bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Post-Traumatic Stress and Depression Among Older Puerto Ricans: How Does Loneliness Matter?
Authors: Wang Kaipeng , Cuevas Adolfo , Zhang Anao , De Fries Carson , Hinton Ladson , Falcón Luis
Published: December 2021

Puerto Ricans have a significantly higher prevalence of post-traumatic stress disorder (PTSD) than other racial and ethnic groups. PTSD can lead to co-morbid depression, which exacerbates the risk for compromised mental and physical health among older adults. Loneliness, a robust indicator of poor social support, is likely to worsen the dysphoric symptoms of PTSD and increase the risks of depression. However, few studies have focused on the moderating role of loneliness on the association between post-traumatic stress and depression. This study examines the association between post-traumatic stress and depression and whether such an association differs by loneliness among older Puerto Ricans. Data were collected from 304 Puerto Ricans aged 60-81 living in the Greater Boston area who responded to questionnaires in a survey. We used ordinary least squares regression to examine the association between post-traumatic stress, loneliness, and depression. We found that post-traumatic stress was significantly associated with higher levels of depression; however, the association was contingent on experiences of loneliness. The association between post-traumatic stress and depression was stronger for those experiencing a higher degree of loneliness. Findings underscored the role that loneliness plays in exacerbating the risk of developing co-morbid PTSD and depression among older Puerto Ricans. In working with older Puerto Ricans experiencing post-traumatic stress, it is important for mental health professionals to incorporate the assessment of loneliness and to prevent and reduce co-morbid depression by addressing loneliness through improving social skills, enhancing social support, and reducing maladaptive social cognition.
Universal DNA Methylation Age Across Mammalian Tissues
Authors: Ake Lu Viviana Perez , Fei Zhe , Raj Ken , Horvath Steve
Published: December 2021

Aging is often perceived as a degenerative process caused by random accrual of cellular damage over time. In spite of this, age can be accurately estimated by epigenetic clocks based on DNA methylation profiles from almost any tissue of the body. Since such pan-tissue epigenetic clocks have been successfully developed for several different species, it is difficult to ignore the likelihood that a defined and shared mechanism instead, underlies the aging process. To address this, we generated over 10,000 methylation arrays, each profiling up to 37,000 cytosines in highly-conserved stretches of DNA, from over 59 tissue-types derived from 128 mammalian species. From these, we identified and characterized specific cytosines, whose methylation levels change with age across mammalian species. Genes associated with these cytosines are greatly enriched in mammalian developmental processes and implicated in age-associated diseases. From the methylation profiles of these age-related cytosines, we successfully constructed three highly accurate universal mammalian clocks for eutherians, and one universal clock for marsupials. The universal clocks for eutherians are similarly accurate for estimating ages (r>0.96) of any mammalian species and tissue with a single mathematical formula. Collectively, these new observations support the notion that aging is indeed evolutionarily conserved and coupled to developmental processes across all mammalian species - a notion that was long-debated without the benefit of this new and compelling evidence.
Self-Reported Discrimination, Resilience, and Oral Health-Related Quality of Life Among Older Chinese Americans
Authors: Mao Weiyu , Wu Bei , Chi Iris , Yang Wei , Dong XinQi
Published: December 2021

There is a lack of empirical evidence on self-reported discrimination and oral health-related quality of life (OHRQoL). Further, the mechanism linking the two constructs is not well understood. This study aimed to examine the relationship between self-reported discrimination and OHRQoL and investigate resilience as a mediator in such a relationship among foreign-born older Chinese Americans. Data came from the Population Study of Chinese Elderly in Chicago collected between 2017 and 2019. The working sample included 3,054 foreign-born Chinese Americans (60+ years of age). Mediation analysis was conducted to examine the direct and indirect pathways towards OHRQoL. Self-reported discrimination was directly and indirectly associated with poorer OHRQoL. Resilience mediated the relationship between self-reported discrimination and OHRQoL. Specifically, individuals experienced discrimination reported weaker resilience, and subsequently, reported poorer OHRQoL. Findings illustrate the importance of studying self-reported discrimination in relation to OHRQoL and further identify resilience as an intermediary pathway to promote OHRQoL.
Changes in Job Quality as People Work Beyond Pensionable Age in Sweden
Authors: Sacco Lawrence , Cahill Kevin , Westerlund Hugo , Platts Loretta
Published: December 2021

This paper uses data from the biennial Swedish Longitudinal Occupational Survey of Health to examine changes in job quality among older workers, controlling for work intensity and employment characteristics. Job quality outcomes included job satisfaction and physical (dangerous, strenuous or unpleasant work) and psychosocial (job strain, effort-reward imbalance, work time control) working conditions. First difference estimation was used to analyze within-individual changes in job quality, as well as changes in hours, employment characteristics (shifting to a non-permanent contract, the private sector and self-employment) and health. Individuals who worked beyond pensionable age experienced statistically significant improvements in job quality, with larger improvements among those who reduced working hours and shifted from permanent to non-permanent contracts, from the public into the private sector, and from wage-and-salary to self-employment. We conclude that work beyond pensionable age is a distinctive period characterized by employment that becomes more flexible and rewarding and less stressful.
A Pandemic Paradox: Innovations in Psychological Resiliency and Suicide Prevention in Older Adults
Authors: Heisel Marnin
Published: December 2021

The COVID-19 pandemic has had a substantial negative impact on the health and well-being of older adults, a demographic with the highest proportion of fatalities in North America. Long-term care and retirement homes have been especially hard hit. Sheltering in place can increase social isolation among older adults and contribute to feelings of stigmatization, burden, stress, anxiety, anger, and despair. As older adults also account for high rates of suicide, fear of infection, reduced access to professional and social supports, and growing apathy, hopelessness, and social isolation could amplify suicide risk (see Zortea et al., 2020). The speaker will discuss how his program of research on psychological resiliency and suicide prevention in older adults has pivoted online over the past year, and how the pandemic has paradoxically inspired innovative approaches to research, education, clinical practice, and social advocacy for older adults that will likely continue well beyond the present time.
Social Connections: Transformative Experiences Amid Disruptive Times
Authors: Cudjoe Thomas
Published: December 2021

Today many older adults are experiencing intensified social isolation and loneliness as they attempt to “stay safe at home.” The notion, is a stark contrast from our understanding of the importance of social connections on health and well-being. This session highlights: first hand experiences caring for older adults during the COVID-19 pandemic and the implications of social isolation on the health of older adults. The speaker will offer perspectives for ESPO members on the role of community engagement in orienting research agendas, both now (amid the pandemic) and into the future.
The Impact of COVID-19 and Associated Restrictions on Physical Activity Among Assisted Living Residents
Authors: Galik Elizabeth , Resnick Barbara , McPherson Rachel
Published: December 2021

COVID-19 and associated restrictions significantly impacted residents in assisted living (AL) communities. This was a descriptive study of 35 AL communities that were participating in an implementation trial of Function Focused Care for Assisted Living Residents with Dementia during the COVID-19 pandemic. Within twelve months of the COVID-19 pandemic, 18% of the AL communities had at least one resident who was positive for COVID-19. Almost half of the ALs allowed health care providers into the setting. All of the ALs facilitated family visits outside and by telephone and technology, but only 11% allowed visitors inside the community. Over 50% stopped using recreational supplies to encourage physical activity and 28% reported that residents experienced more behavioral and psychological symptoms of dementia. Restrictions designed to prevent the spread of COVID-19 may have negatively impacted resident behavior and the AL staff’s engagement of residents in physical and recreational activities during the pandemic.
Features of Rural Communities in Latin America and Sub-Saharan Africa That Influence Well-Being of Older Persons
Authors: Curreri Nereide , Banda Andrew , Keating Norah , Hoffman Jaco , Parodi Jose
Published: December 2021

In their recent volume, Critical Rural Gerontology, Skinner et al (2021) challenge us to set aside unidimensional notions of rural communities as bypassed vs very supportive; and to identify the elements of rurality that empower or exclude older people and how these differ across cultures and settings. Covid-19 has highlighted the need for safe and inclusive communities. Given that LMIC will be home to the majority of older adults (Gonzales et al. 2015), we undertook a scoping review of features of rural communities that influence wellbeing of older people in countries across Latin America and Sub-Saharan Africa. The review included literature in English, French, Spanish and Portuguese, using search engines MEDLINE, CINAHL Complete, PsycInfo, SocINDEX, SciELO, AJOL (Africa Journals Online), LILACS, Redalyc, LatinIndex and Clacso. Findings illustrate diversity in how community features including remoteness, infrastructure and belonging influence material, social and subjective wellbeing of older residents.
Religious Service Attendance, Allostatic Load, and Mortality Among Black Men
Authors: Bruce Marino , Beech Bettina , Kermah Dulcie , Marshall Gillian , Archibald Paul , Smith Genee , Thorpe Roland
Published: December 2021

Black men experience high levels of social and psychological stress and religion has been a coping strategy. The purpose of this study was to examine the association between religious service attendance and mortality among Black men. Data were drawn from the NHANES III (1988-1994) sample linked to the 2015 public use Mortality File. The analytic sample (n=2300) was restricted to Black men. All-cause mortality was the primary outcome and religious service attendance was the primary independent variable. Findings from Cox proportional hazards models indicated participants who attended at least once per week were 18% less likely to die than their peers who did not attend a religious service at all (fully adjusted HR 0.82; CI 0.68-0.99). The robust association between religious service attendance and mortality among Black men suggest that prospective studies are needed to further examine the influence of religion on health among this population.
Psychosocial Risk Factors of Quality of Life Outcomes Among Older Adults Living With HIV
Authors: Brown Monique
Published: December 2021

Antiretroviral therapy, higher education, and HIV disclosure have been linked to improved quality of life (QoL) among people living with HIV. However, research examining psychosocial risk factors of QoL among older adults living with HIV (OALH) is lacking. Therefore, the main aim of this study was to examine the psychosocial risk factors of QoL among OALH. Data were obtained from 156 adults aged 50 and older living with HIV in South Carolina. Multivariable regression models adjusting for sociodemographic characteristics were used to determine the association between psychosocial risk factors and QoL domains among OALH. Stigma was associated with the physical (β=0.058, p=0.023), social (β=-0.149, p=0.006), and spiritual (β=0.124, p=<0.001) domains. Resilience was associated with the psychological (β=0.206, p=<0.001), independence (β=0.100, p=0.010), social (β=0.166, p=0.004), and environmental (β=0.312 p=<0.001) domains. Depression and experiencing trauma were also associated with varying QoL domains. Findings may inform interventions geared towards improving QoL among OALH.
An Ecological Model of Risk Factors in Older Adults With Repeated Exposure to Elder Mistreatment
Authors: Li Mengting , Le Qun , Dong XinQi
Published: December 2021

Limited empirical studies examined the factors related to repeated EM exposures among Chinese older immigrants. Guided by the ecological model, this study aims to explore what are the risk factors leading to recurrence of EM. Data were drawn from the two-wave PINE Study with 725 participants having EM at baseline and 191 reported repeated EM after two years. EM was evaluated by a 66-item instrument, including psychological, physical, and sexual mistreatment, financial exploitation, and caregiver neglect. Logistic regression was used. Increasing financial independence was associated with lower possibility of repeated EM (OR: 0.72, 95%CI 0.56-0.92). Every one unit increase in ADL impairment (OR: 1.10, 95%CI 1.02-1.18), IADL impairment (OR: 1.09, 95%CI 1.05-1.13) and increase frequency of alcohol consumption (OR: 1.33, 95%CI 1.06-1.66) were associated with higher possibility of repeated EM. Social service could improve physical function, provide financial support, and reduce health-risk behavior to prevent the recurrence of EM.
Cultural Differences in Older Immigrants' Health and Social Services Use
Authors: Diederich Freya
Published: December 2021

Even though Germany has a mandatory health and long-term care insurance with no or only very low co-payments, immigrants and the native population differ in their health and social services use. Differences in cultural traits and a lack of knowledge about the institutional setting are frequently mentioned as contributing factors. Relying on the epidemiological approach in the economic literature, this empirical study shows that both cultural traits that prevail in older immigrants’ country of origin and older immigrants’ knowledge about the host country’s institutional setting affect their health and social services use in Germany. We distinguish foreign-born immigrants and their descendants as both groups differ in their connection to the home and the host country. The results will be used to discuss immigrants’ access and potential barriers to the use of health and social services in comparison to the native population.
How Active Aging Policies Evolved in Italy? A Systematic Review of National and Regional Policies
Authors: Barbabella Francesco , Lucantoni Davide , Socci Marco , Lamura Giovanni , Principi Andrea
Published: December 2021

In recent years, active aging became a concept progressively considered by policy makers in Italy. A national project for creating a multilevel and co-managed coordination of active aging policies was launched in 2019 by the Italian Government and the National Institute of Health and Science on Ageing (IRCCS INRCA). A systematic review of active aging policies was conducted at both national and regional level. Results showed that national policies still reflect the general categorical fragmentation of Italian welfare system, although substantial developments were found in some sectors, i.e. prolonging working life, supporting families, social inclusion, and healthy ageing. Ten out of twenty-one regions have approved laws dedicated to active aging, although in most cases these laws are too recent to show impact. National and regional policy makers still need to overcome several cultural, coordination and fragmentation challenges for improving active aging policies and harmonise them with societal needs.
Creating, Recruiting, and Developing: Key Tasks and Their Challenges
Authors: Ansello Edward , Helm Faith
Published: December 2021

The ECHO model is uniquely suited to developing education for a wide range of agencies and providers serving the needs of older adults with IDD. The program’s structure and its educational philosophy depend on modeling teamwork in both the hub and the spokes. Recruitment of participants included paid caregivers, healthcare practitioners, and direct service providers, focusing on team participation at each site. In developing the curriculum, it was critical to recognize the roles played by each sector, as well as the complementary contributions of others. Consequently, curriculum content needed to be multidisciplinary and multifocal, and recognize both the breadth of contributors and time limits in selecting content for each session. Didactic presentations and case studies embodied these features. Priorities included best practices in person-centered care; differential diagnoses; and physical, social, and environmental factors. The facilitators of, and challenges to, these priorities offer implications for advancing educational programs with similar objectives.
Working while Caring for Older Adults with Hearing Impairment and Dementia: Evidence from the NSOC
Authors: Morales Emmanuel Garcia , Varadaraj Varshini , Swenor Bonnielin , Reed Nicholas
Published: December 2021

Age-related hearing loss (HL) and dementia are common among older adults. The implications of caregiving for older adults with dementia is documented. Whether the presence of HL modifies these association is unknown. We used data from the 2011 NHATS/NSOC. Hearing loss and dementia were identified among care recipients (CR). Our outcomes included: hours of care provided, and caregiver’s work activities. Among 1,013 caregivers, 456 assisted individuals without HL or dementia (HL-/D-), 229 with dementia (D+), 193 with HL, and 135 with HL and dementia (HL+/D+). In fully adjusted models, as compared to caregivers of HL-/D-, caregivers of D+ spent 39.1 hours more (95% CI: 13.6,64.6) in caregiving, caregivers of HL+/D+ spent 56.6 more hours (95% CI: 25.1,88.1). We found no differences in work activities between CR groups. The presence of HL increases the caregiving needs of adults with dementia. The additional time does not affect the labor participation of caregivers.
Sensory Impairment and Algorithmic Classification of Early Cognitive Impairment in Middle-Aged and Older Adults
Authors: Cai Yurun , Agrawal Yuri , Schrack Jennifer , Gross Alden , Armstrong Nicole , Simonsick Eleanor , Resnick Susan
Published: December 2021

Sensory function has been linked to cognitive impairment and dementia, but the link between multiple sensory impairments and early cognitive impairment (ECI) is unclear. Sensory function (vision, hearing, vestibular, proprioception, and olfaction) was measured in 390 BLSA participants (age=75±8 years; 57% women; 69% white) from 2012 to 2018 over a mean 3.6 years. ECI was defined based on 1 standard deviation below age-and race-specific means in Card Rotations or California Verbal Learning Test immediate recall. Cox proportional hazard models examined the risk of ECI for each sensory impairment and across categories of impairments. Vision impairment (vs. no vision impairment) was associated with a 70% greater risk of ECI (HR=1.70, p=0.05). Participants with 1 or ≥2 sensory impairments had triple the risk of ECI (HR=3.74 and 3.44, p=0.008 and 0.02, respectively) compared to those without impairment. Future studies are needed to examine whether treatment for sensory impairments can modify these risks.
Longitudinal Effects of Coping Strategies on Mental Health of Older Adults Living Alone During the COVID-19 Pandemic
Authors: Kim Seoyoun , Yoon Hyunwoo , Jang Yuri
Published: December 2021

The COVID-19 pandemic and related social distancing measures have posed a significant threat to the mental health of older adults, particularly those living alone. Accordingly, the World Health Organization implemented the #HealthyAtHome program, encouraging people to keep in regular contact with loved ones, stay physically active, and keep a regular routine. The current study aims to examine a micro-longitudinal link between positive coping strategies (e.g., exercise, meditation, relaxation, and virtual social contacts) and depressive symptoms among older adults who live alone during the COVID-19 pandemic. We used 21 biweekly waves of longitudinal data from the Understanding America Study (UAS) collected between April 2020 and February 2021 (N=839, observation= 16,256). The multilevel models with correlated random effects were estimated to examine lagged effects of coping strategies (t-1) on depressive symptoms (t). The analysis used the xthybrid command with clustered standard errors in Stata 15.1. The results show that exercise (b=-.10, p=0.02), relaxation (b=-02, p=0.01), and virtual social contacts (b=-.01, p=0.01) were predictive of lower depressive symptoms even after controlling for time-invariant and time-varying covariates. Meditation, however, was associated with higher depressive symptoms (b=.01, p=0.02). The results show that modifiable lifestyle factors, such as taking time to exercise or relax, may enhance mental health and well-being for older adults living alone. Virtual social contacts such as video calls could be an effective way to keep older adults socially connected and emotionally healthy.
Antidepressant Use and Risk of Suicidal Behavior in Older Persons With Depression: A Cohort Study in Hong Kong
Authors: Chai Yi , Luo Hao , Man Kenneth K C , Lau Wallis C Y , Wong Ian C K
Published: December 2021

Background: Depression is highly prevalent in older adults and requires treatment. However, debate persists on whether antidepressant use is associated with an elevated risk of suicidal behavior. This study aims to examine the short- and long-term risk of suicidal behavior by various classes of antidepressants in older persons with depression. Methods: Persons aged 40 years and above and received a clinical diagnosis of depression between January 1, 2001, and December 31, 2016 were identified from the Clinical Data Analysis and Reporting System in Hong Kong. The risk of suicidal behavior in persons who were prescribed antidepressants was compared with persons who were not prescribed any antidepressant drugs. Antidepressants were classified as tricyclic and related antidepressant drugs (TCAs), selective serotonin reuptake inhibitors (SSRIs), noradrenergic and specific serotonergic antidepressants (NaSSAs), serotonin–norepinephrine reuptake inhibitors (SNRIs) and others. Incidence and adjusted hazard ratio (aHR) of subsequent self-harm and suicide within one-year and the whole study period were estimated by age groups. Results: A total of 34,927 persons aged 40-64 years, and 19,300 persons aged 65+ years were included. In the younger age group, the highest short-term and long-term risks were found in others (aHR, 2.33; 1.02-5.34) and NaSSAs (2.88; 2.15-3.86), respectively. In the older age group, no significant association was observed between antidepressant use and suicidal behavior across all antidepressant classes. Conclusion: The self-harm and suicide associated risks vary across antidepressant classes and age groups. Cautions are always needed for antidepressant prescriptions.
Association of Early-Life Family and Nieghborhood Circumstances With Depressive Symptoms in Chinese Older Adults
Authors: Wu Chenkai , Tan Jie
Published: December 2021

A growing body of literature suggests that early life circumstances can influence mental health throughout the lifespan. However, how these early life circumstances cumulatively contribute to depression in old age is not completely understood. The present study examined the associations of eight factors representing multifaceted early life experience at individual, family, and community levels with depression among community-dwelling older adults. Data were from the China Health and Retirement Longitudinal Study. We included 8,239 community-dwelling individuals who were ≥60 years, completed the life history questionnaire, and had assessment of depression. Chi-square test was used to examine the unadjusted associations between each of the eight early life risk factors and depression. An early life disadvantage index was established using risk factors that were significantly associated with depression. Logistic regression was used to examine the association of each early life risk factor and the index with depression. Of 8,239 individuals included, 2,055 (24.9%) had depression. In bivariate analysis, each of eight early life risk factors was significantly associated with depression. Except for maternal and paternal education, all risk factors persisted to be associated with depression after multivariable adjustment. In the multivariable-adjusted model, a one-point higher in the early life disadvantage index (range: 0-6) was associated with a 45% (95% CI: 37%, 53%) higher odds of depression. There was a strong association between early life environments and depressive symptoms among Chinese community-dwelling older adults. Adverse early life circumstances could contribute cumulatively to depression in old age.
Differential Treatment of Older Workers Due to COVID-19: Potential for Ageism and Age Discrimination at Work
Authors: Hollis-Sawyer Lisa
Published: December 2021

This paper examines the implications of employers' current COVID-19 protective workplace attendance policies toward older workers, potentially creating the outcomes of increased numbers of involuntary retirees and the discouraged older worker syndrome among otherwise qualified older workforce participants. How potential ageist assumptions and age discrimination under COVID-19 affect workplace decisions in reflection on the Age Discrimination in Employment Act (1967) guidelines is discussed. Older workers may remain in the workforce longer than ever before due to having healthier life expectancies. Workplace policies need to be increasingly sensitive to older employees’ rights to sustain their workplace engagement (Cummins, 2014; Cummins, Harootyan, & Kunkel, 2015). The author reviewed current unemployment trends in 2020 and emerging litigation in reflection upon general issues of COVID-19 related age discrimination in the older workers' workplace attendance decisions by employers and the historical framework of the Age Discrimination in Employment Act (1967, with significant amendments in 1978 and 1986). The policy analysis paper presents the implications of employers' COVID-19 protective policies on older workers and how it may affect the “health” of the workplace and older adults and the economy beyond the pandemic. Lastly, strategies to address an "age-friendly" workplace during a pandemic and post-pandemic are discussed.
Eldercare Responsibilities and Physical Health Symptoms Among Manufacturing Workers
Authors: Fortinsky Richard , Barnes-Farrell Janet , Garza Jennifer , Lacey Samantha , Austin Hannah , Grady James , Cherniack Martin
Published: December 2021

Working adults responsible for providing care to older relatives at home (eldercare) have reported greater psychological health problems such as depressive symptoms and stress than workers without eldercare responsibilities. Less is known about how eldercare is associated with physical health symptoms such as sleep-related problems and pain. Among manufacturing workers, such physical health symptoms have the capacity to diminish productivity. Therefore, we explored associations between eldercare responsibilities and physical health symptoms that could affect work performance in a sample of 357 adult employees from five manufacturing companies in a northeastern US state. Research questions were: are workers with eldercare responsibilities more likely than those without eldercare responsibilities to report sleep-related and pain-related symptoms, and are the number of eldercare tasks associated with these physical health symptoms? Among sample members, 52 (14.6%) provided eldercare, 62% were male, mean(standard deviation) age=49.8(12.7), and 77% were non-Hispanic White; no demographic differences were found between those with and without eldercare responsibilities. In bivariate analyses, we found that providing eldercare was associated with lower sleep quality (p=.05), fewer hours of sleep during the workweek (p=.04), more pain interference at home and at work (p=.02), and more pain on average in the past week (p=.01). Providing more types of eldercare tasks ranging from personal care to providing transportation was associated with more pain on average in the past week (p = .04). We conclude that eldercare is associated with physical health symptoms that could directly affect job performance among manufacturing workers. Workplace policy implications will be discussed.
Circadian Rest and Activity Rhythms and Cognitive Change in the Baltimore Longitudinal Study of Aging
Authors: Rabinowitz Jill , An Yang , Wanigatunga Sarah , Zipunnikov Vadim , Wu Mark , Simonsick Eleanor , Resnick Susan , Spira Adam
Published: December 2021

Alterations in 24-hour movement patterns, or circadian rest/activity rhythms (RARs), commonly occur with aging. Using linear mixed effects (LME) modeling, we examined associations of baseline RARs with longitudinal change in cognition. Participants (N=424; 47% male, baseline age 72.8±10.1 years) were from the Baltimore Longitudinal Study of Aging and completed 5.6±0.8 nights of wrist actigraphy at baseline. Tests of memory, executive function, attention, language, and visuospatial ability were administered at baseline and subsequent visits (3.7±1.7 years of follow-up in those with >1 visit (n=295)). In unadjusted random intercept and slope LME models, greater RAR stability predicted slower memory decline, and higher activity during participants’ least active 5 hours (L5) predicted slower decline in visuospatial ability. After covariate adjustment, higher activity in participants’ most active 10 hours (M10) and higher L5 predicted slower decline in visuospatial ability (p<.05). Further research is needed on RARs as risk factors for later-life cognitive decline.
Evaluating Implementation of the Behavioral Recovery Outreach (BRO) Team: One Year of Implementation
Authors: Jedele Jenefer , Griffin Cameron , Matthews Kathleen , Vinson Latrice
Published: December 2021

We present evaluation results after one year of implementation by nine BRO Teams. Monthly checklists documented consistent composition across teams: a psychologist, social worker and nurse. Social workers were recognized as having a critical role in implementation, serving as a referral source and liaison between the CLC, Veteran/family, and community facility. Early implementation focused on team and program development with barriers including unprotected time for Team members. In the first year, the nine teams enrolled 70 Veterans, discharging 86% to community facilities. Characteristics of the Veterans suggest Teams are reaching the complex Veteran targeted by the model. Barriers to successful discharge include community facility inexperience/training and confidence to manage complex residents. COVID emerged as the leading barrier to outreach to internal and external partners and providing transitional support to the Veteran after discharge. We discuss the impact of these preliminary findings on future implementation and dissemination of the model.
A Qualitative Comparison of the Post-COVID Retirement Experience Between Japanese and American Older Adults
Authors: Bradley Dana , Nishikitani Mariko , Ariyoshi Mie , Yokota Fumihiko , Tucker Gretchen , Allen Laura
Published: December 2021

The purpose of this collaborative study between researchers in Japan and the U.S. was to understand the retirement experience and potential changes in social interactions (amount, type, and mode of communication) among older adults living independently in the community. Specifically, we were interested in individuals’ expectations about retirement and the types of social interactions experienced prior to and post-retirement, situated within the context of the COVID-19 pandemic. Both research teams conducted in-depth one-on-one interviews with community-residing retired older adults in early 2021. In the findings we explore similarities and differences between the retirement experiences of Japanese and American older adults, including methodological differences that transpired; specifically, we evaluate the meaning and experience of the COVID-19 pandemic in each of these cultural contexts and how retired older adults experienced its impact in their social interactions.
Developing Culturally Competent Technology for Older Adults in Japan and the United States
Authors: Allen Laura , Bradley Dana , Tucker Gretchen
Published: December 2021

The United States and Japan are experiencing an exponential growth in the number of persons age 65 and older. To address certain aging-related issues, assistive technological advancements are being developed. These technologies need to be reliable, safe, secure, and culturally accepted by older adults. In addition, technology must be developed within the unique cultural contexts of each country. One approach currently being used is an interdisciplinary team approach comprised of researchers representing gerontology, information systems, robotics, health sciences, sociology, and computer sciences between two universities in the United States and two Japanese universities. This collaborative project between institutions and countries highlights the need to understand the cultures and traditions of each of these countries. To further develop culturally competent technology, an integrative research plan is being utilized, which incorporates the use of community engagement to examine the influence of the cultural context among older adults.
Ohio's Dual Eligible Population: Effects of Program Design and Implementation on Care Management
Authors: Heston-Mullins Jennifer , Abbott Katherine , Koumoutzis Athena
Published: December 2021

MyCare Ohio is a prospective blended managed care payment model program tasked to provide comprehensive and coordinated care to Ohio residents who are dully eligible for Medicare and Medicaid. To understand the administration and day-to-day implementation of care management within MyCare Ohio, n=75 interviews with a total of n=331 personnel from Area Agencies on Aging, Managed Care Plans, and service providers were conducted. Interviews were audio recorded, transcribed, and checked for accuracy. Data were analyzed by iterative reviews and deductive coding in Dedoose. Respondents provided insights on how care management activities are affected by program design features (e.g., ability to opt-out of the Medicare component), transitions between acute and long-term care settings, documentation systems and data-sharing, and high numbers of beneficiaries with behavioral health diagnoses. Implications for practice and policy will be discussed.
Disability and Older Age Return Migration: Evidence Against the Salmon Bias
Authors: Sheftel Mara
Published: December 2021

Mexican immigrants make up an increasing proportion of the US population 65 and older. Whereas this population has among the lowest rates of disability at working ages, there is growing evidence of high rates of disability at older ages, findings which contradict what mechanisms of selection, namely the “salmon bias,” would predict. However, largely due to data limitations disability rates between those who stay in the US into older ages and those who return to Mexico are rarely compared. Here two waves of data from the US based Health and Retirement Study and the Mexican Health and Aging Study are combined to create a novel dataset that enables an interrogation of the widely held assumption of negative selection on health among return migrants. Investigating three measures of functional limitation and disability, results show higher prevalence of disability for stayers as compared to both younger and older returnees. These results are robust to controls for childhood background, adult socioeconomic status, and migration related variables and hold for those who immigrated during different immigration policy regimes. These findings are novel not only because they stand in opposition to previous assumptions about the direction of health selective return migration, but also because they mean that those remaining in the United States into older ages are among the most vulnerable.
Psychosocial and Physical Activity Outcomes Among Group Lifestyle Balance Program Participants With Arthritis
Authors: Der Ananian Cheryl , Delgado Ferdinand , Hudzinski Taylor
Published: December 2021

Background: Weight loss and physical activity (PA) are recommended for arthritis management. The Group Lifestyle Balance (GLB) Program(TM) is an evidence-based, lifestyle change program for weight loss in individuals with prediabetes, but hasn’t been evaluated in people with arthritis. Purpose: The purpose of this study was to evaluate the effectiveness of an adapted version of the GLB program on PA and psychosocial outcomes related to weight loss among overweight (Body Mass Index >27) individuals with arthritis. Methods: A single-group, quasi-experimental design was used to examine the effects of the adapted GLB program on measures of PA and psychosocial outcomes. All participants (N=15) received the GLB program and completed the following surveys: CHAMPS PA, Self-Efficacy for PA (SE), Social Support for PA (SS), Weight Loss Efficacy (WEL) and Barriers to Healthy Eating (BHE) at baseline, 12-weeks, 6 months, and 12 months. Repeated measures ANOVA and the Friedman Test were used to examine changes over time. Results: Participants (aged 53-79 years) were primarily female (82%), white (94%), and college educated (94%). Significant improvements were found in BHE subsections of self-control and motivation (p=0.002), daily mechanics (p=0.042), and WEL subsections of availability (p=0.049), social pressure (p=0.010), physical discomfort (p=0.011), and positive activities (p=0.007). Weekly caloric expenditure (p=0.004), metabolic equivalent minutes (p=0.022) for all activities, and moderate-intensity activities (p=0.019) also showed significant improvements. However, most improvements were seen in the short-term. Conclusions: The GLB program should be further evaluated for its effectiveness in people with arthritis.
Episodic Memory in Older Adults Without Dementia: A Meta-Analysis of Aerobic Exercise Interventions
Authors: Aghjayan Sarah , Bournias Themistokles , Stillman Chelsea , Donofry Shannon , Marsland Anna , Erickson Kirk
Published: December 2021

The effect of aerobic exercise interventions on episodic memory performance among older adults without dementia remains a matter of intense debate. Prior meta-analyses examining this association have reported minimal improvements in episodic memory performance following exercise training but have also been plagued by several limitations, including restrictive inclusion criteria, combined sample populations, and infrequent examination of the effect of exercise parameters (e.g., volume). To address these gaps, we conducted a meta-analysis of randomized controlled trials (RCTs) to determine if aerobic exercise interventions influence episodic memory performance in older adults without dementia and to examine potential moderators of these effects (e.g., sample and intervention characteristics). Included studies met the following criteria: (1)Studies of adults (M≥55 years) with normal cognition, subjective cognitive decline, or mild cognitive impairment; (2)Aerobic exercise RCTs; and (3)Assessment of episodic memory. Intervention effects were represented by Hedges’ g and combined into pooled effect sizes using random- and mixed-effects models. Thirty-three studies met inclusion criteria, representing data from 2,488 participants. The primary analysis yielded a significant positive effect of aerobic exercise on episodic memory (Hedges’ g[CI]=0.28[0.10-0.47]; p=0.003). Mixed-effects analyses demonstrated a positive effect on episodic memory among studies with a high percentage of females (>66%), participants with normal cognition, studies reporting intensity, studies with a no-contact or nonaerobic physical activity control group, and studies prescribing 2,100–3,900 total minutes of activity (range 540–8,190 minutes). These results suggest that aerobic exercise may act as an accessible, non-pharmaceutical intervention to improve episodic memory in late adulthood before changes in cognition are detected.
What Is Paradoxical Lucidity?
Authors: Peterson Andrew , Karlawish Jason
Published: December 2021

In this presentation, I provide a conceptual background from which the other symposium speakers can describe detailed methods for investigating paradoxical lucidity (PL) in dementia. First, I outline the clinical and ethical significance of studying PL. Second, I describes how PL is understudied and so difficult to measure. A working definition of PL has been formulated from case reports, but aspects of this definition remain vague. I argue that this vagueness challenges the measurement of PL and the generalizability of study results. I conclude by proposing ways to address these problems.
Non-Inferiority of a Group LiFE Version Compared to the Original, Individual LiFE to Prevent Falls
Authors: Jansen Carl-Philipp , Nerz Corinna , Labudek Sarah , Gottschalk Sophie , Dams Judith , Klenk Jochen , Becker Clemens , Schwenk Michael
Published: December 2021

The ‘Lifestyle-integrated Functional Exercise’ (LiFE) program has been shown to reduce risk of falling via improvements in balance and strength while increasing physical activity in older adults. Its one-to-one delivery comes with considerable costs hampering large scale implementability. To potentially reduce costs, a group format (gLiFE) was developed and analyzed for its non-inferiority to LiFE in reducing activity-adjusted fall incidence after 6 months. Further, intervention costs and physical activity were analyzed. Older adults (70+ years) at risk of falling were included in this multi-centre, single-blinded, randomized non-inferiority trial. LiFE was delivered in nine intervention sessions to increase balance, strength, and physical activity, either in a group (gLiFE) or at the participant’s home (LiFE). 309 persons were randomized into gLiFE (n=153) and LiFE (n=156). Non-inferiority for activity-adjusted falls was inconclusive; the incidence risk ratio (IRR) of gLiFE was 1.350 (95% CI: 0.856; 2.128) at 6 months. Falls were largely reduced in both groups. Physical activity was superior in the gLiFE group (gLiFE +880 steps; CI 252, 1,509) which also had a cost advantage under study conditions as well as real world estimations. GLiFE was associated with lower intervention costs, making it a cost-efficient alternative to the individually delivered LiFE. The added value of gLiFE is the greater effect on physical activity, making it particularly attractive for large scale PA promotion in public health concepts. Depending on individual needs and preferences, both formats could be offered to individuals, with a greater focus on either fall prevention (LiFE) or physical activity promotion (gLiFE).
Recruiting and Screening Older Adults With Alzheimer’s Disease for the FIT-AD Trial
Authors: Yu Fang , Wyman Jean , Greimel Susan , Zhang Lin
Published: December 2021

Recruiting older adults with Alzheimer’s disease (AD) into clinical trials has been very challenging even for resource-rich trials. This presentation will discuss the recruitment rate, screening ratio, and recruitment yield and costs in the FIT-AD Trial. The FIT-AD Trial was a single-site, pilot randomized controlled trial testing the effects of 6-month aerobic exercise on cognition and hippocampal volume in community-dwelling older adults with mild-to-moderate AD dementia. Ten recruitment strategies and a 4-step screening process were used to ensure a homogenous sample and exercise safety. The target sample size was 90. During the 48-month recruitment period, 396 individuals responded to our recruitment, 301 were reached, and 103 were tentatively qualified at step 4. Of these 103, 67 (69.8%) completed the optional magnetic resonance imaging (MRI) component of the trial and 7 were excluded due to abnormal MRIs. In year 4, our sample size was increased to allow individuals in the screening process a chance to enroll, resulting in a final sample size of 96. Per enrolled participant, the recruitment rate was 2.15, the screen ratio was 2.92, and the recruitment yield was 31.9%. Over 49% of the enrolled participants were yielded through referrals (28.1%) and Alzheimer’s Association events/services (21.9%). The total recruitment cost was $38,246 ($398 per randomized participant). The results indicate that a multi-prong, extensive community outreach-based approach is essential in recruiting older adults with AD dementia into an exercise trial. Referral was the most cost-effective strategy. Two individuals needed to be screened to enroll one participant.
Factors Predicting Delay of Medical and Dental Care Among American Adults Over 50 During the COVID-19 Pandemic
Authors: Chan Athena Chung Yin , Sneed Rodlescia
Published: December 2021

Delaying or avoiding medical care is associated with a range of poor health-related outcomes. Due to concerns about the coronavirus (COVID) pandemic, many older adults delayed or avoided seeking medical and dental care in 2020. The purpose of this study was to examine factors predicting delay or avoidance of care among older adults. Participants were U.S. adults aged ≥ 50 who participated in the Health and Retirement Study, a population-based study of community-dwelling adults. Delays in seeking or obtaining medical and dental care were assessed via self-report in June 2020. Hierarchical logistic regression models were used to predict the influence of demographic variables (e.g. age, marital status, race and ethnicity, gender, education, work status), health insurance status, health status, and COVID-related experiences (self or household history of COVID diagnosis, knowing anyone who died from COVID, willingness to take risks, and pandemic concerns) on delay or avoidance of medical or dental care. Overall, 30% of our sample reported delaying or avoiding medical or dental care. Delayed care was lower among younger age (0.97; 0.96-0.99); non-Hispanic Blacks (0.59; 0.43-0.80), Hispanics (0.63; 0.45-0.87) and women (0.78; 0.63-0.97). Moreover, care avoidance was significantly higher among persons with disability or on sick leave 1.56; 1.04-2.33), those with chronic diseases (1.41; 1.00-2.01), those with fair/poor self-rated health (1.33; 1.03-1.73), and those with high COVID-related concerns (1.34; 1.07-1.68). Understanding factors associated with medical care will inform targeted care delivery and health promotion encouraging persons in need to safely seek timely healthcare services.
Early Descriptions of Family Caregivers' Experiences With Unexpected Lucidity
Authors: Kim Kyungmin , Griffin Joan , Bangerter Lauren , Biggar Virginia , Finnie Dawn , Frangiosa Theresa , Gaugler Joseph , Lapid Maria
Published: December 2021

To develop an operational definition of and typologies for episodes of lucidity (EL), we conducted a cross-sectional study of former/current family caregivers from UsAgainstAlzheimer’s A_LIST (N = 538). More than 60% of caregivers (n = 294, 62%) reported witnessing EL with their care recipient over the course of their dementia. Most episodes happened in late stages of dementia (71%). Only 10% happened within 7 days before death. The majority of episodes (71%) lasted <30 minutes. About half the episodes were characterized by uncharacteristic speech and communication. Caregivers perceived these experiences positively (M = 4.10; range = 1–5), but also expressed desire to know why/when EL occurs and how to best respond to it. Data will be used to refine definitions and typologies, and then a prospective, demographically diverse survey will be administered to family caregivers to assess predictors of EL, linking EL to caregiver well-being and bereavement response.