bluuebunny/crossref_metadata_2025 huggingface dataset:
Creative Arts Interventions as a Way to Combat Ageism and Increase Student Interest in Gerontology
Authors: Ihara Emily , Tompkins Catherine , Inoue Megumi , Barrett Kendall
Published: December 2021

Despite the continuous, growing need for health professionals who are trained to work with older adults living with Alzheimer’s disease and related disorders (ADRD), research shows that recruitment and retention of gerontological health care professionals remains low. Ageism plays an important role in this resistance and continues to have societal impact, even proliferating in disturbing ways during the COVID-19 pandemic via stereotypes, discrimination, and framing in the media. Gerontologists in various health professional educational settings continue to address the need to infuse aging content in creative ways and increase the competency of all health professionals to combat ageism and understand the importance of specialized care for this population. Our gerontological research team has engaged students in various ways to increase interest in aging issues and ADRD. Current research projects involve the implementation of non-pharmacological, creative arts interventions, including Mason’s Music & Memory Initiative (M3I) and TimeSlips, both which have the potential to appeal to intergenerational partnerships and provide students with tools to communicate better with those living with ADRD. We examined attitudes about aging among undergraduate and graduate students (N=78) who have completed our training modules and/or participated in these two projects. The asynchronous trainings provide content on ADRD and the implementation of non-pharmacological, creative arts interventions. We examined students’ attitudes about aging and ADRD and analyzed their open-ended responses regarding their experiences with someone living with ADRD. Various levels of education, relationships with older adults, and life experience influenced their responses regarding their attitudes about aging.
Intergenerational Programming During the Pandemic: Transformation During (Constantly) Changing Times
Authors: Jarrott Shannon , Leedahl Skye , Butts Donna
Published: December 2021

Implementing intergenerational programming amidst the COVID-19 pandemic has required creativity, partnership, and dedication to the work. Most intergenerational programs involving in-person meetings or events are accompanied by guidelines to protect participant health and safety. Programming is routinely cancelled or postponed due to poor weather or contagious illness, particularly when a vulnerable population is involved. The needs for safety precautions and continued intergenerational contact were both amplified during the pandemic, leading many to modify or innovate ways to engage generations rather than eliminate contact for extended periods. Technology has afforded new approaches to engage young people and older people with each other; non-technological ways have also proven effective. This symposium will address strategies used to implement intergenerational programs during the pandemic. Authors will highlight lessons learned and strategies they expect to retain in the future. The first paper describes a pivot in nutrition programming designed for a shared site with preschool children and frail older adults. In paper two, authors discuss their partnership-based approach shifting to remote offerings of Cyber-Seniors programming. Paper three addresses how MentorUp Service-Learning expanded its reach by adaptations to virtual programming for older adults in retirement communities. The final paper presents evaluation data comparing arts programming delivered in-person pre-pandemic and again virtually during the pandemic. In each case, researchers and community partners learned techniques to maintain their programmatic foci. Some projects developed strategies they plan to maintain post-pandemic. Donna Butts, Executive Director of Generations United serves as the symposium discussant.
The Long and Winding Road: Early Years of the Accreditation for Gerontology Education Council
Authors: Maiden Robert , Schafer Donna
Published: December 2021

The long road of establishing an accreditation entity began in August 2010 when the AGHE Accreditation Task Force was convened. After numerous meetings complete with loud and vigorous debates, AGEC, the Accreditation for Gerontology Education Council emerged in 2016. Over the subsequent years, the Standards hit the hard road of reality leading to various revisions to the Handbook. The symposium’s first presentation concerns the history of AGEC and its further development into an independent entity. The key purpose of AGEC is assuring gerontology programs educational quality and enhancement governed by the principle of self-evaluation and peer review that engenders trust. The next presentation discusses the marketing aspect of AGEC built on getting feedback from the public. One of the outcomes of conducting focus groups and surveying the public is the discovery that prospective students really see the value of accreditation. The penultimate presentation focuses on refinements to procedures alluded to in the first presentation in response to the feedback received in meeting with institutions and faculty about what accreditation offers to students, stake-holders, and ultimately the older adults served by the graduates in the work force. The key goal is to clarify the expectations and simplify the application process. On no other issue has more time been spent than on the assessment of students’ competency. Our last presentation explains competency-based education consisting of well-articulated student learning outcome measures that are consonant with the program’s mission that lead to "closing the loop" of continuous and durable improvements in the learning environment.
Meeting the Challenges of COVID-19 in Long-Term Care: Lessons Learned From an International Perspective
Authors: Wolf-Ostermann Karin , Boltz Marie
Published: December 2021

The outbreak of COVID-19 is a major challenge for health care systems all over the world. Older residents of long-term-care facilities (LTCF) such as nursing homes (NH) are among those at highest risk for COVID-19 and comprise a population with dramatically higher rates of morbidity and mortality than the general community. NH staff are also affected by the pandemic as they are challenged by increased workloads, emotional burden caused by the loss of resident life, and the fear of becoming infecting themselves or infecting family members. Finally, the pandemic places emotional and practical demands upon informal carers who are involved in the life of the NH resident. Therefore, research should investigate different perspectives on LTCF during the pandemic and discuss major challenges and possible support structures and strategies. Such an understanding is necessary to optimize care, support post-pandemic recovery, and prepare for future public health challenges. This international symposium will therefore provide four presentations to address these issues. The first presentation will report on global mortality data associated with COVID-19 in LTCF. The second presentation reports on the situation in German NHs addressing the complex situation of morbidity, care dependency, and social isolation. The third presentation will describe the effects of the pandemic upon NH staff in Poland. The final presentation examines the impact and guidelines of allowing visitors in NHs in the Netherlands for residents, family caregivers and staff. Our discussant, Marie Boltz, will synthesize the research findings and lead a discussion of future directions for policy and practice.
Refining the Loop of Continuous Improvement
Authors: Maiden Robert , Abushakrah Jan
Published: December 2021

Academic assessment of student competency is essential to measure learning within a gerontology program. In its self-evaluation, a program must assess its student learning outcomes. JoAnn Damron-Rodriguez et al. (2019, p. 423) proposed a systematic approach that has several levels. The key is to utilize a competency-based education model. Moreover, to satisfy workforce goals the gerontology program must adopt the AGHE competencies that reflect the knowledge, skills, and attitudes necessary to serve older adults at an acceptable level of care. The next step involves generating well-articulated quantitative or qualitative measures of student learning outcomes (SLOs) consistent with the program’s mission statement that include twelve competency domains. SLO measures include test grades, assignments, projects, portfolios, field experiences, essay questions, multiple choice items, and so on. The program’s enhancement loop requires the evaluation of SLOs, faculty discussion of them, and a continuous modification cycle "closing the loop" to reach the program’s goals.
Mental Health and Well-Being Among Individuals With a Sensory Loss During COVID-19 Lockdown Measures
Authors: Merten Natascha , Schultz Amy , Walsh Matthew , van Landingham Suzanne , Peppard Paul , Ryff Carol , Malecki Kristen
Published: December 2021

Hearing and vision impairment are highly prevalent chronic conditions and are associated with poorer mental health and well-being. Mental health problems may be exacerbated by COVID-19-related lockdown measures and limitations of in-person contacts may affect those with sensory impairments more severely. We aimed to determine whether hearing and/or visual impairment were associated with worse mental health and psychological well-being during lockdown measures in Spring/Summer 2020 in Wisconsin. We included 1341 (64% women, aged 20-92 years) Survey of the Health of Wisconsin participants of a COVID-19 survey (May-June, 2020). We assessed self-reported current mental health and psychological well-being and vision and hearing impairment. Logistic regression models with vision and hearing impairments as determinants and multiple mental health and well-being outcomes were used and adjusted for age, gender, race, education, heart disease, hypertension, hyperlipidemia and diabetes. In preliminary analyses, we found associations of vision impairment with increased odds of generalized anxiety disorder (odds ratio=2.10; 95% confidence interval=1.32-3.29) and depression (2.57; 1.58-4.11). Individuals with a vision impairment were more likely to be taking medication for depression (1.75; 1.13-2.68), report being lonely (1.65; 1.00-2.64) and report hopelessness (1.45; 1.01-2.08). Individuals with a hearing impairment were more likely to be taking depression medications (1.72; 1.07-2.73) and to report being lonely (1.80; 1.05-2.98). Sensory impairment was not associated with stress levels or sense of purpose in life. Individuals with sensory impairment may represent a particularly vulnerable population during the COVID-19 pandemic. Future research should determine underlying reasons and interventions to mitigate this populations’ disadvantages.
Acuity Differences Among Newly Admitted Medicare Residents in Rural and Urban Skilled Nursing Facilities
Authors: Jonk Yvonne Catharina , Coburn Andrew , McGuire Catherine , Thayer Deborah , Mauney Karen
Published: December 2021

Using the 2015 national Minimum Data Set Version 3.0, the Area Health Resources Files, the 2015 Provider of Services File, and the Rural-Urban Commuting Area codes, this study assessed rural-urban differences in newly admitted, Medicare skilled nursing facility (SNF) residents’ functional status, cognitive performance, and behavioral issues using self-performance, early loss, and late loss Activities of Daily Living (ADLs); the Cognitive Function Scale (CFS); and indicators of aggression, psychosis, or wandering, respectively. The study evaluated 686,881 unique patient assessments for newly admitted Medicare SNF residents across 15,157 facilities in 47 states. Negative binomial and generalized linear models with state fixed effects and clustering by SNFs were used to evaluate rural-urban acuity differences before and after adjusting for socio-economic factors; admission source, and market area characteristics. Compared to urban SNF residents, rural residents were more likely to be cognitively impaired (45% Isolated Small Rural, 44.5% Small Rural, 41% Large Rural, 38.8% Urban), and have behavioral issues (6.7% rural, 4.8% urban). Unadjusted and adjusted regression models confirmed bivariate findings that rural SNF residents were less functionally impaired (IRR range: 0.974-.987), but had more cognitive and behavioral issues in more remote rural locations than urban. The (unadjusted) odds of cognitive impairment were 1.1-1.3 times higher for residents of rural vs urban SNFs; while the odds of having any one of the behavioral issues were 1.2-1.6 times higher in more remote rural locations. The capacity of rural SNFs to manage complex cognitive and behavioral problems deserves further research.
Impact of Race on Decision Making for Nursing Home Residents With Advanced Dementia: Can We Disrupt and Transform?
Authors: Lopez Ruth , Roach Ashley , Hendricksen Meghan , Rogers Anita , Epps Fayron , McCarthy Ellen
Published: December 2021

Despite 20 years of research and numerous experts and associations advocating a palliative approach to care for nursing home (NH) residents with advanced dementia, research consistently demonstrate striking and persistent racial differences in the use of burdensome interventions such as feeding tubes and hospital transfer. Most notable is that Black NH residents experience more burdensome interventions at the end of life. The reasons for these differences are poorly understood. The purpose of this study was to examine NH staff members’ perceptions of advance care planning with proxies of Black and White residents. We conducted thematic analysis of semi-structured interviews with 158 NH staff members gathered as part of the ADVANCE study. This is a large qualitative study in 13 NHs in 4 regions of the country aimed at explaining regional and racial factors influencing feeding tube and hospital transfer rates. We found that NH staff, regardless of region of the country, held several assumptions about Black proxies including: being attached or not wanting to let go; not wanting to talk about death, believing everything must be done; not wanting to play God; having large conflicted families, not trusting; putting on attitude, and tending not to use NHs. We found that these assumptions led some NH staff to feel that rather than engaging in shared decision making, they were engaged in a battle with proxies leading them to pick and choose their battles and at times even giving up trying. Whether these assumptions can be disrupted and transformed will be discussed.
Oral Health in Adult Patients Receiving Palliative Care: A Mixed Method Study
Authors: Chen Xi , D'Souza Violet , Thomsen Timothy , Gilbertson-White Stephanie , Madiloggovit Jirakate , Pendleton Chandler , Xie Xianjin , Munjal Arshi
Published: December 2021

Oral disease is highly prevalent in persons receiving palliative care (PRPC). Yet, little is known about how PRPC perceive their oral health status and related treatment needs. Forty-nine PRPC were recruited. They first completed a structured oral symptom review, followed by an oral exam. A nested sample of 11 participants also completed an in-depth interview querying their perceived oral health concerns and related treatment needs. Quantitative and qualitative data was analyzed and integrated for interpretation. Eighty-six percent of participants reported at least one oral symptom, including dry mouth (83.7%), a pain-related symptom (40.8%), or oral function difficulties (51.0%). About 40% of participants reported compromised quality of life due to oral conditions; however, the perceived impacts and treatment needs were modest. Oral disease was highly prevalent in PRPC, yet its overall impact was modest. Except for painful symptoms, most participants reported limited desire to seek treatment for oral health conditions.
Pandemic-Driven Disruptions in Oral Health: Transformative Trends in Care for Older Adults
Authors: Ghezzi Elisa , Zwetchkenbaum Samuel , Fisher Mary , Fukuoka Brooke , Dodge Jeffrey , Helgeson Michael
Published: December 2021

Oral healthcare for the aging was severely disrupted during the pandemic of coronavirus disease 2019 (COVID-19). Transformative changes in care delivery involved teledentistry, mobile/portable dentistry, minimally invasive dentistry, aerosol minimization, and interprofessional oral care. Management of chronic oral health problems evolved through periods of limited to no access to daily and professional oral healthcare. Access to care has been influenced by availability of the oral care workforce, variability in long term care policy, and the lack of funding to cover medically necessary services delivered via asynchronous telehealth technologies. Impacts were identified six and twelve months into the pandemic. These will be compared to the state of oral healthcare for the aging 18 months from the start of the pandemic. The impact of vaccination on access to care will be explored. Variability between states (Idaho/Michigan/Minnesota/Rhode Island) will be addressed. Directions of new and needed research opportunities will be discussed.
Funding Influencing Practice and Outcomes in Reablement
Authors: Parsons Matthew , Rouse Paul
Published: December 2021

Internationally, Home Care is invariably funded through fee-per-service, e.g., if an hour of care is delivered, the provider receives an associated amount of funding. However, the funding model discourages reductions in packages-of-care when a client’s functional capacity improves, and further disincentivises providers to discharge clients. Similarly, staff income is often directly associated to the delivered hours-of-care and if a client’s hours are reduced, so is their income; again, discouraging the right behaviour, such as reporting improvements in independence levels. In 2008 in New Zealand, we developed a case-mix funding methodology and have been progressively implementing the new model since that time. This presentation highlights the findings in relation to how Home Care service hour allocations titrate against needs following implementation of the model as well as a number of other key quality outcomes that have been observed as a result of the case-mix model.
Role of Emotional Attachment and Reciprocity in Sons’ Perceived Care Motivation for Parental Figures
Authors: Wakui Tomoko , Hirayama Ryo , Kai Ichiro
Published: December 2021

The collapse of the traditional Japanese household system and the subsequent social advancement of women has led supporting parents as a family matter, and led more men to assume caregiving roles; however, very few studies have focused on sons’ care motivation. This study aimed to understand adult sons’ perceived care motivation and to examine the respective related factors of emotional attachment and reciprocity. A total of 1322 men (M [age] = 44.5) participated in a web-based questionnaire survey. Perceived care motivation for providing five types of support (e.g., helping with daily activities and housework) to each parent and parent-in-law was assessed. Regression analyses revealed that emotional attachment with parents and parents-in-law predicted perceived care motivation for all types of support. Furthermore, the role of reciprocity was indicated by the association between rearing by mother-in-law and son-in-law’s motivation to provide assistance in financial matters, housework, and visiting a hospital.
It's Not Healthy Fellowship: Negative Interactions and the Implications for Middle- and Old-Age Black Men
Authors: Skipper Antonius , Marks Loren , Chaney Cassandra
Published: December 2021

Despite the benefits of social support on the well-being of Black men across the life course, scholars are more closely examining the potentially negative outcomes associated with some social networks. As one social support system, the Black church frequently serves middle and old age Black men who identify as religiously involved. Yet, higher levels of religious involvement have also been associated with more church-related negative interactions. The present study utilizes a grounded theory approach to examine the negative interactions of religious middle and old age Black men. A semi-structured interview protocol is used to gather data from 35 Black men between the ages of 45 and 76. Analyses reveal that church-related negative interactions broadly fall within the following themes: (1) Ageism Within Intergenerational Churches, (2) People are Messy, and (3) Issues with Leadership. Since negative interactions can be more detrimental than social support is beneficial, health-related implications are discussed.
Exploring Life Instability’s Relationship to the Mental Health of Older Adults With HIV
Authors: Weinstein Elliott , Harkness Audrey , Ironson Gail , Shrader Cho-Hee , Duncan Dustin , Safren Steven
Published: December 2021

The study is one of the first to examine both the prevalence of life instability among older adults with HIV (OAWH) in a community clinic and its relationship to their mental health. OAWH (N=623) from a community medical clinic completed an interviewer-administered assessment (English/Spanish) which included an additive Life Instability Index (LII) composed of indicators at the individual (e.g. education, housing instability, employment status) and community (e.g. poverty, transportation) levels. Participants were a mean age of 60 years (SD = 5.90) with the majority identifying as Black-non-Hispanic (65.9%), cisgender male (60.8%), and heterosexual (80.6%). Participants reported an average of 6.08 destabilizing factors (SD = 1.44). In multiple linear regression analyses LII was significantly related to increased substance use among participants (b= 0.08, p < 0.01), but not with anxiety or depression. An LII is an innovative approach to assess the relationship between OAWH’s mental health and social determinants of health.
Content Development for a Virtual Social Engagement Intervention
Authors: Shende Shraddha , Lothary Allura , King Justine , Jones Sarah , Mudar Raksha , Myers Dillon , Rogers Wendy
Published: December 2021

Video technology has the potential to provide older adults with socially and cognitively engaging activities for in-home participation. We are exploring use of OneClick.chat, a video technology platform, to present older adults with and without mild cognitive impairment opportunities for engagement. In collaboration with iN2L we have developed events that will facilitate conversations that do not rely on episodic memory, cover a range of topics, and represent different cultures and interests. We selected event topics that were positive, socially and cognitively engaging, and included a range of pictures based on our previous research. Events were carefully controlled for length of presentation, picture type, and readability. Discussion questions related to the events were designed to stimulate engaging conversations through open-ended questions and to not burden memory recall or enforce stereotypes. Our work highlights potential future avenues for researchers and home and community-based organizations to use technology to promote social engagement.
Ethnicity and race in access and usage of health and social care: results from a scoping review
Authors: Torres Sandra
Published: December 2021

Scholarship on ethnicity and old age is at a crossroad now that increased diversity is a given in older populations. The same holds true for the study of the role that ethnicity and race play in access and usage of health and social care in old age. This presentation relies on a scoping review of scholarship published between 1998 and 2020 that brings attention to the ways in which ethnicity & race – as grounds for stratification and disadvantage - are made sense of in this scholarship. The presentation will describe the topics that the review divulged, whether racism has been acknowledged in this scholarship so far, and how this has been the case. In doing so, this presentation will argue that if we are to address the inequalities that older ethnic minorities face we need not only a diversity-astute research agenda but also an injustice-aware one.
Aging Equally? Employing Active Aging Policy in the United Kingdom
Authors: Foster Liam
Published: December 2021

The UK’s responses to the challenges of ageing have largely focused on productivist notions of active ageing, with more comprehensive responses tending to be reactive and largely remedial. This presentation will show that productivist policies, often characterised by individual responsibility, including raising the retirement age, restricting access to early retirement, and providing a stronger link between pension benefits and contributions, have incentivised remaining in the labour market. These strategies have been justified in the context of ageing populations and increasing pension costs. However, opportunities to extend working lives have not been experienced equally. In practice most policies are gender blind. Furthermore, a more comprehensive approach to active ageing in the UK needs a collective emphasis to mobilise a wide range of societal resources, underpinned by a commitment to public welfare, which is highly problematic under neo-liberalism. Therefore, a comprehensive approach to ageing in the UK requires a substantial ideological shift.
Efficacy of Online Goal Management Training for Age-Associated Executive Impairment
Authors: Zhu Lynn , D'Amico Danielle , Vandermorris Susan , Wang Yushu , Levesque Laryssa , Lass Jordan , Troyer Angela , Levine Brian
Published: December 2021

Goal Management Training® (GMT) is a standardized cognitive rehabilitation program that enhances individuals’ awareness of executive function impairments and trains them to regularly monitor and manage their goals. In-person GMT is well-validated among numerous subpopulations, including people experiencing age-related cognitive impairment or acquired brain injury, and people with psychiatric disorders. The goal of this study was to evaluate the efficacy and usability of online GMT relative to computerized “brain training” in a registered randomized controlled trial (protocol NCT03602768 at Trials.gov). Both interventions were administered in a self-paced format, with background therapist support provided for GMT. Primary outcomes were measured as self-reported executive impairment on standardized measures (the Dysexecutive Questionnaire and the Cognitive Failures Questionnaire) at pre-, immediate post-, and 6 weeks post-intervention. 62 older adults without psychiatric or neurological diagnoses completed the trial (online GMT: n = 37, age[mean] = 69 years; computerized brain training: n = 25, age[mean] = 64 years; both groups: 76% female). Improvements on the primary outcomes were observed post-intervention and were maintained at follow-up. GMT and computerized brain training groups could not be differentiated statistically, possibly due to restriction of range in the outcome measures at baseline. Additionally, the self-paced format prolonged the intervention beyond the recommended duration, which may have diluted efficacy. GMT was well-received, with participants reporting frequent use of the trained metacognitive strategies. Future studies will examine online GMT’s effectiveness in samples with documented executive impairment and with additional supports to promote engagement for this virtual program.
Evaluation of an Ecological Momentary Intervention for Depression in Older Adults Living Alone
Authors: Kim Heejung , Hong Soyun , Lee Sangeun , Song Kijun , Kim Mijung , Kim Yuntae , Kim Hyein
Published: December 2021

Depression is a common but treatable mental health problem among older adults. Daily management and monitoring is very important; thus, diverse approaches have been developed. The objective of this research was to develop and pilot-test a counseling-plus-mobile health (mHealth) intervention using ecological momentary intervention (EMI) to reduce daily depressive mood for older adults living alone. Of 64 older adults living alone in community settings, 44 completed mHealth training and EMI for 7 weeks between October 2018 and October 2019. Study participants were randomized into experimental and control groups. The intervention was based on the protocol developed for an mHealth program for older Korean adults. Participants wore an actiwatch that measured their depressed moods four times a day for 2 weeks. Depressive symptoms were measured using the Hamilton Depression Rating Scale (K-HDRS) and the Korean version of the Short Geriatric Depression Scale (SGDS-K). Sleep quality was assessed using the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K). The mean age of the study sample was 76.05±5.66 years, and the majority of the participants were female (61.0%, 36/59). There were no demographic characteristic differences between intervention and control groups. Based on multi-level modeling, EMI was not associated with significant improvements in depressive symptoms. However, depressive symptoms showed an initial decreasing trend, leveling off toward the end of the intervention period. This study finding could function as preliminary data to develop mHealth-based EMIs for older users in a larger, long-term study.
AgingPLUS: A Randomized Trial to Increase Physical Activity in Middle-Aged and Older Adults
Authors: Diehl Manfred , Schrack Jennifer
Published: December 2021

Engagement in physical activity (PA) has well-documented benefits for delaying or preventing age-related diseases. Thus, it is important to study innovative ways to increase PA in the adult population. This symposium describes AgingPLUS, an ongoing trial that addresses three psychological mechanisms to increase adults’ PA: Negative views of aging (NVOA), low self-efficacy beliefs, and deficient goal-planning skills. The symposium also presents preliminary findings, based on a pre-pandemic subsample, on changes in explicit NVOA, implicit VOA, and changes in PA. Diehl et al. describe the theoretical background and study design of the ongoing RCT. This also includes the main study hypotheses. Rebok et al. present preliminary findings showing significant effects of the intervention on NVOA and frequency of moderate intensity exercise. Effects on physical function and accelerometry measures were not statistically significant in this subsample. Tseng et al. examined the effects of the intervention on two measures of implicit VOA: a lexical decision-making task (LDMT) and the Brief Implicit Association Test (BIAT). Findings showed that differences in post-intervention latencies on the LDMT were not statistically significant. Differences on post-intervention BIAT d scores also failed to be significant. Finally, Nehrkorn-Bailey et al. tested a multiple mediator model examining the mediational role of self-efficacy (SE) and exercise intention (EI) on PA. Results showed that Week 4 SE significantly mediated the effect of intervention condition to Week 8 anticipated PA engagement. Week 4 EI significantly mediated the effect of intervention condition on Month 6 PA engagement. Anticipated PA effects predicted subsequent involvement in PA.
AgingPLUS: Theoretical Background and Study Design of the Randomized Trial
Authors: Diehl Manfred , Rebok George , Roth David , Li Kaigang , Nehrkorn-Bailey Abigail , Rodriguez Diana , Thompson Katherine
Published: December 2021

The AgingPLUS program targets three psychological mechanisms that are known barriers to middle-aged and older adults’ engagement in physical activity (PA): Negative views of Aging (NVOA), low self-efficacy beliefs, and poor goal planning skills. These risk factors are addressed in a 4-week intervention program that is compared to a generic health education program as the control group. Middle-aged and older adults (age 45-75 years) are enrolled in the trial for 8 months, with four assessment points: Baseline (pre-test), Week 4 (immediate post-test), Week 8 (delayed post-test), and Month 6 (long-term follow-up). The major outcome variables are participants’ engagement in PA as assessed via daily activity logs and actigraphs. Positive changes in NVOA, self-efficacy beliefs, and goal planning are the intervention targets and hypothesized mediating variables leading to increases in PA. This trial adopted the experimental medicine approach to assess the short- and long-term efficacy of the AgingPLUS program.
Examining the Effects of the AgingPLUS Program on Physical Activity: A Multiple Mediator Model
Authors: Nehrkorn-Bailey Abigail , Rebok George , Roth David , Chung Shang-En (Michelle) , Li Kaigang , Rodriguez Diana , Thompson Katherine , Diehl Manfred
Published: December 2021

This study examined the effect of the AgingPLUS program on anticipated physical activity (PA) and PA engagement, along with the hypothesized mediator roles of self-efficacy (SE) and exercise intention (EI). Data came from 147 participants (Mage = 60.11 years; SD = 8.28 years) of the ongoing trial. Structural equation modeling tested the effects of the intervention, week 4 EI, and week 4 SE on anticipated PA at week 8 and engagement in PA at 6 months. The pathway from week 8 anticipated PA to month 6 PA was also assessed. Results showed that week 4 SE significantly mediated the pathway of intervention condition to week 8 anticipated PA, whereas week 4 EI significantly mediated the pathway from intervention condition to engagement in PA at 6 months. Furthermore, anticipated PA predicted subsequent engagement in PA. Results from these analyses provide preliminary support for the efficacy of the AgingPLUS program.
Links of Short Physical Performance Battery Score with Incident Dementia: Results from the NHATS
Authors: Wu Di , Smail Emily , Schrack Jennifer , Wanigatunga Amal , Kasper Judith , Spira Adam
Published: December 2021

Physical performance is associated with cognitive function in later life, but few studies have examined the prospective association of physical performance with incident dementia. We studied 4539 community-dwelling National Health and Aging Trends Study (NHATS) participants aged ≥65 years with data on demographics and the Short Physical Performance Battery (SPPB) in 2011, who were followed through 2014. Our outcome was dementia diagnosis from a validated NHATS algorithm. We applied survey weights to make results nationally representative and performed Cox regression analyses. After adjustment for potential confounders, lower baseline SPPB scores were associated with incident dementia (HR=1.68, p < 0.01). Slower gait speed was the SPPB component most strongly associated with incident dementia (HR=1.21, p < 0.01). We found that poorer physical performance was linked to incident dementia in a cohort of older adults. More research is needed to examine the effect of improving physical performance on the prevention of dementia.
COP Cells in States of Bone Anabolism and Abnormal Calciﬁcation/Ossification
Authors: Pignolo Robert
Published: December 2021

Circulating osteogenic progenitor (COP) cells are a population of cells in the peripheral blood with the capacity for bone formation, as well as broader differentiation into mesoderm-like cells in vitro. There are several pathologies of accelerated bone formation and physiological responses to injury in which COP cells have been theorized to play a role. These include fracture, vascular calciﬁcation, and subtypes of heterotopic ossiﬁcation (HO). Overall, the available studies suggest COP cells are likely to be mobilized in response to fracture, home to the site of injury, undergo a maturation process, and contribute to the osteogenesis and angiogenesis required for fracture healing. HO is the pathological process of bone formation in nonskeletal tissue and can be acquired or hereditary. COP cells may seed sites of injury and inﬂammation that precede the formation of endochondral bone identiﬁed in both genetic and nongenetic forms of HO. Vascular calciﬁcation is a common occurrence in older adults and is strongly associated with poorer cardiovascular health outcomes. It appears that COP cells, particularly those expressing hematopoietic and vascular markers such as CD45 and CD34, contribute to the calciﬁcation and ossification of atherosclerotic plaques and aortic valves, and that they correlate to the severity of the calciﬁcation. Whether COP cells are attracted to sites of injury and inﬂammation and so are highly associated with fracture, vascular calcification/ossification and HO, or whether they underlie these processes at a more mechanistic level, remains to be more clearly demonstrated.
Contribution of Sensory Function to Preclinical Indicators of Physical and Cognitive Functioning With Aging
Authors: Agrawal Yuri , Schrack Jennifer , Swenor Bonnielin
Published: December 2021

There are well established associations between sensory loss and physical and cognitive deficits with aging, but gaps remain in our understanding of the associations between sensory function and early preclinical indicators of physical and cognitive decline. This symposium will present data from the Baltimore Longitudinal Study of Aging (BLSA) on a series of studies investigating the links among sensory function, motor function, and physical and cognitive outcomes in older adults. In the first study, Dr. Gross will present an operational definition of early cognitive impairment (ECI) based on a combination of two cognitive measures – the Card Rotations test and the California Verbal Learning Test Immediate Recall – to predict progression to MCI/AD. In the second study, Dr. Cai will evaluate the relationship between multisensory impairment (in vision, hearing, olfaction, proprioception and vestibular function) and the algorithmic definition of ECI. In the third study, Dr. Armstrong will evaluate the association between multisensory impairment and another biomarker of ECI or preclinical AD, specifically PET-PiB deposition. In the fourth study, Dr. Schrack, will present the joint contribution of multisensory (hearing and vision) impairment and motor function (gait speed) on risk of incident MCI/AD in longitudinal analyses. Finally, Dr. Martinez Amezcua will present the longitudinal association between hearing and vestibular function and decline in higher level physical function and endurance performance. Taken together, these studies present compelling data about the contribution of sensory function to preclinical indicators of physical and cognitive functioning with aging.
Derivation and Validation of an Algorithmic Classification of Early Cognitive Impairment
Authors: Gross Alden , An Yang , Lin Frank , Ferrucci Luigi , Schrack Jennifer , Agrawal Yuri , Resnick Susan
Published: December 2021

The long prodromal period for dementia pathology demands valid and reliable approaches to detect cases before clinically recognizable symptoms emerge, by which time it may be too late to effectively intervene. We derived and compared several algorithms for early cognitive impairment (ECI) using longitudinal data on 1704 BLSA participants. Algorithms were based on cognitive impairment in various combinations of memory and non-memory tests, and the CDR. The best-performing algorithm was defined based on 1SD below age-and race-specific means in Card Rotations or California Verbal Learning Test immediate recall, two tests that in prior work show the earliest declines prior to dementia onset. While this ECI algorithm showed low concordance with concurrent adjudicated MCI/dementia (AUC: 0.63, sensitivity: 0.54, specificity: 0.73), it was among the best predictors of progression to MCI/dementia (HR: 3.65, 95% CI: 1.69,7.87). This algorithm may be useful in epidemiologic work to evaluate risk factors for early cognitive impairment.
Aging Through the Time of COVID-19: Healthcare Access for Older Adults Living With Chronic Conditions
Authors: Peckham Allie , Maxfield Molly , Pituch Keenan , Guest M Aaron , Sivanandam Shalini , Doebbeling Brad
Published: December 2021

Chronic conditions require on-going continuous management and preventive treatment. Over 80% of adults aged 65 and older have multiple chronic conditions. Concerns have arisen about how the COVID-19 pandemic is affecting the management of chronic conditions. Delay, avoidance, and poor management of healthcare during the COVID- 19 pandemic may increase the risk of unnecessary hospitalizations and mortality. This study aims to understand the impact of COVID-19 on healthcare access in a U.S. sample of Americans 50 years of age or older. Participants completed an online survey about healthcare access and other risk factors during the COVID-19 pandemic. Multinomial regression analysis examined the results of two key access points: healthcare provider /doctor (n=468) and medication (n=754). One-half (56%) of those who needed access to a provider were able to be seen. Participants who were older, had multiple chronic conditions, and those with a provider were more likely to have access. However, when individuals with more chronic conditions did not have access, they indicated that this lack of access was due to COVID-19. When not receiving access to medications, unemployed participants attributed the lack of access more often to COVID-19 than other reasons. These findings demonstrate an important lack of access to providers and medication among older adults during the pandemic. In multivariate models, this lack of access was most often due to COVID-19, in addition to traditional factors such as insurance, employment, and medical and behavioral comorbidity. Interventions are needed to lower access barriers to care even further during COVID-19.
Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The OPACH Study
Authors: Schumacher Benjamin , Bellettiere John , LaMonte Michael , LaCroix Andrea
Published: December 2021

We sought to investigate the association between steps per day (steps/d) and incident fall risk while also assessing the role of physical functioning on this association. Steps/d were measured by accelerometer for 7 days in 5,545 women aged 63 to 97 years between 2012 - 2014. Falls were ascertained from daily fall calendars for 13 months. Median steps/d were 3,216. There were 5,473 falls recorded over 61,564 fall calendar months. The adjusted incidence rate ratio comparing women in the highest vs. lowest step quartiles was 0.71 (95% confidence interval, 0.54 - 0.95; P-trend across quartiles of steps/d = 0.01). After further adjustment for physical function using the Short Physical Performance Battery, the rate ratio was 0.86 (0.64-1.16; P-trend = 0.27). Mediation analysis estimated that 66.7% to 70.2% of the association of steps/d and fall risk may be mediated by physical function. In conclusion, higher steps/d were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.
Finding Static Stability Limits: Comparison of Reactive Balance in Older People With and Without a History of Falls
Authors: Hackbarth Michel , Koschate Jessica , Lau Sandra , Zieschang Tania
Published: December 2021

Reactive balance is a highly relevant fall risk factor, but is rarely considered in clinical practice. Especially medio-lateral perturbations lead to a pronounced instability of the gait pattern. However, there is no consensus on a method for the assessment of individually challenging perturbation intensities to apply during walking. The aim of this study is to determine and compare the static stability-limits in older adults with and without a history of falls. Twelve older adults with (OAF; 75.6 ±3.66,9♀) and 19 older adults without a history of falls (OA; 77.5 ±4.99,12♀) were subjected to progressive-intensifying perturbations while standing on a perturbation treadmill. In addition, functional performance (Mini-BESTest), fear of falling (FES-I), and physical activity (kcal) were assessed Deflection of the treadmill-platform was randomized by timing and direction and was increased until the subject had to compensate with a step (stability-limit). The maximum deflection distance for each direction, as well as the FES-I score, mini-BESTest score, and activity level were evaluated for group differences using the t-test and Mann-Whitney-U test (α≤5%). There were no significant group differences in the mini-BESTest and between the maximum tolerated deflection distances. The OAF-subjects showed an increased FES-I score (median for OA=18.0 and OAF=22.0, p=0.032) and higher activity levels (median for OA=1974 kcal and OAF=3365 kcal, p=0.011). Despite an increased fear of falling, the older adults with a fall history showed a similar stability-limit, but higher activity levels. In future experiments these static stability limits should be tested during walking and evaluated via motion analysis.
Family Caregiving Disrupted by COVID-19: Overcoming Challenges Through Resilience and Flexibility
Authors: Wyman Mary , Wray Laura
Published: December 2021

The impacts of the COVID-19 pandemic have been global and pervasive – yet only partially understood. Older adults and their family caregivers have experienced profound and unprecedented challenges as a result of COVID-19. This symposium features research on these disruptions and the creative adaptations undertaken in response. Four presentations present a variety of geographic regions, caregiving settings, and research focal points. Avidor and Ayalon present findings from interviews with family caregivers of residents in long-term care, highlighting the issues faced as a result of dramatic shifts in policy and procedures in support of pandemic infection control. Gum and colleagues focused on how service access has changed for community-dwelling older adults and their families during the pandemic, and how agencies may best leverage the flexibility of caregivers to adapt service provision. Boucher et al. compare the challenges faced by family caregivers during COVID-19 with those faced during a natural disaster, and highlight unique differences in service access for caregivers of military veterans. Finally, Ko and co-authors share their experience with the implementation of a technology intervention to reduce caregiver stress as part of a research trial, and how the protocol adjustments necessitated by COVID-19 revealed the unique potential of such technologies to support caregivers under isolated conditions. The presenters will focus on themes of resilience and lessons learned for health care systems, service agencies, and society to best support family caregivers in challenging circumstances moving forward.
Disaster Caregiving: Caregivers Negotiating Storms and COVID-19 for Veterans and Non-Veterans on the Gulf Coast
Authors: Boucher Nathan , McKenna Kevin , Dombeck Carrie , Clark Amy , Wang Ke , Olson Jennifer , Shepherd-Banigan Megan
Published: December 2021

Natural disasters and COVID-19 likely add complexity to caregiving efforts, yet little is known about these effects. We will discuss our findings exploring additional needs and challenges experienced by caregivers during hurricanes, floods, and COVID focused on US Gulf Coast states. We interviewed caregivers of both Veterans (n=13) and non-Veterans (n=11). The presentation will include an overview of 1) types of resources needed or used related to storms and to COVID, including social support and access to information for both emergency planning and recovery; 2) caregiver experience before, during, and after the disaster including psychological effects on caregivers and addressing special health needs; 3) comparisons of challenges during storms versus COVID including emotional impact and access to health and specialty care; and 4) additional resources used by caregivers of Veterans. We will also address how these data are informing national caregiver support programs.