bluuebunny/crossref_metadata_2025 huggingface dataset:
PEEKING UNDER THE COVERS: EXAMINING ETHICAL ISSUES IN ASSISTED LIVING
Authors: Turner Kelly , Agans Gretchen , Donohue Erin , Madison Barqueisha , Lesandrini Jason , Morgan Jennifer , Kemp Candace
Published: December 2022

Assisted living (AL) communities comprise complex social environments composed of residents, staff, and other care partners, including external workers and residents’ family and friends. Interactions among these stakeholders, especially pertaining to decisions related to resident care, frequently are fraught with value conflicts and uncertainties. Although much attention has been devoted to the ethics of aging and end-of-life in acute care settings, there is very little research on ethical issues in AL. To address this critical knowledge gap, our interdisciplinary team of gerontologists and bioethicists developed a typology of ethics issues in AL, adapting existing categorizations designed for acute care. We applied this typology to qualitative data gathered over a one-year period as part of an NIA-funded longitudinal study focused on residents with dementia living in four diverse AL communities (R01AG062310). The team coded 465 fieldnotes and interviews, analyzing data for the frequency and context of ethical issues. We found ubiquitous conflicts between residents’ autonomy and care partners’ obligations to maintain resident safety, as well as a high prevalence of organizational issues related to staffing and expertise. Comparing code frequency and type across the four communities, we discovered manifold ways in which facility size, organizational structure, and care practices affect the profile of value conflicts in resident care. During data analysis, we also developed new codes for ethics issues arising in AL, including, ‘cognitive decline stigma’ and ‘uncertainty regarding professional obligations,’ creating new avenues of study. We conclude our presentation by discussing implications for best practices and policy formation in AL.
SUCCESSFUL TRANSITIONS TO LONG-TERM CARE COMMUNITIES
Authors: Koltz Daniel , Koltz Rebecca
Published: December 2022

Older adults who transition to independent and assisted-living communities perceive their transition experience differently. This research focused on understanding what factors were predominant for a successful transition from a long-time home to a dependent living community. A constructivist grounded theory method was used to explore the experiences of 18 older adults who had relocated within the past year. The participants of this study were aged 65-95 years and are equally represented by gender. Equal numbers of respondents transitioned into independent and assisted-living accommodations. Five factors related to a central concept of behavioral attitude were found to be key for a successful transition. When an older adult reported a successful transition, their behavioral attitude was positive about their new living environment. The five factors that contributed to their positive attitude are creating a new place, increased community integration, sense of safety and security, independence while dependent, and accepting a new life stage. The theory that emerged from the research emphasizes that when an older adult has increased awareness about the five factors associated with adapting to a dependent living community, this awareness will promote a positive behavioral attitude and increase the opportunity for success during and after a transition. Family members, LTC community administrators and social workers could all benefit from understanding these factors for a successful transition. Enhancing a positive experience for an older adult and improving their behavioral attitude toward the new transition.
ORGANIZATIONAL SUPPORTS ASSOCIATED WITH NURSING ASSISTANTS’ JOB SATISFACTION DURING COVID-19
Authors: Bryant Natasha , Cimarolli Verena , Falzarano Francesca , Stone Robyn
Published: December 2022

The COVID-19 pandemic has disproportionately affected nursing home residents and staff, including the nursing assistants who provide critical supports for older adults and people with disabilities. The pandemic has added significant strain to an already vulnerable nursing home workforce, which has historically experienced high levels of turnover, chronic staffing shortages, and high burnout. At the same time, it has generated awareness of the value of the direct care workforce to provide care in places for those most at risk from the disease. Job satisfaction of nursing assistants is as major driver of turnover and intent to leave the job. Research has demonstrated organizational supports and job stresses that are associated with job satisfaction and turnover. However, limited research has investigated the factors associated with job satisfaction in nursing homes during the COVID-19 pandemic. Using data from an employee engagement and management system, we examined organizational supports (e.g., supervision, appreciation, safety) and work-related stresses associated with job satisfaction among nursing assistants in nursing homes (n=402). Higher quality of supervision, feeling appreciated for the job, and feeling safe and comfortable at work were associated with higher levels of job satisfaction. Work-related job stressors –increased workload demands and understaffing – were associated with lower job satisfaction. Our findings provide insights into the importance of employer supports and reducing work-related stressors in nursing assistants’ job satisfaction and practical implications for nursing home leadership regarding how to support workers
THE RELATIONSHIP BETWEEN THE FEAR OF FALLING AND QUALITY OF LIFE IN NURSING HOME RESIDENTS: THE ROLE OF ACTIVITY RESTRICTION
Authors: Xu Dongjuan , Wang Yaqi , Zhu Shanshan , Wang Kefang
Published: December 2022

Falls among older adults are a significant later life course event with detrimental impacts on health, quality of life (QOL), and mortality. Fear of falling (FOF) is a common problem, which can lead to physical and social activity restriction and poor QOL. However, few studies have comprehensively explored the relationships among FOF, activity restriction, and QOL among nursing home residents. This study aimed to investigate: 1) whether FOF is negatively associated with QOL; and 2) the mediating role of activity restriction in the relationship between FOF and QOL among nursing home residents in mainland China. This is a cross-sectional study. A total of 316 residents from 27 nursing homes participated in this study. The mixed-effects multivariate linear or ordinal logistic regression models were conducted. All statistical models were adjusted for resident- and facility-level variables. More than half of nursing home residents (55.4%) reported they often or always reduced their activities. As expected, FOF was directly associated with lower levels of QOL (β = -0.19, p = 0.010). However, the strength of this association was attenuated and no longer significant with the inclusion of activity restriction in the model. FOF was positively associated with activity restriction (β = 0.33, p < 0.001) and activity restriction was negatively associated with QOL (rarely/sometimes reduced activity: β = -1.23, p = 0.386; often/always reduced activity: β = -3.85, p = 0.014). Given the aging of our populations, it is important to take FOF and activity restriction into account when caring for older people.
INTERVENTIONS TARGETING LONELINESS AND ISOLATION AMONG LONG-TERM CARE RESIDENTS: A SYSTEMATIC REVIEW
Authors: Raciti Audrieanna , Lyons Amy , Chang Yu-Ping
Published: December 2022

The impact of loneliness and social isolation on health is a significant concern among people residing in long term care. Researchers have begun to design and test interventions to lessen the burden of these impacts on the individual as well as our already strained healthcare system. The purpose of this review is to synthesize types and outcomes of interventions designed to reduce loneliness and isolation among long term care residents. Six databases: CINAHL, PUBMED, Cochrane, Web of Science, PsycInfo, and Embase were searched to identify studies leveraging the use of various interventions for alleviating feelings of loneliness and isolation within long term care residents. Multiple keywords were used including loneliness, social isolation, long-term care, nursing home, treatment, and strategies. Articles were screened if they were published between 2012 and present. Twenty studies were included in this systematic review. All studies have a small sample size. Only four studies were randomized controlled trials. Interventions included laughter therapy, adaptive sports, social robotics, horticultural therapy, spirituality, electronic cognitive behavioral therapy, music therapy, virtual reality, expressive arts, telephone discussions, video conferencing, peer mentoring, and animal assisted therapy. The majority of the interventions demonstrate a significant improvement in alleviating feelings of loneliness and social isolation, while some interventions also show improvement in quality of life and physical ability. However, some studies have a high attrition rate. Future research is needed to utilize a more rigorous design with a large sample size. Participant engagement should be considered as part of the intervention activities.
USE OF COMPLEMENTARY HEALTH APPROACHES AND PRESCRIPTION OPIOIDS AMONG VETERANS WITH MUSCULOSKELETAL DISORDERS
Authors: Han Ling , Goulet Joseph , Skanderson Melissa , Redd Doug , Brandt Cynthia , Zeng Qing
Published: December 2022

Complementary and integrative health approaches (CIH) are recommended in national guidelines for managing chronic pain and de-prescribing opioids. We followed 1,993,455 opioid-naïve Veterans with musculoskeletal disorders for two years after index diagnosis during 2005-2017. CIH exposure was defined as primary care visits for acupuncture, massage and chiropractic therapy using natural language processing and administratively coded data. Opioid prescriptions dispensed during follow-up period were abstracted from Veterans Health Administration electronic pharmacy records. Propensity score (PS) was used to match one control for each CIH recipient. Overall, 140,902 (7.1%) Veterans received CIH, with those age ≥65y the lowest prevalence (2.7%). Cox proportional hazard model revealed that time to first opioid prescriptions was longer for CIH recipients than PS-matched controls (136,148 matched pairs) and varied across age (p for interaction 0.003). The adjusted Hazard Ratio (HR) was 0.48 (95% Confidence Interval (CI): 0.45-0.51) for Veterans age ≥65y, 0.44 (95% CI: 0.43-0.45) for 50-64y and 0.47 (95% CI: 0.46-0.48) for ≤49y. Restricted mean survival time (RMST) models estimated a smaller CIH benefit for Veterans ≥65y, with an average 3.3 (95% CI: 3.2-3.5) month RMST difference, in contrast to 4.2 (95% CI: 4.1-4.3) and 3.7 (95% CI: 3.6-3.8) months for younger counterparts. Sensitivity analyses in full cohort or modeling total supply and daily dose of opioid prescriptions derived consistent results. These findings suggest potential benefits of CIH in delaying and reducing opioids prescriptions for patients with chronic pain. The observations of lower rate and smaller benefit of CIH use among older Veterans warrants further investigations.
BRAIN RESPONSE IN THE ELDERLY AFTER TAI CHI PRACTICE ASSESSED WITH NEUROIMAGING TECHNIQUES: A LITERATURE REVIEW
Authors: Liu Hao (Howe) , Salem Yasser , Arguello Eric
Published: December 2022

Tai Chi (TC) has been often provided to older adults by rehabilitation professionals for medical dysfunction and anti-aging healthcare. In the last 10 years, there has been an increase in the number of studies examining the effects of TC on brain as assessed by neuroimaging including near infrared spectroscopy (NIRS), and structure and functional magnetic resonating imaging (sMRI & fMRI). Thus, the purpose of this literature review is to evaluate how TC practice may affect the brain in the elderly as assessed by neuroimaging techniques. A comprehensive literature search was conducted using a variety of key words with different search engines to search from the last 10 years until January 15, 2022. Studies were included if they investigated topographic brain responses after TC practice in the elderly population. A total of 12 original studies with 15 articles met the criteria and were included for the review process. The results showed increased volume of cortical grey matter, improved neural activity, and increased neural connectivity in different brain regions, including the frontal, temporal, and occipital lobes, followed by cerebellum and thalamus. Intriguingly, the longer one practices TC, the more his/her brain areas may be altered. Such neural findings after TC practice are often associated with neurobehavioral improvements in attention, cognitive execution, memory, emotion, and risk-taking behaviors. Tai Chi is a promising exercise that is able to improve morphological capability and neurofunctional activity in the brain in the elderly. These improvements seem to be associated with time-length of TC practice.
SCALING UP A FALL PREVENTION PROGRAM IN RURAL COMMUNITIES: FEASIBILITY AND LESSONS LEARNED
Authors: O'Connor Melissa , Strommen Jane , Brotherson Sean , Estepp Philip , Grace Rachel , Pedersen Megan , Undem Teri , Saxena Divya
Published: December 2022

In North Dakota, 28% of adults over age 65 report falling each year, resulting in substantial morbidity and mortality. Evidence-based fall prevention programs can benefit quality of life and maintenance of daily living activities, particularly for community-dwelling older adults. The Stepping On fall prevention program, a national evidence-based program, is designed to educate older adults about risk factors for falls, safety strategies, and coping behaviors. The program consists of seven weekly community-based workshops conducted in a small-group setting by two trained facilitators. The Stepping On program was introduced in North Dakota in March 2012. Since that time, 132 workshops have taken place in rural communities across the state, serving 1,502 participants. The number of workshops and participants steadily grew between 2012 and 2019. In the year 2012-13, 127 individuals participated in ten workshops. By 2019, before the program was suspended during the pandemic, 199 individuals participated in 16 workshops; 24 workshops had previously been held in 2018. The current study discusses the implementation process as the program scaled up and expanded to more locations. The feasibility and sustainability of conducting the program in isolated rural areas, challenges encountered, and lessons learned will also be discussed. It is important that residents in rural communities have access to evidence-based programs like Stepping On so they can experience the benefits.
STRATEGIES TO ADDRESS COVID-19 VACCINE HESITANCY AMONG OHIO NURSING HOME STAFF
Authors: Kunkel Miranda , Applebaum Robert , Nelson Matt
Published: December 2022

Background

Nursing home staff members unvaccinated against COVID-19 pose an ongoing public health risk considering their frequent contact with older adults, a population especially vulnerable to the virus. In order to address vaccine hesitancy and foster vaccine confidence effectively among nursing home staff, evidence-based health communication strategies are necessary.

Methods

Using a dataset composed from three sources of Ohio nursing home data, the research questions guiding this study are as follows: 1) What is the relationship between engaging in various strategies to address vaccine hesitancy and vaccination rates among staff?; 2) Does hiring infection preventionists affect vaccination rates among staff? Multivariable linear regression techniques were used to assess all variables.

Results

Peer counseling and providing time off to the staff for vaccination statistically significant strategies to reduce vaccine hesitancy among staff. Compared to facilities that did not engage in peer counseling, those that did saw an average increase of 3.6% of their staff vaccinated. Compared to facilities that did not provide time off to their staff for vaccination, those that did saw an average increase of 4.2% of their staff vaccinated. Discussion: Peer counseling should be pursued as a viable strategy for fostering vaccine confidence among nursing home staff and further studied in more diverse populations. Implications for nursing home staff acceptance of facility-wide initiatives will be discussed.
SEDENTARY BEHAVIORS AND PHYSICAL ACTIVITY EXPERIENCES OF LATINX OLDER ADULTS: A THEMATIC CONTENT ANALYSIS
Authors: Bohplian Suweena , Liu Kristy , Fritschi Cynthia , Bronas Ulf
Published: December 2022

Sedentary behavior (SB) accounts for ~7.5 % of cardiometabolic mortality globally. The burden of cardiometabolic disease is especially high among Latinx adults and increases with age. Physical activity (PA) is crucial for maintaining health, yet most Latinx older adults do not meet PA guidelines and spend much time in SB. The aim of this study was to use thematic content analysis to describe the meaning of SB; and the experiences, facilitators, and barriers to PA among Latinx adults. Individual interviews were conducted among 30 Latinx older adults aged 55 to 75 years (60.7 ± 5.7 years) and BMI 20.78 to 42.13 kg/m2 (29.8 ± 4.4 kg/m2) who were enrolled in a larger study of PA. Results showed major themes included meaning of SB, consequences of SB, barriers, and facilitators of PA. Meaning subthemes included sitting for leisure as different from sitting work and value statements about laziness. Three participants did not understand the word “sedentary behaviors”. Consequence subthemes included effects on physical (circulation, obesity, fatigue) and mental health (cognitive and psychological). Barriers to PA included COVID-19, environment (weather, safety), culture (language, no relationships with non Latinx communities), time constraints (work), and physical conditions (pain and illness). Facilitators of PA include self-motivation, family, and community support (public parks, gyms, PA program from community organizations). These findings shed deeper meaning about SB and PA among the Latinx culture. These findings will be key in developing culturally appropriate interventions to improve physical and mental health specifically for the Latinx older adult population.
COGNITIVE-MOTOR GAMING IN OLDER ADULTS: FEASIBILITY OF TELEASSESSMENT AND TELEREHABILITATION ON FALL RISK
Authors: Bhatt Tanvi , Subramaniam Savitha , Kitsiou Spyros , Kannan Lakshmi , Wilson Edwina
Published: December 2022

There is limited guidance for clinically relevant tele-assessment, and access to a comprehensive physical-activity (PA) based telerehabilitation paradigm to enhance physical function, and slow progression of frailty among older adults (OA). In this we first examined the usability, safety, and feasibility of tele-assessment and telerehabilitation program on physical, and CV function. Subsequently evaluated its compliance and effectiveness. Healthy OAs (n=23,>65 years) participated a custom-designed exergaming-based tele-exercise program (EG-BTxP) delivered in home-setting for 4 weeks (3 sessions/week) consisting of 4 exercise modules: Dancing, aerobics, cognitive-motor gaming and mind-body exercises (yoga and tai-chi) in groups of 5. Pre- and post-training, a real-time online teleassessment was performed and change in lower limb strength, endurance (30-second chair stand test), static balance (one-legged stand test, Romberg test), and dynamic balance (4-step square test), aerobic endurance (2-minute step in place test) were assessed. Participants were provided with wearable sensors and education to self-monitor heart rate during exercise and report back to health coach after each module. Participants responded positively on the qualitative usability survey and there were no adverse events . All participants were able to tolerate the teleassessment and tele-intervention with a compliance of >90%. Post-training, there were improvements in 30-second chair stand test; (p< 0.01), one-legged stand test, Romberg test, and 4-step square test, (p< 0.05). Further, number of steps in the 2-minute step-in-place test increased (p < 0.05). These findings suggest that gaming-based tele-exercise programs could be safely implemented in community-based settings to increase compliance with participation for improved physical rehabilitation outcomes.
STRATEGIES TO IMPLEMENT AGE-FRIENDLY CARE FOR OLDER ADULTS ACROSS CONVENIENT CARE CLINICS
Authors: AlDossary Heba , Bender Anna , Foradori Megan , Pohnert Anne , Hughes Robin , Greenberg Sherry , Dolansky Mary
Published: December 2022

A growing proportion of the population in the United States are older adults, and they are frequent users of convenient care clinics. This is particularly true for older adults from systematically marginalized communities who may be at greater risk for chronic health conditions and unmet healthcare needs. These trends render convenient care clinics critical sites to reimagine the provision of care for older adults. To improve the quality of care the CVS MinuteClinic implemented the Institute of Healthcare Improvement’s Age-Friendly Health Systems 4Ms Framework (assessing What Matters, Medication, Mentation, and Mobility). Research to evaluate two interventions (reflective learning and virtual clinic participation) to improve healthcare providers’ (HCP) uptake of the 4Ms was implemented. After the interventions, HCPs were provided a self-administered online survey to capture qualitative reports of reflections on learning and implementing the 4Ms. A total of 32 providers from both groups completed the survey. Using a codebook thematic analysis approach, facilitators and barriers for implementation were identified as were HCPs’ innovative approaches to consistently and effectively implement the 4Ms. Facilitator themes were the presence of resources (e.g., peer coaches) and the perceived value of the 4Ms model. Barrier themes included time, documentation issues, workflow challenges, HCP stress, and HCP comfort. Innovation themes included designing efficient workflows, scaffolded 4Ms learning, and collaboration. These findings underscore the supports/innovations to amplify and challenges to address to support HCPs in learning and implementing the 4Ms to improve the quality of care for older adults.
IMPACT OF A SOCIAL CONNECTION PROGRAM ON OLDER ADULTS DURING THE COVID-19 PANDEMIC
Authors: Ungar Rachel , Tkatch Rifky , Cheng Yan , Kraemer Sandra , McGinn Michael , Wicker Ellen
Published: December 2022

Background

Research demonstrates social connections decrease loneliness and improves life satisfaction among older adults. However, the COVID-19 pandemic limited social connectedness, specifically for older adults. Thus, programs aimed to increase social connectedness among older adults are integral to their well-being. Purpose: The primary objective of this study was to determine if the telephonic Peer-to-Peer (P2P) program could improve social connectedness and reduce loneliness among older adults. A secondary objective was to improve life satisfaction and social support.

Methods

Eligible older adults (age 65+) were recruited via outbound calls and/or a mailer. Participants were mailed a T1 survey, completed intervention training, and matched into a dyad. The matched dyad engaged in weekly telephone calls for 12 weeks. Post 12 weeks, participants completed a T2 survey, and a T3 four weeks later.

Results

A total of 475 participants completed a T1, and 125 dyads (250 individuals) completed a T3. Older females were more likely to participate (77% female, 44% 75+ old). Individuals who were lonelier at baseline showed a significant improvement in loneliness throughout the program, as well as improvement in social support, life satisfaction, and subjective happiness.

Conclusion

Results from this program showed significant improvement in psychosocial well-being outcomes for lonely older adults. This program took place during the initial months of the COVID-19 pandemic and demonstrated success for lonely older adults with limited technology who may have been socially isolated during this time.
SOCIAL SUPPORT AND LONELINESS AS DETERMINANTS OF THE ONSET OF DISABILITY AMONG PUERTO RICAN OLDER ADULTS
Authors: Matos-Moreno Amilcar , Mehta Neil , Villamor Eduardo , Wang Lu , de Leon Carlos Mendes
Published: December 2022

Background

The effect of loneliness and social support on health is poorly understood among older Puerto Ricans. As family size continues to decrease in Puerto Rico due to out-migration, a higher number of older adults have fewer family members to rely on, which may lead to detrimental health outcomes.Method: Using both waves (2002-03 and 2006-07) of the Puerto Rican Elderly: Health Conditions database, we examined the association between social support, living alone, and incident disability among a sample of older adults over 60 years of age residing in Puerto Rico. Disability was defined as the occurrence of difficulties with Activities of Daily Living (ADLs).

Results

13.4% of older adults in our sample developed some form of disability. Older adults who developed a disability indicated receiving higher levels of social support (2.04 vs. 1.64) and loneliness (30.7% vs. 22.8%). Using multivariate logistic regression, we found that receiving social support increased the odds of developing a disability by 17% (OR: 1.17; CI: 1.02 – 1.35). Older adults who live alone had 58% higher odds of developing a disability (OR: 1.58; CI: 1.01 – 2.46).

Conclusion

The presence of social support and loneliness was correlated with a population prone to developing disabilities. Our findings concur with the well-established literature on psychosocial determinants in late life. However, this study represents the first attempt to understand psychosocial measures and disability in Puerto Rico. Public health organizations and healthcare systems must develop new societal mechanisms of support for older adults at risk of developing disabilities.
NOBODY KNOWS ME HERE: LONELINESS AMONG OLDER AFRICAN IMMIGRANTS
Authors: Adeniji Dolapo , Ashirifi Gifty , Adamek Margaret
Published: December 2022

Migration in later life is often accompanied by stressors such as acculturation and disconnection from previous social networks in one’s country of origin. Loneliness emerged in previous studies as one of the challenges that negatively impact older immigrants’ physical and mental health. Despite the rapid growth of this population in the United States, there is limited knowledge about loneliness experiences of older African immigrants. Thus, this study explored the loneliness experiences of older African immigrants living with their adult children in the United States. In-depth interviews were conducted with nine participants aged 69-84. The tape recordings of the interviews were transcribed verbatim for thematic analysis. Findings show that loneliness was prevalent among study respondents, despite living with their adult children’s family. Four major themes emerged from the study: 1) “Nowhere to go” (loneliness experience), 2) “It makes one sick if one is doing nothing” (consequences of loneliness), 3) “My grandkid makes me happy” (protective strategies) and 4) “If they ask older people to come. I will go there” (way forward in the community). Living with adult children may not prevent loneliness for older immigrant parents. Although the participants demonstrated resilience, their coping strategies were insufficient to overcome their loneliness. To address the gap in resolving loneliness, strategies are needed to increase older African immigrants’ social connectedness with their peers, family, and community. Interventions that promote social interactions and embeddedness into their local community are needed to ensure a good quality of life for older African immigrants.
PERSONALITY AND LONELINESS IN LATER LIFE: THE MEDIATING ROLE OF FRIENDSHIP
Authors: Lim Emily , Burr Jeffrey
Published: December 2022

Loneliness is prevalent among American older adults and is related to poor health outcomes. Existing studies on the association between personality and loneliness are limited and no study examined the mediating role of friendship. This study investigated how personality traits are linked to loneliness, and how friendship mediated the relationship between personality and loneliness. Using three waves of the Health and Retirement Study (N=3,259), we estimated a model with personality traits in 2010 (openness to experience, extraversion, consciousness, agreeableness, and neuroticism), friendship dimensions in 2014 (number of close friends, frequency of contact with friends, positive and negative friendship qualities), and loneliness in 2018 among community-dwelling adults aged 50 years and above (M=65.54 years old, SD=8.93). Extraversion and neuroticism were negatively and positively associated with loneliness, respectively. All friendship dimensions, except negative friendship quality, were negatively associated with loneliness. Our structural equation modeling results indicated that the number of close friends negatively mediated the relationship between extraversion and loneliness. The relationships between extraversion, agreeableness, neuroticism and loneliness were negatively mediated by positive friendship quality. Negative friendship quality positively mediated the relationship between neuroticism and loneliness, and negatively mediated the consciousness-loneliness link. Friendship contact frequency negatively mediated the relationships between openness to experience, extraversion, and loneliness but positively mediated the relationship between consciousness and loneliness. These results provided insights that help us better comprehend the mechanisms leading to loneliness. Social intervention programs could be developed that tailor different personality traits and friendship dimensions to potentially reduce loneliness in later life.
LIVING WITH END-STAGE LIVER DISEASE: PERSPECTIVES OF YOUNGER AND OLDER PATIENT–CARE PARTNER DYADS
Authors: Hansen Lissi , Rosenkranz Susan , Hiatt Shirin
Published: December 2022

The uncertain trajectory of end-stage liver disease (ESLD) leaves patients and their informal care-partners to face psychological, physical, social, and financial burdens, complicating their relationship. Knowledge is lacking on how living with ESLD affects patients and informal care-partners. The study purpose was to compare how ESLD affects relationships between younger and older patient-care-partner dyads. Patients with ESLD and informal care-partners were recruited through liver clinics at two hospital settings. They completed questionnaires including two open-ended questions about how ESLD affected their relationship (R01NR016017, NINR/NIH). Patient eligibility criteria: age >21 and MELD-Na score >15. Care-partner eligibility criteria: age ≥18 and identified as patient’s primary support. Conventional content and qualitative dyadic analysis were used to analyze written responses to the two questions. Data were available for 140 patient-care-partner dyads. Patients averaged 57 years old (range, 23-83 years; 69% were male; 31% with ETOH as primary etiology). Care partners averaged 57.5 years old (range, 19-85 years; 74% were female). Older dyads were more likely to report having a closer relationship, although tempered by uncertainty and symptoms limiting activities. Younger dyads emphasized managing symptoms, financial stress, caregiving burden, and lack of intimacy among spousal/partners. Diverging and overlapping themes within dyads reflected caregiving challenges, relationship strain, and support from other relationships. Clinicians should provide information and identify helpful resources that support the patient- care-partner dyad and their ability to manage ESLD. Future longitudinal dyadic studies should examine the patient-care-partner relationship at different points in the disease progression to develop interventions that help living with ESLD.
CHANGE IN OLDER ADULTS’ SELF-EFFICACY TO HANDLE DISASTERS AFTER A PREPAREDNESS PROGRAM: ROLE OF SOCIAL NETWORKS
Authors: Jaboob Saida , Thompson Lena , Ilavarasan Abinaya , Ashida Sato
Published: December 2022

Social support networks provide a context within which older adults maintain their safety and well-being. Preparing for disasters and emergency situations can help older adults stay safe independent after a disaster. Self-efficacy to prepare for and handle disaster situations can influence how older adults proactively prepare and protect themselves. Fifty-four older adults 61 to 92 years of age in Eastern Iowa were interviewed before and after participating in an intervention program that helped them develop personalized disaster management plans. Participants reported seven support network members on average, ranging from one to 23. About one-third of the network members were participants’ children and grandchildren, 11% were their siblings and parents, and 58% were non-family members such as friends and neighbors. Out of 549 network members identified, 245 were selected as someone participants can depend on during emergency situations; 47% were family whereas 43% were non-family members. Participants who reported higher numbers of network members whom they can depend on in emergency situations at baseline showed more increase in self-efficacy to manage disasters one-month after receiving the intervention (p=0.02). Having social support network members whom older adults feel they can turn to during emergency situations may help boost their confidence in handling and preparing for disasters through participating in a disaster preparedness program. Participants indeed identified additional members whom they could depend on in disaster situations after the intervention. Future studies may test strategies to enhance social support networks to increase confidence among older adults to prepare for and handle disasters.
MORTALITY RISK BY STATE-LEVEL POVERTY IN COLOMBIA AT DIFFERENT AGE GROUPS
Authors: Osuna Margarita , Crimmins Eileen , Ailshire Jennifer
Published: December 2022

Residence in high poverty states has been associated with increased mortality risk in the United States, but less attention has been paid to the relationship between state-level poverty and mortality in younger to older adults in Latin America. Poorer states in Colombia, one of the most populous and rapidly aging countries in Latin America, tend to report less access to healthcare, education, and economic opportunities. We examine the relationship between mortality and state-level poverty in Colombia by age and gender. We use data from the 2018 Colombian Census and Vital Statistics to calculate mortality levels and male-female ratios in mortality separately for three broad age categories: young (ages 20-39), middle-aged (40-69), and older adults (70 or older). We find an association between high poverty and high mortality risk among younger men, no association for middle-aged men, and a negative association between mortality risk and poverty among older men. We did not find any evidence for an association between state-level poverty and mortality at any ages. Our results highlight that, for men at older ages, poverty had a counterintuitive association with mortality. These results may be due to selective survival older ages in Colombia or to older adults who are aging into a social safety net that includes healthcare and income benefits. Future research should investigate the impact that unequal access to economic resources and distribution of health care resources has on women and men across age groups in Colombia.
YOUNGER AND OLDER ADULTS PERCEPTIONS OF STRESSORS AFTER A FLOOD
Authors: Cherry Katie , Friis Marlene , Bordes Piper , Calamia Matthew , Elliott Emily
Published: December 2022

In August of 2016, historic flooding in Baton Rouge, Louisiana resulted in catastrophic damages and claimed 13 lives. This study is part of a larger research program on post-flood health and well-being across the adult lifespan. Participants (n=223, age range: 18-88 years) were tested during the immediate impact phase (Wave 1) and most participated in a follow-up assessment 9 (+/- 3) months later (Wave 2). In this study, we compared participants’ narrative responses to an open-ended question at Wave 2 concerning the most stressful aspect of the 2016 flood. We hypothesized that older flood survivors would report stressors related to rebuilding and financial loss more often than younger survivors based on the Conservation of Resources theory (Hobfoll, 1989). Three groups were compared: non-flooded (controls), single disaster (flooded in 2016) and double disaster (flooded in 2005 and again in 2016). To create younger and older comparison groups, age was split at the median with sample sizes that ranged from 28 to 34 younger and older participants within each flood exposure group. Content analyses of responses by independent coders blind to the purpose of the study revealed that older flood victims reported greater stressors related to rebuilding flood-damaged homes and financial stressors than did their younger counterparts. In contrast, younger flood victims were more likely to report childcare issues and being displaced from their homes as stressors compared to the older victims. Implications of these data for understanding age-related vulnerabilities after severe weather events are discussed.
FUCOIDANS ARE NOVEL SENOTHERAPEUTICS THAT ENHANCE SIRT6 AND DNA REPAIR ACTIVITY
Authors: Zhang Lei , Hughes Brian , Tombline Gregory , Angelini Luise , Yousefzadeh Matt , Gorbunova Vera , Niedernhofer Laura , Robbins Paul
Published: December 2022

With age, senescent cells accumulate in various tissues where they contribute to loss of tissue homeostasis, aging, and age-related diseases through their inflammatory senescence-associated secretory phenotypes (SASPs). Senotherapeutics able to selectively eliminate senescent cells, termed senolytics, or suppress the detrimental SASPs, termed senomorphics, have been demonstrated to improve age-associated comorbidities and aging phenotypes. To discover novel senotherapeutics translatable to promote healthy longevity, we conducted a drug screening of diverse natural products based on the characteristic senescence-associated β-galactosidase activity. Several fucoidans from different brown seaweed were found to exhibit potent senotherapeutic activity. Fucoidans are long-chain sulfated polysaccharides found in various species of brown algae including seaweed. The best senomorphic fucoidan was able to suppress senescence in cultured senescent fibroblasts, in ex vivo human tissue explants, and in vivo in mouse models of natural and accelerated aging. Specifically, fucoidan reduced markers of cellular senescence and SASP in senescent mouse and human cells. Acute treatment of the fucoidan in naturally aged mice reduced tissue senescence, especially in the kidney and lung. Chronic treatment of the fucoidan in Ercc1-/Δ progeria mice attenuated composite aging symptoms and extended healthspan. Interestingly, preliminary mechanistic studies demonstrated that fucoidan can improve non-homologous end-joining-directed DNA damage repair and increase the mono-ADP-ribosylation activity of SIRT6, suggesting a relationship between cellular senescence, DNA repair, and SIRT6 signaling pathways. Collectively, fucoidans were identified as novel senotherapeutics with translational potential for reducing cellular senescence, ameliorating age-associated phenotypes, and extending healthspan as well as able improve DNA repair pathways through modulation of SIRT6 activity.
REVIEW OF TECHNOLOGY-BASED INTERVENTIONS ADDRESSING SOCIAL DISCONNECTION AMONG DEMENTIA CAREGIVERS
Authors: Mao Weiyu , Qi Xiang , Chi Iris , Wu Bei
Published: December 2022

Social disconnection is a major public health concern. Informal dementia caregivers are particularly vulnerable to social isolation and loneliness, as the majority are older adults and at elevated risk of adversity. Technology-based interventions could offer accessible, affordable, and convenient solutions. Using a scoping review approach, we aimed to identify and synthesize existing technology-based interventions to address social isolation and loneliness among informal dementia caregivers. In a systematic search across six databases within the last ten years, ten eligible studies were included. The intervention type, format, and duration varied widely. The results suggested that technology-based interventions could reduce feelings of loneliness and improve caregiver well-being. The findings offer opportunities to use technology to reduce or prevent social isolation and loneliness. Investigating the role of technology in interventions addressing social isolation and loneliness among informal dementia caregivers could potentially overcome barriers to low uptake of services and improve sustainability of the interventions.
ALTERED SUPER ENHANCER – PROMOTER INTERACTIONS MEDIATED BY YY1 UNDERLIE AGE-INDUCED TRANSCRIPTOME
Authors: Dang Weiwei , Sun Luyang , McCauley Brenna
Published: December 2022

Significant changes in transcriptome during aging have been observed in various tissues and cell types, even at the single-cell level. However, the molecular mechanisms that underlie these changes remain poorly understood. Using an ex vivo mesenchymal stem cells (MSC) replicative aging model and Hi-C technology, we discovered that, rather than large-scale changes in chromosome conformation, alterations to super enhancer – promoter looping interactions had the best positive correlation with age-associated transcriptome. Furthermore, we found evidence that these age-induced transcriptomic changes are mediated by YY1, a key regulator of promoter-enhancer looping. This work, for the first time, unveiled a molecular mechanism elucidating the changes in transcription during aging.
CAUSAL INFERENCE IN PSYCHOPATHOLOGY OF DEPRESSIVE SYMPTOMS IN MIDDLE-AGED AND OLDER ADULTS
Authors: Zhu Zheng , Qi Xiang , Pei Yaolin , Wang Jing , Wu Bei
Published: December 2022

Most previous research studied depression as a holistic conception and ignored the complex relationships between depressive symptoms. How depressive symptoms interact with each other is still unknown. The aims of this study were to develop symptom networks of middle-aged and older adults and to explore the core symptom in the symptom networks. This study used three-wave data from the China Health and Retirement Longitudinal Study (CHARLS) in 2013 (T1), 2015 (T2), and 2018 (T3). Depressive symptoms were measured by the 10-item Epidemiological Research Center for Depression Scale (CES-D). A multilevel vector autoregression model (VAR) was used to identify 10 depressive symptoms dynamically interacting with each other over time. A total of 3558 participants were included in the final analysis. The strongest direct effects were “D10: felt fearful” -> “D6: felt everything I did was an effort” (β=0.14). “D10: felt fearful” reported the largest value of out-predictability (r=0.064) and out-strength (r=0.635). “D3: felt depressed” reported the largest value of in-predictability (r=0.077) and in-strength (r=0.545). Substantial heterogeneity in the network may stem from an individual’s gender and living region. “Felt fearful” was the strongest predictor compared to the other nine depressive symptoms based on node centrality. It was also the most crucial bridge node between negative symptoms cluster and positive affects cluster. Network density and the sum of all absolute strength centrality should also be incorporated into clinical practice as key indicators of emotional vulnerability, particularly in male middle-aged and older adults.
THE INFLUENCE OF TREATMENT DELAY INCREASE RISKS OF CANCER MORTALITY AMONG OLDER ADULTS: A POPULATION-BASED STUDY
Authors: Cambia Jansen , Orlina Edmund Cedric , Liu Jason Jiashuan
Published: December 2022

Treatment delays during the ongoing COVID-19 pandemic has worsened oncologic outcomes, such as increasing early mortality among older adults. We investigated the association of treatment delay on the 2-year and 5-year risk of all-cause mortality, and stratified among age ≤60 and age >60 years. This was a retrospective study of cancer patients using the Department of Health-Rizal Cancer Registry (DOH-RCR) from 1971–2012. We employed Poisson regression analysis to compare the risk of death among patients with different treatment delay lengths, defined as interval from diagnosis to treatment of ≤30 days, 31–60 days, and >60 days. We included 16,472 cancer patients. After adjusting for confounding, the 2-year risk of death was significantly higher among patient with treatment delay of >60 days by IRR=1.27 [95% CI=1.2–1.3] and 5-year risk by IRR=1.21 [95% CI=1.2–1.3], compared to delay of less than 60 days. Consistent findings were observed by age-groups, revealing that delay of >60 days puts age≤60 and age>60 years at higher risk of 5-year mortality, by IRR=1.21 [95% CI=1.2–1.3] and IRR=1.20 [95% CI=1.1–1.3], respectively. Treatment delay was associated with overall cancer mortality for cancer diagnoses at any age range. However, further investigation is needed to understand the predictors of longer treatment delay, which may provide consolation to balanced care during the current pandemic.
MULTI-CASE STUDY OF A NOVEL HEALTHCARE DELIVERY MODEL TO SUPPORT AGING IN PLACE IN RURAL, REMOTE, AND SMALL URBAN AREAS
Authors: Hulko Wendy , Mirza Noeman , Rush Kathy , Hemingway Dawn , de Leeuw Sarah , Plamondon Katrina , Bartle Emily , Chisholm Lilly
Published: December 2022

Aging in place has long been a policy objective in Canadian healthcare, with accompanying concerns about older adults in rural and remote regions, and growing interest in small urban areas as distinct from large urban ones. As one of the six health authorities in British Columbia (BC), Interior Health (IH) developed and implemented an innovative healthcare delivery model to support aging in place for older adults, while addressing system issues of cost containment and resource allocation. By transferring funds from acute care to primary care, IH created Seniors Health and Wellness Centres (SHWCs) in two small urban areas (Kelowna and Kamloops) and a third one with two rural sites (Salmon Arm and Revelstoke). Our multi-case study aimed to compare how the SHWCs are meeting their objectives, and addressing the priorities of rural and small urban older adults and their social determinants of health (SDoH). We used mixed methods of data collection and analysis, including key informant interviews (n=9), service user questionnaires (n=10), document analysis (n=19), and secondary data analysis of service usage (n=2343) to answer research questions (RQs) on the outcomes and impacts of IH’s restructuring. The results show the outcomes (RQ1) to be three SHWCs which vary considerably in their design and usage, including access, quality, and continuity of care. Our findings on the impacts (RQ2) indicate the SHWCs are meeting their cost reduction aims while concentrating on some SDoH (income & dis/ability) and neglecting others (gender, racism, rurality), and progressing slowly in addressing certain priorities of older adults.