bluuebunny/crossref_metadata_2025 huggingface dataset:
MULTIPLE CHRONIC CONDITIONS AND RISK OF DEMENTIA AND COGNITIVE IMPAIRMENT
Authors: Lee Yura , Cho Youngjoo , Oh Hyunkyoung
Published: November 2019

This study explores the relationship between the presence of multiple chronic condition and risk of dementia and cognitive impairment with no dementia (CIND) among older Americans. The study sample included 617 participants aged 70 years and older from the Aging, Demographics, and Memory Study (ADAMS). An expert consensus panel of the ADAMS data provided each participant a cognitive diagnosis into 1) no cognitive impairment, 2) CIND, or 3) dementia. The presence of multiple chronic condition was defined as having three or more chronic conditions in this study (e.g., heart attack, stroke, respiratory problems, cancer, hypertension, diabetes). Functional limitation, depression, cognitive activity engagement, apolipoprotein E (ApoE), and sociodemographic characteristics were included as covariates. A multinomial logistic regression analysis showed that individuals who have multiple chronic conditions have increased odds of being diagnosed with CIND versus no cognitive impairment controlling for other covariates. However, multiple chronic condition was not associated with increased risk of being diagnosed with dementia versus no cognitive impairment. Conclusion: The finding suggests that the presence of multiple chronic conditions may be a risk factor for cognitive impairment in later life. However, further investigation using a longitudinal design is needed to better understand the relationship between cognition and multiple chronic conditions.
CHALLENGES IN SELF-MANAGEMENT AMONG OLDER ADULTS WITH HYPERTENSION AND DIABETES
Authors: Oh Hyunkyoung , Lee Yura , Choi Wonchan , Zheng Zhi
Published: November 2019

This abstract introduces an ongoing research project that aimed to develop a patient-centered self-management program using health information and technologies for older adults with hypertension and diabetes. The purpose of the project in the first phase was to better understand challenges in self-management faced by older adults with both conditions. A semi-structured and face-to-face interview was conducted to explore the challenges in self-management of the target population living in Milwaukee areas, Wisconsin. Audio recordings were transcribed in verbatim; transcripts were analyzed; and themes were identified. A total of six individuals participated in this study by January 2019. Their age ranged from 56 to 75. Four of them were female; five of them were African Americans; and one was Caucasian. All participants reported more than two additional conditions that were arthritis, cardiovascular diseases, pain, kidney diseases, respiratory diseases, and depression. Most participants were self-managing their conditions mainly by taking prescribed medications. Several themes were emerged as challenges to self-management: monitoring blood pressure and glucose, engagement in physical activity, and healthy eating. Among these, participants reported healthy eating as the most difficult self-managing activity. Majority of participants expressed the need for physical activity support due to pain and/or vision problems known as one of diabetic complications. Understanding challenges and needs of a specific population is the first step for health care providers to support self-management of the patients appropriately. The results of this preliminary study will help health care providers develop effective self-management programs for older adults with both conditions.
COGNITION AND HISTORY OF MULTIPLE HEALTH CONDITIONS OVER 20 YEARS: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY
Authors: Bendayan Rebecca , Federman Alex D , Dobson Richard J
Published: November 2019

Research to date on multimorbidity and cognitive impairment is mainly cross-sectional or with limited history information of the health conditions. The present study explores the association between cognitive performance and previous history of health conditions over 24 years in a sample of 4858 respondents of the Health Retirement Study. Data from health conditions between 1998 and 2014 included self-reports for hypertension, diabetes, arthritis, stroke, cancer, lung and heart diseases and psychiatric problems. Duration of the health condition was categorized as more than 10 years, between 4 and 10 years, less than 4 years and no condition. Cognition was assessed using a summary index of cognitive performance including measures of memory, working memory, speed processing, knowledge, and language. ANOVA and post hoc tests were performed to explore the association between cognition and the duration of each health condition independently. Multiple linear regression analyses were performed to explore the association between multiple health conditions and cognitive performance. Results showed significant independent associations between cognitive performance in 2014 and each health condition, except for cancer [F(1,4)=2.60; p =.51]. When all the health conditions were considered in the regression models, we found that cognitive performance is negatively associated with high blood pressure and stroke (independently of the duration of the condition), long-term diabetes and lung diseases (i.e., for more than 10 years) and recent cancer (i.e., in the last 4 years). Our findings highlight that considering duration of co-existent health conditions is key for identifying individuals at greater risk of cognitive impairment.
HEALTHCARE PROVIDERS’ EXPERIENCES IN CARING FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS
Authors: Ploeg Jenny , Yous Marie-Lee , Fraser Kimberly , Dufour Sinéad , Kaasalainen Sharon , McAiney Carrie , Markle-Reid Maureen , Baird Lisa Garland
Published: November 2019

The management of multiple chronic conditions (MCC) in older adults living in the community is complex. Little is known about the experiences of interdisciplinary primary care and home providers who care for this vulnerable group. The aim of this study was to explore the experiences of healthcare providers in managing the care of community-living older adults with MCC and to highlight their recommendations for improving care delivery for this group. A qualitative interpretive description design was used. A total of 42 healthcare providers from two provinces in Canada participated in semi-structured interviews. Participants represented diverse disciplines (e.g., physicians, nurses, social workers, personal support workers) and settings (e.g., primary care and home care). Thematic analysis was used to analyze interview data. The experiences of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), involving and supporting family caregivers, (4) using a team approach for holistic care delivery, (5) encountering rewards and challenges in caring for older adults with MCC, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers highlighted the need for a more comprehensive integrated system of care to improve care management for older adults with MCC and their family caregivers. Specifically, they suggested increased care coordination, more comprehensive primary care visits with an interprofessional team, and increased home care support.
SELF-REGULATION STRATEGIES IN MANAGING MULTI-MORBIDITIES AMONG COMMUNITY-DWELLING PEOPLE AGING WITH ARTHRITIS
Authors: Zhang Wenhui , Radhakrishnan Kavita , Becker Heather , Acton Gayle , Holahan Carole K
Published: November 2019

Quantitative and qualitative evidence supported the self-regulation strategies of Selection, Optimization and Compensation (SR-SOC), used by people aging with single and multiple chronic conditions (MCCs) to adapt to chronic disabling symptoms and live well. This study investigated the SR-SOC Strategies in the self-management of community-dwelling people aging with arthritis and MCCs. 140 individuals aged > 50 completed the demographic questionnaire, Functional Comorbidity Index (FCI), Brief Health Literacy Screening, Lubben Social Network Scale, Patient-Healthcare Provider Communication Scale, Health Insurance Check-list, PROMIS Adult Self-Reported Health Measures, SOC Questionnaire, Arthritis Self-Efficacy Scale, Healthcare Service Utilization Questionnaire, and a visual analogue QOL scale. With the theoretical framework, multivariate hierarchical stepwise regression was used to predict SR-SOC Strategies, arthritis self-efficacy, healthcare utilizations and QOL. Majority of the sample were female (70%), with < Bachelor’s degree (56%), White (34%) or African American (33%), with personal annual income < $25,000 (52%). Thirty-seven percent reported fairly and 26% poorly adequate income. Number of FCI count ranged from 2 to 14 (Mean =3.8). The top four comorbidities were obesity, diabetes, visual impairment and degenerative disc disease. QOL ranged from 0.5 to 10.0 (Mean=7.2, SD=2.2). Age, physical symptom cluster (pain, fatigue and cognitive abilities) and healthcare provider communication quality significantly predicted SR-SOC strategies. Income adequacy, physical symptom cluster and SR-SOC strategies significantly predicted arthritis self-efficacy. FCI significantly predicted healthcare utilization total, inpatient healthcare utilization, clinician visit and hospitalization. With income adequacy, FCI significantly predicted home health visit and emergency room visit. Being African American and FCI significantly predicted prescriptions filled.
RACIAL-ETHNIC DIFFERENCES IN MULTIMORBIDITY PROGRESSION ACCORDING TO BODY-WEIGHT STATUS AMONG OLDER U.S. ADULTS
Authors: Botoseneanu Anda , Markwardt Sheila , Allore Heather , Nagel Corey , Newsom Jason T , Dorr David A , Quiñones Ana R
Published: November 2019

Obesity and multimorbidity are more prevalent among underrepresented U.S. racial/ethnic minority groups. Evaluating whether racial/ethnic disparities in multimorbidity accumulation vary according to body-mass index (BMI) may guide interventions aimed at reducing multimorbidity burden in vulnerable racial/ethnic groups. We used 1998-2014 data from the Health & Retirement Study (N=8,635 participants, age 51-55 years old at baseline) and negative binomial models stratified by BMI category to evaluate differences in rates of accumulation of seven chronic conditions (arthritis, cancer, diabetes, heart disease, hypertension, lung disease, and stroke), focusing on differences between racial/ethnic groups [White (reference; 64.7%), Black (21.5%), Hispanic (13.8%)]. Overweight and obesity were more prevalent in Black (80.9%) and Hispanic (78.6%) than White (69.9%) participants at baseline; in all BMI categories, Black participants had higher rates of multimorbidity compared with White participants (normal BMI:β=0.304, p<0.001; overweight:β=0.243,p<0.001; and obese:β=0.135,p=0.013); initial burden of disease was similar between Whites and Hispanics in the normal and overweight categories, but significantly lower among Hispanics (vs. Whites) in the obese category (β= -0.180,p=0.017). We found no significant differences in rates of disease accumulation between the racial/ethnic groups in any of the BMI categories. There are substantial differences in initial disease burden between Black and White middle-aged/older adults, but not in the rate of accumulation of disease between the race/ethnic groups in the 3 main BMI categories. These findings suggest an opportunity to reduce racial disparities in multimorbidity by intervening early in the lifecourse to reduce the burden of chronic disease among vulnerable racial minorities prior to entering middle-age.
TRANSITION IN FAMILY RELATIONS IN IMMIGRANT FAMILIES: THE CASE OF CHINESE OLDER IMMIGRANTS IN THE UNITED STATES
Authors: Guo Man , stensland Meredith , Li Mengting , Dong XinQi
Published: November 2019

Using panel data of 2,604 Chinese older immigrants in Chicago over a two-year period, this study examined continuity and changes in intergenerational relationship patterns and their mental health implications. Latent transition analysis revealed five types of family relations: traditional, modified traditional, coresiding-unobligated, independent, and detached. Over the two years, about 43% of the respondents shifted to a different relationship type, with the most common changes being shifting into modified traditional or independent relations, or from detached relations. Controlling for baseline socio-demographic, acculturation, mental health variables, and variables representing life transitions over time, having detached relations was related to greater depressive symptoms in two years and having modified traditional relations was associated with better quality of life at the follow up. The findings revealed heterogeneity and fluidity of intergenerational relations among older immigrant populations and point to the important role of family relations in their well-being.
GENDER INFLUENCES ON LIFE SPACE TRAVEL AMONG THE OLD-OLD
Authors: Han Chengming , Kahana Eva , Kahana Boaz , Bhatta Tirth
Published: November 2019

This paper focuses on gender influences on life space mobility based on distance from home traveled by elderly retirees. Consideration of life space travel offers a window into environmental autonomy and complexity in late life. The gendered nature of time use and social networks have been primarily studied in younger age groups. Our sample included 437 older adults (mean age 83 for both men and women) living in a large Florida retirement community that offered no services. Mean age was 83 for both men and women. Fewer (37.6%) women than men (69.7%) were married and more men drove a car (83% vs 63%).Women reported poorer subjective health and had more IADL limitations. Compared to women, men were significantly more likely to travel long distances. Women’s weekly and monthly travel tended to be local, limited to their neighborhood. On average, respondents of both genders visited their families and friends out of town every month. Better health, current driving and volunteering were related to longer driving distances for both genders, but these advantages were no longer significant after controlling for demographic characteristics. Our findings underscore the complex relationships between gender and life space travel in late life. Even among elderly men and women of the same age better health and driving resources contribute to larger life space for elderly men.
ASSOCIATIONS OF GENETICS AND LIFE COURSE CIRCUMSTANCES WITH A NOVEL AGING MEASURE THAT CAPTURES MORTALITY RISK
Authors: Liu Zuyun , Chen xi , Gill Thomas M , Ma Chao , Crimmins Eileen , Levine Morgan E
Published: November 2019

We aimed to evaluate associations between a comprehensive set of factors, including genetics and childhood and adulthood circumstances, and a novel aging measure, Phenotypic Age (PhenoAge), which has been shown to capture mortality and morbidity risk in the U.S. population. Using data from 2339 adults (aged 51+) from the U.S. Health and Retirement Study, we found that together all 11 study domains (4 childhood and adulthood circumstances domains, 5 polygenic scores [PGSs] domains, and 1 demographics, and 1 behaviors domains) accounted for about 30% of variance in PhenoAge after accounting for chronological age. Among the 4 circumstances domains, adulthood adversity was the largest contributor (9%), while adulthood socioeconomic status (SES), childhood adversity, and childhood SES accounted for 2.8%, 2.1%, 0.7%, respectively. All PGSs contributed 3.8% of variance in PhenoAge (after accounting for chronological age). Further, using Hierarchical Clustering, we identified 6 distinct subpopulations/clusters based on the 4 circumstances domains, and 3 subpopulations/clusters of them that appear to represent disadvantaged circumstances were associated with higher PhenoAge. Finally, there was a significant gene-by-environment interaction between a previously validated PGS for coronary artery disease and the most apparently disadvantaged subpopulation/cluster, suggesting a multiplicative effect of adverse life course circumstances coupled with genetic risk on phenotypic aging. We concluded that socioenvironmental circumstances during childhood and adulthood account for a sizable proportion of differences in phenotypic aging among U.S. older adults. The disadvantaged subpopulations exhibited accelerated aging and the detrimental effects may be further exacerbated among persons with genetic predisposition to coronary artery disease.
CORESIDENCE OF OLDER PARENTS AND ADULT CHILDREN BENEFITS OLDER ADULTS’ PSYCHOLOGICAL WELL-BEING: PATH ANALYSIS
Authors: Lee Soohyoung r
Published: November 2019

Even though the coresidence of older parents and their adult children is no longer a rare phenomenon in current society, a little is known about the benefit of living with adult children from older adults’ perspectives compared to the risk of this living situation. Previous research suggests that older adults’ psychological well-being is low when they live with their adult children, and this become more salient among single parents, such as widowed or divorced. The current paper utilizes the National Health Measurement Study with a sample of age 55 and over, and their SF-36 Mental Health Component score, and psychological well-being self-acceptance score was measured. Path analysis reveals while mental health and psychological well-being scores are lower among single older adults at the time of the survey (e.g., divorced, widowed) than non-single, coresidence of older adults and adult children completely mediates the negative relationship between being single and both mental health psychological well-being. A complete mediation effect of living with an adult child on older adults’ mental health and psychological well-being is consistent with both white and non-white minority older adults. This suggests that living with adult child benefits older adults’ mental health and psychological well-being. The current study seeks to stimulate ideas that might generate the next answer to community-based care in our current aging society.
WHY DON’T ELDERS ADOPT TWO-FACTOR AUTHENTICATION? BECAUSE THEY ARE EXCLUDED BY DESIGN
Authors: Das Sanchari , Streiff Joshua , Huber Lesa L , Camp L Jean
Published: November 2019

Two-Factor Authentication (2FA) provides effective protection for online accounts by providing efficient and highly robust access control. Adoption and usability, however, remain challenges for such technologies. Most research on 2FA focuses on students or employees in the tech sector. For example, our research with student populations found that lack of adoption was primarily due to a lack user risk concern matched with confidence in their ‘strong’ password strategies. The situation for older adults (> 60 years) was quite different, as we discovered through detailed interviews and think-aloud protocols targeted at understanding the registration, after installation, and their (un)willingness to use 2FA. We focused our research on USB security hardware tokens; additionally, we asked about other 2FA strategies which the participants adopted (if any). Their lack of adoption of the devices stemmed from its shortfall of inclusive design. Most available security tokens which were compliant with tablets have very small form factors; nearly invisible in a purse, and easy to slip through a pocket. The larger security keys are device and browser (Google Chrome) dependent. The organizations which would be most invested in protecting older people -- retirement management funds, the Social Security Administration, Medicare, and banking institutions - reasonably do not adopt 2FA because of its lack of acceptability. Our negative result is that older adults are caught in a negative feedback loop where lack of adoption prevents availability, and vice versa. The positive result is that these concerns are straight-forward to overcome.
DOES CHANGE IN INTERNET USE PREDICT PSYCHOLOGICAL WELL-BEING AMONG OLDER ADULTS?
Authors: Berkowsky Ronald W
Published: November 2019

Previous work focusing on the relationship between Internet use and quality of life among older adults (aged 65+) has found evidence of various positive impacts. This project expands upon this work by examining the relationship between Internet use and measures of psychological well-being (PWB) including autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. The analytic sample is derived from two waves of data (Time 1 = 2004, Time 2 = 2011) taken from the Wisconsin Longitudinal Study and includes a sample of older adults aged~65 at Time 1 (N = 4943). Participants were separated into four categories: those who did not use the Internet at Time 1 or 2, those who used the Internet at Time 1 only, those who used the Internet at Time 2 only, and those who used the Internet at both Time 1 and 2. Regression analyses were performed with the Time 2 PWB measures as the outcomes and the Internet use categories as the primary predictors. Results indicate that while continuous Internet users typically reported higher PWB scores compared to non-users, those who stopped use between Time 1 and 2 also reported higher scores and those who started use between Time 1 and 2 reported lower scores. These results generally held when introducing Time 1 PWB measures as controls, suggesting changes in Internet use may affect PWB but not necessarily in the predicted directions. Additional control variables, potential explanations, and implications for future research are discussed.
LOOK WHO’S TALKING: TRADITIONAL AND ELECTRONIC MEDIUMS OF CONTACT LINKED WITH LATER-LIFE SIBLING RELATIONSHIPS
Authors: Hill Melanie S , Yorgason Jeremy B , Coyne Sarah , Jensen Alexander C
Published: November 2019

The sibling role is often the longest lasting relationship between individuals. As such, older adults may turn to siblings in later life as it is a relationship that is already familiar. Having a close and less conflictual relationship with a sibling may be especially important as older adults value siblings for emotional and practical support exhibited through contact. Minimal research has examined mediums of contact used between sibling dyads despite the increase use in technology among older adults. Using a sample of 491 Americans (Mage = 58.96) recruited via Amazon Mechanical Turk (Mturk), the current study examined five mediums of contact (i.e., in person, telephone, e-mail, texting, and social media) and how each type independently is related to sibling closeness and conflict. Further, using regression analyses in STATA, two and three-way interactions were examined to assess the role of sibling dyad composition affecting this relationship. Results indicated that contact through telephone was associated with higher sibling closeness for all sibling dyads, and that association was stronger for females with a sister compared to males with a brother. Further, in person and texting contact was especially beneficial for females with a brother. Main effects revealed contact in person, via social media, over the telephone, or through email, reported more sibling closeness, while those who engaged in more email contact reported less conflict. Thus, even in later life, siblings are keeping in contact with one another through both traditional and electronic mediums of communication, and this contact appears especially beneficial for sisters.
AGE-SPECIFIC VIEWS ON INVASIVE AND NON-INVASIVE HUMAN ENHANCEMENTS FOR COGNITIVE DECLINE
Authors: Rainville G , Skufca Laura , Eller Madeline
Published: November 2019

This research examines the degree to which younger and older Americans approve of addressing cognitive decline using either a pill-based or an implant-based intervention to restore prior functioning. Half of a probability-based online sample expressed concerns over side effects and levels of approval for a pill-based intervention whereas the remainder of the sample did so for a relatively invasive implant-based enhancement (data were interviews of 2,025 American adults gathered by NORC’s AmeriSpeak panel as part of the AARP Human Enhancements study). We predicted and found that relative disapproval of the implant-based intervention was only significant among those with high concerns over side effects. However, when looking at two age groups for which cognitive decline differed in salience, relative disapproval of the implant-based enhancements were relatively stronger for those 50 and older even among those with few concerns over side effects. This age-based aversion to invasive forms of enhancements may have public health implications in that the subgroup who may most-immediately benefit from the enhancement and may be in the market for only non-invasive enhancements. It is not clear if such enhancements, however, could be delivered via a pill or other non-invasive forms.
SOCIAL MEDIA AND SOCIAL WELL-BEING IN LATER LIFE
Authors: Quinn Kelly
Published: November 2019

Social well-being is important to health, but maintaining social relations often becomes difficult in later life due to retirement, chronic disease, and the death of spouses and friends. Social media platforms, such as Facebook and Twitter, present accessible and low cost communication technologies that are associated with enhanced feelings of social connection and reduced loneliness in younger age groups. This paper examines whether similar benefits might arise for adults at older ages. Using a four-week social media training workshop as a randomized, controlled wait-list intervention, this study examines whether social benefits are realized among a group of novice social media users, aged 65+. Measures of social well-being, including social capital, loneliness, social connectedness, and social provisions, were assessed at pre- and multiple post-test intervals for differences related to social media learning. Findings revealed only small differences between groups in one dimension of social connectedness, that of social integration. As these findings seemingly contradict studies conducted with younger persons, the contexts of social media use in older adulthood are discussed. These include the relevance of lower social media adoption rates, as well as influences that intersect with an older person’s life stage, such as gaps in network coverage on technological platforms, perceptions of the value of weak connections, and a reduced digital skills base. These additional factors are relevant to understanding disparity in the benefits that can be obtained through the use of social media and highlight the differing needs that social media fulfill at varying life stages.
FACTORS ASSOCIATED WITH UNMET HEALTHCARE NEEDS IN OLDER ASIAN AMERICANS
Authors: Yoon Hyunwoo , Yoon Hyunwoo , Jang Yuri , Choi Kwangyul
Published: November 2019

Older Asian Americans are the fast-growing but understudied population in health disparities research. Using a sample that reflects cultural/linguistic diversity, the present study explored general (health insurance, usual place for care, income) and immigrant-specific (nativity, length of stay in the US, English proficiency, acculturation) risk factors of unmet healthcare needs in older Asian Americans. Data were drawn from the Asian American Quality of Life survey (N = 533). With the inclusion of a considerable number of non-English-speaking individuals, the present sample presented a high rate of unmet healthcare needs. Those with a shorter stay in the US, limited English proficiency, and lower level of acculturation had increased odds of having unmet healthcare needs than their counterparts after controlling for background characteristics. Challenging the myth of model minority, findings highlight the importance of immigrant-specific factors in identifying risk groups of unmet healthcare needs and demonstrate vulnerability in access to healthcare.
DEVELOPMENT AND EVALUATION OF EDUCATIONAL MATERIALS REGARDING MENTAL HEALTH MOBILE APPS AMONG OLDER VETERANS
Authors: Scales Ashley , Loup Julia , Juang Christine , Sakai Erin , Ma Flora , Gould Christine E
Published: November 2019

The number of older adults using mobile devices has doubled over recent years; however, many need assistance in learning how to use their device. To address this gap, we developed patient education materials teaching older Veterans how to download apps and the basics of mobile device and app use. For example, we developed step-by-step guides for three Veteran Affairs mobile apps that target mental health symptoms. Material development involved feedback from providers and older Veterans using a multi-step mixed methods evaluation process. Local technology and geriatric content experts provided initial feedback; all experts agreed the materials would be helpful to teach Veterans about mental health apps. We subsequently interviewed older Veterans (M = 78.5 years) who evaluated the materials. Over 50% of Veterans found the guides clear, articulate, and useful; 83.3% noted they would recommend to others. Lastly, providers who see older Veterans regularly rated the materials; 79% of providers rated the materials as helpful, with an average rating of 4.3 (1 = Strongly Disagree to 5 = Strongly Agree). Providers viewed the materials and apps as useful supplements to psychotherapy and especially useful for individuals who are unable to return to clinic. Overall, both providers and Veterans found the materials easy to understand and valuable for those new using mobile apps or devices. Findings from the evaluation process suggest the design of the materials may be vital to increasing the use of mental health mobile apps among older Veterans.
THE UNCANNY VALLEY REVISITED: AGE-RELATED DIFFERENCE AND THE EFFECT OF FUNCTION TYPE
Authors: Tu Yun-Chen , Chien Sung-En , Lai Yueh-Yi , Liu Jen-Chi , Yeh Su-Ling
Published: November 2019

Due to declined birthrate and the increased aging population, solving the problem of labor shortage has become important. Introducing robotic labors could effectively help older adults’ daily lives. However, older adults’ acceptance of robots was lower than younger adults. Robot’s appearance might be one of the reasons. The Uncanny Valley (UV) refers to the phenomenon that people rate more positively as robots become more humanlike, but only up to a certain point; as it approaches near-perfect similarity of human appearance, likeability drops and forms an uncanny valley. Nonetheless, previous results supporting the UV were mainly from younger adults. We examined whether the UV is also applicable for older and middle-aged adults. We also examined whether the acceptance of function (companion vs. service) would change based on robot appearance, and whether robot-induced traits have any relation with the acceptance of robot function. We asked younger (N= 80, age 18-39), middle-aged (N= 87, age 40-59), and older (N= 88, age 60-87) adults to view each picture of 84 robots and evaluate their impression of each robot and intention of use regarding robot function. Contrary to the UV found for younger and middle-aged adults, older adults did not show UV–they preferred humanlike over non-humanlike robots, regardless of the robot function. Scores on each trait–except for authoritativeness–showed positive correlations with the acceptance of functions. These findings imply that the design of assistive robots should take UV into consideration by customizing robots’ appearances and functions to different age groups.
A MAGIC GATHERING: PILOTING AN AUGMENTED REALITY ENGINE TO PROMOTE MENTAL HEALTH AND WELL-BEING
Authors: Chan Thomas , Matook Daniel , Argueta Isaac , Kennedy Jonathan , Argueta Jeremy , Chan Thomas
Published: November 2019

Augmented reality (AR), superimposing digital assets onto the real-world (i.e., holograms)—offers a paradigm shift in delivering immersive interventions for aging adults. Reminiscence and life review are robust intervention techniques that have decades of empirical support to boost mood and meaning in older adults. In this presentation, we demonstrate the applied research and technology development process to create an AR reminiscence and life review engine for aging adults and their caretakers. We conducted 25 needs assessment interviews with community-dwelling older adults, and assisted living facility directors, nurses, and residents. Initial analyses revealed the need for: (1) finding scalable and cost-effective solutions to alleviate time burden for caregivers; (2) increasing variety of activities that do not need much instruction; (3) producing activities that grab and maintain attention; and, (4) generating more personalized activities that do not divert too much time from caretakers. We integrated the findings to develop a working prototype AR engine called “Project Phonado.” From preliminary user testing, Project Phonado aids in boosting mental health and meaning in aging adults—at least temporarily (immediate and one day follow-up). We will show clips of some pilot user testing of the engine and discuss the next evaluation and development steps.
DIFFERENT ASPECTS OF ACCULTURATION AND COGNITIVE HEALTH AMONG MINORITY OLDER IMMIGRANTS
Authors: Wang Bei , Dong XinQi , Simon Melissa A , Li Mengting
Published: November 2019

Immigration and acculturation process in host society have been closely linked to health consequences among the immigrant populations. However, it has been inadequately examined regarding its relationships with cognitive outcomes. Data were drawn from PINE Study. Linear regression analyses were used to examine associations between acculturation levels (media use, ethnic social relations, and language proficiency) and cognitive performance. After adjusting for potential confounding variables, higher levels of acculturation were associated with better cognitive performance. More specifically, higher levels of acculturation in aspects of media use and ethnic social relations were associated with better cognitive performance, whereas it has no significant association with the language preference aspect. Research and practice addressing health disparities and cognitive impairment should leverage efforts to provide culturally relevant resources to less acculturated populations in the US. More longitudinal studies are needed to clarify the influence of acculturation on cognitive performance and its mechanism.
WRIST-WORN TRI-AXIAL ACCELEROMETER VALIDATION IN YOUNG, MIDDLE-AGED, AND OLDER ADULTS
Authors: Manini Todd M , Saldana Santiago , Corbett Duane , Wanigatunga Amal A , Navarro Eduardo , Mardini Mamoun T , Casanova Ramon
Published: November 2019

Purpose: This study evaluated wrist-worn accelerometers for estimating metabolic intensity and classifying activity types across a wide age spectrum. Methods: Participants (n=141, 67% women, aged 20-89 yrs) performed a battery of 31 common daily activities (e.g. washing dishes, walking) in a standardized laboratory setting. A tri-axial accelerometer was worn on the right wrist during each activity whiel a portable metabolic unit was used to measure oxygen consumption (ml/kg/min), which was converted into metabolic equivalents (METs). Random forest analyses estimated metabolic intensity and classified activity type based on seven data features. Resulting estimates were cross-evaluated on a separate sample of 16 participants who performed a sub-set of activities in their home. Results: In the laboratory setting, mean differences between measured and predicted MET value for sedentary (0.36), lifestyle (0.02) and locomotor (0.30) activities were low, but the 95% limits of agreement ranges were relatively large (+/-1.0, +/-1.8, +/-3.1, respectively). Data features were 85%, 88%, and 71% accurate for identifying sedentary, lifestyle and locomotor activities. Prediction equations had an overall mean difference of 0.19 METs (95% limits of agreement = -1.3 to 1.7) when activities were performed at home. Conclusion: Data features extracted from a wrist worn tri-axial accelerometer provide a moderate-to-high group estimate of metabolic intensity and had modest accuracy in identifying activity types across a variety of daily activities. However, significant between person variations were evident. Additional work is needed to refine wrist-worn accelerometers for estimating physical activity type, intensity, duration and frequency across the age spectrum.
FEASIBILITY OF MOBILE HEALTH FOR LOW-INCOME MINORITY HISPANIC PATIENTS WITH A STROKE
Authors: Dang Stuti , Sarhadi Kasra , Kenya Sonjia , Dong Chuanhui , Ferras Natalie , Romano Jose , Carrasquillo Olveen
Published: November 2019

Stroke is a leading cause of death and functional impairment that disproportionately impacts Hispanics. Several studies have supported the feasibility of mobile health interventions (mHealth) to provide health monitoring and patient education for improving chronic disease management, but none have focused on Latino stroke patients. The Hispanic Secondary Stroke Prevention Initiative is a randomized study of 200 stroke patients designed to evaluate the impact of a 12-month multi-modal Community Health Worker (CHW) and mHealth intervention on blood pressure control. Eligible participants were Latinos who experienced a mild-moderate stroke within the last five years. The CHW component included home visits, telephone calls, and daily text messages to obtain home blood pressure readings and provide patient navigation and health education. Feasibility was defined as the proportion of patients that responded to at least half the messages. Pre-post paired t-tests assessed improvements in question accuracy while correlation coefficients highlighted improvements in response rates. Among the 65 participants randomized to the intervention, the response rate was as follows: 37% - >50% response, 21% - 25-50%, 19% - 10-25%, and 23% - <10%, This finding suggests that mHealth interventions may be challenging in this population. However, the proportion of questions answered correctly increased from 63% to 84% in the intervention period’s last two months (p<0.05). There was a positive correlation between increased response rates and response accuracy to patient education assessments (r=0.82, p<0.05). These improvements in health knowledge suggest that a subset of patients may benefit from mHealth interventions, and the benefit correlates with use.
NOVEL REMOTE ASSESSMENT OF THE STANDING POSTURAL CONTROL IN YOUNGER AND OLDER ADULTS USING SMARTPHONE APPLICATION
Authors: Zhou Junhong , Yu Wanting , Zhu Hao , Lo On-Yee , Travison Thomas , Lipsitz Lewis , Manor Brad
Published: November 2019

In older adults, assessment of standing postural control under various task and/or environmental conditions provides valuable insight into cognitive-motor function. To date, however, such assessments have been limited primarily to laboratory or clinical settings. We therefore created a smartphone App to enable remote assessments of postural control. This App provides users with standardized multi-media instructions and harnesses the phone’s internal motion sensors to capture postural sway, with the phone placed in the user’s pants pocket, during trials of standing with eyes open, eyes-closed, and while performing serial-subtractions (i.e., dual tasking). We then established the test-retest reliability of several metrics of postural sway derived from this assessment tool, as well as their sensitivity to the effect of age and standing condition. Fifteen healthy younger and 15 older adults completed multiple standing trials in two separate laboratory visits and on three separate days in their own homes. Postural sway metrics included the mean distance from the center of the trajectory and root mean square were derived from both transverse-plane acceleration and angular velocity time series. Each sway metric demonstrated excellent test-retest reliability, even when analyzed separately by group and standing condition (ICCs: 0.78-0.89). Moreover, each metric was sensitive to age group and standing condition, such that greater sway was observed in older adults as compared to younger adults (p<0.03), and in more challenging standing conditions (p<0.0001). These results suggest that sensitive metrics of standing postural control may be reliably obtained from remote smartphone-based assessments in both younger and older adults.
DEVELOPMENT AND TESTING OF AN ACCELEROMETER-BASED POSITIONAL MONITORING SYSTEM
Authors: Jarvis Leighanne , Moninger Sarah , Throckmorton Chandra , Pavon Juliessa M , Caves Kevin
Published: November 2019

Health and fitness are contributing factors to physical resilience, or the ability to resist or recover from functional decline following health stressors. Accelerometer based activity monitors have been used in both the in-patient and outpatient setting to monitor mobility. While using sensors to track mobility is increasing, most clinical settings rely on patient reported outcomes. These measures often under or overestimate movement. The lack of a clinically meaningful way to measure mobility in the in-patient setting is a barrier to improving the mobility of hospitalized individuals. This is especially important when considering that over one-third of hospitalized older adults are discharged with a major new functional disability in performing activities of daily living. Our goal was to automatically determine if the subject is laying, reclining, sitting, standing, and walking to better reflect actual activity. Other platforms and studies indicate the ability to determine a difference in activity vs. inactivity or laying and reclining vs. standing and walking, but not all five phases of movement defined here. The aim of this study was to use accelerometer data to train a machine learning algorithm to automatically classify the postural changes (i.e. laying, reclining, sitting, standing, and walking). Preliminary results demonstrate that our trained algorithm is overall 95% accurate in determining each position from unlabeled data from the subject population. Additionally, this algorithm will be applied to in-patient hospitalized older adults for tracking of positions throughout the day.
VETCONNECT: A VA TELEHEALTH PROGRAM PROVIDING TREATMENT, EDUCATION AND TRANSITIONS OF CARE TO NURSING HOME VETERANS
Authors: Levy Cari , Hale Anne , Galenbeck Emily , Haverhals Leah M
Published: November 2019

Transporting nursing home Veterans to hospitals for outpatient care can present many challenges, including lengthy time in transit, coordination difficulties between the hospital and nursing home, and travel burden on Veterans. In June 2017, the VetConnect program began offering Veterans in Colorado residing in Department of Veterans Affairs (VA) contracted Community Nursing Homes (CNHs) and State Veteran Nursing Homes (SVHs) telehealth appointments in Geriatrics, Mental Health, Palliative Care, and Psychiatry via clinicians at the Rocky Mountain Regional VA Medical Center (VAMC). Then in June 2018, VetConnect expanded to offer Virtual Tours for Veterans transitioning out of inpatient care to CNHs the opportunity to virtually tour the CNH, connecting with CNH staff through video for a more stress-free and informed transition from hospital to CNH. In winter 2018, VetConnect expanded once more to include Dementia Educational Outreach Series for CNH and SVH staff, allowing them to connect virtually to VA staff with expertise in dementia care and other Veteran-specific topics such as treating post-traumatic stress disorder (PTSD). To date, VetConnect has provided 502 telehealth visits, 18 Virtual Tours, and 4 dementia ECHO trainings (with 58 nursing home staff participants). Evaluation measures to be presented include collection and analysis of telehealth nurse field notes (who are present with Veterans at CNHs/SVHs during telehealth visits), creation of process maps, conducting key stakeholder interviews, and identification of potential impacts the VetConnect program has had on VA to CNH and SVH relationships and Veteran health.
TECHNOLOGY FOR HOME MONITORING
Authors: Charness Neil H
Published: November 2019

Healthcare is increasingly moving away from expensive hospitals into the home. Although there are advantages to managing chronic health conditions in homes, there are also a number of disadvantages, beginning with aging adults’ unfamiliarity with the technologies being deployed. Too often, designs and instructional materials are not developed with aging users’ capabilities in mind. Health technology also confronts users with significant challenges including just-in-time learning when users are under significant stress. Technology support is often lacking. Also, care coordination for multiple chronic conditions is challenging. For instance, patients are often provided with multiple electronic health record portals. I discuss the reliability of and some of the practical challenges for a home health monitoring system used by older adults and those with heart failure over a 6-month interval. The system featured components such as a wrist-worn sensor package, daily tablet surveys, blood pressure cuff, weight scale, and bed sensors.
SOCIAL ISOLATION AMONG THE RECIPIENTS OF THE MINIMUM LIVELIHOOD GUARANTEE PROGRAM IN CHINA
Authors: Zhang Yalu , Mui Ada
Published: November 2019

The eligibility for the minimum livelihood guarantee program in China is generally based on means testing, including a complicated income test and a household registration test. Even though the fiscal budget for this program steadily increased in the last two decades, the number of beneficiaries has decreased in both rural and urban areas since 2011. The recipients were stigmatized because their names are reported in the public domain and are known to their neighbors. Some beneficiaries tended to reduce social participation for fear of losing the eligibilities due to the stricter criteria or the stigma associated with receiving benefits. This paper examined the adverse impact of this welfare program on social isolation among Chinese middle-aged and older adults (n=8,447) using the panel data from the China Health and Retirement Longitudinal Study and the propensity score weighted difference-in-differences method (PSM-DID). The results present disparities between urban and rural older adults—The older program recipients in urban areas significantly reduced social participation by 20.53%, while the adverse impact was not statistically significant among rural recipients. Compared to older adults (aged 60 and above), middle-aged adults (aged between 45 and 60) were not socially isolated due to program enrollment in both rural and urban areas at the 95% confidence level. This paper for the first time addresses the causal relationship between program enrollment and the adverse impact of social isolation. It also alerts policymakers and local program administrators to protect older program recipients from stigma, sense of shame, and reduced social connection.