bluuebunny/crossref_metadata_2025 huggingface dataset:
Space, Context, Human Capital: A Macro-Micro Perspective on Social Environment and Financial Literacy in Later Life
Authors: Li Yang , Mutchler Jan , Miller Edward , Xiao Jing Jian , Tucker-Seeley Reginald
Published: December 2021

Despite a large body of literature documenting the association between individual characteristics and financial literacy, our understanding of the impact of macro-environmental conditions on individual financial literacy remains limited, particularly in later life. Drawing from a micro-macro perspective on the social environment and individual processes, we examined the extent to which three state-level contextual characteristics were associated with individual later-life financial literacy in the United States: tertiary educational attainment, poverty prevalence, and Internet penetration. We utilized data from the 2019 Understanding America Study (UAS) for adults aged 50 years or older to assess financial literacy (n=2,930), and data from the American Community Survey to evaluate contextual conditions. The UAS is a nationally representative survey panel supported by the Social Security Administration and the National Institute on Aging. Cross-sectional multilevel regression models were used to examine the hypothesized effects. We found that state-level poverty prevalence was negatively associated with individual financial literacy while state-level Internet penetration was positively associated with individual financial literacy, over and above individual characteristics known to impact financial literacy. No association was found between state-level educational attainment and individual financial literacy after controlling for respondents’ own education. Findings suggest that the social environment may condition financial literacy in later life through exposure to opportunities that promote knowledge acquisition. Interventions to enhance later-life financial literacy may benefit from targeted approaches that take into account the environmental characteristics of their locations of residence.
Cognition in Primary Care Community Resource Directory for Individuals, Caregivers, and Providers
Authors: Suchsland Monica Zigman , Fitzpatrick Annette , Gaster Barak , Raetz Jaqueline , Illes Judit , Olivari Benjamin , McGuire Lisa , Belza Basia
Published: December 2021

A KAER Model recommendation is to refer individuals diagnosed with dementia to resources that help them prepare for the future and services that provide ongoing support. The purpose of this project was to locate local quality services and develop a resource directory for persons with cognitive impairment for use by providers, staff, individuals, families, and caregivers. We worked with a Community Advisory Board and interviewed individuals and caregivers to understand what resources are useful and important to include in the resource directory. We built a web-based resource directory that allows users to query resources based on specific needs. We integrated the resource directory within the electronic health record for providers to include after visit summaries. A resource directory was deployed for community use, with goals of sustainability and longevity after this project is completed.
Caring From Afar: Long-Distance Caregivers’ Use of Supportive Services for Themselves
Authors: Cimarolli Verena , Wylie Molly , Zucchetto Jillian Minahan , Falzarano Francesca , Horowitz Amy
Published: December 2021

Although long distance caregivers (LDCs) are starting to be recognized as a subgroup of care partners experiencing unique challenges and stresses, it is unknown 1) what types of supportive services LDCs use for themselves and 2) what factors are associated with supportive service use in this understudied caregiving population. In our sample of 304 LDCs (Mage=56.9), the most frequently utilized service was video phone/webcam systems to monitor the care recipient (CR). Guided by Andersen’s Model of Health Care Utilization and using multiple hierarchical regression analysis, younger age of the LDC (a predisposing factor) and need-related characteristics (greater caregiving burden and depressive symptoms, more time spent helping the CR, and worse CR functional status) were associated with greater use of supportive services. Enabling factors were not associated with service use. These study findings can help inform how to engage LDCs in supportive service utilization.
Preferences and Determinants of End-of-Life Care Among Older Chinese Americans
Authors: Kong Dexia , Kozlov Elissa , Dong XinQi
Published: December 2021

End-of-life (EOL) care awareness and practice remain particularly low among older Chinese Americans. More empirical evidence regarding EOL is needed to develop culturally-relevant interventions to promote EOL engagement in this minority population. Using population-specific data, this study investigates preferences and associated sociodemographic and health determinants related to EOL among older Chinese Americans. Data were from the Population-based Study of Chinese Elderly in Chicago (collected 2017-2019, N=3,124). Linear and logistic regressions were conducted. Of the sample, 46.1% considered EOL care planning as important or somewhat import. Nearly 22% had EOL discussions with families. The most preferred EOL locations were home (43.7%), hospital (35.5%), nursing home (10.1%), and hospice (4.3%). Overall, 47.1% perceived EOL care as family decisions, 39.6% regarded EOL care as personal decisions, 7.5% preferred children to make EOL decisions, and 3.3% preferred a spouse to make EOL decisions. Chinese older adults who were female (B=0.10, p<0.01), married (B=0.11, p<0.01), had higher education (B=0.02, p<0.001), acculturation level (B=0.02, p<0.001), and religiosity (B=0.12, p<0.001), and more chronic conditions (B=0.05, p<0.001) were more likely to consider EOL as important. Those with older age [Odds Ratio (OR)=1.02, 95% Confidence Interval (CI)=1.01-1.03], female gender (OR=1.44, 95% CI=1.18-1.77), higher levels of education (OR=1.02, 95% CI=1.01-1.04), acculturation (OR=1.04, 95% CI=1.01-1.06), and religiosity (OR=1.11, 95% CI=1.02-1.21), longer U.S. residence (OR=1.02, 95% CI=1.01-1.03), and more chronic conditions (OR=1.13, 95% CI=1.06-1.21) were more likely to have discussed EOL preferences with their families. Study findings underscore low engagement in EOL planning in this population and the need for culturally-appropriate interventions.
Unmet Family Needs in Hospice and Research Priorities: Perspectives From a National Sample of Hospice Agencies
Authors: Becker Todd , Cagle John
Published: December 2021

Although hospice cares for nearly 1.5 million patients and families annually, little is known about practitioners’ opinions of current gaps in care and research. To this end, we posed two open-ended questions to hospice representatives to identify practice-relevant research priorities. Data stem from two optional questions (Q1: N = 72; Q2: N = 73) appended to Cagle et al.’s (2020) national survey of 600 randomly selected hospices, stratified by state and profit status. Most participants provided the majority of care in-home (84.7%; 79.5%) and worked at a medium-sized hospice (50.0%; 49.3%). Responses to Q1 (“What is the biggest unmet need for hospice patients and families?”) and Q2 (“In your opinion, what is the most pressing topic that hospice researchers need to study?”) were analyzed for content and then synthesized. Analyst triangulation and peer debriefing improved trustworthiness. Emerging domains included: access to hospice, hospice services and workforce issues, and education. The access to hospice domain contained a subtheme regarding the need for earlier referrals. Participants noted that short lengths of stay undermine the clinical benefits to patients and families, and that hospice enrollment criteria may contribute to inadequate lengths of stay. The hospice services and workforce issues domain largely focused on burnout prevention. Participants acknowledged that provider self-care was linked to the quality of patient care. The education domain contained subthemes related to improving physician knowledge regarding prognostication and referral, and to patients and families regarding misconceptions about hospice care. Findings highlight critical needs for future hospice research and policy change.
Communicative Coping and Friendship Among Persons Living With Dementia: Findings From Long-Term Care
Authors: Saunders Pamela
Published: December 2021

The study of identity is central to many disciplines, however there is a special link that connects language and discourse to identities. The way people speak reveals a lot about who they are. Through discourse and communication individuals convey and negotiate their sense of self (de Fina, 2020). Regardless of cognitive status, persons living with dementia (PLWD) use language to construct for themselves a social identity of being included in friendship networks (de Medeiros et al., 2011). This paper uses data from the Friendship Study to examine the use of such communicative coping behavior (CCB) for friendship formation. Ethnographic observations of PLWD were conducted in a Long-Term Care residential setting. Sociolinguistic discourse analysis of verbatim transcripts with reference to the CCB Checklist (Saunders et al., 2016) reveal evidence of CCB use. Results suggest that different types of CCBs were used to construct identity and negotiate friendship challenges in different contexts.
Leveraging ACL Funding to Implement an Evidence-Based Falls Prevention Program in Three GWEPs
Authors: Flaherty Ellen , Tumosa Nina
Published: December 2021

Primary care practices have a robust capacity to screen older adults for falls risk and refer them to evidence-based falls prevention programs delivered by Community Based Organizations (CBOs). However, due to a difference in the culture and nature of the work done in these two systems of care, there is often a lack of coordination and communication. Dartmouth has worked to bridge this gap for the past five years through our Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Program (GWEP). GWEP goals include the promotion of Age-Friendly Health Systems by focusing on the 4 Ms: What Matters Most, Medication, Mentation and Mobility. GWEPs commonly operationalize the Mobility component via falls risk screening and prevention programs. Though CBOs are well suited to deliver falls prevention programs, implementing, disseminating and sustaining community-based falls prevention programs in an environment of cost containment, limited funds for community-based services and workforce issues is challenging. Previous Administration for Community Living (ACL) grant funding enabled us to develop the Dartmouth Falls Prevention Training Center (D-TC) using our expertise in training and community-based implementation of evidence-based interventions. The D-TC offers training and implementation support to primary care and CBOs on screening, referring and capacity-building for falls prevention programs. We will discuss challenges and successes implementing the Dartmouth falls prevention model with two additional GWEP grantees, Baystate and the University of Rhode Island. Benefits of leveraging ACL and HRSA funding to achieve synergistic goals to reduce falls in older adults will be explored.
Adopting and Adapting a Falls Prevention Program: Lessons Learned From Implementing a Model From a Different Context
Authors: Morelli Alexandra , Petrie Carol , Ferrone Christine , Clark Phillip
Published: December 2021

Geriatric Workforce Enhancement Programs (GWEPs) are ideally suited to develop and implement educational programs to transform the geriatric care system. They link academic programs, clinical partners, and community-based organizations to bridge care system gaps to improve the health and social care of older adults. Such a collaboration is especially important in falls prevention, where primary care assessments generate referrals to community programs that enroll older adults to reduce their risk of falling. However, exporting an evidence-based model developed in one context for implementation in another is not without its perils and pitfalls. This paper explores the challenges of applying a model developed elsewhere to the Rhode Island context, including the need to understand how structural differences in academic, primary care, and community-based systems require flexibility, innovation, and persistence in overcoming the networking challenges in these different settings. Recommendations for implementing program models in a variety of settings are explored.
Promising Long-Term Residential Care Policy Guidance for Staff to Support Resident Quality of Life
Authors: Hande Mary Jean
Published: December 2021

This paper reviews 63 policy documents in four Canadian jurisdictions that guide long term residential care staff on how to enhance 11 resident quality of life in Canada. We found guidance in each jurisdiction that provide clear language to support staff discretion and flexibility to navigate regulatory tensions and enhance resident quality of life. Newer policies tend to reflect more interpretive approaches to staff flexibility and broader quality of life concepts. We argue that if interpreted through a resident quality of life lens and with the right structural supports, these promising texts offer important counters to the rigidity of long term residential care policy landscape and can be leveraged to effectively broaden and enhance quality of life for residents in long term residential care.
Energy and Exhaustion May Explain Different Subdomains of Perceived Fatigability
Authors: Katz Rain , Cohen Rebecca , Gmelin Theresa , Moored Kyle , Qiao Yujia (Susanna) , Slavin Maggie , Glynn Nancy W
Published: December 2021

Fatigability is a more sensitive measure of one’s perception of fatigue. To identify an appropriate fatigue question when a fatigability measure is unavailable, we examined associations between widely used global fatigue questions and perceived physical and mental fatigability. Participants (N=896, age=74.7±6.6, 58.1% women) from two aging research registries completed the valid Pittsburgh Fatigability Scale (PFS, 0-50) and five global fatigue questions: energy level (0-10), running out of energy (0-5), feeling energetic (0-6), feeling tired (0-6), and feeling exhausted (0-6) over past four weeks. All fatigue measures were correlated (p<0.0001) with physical (|r| range=0.48-0.57) and mental fatigability (|r| range=0.31-0.39). “Energy level” and “feeling exhausted” had strongest associations with physical and mental fatigability, respectively, in age, sex, BMI-adjusted regression models (p’s<0.001), suggesting older adults can distinguish between physical and mental domains. Future work will explore how these constructs are distinct but related, and confirm the optimal proxy for the two fatigability subdomains.
COVID-19 Impact on Alberta Nursing Home Workers: An Interpretive Descriptive Study With Direct Care Providers
Authors: Spiers Jude , Titley Heather , Savage Amber , Thorne Trina , Young Sandra , Asadi Neda , Schalm Corinne , Estabrooks Carole
Published: December 2021

COVID-19 has devastated the LTC sector, but we lack systematic information on the impact on frontline staff. Our research, a partnership with the continuing care branches of Alberta Health and Alberta Health Services, was aimed at assessing COVID-19 impacts on staffs’ well-being and quality of work-life and quality of care and life among residents. Here we report on staff. Using an interpretive descriptive approach, we interviewed 140 staff from January through April 2021, in 34 nursing homes. Facilities selected varied in ownership (public/private) and COVID-19 status (high, moderate, or low incidence). Virtual interviews focused on three key areas of impact: (a) staff mental and physical health, well-being, and work-life, (b) the facility, and (c) on residents. Interviews were analyzed using inductive content analysis. Dominant themes included a commitment of staff to resident wellbeing; a norm of stoicism in which accumulative stress of COVID-19 is recognized in participants’ private lives but not their work; the critical role of teamwork in managing extra workload associated with COVID-19 protocols; role flexibility, particularly managers’, enables workers to minimize interruptions to care activities; governmental wage subsidies and the restriction of workers to only one facility benefits residents and workers in terms of time and familiarity, but some health care aides faced a wage reduction of 30-40%. Alongside the research component, we regularly met with stakeholders and end-users to discuss emerging findings and potential areas needing urgent intervention, as well as longer-term programming as the impact of COVID-19 will persist for many years.
Objective Sleep Quality and the Underlying Functional Neural Correlates Among Older Adults With Probable MCI
Authors: Hsu Chun Liang , Falck Ryan , Backhouse Daniel , Chan Patrick , Dao Elizabeth , ten Brinke Lisanne , Manor Brad , Liu-Ambrose Teresa
Published: December 2021

Poor sleep is a strong risk factor for dementia and is commonly reported among older adults with mild cognitive impairment (MCI). However, the neural underpinnings of poor sleep among older adults with MCI remains equivocal. The goal of this cross-sectional analysis was to explore the relationship between resting-state functional connectivity in the brain and sleep quality as measured by actigraphy. We hypothesize lower sleep efficiency and higher sleep fragmentation may be associated with aberrant functional connectivity of brain regions involved in somatosensory, somatomotor, and attentional processing. Thirty-six community-dwelling older adults with probable MCI between 65-85 years (mean=71.8 years) were assessed for sleep quality using a motion watch to quantify sleep efficiency and fragmentation over 14 days. All participants completed resting-state functional magnetic resonance imaging (fMRI) within 14 days of sleep monitoring. Independent associations between network connectivity and sleep quality were determined using general linear models. Examined networks included the somatosensory network (SMN), dorsal attention network (DAN), ventral attention network (VAN), frontoparietal network (FPN), and default mode network (DMN). Mean Montreal Cognitive Assessment score was 22.5 (SD=2.7) and Mini-Mental State Examination score was 28.3 (SD=1.5). Mean sleep efficiency and fragmentation index was 80.1% and 31.8 respectively. Higher sleep fragmentation correlated with increased connectivity between the SMN and insula, the SMN and posterior cingulate, as well as FPN and primary motor area (Z=3.1; p<0.05). These results suggest aberrant functional connectivity between brain regions involved in attentional and somatosensory processes may be associated with disrupted sleep mechanisms in older adults with MCI.
Wake After Sleep Onset Mediates the Link Between Neighborhood Social Environment and Cognition in Older Adults
Authors: Fausto Bernadette , Yu Kexin , Duberstein Paul
Published: December 2021

Cognition is influenced by the neighborhood social and physical environment, but the underlying mechanisms by which neighborhood environment affects cognition are unclear. We tested the hypothesis that sleep mediates the effects between environmental exposures and cognition. We employed structural equation modeling to examine interrelationships among neighborhood social and physical environment, actigraphic sleep characteristics, and global cognition in a sample of older adults (N=3,196) from Round 2 of the National Social Life, Health, and Aging Project. Results indicated that participants with better cognition lived in salutary (e.g., cohesive, safe) social environments (est.=0.03, p<.001) and less disruptive (e.g., noisy, polluted) physical environments (est.=-0.04, p<.001). The mediation hypothesis was partially supported. Time spent awake after sleep onset mediated the social environment-cognition relationship, but sleep characteristics did not mediate the physical environment-cognition relationship. Future work should identify other environmental influences on sleep and cognition in aging to inform public health intervention priorities.
Expanding Arizona’s Dementia Capable System
Authors: Coon David
Published: December 2021

Currently, 5.8 million US adults live with Alzheimer’s disease (ADRD); the number is expected to double by 2050. Arizona will experience the greatest percent increase in ADRD by 2025. This project targeted three underserved groups in order to expand Arizona’s dementia capable system: people living alone with ADRD; people with Down Syndrome or another intellectual/developmental disability (DS/IDD) aging with ADRD and their family caregivers; and people with ADRD and their caregivers in the Latino community. This presentation describes the development and delivery of the project’s educational workshops, case management services, and evidence-based programs. Over 2,220 participants have participated in workshops to date with the largest percentage being case managers, care coordinators, and discharge planners. Evaluations have been extremely positive with 86.1% being “very likely” to recommend the project to others. The presentation concludes with findings and lessons learned regarding the delivery of the project’s evidence-based programs and case management services.
Irving S. Wright Award of Distinction Lecture, Vincent Cristafalo Award Lecture, and Terrie Fox Wetle Award Lecture
Authors: Barzilai Nir , Wetle Terrie Fox
Published: December 2021

The Irving S. Wright Award of Distinction Lecture will feature an address by the 2021 recipient Malene Hansen, PhD of the Buck Institue for Research on Aging. The Vincent Cristofalo Rising Star Award in Aging Research lecture will feature an address by the 2021 recipient, Morgan Levine, PhD, of Yale University. The Terrie Fox Wetle Award lecture will feature an address by the 2020 recipient, Kali Thomas, PhD, FGSA of Brown University and an address by the 2021 recpient, Andrea Gilmore-Bykovskyi of the University of Wisconsin, Madison. These awards are given by the American Federation for Aging Research, Inc.
Domestic and International Perspectives on Financing Adult Education and Training
Authors: Helsinger Abigail , Dikhtyar Oksana , Cummins Phyllis , Hicks Nytasia
Published: December 2021

Adult education and training (AET) over the life-course is necessary to participate in economic, social, and political activities in the time of globalization and technological advancement. However, little research has been done to identify mechanisms to fund AET opportunities among middle-aged and older adults from a comparative international perspective. Our study aimed to identify strategies to finance AET opportunities for middle-aged and older adults through an international lens, to help identify barriers and facilitators in effort to best support adult learners regardless of education background or socioeconomic characteristics. We carried out a descriptive qualitative study to facilitate an in-depth understanding of funding mechanisms available to adult learners in the selected countries, from the perspective of adult education and policy experts. Data were collected using semi-structured interviews with 61 international adult education experts from government agencies, non-governmental organizations, and education institutions. Our informants represented 10 countries including Australia, Canada, Germany, Italy, the Netherlands, Norway, Singapore, Sweden, the United Kingdom, and the United States. Data included at least one in-depth phone or web-based qualitative interview per informant in addition to information gathered from written materials (e.g., peer-reviewed publications and organizational reports). We identified three financing options that arose as themes: government-sponsored funding; employer-sponsored funding; and self-funding. We found that government-sponsored funding is especially important for low-skilled, low-income older adults for whom employer-sponsored or self-funding is not available. Our results have implications for lifelong AET policy changes, such as adaptations of successful AET funding programs across global communities.
Characterizing Supportive Services Use by Caregiving Relationship Status
Authors: Travers Jasmine , Fabius Chanee
Published: December 2021

Informal caregivers of aging older adults experience a high degree of burden and strain. These emotional experiences often stem from stressful tasks associated with caregiving. Caregiving supportive services that target the provision of support for stressful tasks are instrumental in alleviating caregiving burden and strain. Research is limited on what types of caregiving supportive services caregivers are accessing by relationship status and their source of information. We sought to characterize caregiving supportive services use by caregiving relationship status. We analyzed cross-sectional data from the 2015 National Study of Caregiving limited to caregivers of older adults □65 years. Caregiver relationship status (i.e., spouse, child, other relative/non-relative) was the independent variable. Bivariate analyses were performed to examine the association with caregiver relationship status and 1) any use of supportive services, 2) type of supportive service used among users, and 3) source of information about supportive services. Our sample consisted of 1,871 informal caregivers, 30.7% reported using supportive services. By caregiver relationship status, children had the greatest use of supportive services compared to spouses and other relatives/non-relatives (33.3% vs. 22.5% vs. 22.1%, p=.02, respectively). Among users of services, there were no differences in type of services used. Spouses primarily received their information about services from a medical provider or social worker (73.8%, p=.004). Our findings highlight the need to ensure that other caregiving groups such as spouses have access to important supportive services such as financial support. Medical providers and/or social workers should be better leveraged and equipped to provide this information.
Shared Humanity: Advancing the Personhood of People Living With Dementia
Authors: Sabat Steven
Published: December 2021

During the past three decades, the idea of personhood, and the degree to which people living with dementia (PLWD) possess it and ought to be treated as such, has been discussed by a number of important scholars such as Tom Kitwood and John Swinton. Although both asserted that PLWD ought to be treated as persons, their notions of personhood appear to be quite different. Kitwood noted that personhood was a status “bestowed” on another individual, whereas Swinton asserted that personhood was endemic to human beings. Yet, these approaches are complementary. I show, using case studies, how supportive communities are required for PLWD to teach us about our humanity, so long as we remain “finely aware and richly responsible” (Nussbaum, 1990). Our humanity is shared, in the Zulu concept of “Ubuntu” (Tutu, 1981;1989), when each individual’s humanity is ideally expressed in relationship with others. This has important implications for clinical practice.
Evaluation of the Savvy Caregiver Program for LGBTQIA Adults Living With Alzheimer's Disease and Related Dementias
Authors: Flatt Jason , Pollock Kiera , Song Yeonsu , Wharton Whitney , Anderson Joel
Published: December 2021

Approximately 350,000 LGBTQIA+ older adults in the U.S. currently have Alzheimer’s disease and related dementias (ADRD), with projections nearing 1 million by 2030. LGBTQIA+ older adults face challenges in receiving adequate and inclusive care and caregiving support due to the inability to rely on traditional family networks, greater disability, and discrimination when seeking aging services. Working with the Los Angeles LGBT Center Aging in Community Initiative, we evaluated the: 1) Adaptation of the Savvy caregiver training program for care providers of LGBTQIA+ persons living with ADRD; and 2) Feasibility and acceptability of the program. Care providers were very satisfied with the program, strategies, information, and activities of the tailored Savvy program. For psychosocial outcomes, there were trends in greater care planning, increases in asking friends/family for support, and decreased loneliness. Additional research is needed on culturally-relevant aging services and behavioral interventions for care providers of LGBTQIA+ persons living with ADRD.
Marital Status, Marital Transitions, and Sleep Quality in Mid to Late Life
Authors: August Kristin
Published: December 2021

Sleep is an important behavior in the prevention and management of chronic conditions in later life. Marital status may account for variability in sleep quality, but little is known about this association in the later part of life or how transitions into and out of marriage are related to changes in sleep quality. This study used the resource model and crisis model as frameworks to understand how marital status and marital transitions were related to sleep quality in mid to late life and whether these findings differed by gender. Interview data from 2,872 participants 50-74 years old (M=59.77 years; 63.7% women) from the ORANJ BOWL, a longitudinal panel study in New Jersey, were used. Marital status and sleep quality were examined in two waves approximately 10 years apart. All analyses controlled for health and sociodemographic characteristics. Weighted regressions revealed that individuals in committed romantic relationships and women had worse sleep quality than those in other marital status groups and men (p<.005). Weighted fixed effects regressions revealed that compared to individuals who remained married, individuals who remained divorced or widowed or who became widowed had better sleep quality, whereas those who became divorced had worse sleep quality (ps<.05); individuals who transitioned into marriage had better sleep quality than those who remained divorced or widowed (ps<.03). Findings differed depending on the index of sleep quality examined. Efforts to understand which middle-aged and older adults are most vulnerable to sleep disturbances can inform the design of interventions to promote better sleep quality.
Functional Mobility, Aging, and People With Mental Illness: Issues and Challenges
Authors: Zechner Michelle , Anderson Ellen , Gill Kenneth
Published: December 2021

People with serious mental illness (SMI) are more likely to experience chronic health conditions at younger ages, which increases the risk of premature death. Co-morbid health conditions and risk for premature death are well-studied in the population, however less is understood about the impact of aging and SMI on functional ability. Research suggests that the population walk less and may have lower fitness levels than other populations (Gill et al., 2016). Specific data exploring functional age of people with SMI is sparse. The authors compared published standardized geriatric functional fitness values for people over 65 to baseline values of a community sample of people living with SMI who participated in a community health promotion intervention. The average age of the sample was 50 (SD=11). Three physical functioning measures were used in the comparison to measure physical functioning; the Sit to Stand Test, 6 Minute Walk, and Single Legged Stance. Results indicated significant differences in mean physical functioning values between the sample and standardized geriatric values. The sample performed at levels 20-30 years older than their chronological age. This finding suggests that mental health and aging services may need to adjust interventions, services and methods to improve physical functioning in middle-aged and older adults living with SMI. Premature functional decline impacts community living skills, independent living, housing choice, vocational options, and may impede personal goal attainment. Recommendations for interventions will be offered, as will suggestions for policies targeting services that cross aging and mental health silos.
Trauma, Posttraumatic Stress Disorder, and Treatment Among Middle-Aged And Older Women
Authors: Sampson Laura , Jha Shaili , Ratanatharathorn Andrew , Roberts Andrea L , Kubzansky Laura D , Rimm Eric B , Koenen Karestan C
Published: December 2021

Posttraumatic stress disorder (PTSD) is twice as prevalent in women as in men, and is an established risk factor for chronic disease, but few studies have comprehensively assessed lifetime PTSD in middle-aged and older civilian women. We surveyed 33,328 women aged 54-74 from the Nurses’ Health Study II from August 2018 to January 2020 to understand trauma exposure, PTSD based on the Diagnostic and Statistical Manual of Mental Disorders Version 5, and trauma-related treatment use. The majority (82.2%) of women reported one or more lifetime traumas. 10.5% of those with trauma had lifetime PTSD and 1.5% had past-month PTSD. The most common trauma types were sudden or unexpected death of a loved one (44.9%) and interpersonal or sexual violence (43.5%). Almost 30% experienced occupational (nursing-related) trauma. Interpersonal or sexual violence event types explained the largest proportion of PTSD cases (33.6%) out of seven categories of events assessed. Only 25% of women with trauma ever accessed trauma-related treatment, but this proportion was higher (66.4%) among those with diagnosable PTSD, and among those with current depression (35.9%). Treatment was most common among women who experienced interpersonal/sexual violence and lowest among those with occupational trauma, but treatment satisfaction did not vary by worst trauma type. Psychotherapy was the most common type of treatment. These results demonstrate that trauma is nearly universal in middle-aged to older women, which has important implications for their long-term health and well-being—particularly in the era of COVID-19 which is likely to produce additional trauma in this population.
Refining an Oral Health Care Partner Intervention Using Behavior Change Techniques
Authors: Bryant Ashley Leak , Hirschey Rachel , Caiola Courtney , Chan Ya-Ning , Plassman Brenda , Wu Bei , Bailey Donald , Anderson Ruth
Published: December 2021

Following a pilot, we refined an oral health carepartner intervention for individuals with mild dementia (IMD). In this intervention, we use behavior change techniques (BCTs) to foster changes by carepartners including using new oral-care techniques and developing skills for using cueing and communications approaches to support behavior changes by IMD (duration and frequency of toothbrushing and oral-hygiene skills); thus, improving plaque and gingival indices. We describe our approach to refining the intervention manual including a) completing the self-paced BCT taxonomy course, b) developing a coding schema, c) coding the original manual for evidence of BCTs, and d) refining the manual to improve use of BCTS in the refined intervention. Our results detail how BCTs can be applied to refine and improve interventions. This research demonstrates the value in using BCTs for interventions to address how carepartners and IMD can collaborate to improve oral hygiene care.
Having a Post-Retirement Job: Improvisation and Containing Commitments
Authors: Platts Loretta , Ignatowicz Agnieszka , Westerlund Hugo , Rasoal Dara
Published: December 2021

This qualitative paper focuses on individuals who work after pensionable age, a distinctive period in the late career when workers are supported by the known and reliable income of a pension. Using constant comparative analysis, we analyzed interviews from a purposive sample of 25 Swedish people in their late sixties and early seventies. We examined conditions for being in paid work in terms of enabling factors (self-employment, shift work, shortage occupation), improvisation, and the role of chance. The interviews revealed that post-retirement workers took charge of the aspects of work that mattered most to them, evading the disciplinary aspects of work by controlling scheduling and limiting the duration of their commitment. These constrained commitments had knock-on effects of improving psychosocial working conditions. Women and immigrants—groups facing low pensions—experienced the greatest financial consequences of being unable to work in their retirement years in order to supplement their pension income.
The Relationships Between Physical Activity Behavior, Daily Experiences, and Well-Being in Everyday Life
Authors: O'Brien Erica , Almeida David , Hoppmann Christiane
Published: December 2021

A physically active lifestyle has several health benefits in both the short- and long-term. This includes higher levels of emotional and psychological well-being and, in many cases, maintained well-being despite stressful experiences that can have countervailing, negative impacts on health. This symposium presents innovative research that (a) links physical activity to positive and negative events or experiences in middle-aged and older adults, and that (b) uses different assessment and analytical techniques to unpack these links on multiple timescales – between moments, days, and years. Lee and colleagues investigate the influence of daily positive experiences on the likelihood and extent of physical activity. O’Brien and Almeida examine how daily stressor experiences predict engagement in different intensities of physical activity and highlight moderating factors such as perceived stressor control. Lastly, Benson and colleagues report on whether the potential for daily physical activity to protect against negative stressor responses differs with age and changes across the adult lifespan. Together, these papers consider the nature and mechanisms of the relationship between physical activity and everyday experiences (e.g., stressors and positive events). They also underscore the importance of assessing relationships on different timescales to obtain a clearer understanding of intrapersonal and developmental processes. As discussant, Hoppmann will assess the strengths and limitations of these papers, elaborate on underlying and overarching themes, and identify future directions in this field.
Positive Events and Physical Activity in Daily Life for Middle-Aged and Older Adults
Authors: Lee Sun Ah , Benson Lizbeth , O'Brien Erica , Conroy David , Almeida David
Published: December 2021

Previous studies reveal that positive affective well-being is positively associated with physical activity. The present study extends this work by examining the relationship between positive events and physical activity in daily life. Participants (N=1,016, ages 43-90, 56% women) from the third wave of the National Study of Daily Experiences reported their experiences of positive events and physical activity in eight daily diary interviews. Results from multilevel model analyses showed that on days when participants experienced more positive events than usual, they were more likely to engage in physical activity and reported engaging in greater physical activity than usual. Further, participants who experienced more positive events on average across the study period also reported engaging in greater daily physical activity. These results were invariant across age. Our findings highlight the importance of naturally-occurring positive experiences in daily life across middle- and later adulthood.
Polyvictimization and Cognitive Function in an Ethnic Minority Aging Population
Authors: Li Mengting , Dong XinQi
Published: December 2021

Globally, around 1 in 6 older adults experienced some form of elder mistreatment in community settings. However, little is known about the prevalence of polyvictimization, or experience of multiple forms of abuse, which may exacerbate negative outcomes over that of any one form of victimization in isolation. Data were drawn from the PINE study. Polyvictimization was defined as exposure to multiple forms of victimization, including psychological, physical, and sexual mistreatment, financial exploitation, and caregiver neglect. Cognitive function was evaluated by global cognition, episodic memory, executive function, working memory, and MMSE. Regression analyses were performed. Among 3153 participants, 128 experienced two forms of abuse while 12 experienced three or more forms of abuse. Polyvictimization was associated with lower global cognition (b=-0.05, SE=0.02, p<.05), episodic memory (b=-0.06, SE=0.03, p<.05), working memory (b=-0.14, SE=0.07, p<.05), and processing speed (b=-0.68, SE=0.33, p<.05). Interventions could target older adults with polyvictimization and protect their cognitive function.
Face-Saving and Help-Seeking Among U.S. Chinese Older Adults With Elder Mistreatment
Authors: Chao Ying-Yu , Kong Dexia , Dong XinQi
Published: December 2021

Chinese culture places a high value on saving face and not bringing shame to the family. This study aimed to examine the associations between face-saving and help-seeking among U.S. Chinese older adults who experienced elder mistreatment (EM). Data were retrieved from the PINE study. Regression analyses were performed. Most EM victims sought help from informal sources only (48.21%), followed by no help (26.79%), informal plus formal help (19.64%), and formal help only (5.36%). For EM screening, face-saving was associated with informal help-seeking intentions (p < .05). For EM subtypes, face-saving was associated with overall help-seeking intentions for financial exploitation (p < .05), but not on physical mistreatment, psychological mistreatment, and caregiver neglect. Face-saving was not associated with help-seeking behaviors. Study findings underscore the significance of a unique cultural value in understanding EM help-seeking intentions among Chinese older adults. Cultural constructs should be considered in future EM research in diverse populations.
Social Isolation and Aging Out of Place Among Immigrants and Refugee Seniors in Canada
Authors: Johnson Shanthi , Bacsu Juanita-Dawne , McIntosh Tom , Jeffery Bonnie , Novik Nuelle
Published: December 2021

Immigrant and refugee seniors experience cultural barriers, discrimination, and limited networks which increase the risk of social isolation and thus hinder their active participation in the society. This paper explores social isolation among immigrant and refugee seniors in Canada based on an environmental scan of federal/provincial/territorial and community-based programs and a systematic scoping review. Findings revealed important gaps and regional disparities in opportuntiies to reduce social isolation and great active participation. Research was limited, often qualitative in nature, typically based on larger urban centres, with measurement issues related to the need for consideration beyond one's living arrangements. The results highlight the need for greater understanding Canada’s immigration and refugee system and policies, and collaboration across levels of government. Reducing issues of social isolation and enabling better active aging for vulnerable seniors require a more nuanced and multidimensional conceptualization with prioritization on addressing the unique factors of culture and geographical context.
Implications and Recommendations From a Project ECHO Series on Aging With IDD
Authors: Helm Faith , Mathews Jenni
Published: December 2021

Ongoing evaluations of innovative educational programs provide opportunities for quality improvement. This paper reports results from a Project ECHO series on lifelong IDD and dementia. Participant responses (n = 85) were collected from spoke sites in various settings across the US. Using a 5-point (5 very effective) Likert scale, data were collected from assessment items on 4 didactic presentations and 5 case studies representing essential components of the ECHO model. Overall scores by spoke sites for satisfaction with the didactic and case presentations ranged from 3.94 to 4.94; relevance of case studies to the work setting ranged from 4.0 to 4.75. Knowledge gain questions showed consistently positive directionality. As a result of their participation, spokes rated intent to provide better care for patients (57% to 88%), train staff (62% to 81%), and educate family/caregivers (57% to 88%). Implications of findings for the application of quality improvement methods are discussed.
COP Cells and Tissue Loss Syndromes: Frailty, Sarcopenia, and Osteoporosis
Authors: Duque Gustavo
Published: December 2021

COP cells have been identified as having a potential role in the pathogenesis of tissue loss syndromes such as osteoporosis and frailty. This is based on the hypothesis that their dysregulation may cause a decrease in bone and muscle formation, which also increase the risk of adverse outcomes such as frailty and disability. Whereas high numbers of COP cells have been associated with osteoporosis and fracture healing, a low percentage of COP (%COP) cells have been associated with frailty and disability. In addition, low expression of lamin A (a protein of the inner nuclear envelope) in COP cells has also been associated with frailty and disability in older persons. In this session, the evidence on quantification methods for COP cells in clinical settings and the potential clinical use of COP cells in tissue loss syndromes will be discussed. This discussion will include current evidence supporting the use of COP cells as a biomarker or as a novel therapeutic approach to these age-related conditions.
Association Between Evening Light Exposure and Subjective Sleep Measures Among People Living With Dementia
Authors: McPhillips Miranda , Hwang Yeji , Talwar Sonia , Hodgson Nancy
Published: December 2021

Excessive light exposure before bedtime can disrupt one’s circadian rhythm and can lead to poor sleep. The purpose of this study was to describe the relationship between evening light exposure and subjective sleep measures in people living with dementia (PLWD). We conducted secondary data analysis using the baseline data from Healthy Patterns Clinical Trial (N=137). We used Actiwatch Spectrum Plus to collect light data over three consecutive days. We defined evening light exposure as the average white light intensity for 4 hours before sleep. Sleep measures included Epworth Sleepiness Scale and PROMIS Sleep-Related Impairment. We used univariate regression analysis. We found that that greater evening intensity of light exposure was associated with higher daytime sleepiness (β=0.209, p=0.015) and more sleep impairment (β=0.228, p=0.014). The results of our study suggest that exposure to bright light during evening can disturb nighttime sleep and increase daytime sleepiness in PLWD.
The Biology of COP Cells: Mesenchymal of Hematopoietic?
Authors: McGee-Lawrence Meghan
Published: December 2021

Circulating osteogenic precursor (COP) cells constitute a recently discovered population of circulating progenitor cells with the capacity to form not only bone but other mesenchymal tissues. A small but growing body of literature explores these cells, but with a great deal of disagreement and contradiction within it, mainly whether these cells are from mesenchymal or hematopoietic origin. This session will discuss the origins and biological characterization of these cells, including the identification strategies used to isolate these cells from the peripheral blood. It also examines the available knowledge on the in vitro and in vivo behaviour of these cells in plastic adherence, differentiation capacity, proliferation, and cellular homing. We will also review the profound and exciting implications for future use of COP cells in clinical practice, particularly in comparison with other types of stem cells.