bluuebunny/crossref_metadata_2025 huggingface dataset:
STRUCTURAL AND FUNCTIONAL ASPECTS OF SOCIAL NETWORKS AND EMOTIONAL WELL-BEING AMONG LGBT OLDER ADULTS
Authors: Prasad Anyah , Burr Jeffrey , Miller Edward , Fredriksen-Goldsen Karen
Published: December 2023

Network size and composition are structural aspects and perceived support is a functional aspect of social networks. How these social network characteristics are related to LGBT older adults’ emotional wellbeing is not well understood. We investigated these relationships using data from The Caring and Aging with Pride study, a cross-sectional survey of 2,560 LGBT Americans aged 50 years and above, employing a series of mediated and moderated-mediated regression analyses. Results indicated that larger social networks were associated with more perceived support and perceived support partially mediated the association between network size and emotional wellbeing. Results also showed that stress was associated with poor emotional wellbeing via depletion of perceived support but less so when LGBT older adults were embedded in larger networks. These findings are in line with the Convoy Model of Social Relationships and The Stress Process Model; further, the results support Kondrat and colleagues’ suggestion that social network size has a moderating role, while social support has a mediating role between stress and health. Also, the Theory of Homophily postulates that shared identity may enhance group cohesion and feeling supported. Accordingly, we observed that perceived support and its mediation role were stronger with LGBT and older network members compared to non-LGBT and younger network members. A larger network of non-LGBT older adults had a more direct beneficial association with LGBT older adults’ emotional wellbeing. Our observations have practical implications for programs that aim to support LGBT older adults’ emotional wellbeing by strengthening social support through their social networks.
WOMEN’S STORIES: NARRATIVES ABOUT RELATIONSHIPS AND RESILIENCE
Authors: Watson Wendy , Faulkner Sandra , Stelle Charlie
Published: December 2023

Research has demonstrated that relationships are important in the lives of older women. Thirty-one women between the ages of 64-86 participated in interviews about their lives and relationships across the life course. In the interviews, women talked about their family of origin, friendships, romantic relationships, and their children and grandchildren. They explained how their relationships developed across the life course and how they have maintained their relationships, including how COVID-19 affected their maintenance behaviors. In the interviews, women constructed narratives that explained who they are as individuals and who they are in relationships. Through a poetic analysis of the interviews, resilience stood out as an overarching theme across the stories from women of different ages, marital statuses, economic backgrounds, and current and former occupations. Many women spoke of growing up in poor, rural areas and finding the strength to build a better life for themselves. There were stories of abuse, both in their family of origin and in chosen partners. Narratives included many instances of loss and hardships through caregiving, deaths of friends and relatives, and dissolution of relationships. Throughout it all, these women claimed resilience brought about through their own strength and determination and through relationships with people who supported them, mentored them, and built them up. This paper will discuss the many ways in which these thirty-one women exemplified resilience in their past, in their current lives, and as they looked toward their futures.
THE CRUCIAL ROLE OF LEPTIN IN MEDIATING VISCERAL ADIPOSITY-ASSOCIATED AGING PROCESS
Authors: Zhao Shangang
Published: December 2023

Visceral adiposity is a hallmark of aging and an important contributor to reduced healthspan and lifespan. The factors that mediate the detrimental effects of aging-associated visceral adiposity are poorly identified. Here, we have shown that hyperleptinemia, induced by a leptin transgenic cassette in adipose tissue, accelerates diet-induced obesity and glucose intolerance. In addition, hyperleptinemia promotes adipose tissue inflammation. Chronic culture of stromal vascular fraction (SVF) with leptin reduces the capacity of differentiation and increases inflammation. Moreover, chronic hyperleptinemia in fat depots accelerates the development senescent cells to establish a senescent-associated secretory phenotype (SASP), including increased local inflammation. This result indicates hyperleptinemia may be a “unidentified” driver for cellular senescence. Moreover, deletion of leptin in visceral fat depots significantly reduces visceral adiposity and senescent-associated secretory phenotype (SASP). These results highlight the crucial role of leptin in establishing SASP and targeting leptin may be a novel approach to alleviate aging-associated metabolic syndromes.
EVERY DAY I HAVE THE BLUES
Authors: Blues Elwood
Published: December 2023

The Blues Brothers are an American blues and soul revivalist band founded in 1978 by comedians Dan Aykroyd and John Belushi as part of a musical sketch on Saturday Night Live. Belushi and Aykroyd fronted the band, in character, respectively, as lead vocalist ’Joliet’ Jake Blues and harmonica player/vocalist Elwood Blues, donning black suits with matching fedoras and sunglasses.
IMPLEMENTATION SCIENCE: A STRATEGY FOR ADDRESSING HEALTH EQUITY AMONG RACIALLY DIVERSE OLDER ADULTS
Authors: Bullock Karen , Campos Barbara Mendez
Published: December 2023

Objective

Implementation science as a strategy for helping diverse populations of older adults address barriers to mental treatment, has become increasingly important since COVID19. This paper disseminates information about the results of an interdisciplinary intervention that tailored mental health services to racially and ethnically diverse community-dwelling older adults. Method: An interdisciplinary team of researchers (MD, APRN, MSW) performed an intervention that consisted of weekly visits to the community and provided diagnostic, triage, and psychosocial services to older adults. Evaluation of the intervention included data collected at baseline and three-month follow-up visits.

Results

350 elderly residents received mental health screening with some assessment of physical health and well-being. The number of visits per resident during the intervention phase, ranged from 1 to 11, with an average of 3. Tailoring the intervention to the specific cultural needs of the participants led to the development of a weekly community engagement group for monolingual Spanish-speaking residents and others. 49% of those receiving the intervention, self-reported their race and/or ethnicity as African American or Caribbean, 43% were Latino, and 8% were Caucasian, all of whom self-referred as participants in this health service outreach program. Initial evaluations resulted in referral to community providers (60%), team case management (20%), or no services needed (20%).

Conclusion

Research studies designed to have positive impacts on older adults that have been historically underrepresented in health services research may improve its effectiveness by tailoring processes to be community informed and culturally responsive to structural and system barriers to treatment.
DAILY STRESS CONTRIBUTES TO GENDER DISPARITIES IN LONG-TERM CHRONIC DISEASE RISK
Authors: Cichy Kelly , Koumoutzis Athena , Witzel Dakota , Stawski Robert
Published: December 2023

Compared to men, women exhibit worse health outcomes, including increased risk for chronic disease (Carmel, 2019). Exposure and affective responses to daily stressors represent a risk factor for long-term health (Piazza et al., 2013) with research revealing a complex pattern of gender differences in affective responses to stressors (Birditt et al., 2005; Witzel et al. 2022). Together, findings suggest stressor exposure and affective reactivity may represent accessible intervention targets to reduce chronic disease risk and health disparities. Using data from Wave II of the National Study of Daily Experiences and MIDUS Waves II and III, this study explores: 1) gender differences in chronic disease risk; 2) prospective effects of differential exposure and reactivity on chronic disease risk 10 years later; and 3) whether daily stress processes (DSP) partially account for gender differences in chronic disease. Respondents include adults ages 34-84 years (N = 1209), who reported on daily stressors and affect for eight days during NSDE II and on chronic conditions during MIDUS III. Covariate-adjusted multilevel models revealed women reported more chronic conditions compared to men (p < .0001). DSP processes, including differential exposure (p < .01) and affective reactivity (p < .05) are associated with increased chronic conditions. Further, the magnitude of the gender differences in chronic conditions was reduced after accounting for DSP variables. Findings highlight the contribution of DSP for chronic disease risk and gender disparities in physical health. Implications for addressing DSP as accessible intervention targets will be discussed.
DAILY NEGATIVE AND POSITIVE EVENTS AND DAILY WELL-BEING: DYADIC LINKS IN COUPLES LIVING WITH EARLY-STAGE DEMENTIA
Authors: Polenick Courtney , Kaba Diarratou , Daniel Nikita , Lambert Olivia , Salwi Shreya , Valera Juhi , Birditt Kira
Published: December 2023

Spouses have powerful influences on well-being in middle and later life, but we know little about how daily events impact well-being in older couples that include persons living with dementia (PLWD). We examined associations between daily negative and positive events and daily well-being (negative mood and positive mood) in 36 heterosexual married couples living with early-stage dementia. Participants included PLWD (M = 71.47 years, SD = 6.90, range = 53-82 years) and their spouses (M = 69.69 years, SD = 7.26, range = 59-87 years) who both completed brief morning and evening phone interviews over 7 consecutive days. Longitudinal actor-partner interdependence models controlled for own and partner reports of daily well-being in the previous day, whether each day was a weekend day, and the gender of PLWD. We estimated separate models for negative mood and positive mood. Both PLWD and their spouses reported higher negative mood when they reported more negative events in the same day and when their partner reported more negative events in the previous day. Over and above these associations, both partners in the couple reported lower negative mood on days when spouses of PLWD reported more positive events. Spouses of PLWD reported higher positive mood on days when they reported more positive events, but lower positive mood on days when PLWD reported more positive events. These findings highlight the importance of understanding dyadic influences on daily well-being among PLWD and their spouses.
CHILDHOOD ADVERSITY, NEIGHBORHOOD CONTEXTS, AND COGNITIVE FUNCTION IN ADULTHOOD
Authors: Choi Jean , Muñoz Elizabeth , Scott Stacey , Sliwinski Martin
Published: December 2023

Childhood adversity may play an important role in cognitive health and aging. Neighborhood contexts in adulthood can serve as risks or resources that may modify the effects of childhood adversity on adult cognitive function, but these effects are not well-understood. We examined whether current positive (i.e., neighborhood cohesion) and negative (i.e., neighborhood violence) neighborhood contexts moderated the effect of childhood stress exposure on cognitive function in adulthood. We used data from 210 adults (Mage = 46.79, SD = 11.02; range: 25–65) residing in a single Zip code in Bronx, New York who completed measures of childhood adversity, current neighborhood contexts, and lab-based cognitive tasks. After adjusting for relevant demographic covariates, childhood adversity was not associated with cognitive function. The interaction between childhood adversity and neighborhood violence was significant, whereby lower childhood adversity was linked with worse performance in perceptual speed for individuals who reported both low (b = 1.19, SE = 0.37), p = .001) and high neighborhood violence (b = 0.75, SE = 0.26, p = .005), with higher scores indicating slower responses and worse performance. Unexpectedly, neighborhood violence was not predictive for those who reported greater childhood adversity. The interaction effect for neighborhood cohesion was not significant. Results indicate that childhood adversity may not have universal effects across all cognitive domains, but rather its effects are complex and may affect cognitive functioning to be adaptive to certain environmental contexts. This study underscores the need to replicate and examine the long-term consequences of these effects on cognitive aging.
THE IMPACT OF THE COVID-19 PANDEMIC ON FAMILY CARE PARTNERS OF PERSONS WITH DEMENTIA IN ASSISTED LIVING FACILITIES
Authors: Antonsdottir Inga
Published: December 2023

Background

The Covid-19 pandemic affected persons living with dementia and their family care-partners. Family care-partners are diverse, including spouses, children, and friends. Care-partners may live with the care recipient, or apart from them. Covid-19 policies and priorities isolated care-partners living at home, while banning others from supporting their loved ones in assisted living facilities (ALF). Purpose: The purpose of this study was to examine the impact the covid-19 pandemic had on family care-partners of persons living with dementia.

Methods

This study used an online survey of 133 family care-partners (89 living in ALF, 44 living in the community).

Results

Among family care-partners, 34.8% of those who lived in an ALF reported a severe change in routine compared to 38.6% of those living in the community. 78.7% of ALF care-partners reported that they were unable to visit their loved one in a care facility, compared to 31% of care-partners living in the community. 67.4% of ALF care-partners were separated from the person with dementia that they cared for, compared to 22.7% of care-partners living in the community. 70.5% of CPs in the community reported they had to spend a lot more time taking care of a family member with dementia compared to 13.5% of ALF CPs.

Conclusion

Unique differences exist in how the pandemic impacted the lives of family care-partners of community-based or ALF-based persons living with dementia. Understanding these differences can help tailor policies and healthcare priorities to best support family care-partners living in community or ALF settings.
AT THE NEXUS OF PUBLIC POLICY AND AGING: DOCTORAL STUDIES IN GERONTOLOGY AT THE UNIVERSITY OF MASSACHUSETTS BOSTON
Authors: Miller Edward , Burr Jeffrey , Boerner Kathrin , Silverstein Nina , Mutchler Jan
Published: December 2023

One in five PhDs in Gerontology are graduates of the Gerontology doctoral program at the University of Massachusetts (UMass) Boston. The mission of UMass Boston’s program is to provide advanced training and research in gerontology within an interdisciplinary framework drawn primarily, but not exclusively, from the social and behavioral sciences. The program is designed to prepare students for leadership roles as educators, researchers, planners, and policy makers. The program has a deep emphasis on policy development, analysis, and impact, an attribute that goes back to the roots of the Gerontology enterprise at UMass Boston in the late-1970s. This presentation provides an overview of the program’s history and curriculum, along with coursework, research and service-learning experiences, and career paths in policy research and implementation. The program also is committed to increasing diversity in the field of gerontology, with the aim of strengthening policy impact and reducing disparities in the aging experience.
PREPARING FOR ADVANCING ILLNESS AND END OF LIFE WITH DEMENTIA
Authors: van der Steen Jenny
Published: December 2023

Dementia involves coping with advancing illness that involves cognitive and functional decline. Also decision-making capacity diminishes, which implies that preparing for a future and taking opportunities to exercise individual and relational autonomy is particularly relevant in the case of dementia. Engaging the person with dementia and family caregivers meaningfully in formal or informal advance care planning conversations may require addressing specific challenges. Health care providers often lack time or are reluctant to broach these conversations. Often conversations are delayed even in institutional long-term care settings as residents, their family caregivers and care providers may all view advance care planning as uncomfortable and difficult to initiate. Special support for health care providers to develop skills, confidence and taking initiative is needed. This symposium presents about new, large qualitative and quantitative studies with contributions from the UK and Canada, and international work. It addresses preparing for an uncertain future through advance care planning and decision making about future care and treatment which may include conversations about the end of life. We present and evaluate tools to support the process across settings.
DISCUSSING THE FUTURE FOLLOWING A DIAGNOSIS OF DEMENTIA. FINDINGS FROM THE PREPARED STUDY (ENGLAND)
Authors: Dixon Josie
Published: December 2023

The PrepareD study (England) adopts a relational autonomy perspective to examine the various conversations that people with dementia and their families have about the future, with each other and with health and care providers, in the year following a dementia diagnosis. We present survey data gathered from a large cohort of 900 people in England who have been recently diagnosed with dementia and their caregivers about informal conversations about the future and advance care planning conversations with health and care providers. We also present findings from in-depth qualitative research with 30 of these respondents, a purposively selected mix of people with dementia and caregivers. Findings from the qualitative research cover how people with dementia and family members interact; the objectives, hopes and expectations they have for their conversations; and how input from professionals and wider social influences shape these interactions. We use findings from the study to reflect on what effective support for informal conversations between people newly diagnosed with dementia and their families about future care could look like and how, and by whom, it could be provided. We also aim to identify theoretical models of relational autonomy that could be useful for developing these approaches further.
DEVELOPMENT OF A DECISION SUPPORT FRAMEWORK TO PROMOTE COMFORT AMONG PATIENTS WITH SEVERE DEMENTIA IN THE HOSPITAL
Authors: Davies Nathan , Smith Ellen McCoy , Shah Malvi , Sampson Elizabeth
Published: December 2023

Hospital wards can be challenging settings, particularly for those with dementia, and exacerbate symptoms and behavioural issues. Improving care for persons with dementia and providing a simple decision support framework to help guide staff in person-centred and holistic management of these problems has the potential to improve hospital care. We aimed to co-design an evidence-based, practical way to support hospital staff and family carers in identifying discomfort and distress, maximising comfort and reducing behaviours that challenge or are distressing to people with dementia who are towards the end-of-life. We conducted a co-design study informed by data from 1. Literature review; 2. Cohort study of comfort and discomfort in people with severe dementia admitted to hospitals (n=63); and 3. Interviews with family carers and health care professionals (n=18). These data sources were synthesised and presented to key stakeholders through co-design meetings and workshops. The resulting decision support framework uses a three-stage process of: 1) assessment of comfort/discomfort; 2) consider causes of discomfort; and 3) address needs of the individual to manage the discomfort. The framework is presented in the form of a series of flowcharts that can be used easily on busy wards. We will present examples of the framework along with key findings from the cohort study. This is the first study to develop decision support for hospital staff and families addressing comfort towards the end of life. This toolkit has practical implications for everyday working on hospital wards but also a resource for planning for end-of-life care.
EXPLORATION OF THE NEED FOR GRIEF SERVICES: METHODOLOGY OF A COMMUNITY-BASED RESEARCH STUDY
Authors: Stone-Bury Lisa
Published: December 2023

Within the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, community-based research (CBR) is a key component of Exploration and Preparation. This presentation describes the process of conducting a CBR study on grief service needs within Colorado Springs. A community-academic partnership was formed, resulting in a multidisciplinary team of clinical geropsychology academics, a chaplain, a mental health professional, and a funeral director, with the goal of launching a non-profit grief center that catered to identified local needs. Challenges and successes in this partnership will be explored. Two surveys were created: (1) community-wide survey targeting adults across the lifespan and (2) professional survey targeting individuals who interface with grief in their profession (e.g., healthcare providers, educators, lawyers, faith leaders). The authors facilitated survey development that balanced practical needs with existing empirical literature on grief services. Qualitative and quantitative measurement focused both on past experiences with grief (to understand the community’s history) and use of future grief services (to understand the types of services most desired by the community). The multidisciplinary team pooled resources related to recruitment and dissemination of the surveys, combining traditional research recruitment practices (e.g., undergraduates, research database of older adults) with networks of local community leaders (e.g., places of worship, local healthcare agencies, newspapers). These CBR efforts resulted in large samples of community members (n = 668; age range = 18 to 65+) and professionals (n = 141). Ultimately, this CBR study laid important groundwork to prepare the multidisciplinary team to match their services to the community’s expressed needs.
LATE WORKING LIFE IN THE TRIPLE TRANSITION AND THE GLOBAL PERMACRISIS
Authors: Motel-Klingebiel Andreas , Naegele Gerd , Oylu Gulin , Genelyte Indre , Kelfve Susanne
Published: December 2023

Late working life faces multiple challenges in the triple transition of demographic, technological and environmental change and the global permacrisis. This contribution provides a conceptual framework for research on the significance of extended late work for the sustainability, equity, inclusion, and productivity of aging societies, based on an understanding of the three major long-term shifts as a complex triple transition with potentials and challenges for societies, economies, employers, and individuals. This triple transition is embedded in an ongoing and even accelerating societal and economic permacrisis with increased social risks and limited predictability, in which resilience – of economies, life-courses and welfare states - gains importance, while the dominant tetrad of sustainability, equity, inclusion and productivity remains on the European social and economic policy agenda. The presentation introduces a review of European policy reports on aging and late work and introduces results from the research programme EIWO (www.eiwoproject.org) based on Swedish register information and European survey data to illustrate trends and gaps in European late work, research, and policy. The presentation discusses age integration of life and work courses as a systematic strategy to promote quality of life as well as social sustainability, equity, inclusion and productivity and resilience. Participants will gain an understanding of the conceptualization and implementation of gerontological multi-level research on the macro- and micro-social relevance of late working life in the triple transition and the global permacrisis.
THE PERSISTENCE OF AGE DISCRIMINATION IN SHAPING LATE WORKING LIVES
Authors: Crossdale Rachel , Foster Liam , Walker Alan
Published: December 2023

The aging population and subsequent demographic shift have driven the Extended Working Lives (EWL) agenda to become an important policy goal. However, millions of older workers leave the workforce each year due to unsupportive work environments attributed in part or in whole to ageist policies and practices, raising questions about older workers’ perceptions of themselves in the workforce and what this means for the EWL agenda. Using data from 25 qualitative interviews, our research finds that ageism continues to play a part in the decision-making process of older workers when considering their future. These findings fall into two categories: Age barriers within the workplace and Perceptions. Age barriers within the workplace include tasks or events that incite a feeling of separation from younger peers, such as training, social interaction, and digitization. Perceptions are older workers’ internalized expectations of themselves and their abilities. Our findings suggest these perceptions do not align with the reality for older workers, thus contributing to internalized ageism. The need to target stereotypical attitudes towards older workers was highlighted as an age barrier to employment before the turn of the century. However, despite the Extended working Lives, Active Aging and Fuller Working Lives Agendas changing the policy context around older workers, this research suggests that the same stereotypes continue to pervade older workers both externally from policy and practice and internally in self-perceptions. A life-course approach to policy is needed to improve conditions for older workers and to challenge ageist stereotypes in a meaningful way.
THE IMPORTANCE OF LIFELONG LEARNING FOR AVOIDING EXCLUSION—POLICY FRAMEWORKS AND EXPERIENCES OF OLDER WORKERS
Authors: Penning Nehle , Crossdale Rachel , Reichert Monika
Published: December 2023

Qualification requirements in the labour market in Europe have increased across the board. Increasing provision and accessibility of lifelong learning is central to promoting employability among older workers. However, older workers are more likely to lack formal and to hold out of date qualifications. Sweden, Poland, Germany and the UK, despite differences in regime and political approach to lifelong learning, have unequal distribution of access and opportunity. This paper examines how older workers in the four countries assess the role of lifelong learning throughout working life as well as what links to national policies can be identified. The analysis is based on 100 semi-structured and problem-centred interviews in the four countries with older workers (age 55 and older) of different backgrounds (gender, educational level, sector of employment, ethnicity). Content analysis according to Kuckartz (2018) was used as method of analysis. The interview data shows that lifelong learning plays an important role for older workers in the prevention and/or management of exclusion risks throughout working life. However, the potential of lifelong learning for EWL is limited by barriers at the company and regulative level and differences between the public and private sector are noticeable. In late working life, in particular financial constraints as well as ageism lead to inequalities in relation to lifelong learning opportunities. In all four nations a higher priority need to be given to an integral support of lifelong learning throughout the life-course as well as age stereotypes need to be dismantled for a successful EWL agenda.
OLDER WORKERS’ AND EMPLOYERS’ PERSPECTIVE ON EXTENDING WORKING LIFE: THE CASE OF POLAND
Authors: Perek-Białas Jolanta , Urbaniak Anna , Krygowska-Nowak Natalia , Varlamova Maria
Published: December 2023

Extending working life is considered an adequate policy response to population aging and workforce shrinkage. However, in some countries, like Poland, there are still no clear mechanisms supporting extending working life. Poland makes an interesting case, as while the eligible retirement age is one of the lowest in Europe, no plans to increase it are set. The aim of this paper is to present perspectives of older workers and employers on extending working life. We identify factors that constitute supportive and unsupportive working environments from the perspective of older Polish workers and show how employers perceive workers over 50 in the workplace. First, the qualitative component of the programme EIWO ‘Exclusion and Inequality in Late Working Life’ is analysed. We draw from 25 semi-structured interviews conducted between June and November of 2021 with men and women aged 55-75 years old working in private and public sectors in Poland. Secondly, the probability survey among Polish employers (n=1,037) was analysed to show the attitudes and perceptions of employers. Older workers working in the public sector feel less satisfied with the financial aspects of employment, less motivated to extend their working lives, and more often describe practices of pushing older workers out of the labour market. The analyses of employees give matching results. These findings highlight that in the absence of a governmental strategy, extending working life is more dependent on employers and employees that might differ among sectors of employment.
ILLUSTRATIONS OF EXTENDED WORKING LIVES: WHAT INSIGHTS DO THE CONCEPTS OF EXCLUSION AND PRECARITY OFFER?
Authors: Grenier Amanda
Published: December 2023

Amanda Grenier will act as the discussant for the set of papers in this symposia session, bridging insights from European research with North American perspectives. Situated as an attempt to bridge research findings with a larger critical practice of theory-building theory, she will explore what the concepts of exclusion and precarity offer our interpretations of these papers, as well as how the findings of each contribute to the state of knowledge on exclusion and precarity. She will begin with a brief clarification of the definitions and conceptual boundaries of social exclusion and precarity carried out in Europe and North America and situate key findings of the papers as an effort to theorize older workers lives in contemporary conditions. For example, the well-known concept and domains of social exclusion can be considered to offer ways of understanding processes of exclusion at the mezzo level, as exercised through policies, practices, and/or place. Illustrations from the papers will be linked with existing work on exclusion. She will then draw attention to the concept of precarity as a lens of analysis to connect the micro-level vulnerabilities experienced in the working lives of older people with the shifting social and state structures that form the backdrop for older people’s lives (and the systems within which European research is carried out). Specific examples will be drawn from the set of papers, and a moderated question and answer period will follow.
INEQUALITIES IN POLYPHARMACY IN ADULTS AGED 65+ IN ENGLAND
Authors: Iqbal Anum , Hanratty Barbara , Matthews Fiona , Sinclair David , Richardson Connor , Todd Adam
Published: December 2023

Understanding the role of socio-economic factors in the number of medications an individual is prescribed, can help healthcare practitioners target medication reviews and safer prescribing, improving quality of life. We aimed to understand the association between socio-economic factors and polypharmacy - defined as the use of five or more medications at any given time. Data was used from the Cognitive Function and Ageing Study (CFAS), focusing on adults aged 65 years and over. Data from CFAS I and CFAS II, was used to understand the relationship between education (a marker of socio-economic status) and polypharmacy. Individuals were categorised on the number of years in full time education, and baseline cohorts (wave 1) from each study were compared, to identify the longitudinal effect. Logistic regression was used to assess the association between polypharmacy and education. Increased number of years of full-time education was associated with a decreased likelihood in polypharmacy, in CFAS II - those with <10 years of full-time education showed higher odds of polypharmacy, when compared to individuals with 10-11 years of full-time education, OR 1.61 (95 % CI 1.44-1.80). However, similar odds were displayed across each education category and polypharmacy in CFAS I. Results have showcased growing inequalities in healthcare, particularly through the influence of education on polypharmacy. Socio-economic factors could be used to trigger for medication related review services.
BRIDGING RESEARCH TO PRACTICE: PRO-HOME EMPOWERS CARE PARTNERS TO PROMOTE EXERCISE IN HOME CARE
Authors: Muramatsu Naoko
Published: December 2023

Regular physical activity (PA) benefits people of all ages. Mounting scientific evidence shows PA’s health benefits in older persons with chronic conditions. However, there remains a large research-to-practice gap in PA, especially in long-term services and supports (LTSS). Older adults who need help with basic daily activities, such as walking or standing, continue to face barriers at multiple levels of LTSS to become and remain physically active. This symposium will address the much-debated research-to-practice gaps, focusing on frail community-dwelling older adults in the context of a NIA-funded clinical trial. “Promoting Seniors’ Health with Home Care Aides (Pro-Home)” tests the effectiveness of a gentle, low-intensity PA program delivered by home care aides (HCAs) for community-dwelling older adults with nursing-home eligible care needs in real-world home care settings. Pro-Home is innovative because it empowers direct care workers (HCAs) with an easy-to-learn toolkit to deliver the program and keep their older clients motivated. The symposium starts with an overview of Pro-Home (Muramatsu), barriers and facilitators of Pro-Home at multiple levels of the LTSS system (Cruz Madrid), followed by Pro-Home’s critical elements: of research and practice: client-HCA dyad relationships and partnerships with stakeholders (Hu), in-home assessment of motor function in frail older adults (Yin), and inter-professional co-learning (Skowronski). The symposium concludes with a dialogue with the audience to identify actionable policy and practice strategies for building research-to-practice and practice-to-research bridges to build health promotion into LTSS to promote the well-being of older adults with disabilities and their care partners.
PRO-HOME: AN IMPLEMENTATION SCIENCE FRAMEWORK FOR MULTILEVEL BARRIERS AND FACILITATORS IN LTSS
Authors: Madrid Katya Cruz , Berbaum Michael , Walton Surrey , Zanoni Joseph , Marquez David , Muramatsu Naoko
Published: December 2023

Promoting Seniors’ Health with Home Care Aides (Pro-Home) is a randomized controlled trial (RCT) of a gentle physical activity program for frail older adults conducted in a community-based long-term services and supports (LTSS) delivery setting. Pro-Home is a hybrid effectiveness-implementation study, which aims to examine (1) the effectiveness of the program delivered by home care aides (HCAs) in maintaining physical function in older homecare recipients, and (2) how the intervention works in a real-world Medicaid-funded LTSS system. This paper describes barriers and facilitators that have long existed or evolved during the Pro-Home development, using quantitative/qualitative data from the mixed-method study informed by an implementation science framework. Facilitators include the knowledge and partnerships that resulted from multiple preliminary studies that illuminated HCAs’ work/life-related stressors, coping resources, and underutilized capacity and motivation to promote the health of clients and HCAs themselves in the context of the LTSS system. Another facilitator has been the physical activity program developed in another state’s LTSS service setting (not in an academic setting). The program was easy to learn and adapt into a program to be delivered by HCAs (as opposed to care managers). Barriers included turbulent LTSS environments (e.g., rapidly growing managed care presence, COVID-19). Those barriers have been addressed through partnership with stakeholders at multiple levels. Having completed the intervention and data collection phases, we found the project’s planning and implementation challenging but rewarding. Pro-Home has produced rich information that will have many implications for research, practice, and LTSS services delivery and financing systems.
HOME CARE DYADS AND STAKEHOLDERS IN THE CONVOY OF SOCIAL RELATIONSHIPS: A BASIS OF COMMUNITY-BASED RCT
Authors: Hu Elise , Yin Lijuan , Caceres Maria
Published: December 2023

Relationships within homecare dyads are the core in both informal and formal caregiving. Home care aides (HCA), a type of formal (paid) caregivers, provide in-home non-medical care to older adults who need assistance with daily activities. The Pro-Home study relied on client-HCA relationships and collaborating homecare stakeholders to recruit dyads in this randomized controlled trial (Randomized N = 128). Participating clients were mostly unmarried and unable to meet with family/friends multiple times a week. More than half lived alone, two thirds were cared for by a HCA who was not a family member, and the majority reported having a good relationship with their HCA. Most participating clients kept the same HCA throughout the 4-month intervention, before and throughout the ongoing COVID-19 pandemic. These characteristics highlight the critical role of homecare workers in caring and health promotion as older clients’ social convoy. However, the pandemic has posed challenges to these dyads. A higher proportion of clients participating in the intervention during the pandemic lost or were reassigned a HCA (20%) compared to those completed the intervention prior to the pandemic (10%). Our community collaborators reported increased staff turnovers and nationwide HCA shortages that created difficulties in care coordination. These findings will inform the ongoing debate on future financing and delivery systems of long-term services and supports, which are increasingly provided in home and community settings in the U.S. and other countries.
EMPOWERING BETTER END-OF-LIFE DEMENTIA CARE (EMBED-CARE): A DIGITAL CLINICAL DECISION SUPPORT FRAMEWORK
Authors: Davies Nathan , Sampson Elizabeth , Aworinde Tofunmi , Gillam Juliet , Kenten Charlotte , Phillips Bethan , Evans Catherine , Ellis-Smith Clare
Published: December 2023

People with dementia experience a variety of unmet palliative care needs. There is a need to empower people with dementia, family carers and professionals, to be able to better assess and monitor needs, and manage symptoms. We aimed to co-design and evaluate acceptability, feasibility and implementation of an integrated model of palliative dementia care to support holistic assessment, decision making and management of needs for those living in community and residential care (EMBED-Care Framework).We used a co-design approach, using framework analysis to synthesize data from evidence reviews, routine data, and cohort study, we presented findings to a series of co-design workshops, to produce the Framework. The Framework consists of a holistic assessment; priority setting; and decision support using clinical decision support tools, delivered on an app. The holistic assessment identifies areas of concern and identify priorities of care, through a process of shared decision making. Each concern is linked to a decision support tool to support decision making and to address priorities. App alerts and reminders communicate concerns among teams and carers. We are testing the Framework in a 6-month feasibility study with two residential homes and two community settings in England. We are collecting outcomes including decisional conflict, satisfaction with care, and unmet needs. We are interviewing all users to explore acceptability and implementation. We will present development of the EMBED-Care Framework and preliminary findings from our feasibility study, focusing on the acceptability and lessons for implementation which can be applied to the wider dementia community and similar interventions.
EXPLORING THE IMPLEMENTATION OF THE STRENGTHENING A PALLIATIVE APPROACH IN LONG-TERM CARE PROGRAM IN A CLINICAL TRIAL
Authors: Kaasalainen Sharon , Hunter Paulette , Thompson Genevieve , Wickson-Griffiths Abigail
Published: December 2023

Despite the high mortality rates in long-term care (LTC) homes, most do not have a formalized palliative program. Hence, our research team developed the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) program. This presentation will address how the SPA-LTC intervention was designed to be scaled up in a large randomized control trial, related implementation issues and strategies used to address them during the trial. This study used a cross-jurisdictional, effectiveness-implementation type II hybrid cluster design to evaluate the SPA-LTC program in 18 LTC homes across three provinces in Canada. The implementation component was designed as a formative evaluation to explore how to adapt the SPA-LTC program in real time. The SPA-LTC intervention leveraged both internal (palliative champion team) and external supports (palliative consultants) to build capacity within the LTC home to support and prepare residents and families for end-of-life decision making. Due to staff shortages and their inability to attend lengthy education sessions, we held four one-hour education sessions for the palliative champion team that were led by external palliative consultants over three months. Reach of the intervention was compromised as approximately 10% of participating residents died before a palliative care conference could be held. As a result, we prioritized residents who had lower Palliative Performance Scale (PPS) scores when planning a care conference. Clearly, efforts are needed to evaluate both the implementation and effectiveness of complex interventions, such as a palliative program, within a pragmatic approach given the real-life challenges that currently exist in this sector.
ANTIDIABETIC THERAPIES METFORMIN AND TRODUSQUEMINE MODULATE MIRNAS INVOLVED WITH LIVER METABOLISM
Authors: Ashiqueali Sarah , Schneider Augusto , Zhu Xiang , Juszczyk Ewelena , Zhu Yun , Bartke Andrzej , Siddiqi Shadab , Masternak Michal
Published: December 2023

Type II diabetes mellitus (T2DM) afflicts approximately 33% of individuals over the age of 65 increasing susceptibility to dyslipidemia, a hallmark of non-alcoholic fatty liver disease (NAFLD). Due to the idiopathic nature of NAFLD, there is no standard of care with only lifestyle intervention strategies available to improve hepatic function. Although dietary modifications and physical activity can prevent the pathogenesis of NAFLD, poor compliance has sparked an urgent need for pharmacological options to achieve glycemic control and prevent the onset of comorbidities. Metformin (MF) is commonly used medication to treat T2DM and has recently gained attention as an anti-aging intervention in non-diabetic individuals. Trodusquemine (MSI-1436) is a drug that induces fat loss by inhibiting the protein tyrosine phosphatase 1B (PTP1B), an enzyme that impairs leptin and insulin signaling. Using miRNA sequencing, we identified a cohort of miRNAs that are influenced by MF and MSI-1436 in the livers of UMHET3 mice. Our in-depth analysis and RT-PCR validation indicated groups of miRNAs regulating the processes of de novo lipogenesis, fatty acid oxidation, very-low-density-lipoprotein and cholesterol transport. Importantly, miR-379-5p, a known modulator of cholesterol metabolism, reported to be inhibited in the livers of patients with NAFLD and in mouse models of diabetes, was found to be upregulated by MSI-1436 in both sexes when comparing with both CTL and MF groups. In summary, our study showed that MSI-1436 more potently inhibits mechanisms involved with liver homeostasis relative to MF yielding insight on its therapeutic potential in concurrent liver diseases resulting from T2DM.
SUPPRESSION OF MICROBIOME SENSING—FREE FATTY ACID RECEPTOR 2 (FFAR2) SIGNALING EXHIBITS EARLY AGING
Authors: Mishra Sidharth , Prajapati Santosh Kumar , Jain Shalini , Yadav Hariom
Published: December 2023

Abnormalities in gut microbiome contribute to age-related diseases, causal to unhealthy aging, and early mortality, but mechanisms still remain largely unknown. Our recent research shows that old microbiota lacks the capacity to produce beneficial metabolites like short-chain fatty acids (SCFAs), which in turn promote gut permeability and systemic inflammation. SCFAs activates free fatty acid receptor 2 and 3 (FFAR2/3) signaling, at least in part, to exhibit their benefits on host cells; however, the role of these signaling in aging process is not well understood. We discovered that in addition to gut the brains of old mice show lower expression of FFAR2. Further, FFAR2 deletion in the intestine shows a shorter life span compared to wild-type mice. They also show a higher cognitive decline at early age. Similarly, intestine specific FFAR2 KO in APP/PS1 (Alzheimer’s disease [AD] model) background shows higher progression of AD including amyloid beta (A-beta) and tau accumulation, linked with higher blood brain barrier (BBB) permeability and neuroinflammation. These changes are associated with increased gut permeability and systemic inflammaging. Interestingly, a newly discovered natural FFAR2 agonist- Fenchol reduces these abnormalities in gut-brain and prevented the progression of cognitive decline and AD pathology. These results show that microbiome sensing FFAR2 signaling deficiency develops an early aging phenotype in mice, while its agonism using natural compound can delay/ prevent the progression of early aging.
IN THE PRESENT AND IN THE FUTURE: HOW TIME PERCEPTION AND TIME ORIENTATION SHAPE WELL-BEING ACROSS ADULT LIFE
Authors: Choi Yoonseok , Chu Li , Carstensen Laura
Published: December 2023

Individuals are able to maintain or even improve their wellbeing well into older adulthood. Socioemotional selectivity theory describes such age-related improvement in terms of motivational shifts toward emotionally meaningful goals with shrinking future time horizons. However, the association between future time perceptions and well-being is in need of being further clarified. In this symposium, four presentations will shed light on three different aspects of future time perceptions — time savoring, future preoccupation, thinking about the future — and their associations with wellbeing. Growney et al will present a study that utilizes a day reconstruction method to examine if time savoring is associated with psychosocial wellbeing and helping behaviors in workplaces. Pauly et al will discuss the potential benefits of time savoring for how solitude is experienced, by examining the buffering role of time savoring in depressive mood and somatic symptoms during solitude. Chu et al offers an alternative conceptualization of future time horizons, future preoccupation, capturing the worries and fixation on future preparation, and discusses its role in wellbeing across the life span. Choi et al discuss the role of thinking about the future for age-related differences in everyday experiences of happiness of varying arousal levels. The symposium will end with a discussion by Laura Carstensen integrating these findings into research on future time perspective and wellbeing across the life span. By elucidating more specific time-related experiences, our findings contribute to a more comprehensive understanding of how age-related changes in future time perspectives shape wellbeing trajectories across the life span.