bluuebunny/crossref_metadata_2025 huggingface dataset:
Are there really games in Utopia? A reinterpretation of Suits’s The Grasshopper
Authors: Erspamer Melanie , Ridge Michael
Published: December 2020

In this essay we argue that there is a contradiction lurking at the heart of Bernard Suits's seminal book on the philosophy of games, The Grasshopper, which has oddly gone unnoticed for 43 years. Suits argues that games need inefficiency and defines inefficiency such that it wouldn't exist in Utopia. This trivially entails that there could be no games in Utopia, yet the whole normative point of The Grasshopper is that games would be the only worthwhileactivity in Utopia. We then diagnose Suits's error and suggest some ways forward.
The effects of assisted reproduction technologies on metabolic health and disease†
Authors: Heber Maria Florencia , Ptak Grażyna Ewa
Published: December 2020

The increasing prevalence of metabolic diseases places a substantial burden on human health throughout the world. It is believed that predisposition to metabolic disease starts early in life, a period of great susceptibility to epigenetic reprogramming due to environmental insults. Assisted reproductive technologies (ART), i.e., treatments for infertility, may affect embryo development, resulting in multiple adverse health outcomes in postnatal life. The most frequently observed alteration in ART pregnancies is impaired placental nutrient transfer. Moreover, consequent intrauterine growth restriction and low birth weight followed by catch-up growth can all predict future obesity, insulin resistance, and chronic metabolic diseases. In this review, we have focused on evidence of adverse metabolic alterations associated with ART, which can contribute to the development of chronic adult-onset diseases, such as metabolic syndrome, type 2 diabetes, and cardiovascular disease. Due to high phenotypic plasticity, ART pregnancies can produce both offspring with adverse health outcomes, as well as healthy individuals. We further discuss the sex-specific and age-dependent metabolic alterations reflected in ART offspring, and how the degree of interference of a given ART procedure (from mild to more severe manipulation of the egg) affects the occurrence and degree of offspring alterations. Over the last few years, studies have reported signs of cardiometabolic alterations in ART offspring that are detectable at a young age but that do not appear to constitute a high risk of disease and morbidity per se. These abnormal phenotypes could be early indicators of the development of chronic diseases, including metabolic syndrome, in adulthood. The early detection of metabolic alterations could contribute to preventing the onset of disease in adulthood. Such early interventions may counteract the risk factors and improve the long-term health of the individual.
Household Debt and Monetary Policy: Revealing the Cash-Flow Channel
Authors: Flodén Martin , Kilström Matilda , Sigurdsson Jósef , Vestman Roine
Published: December 2020

We examine the effect of monetary policy on household spending when households are indebted and interest rates on outstanding loans are linked to short-term interest rates. Using administrative data on balance sheets and consumption expenditure of Swedish households, we reveal the cash-flow transmission channel of monetary policy. On average, indebted households reduce consumption spending by an additional 0.23–0.55 percentage points in response to a one-percentage-point increase in the policy rate, relative to a household with no debt. We show that these responses are driven by households that have some or a large share of their debt in contracts where interest rates vary with short-term interest rates, such as adjustable-rate mortgages (ARMs), which implies that monetary policy shocks are quickly passed through to interest expenses.
A novel phytase from Citrobacter
gillenii: characterization and expression in Pichia pastoris (Komagataella pastoris)
Authors: Tkachenko Artur A , Kalinina Anna N , Borshchevskaya Larisa N , Sineoky Sergey P , Gordeeva Tatiana L
Published: December 2020

The phyCg gene encoding a new phytase from Citrobacter gillenii was optimized, synthesized, cloned and expressed in Pichia pastoris. Analysis of the amino acid sequence of the enzyme showed that it belongs to the histidine acid phosphatase family. The amino acid sequence of the PhyCg phytase has the highest homology (73.49%) with a phytase sequence from Citrobacter braakii. The main characteristics for the purified recombinant phytase were established. The optimum pH and temperature were 4.5 and 50°C, respectively. The specific activity of the enzyme was 1577 U/mg. The Michaelis constant (Km) and the maximum reaction rate (Vmax) for sodium phytate were 0.185 mM and 2185 U/mg, respectively. The enzyme showed the pH and trypsin stability and had a high activity over a wide pH range.
Got mutants? How advances in chlamydial genetics have furthered the study of effector proteins
Authors: Andersen Shelby E , Bulman Lanci M , Steiert Brianna , Faris Robert , Weber Mary M
Published: December 2020

Chlamydia trachomatis is the leading cause of infectious blindness and a sexually transmitted infection. All chlamydiae are obligate intracellular bacteria that replicate within a membrane-bound vacuole termed the inclusion. From the confines of the inclusion, the bacteria must interact with many host organelles to acquire key nutrients necessary for replication, all while promoting host cell viability and subverting host defense mechanisms. To achieve these feats, C. trachomatis delivers an arsenal of virulence factors into the eukaryotic cell via a type 3 secretion system (T3SS) that facilitates invasion, manipulation of host vesicular trafficking, subversion of host defense mechanisms and promotes bacteria egress at the conclusion of the developmental cycle. A subset of these proteins intercalate into the inclusion and are thus referred to as inclusion membrane proteins. Whereas others, referred to as conventional T3SS effectors, are released into the host cell where they localize to various eukaryotic organelles or remain in the cytosol. Here, we discuss the functions of T3SS effector proteins with a focus on how advances in chlamydial genetics have facilitated the identification and molecular characterization of these important factors.
Induction of the reactive chlorine-responsive transcription factor RclR in Escherichia coli following ingestion by neutrophils
Authors: Königstorfer Andreas , Ashby Louisa V , Bollar Gretchen E , Billiot Caitlin E , Gray Michael J , Jakob Ursula , Hampton Mark B , Winterbourn Christine C
Published: December 2020

Neutrophils generate hypochlorous acid (HOCl) and related reactive chlorine species as part of their defence against invading microorganisms. In isolation, bacteria respond to reactive chlorine species by upregulating responses that provide defence against oxidative challenge. Key questions are whether these responses are induced when bacteria are phagocytosed by neutrophils, and whether this provides them with a survival advantage. We investigated RclR, a transcriptional activator of the rclABC operon in Escherichia coli that has been shown to be specifically activated by reactive chlorine species. We first measured induction by individual reactive chlorine species, and showed that HOCl itself activates the response, as do chloramines (products of HOCl reacting with amines) provided they are cell permeable. Strong RclR activation was seen in E. coli following phagocytosis by neutrophils, beginning within 5 min and persisting for 40 min. RclR activation was suppressed by inhibitors of NOX2 and myeloperoxidase, providing strong evidence that it was due to HOCl production in the phagosome. RclR activation demonstrates that HOCl, or a derived chloramine, enters phagocytosed bacteria in sufficient amount to induce this response. Although RclR was induced in wild-type bacteria following phagocytosis, we detected no greater sensitivity to neutrophil killing of mutants lacking genes in the rclABC operon.
Sense of Community and Quality of Life for Older Adults In Puerto Rico 2 Years After Hurricane Maria
Authors: Buckley Tommy , Burnette Denise , Fabelo Humberto , Yabar Mauricio
Published: December 2020

Psychological sense of community plays an important role in the wellbeing of older adults, especially in cultures that revolve around community involvement and support. In 2017, Hurricane Maria devastated Puerto Rico, deeply altering community structure and social life. This study draws on the Ecological Theory of Aging to test the proposition that older adults’ sense of community is associated with self-assessed quality of life two years later. We conducted face-to-face interviews with a non-probability sample of 154 community-dwelling adults aged 60+ in Puerto Rico. We measured sense of community with the Brief Sense of Community Scale (BSCS) (range 0-32, mean= 24.75, SD= 6.04) and quality of life (QOL) with the EUROHIS-QOL 8-item index (range 0-32, mean= 21.61, SD=5.92). We used multiple linear regression to test the association of sense of community and quality of life while controlling for relevant covariates. Higher levels of sense of community were associated with better quality of life (β=0.270, p<0.001), while increased mental health symptoms (β=-0.557, p<0.001) and poor self-rated health (β=2.964, SE=7.17, p<0.001) were associated with lower quality of life. Findings indicate that sense of community is an important contributor to older adult’s quality of life in Puerto Rico, perhaps in part due to cultural and age-related factors. Moreover, sense of community may serve as a protective factor against adverse outcomes after large scale natural disasters. Researchers should continue to examine this association while advocating for and developing policies and programs that promote older adults' sense of community in post-disaster contexts.
They Do Their Best, but Their Best Isn’t Good Enough: How Social Housing Can Support Older Tenants Aging in Place
Authors: Sheppard Christine , Austen Andrea , Hitzig Sander
Published: December 2020

Toronto Community Housing (TCH) is the second largest social housing landlord in North America, and is home to over 27,000 older adults, half of whom live in 83 “seniors-designated” buildings. There is inadequate and inconsistent delivery of services in these buildings, negatively impacting tenants’ ability to age in place. We conducted two half-day consultations with service providers (n=74) and tenants (n=100) to identify strategies to improve unit condition, promote stable tenancies (i.e., prevent evictions) and enhance access to health and support services for older adults living in TCH. Through facilitated discussion, participants identified their top two recommendations for each priority area and reflected on the strategies that were hardest and easiest to implement, as well as the ones that would have the most and least impact on quality of life for older tenants. Participants recognized the need for more education as a way to empower older tenants and reduce stigma associated with unit condition issues (e.g., pest problems) and arrears. More frequent touch points with tenants was also recommended as a way to identify older adults at-risk of eviction and work proactively (instead of reactively) to support them. Service providers and tenants believed that system navigators working directly in the buildings would be a key facilitator to building trust and helping older tenants access needed services. Outcomes of the have several program and policy implications for TCH, as they partner with the City of Toronto to design a new integrated service model for the seniors-designated buildings.
Change Over Time in Linguistic Acculturation: A Comparison Between Cuban and Non-Cuban Hispanic Immigrants
Authors: Chiriboga David , Park Nan Sook , Jang Yuri , Molinari Victor
Published: December 2020

While acculturation and its implications for mental health have received extensive attention in studies with older immigrant populations, change over time in acculturation less so. This paper examines change over a two-year period in levels of linguistic acculturation among Cuban (n = 186) and non-Cuban Hispanic (n = 116) immigrants living in Florida. Data came from the waves of the Survey of Older Floridian (SOF), conducted using a statewide sampling frame based on population densities, with a computer-assisted telephone interview strategy. Calls were initiated through random digit dialing, and a follow-up interview was added approximately two years later. Measures included six acculturation items, one dealing with the participant’s language preference for the interview itself and five items dealing with language ability and usage. Results indicated that non-Cuban Hispanics were significantly more acculturated than Cuban Hispanics, and that at least 75% of Wave 2 acculturation was accounted for by Wave 1 status. After controlling for initial levels of acculturation, those who at first interview reported more economic problems and those reporting fewer depressive symptoms were more acculturated at follow-up. It was concluded that while linguistic acculturation is relatively stable, interventions to increase acculturation have implications for mental health service utilization.
Depressive Symptoms in Older African Immigrants: A Descriptive Study
Authors: Nkimbeng Manka , Baker Zachary , Taylor Janiece , Szanton Sarah , Shippee Tetyana , Gaugler Joseph
Published: December 2020

In FY 2018-2019, the National Institutes of Health devoted $2,387,505,711 to projects studying depression. Before and following their arrival into the United States stressful life circumstances may render African immigrants particularly at risk for depression. The objective of this study is to provide an estimate and identify correlates of depressive symptoms in older (≥50 years) African immigrants. We performed secondary data analyses of the Older African Immigrant Health study (n = 148). Bivariate analyses evaluated associations between depressive symptoms and sociodemographic and immigration-related factors. Depressive symptoms were measured with the PHQ-8 scale and scores of ≥ 5 were considered indicative of depressive symptoms. The mean age of participants was 62 years (SD:8.2), 61% were female, 30% had less than high school education, and 58% reported having health insurance coverage. Thirty percent of the sample had depressive symptoms (PHQ-8 score of ≥ 5) but only one individual would be classified as having moderately severe or severe depression (PHQ-8 ≥15). Depressive symptoms did not differ by age, marital status, education, or income. There was a statistically significant difference in depressive symptoms by reason for migration, recruitment location, and employment status. Although only one participant would be classified as severely depressive, a large proportion of this sample had depressive symptoms. Mental health concerns were reported as a significant health problem for African immigrants visiting a community service organization in New York. More research is needed to examine the prevalence, immigration-related correlates, predictors, and health ramifications of depression in older African immigrants.
Multidimensional Profiles of Religiosity: Do They Matter for Gen-Xers’ Psychological and Familial Well-Being?
Authors: Cheng Kent Jason , Hwang Woosang , Kim Jeung Hyun , Silverstein Merril , Brown Maria
Published: December 2020

Although researchers have suggested that religiosity is a multidimensional construct, less is known about the long-term effects of religiosity profiles on Generation X (born between 1965 and 1980) adults’ psychological and familial wellbeing over the life courses. Thus, the goal of this study is (1) to identify unobserved profiles of young-adult Gen-Xers’ religiosity based on religious attendance, religious intensity, spirituality, and religious ideology, (2) to investigate demographic factors that predict membership in these religiosity latent classes, and (3) to examine how these profiles of religiosity predict Gen-Xers’ psychological wellbeing (self-esteem, life satisfaction, and depression) and familial wellbeing (martial satisfaction, and affectual and associational solidarity toward their aging parents) in early and middle adulthood. We selected 462 Gen-Xers from the Longitudinal Study of Generation in the 2005 (mean age = 30.25) and the 2016 waves (mean age = 41.25). In terms of data analysis, the three-step latent class analysis was conducted. We identified four religiosity profiles among young-adult Gen-Xers: strongly religious, weakly religious, literalists but not religious, religious but not literalists. Less educated single Gen-Xers were more likely to be in the strongly religious class, and less likely to be in other classes. Gen-Xers in the strongly religious class reported high scores of psychological and familial wellbeing than those in other religiosity classes. Given that the religiosity of the U.S. population has declined substantially over the past few decades, our findings indicate that religiosity is an important resource for Gen-X adults’ psychological and familial wellbeing.
Enhancing Dementia Caregivers’ Emotional Coping in an Intergenerational Expressive Arts Based Therapy Program
Authors: Carden Keisha , Allen Rebecca , Ramos Katherine , Potts Daniel , Ivey Keisha
Published: December 2020

Dementia caregivers often experience elevated levels of stress and are at increased risk for psychological disorders. Recent research has implicated emotional avoidance, psychological inflexibility, and related processes in the development and maintenance of psychopathology. Addressing these processes is essential for improving caregiver mental health. This pilot study examined changes in emotional avoidance, psychological inflexibility, and anticipatory grief among familial caregivers of individuals with dementia enrolled in an intergenerational expressive arts program (Bringing Art to Life). Caregivers were an average age of 63.32 (11 NHW, 8 AA; 13 Women, 6 Men). On average, caregivers’ emotional avoidance and psychological inflexibility (M = 19.63, SE = 2.16) decreased significantly after participating in the program (M = 15.06, SE = 1.80). This difference, -4.57, BCa 95% CI [1.82, 7.13], was significant, t(15) = 3.81, p = .002, and represented a medium-sized effect, d = 0.70. Overall experience of anticipatory grief (M = 51.88, SE = 3.26) also decreased (M = 48.00, SE = 2.79). More specifically, caregivers’ reported sadness and loneliness (M = 17.63, SE = 1.37) decreased significantly (M = 14.5, SE = 0.95), BCa 95% CI [1.25, 5.00], t (15) = 3.21, p = 006, and represented a medium-sized effect, d = 0.64. These findings illuminate novel ways in which interventions might both target underpinnings of the caregiver stress process and improve the dyadic relationship. Specific intervention elements are explored and recommendations are made for future intervention development and implementation as well as measurement based outcome tracking.
The Influence of Social Roles on the Well-Being of Older Caregivers: Social Isolation as a Potential Mediator
Authors: Baik Sol
Published: December 2020

Engagement in productive roles has been associated with better health in later life. According to identity accumulation theory, more social roles help individuals be more socially integrated, leading to enhanced psychological well-being by diminishing the risk of focusing their energy into a single role. However, less is known about the mechanisms behind the relationship between productive roles and mental health of older caregivers. The aims of this study are to examine: (1) the association between productive social roles and psychological well-being for caregivers and non-caregivers, and (2) the mediating effect of social isolation on this relationship. The study analyzed 3,951 community-dwelling Medicare beneficiaries ages 65 or above from Rounds 1 to 3 of the National Health and Aging Trends Study (210 caregivers, 3,741 non-caregivers). Multiple-group analysis for structural equation modeling was conducted to compare caregivers to non-caregivers. For both caregivers and non-caregivers, having a volunteer role increased well-being, while paid employment was not significantly associated with well-being. Social isolation mediated neither employee nor volunteer role with well-being for both caregivers and non-caregivers. Assuming that volunteering for others without monetary compensation brings meaning in life, this finding supports the provision of services (e.g., respite care) that could supplement caregiving time, allowing caregivers to have more freedom to use the time in such community-engaging roles. Even though self-rated health was controlled, there is a chance that healthier individuals engage in productive roles. Thus, reciprocal relationships between productive roles and health should be considered in future investigations.
Regional Brain Volumes Associated With Depression in the National Alzheimer’s Coordinating Center Uniform Data Set
Authors: Burke Shanna , Li Tan , Grudzien Adrienne , Barnes Christopher , Hanson Kevin , DeKosky Steven
Published: December 2020

Depression has been associated with greater risk of Alzheimer’s disease (AD), and existing research has identified structural differences in brain regions in depressed subjects compared to healthy samples, but results have been heterogeneous. We sought to determine the effect of depression on regional brain volumes by cognitive and APOE e4 status. Secondary analysis of the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set was conducted using complete MRI data from 1,371 participants (mean age: 70.5; SD: 11.7). Multiple linear regression was used to estimate the adjusted effect of depression (via the Neuropsychiatric Inventory Questionnaire) on regional brain volumes through measurement of 30 structural MRIs. Depression in the prior two years was associated with lower total brain, cerebrum,, and gray matter volumes and greater total brain white matter hyperintensities (p<.05). Greater volumes were also observed in all ventricular volume measures. Lower mean volumes were observed in six additional frontal lobe and parietal lobe cortical regions. Alternately, depression antecedent to the past 2 years correlated only with occipital lobe gray matter volumes (right, left, total). Our findings suggest that depression in the prior two years is associated with atrophy across multiple brain regions and related ventricular enlargement, even after controlling for intracranial volume and demographic covariates. The duration of depression influences results, however, as depression prior to 2 years before assessment was correlated with significantly fewer and different regional brain volume changes.
The Who and When of Worry: The Fading Impact of Gender on Worry and Anxiety Severity Among Older Adults
Authors: Granier Katie , Ingram Rebecca , Segal Daniel
Published: December 2020

Introduction. This study examined the influence of age and gender on diverse worry constructs and overall anxiety among younger (age 18-30) and older (age 65+) adults. Methods. 411 participants (311 younger, 100 older adults; 77.1% female) completed the PSWQ, BMWS, WDQ, and GAS online. Results. Among a series of 2x2 between-subjects ANOVAs, significant interaction effects between age and gender were found among all worry and anxiety measures. Specifically, there was a significant interaction effect on worry severity as measured by the PSWQ (F[1, 393]=4.28, p<.05), the WDQ (F[1, 397]=8.42, p<.01) and the BMWS (F[1, 396]=10.41, p<.01). Gender had a larger impact on worry among younger adults than older, though both age groups showed similar patterns of women reporting greater worry than men. Though both younger and older adults showed a gender difference in worry severity, this difference was mitigated by late life. There was also an interaction effect on anxiety (GAS total) in that younger women reported greater anxiety than younger men but older adults reported similar anxiety across genders, F(1, 384)=9.78, p<.01. Simple main effects analysis showed that younger women scored higher than older women on all measures of worry and anxiety, whereas younger men scored higher than older men on the PSWQ and WDQ but not the BMWS or GAS. Discussion. Consistent with previous literature, women reported greater worry and anxiety than men. However, this difference was mitigated and even extinguished among some measures in older adults. Possible explanations are discussed.
Up North and Down South: Regional Differences in Pain, Religious Coping, and Negative Affect in Osteoarthritis
Authors: Cheesman Katherine , Parmelee Patricia , Smith Dylan
Published: December 2020

Objective: This research examines regional differences (Northern vs. Southern) in pain, religious coping, and negative affect among African Americans (AA) and non-Hispanic Whites (NHW) over the age of 50 with physician-confirmed knee osteoarthritis (OA). Methods: As part of a larger study of racial/ethnic differences in everyday quality of life with OA, 116 persons were recruited from sites in Alabama (n = 64) and New York (n = 52). Participants completed global measures of pain (PGC Pain Scale) and religious coping (Brief RCOPE); daily variability in pain, coping, and affect was assessed using a daily diary methodology consisting of 4 daily phone calls over 7 days. Site comparisons were conducted using one-way multivariate analysis of covariance (MANCOVA) with covariates of race, sex, education, and marital status. Results: There was a significant multivariate effect of site on pain, religious coping, and affect, F(5, 104) = 3.846, p = .003, Wilk’s Λ = .844, partial η2 = .156. Follow-up univariate tests and mean examinations revealed that Southerners reported statistically more daily pain (M = 2.023, SD = .89), religious coping (M = .618, SD = .427), and negative affect (M = 6.556, SD = 2.661) than Northerners (M = 1.810, SD = .719; M = .386, SD = .417; M = 5.865, SD = 1.446). Implications: Results contribute to a growing understanding of how individuals use their religious beliefs to cope with daily pain. (Supported by R01-AG041655 D. Smith and P. Parmelee, PIs.)
Self-Efficacy Proxy Predicts Physical Frailty Incidence Over 8 Years in Non-Institutionalized Older Adults
Authors: Hladek Melissa , Zhu Jiafeng , Buta Brian , Szanton Sarah , Bandeen-Roche Karen , Walston Jeremy , Xue Qian-Li
Published: December 2020

Physical frailty is defined as a syndrome of decreased physiologic reserve conferring vulnerability to functional decline, mortality and other adverse outcomes in response to a stressor. One potential modifiable risk factor of frailty is self-efficacy, which is confidence in one’s ability to perform well at a task or domain in life. Self-efficacy is associated with improved health behavior and decreased chronic disease burden but has not been studied extensively in frailty research. Therefore, the purpose of this study was to evaluate a general self-efficacy proxy measure’s ability to predict frailty in a nationally representative sample of older adults using data from the National Health and Aging Trends Study (NHATS) collected from 2011-2018. 4,835 older adults (65+) were dichotomized into low and high self-efficacy groups using the one-item self-efficacy proxy measure in NHATS. The Physical Frailty Phenotype was used to assess frailty. A discrete time hazard model was used to obtain incident hazard ratios of frailty in two models. Model 1 was adjusted for age, race, sex, education and income. Model 2 contained Model 1 covariates and activities of daily living and co-morbidities. We found that low self-efficacy predicted a 41% increased risk of developing frailty over 8 years after adjustment for socio-demographics (P<0.0001) and a 27% risk of incident frailty after further adjustment for activities of daily living and co-morbidities (P=0.004). This study provides preliminary evidence that self-efficacy may be a key modifiable element to incorporate into multi-modal frailty interventions.
Acute Life Interventions, Goals, and Needs Program: Social Determinants of Health Among the Most Vulnerable
Authors: Munoz Lizette , MacKenzie Blair , Chun Audrey , Fani Shamsi , Lavayen Susana , Chow Stephanie
Published: December 2020

The Acute Life interventions Goals and Needs program(ALIGN) at Mount Sinai Hospital in New York City, is an inter-professional team dedicated to offering temporary intensive ambulatory care services to the most complex older patient population. This allows us to care for the most vulnerable population which often incur multiple hospitalizations, emergency room visits. Mr.C is a 81 yo male with past medical history of Chronic COPD, Depression, Gait instability, Mild Neuro-cognitive disorder, Hearing Loss, Coronary artery disease. Most significantly he had 3 ED visits, 1 admission, where he was found on the floor of his apartment after two days, by a meals on wheels volunteer. Team conducted a comprehensive assessment of Mr.C’s social determinants of health and compiled a care plan. We learned that Mr.C does not like to bother others therefore found it difficult to seek help. Team built intensive rapport and gained his trust to help simplify medications, increase engagement and explore barriers to home care. Mr.C was connected to several community agencies including, meals on wheels for more stable food access, psychiatry to discuss depression and isolation, adult protective services for deep cleaning,financial management, pharmacy for blister packing, home care services and case management to continue encouragement with care plan. Mr.C is now able to reach out to the team as needed and has a navigator to help with managing care. This is one of many cases ALIGN encounters, that often go undetected due to comprehensive inter-professional care needed and minimal time given in traditional primary care.
Socioeconomic Correlates of Healthy Aging Among Older Cambodians
Authors: Kuy Kakada , Li Yuekang
Published: December 2020

Healthy aging is one of the most critical goals to attain on the World Health Organization’s global aging agenda for developing countries. However, healthy aging has not been widely studied among the many older adults living in those nations. For example, most of the Cambodia’s economically deprived older adults earn less than a dollar a day, while little scientific evidence is known about their healthy aging situation and their support system. Our study aimed to examine socioeconomic correlates of healthy aging among older Cambodians in three provinces. Data of a sample of older Cambodians ages 60 and above (N=210) from 12 districts were collected. Healthy aging was measured using the Healthy Ageing Index developed based on a Southeast Asian context. We measured social support using the Social Network and Social Support scale. Financial conditions were measured by an index derived from subjective and objective measurements. Multilevel mixed-effects models showed that better social supports from friends and family members, better financial conditions and education were associated with improved health aging among older Cambodians. Supports from friends had a stronger relationship than supports from family members. As one of the first studies examine the social determinants of health among older Cambodians, this study adds to the literature by substantiating the important roles of financial conditions and social support in determining their health and well-being. Findings point to the importance of improving living standard and maintaining social support of the older population in the country.
The Effect of Neighborhood Cohesion Across the Lifespan on Cognitive Health
Authors: Munoz Elizabeth , Ng Yee To , Han Sae Hwang
Published: December 2020

Neighborhood environments may serve as protective factors against cognitive impairment and decline. Recent evidence shows that neighborhood cohesion is associated with better cognitive health in adulthood. We extend the current literature by evaluating how neighborhood cohesion across the lifespan may influence cognitive function in adulthood. We used data from the Health and Retirement Study (HRS) and the HRS Life History Survey. Participants who were 50-89 years old at baseline, completed up to 10 longitudinal waves, and were not cognitively impaired in the last wave were included in the analyses (N=2,057). Early-life neighborhood cohesion was assessed with participants’ retrospective ratings of sense of belonging in their local areas at age 10, when they first had a full-time job, and at age 40. Participants’ assessment of neighborhood cohesion assessed at the final wave was treated as the current indicator of cohesion. Cognitive function was assessed with the full HRS cognitive battery. Preliminary findings from hierarchical mixed models showed an overall decline in cognitive function across time. Current and age 10 neighborhood cohesion were independently associated with better baseline cognitive function, but did not predict cognitive change. Interaction terms involving cohesion at age 10 and current neighborhood cohesion showed that current cohesion buffered the negative effect of low cohesion at age 10. No significant associations were observed for cohesion during the full-time job and age 40 periods. Although effect sizes were small, these results indicate that neighborhood cohesion in older adulthood may offset the detrimental effects of negative childhood environments on cognitive health.
Rural and Non-Rural Digital Divide Persists in Older Adults: Internet Access, Usage, and Perception
Authors: Lee Hee Yun , Choi Eun Young , Kim Youngsun , Neese Jessica , Luo Yan
Published: December 2020

Despite the overall increase in Internet use among older adults, the digital divide within older Americans remains substantial. This trend is particularly true for older adults living in rural areas. Informed by the Social Determinants of Health Framework, our study aims to examine how one’s residential area relates to (1) Internet Access, (2) subtypes of usage patterns, and (3) perceptions on technology use. Cross-sectional data were drawn from the 2012 Health and Retirement Study (HRS). The sample consisted of 18,196 older adults aged 50 and above (47.6% rural residents). A series of linear and logistic regression analyses were performed. Our models controlled for demographic characteristics, socioeconomic status, and health conditions. Compared to older adults living in urban areas, those residing in rural areas had 29% lower odds of internet access. Living in rural areas predicted lower levels of all sub-types of technology use (communication, financial, health, and media technology). In addition, non-users in rural areas showed more unfavorable perceptions of technology than urban residents. They were more likely to conceive technology as “too complicated”, “too hard to learn”, and “too difficult to keep up with all changes.” Our findings suggest that substantial segments of older adults in rural areas are still behind in accessing and adopting digital technology. Targeted intervention efforts are urgently needed to reduce technology inequality including comprehensive plans to expand broadband access and building mobile technology infrastructure for rural communities.
Poor Sleep Health and Next Day Work Impairment: The Mediating Role of Fatigue
Authors: LaRocque Breann , Mu Christina , Lee Soomi
Published: December 2020

Nightly sleep impacts next-day alertness and cognitive functioning. For healthcare professions, work impairment can be life-threatening for patients. Thus, understanding how sleep affects work quality is imperative to promoting medical safety and overall health of workers. The current study investigated whether nightly sleep health is associated with next-day work impairment in nurses and whether this association is mediated by daily fatigue. Sixty nurses reported their sleep characteristics, fatigue, and work impairment using ecological momentary assessment for two weeks. We used a series of multilevel models (a path: sleep→fatigue, b path: fatigue→work impairment, c path: sleep→work impairment, c′ path: sleep and fatigue→work impairment), adjusting for sociodemographics and work shift. At the between-person level, poorer sleep quality was associated with greater work impairment (βc=-23.36, p<.001). This association was mediated by fatigue such that poorer sleep quality was associated with greater fatigue (βa=-19.54, p<.01), which was further associated with greater work impairment (βb=0.79, p<.001). After including fatigue, the association of sleep quality with work impairment was reduced (βc′ =-7.07, p=.08). Similarly, fatigue mediated the relationship between sleep sufficiency and work impairment (βa=-16.49; βb=0.79; βc=-19.36; p<.001; βc′ =-6.32, p=.05). At the within-person level, on days after long sleep duration (>8hrs), nurses reported greater work impairment (βc=10.08, p<.01), however, this was not mediated by fatigue. Our results suggest that poor sleep health may impair next-day work performance, mostly through increased fatigue. Future interventions for nurses can target daily fatigue to reduce the adverse effects of poor sleep on work impairment.
Pre-Loss Group Therapy for Family Caregivers of Persons With Dementia: Translation Into Practice
Authors: Supiano Katherine , Andersen Troy , Luptak Marilyn , Beynon Cynthia , Iacob Eli , Li Hui
Published: December 2020

We developed Pre-Loss Group Therapy (PLGT) for dementia caregivers at risk for Complicated Grief (CG). PLGT is a manualized ten-session multi-modal group therapy that includes elements of cognitive behavior therapy, motivational interviewing, exposure therapy, memory revisiting, meaning-making, and self-care. We implemented and evaluated three PLGT cohorts in three long-term care facilities with family caregivers at-risk for CG whose care recipient had a life expectancy of 6 months or less and resided in a long-term care facility (NT = 24). Evaluation of participant preparedness for the death of the persons with dementia (PWD), self-care and grief outcomes showed significant improvement across multiple domains between pre and post-group, notably a statistically significant decrease in grief as measured by the Inventory of Complicated Grief score from baseline (M = 25.67, SE=1.80) to post-group (M = 14.41, SE=1.65) t(21)= 6.280, p<0.001. Clinician-rated grief severity declined (N=22, β = –0.472, SE = 0.018, p < 0.001) per week and grief improvement increased (N=22, β = 0.259, SE = 0.023, p < 0.001) per week, as assessed on the Clinician Global Impressions Scale. We subsequently trained two LCSWs to conduct PLGT, and both clinical outcomes and treatment fidelity and skills measures achieved performance levels of master clinician-trainers. Family caregivers at risk for CG may benefit from group therapy targeting preparedness and pre-loss grief experience, as we provide with PLGT. Manualized PLGT is suitable for implementation by LCSWs in the settings of hospice and long-term care.
A Community Space With Diverse Activities Support Older Adults’ Social Participation and Sustain Social Connection
Authors: Kim Dongyool , Masuda Taichi , Higuma Shuichiro , Yang Yerim , Terazawa Sayaka , Takase Mai , Ogino Ryogo , Goto Jun
Published: December 2020

Active older adults in Japan participate in multiple social activities to be socially involved. However, physical limitation and decline in enthusiasm due to ageing decrease their participation. Diverse activities should be available at one place, close to older adult’s residence, to sustain social connections. A community space was launched at Toyoshikidai housing complex (Kashwia, Japan) in February 2018. The place offers about 25 activities per month. This research aimed to elucidate the relationship between activity type and motivation for participation, and study the effect of the community space on older adults’ social connection. A cross-sectional questionnaire survey was conducted targeting the attendees of community space (February 2020). Of attendees, 68% lived within 10-minutes walking distance to the community space (N=101). The activities were classified into craft, exercise, and music. The motivation for attending craft events were information exchange and relaxation, as was health maintenance for exercise events. Participating in group performance was the motivation to attend active music event, and casual gathering and network expansion was for passive music event. The frequency of social participation outside the community space was low in the group aged over 75 years. This group attended the activities at the community space more frequently than did the younger group. Differences in the number of social connections were not found. This result implies that older adults maintained their social connection by attending activities held at the community space. The diverse programs and close location of the community space might have contributed to the motivation of participation.
Substance Use Is Common in Elder Abuse Cases: Qualitative Findings From a Multi-Disciplinary Team
Authors: Khalili Seyed Parham , Elman Alyssa , Clark Sunday , Bao Yuhua , Zhang Yiye , Jeng Philip , Wen Katherine , Rosen Tony
Published: December 2020

Elder abuse is mistreatment of an older adult by a caregiver or another person in a position with an expectation of trust. Adversely affecting as many as 10% of community-dwelling older adults in the US, it may include physical abuse, sexual abuse, psychological abuse, financial exploitation and neglect. Mental illness and substance use by caregivers, family members and victims themselves have been described as risk factors for multiple forms of elder abuse in prior cross-sectional analyses but the impact on these cases is poorly understood. To explore this association we conducted a focus group using a semi-structured format involving an inter-disciplinary group of elder abuse professionals that are part of the New York City Elder Abuse Center enhanced multi-disciplinary team (EMDT) in Staten Island, New York. Focus group participants reported that opioid, cocaine, cannabis and alcohol use is common among perpetrators of elder abuse, especially in cases of financial mistreatment, verbal and physical abuse. Other potential consequences included eviction of the older adult victim, co-dependency and involvement of the older adult in the procurement of illicit substances, and substance use by the older adult. Respondents specifically expressed concerns that the opioid epidemic, including rising heroin use, may be changing the frequency and nature of elder abuse, and that case investigations offer an opportunity to facilitate referrals for formal substance use disorder assessment and treatment. Future work includes additional focus groups and quantitative analysis to clarify the intersection between substance use and elder abuse and inform intervention and prevention strategies.
Turning Seniors’ Voices into Action on Elder Abuse: Findings From a Project Empowering Older Adults to Assist Peers
Authors: Hsieh Jessica , Tan Sharon , Mirza Raza , McDonald Lynn
Published: December 2020

Elder mistreatment, often understood in the context of abuse and neglect, is a growing concern for the health and wellbeing of seniors and their families. A 2015 Canadian prevalence study by the National Initiative for the Care of the Elderly (NICE) found that seniors who are mistreated are more likely to talk to peers, and not clinicians, police or family. However, a lack of knowledge, access to resources, and community stigma may limit seniors’ abilities to address mistreatment. This study evaluated the impact on knowledge, attitudes, and behaviours of having seniors deliver workshops on mistreatment to other seniors. A seniors advisory committee developed content for sixteen workshops. Senior facilitators delivered sixteen workshops about mistreatment across Ontario. Participants completed pre/post-surveys assessing changes in knowledge, attitudes, and behaviours. Results indicate that workshops effectively increased awareness of mistreatment issues among participants, on average, by 37.32%. Participants experienced a 43.98% increase in their perceived preparation to provide information to an older adult asking about mistreatment. Barriers to help-seeking among seniors with knowledge of mistreatment include finding trustworthy sources and a lack of legal protection. Prior to the training, healthcare providers were the main sources of information for participants (57.75%); depending on the severity of the situation, 60.43% of participants indicated eventually reporting to police, who are not the preferred source of information. Senior-led workshops about mistreatment appear to be effective for increasing knowledge and encouraging disclosure and help-seeking behaviours. Results support prevention models that empower seniors to educate other seniors on issues around mistreatment.
Value-Based Purchasing Financial Outcomes Among Minority-Serving Skilled Nursing Facilities
Authors: Hefele Jennifer Gaudet , Sharma Hari , Conkling Bryant , Xu Lili , Wang Xiao (Joyce)
Published: December 2020

Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) ties post-acute payments to readmissions performance. Minority-serving SNFs tend to be poorly resourced and understanding the financial implications of SNF-VBP is important. Our study examined VBP payments and penalties among minority-serving SNFs. We conducted cross-sectional analysis using public data sources. We defined minority-serving as SNFs with >50% of residents who are African American (AA)/Black (n=764) or with >50% of residents who are Hispanic/Latino (n=164). Majority-White SNFs (>50% residents who are White) were the reference group (n=11,002). Outcomes examined were: being in top 20% of performance rankings; receiving a bonus; receiving a bonus that was above the median bonus dollar amount; being in bottom 20% of performance rankings; receiving a penalty; receiving a penalty that was below the median penalty dollar amount. Logistic models estimated the likelihood of experiencing each performance outcome for AA/Black-serving and Hispanic/Latino-serving SNFs in reference to majority-White SNFs. Results show that minority-serving SNFs not only perform worse but also experience greater negative financial impacts. Among those penalized, Hispanic/Latino-serving SNFs had the largest average penalty amounts: $32,575 compared to approximately $26,000 for both AA/Black- and White-serving SNFs. Hispanic/Latino-serving SNFs had 1.69 times the odds of receiving larger than median penalties and AA/Black-serving SNFs had 27% lower odds of receiving higher than median bonus payments. Average penalties approximate the average salary for a certified nursing assistant, the primary direct care worker in this setting. Results from this study raise concerns over long-term impacts. Alternative approaches to encouraging quality should be considered.