bluuebunny/crossref_metadata_2025 huggingface dataset:
ASSESSING MODERATED MEDIATION IN THE RELATIONSHIP BETWEEN SYMPTOM COUNTS, FALLS, AND HEALTH OUTCOMES
Authors: McKay Michelle , Brace Margaret
Published: December 2023

Almost half of older adults experience multiple symptoms that limit function and increase the risk for falls. The study aimed to determine if the relationship between symptoms (pain, endurance, weakness, balance, depression/anxiety) and outcomes (hospitalization, residential care, activity limitations, wellbeing, and mortality) are mediated by falls and whether symptoms further moderate outcomes of falls. Data from community-dwelling older adults (≥ 65 years, n=4921) enrolled in the National Health and Aging Trends Study (NHATS) 2015 cohort were used for analysis. Symptoms were categorized by symptom count (0, 1, 2, 3, 4, ≥5). Using generalized structural equation modeling, 2015 symptom counts were modeled to predict 2016 falls, 2016 health outcomes, and 2017 mortality. Falls partially mediated the association between symptoms in one year and outcomes the following year for all except residential care. In addition, the effect of falls on hospitalization is significantly moderated by symptoms (interaction of symptoms and fall OR=.89, robust SE=.045, p=.025). This dampening effect indicates that the overall effect of falls on hospitalization (OR=2.19, robust SE=.36, p<.001) is stronger at the lower levels of symptom count and weaker at the higher levels of symptom count. When there are ≥5 symptom present, there is no significant difference between the predicted probability of hospitalization for those who have not experienced a fall (.31, 95%CI: .28 to .34) and those who have fallen (.36, 95%CI: .31 to .41). Understanding the complex relationship between symptoms, falls, and outcomes can assist with developing interventions for symptom management and fall prevention.
ASSESSING THE UPTAKE OF CORE OUTCOME SETS IN RANDOMIZED CONTROLLED TRIALS FOR PARKINSON’S DISEASE
Authors: George Joanna , Paul Eli , Ward Shaelyn , Fitzgerald Kyle , Jones Garrett , Magana Kimberly , Ford Alicia , Vassar Matt
Published: December 2023

Background

Parkinson’s Disease (PD) affects 1% of adults aged 60 and older, including 10 million individuals worldwide. As PD’s incidence rises, research funding is increasing substantially. PD’s core outcome set (COS) provides standardization for PD clinical trial outcomes. Adherence to the PD COS may improve research quality and study comparability. Objective: Analysis of the COS uptake rate before and after the PD COS publication.

Methods

On June 26th, 2023, we conducted a search of ClinicalTrials.gov to retrieve phase III/IV adult PD trials between 2013 and 2023. Screening for inclusion and data extraction occurred in a masked, duplicate fashion. Trial characteristics and COS uptake rate were extracted from this sample.

Results

In our 111 included trials, the COS uptake rate was highest for the ‘Walking and Balance’ outcome and lowest for the ‘Hospital Admissions’ outcome. Overall, there was a non-significant monthly increase of 0.26% (P = 0.266, CI = [-0.20, 0.72]) in “COS-defined outcome” measurement when comparing pre- and post-COS publication.

Conclusion

Overall, our study found no significant increase in COS uptake in PD clinical trials. We found multiple outcomes to be vastly unmeasured and heterogeneity among the measurement instruments used. These findings introduce complexity to the standardization and comparability of RCT outcomes. Barriers to COS uptake may be complex; however, overcoming these factors is vital to improving the usefulness of PD research.
ASSESSMENT OF DECISIONAL COMPETENCE IN DEMENTIA– A QUALITATIVE STUDY OF 60 EUTHANASIA CASES
Authors: van den Bosch Arne , Marijnissen Radboud , Hanssen Denise , Voshaar Richard Oude
Published: December 2023

The Netherlands allows euthanasia or assisted suicide (EAS) for people with dementia. The number of dementia EAS cases gradually increases every year, up to 288 cases in 2022. This practice remains controversial, as dementia is not directly lethal and may impair decisional competence. The Dutch euthanasia review committees (RTE) refer to Appelbaum and Grisso’s criteria for the assessment of decisional competence, but how these criteria are applied in clinical practice remains unknown. This study examined qualitatively which factors, and how, influence the judgment of decisional competence for EAS requests of people with dementia. Thematic analysis of 60 dementia EAS case summaries published online by the RTE between 2012 and 2021. Twenty patients had an advance directive and were decisionally compromised at time of EAS. Forty patients were decisionally competent at time of EAS, of which twenty also had an advance directive (purposive sampling). Two researchers independently coded all text related to decisional competence. A theoretical framework was developed. The four cognitive criteria of Appelbaum and Grisso were dimensional and cut-off points were influenced by six supporting factors that also directly impacted on competence assessment, i.e., level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and the patient-physician relationship. The number of involved physicians and executed investigations were two contextual factors. The multidimensionality and subjectivity of decisional competence assessment may pose ethical and legal challenges. Continuous quality improvement processes may be needed in daily care, including possibilities for reflection.
BRIDGE EMPLOYMENT OR ENCORE CAREER? PREDICTORS THAT DISTINGUISH LATER LIFE CAREER TRANSITIONS
Authors: Oh Yun taek
Published: December 2023

Moving away from the traditional lock-step retirement to multiple retirement pathways, later-life career transition has been prevalent for about a half-century (Ruhm, 1990). So-called “encore career,” many older workers start their second career after leaving their original career jobs. However, leaving one’s career job is not a distinct prequel to an encore career; instead, it is an essential step to bridge employment as well. While these two transitions have different purposes, reasons, and outcomes, the predictors distinguishing between them are relatively not well-documented. Using the sample of respondents with career jobs in the Health and Retirement Study, this study distinguished various later-life transitions by the voluntariness of career transition and the duration of labor force participation after the transition and then investigated the predictors that distinguish between bridge employment and encore career. Based on the theoretical predictions from multiple disciplines, such as the resource-based dynamic process model and continuity theory, I stated and tested a set of hypotheses using multinomial logit estimation. The result showed that financial, physical, and mental health resources, and retirement identity when transitioning to new jobs predict whether older workers take bridge employment or encore careers. This result provides a helpful hint to policymakers and employers who want to retain older workers in the labor force. Because the indicators for the voluntariness of career transition are available for those who left their career employers only, further research is needed once the voluntariness measures for other work adjustments are available.
CHALLENGES AND CONSIDERATIONS IN RESEARCH WITH OLDER ADULTS EXPERIENCING HOMELESSNESS
Authors: Pope Natalie , Latimer Abigail , Moser Debra , Sasdi Olivia , Okeyo Hilda
Published: December 2023

Individuals in their late 50s and 60s constitute the fastest growing cohort of homeless adults; homelessness among the older adult population is expected to triple by 2030 (Culhane et al., 2019). Older adults find themselves homeless due to systemic (e.g., unaffordable housing, structural racism, increasing healthcare costs) and individual factors (e.g., substance misuse, mental health diagnoses). Unhoused older adults have high rates of multiple chronic conditions (Henwood et al., 2018) worsened by unmet healthcare needs (Baggett et al., 2010). Older adults, especially those with serious illness, struggle to find and maintain housing compared to younger adults without illness. Patient and clinician-informed services/programs are needed, but the nature of serious illness and homelessness research comes with unique considerations. Research challenges in this population include inclusive and adequate recruitment, participant screening, and boundary issues (Hanson et al., 2014; Lashley, 2023). We will present lessons learned from completing two successful qualitative studies with unhoused older adults and clinical subject groups. Issues encountered during our research include dealing with recruitment obstacles, evaluating and responding to participants’ cognitive impairment and mental health issues, managing emotional labor experienced by the research team, developing stakeholder relationships, and making decisions about adequate and appropriate study compensation. We describe challenges, opportunities, and suggestions for collecting primary data from unhoused older adults. We encourage gerontological researchers not to avoid this hard-to-reach, high-risk population. The lessons learned in designing and implementing studies tailored to the unique challenges of unhoused older adults can promote inclusion of the perspectives and needs this population.
CHILDHOOD SOCIOECONOMIC STATUS GRADIENTS IN FUNCTIONAL LIMITATIONS: THE ROLE OF MACRO-ECONOMIC CONTEXT
Authors: Fuller-Rowell Thomas , Sultana Samia , Hudson Amy , Kim Eric , Ryff Carol
Published: December 2023

A large number of studies have documented an association between childhood socioeconomic status (SES) and adult health or illness. However, relatively little is known about how this SES-health gradient varies across macro-economic contexts. The current study examined state-level mean income as a moderator of the association between the education level of a person’s parents and functional limitations in the United States (N = 10,685, Mean age = 47.7, SD = 13.6, 51% female, 86% White; 6% Black; 8% other or missing). Data were from an economic time series database (1917-2018) and the Midlife in the United States Study (MIDUS). Time series data were merged with MIDUS data (1995 core sample and 2012 refresher) by state of residence and year to determine exposure to state economic characteristics during three periods of the life span: prime working years (ages 30-55), early adulthood (20-25) and childhood (0-15). Results indicated that the SES-functional limitations gradient was attenuated for those who lived in a state with a higher mean income from ages 30-55, 20-25, and 0-15 (p’s < .05). The moderating role of state-level economic exposures between ages 30 and 55 (but not at earlier life stages) differed by gender such that the attenuation of the SES-functional limitations gradient in more affluent states was more strongly evident among females than males. Findings suggest that the role of childhood SES in later life health varies across state-level economic contexts with notable differences by gender and age group. Future directions and policy implications are discussed.
CIRCADIAN CLOCK DISRUPTION: SEX-SPECIFIC EFFECTS ON METABOLISM & COGNITION IN AN ALZHEIMER’S MODEL
Authors: Scroggins Laila , Zhang Qing , Koronowski Kevin , Palavicini Juan
Published: December 2023

Preclinical studies have been largely performed on transgenic murine models of early-onset AD, which only accounts for a small fraction of AD cases. A number of confounds have impacted and limited the translatability of these mouse models, including potential off-target genetic effects, artifacts resulting from ultra-physiological overexpression of specific gene products, and overblown pathologies in non-fully developed brains. The objective of this study is to leverage a new microtubule-associated protein tau knockin (MAPT H1-GR) mouse model to assess the effects of an understudied environmental factor associated with AD, a disturbed circadian rhythm, on whole body and brain metabolism, tauopathy, neuroinflammation, neurodegeneration, and cognition. For the experimental design, a cohort of 32 mice was divided into two groups, normal light conditions (NLC) and chronic jet lag (CJL). The CJL mice have a regulated light schedule which shifts 4 hours ahead every 3 days while the NLC mice have a continuous 12 hours of light and 12 hours of dark schedule. Non-fasted and overnight-fasted glucose, ketones, and lactose levels were measured. CJL led to a sex-dependent disruption of fuel utilization during fasting conditions with males displaying more dramatic phenotypes than females. CJL also led to sex-specific changes in body composition, assessed via qMRI testing every other month, specifically at the level of fat mass in males. Cognitive assessment through the Barnes Maze test revealed a disruption of spatial memory in males, while females seemed to be protected from the deleterious effects of CJL on cognition.
COMPARING THE FEASIBILITY OF A LONELINESS AND SOCIAL ISOLATION GROUP IN A PRIMARY CARE VS COMMUNITY SETTING
Authors: Zubatsky Max , Berg-Weger Marla , Tziarli Dimitra , Livingston Rachel , Drake Judy , Taylor Ashley
Published: December 2023

Social isolation and loneliness is now considered a public health epidemic in the United States for the older adult population. While providers try to address certain health and lifstyle issues in this population through medications and other medical referrals, there are few non-pharmacological group interventions to curb feelings of isolation and loneliness. This study will determine if a psychosocial group intervention in primary care results in decreases of loneliness and health risks compared to a community-based group. The intervention is called “Circle of Friends,” which is an evidence-based group to alleviate loneliness and increase socialization through a rehabiliation model of care. Participants must be 60 years and older, report subjective feelings of loneliness, have reported being homebound and/or isolated over the last six months, and have very few social connections. The current study has collected initial pre-group data from eight older adults from the community group, and the research team is recruiting participants in the primary care group setting. It is anticipated that the Primary Care Circle of Friends Group will report higher improvements in loneliness and health indicators compared to the community-based group. The primary group will take place in an underserved Federally Qualified Health Center, and the community-based group will take place in the conference room of a university setting. Early qualitative themes that facilitators have reported around recruitment include: 1.) Challenges with planning transportation, 2.) Building trust in joining a new group, and 3.) requests of extra resources in addition to this group.
CORRELATES OF SLEEP HEALTH AMONG OLDER PEOPLE WITH AND WITHOUT HIV IN UGANDA
Authors: Yoo-Jeong Moka , Ratnayake Aneeka , Olivieri-Mui Brianne , Tong Yao , Tsai Alexander C , Okello Samson , Asiimwe Stephen , Siedner Mark
Published: December 2023

The proportion of older people in Uganda is expected to grow rapidly. Sleep issues disproportionately affect older people and people with HIV (PWH). Identifying determinants of sleep health is essential in the development of interventions. Thus, we assessed sleep-related factors in older Ugandans (aged ≥50 years) using cross-sectional data from the Quality of Life and Aging with HIV in Rural Uganda study. Sleep outcomes were measured by the Pittsburgh Sleep Quality Index (quality, duration, efficiency). The associations between sleep outcomes and potential determinants (loneliness, urban/rural setting, depression, anxiety, alcohol use, physical activity) were evaluated using multivariable linear regressions. Of 556 participants, 271 were PWH and 285 were people without HIV (PWoH). The two groups were similar in age, sex, and education. Depression screening via the 13-item Hopkins Symptoms Checklist was positive in 131 participants (PWH: 28.2%; PWoH: 21.6%; p=.05). There were no differences in sleep outcomes by HIV serostatus. Mean sleep quality was 0.89 (SD=0.78; range=0-3, 0=very good to 3=very bad), mean sleep duration was 6.5 hours (SD=1.7), and mean sleep efficiency was 74% (SD=19.5%; >85% is optimal). Depressive symptoms were associated with worse sleep quality (b=0.58; p<.001), reduced sleep duration (b=-0.94; p<.001), and worse sleep efficiency (b=-0.12; p<.001) regardless of HIV serostatus. Interestingly, older age was related to increased sleep duration (B=0.04, p=.001). Interventions targeting depression among older Ugandans may help with sleep. Longitudinal studies are needed to determine the bi-directionality of this relationship and further elicit potential pathways to support sleep health among older Ugandans.
CORRELATION OF SHOULDER RANGE OF MOTION WITH LOWER EXTREMITY PERFORMANCE AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: Almardawi Ranyah , Gray Vicki , Frakes Nathan , Liang Yuanyuan , Davis Derik
Published: December 2023

More than one-third of older adults have mobility limitations. Yet the impact of shoulder dysfunction on lower extremity performance is only nascent in description. We tested the hypothesis that shoulder range of motion (ROM) correlates with lower extremity performance. Data were collected from 26 community-dwelling older women (80.8%) and men aged ≥ 65 years (mean±standard deviation=71.9±5.3 years) enrolled in a pilot study at one time point. Bilateral shoulder ROM testing for forward flexion (FF), abduction (ABD), and adducted external rotation (Add-ER); and Short Physical Performance Battery (SPPB), gait speed (GS), 6-meter narrow walk test (6M-NWT), and stair climb power test (SCPT) were performed. The sum of bilateral FF, ABD, and Add-ER was determined (Total-ROM) for each participant. Spearman’s rank-order correlation (rho) with 95% confidence intervals (CIs) was used to measure the strength and direction of correlation for Total-ROM with the mobility outcome measures. The study sample demonstrated Total-ROM, 709.5° ± 80.1°; SPPB score, 10.9 ± 1.3; GS, 1.2 ± 0.2 m/s, 6M-NWT time, 7.3 ± 3.9 s; and SCPT, 240.7 ± 90.7 watts. Total-ROM correlated with: SPPB 0.56 (0.22,0.78), p=0.003; GS, 0.59 (0.27,0.80), p=0.001; SCPT, 0.54 (0.20,0.77), p=0.004; and 6M-NWT, -0.63 (-0.82,-0.33), p< 0.001. The results provided preliminary evidence that shoulder ROM correlates moderately with measures of lower extremity performance in community-dwelling older adults. Future studies are warranted in older populations to test for the longitudinal association of shoulder ROM with lower extremity performance and to determine if treatment of shoulder dysfunction provides effective prehabilitation to mitigate age-related declines in mobility.
CROSS-CULTURAL VALIDATION OF THE OARS INSTRUMENT FOR THE ASSESSMENT OF ELDERLY ANGOLANS
Authors: Barbara Rita
Published: December 2023

Background

The Older Americans Resources and Services (OARS) instrument is widely used internationally, but requires validation in specific contexts, such as Angola. This study aims to cross-culturally validate the OARS for assessing elderly Angolans.

Methods

The cognitive and functional domains of the OARS were cross-culturally adapted, followed by psychometric analysis on a representative sample. Domains of activities of daily living and mental health were evaluated. Internal reliability was assessed using Cronbach’s alpha coefficient, resulting in 0.80 for activities of daily living and 0.80 for mental health, with a 95% confidence interval.

Results

The psychometric analysis demonstrated consistent reliability in the domains of activities of daily living and mental health, with Cronbach’s alpha coefficients of 0.80 for both, supported by 95% confidence intervals. These results indicate substantial reliability.

Conclusion

The cross-cultural validation of the OARS is ongoing, and preliminary results from the psychometric analysis reinforce the reliability of the domains of activities of daily living and mental health. Adapting the OARS could be a valuable tool for assessing elderly Angolans, providing reliable and internationally comparable data. Keywords: OARS, elderly, cross-cultural validation, psychometric analysis.
CULTURALLY SENSITIVE STRATEGIES TO RECRUIT FOREIGN EDUCATED NURSES FOR US LONG-TERM CARE RESEARCH
Authors: Thompson Roy , Wipke-Tevis Deidre , Olanrewaju Sherif , Odemuyiwa Olumayowa A , Squires Allison
Published: December 2023

Long-term care (LTC) facilities experience chronic nursing staff instability which negatively impacts resident health outcomes. Recruiting Foreign Educated Nurses (FENs) is one strategy to stabilize the nursing workforce but most studies on FENs, use secondary data from: American Community Survey and the National Sample Survey of Registered Nurses. Few empirical studies have examined FEN experiences, employment outcomes, and impact on US LTC facilities. Since LTC facilities are dependent on FENs to meet minimum staffing requirements, additional research is needed to better understand FEN workforce issues in LTC, how to improve its sustainability, and the links to resident outcomes. Mistrust of researchers, however, may make FENs hard to reach. Therefore, conducting primary research on FENs in LTC requires culturally sensitive and community-engaged recruitment strategies. Drawing from existing literature and lessons learned from primary research conducted with FENs working in LTC facilities in the southeastern US, we will review best practices for recruitment so researchers can understand the cultural and structural issues that may affect research conduct in facilities where FENs are employed and their recruitment as participants. Developing relationships with FEN leaders as well as the Nigerian, Jamaican, Filipino, and/or Asian nurses associations can facilitate access to the population. Key stakeholder relationships also include the American Nurses Association, State Boards of Nursing, and Commission on Graduates of Foreign Nursing Schools as they can facilitate entrée into data sources and networks for recruitment. Understanding recruitment strategies will strengthen research that deepens our understanding of workforce issues among FENs in LTC.
ADAPTING TELEHEALTH EVIDENCED BASED PROTOCOLS FOR VETERANS WITH MOOD AND NEUROCOGNITIVE DISORDERS: A CASE STUDY
Authors: Hosseini Charissa
Published: December 2023

Aging Veterans with mood and neurocognitive disorders typically have a complex medical and psychiatric presentations leading many providers to exclude them from treatment, expressing that psychotherapy is not appropriate. This form of exclusionary care may decrease help seeking behavior and amplify existing psychological symptoms to an already stigmatized and isolated population. The following case study, outlines a 24-session approach to integrating evidenced based protocols such as Cognitive Behavioral Therapy (CBT) and Narrative Life Review Therapy via telehealth. The presentation will discuss cultural considerations to take when working with Aging Veterans that have co-occurring mood and cognitive difficulties as well as reflect upon the successes and challenges of providing telehealth with this population.
DIETARY NITRATE SUPPLEMENTS AND AEROBIC EXERCISE MODIFY FRAILTY IN AN AGE-DEPENDENT MANNER IN FEMALE C57BL/6 MICE
Authors: Bisset Elise , Howlett Susan
Published: December 2023

We previously demonstrated that aerobic exercise attenuates the development of frailty in older female mice. Here we combine the common dietary supplement, sodium nitrate, with aerobic exercise to determine if this combination will work to attenuate frailty across lifespan. Adult (7-9 months) and aged (24-25 months) female mice were given free access to a running wheel and/or sodium nitrate (1mM, drinking water), or neither for 3 months. We measured blood pressure (tail cuff), running volume, frailty (frailty index), and body composition (DEXA). Blood pressure was unaffected by nitrates or exercise at both ages. While young mice ran more than older mice (3.5±0.4 vs 1.2±0.2 km/day), running was unaffected by nitrates. Older mice were frailer at baseline than younger mice (0.13±0.04 vs 0.03±0.004; p< 0.001). In older sedentary controls, frailty increased over time (0.15±0.02 to 0.19±0.03: p=0.03), but this was prevented by nitrates (0.13± 0.02 to 0.12 ± 0.01), exercise (0.12±0.03 to 0.18±0.03), and both (0.12±0.02 to 0.12±0.01). Older sedentary controls saw age-related weight loss (32.5±3.0g to 29.7±2.3g: p=0.02) which was prevented by exercise or nitrates. In older mice, mortality was highest in sedentary controls (46%) and lowest in exercised mice fed nitrates (0%). In contrast, while exercise attenuated frailty in young mice, nitrates did not. Young mice also had few changes in body composition; none died. While nitrates with or without exercise are beneficial for older mice, they had little effect in younger mice. These results suggest that nitrates alone or with exercise, may help prevent frailty in older females.
DIFFERENCES IN WHITE MATTER MICROSTRUCTURE IN MIDDLE-TO-OLDER AGE ADULTS WITH CHRONIC KNEE PAIN
Authors: Bell Kristina , Strath Larissa , Nodarse Chavier Laffitte , Valdes-Hernandez Pedro , Fillingim Roger , Cruz-Almeida Yenisel
Published: December 2023

Abundant research suggests aberrant white matter microstructure in patients with chronic pain as well as in older adults independently, where pain can significantly impact daily function. However, most studies fail to consider pain and aging interactions, particularly in middle and older-age. We aimed to explore differences in white matter microstructure (i.e.,Fractional Anisotropy (FA)) by pain’s impact on daily function (i.e., high (n=60) versus low pain impact (n=111) in middle-(45-59 years old, n=129) versus older adults (60-XX years old, n=77) using diffusion tensor imaging. Participants (n=171) underwent laboratory visits to collect multi-modal pain and neuroimaging measures. We employed a linear mixed model approach to test main effects of pain impact and age groups as well as their interaction with Bonferroni-corrected multiple comparisons. Findings demonstrated a significant pain impact and age interaction on FA (p’s≤0.05) in the left caudal anterior cingulate, left caudal middle frontal, left and right rostral middle frontal and left and right insular regions. Specifically, middle-aged adults with high impact pain had significantly worse brain microstructure across these regions compared to the older adults reporting high impact pain (p’s≤0.05). These findings highlight the need to study pain across the lifespan. Given the higher prevalence of chronic pain in middle-age compared to older age, future studies are urgently needed to test whether interventions in middle-age could halt pain’s impact on brain and function.
EARLY DETECTION OF ALZHEIMER’S DISEASE AND RELATED DEMENTIAS FROM VOICE RECORDINGS: THE FRAMINGHAM HEART STUDY
Authors: Ding Huitong , Lister Adrian , Karjadi Cody , Au Rhoda , Lin Honghuang , Bischoff Brian , Hwang Phillip
Published: December 2023

With the aging global population and the increasing prevalence of dementia, there is a growing focus on identifying mild cognitive impairment (MCI), a pre-dementia state, to enable timely interventions that could potentially slow down neurodegeneration. Producing speech is a cognitively complex task that engages various cognitive domains, while the ease of audio data collection underscores the potential cost-effectiveness and noninvasiveness that voice may offer. This study aims to construct a machine learning pipeline that incorporates speaker diarization, feature extraction, feature selection, and classification, to identify a set of acoustic features that exhibit strong MCI detection capability. The study included 100 MCI cases and 100 healthy controls (HC) matched for age, sex, and education from the Framingham Heart Study. Participants’ speech responses during cognitive tests were recorded, and the recorded audio was processed to identify segments of each participant’s voice from recordings that included voices of both testers and participants. A comprehensive set of 6385 acoustic features was then extracted from these voice segments using the OpenSMILE and Praat softwares. Subsequently, we constructed a random forest model using the features that exhibited significant differences between the MCI and HC groups. We identified an optimal subset of 29 features that resulted in an AUC of 0.87, with a 90% confidence interval ranging from 0.82 to 0.93. This study showcases the potential of human voice as a valuable resource for improving early detection of ADRD and motivates future opportunities to use passive voice collection tools, such as hearing aids, to measure brain health.
EFFECTS OF HIGH-INTENSITY AQUATIC EXERCISE ON INFLAMMATION AND COGNITION IN OLDER ADULTS WITH MCI
Authors: Louras Peter , Savettiere Adriana , McNerney Windy , Fairchild Kaci
Published: December 2023

Exercise shows immune benefits in older adults and can reduce the risk of late-life cognitive impairment and dementia. This study sought to explore the effects of high-intensity aquatic-based exercise on older adults with mild cognitive impairment (MCI), specifically by examining changes in inflammatory plasma protein concentrations and cognitive performance. A secondary data analysis was conducted on 20 healthy volunteers (mean age 68.2 ±7.75 years) who participated in 6 months of supervised aquatic exercise training. Participants completed a battery of neuropsychological assessments and whole blood draws at pre- and post-intervention. Plasma protein concentration levels were attained using the Olink Target96 Inflammation panel [Uppsala, Sweden]. Mixed effects models assessed the effects of protein concentration change scores on selected cognitive outcomes, while controlling for age. Results indicated that following the exercise intervention, significant changes in two inflammatory-related proteins (Extracellular newly identified receptor for advanced glycation end-products binding protein [EN-RAGE]; Interleukin-20 receptor subunit alpha [IL-20RA]) were associated with improved verbal memory and processing speed endpoints. Specifically, decreased EN-RAGE concentrations resulted in significantly improved delayed verbal memory scores (parameter estimate= -0.893, p= .023), while increased IL-20RA concentrations led to better task completion (parameter estimate= 2.145, p= .030). These findings demonstrate the cognitive benefits of aquatic-based exercise for older adults and those with MCI, and suggest these effects are mediated by alterations in pro- and anti-inflammatory protein markers such as EN-RAGE and IL-20RA. Larger studies are warranted to replicate these findings, and to further explore the role of activity-induced inflammatory changes on late-life brain health.
EFFICACY OF MALNUTRITION SCREENING AMONG OLDER VETERANS AT AN URBAN VA HOSPITAL
Authors: Cassatt Sarah , Parker Elizabeth
Published: December 2023

Nearly half of the Veteran population is >65 years. Older Veterans are at increased risk of malnutrition associated with increased mortality, morbidity, length of stay, and readmissions. Malnutrition-focused quality measures are needed to combat this public health issue. The purpose of this study was to identify gaps in malnutrition screening at an urban VA facility. Chart auditing was conducted for all medical admissions during 72 hour periods across 14 months. Auditing determined if nutrition screening was completed, with an admission weight, and if nutrition was consulted for nutritionally compromised Veterans. Screening was conducted using the Malnutrition Screening Tool (MST). Additionally, estimated prevalence of nutritionally compromised Veterans was assessed using auditing data from 30 days. Audit data showed that on average only 57.4% (n=458) of Veterans admitted for inpatient care were screened correctly. Of those screened incorrectly, the three most common errors were 1) not collecting a weight on admission (N=82 (42.1%)); 2) inaccurate weight change interpretations (N=41 (21%)); 3) failure to refer nutritionally at-risk Veterans to nutrition services (N=38 19.5%)). Prevalence auditing demonstrated over 1/3 of Veterans were nutritionally compromised at the start of their hospitalization (36.43%, (N=295)). With an increasingly aging population in the United States there is a focus on shifting to value based payment systems. The new CMS Global Composite Malnutrition Score will include evaluation of hospitals malnutrition screening processes. There is a significant opportunity to close these gap areas and to adopt clinically relevant best practices to provide nutrition care earlier to at risk Veterans.
ELDER ABUSE RISK ASSESSMENT MODEL FOR ALZHEIMER’S DISEASE WITH SOCIAL DETERMINANTS OF HEALTH AND MEDICAL FACTORS
Authors: Pappadis Monique , Wood Leila , Westra Jordan , Schlag Karen , Czyz Rebecca , Kuo Yong-Fang , Raji Mukaila , Mouton Charles
Published: December 2023

Older adults with Alzheimer’s Disease and Related Dementias (ADRD) are at an increased risk for elder abuse (EA). Using a 20% national Medicare database, we developed an EA risk-assessment model, including older adults with and without ADRD. Beneficiaries aged 66 and older in 2016, without an EA diagnosis in 2015 or 2016, and Medicare Part A/B/D eligible with no HMO through 2018 were included (N=2,261,166; ADRD, n=187,805, 8.3%). Outcome of interest was an EA diagnosis. The cohort was split into three subsets, training (50%), testing (25%), and validation (25%). Predictive models included demographics, comorbidities, symptoms, injury history, claims-based frailty scores (0-1), medical screening and procedures, and social determinants of health (SDoH). Only 0.2% had an EA diagnosis. EA models were conducted using logistic regression and machine learning methods (random forest, gradient-boosted tree classification, and multilayer perceptron classification). The logistic regression model was the best predictive model (AUC=0.73; Sensitivity=0.80; Specificity=0.47; GINI Impurity=0.50; Agreement=46.77%). Many SDoHs (e.g., primary support and marital problems, housing/income problems and dual eligibility, Black Race), STI testing, behavioral health and medical conditions, and greater frailty were associated with increased risk of EA at 2 years for the total sample (with and without ADRD). For those with ADRD, SDoHs (e.g., marital and housing/income problems), male sex, aged 71-75 (vs 66-70), lung cancer, PTSD , and greater frailty were associated with increased EA risk. Coupled with qualitative interviews, our findings will guide the selection of the most pertinent risk and protective factors to incorporate into an EA screening intervention tool.
END-OF LIFE CARE PLANNING: THE ROLE OF FAMILY FOR VIETNAMESE AMERICANS AND FILIPINO AMERICANS
Authors: De Fries Carson , To My Ngoc , Sun Fei , Wu Bei , Levkoff Sue , Wang Kaipeng
Published: December 2023

Research has demonstrated a lack of understanding around the significant disparities in end-of-life (EOL) care decisions and culturally sensitive EOL care practices among older Southeast Asian Americans (SAA). Little is known regarding the factors related to the experiences and attitudes toward family involvement in EOL care, especially among these populations. This study explored how family relationships shape attitudes towards and experiences of family involvement in EOL care among older Vietnamese American and Filipino Americans. Three focus groups consisting of one Filipino group (in English), and two Vietnamese groups (one in English, one in Vietnamese) were held with 12 participants aged 55 or above. Interview questions centered around EOL care preferences and experiences and the role of family relationships in EOL care. Participants reported they could trust their children the most with their EOL care wishes, and expressed the preferred place for EOL care to be “home” rather than institutional settings. While some reflected that previous experiences with older family members (e.g., parents, aunts and uncles) facilitated EOL care discussions, others acknowledged resistance from some in participating in these conversations. Cultural and language differences led to participants’ resistance to formalized care and hindrances to EOL care planning. Finally, financial cost, concern about burdening younger generations who “have their own lives”, and difficulty navigating information were cited as barriers to EOL care. Findings from this study can provide improved understanding of the role that family plays in individuals’ EOL care experiences and improve culturally responsive EOL care practices for SAA populations.
END-OF-LIFE DOULAS: EXPLORATION OF VALUES, GOALS, AND MOTIVATIONS
Authors: Thompson Amber
Published: December 2023

End-of-life doulas provide non-medical support to individuals and families during end-of-life. Current research focuses on identifying the doula role and services offered at end-of-life, primarily in relation to existing medical care. The findings highlight the ambiguity of the role and resulting confusion for healthcare providers, individuals, and families. Using data collected from on-line surveys, the aim of this study was to explore the values, goals, and motivation of those identifying as end-of-life doulas (n=232). In addition to questions about the role and services provided, 14 items assessed the doulas’ underlying values through goals and motivations. Questions addressed their motivation for becoming a doula and their goals for this role, such as: 1) promoting well-being during end-of-life 2) providing a less medicalized model, including advocating for death reform, and 3) wanting to professionalize and/or commodify the non-medical care they provide. Exploratory factor analysis supports two underlying factors describing the doulas’ goals and motivations including social values (i.e., perceived positive impact on society) and functional values (perceived problem solution) (Cronbach’s alpha .85 and .75 respectively). Content analysis of open-ended survey responses describing motivations for becoming an end-of-life doula strengthen this perspective and expand it to include emotional motivations (i.e., “called” to the work, or personal experiences with death). These unique findings demonstrate the need for more research documenting the underlying values organizing end-of-life doulas. The potential benefits of investigating values include progress towards clarification about the role of end-of-life doulas, and how they may contribute to providing person-and-family centered care during end-of-life.
ENGAGING DIVERSE OLDER ADULTS IN AGING RESEARCH: IDENTIFYING COMMUNICATION AND COMMUNITY ENGAGEMENT STRATEGIES
Authors: Gaillard Trudy , Carr Dawn , Sheffler Julia , Weiss Ursula , Neff Donna , Charness Neil , Webb Fern
Published: December 2023

A growing challenge is ensuring that diverse older adults participate in research studies. If studies are not inclusive of diverse populations, it is not possible to determine if interventions are likely to be universally beneficial or reduce health disparities. Smaller and more regional studies are particularly likely to struggle to recruit and retain diverse older adults for their research. This project uses quantitative and qualitative data based on a new collaboration consisting of independent scholars at four research institutions associated with three participant research registries on aging in Florida. The aims of this project are to: 1) describe characteristics of aging-focused research registrants, and 2) share communication strategies for recruitment specifically designed to increase participation of a variety of underrepresented populations, including minority, rural, and under-served. Preliminary results show that it is important to specifically adopt culturally informed recruitment strategies given its direct result in adequate representation from diverse and under-represented groups. All three participating registries are currently enrolling persons and seek a specific diverse demographic which captures the racial, cultural and geographic variation observed in residents throughout Florida. For example, these registries seek individuals who self-identify as African American/Black, Caribbean, Hispanic/Latino adults aged > 55 years; persons living in rural communities, and persons who have survived cancer or are interested in cancer-related research. We describe current infrastructure employed at each institution as well as recommendations in building long-term trust across each collaborating institution. Finally, we share an innovative model leveraging strengths and opportunities for statewide engagement across each registry.
EPIDEMIOLOGIC PATTERNS OF POTENTIALLY INAPPROPRIATE MEDICATION USE IN OLDER ADULT DRIVERS
Authors: Cotton Jesse , Huang Beicheng , Chihuri Stanford , Lang Barbara , Li Guohua
Published: December 2023

Use of potentially inappropriate medications (PIMs) by older adult drivers has been linked to increased crash risk. The objective of this study was to examine the epidemiologic patterns of PIM use in a cohort of 2990 drivers aged 65-79 years at the time enrollment (July 2015 to March 2017). We applied the 2023 Beers Criteria to identify PIMs from medication data collected through the “brown-bag review” method at baseline, year 2 and year 4 of follow-up for older adults participating in the Longitudinal Research on Aging Drivers project. We assessed time trends in the prevalence of PIM use and the composition of PIMs using the chi-square tests. The prevalence of PIM use was 16.2% at baseline, which decreased slightly in year 2 (14.0%) and year 4 (13.2%). The three most frequently used PIMs were nonbenzodiazepine hypnotics, antidepressants, and estrogens, accounting for 19.4%, 17.8% and 14.1% of all PIMs, respectively. Of PIM users, 12.7% were using ≥2 PIMs at baseline, 12.5% in year 2, and 10.0% in year 4. PIM use among older adult drivers is fairly common. Epidemiologic patterns of PIM use among older adult drivers have remained stable during the four years of follow-up.
EVALUATING THE SENIOR EMPLOYMENT AND SOCIAL ACTIVITY SUPPORT PROGRAM IN KOREA: A SYSTEMATIC REVIEW OF SATISFACTION
Authors: Koh Young Bin , Lee Yeonjung
Published: December 2023

For older people, jobs provide not only income security, but also a social role. Jobs also give them a sense of subjective security in terms of maintaining self-esteem and self-identity, and improve their overall life satisfaction. The Senior Employment and Social Activity Support Program (SESAP) provides for older Koreans for supplemental income security and social participation in old age by creating and providing social jobs that match the aptitudes and abilities of the senior citizens. It has been 20 years since the SESAP was introduced, and many studies have accumulated to evaluate the program in many different aspects. This study aims to summarize the existing studies focusing on satisfaction with program among participants. A systematic literature review was conducted to identify empirical research studies written in Korean and published in a peer-reviewed journal between 2004 and 2023. To this end, we searched through RISS, KISS, and DBpia databases using the selected keywords and obtained 126 articles. After removing duplicates and excluding gray literature, 26 articles were selected and analyzed through a peer-review process. Analysis of the selected literature shows that a majority of the program participants are women, and satisfaction with salary was lower compared to other types of program satisfaction (i.e., job content, work environment, and relationship with co-workers). Lastly, satisfaction with program are associated with other indicators such as better life satisfaction, and quality of life. This systematic review provides suggestions for further research to improve the satisfaction with SESAP among participants.
EXAMINING DEMENTIA AND NONDEMENTIA CAREGIVERS’ NUTRITION AND OVERALL HEALTH
Authors: Nehrkorn-Bailey Abigail , Edmonds Tanner , Quatsoe Alissondra
Published: December 2023

The literature on dementia caregivers is sparse. A study from Sheehan et al. (2021) concluded that the well-being of dementia caregivers and nondementia caregivers largely did not differ. To note, the sample size in that study was limited and no health behaviors were assessed. This study extends and adds to the Sheehan et al. (2021) study by utilizing the July 2023 Behavioral Risk Factor Surveillance System data (CDC, 2023) to examine nutrition (i.e., fruit and vegetable intake) and overall physical and mental health among (1) dementia caregivers and (2) nondementia caregivers. Two multiple mediation analyses were conducted comparing caregiving group (n = 4,853 dementia caregivers; n = 28,698 nondementia caregivers): physical health was the outcome in Model 1, and mental health was the outcome in Model 2. The direct pathway from caregiving group to (1) physical health in Model 1 was significant (b = -.05, p < .001) and (2) mental health in Model 2 was significant (b = -0.11, p < .001). The pathway from caregiving group to vegetable intake was significant in both models, but the caregiving group-fruit intake pathway was not significant. The pathways from vegetable and fruit intake to physical and mental health were all significant. Lastly, vegetable intake significantly mediated the pathway from caregiving group to (1) physical health (b = 0.001, CI = [.0003 to .0020]) and (2) mental health (b = 0.001, CI = [.0002 to .0015]). These findings indicate important diet and overall health differences between dementia and nondementia caregivers.
EXAMINING THE ASSOCIATION BETWEEN LAND COVER AND PHYSICAL MOBILITY: FINDINGS FROM THE NHATS STUDY (2021)
Authors: Perera Rohini , Gronlund Carina , Noppert Grace , Duchowny Kate
Published: December 2023

The vast majority (88%) of adults wish to age in place. An aesthetically pleasing environment has been found to be associated with better physical functioning and reduced disability, however specific land cover features (i.e. blue, green, urban spaces) and their relation to mobility have not been fully investigated. Data come from the National Health and Aging Trends Study (NHATS, 2021), a nationally representative sample of Medicare beneficiaries, and the National Neighborhood Data Archive (NaNDA), a data repository with census-tract measures of land cover. Mobility was assessed using the objective Short Physical Performance Battery (SPPB) and subjective physical capacity (PC) (range = 0-3 for both measures). Higher categories for both measures indicate better mobility. The analytic sample included 2,939 individuals (58.3% women) with mean age 81.8 years (SD = 6.4) from 2,071 census tracts. In fully-adjusted ordinal logistic regression models, compared to those in the lowest SPPB category, each percentage increase of blue space was associated with a 3.6 greater odds of being in the next highest category of SPPB (aOR= 3.61, 95% CI = 1.20-10.84 ). In contrast, each percentage increase of urban space was associated with a 18% decreased odds of being in the next highest category of SPPB (aOR= 0.82, 95% CI = 0.67-0.99). Similar associations were observed with PC, although were not statistically significant. Since decreased mobility is associated with numerous negative health outcomes, results from this study highlight the need to consider land cover as a potential policy lever to promote mobility among older adults.