bluuebunny/crossref_metadata_2025 huggingface dataset:
Causal Mediation of Stress Reduction in Family Dementia Caregivers: A Focus on Mindfulness
Authors: Gomez Liliana Ramirez , Jain Felipe
Published: December 2021

Although mindfulness therapies have demonstrated benefits for reducing stress and improving psychological symptoms in family dementia caregivers, the mechanisms underlying these salutary effects are unknown. We report a causal mediation pathway to improvement of stress symptoms in family dementia caregivers with Mentalizing Imagery Therapy (MIT), which employs mindfulness and guided imagery tools to reduce stress and improve understanding of self and others. In a randomized controlled trial of short-term 4-week MIT (N=24) versus a psychosocial support group (N=22), MIT demonstrated superior benefit for reducing perceived stress (p=.006). Increased trait mindfulness was a causal mediator of this effect (p=.02). Neuroimaging pre and post intervention found that increased mindfulness was associated with strengthened connectivity of the dorsolateral prefrontal cortex with an emotion regulation network (p<.001). The results are discussed in light of theories of cognitive control and may inform the design of future studies aimed at reducing family caregiver stress.
The Social Effects of an Intergenerational E-Mail Pal Program
Authors: Lise Kristi , Zucchetto Jillian Minahan , Siedlecki Karen
Published: December 2021

Ageist attitudes and loneliness negatively impact both younger and older adults (e.g., Sun et al., 2019). This study utilized a randomized waitlist-control design to investigate the effects of a six-week intergenerational e-mail pen pal program on loneliness in younger and older adults and ageism in younger adults. Thirty-three younger adults (18-30 years) and 28 older adults (over age 65) completed an online survey assessing ageist attitudes, loneliness, well-being, and other individual differences. One week after completing a baseline survey, 17 email pen pal pairs began the six-week e-mail intervention. Participants repeated the survey one week after the completion of the intervention (which was eight weeks after the baseline for the control participants). Analyses showed that at baseline, younger adults (M=2.41, SD=.76) reported higher levels of loneliness compared to older adults (M=1.65, SD=.77), t(59) = 3.85, p < .001. Repeated measures ANOVAs showed that the intervention did not have a significant effect on ageism or loneliness in either younger or older adults. However, the effect size of the intervention for loneliness among older adults was moderate to large (η2= .07). Descriptive statistics indicated that older adults in both the intervention and control groups experienced an increase of loneliness during the post-test. However, the older adults in the intervention group experienced less of an increase compared to older adults in the control group. This suggests that the intervention may have buffered the increase in loneliness that older adults may experience during the winter months and during the onset of the COVID-19 pandemic.
Aging Strong: Promoting Resilience Through Optimism, Purpose, and Social Connections
Authors: Wicker Ellen , Schaeffer James
Published: December 2021

Resilience is defined as the ability to adapt and cope with circumstances in a way that empowers one to emerge stronger, thrive, and incorporate lessons learned. Resilience as a trait can be learned and modified and have a significant impact on healthy aging. UnitedHealthcare (UHC) and AARP Services, Inc. (ASI) are committed to the health and well-being of participants in UHC’s Medicare Supplement insurance plans, recognizing that health and wellness need to be promoted on a holistic level to ensure successful aging. In this effort, an initiative titled Aging Strong 2020 was developed to promote health, well-being, and increase resilience by focusing on the key individual pillars of enhanced purpose in life, social connectedness, and optimism. To accomplish this goal, a series of eight interventions over three years were created and delivered, with a focus on the key pillars in order to improve clinical and psychological health outcomes and participants’ satisfaction with health care. This symposium will specifically discuss efforts related to the Aging Strong 2020 program. First, we will describe the prevalence and outcomes of the pillars in a large national survey. Next, key challenges and successes in recruitment and retention for the various interventions will be highlighted, followed by overall findings from the eight interventions targeting the pillars. Finally, qualitative findings on participant experience as a result of participation will be discussed. Results from these initiatives demonstrate that interventions designed to improve well-being among older adults contribute to the holistic model of health.
Implementation of a Shared Decision-Making Tool for Osteoarthritis Treatment to Reduce Decisional Conflict
Authors: Watkins Yashika , Gonzalez Rose , Johnson Charla , Kaur Ravneet
Published: December 2021

Shared decision making is a key component of patient centered care where clinical evidence and the patient’s preference and values are considered. Physical activity and weight loss are often recommendations in the treatment plan, especially in mild to moderate stage of osteoarthritis (OA). Movement is Life (MIL) created an innovative SDM tool to provide a framework for patient-centered discussions. The tool leverages an underlying Markov Model and represents the likely pain, activity levels, and lost productivity at three future time points. By comparing the patient’s likely progression depending on treatment choices compared to doing nothing, the patient has an illustration of future state. A pilot of N=108 women, ages 45-64, with chronic knee pain for at least three months and at least one co-morbidity (obesity, hypertension, diabetes) were randomized to a control (n=54) or intervention (n=54) arm of the study at eight centers across the United States. Results showed the demographic profiles were similar between the groups. At one-month, n=47 control and n=50 intervention patients returned for evaluation. Self-reported level of physical activity increased in the intervention group (56% vs 34%, p = 0.0229). Qualitative feedback from the intervention group indicated high satisfaction with use of the tool. Both groups reported a high likeliness to recommend the provider to a friend or family member. Inclusion of the SDM tool added an average of one minute to the patient counseling time over the control group. The quasi script provides a consistent communication pathway and may reduce disparities by addressing unconscious bias.
Predicting Symptom Severities in Middle-Aged and Older Adults With Arthritis and Multimorbidity
Authors: Zhang Wenhui
Published: December 2021

Introduction: Uncertainties increase with disease guideline-driven decision-making for older adults as their numbers of chronic conditions and functional limitations increase. A national study found that people with arthritis plus ≥ one other chronic condition have reported significantly higher social participation restriction, serious psychological distress, and work limitation than those with ≥two non-arthritis chronic conditions. However, how arthritis comorbidities contribute to the symptoms such as pain, fatigue, sleep, depression, anxiety, and cognitive abilities that chronically impair people’s daily functioning remain unexplored. Purpose: To explore how arthritis comorbidities predict the symptom severities of pain interference, fatigue, sleep disturbance, depression, anxiety, and cognitive abilities among community-dwelling middle-aged and older adults. Method: 140 community people aged over 50 with arthritis and multimorbidity were recruited. Stepwise regressions predicted the PROMIS symptoms of pain interference, fatigue, sleep disturbance, depression, anxiety, and cognitive abilities with arthritis type and 18 comorbidities measured by the Functional Comorbidity Index checklist after controlling for demographics. Results: Obesity, chronic obstructive pulmonary disease, diabetes, and income significantly predicted pain interference (adjusted R2=35%). Marital status, obesity, and peripheral vascular disease significantly predicted fatigue (adjusted R2=17%). Depression diagnosis and income adequacy significantly predicted depressive symptoms (adjusted R2=23%). Depression, income adequacy, and anxiety diagnosis significantly predicted anxiety (adjusted R2=23%). Age significantly predicted cognitive abilities (adjusted R2=12%). Discussion: Comorbidities and socio-demographics, especially income, impact symptom experiences of people aging with arthritis and multimorbidity. Future studies should explore the pathogenesis among arthritis, comorbidities, and symptoms for tailored intervention while disclosing health disparities associated with the arthritis multimorbidity.
Risk Factors for Cognitive Decline in Older Adults in Puerto Rico: Assessing Bias From Sample Attrition
Authors: Downer Brian , Pope Caitlin , Bell Tyler , Milani Sadaf , Andel Ross , Crowe Michael
Published: December 2021

Many risk factors for cognitive decline are associated with mortality and are common among older adults who cannot complete a survey interview. Our objective was to compare analyses of risk factors for cognitive decline among older adults in Puerto Rico with and without accounting for sample attrition. Data came from the Puerto Rican Elderly: Health Conditions Study. Our sample included 3,437 participants interviewed in 2002/03. Cognitive function was measured using the Mini-Mental Caban (MMC). The outcome was the change in MMC score between 2002/03 and 2006/07. Logistic regression was used to estimate inverse probability weights for being interviewed in 2006/07 (n=3,028) and completing the MMC at follow-up (n=2,601). Linear regression models were used to assess the association between stroke, hypertension, diabetes, smoking status, and cognitive decline with and without the IPWs. In the unweighted analysis, stroke was associated with a significantly greater decline in cognition (b=-0.62, standard error [SE]=0.30, p=0.04). Hypertension (b=-0.02, SE=0.12, p=0.84), diabetes (b=-0.22, SE=0.13, p=0.10) and being a current (b=0.05, SE=0.22, p=0.84) or former smoker (b=0.05, SE=0.14, 0.74) were not associated with cognitive decline in the unweighted analysis. The results were similar when including the IPW for mortality (stroke b=-0.63; hypertension b=-0.03; diabetes: b=-0.20; current smoker: b=0.08; former smoker: b=0.07) and having completed the MMC at follow-up (stroke b=-0.58; hypertension b=-0.03; diabetes: b=-0.20; current smoker: b=0.03; former smoker: b=0.09). These findings indicate that stroke is a risk factor for cognitive decline among older Puerto Rican adults even after accounting for selective attrition.
The Utility of the WHO Intrinsic Capacity Screening Tool to Identify Physical and Mental Function Declines
Authors: Ma Lina , Zhang Yaxin , Liu Pan , Li Yun
Published: December 2021

Background: The disease concept is increasingly being replaced by a functional approach to address the healthcare needs of the older people. WHO proposed the Integrated Care for Older People (ICOPE) screening tool to identify older people with priority conditions associated with declines in intrinsic capacity (IC). Very few evidence on the clinical utility of the ICOPE tool is available. Objectives: To determine if the tool can identify adults with poor physical and mental function. Method: 376 participants aged 50–97 years were included. IC was assessed with the WHO ICOPE screening tool, covering the following five domains: cognitive decline, limited mobility, malnutrition, sensory loss, and depressive symptoms. We assessed the activities of daily living, the Fried frailty phenotype, FRAIL scale, SARC-F scale, MMSE, GDS, social frailty, and quality of life. Peak expiratory flow, bones mineral density, body composition were obtained. Results: 69.1% of the participants showed declines in IC. Participants with declines in IC were older, had more chronic diseases, worse general health, worse physical function as indicated by lower Barthel index, walk speed, grip strength, and physical fatigue, worse mental function indicated by lower MMSE scores, higher GDS scores, more mental fatigue, and worse social function. After adjusting for age, IC was positively correlated with walking speed, resilience score, and MMSE score and negatively correlated with frailty, SARC-F score, IADL score, GDS score, and physical and mental fatigue. Conclusion: The WHO ICOPE screening tool is useful to identify adults with poor physical and mental function in Chinese older adults.
COVID Vaccine Rollout for Older Adults in Israel
Authors: Mahroum Naim
Published: December 2021

The COVID vaccine rollout in Israel has prioritized older adults. It led to a substantial decline in the incidence of COVID-19 in older adults. The new variants are threats to the current achievements. We will provide detailed information later. The symposium has experts from 8 countries. We will use an interview and dialog format, instead of presentations.
ENHANCE: The Center for Enhancing Neurocognitive Health, Abilities, Networks, & Community Engagement
Authors: Czaja Sara , Boot Walter , Bourgeois Michelle
Published: December 2021

Approximately 9 % of those aged 65 and over have a cognitive impairment due to a variety of causes including Alzheimer’s disease and other forms of dementia, Mild Cognitive Impairment (MCI), Parkinson’s disease, traumatic brain injury (TBI), and stroke. Few technology solutions have been directed towards supporting older adults with cognitive impairments and the literature regarding the efficacy of these solutions is sparse. In this symposium, we describe our new Center called ENHANCE (Enhancing Neurocognitive Health, Abilities, Networks, and Community Engagement), which is focused on developing technology support for aging adults with a cognitive impairment due to MCI, TBI, and Stroke. Sara Czaja will provide an overview of the conceptual framework, goals, and structure of ENHANCE, and describe the STRUMM project, that focuses on the design and evaluation of an innovative intelligent adaptive software package aimed at providing cognitive and social support to aging adults with cognitive impairments. Wendy Rogers will discuss the ENACT project, a longitudinal needs assessment focusing on understanding the needs, challenges, and support preferences of our target population and informal caregivers. Neil Charness will describe the AUGMENT development project, which is concerned with developing an instructional support tool for mobility activities, such as wayfinding, locating, and using transportation services. Finally, Walter Boot will discuss the DREAM development project, which is focused on developing a technology-based cognitive aid to support prospective memory activities. Michelle Bourgeois will serve as the discussant for the symposium and highlight the unique opportunities and challenges associated with ENHANCE.
Interdisciplinary Education Model in the Study of Aging: Example and Course Design
Authors: Su Yan-Jhu
Published: December 2021

Collaboration among various disciplines is essential to the gerontology curriculum because it is a a new and comprehensive subject. This presentation will discuss the design of interdisciplinary courses to include practical applications in the study of aging. The presenter will share examples based on personal experience to illustrate how music and psychology may be applied to the study of aging. In addition, the presentation will include analysis of actual course designs to show how different fields can be integrated in the classroom setting. This symposium presentation intends to improve cross-discipline applications as well as help students contribute to and benefit from the study of aging.
Assessing Knowledge, Attitudes, and Beliefs of Nurses About LGBTQ Older Adults Using a Documentary Video
Authors: Dutton Suzanne
Published: December 2021

Statistics reveal that lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults experience health disparities and barriers to accessing healthcare because of discrimination and fear of disclosing sexual orientation. Nurses receive limited education regarding care for LGBTQ older adults. This study exposed nurses to the documentary, Gen Silent, which details LGBTQ older adult experiences. The objective of the study was to increase participants’ understanding of LGBTQ health disparities. A one-group pre-/post-test design was conducted to test the effect of the documentary on knowledge and attitudes about LGBTQ health. A total of 379 nurses participated in the study. A questionnaire including a 16-item standardized scale and an open-ended question asking how participants would change their practice was administered before and after the intervention. Findings revealed statistically significant increases in LGBTQ knowledge and inclusive attitudes. This research supports the use of a documentary as an educational method related to LGBTQ older adults.
Factors and Functions Associated With Health and Well-Being Among Older Adults: Evidence From NHATS
Authors: Anderson Loretta , Wennberg Alexandra , Gibson Allison
Published: December 2021

The National Health and Aging Trends Study (NHATS) is a nationally representative sample of Medicare beneficiaries aged 65 and older. From 2011 through 2020, annual in-person interviews have collected data in many areas, including health, environment, wellbeing, cognition, and function. With a decade of follow-up, including replenishment samples, NHATS is an ideal setting to investigate trends and trajectories of aging. Aging is heterogeneous and understanding the myriad of factors and functions that impact health and wellbeing is critical to developing interventions and care to promote health and wellbeing. Considering a multifactorial, wholistic approach to aging will provide a deeper understanding to create an impact. This symposium features pivotal research conducted using NHATS data, while highlighting overall strengths of the dataset for future research. The first presentation of this symposium investigates the factors that define cognitive profiles associated with dementia diagnosis over a period of five years. The second presentation investigates the role engagement in personally meaningful activities play in cognitive, emotional, functional, and health-related outcomes in older adults. The third presentation investigates the association between sleep medication use and fall risk among older adults with and without dementia. The session concludes with an investigation of end-of-life communication in persons with dementia and hearing impairment.
Cognitive Decline Over a 5-Year Period: The National Health and Aging Trends Study
Authors: Gibson Allison , Holmes Sarah , Richardson Virgina
Published: December 2021

The classification of Alzheimer’s disease and related dementia (ADRD) is important for understanding the progression of cognitive decline. This longitudinal study used data from the National Health and Aging Trends Study (NHATS). A sample of 3,287 eligible Medicare beneficiaries were included in the study. Nine cognitive profiles were examined from Waves 1 to 5 (2011-2015). Discriminant factor analysis was used to identify factors that differentiated across the cognitive profiles. Results showed that 1,076 had some measure of “possible” or “probable” dementia over the 5 years. In Wave 1, there were 104 self-reported ADRD diagnoses, and in Wave 5, there were 327 self-reported ADRD diagnoses. Social participation was an important factor in those that impairment reversed from probable to possible ADRD. Findings support previous evidence that certain activities may slow or reverse cognitive decline and can inform future studies exploring the causality of dementia onset.
Falls Among High- and Low- Frequency Sleep Medication Users With and Without Dementia
Authors: Anderson Loretta , Wennberg Alexandra
Published: December 2021

Difficulty with sleep and falls are prevalent among older adults. Sleep medication use is associated with falls in older adults, but little is known about its impact in older adults with dementia. We used data from the 2011 National Health and Aging Trends Study to assess the association of low- versus high- frequency sleep medication use with falls in older adults with self-reported dementia. In our fully adjusted model, among those with dementia, high-frequency sleep medication users were more likely to fall than low-frequency sleep medication users (OR=3.86, 95% CI: 1.31, 11.37). Among those without dementia, high-frequency sleep medication users were more likely to fall than low-frequency sleep medication users (OR=1.40, 95% CI: 1.11, 1.77). Reducing sleep medication use in older adults with and without dementia may help reduce the risk of falls and fall-related outcomes in older adults.
Hearing Loss and Neuropsychiatric Symptoms in Persons With Dementia at the End of Life
Authors: Nieman Carrie , Regier Natalie
Published: December 2021

Access to effective communication is critical to the conversations that occur at end-of-life and represents an unaddressed need within palliative care. These challenges may disproportionately affect persons with dementia (PWD). Hearing loss is one of the most common comorbidities among PWD and is independently associated with neuropsychiatric symptoms. However, relatively little is known about the potential impact of hearing loss on PWD at end-of-life. We examined last month of life (LML) data from 971 proxies of deceased PWD from the National Health and Aging Trends Study (2011-2020). Hearing difficulty was associated with increased anxiety/sadness in PWD, χ2(1)=4.596, p=.032, such that 65.6% of persons with hearing difficulty reported anxiety/sadness in the LML. Binary logistic regression found that hearing difficulty was significantly associated with increased anxiety/sadness (OR=1.40, 95% C.I. 1.00 – 1.80, p < 0.05). Interventions that optimize communication for PWD may be a meaningful approach to improving the end-of-life experience.
Health Disparities in COVID-19: Implications for Research, Policy, and Practice
Authors: Mingo Chivon , Rooks Ronica
Published: December 2021

The rapid transmission of COVID-19 has resulted in more than 100 million confirmed cases in over 200 countries and continues to have wide-community spread. Consistently, it has been reported that older adults are at a greater risk for requiring hospitalization or dying from the virus compared to younger adults and children. In fact, compared to those age 18-29, age 65-74 are five times more likely to be hospitalized and 90 times more likely to experience death. The risk increases exponentially with age. Individuals 85 and older are 13 times more likely to require hospitalization and 630 times more likely to die from the disease. The physical health-age correlation has permeated the media and many discussions concerning the pandemic. However, fewer discussions have centered on the interaction of age and social variables that further exacerbate COVID-19 related burden or mortality such as race/ethnicity, socioeconomic status, and limited access to healthcare. Therefore, this symposium will bring direct attention to COVID-19 related health disparities that compromise public health, discuss implications on future research, policy, and practice, and discuss opportunities to reduce the burden and mitigate health inequities. The symposium presenters will specifically address the impact of social support during COVID-19, disparities in the effects of social distancing on health status, the economic impact on health, cognitive decline among low-income older adults navigating a global pandemic, and factors associated with higher rates of hospitalizations among racial/ethnic diverse older adults.
Children’s Filial Piety and Parents’ Depressive Symptoms: Findings From a Dyadic Study
Authors: Bergren Stephanie , Le Qun , Dong XinQi
Published: December 2021

Filial piety is an important Chinese cultural value that prescribes child behavior towards their parents, but little is known about its relationship to the parents’ psychological wellbeing. This study utilizes dyad data from the PINE and PIETY Studies. Filial piety was measured by asking how much the participant thought children should 1) care; 2) respect; 3) greet; 4) please and make happy; 5) obey; and 6) provide financial support to their parents. Depressive symptoms were measured by Patient Health Questionaire-9 with a cutoff of 5 indicating the presence of depressive symptoms. Logistic regressions were used to examine the associations controlling for both children’s and parents’ sociodemographic characteristics. Higher filial piety in happy (OR:0.80, (0.65-0.99)) or obey (OR:0.83, (0.68-1.00)) was associated with a lower likelihood of depressive symptoms among parents. Future research should explore the potential causal relationships between children’s filial piety and parents’ mental health.
Parents’ Self-Reported Versus Child Evaluation of Parents’ Mental Health Outcomes: Is There a Difference
Authors: Dong XinQi , Hua Yingxiao , Kong Dexia , Le Qun
Published: December 2021

Older Chinese-Americans are more likely to experience depressive symptoms compared to the general U.S. aging population. This paper aims to examine the level of congruence between parents’ self-reported mental health and children’s evaluation of their parents’ mental health. Dyad-level understanding is particularly relevant considering the family-based medical decision-making preference in the Chinese-community. Older parents’ depressive symptoms were measured by PHQ-9 with a cutoff of 5 indicating the presence of depressive symptoms. Adult children were asked whether their parents informed them of their depressive symptoms or if they suspected that their parents were depressed. Logistic regressions were conducted. Parents’ self-reported depressive symptoms were associated with both adult children’s awareness (OR:3.28 (2.00-5.39)) and suspicion (OR:3.10 (2.02-4.77)) of their parents’ depressive symptoms. Results remained consistent among mother-child and father-child dyads. Study findings underscore the importance of incorporating adult children’s’ perspective in mental health research in the Chinese community.
The Association Between Parents’ Physical Function and Adult Children’s Caregiving Burden
Authors: Bergren Stephanie , Le Qun , Kong Dexia , Dong XinQi
Published: December 2021

Using data from 544 older parents-adult children Chinese American dyads, this study aims to understand the association between older parents’ physical function and their adult children’s perceived caregiving burden. Parents’ physical function was assessed by the Katz Index of Activities of Daily Living (ADL) and the Lawton Instrumental ADL (IADL), with higher scores indicating more functional limitations. Adult children’s caregiving burden was assessed in five dimensions, including time dependence, developmental, physical, social, and emotion burden. Logistic regression was used to examine the association. More ADL limitations were associated with a higher likelihood of developmental burden (OR:1.14 (1.06-1.23)) and physical burden (OR:1.14 (1.06-1.23)) burden. More IADL limitations was associated with a higher likelihood of time dependence burden (OR:1.08 (1.03-1.12)), developmental burden (OR:1.06 (1.03-1.09)), and physical burden (OR:1.08 (1.04-1.12)). Parents’ physical function was not related to children’s social and emotional burdens. Practice and research implications will be discussed.
Just Another Storm: Conceptualizing Older Adults’ Perceptions of the COVID-19 Pandemic
Authors: Hanks Roma , Freed Christopher , Lio Shoon , Arrieta Martha
Published: December 2021

Older adults of color who experience health disparities are especially vulnerable to health and economic adversity related to COVID-19. This study focuses on nine zip codes wherein 70.2% of residents are of African-American descent and an estimated 31.5% of residents live in poverty. To understand the lived experience of the COVID-19 pandemic, perceived challenges of COVID-19, and the dissemination of information related to COVID-19, we collected interview and focus group data in Spring 2020 from fifteen community members, leaders, or advocates. Analyses reveal that older individuals approach the COVID-19 pandemic with familiar disaster mitigation strategies. Other persons perceive the pandemic as another community challenge that African-Americans must confront. Older adults report generational differences in perceptions of the risk of COVID-19 and compliance with health guidelines. Overall, analyses reveal a deeply cultural context for intergenerational responses associated with COVID-19 and a sense of agency among older community leaders as health advocates.
Emotional Well-Being Human Studies
Authors: Lin Feng
Published: December 2021

Early evidence indicates an association between EWB and underlying brain processes, and that those processes change with both normal and pathological brain aging. However, the nature of these associations, the mechanisms by which EWB and its component domains change with brain aging, and how those changes may be associated with common neuropathologies in ADRD, are largely unexplored. We propose an appraisal-adaptation model in understanding relationships between EWB and ADRD. For human models, we encourage the use of well-established measures that directly assess eudaimonic and hedonic EWB, including abnormal scenarios (e.g., neuropsychiatric symptoms, anhedonia, loneliness, etc.), as well as older adults with exceptional cognition (i.e., superagers or supernormals). Dr. Lin will review premises associated with the appraisal-adaptation model in conducting human research on EWB, aging, and ADRD.
Emotional Well-Being Animal Models
Authors: Wang Kuan
Published: December 2021

Clinical studies suggest an association between EWB and the risk or progression of AD. However, the mechanistic link and causal relationship between EWB and AD remain unknown, due to limited experimental access and control of the underlying human brain processes. Animal models offer genetic control of AD mutations and neural circuit analysis tools, but subjective feelings of EWB cannot be assessed through self-report. To study EWB across species, we adopt a theoretical framework that views emotions as central brain states that respond to exteroceptive or interoceptive stimuli and cause multiple cognitive, somatic and behavioral changes. Recent neuroanatomical and functional imaging studies have identified evolutionarily related brain circuits in the encoding and regulation of central emotional states in animals. Dr. Wang will review progress in elucidating the functional activities of these circuits and discuss the challenges and opportunities to link these neural representations to EWB and AD related pathological progression.
NIA Priorities on Emotional Well-Being
Authors: Simmons Janine
Published: December 2021

In 2021, NIH funded six high-priority research networks designed to develop resources to support and advance the study of emotional well-being (EWB) and its core components. These research networks aim to advance the field by facilitating transdisciplinary research in the social, behavioral, psychological, biological, and neurobiological sciences. The National Institute on Aging (NIA) co-sponsored the RFA, and provided funding for NEW Brain Aging, because of the central importance of EWB to health trajectories across the adult lifespan. In this presentation, Dr. Simmons, Chief of the Individual Behavioral Processes Branch within the NIA Division of Behavioral and Social Research (BSR), will discuss how EWB research fits within NIA priorities. She will then facilitate open discussion about NIA and BSR’s vision for the EWB ‘network of networks,’ the synergy of NEW Brain Aging with other members of the larger network, and the opportunities these networks will provide for investigators interested in EWB.
Association of Leukocyte Telomere Length With Perceived Physical Fatigability
Authors: Katz Rain , Zmuda Joseph , Lee Joseph , Honig Lawrence , Christensen Kaare , Feitosa Mary , Wojczynski Mary , Glynn Nancy W
Published: December 2021

Leukocyte telomere length (LTL) is a potential marker of biological aging, but its relationship to fatigability, a prognostic indicator of phenotypic aging (e.g., functional decline) is unknown. We hypothesized shorter LTL would predict greater perceived physical fatigability. Two generations of participants (N=1,997; 309 probands, 1,688 offspring) were from the Long Life Family Study (age=73.7±10.4, range 60-108, 54.4% women). LTL was assayed at baseline and 8.0±1.1 years later perceived physical fatigability was measured using the validated, self-administered 10-item Pittsburgh Fatigability Scale (PFS, 0-50, higher scores=greater fatigability). Prevalence of greater physical fatigability (PFS scores≥15) was 41.9%. Using multivariate linear regression, one kilobase pair shorter LTL predicted higher PFS Physical scores (β=0.9, p=0.025), adjusted for family relatedness, generation (indicator for age), field center, follow-up time, sex, and follow-up body mass index, physical activity, health conditions. LTL, a promising marker of future fatigability, may allow for early identification of those at-risk for deleterious aging.
Associations Between Perceived Fatigability and Amyloid Status in the Baltimore Longitudinal Study of Aging
Authors: Liu Fangyu , Dougherty Ryan , Wanigatunga Amal , Bilgel Murat , An Yang , Simonsick Eleanor , Resnick Susan , Schrack Jennifer
Published: December 2021

Higher level of and greater longitudinal increase in perceived fatigability are linked to cognitive decline and lower brain volumes in older adults. However, it remains unclear whether perceived fatigability is associated with Alzheimer’s disease-related brain pathology. In the BLSA, 163 participants without neurological disease or cognitive impairment (aged 74.7+/-8.4 years, 45% men) were assessed for perceived fatigability using rating of perceived exertion after a 5-minute (0.67 m/s) treadmill walk and Aß burden using 11C-Pittsburgh compound B (PiB) positron emission tomography. Forty-four participants were PiB+ based on a mean cortical distribution volume ratio (DVR) cut point of 1.066. After adjusting for demographics, body composition, comorbidities and ApoE-e4, higher perceived fatigability was not associated with PiB+ status (OR=0.84; 95% CI: 0.69, 1.05). Results suggest perceived fatigability may contribute to cognitive decline through pathways other than Aß pathology. Future studies should target other mechanisms linking perceived fatigability and cognitive decline.
Dyads' Perceptions: Recruiting Persons Living With Dementia and Caregivers in a Clinical Trial
Authors: Sefcik Justine , Petrovsky Darina , Brewster Glenna , Li Junxin , Gooneratne Nalaka , Hodgson Nancy , McPhillips Miranda
Published: December 2021

Recruiting persons living with dementia (PLWD) and their caregivers (dyads) into research is challenging and costly. The purpose of this study was to better understand factors that influence dyads decisions to enroll in a clinical trial. We used Ajzen’s Theory of Planned Behavior (TPB) to develop a qualitative interview guide and analyze the data with a directed content analysis. We conducted semi-structured telephone interviews with 12 PLWD and 9 caregivers who all enrolled in one clinical trial. Aligning with the TPB we found the following positively influenced enrollment: 1) wanting to learn, in-person meetings with knowledgeable staff, and the money always helps (attitudes toward joining); 2) to support another person (perceived norm); and 3) easy to participate (perceived behavioral control). Flexible scheduling and the study taking place in the home was comfortable and convenient for participants. Findings can inform future recruitment efforts and research studies.
Implementing Physical Activity Studies During COVID-19 and Winter Storms: Lessons Learned
Authors: Na Annalisa , Murphy Calliope , Chao Tony , Morrison Charles , Chapman Karen , Lindsey Ronald , Hastings Mary
Published: December 2021

Patient recruitment and retention are challenging for longitudinal studies. Stay-at-home restrictions for the Galveston and Houston regions in 2020 for COVID-19 and in 2021 for the Winter Storms shut down elective healthcare activities and created additional recruitment barriers during the implementation of a 12-month study examining the physical function of older adults receiving a total knee arthroplasty. This presentation describes recruitment and retention strategies during natural disasters. Ten participants started the study during the pandemic and 6 remained through the winter storms (3 withdrew, 1 no showed). Physical activity monitors were distributed and collected through mail, patient reported outcomes were completed online or over the phone, clinician-initiated measures were only collected when clinics were open, and efforts were made to minimize staff burden and follow evolving hospital guidelines. Most importantly, regular communication and follow-up with participants, research team, and department personnel created a sense of community.
Linkages Between Indigenous Cultural Generativity and Sobriety to Promote Successful Aging Among Alaska Natives
Authors: Lewis Jordan
Published: December 2021

This article builds on the People Awakening Project, which explored an AlaskaNative understanding of the recovery process from alcohol use disorder and sobriety. The presentation will explore motivating and maintenance factors for sobriety among older AN adult participants (age 50+) from across Alaska. Ten life history narratives of Alaska Native older adults, representing Alutiiq, Athabascan, Tlingit, Yup’ik/Cup’ik Eskimos, from the PA sample were explored using thematic analysis. AN older adults are motivated to abstain from, or to quit drinking alcohol through spirituality, family influence, role socialization and others’ role modeling, and a desire to engage in indigenous cultural generative activities with their family and community. A desire to pass on their accumulated wisdom to a younger generation through engagement and sharing of culturally grounded activities and values, or indigenous cultural generativity, is a central unifying motivational and maintenance factor for sobriety. The implications of this research indicates that family, role expectations and socialization, desire for community and culture engagement, and spirituality are central features to both Alaska Native Elders’ understanding of sobriety, and more broadly, to their successful aging. Sobriety can put older Alaska Native adults on a pathway to successful aging, in positions to serve as role models for their family and community, where they are provided opportunities to engage in meaningful indigenous cultural generative acts.
Pet Ownership and Longitudinal Change in Physical Function: Evidence From the BLSA
Authors: Friedmann Erika , Gee Nancy , Simonsick Eleanor , Barr Erik , Resnick Barbara , Werthman Emily , Adesanya Ikmat
Published: December 2021

Successful aging depends on avoiding disease and disability, maintaining high physical and cognitive function, and psychological adaptation. Research examining the relationship of pet ownership (PO) or human-animal interaction (HAI) to human health supports contributions to these successful ag-ing-related outcomes at some point in the life-cycle, mostly in populations with diseases or disabili-ties. We examine the contributions of PO to maintaining physical capacity among generally healthy community-dwelling older participants in the Baltimore Longitudinal Study of Aging (BLSA). Partici-pants’ [N=637, mean age=68.3 years (SD=9.6), pet owners N=149] completed a standardized physi-cal function test battery (among other measures) every 1-4 years and a ten-year PO history. Linear mixed, or generalized linear mixed, models with time varying PO were used to examine change in successful aging-related outcomes over up to 13 years [mean=7.5, (SD=3.6)] according to PO. Physi-cal function declined across all domains examined, but was observed to be less severe with PO in overall physical performance (p<0.001), rapid gait speed (p=0.041), 400-meter walk time (p<0.001), and reported physical wellbeing (p=0.032). No differences were observed for grip strength (p=0.56), usual gait speed (p=0.07), and leisure time physical activity (p=0.26) after con-trolling for age. This study provides the first longitudinal evidence that PO may promote successful aging among community-dwelling healthy older adults by moderating age-related declines in physical functional status in late-life.
Support From a Distance: How Home Care Agencies Influence Paid Caregiving in the Home
Authors: Franzosa Emily , Stone Robyn
Published: December 2021

Paid caregivers (e.g., home health aides, personal care attendants, and other direct care workers) who care for functionally impaired older adults in the home frequently report that while rewarding, their work is logistically, physically, and emotionally demanding. Unlike direct care workers in institutional settings, paid caregivers work with care recipients one-on-one in private settings and often have limited contact with or support from their employers. These factors contribute to high workforce turnover and may impact the quality of patient care. In this symposium, we explore ways that home care agency policies and practices influence the experience of giving and receiving care in the home. First, Bryant et al. describe the range of agency-based models and the impact of workplace design in creating supportive working environments. Next, Fabius et al. explore characteristics of direct care agencies across Maryland, with implications for worker training and support. Reckrey et al. describe the differing perceptions of aides, caregivers and providers around the role agencies play in defining paid caregivers’ roles, and how this may lead to conflict within the caregiving team. Finally, in the context of COVID-19, Franzosa et al. examine communication and coordination between Veterans Affairs-paid agencies and home health aides during the pandemic, while Tsui et al. present a case study of an agency’s efforts to support paid caregivers through group support calls. Together, these studies highlight challenges in the structure, organization and perceptions of home care agencies, and identify potential avenues for agencies to support paid caregivers and their clients.
Job Design for Home Care Work: Perspectives From Employers and Home Care Aides
Authors: Bryant Natasha , Stone Robyn , Hennessa Alex
Published: December 2021

Home-based care is a rapidly growing sector becoming more important to individuals, families, providers, and payers. The ways in which agencies create the work environment for home care aides who are essentially in their clients’ homes is not adequately documented and may be changing rapidly with labor market innovations. This qualitative study describes how different home care business models (e.g., non-profit VNAs, for-profit franchises, uber-style matching, worker-owned coops) address job design and the overall work environment for home care aides. Interviews with employers and focus groups with home care aides examine workplace practices, how work is organized and supported when the workforce is virtual and the workplace is a client’s home, and the perceived attributes of a positive workplace environment across business models. This study fills significant knowledge gaps about home care workplace design and the role of agencies in creating a supportive environment.
Characteristics, Challenges, and Support of Maryland's Direct Care Workers: Findings From a Statewide Agency Survey
Authors: Fabius Chanee , Johnston Deirdre , Wolff Jennifer
Published: December 2021

Direct care workers (e.g., personal care aides) are paid health care professionals who provide hands on assistance with daily activities to persons with disabilities in home, community, and institutional settings. Many workers are employed by direct care agencies, but little is known or understood about the organizational attributes of these agencies. We describe results from a mixed mode (postal mail, electronic, and telephone) survey of n=1112 residential care agency administrators in Maryland to assess organizational (e.g., size, supplemental services) and direct care worker (e.g., training) characteristics. Preliminary findings indicate that half of direct care agencies’ revenue comes from Medicaid and roughly 40% of clients are living with dementia. Administrators report challenges managing dementia-related behaviors (70%), communicating with persons living with dementia (63%) and interacting with family caregivers (63%). Findings from this work will inform the development of an organizational level intervention that targets training and support of direct care workers.
Navigating COVID-19: Communication and Coordination Between Home Care Agencies and Aides Caring for Older Veterans
Authors: Franzosa Emily , Judon Kimberly , Gottesman Eve , Runels Tessa , Koufacos Nicholas
Published: December 2021

Home health aides are essential members of the home care team, but often report limited communication with agency supervisors. To explore the impact of COVID-19 on these dynamics, we conducted semi-structured interviews with providers (n=9), contracted home health agencies (n=6), and aides caring for veterans (n=8) at an urban Veterans Affairs medical center. Data were analyzed through thematic analysis. Agencies relied on aides to observe and report on patients’ conditions, including COVID-19 symptoms, but aides were not always aware of follow-up and wanted more information about their patients’ health and COVID-19 status. Agencies also reported providing personal protective equipment (PPE) and infection prevention guidance to aides; however, some aides reported purchasing their own PPE and seeking out private COVID-19 testing. Supporting aides by providing needed training and protective resources, and engaging them more collaboratively in medical care, may help improve job satisfaction and quality of care.
I Would be More at a Loss Without It: Technology as a Tool for Resilience for Older Adults During the COVID-19 Pandemic
Authors: Newmark Rebecca , Allison Theresa , Smith Alexander , Perissinotto Carla , Kotwal Ashwin
Published: December 2021

COVID-19 associated shelter-in-place orders led to concerns about worsening social isolation and inadequate access to technology among older adults, yet little is known about technology use in this population during the pandemic. We examined older adults’ experiences with technology during shelter-in-place in order to identify lessons learned for a post-pandemic world. We conducted semi-structured in-depth interviews with a purposive sample of 20 community-dwelling older adults in San Francisco. Two independent coders conducted concurrent data analysis using inductive and deductive approaches to identify salient themes. Participants were 78 years on average (range 64-99), 55% female, 25% Black, 75% lived alone, and 60% reported at least one ADL impairment. Technology emerged as core aspect of resilience, indicating whether older adults could navigate pandemic restrictions, with two primary themes identified. First, many participants reported discovery of new technologies to maintain or develop new connections, including Zoom-based community groups and telehealth services (“there’s all kinds of virtual programs where you can exercise”). Second, older adults were resourceful in identifying community resources and enlisting family members to learn (“I had to ask one of my granddaughters how to make the chat thing work”). Despite difficulty navigating passwords, software updates and other common obstacles, most participants expressed gratitude for technology and the connectivity made possible. Many indicated an intention to integrate new technology-based social interactions into everyday life even after restrictions ended. The COVID-19 pandemic has highlighted the role technology can play in fostering resilience among older adults in adapting to external stressors.