bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple Chronic Condition Combinations and Cognitive Task Performance
Authors: Ogletree Aaron , Katz Benjamin
Published: December 2020

A growing body of literature describes important advances in the study of chronic conditions, most notably a paradigm shift from the study of individual chronic conditions to the study of multiple chronic conditions (MCCs). Despite these advances, little research has explored MCC combinations, and almost no published research has explored how MCC combinations are related to cognitive outcomes in older adult populations. Using data from the Health and Retirement Study, we categorized 17,349 older adults into one of 32 groups using self-reports of five of the most commonly diagnosed conditions. These included arthritis, diabetes, heart problems, hypertension, and respiratory problems. We utilized ANOVA to examine the associations between combinations of MCCs and performance on two cognitive tasks associated with executive function and fluid intelligence: verbal fluency and verbal analogies. Results demonstrated that older adults with a greater number of health conditions performed more poorly on both the verbal fluency (p<.0001) and analogies (p<.0001) tasks than those with fewer conditions. Some MCC combinations were associated with poorer cognitive task performance than other combinations: for example, older adults in the Heart-Hypertension-Respiratory group had an average score of 488.73 (SD=24.96) on the verbal analogies task and 14.06 (SD=7.06) on the verbal fluency task. Conversely, adults in the Arthritis-Heart-Respiratory group had average scores of 503.69 (SD=27.89) and 16.45 (SD=7.03), respectively, suggesting differential additive effects of MCCs. These findings demonstrate the complex associations of specific MCC combinations with cognitive performance and highlight the importance of better understanding the unique needs of older people with MCCs.
Implementation of Disaster PrepWise, an Online Disaster Preparation Tool for Older Adults
Authors: Thompson Lena , Henja Emily , Beckman Travis , Ashida Sato
Published: December 2020

Older adults are less prepared for disaster situations than younger adults due to expenses, complicated preparation processes, and lack of support. We previously developed and tested a disaster preparedness program for older adults and showed its impact on improving preparedness and personal emergency support network. Using a 5-step community-engaged approach and in collaboration with our Stakeholder Advisory Board (SAB), we adapted this Disaster PrepWise program to an online platform and developed implementation plans within existing community-based service infrastructure. Community engagement processes allowed us to create an online tool that was considered “important” and “useful” by older adults and program deliverers. In terms of reach, 73 potential participants attended an introductory presentation and 47 participated. Those who participated were similar to those who did not in terms of gender and race. Twenty-seven participants completed surveys before and one-month after the program and reported engaging in an average of 2.9 additional recommended behaviors after intervention (t(26)=2.85, p=0.00). The major organizational barrier to adoption was limited staff time. Participating older adults reported adopting what they learned through the program in their daily life. Implementation process data showed multiple modifications made during delivery including delivery of the program in one instead of two sessions. The implementing organization reported their likelihood of maintaining this program within their practice as “extremely likely.” Community-engaged approaches and process data led to an acceptable and useful program and implementation strategies that helped enhance preparedness behaviors among older adults. Future work will focus on program dissemination and larger scale evaluation.
I Never Thought About Leaving: Why Residents Aged in Place Within Neighborhoods Experiencing Urban Decline
Authors: Langendoerfer Kaitlyn
Published: December 2020

Despite the rich literature on “aging in place”, few studies have examined why older adults remain within neighborhoods that have experienced urban decline. This study defines “aging in place” as the process of aging within one’s neighborhood over the life course. Further, much of the literature surrounding disadvantaged, urban communities have concentrated on those who left and portray those who remain as trapped. This is particularly true for older African Americans. The purpose of this study was to understand what influenced older, African American residents to stay within their declining neighborhoods. Data was utilized from 4 years of ethnographic observations with 30 older (age 60+), African-American adults who aged within Cleveland. Additionally, multiple in-depth life history interviews were conducted with 13 of these residents. Data was analyzed using grounded theory techniques. All residents expressed a desire to remain within their neighborhoods and many indicated that they never thought about leaving. While each resident had their own reasons for staying, common themes emerged related to: 1) autobiographical insideness, 2) sense of identity, 3) home ownership, and 4) interdependent lives. This study has important implications for research related to aging in place and place attachment. For one, it provides a counter narrative to the dominant notion that residents of poor neighborhoods would leave if they had the resources to relocate. Additionally, by using a narrative method, the older adults were able to explain for themselves why they stayed and describe the meaningful lives they created despite neighborhood decline.
The Mediating Role of Optimism on the Relationship of Activities of Daily Living and Well-Being Among Older Adults
Authors: Cheng Kent Jason , McMaughan Darcy , Smith Matthew
Published: December 2020

Limitations on activities of daily living (ADL) and instrumental activities of daily living (IADL) can be deleterious to an older person’s life satisfaction and overall feelings of wellbeing. This study explored the possible mediating role of optimism on relationship between changes in ADL/IADL and life satisfaction over time. Using 2006-2016 data from the Health and Retirement Study (n=11,869), growth curve modelling was used to account for intra-individual and inter-individual changes in life satisfaction trajectories. All models controlled for age, sex, marital status, years of education, self-rated health, labor force status, log of household income, and attrition. In the baseline model without optimism and with all controls, coefficients for ADL (Beta=-0.13, P<0.01) and IADL (Beta=-0.12, P<0.01) were negatively significantly associated with life satisfaction. When optimism was introduced to the model, coefficients for both ADL and IADL increased by 0.01 and remained statistically significant, which suggests some mediating effects. When interaction terms between ADL/IADL and optimism were introduced, coefficients for ADL and IADL became statistically insignificant. However, the interaction between ADL and optimism (Beta=-0.02, P<0.05) was negatively significantly associated with life satisfaction. Findings suggest that optimism may protect against the negative impact of ADL/ IADL on life satisfaction. While changes in physical functioning and mobility may influence mental health status (e.g., depression, feelings of isolation), such consequences are not inevitable. Efforts are needed to highlight the positive aspects of aging and opportunities for life enrichment to increase morale and optimism among older adults.
Maybe She’ll Make Some Friends?: Family Members Cultivating Intimacy in Assisted Living
Authors: Fitzroy Andrea , Kemp Candace , Burgess Elisabeth
Published: December 2020

Intimacy continues to be important in later life, including for older adults in long-term care settings such as assisted living (AL). Our past work shows that intimacy is a multi-dimensional process and can involve a variety of partners. Drawing on data from the qualitative longitudinal “Convoys of Care” study (R01AG044368), we extend this research to examine the role family members play in cultivating intimacy and close relationships of AL residents. Using a grounded theory approach, we analyzed 2,224 hours of participant observation, and formal interviews with 28 assisted living residents (aged 58-96) and their formal and informal care partners (n=114) from four diverse AL communities. Findings show that family members can play integral roles in residents’ experiences with intimacy, directly as relationship partners, and by facilitating or impeding residents’ contacts with others. Family members cultivated residents’ intimacy opportunities and experiences by direct engagement, resident advocacy, to non-involvement and disengagement. Family members’ roles in cultivating intimacy fluctuated over time, increasing at times of health concerns and family change. Perceptive family members considered older adults’ intimacy preferences when cultivating their intimate relationships. Family members concerned for the safety of their loved one sometimes acted as “gatekeepers” to intimacy by interfering in intimate relationships. We conclude with a discussion of implications for policy and practice aimed at improving the intimacy process and opportunities for older adults receiving long-term care.
Mediterranean versus Western diet effects on cerebral cortical thickness and volume in cynomolgus monkeys
Authors: Frye Brett , Craft Suzanne , Register Thomas , Kim Jeongchul , Whitlow Christopher , Lockhart Samuel , Shively Carol
Published: December 2020

Diet may influence the risk for cognitive decline and neurodegenerative disorders, including Alzheimer’s disease (AD), but these relationships are difficult to study in humans. Cynomolgus macaques (Macaca fascicularis) are appropriate models for investigations of diet effects on the brain because, like humans, they are omnivorous, have complex central nervous systems, are susceptible to diet-induced diseases, and accumulate amyloid and tauopathies with age. Using structural magnetic resonance imaging, we examined diet effects on brain anatomy by measuring thickness and volume of several areas relevant to AD in 38 middle-aged females, at baseline and after Mediterranean or Western diet consumption for 36 months (equivalent to a 9-year follow-up in humans). Using repeated measures analysis, cortical thicknesses generally increased in the Western diet group. Western diets also resulted in increases in total brain volume and cortical gray matter and decreases in cerebrospinal fluid, white matter, and deep gray matter (striatum and thalamus) (all p’s≤0.05). In contrast, thicknesses and volumes generally remained unchanged in animals consuming Mediterranean diets. Taken together, these findings demonstrate that Western diets induce widespread structural shifts which may increase risk of cognitive decline and neuropathology, whereas Mediterranean diets may exert a stabilizing influence on the brain. This study provides important insights about the significance of diet on brain structure and lays the groundwork for future investigations to uncover the molecular underpinnings of diet-induced changes in the brain. Mediterranean diet may protect against structural changes in brain that occur with age in those consuming a Western diet.
Painting by Lesions: Functional Networks Affected by White Matter Lesions Are Associated with Poorer Cognition
Authors: Crockett Rachel , Hsu Chun Liang , Tam Roger , Handy Todd , Liu-Ambrose Teresa
Published: December 2020

Cerebrovascular disease (CvD) is the second most common cause of dementia. Its associated pathology, such as white matter lesions (WML), is associated with reduced cognition. Due to the high variability, the relevance of WML location remains unknown. We hypothesised that although the location of WMLs may appear sporadic, they may actually lie within common functional networks. We used novel imaging methods to map the location of WMLs in a clinical sample with the functional connectivity associated with the same location in the human connectome. This identified the functional networks containing the largest WML load (>50%) in older adults with CvD. We then analyzed the association between level of disruption to these networks and measures of global cognition and executive functions. Included in this study were 164 older adults (>55 years old) with CvD. Cognition was assessed using the: 1) Montreal Cognitive Assessment (MoCA); 2) Stroop Colour Word Test; 3) Trail Making Tests; and 4) Digit Symbol Substitution Test. Our results found that the visual network and ventral attention network (VAN) surpassed the 50% overlap threshold with 85% and 66% overlap respectively. Additionally, after controlling for multiple comparisons and age, the level of disruption to the VAN was significantly associated with poorer global cognition, as measured by the MoCA (p=.001). These novel findings identify the functional networks most affected by the presence of WMLs in older adults with CvD and suggest that the disruption to the VAN caused by WML load may underlie the deficits seen in cognition in this population.
Hospitalizations in Adults With Alzheimer’s Disease and Related Dementia—United States, 2016–2017
Authors: Taylor Christopher , Olivari Benjamin , McGuire Lisa
Published: December 2020

Alzheimer’s disease and related dementias (ADRD) are a significant public health burden. Collectively, ADRD have been called the most expensive chronic conditions in the United States due to outsized health care utilization. Data from the 2016 and 2017 Healthcare Cost Utilization Project National Inpatient Sample, an all-payer representative sample of US hospitalizations, were used to describe hospitalizations in adults ≥65 years with ADRD. Chronic conditions were defined using International Classification of Disease, Tenth Edition, Clinical Modification (ICD-10-CM) code definitions from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. Code definitions from the Agency for Healthcare Research and Quality defined potentially preventable hospitalizations where admission might have been avoided by appropriate outpatient primary care management. One in six hospitalizations in adults ≥65 years were for persons with ADRD, including 1 in 3 adults ≥85 years. Among those with ADRD-related admissions, the most common reasons for admission, as defined by the principal diagnosis, were heart disease (18.1%), certain infections (14.5%), injuries (12.7%), respiratory illness (11.2%), and genitourinary conditions (10.4%). In hospitalized adults with ADRD, the prevalence of diagnosed urinary tract infection (37.0%)—a potentially preventable hospitalization—is more than double the prevalence in adults without ADRD (15.5%, prevalence ratio = 2.39, 95% confidence interval: 2.37-2.42). Common comorbidities, injuries, and potentially preventable hospitalizations all contribute to hospitalizations in adults with ADRD. Focusing on injury prevention and appropriate outpatient management of comorbidities in adults with ADRD might reduce the number of hospitalizations, including potentially preventable hospitalizations, among adults with ADRD.
The Effect of Social Activities on the Life Satisfaction of Korean Older Adults
Authors: Kim Meeryoung
Published: December 2020

As life expectancy increases, older adults need to find ways to occupy their time for 20-30 years. For Korean older adults, social activities such as having relationships with others as well as, involvement in organizations and volunteer work, are important for their social identity. Social activities are one of the categories of Rowe and Kahn’s successful aging, this study examined the effect of having relationships, involvement in organizations and volunteering on the life satisfaction of older adults. This study used the 6th additional wave of the Korean Retirement and Income Study (2016). The target population was older adults (50~59, 60~74, 75+). The sample size was 1,921, 2,344 and 962 respectively. For data analysis, ANOVA and multiple regressions were used. The demographic variables were controlled. As for independent variables, having relationships, involvement in organizations, and volunteering were used. For the dependent variable, life satisfaction was used. Having relationships, involvement in organizations and volunteering were significantly different by age group. For each age group, the factors affecting life satisfaction differ. For the middle aged group, involvement in organizations and volunteering were significant factors affecting life satisfaction. For young-old adults, volunteering had the most significant effect on life satisfaction. Finally, for old-old adults, both having human relations and involvement in organizations were significant. These findings imply that social activities differ by age group. Also, the kind of activities affecting life satisfaction differ by age group. These findings imply that it is important for older adults to be involved in society, in various ways.
Age Associated With Preference for More and Emotionally Meaningful Information in Time-Use Decisions
Authors: Shavit Yochai , Carstensen Laura
Published: December 2020

Socioemotional selectivity theory posits that goals change as a function of perceived time-horizons. As people age and time-horizons grow increasingly limited, people prioritize goals realized in the present over goals that will be realized in the distant future. Because goals that are emotionally meaningful are realized in their pursuit SST predicts that such goals will be prioritized by older people. Previous investigators have observed that age is negatively associated with search for information in decision making and attributed the finding to an effort to reduce cognitive load. In the present study, we hypothesized that because time becomes increasingly valued as it grows scarce, decisions about time use will show different patterns. We further hypothesized that age is associated with preference for information about present-oriented, namely emotional, benefits of activities over future-oriented benefits. 262 participants, aged 18-93 years, were presented with a hypothetical scenario inviting them to participate in one of four activities. On a grid containing 12 cells, participants were given the option to review information about activities’ emotionally meaningful and future-oriented benefits. Participants could review as many cells as they wished before indicating their interest in the activity. Across all activities, age was associated with preference for reviewing emotionally meaningful information. Moreover, in this scenario age was associated with reviewing more not less information. Age-related preferences for more information was apparent despite a negative age association with recall-memory, suggesting that cognitive load does not deter information search when decisions align with socioemotional goals.
Changing Educational Gradients in Life Expectancy With and Without Disease Among U.S. Older Adults From 2000 to 2010
Authors: Farina Matthew , Cantu Phillip , Hayward Mark
Published: December 2020

Recent research has documented increasing education inequality in life expectancy among U.S. adults; however, much is unknown about other health status changes. The objective of study is to assess how healthy and unhealthy life expectancies, as classified by common chronic diseases, has changed for older adults across education groups. Data come from the Health and Retirement Study and National Vital Statistics. We created prevalence-based life tables using the Sullivan method to assess sex-specific life expectancies for stroke, heart disease, cancer, and arthritis by education group. In general, unhealthy life expectancy increased with each condition across education groups. However, the increases in unhealthy life expectancy varied greatly. While stroke increased by half a year across education groups, life expectancy with diabetes increased by 3 to 4 years. In contrast, the evidence for healthy life expectancy provides mixed results. Across chronic diseases, healthy life expectancy decreased by 1 to 3 years for respondents without a 4-year degree. Conversely, healthy life expectancy increased for the college educated by .5 to 3 years. While previous research shows increases in life expectancy for the most educated, trends in life expectancy with chronic conditions is less positive: not all additional years are in lived in good health. In addition to documenting life expectancy changes across education groups, research assessing health of older adults should consider the changing inequality across a variety of health conditions, which will have broad implications for population aging and policy intervention.
Attitude Toward Family Involvement in End-of-Life Care Among Older Chinese Americans
Authors: Wang Kaipeng , Liu Yanqin , Sun Fei , Kong Dexia , Wu Bei
Published: December 2020

Family involvement is critical to end-of-life (EOL) care of older adults. Attitude toward family involvement in EOL care can be influenced by family relationship. Yet, mechanisms explaining such influence have not been examined among older Chinese Americans. This study aims to examine the association between family relationship and older Chinese Americans’ attitude toward family involvement in EOL care and explore pathways of this association. Potential mediators include self-efficacy, perceived benefits, and perceived barriers of discussing EOL care with family members. Data were collected from 276 Chinese Americans aged 55+ in two metropolitan areas in 2018. Participants’ average age was 74 years (SD=9.6). Approximately 64% of the sample were female. Most participants (57%) held positive attitudes toward family involvement in EOL care. Using the Structural Equation Modeling method, we found that family relationship had a significant positive total effect on positive attitude toward family involvement in EOL care (z=5.57, p<0.001). Indirect direct of family relationship on attitude toward family involvement in EOL care through both self-efficacy (z=3.13, p<0.01) and perceived barriers (z=2.30, p<0.05) of discussing EOL care with family members was significant. Results suggest that improving family relationship may increase elder’s self-efficacy and reduce barriers of discussing EOL with family members, which is associated with more positive attitude toward family involvement in EOL care. Findings provide empirical evidence of how family relationship affects older Chinese Americans’ attitude toward family involvement in EOL care and underline the need for family-centered interventions for older Chinese Americans.
Process-Outcome-Relationships and Solution-Based Interventions With Grandparent Caregivers
Authors: Rodriguez Julian Montoro , Hayslip Bert , Ramsey Jennifer , Jooste Jane
Published: December 2020

Grandparents raising grandchildren face many challenges such as isolation, stigma, negative thoughts, and biases from age peers and service providers. In contrast, recent work suggests a need to re-frame grandparent caregiving in positive terms. In this light, the present study explored the processes key to the success of a solution-focused intervention with such persons. Fifty-two grandparents caregivers participated in a six-session solution focused intervention, using the theoretical framework of Selection, Optimization and Compensation (SOC) by Baltes & Baltes (1990). Throughout the program the emphases were on goal setting, solution focused thinking and communication skills. Participants were randomly assigned to intervention or waiting list control conditions. Within each session measures of hopefulness, positive thoughts about one’s grandchild, solution focused thinking, self-rated stress and perceived goal attainment were taken. Results indicated significant decreases in stress and increases over six sessions in hopefulness, positive thoughts about the grandchild, being solution-oriented and success in overcoming barriers interfering with goal setting and implementation (p<.05). Measures of goal accomplishment, strategy usage, success and satisfaction with effort were uniformly high. Such findings speak to key processes underlying the efficacy of a solution-focused intervention with grandparent caregivers. Measures of such processes also predicted outcome measures, e.g., resilience, positive affect, caregiver strain, well-being, loneliness, depression, parental efficacy and adequacy of service needs met. These findings reinforce the importance of understanding change processes as predictors of solution-focused intervention outcomes with grandparent caregivers and are consistent with the need to emphasize such persons’ strengths.
Skipping Meals Is Associated With Symptoms of Anxiety and Depression in U.S. Older Adults
Authors: Anderson Loretta
Published: December 2020

Previous studies have shown that higher levels of economic hardship in older adults is associated with increased odds of adverse health outcomes such as insomnia, anxiety, and depressive symptoms. The objective of this study was to determine if there was a differential association between individual measures of economic hardship and aforementioned adverse health outcomes. Cross-sectional analysis was conducted using data from the 2013 National Health and Aging Trends Study (NHATS). Logistic models were developed to assess the association between four measures of economic hardship which included not having enough money for food, utility bills, mortgage/rent, or medical bills/prescription drugs. Measures of adverse health outcomes were symptoms of depression, anxiety, and insomnia. There were 4467 community-dwelling older adults (65+) in the analyses. Results indicated those who skipped meals were more likely to have depression, anxiety, and insomnia symptoms than those who did not skip meals. After adjusting for race, age, gender, education, and total number of comorbid health conditions, skipping meals was associated with depression (OR=2.71, p<.05) and anxiety (OR=2.84, p<.01). Skipping meals did not have a statistically significant association with insomnia. The analysis for skipping meals showed a higher odds and more statistically significant results than the other measures of economic hardship listed above. These findings are relevant to population-based efforts to improve quality of life in aging populations and may be of interest to those researchers investigating the gut-brain axis. These findings may also inform future policy efforts to address health disparities and food insecurity in older adults.
Childlessness, Individual Socioeconomic Resources, and Health: Exploring Variation in 20 Countries
Authors: Quashie Nekehia , Mair Christine , Antczak Radoslaw , Arpino Bruno
Published: December 2020

Childless older adults may be at risk for poorer health cross-nationally, yet most studies on this topic analyze only a small number of countries and only 1 or 2 health outcomes. To our knowledge, two papers exist that explore associations between childlessness and multiple indicators of health using data from a large number of regionally diverse countries (e.g., 20 countries from North America, Asia, and Europe), but neither study includes an examination of socioeconomic resources. The level of health risk faced by childless older adults is likely to be distinctly shaped by older adults’ socioeconomic resources (e.g., education, income, wealth). Associations between childlessness, socioeconomic resources, and health may also differ by country context. Using harmonized, cross-national data for adults aged 50 and older across 20 high- and middle-income countries (United States (HRS), European Union (SHARE), Mexico (MHAS), and China (CHARLS) from the Gateway to Global Aging data repository), we explore if and how individual-level socioeconomic resources (income, education, wealth) moderate associations between childlessness and five health indicators (self-rated health, ADL limitations, IADL limitations, chronic conditions, and depression). Results suggest that associations between childlessness and health outcomes vary by individual socioeconomic resources in some country contexts, but not in others. We discuss these findings in light of the impact of individual-level socioeconomic resources on older adults’ support options and health outcomes cross-nationally.
Does Sexual Orientation Influence Trajectories of Change in Health? A 20-Year Follow-Up Study
Authors: Nelson Christi , Andel Ross
Published: December 2020

We examined the differences in physical health outcomes over a 20-year period between lesbian, gay, and bisexual (LGB) and heterosexual middle-aged and older adults. We also examined whether the associations were moderated by social support and affect. The analytical sample included 168 LGB adults and 336 propensity-matched heterosexual adults from the Midlife in the United States (MIDUS) study, ranging in age from 25 to 74 years (mean age=42.83) at baseline. Using negative binomial generalized estimating equations and mixed-effects analyses, data from three waves of MIDUS, spanning approximately 20 years from 1995 to 2014, were used to examine the associations between sexual orientation and the health outcomes (number of chronic conditions and functional limitations). Social support and affect were added to the models to test for moderation. The results found that LGB participants reported one more chronic condition at baseline and scored significantly higher for functional limitations. However, LGB participants increased less over time for number of chronic conditions than heterosexual participants, and there were no significant differences in terms of changes in functional limitation over time. Positive affect reduced the strength of the relationship between sexual orientation and functional limitations for LGB participants. No other moderating effects were significant. The results of this study suggest that LGB individuals may become resilient to the negative health effects of minority stressors over time. Interventions should focus on improving the health of LGB individuals when they are younger and more at risk of negative health outcomes.
Aging and Advanced Dementia Matters: End-of-Life Care in Nursing Homes
Authors: Lopez Ruth , McCarthy Ellen , Hendricksen Meghan , McLennon Susan , Rogers Anita , Harris LaKeva , Roach Ashley , Mitchell Susan
Published: December 2020

Over 5 million Americans have dementia, and the majority will die in nursing home (NHs). While comfort is the main goal of care for most NH residents with advanced dementia, they commonly receive burdensome and costly interventions such as hospital transfers and feeding tubes that are of little clinical benefit. Despite 20 years of research and numerous experts and associations advocating a palliative approach to care, quantitative studies continue to demonstrate striking and persistent regional, facility, and racial differences, including: greater intensity care among African American versus White residents; greater intensity of care in the Southeastern US; and wide variation in care among NHs in the same region of the country. The reasons for these differences are poorly understood. Assessment of Disparities and Variation for Alzheimer’s disease in Nursing home Care at End of life (ADVANCE) is a 3-year, NIA funded qualitative study of 16 NHs in 4 regions of the country which aims to explain regional and racial factors influencing feeding tube and hospital transfer rates. The purpose of this presentation is to present the methodology established in this study and to highlight factors challenging and enabling implementation of the study protocol. To date, data have been collected in 11 NHs, and include 135 staff interviews, 40 proxy interviews, and nearly 800 hours of observation. These findings demonstrate that although challenging, large qualitative research is possible and holds promise as an effective method to illuminate complex processes influencing end-of-life care for NH residents with advanced dementia.
Building a Framework for Care of Older Patients in an Academic Setting: High Risk Geriatrics Ambulatory Care Program
Authors: Chow Stephanie , Chun Audrey , Munoz Lizette , Fani Shamsi , Morrison Rolfe Sean , MacKenzie Blair , Lavayen Susana , Hung William
Published: December 2020

BACKGROUND: Traditional models of geriatric medicine and health system reimbursement structure often force ambulatory care teams to function as high-volume delivery programs, thereby dis-servicing our most vulnerable and frail older patients. This “high cost and high needs” labeled demographic requires uniquely adapted plans from medical and social work providers. METHODS: To better examine opportunities for improved framework for geriatric ambulatory care, the Acute Life Interventions, Goals & Needs (ALIGN) Program has launched several inter-professional pilot programs, each with intention to explore components of health care service to older patients, and feasibility of implementation in other health care systems. Three current models include the ALIGN Program itself, a telemedicine community paramedicine program, and a geriatric surgery co-management program. RESULTS: Preliminary results are forthcoming, with initial promising findings. For the first 126 patients enrolled, mean emergency room (ED) visits 6 months prior to ALIGN enrollment were 1.7 visits per person, reduced to 0.7 ED visits/person 6 months post-graduation from the program, and 126 fewer ED visits. Mean hospitalization 6 months prior to enrollment was 0.32 per person, whereas 6 months post-graduation was 0.2 hospitalizations/person, totaling 40.32 hospitalizations saved. Mean length of stay in the hospital 6 months prior to ALIGN enrollment for the 22 patients admitted was 7.7 days, reduced to 7.3 days post-graduation, and 32 fewer hospital days in the small subset of patients requiring hospitalization despite program interventions. CONCLUSION: The ALIGN Program’s multi-professional and flexible modularity highlights promising innovative frameworks for ambulatory geriatrics care, warranting further exploration and collaboration.
Parental Longevity Is Associated With Brain Volumes in Selected Areas
Authors: Tian Qu , Melzer David , Pilling Luke , Ferrucci Luigi
Published: December 2020

A few studies report that parental longevity is associated with faster gait speed, less memory decline, a lower risk of Alzheimer’s disease, and lower white matter hyperintensities. Data on structural neuroimaging correlates of parental longevity and its spatial distribution are limited. This study aims to examine relationships of parental longevity with regional brain volumes. We identified 10,513 participants from UK Biobank (mean age=58±6, ranged40-70, 50%women) with data on parental longevity and information on MRI regional brain volumes that have been related to executive function (dorsolateral prefrontal cortex), memory (hippocampus, parahippocampal gyrus, inferior temporal lobe, middle temporal lobe) and motor function (precentral gyrus, putamen, caudate, corpus callosum). Participants were categorized based on whether at least one parent lived to age 85 or older or neither parent survived to age 85. Associations of parental longevity with each brain volume measure were examined using linear regression, adjusted for age, sex, education, ApoE e4 status, total gray matter atrophy, white matter hyperintensities, hypertension, and glucose. Compared to participants whose both parents died before 85, those with at least one parent surviving to 85 had greater brain volumes in hippocampus, parahippocampal gyrus, inferior temporal lobe, middle temporal lobe, and precentral gyrus in fully adjusted models (Bonferroni corrected p<0.01). There were no significant associations with volumes in dorsolateral prefrontal cortex, putamen or caudate. Parental longevity is associated with preserved brain structure localized in memory- and motor-related cortical regions. These findings support previous reports that parental longevity is associated with better memory and gait with aging.
Patterns and Predictors of Residential Care Transitions Over Time Among Medicare Beneficiaries
Authors: Chyr Linda , Fabius Chanee , Drabo Emmanuel
Published: December 2020

Older adults prefer to age in place, but sociodemographic characteristics, health factors, and socioeconomic resources may influence their decision to move into other residential care settings (e.g., assisted living) or nursing homes. The characterization of residential care transitions and factors contributing to these transitions is limited. This study describes patterns and identifies predictors of transitions across community, residential care settings, and nursing homes among N=7076 Medicare beneficiaries in the National Health and Aging Trends Study, from 2011-2018. A discrete-time, multi-state Markov model was used to estimate the annual probabilities and hazards of transitioning across settings, adjusting for sociodemographic, health, and socioeconomic factors, mortality risk, as well as censoring from loss to follow-up. Most beneficiaries did not experience transitions: annual probabilities of remaining in the community, residential care settings, and nursing homes were 93%, 78%, and 73%, respectively. Being older, having dementia, being hospitalized in the last year, living alone, having multimorbidity, and having some or any functional limitations were associated with higher hazards of transition from the community to residential care settings and nursing homes. Being on Medicaid was associated with a reduced hazard of transitioning from the community to residential care settings (hazard ratio [HR]: 0.57; 95% CI: 0.36-0.91), but a higher hazard of transitioning from the community to nursing homes (HR: 1.37; 95%: CI: 0.98-1.91). As long-term services and supports increasingly shift from institutional to home and community-based care, our results can inform the design of federal and state policies targeting transitions across the care continuum.
Development of Dementia Best Care Practices in Long-Term Care Settings Online Modules
Authors: Dassel Kara , Garrett Larry , Andersen Troy , Ballard James , Freimer Martin , Butler Jorie , Edelman Linda
Published: December 2020

One arm of the Utah Geriatrics Education Consortium focuses on providing Alzheimer’s disease and related dementias (ADRD) education to formal and informal caregivers. An interdisciplinary group of faculty developed a 3-hour online training program focused on best care practices, recommended by the National Alzheimer’s Association, for persons with ADRD residing in long-term care settings. Topic include: 1) Overview of Dementia (e.g., What are types of dementia and the associated symptoms?), 2) Understanding Behaviors and Your Approach (e.g., What are the best methods for recognizing and reporting behavior change?), 3) Effective Communication within Long-Term Care (e.g., What are the best strategies to enact effective team meetings?), and 4) Communication and Responding to Behaviors (e.g., What are methods for reducing patient agitation?). Throughout the four modules a case study follows “Mrs. Jones” to demonstrate the skills and techniques raised in each module. Pre- and post-evaluation questions are embedded in the training program.
Theoretical Framing and Dissemination of Ageism First Aid: A Significant Tool for the AFU Movement
Authors: Reynolds Laurinda , Newsham Tina
Published: December 2020

By graduation most high school students have negative feelings about aging, the idea of working with older people is unappealing, and few choose to study aging. When non-traditional students of any age enroll after gaining experience in the workforce, they experience ageism and may not persist to degree completion. The value of Ageism First Aid (AFA) as an internal and external AFU tool is supported by Bronfenbrenner’s Ecological Theory and Rogers’ Diffusion of Innovation theory. AFA utilization during high school can increase traditionally-aged student enrollments. Its use for professional development on campuses can improve the campus climate for all constituents and ensure graduates will know how to avoid contributing to aging stigma. AFA use by providers of aging services and support can reduce the aging stigma older people experience. Attendees will receive handouts with a variety of dissemination models and information on how to gain institutional access to AFA. Part of a symposium sponsored by Age-Friendly University (AFU) Interest Group.
Campus-Wide Buy-In for an Age-Friendly University: One Goal and Many Paths
Authors: Zakrajsek Andrea , Andreoletti Carrie
Published: December 2020

Recognizing a growing aging population around the world as well as the many benefits of engaging learners at any age in higher education institutions (Kressley & Huebschmann, 2002; Morrow-Howell, et al., 2019; Silverstein, Choi, & Bulot, 2001), the Age-Friendly University (AFU) international initiative offers a medium to support diversity and inclusion efforts based upon age. Dublin City University (DCU), along with Arizona State University (ASU) and Strathclyde University, developed 10 Age-Friendly University (AFU) principles which offer a guide for institutional commitment to age-diversity that can be realized through institutional goals, aims, and initiatives (DCU, n.d., Talmage, Mark, Slowely, & Knopf, 2016). Because of the non-prescriptive nature of these principles, universities endorsing them have opportunities to forge varied paths in the unified goal of age-friendliness. Presenters will share lessons learned from development of the AgeAlive collaborative hub to advance age-friendly research and community-based projects at Michigan State University, the value of cross-campus partnerships at the University of Hartford, the critical support provided by the Adult Learner Programs and Services office at Northern Kentucky University, and the intentional alignment of AFU efforts with administrative priorities at Eastern Michigan University, and journey from focusing on programs to embedding age-friendly practices throughout the institution at Arizona’s State University. Through the diverse paths these presenters used to obtain support for the AFU principles at their respective universities, participants who are just beginning their AFU journeys will learn actionable strategies for increasing age-friendliness at their own institutions.
Supporting PhD Students to Become Faculty in Gerontological Social Work: AGESW’s Fellowship Program
Authors: Mauldin Rebecca , Lubben James
Published: December 2020

In the United States, the field of social work faces a critical shortage of students and faculty with expertise in gerontology needed to meet the growing needs of an aging society. To help recruit, train, and retain aging-related social work practitioners, researchers, and educators, the Association for Gerontological Education in Social Work (AGESW) created the Pre-Dissertation Fellowship Program in 2010. AGESW provides leadership in the areas of gerontological social work education, research, and policy and its PDFP was designed to support doctoral students in their education and future careers. In this 10th anniversary year of the PDFP, this symposium presents multiple perspectives of PDFP program evaluation. The first paper uses qualitative data from eight years of PDFP evaluations to identify types of professional skills attained through the program and areas of professional development missing from PDFP fellows’ home doctoral programs. The second paper uses quantitative data from a retrospective survey administered to PDFP alumni to describe their perspectives on the effects of the program. The third paper uses data from a retrospective survey of three cohorts of PDFP alumni to demonstrate the use of social network analysis for program evaluation. The fourth and final paper uses an idiographic approach to explain benefits of the PDFP from the perspectives of early stage scholars who participated in the program. Overall, the symposium provides evidence that suggests the effectiveness of the PDFP in building professional networks, mentoring doctoral students, and teaching academic skills and discusses using the PDFP model in other gerontological fields.
An Evolution of the Standards to Enhance Gerontological and Geriatric Education
Authors: Shovali Tamar , Kopera-Frye Karen , Montepare Joann
Published: December 2020

This presentation will focus on AGHE’s evolving discussions on gerontological and geriatric programming. The earliest discussion resulted in development of the first edition of the standards and guidelines for programs in 1989. In 2014, the AGHE Academic Program Development Committee (APDC) created new core competencies for gerontological education. Currently, members from both the AGHE APDC and Advancement Subcommittees are collaborating on revising the AGHE Standards and Guidelines (6th edition, 2015) to align with competencies. This presentation will discuss the new and improved version (draft available in November 2020). First, presenters will review points regarding how this update will aid in Accreditation for Gerontology Education Council and Program of Merit self-study program reviews. Secondly, the presenters will explain how the revision will increase gerontological education program integrity. Lastly, the presenters will explain how this update will be consistent with the trend across institutions utilizing these competencies in gerontological and geriatric education. Part of a symposium sponsored by the Geriatric Education Interest Group.
Lifelong Learners’ Contributions to the Campus Community
Authors: White Barbara
Published: December 2020

The 2,000 member Osher Lifelong Learning Institute (OLLI) at California State University, Long Beach offers non-credit classes to adults 50 and older. We have an ongoing strategic goal (2014, 2019) to “increase our University and student involvement.” Integration into the campus community includes members volunteering as participants in survey and participatory faculty and student research related to biopsychosocial aspects of aging, faculty/student data collection in selected OLLI classes, vetting students to teach OLLI classes, acting as resources for professors/students in product development related to aging, guest lecturing in University courses, and providing internships for students at OLLI. Collaborations have led to multiple faculty/student publications and presentations. We also endow an annual award for graduate students to support their research/projects related to aging. In return, we request and provide students the opportunity to present their results to our members. Outreach strategies will be discussed.
Acceptance and Uptake of Technology Among Older Adults: Findings From CREATE
Authors: Czaja Sara , Xie Bo
Published: December 2020

Technology is ubiquitous in everyday life and technology use is essential to independent living. Technology applications are deployed in most settings (e.g., healthcare, work) and also changing how we communicate, and access information and services. Despite increases in technology uptake among older people, an age-related digital divide remains. Drawing from research conducted by the Center for Research and Education on Aging and Technology Enhancement (CREATE), this symposium will discuss the acceptance and uptake of technology among older adults and factors influencing technology adoption. S. Czaja will discuss recent technology trends and how they vary according to technology type and subgroups of older adults. Based on CREATE findings, she will also discuss age group and cohort differences in interest in and comfort with technology. W. Boot will present findings from a study that examined adherence to a technology-based cognitive training program and how individual difference factors shaped adherence. N. Charness will present findings regarding whether advanced driver assistance systems (ADAS) can improve older adult driving performance, and older adults’ acceptance and perceptions of value of ADAS systems. M. Harris will discuss health related technology interventions and how integration of technology acceptance and behavior change models can provide insights for the design of health behavior interventions aimed at older adults. J. Sharit will provide findings from a study, which examined the willingness of older adults to adopt a variety of technologies and factors influencing willingness to adopt. Bo Xie will lead a discussion of these issues and outline areas for future research.