bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining Subjective Aging through the Lens of the Caregiver Experience
Authors: Hardin-Sigler Kristen , Grelle Kaitlin , Deason Rebecca
Published: December 2021

Caregivers of individuals with Alzheimer’s disease and related dementia (ADRD) often experience burden that has been associated with poor physical and psychological health outcomes (Andren & Elmstahl, 2007; Zimmerman et al., 2018). However, very little research investigates how the caregiving experience may impact an individual’s subjective aging experience. Various aspects of subjective aging have been implicated in health outcomes and memory function (Brothers et al., 2017; Stephan, Sutin, Caudroit, & Terracciano, 2016). The purpose of this study was to investigate the differences in perceptions of subjective aging between caregivers and non-caregivers. Participants (N = 185) completed a survey assessing several aspects of subjective aging, including subjective age, or how old an individual feels, memory function, well-being, attitudes towards aging, and aging stereotypes. A series of independent t-tests indicated that there were significant differences between groups on subjective age (p = .013), and subjective memory function (p = .013). Caregivers (n = 93) reported feeling significantly older than their chronological age, reported significantly more subjective memory complaints, and also reported poorer subjective memory function when compared to the non-caregiver (n = 92) control group. Previous literature does suggest that older subjective age ratings are associated with poor subjective memory function, so these results are not necessarily surprising. However, these results suggest that caregiving for individuals with ADRD may negatively impact caregivers’ perceptions of their own aging experience, but not necessarily their perceptions about aging in general.
How Frequently are Caregivers Included in Patient Education for Oncology Patients?
Authors: Fields Beth , Mueller Anne
Published: December 2021

A growing body of literature shows that family and unpaid caregivers of older adults with cancer are assuming more care responsibilities, especially after discharge from an inpatient admission, and frequently report feeling unprepared to do so. Interprofessional collaborative practice can rectify this gap to help ensure caregivers are included in the care team and patient education in the hospital. This retrospective data analysis of electronic health record data examines the prevalence of caregiver involvement in education activities conducted by health care practitioners for older adult cancer inpatients at an academic medical hospital in the midwestern United States. Our dataset includes a total of 676 admissions of older adult cancer inpatients (565 unique patients) between 9/1/2018 and 10/1/2019. Descriptive statistical analyses were conducted to determine the prevalence of caregiver involvement in patient educational activities. The average patient was 75 years old (range: 66-89), white(95%) and male (57%). Approximately 5,720 educational topics were discussed with patients, and 88% of admissions included some patient education. Caregivers were included in 29.6% of educational topics discussed and at least one education session for 42.9% of all admissions. Caregivers are important collaborators in supporting the health and well-being of older adults with cancer, but they are often not included in patient educational activities prior to discharge. Practioners may need to evaluate barriers to including caregivers in patient education activities. A better understanding of this gap in education can help inform future interprofessional collaborative practice initiatives.
Self-efficacy in Thought Control , not Positive Gains, Mediates Effect of Benefit-Finding Intervention for Carers
Authors: Cheng Sheung-Tak
Published: December 2021

This study examines the therapeutic mechanism of the benefit-finding therapeutic (BFT) intervention that used cognitive reappraisal and alternative thinking to construct positive aspects of caregiving (PAC), in a cluster-randomized controlled trial for Alzheimer caregivers. 42 caregivers received BFT whereas 87 received psychoeducation as control. Both interventions were held in groups. Depressive symptoms and global burden were outcomes measured at baseline, postintervention, and 4- and 10-month follow-up. Mediators considered included PAC and three self-efficacies—controlling upsetting thoughts (SE-CUT), responding to disruptive behaviors, and obtaining respite. Using mixed-effects regression, we demonstrated that benefit-finding increased caregivers’ PAC and SE-CUT, but that only SE-CUT uniquely predicted depressive symptoms and global burden longitudinally. Path analyses with bootstrapped confidence intervals showed that SE-CUT change from baseline to postintervention mediated intervention effects on depressive symptoms, but not global burden, at both follow-ups. No mediation effects were found for PAC and the other self-efficacies. As a conclusion, The BFT effect on depressive symptoms was partly accounted for by improvement in SE-CUT. The therapeutic mechanism for the effect on burden remained unknown. The study sheds light on the importance of actively promoting positive caregiver functioning.
Daily Sleep, Well-Being, and Adult Day Services Use Among Dementia Care Dyads
Authors: Liu Yin , Leggett Amanda , Kim Kyungmin , Polenick Courtney , McCurry Susan , Zarit Steven
Published: December 2021

Sleep is critical for health and well-being among both persons with dementia (PwD) and their family caregivers (CG). This study described sleep characteristics for dementia family care dyads, then examined the associations with sleep quality, daytime functioning, and mood in the context of Adult Day Services (ADS) use. Caregivers (n = 173) reported daily bedtime, wake time, and sleep quality for themselves and the persons with dementia across 8 consecutive days (N = 1,359), where PwD attended ADS at least 2 days of the week. They also reported their own fatigue and affect and PwD’s daytime and nighttime sleep and behavior problems on each day. Findings from multilevel models suggested that bedtime was earlier and total time in bed was shorter before an ADS day for the dyad, and also on an ADS day for PwD; wake time was earlier for the dyad on and following an ADS day. Using ADS related to better prior night sleep quality for PwD; it also weakened the association between nighttime sleep problems and higher daytime negative affect for CG. Yesterday’s ADS use buffered the negative impact of shorter total time in bed on CG daytime fatigue; it also buffered the association between nighttime sleep problems and lowered CG daytime positive affect. Regular ADS use may protect against the adverse impact of sleep disturbances on daytime functioning and well-being for dementia care dyads.
Gender-specific predictors of poor sleep quality and insomnia among caregivers of persons living with dementia
Authors: Brewster Glenna , McPhillips Miranda , Yeager Kate , Epps Fayron , Johnson Kalisha Bonds , Hepburn Kenneth , Bliwise Donald
Published: December 2021

Caregiving for a person living with dementia (PLwD) may influence sleep patterns. Gaps exists about whether caregiver and PLwD factors impact sleep differentially based on caregivers’ gender. The aim of this secondary data analysis was to identify predictors of sleep quality and insomnia in a sample of caregivers, stratified by gender, participating in a randomized controlled trial of a psychoeducational intervention. Outcome measures were sleep quality (Pittsburgh Sleep Quality Index, PSQI) and insomnia (Insomnia Severity Index, ISI). Participants (n=261) also completed measures about caregivers’ perceived stress, burden, depression, and self-care, and PLwD’s behaviors (i.e., apathy, sleep disorders). Linear regression modeling was used to identify the overall predictors of poor sleep quality (PSQI > 5; 52% of the sample) and insomnia (ISI > 7; 41% of the sample). Caregivers were primarily female (70.5%), White (73.6%), mean age of 64.6 (±11.2) years, and typically caring for a spouse (65.9%). For male caregivers, predictors of poor sleep quality were assisting the PLwD with instrumental activities of daily living and PLwD neuropsychiatric symptoms (F=4.45, p<.001); while caregiver self-care and PLwD neuropsychiatric symptoms predicted insomnia (F=4.49, p<.001). For female caregivers, the predictors of poor sleep quality were caregiver depressive symptoms and burden, and frequency of PLwD behavioral problems (F=4.46, p<.001); however, only perceived stress predicted insomnia (F=4.32, p<.001). Various factors related to caregiving appear to be more important than others in predicting sleep outcomes of male/female caregivers. Health care professionals should acknowledge gender differences when designing and implementing programs and interventions to improve sleep.
Recognizing and Responding to Elder Mistreatment: Developing and Testing an Online Training for EMS Practitioners
Authors: Haggerty Kristin Lees , Miller Melanie , M. Wardlaw Dana , Campetti Randi , Myint-U Athi , Cannell Brad
Published: December 2021

Elder mistreatment is an urgent and under recognized public health concern with devastating consequences for older adults, families, and health systems. Risk for elder mistreatment has increased during the COVID-19 pandemic, further highlighting the urgency to address it. Prehospital emergency medical service (EMS) practitioners have unique opportunities to recognize signs of elder mistreatment but often lack the training and tools required to facilitate consistent identification and intervention. To address this gap, Education Development Center collaborated with a team of expert advisors and EMS practitioners to develop and pilot test Recognizing and Responding to Elder Mistreatment: An Online Training for EMS Practitioners with funding from the RRF Foundation for Aging. This training aims to prepare EMS practitioners to recognize potential mistreatment and report suspected elder mistreatment in line with state laws and their professional code of ethics. In this presentation, we will describe the iterative development process, present results from a pilot test conducted with EMS practitioners in Massachusetts and share strategies and progress for disseminating the training nationally. The pilot study utilized a pre-post design to assess changes in knowledge, attitudes, and practices at baseline, immediately after and two months following participation in the training. Results indicate statistically significant improvements in knowledge related to elder mistreatment identification and response from pre- to post-training and maintenance of these improvements two months later. Participants reported feeling more prepared to address elder mistreatment in their work as EMS practitioners and applying their new knowledge and skills during the two months following the training.
Social Workers in Primary Care Increase Access to Palliative Care
Authors: Cornell Portia , Halladay Christopher , Gozalo Pedro , Montano Anna-Rae , Celardo Caitlin , Rudolph James
Published: December 2021

Clinical trials show that palliative care improves patient experiences and reduces costs, and use of palliative care and hospice care have been increasing over the past three decades. In the Veterans Administration health care system (VA), Veterans may receive palliative care concurrently with other treatments. However, many barriers exist to the use of palliative care, such as patients’ misperceptions. Social workers in primary care teams may increase use of this valuable service by establishing trust between patient and care team, educating patients and caregivers, and coordinating services. Leveraging a national social-work-staffing program as a natural experiment, we evaluated the effect of hiring one or more social workers to the primary-care team on use of palliative or hospice care among Veterans with a recent hospital stay. Our data included 91,675 episodes of care between 2016 and 2018. 1.45 percent of episodes were followed by use of palliative care or hospice within 30 days. The addition of one or more social workers through the staffing program was associated with an increase of 0.53 percentage points (p<0.001) in the probability of any palliative or hospice care, i.e., a more than 30% increase relative to the mean. Policy makers and health system leaders who seek to improve patient experience and reduce costs through increased access to palliative and hospice care could consider social work staffing as a policy tool to achieve those aims.
Effects of a 6-week integrated dementia prevention intervention in community-dwelling older adults
Authors: Tak Sunghee , Kim Ji-yeon , Ko Hana , Jung SuJung , Lee Jaegyeong
Published: December 2021

This study examined the week of a 6-session integrated dementia p program on dementia knowledge, attitude toward dementia, fear of dementia, and dementia prevention behaviors among community dwelling elders. Using a nonequivalent control group, pre-posttest design, study participants were recruited from a senior center in Seoul, Korea. A total of 40 participants completed the study while half of them were in the experimental group and another half were in the control group. They completed survey questionnaires before and after the program. The findings showed that the program was effective only to decrease the fear of dementia of the older adults. Knowledge, attitude toward dementia, and healthy behaviors may be difficult to change in a short period of time. However, the integrated dementia prevention program may be effective to decrease negative emotions, particularly, fear toward dementia among older adults. The fear of dementia needs to be further assessed individually in order to identify particular causes and triggers and provide tailored interventions.
Understanding the Abnormal Today for Life Tomorrow: A Study of the Generations During the COVID-19 Pandemic
Authors: D'Ambrosio Lisa , D'Ambrosio Lisa
Published: December 2021

The spread of COVID-19 in the United States in early 2020 abruptly transformed American life, with widespread closures of public spaces and businesses, limitations on social activities, and the need for individuals to physically distance from each other. Some changes wrought by the virus may persist post-pandemic - such as Americans' adoption of new technologies or disease prevention behaviors. Since the onset of COVID-related safer-at-home orders, the MIT AgeLab has sought to understand how the pandemic affects people’s attitudes and behaviors. This symposium will present findings drawn from three waves of national, online surveys conducted in 2020: March (N=1202), May-June (N=1,387), and November-December 2020 (N=1444). The surveys explored participants’ COVID-19-related attitudes and behaviors across a range of domains. Each presentation in this symposium will highlight a different focus of cross-generational research conducted over time, with a particular focus on experiences of adults ages 55 and over. The first will focus on participants’ overall health, wellbeing, and perceptions of the COVID-19 vaccine. The second will present experiences of family caregivers of older adults and children. The third will center on the impact of the pandemic on the generations’ retirement and longevity planning experiences. The fourth and final presentation will focus on participants’ attitudes and experiences using and adopting technology. This symposium will deepen attendees’ understandings of multigenerational attitudes and experiences during the COVID-19 pandemic, with a particular focus on the experiences of adults ages 55 and over.
Dementia Care Coaching: A Pilot to Evaluate Acceptability and Feasibility in Care Communities
Authors: Prophater Lorna , Kim Boeun , Belza Basia , Cameron Sarah , Fazio Sam
Published: December 2021

The Alzheimer’s Association (AA) Dementia Care Practice Recommendations (DCPR) outline ten recommendations to achieve quality care with a person-centered focus. The AA has developed tools to assist care communities (CC) to evaluate their status within the recommendations by working with a trained coach to maximize adoption and implementation of these recommendations. The purpose of this pilot was to evaluate the acceptability and feasibility of pairing trained DCPR coaches with CC teams to implement the DCPR tools. Seven CCs were recruited and four received the DCPR overview and self-assessment. Of the four CC, one withdrew and did not receive the intervention. The remaining three were located in a suburban area, nonprofit, and with memory care units. Data was collected from November 2019 through March 2020. Nine CC staff participated with a mean age 35.8 years and had worked for 11.8 years. Baseline mean scores on the Organizational Readiness to Implementing Change (ORIC) scale were 4.6 for the commitment domain and 4.4 for the efficacy domain. Mean scores on the Nursing Home Employee Satisfaction Survey were high. Sixty-nine percent of CC participants were satisfied with their jobs (greater than 4). Findings from mid-project interviews with the coaches revealed difficulty with scheduling appointments, significant efforts needed to get the “right” people at the table and need for the DCPR tools to be more user-friendly. No post-intervention results were collected due to closing of the CCs to visitors due to COVID. The DCPR tools shows promise and are being evaluated in additional CCs.
Parenting Stress and Mental Health in Midlife Adults: Evaluating the Role of Gender
Authors: Choi Jean , Munoz Elizabeth , Corley Robin , Wadsworth Sally , Reynolds Chandra
Published: December 2021

Parenthood is a major source of stress in midlife that can have adverse consequences for long-term mental health trajectories. Yet, little research asks how parenting stress impacts mental health for both mothers and fathers in midlife. The current study examined (a) whether parenting stress was associated with parental depressive and anxiety symptoms and (b) whether these associations vary by gender. We utilized data from the ongoing Colorado Adoption/Twin Study of Lifespan behavioral development and cognitive aging (CATSLife); participants were aged 28 to 49 who reported having child(ren) (N = 520). Participants completed surveys that encompassed measures of demographics, relationships, health, and well-being. Overall, multilevel models accounting for non-independence among siblings and with relevant covariates (e.g., number of children, marital status) showed that higher levels of parenting stress were associated with greater depressive (b = .47 (.12), p<.001) and anxiety (b = .27 (.09), p<.05) symptoms. An evaluation of the individual parenting stress items indicated that feeling less happy and more overwhelmed in the parental role were significantly associated with higher levels of anxiety and depressive symptoms. Parents who reported feeling less close to their children were also significantly more likely to report greater levels of depressive symptoms. These effects were consistent across mothers and fathers. Our study provides further insight into the negative associations between parenting stress and mental health among both mothers and fathers, and warrants further investigation into resources that may buffer these negative effects prior to late life.
The Long-Term Impact of Childhood Disability on Mental Health in Mid- to Late-Adulthood
Authors: West Jessica
Published: December 2021

For decades, life course and stress process scholars have documented that negative, stressful experiences in childhood have consequences for health across the life course. One aspect of the childhood adversity that deserves more research attention is childhood disability. Children with disabilities experience higher levels of psychological distress compared to their peers and having a disability can negatively impact traditional markers of the transition to adulthood (e.g., education, employment, family status). At present, there is limited evidence regarding the impact of childhood disability on mental health over multiple years of adulthood. This study applies random effects models to nationally representative data from five waves (2008-2016) of the Health and Retirement Study (n=15,380; n=590 with a childhood disability), to examine how experiencing disability before the age of 16 shapes depressive symptoms over multiple years of adulthood. Given known gender differences in mental health, the models are stratified by gender to examine how the association between childhood disability and adult mental health varies by gender. Preliminary results suggest that experiencing a childhood disability is associated with different patterns of depressive symptoms in adulthood. Men who experienced childhood disability report more depressive symptoms in adulthood, net of sociodemographic, adult health, and childhood disadvantage covariates. Women who experienced childhood disability report more depressive symptoms in adulthood, net of all covariates except for childhood depression. Next steps are to conduct age-based growth curve models using Stata’s mixed function to estimate whether childhood disability influences baseline and growth of depressive symptoms in adulthood.
Technology acceptance and depressive symptoms among community-dwelling older people
Authors: Kang Suk-Young , Kim Jeungkun , Winthal Jeffrey , Lenz Rosemarie
Published: December 2021

Depression is a major public health issue among older adults, with an estimated prevalence between 5% and 10%. The aim of this study is to explore the possible benefits technology acceptance has in reducing depression among older people. Mail-survey data were collected from community-dwelling adults over the age of 65. This method was chosen over face-to-face surveys due to Covid-19. There were 192 total participants. The GDS-5 was used to measure the level of depressive symptoms. Among the participants, 25 participants (13%) scored higher than 2, indicating the presence of depression. Using a hierarchical regression analysis revealed that the equation explained 42.4 % of the variance (adjusted R square =.382) in levels of depression (F (3,176) = 9.973, p <.000). Variance inflation factor (VIF) values were smaller than 10, indicating that multicollinearity among the correlates was not an issue. The correlates of the level of depression were: level of education, overall physical health, level of loneliness, perceived ease of technology use, attitude toward technology use, and intent to purchase new technology for older people. Results indicate that a positive attitude toward technology use might be inversely associated with depression levels. This shows how quality of life related to mental health may be improved by a change in attitude in favor of technology use. Participants were interested in learning to use new technology, and would like more opportunities to do so. Policy changes that increase lifelong learning options would help to make this happen.
Predictors of COVID-19 Related Stress Among Custodial Grandmothers
Authors: Jeanblanc Alexandra , Dolbin-MacNab Megan , Musil Carol , Smith Gregory
Published: December 2021

This paper examined predictors of COVID-19 stressors among 316 custodial grandmothers raising school-aged grandchildren using regression. Grandmothers, who were participants in two nationwide behavioral RCTs, completed an online questionnaire in Spring 2020. Predictors included grandmother demographics, depressive symptoms, perceived caregiving stress and reward, stress management strategies, and grandchild factors. Outcomes included grandmothers’ stress related to using bad coping habits (r2=.24), grandchildren’s remote learning(r2=.39), household conflict (r2=.29), COVID-19 fear and uncertainty (r2=.28), and finances(r2=.24). Regression results indicated that grandmothers’ pre-existing depressive symptoms predicted all outcomes except remote learning stress. Higher caregiving stress was associated with all outcomes, except concerns about using bad coping habits. Grandmothers with less perceived access to care reported greater concern about bad coping habits and remote learning stress, while minority grandmothers reported more financial stress and COVID-19 fear and uncertainty. Findings suggest that the COVID-19 pandemic has compounded the stress experienced by already burdened custodial grandmothers.
Evaluating The Economic Impact Of Marriage Versus Cohabitation In Same-Sex Couples Age 50+
Authors: Massihzadegan Setarreh , Mutchler Jan
Published: December 2021

Utilizing the first set of 5-year American Community Survey data available since the United States’ legalization of same-sex marriage in mid-2015, this poster investigates the economic security of older adults (age 50+) in same-sex marriages compared to those in same-sex partnerships who are cohabiting but not married. Viewed through the lens of cumulative disadvantage theory, we consider differences in the economic circumstances of same-sex couples by gender and by geographic location. Findings point to gender differences in economic well-being, but relatively few differences based on marital status. For example, rates of low income are somewhat higher among female couples than among their male counterparts, but marital status differences are not substantial. These findings suggest that the benefits of being married that have long been recognized among older adults may not extend equally to same-sex couples. Findings are discussed with respect to the emerging salience of marriage within the LGBTQ older community, future research opportunities, and important policy implications.
Cultivating a Patient-Centered Environment (CAPE): Renovations in Long-Term Chronic Care
Authors: Howard Elizabeth , Retalic Tammy
Published: December 2021

Achieving institutional goal of full, person-centered care was encumbered by an outdated structural “hospital model” at one long-term care facility that undertook building renovations, transforming long hallways into “neighborhood” of compact households. Quality of Life Survey and Long-term Care Minimum Data Set generated data at baseline and 1-year follow-up, comparing renovated(RU) and non-renovated unit(NRU) residents (n=36) to evaluate achievement of person-centered care. RU residents indicating they could “eat when I want” increased 75% to 81% at follow-up and decreased 17% for NRU residents. Sixty-seven percent of RU residents reported bathing “when they want” in contrast to 40% of NRU residents. Most RU residents agreed, “staff act on my suggestions.”More RU residents (68% vs 53%) agreed: “I spend time with other like-minded residents” and more RU residents (86% vs 43%) reported opportunity to explore new skills, interests. RU residents more often reported (50% vs 37%) “people ask for my help or advice.” Similar differences were observed with “it is easy to make friends here,” 67% RU residents responding affirmatively. RU residents reporting “feeling down” improved, moving from 46% to 50% disagreeing with this item with while increased number of NRU residents (18% to 22%) reported “feeling down” at follow-up.Improvement with independent performance of bed mobility, transfer, walking, and dressing among RU residents was observed while NRU residents had decreased percentages of independence. Evaluation of resident outcomes demonstrated improvement with personal choice, activities, personal relationships, functional independence and mood. Physical unit renovations appear to enhance implementation of person-centered care model.
Failure to Thrive: Nursing Home Staff Experiences in Caring for Residents during the COVID-19 Pandemic
Authors: Chang Yu-Ping , Raciti Audrieanna , de Rosa Cristina , Doerzbacher Margaret , ZHou Yanjun , Chen Chia-Hui , Lyons Amy
Published: December 2021

Nursing home residents and staff have accounted for roughly 40% of Coronavirus-related deaths in the U.S. The burden of caring for vulnerable residents coupled with isolation policies has taken a significant emotional toll among direct health care staff in long term care facilities. This study explores nursing home staff’s experiences in caring for residents during the COVID-19 pandemic. A qualitative descriptive approach with a semi-structured guide was used to conduct individual interviews. We recruited nursing home staff employed during the COVID-19 pandemic in long term care facilities located in New York State. Interviews were recorded, transcribed verbatim, and then analyzed using Braun and Clarke’s Reflexive Thematic analysis. Twelve nursing home staff were interviewed. Participants consistently refer to failure-to-thrive as an extremely concerning problem because many residents demonstrate decreased appetite and poor nutrition, inactivity, and depressive symptoms due to social isolation. They also often feel frustrated and overwhelmed due to uncertainty and shortages of staff. Five main themes were identified, including doing their best to manage residents’ failure-to-thrive, working as a team, keeping family members informed and connected, struggling to balance competing personal and professional demands, and needing support to reduce stress and build strength. Our study findings indicate that nursing home staff experienced a high level of stress and identified failure-to-thrive caused by isolation and loneliness as a common phenomenon among nursing home residents during the COVID-19 pandemic. Interventions are urgently needed to reduce isolation and loneness in nursing home residents and to provide support for staff.
Indicators of Elder Mistreatment: Correlates among Veterans Receiving Care in the Veterans Health Administration
Authors: Jedele Jenefer , Griffin Cameron , Weitlauf Julie
Published: December 2021

Among community-dwelling adults ages 65 and older, approximately 11% have experienced elder mistreatment (EM), including physical, emotional or sexual abuse, neglect, or financial exploitation. EM research typically focuses on this age group; however, Veterans receiving Veterans Health Administration (VHA) care have increased earlier morbidity, which may accelerate the impacts of EM. Using a cohort of all VHA Veterans 50 years and older with VHA use in 2018-2020, we examined correlates of EM. ICD-10 codes from clinical encounters identified Veterans with indications of EM (n=4,427). A 10% sample of Veterans without indications of EM was selected for comparison (n=530,535). Logistic regression compared EM+ Veterans to the comparison sample and assessed overall demographic and clinical differences as well as differences by age, i.e. 50-64 versus 65 and older. Overall, female gender (OR=5.3, 95% CI=4.3-6.5), non-white race/ethnicity (OR=1.7, CI=1.5-1.9), dementia (OR=3.0, CI=2.6-3.5), PTSD (OR=2.0, CI=1.6-2.5), anxiety (OR=1.3, CI=1.0-1.5), military service connected disability status (OR=1.3, CI=1.1-1.5), and higher Elixhauser medical morbidity scores (OR=1.1, CI=1.1-1.1) were associated with EM. Prior year ER visits (OR=28.0, CI=23.6-33.4), inpatient stays (OR=14.0, CI=11.5-17.0), and mental health visits (OR=26.1, CI=22.2-30.6) also predicted EM+ status. Forty-six percent of VHA Veterans with indicators of EM were aged 50-64. For these Veterans, female gender, PTSD, service connection, and mental health visits were associated with increased risk of EM compared to Veterans 65+. Findings highlight clinical correlates of EMs among Veterans in VHA care. Increased awareness of EM risk factors is warranted and may inform VHA efforts for EM prevention, detection and intervention.
Living in the New Normal: Effect of Residential Setting on Perception of a Meaningful Life among Older Women
Authors: Scott Judith , Graham Helen , Mayo Ann , Benton Melissa
Published: December 2021

Perception of a meaningful life is related to depression, anxiety, and general well-being. The sense that one’s life is meaningful influences overall quality of life, which influences aging well. It is not clear whether differences in residential setting influence perception of a meaningful life. This study evaluated the effect of residential setting (community versus assisted living) on perception of a meaningful life in 48 older (79.7 ± 1.0 years) women living in the community (n=24) or assisted living (n=24) who were pair matched by age. They completed a one-time questionnaire regarding self-rated health and whether life has meaning. Both questions were scored on a 5-point scale with 0 indicating poor health or no life meaning and 4 indicating excellent health or strong life meaning. There were no significant differences in age between women in community living (CL) and assisted living (AL) (78.0 ± 09 vs. 81.5 ± 1.6 years, respectively; p=0.7). Both groups also reported similar self-rated health scores (CL: 2.4 ± 0.2; AL: 2.2 ± 0.2; p=0.4), indicating good-very good health. However, there were significant differences between groups in their perception of a meaningful life. Women in CL reported significantly lower scores compared to women in AL (2.9 ± 0.2 vs. 3.6 ± 0.1; p=0.006), indicating that women in CL perceived a less meaningful life. Based on our findings, it appears that the supportive infrastructure provided by AL residential settings may promote quality of life and successful aging by enhancing the perception of a more meaningful life.
The Impact of Unmet ADL Need on the Self-Rated Health and Life Satisfaction of Chinese Older Adults
Authors: Huang Jing , Choi Edmond Pui Hang , Chau Pui Hing
Published: December 2021

This study aims to examine the associations of change in unmet need for assistance with Activities of Daily Living (ADL) with the self-rated health and life satisfaction of community-dwelling Chinese older adults. Using national longitudinal data from the Chinese Longitudinal Healthy Longevity Study, we examined the associations of unmet ADL need with self-rated health and with life satisfaction from baseline (T1) to a 3-year follow-up (T2) among 1,914 older adults with ADL limitation. Change in unmet ADL need was categorized into “Persistently Unmet”, “Unmet at T1 Only”, “Unmet at T2 Only”, and “Never Unmet”. Self-rated health and life satisfaction were rated by 5-point Likert scales. Linear mixed models were performed to examine the associations, controlling for sociodemographic factors, health conditions, and social support. The results showed that older adults whose ADL needs were persistently unmet, those unmet at T2 only, and those never unmet, experienced a significant decline in self-rated health from baseline to follow-up, but those unmet at T1 only experienced a significant rise in self-rated health. While the life satisfaction was stable from baseline to follow-up among older adults whose ADL needs were persistently unmet or never unmet, it significantly decreased among those unmet at T2 only and significantly increased among those unmet at T1 only. The effects of unmet ADL need on self-rated health and life satisfaction appeared to be short-term rather than long-term. These findings facilitate a better understanding of unmet ADL need and emphasize the importance to fully meet the ADL needs of older adults.
Women with Obesity Are More Likely to Have Long-Term Indwelling Bladder Catheterization in U.S. Nursing Homes
Authors: Harris John , Ackenbom Mary , Trinkoff Alison , Handler Steven , Engberg John , Wolf David , Castle Nicholas
Published: December 2021

Reducing indwelling catheters and increasing clean intermittent catheterization is a key element of effective infection control and maintaining functional independence in nursing homes. Nursing care is often more difficult as obesity increases, leading to more nursing care or equipment to provide care. We hypothesized that nursing homes are more likely to use indwelling catheters for people with obesity because indwelling catheterization likely eases the nursing burden of toileting and personal hygiene care for residents with obesity. The study design was a retrospective cohort study of U.S. nursing home female residents in Minimum Data Set in 2013. Obesity and normal weight (the reference group) were categorized using National Institutes of Health criteria. Indwelling and intermittent bladder catheterization was defined during periodic assessment of residents. We modeled the outcomes using logistic regression using a robust variance estimator. Model covariates included obesity category, resident age, dementia status, comatose status, Stage 3 or 4 pressure ulcers, and the number of activities of daily living deficits. The study cohort included 1,068,388 female residents in 15,230 nursing homes. Obesity (BMI ≥ 30 kg/m2) prevalence was 31.9%. The prevalence of indwelling catheterization was 5.2% and of intermittent catheterization was 0.4%. The odds ratio of indwelling catheter use for obese residents varied from 1.05 to 1.74 (all with p-values <0.001), whereas the odds ratio. of intermittent catheter use varied from 0.84 to 0.46 (all with p-values <0.01) compared to residents of normal weight. Increasing obesity is independently associated with increased long-term indwelling bladder catheterization and decreased intermittent catheterization.
Development of a Multi-Modal, Dyadic Intervention for Persistent Pain: A Qualitative Study
Authors: Fox Aimee , Fruhauf Christine , Portz Jennifer , Van Puymbroeck Marieke , Sharp Julia , Leach Heather , Schmid Arlene
Published: December 2021

People who experience persistent pain often require help from a family member, partner, or friend. These caregivers frequently have pain, but are often not included in interventions. Caregivers and care-receivers who both experience pain are more likely to be socially isolated, experience communication conflict, and have decreased quality of life. Interventions should target caregiving dyads to help them manage their pain together. Feasibility studies that include manual development, intervention evaluation, and refinement of intervention manuals support randomized controlled trials and help move interventions from research to practice. Thus, the purpose of this qualitative study was to explore (a) the needs of caregiving dyads, (b) input from medical and allied health experts, and (c) feedback from intervention facilitators and evaluators, informing the development and refinement of an intervention manual for people with persistent pain. A total of 16 caregiving dyads and one individual (caregiver couldn’t participate) experiencing pain participated in focus groups. Eight experts then participated in a focus group or one-on-one interview. Lastly, after the intervention ended, 15 intervention facilitators and fidelity evaluators participated in one focus group. Data were uploaded into NVivo software and analyzed using constant comparison. Findings identified the importance of interventions to focus on pain interference, novel and modifiable approaches to managing pain as a dyad, and addressing the emotional and psychological effects of experiencing pain. Using qualitative approaches to develop, test, and refine an intervention manual enhances the relevancy, acceptability, and translation of our intervention to meet the needs of caregiving dyads experiencing pain.
Gender Differences in Pain: Examining Explanations for the Association
Authors: Michael Cherish , Barrett Anne
Published: December 2021

Physical pain is a gendered experience: Women report higher levels of it than do men. This pattern may stem from differences in experiences of the body. Women are socialized to be attentive to its functioning, appearance, and sensations, while men are discouraged from paying much attention to their bodies. Little is known, however, about the precise social and economic pathways leading to gender differences in pain, especially in middle and later life when pain is most prevalent. We examine this issue using data from Wave 3 of Midlife in the United States (2013-2014). We consider four possible explanations for women’s more frequent reports of pain: economic security, physical and mental health, social relationships, and discrimination. Results indicate that women are more likely than men to report experiencing chronic pain, as well as greater effects of it on their everyday lives. However, only two of the explanations contributed to explaining this association. Economic security and physical and mental health accounted for substantial portions of the association between gender and pain – 57 and 73 percent, respectively. In contrast, no mediating role was observed for either women’s social relationships, in particular the greater strain they experience in them, or their more frequent reports of everyday and lifetime discrimination. The final model including all the possible explanations revealed that gender was no longer significant, suggesting that middle-aged and older women’s greater pain is explained by their worse health and economic circumstances.
A Coordinated Analysis Examining the Association Between Personality Traits and Cognitive Dispersion
Authors: Yoneda Tomiko , Marroig Alejandra , Willroth Emily , Graham Eileen , Hofer Scott , Mroczek Daniel , Muniz-Terrera Graciela
Published: December 2021

Cognitive dispersion is the degree of within-person variation in performance across cognitive tasks at the same testing occasion. Existing literature indicates that cognitive dispersion may be an early marker of poor brain health, dementia and mortality. Limited research, however, has examined individual differences in cognitive dispersion. Although personality traits are associated with individual differences in cognitive functioning, no research has examined personality and cognitive dispersion. In this project, we execute a pre-registered, coordinated analysis of seven diverse, international longitudinal studies of aging (Ntotal=33,581; mean age range=56.4-71.2) to investigate the extent to which the Big Five personality traits are associated with cognitive dispersion. For methodological approach, see /osf.io/wrnjq/. Cognitive dispersion scores were derived from cognitive test results, and independent linear regression models were fit independently in each study to examine personality traits as predictors of dispersion scores, adjusting for mean cognitive performance and socio-demographics (age, sex, education). Results from individual studies were synthesized using random-effects meta-analyses. Results revealed minimal evidence for associations between cognitive dispersion and personality traits in independent analyses or in meta-analyses. Based on the meta-analytic estimates, only higher levels of openness were associated with greater cognitive dispersion. Mean cognitive scores were negatively associated with cognitive dispersion across the majority of studies, indicating that individuals with higher mean performance had less dispersed cognitive scores. Our study contributes to the replicability and transparency efforts characteristic of open science by pre-registering our study and drawing on the collaborative network of the Integrative Analysis of Longitudinal Studies of Aging and Dementia (IALSA).
Impact of Personality Features and Interpersonal Problems on Anxiety Among Older Adults
Authors: Noel Olivia , Segal Daniel , Granier Katie , Pifer Marissa , Stone Lisa
Published: December 2021

Introduction: Anxiety is a significant mental health problem among older adults and is associated with multiple other mental disorders, poor psychosocial functioning, and reduced quality of life. Personality traits and disorders, along with interpersonal problems, may play a significant role in anxiety, but these relationships are not well understood among older adults. This study examined relationships between anxiety with normative personality traits, personality disorder (PD) features, and interpersonal problems. Method: Community-dwelling older adults (N = 130) completed the Geriatric Anxiety Scale (GAS), Coolidge Axis Two Inventory (CATI), Big Five Inventory-2 (BFI-2), and Circumplex Scales of Interpersonal Problems (CSIP). Results: Anxiety was positively correlated with 13 of 14 CATI PD scales, ranging from .23 (Narcissistic) to .61 (Depressive). Regarding normative personality, anxiety was associated with Agreeableness (-.23), Conscientiousness (-.30), Extraversion (-.31), and Negative Emotionality (.56). Regarding interpersonal problems, anxiety was positively related to all eight CSIP scales: Self-Sacrificing (.30), Domineering (.31), Exploitable (.40), Intrusive (.41), Self-centered (.47), Nonassertive (.50), Socially Inhibited (.60), and Distant/Cold (.62). Regression analyses indicated that PD features accounted for the most variance in anxiety (53%), followed by interpersonal problems, (46%) and normative personality traits (33%). Discussion: Anxiety appears to be meaningfully associated with PD features, several aspects of normative personality, and interpersonal problems, suggesting that these variables may play a role in the development of anxiety, or vice versa. Our findings especially speak to the growing awareness of the deleterious impact of PD features on clinical syndromes in later life, as evidenced by strong comorbidities with anxiety.
Effects of Tai Chi on Biomarkers and Their Implication to Neurorehabilitation – A Systemic Review
Authors: Liu Howe , Salem Yasser
Published: December 2021

Introduction: As an effective holistic therapeutic exercise program, Tai Chi (TC) has been widely used for patients with a variety of neurological disorders. In last 1-2 decades, there has been an increase in the number of research studies that examined the TC effects on biomarkers andIntroduction: As an effective holistic therapeutic exercise program, Tai Chi (TC) has been widely used for patients with a variety of neurological disorders. In last 1-2 decades, there has been an increase in the number of research studies that examined the TC effects on biomarkers including inflammatory cytokines, oxidative stressors, and neurotrophic factors. Thus, the purpose of this article is to review such effects and their possible implications to neurorehabilitation. Method: In this systematic review, we searched TC-related articles from the last 15 years until July 2020 that had investigated changes of biomarkers after TC practice. The search identified 24 studies that were included in our analysis. Results: It is found that TC practice is able to 1) reduce pro-inflammatory and increase anti-inflammatory cytokines (including Interleukins -1, 6, 10, 12, tumor necrosis factor, the nuclear factor kappa-light-chain-enhancer of activated B cells, and the C-reactive protein); 2) decrease oxidative stress factors (like plasma 8-isoprostane, malondialdehyde, and protein carbonylation); and 3) increase neurotrophic factors (brain-derived neurotrophic factor (BDNF), and N-Acetylaspartate). Conclusions: TC may take effect on patients with neurological dysfunctions through anti-inflammation, anti-oxidative stress, and neural health promotion.