bluuebunny/crossref_metadata_2025 huggingface dataset:
CAREGIVER CHALLENGES: SOCIAL SUPPORT FOR DEMENTIA CARE OF OLDER ADULTS DURING HOSPICE ENROLLMENT
Authors: Cho Hannah , Sefcik Justine , Washington Karla , Oliver Debra Parker , Demiris George
Published: December 2023

Every year, many ADRD patients rely on informal caregivers for providing care during hospice enrollment. Driven by dedication, these caregivers play a vital role. However, their responsibilities intensify over time, leading to emotional strain. Inadequate support causes burnout and stress. Limited research targets the unique needs of caregivers of ADRD patients enrolled in hospice. The purpose of this study was to describe the caregivers’ experiences regarding social support while providing care for older adults with ADRD in hospice. A qualitative descriptive approach was taken with semi-structured interviews of 20 caregivers of ADRD hospice patients (85% female; mean age [SD]: 63.75 [12.1]), including both Caucasian (70%) and African American (30%) individuals. Through content analysis, we identified three themes that described caregivers’ experiences with social support: 1) Changes in social life (e.g., homebound, stress, and family conflicts), 2) Opportunities for social connection (e.g., social support systems with family, friends), 3) Communication Modalities. These findings offer crucial insights into the diverse range of experiences caregivers face regarding social support. Additionally, it highlights the significance of caregivers needing assistance to sustain connections, take essential breaks, and adapt to shifts in their social environments. The challenges they confront and the positive elements of the support they receive are brought to light through this study. Further research into effective communication modalities and respite services could significantly enhance caregivers’ support.
CELLULAR RESILIENCE AND THE AGING HEART: UNDERSTANDING MITOCHONDRIAL INJURY MECHANISMS USING THE BABOON
Authors: Adekunbi Daniel , Reilly Elizabeth , Sanchez-Reilly Sandra , Li Cun , Nathanielsz Peter , Cox Laura , Salmon Adam
Published: December 2023

Background

Aging-related cardiovascular disease is deadly worldwide. Cardiac aging in non-human primates (NHP), including baboons, is similar to humans, and intrauterine growth restriction animal models (IUGR) have shown to accelerate cardiac aging and foment cardiomyopathies. Objective: To measure and compare basal and metabolically stressed mitochondrial function among cardiac fibroblasts (CF) isolated from control vs. prematurely older (IUGR) baboons.

Methods

CF were isolated from IUGR and control baboon hearts under standard conditions (25mM Glucose). Additional subgroups were exposed to Metabolic Stress (MS-exposed to 2-hours of low glucose, 1mM). Mitochondrial Oxygen Consumption Rate (OCR) and extracellular acidification rate (ECAR) were measured via Seahorse XFe96 instrument.

Results

Donor Age: 13.27 – 17.52 years (elderly baboons), Male/Female data combined, n=4-5. OCR was higher in control relative to IUGR among all groups. ATP demand and non-mitochondrial respiration had similar values between control and IUGR. MS impacted CF bioenergetics similarly in control and IUGR. ECAR was higher in MS cells in both control/IUGR. OCR:ECAR ratio was higher in control vs IUGR while MS lowered OCR:ECAR ratio in control to levels comparable to IUGR.

Conclusion

Higher OCR indicated increased metabolic demands of aging cells depending on glycolysis for survival. MS significantly impaired mitochondrial function across all cardiac cells regardless of aging. IUGR not only accelerated cardiac aging but impaired basal and metabolic response of CF. CF retain metabolic characteristics of their donor status and represent a cardiac aging model to explore mitochondrial injury mechanisms, understand cellular resilience and subsequently develop protective translational interventions.
CENTENARIAN PHYSICAL FUNCTION EVOLUTION AND COVID-19 IMPACT: A STUDY IN JAPAN
Authors: Zhang Xinyu , Gondo Yasuyuki
Published: December 2023

Studies show that centenarians’ physical function and ADL levels improved in the recent cohort. However, it is unclear whether this positive trend has altered due to the COVID-19 pandemic. Recent studies indicated that physical function decreased even in younger older adults because of the limited daily activity during the pandemic period. Is this true for centenarians? This study has two aims: firstly, to investigate whether the physical function of Japanese centenarians has improved over the years; secondly, to examine the impact of COVID-19. We used the data collected from 2014 to the present day in Kyotango City. The City Hall has been collecting data including the functional status of all centenarians who turned 100 years old every year. In this study, we divided nine years into three periods: 2014-2016 (P1), 2017-2019 (P2), and 2020-2022 (P3). For each period the number of participants was 122, 116, and 153. The results revealed that the prevalence of bedridden centenarians showed an upward trend over the years. Concurrently, the proportion of centenarians capable of unrestricted mobility exhibited an upward trajectory from P1 to P2, followed by a subsequent decrease from P2 to P3. In conclusion, if there was no COVID-19 pandemic, the functional level of Japanese centenarians could be improved over the years. At the same time, the gradually increasing trend of bedridden centenarians might indicate intensive medical and institutional care enables centenarians with fragile conditions to survive.
CHARACTERIZING NURSING HOME VISITATION POLICIES AND PROCESSES DURING THE COVID-19 PANDEMIC
Authors: Hawes Courtney , Brazier Joan , Meehan Amy , Gabois Emily
Published: December 2023

The COVID-19 pandemic drastically changed how nursing homes facilitated visitation between residents and their families. Nursing homes needed to modify visitation approaches in response to changing policies and guidelines from varying governing bodies. Additionally, restrictions were constantly adjusted due to fluctuations in COVID-19 infection rates within facilities and the larger communities in which they exist. Through data from 156 in-depth, semi-structured interviews with nursing home administrators, conducted at three-month intervals throughout the COVID-19 pandemic, administrator experiences are captured as they navigated these changes. Interviews provide valuable insight into strategies used during shut-down of in-person visitation, allowance of compassionate care and essential caregiver visits, and the resumption of in-person visitation, while also demonstrating the challenges of each visitation stage and the second-hand emotional responses of resident families. During the shut-down of in-person visitation, facilities conducted virtual visits and implemented new strategies including parades and window visits. Compassionate care and essential caregiver visits were used for those in hospice or experiencing weight loss and depression resulting from restrictions, though some administrators reported being flexible in their definitions of compassionate and essential caregiver visits. When in-person visitation resumed, interviews highlight the use of screening, social distancing, and monitoring during indoor visitation, as well as the approaches facilities took to respond to the challenges of staffing shortages and outbreak concerns. Study findings provide insight into how facilities may navigate future visitation changes and restrictions to maximize safety, the overall well-being of residents and the efficiency of facilitating visits.
CHATGPT, WHAT IS A DEDUCTIBLE? DIGITAL ASSISTANTS AS AN INFORMATION SOURCE FOR MEDICARE QUERIES
Authors: Langston Emily , Charness Neil , Boot Walter
Published: December 2023

Since being first introduced to the public in late 2022, chatbots that are based on large language models (LLMs) have attracted a great deal of attention. However, despite their popularity, these chatbots have been shown to give inaccurate information in response to user queries. Several polls conducted in 2022 suggest that the public is generally skeptical about the use of Artificial Intelligence (AI), particularly in the context of healthcare, and older adults are the most distrustful age group, despite the fact that they are the least likely to have interacted with an LLM such as ChatGPT. Meta-analysis on trust in AI has shown that users are most influenced by the accuracy and reliability of the AI trustee. In our study, we assessed the accuracy of speaker-based assistants, Alexa and Google Assistant, as well as two LLMs, Bard and ChatGPT4 on Medicare terminology and knowledge and compared their accuracy to that of a large representative sample of Medicare beneficiaries. Google Assistant was found to perform significantly worse than beneficiaries on both terminology and knowledge questions. Alexa was found to perform significantly worse than beneficiaries on terminology questions. Conversely, both Bard and ChatGPT4 were found to perform significantly better than beneficiaries on both terminology and knowledge questions. We conclude that Medicare beneficiaries should not rely on Google Assistant for terminology help or general knowledge queries, nor should they rely on Alexa for terminology help. ChatGPT4 and Bard are potentially valuable resources for beneficiaries with terminology-based and general knowledge queries.
CHILDHOOD ADVERSITY IS ASSOCIATED WITH MENTAL HEALTH BUT NOT COGNITIVE DECLINE IN OLDER ADULTS
Authors: Lian James , Kiely Kim , Callaghan Bridget , Anstey Kaarin
Published: December 2023

Objective

The aim of this study was to examine the association between childhood adversity and mental health and cognition in older adults.

Methods

The sample included older Australian adults from the Personality and Total Health (PATH) Through Life Project (N = 2551). Childhood adversity was measured using a 17-item scale of domestic adversities (e.g., poverty, neglect, physical abuse, verbal abuse) and modelled using cumulative risk analysis (LCA). Mental health was measured using four validated depression and anxiety questionnaires and cognitive impairment was determined by a clinically validated algorithmic diagnostic criteria. The association between childhood adversity and late-life mental health was estimated using generalised additive models, and the association with cognition utilised multiple logistic regressions. Models were adjusted for gender, race, and education.

Results

Generalised additive models indicated that a greater number of cumulative adversities were associated with poorer scores on all four mental health measures. No notable interactions between ACEs and gender were observed. In contrast, there was no association between childhood adversity and cognitive impairment in any of the tested logistic regression models. No gender differences were observed and no interactions with education or genotype were found.

Conclusion

Consistent with prevailing literature, our study provides additional evidence for the enduring effects of domestic childhood adversity on anxiety and depression in older adulthood. Furthermore, the absence of associations between early adversity and cognitive impairment indicates that other factors might play a more prominent role in determining late-life cognitive outcomes.
CHRONIC DISABILITIES AND POLYSUBSTANCE USE IN ADULTS AGED 50 + ACROSS 25 US STATES
Authors: Massey John , Thompson Mika , Johnston Laura , Phillips Michael
Published: December 2023

Given an aging demographic that reports higher substance use patterns than preceding generations, as well as variability in cannabis legality at the state level, substance use and abuse is an area of concern for older adults experiencing chronic disabilities. Examining trends for polysubstance use for three of the most used substances (nicotine, alcohol, and cannabis) allows for possible insight into use patterns exhibited by older adults, particularly those with disabilities. Using national data across 25 states from 2020-2021 BRFSS, we investigated recent substance use for adults aged 50 and over (N=200,793). We conducted multinomial regression analyses to examine polysubstance use by individual disabilities (including hearing, vision, cognition, mobility, self-care, and independent living) and any disability. Our results indicated that 36.72% reported at least one disability, while 1.46% reported recent polysubstance use of alcohol, nicotine, and cannabis. All but one (mobility) of the individual disabilities were associated with higher odds of polysubstance use. Having any disability was associated with 42% higher odds of polysubstance use (OR: 1.42, 95%CI: 1.30-1.56) compared to no use. Understanding trends associated with polysubstance use for the three most commonly used substances in the U.S. for older adults 50+ with disabilities may influence future policy discussions, public health campaigns, efforts to educate older adults on the potential harms associated with polysubstance use, and at improving health equity and population health outcomes.
CLIMATE CHANGE, AIR POLLUTION, AND MENTAL HEALTH AMONG OLDER KOREAN AMERICAN RESIDENTS IN LOW-INCOME SENIOR HOUSING
Authors: Park Juyoung , Jang Yuri
Published: December 2023

Given the impact of climate change and air pollution on human health, the present study examined how older individuals’ perceived disruption by extreme weather and air pollution would be linked with mental health. We focused on older Korean Americans living in low-income senior housing and selected anxiety as an indicator of mental health. Data came from surveys with Korean American residents in five low-income senior housing facilities located in the Greater Los Angeles area (n=343, Mean age = 78.4). Anxiety, measured with the GAD-7, averaged 3.38 (SD = 3.77). Perceived levels of disruption caused by extreme weather and air pollution averaged 1.71 (SD = .69) and 1.75 (SD = .72), respectively, out of a range from 1 (not at all) and 4 (very much). Individuals who reported greater disruptions by extreme weather and air pollution had a higher level of anxiety. Given the high correlation between the two types of disruption (r = .56, p < .001), we tested separate regression models of anxiety. Each variable of the perceived disruption by extreme weather (β = .18, p < .001) and air pollution (β = .18, p < .001) was found to have a significant impact on anxiety. Although limited by the use of a small sample of convenience restricted to one ethnic group in one geographic location, our findings suggest the potential mental health impact of climate change and air pollution and call attention to intervention strategies.
CLINICAL CORRELATION OF MOCA AND TAU IMAGING
Authors: Sunil Surya , Nair Malini , Byrne Nicole , Rodriguez Adriana , Nair Anil K
Published: December 2023

Background

Tau-PET Scan measures brain tau deposition. Montreal Cognitive Assessment (MOCA) is used for cognitive impairment in (MCI) and Alzheimer Disease (AD). We analyzed the correlation of MOCA to tau-PET imaging in a memory clinic. Hypothesis Tau-PET positivity correlates with lower MOCA scores in memory clinic patients Objectives To assess the correlation of tau-PET positivity to MOCA test scores in memory clinic patients To evaluate an MOCA score cut-off that translates optimally to tau-PET positivity

Method

Retrospective observational chart review study of 34 patients attending a memory clinic in Boston, MA, with MOCA score and tau-PET scan included for analysis No stratification based on initial or final diagnosis, severity of cognitive impairment, or tracer used. Baseline MOCA and a binary PET scan result were analyzed with covariates age, sex and race. Analysis done on ‘R’ v. 2.4.0. Pearson correlation estimated MOCA score to tau-PET status. Kruskal Wallis/Chi square tests for relationship of age, sex, gender and education with MOCA score and tau-PET status. ROC analyses and sensitivity/specificity were obtained.

Results

Tau PET positivity did not correlate significantly with MOCA score (r= -0.24, 95%CI –0.54 to -0.12, p=0.19). A cut point of 22 on the MOCA estimated tau deposition in the brain by PET scan, with an AUC of 80%, 95% CI –0.6 to –0.99, possibly indicating a ceiling effect on the MOCA.

Conclusion

Tau PET does not correlate with MOCA scores, possibly due to a ceiling effect in the mild impairment subjects.
CLINICIAN PERSPECTIVES ON PRE-VISIT AGENDA-SETTING FOR PERSONS WITH DEMENTIA AND THEIR CARE PARTNERS
Authors: Cassidy Jessica , DesRoches Catherine , Hurwitz Isabel , Wolff Jennifer , Lum Hillary
Published: December 2023

Family care partners often assist persons with dementia in managing their health care, including through healthcare system patient portals. Thus, gaps in communication with family care partners can lead to unmet care needs. OurNotes is an agenda setting intervention included within pre-visit questionnaires that is sent through the patient portal. The intervention aims to encourage patients to share concerns before the visit to enhance communication between patients and clinicians. The objective of this study was to understand clinician perspectives on use of OurNotes in dementia care, including engaging care partners and suggestions for improving the intervention. Semi-structured interviews were conducted with 20 clinicians from two health systems with experience using OurNotes and caring for patients with dementia. Using rapid assessment methods, a codebook was developed and used in a team-based, thematic analysis. Participants were majority White, female, between 30-39 years, worked in primary care, and physicians. Clinicians identified: 1) Benefits of pre-visit preparation that enhanced clinician knowledge of the patient and/or care partner agenda; 2) Improved delivery of family-centered dementia care through greater care partner involvement; 3) Challenges of balancing patient and care partner concerns during clinical visits; and 4) Suggestions for focused efforts on improving care partners’ accessibility and use of OurNotes (and the patient portal). We conclude that optimizing use of OurNotes by care partners may support effective agenda setting by patients, care partners, and clinicians, and ultimately improve dementia care.
CO-DESIGNING A GREEN ACTIVITY PRESCRIPTION PROGRAM WITH HISPANIC/LATINO PERSONS LIVING WITH MEMORY CHALLENGES
Authors: Lassell Rebecca , Tamayo Valeria , Pena Triana , Tejeda Carlos , Torres Anderson , Zwerling Jessica , Gitlin Laura , Brody Abraham
Published: December 2023

Nature activities can improve well-being and may modify risk factors for cognitive decline. There is a gap between nature activities offered within a person’s community and their ability to participate in them, including Hispanic/Latino persons living with memory challenges (MCI and mild dementia) in urban lower-resourced areas. An occupational therapist can bridge this gap by tailoring nature activities available in a person’s home, neighborhood, and community to their interests and needs. Utilizing a participatory approach, we sought to co-design a 12-week Green Activity Prescription (GAP-H) with Hispanic/Latino individuals living with memory challenges and their care partners. Participants were recruited via convenience and snowball sampling in the Bronx, NY with outdoor activity professionals (n=7), Hispanic/Latino persons living with memory challenges and care partners (n=5), and interdisciplinary healthcare providers/dementia experts (n=7). Co-design occurred iteratively with 5 focus groups and 2 individual interviews lasting 30-90 minutes and focused on intervention and research design. Sessions were recorded and transcribed. Utilizing directed content analysis data was coded using a priori codes intervention design and research design. Participant preferences for intervention design were captured by subcodes session duration (30-90 minutes), frequency (4-8 sessions), and delivery modes (in-person and phone). Participants’ preferred nature activities included group exercise and outdoor crafts [crocheting], outcomes of well-being, social participation, decreased loneliness, and stewardship were identified. Preferred language for recruitment materials were memory challenges, Hispanic/Latino, and well-being. Referral pathways were identified including community-based organizations and primary care. Findings can inform the co-design process of other interventions for this population.
COGNITIVE DECLINE AND FALLS ARE INDEPENDENT RISK FACTORS FOR SWALLOWING DYSFUNCTION IN OLDER PEOPLE
Authors: Liu I-Ting
Published: December 2023

Aging, oropharyngeal lesion, neuromuscular and progressive neurological disease such as dementia are well-known risk factors of dysphagia. The aim of this study is to evaluate the significant risk factors of swallowing dysfunction in clinical practice. 100 subjects aged 65 or older who received Comprehensive Geriatric Assessment (CGA) were enrolled at EDA Hospital, Taiwan, form January 2022 to February 2023 (IRB: EMRP-110-108). Exclusion criteria: unable to communicate 、advanced disease or totally dependent. CGA was performed by well-trained nurses and geriatrician. Swallowing dysfunction was identified by abnormal swallow exam or related complaints. Cognitive impairment was defined as Short Portable Mental State Questionnaire (SPMSQ) < 8 (SPMSQ < 6 in those without education) or with diagnosed dementia. Binary logistic regression was constructed to assess the independent associated factors of dysphagia. Basic demographic analysis showed that patients with dysphagia were older, had poor ADL, higher number of geriatric syndromes and chronic comorbidities. Multivariate analysis revealed that cognitive decline (OR: 82.74, p=0.035) and falls (OR: 45.17, p=0.011) are still independent associated factors of swallow dysfunction after adjustment for age, sex, BMI, socioeconomics, other geriatric syndromes, chronic comorbidities including stoke and Parkinson disease. Dementia was known as one of the risk factors of dysphagia. Another small follow-up study demonstrated that falls risk is predictive of dysphagia in Parkinson’s disease. Through this study, participants will be able to identify the high-risk group of dysphagia. Prevention such as pneumococcus vaccination, oral hygiene, and speech therapy can be applied on those who have a fall history and clinical cognitive impairment.
COGNITIVE DISPERSION IS ASSOCIATED WITH PROTECTIVE COGNITIVE AND SOCIODEMOGRAPHIC FACTORS IN MIDUS
Authors: Klepacz Laura , Hamm Jeremy , Cerino Eric
Published: December 2023

Research examining the relationship between an individual’s levels of variability across a range of cognitive domains (dispersion) suggests that higher dispersion may be an early indicator of future cognitive impairment. However, this literature is still in its infancy and more research is needed to systematically examine the correlates of dispersion in large-scale, national samples that include individuals across the adult lifespan. Our study thus examined the relationship between cognitive dispersion across 6 tasks, mean cognitive performance, and sociodemographic characteristics in a national sample of adults from the Midlife in the United States (MIDUS) study (n=4,198; age 55±12.45). Dispersion was calculated by generating an intraindividual standard deviation across 6 unique cognitive tasks spanning several neuropsychological domains. In contrast to past research, bivariate correlations indicated that higher levels of cognitive dispersion were associated with higher levels of mean performance across cognitive tasks (r=0.28), higher education (r=0.08), higher income (r=0.04), and younger age (r=-0.07) (all ps<.05). The positive association between cognitive dispersion and mean performance was strongest for the episodic memory and working memory tasks. These results were consistent in both wave 2 and 3 of MIDUS and replicated in regression analyses that also revealed an increase in dispersion across waves 2 and 3 of MIDUS was associated with an increase in mean performance across the two waves (b=0.05, p<.001). Results of our study point to the possibility that, in certain unimpaired adult lifespan populations, dispersion may be associated with protective cognitive and sociodemographic factors linked to healthy cognitive aging.
COMPARING ILLNESS PERCEPTIONS OF MULTIMORBIDITY AMONG OLDER ADULT UTILIZERS AND NON-UTILIZERS OF HOME-BASED CARE
Authors: Bankole Ayomide
Published: December 2023

Health behavior interventions targeting illness perceptions improve outcomes for those with chronic illness. Research investigating illness perception in the context of multimorbidity suggests illness-perception of multimorbidity (IP-MM) predicts short-term health status among individuals with multimorbidity. However, less is known about IP-MM among home-based care (HBC) utilizers who receive in-home support for multimorbidity management. This study aimed to compare IP-MM among older adults HBC-utilizers and non-utilizers. Secondary analysis of a cross-sectional study exploring IP-MM in 116 community-dwelling older adults with ≥2 chronic conditions. IP-MM was assessed via MULTIPleS summary and subscale scores (0-78), including causal-links (0-9), prioritization (0-12), treatment-burden (0-18), activity-restrictions (0-9), and emotional-representations (0-30), where higher scores indicate stronger perceptions. HBC-utilizers self-reported receiving nursing, rehabilitative, or medical services at home. One sample t-tests was performed to compare MULTIPLeS subscales between HBC-utilizers and non-utilizers. HBC utilizers comprised of 18% with 82% as non-utilizers. Mean number of chronic conditions was 4.5 (2); Mean age was 73.3 (6.72), 71% female, 35% Hispanic, 33% Black, 27% White, and 5% Asian. Mean (SD) MULTIPleS summary score was 39.39 (21.1). Subscales scores:[activity restriction: 5.19 (2.88); causal relationships: 4.81 (3.07); prioritization:8 .24 (3.52); treatment burden: 7.84 (5.57). HBC utilizers had significantly higher mean treatment-burden subscale scores (10.38 ± 5.51), than non-utilizers (7.28 ± 4.45), p=0.027. No significant differences in other subscales or summary scores. Older adult HBC-utilizers and non-utilizers experienced comparable IP-MM, differing only in treatment burden perceptions. Additional research on IP-MM is needed to develop interventions that improve multimorbidity management and treatment-burden among HBC utilizers.
COMPARISON OF SELF-RATED HEALTH, FRAILTY-INDEX, AND MULTIMORBIDITY AS HEALTH INDICATORS
Authors: Halonen Pauliina , Enroth Linda , Jääskeläinen Tuija , Koskinen Seppo , Jylhä Marja , Kananen Laura
Published: December 2023

Self-rated health (SRH) predicts mortality and other adverse events (e.g. hospitalizations, intensive care), and reflects clinical biomarker levels even in individuals without diseases. We hypothesize SRH captures information relevant to clinical decision-making, with minimal effort, and might be used prior to more intensive and focused health assessments. To explore the clinical utility of SRH, we 1) analysed its overlap with clinical health assessments, multimorbidity, and Rockwood frailty-index (FI), and 2) compared their performances in mortality prediction. Our data came from two population-based cohort studies in Finland: Health 2000 Survey (H2000: n=6,329, aged 30-97 years) and National FinHealth 2017 Study (FH17: n=4,105, aged 30-98 years). Cox regression adjusted for age and sex, and Harrel’s C-index were used to assess the performances of continuous SRH, FI, and multimorbidity in 4-years-all-cause mortality prediction. Of those with fair/poor SRH, 85% in H2000 and 91% in FH2017 were also frail (FI≥0.25), and 91% and 81% had at least two diseases, respectively. Baseline SRH (H2000: HR[95CI]=3.14[2.10-4.69], FH17: HR[95CI]=4.57[2.37-8.83]), FI (H2000: HR[95CI]=1.40[1.28-1.53], FH17: HR[95CI]=1.54[1.32-1.80]) and number of diseases (H2000: HR[95CI]=1.18[1.10-1.27], FH17: HR[95CI]=1.18[1.03-1.35]) predicted death, and their C-indices were 0.879, 0.884, 0.877 in H2000 and 0.797, 0.800, 0.779 in FH17, respectively. SRH is concordant with clinical health indicators, such as multimorbidity and FI, and predicts mortality equally well in community-dwelling adults. The analyses are ongoing and we will further assess the utility of SRH in other cohorts, using other outcomes, and clinical indicators from registers, and perform age-, sex- and disease-stratified analyses.
COMPARISONS BETWEEN COGNITIVELY-IMPAIRED AND HEALTHY OLDER ADULTS ON NAVIGATION METRICS
Authors: Pervratil Michael , Kossowska-Kuhn Dorota , Charness Neil
Published: December 2023

Being able to navigate one’s environment is a critical skill that contributes to daily living in a variety of circumstances. Navigation is also a complex skill, composed of multiple subskills that play a part in overall performance. Along with other facets of cognition, navigation ability is expected to decline as a part of normal aging processes. What is of additional interest is how cognitive impairment (CI) relates to navigation in older adults. Throughout the literature, differences in navigation have been demonstrated between CI populations and healthy older adults. The current study sought to probe these components of navigation by comparing CI and healthy older adults on several measures of navigation ability. A sample of CI older adults were collected across three sites in the eastern United States. As a part of a larger project, participants completed objective and subjective measures of navigation, and their results were compared with a large sample of community-dwelling older adults (ages 60-90). The goal of these analyses was to determine where CI and healthy older adults differed in navigation. The CI sample performed significantly worse on the spatial orientation test (SOT) and reported significantly worse outcomes on a general wayfinding scale. However, there was no significant difference in self-assessed need for help when navigating or frequency of feeling lost. This divergence in outcomes is highlighted and deliberated further. Utilization of subjective and objective measures is discussed along with limitations of the data.
CORRELATES OF PHYSICIAN TRUST: DEMOGRAPHIC FACTORS AND EXPERIENCES OF MEDICAL CARE DISCRIMINATION
Authors: Mundy Lindsey , Judd Suzanne , Clay Olivio , Howard Virginia , Durant Raegan , Crowe Michael
Published: December 2023

Lack of trust between older adults and their physicians may decrease adherence to medication or limit disclosure of information to healthcare providers. Trust may be shaped in part by demographic factors as well as previous experiences of discrimination in healthcare. We hypothesized that more experiences of discrimination in a medical care setting would be negatively associated with general physician trust. We used cross-sectional data from a follow-up visit (2013-2016) of the national REasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort study. Our sample included participants who completed an 11-item general physician trust measure (score range=11-55) and a four-point item about discrimination in medical care settings (n=8,235, age 52-98, 31% Black, 45% men). We examined two sequential linear regression models with trust as the outcome, with the first model including demographic factors and the second adding discrimination in a medical setting. Female gender (β=-0.09, p<.05), Black race (β=-0.03, p<.05), and higher level of education (β=-0.8, p<.05) were each related to lower trust. Higher income (β=0.04, p<.05) and older age (β=0.12, p<.05) were associated with higher trust. Perceived discrimination had a negative association with physician trust (β=-0.14, p<.05) and the relationship between Black race and trust reversed direction and was no longer statistically significant (β=0.20, p=.298) with discrimination in the model. The potential impact of previous discrimination experiences in a medical care setting on physician trust should be considered when providing healthcare services to diverse populations of older adults.
COVID-19 IMPACT ON HEALTH JOURNEYS FOR VETERANS WITH CHRONIC CONDITIONS
Authors: Hossain Sheikh , Judon Kimberly , Augustine Matthew , Brown Sheldon , Boockvar Kenneth , Dolamore Michael , Villalba Madeline , Baim-Lance Abigail
Published: December 2023

The majority of Veterans receiving care in the Veterans Administration (VA) are over 65 years, and many have multiple chronic conditions and functional limitations. In this mixed methods pilot study, we sought to understand how these Veterans experienced the pandemic and associated VA health system changes across two contrasting (rural/urban) VA New York medical settings. From December 2021-January 2023, we conducted semi-structured interviews including co-created journey maps and extracted participants’ demographic and clinical characteristics and outpatient encounters. Journey maps visualized health and related episodes and associated pain and bright spots calibrated by intensity. 40 Veterans participated. An intense COVID-19 reaction emerged in 25% (10/39) of participant journeys. A majority (80%; 8/10) had a mental health (MH) diagnosis, compared to 55% (21/39) overall. A journey typically began with feeling shocked, afraid, or in extreme distress; subsequently there was divergence with some expressing feeling better and others describing lingering negative effects on daily routines, views of a changed world, and persistent VA service impacts. Some reported new perceptions of vulnerability due to age and decreased well-being. Participants in this group used on average more outpatient care before and during the pandemic than other participants and transitioned to greater consumption of virtual care, reflecting utilization trends across participants with mental health diagnoses. The group had mixed feelings about the benefits of virtual care. Ongoing challenges with COVID-19 may indicate the potential need for additional well-designed supportive services and environments particularly sensitive to the long-term impact of COVID-19.
COVID-19 INFORMATION ELICITING STEREOTYPE THREAT CAN HARM OLDER ADULTS’ COGNITIVE FUNCTION
Authors: Pham Julie , Shumaker Morgan , Bowen Holly
Published: December 2023

During the COVID-19 pandemic, older adults were identified as an at-risk group for developing severe physical symptoms. In addition to physical presentations, evidence indicated COVID-19 related changes in cognitive and neurological function; specifically, increased risk of stroke, reduced attention, concentration, and memory problems. Given that older adults remain particularly vulnerable to severe symptoms, exposure to information about COVID-19 and the associated cognitive symptoms may have adverse effects on their cognitive performance. This phenomenon, known as stereotype threat, describes situations in which negative stereotypes about a particular group can impair functioning. The current study aims to examine how exposure to adverse age-related information about the pandemic may impact cognitive performance compared to more neutral age-related information. 484 older adults were recruited February through July 2023 via Amazon Mechanical Turk and Cloud Research Connect. Participants were randomly assigned to a neutral or threat condition and read a paragraph related to aging or COVID-19, respectively. Afterwards, participants completed a memory task followed by a series of questionnaires to assess demographics, mood, depression, and COVID-19 health history. A one-way ANCOVA was conducted to evaluate the effect of COVID-19 threat on memory performance while controlling for history of COVID diagnosis. Findings indicate a significant difference in scores such that individuals in the threat condition had worse memory performance, compared to those in the neutral condition. This suggests that just reading information about COVID-19 may pose a threat to older adults’ cognitive abilities and further demonstrates the far-reaching effect the pandemic has had on individuals.
CREATIVE ACTIVITIES AND COGNITION AMONG OLDER ADULTS: DOES EDUCATION MODERATE THE BENEFITS OF CREATIVE ACTIVITIES?
Authors: Fassi Janelle
Published: December 2023

Engagement in leisure activities has been shown to offset age-related cognitive losses. Although activity engagement has a compensatory effect on later life cognition among adults with low educational levels in early life, no studies have examined this effect with creative activity engagement. The aims of the present study were to (1) investigate whether older adults’ engagement in any creative leisure activities is related to cognitive functioning, (2) investigate whether the number of creative activities in which older adults engage is related to cognitive functioning, and (3) determine whether education moderates the relationship between creative engagement and cognitive functioning. This present study utilized a nationally representative sample of 2,462 adults aged 65 years and older from the Health and Retirement Study, who completed either the 2016 or 2018 waves of the Leave Behind Questionnaire and the 2015 wave of the Consumption and Activities Mail Survey. Results from linear regression models revealed that creative engagement was associated with better cognitive functioning scores (β=0.74, p<.001). Additionally, more years of education were associated with better cognitive functioning scores (β=0.49, p<.001). Engaging in four creative activities is also associated with better cognitive functioning compared to engaging in no activities (β=1.38, p<.01). In sum, the results were in line with previous research that creative engagement and education are positively associated with cognitive functioning. Contrary to previous findings, creative engagement did not have a compensatory effect on cognitive functioning among individuals with fewer years of education.
DEFINING ‘OUTBREAK’: ADMINISTRATORS’ EXPERIENCES MANAGING COVID-19 AT US NURSING HOMES
Authors: Brazier Joan , Meehan Amy , Hawes Courtney , Shield Renee , Gabois Emily
Published: December 2023

The CDC defines a COVID-19 outbreak as starting with a single positive case of a staff member or resident in a facility and ending after there have been no new cases for 14 days. According to a report from the U.S. Government Accountability Office, 94% of nursing homes in the U.S. experienced multiple COVID-19 outbreaks, resulting in a reported 1.66 million residents and 1.64 million staff members with confirmed COVID-19 as of July 2023. Research has shown that COVID-19 outbreaks froze new admissions and caused significant financial strain. This qualitative study aimed to examine how COVID-19 outbreaks were managed in U.S. nursing homes. 156 interviews were conducted with nursing home administrators from 40 facilities across the U.S. between July 2020-December 2021. Two major themes emerged from thematic analysis: 1) the definition of “outbreak” as a single individual testing positive with COVID-19 was inconsistently communicated to nursing home administrators at the start of the pandemic; and 2) administrator self-reports of COVID-19 outbreaks at their facilities indicated that many endured multiple outbreaks which were long-lasting (greater than 1 month). As policy makers and industry experts review policies around managing nursing home viral outbreaks, they should consider the emerging infection control strategies from the pandemic which successfully prevented the spread of COVID-19 and update the response to an ‘outbreak’ such that infection control mitigation measures are effective without causing restrictions that are detrimental to resident well being or nursing home financial hardship.
DEMENTIA CARE IN ASIAN AND LATINO COMMUNITIES: PERSPECTIVES FROM FAMILY CAREGIVERS AND SERVICE PROFESSIONALS
Authors: Patano Arienne , Sun Fei , Ortiz Daniel Vélez , Liu Ethan
Published: December 2023

While community-based support and services are increasingly available to family caregivers (FCGs) of a person with dementia (PWD), those from ethnic minority groups tend to be underserved. This study aimed to identify unaddressed challenges to dementia care and uncover strategies to better assist FCGs within Asian and Latino communities in Michigan. Focus group and individual interviews were conducted with service professionals (SPs) and FCGs. Specifically, we ran two focus groups with SPs (n=11), and one with Asian FCGs (n=8). Four individual telephone interviews were conducted with Latino FCGs. Sessions were audiotaped and conducted in the participants’ preferred language, then transcribed and translated into English for analysis. Shared challenges to dementia care included: transportation to services; lack of translation services and language-concordant specialists, daycare/respite workers, and in-home care staff; and feelings of shame in needing support. Latino FCGs reported the emotional burden of witnessing the cognitive decline of their PWD, whereas Asian FCGs focused on challenges related to the behaviors of PWD. SPs and FCGs expressed the desire for more education for FCGs on dementia and self-management of stress. Limited technology literacy impacted their access to digital education. Culturally informed outreach and intervention strategies were recommended, such as partnering with community leaders and adapting cultural practices (e.g., providing family-oriented events, and using social media popular among specific ethnic groups). This study highlights the sociocultural challenges and practical outreach approaches for FCGs in Asian and Latino communities by integrating the perspectives of FCGs and SPs involved in dementia care.
DEMENTIA CARE PARTNER ACTIVATION PROGRAM FOR FILIPINO AMERICANS
Authors: Ramos Mary Dioise , Sakib Nazmus , Hasan Mehedi
Published: December 2023

This study aims to enhance the quality of life and health outcomes for individuals with Alzheimer’s Disease and Related Dementia (ADRD) and their care partners through a culturally tailored support program. Specifically focusing on the unique challenges Filipino and Filipino American (FA) caregivers face, we seek to address disparities in access to care and develop strategies for effective health system navigation. The research employs a multifaceted approach, combining surveys, focus groups, observational techniques, and interviews to assess the caregiving experience comprehensively. Our primary objectives include evaluating the impact of caregiving burden, socio-emotional support, and health literacy on emergency department visits and hospital admissions for ADRD patients. Preliminary results highlight the significance of culturally sensitive interventions. FA caregivers often encounter difficulties due to cultural beliefs, knowledge gaps about ADRD, and limited support networks. This study outlines the development and testing of a specialized program designed to empower FA caregivers with the skills needed for proficient care management and emergency response. By engaging these caregivers in participatory action research, the program aims to foster active involvement and enhance their caregiving capabilities. The study’s outcomes emphasize the potential for improved quality of life and health outcomes for individuals with ADRD and their caregivers. By addressing FA caregivers’ unique challenges in the context of disparity populations, our research contributes to enhancing health system navigation behaviors and promoting culturally attuned care practices. This initiative promises to reduce emergency department visits and hospital admissions, benefiting ADRD patients and their dedicated care partners.
DEMENTIA PREVENTION: THE COST-EFFECTIVENESS OF PREVENTION SERVICES IN JAPANESE LONG-TERM CARE SYSTEM
Authors: Hu Xujing , Wu Yunfan , Yamakawa Miyae , Kanaya Reiko
Published: December 2023

Objectives

To analyze the cost-effectiveness of prevention services (Named “Support” in Japanese official documents) in Japanese Long-Term Care Insurance system, which draws data from a large volume of 10-year database in Osaka Prefecture. Design: We design an approach to estimate cost-effective prices using aggregate data including costs of dementia in 10 years, time of dementia first diagnosed, changes of care levels, and quality of life. Measurements: The outcomes were average annual expenditure per unit of services.

Results

In higher risk groups of dementia, prevention services delaying cognitive decline and enhancing quality of life were cost effective at $206 per individual. However, this cost-effectiveness will wear off as symptoms worsen and the care levels increase.

Conclusion

Prevention services from Long-Term Care Insurance system are possibly to be cost-effective, but this cost benefit is not long-term .
RURAL-URBAN DIFFERENCES IN DIGITAL HEALTH USE OF MEDICARE BENEFICIARIES
Authors: Power Shannon , Yeo Hyesu
Published: December 2023

Growing reliance on digital healthcare appears to marginalize rural older adults with limited technology access and experience. Existing research explores telehealth uptake of Medicare beneficiaries but does not consider the role of locality in digital health use (DHU). Using the 2021 National Health and Aging Trends Study data, this study compares rural-urban Medicare beneficiaries’ DHU (weighted N=18,729,829). Informed by the Senior Technology Acceptance Model, multiple linear regressions were performed on rural and urban models separately, including DHU, social determinant, and technology readiness variables. Participants in this study were predominantly White, female, and in their 70s. In the final model, men were more likely to use DHU than women in both rural-urban samples (β=.13, β=.08, p<.05, respectively). Tablet access was the only significant device for DHU among rural residents (β=.18, p<.05), while computer access (β=.12, p<.05) was the most significant among urban residents. Online grocery shopping was the most predictive prior technology experience of DHU for rural dwellers (β=.24, p<.05), while online banking led for urban dwellers (β=.21, p<.05). These unique differences between rural-urban samples can inform research on how to specifically design and implement digital interventions to increase rural older adult uptake. Healthcare workers can emphasize similarities between DHU and older adults’ prior technology experience to build perceived ease of use. Expanding opportunities for rural older adults to interact with technology in daily life builds experience which best predicts DHU. Policymakers should consider the impact of locality and involve aging community stakeholders to advance equitable DHU in the digital age.
DEPRESSION AND ROLE OVERLOAD IN FAMILY CAREGIVERS OF PEOPLE LIVING WITH AND WITHOUT DEMENTIA
Authors: McDonald Claire , Bravo Adrian
Published: December 2023

The present study examined the associations between caregiver assistance, role overload as a stressor, and depression symptoms among caregivers of adults age 65 and older living with and without probable dementia. Specifically, we hypothesized that more time spent caregiving would be associated with higher depressive symptoms via greater role overload and this indirect association would be stronger for those caregiving for an older adult with probable dementia versus no probable dementia. This study analyzed data from round 11 of the National Health and Aging Trends Study (NHATS) and the supplemental National Study of Caregiving (NSOC), which were collected from 2021 through early 2022. The majority of caregivers (207 probable dementia caregivers, 451 no probable dementia caregivers) identified as white (69%), female (70%), and reported an average age of 63.33. A moderated mediation model was tested using the PROCESS Macro (Hayes, 2013) in SPSS. Within our model, dementia classification was found to moderate the effect of the number of days spent caring on role overload (B = .048, SE = .019, t = 2.54, p = .011). Moreover, the overall moderated mediation model was supported with the index of moderated mediation = 0.0094 (95% CI = .0010, .0192). These results indicate that the more days a caregiver spent helping was associated with more symptoms of depression via higher caregiver overload, especially among those caregivers taking care of an older adult with probable dementia. These findings highlight the importance of making healthcare services available and accessible for caregivers.