bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining How African American Family Dementia Caregivers Conceptualize and Manage Crisis Events
Authors: Cotton Quinton , Block Laura , Morgan Jennifer , Gilmore-Bykovskyi Andrea
Published: December 2020

African American (AA) family dementia caregivers report high unmet needs, which often culminate in crisis – an unplanned stressful situation requiring immediate decision. However, perspectives from AA caregivers regarding crisis are lacking. To gain insight into caregivers’ conceptualization and experiences of crisis, we used community/coalitional-based recruitment of AA caregivers to conduct semi-structured interviews with 34 AA caregivers which were analyzed using thematic analysis (N=34, 94% female, 56% ages 65 to 74). AA caregivers largely perceived crisis as stressful events, a normal part of caregiving and viewed management of these events as routine. Crisis was characterized as ongoing, lengthy or emergent, sometimes necessitating external support (.e.g. hospitalization). Caregivers managed crisis by increasing caregiving work, de-prioritizing their own health and needs, involving family and friends, and accessing emotional support through neighborhood connections. These perspectives can inform future culturally-tailored interventions that are responsive to AA strengths, values, and help seeking preferences.
Impact of Fear of Falling on Future Falls and Changes in Physical Activity in Older Adults With Glaucoma
Authors: Ramulu Pradeep , E Jian-Yu , Mihailovic Aleksandra , Kuo Pei-Lun , West Sheila , Gitlin Laura , Li Tianjing , Schrack Jennifer
Published: December 2020

To understand how Fear of falling (FoF) alters mobility, FoF was evaluated annually in 243 older adults (median age=70) with varying degrees of visual field loss from glaucoma, and Rasch-analyzed FoF scores associated with the likelihood of falling in the following year (judged by prospective calendar data) and changes in physical activity (Judged by annual accelerometer trials). At lower FoF levels, each one-unit worsening in FoF was associated with a 2.73-fold higher odds of reporting a fall in the next year (95% CI:1.55,4.81) but not with average daily steps taken (p = 0.44). At higher FoF levels, inter-year changes in FoF were not significantly associated with a fall in the next year (p = 0.78); but were associated with 407 fewer daily steps taken per one-unit change in FoF (95% CI:-743,-71). FoF is an important driver of mobility; the specific aspects of mobility affected varies by the degree of FoF.
Creating and Keeping Exercise Gains Into Your 70s, 80s and 90s
Authors: Manning Kenneth , Kopp Teresa , Oursler Kris ann , McDonald Michelle , Morey Miriam , Hall Katherine , Lee Cathy , Giffuni Jamie
Published: December 2020

Background: Gerofit, an exercise program for older Veterans, is undergoing national dissemination (17 sites in 6 years). Four sites have accrued 4-year functional outcomes (gait speed, 8-foot-up-and-go, 30-second chair stand, and six-minute walk). Methods: Functional assessments were administered quarterly in first year and annually thereafter. Individuals with baseline and at least two follow up measures were included for analysis (n=587). Means were gathered across each timepoint. Results: Mean values for functional assessments from baseline to 4 year were as follows: gait speed m/s- 1.04, 1.12, 1.13, 1.13, 1.09, 1.07, 1.13; 8 ft-up-and-go seconds- 7.6, 6.82, 6.69, 6.69, 7.29, 7.29, 7.51; 30 second chair stands 11.88, 14.06, 14.72, 14.89, 14.69, 14.71, 14.96; and six-minute-walk yards- 499, 532, 541, 544, 531, 530, 556. All follow up measures were significantly improved over baseline (P<.01) and superior to normative age-related decline. Implications: Results indicate that exercise promotes compression of morbidity and improved functional health.
One Song, Many Voices: Dementia and The Power of Music
Authors: Sheets Debra , MacDonald Stuart , Smith Andre
Published: December 2020

Choral singing is a novel approach to reduce dementia stigma and social isolation while offering participants a sense of purpose, joy and social connection. The pervasiveness of stigma surrounding dementia remains one of the biggest barriers to living life with dignity following a diagnosis (Alzheimer Society of Canada, 2018). This paper examines how a social inclusion model of dementia care involving an intergenerational choir for people living with dementia, their care partners and high school students can reduce stigma and foster social connections. Multiple methodologies are used to investigate the effects of choir participation on cognition, stress levels, social connections, stigma, and quality of life. Results demonstrate the positive impact of choir participation and indicate that this socially inclusive intervention offers an effective, non-pharmacological alternative for older adults living with dementia in the community. Discussion focuses on the importance of instituting meaningful and engaging dementia-friendly activities at the community level.
Leveraging Existing Data from CMS-Linked Cohort Studies for the Advancement and Translation of Frailty Research
Authors: Xue Qian-Li , Ensrud Kristine , Lin Shari
Published: December 2020

As population aging is accelerating rapidly, there is growing concern on how to best provide patient-centered care for the most vulnerable. Establishing a predictable and affordable cost structure for healthcare services is key to improving quality, accessibility, and affordability. One such effort is the “frailty” adjustment model implemented by the Centers for Medicare & Medicaid Services (CMS) that adjusts payments to a Medicare managed care organization based on functional impairment of its beneficiaries. Earlier studies demonstrated added value of this frailty adjuster for prediction of Medicare expenditures independent of the diagnosis-based risk adjustment. However, we hypothesize that further improvement is possible by implementing more rigorous frailty assessment rather than relying on self-report of ADL difficulties as used for the frailty adjuster. This is supported by the consensus and clinical observations that neither multimorbidity nor disability alone is sufficient for frailty identification. This symposium consists of four talks that leverage data from three CMS-linked cohort studies to investigate the utility of assessment of the frailty phenotype for predicting healthcare utilization and costs. Talk 1 and 2 use data from the NHATS cohort to assess healthcare utilization by frailty status in the general population and the homebound subset. Talk 3 and 4 use data from the MrOS study and the SOF study to investigate the impact of frailty phenotype on healthcare costs. Taken together, their findings highlight the potential of incorporating phenotypic frailty assessment into CMS risk adjustment to improve the planning and management of care for frail older adults.
Physical Frailty, Cognitive Impairment, and Healthcare Utilization in Linked Cohort and Claims Data
Authors: Buta Brian , Sheehan Orla , Chung Shang-En , Blinka Marcela , Xue Qian-Li
Published: December 2020

Accurate prediction of healthcare utilization is an important issue for Medicare managed care organizations. We hypothesized that physical frailty and cognitive impairment increase the risk of healthcare utilization in older adults receiving Medicare coverage, independent of age and multimorbidity. We used the marginal means/rates model to investigate the association between baseline cognitive impairment with/without frailty (using the physical frailty phenotype), vs. frailty alone, in NHATS and the number of incident non-ER-related hospitalizations and emergency room (ER) visits within 12 months in linked Medicare claims data (N=3,915). After covariate adjustment, physical frailty alone was predictive of both non-ER-related hospitalizations (HR=1.77; p=0.012) and ER visits (HR=1.75; p<0.001). Cognitive impairment with or without frailty was only associated with ER visits (HR=1.53, p=0.002; HR=1.30, p=0.001). Our findings support the value of physical frailty and cognitive impairment assessment above and beyond multimorbidity to improve the prediction of care utilization for vulnerable subgroups of Medicare beneficiaries.
Occupational Complexity and Late-Life Global Cognition: The SONIC Study
Authors: Ishioka Yoshiko , Gondo Yasuyuki , Masui Yukie , Nakagawa Takeshi , Inagaki Hiroki , Ogawa Madoka , Yasumoto Saori , Ishizaki Tatsuro
Published: December 2020

Studies have reported that work exposure to cognitively demanding environments predicted the level of late-life cognitive abilities. To date, whether or not such a relationship between work complexity and cognitive function is maintained in very old adults remains unknown. In the present study, we examined how the associations between lifetime work’s complexity and global cognition vary by age groups (70s, 80s, and 90s). To this end, we used data from 2754 Japanese community-dwelling participants in the SONIC Project. Specifically, we tested multiple group path models comparing the models based on differences in age and gender. The effects of work complexities on global cognition were found for male septuagenarians and octogenarians, having controlled for the variables related to education. The relationships between them were marginally significant for male nonagenarians. Based on the analysis, we discuss the maintenance of cognitive reserve and implications for cognitive and physical health in very old ages.
Greater Perceived Physical Fatigability Is Associated with Lower Cognition: The Long Life Family Study
Authors: Gmelin Theresa , Rosso Andrea , Andersen Stacy , Cosentino Stephanie , Wojczynski Mary , Christensen Kaare , Boudreau Robert , Glynn Nancy
Published: December 2020

Greater perceived physical fatigability is associated with physical functional decline, but few studies have examined its relation with cognition. Adults ≥60 (mean±SD age 73.7±10.5, 54.7% female, 99.6% white) from the Long Life Family Study (n=2355) completed the Pittsburgh Fatigability Scale (PFS, 0-50, higher=greater fatigability) and a neurocognitive examination. Generalized estimating equations were used to account for family structure. Covariates included age, sex, field center, depressive symptoms (Center for Epidemiological Studies-Depression), education, and self-reported health. Each 1-point greater PFS was associated with lower: (1) global cognition (Mini-Mental Status Exam; β=-0.36,p<.0001), (2) verbal fluency (phonemic: β=-0.09,p=.029 and semantic: β=-0.14,p<.0001), (3) memory (Hopkins Verbal Learning Test-Revised: β=-0.06,p=.037), and (4) psychomotor speed (Digit Symbol Substitution Test: β=-0.10,p<.0001), after covariate adjustment. Greater perceived physical fatigability was significantly associated with lower memory and cognitive function in older adults, and may represent a promising new biomarker of biological aging reflecting declining brain reserve, resilience, and neurodegeneration.
Developmental Evaluation of an Established Advisory Board
Authors: Lessem Rachel
Published: December 2020

CJE SeniorLife developed the PCORI-funded Bureau of Sages, a research advisory board of nursing home community members and older adults, who live at home and receive long term services and supports (LTSS). Bureau members share experiences, build knowledge, and develop skills for working together to provide voice to the direction, design, and implementation of aging research. The PCORI-funded Sages in Every Setting project developed four additional bureaus, expanding and diversifying a pool of researchers, providers, and older adults living with LTSS who have the knowledge, skills, and opportunity to collaborate in research. Evaluation results reveal that the Sage Model is translatable into new settings; partners were able to adapt the provided resources; researchers receive useful input from bureaus to improve their work; and, participation in a research advisory board is a benefit to its members. In addition, we will share challenges to establishing and expanding the Sage Model. Part of a symposium sponsored by the Patient/Person Engagement in Research Interest Group.
Assessing Older Adults’ Frequency of Going Outside and Physical Performance: NHATS 2017
Authors: Sefcik Justine , Granche Janeway , Coates Martha , Hathaway Zachary , DiMaria-Ghalili Rose Ann
Published: December 2020

Little is known about community-dwelling older adults’ outdoor activity and the relationship between physical function and frequency of going outside. Using the 2017 NHATS (N = 4,465), we looked at self-reported outdoor frequency (Likert scale: every day to once a week or less) and the Short Physical Performance Battery (SPPB; participants completed five different physical activities to measure physical performance; total scores ranged from 0, not attempted, to 12, the best). A logistic model comparing community-dwelling older adults going out most days (18.3%), some days (10.3%), or rarely/never (3.4%) to those going out every day found ORs of 0.85, 0.70, and 0.58 respectively (all p<0.0001) for a one-unit increase in SPPB score. Interdisciplinary teams can use findings to assess disabled community-dwelling older adults’ frequency of going outdoors. Implications for interventions to assist with increasing times leaving the home (e.g. mobility devices, caregiver assistance) will be discussed.
Sensory Loss and the Healthcare System: Outcomes and Navigation
Authors: Reed Nicholas , Yeh Charlotte
Published: December 2020

Communication is fundamental to patient-centered care. However, sensory impairment limits communication among older adults. Specifically, hearing impairment strains communication via degraded auditory encoding while vision impairment distresses ability to read and interpret visual cues. The presence of dual sensory impairment, defined as concurrent hearing and vision impairment, may exacerbate these effects. The potential consequence s of age-related sensory loss on health care interactions and outcomes are beginning to surface in epidemiologic studies demonstrating poorer patient-provider communication, higher medical expenditures, increased risk of 30-day readmission, and longer length of stay when compared to individuals without sensory loss. Importantly, these associations may be amenable to intervention via sensory aids; however, uptake to sensory care is low. Notably, less than 20% of persons with hearing impairment have hearing aids and over 55% of Medicare Beneficiaries with reported vision problems have not had an eye examination in the prior year. Affordability and access may contribute to lack of sensory care uptake as Medicare explicitly excludes coverage of vision and hearing services. In this symposium, we will review current and new evidence for whether sensory loss affects health care outcomes, including satisfaction with care, incident delirium during hospitalization, navigation of Medicare, and present data on how persons with sensory loss are more likely to delay their care independent of cost and insurance factors suggesting fundamental changes in health care system interaction. We will place these results within the context of current national quality care and policy initiatives and review methods to address sensory loss.
Satisfaction With Health Care by Dual Sensory Impairment Status
Authors: Assi Lama , Shakarchi Ahmed , Swenor Bonnielin , Reed Nicholas
Published: December 2020

Sensory impairment is a barrier to patient-provider communication and access to care, which may impact satisfaction with care. Satisfaction with the quality of care received in the past year was assessed in the 2017 Medicare Current Beneficiary Survey (weighted sample=53,905,182 Medicare beneficiaries). Self-reported sensory impairment was categorized as no sensory impairment, hearing impairment (HI)-only, vision impairment (VI)-only, and dual sensory impairment (DSI) – concurrent HI and VI. In a model adjusted for sociodemographic characteristics and health determinants, having DSI was associated with higher odds of dissatisfaction with the quality of care received (Odds Ratio [OR]=1.53, 95%Confidence Interval [CI]=1.14-2.06) relative to no sensory impairment; however, having HI-only or VI-only were not (OR=1.33, 95%CI=1.94-1.89, and OR=1.32, 95%CI=0.95-1.93, respectively). These findings have implications for healthcare providers as Medicare shifts to value-based reimbursement. Moreover, previous work that singularly focused on HI or VI alone may have failed to recognize the compounded effect of DSI.
Acculturation and Subsequent Oral Health Problems Among Older Chinese Americans: The Role of Neighborhood Disorder
Authors: Mao Weiyu , Wu Bei , Chi Iris , Yang Wei , Dong XinQi
Published: December 2020

To further understand social, cultural, and personal predictors of oral health outcomes, this study addressed the relationship between acculturation and subsequent oral health problems and tested the moderating role of neighborhood disorder in such a relationship among older Chinese Americans. The working sample included 2,706 foreign-born community-dwelling older Chinese Americans aged 60 years or older who participated in the Population Study of Chinese Elderly in Chicago at the baseline and the first follow-up. Stepwise Poisson regression using lagged dependent variable was conducted. Behavioral acculturation was protective against subsequent oral health problems. Residence in Chinatown was associated with an increase in the risk of subsequent oral health problems. The relationship between behavioral acculturation and subsequent oral health problems varied by levels of neighborhood disorder. To reduce oral health-related disease burdens, it is important to consider the role of acculturation and the neighborhood on subsequent oral health problems in practice and policy. Part of a symposium sponsored by the Oral Health Interest Group.
Calculating the True Costs of Food Service in Long-Term Care: Development of a Costing Methodology
Authors: Wheeler Mikaela , Abbey Karen , Capra Sandra
Published: December 2020

As population’s age and the need for long term care (LTC) increases, so too does the focus on the costs to provide that care. Providing food, oral nutrition supplements and meals, can be a considerable expense to a home. The objective of this research was to develop a valid foodservice costing tool (FCT), to calculate the real cost of providing foods and meals in LTC. Current costing methodologies are not specific to LTC and do not account for all costs of a foodservice, including staff, procurement and nutrition supplements. An initial tool was developed using the systems approach in conjunction with literature and professional knowledge. This was piloted in real world contexts, using volunteer LTC homes. Four iterations of the tool were completed to assess its feasibility in calculating costs and useability. Managers were interviewed after completing the tool to gather an understanding of how the tool was interpreted and to refine completion. Following feedback, the resulting tool consists of nine sections, measuring both costs incurred in meal production and service as well as analysis of staff workloads. Preliminary results show consistency between homes within Australia, indicating that the true cost is much higher than that reported in the literature to date. The development of a comprehensive, usable tool which captures the total cost of foodservice allows homes to accurately report and understand costs from a systems level. This information can be used to demonstrate cost effectiveness of a foodservice and the potential to justify and plan future system changes.
Vaccination in Older Adults: The Who and What
Authors: Friedland Leonard
Published: December 2020

Aging brings increased impact of infectious disease in terms of hospitalization, morbidity, and mortality. This increased susceptibility to infection results from immunosenescence, age-related changes in the immune system, anatomic and functional changes, and environmental exposure to infections. Adults age 65 and over are at increased risk of pertussis, shingles, influenza and pneumococcal disease, and evidence-based recommendations for vaccination are protect older adults against these diseases. Underlying medical conditions including end stage renal disease, chronic lung, heart and liver disease, diabetes and immunocompromised place adults age 65 and over at increased risk of infectious diseases, therefore evidence-based vaccine recommendations in older adults with additional risk factors are in place to protect against varicella, hepatitis A and B, meningococcal meningitidis and Haemophilus influenzae type b. Investigational vaccines are developed to protect against infectious diseases causing significant morbidity and mortality in older adults, for example, respiratory syncytial virus, to further promote healthy aging. Part of a symposium sponsored by the Health Behavior Change Interest Group.
The Value of Vaccination in Older Adults: The Why
Authors: Buck Philip
Published: December 2020

The incidence of vaccine-preventable diseases remains high among older adults in the US, despite longstanding immunization recommendations, and is projected to increase as the population ages. The impact of US population aging on the burden of four vaccine-preventable diseases (influenza, pneumococcal disease, shingles, and pertussis) was modeled over a 30-year time horizon, with cumulative direct and indirect costs increasing from $378 billion over 10 years to $1.28 trillion over 30 years. Compared to current levels of vaccination coverage, increasing coverage was predicted to avert over 33 million cases of disease and greater than $96 billion in disease-associated costs, with a corresponding increase in vaccination costs of approximately $83 billion over the entire 30-year time period. Specific examples of cost-effectiveness analyses that assess the epidemiologic and economic impact of vaccination against shingles and pertussis in older adults will be discussed. Part of a symposium sponsored by the Health Behavior Change Interest Group.
WHO World Reports on Hearing and Vision: Meeting the Growing Needs of Older Adults
Authors: Nieman Carrie , Swenor Bonnielin , Yeh Charlotte
Published: December 2020

The World Health Organization’s (WHO) World Report on Vision was released in October 2019 and the World Report on Hearing debuted at the World Health Assembly in May 2020. The Reports recognize the fundamental nature of sensory health in the health and well-being of individuals and societies and outline the significant and growing burden of hearing loss and vision impairment across the life course. Together the efforts call for more affordable, accessible, and integrated care to foster sensory health for all and represent a major opportunity to advance vision and hearing care as public health priorities nationally and internationally. With the largest burden of sensory impairment among older adults, this symposium will focus on applying the findings and recommendations of the Reports to gerontology. The first presentations will provide an overview of the World Reports on Vision and Hearing from members of the core working groups involved in the Reports and discuss them within the context of the WHO’s Decade of Healthy Aging. The second set of presentations will feature the latest findings related to sensory health from the Global Burden of Disease Study. In moving toward action, task sharing is a critical theme that runs throughout the Reports and we will cover the application of task sharing to hearing care as an example of applying public health principles to advance sensory health. As we advocate for improving the lives of older adults, sensory health remains a significant component with great potential for progress and collaboration.
Updates on Hearing From the Global Burden of Disease Study
Authors: Haile Lydia , Orji Aislyn , Briant Paul , Adelson Jaimie , Davis Adrian , Vos Theo
Published: December 2020

Hearing loss is estimated annually as part of the Global Burden of Disease study. In 2019, input data came from 308 surveys in 77 countries. Hearing loss was measured by taking the pure-tone average of audiometric thresholds ranging from .5– 4 kHz. We ran severity-specific prevalence models, adjusting the severity for hearing aid use down one level, and separately estimating hearing loss due to meningitis, otitis media, congenital abnormalities, and age-related and other factors. In 2019, 1.5 billion (95% UI=1.5–1.6) people experienced hearing loss, primarily due to age and other factors. Of those with hearing loss, 74% (UI=71–77%) had mild hearing loss and 7% (UI=6–9%) used hearing aids. Globally, age-related hearing loss was the third-ranked cause of Years Lived with Disability after low back pain and migraine. Due to ageing, the hearing loss burden has increased over time, indicating a greater need for hearing healthcare services world-wide.
The ACHIEVE Trial: Lessons Learned From Nesting a Randomized Controlled Trial Within an Observational Cohort Study
Authors: Deal Jennifer , Reed Nicholas , Couper David , Hayden Kathleen , Mosley Thomas , Pankow Jim , Lin Frank , Coresh Josef
Published: December 2020

Hearing impairment in older adults is linked to accelerated cognitive decline and a 94% increased risk of incident dementia in population-based observational studies. Whether hearing treatment can delay cognitive decline is unknown but could have substantial clinical and public health impact. The NIH-funded ACHIEVE randomized controlled trial of 977 older adults aged 70-84 years with untreated mild-to-moderate hearing loss, is testing the efficacy of hearing treatment versus health education on cognitive decline over 3 years in community-dwelling older adults (Clinicaltrials.gov Identifier: NCT03243422.) This presentation will describe lessons learned from ACHIEVE’s unique study design. ACHIEVE is nested within a large, well-characterized multicenter observational study, the Atherosclerosis Risk in Communities Study. Such nesting within an observational study maximizes both operational and scientific efficiency. With trial results expected in 2022, this presentation will focus on the benefits gained in design and recruitment/retention, including dedicated study staff, well-established protocols, and established study staff-participant relationships. Part of a symposium sponsored by Sensory Health Interest Group.
Assessing Health Literacy Among East Asian Older Populations
Authors: Yamashita Taka
Published: December 2020

Health literacy assessment tools that are designed and validated specifically for East Asian older adults are limited. This session reviews the existing health literacy assessment tools and discusses possible applications in East Asian older adults. As an alternative to the population-level health literacy assessment, the general literacy measures and assessment approach in the Program for International Assessment of Adult Competencies (PIAAC) data are discussed. As a case demonstration, the PIAAC literacy measures in Japan and Korea are summarized and evaluated for the applicability in aging and health research with East Asian older adults.
Examining Consequences Related to Unmet Care Needs Across the Long-Term Care Continuum
Authors: Morales Meghan Jenkins , Robert Stephanie
Published: December 2020

At some point in our lives, approximately 70% of us will need support to help with daily care. Without adequate assistance we may experience unmet care need consequences (UCNC) – such as skipping meals, going without clean clothes, or taking the wrong medication. This study examines the likelihood of experiencing UCNC related to gaps in assistance with activities of daily living (ADL) and instrumental activities of daily living (IADL) across long-term care arrangements: informal community care, paid community care, residential care, and nursing homes. We examine a sample of older adults receiving assistance in a care arrangement (N=2,499) from the nationally representative 2015 National Health and Aging Trends Study. Cross-sectional and longitudinal regression models, adjusting for differences in demographic and health/functioning characteristics, examine if type of care arrangement in 2015 is associated with UCNC in 2015 and change in UCNC by 2017. Holding all else constant, there were no significant differences in UCNC related to ADLs in 2015 across care arrangements. However, those receiving paid community care were more likely to experience UCNC related to IADLs (going without clean clothes, groceries, or a hot meal and making medication errors) compared to those receiving only informal care (OR=1.64, p<.05) or residential care (OR=2.19, p<.01). By 2017, paid care was also significantly associated with continued UCNC, but older adults in informal care arrangements were most likely to experience a new UCNC. Results suggest improving/expanding assistance with IADLs among community-dwelling older adults, and promoting equitable access to residential care, to reduce UCNC.
The Hype and Hope of Stem Cell Rejuvenation
Authors: Harris Melissa
Published: December 2020

Adult stems play a major role in keeping our bodies in good working order by replenishing tissue as it wears out, and by providing new cells in the event of injury or damage. Unfortunately, the biological process of aging does not discriminate, and all cells, including our stem cells fall prey to getting older. Failing stem cells contribute to characteristics of aging and degenerative disease, and regenerative medicine research has focused on identifying ways in which stem cells can be used or rejuvenated to alleviate the symptoms of old age. Stem cell rejuvenation, however, has also inspired companies to provide services for harvesting and storing young stem cells with little real idea of how these stem cells might be used or their efficacy. In this seminar we will review what is known about the way in which stem cells fail, and the hype and hope surrounding stem cell rejuvenation.
Building Global Perspectives in a Diverse World
Authors: Glicksman Allen , Ring Lauren , Liebman Michael , Rodriguez Misha
Published: December 2020

There is a growing emphasis on diversity and its impact on health care. Our research has focused on migrants who are Mandarin speaking Chinese and Puerto Rican. Through a series of focus groups conducted in their native languages we discovered that barriers to service access differ across the two groups. In addition, many of these services are administered by individual states rather than the federal government. The diversity across migrant groups and state policies creates a challenge in using findings to establish national or international standards for best practices with older migrants. How then can we apply lessons about diversity and the impact of programs on a national and international scale? We propose the use of Social Interaction Modeling as a method for understanding patterns of behavior at both national and international levels, while preserving the unique character of each migrant group and the context within which they live.
Older Adults and Technology Use: A Systematic Literature Review
Authors: Choi Hyung Wook , DiMaria-Ghalili Rose Ann , Kelly Mat , Poole Alexander , Yan Erjia , Huh-Yoo Jina
Published: December 2020

Researchers are increasingly interested in leveraging technology to support the physical and mental well-being of older adults. We systematically reviewed previous scholars’ criteria for sampling older adult populations, focusing on age cohorts (namely adults over 65) and their use of internet and smart technologies. We iteratively developed keyword combinations that represent older adults and technology from the retrieved literature. Between 2011 and 2020, 70 systematic reviews were identified, 26 of which met our inclusion criteria for full review. Most important, not one of the 26 papers used a sample population classification more fine-grained than “65 and older.” A knowledge gap thus exists; researchers lack a nuanced understanding of differences within this extraordinarily broad age-range. Demographics that we propose to analyze empirically include not only finer measures of age (e.g., 65-70 or 71-75, as opposed to “65 and older”), but also those age groups’ attitudes toward and capacity for technology use.
UPDATE ON NIH INCLUSION ACROSS THE LIFESPAN
Authors: Bernard Marie
Published: December 2020

The National Institute on Aging (NIA) at the National Institutes of Health, Department of Health and Human Services, is the federally designated lead agency on aging research, and has supported significant research on aging as a life-long process. In the last five years, NIA experienced a tripling of its budget. Although much of this funding is targeted to Alzheimer’s disease (AD) and AD related dementias (ADRD) research, there was an increase in funds allocated to non-AD research in keeping with the overall growth of NIH. This symposium will provide a forum for exploration of the implications of the budget increases for the general research community. It will involve NIA’s senior staff discussing research priorities and programs supported by the Institute. A question-and-answer session will follow brief introductory remarks on current funding and future priorities and research directions of NIA.
Defining the Construct of Health Behavior Maintenance
Authors: Raj Mina , Bettger Janet , Hughes Susan , Hughes Jaime
Published: December 2020

Prior research on health behavior maintenance has proposed several key constructs that distinguish this concept from initiation. Initiation is thought to depend upon action self-efficacy, goal setting, and outcome expectations. Maintenance, on the other hand, depends upon self-regulation, relapse prevention, recovery self-efficacy, and satisfaction with original outcome expectations. Although much prior research has focused on cognitive components of maintenance, there has been little attention to how higher-order cognitive processing and decision-making may be challenging for some older adults. This presentation will discuss a proposed conceptual model of health behavior maintenance, specifically as this construct applies to older adults. Special consideration will be given to how both normative and non-normative age-related changes (e.g., physical, cognitive, psychosocial) impact maintenance and how such changes might influence older adults’ goals and outcome expectations. Finally, individual-level maintenance will be discussed within a larger context of program sustainability at community and population levels.
Disparities in Opioid Use for Pain Control Among Older Adults: The Role of Social Factors
Authors: Jansen Taylor
Published: December 2020

Over 50% of older adults (65+ years old) suffer from pain, and an estimated 25% of older adults use prescription opioids to treat their pain. Older adults are physiologically vulnerable to the effects of opioids; yet, they are prescribed more than all other age groups. This study used the Health and Retirement Study 2016 Core dataset (N=3,916) to analyze the moderation effect of social support on the association between pain and prescription opioid use in people aged 65+ using logistical regression analysis. Results show that older adults with severe pain were more likely to use prescription opioids (OR= 4.84) after considering covariates. Higher perceived social support was associated with higher likelihood of prescription opioid use for severe pain (OR=1.53). Older adults are at greater risk of pain and social isolation compared to younger age groups, making them a vulnerable group to consider as policy makers tackle this nationwide epidemic.
Bridging the Past and the Future: Why Age Matters in Behavioral Health Training
Authors: Allen Rebecca , Carden Keisha
Published: December 2020

This symposium presents data from three applied clinical research projects that involve intergenerational interaction as one component of effective treatment. The first paper describes learner outcomes in an intergenerational art therapy and reminiscence program provided in an adult day service facility. Results show that, in comparison with students in a didactic psychology of aging course or an introductory psychology course, learners in the experiential learning course demonstrated increased empathy, as well as better attitudes toward and increased interest in working with persons with dementia (PWD). The second paper focuses on observed outcomes for older PWD participants in this art therapy and reminiscence program, showing that intergenerational communication engagements exceed engagements with art. Mixed method data across time indicated that PWD benefitted from the treatment, facilitated by undergraduate student learners. The third paper focuses on cultural humility and the importance of racial diversity in providers conducting behavioral health screening in an integrated geriatric primary care clinic. Training issues and behavioral health outcomes regarding assessment of cognitive status, cultural mistrust, and test validity are considered. The fourth and final paper considers how intergenerational dynamics facilitated group cohesion and allowed for increased normalization of common challenges in mindfulness practice. Training issues for graduate student therapists are described. Consideration of level of behavioral health integration in each site, treatment efficacy, and the impact of intergenerational relationships are the foci of discussion. This symposium will show why age matters in behavioral health training.
Assessing and Harnessing the Power of Intergenerational Interactions in Mindfulness-Based Treatment Groups
Authors: Dragan Deanna , Newman Andrea , Torres Calia , Carden Keisha , Letang Sarah , McDuffie Danielle , Bontemps Andrew , Allen Rebecca
Published: December 2020

Mindfulness-based interventions (MBIs) in individual and group formats, have been shown to be effective for a variety of psychological disorders. Due to the promising evidence supporting the wide applicability of mindfulness skills, graduate student therapists were trained to deliver groups that attracted diverse individuals across the lifespan. In these groups, therapists noted how intergenerational dynamics facilitated group cohesion and allowed for increased normalization of common challenges related to practicing mindfulness skills. Therapists’ prior training on cohort differences and treatment recommendations for older adults served as an important foundation to navigating these group interactions. Barriers to simultaneously collecting data and delivering intervention components were noted by the student therapists. Future research and therapist training gaps in knowledge related to effectively facilitating intergenerational groups were identified.
Risky Preferences: Nursing Staff Perceptions of Risks May Impede Delivery of Person-Centered Care
Authors: Behrens Liza , Van Haitsma Kimberly , Kolanowski Ann , Boltz Marie , Sciegaj Mark , Abbott Katherine , Madrigal Caroline
Published: December 2020

Nursing home (NH) staff perceptions of risks to residents’ health and safety is a major barrier to honoring resident preferences, the cornerstone of person-centered care delivery. This study examined direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents’ preferences for everyday living and care activities. Participants (N=27) were mostly female (85%), had more than 3 years of experience (74%), and worked in NHs experiencing 6-12 health citations. Content analysis of 12 focus groups indicated nursing staff perceptions of risks may impede delivery of PCC. This is supported by the overarching theme: pervasive risk avoidance; and sub-themes of: staff values, supports for risk-taking, and challenges to honoring preferences. Findings will be discussed considering a newly modified risk engagement framework meant to understand and inform the clinical management of older adult preferences perceived to carry risks. Opportunities for future research will be discussed (e.g. measurement development). Part of a symposium sponsored by the Research in Quality of Care Interest Group.
Staff Barriers to Fulfilling Assisted Living Resident Daily Care and Activity Preferences
Authors: Roberts Tonya , Parks Jillian , Greenhalgh Ella , Hansen Josephine , Wheelis Olivia , Wilke Sara
Published: December 2020

Person-centered care (PCC), or delivery of care consistent with preferences, has been associated with improved care and quality of life for residents in long-term care (LTC). However, research has shown PCC has not been universally adopted. While general implementation barriers have been identified, little research has focused on barriers to meeting specific types of resident daily care and activity preferences. The purpose of this study was to describe LTC staff barriers to fulfilling specific types of resident preferences. A descriptive, qualitative study with 19 assisted living staff from nursing, dietary, and activities was conducted. Semi-structured interviews focused on identifying work system barriers to meeting specific types of resident preferences were analyzed using thematic analysis. Findings suggest shift assignments, staffing challenges, and facility schedules influence staff ability to meet certain types of preferences. The results suggest innovative design of shift schedules and assignments may help staff meet certain types of preferences. Part of a symposium sponsored by the Research in Quality of Care Interest Group.
Meaningful Aging in the Face of Vulnerability: Perspectives From the Humanities and Arts
Authors: de Medeiros Kate , O’Neill Desmond
Published: December 2020

This symposium interprets GSA’s 2020 leading conference theme, “Why Age Matters”, as touching upon fundamental existential questions about the meaning of old age. Although meanings of aging have always been implicitly present in a variety of disciplinary gerontological studies, scholars from the humanities and arts have traditionally taken the lead in the field to provide thorough reflections and analyses about what makes later life meaningful. In this symposium, we aim to present a selection of perspectives from the humanities and arts that explore how meaningful aging can be realized in circumstances of the increasing vulnerability that inevitably accompanies old age. First, Hanne Laceulle uses a practice-theoretical philosophical framework to argue that the common assumption that vulnerability constitutes a threat to meaningfulness deserves to be nuanced, because meaning can also occur in the process of integrating vulnerability in one’s life. Second, Theresa Allison, Jennie Gubner and Alexander Smith show how vulnerable older adults living with dementia and their caregivers seek meaning in daily life, adapting meaningful activities to circumstances of increasing vulnerability. Third, Kate de Medeiros and Ulla Kriebernegg discuss how a dialogue between facts and fictions, narrative and literary gerontology, can contribute in seeing vulnerability as a form of resistance. Fourth, Margaret Perkinson illustrates the power of visual images as elicitors of reflections on meaning among the older inhabitants of a Guatemalan village. Documenting villagers’ own perspectives through PhotoVoice methodology underscores the fundamental importance of taking first-person perspectives into account when studying meaning.
Building and Sustaining a Community Advisory Board of African American Older Adults for Volunteer Research
Authors: Mitchell Jamie , Perry Tam , Johnson-Lawrence Vicki , Rorai Vanessa
Published: December 2020

Older African Americans’ (AA) participation in health-related research is severely limited; they are not involved in sufficient numbers and for sufficient duration to ensure the applicability of advancements in medical and behavioral health. This research participation gap exacerbates older AAs vulnerability to poor health outcomes and disparities. The Michigan Center for Urban African American Aging Research employs a progressive community-based participatory model that utilizes a structured community advisory board (CAB) of older AAs in metro Detroit to oversee the research recruitment and retention of fellow AA older adult research participants. CAB members are provided ongoing training on social and behavioral health research, supported in acting as a consultancy to outside researchers where they can be compensated for their expertise and engagement, and empowered as gatekeepers of a participant research registry of over 1000 AA older adults. This model has broad potential for advancing community engaged research with AA older adults.
Working With Communities to Support Minority Caregivers: The PRISMA Health REACH Expansion Project
Authors: Spencer Mindi , Miller Maggi , Jahries Diana , Davis James
Published: December 2020

In 2019, the NIH presented the results of its two-year visioning process to advance the science of minority health and health disparities. The PRISMA Health REACH Expansion (PH-REACH E) is an innovative, community-academic partnership between a hospital memory clinic, meal delivery service, research university, and low-income health clinic. The purpose is to: 1) increase the dementia capability of community-based programs, 2) offer caregivers of persons with dementia the REACH intervention, and 3) identify and connect racial minority and/or rural residents with services to promote health and well-being in older adulthood. This presentation will detail the PH-REACH E framework and present program results, which include improved caregiver outcomes (e.g., reduced burden, increased self-efficacy, reduced depression) and enhanced dementia capability (e.g., increased dementia knowledge) of partner organizations. This program illustrates some key recommendations of the NIH – community engagement in intervention adaptation, multisectoral collaboration, and promoting systems-level change to reduce health disparities.
Nutrient Intake Patterns Predict Homeostatic Dysregulation in an Older Quebec Population
Authors: Cohen Alan , Senior Alistair , Legault Véronique , Raubenheimer David , Simpson Stephen , Presse Nancy , Gaudreau Pierrette , Couteur David Le
Published: December 2020

The geometric framework for nutrition has largely been applied to macronutrients in experimental settings. Here, we utilize the framework to examine both macro and micronutrient intake patterns in observational human data. We used nutritional intake patterns (3x 24h recall per visit) of 1754 older Quebecers from the NuAge cohort to predict multi-system homeostatic dysregulation scores calculated from 30 biomarkers. Intermediate intake of both macro- and micronutrients was generally associated with lower dysregulation scores (i.e., better health). Furthermore, there were often nutrient-nutrient interactions, such that the optimal level of one nutrient depends on the intake level of others. However, higher protein intake was generally associated with better health, and results varied substantially across different dysregulation systems. Accordingly, even though nutrition does have important effects on health trajectories during aging, it will be challenging to arrive at population-level recommendations to fine-tune nutrient intake patterns to optimize health beyond “everything in moderation.” Part of a symposium sponsored by the Nutrition Interest Group.
Partitioning Analysis of Disparities and Time Trends in Alzheimer’s Disease and Related Dementia
Authors: Akushevich Igor
Published: December 2020

This study uses Medicare data to i) identify age patterns, time trends, and race/geography-related disparities in prevalence and mortality of AD/ADRD; ii) apply partitioning methodology to separate out trends in causal components including incidence and survival, and iii) expand the method for analysis of disparities to identify the magnitude and trends in causal components of race-related disparities in AD/ADRD. Analysis shows that the trend in AD/ADRD incidence explains up to 70% of the observed changes in AD prevalence and mortality and is the main contributor to the differences in race-specific prevalence (higher for African Americans (AA)). Differences in race-specific incidence explain up to 80% of the disparity while 20% are due to difference in survival. This indicates that for AAs, incidence is worse but survival is better. This is confirmed by direct evaluations of hazard ratios: AD incidence HR for AA is 1.50(1.46,1.54) and 0.93(0.91,0.96) for survival after AD diagnosis.