bluuebunny/crossref_metadata_2025 huggingface dataset:
EXPERIENCES AND BARRIERS TO SUCCESS FOR MID- AND LATER-LIFE COLLEGE STUDENTS: APPLYING A GERONTOLOGICAL LENS
Authors: Cummins Phyllis , Arbogast Annabelle , McGrew Kathryn , Bahr Peter
Published: November 2019

Adult students have emerged as a key population of interest within higher education as states and institutions strategize to meet postsecondary attainment goals. However, much of the previous research on non-traditional age college students has collapsed all students age 25 and older into a single category, glossing over important age and life stage differences. Using a gerontological lens, this paper examines experiences and barriers encountered by mid-and later-life (MLL) students (age 40 and older) attending community colleges. We report qualitative findings from a mixed-methods study of MLL students in Ohio community colleges, funded by the Institute of Education Sciences. Based on thematic analysis of interviews and focus groups with students, faculty, staff, and administrators at 23 colleges, we identify multiple dimensions of age and aging that each play a meaningful role in shaping MLL students’ community college experiences and outcomes. Additionally, we provide an in-depth profile of MLL students—including their educational and work trajectories, reasons for enrolling, and experiences in community colleges—that can help colleges better recruit and serve this segment of the adult student population. MLL students face both unique and common barriers that colleges can address at the classroom, program, and institution levels. Implications for research, policy, and practice are discussed.
ADULT CHILDREN’S UNDERSTANDING OF PARENTS’ CARE AND LIVING PREFERENCES AT END OF LIFE
Authors: McDarby Meghan , Picchiello Matthew , Kozlov Elissa K , Ju Catherine , Worthalter Dani , Carpenter Brian
Published: November 2019

Adult children who are uninformed about their parents’ preferences for end-of-life care may not be prepared to advocate on their behalf when the circumstances arise. The purpose of the current analysis was to examine how well adult children understand their parents’ end of life preferences. We analyzed responses from adult children (n = 70) of 40 older adults (65+) who participated in an intervention to improve family communication about end-of-life care. We compared children’s and parents’ responses on the same set of 6 questions about healthcare decision-making (e.g., “Which medical decision-maker has the final say?”) and 4 questions about living preferences (e.g., “Would you want to move to a nursing home?”). We also examined demographic differences between children who had higher agreement (≥ 6/10 questions correct; n = 32) versus lower agreement (<6/10 questions correct; n = 38). On average, children provided the same response as their parents on approximately 5 out of 10 questions. Overall, adult children answered more questions correctly about living preferences compared to preferences about healthcare decisions (t(69) = 6.59, p < 0.001). In terms of demographic characteristics, there were no significant differences between children with higher and lower agreement with their parents’ preferences on variables including gender, frequency of contact with parents, and living proximity to parents. Our results underscore the need for increased communication between adult children and their parents about topics likely to influence quality of care at end of life.
COULD CHASING GRANDKIDS KEEP US YOUNG? THE ASSOCIATION BETWEEN CUSTODIAL GRANDPARENT STATUS AND HEALTH
Authors: Nadorff Danielle K , Williamson Emily A , McKay Ian T
Published: November 2019

There are approximately 7.2 million grandparents living with their grandchildren in the United States. Of these, roughly 2.5 million are skipped-generation households in which grandparents are solely responsible for meeting the needs of their grandchildren (U.S. Census, 2017). Previous research has established that custodial grandparents suffer from added strain and burden compared to their peers, which negatively impacts their health (Lo, M., Liu, Y., 2009). A decline in functional ability has a negative impact on not only the lives of these older adult grandparents but also their family members who are dependent upon them for care. The current study examines adults aged 65 and older using data from the American Community Survey 2016 to assess the extent to which raising one’s grandchildren is associated with five areas commonly subject to decline in older adulthood: cognitive performance, self-care ability, ambulatory difficulty, hearing, and vision abilities. Hierarchical binary logistic regression analyses found that after controlling for the effects of age, sex, race, and income-to-poverty ratio, custodial grandparents (those who reported having primary responsibility for their grandchildren in their own home with no parents present) were significantly less likely than their peers to report experiencing any of these five disabilities. Details of each model and clinical implications will be discussed.
VALIDATION OF THE CAREGIVER REACTION SCALE IN A SAMPLE OF NON-HELP-SEEKING CAREGIVERS
Authors: Malley Kelly A O , Bacharz Kelsey , Qualls Sara H
Published: November 2019

The Caregiver Reaction Scale (CRS) is a comprehensive measure of the family caregiving experience that assesses burden, family strains and positive aspects of caregiving (PAC). The CRS has been validated in sample of older adult help-seeking caregivers, but its validity and reliability in a non-help-seeking sample of caregivers was unknown. This study aimed to explore how well the CRS assesses the full caregiving experience in a younger non-help-seeking sample of family caregivers and to further evaluate the validity of the PAC subscales. A sample of non-help-seeking caregivers (N =452; Mage = 48.56, SD = 17.15) completed online questionnaires of burden, positive aspects of caregiving, and psychological well-being. All subscales of the CRS demonstrated very good internal consistency reliability (α ≤ .88). The PAC subscales of the CRS demonstrated medium to large positive correlations with a measure of positive aspects of caregiving (r ≥ .44) and small to medium positive correlations with psychological well-being (.25 ≥ r ≤ .42). Burden subscales of the CRS had large positive correlations with another measure of burden (r ≥ .66). Medium positive correlations were also found between family and job conflict subscales of the CRS and the burden measure (r ≥ .35). CRS PAC subscales were negatively correlated with the burden measure (r ≤ -.13). The CRS is a valid and reliable measure of the caregiving experience as evidenced by convergent and discriminant validity of CRS subscales and well validated measures of burden and positive aspects of caregiving.
GRANDPARENT CAREGIVERS: THE RELATION BETWEEN SOCIAL NETWORKS AND RESILIENCE
Authors: Mendoza Nancy , Fruhauf Christine
Published: November 2019

Grandparents raising grandchildren experience multiple challenges as they take on the unexpected role of caring for their grandchildren, which usually occurs under stressful and stigmatizing conditions. Many of the challenges grandparents experience are well documented in the research. Less attention is given to understanding how a grandparent caregiver’s social network changes when s/he becomes a caregiver and how her/his social network influences resilience. Thus, the purpose of this study was to use social network analysis (SNA) to examine the relation between social networks and resilience in grandparents raising their grandchildren. This was done by conducting face-to-face interviews with twenty grandparents raising grandchildren after they completed a survey measuring social support, social isolation, and resilience. The interview protocol included questions related to participants’ social network, social support, and services. Prior to the interviews, using data from the surveys participants were identified as representing one of four resilience quadrants: resilient, maladaptive, competent, and vulnerable. Qualitative analysis of grandparent’s social networks across groups indicated resilient grandparent caregivers’ networks were structured in a way that provided more opportunities for the inflow of new information and resources. Whereas the proportion of professionals in maladaptive grandparent caregivers’ networks tended to be less than for other networks. This could suggest that for grandparent caregivers, having professionals in one’s network can be beneficial. Findings from the current study provide opportunities for future research such as identifying ways to help grandparent caregivers structure their social networks to promote resilience.
A BI-NATIONAL COMPARISON OF FEDERAL SAFETY NET PROGRAMS FOR LOW-INCOME ELDERLY IN THE U.S. AND MEXICO
Authors: Aguila Emma , Angel Jaqueline L
Published: November 2019

Population aging in Mexico as in the United States is expected to accelerate over the next thirty years, and the proportion of individuals 65 and older will triple to approximately 20 percent by 2050 in both nations. Older people of Mexican origin are at high risk of protracted periods of poor health, a reality exacerbated by poverty. We use the Health and Retirement Study (HRS 2012-2014, N= 2,575) and Mexican Health and Aging Study (MHAS 2012-2015; N=16,131) to compare profiles of older Mexican-origin recipients of income supplements. We find Mexican immigrants are lower-income, less healthy, and less likely to receive supplements than Mexican origin in U.S. In contrast, return migrants are more likely to receive supplements than non-migrants in Mexico. Income supplement recipients are more likely to receive Medicaid and Seguro Popular. We discuss implications of financing safety net programs and the potential dependency burden in two countries aging rapidly.
DOES PHYSICAL FUNCTION RESPONSE TO INTENTIONAL WEIGHT LOSS IN OLDER ADULTS VARY BY RACE-ETHNICITY?
Authors: Beavers Daniel P , Neiberg Rebecca , Beavers Kristen , Kitzman Dalane , Nicklas Barbara M , Messier Stephen , Rejeski Jack , Kritchevsky Stephen
Published: November 2019

The purpose of this study is to explore whether the effect of weight loss on physical function in older adults varies by race/ethnicity. Individual level data from 1369 older, (67.7±5.4 years), obese (BMI: 33.9±4.4 kg/m2), adults (30% male, 21% African American) who participated in eight randomized controlled trials of weight loss were pooled. Studies were 5-6 months in duration and collected baseline demographic and pre/post gait speed (n=1296), short physical performance battery (SPPB; n=866), and grip strength (n=401) data. Treatment effects were generated by weight loss assignment [weight loss (WL; n=764) versus non-weight loss (NWL; n=605)], as well as categorical amount of weight change (high loss: >-7%, moderate loss: -7 to -3%, and weight gain/stability: <-3%). Analyses were adjusted for age, sex/gender, study, education, baseline BMI, and baseline value of the outcome measure of interest. Race/ethnicity stratified results were presented if the interaction term was p≤0.10. A race/ethnicity*weight loss assignment interaction was observed for gait speed (p=0.07), with African Americans experiencing greater weight loss-associated improvement (WL: 0.07±0.01 m/s versus NWL: 0.02±0.01 m/s; p=0.03) compared to Whites (WL: 0.08±0.01 m/s versus NWL: 0.07±0.01 m/s). A race/ethnicity*weight loss amount interaction was also observed for gait speed (p<0.01), with greater weight loss associated with greater improvement in both African Americans and Whites; although, gains were most apparent in African Americans experiencing high loss (0.12±0.02 m/s) compared to gain/stability (0.01±0.01 m/s). The beneficial effects of weight loss on gait speed appear greater in African Americans and are augmented with greater weight loss.
VALIDITY OF COMMUNITY-BASED FRAILTY CHECK-UP BY SENIOR VOLUNTEERS FOR PREDICTING ADVERSE HEALTH OUTCOMES
Authors: Tanaka Tomoki , Takahashi Kyo , Akishita Masahiro , Iijima Katsuya
Published: November 2019

Aim: For achieving healthy aging for all, multi-faceted frailty is serious problem in super-aged society such as Japan. We developed community-based frailty check-up program performed by trained senior volunteers. In this study, we aimed to validate the ability of the results of check-up to predict needing long-term support or care insurance or death in community-dwelling older population. Methods: A total of 1,536 older adults (mean age, 73.0±6.1 years; 74% women; non-eligible for long-term support or care) participated in the check-ups held from April, 2015 to March, 2018 in Kashiwa City, Japan. At check-ups cite, 21 items including nutrition, oral and physical functions, and social conditions were assessed; Outcome was needing long-term support or care insurance, or death from the day of check-ups until October, 2018. Results: During follow-up {median 678 days (inter-quartile range, 199-1263)}, 116 (7.6%) were newly needing for long-term support (n=50) or care (n=49), or death (n=18). The number of positive responses among 21 items was associated with decreased risks of outcome {age-sex adjusted hazard ratio (95% confidence interval), 0.87 (0.81-0.92)}. Compared those with > 18 positive responses (third tertile), individuals with < 14 positive responses (first tertile) were highly increased risks of outcome {age-sex adjusted hazard ratio (95% confidence interval), 2.44 (1.22-4.49)}. Conclusions: Community-based frailty check-ups program could predict the needing long-term support or care insurance or death in community-dwelling older population. The appropriate intervention for individuals with bad results of the check-up might contribute to serving as early prevention of multi-faceted frailty.
HAS FRAILTY SCORE AND FRAILTY LETHALITY CHANGED OVER TIME? HARMONIZATION OF NHANES COHORTS FROM 1999 TO 2016
Authors: Blodgett Joanna M , Rockwood Kenneth , Theou Olga
Published: November 2019

Positive advances in life expectancy, healthcare access and medical technology have been accompanied by an increased prevalence of chronic diseases and substantial population ageing. How this impacts changes in both frailty level and subsequent mortality in recent decades are not well understood. We aimed to investigate how these factors changed over an 18-year period. Nine waves of the National Health and Nutrition Examination Survey (1999-2016) were harmonized to create a 46-item frailty index (FI) using self-reported and laboratory-based health deficits. Individuals aged 20+ were included in analyses (n=44086). Mortality was ascertained in December 2015. Weighted multilevel models estimated the effect of cohort on FI score in 10-year age-stratified groups. Cox proportional hazard models estimated if two or four-year mortality risk of frailty changed across the 1999-2012 cohorts. Mean FI score was 0.11±0.10. In the five older age groups (>40 years), later cohorts had higher frailty levels than did earlier cohorts. For example, in people aged 80+, each subsequent cohort had an estimated 0.007 (95%CI: 0.005, 0.009) higher FI score. However, in those aged 20-29, later cohorts had lower frailty [β=-0.0009 (-0.0013, -0.0005)]. Hazard ratios and cohort-frailty interactions indicated that there was no change in two or four-year lethality of FI score over time (i.e. two-year mortality: HR of 1.069 (1.055, 1.084) in 1999-2000 vs 1.061 (1.044, 1.077) in 2011-2012). Higher frailty levels in the most recent years in middle and older aged adults combined with unchanged frailty lethality suggests that the degree of frailty may continue to increase.
RACIAL AND ETHNIC DIFFERENCES BETWEEN GRIP STRENGTH AND FUNCTIONAL LIMITATIONS: RESULTS FROM NHATS 2010-2014
Authors: Vasquez Elizabeth , Quiñones Ana R , Gensburg Lenore
Published: November 2019

Current research regarding grip strength highlights the robustness of grip strength as a predictor of morbidity and mortality. The aim of this study was to evaluate the association of grip strength over four years with functional limitations among racially/ethnically diverse older adults. We analyzed National Health and Aging Trends Study (NHATS) data 2010-2014. Our sample included 4,413 adults > 65 years old. Functional limitation was defined as a sum of difficulty performing eight ADL/IADLs (range 0-8) at each wave. Grip strength was measured using a digital hand dynamometer and readings were recorded in kilograms (kg) (maximum of 32 kg for men and > 20 kg for women). We estimated stratified linear regression models by race/ethnicity and age, and adjusted for BMI, education, and gender. The majority of the sample was between 65-79 years of age (64%), 55.1% were female and the average BMI was 27.5. We found that differences in ADL/IADL limitations increased and grip strength decreased over the four year period of observation. We also found racial/ethnic differences between waves 1 and 4 with greater ADL/IADL limitations for Hispanics with lower grip strength scores compared to non-Hispanic whites. There were racial/ethnic differences in the association between grip strength and ADL/IADL over time in Non-Hispanic blacks and Hispanics when compared to Non-Hispanic whites. This is an important issue to address since loss of muscle strength in older adults may lead to several negative outcomes such as limited activities of daily living which may affect older adults differentially based on race/ethnicity.
UNDERSTANDING AGING AND FRAILTY WITH A PREDICTIVE NETWORK MODEL
Authors: Farrell Spencer , Mitnitski Arnold , Rockwood Kenneth , Rutenberg Andrew
Published: November 2019

Health deficits are age-related binary health issues (typically self-reported disabilities) that accumulate with age. Acquiring a deficit makes an individual more frail and susceptible to other associated deficits. We model this process as a network of health deficits that interact with each other. Mortality depends on an individual’s current deficits and their age. The model is trained with self-reported data from the Canadian Study of Health and Aging (CSHA) or the National Health and Nutrition Examination Survey (NHANES). The model generates longitudinally data for synthetic-individuals with frailty trajectories and mortality resembling the observed data. We verify this by comparing the prevalence of individual deficits, correlations between deficits, and predicted death ages with test data. Our trained model performs well on all of these measures. Our model informs our understanding of aging by providing an interaction network representing the associations between pairs of deficits. Our model can generate the frailty trajectories of individuals starting from a set of deficits at a given age. This can extrapolate the trajectories of observed individuals to older ages and enables “inducing” or “treating” deficits to understand the effects of individual deficits or sets of deficits on health.
RELATIONSHIP OF PREOPERATIVE COMPREHENSIVE GERIATRIC ASSESSMENT TO HEALTH STATUS IN OLDER ADULTS
Authors: Lee Ji Yeon , Kim Kwang Joon , Kim Chang Oh , Lee Kyung Hee
Published: November 2019

Although comprehensive geriatric assessment has been widely used in surgical older adults, its relationship to health status has not been fully identified. This study aimed to examine the relationships of preoperative comprehensive geriatric assessment to frailty and length of stay. This was a descriptive study based on multi-professional health assessments found in electronic medical records. Study participants were 150 older adults in a neurosurgical department. The comprehensive geriatric assessment was comprised of nutrition, functional status, physical activity, depression, cognition, and basic items such as the Timed Up and Go test, grip strength, and self-rated health. Frailty level and length of stay were dependent variables which represented health status. The result showed that instrumental activities of daily living, physical activity, nutrition, self-rated health, and cognition were significantly associated with frailty. Specifically, comparing robustness with pre-frail and frail level, worseness in the instrumental activities of daily living, self-rated health, physical activity, and nutrition were associated with frailty. With progression of frailty level from pre-frail to frail, the worse score in the cognitive function and self-rated health were associated with frailty. In addition, more depressive symptoms, postoperative complications, and prolonged in the Timed Up and Go test were associated with lengthened hospital stay. Older adults with worsened status in physical, emotional, or cognitive function tended to be frail and stay longer in the hospital. Clinicians need to pay attention to the subcomponents of the comprehensive geriatric assessment and are encouraged to implement it to improve health status of surgical older adults.
COMPARATIVE PERFORMANCE OF FOUR CLAIMS-BASED FRAILTY MEASURES IN THE UNITED STATES MEDICARE DATA
Authors: Kim Dae H , Patorno Elisabetta , Pawar Ajinkya , Lee Hemin , Schneeweiss Sebastian , Glynn Robert
Published: November 2019

Background: There has been increasing effort to measure frailty in the United States Medicare data. The performance of claims-based frailty measures has not been compared. Methods: This retrospective cohort study included 2,326 community-dwelling Medicare beneficiaries who participated in the 2008 assessment of the Health and Retirement Study. The claims-based frailty measures developed by Davidoff, Faurot, Segal, and Kim were compared against clinical measures of frailty (gait speed, grip strength) using correlation coefficients and health outcomes (e.g., mortality, hospitalization, activities-of-daily-living disabilities) over 2 years using C-statistics. Results: The Davidoff, Faurot, Segal, and Kim indices were negatively correlated with gait speed (-0.19, -0.33, -0.37, and -0.37, respectively), but age and sex adjustment variably attenuated the correlation to -0.17, -0.22, -0.18, and -0.33, respectively. The corresponding correlation coefficients with grip strength were -0.17, -0.27, -0.35, and -0.24, which attenuated to -0.09, -0.14, -0.05, and -0.23 after age and sex adjustment, respectively. The models that included age, sex, and each of Davidoff, Faurot, Segal, and Kim indices showed C-statistics of 0.67, 0.71, 0.71, 0.75 for mortality (versus C-statistic for age and sex: 0.66); 0.59, 0.64, 0.63, 0.70 for hospitalization (versus C-statistic for age and sex: 0.58); and 0.64, 0.63, 0.63, 0.70 for activities-of-daily-living disabilities (versus C-statistic for age and sex: 0.61), respectively. Conclusions: The choice of a claims-based frailty measure results in a meaningful variation in the identification of frail older adults at high risk for adverse health outcomes. Claims-based frailty measures that included demographic variables offer limited risk adjustment beyond age and sex.
OPTIMAL HEALTH PROFESSIONAL STAFFING OF PRIMARY CARE AND GERIATRIC PRACTICES SERVING FRAIL OLDER ADULTS
Authors: Donelan Karen , Spetz Joanne
Published: November 2019

This symposium will include 3 papers that provide critical interprofessional and interdisciplinary perspectives on our work to understand and measure staffing in health care teams caring for older adults, and frail older adults. The Health Teams for Frail Elders project was funded by the Gordon and Betty Moore Foundation from August 2016 to October 2018. Dr. Karen Donelan, project Principal Investigator, will chair the session, providing a brief project overview of project aims and activities. A survey and health services researcher, Dr. Donelan will set the context for this large scale project. Dr. Barbara Roberge, a geriatric nurse practitioner who established one of the first senior health programs in the nation along with Dr. Kenneth Minaker at Mass General Hospital, was our primary care and nursing lead on our site visits. She will talk about the care settings we visited, her development of a site assessment tool that covered a range of frail elder needs, and will summarize professional roles and staffing observed within different site types. Dr. Julie Berrett-Abebe, a junior investigator on our team (PhD 2017), will present a paper on the competencies and roles of social workers and community health workers in primary and geriatric practices, as well as the roles of community health workers. Dr. David Auerbach, a national expert in health policy and workforce analysis, will present 4 models of staffing of practices, demonstrating efficiencies in optimizing services for frail elders while minimizing costs.Dr. Joanne Spetz will be the discussant of cross-cutting themes.
INFLUENCING FACTORS OF SUBJECTIVE AGE: FINDINGS FROM THE KUSATSU LONGITUDINAL STUDY ON AGING AND HEALTH
Authors: Ikeuchi Tomoko , Seino Satoshi , Taniguchi Yu , Narita Miki , Abe Takumi , Amano Hidenori , Kitamura Akihiko , Shinkai Shoji
Published: November 2019

Background: Subjective age (SA) has been found to be a biopsychosocial marker of aging, yet little is known about factors that influence SA development. This study examined factors influencing SA using longitudinal data of community-dwelling older Japanese. Methods: Data drawn from the Kusatsu Longitudinal Study were collected during annual health check-ups in 2017 and 2018 from participants (aged 65-95) who completed all the measurement items used for this analysis (N=981). SA was indexed by asking participants to specify in years how old they felt. Proportional discrepancy scores ((subjective age - chronological age)/chronological age ×100) were calculated to indicate younger or older SAs and used as a dependent variable. As influencing factors of SA, chronological age, sex, years of schooling, history of smoking, cognitive function (using MMSE scores, range 14-30 at baseline), depressive symptoms, physical function (gait speed), and social function (employment status) were examined. Analyses were performed with random-effects GLS regression models. Results: Significant partial regression coefficients were found for cognitive function (0.48%, CI: 0.18, 0.79), years of schooling (-0.42%, CI: -0.69, -0.15), depressive symptoms (0.32%, CI: 0.11, 0.53), and chronological age (-0.18%, CI: -0.30, -0.68). Implications: This study found that older age and longer years of schooling were associated with younger SA, while better cognition and depressive symptoms were linked to older SA. Better cognition being associated with older SA was inconsistent with existing studies. This may be due in part to the association of better cognition and the level of satisfaction influenced by awareness of age-related physical/social changes.
EVACUATING OR SHELTERING IN PLACE DURING A DISASTER: HOW ASSISTED LIVING ADMINISTRATORS MAKE THE DECISION
Authors: Peterson Lindsay J , Hyer Kathryn , Dosa David , June Joseph , Dobbs Debra J , Thomas Kali S
Published: November 2019

The decision to evacuate or shelter in place during a natural disaster such as a hurricane is complicated and poses risks to long-term care residents. While research has documented the difficulty of the evacuation decision for nursing home administrators, little is known about how assisted living residence (ALR) administrators make this decision. This is a concern given the physical and cognitive impairment level of many ALR residents, the increasing number of ALRs in the U.S., and the frequency of natural disasters. The purpose of this paper was to explore the factors that influenced whether assisted living administrators evacuated their ALRs for Hurricane Irma, a large hurricane that made landfall on Florida’s Southwest coast in September, 2017. This qualitative study used semi-structured interviews and focus groups with ALR owners or administrative staff (N=60) with questions including how they prepared for Hurricane Irma, their experiences during the hurricane, including whether they evacuated or sheltered in place, and lessons learned. The sample includes small (< 25 beds) and large ALRs in the multiple Florida counties affected by the hurricane. A content analysis approach was used. Atlas.ti version 7 was used for initial and axial coding. Prevalent themes included “emergency management planning”, “logistics”, “pressure”, “storm characteristics,” and “staffing”. The results of this study have implications for long-term care policy and training, potentially leading to changes in how ALR leaders prepare for and respond to disasters to improve the safety of residents.
A QUALITATIVE STUDY OF NURSING HOME STAFF CONCEPTUALIZATION OF EVERYDAY DECISION-MAKING CAPACITY
Authors: Mills Whitney L , Kunik Mark E , Kiefer Lea , Curren-Vo Hannah , Mochel Amy , Naik Aanand
Published: November 2019

Because nursing homes are both a residence and a treatment setting, care providers are faced with the challenge of balancing resident autonomy and safety on a daily basis. While there are standardized approaches for determining a capacity to make larger decisions such as providing consent for medical procedures, there are virtually no methods for assessing capacity to make everyday decisions (e.g., food choices, smoking, navigating outside the nursing home). While it is easier for staff to prevent residents from making decisions they deem risky, to truly offer person-centered care, it is important to support a resident’s right to make decisions if they have the capacity to do so. Currently, little is known about how nursing home staff conceptualize and determine everyday decision-making capacity and how that information is used in care planning. To understand the current processes and language nursing home staff use when considering a resident’s decision-making capacity, we conducted interviews with 37 staff at two Veterans Affairs (VA) Community Living Centers (VA-operated nursing homes; CLCs). Using qualitative content analysis, we coded the transcribed interviews and identified several overarching themes: autonomy vs. safety, communication (e.g., pathways, with caregivers, with residents), determining capacity (e.g., information gathering, assessment, assumptions, indicators, interdisciplinary team member roles, referrals), interventions (e.g., legal and staff-led), and terminology used. We will describe how the findings from this study can be used to tailor development and adaptation of tools to help nursing home staff assess resident everyday decision-making capacity and to incorporate the results into person-centered care approaches.
ORGANIZATIONAL CHARACTERISTICS OF HIGHLY PERSON-CENTERED UNITS IN SWEDISH NURSING HOME
Authors: Sköldunger Anders B , Backman Annica
Published: November 2019

The movement from an institutional model of care towards a person-centred care as the gold standard of practice is now guiding the provision of care services in nursing homes around the world. The organizational context of care has been described as a determining factor for the extent to which staff can offer person-centred care. However, few studies have empirically investigated which factors that defines nursing home units as being person-centred. Providing information about organizational characteristics would therefor provide insight into an organizational context with capacity to enhance a person-centred care. Thus, the aim was to explore factors of nursing homes with high vs. low person-centred care with focus on organizational variables. The study was based on a cross-sectional national survey, and data on 4831 residents, 3605 staff, and facility variables were collected in 2014. Descriptive statistics and regression modelling were used to analyze the data. The preliminary results showed that characteristics of highly person-centred units were; dementia specific units and units with fewer number of beds. No significant differences were seen between private and public nursing homes in terms of degree of person-centred care. Person-centred units was characterized by managers supporting staff to provide individualized care based on the resident’s needs, as well as staff receiving supervision of a reg. nurse in the direct care. These findings can be seen as facilitators ’ for person-centred care, suggesting several contextual and organizational elements of significance for enhancing person-centred practice.
IMPACT OF A COLLABORATION WITH CLINICAL PHARMACISTS ON OSTEOPOROSIS TREATMENT RATES
Authors: Levis Silvina , Lagari Violet , Garcia Maribel , Kwok Sue , Salazar Martha
Published: November 2019

Despite the availability of effective drugs to treat osteoporosis, many patients remain untreated and at high risk for developing a fracture. To improve treatment rates, we included clinical pharmacists in the management of patients with osteoporosis. Over 6 months, 30 days after bone mineral density (BMD) results became available to the ordering physician, all patients with an abnormal BMD were evaluated for management according to guidelines if they had not been approached for care. One of three clinical pharmacists discussed patients with the team that included an endocrinologist and a geriatrician. The team made recommendations and pharmacists followed-up by calling patients and prescribing medications. After excluding those who were already on treatment or did not have an indication, 87 patients qualified: 57 (66%) had T-score ≤-2.5, 19 (22%) had osteopenia and high FRAX score, and 11 (12%) osteopenia by BMD and a fragility fracture. After 30 days, the ordering physicians had treated 32/87 (37%) of patients with an indication: 26/57 (46%) patients with T-score ≤-2.5, 1/19 (2%) with high FRAX, and 5/11 (50%) with fractures. After the pharmacists’ intervention, an additional 33/87 (38%) patients were on treatment: 16 with T-score ≤-2.5; 14 with high FRAX, and 3 with fractures; 6 patients were unreachable, 9 declined, and 6 were referred to endocrinology for work-up. By the end of the 6-month period, 75% of patients with an indication received osteoporosis treatment. These results suggest that an osteoporosis intervention employing clinical pharmacists as part of a multidisciplinary team effectively improves osteoporosis treatment rates.
MEASUREMENT EQUIVALENCE OF THE KESSLER 6 PSYCHOLOGICAL DISTRESS SCALE FOR OLDER ASIAN IMMIGRANT SUBGROUPS
Authors: Shon En-Jung
Published: November 2019

The Kessler 6 (K6) Psychological Distress Scale is a well-known screening instrument to screen for psychological distress of general population. While some studies (e.g., Mitchell & Beals, 2011) concluded that the K6 was appropriate for capturing psychological distress of diverse racial/ethnic groups, other studies (e.g., Andersen et al., 2011) reported that it was less successful in screening for psychological distress of diverse racial/ethnic groups. Few studies conducted measurement equivalence test across older Asian immigrant subgroups. Using Multiple Group Analysis, this study examined whether parameters of the single factor model (items: nervous, hopeless, restless or fidgety, so depressed, everything was an effort, and worthless) is equivalent across the two Asian immigrants (≥65 years; Chinese [n=175] and Korean [n=300] immigrants). Data were generated from the California Health Interview Survey. The configural model showed good fit (X2=41.70 [df=16, p<.001], X 2/df=2.61, CFI=.98, GFI=.97, RMSEA=.06 [90% CI=.04-.08], and SRMR=.04). When all factor loadings were constrained, it indicated measurement non-invariance status between Chinese and Koran (ΔX 2=17.86, Δdf=5, p=.003, CFI=.972, ΔCFI=.009). Given findings of non-invariance on the full constrained model, the invariance test of each factor loading was performed additionally. It was focused on evaluating which items were similar or different across the two groups. The three items, ‘hopeless,’ ‘restless,’ and ‘depress,’ were significantly nonequivalent between the two groups. Clinicians/researchers should aware of the potential risk for misclassification when they try to screen for psychological distress in older Chinese or Korean immigrants. Professionals should pay attention to cross-cultural comparability when interpreting results from the K6.
DISABILITY IN PRISON ACTIVITIES OF DAILY LIVING AND DEPRESSION IN OLDER PRISONERS: A PROSPECTIVE STUDY
Authors: Barry Lisa C , Wakefield Dorothy , Steffens David C , Conwell Yeates
Published: November 2019

The U.S. prison population is aging; more persons are being incarcerated in the second half of life and are aging “in place.” In the first prospective study to evaluate older prisoners’ mental health (Aging INSIDE), we determined if disability in activities of daily living specific to prison, prison activities of daily living (PADLs), predicts depression in this vulnerable population. To date, 134 older prisoners (age ≥50) sentenced at 9 Connecticut correctional facilities completed in-person interviews (baseline and one-year follow-up). A score of ≥10 on the 9-item Physician Health Questionnaire (PHQ-9) indicated depression. Participants were considered to have PADL disability if they reported any of the following as “very difficult” or “cannot do”: climbing on/off the top bunk (34%), cleaning their cell (5%), hearing orders (6%), walking while wearing handcuffs (33%) or shackles (34%), standing in line for medications (4%), and walking to chow (5%). Participants were mean age 57.0±6.6 years (range 50-79 years), racially diverse (43% White, 38% Black, 19% Hispanic/Other), 69 (50%) had PADL disability, and 35 (25%) were depressed at follow-up. Using logistic regression and controlling for gender, number of chronic conditions, lifetime suicide attempt, and baseline depression, baseline PADL disability was associated with depression one year later (OR = 3.41; 95%CI = 1.16, 9.97). As depression is a strong risk factor for subsequent suicide, and given the high rate of suicide among older prisoners in the U.S., these preliminary results indicate that PADL assessment may offer a simple means of identifying older prisoners at risk of depression.
METABOLIC INTEGRITY – A FACTOR IN AGING AND A PLAYER IN THE MECHANISMS OF CR
Authors: Anderson Rozalyn
Published: November 2019

An emerging paradigm in aging research identifies metabolic dysfunction as a root cause in age-related disease vulnerability. Several diseases of aging, including diabetes, cancer, and neurodegeneration, have an established metabolic component. Our studies have focused on links between metabolic status and disease vulnerability. Caloric restriction (CR) delays aging and the onset of age-related disease in diverse species, including nonhuman primates. Molecular profiling identifies CR responsive elements in the transcriptome, proteome, and metabolome that are highly enriched for metabolic pathways and in particular mitochondrial processes. These data show that improvements in health and survival are associated with maintenance of system wide metabolic homeostasis and preserved energy metabolism among tissues. Metabolic biomarkers identified in these studies may be clinically relevant for the early identification of elevated disease risk in humans and could even be potential targets for the development of novel strategies to lower disease vulnerability as a function of age.
THE EFFECTS OF IMMIGRANT STATUS ON WELL-BEING AMONG OLDER ADULTS BY RACE-ETHNICITY: A MULTI-GROUP ANALYSIS
Authors: Moon Heehyul , Kim Hyesook , Rote Sunshine , Haley William E
Published: November 2019

Although prior researchers have decried the lack of research on racial/ethnic minority older adults, they have been less vocal about the gaps in research concerning the ways in which immigrant status and race/ethnicity affect their well-being. Thus, we examined the role of immigrant status on the stress coping process by race/ethnicity using the Transactional Model of Stress and Coping. The multi-group analysis function in structural equation modeling was used to determine whether the stress coping process was equivalent across three racial/ethnic groups (Non-Hispanic White (NHW), Non-Hispanic Black(NHB), and Hispanic) by immigrant status using the Round 1 of the National Health and Aging Trends Study (NHATS, (U.S.-born= 4,799, foreign-born=612)). We found that immigrant status and race/ethnicity may have complex effects on the stress coping process. For example, the total effects of being an immigrant were significantly associated with more stressors, less resources, and worse physical health. Except NHW, the total effects of being immigrant were associated with higher levels of depression and anxiety. With respect to the direct and indirect effect of immigrant status in the three groups, the Hispanic group has a larger effect of immigrant status on stressors, resources, depression/anxiety and physical health than their NHW and NHB counterparts. The results indicated that immigrant racial/ethnic minority older adults were more likely to have higher levels of depression and anxiety than the U.S.-born except for NHW. Immigrant status will require special attention in both assessment and management of depression/anxiety among racial/ethnicity minority older adults.
PAIN THAT LIMITS PHYSICAL ACTIVITY AFFECTS COGNITION IN ADULTS
Authors: Elliott Amanda F , Horgas Ann
Published: November 2019

Reduced cognitive skills have been observed in adults with chronic pain. The purpose of this study was to explore the relationship between pain and cognition in adults utilizing a large national sample. This was a cross-sectional study employing the 2015 wave of the Behavioral Risk Factor Surveillance System (BRFSS). A total of 134,058 adults had complete data on the variables of interest for this study. Half of the sample (50%; n = 66,479) reported having joint symptoms or arthritis that was physically limiting and 16% (n = 21,976) reported having difficulty concentrating, remembering, or making decisions. Twelve percent (n = 16,537) of this sample reported having both physically limiting pain and difficulty concentrating and remembering. Chi-square analyses reveal a statistically significant association between pain and cognition in this sample [X2(1, N= 134,058) = 6925.5, p<.01], with a small to medium effect size (phi=0.227). This study provides support that pain is associated with difficulty concentrating and remembering in adults. Pain is a common persistent symptom among older adults and its effect on cognitive functioning should be noted. Effective pain treatment strategies are warranted to help reduce the cognitive burden of chronic pain. In turn, in older adults who are experiencing concentration or memory problems, health care providers should assess the individual’s pain as a possible contributor. Additional studies assessing both pain and cognition are warranted, especially looking at the relationship of these conditions over time.
FEAR AND DYNAMIC INFLAMMATORY RESPONSE TO MOVEMENT AMONG OLDER ADULTS WITH LOW BACK PAIN: A FEASIBILITY ANALYSIS
Authors: Simon Corey , Keefe Francis , Hicks Gregory , Pieper Carl , Colon-Emeric Cathleen
Published: November 2019

Low back pain (LBP) is a prevalent cause of disability, with higher prevalence among older adults. However, the level of LBP disability cannot be explained by either pain intensity or LBP pathology (bone degeneration). We hypothesize that older adults with LBP are susceptible to disability based on the combination of two factors: fear of movement and dynamic inflammatory response to movement (DIR). In this feasibility study, we are measuring these two factors among 30 older adults aged 60-85 with LBP. Participants attend a laboratory session to complete four performance tasks: 30-second chair rises, seated trunk rotation, standing forward reach, and Six-Minute Walk. Fear of movement is tested using the Tampa Scale for Kinesiophobia and Situational Catastrophizing Questionnaire. DIR is tested by drawing blood via a peripheral venous catheter before and after performance tasks, and assessing changes in six inflammatory markers: IL-6,8,10; TNF-alpha, c-reactive protein, and substance P. LBP disability is assessed using the Late-life Functional Disability Instrument (LLFDI) and 7-day ecological momentary assessment (EMA) via smartphone application. Participants have tolerated all laboratory testing procedures and have adequately reported LBP disability in the home and community using EMA. We will test for exploratory associations between fear of movement, DIR, and LBP disability measures using ordinary least squares regression analyses. The overarching goal of this research line is to determine if the combination of fear of movement and DIR are an actionable clinical risk phenotype of downstream LBP disability among older adults.
A SCREEN OF WILD-DERIVED FLY STRAINS REVEALS CG34351 AS A REGULATOR OF TOXIC EFFECTS OF A RICH DIET
Authors: Brem Rachel
Published: November 2019

Dietary restriction (DR) extends lifespan and healthspan, by mechanisms that remain incompletely understood. To identify new genes with a role in dietary response, we developed a screening strategy harnessing genetic variation among wild fruit flies. We quantified the lifespan of lines of the Drosophila Genetic Reference Panel on protein-rich and DR diets, and mapped polymorphisms associated with diet-dependent longevity. Among the hits was CG34351/decima, an ortholog of the mammalian GABA-receptor regulator RGS7BP. In validation experiments, pan-neuronal knockdown of decima extended lifespan and elicited repression of Drosophila insulin-like peptides, in flies on the rich diet but not on DR. Knockdown of decima in GABA neurons rescued fat storage and energy availability defects that derive from overnutrition. We propose that decima tunes signaling in these neurons upstream of the insulin pathway to rewire metabolism. These results establish decima as a determinant of the toxic effects of the rich diet in the fly.
EXPECTATIONS AND VALUE OF EDUCATION OF STUDENTS OF THE MASTER IN GERONTOLOGY OF THE UNIVERSITY OF GUADALAJARA
Authors: Arias Martha Elena Vazquez , Merino Elva Dolores Arias
Published: November 2019

For Institutions of Higher Education, it’s important to know better the expectations and the value of education of their students to plan and offer successful postgraduate educational services The purpose of this project is to identify and analyze the expectations and the value of education of students of the Master in Gerontology at the University of Guadalajara, The data collection was carried out through a questionnaire divided into two parts. The first one contemplated socio-demographic characteristics of the participants such as: name, age, marital status and coexistence with older adults. In the second part, the Value of Education Scale (Battle & Wigfield, 2003) was applied, which measures different aspects of the expectations and the value that graduate students give to education. 25 students participated. 64% (16) were women and 36% (9) were men, with an age range of 24 to 53 years. Single people (80%) and 56% coexist with older adults every day. Highest scores: Intrinsic Values “I like to learn from people who are experts in their field” 4.96. Value of Achievement “graduate studies have a great value for me” 4.64. Value of Utility “I want to complete my postgraduate studies to acquire knowledge and experience” 4.80. Cost Perceived “I think in the end it will be worth the postgraduate despite all the work and effort.” 4.96. We consider a guarantor of success for our students, their high expectations and the value they give to their education that make them stand out and gain knowledge every day.