bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of a multiple chronic condition (CC) remote monitoring program on clinical outcomes among older adults
Authors: Dzubur Eldin , Yu Jessica , James Roberta , Hoffman Julia , Shah Bimal
Published: December 2021

Older adults are faced with an increased risk of comorbid chronic disease such as diabetes. While multiple health behavior change interventions (MHCIs) are known to improve clinical outcomes more than targeted interventions, less is known whether such effects persist in older populations. The objective of the study was to examine the effects of multiple chronic condition (CC) remote monitoring program enrollment and mental health program enrollment on glucose and blood pressure reduction, adjusting for self-monitoring behaviors. In a sample of 594 older adults (age 55+, 14% 65+ years, 46.8% female) evaluated over a 12-month period, statistical models showed that older adults with uncontrolled diabetes (A1c >= 7.0%) had a 7.9 pt. reduction in blood glucose for each additional program enrolled and a 22.7 pt. reduction in blood glucose when enrolled in mental health compared to those not enrolled. Similarly, older adults with uncontrolled hypertension (BP >= 130/80) had a 4.8 pt. reduction in systolic blood pressure for each additional program enrolled and a 7.2 pt. reduction in systolic blood pressure when enrolled in mental health compared to those not enrolled. The findings indicate the potential for multiprogram digital health interventions that incorporate mental health to further improve clinical outcomes in older adults suffering from multiple chronic diseases, namely diabetes and hypertension.
Examining Different Types of Sleep Among Custodial Grandparents During COVID-19
Authors: Clark Karen , Mayfield Kellie , Anderson Raeda
Published: December 2021

Sleep is associated with healthy living. With increased age, sleep is harder to initiate and maintain. Currently, over two million grandparents have become primary caregivers to their grandchildren and are at risk for poor sleep outcomes. Research shows that grandparent caregivers are at risk for depression due to poor sleep quality. Thus, this study aimed to identify the sleep quality of custodial grandparents to gain a better understanding of sleep patterns during COVID-19 in 2020. Thirty-four custodial grandparents were recruited from the Georgia Division of Aging Kinship Care Support Groups from September through October 2020. Participants were between 42 to 78 years old with a mean age of 57. Participants completed the Pittsburgh Sleep Quality Index. Stata statistical software was used to analyze the relationship between the sleep quality subscales. Results showed a significant positive relationship for custodial grandparents between sleep quality and daytime dysfunction (χ2=25.993, p=0.002; Γ=0.495, p=0.039) as well as sleep quality and sleep disturbance (χ2=11.129, p=0.084; Γ=0.751, p<0.001). There is a significant positive relationship between daytime dysfunction and sleep duration (χ2=14.984, p=0.091; Γ=0.681, p<.001), where grandparents with daytime dysfunction have longer sleep duration. Findings suggest grandparents with poor sleep quality are more likely to experience daytime dysfunction and have more sleep disturbances in the COVID-19 environment. Our study will benefit researchers and practitioners caring for custodial grandparents and contribute to future research focused on custodial grandparents and sleep quality.
Loneliness and Isolation as Barriers to Mental Health Services in a Rural Community
Authors: Maiden Robert , Gagne Danielle , Hayslip Bert
Published: December 2021

As America grapples with COVID-19, issues regarding mental health have been of rising concern, particularly among those who are isolated. According to the May 2021 American Perspectives Survey, “Americans report having fewer close friendships than they once did, talking to their friends less often, and relying less on their friends for personal support1.” Additionally, 49% have three or fewer close friends in 2021, compared to 27% in 1990. 17% have no friends in their core social network. Loneliness has been associated with physical and mental health risks. We sought to explore whether loneliness was also a barrier to seeking mental health services. 90 surveys were collected from rural New York. Respondents were aged 51 to 90, Caucasian (96.6%), and female (73.3% vs, 26.7%). Overall, 34.8% said they lived alone. 29.2% would seek mental health services for feelings of loneliness, while 75.4% would do so if isolated from family. Those who felt detached or isolated from others were significantly less likely to seek help from a counselor (r = - 0.25) or MD (r = - 0.37). Isolation also negatively related to measures on the resiliency scale (Purpose: - 0.22, Perseverance: - 0.33, being ok alone: - 0.32), and positively related to depression (r = .65). Those scoring higher on the “okay with being alone” scale had an increased likelihood of seeking counseling (r = 0.22). Thus, isolation and loneliness are complex topics. Intervention ought to be based on perceptions of being alone. Further research is needed.
Measuring Mindfulness: Assessing the Utility of the FFMQ in the Older Veterans With Dementia and Their Caregivers
Authors: Clawson Brian , Block Phoebe , Durkin Daniel , Collins Amber , Jacobs Lindsey , Hilgeman Michelle
Published: December 2021

Mindfulness is increasingly popular as a low cost, convenient, and accessible way to address mental health and chronic health conditions. Despite its popularity, best practices in measuring mindfulness in clinical settings and intervention research are still being defined. The Five Facet Mindfulness Questionnaire (FFMQ-15) measures mindfulness traits; however, its use has been limited in older adults, those with dementia, and caregivers. Method: Caregivers (N=82) and veterans with dementia (N=62) enrolled in a randomized pilot intervention study completed the 15-item FFMQ at baseline, 6-month, and 12-month assessments. Veterans were mostly male (98%), White/Caucasian (65%), and living with a partner/spouse (79%). Caregivers (M=65 years old) were mostly female (89%) and White/Caucasian (66%). FFMQ response options were simplified to a 3-point Likert-scale for individuals with dementia (0=rarely true to 2=often true). Results: Internal consistency statistics (Cronbach’s alphas) at the scale-level were acceptable among caregivers at baseline and 6-months (.71-.75) but questionably reliable at 12-months (.59, N=46). For individuals with dementia, the simplified version of the FFMQ (with 3 response options) achieved questionable reliability at baseline (.57, N=56) and 6-months (.67, N=32), but improved to acceptable at 12-month assessments (.75, N=15), after significant attrition. Conclusion: Researchers should apply caution when using the FFMQ total score with caregivers and those with cognitive impairments. Though simplified response options eased administration, utility of the tool may be limited in those who are more impaired. Before mindfulness measures can be used meaningfully, reliability of available tools like the FFMQ-15 need to be examined in more diverse samples.
Multifaceted sleep health score is associated with frailty in a national sample of older adults in Taiwan: Sex matters
Authors: Chen Tuo Yu , Lee Soomi , Buxton Orfeu
Published: December 2021

Although individual sleep characteristics are related to frailty, these characteristics do not occur separately. A multidimensional measure of sleep might provide a better estimation of frailty compared to isolated sleep characteristics. This study investigated the association of a multidimensional measure of sleep health with frailty and examined whether such relationship differed by sex. Data were from the Taiwan Longitudinal Study on Aging (2011), a survey with a nationally representative sample of Taiwanese older adults (N=2,015). Frailty was defined using the Fried-criteria. Self-reported sleep during the past month was used to conceptualize the five sleep health dimensions in the SATED model (satisfaction-alertness-timing-efficiency-duration; higher scores representing better sleep health). Their relationship was estimated using logistic regression analysis adjusting for sociodemographic (age, sex, education), health (chronic conditions, cognitive function, pain, depressive symptoms [excluding items overlapping with frailty and sleep]), and lifestyle (drinking, smoking, exercise) characteristics. The results showed that having a better sleep health composite score was significantly related to lower odds of being frail in both sexes adjusting for sociodemographic information. Such effect remained significant among females but not males after adding health and lifestyle characteristics to the models. Sleep satisfaction and daytime alertness in both sexes and sleep duration among females were significantly associated with frailty adjusting for sociodemographic information. Only alertness among males was significantly related to frailty in model with all covariates. Our findings show that having a better sleep health across multiple dimensions is related to a lower risk of being frail, and the association differs by sex.
Nutrition Program Improves Health-Related Outcomes of Non-Diabetic Elderly at Nutritional Risk
Authors: Brunton Cory , Venegas-Sanabria Luis Carlos , Gomez Gabriel , Misas Juan Diego , Sulo Suela
Published: December 2021

Malnutrition or its risk affects up to 1 in 3 older adults receiving outpatient care post a hospitalization or for chronic disease management. Although malnutrition poses a negative burden on someone’s recovery and health preservation, it can be effectively addressed through cost-effective nutrition interventions delivered as comprehensive quality improvement programs (QIPs) aiding to advance healthcare professional’s nutrition education/training and improve quality of care for at-risk/malnourished individuals. Although evidence from US and Europe demonstrates nutrition-focused QIPs are effective in delivering high-quality nutrition care and improve health outcomes of outpatients at-risk/malnourished, to date, no evidence has been reported from Latin American countries. We assessed effectiveness of a comprehensive, nutrition-focused QIP in a Colombian outpatient clinic. Between 09/2019-03/2020, 504 (of total 618) QIP participants were classified at-risk/malnourished and non-diabetics. Participants were followed for 90-days either in-person or via telehealth mechanisms (during COVID-19-imposed lockdown period). QIP interventions included healthcare professional nutrition education; QIP participant continuous nutrition and exercise counselling and 60-day supply of oral nutrition supplement (Ensure®, Abbott). QIP participants were 69% female, with >2 comorbidities, and mean age of 73. Improvement or maintenance of good mental health/well-being, frailty status, cognition and quality of life was reported for 90.7% (456/503), 87.3% (407/466), 86.7% (405/467) and 47% (237/504) participants, respectively (p-values<0.05). Results support QIP effectiveness in driving improved health-related outcomes for non-diabetic, at-nutritional-risk participants. These findings highlight the importance of nutrition-focused QIPs with ONS for older adults during their recovery phase post a recent hospitalization and/or for chronic disease management.
Perceived Everyday Discrimination and C- Reactive Protein Influence on Cognition of Older Black Adults
Authors: Kirven Sydney , Farmer Heather , Thierry Amy
Published: December 2021

Black adults and women are more likely to experience serious cognitive decline in older age than their white and male counterparts. Evidence suggests perceived discrimination is associated with poor cognition in older adults, though the mechanisms remain unclear. Perceived discrimination has been linked to elevated inflammatory markers, such as C-reactive protein (CRP), which increases risk for worse cognitive functioning. Yet, little research has investigated whether CRP is implicated in the association between discrimination and cognition among Black older adults or if this relationship differs by gender. Using 2006-2016 data from Black adults ≥65 years old(N=1343) in the nationally representative Health and Retirement Study, random effects linear regression models (1) tested the association between discrimination and cognitive functioning; (2) explored whether this relationship differed for women and men; and (3) assessed whether elevated CRP mediated the association between discrimination and cognitive functioning. More frequent discrimination was associated with worse cognitive functioning (b= -0.24, SE=0.11, p<0.05), though gender did not moderate this relationship. Elevated CRP was significantly associated with worse cognitive functioning (b= 0.40, SE=0.18, p<0.05). Discrimination remained statistically significant in this model, indicating no mediation by CRP. Of note, inclusion of depressive symptoms and cardiometabolic conditions accounted for the association between both discrimination and CRP with cognitive functioning. These findings demonstrate the need for more within-group research on older Black adults documenting the complex relationship between discrimination, inflammation, and cognitive health. This approach will provide greater understanding of the biopsychosocial mechanisms underlying disparities in cognitive functioning in Black adults.
The Effects of Mid-life Stress Exposure on Black-White Differences in Cognitive Decline
Authors: Mitchell Uchechi
Published: December 2021

Cognitive decline is a precursor to cognitive impairment and dementia. Recent research suggests that cognitive decline may begin earlier in the life course for Blacks and that Black-white disparities in cognitive function emerge in midlife. Disproportionate exposure to chronic and acute stressors during mid-life may explain Black-white differences in trajectories of cognitive function over time. In this study we use data from approximately 3,700 Black and white respondents age 51-64 from the Health and Retirement Study to examine race differences in cognitive decline and the role mid-life stress exposure play in these differences. Initial findings suggest that mid-life Blacks have lower levels of cognitive function, but their rates of cognitive decline do not differ significantly from mid-life whites. Financial strain and everyday experiences of discrimination are inversely associated with cognitive decline and only partially explain differences in cognitive decline between mid-life Blacks and whites.
Perceptions of Partner Cognitive Ability During the COVID-19 Pandemic
Authors: Reese-Melancon Celinda , Margrett Jennifer , Russell Dan , Turner Rachael , Harrington Erin , Stratton Lauren , Savla Jyoti
Published: December 2021

Media reports provide anecdotal evidence of increased forgetfulness during the COVID-19 pandemic (Cushing, 2021; Purtill, 2020). Scientific evidence suggests social isolation can impact on cognition (Evans et al., 2018), but the question remains whether those living with a partner experience similar deficits. The present study examined whether middle-aged and older adults’ perceptions of their own and their partner’s memory abilities were related to self-reported impact of the pandemic on daily life (e.g., limited social interactions, delayed health care, and disruption to routine). In a sample of 80 married individuals (49% female; age range 40-86 years), we found that participants’ beliefs about the impact of the pandemic on daily life and their depression ratings significantly predicted (p<0.05) their perceptions of their partner’s prospective memory abilities. Specifically, pandemic impact on daily life predicted 9.3% of the variance in participants’ reported perceptions of their partners’ prospective memory abilities, and participant depression ratings predicted an additional 5.1% of the variance. Surprisingly, these variables did not predict perceptions of participants’ own cognition or perceptions of partners’ retrospective memory abilities. In sum, people who reported greater impact of the pandemic on their lives were more likely to believe that their partner frequently forgot to carryout prospective memory intentions (e.g., failed to pass along a message or take medication), and depression further clouded their perception of their partner’s cognition. These findings should be extended to consider relationship quality and whether individuals consider their partners a reliable source of external memory support during times of life disruption.
Problem-Drinking Across the Lifespan: Cross-Sectional Versus Longitudinal Effects Among Midlife and Older Adults
Authors: Kady Annabel , Li Yimei , DiBello Angelo , Lee Matthew
Published: December 2021

When considering problem drinking from a lifespan-developmental perspective, an often-stated premise is that problem drinking escalates during adolescence, peaks around early young adulthood, and then declines throughout the remainder of the lifespan. However, while there is a strong empirical basis for such changes throughout adolescence and young adulthood, the notion of continued declines throughout midlife and older adulthood is less firmly established and based primarily on cross-sectional data. Thus, this study contrasted cross-sectional versus longitudinal age effects on problem-drinking changes across the lifespan, with particular focus on midlife and older adulthood. Analyses used data from a large, two-wave, U.S.-representative sample. We generated descriptive “porcupine figures” graphically depicting both cross-sectional and longitudinal age effects simultaneously, and we estimated mixed-ANOVAs to partition, test, and contrast cross-sectional versus longitudinal age effects. As expected, analyses confirmed the well-known rise and fall of problem drinking across young adulthood in both cross-sectional and longitudinal age effects. In contrast, in midlife and older adulthood, only cross-sectional age effects were consistent with the notion of continued age-related declines throughout these ages, whereas the longitudinal data showed a mixture of stability and escalation at these ages. Age-confounded cohort effects are one plausible explanation for how cross-sectional data can lead to spurious conclusions about developmental change. By potentially yielding a more accurate understanding of lifespan-developmental change in midlife and older adulthood, findings like ours could help guide lifespan-developmentally-informed interventions for midlife and older-adult problem drinkers; an objective of increasing importance in light of the ongoing aging of the U.S. population.
Residential Care in California: Spatial and Temporal Trends in Facility Development and Care Capacity
Authors: Frochen Stephen , Ailshire Jennifer , Rodnyansky Seva , Sheehan Connor
Published: December 2021

The U.S. is aging, and the older adult population and number of long-term care services are growing but not at corresponding rates and concentrations depending on location. Insufficient research has analyzed residential care at the neighborhood or city level of analysis, where geographical trends in growth often reveal notable patterns of long-term care unobserved at county and state levels of analyses. We merged the California Department of Social Services Residential Care for the Elderly Dataset with census place and tract data to chart the growth of facilities and beds per older adults in all of California and its three largest cities, including 805 facilities licensed from 1996 to 2015. During the study timeframe, residential care steadily increased in California by the number of facilities and beds relative to older adults. However, due to a consistently increasing older adult population, the Cities of San Diego and San Jose experienced gradual and intermittent decline in capacity per older adults, respectively, even as they added many beds to their inventories from the sporadic development of large assisted living and continuing care retirement communities. Additionally, San Jose and Los Angeles exhibited the most overlap in mapping densities of facility development and oldest old adults, with San Diego showing less intersection in cartographic analysis. Understanding facility development and care capacity trends can help local agencies and jurisdictions in the U.S. and other countries discern whether planning policies and other geographical and development factors appropriately encourage the development of residential care and other long-term care facilities.
Systems aging clock: A novel epigenetic aging clock modeled from organ & bodily function based mortality indices
Authors: Sehgal Raghav , Levine Morgan
Published: December 2021

A diverse array of aging clocks, derived from a variety of omics data and clinical biomarkers, have been developed to describe aging and predict age-related disease. As such, these biomarkers are particularly applicable for use in observational studies, basic science and clinical trials focused on tackling biological aging. However, ongoing research suggests significant heterogeneity in aging, with deterioration and disease occurring in different organ systems or functional domains at various rates across individuals. Existing aging clocks only measure heterogeneity in the degree of aging, not in the manner of aging (e.g. different organ systems or functional domains). We hypothesize these unique trajectories exist and that they can be captured using a systems based approach. In our work, using clinical chemistry biomarkers from participants in the Health and Retirement Study (HRS), Framingham Heart study (FHS) and Women’s Health Initiative (WHI) , we modeled unique epigenetic aging trajectories from distinct groups of biological processes (such as Immune function, metabolic function, hepatic function, cardiac function, renal function and more). Interestingly, these biological system specific scores when combined gave an aging clock with superior mortality prediction than any published aging clock. We further validate the system aging scores and aging clock in different clinical studies to show the added advantage of such a measure, such as the fact that people with similar epigenetic age may have very different system scores. Overall, this method introduces the potential for quantitative and multi-dimensional, personalized aging scores that are indicative of an individual’s disease and disorder risk.
The Challenge of Identifying Representative Samples in Research Involving Minority Participants
Authors: Pilonieta Giovanna , Geldmacher David
Published: December 2021

Determining participants' demographics, cognition, and functional performance by race is crucial to understanding disparities in clinical research on Alzheimer’s disease. We compared demographic and performance variables between Black/African American (B/AA; N=30; 41%) and White participants (N=43, 59%) in the UAB Alzheimer's Disease Center. Among 73 participants, 38 (52%) were women, mean age was 65.7 (SD 9.47), and mean education was 16 (2.31) years. Significant differences in gender proportions across race groups were observed. B/AA women represented 70 % of their race group, white women represented 39.5 %. There were no statistically significant differences in age, education, cognitive or functional severity, reasons to participate in research, referral source, objective measures of cognition, or informant-rated daily function by race group. In conclusion, despite 50% oversampling of B/AA participants compared to the State population, no differences in cognitive and functional performance at the time of enrollment were associated with race.
Using Team-Based Learning in an Online Synchronous Gerontology Course
Authors: Janssen Leah
Published: December 2021

Team-based learning (TBL) was chosen for its learner-centered approach to intentional engagement and purposeful application of course material in a cross-listed, upper-level gerontology class (i.e., Social Forces in Aging). Intedashboard, an online TBL platform, was utilized to support the online synchronous course, which is especially useful for its integration of class material, module assessments, peer/course evaluations, and dashboard display of live team activity. From the perspective of an emerging scholar, this symposia session will explore the application of TBL as a tool for developing teams, helping students personally connect with course material, and support inclusive teaching initiatives. More specifically, this presentation examines how a scaffolded TBL exercise on cumulative advantage/disadvantage, intersectionality, and social identities led to increased identification and awareness of students’ social location, and the perceived impacts on their later lives.
Innovation in Times of Uncertainty: Clinical Trials in Nursing Homes During SARs-CoV-2
Authors: Carpenter Joan
Published: December 2021

In March 2020 the Centers for Medicare & Medicaid Services (CMS) announced restrictions on visitors and nonessential personnel in nursing homes to protect residents and facilities from SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreaks. At the time, these measures were “temporary” but they continued well into 2021 resulting in a prolonged pause on in-person study activities in a palliative care clinical trial in 12 nursing homes. This session will address the impact of this pause and decisions made to overcome the potential failure of the trial. Of utmost importance was respecting nursing homes rapidly changing context, continued communication with the site leadership, transitioning to phone and video-conference study activities, and designing a retrospective study using existing data to answer a different but similar research question. As clinical researchers move forward implementing trials and complex interventions in nursing homes, we must use the lessons learned to design flexible trial protocols.
Timing and Support Matter: Caregiving Demands at the Intersection of Stress Process and Life Course Perspectives
Authors: Lee Yeonjung , Bierman Alex , Penning Margaret
Published: December 2021

Extensive research documents the outcomes of family caregiving. However, perspectives differ, with some suggesting that caregiving provides psychological rewards and others suggesting that the stress of caregiving carries psychological costs. We argue that both of these perspectives are correct, but their applicability will differ based on the timing of caregiving and the availability of social support. A life course perspective suggests that the timing of a stressor in the life course will create variations in its mental health impacts, whereas a stress process perspective suggests that the consequences of a given stressor for mental health will vary based on the availability of social support. A synthesis of these two perspectives then suggests that social support will act as stress buffer differently depending on the age of caregiver. To examine these questions, we use a subsample of respondents who reported caregiving (N=20,441) in the 1st wave of the Canadian Longitudinal Study on Aging. Analyses provide evidence of different outcomes of caregiving, according to both the timing of caregiving and the availability of support. In particular, a high level of caregiving demands are associated with greater depression and lower life satisfaction. Social support inhibits both associations, and the association between high demands and life satisfaction is stronger in older caregivers. Social support does not buffer high caregiving demands more strongly at older ages, though, showing two distinct process. Demanding caregiving appears particularly detrimental for psychological well-being as people age, and the efficacy of social support resources do not increase to compensate.
Curricular Approach to IPE: Preparing Health Professions Students to Deliver Team-Based Care
Authors: Barnes Stacy , Horton Kelly
Published: December 2021

Interprofessional education (IPE) is essential to prepare students for future healthcare careers and to meet accreditation requirements for health profession schools. After surveying successful IPE programs across the country, Marquette University developed a curricular approach. Over 1,500 students from 10 health professions (Athletic Training, Medical Laboratory Science, Counseling Psychology, Dentistry, Medicine, Nursing, Occupational Therapy, Physical Therapy, Physician Assistant Studies, Speech-Language Pathology) currently participate in a series of four interactive, half-day courses which are aligned with the Interprofessional Education Collaborative (IPEC) core competencies. Courses were moved online in response to the pandemic and are currently delivered using Microsoft Teams. Feedback from learners and faculty is gathered using post-event surveys and has been overwhelmingly positive. Learner outcomes are measured using the Interprofessional Collaborative Competencies Attainment Survey. Overall, this approach has proven to be an effective and efficient model for delivering IPE to large numbers of students.
Adapting A Project-Based Aging Laboratory During a Pandemic
Authors: Andersen Troy , Edelman Linda
Published: December 2021

Aging Well in Utah is a competitive 2-semester project-based Honor’s College Praxis Laboratory for 9 students from different degree programs dedicated to deepening understanding of the aging process through a broad gerontological lens. This session will address how the course was adapted during the COVID-19 pandemic, including: 1) scheduling virtual class times with guest lecturers; 2) conducting older adult interviews via Zoom to provide students experience in communicating “what matters most”, one of the 4Ms of Age Friendly HealthCare; 3) adapting a student-designed medical narrative project highlighting stories of transition and healing through the dying process for previously unsheltered residents of a hospice program to focus on the lived experience of hospice patients during COVID-19; and 4) utilizing virtual technology to interview hospice patients, family members and hospice staff. In spite of challenges, student evaluations were above average and reported increased interest in incorporating age-friendly concepts into future careers.
The First Intervention Study for LGBTQ+ Older Adults With Dementia and Caregivers: COVID-19 Lessons Learned
Authors: Goldsen Karen Fredriksen , Teri Linda , Kim Hyun-Jun , Emlet Charles , Petros Ryan , Brown Charlotte , McKenzie Glenise , La Fazia David
Published: December 2021

LGBTQ+ older adults face significant health disparities with higher rates of cognitive impairment and social isolation. Yet, the cognitive health needs of LGBTQ+ adults and caregivers have not been adequately addressed in clinical trials and services. In this presentation, we will share findings from Aging with Pride: IDEA (Innovations in Dementia Empowerment and Action), the first randomly controlled trial (RCT) intervention study designed to improve quality of life of LGBTQ+ adults living with dementia and caregivers, and to reduce institutionalization. In this presentation, we will share preliminary efficacy findings, the effectiveness of culturally responsive approaches, and Covid-19 adaptations, including delivery by virtual chat rather than in-home, technology training, ensuring safety of virtual intervention components, and providing on-going technology support. Preliminary findings suggest a higher intervention retention rate in the virtual delivery as compared to in-home. This study illustrates innovative ways to serve disadvantaged communities in dementia care and aging services.
Circadian Alignment of Feeding Regulates Lifespan Extension by Caloric Restriction
Authors: Acosta-Rodriguez Victoria , Rijo-Ferreira Filipa , Izumo Mariko , Xu Pin , Green Carla , Takahashi Joseph
Published: December 2021

Caloric restriction (CR) promotes longevity in several species. Classic CR protocols often lead to chronic cycles of 2h-feeding/22h-fasting, raising the question whether calories, fasting or time of day are causal. To address this, we tested an AL control group and five CR protocols with different timing and duration of feeding/fasting cycles. C57BL/6J male mice were subjected to 30% CR as one single meal a day at the beginning of the day or night (classical protocols with < 2h feeding, CR-day and CR-night), or smaller meals distributed for 12h (CR-day-12h and CR-night-12h), or evenly spread out throughout 24h (CR-spread) to abolish the otherwise daily feeding pattern adopted by nocturnal animals. We found that CR alone is sufficient to extend lifespan without fasting. However, the benefits are enhanced if feeding/fasting cycles are present and match their normal nocturnal activity. Circadian alignment of feeding with at least 12h fasting boosts CR-mediated increase on survival in mice, independently body weight. Aging leads to widespread upregulation of inflammation-related genes and downregulation of metabolic pathways in liver from ad lib fed mice; whereas CR at night ameliorates these aging-related changes and preserves circadian oscillations in gene expression. Overall, our results demonstrate that circadian interventions promote longevity and provide a novel perspective for elucidating mechanisms of aging.
CAPABLE Program Improves Disability in Research and Implementation Settings
Authors: Szanton Sarah , Li Qiwei , Gitlin Laura
Published: December 2021

Interventions to reduce disability are crucial for older adults with disabilities to avert unnecessary hospitalizations or nursing home placements and improve daily life. Developed and tested at one research site, multiple health systems and community based organizations have since implemented CAPABLE. All published or peer reviewed tests of CAPABLE were reviewed (six studies, 11 sites) with a total of 1087 low-income community-dwelling older adults with disabilities. Participants were an average age of 74-79, cognitively intact, and self-reported difficulty with one or more activities of daily living (ADL). These trials were reviewed by extracting the participants’ scores on main outcomes, ADLs and IADLs, and when available, fall efficacy, depression, pain and cost savings. All studies yielded improvements in ADL and IADL limitations, with small to strong effect sizes. Studies with the complete dose of CAPABLE showed more improvement in ADLs and cost savings than the studies that implemented a decreased dose.
Social Isolation as a Risk Factor for Cigarette Smoking in Older Adults
Authors: Gimm Gilbert , Pomeroy Mary Lou , Cudjoe Thomas
Published: December 2021

Objective: This study examined the prevalence of social isolation and cigarette smoking in a national sample of community-dwelling older adults, and assessed the role of social isolation on the risk of cigarette smoking. Methods: Using data from 8,044 participants (age 65+ years) across two waves of the National Health and Aging Trends Study (NHATS), we analyzed the prevalence of social isolation in older adults and as a risk factor for cigarette smoking. Social isolation was measured across 4 relationship domains (Cudjoe, 2018) on a scale of 0 to 4, using objective measures of social interactions. Descriptive and logistic regression analyses were conducted to assess how social isolation is associated with smoking. Results: Preliminary results showed that 18.2% of older adults were socially isolated (3.5% severely isolated) and 7.1% of participants reported current smoking. We found that both social isolation (OR = 2.5, p<.001) and severe isolation (OR = 5.9, p<.001) increased the odds of smoking. Also, older adults with depression (OR = 1.6, p<.01) and dual-eligible beneficiaries (Medicare and Medicaid) with TRICARE coverage (OR = 4.6, p<.05) had greater odds of smoking. However, we did not find evidence that the odds of smoking varied significantly by the number of chronic conditions. Conclusion: Social isolation is associated with an increased risk of cigarette smoking among older adults. Smoking may be an important behavior in the pathway between social isolation and its association with morbidity and mortality.
Perspectives on How Fall Prevention Technologies Can Support Older Adults’ Self-Monitoring Processes
Authors: Meija Shannon , Hong Sungjae , Griffin Aileen , Su Tai-Te , Sosnoff Jacob
Published: December 2021

Fall risk increases as older adults lose the functional resources necessary to maintain balance while completing everyday activities. As functional resources often decline gradually with age, momentary deficits may not be apparent until after a fall occurs. Mobile fall prevention technologies could support older adults in self-monitoring their ability to safely navigate their environments. In this paper we present perspectives on self-monitoring and feedback in a sample of older adults (n = 20, 50% female, age 65+) who had self-assessed their balance via a smartphone for 30 consecutive days. Thematic analysis of semi-structured interviews showed that fall history differentiated a) participants’ awareness of day-to-day variation in functional ability; b) trust in the accuracy of self-monitoring; and c) imaginations of what types of feedback a mobile fall prevention technology should provide. Insight on older adults’ internal self-monitoring processes and guidelines for feedback design are discussed.
Initial Results From SOMMA: Contribution of Mitochondrial Function to Walking and Fitness
Authors: Cummings Steve , Cawthon Peggy , Goodpaster Bret , Hepple Russell , Glynn Nancy W , Kritchevsky Stephen , Newman Anne , Coen Paul
Published: December 2021

We hypothesize that the capacity of mitochondria in quadriceps skeletal muscle to generate ATP energy by respirometry (OXPHOS) in biopsies from the vastus lateralis, and in whole quadriceps muscle by 31PMRS (ATPmax) would contribute to 4 and 400m gait speed and to peak oxygen consumption on treadmill testing (VO2peak). In analyses from the first SOMMA participants recruited (N=122), OXPHOS was similarly associated with 4m (r=0.21) and 400 m (r=0.21) walking speed (P<0.01). However, ATPmax was not associated with either 4m or 400m walking speed (r=-0.02 and -0.07 respectively). In contrast both OXPHOS (r=0.43) and ATP max (r=0.35) were more strongly correlated with fitness (VO2 peak). These findings suggest that in older people, the mitochondrial capacity to generate ATP plays an important role walking speed and may be even more important to fitness.
Muscle Quality Revisited: Biopsy Energetics, MR Spectroscopy, and Muscle Power and Strength
Authors: Newman Anne , Santanasto Adam , Strotmeyer Elsa , Nicklas Barbara , Coen Paul , Goodpaster Bret , Cummings Steve
Published: December 2021

With age, strength may decline faster than muscle mass pointing to a deterioration in muscle quality. Aspects of muscle quality and function are being measured in SOMMA; we hypothesized that in vitro and in vivo bioenergetics capacity of muscle would be related to muscle strength and power. Associations differed between men and women. In men (n=48, ATPMAX, 70, max OXPHOS and max ETS) but not women (n=68, ATPMAX, n=103, max OXPHOS and max ETS), muscle ATP regeneration by 31P MR spectroscopy was correlated with leg power (r = 0.27, p= 0.05). Energy production in tissue was similarly more strongly correlated with power in men than women, though not statistically significant. Correlations between the tissue measures and strength were also stronger in men than women. In ongoing follow-up, we will be able to determine what role that muscle tissue energetics plays in explaining the loss of strength and power with aging.
Assessing Mitochondrial Energetics of Skeletal Muscle in the Study of Muscle Mobility and Aging (SOMMA)
Authors: Goodpaster Bret , Cawthon Peggy , Kritchevsky Stephen , Newman Anne , Hepple Russell , Cummings Steve , Coen Paul
Published: December 2021

Mitochondria produce energy as ATP that essential for muscle contraction and movement. We hypothesize that age-related decreases in the capacity to generate ATP in muscle plays a major role in loss of mobility with aging. In SOMMA, we use high-resolution respirometry to measure the activity of electron transport system (ETS) in permeabilized muscle fibers from muscle biopsies. This allows us to assay ETS function in a highly controlled ex vivo experiment at the myocellular level, removed from other potentially limiting physiological factors including supplies of substrates and oxygen. We are also measuring the maximal capacity to generate ATP (ATPmax) in vivo by 31PMRS. ATPmax reflects the rate of phosphocreatine replenishment via oxidative phosphorylation. Analysis from the first 113 participants indicates that ATPmax correlates with Maximal OXPHOS (r=0.27, P=0.005), and Maximal ETS capacity (r=0.17, P=0.08). This suggests that these approaches provide complementary information on skeletal muscle energetics.
Alcohol- and Drug-Associated Injury Outcomes Among Older Adults Involved in Car Crashes
Authors: Adeyemi Oluwaseun
Published: December 2021

Understanding how recent alcohol or drug use among older adults involved in car crashes can inform emergency care team on the morbidity and mortality risks. This study aimed to assess the odds of worsened health outcomes among older adults with evidence of alcohol or drug ingestion. This cross-sectional analysis used crash census data from the National EMS Information System. The outcome variable was the health outcome after EMS care, measured on a four-point ordinal scale: lower acuity, emergent, critical, and dead. The predictor variable was alcohol/drug use (present/not present). Age, race, gender, part of the body injured, and the revised trauma score of the patients were used as confounders. Odds ratio were calculated using proportional ordinal logistic regression. A total of 42,992 individuals, aged 65 years and older, were involved in car crash events, which required EMS activation. About 22.9% needed emergent care, 4.4% were classified as critical, and 0.4% died without resuscitation efforts. At the time of crash, 3.8% of the older population had evidence of alcohol or drug use. After adjusting for age, gender, race, injury location and revised trauma score of the crash patients, alcohol/drugs were associated with 54% increased odds of worse clinical outcome (AOR:1.54; 95% CI: 1.32-1.80). The adjusted odds remained elevated in urban (AOR: 1.69; 95% CI: 1.42-2.02) and suburban (AOR: 2.21; 95% CI: 1.12-4.35) and not significantly elevated in rural areas. Study findings can inform EMS service and emergency room care as well as policies that strengthen the urban and suburban EMS.
Changes in Transportation During the COVID-19 Pandemic: Results From a Survey of Middle-Aged and Older Floridians
Authors: Barrett Anne , Michael Cherish , Noblitt Jessica
Published: December 2021

The pandemic’s numerous effects on everyday life include reductions in driving and changes in the use of other transportation modes, like getting rides from family and friends, walking, and biking. Aside from broad patterns, however, little is known about these changes, including how they affected different groups of the population and how they felt about them. Our study addresses these issues using data collected from an online survey of over 4,000 Floridians aged 50 or older, conducted between December 2020 and April 2021 and funded by the Florida Department of Transportation to support its aging road user program, Safe Mobility for Life. Changes in driving and in rides from family and friends were more striking than those in other transportation modes. Nearly 30 percent of respondents decreased their driving during the pandemic, while 20 percent got fewer rides from family and 25 percent got fewer rides from friends. In contrast, only 11 percent decreased their walking, and the same percentage increased it. Less common were changes in biking, with percent 7 decreasing and only 4 percent increasing it. Multivariate analyses revealed that these changes were influenced by gender, race, age, socioeconomic status, and health. Further insight was gained from analysis of an open-ended item, revealing positive and negative assessments of the changes. Positive assessments centered on feeling satisfied with working at home, spending more time outdoors, having more free time, and saving money. Negative assessments centered on social isolation, dissatisfaction with government responses to the pandemic, and reduced transportation options.
Overcoming Health Promotion Barriers in Rural Health: A Qualitative Analysis
Authors: Batsis John
Published: December 2021

Weight loss interventions are fraught with difficulties for older adults in rural areas due to transportation difficulties, reduced availability of staff, and lack of programs. Telemedicine can overcome these barriers. A qualitative analysis of data from 44 exit-interviews from a rural-based, older adult weight loss study, informed by thematic analysis, was conducted. Participant’s age was 73 years (73% female) and BMI was 36.5kg/m2. Distance to the site was 24 miles (31 min). Key themes included: a) telemedicine can help improve one’s health, is more practical than in-person visits, is less costly, and time efficient; b) the majority (60%) were initially apprehensive about using telemedicine, a fear that resolved quickly; c) setting up telemedicine was easy and acceptable, despite a quick learning curve; d) having a team member for troubleshooting was important. Using telemedicine in older adults with obesity residing in rural areas should be considered in health promotion interventions.
Certified Older Adult Peer Support Specialists' Use of Technology to Support Older Adults in the Community
Authors: Fortuna Karen
Published: December 2021

Middle-aged and older adults with mental health conditions have a high likelihood of experiencing comorbid physical health conditions, premature nursing home admissions, and early death compared with the general population of middle-aged and older adults. An emerging workforce of certified older adult peer support specialists aged 50 years or above is one of the fastest growing mental health workforces and may be a suitable community-based workforce to simultaneously support the mental health, physical health, and aging needs of middle-aged and older adults with a serious mental illness. Older adult peer support specialists are people with a lived experience of aging into middle age and older adulthood with a mental health condition. This presentation will present three single-arm pilot studies examining how certified older adult peer support specialists’ incorporate technology, including text messaging, ecological momentary assessments, and smartphone applications into practice and clinical outcomes among older adults with serious mental illness.
Vulnerability and Resilience Among Older Adults During the COVID Pandemic
Authors: Aldwin Carolyn
Published: December 2021

The COVID-19 pandemic is particularly challenging for many older adults. They are strongly encouraged to practice social distancing and sheltering in place to decrease morbidity and mortality risks. However, social isolation and loneliness increase the risk of mental and physical health problems. Nonetheless, there are indications that older adults may be more resilient than originally thought. Park et al. present longitudinal findings that younger adults fared worse than middle-aged or older ones, reporting greater distress and less social support, mindfulness, and emotion regulation skills. For older participants, acceptance of negative emotions and social support predicted lower distress. Choun et al. also present longitudinal data, showing that depressive symptoms decreased among older adults during the lockdown phase of the pandemic, but reflected changes in loneliness and physical health symptoms. Stellman et al. found that moderate levels of combat experience were helpful for some older Vietnam veterans coping with the pandemic, although a few found that it made coping more difficult. Turner et al. found that positive, non-familial intergenerational contacts were associated with a higher number of positive pandemic-related changes, such as finding new hobbies and meaning in work. Finally, Aldwin et al. present a social ecological approach to vulnerability and resilience. Using qualitative data, they found that stressors and resources were reported at personal, interpersonal and societal levels. Further, older adults both took comfort from and contributed to community resources during this pandemic. In summary, this symposium identified factors that contribute to older adults’ resilience during this pandemic.