symptomology during the early months of the COVID-19 pandemic.
Bereavement and Physiological Dysregulations in African American Adults
Authors: Song Jieun , Mailick Marsha
Published: December 2020

This study uses data from National Survey of Midlife in the U.S. (MIDUS) to examine the effect of bereavement on physiological dysregulations in African American adults, with moderating effects of gender. Models were estimated using data from 210 Non-Hispanic African American respondents who participated in MIDUS 2 (M2: 2004-2005) and the biomarker data collection (2004-2009). We analyzed data from two groups, respondents who experienced the death of an individual(s) close to them, either family or friends (97 women, 40 men) and respondents who did not experience any deaths of close individuals during the same period (46 women, 27 men), controlling for age, education, marital status, prior family bereavement, number of negative life events since M2, and physical health prior to bereavement. Physiological dysregulations were assessed for 7 systems: HPA axis, glucose metabolism, lipids metabolism, sympathetic system, parasympathetic system, inflammation, and cardiovascular functioning. The results show that African American men and women who experienced bereavement were at higher risk of dysregulation of glucose metabolism (assessed by HbA1c, HOMA-IR, and fasting glucose) than the non-bereaved, even after adjusting prior diabetes diagnosis. In addition, African American women (but not men) who experienced recent bereavement were at higher risk of dysregulation of HPA axis functioning (assessed by urinary cortisol and blood DHEA-S) than their counterparts. The other physiological systems were not significantly associated with bereavement experience in African American adults. The findings suggest that bereavement has adverse impacts on health in African American adults via dysregulations in glucose metabolism and HPA axis functioning.
Disruptions to Care and the Use of Telehealth Among Older Adults During the COVID-19 Pandemic
Authors: Prusaczyk Beth , Carpenter Brian , Morrow-Howell Nancy , Lenze Eric
Published: December 2020

Reports emerged early in the 2020 COVID-19 pandemic that older adults were foregoing non-COVID19-related care, due to fears of contracting the virus during appointments and because of healthcare providers’ reduced operations. Beginning in July, 2020, we explored the impact of the pandemic on disruptions to care and older adults’ use of telehealth. Preliminary results from 53 older adults aged 66 to 93 (mean: 72.6) found that many older adults experienced disruptions in their care, ranging from 30-50% depending on the type of care. The most commonly disrupted care types were mental health and rehabilitation care (occupational, physical, or speech therapy), with 50% of older adults reporting disruptions to mental health and 50% to rehabilitation care. The most common reason for the disruptions was closed care providers’ offices. Similar results were found for primary care (46% reporting disruptions), dental care (44%), and vision care (30%), with between 62-71% citing closed offices as a reason for the disruption. The use of telehealth among the sample was high (44%), and the majority (83%) of these older adults reported never having used it previously. All who used it reported being very or somewhat comfortable with the technology, and 83% said they would use it again even if in-person care was available. These findings suggest the pandemic has had a significant impact on older adults’ care and that the expansion of telehealth could be increase access to care during and after the pandemic.
National Early Warning Scores And COVID-19 Deaths In Care Homes: An Ecological Time Series Study
Authors: Stow Daniel , Barker Robert , Matthews Fiona , Hanratty Barbara
Published: December 2020

Tracking COVID-19 infections in the care home population has been challenging, because of the limited availability of testing and varied disease presentation. We consider whether National Early Warning Scores (NEWS/NEWS2) could contribute to COVID-19 surveillance in care homes. We analysed NEWS measurements from care homes in England (December 2019 to May 2020). We estimated pre-COVID (baseline) levels for NEWS and NEWS components using 80th and 20th centile scores for measurements before March 2020. We used time-series to compare the proportion of above-baseline NEWS to area-matched reports of registered deaths in care home residents from the Office for National Statistics We analysed 29,656 anonymised NEWS from 6,464 people in 480 care home units across 46 local authority areas. From March 23rd to May 20th, there were 5,753 deaths (1,532 involving COVID-19, 4,221 other causes) in corresponding geographical areas. A rise in the proportion of above-baseline NEWS was observed from March 16th 2020. The proportion of above-baseline oxygen saturation, respiratory rate and temperature measurements also increased approximately two weeks before peaks in deaths. We conclude that NEWS could contribute to disease surveillance in care homes during the COVID-19 pandemic. Oxygen saturation, respiratory rate and temperature could be prioritised as they appear to signal rise in mortality almost as well as total NEWS. This study reinforces the need to collate data from care homes, to monitor and protect residents’ health. Further work using individual level outcome data is needed to evaluate the role of NEWS in the early detection of resident illness.
Do Perceptions of Own and Spouse Survival Affect Advance Care Planning?
Authors: Carr Deborah , Lou Yifan
Published: December 2020

COVID-19 has intensified the need for advance care planning (ACP), or formal preparations for end-of-life care, prior to the time such decisions are required. We propose that older adults’ perceived chances of survival, and one’s perceptions of whether they will outlive their spouse may be powerful motivators of ACP. Using data from the Wisconsin Longitudinal Study (WLS, n=4908, M age = 65), we examine the extent to which: (a) one’s perceived 10- and 20-year survival and (b) projections of dying before, after, or at the same time as one’s spouse affect three aspects of ACP (living will, durable power of attorney for health care designations (DPAHC), and discussions). Multivariate analyses are adjusted for health, demographics, socioeconomic characteristics, and death anxiety. In the full sample, women who perceived a high likelihood of 20-year survival were less likely (OR=.604, p < .05) whereas their male counterparts were more likely (OR = 1.4, p <.01) to name a DPAHC (relative to those who perceived a medium likelihood of survival). Among married persons only (n=3860), people who perceive that they will pre-decease their spouse are 1.5 times as likely to name their spouse as DPAHC (vs. no DPAHC), but are no more likely to name a different person to the role (relative to those who perceive that they and spouse will die at the same time). Practitioner and family conversations about older patients’ projected survival and how it shapes decision making are especially important as COVID-19 may require rapid decisions about end-of-life treatments.
A Genome-Wide Integrative Study of DNA Methylation, Gene Expression, and Later Life Hand Grip Strength
Authors: Soerensen Mette , Mengel-From Jonas , Christensen Kaare , Christiansen Lene , Tan Qihua
Published: December 2020

Hand grip strength (HS) measures muscular strength and associates with multiple health outcomes and mortality. Studies of epigenetic and transcriptomic markers could help elucidate the biology behind HS; markers for which monozygotic (MZ) twins are excellent study populations. We performed integrated enrichment analyses (IEA) of an epigenome-wide association analysis (EWAS) and a transcriptome-wide association analysis (TWAS) of HS in blood samples of 452 MZ twins (56-80 years of age). Unsupervised IEA were conducted by the KeyPathwayMiner algorithm, while supervised IEA were performed by the KEGG and Reactome databases. No individual CpG site or probe passed correction for multiple testing. Investigating the overlap in genes with p-values<0.01, 0.005 or 0.001 in the EWAS and TWAS, revealed 67, 21 and 2 unique genes, respectively. The latter 2 were TESK2 and VWA1. By the supervised approach, the 67-gene overlap identified three pathways related to “antigen processing and presentation”, driven by HLA-A, HLA-B, TAP2 and PSME2. With the unsupervised approach the 21-gene and 67-gene overlaps revealed networks containing 7 and 19 genes, respectively. Exception nodes (added by the algorithm for structure) were CREBBP and CSNK2A2 for the former, and APP and HSP90AB1 for the latter. The remaining IEA revealed no gene sets or networks. Several of these genes have previously been linked to HS relevant traits, e.g. arthritis (HLA-A, HLA-B and TAP2), smooth muscle and cardiovascular function (TESK2, HLA-B and APP) and sarcopenia (HSP90AB1). Hence, this study reports genes and pathways previously reported for physical functioning, yet also novel candidates for further verification.
Effective and Evidence-Based: How the 4Ms Age-Friendly Framework Can Result in Improved Care in a Rural Primary Care Clinic
Authors: Tobey Leah , McAtee Robin
Published: December 2020

As healthcare providers struggle to reframe aging, framing Age-Friendly care is also occurring. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve clinical health outcomes of older adults (OA) in primary care settings. As a member of the 2020 Institute for Healthcare Improvement (IHI) Age-Friendly cohort, the AGEC has partnered with ARcare, an AR federally qualified healthcare clinic network, to implement the 4Ms in 4 rural clinics over 3 years. AGEC’s first goal of working with rural primary care clinics is to improve their knowledge of best practices of caring for OA. This was started by providing Geriatric Interdisciplinary Team Training to clinic staff, obtaining baseline data of common health related indicators for OA and starting regular geriatric focused training. Training on the 4Ms (Matters, Medication, Mentation Mobility) framework was next and completed followed by planning and implementation. The process was well received and results are promising. Year 1 data in one clinic show incremental improvements over baseline data in several areas including assessing Mobility with fall screens which has improved over 50% in one year and annual wellness visits (where all 4Ms are reviewed) have increased 30%. However, several areas of opportunities for improvement have also been noted and turned into quality improvement projects (QI). This includes an opportunity to improve depression screens for the clinic’s Mentation measure, which dropped almost 30% in one year. QI projects are ongoing to improve each of the elements of becoming age-friendly.
High Occurrence of Dementia in Older Adults Returning to Community From Prison
Authors: Byers Amy , Li Yixia , Barry Lisa
Published: December 2020

Very little is known about Alzheimer’s Disease and related dementias (AD/ADRD) and diseases (e.g., Parkinson’s/PD) in older adults returning to community from prison (“older reentry adults”). We utilized a national sample of older veterans to conduct the first study documenting the occurrence (prevalence/incidence) of AD/ADRD and related diseases in older reentry adults. We examined 28,235 reentry veterans who were aged 50 years and older at their most recent release date and Medicare beneficiaries, 2008 through December 31, 2017. AD/ADRD and related diseases were identified by ICD-9/10 codes in the electronic health record from Medicare and inpatient/outpatient Veterans Health Administration data. We examined distributions of AD/ADRD and related diseases across 4 age categories (sample %): 50-64 (55%), 65-74 (37%), 75-84 (7%), and 85+ (0.7%). Of the 28,235 veterans 50 years and older, 17% (n=4,725) had dementia (defined by AD/ADRD based on NIA criteria) or mild cognitive impairment (MCI) and 3% (n=794) had PD. Of those with dementia/MCI, 18% had AD and 26% MCI. Nearly 40% of dementia diagnoses occurred prior to/on most recent release date, and 40% of PD diagnoses occurred prior to/on most recent release date. Differences were significant across age groups (P<.001), with very high rates of diagnoses across all age groups, as well as indicative of high occurrence of early onset dementia and “accelerated aging” [50-64, 14%; 65-74, 18%; 75-84, 33%; and 85+, 53%]. This study is a first step in filling a major research gap by describing AD/ADRD, MCI and related diseases in reentry adults.
Dual Decline in Gait and Cognition Is Associated With Future Dementia: Evidence for a Phenotype
Authors: Odasso Manuel Montero , Speechley Mark , Camicioli Richard , Kamkar Nellie , Tian Qu , Ferrucci Luigi , Bray Nick , Pieruccini-Faria Frederico
Published: December 2020

BACKGROUND: The concurrent decline in gait speed and cognition are associated with future dementia. However, the clinical profile of those who present with dual-decline has not yet been described. We aimed to describe the phenotype and risk for incident dementia of individuals who present a dual-decline in comparison with non dual-decliners. METHODS: Prospective cohort of community-dwelling older adults free of dementia at baseline. We evaluated participants’ gait speed, cognition, medical status, functionality, incidence of adverse events, and dementia biannually over 7 years. Gait speed was assessed with a 6-meter electronic-walkway, and global cognition was assessed using the MoCA test. We compared characteristics between dual-decliners and non dual-decliners using t-test, Chi-square, and hierarchical regression models. We estimated incident dementia using Cox models. RESULTS: Among 144 participants (mean age 74.23 ± 6.72 years, 54% women), 17% progressed to dementia. Dual-decliners had a three-fold risk (HR: 3.12, 95%CI:1.23-7.93, p=0.017) of progression to dementia compared with non dual-decliners. Dual-decliners were significantly older with a higher prevalence of hypertension and dyslipidemia (p=0.002). Hierarchical regression models show that age and sex alone explained 3% of the variation in the dual-decliners group, while adding hypertension and dyslipidemia increased the explained variation to 8% and 10 %, respectively. The risk of becoming a dual-decliner was 4-fold if hypertension was present. CONCLUSION: Older adults with concurrent decline in gait speed and cognition represent a group at the highest risk of progression to dementia. These dual-decliners have a distinct phenotype with a higher prevalence of hypertension, a potentially treatable condition.
Exploring the Experiences of Persons Living With Dementia and Their Care Partners in a Memory Café-Style Program
Authors: Bunting Morgan , Antonsdottir Inga , Bailey Marti , Samus Quincy
Published: December 2020

Community-based supportive care interventions are needed to address unmet needs and maximize quality of life for persons living with dementias and their care partners (care dyad). Memory cafés and similar programs serve as a potentially important vehicle to reduce dementia stigmatization, improve inclusiveness, promote well-being, socialization and meaningful activity engagement, and disseminate dementia-related education and knowledge. Despite gaining popularity, little is known about how these programs impact participants or how they work best. The Club Memory® program in Washington, D.C. is an enhanced memory café-style program that delivers a normalizing environment, decreased negative stigma and a chance to experience a catalyst for change despite disease progression. Using qualitative methods, we investigated the perceived impact, benefits, and weaknesses of Club Memory from multi-stakeholder perspective, to explore how this program might be improved and standardized for broader implementation. We conducted two focus groups, one of care partners and one of persons living with dementia (N=12). Upon analyzing transcriptions, five common themes emerged among the focus groups: Atmosphere, Sense of Community, Skill-Building, Tools and Strength in Staff. Integrating perspectives from the care dyad revealed congruent thoughts on program perception, benefits and strengths, and opportunities for improvement. Club Memory® appears to be a valuable model that creates a stigma-free supportive environment, educates and engages the care dyad to foster understanding, confidence, curiosity and empowerment. Our findings contribute to a deeper understanding of the impact community-based strategies can positively impact the care dyad’s life.
Stigmatizing Beliefs About Alzheimer’s Disease in Diverse Ethnic Groups of Asian Americans
Authors: Liang Jiaming , Jang Yuri
Published: December 2020

Cumulative studies have investigated Alzheimer’s disease (AD)-related issues among Asian Americans, but few have considered ethnic diversities within the Asian group. Using an ethnic-diverse Asian American sample, the present study explored the prevalence, ethnic variations, and predictors of stigmatizing beliefs about AD: (1) AD is a normal process of aging, (2) it is embarrassing to have a family member with AD, and (3) social interactions with an AD patient should be avoided. Inspired by the sociocultural health beliefs model, a focus was given on the role of immigration and culture-related variables. Using data from the 2015 Asian American Quality of Life survey (N = 2609, age range = 18-98) that includes Chinese, Asian Indian, Korean, Vietnamese, Filipino, and other Asians, logistic regression was conducted to examine how each of the three stigmatizing beliefs would be predicted by (1) demographic variables and (2) immigration and culture-related variables. Results indicate that the prevalence of the stigmatizing beliefs about AD varied across ethnicities. More than 63% of Vietnamese associated AD with a normal process of aging, and about 10% of Chinese reported that they would feel embarrassed if their family member had AD. Logistic regression models demonstrated that advanced age, male gender, low education, and limited English proficiency increased the odds of reporting one or multiple stigmatizing beliefs about AD. The findings suggest a varying degree of AD-related misconceptions and stigmatization and call attention to the need for culturally sensitive community education on AD in Asian communities.