bluuebunny/crossref_metadata_2025 huggingface dataset:
What is the Relationship between Functional Limitations, Pain, and Self-Perceptions of Aging?
Authors: Zucchetto Jillian Minahan , Blasi Ashley
Published: December 2021

Self-perceptions of aging (SPA) influences health and mortality during older adulthood (e.g., Kotter-Grühn et al., 2009; Sargent-Cox et al., 2012). Westerhof and Wurm (2015) found that increasing functional limitations (FL) worsened older adults’ SPA. Additional research is needed to identify other factors that influence SPA. Although pain is common among older adults and is a frequent cause of disability (e.g., Brooks et al., 2019), it has not been examined as a factor influencing SPA. Pain is often misperceived as an inevitable part of aging because of widely held negative stereotypes about aging (Thielke et al., 2012). The experience of pain may activate internalized negative stereotypes about aging, which may worsen SPA. Thus, this study investigated: 1) the relationship between chronic and recent pain, FL, and SPA, and 2) the interactive effect of FL and pain on SPA within a sample of community-dwelling adults aged 65 years and older. This study included 5,126 participants from the 2014 wave of the Health and Retirement Study. Controlling for covariates, chronic pain (β = .09, p < .001) and recent pain (β = .12, p < .001) were associated with negative SPA and were stronger than FL (β = .04, p < .01). There was also a small interaction between FL and recent pain on SPA (β = -.03, p < .01) such that the negative impact of FL on SPA was stronger among individuals who reported low pain. These findings highlight the importance of pain in older adults’ evaluation of their own aging.
Older adult maintaining and improving health self-management through peer supported SMART goal setting
Authors: Hynes Mary , Anderson Nicole , Kastner Monika , Astell Arlene
Published: December 2021

Non-medical interventions to address risk factors (such as reducing smoking, increasing physical activity, and tackling limited social interaction) are needed to help tackle escalating social and financial health costs. Peer supported interventions have been used successfully to support persons’ health self-management; however, there is limited evidence for group interventions facilitated by older adults. A proof-of-concept study by the first author demonstrated the potential of older adults meeting in groups to each create and follow through with a single SMART goal for any area of health over one-month. This study extends SMART goal setting to enhancing health management over six months. Older adult participants from across Ontario will attend virtual SMART goal setting group sessions followed by six monthly support group meetings where they are free to choose any goal, whether a mitigation or a new behavior. Each month the facilitator will assist participants to continue, modify, or set a new goal. At the end participants will complete surveys about their satisfaction with the method, their results and their desire to continue with SMART goals. They will also be asked if they would like to facilitate new groups to continue the spread of peer-supported SMART goal groups. This study is designed to empower older adults to maintain or improve management of their physical, psychological, and/or social health. It will reveal the impact of an older adult created and guided group health intervention on feelings of self-efficacy and well-being.
Joint Trajectories of Multimorbidity, Function, Cognition, and Depression in the HRS (1998-2016)
Authors: Nagel Corey , Allore Heather , Newsom Jason , Botoseneanu Anda , Dorr David , Thielke Stephen , Kaye Jeffrey , Quiñones Ana
Published: December 2021

There is substantial heterogeneity in the impact of multimorbidity on functional, cognitive, and emotional health. Few studies, however, have examined this simultaneously across these multiple domains. We used finite mixture modeling to identify latent clusters of individuals following similar joint trajectories of multimorbidity, functional ability, cognitive performance, and depressive symptoms among 11,841 HRS respondents aged 65+ from 1998 to 2014. We identified four distinct clusters of joint trajectories: (1) 32.5% of the sample were characterized by low multimorbidity (mean = 0.60 conditions at age 65; 2.2 conditions at age 90), minimal deterioration in functional or cognitive ability, and low depressive symptoms; (2) 33.5%, had increased multimorbidity compared with the first group (mean = 2.3 at age 65; 4.0 at age 90) but minimal functional or cognitive impairment and low depressive symptoms; (3) 19.9%, had relatively low multimorbidity (mean = 1.3 at age 65 increasing to 2.8 at age 90), but exhibited worsening cognitive performance, increasing functional limitations, and moderate depressive symptoms ; and (4) 14.1%, had higher multimorbidity (mean = 3.3 at age 65 increasing to 4.6 at age 90), worsening cognitive performance, substantial functional limitation, and high depressive symptoms. Black and Hispanic race/ethnicity, lower levels of income and education, male gender, and smoking history were significantly associated with membership in classes characterized by higher multimorbidity, cognitive and functional impairment, and greater depressive symptoms. This study provides insight into the heterogenous trajectories of aging and helps identify older individuals at higher risk for poor aging outcomes across multiple health domains.
Housing, Neighborhood Factors, and Cognitive Status of Older Adults Living in Houses Versus Apartments
Authors: Cheung Ethan Siu Leung , Mui Ada
Published: December 2021

This study examines associations between housing, neighborhood factors and cognitive status among community-dwelling older adults, and how the associations differ between older adults who live in houses and in apartment buildings. Specifically, using the neighborhood stressor theory, three research questions are examined: 1) What individual-level factors predict late-life cognitive status? 2) After controlling for individual-level factors, what housing and neighborhood factors are significant in predicting older adults’ cognitive status? 3) How do individual, housing, neighborhood predictors of cognitive status differ between house and apartment residents? Using data from the Wave 3 NSHAP, multilevel linear regression analyses are conducted with the total sample. Results suggest that individual-level factors including young-age, female, white, and having a bachelor’s degree are associated with better cognitive status. After controlling for individual-level factors, housing and neighborhood factors including quality maintenance and high level of community safety are associated with higher cognitive scores. In addition to the additive model, we also test the interactive effect between housing type and three level of factors –individual level, housing, and neighborhood factors. Findings suggest that the joint effect of depression and housing type on cognitive status is significant. To explore the last research question, we conduct parallel regression analyses by housing type. Findings suggest that quality maintenance and high level of community safety are associated with higher cognitive scores among house residents only. Findings highlight the predictors of cognitive health vary between older adults living in different residential environments.
Motivations To Join And Stay A Member Of A Village For Older Adults
Authors: Cho Joonyoung , Dunkle Ruth , Pace Garrett
Published: December 2021

People join a customer-driven organization with motivations that may not be static over time, an important issue for long-term organizational viability. In this study, we examined motivations among members of ShareCare, the first Village for older adults in the U.S. Using qualitative data from a random sample of 91 members, we compared motivations for becoming a member and for continuing membership. Motivations to join and continue membership are not necessarily the same. Motivations were categorized as: instrumental, social, and altruistic motivation. We categorized length of membership as short-term: 8-years or less (51.63%) and long-term: 9-years and more (49.37%). While 36% of members joined only for instrumental motivation, 59% continued membership only for instrumental motivation. While about 52% joined with multiple motivations, only 35% of members mentioned multiple motivations when continuing their membership. Finally, 18% of short-term members mentioned altruistic motivation when continuing their membership, while 28% of long-term members mentioned altruistic motivation when continuing their membership. While people’s motivation might change over time, altruistic motivation may be the greatest motivating factor for long-term memberships. Long-term members may identify themselves as supporters rather than users of the organization and cultivate stronger connections with other members over time. Our findings inform how to recruit and retain members in Villages, and customer-driven organizations for older adults more broadly.
Diabetes Prevalence Among Underserved Older Adults in the US: The Case of Native Hawaiians and Pacific Islanders
Authors: Panapasa Sela , Herman William , McNally James
Published: December 2021

The effects of chronic diabetes among older adults in the United States represent ongoing challenges in diagnosis, treatment, comorbidities, amputations, and the increased risk of death. These challenges are made more complicated among underserved populations due to limited access to healthcare, medication costs, and later diagnosis of the condition. These issues are particularly true for the NHPI population, which has high rates of lifetime diabetes, greater levels of poverty, and inadequate health insurance. Useful statistics about diabetes among the NHPI have been difficult to obtain due to their small population size and lack of inclusion in federal health surveys. While early work by Panapasa examined prevalence among NHPI males in California, no reliable measures of diabetes among older NHPI’s existed at the national level. Released in 2017, the 2014 Native Hawaiian Pacific Islander National Health Interview Survey represents the first representative survey of the health and socio-economic correlates for this population, allowing the examination of health conditions such as diabetes at the national level. This presentation will examine the prevalence of diabetes among NHPI’s aged 60 and older and the impacts of this disease on overall health and quality of life. The paper will use the NHPI-NHIS to examine the use and access to diabetic medications and overall access to affordable health care. The paper will examine differences by age group, gender, immigration status, and ethnicity. While we know the overall prevalence of diabetes is high, this paper will offer new information on differentials within the older NHPI population.
Is Resilience Protective of Movement-Evoked Pain in Older Black Women Who Experience Discrimination?
Authors: Astencio Mayra , Bartley Emily , Booker Staja , Sibille Kimberly , Cardoso Josue , Addison Adriana , Fillingim Roger , Terry Ellen
Published: December 2021

Older non-Hispanic black (NHB) individuals experience greater pain and more frequent experiences of perceived discrimination compared to non-Hispanic white individuals with knee osteoarthritis. The current study explored whether being resilient buffers against movement-evoked pain (MEP) in NHB women who report everyday experiences of discrimination. In a secondary analysis of the Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD-2) study, data were collected at the University of Florida and the University of Alabama at Birmingham. Participants were 58 community-dwelling older women who self-identified as NHB and reported knee osteoarthritis. Participants completed the Brief Resilience Scale, a self-report measure of trait resilience. MEP was assessed following the Short Physical Performance Battery. Moderation analyses were conducted to investigate whether resilience moderates the association between experiences of discrimination and MEP. Study site, age, body mass index, and income were included as covariates. Overall, neither everyday experiences of discrimination (b=.292, 95% confidence interval [CI]=-.415 to 1.000) nor trait resilience was associated with MEP (b=-11.540, 95% CI=-23.583 to .503). However, there was a significant interaction (b=1.037, 95% CI=.150 to 1.925) between experiences of discrimination and trait resilience in predicting MEP. Simple slopes analysis revealed that lower discrimination was associated with lower MEP, but only in women who reported high levels of resilience (b=1.100, p=.014), but this protective effect of resilience was absent in women reporting high discrimination. Our findings suggest that as discrimination increases, the protective effects of resilience on movement evoked-pain decreases. Therefore, high trait resilience may be protective when experiences of discrimination are low.
Not out-of-reach: Engaging the older old isolated African Americans with and without MCI
Authors: Struble Laura , Potempa Kathleen , Hampstead Benjamin , Ellis Alexis , Pedroza Jesica , Lichtenberg Peter , Dodge Hiroko
Published: December 2021

The Internet-Based Conversational Engagement Clinical Trial (I-CONECT, ClinicalTrials.gov: NCT02871921) is a multi-center randomized, 12-month efficacy study. There is converging evidence that social isolation is a risk factor of cognitive decline and dementia. We hypothesized that increasing social interaction in older adults with normal cognition or mild cognitive impairment (MCI) could improve or sustain cognitive function through internet-based conversational engagement. African Americans (AA) are at higher risk for developing dementia but their participation in clinical trials is low. Objectives: (1) discuss the effective outreach process to recruit urban AA older old adults (mean targeted age of 80+); (2) describe how we retained participants in a yearlong study using technology-based interventions. The most successful outreach and recruitment sources were the voter registration mass mailings and the Healthier Black Elders Research Center. Successful recruitment methods included: hiring diverse staff, compensating participants’ time, and adjusting research protocols for opting out of MRIs and genetic saliva samples. Technology intervention strategies included: providing user-friendly Chromebooks and free internet connections, simple instructions with pictures, vision and hearing correction, and in-home training with technology support backup. During the pandemic, we could assists participants in learning to use the laptop remotely. Over 12,000 subjects were contacted, which led to 39 randomized participants. Our retention rate thus far is over 75%. This demonstrates that AA older adults are reachable, willing to participate in research and able to use communication technology with appropriate supports for long-term sustainable interaction that may improve cognition and health equity.
Standardized Self-Report Tools in Geriatric Medicine Practice: A Quality Improvement Study
Authors: Northwood Melissa , Heckman George , Didyk Nicole , Hogeveen Sophie , Nova Amanda
Published: December 2021

Comprehensive geriatric assessment (CGA)—a multidimensional diagnostic process to determine medical, cognitive, and functional capacity—has historically included a narrative history supplemented by use of tools to assess domains such as mood or cognition based on assessor preference. This approach to CGA likely works to assess individuals but with increasing clinical complexity and frailty among older adults, a non-standardized approach may mean that key issues are not assessed, and program quality cannot be determined. The COVID-19 pandemic added to these challenges as social distancing practices meant limited face-to-face appointments and use of phone and video assessments. This quality improvement study implemented the interRAI Check-Up Self-Report instrument through a software platform in a specialized geriatric services practice. The instrument can be used over the phone and summarizes specific health problems and needs as well as information about caregiver status and financial trade-offs. Focus groups were also conducted with specialized geriatric services interprofessional team to explore their experiences with implementation. The descriptive analysis of the self-report data revealed expected geriatric issues, such as cognitive and functional impairment, falls and pain. Clients were also commonly experiencing medical instability, cardiorespiratory symptoms, communication impairments, and elevated risk for emergency department visit. Staff found the self-report tool feasible, easy to use, efficient, and the program-level metrics helpful for program planning. In conclusion, introduction of a standardized self-report enhanced CGA by creating a systematic method to flag, track, and prioritize all areas of need for immediate and future care planning at both the client and program level.
PDE4D And HCN1 Ultrastructure In Rhesus Macaque Entorhinal Cortex: Relevance For Aging And Alzheimer's Disease
Authors: Datta Dibyadeep , Mentone SueAnn , Arnsten Amy
Published: December 2021

Tau pathology emerges in a distinct spatial and temporal pattern in Alzheimer’s Disease (AD). Anatomical studies in AD subjects and rhesus macaques show earliest signs of tau pathology in the stellate cell islands in entorhinal cortex (ERC) layer II. However, the molecular mechanisms that confer vulnerability to ERC layer II cells early in AD is unknown. cAMP-PKA magnification of calcium release has been seen in prefrontal cortex, associated with HCN channel opening to dynamically regulate synaptic strength. This process is regulated by phosphodiesterases (PDE), regulation that is lost with age. The current study examined whether this “signature of flexibility” could also be seen in layer II ERC, underlying vulnerability to tau pathology with aging. We used high-spatial resolution immunoEM to localize PDE4D and HCN1 in young rhesus macaque (7-10y) ERC layer II. Our results suggest that PDE4D was concentrated on the SER-spine apparatus and in postsynaptic density, and HCN1 expressed in the membrane near excitatory synapses in dendritic spines. Within dendritic shafts, PDE4D labeling was observed along microtubules and near mitochondria, whereas HCN1 was organized in discrete clusters along the plasma membrane. These data suggest that PDE4D is optimally positioned to modulate cAMP microdomains and control calcium extrusion from the SER. HCN1 channels are localized in subcompartments to facilitate dynamic physiological representation of sensory experience and visual space governed by cAMP-PKA signaling. The anatomical patterns in ERC layer II corroborate our findings in vulnerable glutamatergic circuits in prefrontal cortex, suggesting conserved molecular features in association cortices most susceptible in AD.
Dementia Care Management: Social Capital for Persons with Dementia that Live Alone
Authors: Navarro Adria , Avila Vickie , Conger Lynne
Published: December 2021

Social connections are critical for healthy aging (Ahn et al., 2020). Consistent findings in research for persons with dementia that live alone show that a natural support network is the gold-standard for success, as social capital enhances well-being. Therefore a community-based intervention was piloted as part of a national 'special populations grant' in partnership with the local Meals-on-Wheels program. Dementia care management provided by graduate social work interns sought to provide weekly supportive contacts. Quantitative data was collected at baseline and following the program through administration of standardized measurement tools for "thriving" and for "dementia quality of life." The sample to date (N=33) consists of a majority being white females (82.4%), with additional participants expected as the remaining enrolled complete the program. These early "completers" do not show significant changes in their specific "surviving to thriving" domains, yet they do report greater perceptions of quality in their life as a whole following the dementia care management intervention when comparing post data to their baseline (Chi Square 18.95, p=0.004). To date this intervention continues to be studied and suggests a positive impact is likely for older adults with dementia that live alone, as well as for the communities where they reside.
Risk Factors of Going Missing in People Living With Dementia: A Scoping Review
Authors: Neubauer Noelannah , Perez Hector , Miguel-Cruz Antonio , Daum Christine , Marshall Samantha Dawn , Letts Elyse , Liu Lili
Published: December 2021

Critical wandering is common in persons living with dementia, it is defined as wandering that results in an individual going missing. This exposes the missing vulnerable older adult to risks and dangers. Persons with dementia who become lost and go missing and get lost can face adverse outcomes, such as injury and death, yet the amount of information available on the risk factors associated with these incidents is scarce. The aim of this study was to identify the risk factors associated with critical wandering in persons living with dementia. We used Tricco et al.’s (2018) approach for scoping reviews and searched the following databases: Medline, EMBASE, CINAHL, and Scopus. We included studies that referred to critical wandering in persons with dementia, cognitive impairment, or Alzheimer, and published since 1980. We identified 3,376 publications, which was reduced to 1641 publications after we removed duplications. A total of 78 studies met the inclusion and exclusion criteria for analysis and extraction. A rigorous process to synthesize and categorize the research evidence was followed. We identified four different types of risk factors associated with going missing: (1) personal, (2) physical environment and geographical location, (3) cultural environment, and (4) social environment and support resources. Recognition of these risk factors can help persons living with dementia and their care partners identify interventions and proactive strategies to mitigate or prevent critical wandering. This will support persons with dementia, their care partners, and community organizations to balance safety, autonomy, and independence to maximize quality of life.
Underdiagnosis of Dementia among Indigenous Older Adults with Cognitive Impairment
Authors: Amano Takashi , Gallegos Carlos Andres , Waters William , Freire Wilma
Published: December 2021

Early and timely diagnosis of dementia has been recognized as key to improving health outcomes. However, underdiagnosis among the indigenous population has not been adequately investigated. This study examines the association between indigenous ethnic identity and receiving a diagnosis of dementia and identifies factors associated with receiving a diagnosis of dementia. Data were drawn from Ecuador’s Survey of Health, Welfare and Aging (SABE) – 2009, based on a probability sample of households in Ecuador with at least one person 60 years or older. This is a robust data set that allows for understanding ethnic dimensions and disparities, especially because of the successful recruitment of indigenous households. The final sample consisted of 1,437 people who had cognitive impairment. Whether participants had ever been told that he/she had dementia was compared between the groups of people who identified themselves either as indigenous or others. Binary logistic regression analysis was utilized. Indigenous participants had a lower probability than others of receiving a diagnosis of dementia after controlling for health and function related covariates. This association became statistically insignificant after including socioeconomic factors in the model. The final model revealed that people who had higher educational attainment were more likely to receive a diagnosis of dementia. Findings suggest that underdiagnosis among indigenous older adults can be explained by their lower socioeconomic status rather than by health and functional status. This finding implies the possibility of developing strategies to promote timely diagnosis by targeting populations who are especially susceptible to underdiagnosis of dementia.
Detecting early signs of Alzheimer’s disease and related dementia onset from the EHR
Authors: Schliep Karen , Shepelak Zachary , Bitter Nicolas , Gouripeddi Ramkiran , Ostbye Truls , Smith Ken , Abdelrahman Samir , Tschanz Joanne
Published: December 2021

As dementia is widely under-detected, a predictive model using electronic health records (EHR) could provide a method for early screening to implement preventive strategies. There is limited research on using EHR to identify persons with Alzheimer’s disease (AD) and related dementias (RD). In a data-driven approach, we used all ICD-9 diagnosis and CPT procedure codes from statewide inpatient, ambulatory surgery, and Medicare records, in addition to age at baseline and gender, to detect AD/RD from the Cache County Study on Memory in Aging (1995–2009). After removing participants diagnosed with dementia at baseline (n=335), 3882 (82%) Cache County Study participants could be linked to inpatient, ambulatory surgery, and/or Medicare EHR records; 484 (12.5%) of these 3882 had incident all-cause dementia, with 308 (7.9%) having AD/AD comorbid with RD; and 176 (4.5%) having RD without AD. We removed participant’s ICD-9 codes occurring after first AD/RD diagnoses. EHR features (~2000) along with gold-standard diagnoses as class labels were then used to train and detect AD and/or RD using a Gradient Boosting Trees machine learning algorithm. Models evaluated with nested cross-validation yielded AUCs of 0.70 for all-cause dementia, 0.69 for AD/AD comorbid with RD, and 0.67 for RD without AD. Key factors detecting AD/RD included age at enrollment, cardiovascular, metabolic, and kidney disease, and sleep disturbances, with feature importance varying by record type and time frame prior to dementia onset. Our findings suggest that a patient’s health status up to 12 years prior may be useful in identifying individuals at-risk for dementia development.
Horticulture-based Interventions to Enhance Health and Wellbeing of People Living With Dementia in the Community
Authors: Scott Theresa , Jao Ying-Ling , Tulloch Kristen , Eloise Yates , Pachana Nancy
Published: December 2021

The majority of people living with dementia in the early and middle stages are cared for at home by family caregivers. Participation in meaningful activities is important for good quality of life. Recreation based on horticulture is beneficial for people living with dementia in residential settings, yet evidence within community settings is less clear. The aim of this research was to examine the existing evidence for the impact of using contact with nature, gardens and plants to enhance well-being of people living with dementia in the community. Our secondary aim was to explore the outcome domains and instruments that were employed in the existing research studies, to inform future research efforts and guide clinical practice. A systematic search was conducted covering several databases and gray literature. Original studies that examined group or individual horticulture-based activities or interventions were included. Of 2127 articles identified through searching, 10 were selected for full review. The findings reveal that horticulture-based intervention showed positive impacts on food intake, social interaction, and well-being in older adults with dementia. Some evidence shows that horticulture-based activities may alleviate stressful symptoms associated with living with dementia. Future research may further evaluate the effect of the interventions on cognitive function, physical function, and behavioral symptoms in a more rigorous intervention design.
Implications of Racial Differences in the Shifts in the Setting of Care for Alzheimer’s Disease and Related Dementias
Authors: Yashkin Arseniy , Gorbunova Galina , Yashin Anatoliy , Akushevich Igor
Published: December 2021

The prevailing setting of care has strong associations with the progression of a disease at time of first diagnosis, subsequent treatment, resulting health outcomes as well as both long-term and short-term costs. The care of Alzheimer’s Disease (AD) and Related Dementias (ADRD) has been experiencing a shift from skilled nursing facility to home health care. However, changes in practice do not disseminate equally across the race/ethnicity spectrum of the U.S. and disadvantaged race/ethnicity-related groups often encounter differing conditions from those experienced by the majority. In this study, we calculated the race/ethnicity-related direct healthcare costs of individuals with AD and ADRD, stratified by care-provider structure (physician, inpatient, outpatient, skilled nursing facility, home health, hospice), and modeled the trends and the relative contributions of each setting over the 1991-2017 period using administrative claims from a 5% sample of Medicare beneficiaries. Inflation and the gradual switch of Medicare compensation to the HCC model between 2004 and 2007 were accounted for. We then applied an inverse probability weighting algorithm to propensity-score-match the AD/ADRD race/ethnicity-specific groups to Medicare beneficiaries to make them comparable in demographics and co-morbidity status but without AD/ADRD. Finally, we performed a comparison of the Medicare costs and associated survival within (AD/ADRD vs. No AD/ADRD) and between (Black vs. White vs. Hispanic) race/ethnicity-related groups. Comparisons were done for: i)1-year before; ii) 1-year after iii) years 2-11; iv)years 12-21 and v) years 22+ after an AD/ADRD diagnosis. We found significant race/ethnicity-related differences in costs and survival both before and after propensity score matching.
Finding Factors in Footfalls: Exploring the Factor Structure of Gait in Older Adults.
Authors: Willden Michael , Palmer Josh , Kowalski Kristina , Hundza Sandra , MacDonald Stuart
Published: December 2021

Gait is a reputed marker of global health spanning various bodily systems (MacDonald et al., 2017) and is a robust predictor of deleterious age-related outcomes (Van Kan et al., 2009). However, the sheer number of individual gait variables employed as predictors in the existing literature can obscure interpretations. To address this issue, researchers have explored the factor structure of gait indicators to explain variance in age-related gait performance, identifying disparate models characterized by three to five underlying latent gait constructs comprised of 8 to 23 indicators (Hollman et al., 2011; Lord et al., 2013). Beyond this heterogeneity, additional limitations characterizing this literature include solutions that assume statistical independence among gait constructs, as well as inclusion of severely multicollinear indicators. Using data from the Healthy Minds Healthy Bodies (HMHB) study, the present research focused upon replicating and contrasting previous factor analytic efforts. HMHB participants (n=128) were healthy community-dwelling adults (Mage=72.81±5.24 years; female=100). Gait indicators from a GAITRite computerized walkway were selected according to a priori theoretical rationale, compatibility with previous studies, and consideration of multicollinearity. Gait factor structure was initially analyzed using principal component analysis. Results indicate the presence of three latent gait domains reflecting pace, rhythm, and variability, accounting for over 82.4% of the variance in gait performance. Current proceedings involve implementing confirmatory factor analysis to compare competing gait models. Findings will address disparities across factor models in the gait literature, as well as discuss the optimal number of factors for describing the underlying dimensionality of gait.
Measurement Invariance in the Assessment of Mood Between American and Mexican Community Studies
Authors: Herrera Manuel , Paulson Daniel
Published: December 2021

The Health and Retirement Study (HRS), a principal source for American public health research, has numerous global sister studies. Harmonization efforts seeking to establish measurement equivalence amongst these various datasets, is a critical prerequisite to cross-cultural research. Given well-known cultural variability in depressive symptom endorsement, the purpose of this study was to assess measurement invariance in a brief mood measure used in the HRS and the Mexican Health and Aging Study (MHAS). Total sample size using both groups was 15,319 participants (10,931 HRS; 4,388 MHAS) who were 65 and older from Waves 6 to 13 in the HRS and Waves 1 to 4 in the MHAS. MPlus Version 8.4 was used to conduct CFA analyses of measurement invariance. A contemporary approach with categorical data calls for examining threshold invariance first while establishing configural invariance, before examining invariance tests of thresholds, loadings, and intercepts in a second step. Results were that measurement invariance was not supported in this series of two steps with four out of six indices showing model fit in the first model and none of the indices showing model fit in the second model. These findings implied that there were differences in ways of responding to the brief mood measure between HRS and MHAS participants at the conceptual level. Thus, comparisons based on these measures may result in misleading findings and should be interpreted very conservatively. This study adds to the growing body of literature guiding harmonization efforts from the Program on Global Aging, Health and Policy.
Measurement Invariance of Negative Affect in Ambulatory Assessments of Young-Old and Old-Old Adults
Authors: Schilling Oliver , Lücke Anna , Katzorreck Martin , Kunzmann Ute , Gerstorf Denis
Published: December 2021

Gero-psychological research increasingly considered intense longitudinal assessments of momentary affect to address affective aging. In particular, many studies employed negative emotion item lists for ambulatory assessments of negative affect. However, frequent self-reports on emotion items within short time intervals might change alertness towards and perception of one’s emotional experiences. From an item-response-theoretic point of view, this might impair the stability of item functioning in terms of item discrimination between levels of affectivity and item severity (difficulty). Thus, we examined measurement invariance of negative emotion items commonly used for ambulatory assessments of negative affect. Ambulatory assessments from the EMIL study, obtained over seven consecutive days at six occasions per day from 123 young-old (aged 66-69) and 47 old-old (86-89) adults, were analyzed. Respondents self-reported on 13 negative emotion items, using a 0-100 slider to express the degree to which they felt the respective emotion. We ran multilevel structural equation models with Bayes estimation to analyze variability of negative affect factor loadings, item intercepts, and measurement error variances across repeated measures, thus checking for metric, scalar, and strict factorial invariance. For all sets of parameters, the findings do not strongly support measurement invariance, but point at partial invariance for item subsets. Taking on literature suggesting that criteria for invariance testing should not be too restrictive to meet pragmatic measurement equivalence requirements, further analyses and our conclusions focus on strategies that might allow for acceptable degrees of differential item functioning, enabling reliable analyses of intra-individual short-term variability in negative affect.
Factors Affecting the Intention to Use Exoskeleton for exercise and the Moderating Effect of Frailty
Authors: Bomi Choi , Joo Susanna , Lee Changmin , Kim Chang Oh , Lim Yun Mook , Jun Hey Jung
Published: December 2021

This study aims to find relevant factors influencing the intention to use exoskeletons for exercise (IEE) among older adults and to analyze the moderating effect of frailty. The sample of this study is 310 people (65 or older) without cognitive impairment who completed an online survey. The intention to use exoskeletons was measured with three questions from the Senior Technology Acceptance Model (STAM). Potential relevant factors comprise sociodemographic characteristics, physical and psychological health, exercise, attitude towards aging, and social relationship. Linear regression analyses showed that depressive symptoms, regular exercise, attitude towards aging, and social participation were significantly related to IEE. People with more depressive symptoms and a negative attitude towards aging are more likely to have a higher level of IEE. People who exercise regularly and actively participate in social activities showed a higher level of IEE. Subgroup analyses were performed based on the frailty status measured with Korean Groningen Frailty Indicator (K-GFI). Among people without frailty (N=177), regular exercise, and social participation were positively related to IEE. The number of chronic diseases and social participation was positively related to IEE among people with frailty (N=133). The results of this study implied that poor health conditions lead to an increased need for exoskeletons. The results of this study also suggested that exercise and social participation work as facilitating factors in the context of gerontechnology acceptance. Results of subgroup analyses suggested that influencing factors on IEE can vary depending on the physical functional status.
Technology Anxiety on Attitude Towards Technology: The Moderating Effect of Age-friendly Environment
Authors: Yoon Do Kyung , Lee Seolah , Kim DaeEun , Kim Chang Oh , Jun Hey Jung
Published: December 2021

The purpose of this study was to examine the moderating effect of an age-friendly environment on the relationship between technology anxiety and attitude towards technology among Korean older adults. We collected data by online surveys in February 2021, and the sample was 324 Korean older adults aged 65 and above. The dependent variable was the attitude towards technology, which meant the appraisal about using a wearable robot for exercise. The independent variable was technology anxiety, meaning an individual’s apprehension of using a wearable robot. The moderating variable was age-friendly environment, which comprises domains of the physical environment, social environment, and municipal services. The higher the score is, the more age-friendly the environment was perceived. Control variables were age, sex, education, household income. The moderation effect was estimated by bootstrapping and PROCESS macro. Results showed that when older adults showed a higher level of technology anxiety, their attitude towards technology was less positive. Moreover, the moderation effect of an age-friendly environment was significant. Concretely, in the case of living in a less age-friendly environment, older adults with a higher level of technology anxiety were more likely to report a less positive attitude towards technology. However, the effect of technology anxiety on attitude towards technology was not significant among older adults living in a more age-friendly environment. It suggested that a practical intervention to reduce the level of technology anxiety is in need in order to promote a positive attitude towards technology, especially for older adults living in a less age-friendly environment.
Using Smart Speakers in Low-Income Senior Housing to Enhance the Aging in Place Experience: Stakeholder Views
Authors: Chung Jane , Winship Jodi , Falls Katherine , Parsons Pamela , Bleich Michael
Published: December 2021

Smart speakers provide a platform that can integrate smart home technology and/or safety devices within the home to enhance quality of life and independent living for older adults. However, few attempts to utilize this technology specifically within low-income senior housing (LISH) residents have been documented. Our purpose was to explore different stakeholder perceptions about the use of smart speakers to support aging in place in older adults living alone in LISH. Smart speakers were deployed in individual LISH apartments, equipped with a voice technology-based aging in place solution for the facility. A qualitative analysis of semi-structured interviews using a constant comparative approach for emerging themes was conducted (n=10: older adult users, n=2: housing staff, n=2: voice technology developers). The three participant groups showed diverging perceptions in terms of benefits, uses, and stakeholder interests. Older adults found smart speakers useful in four main areas: assistance with daily tasks, feeling connected, safety measures, and emotional wellbeing. The two other groups showed a broader interest in the use of the smart speaker device, such as residential management tools and communication channels in addition to its potential use as safety and wellness tools. Older adults experienced significant difficulty setting up desired functions or finding instructions, which restricted utilization of the technology to a limited set of tasks. All stakeholder groups addressed a need for formal training or personalized tech support for older adult users. Findings indicate the importance of developing deployment strategies tailored to the needs and characteristics of the target user group.
Age-Related Phenotypes Linked to Aberrant Expression and Localization of a Telomeric Protein
Authors: Stock Amanda , Wang Kun , Liu Chengyu , McDevitt Ross , Sun Chongkui , Gong Yi , Liu Yie
Published: December 2021

Telomere attrition is associated with telomere biology disorders and age-related diseases. In telomere biology disorders, telomere uncapping induces a DNA damage response that evokes cell death or senescence. However, a causal mechanism for telomere attrition in age-related diseases remains elusive. Telomere capping and integrity are maintained by shelterin, a six-protein complex. Rap1 is the only shelterin member that is not required for telomere capping and is expressed at non-telomeric genomic and cytosolic regions. The objective of this study was to determine aberrant phenotypes attributed to non-telomeric Rap1. To test this, we generated a Rap1 mutant knock-in (KI) mouse model using CRISPR/Cas9 editing, in which Rap1 at telomeres is prevented, leaving only non-telomeric Rap1. Cell fractionation/western blotting of primary fibroblasts from Rap1 KI mice demonstrated decreased Rap1 expression and Rap1 re-localization off telomeres, with an altered cellular distribution. This same difference in Rap1 is also observed in human cells with telomere erosion, indicating that aberrant Rap1 in our model may recapitulate Rap1 in aging and human telomere biology disorders. Compared to wild-type control mice, Rap1 KI mice exhibited increased body weight, altered cytokine levels, behavioral deficits, and decreased lifespan. In conclusion, our results reveal a novel mechanism by which telomere shortening may contribute to age-related pathologies by disrupting Rap1 expression and cell localization.
Profiling Epigenetic Age in Single Cells
Authors: Trapp Alexandre , Kerepesi Csaba , Gladyshev Vadim
Published: December 2021

DNA methylation of a defined set of CpG dinucleotides emerged as a critical and precise biomarker of the aging process. Multi-variate machine learning models, known as epigenetic clocks, can exploit quantitative changes in the methylome to predict the age of bulk tissue with remarkable accuracy. However, intrinsic sparsity and digitized methylation in individual cells have so far precluded the assessment of aging in single cell data. We developed scAge, a probabilistic approach to determine the epigenetic age of single cells, and validated our results in mice. scAge tissue-specific and multi-cell type single cell clocks correctly recapitulated the chronological age of the original tissue, while uncovering the inherent heterogeneity that exists at the single-cell level. The data suggested that while cells in a tissue age in a coordinated fashion, some cells age more or less rapidly than others. We showed that individual embryonic stem cells exhibit an age close to zero, that certain stem cells in a tissue showed a reduced age compared to their chronological age, and that early embryogenesis is associated with the reduction of epigenetic age in individual cells, the latter supporting a natural rejuvenation event during gastrulation. scAge is both robust against the low coverage that is characteristic of single cell sequencing techniques and is flexible for studying any cell type and mammalian organism of interest. We demonstrate the potential for accurate epigenetic age profiling at single-cell resolution.
Genes Contributing to Resilience and Sensitivity to Lisinopril at Old Age: Clinical Translation of GWA in Drosophila
Authors: Gabrawy Mariann M , Khosravian Nick , Morcos George S , Jezek Meagan , Walston Jeremy , Abadir Peter M , Leips Jeff
Published: December 2021

Despite impressive results in restoring physical performance in rodent models, treatment with Renin-Angiotensin System (RAS) inhibitors such as Lisinopril have highly mixed results in humans, likely, in part, due to genetic variation in human populations. To date, the genetic determinants of responses to drugs such as RAS inhibitors remain unknown. Given the complexity of the relationship between physical traits and genetic background, genomic studies which predict genotype- and age-specific responses to drug treatments in humans or vertebrate animals are difficult. Here, using 126 genetically distinct lines of Drosophila, we tested the effects of Lisinopril on climbing speed and endurance at young and old age (N=14,310). Our data show that functional response and sensitivity to Lisinopril ranges from significant protection against physical decline (8–100% faster, P< 0.0001) to increased weakness (P< 0.0001) depending on both genotype and age (P< 0.0001). Genome-wide analyses revealed little to no overlap in candidate polymorphisms influencing sensitivity between ages nor between treatments within each age. Furthermore, network analyses led to identification of evolutionarily conserved genes in the WNT signaling pathway as being significantly associated with variations in sensitivity to Lisinopril. Genetic knockdown of Axin, frizzled, nemo, and wingless, genes with human orthologs AXIN1, FZD1, NLK, and WNT1, respectively, abolished the effects of Lisinopril treatment. Our results implicate these genes as contributors to the genotype- and age-specific effects of Lisinopril treatment and as potential therapeutic targets for improvement of resiliency. Our approach should be widely applicable for identifying genomic variants that predict age-dependent responses to pharmaceutical treatments.