bluuebunny/crossref_metadata_2025 huggingface dataset:
MITOCHONDRIAL SYSTEM BIOLOGY AS A WINDOW INTO DISEASES OF AGING
Authors: Cohen Pinchas
Published: November 2019

We identified multiple open-reading-frames (ORFs) within the mitochondrial genome. These ORFs encode putative peptides that we call Mitochondrial-Derived-Peptides (MDPs) which represent a sub-class of a growing group of novel micro-peptides (from both mtDNA and nuclear chromosomes) that serve as signals related to cell and organismal protection and energy expenditure. We described multiple peptides including humanin, SHLPs, and MOTS-c. Exploring mtDNA methylation patterns as well as mito-transcriptomics demonstrated changes in specific ORFs/MDPs in certain diseases. We developed a modified GWAS bioinformatic technique (MiWAS) that identifies SNPs within MDPs that associate with diseases of aging. MOTS-c, and MENTSH, novel anti-obesity/diabetes MDPs, harbors mutation in Asians and Native-Americans, associated with diabetes risk. Thus, MDPs are expressed in an ethno-specific fashion and may contribute to health disparities in a manner related to relevant mitochondrial DNA SNPs. In summary, MDPs are a new class of mitochondrial-hormones that have diagnostic and therapeutic potential in human disease.
NEPHROLOGY CARE AND MORTALITY RATES AMONG PATIENTS WITH END-STAGE RENAL DISEASE IN PUERTO RICO AND THE UNITED STATES
Authors: Rivera-Hernandez Maricruz , Swaminathan Shailender , Thorsness Rebecca , Lee Yoojin , Mehrotra Rajnish , Sommers Benjamin , Trivedi Amal N
Published: November 2019

Hispanics with incidence of end-stage renal disease (ESRD) have shown lower mortality despites their high incidence rates; However, prior research has excluded Puerto Rico (PR). This study compared mortality rates and predialysis nephrology care among Hispanics in the US, Hispanics in PR, and Whites in the US with ESRD from 2006-2015. We identified 791,443 patients using the Renal Management Information System. The primary outcome was age-adjusted 1-year mortality beginning with the 91st day following dialysis initiation. Secondary outcomes were the presence of arteriovenous fistula or graft at dialysis initiation, and receipt of predialysis nephrology care. Despite higher rates of insurance coverage, we identified substantial disparities in access to recommended nephrology care between PR and the US. In addition, the adjusted absolute difference in mortality rates was higher for PR Hispanics. This finding indicates shortcomings in quality of care for Puerto Rico with serious chronic illness and complex care needs.
A CROSS-NATIONAL COMPARISON OF THE SOCIAL SUPPORT NETWORKS OF OLDER MEN AND WOMEN WHO LACK TRADITIONAL FAMILY TIES
Authors: Mair Christine , Knopp Kasey
Published: November 2019

Existing literature on “aging alone” focuses on potential lack of support to “kinless” older adults who do not have traditional family ties (e.g., child, spouse; Margolis & Verdery, 2018), as well as the ways in which childless or unpartnered older adults may construct non-kin networks of support (e.g., friendship; Djundeva et al., 2018; Mair, 2019). In addition, older men’s and women’s social networks vary, with women reporting more network growth than men and potentially lower family involvement (Schwartz & Litwin, 2018). Finally, patterns of support (e.g., family care, friend interactions) differ by country context. However, it is unknown if and how the social networks of older adults who lack traditional family ties may differ by gender, as well as what forms of cross-national variation exist in these patterns. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE, N=17 nations, N=53,247 adults aged 50+), we take advantage of a unique social support network module in this cross-national dataset to compare closeness, proximity, quality, and type of ties by gender among older childless and unpartnered men and women by country. Among those without traditional family ties, we find that older women may be advantaged in terms of social support compared to older men, but that this advantage varies by nation. We discuss the details and implications of these results regarding potential policy implications about the differential risks faced by older men and women who lack traditional family ties in various country contexts.
INTEREST GROUP SESSION—HEALTH BEHAVIOR CHANGE: USING DATA ABOUT PATIENT CHARACTERISTICS TO IMPROVE FALL PREVENTION
Authors: Bergen Gwen
Published: November 2019

Over one in four U.S. older adults (age 65+) reports falling each year with fall-related medical costs estimated at $50 billion. The American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons recommends that healthcare providers assess and manage their patients’ fall risk. The Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative helps healthcare providers incorporate these guidelines by providing tools on how to screen, assess, and intervene to reduce risk. Evaluations of fall prevention have focused on the clinical process and outcomes. Understanding clinical activities is important in fall prevention but a better understanding of older adult characteristics that increase fall-risk, and attitudes that may affect their adoption of evidence-based interventions could improve the effectiveness of prevention strategies. The five presentations in this session include: 1. Demographic, health and functional characteristics of older adults with increased fall risk. 2. Caregivers of people with chronic conditions or disability as a group with increased fall risk. 3. The most effective and efficient ways of identifying older adults with increased fall risk. 4. Facilitators and barriers to older adults’ adherence to evidence-based fall interventions. 5. Applying knowledge of older adult attitudes to improving an implementation of STEADI-based fall prevention. Multifactorial fall prevention strategies such as STEADI focus on the clinical aspects of fall prevention but their success depends on understanding and incorporating older adult characteristics and attitudes. The information presented in this session can inform fall prevention strategies and improve health.
OLDER ADULT FALLS PREVENTION: THREE ADOPTED CLINICAL STRATEGIES FROM EVALUATION OF THE CDC STEADI INITIATIVE
Authors: Edwards Jennifer , Bickford Brittany , Johnston Yvonne , Alford Aaron
Published: November 2019

This evaluation examines patients’ barriers and facilitators to adopting an evidence-based fall prevention strategy. Twenty-one patients were telephone interviewed. The purposive sample includes patients over age 65, screened as at risk for falls, and who received a referral for falls risk intervention. Seven themes emerged from the qualitative analysis of interview transcripts: 1. Behavioral Facilitators, 2. Personal Fall Experiences, 3. Informed Decision-making, 4. Providers, 5. Friends and Family, 6. Home Setting Facilitators, and 7. Risk Perception. Three opportunities were identified: 1. Develop an outpatient follow-up protocol, 2. Develop a falls screening public service announcement, and 3. Partner with the local Office for Aging to connect patients at risk with community programs such as Tai Chi. A systems approach involving the CDC, National Network of Public Health Institutes (NNPHI), Broome County Health Department, and an Upstate New York hospital system’s outpatient practices was vital for the success of this evaluation.
TAKING THE HIGH (SCHOOL) ROAD: DEVELOPING INTERGENERATIONAL INTEREST FOR CAREERS IN AGING
Authors: Karasik Rona J , Greenberg Phyllis A
Published: November 2019

Invisibility and ageism are ever-present challenges to developing a work-force commensurate with the expanding older population (Augustin & Freshman, 2016). Intergenerational and experiential endeavors (e.g., Simulations, Service-Learning, Careers in Aging Week) can counter stereotypes while highlighting gerontology career opportunities. Focusing workforce development efforts on the oft-overlooked population of high school students (Zhang, 2015) has numerous advantages, including: (1) identifying aging-related career paths prior to college; (2) reaching students eligible to become CNAs/PCAs; (3) uncovering potential benefits (e.g., scholarships, tuition reimbursements) agencies may offer to student-employees and (4) countering aging stereotypes. This presentation reports on a multi-faceted undertaking which includes collaborating with local service agencies on a regional aging-workforce initiative, bringing high-school students to a college campus for CIAW events, participating in local/regional career events focused on high school students, and developing/implementing experientially-rich learning opportunities such as a college-credit bearing introductory course on aging to be taught at the high school.
TRAJECTORIES OF PHENOTYPIC MARKERS OF AGING AS PRECURSORS TO FUNCTIONAL CHANGE
Authors: Schrack Jennifer A , Kuo Pei-Lun , Simonsick Eleanor M , Resnick Susan M , Levine Morgan , Shardell Michelle
Published: November 2019

Delineating trajectories of aging phenotypes is essential to understanding mechanisms of clinical disease and disability. We investigated longitudinal changes in measures of body composition, energy expenditure, and brain volumes in >900 participants (age 67.0 (IQR: 57-77) years, 48.1% male) of the Baltimore Longitudinal Study of Aging using mixed effects regression models. Computed tomography-derived thigh muscle cross-sectional area declined 754.2 cm2 per decade at age 60 years (p<0.001) and 1294.3 cm2 at 75 years (p<0.001). Energy reserves, defined as a ratio of energy-cost-to-energy-capacity measured using indirect calorimetry, decreased 11.2% per decade at 60 years (p<0.001), and 16.8% at 75 years (p<0.001). MRI-derived measures of total brain volumes declined 41.6 cm3 per decade at 60 years (p<0.001) and 44.9 cm3 at 75 years (p<0.001). Linking these findings to biological and clinical measures of aging may contribute to more accurate assessment of phenotypic age.
ASSESSING BRAIN VOLUMETRICS IN THE AGING BRAIN USING COMPUTED TOMOGRAPHY
Authors: Irimia Andrei , Maher Alexander , Rostowsky Kenneth
Published: November 2019

Although broadly utilized, computed tomography (CT) has been superseded by magnetic resonance imaging (MRI) for the volumetric assessment of white matter (WM), grey matter (GM) and cerebrospinal fluid (CSF) in the aging human brain. Nevertheless, many scenarios remain where MRI is unavailable or discouraged; furthermore, in developing countries, CT can often be the only accessible imaging method for assessing brain structure in older patients with mild cognitive impairment or Alzheimer’s disease. Thus, there is merit in developing effective approaches for the estimation of brain volumetrics using CT. Here, MRI and CT scans were acquired from 10 older adults [mean (µ) ± standard deviation (σ) of age = 65 ± 7 yrs; 5 females]. To demarcate WM, GM and CSF from head CT, we developed a brain segmentation method based upon probabilistic, atlas-dependent classification. MRI-only segmentation was compared to CT-only segmentation; similarity was calculated through the Dice coefficient (DC). A normal distribution of DCs was found after contrasting the methods [µ ± σ across participants: 85.5% ± 4.6% (WM), 86.7% ± 5.6% (GM) and 91.3% ± 2.8% (CSF)], suggesting a satisfactory capacity of CT to assess brain volumetrics. Sensitivity was adequate: WM, GM and CSF volumes were estimated within ~5%, ~4% and ~3% of their MRI-based values. There was no indication of volume over- or under-estimation with CT [t (9) = 0.89, p > 0.80]. These results facilitate the integration of CT-based brain volumetrics with MRI, thereby offering a wider range of methods for quantifying macroscale brain changes in neurodegenerative diseases.
THE HIGH COST OF SOCIOECONOMICS ON RACIAL DISPARITIES IN HEALTHY AGING
Authors: Shaffer Nancy Chiles
Published: November 2019

Race-related differences in overall health across the age-span are well established; how differences manifest within a cohort selected for good functional status is unclear. Using data from Black and White older adults aged 70-79, in the Health, Aging and Body Composition (Health ABC) study, we created a healthy aging index (HAI) of mental health, fitness, lung capacity, bone mineral density, inflammation, and metabolic syndrome. We assessed if racial differences existed in HAI, the extent education, financial resources and stress attenuated any observed differences, and whether this varied by site (Memphis v. Pittsburgh). Blacks had lower HAI than whites, adjusted for age and site. Further adjustment for finances and education eliminated the effect of race in women and reduced the effect in men by 64%. A significant interaction between site and financial stress was observed. Future research should assess ways to reduce the harmful impact of low socioeconomic status on health.
RECRUITING LGBT OLDER ADULTS FOR RESEARCH
Authors: Prasad Anyah , Fisher Alice , Immel Michael , Boerner Kathrin , Jethwani Kamal , hale Timothy , Centi Amanda
Published: November 2019

LGBT older adults constitute a rare population and so are methodologically difficult to recruit. Due to stigma, many of them may not disclose their sexual/gender identity, which makes it challenging for researchers to reach out to them. Due to history of discrimination, LGBT older adults may not trust researchers. The purpose of this presentation is to discuss strategies used to recruit LGBT older adults to a study on exploring the idea of an online senior center for LGBT older adults in Massachusetts. Building a rapport with community stakeholders, developing trust and having LGBT older adults themselves as part of the research team were important tools to help overcome these challenges. LGBT older adults are very diverse and focused efforts should be made to recruit them from various racial/ethnic backgrounds, rural areas; also, those who are not publicly open about their identity, and who are home bound due to restricted mobility.
RECRUITING FAMILY CAREGIVERS OF PERSONS LIVING WITH DEMENTIA FOR PARTICIPATION IN AN ONLINE INTERVENTION
Authors: Brewster Glenna , Epps Fayron , Nash Rachel , Griffiths Patricia , Phillips Janice , Nocera Joe , Shah Raj , Hepburn Kenneth
Published: November 2019

Responsibilities of caregiving for persons living with dementia make it challenging to participate in in-person research studies. Caregivers may be more willing to participate in studies that are online. This presentation will highlight recruitment strategies of a 4-site telehealth caregiver intervention for caregivers of persons living with dementia. Thus far, we have recruited 596 participants over the period of 2 years: 76, 189, 164 and 167 from each of the sites, respectively. Community partnership strategies such as presentations at churches and events organized by the Alzheimer’s Association, and the Alzheimer’s Disease Research centers, using a handshake protocol, and using social media sites such as Facebook and Twitter have all been effective at recruiting participants. Ongoing communication among the staff at different sites is also an important aspect of successful recruitment. These strategies have enabled recruitment to continue at a consistent rate and enabled the maintenance of relationships within the community.
ASSESSMENT OF COMPARATIVE EFFECTIVENESS RESEARCH GAPS TO PROMOTE AGING IN PLACE: A STAKEHOLDER-DRIVEN APPROACH
Authors: Moscou-Jackson Gyasi , Gummi Sindhura , Clauser Steven B , Arora Neeraj K
Published: November 2019

A priority for many older adults is to remain in their homes and communities. This paper describes the Patient-Centered Outcomes Research Institute’s (PCORI) review of our investment in comparative effectiveness research (CER) that will advance the field of “aging in place.” To inform our systematic evaluation, we first engaged our multi-stakeholder advisory panel of patients/caregivers, clinicians, health systems leaders, and payers to develop and refine a conceptual framework for research focused on aging in place among older adults. Key themes from stakeholders were: aging in place interventions should be patient-centered and align with the patients’ needs and goals, studies should include individuals 55+ years who may be at risk for institutionalization, relevant interventions go beyond environmental modifications and include social support, healthcare (inclusive of palliative care), and personal care services. In addition, aging in place services should focus more on informal caregiver interventions and outcomes since informal caregivers play a major role in enabling older adults to age in place. We identified 14 PCORI-funded CER projects that will provide evidence on the most effective interventions to promote aging in place among older adults; the total investment is $113.4 million dollars. The portfolio is addressing decisional dilemmas faced by multiple stakeholders on a variety of topics including falls prevention, home-based palliative care, and community-based care models; however, several critical CER evidence gaps remain that need to be addressed in future funding investments and will be discussed during the presentation.
THE RELEASE OF TECHNICAL QUALITY AND PATIENT EXPERIENCE STAR-RATINGS FOR HOME HEALTH AGENCIES AND AGENCY SELECTION
Authors: Schwartz Margot L , Rahman Momotazur , Thomas Kali S , Konetzka R Tamara , Mor Vincent
Published: November 2019

To facilitate informed Home Health Agency (HHA) selection for the 3.5 million annual Medicare home health (HH) users, CMS introduced technical quality and patient experience summary star-ratings on the Home Health Compare website in July 2015 and January 2016. There is no information about the relationship between the introduction of these two unique sets of star-ratings and HHA selection. We utilized a conditional logit, discrete choice model, which accounts for all HHAs that each patient could have selected (their “choice-set”) based on ZIP codes, to assess this relationship. We selected a random 5% sample (203,966 admissions) of new Medicare Fee-for-Service HH admissions that occurred in the year before, or the year after star-ratings were released. Star-ratings were obtained from the HH Compare website and categorized as low (=4 stars). We found the introduction of HHA star-ratings was associated with an increased likelihood of selecting an HHA with a high technical quality star-rating, and a decreased likelihood of selecting an HHA with a high patient experience star-rating. After controlling for each patient’s choice-set, patients had 19% increased odds (OR 1.19, 95% CI:1.16,2.23) of selecting a high technical quality HHA and a 12% decreased odds (OR 0.88, 95% CI:0.84,0.92) of selecting a high patient experience HHA, compared to low quality HHAs. Findings suggest patients and referring providers may prioritize technical quality over patient experience. Policy-makers should provide resources to enable HH patients to utilize and interpret the two different HHA star-ratings.
DIGITAL MONITORING OF SLEEP, MEALS, AND EXERCISE AS A PREVENTIVE INTERVENTION FOR DEPRESSION IN BEREAVED SPOUSES
Authors: Stahl Sarah
Published: November 2019

The death of a spouse brings profound change to bereaved survivors’ lifestyle and daily routine. These changes disrupt circadian rhythms which, in turn, places individuals at high risk for depression. The purpose of this study is to examine the feasibility and acceptability of a 12-week behavioral intervention that targets the timing and regularity of sleep, meals, and physical activity via digital monitoring and motivational health coaching. Participants were 60+ years of age and assessed on intervention acceptability and adherence, depression symptoms (Hamilton Rating Scale for Depression) and the rest-activity rhythm, (a downstream indicator of the body’s circadian rhythm (via actigraphic technology). The intervention was rated highly by participants (n=55); 88% were compliant in digital monitoring and 95% were retained. Depression symptoms declined from pre-to post-intervention; and the regularity of circadian rhythms increased. An intervention that targets the regularity of day- and nighttime activities may reduce depression in older spousally-bereaved adults.
HARNESSING THE NETWORK OF GERONTOLOGY IN HIGHER EDUCATION TO IMPROVE RECRUITMENT STRATEGIES
Authors: Eaton Jacqueline , Neal Margaret B
Published: November 2019

While the workforce requires applicants trained to meet the needs of an aging population, many gerontology programs find recruiting students a challenge. Barriers to enrollment vary and are influenced by disciplinary silos, miscomprehension of terminology (such as “gerontology”), vague career paths, and limited resources. Program directors are challenged to identify innovative and new strategies that market training opportunities at a variety of levels and across colleges and departments. In an effort to harness the power of networks, it is our goal that this symposium fosters discussion in order to improve our communal approach to increase the number of individuals prepared for careers in aging. This symposium examines the recruitment experiences and challenges from the perspective of gerontology programs at four universities. Fruhauf (Colorado State University) explores the importance of university-community engagement in support of gerontology programs. Fauth and Liu (Utah State University) describe effective recruitment strategies for an interdisciplinary gerontology certificate housed within a department of Human Development and Family Studies. Eaton (University of Utah) presents the outcomes from a targeted initiative to increase early undergraduate enrollment in an interdisciplinary online gerontology minor. Finally, Yorgason (Brigham Young University) shares a systematic approach to leverage resources and fundraising that successfully increased program enrollment and faculty involvement throughout campus. Dr. Margaret B. Neal, an experienced educator and former director of the Institute on Aging at Portland State University, will facilitate discussion surrounding how we can mobilize our networks to strengthen, innovate, and expand approaches to recruitment in gerontology.
RE-IMAGINING LTC: QUANTITATIVE AND QUALITATIVE RESULTS OF A NATIONAL MODIFIED DELPHI STUDY, IMPLICATIONS AND NEXT STEPS
Authors: Kane Rosalie A , Degenholtz Howard
Published: November 2019

In 11/2016 Robert and Rosalie Kane began a 3-round Delphi study to re-imagine long-term care (LTC), , which took as a starting premise that LTSS in the United States fails to comport to the values and preferences of consumers. The Delphi study is “modified” from more typical Delphi designs because of 1) a sample sizes over 100, 2) an unusually broad topic--optimal LTC systems if not constrained by existing programs, financial arrangements and regulations; and 3) incorporation of new sample at each round. Round 1 asked respondents to rate and add to a list of values important to LTC< but largely was an open-ended request for respondents’ ideas, Round 2 was fielded in 6/2018 with all data collection completed by 11/2018 (the delay partly due to Robert Kane’s sudden death on March 6, 2017 and also the time needed to analyze, summarize and present the complex and detailed responses to the first round). Round 3, to be fielded in 4/2019., will provide participants with the ratings of values, principles and programmatic building blocks at Round Two, and the open-ended comment of respondents in explanation of their ratings. Each Round is analyzed cross-sectionally and can be considered a separate “virtual town square.” Ellen McCreedy and Rosalie Kane, respectively, present quantitative and qualitative results from the first two rounds. Discussants will each comment briefly from their perspectives as 1) state LTC policy developer,2) LTC university-based researcher; 3) consumer advocate, followed by audience and presenter discussion of the implications of the findings.
GRANDPARENTING CHILDREN WITH DISABILITIES AND ITS IMPACT ON GRANDPARENT HEALTH
Authors: Abdul-Malak Ynesse , Meyer Madonna Harrington
Published: November 2019

Across the US, millions of grandparents are providing vital care for their grandchildren with disabilities when their adult children are in need of assistance and public programs do not provide needed supports. Research suggests the impact on grandparent physical health is mixed. This paper draws on in-depth interviews with 50 grandparents to explore how caring for grandchildren with disabilities shapes their physical wellbeing. We use life course perspective to assess the choices grandparents make from available resources and options at different stages of their lives and the effects on their health. We find in addition to providing routine care, helping with feeding, bathing, and dressing, some grandparents provide constant supervision and medically intense care, such as tending to feeding tubes, catheters, and oxygen lines. Many grandparents said care work has improved, or at least helped sustain, their overall level of fitness, while other grandparents find that care work has adverse impacts. Often there is too much chasing, bending, and lifting for their aging bodies. This paper suggests that stronger social programs for children with disabilities and the grandparents who step in to help them would decrease the negative effects of care work on grandparent health.
DOES PERCEIVED LONELINESS MATTER FOR DIVERSE OLDER MEN AND THEIR PROSTATE-SPECIFIC-ANTIGEN TESTING BEHAVIORS?
Authors: Cadet Tamara J , Burke Shanna L , Mitchel Jamie , Conner Kyaien , Nedjat-Haiem Frances
Published: November 2019

Evidence suggests loneliness is associated with poorer health practices and fewer health promoting behaviors, yet may be associated with greater use of the healthcare system. This dichotomy highlights the lack of understanding in the literature about the relationship between the experience of loneliness in early disease detection behaviors, such as prostate cancer screening and appropriate clinical interventions to support older men. Utilizing a series of logistic regression models, this investigation examined the relationship between loneliness and prostate cancer screening in 2008 and 2012 among White, Black, and non-Hispanic men, ages 50-74 years, (n= 4,875 for 2008 and 7.063 for 2012). The data source as the Health and Retirement Study. Findings indicate that White men were less likely to participate in PSA screening in 2008 if they felt left out or isolated. There was a reduced likelihood of screening among Black men who feel as though they have a lot in common with those around them in 2012. Utilizing approaches such as cognitive-behavioral therapy, motivational interviewing, and solution-focused practice, clinical social workers can have shared decision-making conversations to understand this phenomenon. Clinical social workers have unique training in the person-in-environment model that emphasizes the biological, psychological, social, and spiritual factors that influence behaviors such as cancer screening participation, that can help to understand men’s experiences, feelings or needs related to cancer screening participation. Given the lack of focus on men’s, this study provides formative data to test interventions to increase the well-being of older men.
RESTING HEART RATE MODERATES THE RELATIONSHIP BETWEEN NEUROPSYCHIATRIC SYMPTOMS, MCI, AND ALZHEIMER’S DISEASE
Authors: Burke Shanna L
Published: November 2019

Little is known about how resting heart rate moderates the relationship between neuropsychiatric symptoms and cognitive status. This study examined the relative risk of NPS on increasingly severe cognitive statuses and examined the extent to which resting heart rate moderates this relationship. A secondary analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was undertaken, using observations from participants with normal cognition at baseline (13,470). The relative risk of diagnosis with a more severe cognitive status at a future visit was examined using log-binomial regression for each neuropsychiatric symptom. The moderating effect of resting heart rate among those who are later diagnosed with mild cognitive impairment (MCI) or Alzheimer’s disease (AD) was assessed. Delusions, hallucinations, agitation, depression, anxiety, elation, apathy, disinhibition, irritability, motor disturbance, nighttime behaviors, and appetite disturbance were all significantly associated (p<.001) with an increased risk of AD, and a reduced risk of MCI. Resting heart rate increased the risk of AD but reduced the relative risk of MCI. Depression significantly interacted with resting heart rate to increase the relative risk of MCI (RR: 1.07 (95% CI: 1.00-1.01), p<.001), but not AD. Neuropsychiatric symptoms increase the relative risk of AD but not MCI, which may mean that the deleterious effect of NPS is delayed until later and more severe stages of the disease course. Resting heart rate increases the relative risk of MCI among those with depression. Practitioners considering early intervention in neuropsychiatric symptomology may consider the downstream benefits of treatment considering the long-term effects of NPS.
CARDIOVASCULAR RISK MODERATES THE EFFECT OF RESISTANCE TRAINING ON PHYSICAL PERFORMANCE IN OLDER ADULT WOMEN
Authors: Marcotte Lauren , Barha Cindy , Liu-Ambrose Teresa
Published: November 2019

We aimed to examine whether the Framingham Cardiovascular Risk Profile Score (FCRP) moderates the effect of progressive resistance training (RT) on mobility in older adult women. This is an exploratory analysis of a single-blind, 12-month randomized controlled trial in 155 omen, aged 65 to 75 years old, who were randomized to: 1x/week progressive RT; or 2x/week progressive RT program; or 2x/week balance and tone (BAT). At baseline and trial completion, mobility was measured using the Short Physical Performance Battery (SPPB). The SPPB is a composite measure of usual gait speed, standing balance, and sit to stand performance; scores < 9/12 are indicative of functional decline. Baseline 10-year cardiovascular risk was calculated using the FCRP. Participants were classified as either low risk (<16.5% FCRP score; LCVR) or high risk ≥16.5% FCRP score; HCVR). A complete case analysis (n=126) was conducted using a two-way analysis of covariance (ANCOVA) to evaluate the interaction effect of group by FCRP risk on SPPB scores at trial completion; baseline SPPB scores and age in years were entered as covariates. There was a significant interaction effect (F(1,126)=3.74, p=0.027). At trial completion, both 1x/RT and 2x/RT participants with HCVR demonstrated greater SPPB scores than those with LCVR (11.59 vs. 11.38 for 1x/week; 11.86 vs 11.46 for 2x/week). In contrast, BAT participants with HCVR demonstrated worse SPPB scores than those with LCVR (11.18 vs 11.66). Our data suggest that RT may be more efficacious for improving mobility in older women with higher cardiovascular risk than women with lower risk.
BILINGUAL SPEAKERS POSTPONE SYMPTOMS OF COGNITIVE DEFICIT IN PARKINSON’S DISEASE
Authors: Saidi Ladan Ghazi
Published: November 2019

Maintaining cognitive abilities despite healthy aging, neurodegeneration or acute damage is known as cognitive reserve (Stern, 2002; Stern, et. al., 2018). There is evidence for a higher cognitive reserve in bilingual speakers (Kavé, et. al., 2008), mainly due to their improved executive functioning and attention. Thus, I hypothesized that patients with Parkinson’s disease would manifest PD related cognitive symptoms later than monolinguals as a result of better compensation. The aim of this study is to explore how bilingualism affects cognitive abilities in PD patients with cognitive deficit. QPN publicly available database was used to analyze the data on PD patients with (PD-CD) and without (PD) cognitive deficit and their demographic information including the number of spoken languages. Monolingual PD and PD-CD patients were compared to their bi- and multilingual peers on their age of on-set of their cognitive decline as well as descriptive demographic information. The results showed that PD-CD patients who speak more than one language manifest symptoms of cognitive impairment at least three years later than their monolingual peers. These results bring evidence that life-long bilingualism contributes to a stronger cognitive reserve and better compensation in case of a neurodegenerative disorder such as PD.
BLOOD THICKER THAN WATER? STEPGAP IN INTERGENERATIONAL RELATIONSHIPS
Authors: Öberg Peter , Bildtgard Torbjorn
Published: November 2019

The increasing prevalence of ageing stepfamilies and stepchildren’s potential to act as a source of support for older parents has prompted research about intergenerational cohesion in step-relationships. Previous research has hypothesized a qualitative gap (a step-gap) between step and biological relationships to the advantage of the latter. In this Swedish study we compare emotional closeness between older parents and adult children among parents (aged 66-79) who have had both biological and stepchildren, and children (aged X-Y) who have had both biological and stepparents. Qualitative interviews (n=24) of family histories including a hierarchical convoy model of family relationships were collected and analyzed. Results show that with few exceptions biological relationships are rated as emotionally closer than step-relationships, both by parents and adult children, supporting the step-gap hypothesis. While the older parents tend to deemphasize the importance of blood for their ratings, the adult children often emphasize the importance of blood. The difference is explained by a parental adherence to an ideology of equal treatment of children, while the adult children stress the importance of biology for their identity and belonging.
ATTITUDES TOWARD PARENTAL FINANCIAL SUPPORT OF YOUNG-ADULT CHILDREN
Authors: Svynarenko Radion
Published: November 2019

Studies have shown that Americans do not save enough for retirement because they prioritize providing support of their young-adult children over saving for retirement. Attitudes toward parental support has been largely overlooked in existing literature. Using a factorial vignette experimental design and a sample of 500 Americans of age 40 and older, this study investigated how manipulation of contextual factors changed endorsement of parental support. This study found that endorsement of parental support varied depending on the goal of support, whether it was to purchase a car, pay for school tuition, or to pay for down payment for a house. Thus, 67% of respondents endorsed parental financial assistance with purchasing a car, 44% endorsed down payment for a house, and only 38% endorsed paying for college tuition, reflecting overall social importance of these three elements in becoming an adult person. Gender of the child did not affect endorsement of parental financial support to adult children, indicating that there were no gender specific social expectations of who should receive more support from parents, daughters or sons. The major motives of parental support included (a) desire to be a “good parent” and to take responsibility for the child, (b) expectation that children would eventually pay back their parents, and (c) desire to make sacrifice for own children. Parental support may provide numerous benefits to both children and their parents; however, it is important to educate parents on ways to support their children without threatening their own financial needs in retirement.
GAMEPLAN4CARE: AN ONLINE TRANSLATION OF REACH II REFINED THROUGH EARLY STAKEHOLDER USABILITY TESTING
Authors: Cho Jinmyoung , Stevens Alan B , Birchfield Thomas , Sanghi Sandhya , Vernon Ashley , Ory Marcia G
Published: November 2019

Despite a number of evidences on the implementation of multicomponent education and support programs to improve the lives of dementia caregivers, there is still a need to adapt these interventions to various implementation settings and preferences of a new generation of caregivers. In this study, we present the development and usability testing of a dementia caregiver support program, GamePlan4Care (GP4C), an online translation of the Resources for Enhancing Alzheimer’s Caregiver Health II (REACH II) intervention. The goal of the GP4C is to create an online family caregiver support system that would facilitate delivery of an evidence-based skills-training and support for dementia caregivers with the potential of both scalability and sustainability. GP4C includes the full breadth of REACH II education and skill-building materials, delivered within an automated, online platform with integrated support from a Dementia Care Specialist via telephone/video conferencing. Dementia caregivers, community agency staff, and other experts are involved in usability testing to ensure acceptability of this new approach to intervention delivery. The software development is completed and usability testing is currently underway. The feasibility and success of this new modality of intervention delivery will be made possible by an innovative intervention design supported by appropriate technical and content elements. We will also present the strategies employed to adapt the intervention to an online platform capable of supporting caregiver self-directed exposure to therapeutic content, the results of usability testing with approximately 32 caregivers, and feedback from other external stakeholders on the feasibility of this approach.
RATES OF HOSPITALIZATION AND EMERGENCY DEPARTMENT VISITS AND THE QUALITY OF NURSING HOMES IN THE U.S.
Authors: Breunig Ian , Zheng Qing , White Alan , Williams Christianna , Muma Allison
Published: November 2019

CMS strives to reduce costs and improve care for nursing home (NH) residents by reducing acute care transfers. We used a national database of Medicare claims and the Minimum Data Set to build NH stays from July 2017 through June 2018 and identify dates of hospital admissions and emergency department visits without hospitalization (ED) among all residents. We calculated rates of 30-day re-hospitalization and ED among short-stay (rehabilitation) residents, and the number of hospitalizations or ED per long-stay resident day (LSRD), then examined associations with NH Five-Star ratings (data.medicare.gov) and other provider characteristics available from Medicare administrative data. We identified 1.79 million short-stays and 898,290 long-stays at 15,576 NHs. Nationally, the 30-day re-hospitalization rate is 22.6%, the short-stay ED rate is 12.0%, there was one hospitalization every 561 LSRD (1.8 per 1000 LSRD), and there was one ED every 617 LSRD (1.6 per 1000 LSRD). Median facility rates were 22.3% (IQR=17.8%, 27.1%) for 30-day re-hospitalizations, 12.0% (IQR=8.7%, 16.1%) for short-stay EDs, 1.6 hospitalizations per 1000 LSRD (IQR=1.1, 2.3), and 1.4 ED per 1000 LSRD (IQR =0.9, 2.2). Higher rates were strongly associated with lower Five-Star ratings, particularly staffing ratings, and larger, for-profit, non-hospital facilities; even after risk-adjustment. NH variation and associations with provider characteristics suggest it is possible to further reduce acute care transfers. CMS incorporated these measures into the Five-Star rating system, providing greater transparency for residents and possibly incentivizing NHs to improve through competition. Future research should monitor success or identify the need for other avenues to improve.
THEORY-DRIVEN ROLE MODEL STORIES’ EFFECTIVENESS IN IMPROVING PALLIATIVE CARE KNOWLEDGE AMONG A DIVERSE POPULATION
Authors: Hoe Deborah , Rahman Anna , Johari Kayla , Enguidanos Susan
Published: November 2019

Palliative care, specialized medical care for seriously ill people, has been demonstrated to reduce pain and symptoms while increasing satisfaction with health care. Yet, national surveys show that less than 10% of people are aware of palliative care, and among these, many believe it to be synonymous with hospice. The purpose of this study is to determine the effectiveness of 3-minute long theoretically-driven role model video stories at improving knowledge of palliative care. We recruited 161 adults age 50 and older from senior centers, assisted living, and other community-based sites. Pretest-posttest study design was employed and each participant completed 20 question surveys about palliative care knowledge, intent to seek palliative care, and perceptions about the videos. We also recorded participants’ opinions of the videos. Regression analysis was conducted to test the effectiveness of the role model video stories and qualitative analysis to elicit the major themes in participants’ opinions. Overall, palliative care knowledge score (max=13) improved from an average of 4.64 to 9.99 (t=11.99, p<0.001). Two-sample t-test revealed no significant difference in change of score by race. Regression analysis revealed that belief in the role models as real people and participants with 12 years of education significantly predicted higher change in knowledge scores. Conversely, being non-white and widowed were significant predictors of lower changes in score. Qualitative analysis of participants’ perspectives revealed two major positive themes: authenticity and informativeness of videos. This study suggests that theoretically-driven role model video stories may be an effective strategy to improve palliative care knowledge.
CHANGES IN THE MEDICARE HOME HEALTH CARE MARKET: THE IMPACT OF ACA REIMBURSEMENT POLICY
Authors: Torain Jamila M , Davitt Joan , Bright Charlotte L , Miller Nancy , Chard Sarah , Orwig Denise
Published: November 2019

This study evaluated the effect of recent ACA changes to Medicare Home Health Care (HHC) reimbursements on the mix of agencies and staff in the HHC market. We used Provider of Services (POS) data and logistic regression, to determine which agency characteristics were associated with the likelihood of exiting the HHC market and likelihood of decreasing staff before (n=13,878) and after (n=13,702) implementation of the ACA-mandated reimbursement cuts. Free standing agencies had 1.35 times the odds of exiting from the HHC market post ACA cuts. There were no differences in the odds of exiting the HHC market between for-profit and non-profit agencies. Agencies in the New York, Atlanta, and Chicago regions had a greater likelihood of exiting the HHC market post ACA cuts. Small agencies had two times the odds of exiting (aOR= 2.09) and agencies with one or more branch had less than half the odds of exiting (aOR= 0.46) from the HHC market. The average number of all staff was similar before and after the ACA cuts; however, office staff and home health aides experienced the greatest decrease in number. Agencies that were for-profit, free-standing, small, and/or with one or more branch were more likely to decrease staff post the ACA cuts. Agencies in the New York, Atlanta, Chicago, Dallas and Kansas regions were more likely to decrease staff. Overall, the reimbursement cut effects varied by geographic region and had greater impact on more vulnerable agencies and staff that were non-skilled.
METHODOLOGICAL STRATEGIES AND CHALLENGES FOR EVALUATING PARTICIPANT VIEWS ON DEMENTIA RESEARCH RECRUITMENT
Authors: Block Laura , Mullen Shannon , Thomas Gay , Kaiser Betty , Gilmore-Bykovskyi Andrea
Published: November 2019

There is an urgent need to expand enrollment in clinical Alzheimer’s disease (AD) research. Current recruitment methods for AD research predominantly identify patients from primary/specialty clinic settings, potentially creating barriers for individuals unconnected to care. In response to these challenges, the 2018 National Strategy for Research Recruitment and Participation has called for the development of an applied science of recruitment to inform best strategies. However, progress in this area is hindered by methodological challenges to accurately measure AD patient/caregiver participant views on research participation. The objective of this presentation is to report methodological strategies developed to during a prospective qualitative study to investigate AD patient/caregiver views on acute care research recruitment and participation. Participants included patients with dementia (N=2) who had recently been hospitalized and/or their informal caregivers (N=15). We engaged in iterative development and revision of data collection approaches (i.e. semi-structured questions, audiovisual tools, interview guidance) through collaboration with a Community Advisory Board (CAB). Detailed memos were generated to document interview-related challenges, successes and revisions. Therapeutic misconception in delineating research from clinical care was common during interviews regardless of prior research participation. Interview strategies that focus on lived experiences, remove ambiguity from hypothetical recruitment scenarios, and incorporate supportive visual tools that clarify processes around recruitment improved data collection. Challenges included the lack of a common, shared language around recruitment, which was addressed through CAB guidance and input. In conclusion, thoughtful collaboration with community/lay advisers can successfully inform and data collection methods used in applied recruitment research.
SUCCESSFUL AGING AND HEALTHCARE SERVICE UTILIZATION IN EAST ASIA: NATIONAL COMPARISONS OF CHINA, KOREA, AND JAPAN
Authors: Cho Jinmyoung , Nakagawa Takeshi , Yeung Dannii
Published: November 2019

As the older population increases and lives longer, the demand for healthcare has been increased dramatically. To date, it is unknown whether older people’s healthcare utilization varies between countries and how it relates to successful aging. Using Rowe and Kahn’s model, we examine cross-national differences in the relationship between successful aging and healthcare service utilization in East Asia. Harmonized datasets at baseline from China Health and Retirement Longitudinal Study (CHARLS), Korean Longitudinal Study (KLoSA), and Japanese Study on Aging and Retirement (JSTAR) were used. Including 7,651 participants (aged 65-75 years), successful agers were identified using Rowe and Kahn’s criteria (i.e., no disease, no disability, high cognitive function, and active engagement). Healthcare service utilization includes hospital visit, number of hospital stay, number of nights per hospital stay, regular medical center visit, number of medical center visits, and possession of private insurance in previous year. Generalized linear models showed that successful agers’ healthcare service utilization is significantly different from non-successful agers (e.g., OR=2.19, p<.001 for regular medical center visits), and Korean and Chinese healthcare service utilization is different from Japanese (e.g., OR=0.44 and OR=10.18 for Chinese and Korean number of medical center regular visits, respectively, p<.001). Furthermore, the number of nights in hospital among Chinese and Korean successful agers tend to be greater than that of Japanese successful agers (OR=2.93 and OR=1.99 for Chinese and Korean successful agers, respectively, p<.001). This study indicates cross-national variations in pattern of healthcare service utilization between successful and non-successful agers in East Asia.