bluuebunny/crossref_metadata_2025 huggingface dataset:
THE RELATIONSHIP OF FRAILTY, FEAR OF FALLING, AND DEPRESSION WITH HRQOL IN HIGH-RISK OLDER ADULTS
Authors: McKay Michelle A , Copel Linda , Todd-Magel Catherine
Published: November 2019

One in four older adults fall every year. Falls result in negative outcomes including decreased health-related quality of life (HRQoL). Frailty, fear of falling, depression, and HRQoL are not routinely screened in high-risk community-dwelling older adults. Continued study of modifiable fall risk factors is warranted due to varied reported prevalence rates, inconsistent definitions and the persistent high rate of falls resulting in poor HRQoL. The purpose of the study was to determine the relationship between frailty, fear of falling, and depression with physical and mental functioning and well-being measures of HRQoL in community-dwelling older adults 55 years of age and older. A cross-sectional correlational design and chart review were conducted. The sample consisted of 84 primarily African American (81%) nursing home eligible members of the Program for All-Inclusive Care for the Elderly (PACE) program. Data were analyzed with correlational statistics, multiple linear, and hierarchical regression models. Physical functioning and well-being measures were significantly decreased when compared to the general population. Increased frailty, fear of falling, and depression were associated with decreased physical and mental well-being. In the regression model, frailty and fear of falling were significant predictors of decreased physical functioning and well-being, and depression was a significant predictor of decreased mental functioning and well-being. This study provides clarification of the relationship between frailty, fear of falling, and depression with HRQoL in high-risk older adults. Screening for common modifiable risk factors can assist in the development of targeted interventions and treatments to improve HRQoL in high-risk older adults.
BROODING MODERATES THE RELATIONSHIP BETWEEN CEREBROVASCULAR BURDEN AND VASCULAR DEPRESSION
Authors: Legon Manuel Herrera , Paulson Daniel
Published: November 2019

Objective: The vascular depression hypothesis posits that cerebrovascular burden confers risk for late-life depression. Though neuroanatomical correlates of vascular depression (prefrontal white matter hyperintensities) are well established, little is known about cognitive correlates; the identification of which may suggest therapeutic targets. Aims of this study are to examine the hypothesis that the relationship between cerebrovascular burden and depressive symptoms is moderated by brooding, a type of rumination. Method: A sample of 52 community-dwelling, stroke-free, individuals over the age of 70, without history of severe mental illness or dementia completed the Ruminative Responses Scale, and provided self-report (cardiac disease, hypertension, diabetes, high cholesterol) CVB data. The Geriatric Depression Scale was used to assess depressive symptomatology. Results: Results of a bootstrapped model were that self-reported measures of CVB predicted depressive symptomatology. This relationship was significantly moderated by brooding. Among older adults, those who self-reported high CVB and medium to elevated levels of rumination experienced disproportionately more depressive symptomatology. Conclusions: These findings suggest that brooding rumination may be one correlate of the vascular depression syndrome. Future research should examine neuroanatomical correlates of rumination among older adults, and further explore brooding as a therapeutic target for those with late-life depression.
SMART HOME TECHNOLOGY FOR OLDER ADULTS WITH MOBILITY DISABILITIES: POTENTIAL AND CHALLENGES
Authors: Blocker Kenneth A , Koon Lyndsie M , Kadylak Travis , Ramadhani Widya A , Khaleghi Roshanak , Kovac Christopher , Sreenivas Ramavarapu S , Rogers Wendy A
Published: November 2019

Recently, there has been a significant expansion in the number of smart and connected technologies for assisting individuals with a variety of tasks within the home. Examples include digital home assistants (e.g., Amazon Echo), smart lights, smart plugs, robotic vacuums, as well as a multitude of other devices. Such technologies hold the potential to support independence for older adults with long-term mobility disabilities, as they may experience challenges engaging in daily activities. The aim of the current study was to utilize a comprehensive approach with an interdisciplinary team to improve understanding of how to integrate smart technology into older adults’ homes. We focused on identifying functionality that would be useful to them, understanding their perceptions, and developing instructional support. We conducted interviews among older adults with, and without, long-term mobility disabilities to better understand their attitudes towards digital assistants, identify needs for instructional support, and test the usability of our instructional protocol. The overall goal of this research is to improve understanding of older adults’ perceptions of these technologies and identify usability challenges within the home. The instructional protocol offers support by reducing the identified barriers to initial adoption and continued use to promote aging-in-place and improving overall quality of life for older adults with long-term mobility disabilities.
THE ROLE OF PERCEIVED SOCIAL SUPPORT AND PRUDENT DIET INTAKE ON ALLOSTATIC LOAD AMONG OLDER ADULTS
Authors: D'Amico Danielle , Huang Vivian , Millett Geneva , Fiocco Alexandra J
Published: November 2019

Allostatic load (AL), an index of multisystem physiological dysregulation due to chronic stress, has been identified as a predictor of poor health outcomes in late life. Research suggests that perceived social support (PSS) improves health outcomes by buffering the negative effects of stress on wellbeing and increasing health promoting behaviours including consumption of a healthy prudent diet (i.e., fruits, vegetables, lean meats, nuts, and seeds). Research to date has independently demonstrated that higher PSS and prudent diet intake have an effect on AL. A paucity of research, however, has examined how dietary consumption and PSS interact to effect AL in older adults. The objective of this study was to examine the interaction between PSS and prudent diet pattern on AL in 164 non-demented, community-dwelling older adults (Mage= 68.5(.52), 64% female). PSS and diet intake were measured using the Perceived Social Support Scale and the EPIC-Norfolk Food Frequency Questionnaire, respectively. AL was composed of 16 biomarkers stemming from neuroendocrine, metabolic, inflammatory, and cardiovascular systems, stratified by sex. Controlling for age and usual daily energy intake, higher prudent diet consumption (B=-2.04, p=.001), but not PSS, was associated with lower AL. Moderation analysis revealed that higher prudent diet intake was associated with lower AL only for those with low PSS (B=-.83, p=.0006) and mean level of PSS (B=-.43, p=.02). These findings suggest that chronic biological stress may be mitigated by consuming a healthy diet specifically for older adults with lower social support and may further inform intervention strategies to promote healthy aging.
CHILDHOOD SOCIOECONOMIC STATUS AND SENSE OF CONTROL OVER COGNITIVE AGING: DO GENES MODERATE?
Authors: Reynolds Addam S , Greenfield Emily
Published: November 2019

Individuals who lack a sense of control over cognitive aging (SOC-CA) believe little can be done to optimize their cognitive functioning. While prior research indicates that higher SOC-CA is a protective factor against age-related cognitive decline, few studies have examined predictors of change in SOC-CA. To address this gap, we used data from the Midlife in the United States (MIDUS) study. Guided by prior research on linkages between socioeconomic status (SES) and control beliefs, we examined childhood SES as an early life course influence on changes in SOC-CA. The analytic sample consisted of 663 White participants, ages 34 to 81, who were interviewed in 2004 and approximately nine years later. SOC-CA was measured by using three items from the Personality in Aging Context scale, and childhood SES encompassed retrospective reports of parental education and occupational status. A hierarchical linear model was estimated, which modeled SOC-CA at baseline, as well as change over the study period, controlling for gender, age, ancestry, and adult SES. While childhood SES was not associated with SOC-CA at baseline nor over time, a statistically significant gene-environment interaction was found over the 9-year study period. Specifically, participants who scored high on a polygenetic measure for cognitive ability and reported high childhood SES demonstrated a faster rate of decline in SOC-CA. These findings indicate that inter-individual differences stemming from early life influence people’s SOC-CA as they age. Overall, results suggest the importance of subgroup differences within efforts to engage individuals in preventive measures to optimize healthy brain aging.
INVESTIGATING THE INVERSE RELATIONSHIP BETWEEN SMOKING AND PARKINSON’S: EVIDENCE FROM A MULTIETHNIC COHORT
Authors: Youkhana Fadi , Wu Yanyan , Pirkle Catherine M , Hurwitz Eric , Grandinetti Andrew , Katz Alan , Wilkens Lynne R
Published: November 2019

Parkinson’s disease (PD) is the second most common neurodegenerative disease in the United States with more than 50,000 new cases annually. Studies have reported an inverse relationship between smoking status and the risk for PD. Current smoking status, the number of pack-years smoked, and the lifetime duration of smoking have all been shown to have a lower risk for PD compared to non-smokers. However, studies exploring smoking behaviors in a multiethnic cohort with an ample sample size of PD cases to analyze smoking differences between men and women are rare. Using the Multiethnic Cohort (MEC), our study included 680 self-reported cases of PD from total sample of 98,191 Blacks, Latinos, Japanese, Native Hawaiians, and Whites from Hawaii and Los Angeles surveyed in 2003-2007. Stratified by sex, we conducted a cross-sectional logistic regression analysis to examine the odds of developing PD by various smoking indicators. Overall, current smokers had the lowest risk for PD (OR=0.46, 95%CI 0.27-0.76) compared to non-smokers. The odds of developing PD gradually decreased as the number of years of smoking increased with participants that smoked for 50 years or more having the lowest odds of developing PD (OR= 0.41, 95%CI 0.22-0.78) compared to non-smokers. Using a multiethnic cohort, our analyses further supported the inverse association between PD and smoking status, as well as the number of years of smoking. Future studies are necessary to investigate the possible genetic modulation on the relationship between tobacco and PD.
AGING SEXUAL STEREOTYPES AND SEXUAL EXPRESSION IN MID- AND LATER LIFE: EXAMINING THE STEREOTYPE MATCHING EFFECT
Authors: Syme Maggie , Cohn Tracy
Published: November 2019

Ageist sexual stereotypes are culturally embedded and may prohibit midlife and older adults from achieving sexual wellness when internalized over the life course (i.e., stereotype embodiment), which was examined in the current study. A cross sectional, convenience sample of 972 adults aged 50 and older was recruited online via a crowdsourcing platform. Participants completed an online survey assessing aging sexual stigma and their participation in a spectrum of sexual and intimate behaviors. Two hierarchical linear regressions examined study hypotheses predicting a) sexual and b) intimate behaviors among middle age and older adults, while accounting for several known covariates (e.g., education, relationship status, health). Results suggest that older age (β = -.24, p < .001), being a woman (β = -.29, p < .001), and higher levels of aging sexual stigma (β = -.30, p < 0.001) were associated with less sexual activity (F(19, 945) = 32.51, p < .001, R2 = 0.40). For intimate behaviors, older age (β = -0.14, p < .05) and higher levels of aging sexual stigma (β = -0.24, p < .001) were significantly associated with lower levels of intimate activity (F(19, 945) = 39.80, p < .001, R2 = 0.45). Contrary to expectations, neither gender nor age cohort moderated the effect of aging sexual stigma. Ageist sexual stereotypes appear to affect individual sexual health and wellness via internalized beliefs. Future studies should focus on the potential malleability of aging sexual stigma beliefs, and at what point(s) in the life course they are modifiable.
EXAMINING THE NEEDS OF PEOPLE WITH DEMENTIA AND FAMILY CARERS DIRECTLY AFTER THE DIAGNOSIS
Authors: Velden Claudia van der , Asch Iris van , belzen Elsemieke van
Published: November 2019

Most often the diagnosis dementia gives people clarification, but at the same time it raises questions and causes a range of emotions. According to professionals, support for people with dementia and family carers (dyads) nowadays is mainly focused on later-stage-dementia instead on early-stage. Besides, this support is mostly about practical/medical topics and less about emotional/psychological or social topics. Studies show that it is a complex process dyads to cope with the diagnosis in their daily life directly after diagnosis. The aim of the present study was to examine the specific needs of dyads in order to support them in the early-stages after diagnosis. Focus groups, interviews and a literature-review were performed to determine these needs. Together with professionals, the findings were translated into a conversation guide, which helps professionals to have a structured dialogue on practical/medical, emotional/psychological and social topics to support dyads in an early-stage after diagnosis. An evaluation is conducted by observations and interviews with dyads and a work-session with professionals. People with dementia, their caregiver(s) and professionals experienced these conversations as very positive. Dyads indicated the type of counsellor (accessible, warm and open), timing of the conversation and topics about ‘not making the diagnosis too heavy’ and ‘sharing the diagnosis with others’ as important. The professionals were also very positive about the conversations. Important themes for them were focusing on the more personal, holistic and preventive approach in the conversations.
CHARACTERISING POLYPHARMACY IN THE VERY OLD: FINDINGS FROM THE NEWCASTLE 85+ STUDY
Authors: Davies Laurie , Kingston A , Todd Adam , Hanratty Barbara
Published: November 2019

Polypharmacy is potentially harmful and under-researched amongst the fastest growing section of society, the very old (85+). This study aimed to characterise polypharmacy using data from the Newcastle 85+ Study – a prospective cohort of people living in north east England who turned 85 in 2006 (n=845). The prevalence of polypharmacy was examined using cut-points of 0, 1, 2-4, 5-9 and ≥10 medicines – so-called ‘no polypharmacy’, ‘monotherapy’, ‘minor polypharmacy’, ‘polypharmacy’ and ‘hyperpolypharmacy.’ Crosstabulations and Upset plots identified the most frequently prescribed medicines and medication combinations within these categories, at age 85. Mixed effects models assessed whether gender and socioeconomic position were associated with prescribing changes over time (age 85.5-90.5 years). Polypharmacy (49.6%) was more common than minor polypharmacy (24.6%) and hyperpolypharmacy (16.0%). Within these categories, cardiovascular, non-opioid analgesic and gastrointestinal medications were most frequently prescribed. Medication combinations were many and varied. Aspirin and statins were most commonly co-prescribed amongst people with minor polypharmacy and polypharmacy. Non-opioid analgesics, statins, aspirin and loop diuretics were most common in hyperpolypharmacy. Medications varied by gender and socioeconomic status. Nitrates and oral anticoagulants were more frequently prescribed for men. Bisphosphonates, analgesics and antidepressants were more common in women. Cardiovascular medications, including loop diuretics, were more frequently prescribed for socioeconomically disadvantaged people (25th centile Index of Multiple Deprivation (IMD)), with tricyclic antidepressants and selective beta-2 agonists more common amongst the least disadvantaged (>75th centile IMD). By highlighting prescribing patterns, this study informs our understanding of how polypharmacy may contribute to adverse outcomes in later life.
HEALTH CARE PRIORITIES OF OLDER KOREAN IMMIGRANTS: THROUGH THE LENS OF LIFE COURSE THEORY
Authors: Park Hyeyoung K , Docherty Sharron L , Hendrix Cristina C , Anderson Ruth A , Johnson Kimberly S
Published: November 2019

More than half of Korean Americans living in the US are immigrants, these immigrants hold unique cultural perspectives, including collectivism and filial piety that originates from Korean culture. Every older adult has life experiences and background that build and shape their own wishes and values for their health care goals. Thus, a qualitative descriptive study was conducted using the Life Course Theory as a guiding framework to examine older Korean immigrants’ health care goals and the influence of their life courses. Twenty six interviews from 13 participants were analyzed using content thematic analysis. Study rigor was ensured by audit trail, peer debriefing, and prolonged engagement. Data were organized under five overarching themes: health care priorities, time, location, linked lives, and turning point. Older Korean immigrants valued painlessness and being independent as health care goals (Health care priorities). They experienced a dynamic historical period in Korea before immigrating to the US (Time). Once they reached the US, they were disconnected from their social support and traditional values (Location). Children and Korean churches constitute older Korean immigrants’ primary support system once in the US (Linked lives). Their tumultuous life experiences contributed to their current perspectives on health care goals and priorities (Turning point). In studies of older immigrant populations, it is important to acknowledge individual differences while simultaneously understanding the general life history and cultural background behind individuals’ values and perspectives. Life course approach provides both a contextual understanding of older adults’ backgrounds and the trajectories of their individual life courses.
ASSOCIATIONS BETWEEN SMOKING CONSUMPTION, TOBACCO CESSATION ATTITUDES, AND AGE AMONG LATINO HEALTHCARE PROVIDERS
Authors: Hervera Belén , Irarrázabal Lisette , Ferrer Lilian , Cianelli Rosina
Published: November 2019

Hospitalization is a good opportunity to offer smoking cessation programs to smokers. Healthcare providers′ (HCP) tobacco consumption and cessation attitudes are known to affect the provision of cessation interventions. Lesser known are Latino HCP’s tobacco intervention attitudes. This study aimed to examine the associations between tobacco cessation attitudes (TCA), levels of consumption, and demographics among Latino HCP’s. A quantitative, correlational, cross-sectional design was used. 66 HCP’s working in a public hospital in Santiago, Chile self-reported demographics (age, gender, profession), tobacco consumption, and TCA. TCA’s include questions regarding Acceptability of Brief Counseling (ABC), belief whether smoking is harmful for patients, and duty to aid patients quit smoking. Majority of HCP’s (34 years old, 83% female, 58.5% technical nurses, 38.5% nurses, 3.1% Kinesiologists) did not consume tobacco (67%). Pearson’s correlation revealed that greater HCP age was significantly associated with less belief that smoking is harmful for their patients (r = -.36, p. = .004). ABC (M = 22, SD = 5.5) was positively associated with the belief that smoking is harmful for patients (r = .306, p = .016) and duty to help patients quit smoking (r = .574, p = .000). Findings provide evidence that HCP’s TCA’s are important factors to consider during implementation of a brief counseling for tobacco cessation. Further research should focus on increasing HCP’s acceptability of providing cessation care to their patients. Specifically, tailoring education and interventions by age might serve useful to address the differences in TCA’s which may subsequently influence their tobacco cessation practices.
HOW DOES PARENT-CHILD RELATIONSHIP AFFECT CARE? FOCUSING ON MOTHER-DAUGHTER CAREGIVING
Authors: Baba Ayako
Published: November 2019

OBJECTIVE: Long-term caregiver (child)/care-recipient (parent) relationships have both positive and negative effects on care. However, the mechanism of that impact is unclear. This study aimed to explore how parent–child relationships affect care and which aspects cause those effects. METHOD: Five hundred thirty-four adult children who were caring for or had cared for their parents at home completed the scales of parent–child psychological independence, the acceptance of care, care attitude, and care burden. Data were analyzed using a pass analysis with multiple group structural equation modeling to identify the relationship between parent–child psychological independence, acceptance of care, care attitude, and care burden, and the care dyad difference of the models. RESULT: 1) “Reliable relationship with parent” in parent–child psychological independence affected “resignation” and “understanding actively” in acceptance of care. 2) “Psychological individuation from the parent” in parent–child independence affected all subscales of care attitudes. 3) “Resistance” and “understanding actively” in acceptance of care and “auto-pilot” in care attitude affected care burden. 4) In mother–daughter caregiving, “resistance” and “resignation” had stronger effects on “auto-pilot” whereas “utilization of resource” and “flexible response” in care attitude and “resistance” had weaker effects on care burden. CONCLUSION: The relationship between long-term parent–child relationship and care were revealed. In some points, daughters who were caring for or had cared for their mothers had a different model from other care dyads. These results suggest that child caregivers should be supported mentally in accordance to their difficult points and dyads.
URINARY MARKERS OF OXIDATIVE STRESS CORRESPOND TO INFECTION AND AGING IN WILD CHIMPANZEES
Authors: Thompson Nicole A , Otali Emily , Machanda Zarin , Muller Martin , Wrangham Richard , Emery-Thompson Melissa
Published: November 2019

Oxidative stress (OS) plays a central role in aging and results from a variety of stressors, making it a powerful measure of health and a way to examine phylogenetic variation in life history. However, few urinary OS markers have been examined under field conditions, particularly in primates, and their utility to non-invasively monitor acute vs. chronic conditions is poorly understood. In this study, we examined variation in 5 urinary markers of oxidative damage and protection under 5 validation paradigms in 37 wild, adult chimpanzees living in the Kibale National Park, Uganda. We used 925 urine samples to conduct both cross-sectional and within-individual analyses of responses to acute infection and variation with age. Markers of damage (8-OHdG, F-isoprostanes, MDA-TBARS, and neopterin) and total antioxidant capacity were generally positively correlated with one another. Within individuals, all markers responded to at least one if not both types of acute infection. Markers of damage also varied with age, particularly in individuals near death. Unlike in human and rodent tissues, DNA damage in urine decreased with age, both across and within individuals near death, suggesting a potential decline in DNA repair and/or metabolic rate during senescence. Our results suggest that OS can be measured using field-collected urine and may be useful for both short- and long-term indicators of health. Our results further confirm that using multiple markers and longitudinal sampling within individuals is the most productive approach for studies that seek to determine the role of OS in health and lifespan in long-lived organisms.
POLICY MODIFICATION, CLINICIAN TRAINING, AND ENROLLMENT OF COMMUNITY-DWELLING OLDER ADULTS TO ADOPT A MODEL OF CARE
Authors: Spoelstra Sandra L
Published: November 2019

Partnering with a Medicaid Home and Community Based waiver, we tests implementation strategies on adoption and sustainability of a model of care to support aging-in-place, intervening on individual capabilities and the home environment. Knowledge-to-Action model underpins the 2-arm (usual care + internal facilitation versus additive external facilitation) 3-year randomized (sites) trial statewide using an implementation strategy bundle (relationship/coalition/team building; education; interdisciplinary care/coordination; facilitation; and audit/feedback). Consolidated Framework for Implementation Research guides examining characteristics (site/RN-OT-SW/beneficiary), clinician attitude/self-efficacy, leadership/readiness to implement, and policy on adoption and sustainability; and intervention impact on beneficiary outcomes. Linear models will be used to analyze fidelity, Poisson and bootstrapping gage adoption, sustainability, fidelity, and level of facilitation. Champions (internal facilitators/supervisors; N=57) were engaged and 33.3% (n=19) completed online training (1.5 hours; 7.0 [SD 2.3] understood role; 6.8 [SD 1.8] would use training: 1-10 [lo-hi]); 100% (N=19) attended monthly coalition-building meetings. RN-OT-SWs were recruited (mail); 608 of 685 (88.8%) consented and completed online education (5.5 hours; Certified). Policymakers included quality incentives in contracts (10/1/2019) with sites for >95% certified RN-OT-SWs. Beneficiaries (N=12,000) were recruited (mail); 5% (n=608) did not participate (16.1% [n=98] poor cognition; 11.5% [n=70] nursing home/assisted living; 7.1% [n=43] no needs; 5.9% [n=36] too sick; 5.2% [n=32] many caregivers; 5.1% [n=31] inability to improve]; no English/hospitalized/other). Stages of Implementation Completion and fidelity data (September/October) will be reported. Adoption of models of care to support aging-in-place in Medicaid settings are a challenge, and this research harnesses a network (university/policymaker/supervisors/waiver sites-clinicians/beneficiaries) to improve care for vulnerable older adults.
30-DAY READMISSION IN PATIENTS WITH CARDIOVASCULAR DISEASE: DO PATIENTS KNOW THEIR RISK BEFORE DISCHARGE?
Authors: Xu Hanzhang , Farmer Heather R , Granger Bradi , Dupre Matthew
Published: November 2019

Cardiovascular disease (CVD) is the leading cause of disability and death in the United States, and older adults with CVD are at a high risk of readmission after discharge. This study examined whether patients’ perceived risk of readmission at discharge was associated with actual 30-day readmissions in patients with CVD. A standardized survey and electronic health records (EHR) were used to collect sociodemographic, psychosocial, behavioral, and clinical data on patients admitted to the Duke Heart Center (n=730). Prior to discharge, patients were asked their perceived likelihood of returning to the hospital for an unplanned/emergency visit within 30-days. Logistic regression models were used to examine all-cause 30-day readmission among patients who perceived low versus high readmission risk. Nearly 1-in-3 patients (31.4%) perceived high-risk of readmission at the time of discharge. Life stressors, poor self-rated health, and ADL limitations were associated with perceptions of high-risk. Patients who perceived high-risk had significantly higher subsequent readmissions compared with low-risk (23.3% vs. 15.6% p=0.016). Among patients who perceived low-risk of readmission, those who were widowed, had inadequate health literacy, and reported difficulty accessing care exhibited a higher likelihood of being readmitted. In those perceiving a high-risk, nonwhites and those with poor self-rated health, difficulty accessing care, and prior hospitalizations in the past year were significantly more likely to be readmitted. These findings have important implications for identifying CVD patients at high risk of readmission within 30 days after discharge, particularly older adults who may lack adequate resources (e.g., social support, literacy, access to care).
HEALTHY AGEING FOR ALL? SOCIOECONOMIC CHANGES OVER TIME IN DISABILITY-FREE AND INDEPENDENT LIFE EXPECTANCIES
Authors: Bennett Holly Q , Matthews Fiona E , Robinson Louise , Corner Lynne , Kingston A , Jagger Carol
Published: November 2019

Background: Previous research using cross-sectional data shows widening inequalities in disability-free life expectancy (DFLE) by socioeconomic status (SES) in the UK. We aimed to understand the underlying transitions of DFLE and years dependency free (DepFLE) using longitudinal data from the Cognitive Function and Ageing Studies (CFAS I and CFAS II). Methods: Two large population based studies of those aged 65+ in three centres (Newcastle, Nottingham, Cambridgeshire) interviewed at baseline in 1991 (CFAS I) and 2011 (CFAS II) with follow up two years later. Disability was measured using difficulty in activities of daily living (ADL), and dependency by time between help required for ADLs. SES was based on area deprivation categorised into study specific tertiles. Transitions between disability or dependency states and death were modelled using Interpolated Markov Chain software. Results: Between 1991 and 2011, DFLE and disabled life expectancy (DLE) at age 65 increased for men in every SES group, with men being less likely to become disabled or die, and more likely to recover, in 2011 than 1991 across SES groups. For the most disadvantaged women, DFLE was similar, and DLE increased, whilst for the remaining women DFLE increased and DLE was similar. For women probability of recovery increased and probability of death from disability decreased but probability of becoming disabled decreased only for the most advantaged. DepFLE patterns across time were similar but more pronounced. Conclusion: Preventive measures should focus on reducing the disability and dependency onset in the most disadvantaged to ensure inequalities do not widen further.
DEATH ANXIETY AND FINANCIAL DECISION-MAKING IN AGING: A STUDY FROM THE HUMAN CONNECTOME PROJECT AGING (HCP-A)
Authors: Ly Timothy K , Diaz-Santos Mirella , Campbell Liam , Caldera Marcela , Kuhn Taylor , Bookheimer Susan
Published: November 2019

While research addressing late-life death anxiety (the fear of death or the dying process) has focused on end-of-life care decision-making, few have studied the effect of late-life death anxiety on financial decision-making. This is particularly relevant to financial decision-making as older adults are more vulnerable to fraud and deception. The aim of this study was to determine how age and death anxiety affect financial decision-making in a sample of older adults of 60-93 years of age (N = 102), who participated in the HCP-A project at UCLA. To study this relationship, we used a delayed reward discounting task to model financial decision-making, where higher rates of discounting indicate a greater preference for immediate, smaller monetary rewards and lower rates of discounting indicate more future-oriented planning. To account for age-related cognitive decline, cognitive functioning was assessed using the NIH Toolbox. We hypothesized that the presence of death anxiety will increase discounting of future rewards in older adults. Results from a univariate ANOVA showed an interaction between age, death anxiety, and delayed reward discounting. Specifically, older adults with self-reported death anxiety showed greater preference for immediate, smaller monetary rewards. By controlling for cognition, these findings suggest that death anxiety moderates decision-making in late-life adults and may add to our understanding of why older adults are more susceptible to financial abuse. These results suggest a need to consider death anxiety as a moderating variable when developing and implementing policies and services that are geared towards older adults.
THE EFFECTS OF SOCIAL NETWORK ON RESILIENCE OF COMMUNITY-DWELLING OLDER ADULTS LIVING ALONE
Authors: Park Sangmi , Kim Tae Hui , Choi Soyeon , Lee Kyuwon , Jung Jisoo , Hong Myounghee
Published: November 2019

Resilience is one of the components for successful aging and is related to wellbeing in late life. Studies have shown that older people living alone have low resilience. However, most of these studies were mainly conducted on unhealthy participants. The aim of this study is to examine the factors that contribute to resilience of healthy older adults living alone. Older people living alone who are not subject to public health care service provided to the economically or physically challenged or depressed people were recruited. Data collected from 295 participants were used to conduct hierarchical multiple regression analyses, controlling demographic characteristics, level of cognitive and physical functions, and emotional status. A self-reported questionnaire, UCLA Loneliness Scale, Lubben Social Network Scale(LSNS), and Multidimensional Individual and Interpersonal Resilience Measure(MIIRM) were used to measure study variables. A hierarchical model accounted for 48.8% of the variance in resilience. In model 1(demographics), the religion(β=.178, p<.001) and the perceived economic status(β=-.176, p<.001) variables were significantly related to resilience. The subjective health(β=-.109, p=.038) in model 2(level of function) and the loneliness(β=-.379, p<.001) in model 3(emotional status) had a significant effect on resilience. In model 4, the size(β=-.115, p=.029) and the frequency(β=.160, p=.003) of social networks significantly predicted resilience. The results showed that protecting older adults’ social networks could lead to promote their health and wellbeing. What can be inferred from this finding is that even though the members are small, the social network they often have contact with is important for the resilience of older adults living alone.
HEAVY ALCOHOL CONSUMPTION IN MIDLIFE IS ASSOCIATED WITH ACCELERATED BRAIN AGING SIX YEARS LATER
Authors: Slayday Riki E , Franz Carol E , Hatton Sean N , McEvoy Linda K , Lyons Michael J , Kremen William S
Published: November 2019

Excessive alcohol consumption is associated with cognitive decline, exacerbated brain atrophy, and dementia in older adults, but associations with midlife brain health are less well understood. We hypothesized that heavy drinkers would have older-looking brains in late midlife. We examined alcohol consumption at mean age 56 (range 51-59) in 364 men from the Vietnam Era Twin Study of Aging (VETSA) and their predicted brain age at mean age 62 (range 56-67). We created five midlife alcohol consumption groups based on drinks consumed over the past two weeks: never, former, light (1-14), moderate (15-28), and heavy (>28). Participants underwent structural magnetic resonance imaging at mean age 62. Predicted brain age was measured using the Brain-Age Regression Analysis and Computation Utility software (BARACUS). Models adjusted for age, scanner, race/ethnicity, SES, smoking, health, depressive symptoms, alcohol dependence, general cognitive ability at age 20, and non-independence of twins within pairs. Heavy drinkers had a significantly older predicted than chronological brain age (M= 5.93, SE= 0.88) compared to each of the other four groups (p’s < 0.05). There were no significant differences among the never (M= 2.88, SE= 0.98), former (M= 2.76, SE= 0.74), light (M= 3.00, SE= 0.94), or moderate (M= 5.93, SE= 0.88) consumption groups. Heavy alcohol consumption at age 56 was associated with an approximately 3-year greater predicted brain age difference at age 62. There was no evidence of protective effects of light/moderate drinking over non-drinking. The neurotoxic effects of excessive alcohol may exacerbate brain aging in late midlife.
LIVING-APART-TOGETHER RELATIONSHIPS: EXPLORING OLDER ADULT BLACK WOMEN’S PERSPECTIVES ON CAREGIVING EXCHANGES
Authors: Hicks Nytasia
Published: November 2019

Recent research suggests that the preference for living-apart-together (LAT) relationships, where individuals are committed to one another but reside in separate households, has increased among older adults. However, older adult LAT couples prefer not to exchange care to maintain autonomy. In this study, we examine future expectations of spousal caregiving exchanges among older adult black women in LAT relationships. Eleven black women ages 60-74 (married and unmarried) completed two semi-structured phone interviews about future spousal caregiving expectations as to receiving and providing emotional, financial, and physical support. Regarding providing spousal care, findings from this qualitative descriptive study suggest that participants were consistent in their intent to provide emotional support, yet divided in visualizing themselves providing both financial and physical support for a spouse. As to receiving care from a spouse, participants envisioned their spouses providing emotional support, but responses were inconsistent on the expectation of spouses providing financial and physical support. Participants anticipate receiving emotional and physical support from their adult children and/or close family members instead of spouses. Autonomy, level of commitment, and the exchange of health information were also identified as core concepts. This study has implications for applications to different intimate relationships regarding living arrangements, to professionals supporting caregiving families, and to further studies of family gerontology.
LOSS, SLEEP, AND HEART RATE VARIABILITY: GENDER DIFFERENCES
Authors: Chai Hye Won , Jester Dylan J , Lee Soomi , Joo Susanna
Published: November 2019

Death of a significant other is consistently found to have a detrimental effect on cardiovascular functioning, and such relationship may be stronger when loss is accompanied by low-quality sleep. Using data from the Biomarker project of Midlife in the United States study (n=1,310), we examined whether quality-of-sleep has an additive effect on the relationship between loss and heart rate variability (HRV). Loss was measured as losing someone close within a year of data collection, and was categorized based on the respondents’ relationship with the deceased. Relationship was categorized as: immediate family, relative, and friend. Quality-of-sleep was measured using the Pittsburgh Sleep Quality scale. Results showed that the associations among loss, sleep, and HRV differed by gender. For women, losing an immediate family was associated with worse HRV and this did not differ by quality-of-sleep. For men, death of an immediate family was associated with worse HRV only among those with poorer quality sleep. These results suggest that low-quality sleep may indicate psychophysical vulnerability for men who experienced loss, which may relate to their lower capacity for physiological adaptation.
USE OF A HOME SYMPTOM MANAGEMENT ZONE TOOL IN GERIATRIC PATIENTS UNDERGOING CANCER TREATMENT
Authors: Baker Mary F , Shockey Debra
Published: November 2019

Adult oncology practices are caring for a growing number of older adults with cancer. Evidence suggests that patients with cancer have higher emergency department (ED) utilization, particularly in patients 65 years of age and older and in those whose symptoms are poorly controlled. The ED is not the most appropriate nor most cost-effective option for addressing urgent care needs of patients undergoing cancer treatment. This quality improvement project is being conducted in a community medical oncology practice during usual cancer treatment education. Older adult patients starting or changing cancer treatment are presented with a zone tool (green-yellow-red) to inform decision-making at home regarding level of severity of current symptoms and recommended actions (e.g., you are stable, you need to call the office, you need to go immediately to the ED). The tool has been distributed to 28 patients with a goal of at least 30 by 9/20/19. Outcome measures include the number of ED visits in the intervention group compared to a pre-intervention sample of older adults from the same medical oncology office. Other outcome measures are acceptability of zone tool among clinical staff and patients. Preliminary data suggest suggest acceptability among staff and patients; and ease of use among clinical staff. Tracking of visits to the ED in the sample population and surveys of patients and staff are ongoing through October 2019.
VALIDATION OF A BRIEF SCREEN TO IDENTIFY PERSONS WITH DEMENTIA AT RISK FOR BEHAVIORAL DISTURBANCE
Authors: Evans Tracy L , Amspoker Amber , Kunik Mark E , Shrestha Srijana
Published: November 2019

Per current guidelines, clinical assessment of persons with dementia (PWD) should include potential causes of behavioral and psychiatric problems including pain, depression, and caregiver-patient relationship quality. Many validated assessment tools are available; however, administering a battery of instruments is not practical in most clinical settings. Objectives of this secondary analysis are to 1) evaluate the construct validity of brief screens (1-3 questions each) for pain, depression, and relationship strain by examining their associations with validated measures (Geriatric Depression Scale, Modified Philadelphia Pain Scale, Zarit Burden Interview, Mutuality Scale) and medication use and 2) evaluate the predictive validity of each individual screen and the screens as a set (number positive) by examining their associations with frequency of disruptive behaviors on the Revised Memory and Behavior Problem Checklist. PWDs (n=228) were included in the original trial if the PWD or the caregiver endorsed one or more of the three screens. There was evidence of good convergent and discriminate validity for each individual screen (p’s < 0.01). Although only the relationship screen was individually associated with frequency of disruptive behaviors (p < 0.00010), the total number of screens endorsed was positively associated with this frequency (F (2,225) = 5.50, p = 0.005). In this sample, the brief screening questions showed good construct and predictive validity. Further studies are needed to determine if they can be used to identify patients with depression, pain, and/or caregiver-patient relationship problems in the clinical setting.
AGE, SEX, AND FRAILTY INFLUENCE AGE-DEPENDENT CHANGES IN VENTRICULAR STRUCTURE AND FUNCTION IN C57BL/6 MICE
Authors: Howlett Susan E , Kane Alice , Bisset Elise , Keller Kaitlyn
Published: November 2019

The heart undergoes maladaptive changes during aging that set the stage for cardiovascular diseases, but frail older individuals are most likely to develop such diseases. We investigated the impact of frailty on left ventricular (LV) remodeling in male and female mice (aged 9-23 mos). Ventricular function/structure and frailty were assessed with echocardiography (Vevo 2100) and a frailty index (FI) tool. Fractional shortening (systolic function) increased with age (9 vs 23 mos) in males (27.7±2.6 vs 38.4±1.6%; p<0.05) and females (26.9±1.4 vs 32.5±1.8%; p<0.05); similar results were seen with ejection fraction. Conversely, E/A ratios (diastolic function) declined with age in males (1.9±0.1 vs 1.3±0.1; p<0.05) and females (2.1±0.3 vs 1.6±0.1; p<0.05). LV mass and LV internal diameter (diastole) increased with age in females but not in males, while intraventricular septum (diastole) increased in males only. As age-dependent changes were heterogeneous, we stratified the data by FI scores. Interestingly, fractional shortening (r=0.52; p=0.006) and ejection fraction (r=0.52; p<0.0001) were graded by FI score, but only in males. By contrast, LV mass was graded by frailty, but only in females (r=0.55; p<0.0001). Thus, diastolic function declines with age in both sexes while systolic function actually increases. Aging females display increased LV mass and LV dilation whereas older males exhibit septal thickening. These maladaptive changes are graded by frailty, suggesting that cardiac aging is prominent in those with poor overall health. Age, sex and frailty influence cardiac aging, which may predispose frail older men and women to develop different cardiovascular diseases as they age.
EFFECTS OF SOCIAL SUPPORT NETWORK ON AMERICAN OLDER ADULTS’ MEMORY FUNCTIONS
Authors: Cheung Ethan Siu Leung , Ding Kedong
Published: November 2019

Background: Previous studies have found older adults’ cognitive functions are strongly associated with their social networks, including memory. Yet, few studies have explored the influences of specific social network members, such as siblings and children. Further, little studies examined the impact of the size of older adults’ social networks. Hence, this study aimed to investigate how older adults’ relationships with their spouses, siblings, and children, as well as the size of their social networks, affect American older adults’ memory functions. Methods: Using the 2018 data from NHATS, 5547 samples were included. We adopted a multiple logistic regression model to test the impact of social support network sizes, and how associations of social support networks varied between spouses, siblings, and children. All models were calibrated for age, gender, education, income, and race/ethnicity. Results: Analysis showed that higher socioeconomic status (more education and without Medicaid), being female, and younger age were associated with increased odds of having good self-rated memory functions. Older adults with larger social support networks (>=3 individuals) were more likely to have better self-rated memory function (adjusted odds ratio, 1.182, p<0.05), while holding other variables. Having a spouse also increased odds of higher self-rating memory function, in contrast to having children. Conclusion: This study highlighted the importance of having a larger social network size for older adult’s memory function and indicated the necessity of developing intervention programs to expand older adults' social network size, especially for those with lower socioeconomic status.
ALCOHOL USE SCREENING AND INTEGRATED BEHAVIORAL HEALTH IN GERIATRIC PRIMARY CARE IN THE DEEP SOUTH
Authors: Lanai Bailey , Dragan Deanna , Allen Rebecca S , Halli-Tierney Anne , Carroll Dana , Albright Amy
Published: November 2019

This longitudinal behavioral health surveillance and integrated care project aims to assess physical and mental health and substance use in a geriatric primary care setting. Approximately 230 patients (mean age = 76; 74% female; 16% African American) attending an interdisciplinary geriatrics clinic in Alabama have taken part in baseline behavioral health screenings since 2014. Behavioral health measures include cognitive status, self-reported mood, subjective and objective health literacy, and alcohol use. All measures are administered by clinical psychology graduate students. Patients had an average of 5.83 medical diagnoses. Only 26.2% of patients had scores indicating cognitive functioning within normal limits; 32.6% had scores indicative of mild neurocognitive disorder, and 41.2% had scores indicative of dementia. Over 80% of patients had adequate self-reported health literacy; however, measurements of objective health literacy indicated a significant number of individuals have difficulty following medical directions independently. Over 30% of patients reported clinically significant levels of depression or anxiety, and 16.5% of patients reported at least one indicator of hazardous alcohol use. Specifically, 50.7% of patients consume alcohol on at least a yearly basis with 38.2% endorsing at least one problematic drinking behavior and 11.6% scoring in the clinically significant range for alcohol misuse. Moreover, 22.7% report use of opioid pain medication. The results of this study demonstrate that routine hazardous alcohol use screening as one component of integrated behavioral health care within geriatric primary care increases detection of hazardous alcohol use among older adults.