bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-Perceptions of Driving Ability in Older Adults With and Without Alzheimer’s Disease
Authors: Davis Rebecca , Owens Megan
Published: December 2020

A concern for families and persons with dementia is determining when driving cessation is necessary. Older adults often modify driving behaviors as they age due to self-perception of a decline in their abilities. However, it is not known how persons with Alzheimer’s disease modify driving behaviors. The purpose of this study was to determine difference in how similarly aged persons with and without Alzheimer’s disease perceive their driving behaviors and modify them. Data were collected for 48 persons with early stage AD or mild cognitive impairment (MCI) due to AD; and 53 similarly aged older adults without cognitive diagnoses, using a survey on driving frequency, habits, and wayfinding ability. Chi-square analysis was used to determine any statistically significant differences in reported driving habits and difficulties between the study groups. Results from the analysis showed that the majority of the sample was still driving (n=81, 83%). Persons with AD/MCI (n=33, 73%) were less likely to be driving than the control group (n=48, 91%). Of those who were still driving, those with AD/MCI were more likely to limit driving frequency, avoid driving alone and in unfamiliar routes. Worries about getting lost were more frequently noted in those with AD/MCI. The AD group was more likely to make modifications to their driving such as limiting driving to daylight hours and not driving alone. These important results indicate persons with early stage AD/MCI may have self-awareness about driving impairments and make modifications to their driving habits that may increase their driving safety.
Older Adults in Poor Health Received Social Support Mainly From Family: The Singapore Chinese Health Study
Authors: Barrenetxea Jon , Yi Yang , Markides Kyriakos S , Koh Woon Puay , Qiushi Feng
Published: December 2020

While having social support can contribute to the health of older adults, those in poor health may be limited in their capacity to receive social support. We studied health factors associated with social support among 16,948 participants from follow-up 3 of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese. Participants were interviewed at mean age of 73 years (range from 61 to 96 years) using the Duke Social Support Scale. Latent Class Analysis (LCA) was applied to derive groups based on the source and intensity of social support. We ran multivariate logistic regression models to study health factors associated with group membership. LCA revealed four groups in increasing social support scores: The “family restricted”, who had the lowest social support scores and only received support from family (50%); the “loners”, who had some support from extended family and non-family (5%); the “family oriented”, who had broad family support and some non-family support (28%); and the “overall supported”, who had the highest social support scores and received broad support from family, extended family and non-family (17%). Compared to the “overall supported” group, health factors associated with being “family restricted” were: having instrumental limitations [odds ratio (OR) 1.34, 95% confidence interval (CI) 1.19-1.50], having poor self-rated health (OR 1.40, 95% CI 1.28-1.54), being depressed (OR 2.49, 95% CI 2.21-2.81) and being cognitively impaired (OR 1.19, 95% CI 1.04-1.37). Our results showed that older adults in poor health received social support mainly from family.
Association of Vaginal Microbiota With the Genitourinary Syndrome of Menopause Across Reproductive Stages
Authors: Shardell Michelle , Gravitt Patti , Ravel Jacques , Burke Anne , Brotman Rebecca
Published: December 2020

The genitourinary syndrome of menopause (GSM) is a collection of signs and symptoms related to estrogen decline that involves physical changes to the vulva, vagina, and lower urinary tract. GSM signs and symptoms may occur during any reproductive stage but are most common during menopause. Vaginal microbiota, particularly Lactobacillus spp., protect the female genital tract from multiple conditions; however, Lactobacillus spp. abundance declines during menopause. We aimed to determine the longitudinal association of vaginal microbiota with GSM signs and symptoms across reproductive stages. In a two-year cohort study comprising 750 women aged 35-60 years who contributed 2111 semiannual person-visits, low-Lactobacillus spp. vaginal microbiota communities were observed at 21.2% (169/798), 22.9% (137/597), and 49.7% (356/716) of person-visits among pre-, peri-, and post-menopausal women, respectively (p<.001). After covariate adjustment, low-Lactobacillus spp. communities characterized by high Atopobium and Megasphaera relative abundance were associated with vulvovaginal atrophy relative to high-Lactobacillus spp. communities dominated by L. crispatus (OR[Odds Ratio]=3.04, 95% Confidence Interval[CI]=1.02-9.06) among post-menopausal, but not among peri- or pre-menopausal women. Also, post-menopausal women with low-Lactobacillus spp. communities reported decreased libido (OR=1.79, 95%CI=1.04-3.12) and vaginal dryness (OR=1.61, 95%CI=0.89-2.90) more frequently than their counterparts with high-Lactobacillus spp. communities, but not among peri- or pre-menopausal women (p for interaction<.05). Specifically, low-Lactobacillus spp. communities characterized by high Atopobium and Megasphaera relative abundance were related to both decreased libido (OR=2.82, 95%CI=1.11-7.14) and vaginal dryness (OR=3.50, 95%CI=1.18-10.44) compared with high-Lactobacillus spp. communities dominated by L. gasseri/L. jensenii. Vaginal microbiota, particularly Lactobacillus spp., and menopause may synergistically influence GSM.
Evidence for Publicly Reported Quality Indicators in Residential Long-Term Care: A Systematic Review
Authors: Zúñiga Franziska , Osinska Magdalena , Zuniga Franziska
Published: December 2020

Quality indicators (QIs) are used internationally to measure, compare and improve quality in residential long-term care. Public reporting of such indicators allows transparency and motivates local quality improvement initiatives. However, little is known about the quality of QIs. In a systematic literature review, we assessed which countries publicly report health-related QIs, whether stakeholders were involved in their development and the evidence concerning their validity and reliability. Most information was found in grey literature, with nine countries (USA, Canada, Australia, New Zealand and five countries in Europe) publicly reporting a total of 66 QIs in areas like mobility, falls, pressure ulcers, continence, pain, weight loss, and physical restraint. While USA, Canada and New Zealand work with QIs from the Resident Assessment Instrument – Minimal Data Set (RAI-MDS), the other countries developed their own QIs. All countries involved stakeholders in some phase of the QI development. However, we only found reports from Canada and Australia on both, the criteria judged (e.g. relevance, influenceability), and the results of structured stakeholder surveys. Interrater reliability was measured for some RAI QIs and for those used in Germany, showing overall good Kappa values (>0.6) except for QIs concerning mobility, falls and urinary tract infection. Validity measures were only found for RAI QIs and were mostly moderate. Although a number of QIs are publicly reported and used for comparison and policy decisions, available evidence is still limited. We need broader and accessible evidence for a responsible use of QIs in public reporting.
Making Quality Improvement Data Meaningful for Long-Term Care Administrators
Authors: Cranley Lisa , Weeks Lori , Lo T K T (Thomas) , Norton Peter , Estabrooks Carole
Published: December 2020

Tailoring feedback data to engage end-user stakeholders when sharing organizational context data is a central component of quality improvement and integrated knowledge translation. For over a decade, our research team has collected survey data (using the validated Alberta Context Tool) on modifiable aspects of organizational context from long-term care (LTC) staff (e.g., nurses, unregulated providers) across a representative cohort of 94 LTC facilities in Western Canada. We have fed back data at the facility and care unit level with the goal of making research findings more useful for decision-making and aiding improvement efforts. We have used a binary method (more favourable / less favourable organizational context) to report multidimensional data. While useful to our stakeholders (e.g., administrators) we are continually seeking ways to increase the detail in our reporting, while maintaining usability for stakeholders. We have now developed a more detailed method – the context rank summary, which displays rankings of care units within and across LTC facilities. In this study, we used a qualitative descriptive design to explore perspectives of administrators and managers (leaders) from LTC facilities on the two different methods for reporting survey data. We conducted a total of three focus groups with 16 leaders in the Maritimes and Ontario, Canada. Transcripts were analysed using content analysis. Leaders preferred a feedback report that combines a binary method with the greater detail of the context rank summary. Providing organizational context data that is more meaningful, relevant and actionable could offer an additional path to identifying areas for improvement.
Stress and Nursing Home Adjustment: Mediation by Resourcefulness and Self-Efficacy
Authors: Xiao Huimin , Yong Binbin
Published: December 2020

Relocation to a nursing home is often assumed to be associated with stress for older adults. This study aimed to explore how stress affect psychological adjustment of nursing home residents. A cross-sectional survey was conducted. A sample of 386 nursing home residents was recruited from 11 nursing homes in Fujian Province, Southeast China. The Nursing Home Adjustment Scale, Perceived Stress Scale, Resourceful Scale, and General Self-Efficacy Scale were adopted to collect data. The path analysis was used to analyze the relationship of stress, nursing home adjustment, resourcefulness, and self-efficacy. The results indicated that stress directly caused poor nursing home adjustment. It also indirectly affected nursing home adjustment through the mediators of resourcefulness and self-efficacy, respectively. Furthermore, chained mediation was found from stress to nursing home adjustment through resourcefulness, and then through self-efficacy to cope with the negative affect. The current study contributes to the understanding of the mechanism of stress on nursing home adjustment in older adults. To improve their psychological adjustment, additional focus should be placed on enhancing resourcefulness and self-efficacy in nursing home residents.
Inter-Individual Differences in Exercise Responses in Alzheimer’s Disease
Authors: Yu Fang , Salisbury Dereck , Mathiason Michelle
Published: December 2020

Aerobic exercise is widely supported as a disease-modifying treatment for Alzheimer’s disease (AD) in animal models; however, its effects on cognition have been mixed in human studies, which may be attributable to inter-individual differences in aerobic fitness and cognitive responses to aerobic exercise. This study evaluated inter-individual differences in aerobic fitness and cognitive responses to 6-month aerobic exercise in participants with AD dementia by secondarily analyzing the FIT-AD Trial data. Aerobic fitness with the shuttle walk test (SWT), 6-minute walk test (6MWT), and maximal oxygen consumption (VO2max) from cycle-ergometer exercise test, and cognition with the AD Assessment Scale–Cognition (ADAS-Cog). Inter-individual differences were calculated as the differences in the standard deviation of 6-month change (SDR) in outcomes between the intervention and control groups. The sample size was 78 (77.4±6.3 years old, 15.7±2.8 years of education, 41% women). VO2max was available in 26 participants (77.7±7.1 years old, 14.8±2.6 years of education, 35% women). The results show that the SDR was 37.0, 121.1, 1.7, and 2.3 for SWT, 6MWT, VO2max, and ADAS-Cog, respectively, but there were no statistically significant differences between the intervention and control groups in these measures over six months. Our results indicate that inter-individual differences exist in aerobic fitness and cognitive responses to aerobic exercise in AD, which contributed to the favorable, but not statistically significant between-group differences in aerobic fitness and cognition. To conclude, our study is the first to demonstrate inter-individual differences in the responses to aerobic exercise in AD dementia using SDR.
Relationship Between Physical Activity and Function With Quality of Life in Community-Living Older Adults
Authors: Chang Milan , Geirsdottir Olof , Thorsdottir Inga , Jonsson Palmi , Ramel Alfons , Gudjonsson Milan Chang
Published: December 2020

Background: Quality of life (QOL) is a multidimensional concept which is often used as an evaluation of a person‘s health and psychological status. Increasing longevity can be associated with better QOL as long as older adults are independent in daily life. The aim of the study was to examine the associations of QOL with muscle strength and physical function among community-dwelling older adults. Methods: The current cross-sectional study had 225 participants (73.7±5.7yrs, 58.2% female) living in Reykjavik, Iceland. QOL measured using the 36-item short-form survey (SF-36). Covariates were anthropometrics, muscle strength, physical function including timed up and go test (TUG), and 6-minute walking distance (6MWD), physical activity per week (PA). Linear regression analysis was used to examine the association of QOL with physical function. Results: The mean QOL score for the study population was 54.9±6.13. The analysis was adjusted for age and gender, body mass index, height, and PA. We found that QOL was associated with better grip strength (B=1.4, P<0.0001), 6MWD (B=0.03, P<0.0001), slower TUG (B=-0.9, P<0.0001), and higher PA (B=0.03 m, P=0.039). However, QOL was not associated with quadriceps leg strength. Conclusion: The study suggests that QOL was associated with better physical function including grip strength, walking ability and the level of PA among community-dwelling older adults in Iceland.
Usability and Feature Evaluation of the Amazfit Bips Smart Watch in the Precision START Lab
Authors: Chase Jo-Ana , Howland Chelsea , Gallimore Malaika , Reeder Blaine
Published: December 2020

Interventions utilizing consumer-grade wearable and mobile devices may support older adult health and wellness. However, rapid technology change and short industry product release cycles limit timely incorporation of these devices. We developed a novel, multi-stage process to rapidly move from within-team evaluations to lab- and field-based participants studies based on small-sample technology testing methods from Human-Computer Interaction. We present findings from a first-stage evaluation of the Amazfit Bips smart watch for potential use in studies with older adults as part of the methodology validation. A four-person research team conducted evaluations using: 1) a wearables framework for user experience and feature availability; and 2) the System Usability Scale (SUS). Evaluators wore the watch seven days straight from the box. User experience checklists indicated high usability. However, corresponding comments identified challenges with downloading the mobile app, pairing the watch and phone, navigating watch and mobile interfaces, and privacy controls. Average SUS score was 65.6 indicating marginal usability (C grade). While meeting study goals, divergence in usability perceptions suggest the process could be improved by completing each set of instruments separately for the watch and mobile app rather than all at once. Given failures in pairing, app navigation challenges, and small screen size, the Amazfit Bips may be best suited for studies among older adults with a high degree of technical proficiency. For those with little technical experience or high disease burden, training materials and dedicated training with support may be required. Future steps are lab- and field-based tests with older adult participants.
Complementary and Integrative Health Approaches Are Underused Among Older Veterans With Musculoskeletal Pain
Authors: Han Ling , Kerns Robert , Skanderson Melissa , Luther Stephen , Fodeh Samah , Goulet Joseph , Brandt Cynthia
Published: December 2020

Complementary and integrative health (CIH) approaches are recommended in national policy guidelines as viable options for managing chronic pain, yet their use among Veterans has been suboptimal, especially for older Veterans. We identified 64,444 Veterans with a diagnosis of musculoskeletal disorders (MSD) who reported a moderate to severe pain intensity during primary care visits in 2013 from the Veterans Health Administration (VHA) electronic records. Using natural language processing (NLP), CIH use (acupuncture, chiropractic care and massage) was documented for 8169 (6.5%) of 125408 primary care visits in providers’ progress notes. Compared to their younger counterparts, older Veterans aged ≥ 65 years had 21% lower likelihood of using CIH during the year [Odds Ratio (OR): 0.79; 95% Confidence Intervals (CI): 0.73, 0.86] after accounting for demographic, clinical, temporal and spatial confounding using a generalized estimating equation logistic model. Non-white race/ethnicity, tobacco use, medical comorbidities and diagnosis of alcohol or substance use disorders were independently associated with less CIH use (ORs ranging 0.97-0.80, p<0.03-0.0001); whereas female gender, being married and number of MSD diagnoses were associated with greater CIH use (ORs ranging 1.13-1.30, p<0.0001). Redefining CIH use as chiropractic care alone [4.8% person-visits; OR: 0.78 (95% CI: 0.70, 0.86)] or incorporating structured data [9.0% person-visits; OR: 0.76 (95% CI: 0.70-0.82)] in the adjusted GEE model derived consistent results. Research to identify and address barriers to CIH use among older Veterans is encouraged.
Factors Associated With Prescription Opioid Use Among Community-Dwelling Older Adults
Authors: D’Aiuto Carina , Vasiliadis Helen-Maria
Published: December 2020

Opioid use is a growing concern in North America, particularly among older adults. Despite the opioid crisis and the aging population, few studies have evaluated the factors associated with opioid use among older adults. Our sample includes 1657 people aged ≥65 years recruited in primary care clinics from 2011 to 2013 in the Montérégie region of Québec and participating in the “Étude sur la Santé des Aînés” ESA-Services study, a longitudinal study on aging and health service use. The presence of chronic diseases was identified through self-reported health survey data linked to health administrative data. Opioid prescriptions were identified using the provincial pharmaceutical drug registry for those covered under the public drug insurance plan. Logistic regression analyses were conducted to examine the factors associated with opioid use over a 4-year period. 31.9% of participants used opioids. Factors associated with opioid use included: female sex (OR=1.24, 95%CI: 1.01-1.53), annual household income of <$25,000 (OR=1.25, 95%CI: 1.01-1.55), level of social support (OR=0.85, 95%CI: 0.73-0.99), and presence of pain/discomfort (OR=1.66, 95%CI: 1.34-2.04). Further, participants with ≥3 chronic physical conditions also reporting anxiety and/or depression were 3.63 (95%CI: 1.83-7.18) times more likely to use an opioid than those with 0-2 chronic physical conditions and no common mental disorder. Moreover, those with moderate, high, and very high psychological distress were more likely to use an opioid than those with a low psychological distress. Our findings suggest that, among other factors, physical and psychiatric multimorbidity is strongly associated with prescription opioid use in older adults.
Pharmacist-Led Audits for Older Adults With Cancer Yield Significant Interventions
Authors: Erdeljac Hilary , Yager Stephanie , McClain Megan , Wall Sarah , Presley Carolyn , Folefac Edmund , Rosko Ashley
Published: December 2020

Older adults with cancer have comorbidities that require medical management and confounders of chemotherapy and supportive medications exacerbate polypharmacy. A multidisciplinary team model was created to address these needs within the Cancer Aging and Resiliency (CARE) clinic. To reconcile medications for accuracy, compliance, side effects, and effectiveness, a pharmacist-led audit includes identification of potential therapeutic duplications, drug-drug interactions, or potential medication inappropriateness identified using Beers criteria. A pharmacist led review of patient’s prescriptions can identify drug therapy problems (DTP) and result in safer medication management. METHODS: A retrospective review of pharmacy specific interventions was conducted using CARE Clinic patient data from February 2016 to October 2019 evaluating data from n=259 patients. RESULTS: A preliminary analysis of n=137 patients who had received medication reconciliation were included. The mean number of medications per patient was 13.1 ± 5.7 and 457 DTP were identified leading to 523 medication related interventions. There was an average of 3.3 DTP per patient. The most common types of DTP included medication reconciliation (n=137, 30.0%), potentially inappropriate medication (PIM) (n=74, 16.2%), administration/technique (n=35, 7.7%), and drug-drug interaction (n=28, 6.1%). The most frequent types of interventions involved education to the patient (n=166, 31.7%), medication reconciliation (n=137, 26.2%), medication discontinuation (n=84, 16.1%), patient to discuss further with physician (n=39, 7.5%), and medication initiated (n=35, 6.7%). Updated results involving approximately 259 patients will be presented. CONCLUSION: Comprehensive medication review within a multidisciplinary setting for the management of older adults with cancer can reduce polypharmacy and inappropriate medication use.
Prevalence and Risk Factors of Postprandial Hypotension Among Japanese Older Adults in a Facility
Authors: Suzuki Noriko , Hashizume Masahiko , Shiotani Hideyuki
Published: December 2020

Postprandial hypotension (PPH) is an unrecognized sudden drop of blood pressure (BP) after meals and a hidden problem among older people including those living in long-term care facilities (LTCFs). Though PPH causes dizziness, falls, and syncope, it has received little attention from¬¬¬ healthcare workers (HCW) including caregivers, nurses and physicians, and risk factors of PPH should be carefully assessed to improve quality of life. Therefore, we aimed to examine the prevalence and risk factors of PPH in a LTCF in Japan. Participants were 114 older adults living in a LTCF in Japan (mean age 85.9 years old; 85 female (74%)). To examine PPH, blood pressure (BP) was measured before and after lunch. BP after meal was measured four times every 30 minutes. PPH is defined as a BP drop of 20 mmHg or more and we also defined a BP drop within a range of 19 to 15 mmHg as potential-PPH. As risk factors, we compared systolic and diastolic BP at baseline, body mass index, pulse rate, disease and complications between groups with/without PPH. The prevalence of PPH was 41% (47/114) and 52% with potential-PPH; 11% (13/114) added. Among risk factors, systolic BP was significantly higher in those with PPH (142.6 vs 123.5 mmHg, p <0.001). This study revealed that PPH & potential-PPH occurred in half of the subjects in a LTCF in Japan. HCW need to focus on high systolic BP to predict PPH and future research is necessary to prevent and cope with PPH for older people.
Racial, Ethnic, and Place-of-Birth Disparities in Body Types: Association to Glycated Hemoglobin in Older Adults
Authors: Chukwurah Queendaleen
Published: December 2020

Obesity, a public health concern for older adults, contributes to abnormal glycated hemoglobin (HbA1c). We examine place of birth disparities in the prevalence rate of body types and their association to HbA1c using the National Health Nutrition and Examination Survey (NHANES) III. Body mass index /waist circumference (WC) cut off values were used to create six body types: normal weight with normal WC, overweight with normal WC, obese with normal WC, normal weight with high WC, overweight with high WC, and obese with high WC. Abnormal HbA1c was defined as HbA1c >5.7%. Weighted multivariable logistic regression adjusted for age, gender, education, and poverty-income-ratio was run. The sample population included 4,584 participants aged 50 years and older identifying as non-Hispanic whites (NHW), US-born Hispanics (USB-H), and foreign-born Hispanics (FB-H). The mean (SD) sample age was 63.9 (0.3). USB-H had the highest proportion of obese with high WC (35.6%,p<0.0001) compared to NHW (26.6%) and FB-H (22.2%). USB-H (aOR 1.97 95% CI 1.45,2.68) and FB-H (aOR 1.51 95% CI 1.10,2.06) had higher odds of abnormal HbA1c compared to NHW. Overweight with high WC (aOR 1.47 95% CI 1.11-1.93) and obese with high WC (aOR 2.11, 95% CI 1.60-2.79) had a high likelihood of abnormal HbA1c compared to normal weight with normal WC. Further adjustment for co-morbid conditions yielded a significantly improved fitting model (Maximum-rescaled R-square (MRRS) =0.1997,p<0.0001) compared to that further adjusted for health-related behaviors (MRRS=0.082,p<0.0001). The knowledge of these associations in an at-risk sub-population is insightful for clinical assessments and preventive interventions.
Sex Differences in Bone-Active Medication Utilization Before and During the Year After Hip Fracture
Authors: Kirk Jennifer , Orwig Denise , Gruber-Baldini Ann , Hochberg Marc , Magaziner Jay , Rathbun Alan
Published: December 2020

Bone-active medications (BAM) [prescriptions (RxBAM) and supplements(calcium/vitamin D] increase bone mineral density and reduce osteoporotic fracture risk. However, RxBAM utilization rates are low, and it is unclear who is treated with BAMs before/after a hip fracture. This study examined sex differences in BAM use at baseline and predicted the probability of RxBAM use during follow-up(2, 6, and 12-months). The sample included frequency-matched males and females 65 years or older from the Baltimore Hip Studies’ seventh cohort. Differences in baseline characteristics between males and females with complete data(n=313) were assessed using t-tests and chi-square tests. Generalized estimating equations(GEE) predicted the probability of RxBAM use by sex among participants(n=270) with outcome data during follow-up adjusted for baseline characteristics. Prior to fracture, there were sex-differences in BAM use, with fewer men than women taking RxBAMs(9% versus 26%), calcium(18% vs. 57%) and vitamin D (55% vs. 68%). These differences remained over the year post-hip fracture. Only 12(3.5%) participants took RxBAM the entire study period. Of RxBAM users n=70(26%), there were few new-users (n=35), and many participants stopped or never started treatment. Unadjusted GEEs showed that men were less likely to use RxBAM (OR= 0.42; 95% CI:0.22,0.78, p=.007), during the hip fracture recovery period compared to females. However, after controlling for differences in baseline characteristics between males and females, particularly pre-fracture BAM medication use, the observed association (OR=0.62; 95% CI:0.29, 1.31; p= 0.23). RxBAM use was low, especially in men and may contribute to the high rates of preventable subsequent osteoporotic fractures and post-fracture mortality.
Motor and Physical Function Impairments in Middle-Aged and Older Adults in the Baltimore Longitudinal Study of Aging
Authors: Cai Yurun , Tian Qu , Agrawal Yuri , Simonsick Eleanor , Schrack Jennifer
Published: December 2020

Older adults experience motor function decline early in the disablement process, impacting daily activities and contributing to adverse health outcomes. Few studies have comprehensively examined the interrelationships among motor and functional impairments and investigated whether their contributions to mobility difficulty vary in well-functioning older adults. We examined direct and indirect associations of motor and physical function impairments with slow gait speed (<1.0m/s) and mobility difficulty using structural equation modeling (SEM) among 858 participants aged ≥50 years in the BLSA (mean age=74.1±10.6, 55% women). Motor and physical function tests included grip strength, knee extension strength, proprioception, finger tapping, standing balance (semi-, full-tandem, single-leg), repeated chair stands, and usual gait speed. Mobility difficulty was defined as self-reported difficulty in walking ¼ mile or climbing stairs. Motor and physical function impairments increased linearly with age, with 27.6% of participants having slow gait speed and 10.4% having mobility difficulty. Age-adjusted SEMs identified chair stands pace as the strongest predictor of slow gait speed, followed by latent factors of upper and lower extremity muscle strength and standing balance. Chair stands pace was the strongest predictor of mobility difficulty, followed by gait speed. Latent factors of muscle strength, proprioception, finger tapping, and standing balance were indirectly associated with mobility difficulty via gait speed. All models showed good model fit (RMSEA<0.05, CFI>0.95). These findings suggest components of strength and balance are among the most important contributors to poorer functional performance in mid-to-late life. Future longitudinal studies gauging the effect of change in these factors are warranted.
Effects of Dance Therapy on Balance and Risk of Falls in Older Persons
Authors: Chakravarty Esha , Chakravarty Indrani , Chakravarty Ipsito , Bhattacharjee Prasenjit
Published: December 2020

Loss of balance and risk of falls is a major problem in older persons. Literature shows increasing use of yoga practices and dance therapy across Indian oldage homes and day care centres to improve balance and reduce risk of falls in older persons. Aim of this study is to evaluate the effects of dance therapy with focus on therapeutic movements derived from Indian classical dances on balance and risk of falls in older adults of Day Care Centres in Calcutta Metropolitan Institute of Gerontology, under Ministry of Social Justice and Empowerment, Govt. of India. Total of 24 older adults across 2 day care centres participated in the study attending dance therapy sessions for 3 months. All of them self reported problems of balance and repeated falls alongwith difficulties in performing Activities of Daily Living. Twenty one of them were females and 3 males. The mean age of the participants was 75.5 years. Limits of Stabililty (LOS) was used to measure balance and pre tests and post tests were performed. Results showed that the Limits of Stability were significantly higher (17.5%) in older persons after participating in the dance therapy sessions. This study supports that dance therapy using movements derived from Indian classical dance forms can support older persons to function with reduced risk of falls, improved balance, safely carry out mobility tasks and perform better Activities of Daily Living . Further studies can show how dance therapy can facilitate healthy ageing and influence State policies on healthy ageing.
Measuring Fear of Falling and Appraisals of Harm
Authors: Lach Helen , Noimontree Wanida
Published: December 2020

Fear of falling (FOF) causes premature disability in older adults who limit their physical activities, making FOF an important area for aging research. Measures of falls self-efficacy have been widely used, but less attention has been paid to measuring the construct of fear. We re-assessed an older measure of fear and appraisals of harm to determine the factor structure and potential for a shorter version. Data was collected from 329 older adults from a variety of community setting (mean age 76.3, 84% female, 81% White); 63.8% reported FOF. Factor analysis resulted in four factors with eigenvalues greater than 1.0. Two factors achieved adequate Cronbach’s alpha: appraisals of harm outcomes (0.924) and social stigma (0.815). Further analysis was used to identify a short form, resulting in a 6 item measure of appraisal of harm outcomes (Cronbach’s alpha 0.86). The original and short versions were moderately correlated with falls self-efficacy as measured by the short form, and level of fear of falling using a 10-point rating scale (.327 - .492). Research is needed to further clarify psychological targets to help older adults remain physically active to improve quality of life.
Integrated Multidisciplinary Approach to Advance Care Planning for Vulnerable Older Adults
Authors: Gabbard Jennifer , Pajewski Nicholas , Callahan Kathryn , Dharod Ajay , Foley Kristie , Williamson Jeff
Published: December 2020

Advance Care Planning (ACP) is increasingly recognized as a crucial step to ensure patients receive medical care that consistent with their overall goals and values; however it remains suboptimal among vulnerable older adults. The objective was to determine whether a nurse navigator led ACP pathway plus a provider-facing EMR documentation program called ACPSmart improves ACP documentation within the EMR within an Accountable Care Organization (ACO) for vulnerable older adults. This was a randomized, pragmatic, effectiveness clinical trial was conducted from November 1, 2018 to November 1, 2019, at 8 primary care practices. Patients 65 years or older within an affiliated ACO with multimorbidity plus physical impairments, cognitive impairments, and/or frailty were included. Participants were randomized to either a nurse navigator led ACP pathway (NN) or usual care (UC). The primary outcome was documentation of new ACP discussion within the EMR at 12 months along with the quality of ACP discussions. Among 759 randomized patients (379 NN / 380 UC, mean age 77.7 years), compared to usual care, the NN led ACP pathway resulted in a higher rate of ACP documentation (42.2% vs 3.7%, p<0.001). There was also higher completion rates of ACP legal forms (24.3% vs 10.0%, p<0.001), MOST forms (10.3% vs 1.1%, p<0.001), along with documentation of medical decision maker (64% vs 35%, p<0.001). The nurse navigator led ACP pathway plus ACPSmart documentation program increased documentation of ACP within the EMR. This may mitigate prior barriers to ACP and could substantially improve ACP documentation within the EMR.
Frailty as a Moderator of the Relationship Between Social Isolation and Health Outcomes
Authors: Mehrabi Fereshteh , Béland François
Published: December 2020

Previous studies have reported that social isolation is a predictor of adverse outcomes, which is also closely associated with frailty. Very little is known about the moderating role of frailty on the impact of social isolation on health. We performed a cross-sectional analysis of the first wave of the FRéLE longitudinal study, consisting of 1643 Canadian community-dwelling older adults aged 65 years and over. Multivariate regression analysis was performed to examine the interaction between social isolation and frailty on health, controlling for socioeconomic characteristics and life habits. Social isolation was measured through social participation, social networks and support for different social ties namely, friends, children, extended family, and partner. In contrast to Berkman’s theory on the impact of social isolation on health, we found that frailty had no modifying role on the effects of social isolation on health. Frailty was significantly associated with all adverse outcomes. Less social participation was associated with ADLs, IADLs, depression and cognitive decline. The absence of friends was associated with depression and cognitive decline. Less support from children and having no children were associated with ADLs, comorbidity and depression. Fewer contact with extended family and having no family members were notably associated with ADLs and IADLs. Those who received less support from a partner or had no partner were more depressed and had more difficulties in performing IADLs. This study suggests that older adults who participate in social activities and have social ties, feel better with respect to physical health than those who feel isolated.
How Well Do Videos on YouTube Meet Information Needs of ADRD Family Caregivers? A Qualitative Analysis
Authors: Wu Shinyi , Foster Katherine , Ramirez Magaly , Jin Haomiao , Joe Elizabeth
Published: December 2020

Family caregivers need access to information, education, and support for taking care of individuals with Alzheimer’s disease and other dementia (ADRD). As YouTube is increasingly being used for sharing health information, videos regarding the disease and caregiving are becoming an important source of information to support family ADRD caregivers. This study aimed to assess the types and quality of information available on YouTube videos related to ADRD caregiving. A framework categorizing information needs of family ADRD caregivers was developed through a qualitative study with caregivers (N=21) and with healthcare and community stakeholders (N=6). The framework was used to conduct content analysis of YouTube videos. Nineteen categories of information needs were identified, including information about ADRD, healthcare services and treatment, available community resources, caregiving skills, and short- and long-term care. YouTube videos that met the keywords, language, and view selection criteria were evaluated by two coders on a developed rating scale to measure their relevance and helpfulness. A neurologist verified the ratings in 10% of the coded videos for quality assurance. There were 48 English and 23 Spanish videos met the selection criteria. More English (89.6%) than Spanish (56.5%) videos provided tips on handling specific ADRD symptoms. The majority categories of information needs (15 of the 19) were absent in most videos (87.0%, 89.6%). Many of the most watched videos were not rated as helpful. Community-based providers and healthcare organizations are encouraged to make high quality needed information in commonly accessed videos sharing service to support ADRD family caregivers.
Does Anxiety Affect the Clock-Drawing Task in Patients in a Memory Clinic? A Clinical Correlation Study
Authors: Khachan Hamed , Kanjolia Mahak , Nair Anil
Published: December 2020

Background: It is unknown if anxiety levels affect performance on clock drawing test (CDT) in memory clinic patients. Method: We performed a retrospective analysis of memory clinic patients in the south shore of Boston from 2010 to 2019. We correlated anxiety screen data (GAD7) to CDT scores, based on contour, numbers, and hands placement. Univariate analyses used Spearman correlation. A multivariate regression model analzed GAD7 to covariates of CDT, age, sex, and race. Hypothesis : We hypothesized a positive correlation between anxiety levels scored by the GAD7 and CDT. Results: 994 patients in the memory clinic between 2010-2020 had analyzable data. Patients were 58.6% female, 84.6 % White. Mean age was 70.1±14.4, CDT 1.84±1.04. CDT score correlated significantly to race (⍴=-0.16, p< 0.001), age (⍴=-0.28, p<0.001), gender (⍴=0.05, p=0.16), but not GAD7 (⍴=0.05, p=0.27). Multivariate model confirmed the lack of association of anxiety scores to CDT (□= 0.08, p=0.78). GAD7 scores correlated to female gender (□= -1.16, p=0.04). Conclusions: CDT scores were not affected by anxiety as measured on GAD7 scores. However, a positive correlation was shown on anxiety scores in females to CDT completion.
Depression and Cognitive Functioning Among Adults Age 60 and Over: United States, 2011-2014
Authors: Kramarow Ellen , Brody Debra
Published: December 2020

Previous studies have noted an inverse association between depression and cognitive functioning. The objective of this research is to explore this relationship with data from a nationally representative survey containing validated measures of cognition, depression, and other health conditions. The study population was respondents aged 60 and over who completed the examination component of the 2011-2014 National Health and Nutrition Examination Survey (NHANES) (N=3,472). Cognitive tests included the CERAD word list learning trials, measuring immediate and delayed memory, and the Digit Symbol Substitution test (DSST), measuring attention and processing speed. The presence of depressive symptoms was based on a score of 10 or higher out of 27 from the Patient Health Questionnaire (PHQ-9). Statistical analyses included regression models with low cognitive performance (scoring in the lowest 25th percentile) as the dependent variable. Results from regression models showed that having depressive symptoms significantly increased the odds of scoring in the lowest 25th percentile of both the DSST (OR = 3.4) and the CERAD test (OR = 1.7), controlling for age, sex, and race and Hispanic origin. Adding in a measure of heart disease showed an independent effect of heart disease on low cognitive performance (OR = 1.7 for DSST and OR = 1.3 for CERAD test), while the effect of depression was lessened but still statistically significant. In this study, depression is associated with cognitive functioning, but its effect may be attenuated by the presence of other chronic health conditions.
Perceived Partner Responsiveness Attenuate the Link Between Menopausal Symptoms and Depressed Affect
Authors: Lee Kayeon , Jun Hey Jung , Joo Susanna , Lee Sun Ah
Published: December 2020

The years around menopause are the time that associates not only with hormonal changes but with psychological and social transitions, and previous studies have consistently revealed the relationship between menopause and depression. The present study examined the moderating effect of perceived partner responsiveness (PPR) on the association between menopausal symptoms (MS) and depressed affect (DA). The sample was middle-aged climacteric women (N = 754, Age=49-60) from the second wave of Midlife in the United States (MIDUSⅡ). Measurement for MS consisted of the frequency of five symptoms in the past 30 days (insomnia, heavy sweating, painful intercourse, hot flashes, and irritability). PPR was assessed using three items matched the core components of responsiveness (understanding, validating, and caring). Results revealed that there were significant interactions between menopausal symptoms and PPR (b = 0.05, p < 0.039). Specifically, the level of elevation of DA in response to MS was smaller in women with higher levels of PPR (b = 2.93, p < 0.001) than in those with lower levels of PPR (b =3.05, p < 0.001). According to the region of significance analysis, the coefficients of MS on DA were significant within the -2SD to +2SD range of PPR, but it decreased as the PPR increased. Findings suggest that partners’ careful responsiveness may mitigate the detrimental effects of MS on DA among climacteric women.
Presence of Meaning Mediates the Relationship Between Meaning Search and Outcome: A Cross-Cultural Study
Authors: Fung Nicole Long Ki , Fung Helene
Published: December 2020

Search for meaning (SFM) is associated with many well-being measures. The mechanism behind remains unclear. This study explores presence of meaning (POM) as a mediator to explain the association. While dialectical thinking in Eastern cultures values both process and outcome, oppositional thinking in Western cultures makes the two opposing. Since dialectical thinking increases with age, we hypothesize that with increased age, SFM is associated with POM more positively (less negatively). This heightened POM results in better well-being. We surveyed 2014 participants (aged 18-96, Mage= 55.6) in Eastern cultures: Hong Kong and Taiwan; Western cultures: Germany, United States and the Czech Republic. In Eastern cultures, SFM was positively associated with POM and life satisfaction. POM partially mediated the relationship between SFM and life satisfaction (b=0.328, p<.001). With age, SFM was associated more positively with POM and life satisfaction (b=0.009, p<.001). While POM partially mediated the relationship in younger adults (b=0.162, p<.001), full mediation was found in older adults (b=0.451, p<.001). In Western cultures, SFM was negatively associated with POM and life satisfaction. POM partially mediated the relationship between SFM and life satisfaction (b=-0.120, p<.001). With age, the negative association of SFM with POM and life satisfaction was attenuated (b=0.002, p<.001). These finding suggested that SFM becomes more beneficial to older adults across culture via establishing POM. Identifying factors that facilitate the process of achieving meaning through searching is therefore important.
The Impact of Financial Coaching on Health and Finances in Older Scam and ID Theft Victims
Authors: Lichtenberg Peter , Hall LaToya , Campbell Rebecca , Gross Evan
Published: December 2020

Population based and clinical samples consistently demonstrate that older financial exploitation (FE) victims are vulnerable across multiple domains. Our earlier research indicated that older scam and identity theft victims were vulnerable across multiple health and mental health dimensions as compared to a control group. The current work is a longitudinal study of 20 financial coaching participants and 20 controls. Program participants received individual financial coaching to help with credit problems, reporting and collections after they were scam or identity theft victims. Both groups received baseline assessment and 6 month followups (from the time of the end of the coaching). The mean age of the sample was 69 years, with a mean of 15 years of education. Seventy percent of the sample were women and African Americans. Control participants had fewer health conditions and better memory and executive functioning at baseline as compared to coaching participants. While there were no significant health measure changes in the control group, the coaching group demonstrated significantly decreased anxiety at follow up and trends for improved executive functioning and IADLs. Further, while financial stress and social support were significantly lower for the coaching group at baseline, at followup there were no group differences in these measures. The study results provide evidence that the financial coaching program has served as a protective factor in negating many of the adverse outcomes associated with FE and supports financial coaching programs as an appropriate intervention. In addition the coaching services saved or returned monies to nearly 65% of participants.
Are Older Adults Sexually Well: A Comparative Qualitative Study in Portugal and Romania
Authors: Humboldt Sofia von , Niculescu Georgeta , Low Gail , Leal Isabel
Published: December 2020

Objective: This study aims the perspectives of older adults on their sexual well-being. For this purpose, a qualitative research was carried out, which analyzes older adults’ perspectives on indicators of sexual well-being in Portugal and Romania. Methods: Forty seven older participants aged 65 to 91 years, were interviewed. Participants lived in the community. All the interviews went through content analysis. Results: Preliminary results of content analysis generated 5 themes for the Romanian sample: Supportive relationship (k = .92, p < .01); positive financial situation (k = .91, p < .01); good health (k = 94, p < .01); education (k = .88, p < .01); and family support (k = .89, p < .01); and five themes for the Portuguese sample: Supportive relationship (k = .91, p < .01); demonstration of love (k = .91, p < .01); sharing joint activities (k = 92, p < .01); positive attitude and good humor (k = .91, p < .01); and open communication (k = .99, p < .01); Conclusions: This study highlighted the perspectives of Portuguese and Romanian older adults concerning sexual well-being. For both samples, showing a supportive relationship with a partner was the more frequent theme. Keywords: Content analysis; cross-national; older adults; qualitative study; sexual well-being.