bluuebunny/crossref_metadata_2025 huggingface dataset:
Stepping Into the Breach of Federal Inaction: Reforming the Financing of Long-Term Services and Supports
Authors: Cohen Marc , Miller Edward , Feder Judith
Published: December 2020

The growing need for long-term services and supports (LTSS) poses significant challenges to both individuals and government. For the current cohort of adults aged 65 years and over, it is estimated that the total cost of LTSS (including the value of care provided by family members) will exceed $6.3 trillion. These staggering national costs are driven by the large and rapidly growing number of individuals in need, their longer life expectancies, significant caregiver shortages, and the high costs of care. Neither private health insurance nor Medicare cover these expenses; Medicaid serves as a safety net for individuals once they have impoverished themselves. With limited to no retirement savings, most older adults cannot cover this liability. Moreover, few people have private long-term care insurance to cover this risk and the private market for such insurance is troubled. Thus, the ability to pay for LTSS is sharply bifurcated: people must be either be rich enough to pay out-of-pocket, or poor enough to qualify for Medicaid. However, even Medicaid-eligible individuals may not be able access needed care due to the waiting lists common in Medicaid. The purpose of this symposium is to document the continuing failure to tackle this problem by the federal government, and to review state and national proposals and initiatives aimed at filling the void left by federal inaction. Marc Cohen and Edward Miller will serve as presenters and chair and co-chair, respectively; Eileen Tell will also present; Judy Feder will serve as the discussant.
Social Work Training and Readiness for Trauma-Informed Care in Nursing Homes
Authors: Kusmaul Nancy , Becker Todd
Published: December 2020

Most adults have experienced traumatic events (SAMHSA, 2017). Late-life traumas may compound upon trauma histories (Maschi, et al., 2013), accentuating the risks confronting older adults. Per CMS’ updated Requirements for Participation, nursing homes (NHs) must implement trauma-informed care (TIC) approaches, effective November 2019. Many NHs do not staff Masters of Social Work (MSWs), despite their expertise in providing mental health care. Notwithstanding, employed MSWs feel unprepared to help their NHs implement TIC. This presentation discusses findings from a national survey of NH social service directors (N = 932). Results showed 71% (n = 650) reported moderate to strong interest in TIC training. A Kruskal-Wallis H test revealed a statistically significant difference in TIC training interest χ2(1) = 43.690, p < .001, such that MSWs reported higher interest (M = 486.47) than non-MSWs (M = 375.23). There was no difference between those with and without a Bachelor of Social Work.
Everyday Ageism and Health: Evidence From the National Poll on Healthy Aging
Authors: Allen Julie Ober , Solway Erica , Kirch Matthias , Singer Dianne , Kullgren Jeffrey , Malani Preeti
Published: December 2020

This study examined the prevalence of everyday ageism, routine types of age-based discrimination, prejudice, and stereotyping that older adults encounter in their daily lives, and its relationships with health in a nationally representative sample age 50-80 (N=2,048, 52% female, 71% White). Nearly all older adults said they sometimes or often experienced everyday ageism (96% age 65-80, 92% age 50-64). The most common types were beliefs that health problems were an inevitable part of getting older (78%), hearing jokes about aging/older people (61%), and seeing material suggesting that older adults were unattractive/undesirable (38%). Those reporting more experiences with everyday ageism (>3 types) were less likely than those reporting fewer types to have excellent/very good physical health (31% vs. 50%); similar results were found for mental health (60% vs. 80%). This poll documented the ubiquity of minor, but not inconsequential, everyday ageism reported by older adults and its potential ramifications for health.
Quality in Assisted Living: Does It Lie in the Eyes of the Beholder?
Authors: White Diana , Ozcan Tunalilar , Hasworth Serena , Winfree Jaclyn
Published: December 2020

Quality is defined in multiple ways and by different stakeholders (e.g., residents, regulators, informed observers). Using a two-stage stratified sampling strategy, we collected data from N=241 residents living in 31 assisted living and residential care communities (AL/RC) in Oregon. Residents rated their overall satisfaction and satisfaction with the AL/RC as a place to live and to receive care. Each interviewer completed a facility profile summarizing their observations about the setting, including quality of staff-resident interactions and physical environment. Residents and interviewers were also asked whether they would recommend the community to others. Finally, we used deficiency citations given during regular inspections by the licensing agency to proxy regulatory perspective. Results show that perceived quality varied by stakeholder (e.g., residents’ assessments differed from deficiency citations). Given this variation, findings suggest that efforts to make quality indicators publicly available should include multiple measures and perspectives, especially residents.
Homeless on Main Street: Using Photovoice to Highlight Older Adults Among the Hidden Homeless
Authors: Versey H Shellae
Published: December 2020

Homelessness is a reality for a growing number of Americans living in small towns and rural areas. However, unlike in cities, housing instability may be less visible. Using a photo-elicitation method (i.e., Photovoice), this study explores the meaning of place and obscured visibility to currently and formerly homeless older adults living in a small town in central Connecticut.

Participants (N = 27) were recruited from a local service agency, given cameras and asked to photograph areas around town that were meaningful to them. Photographs were developed and followed by in-person, semi-structured interviews with participants in which photos and experiences during the project were discussed. Primary themes included belonging, generativity, social isolation, and place-making as meaning-making. The study culminated in a community photography exhibition in which photographs from the project were displayed in public spaces around town. Implications for community-based interventions to reach homeless groups in rural areas are discussed. Part of a symposium sponsored by the Qualitative Research Interest Group.
Exploring the Relationship Between the CFPB Financial Well-Being Score and the Elder Index
Authors: Mutchler Jan
Published: December 2020

The Elder Index is a cost of living indicator that measures the income older adults need to meet their living expenses while staying independent in the community, calculated on a county-by-county basis for the United States. Analyses based on the Elder Index show that a large segment of the age 65+ population has incomes below the Index, reflecting a level of insecurity that is considerably higher than suggested by the poverty rate. Moreover, comparison of the Elder Index to household income illustrates differences across states in the extent to which incomes cover the cost of necessary expenditures. In this paper we explore how cost of living contributes to subjective financial security among older people, as measured by the CFPB Financial Well-Being Score, using a data match of the Understanding America Study with the Elder Index. Results document this association, offering insight to spatial patterns of financial insecurity in later life.
Empowering Through Education: Understanding Financial Well-Being Among Low-Income Older Adults
Authors: Powers Sara , Edwards Sonya
Published: December 2020

Recognizing the need for and importance of financial capability education among low-income older adults, the non-profit agency, Empowering and Strengthening Ohio’s People (ESOP), implemented an 11-part financial education workshop series with a sample of older adults enrolled in the Senior Community Service Employment Program (SCSEP). Over the course of 10-months, participants attended workshops that covered an array of topics (e.g., budgeting and goal setting, avoiding financial exploitation) and completed a variety of measures aimed at understanding their financial situation and well-being (e.g., CFPB Financial Well-Being Scale, Financial Shocks, Material Hardship, Financial Skill). Results indicated that financial well-being scores significantly increased from the beginning of the workshop series (M=54.49, SD=7.23) to the end (M=58.10, SD=8.10); t(48) = 3.66, p=.001. Discussion will offer insights into the subjective financial experiences of low-income older adults who were actively trying to seek and gain permanent employment to improve their financial situation.
Implementing IG Best Practices in Community-Based Settings: A Pre-Implementation Study
Authors: Juckett Lisa , Jarrott Shannon , Naar Jill , Scivano Rachel , Bunger Alicia
Published: December 2020

Programs that intentionally engage unrelated young and old persons often lead to mutual benefits; however, specific implementation strategies that support the use of evidence-based intergenerational programming in community settings are understudied. With strong demand for training resources among intergenerational program providers, this pilot study examined how a multifaceted training strategy facilitated the implementation of 14 distinct evidence-based intergenerational best practices. Intergenerational programming was implemented with nine staff from two small community sites using three implementation strategies including educational meetings, ongoing consultation, and routine practice reminders. Observational analysis of video recorded intergenerational program sessions indicated that staff adopted an average of 81.7% of intergenerational best practices suggesting the feasibility of implementing IG in community settings. Findings yield valuable insight that can inform training refinements, and selection of strategies for improving implementation. Next steps include aligning specific practices with participant outcomes.
Mortality and Morbidity Among Nursing Home Residents Exposed to Hurricane Irma
Authors: Dosa David , Skarha Julianne , Peterson Lindsay , Jester Dylan , Sakib Nazmus , Ogarek Jessica , Andel Ross , Hyer Kathryn
Published: December 2020

We combined Medicare claims and nursing home (NH) administrative data to determine the mortality and morbidity effect of Hurricane Irma on nursing home residents. We utilized the Centers for Medicare and Medicaid Services (CMS) Standard Analytical Files (SAFs) combined with the Minimum Data Set (MDS) to create an exposure cohort of NH residents residing in Florida facilities immediately prior to Hurricane Irma’s landfall on September 10, 2017. We created a control group of residents who resided in the same NHs over the same dates in 2015, a year when there were no hurricanes. Outcome variables included 30/90-day mortality and first hospitalizations post storm. Compared to the control, an additional 260 more NH deaths were identified at 30 days and 429 more deaths at 90 days. Long stay residents (≥100 days) were at particular risk for mortality compared to short stay residents (<100 days). Hospitalization was also markedly increased.
Mechanisms of Lifespan Extension by Sirt6 in Drosophila melanogaster
Authors: Taylor Jackson , Wood Jason , Finn Matthew , Liu Julianna , Mizerak Evan , Gordon Sarah , Hutfilz Corinne , Helfand Stephen
Published: December 2020

Sirt6 is a multifunctional enzyme that regulates numerous cellular processes connected to longevity. Overexpressing Sirt6 extends lifespan in mice, but the underlying cellular mechanisms are unclear. Here, we used the powerful genetic tools and short lifespan of Drosophila melanogaster to better understand the precise mechanisms by which Sirt6 regulates longevity. Sirt6 OE in flies produces robust extension of median lifespan in both sexes. Molecular and biochemical analyses reveal that Sirt6 OE reduces expression of genes involved in protein synthesis, including many Myc target genes, via epigenetic regulation. We will further discuss our findings on the connection between Sirt6, Myc, and the molecular regulation of protein synthesis and lifespan, as well as additional Sirt6 longevity mechanisms we identified, including autophagy and silencing of transposable elements.
Alzheimer’s Staffing, Services, and Outcomes in Adult Day Health Centers
Authors: Spetz Joanne , Flatt Jason
Published: December 2020

Growing demand for care for Alzheimer’s Disease and related Dementia (ADRD) has resulted in rising use of adult day health centers (ADHCs), which employ teams of professionals including licensed nurses, nursing aides, social workers, and activity directors. This study evaluates the scope of services and staffing models of ADHCs that provide care to persons with ADRD compared to ADHCs that do not, and examines whether there is an association between staffing and client outcomes, measured as rates of hospitalizations, falls, and emergency department visits. We used facility-level data from the 2014 National Study of Long-Term Care Providers (NSLTCP) Adult Day Services Center module. We conducted bivariate comparisons and estimated multivariate regressions to identify ADHC characteristics associated with staffing and client outcomes. ADHCs that offered ADRD services had higher average daily attendance, greater shares of revenue from Medicaid and self-payment, and greater proportions of Blacks and females. They also had greater percentages of enrollees with depression, cardiovascular disease, diabetes, and needing assistance with activities of daily living. There were also greater numbers of registered nurse, licensed practical nurse, and social worker hours per enrollee day, but fewer activity staff hours per enrollee day. Multivariate regressions focused on ADHCs that offered skilled nursing services and revealed that total staff hours per enrollee day were not higher in ADHCs that provided ADRD services, controlling for other characteristics. However, staffing was greater in chain-affiliated ADHCs. Higher staffing levels were associated with lower rates of falls and emergency department visits.
Dopamine-Related Genotype Predicts Trajectories of Gait Reserve in Older Adults
Authors: Sprague Briana , Rosso Andrea , Zhu Xiaonan , Rosano Caterina
Published: December 2020

The capacity to increase one’s gait speed is critical for maintaining safe community ambulation. There is limited work on the longitudinal changes in this capacity and its predictors. Because lower dopamine is associated with lower task adaptation and motivation, we hypothesized that lower dopamine would predict more decline in rapid gait speed. Catechol-O-methyltransferase (COMT) polymorphism and at least 3 repeated rapid and usual pace gait speed assessments were obtained over 10 years in 1,261 older adults (mean age=75.2, 867 White, 659 women). Linear mixed models computed person-specific rapid and usual pace gait speed trajectories. Regression models adjusted for usual gait trajectory tested whether COMT predicted rapid gait trajectory; covariates included, demographic, psychological, cognitive, and physical factors. Val/Val carriers (lower dopamine) declined more in rapid gait compared to Met/Met carriers (higher dopamine; adjusted b=-.002, SE=.001, p=.042). Modifying dopamine may positively influence the ability to maintain rapid gait over time.
Medication Management Capacity Among Older Residents of Low-Income Apartment Buildings
Authors: Badawoud Amal , Parsons Pamela , Lu Juan , Peron Emily , Salgado Teresa , Slattum Patricia
Published: December 2020

MMC is an essential component of safe and independent living. This cross-sectional study was designed to assess MMC among low-income older persons residing in HUD-subsidized housing, located at one of five apartment buildings in urban Richmond, VA. Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) was used to measure MMC during individual, face-to-face interviews. Of the 107 participants, 89% were African-American with an average age of 68.5 years (±7.2), an average of 4.9 (±2.9) comorbidities and using approximately 8 (±4.1) medications on a regular basis. The mean deficit in MMC was 3 (±2.0). The most difficult skill was naming all of the medications (69.2%) followed by stating the indication (46.7%) and knowing how or when all of the medications should be taken or identifying existing refills (38.3%). Many older residents of low-income housing experience challenges in managing medications.
Nutritional Strategies to Counteract Mitochondrial Dysfunction and NAD+ Deficiency in Human Sarcopenia
Authors: Feige Jerome
Published: December 2020

The causes of impaired skeletal muscle mass and strength during aging are well-studied in healthy populations. Less is known on pathological age-related muscle wasting and weakness termed sarcopenia, which directly impacts physical autonomy and survival. We compared genome-wide transcriptional changes of sarcopenia versus age-matched controls in muscle biopsies from 119 older men of different ethnicity. Individuals with sarcopenia demonstrate a prominent transcriptional signature of mitochondrial bioenergetic dysfunction in skeletal muscle, with low PGC-1α/ERRα signalling, and downregulation of oxidative phosphorylation and mitochondrial proteostasis genes. These changes translate functionally into fewer mitochondria, reduced bioenergetic activity, and NAD+ deficiency in sarcopenic muscle. Our results point to mitochondrial homeostasis as a key mediator of pathological muscle aging. Novel nutritional solutions enhancing muscle strength and performance by enhancing mitochondrial function are being tested clinically and will be reviewed. These include activating mitophagy with Urolithin A or restoring NAD+ levels via tryptophane/kynurenine or with nicotinamide riboside.
Measuring Impact and Sustainability of Evidence-Based Dementia Care Treatment in the Community
Authors: Cigliana Jill , Burch Kari , Mueller Nancy , Bajracharya Smriti
Published: December 2020

Through a collaborative agreement with the Administration for Community Living, Memory Care Home Solutions translated the evidence-based program (EBP) Care of Persons with Dementia in their Environments (COPE) into community practice as a covered benefit through Medicare and commercial health insurance for people living with dementia. While many studies have demonstrated the efficacy of family-centered behavioral interventions for this population, few of these interventions have been translated from academic studies into successful community practice. This session will describe the process of translating an EBP into community practice utilizing social work and occupational therapy interventionists with a diverse population of people living in both urban and rural areas of Missouri and Illinois, including modifications required and lessons learned in rural service delivery. Attendees will gain an understanding of the translation process, differential treatment outcomes for people living with dementia and care partners and Medicare billing mechanisms for sustainability.
The Aging Brain: Crossroad of Normal Aging and Dementia
Authors: Tian Qu , Ferrucci Luigi
Published: December 2020

The functional consequences of the aging brain include several aspects of physical and cognitive decline that ultimately cause loss of mobility and dementia. Although in certain individuals, the cognitive and physical correlates of the aging brain occur in parallel, others show decline in one of these functional parameters. Underlying mechanism of this complex process that lead to different manifestations is not well understood. Proposed mechanisms include brain structural changes, tau pathology, specific white matter degeneration, metabolic derangement mostly including lipids metabolism and others. This symposium aims to address the complexity of the aging brain by showcasing studies that span the continuum from normal aging to dementia using data from the Baltimore Longitudinal Study of Aging (BLSA). The wealth of neuroimaging and phenotype data from the BLSA provides the unique opportunity to investigate neural substrates and predictors of aging phenotype, and mechanisms of age-related neurodegeneration and pathology, such as dementia, and loss of mobility. First, we identify multimodal neuroimaging predictors of important aging phenotypes of gait decline (Sargent/Tian) and memory decline (Bilgel). Second, using advanced quantitative MRI technology, we investigate underlying mechanisms of age-related white matter degeneration through potential oligodendrocyte metabolism (Bouhrara). Third, we demonstrate unique cognitive and neuroimaging profiles of dual memory and gait decline (Tian) and neural substrates for bile acids, the primary cholesterol breakdown products (Varma) in relation to dementia. We seek to generate discussions of mechanisms of the aging brain that connect the age-related phenotypes, such as decline of mobility and cognition, to the development of dementia.
Patterns of Daily Physical Activity Across the Spectrum of Visual Field Damage in Glaucoma Patients
Authors: Schrack Jennifer , E Jian-Yu , Mihailovic Aleksandra , Wanigatunga Amal , West Sheila , Gitlin Laura , Li Tianjing , Ramulu Pradeep
Published: December 2020

Visual impairment (VI) has been linked with low physical activity (PA) and higher risk of poor function with aging, yet how VI affects daily patterns of physical activity (PA) is undefined. We assessed the association between visual field (VF) damage and: (i) activity fragmentation and (ii) diurnal patterns of PA in 237 glaucoma patients (mean age=70.6, 51.5% men). PA was measured using the Actical hip-worn accelerometer and VF damage was defined by average VF sensitivity. In adjusted linear models, each 5-dB decrement in IVF sensitivity was associated with 16.3 fewer active minutes/day and 2% higher activity fragmentation (both p<.05). In time-of-day analyses, those with lower IVF sensitivity were less active, but this did not vary by time-of-day. Older adults with worse VF damage demonstrate shorter, more fragmented bouts of PA throughout the day, which may reflect lower physiologic functioning. Future work should examine the temporality of this association.
Does Gerofit Exercise Reduce Veterans’ Use of Emergency Department and Inpatient Care?
Authors: Abbate Lauren , Li Jiejin , Veazie Peter , Intrator Orna , Lee Cathy , Katzel Leslie , Pearson Megan , Morey Miriam
Published: December 2020

Little is known about the relationship between exercise and health care utilization in older adults. This study examined hospitalizations/emergency Department (ED) visits in the 12 months prior to and during 12 months of active Gerofit participation (across 5 sites). Data were compared for each outcome to a propensity matched nearest neighbor sample from the same site [Mean, 95% CI]. Of the 226 Veterans who were active in the program for ≥12 months and enrolled in VA and Traditional Medicare for 12 months prior to Gerofit participation, hospitalizations/ED visits were greater prior to (15.3%/42.0%) than during (6.8%/37.1%) Gerofit participation. Gerofit participants were 8% less likely to have a hospitalization in the 12 months following enrollment than controls [-0.08 (-0.14, -0.02)] but no between-group differences in ED use [-0.00 (-0.11, 0.10)] were observed. Participation in Gerofit may reduce hospitalizations, but its impact on ED use is inconclusive.
Association of Food Insecurity and Sarcopenia: The National Health and Nutrition Examination Surveys
Authors: Batsis John , Petersen Curtis , Gooding Tyler
Published: December 2020

Understanding the association between food insecurity and sarcopenia can inform policies that address healthcare disparities. We identified 2,965 subjects aged ≥60 years with grip strength and food security data from the National Health and Nutrition Examination Surveys 2011-14. Sarcopenia was defined using grip strength <26kg for men and <16kg for women, and food security with the 18-item US Household Food Security Survey. Logistic regression evaluated the association of food insecurity (referent = full security) with sarcopenia, adjusting for age, sex, marital status, race/ethnicity, education, body mass index, smoking, and comorbidities. Mean age (% female) was 76.6 (60.9%) and 68.9 years (53.4%) with and without sarcopenia, respectively. Sarcopenia prevalence was 8.4%. Rates of full food security were higher in those without sarcopenia (90% vs. 84.2%;p<0.001). Food insecurity was strongly associated with sarcopenia (OR 1.79 [1.18, 2.72]), suggesting a need for both longitudinal and interventional studies to target these disparities.
Innovative Interventions: Caring for Persons With Alzheimer’s Disease and Their Caregivers
Authors: Andersen Stacy , Gibson Allison , Marx Katherine
Published: December 2020

There are 5.8 million Americans living with Alzheimer’s disease and more than 16 million Americans providing unpaid care for people with AD and related dementias. Since a treatment that can slow or stop progression of this disease has yet to be discovered, novel interventions are sorely needed to maintain cognitive function and quality of life among individuals with dementia, improve the health and well-being of caregivers, and provide assistance in caregiving duties. This symposium addresses novel interventions in the dementia care continuum ranging from social and leisure activities for improving cognition to incorporation of emerging technologies to assist with caregiving and provides recommendations and priorities for future studies. The first presentation introduces evidence that participation in an intergenerational choir can improve cognition, social connectedness, and quality of life among people with dementia and their caregivers. The second presentation systematically assesses recent randomized controlled trials of computerized cognitive training (i.e., brain games) aimed at improving cognitive function among individuals with cognitive impairment or dementia. The third presentation examines the evidence that interventions employing artificial intelligence such as robots may improve care for persons with Alzheimer’s disease and caregivers’ quality of life and provides suggestions for future studies to better assess the efficacy of these interventions. The session concludes with a presentation on a survey method used to build consensus among a panel of experts across academia and industry which identified the emerging technologies that are expected to become the most prevalent in dementia care and provides recommendations for limiting associated risks.
Music and Brain Health: Recommendations From the Global Council on Brain Health, an AARP Collaborative
Authors: Lock Sarah
Published: December 2020

Music is a complex auditory stimulus that resonates on a physiological, psychological, and spiritual level for people around the world. This symposium will provide highlights from the Global Council on Brain Health consensus report aimed at helping the public to understand the potential that music holds for supporting and enriching brain health. The Global Council on Brain Health (GCBH) is an independent collaborative of scientists, clinicians, scholars, and policy experts convened by AARP to provide evidence-based advice on what people and professionals can do to maintain and improve brain health. The Council translates scientific research into actionable recommendations for the public that will help drive behavior change in individuals across communities and cultures. Issue specialists from around the world were brought together to build consensus, issue recommendations, and offer practical tips. Moreover, we will feature research from our issue experts and provide an overview of the impact of music participation on older adults, including those with dementia. Data from surveys fielded by AARP research, developed in consultation with the GCBH, will also be featured. In sum, this presentation will highlight the work of the Council at the forefront of this international effort to translate advancements in brain health research to the wider public, with an emphasis on individuals aged50 and older.
Me & My Wishes Videos: Congruence of End-of-Life Preferences Between Residents With Dementia, Family, and Staff
Authors: Neller Sarah , Towsley Gail , Wong Bob
Published: December 2020

Me & My Wishes are person-centered videos of long term care residents (ages 65-95) living with dementia discussing their preferences for care including end-of-life (EOL) medical intervention. We evaluated the congruence of six EOL treatment preferences between the residents’ personal videos, medical records (e.g. advance directive), and surveys of family (n= 49) and staff (n=37; 118 responses) knowledge of their preferences. Results were highly discordant. Treatments with the most discordance when comparing videos to comparison groups were IV fluids (medical record, 57.1%) and life support (family, 69.4%; staff, 82.2%). Residents reported EOL treatments were considered acceptable if they were temporary, would relieve suffering, or enabled a return to baseline health. These caveats may lead to discordance if they are not conveyed to family or staff. Our findings highlight the need for conversations among residents living with dementia and their caregivers to improve understanding, congruence and adherence of resident EOL preferences.
Impact of Pain and Discomfort on the Lives of Cognitively Impaired Older Adults and Their Informal Caregivers
Authors: Noh Hyunjin
Published: December 2020

This qualitative study explored the impact of pain and discomfort on the lives of cognitively impaired older adults and their caregivers from the caregiver perspective. Forty-three individuals of age 19+, who identified themselves as primary caregiver to a chronically or seriously ill older adult (age 50+) with cognitive impairment, such as Alzheimer’s Disease and Related Dementia, were recruited at various community settings. Individual, face-to-face interviews were conducted to ask participants how they thought their care-recipient’s pain and discomfort affected the care-recipient’s and the caregiver’s life respectively. Inductive, thematic analysis of interview transcripts revealed several key themes: compromised mobility, limited social interaction or activities, and depressive symptoms in both care-recipients and caregivers; aggravated cognitive decline in care-recipients; and poorer physical health in caregivers. Participants wanted more information on the disease trajectory and available services, particularly home-based therapies and social activities for care-recipients, which provides future program/practice implications.
Defining the Participatory Aspect in Health and Dementia Care Research
Authors: Roes Martina
Published: December 2020

In the last decade, the terms ’engagement’, ‘involvement’, ‘patient-public involvement (PPI)’ and/or ‘participatory research’ have been increasingly used in literature. However, it seems that each author has their own definition of the terms and there is not consensus on what constitutes engagement, involvement or participation in health care research. In a broad sense, it seems that PPI can be understood as a co-design strategy, but the terms are not used consistently. Definitions of participation in research tend toward describing the methodological aspect of research rather than mapping appropriate use of methods. Representation of the diversity of society is also challenging and involvement of people with dementia is often neglected. To improve participatory research and outcomes, it is valuable to understand applied methods. Therefore, we conducted a meta-analysis of literature reviews that analyzed methodological concepts and application of these participatory concepts. This presentation will provide key results of this review. Part of a symposium sponsored by the Patient/Person Engagement in Research Interest Group.
Dual Sensory Impairment and Cognitive Performance, MCI, and Dementia in Older Adults: The ARIC Neurocognitive Study
Authors: Deal Jennifer , Park Junghyun , Reed Nicholas , Abraham Alison , Lin Frank , Windham B Gwen , Sharrett A Richey
Published: December 2020

Dual sensory impairment (DSI) affects 11.3% of adults aged ≥80 years. Hearing and vision impairments are each associated with cognitive decline and dementia, but DSI’s impact is unknown. All-cause dementia and mild cognitive impairment (MCI) were adjudicated using longitudinal cognitive information. Ten neurocognitive tests were summarized using latent variable methods. Hearing was measured using pure tone better-ear thresholds (0.5-4 kHz) and vision with better-eye presenting distance visual acuity and/or contrast sensitivity. In 881 adults (79±4 years, 44% black, 64% female), DSI (vs. no hearing or vision impairment) was cross-sectionally associated with -0.17 standard deviations (SD) [95% confidence interval (CI): -0.32, -0.02] lower global cognitive score and an 87% increased odds (95% CI: 1.01, 3.45) of combined MCI/dementia, after full adjustment for demographic and clinical factors. Future longitudinal research should elucidate the mechanism underlying this association to determine if treatment can delay cognitive decline and MCI/dementia in older adults.
Hearing Loss and Frailty Among Older Adults: The ARIC Neurocognitive Study
Authors: Reed Nicholas , Garcia-Morales Emmanuel , Palta Priya , Lin Frank , Coresh Josef , Schrack Jennifer , Deal Jennifer
Published: December 2020

Hearing Loss (HL) is common among older adults and is associated with factors (e.g., walking speed and social isolation) that may mediate an association with frailty. In the Atherosclerosis Risk in Communities (ARIC) study, frailty was defined as a composite variable (unintentional weight loss, energy expenditure, walking speed, low energy, and grip strength) while HL was measured using pure-tone audiometry. Among, 3179 participants in 2015-2017, 251 (7.9%) were frail. In a model adjusted for demographic and clinical risk factors, mild HL (n=1263; Odds Ratio[OR]=1.42; 95%Confidence Interval[CI]=1.01-2.01) and moderate HL (n=854; OR=1.67; 95%CI=1.09-2.55) were associated with higher odds of frailty relative to those without HL (n=1063). Among participants who completed an ARIC visit 2-years later, the odds of developing frailty tended to be higher among those with mild (OR=1.46; 95%CI=0.91-2.33) and moderate HL (OR=1.43; 95%CI=0.77-2.67). Future research should focus on mechanisms underlying association and determine the impact of treatment of HL. Part of a symposium sponsored by Sensory Health Interest Group.
Changing Safety Net Healthcare Systems to Age-Friendly Healthcare Systems: Lessons Learned
Authors: Faul Anna , Tumosa Nina
Published: December 2020

Federally Qualified Health Centers (FQHC) are important safety net providers in disadvantaged communities. As outpatient clinics in these areas, they qualify for specific reimbursement systems under Medicare and Medicaid. Age-friendly health care is an urgent need to be able to provide quality healthcare to more than 46 million Americans age 65 and older, with that number projected to double to more than 98 million by 2060. Friendly healthcare systems require a focus on the 4Ms framework and is focused on improving the health of people at every life stage and in every community across the country. The 4Ms are as follows: 1) What Matters: Aligning care with each older adult’s specific health outcome goals and care preferences; 2) Medications: If medications are necessary, use age-friendly medications that do not interfere with What Matters, Mentation or Mobility; 3) Mentation: Prevent, identify, treat and manage depression, dementia and delirium across settings of care and 4) Mobility: Ensure that older adults move safely every day in order to maintain function and do What Matters. An age-friendly health system is one in which every older adult’s care is guided by these evidence-based practices (the 4Ms), where the care causes no harms, and where the care is consistent with what matters to older adults and their families. In this symposium five Geriatric Workforce Enhancement Programs at five diverse universities will share their experiences with supporting FQHC in their areas to become age-friendly healthcare systems. The unique lessons learned at these different sites will be shared.
Art for a Lifetime
Authors: Schramel Alexis
Published: December 2020

Art for a lifetime was a bi-weekly programming opportunity in a long-term care (LTC) community taught by students and faculty. We predicted that 1) Resident physical and mental abilities may influence art-making preferences and 2) residents would be concerned about their perceived lack of creativity. Findings revealed that residents with arthritis preferred working with larger forms (e.g., collage and sculpture) and residents with dementia preferred working with bright, colorful materials. Private one-on-one sessions were beneficial for increasing resident confidence and for working on individual projects. Programming also allowed for increased social opportunities among residents, offering occasions to reflect on life experiences. Overall, facilitators of art programming need to quickly adjust and adapt programming based on resident abilities and preferences. Expanding art programming to other long-term care facilities is important for providing increased opportunities for autonomy and decision making, areas that often become more limited when living in LTC.
Associations of Living Environment Attributes with Attitudes Towards Aging Among Older Adults in Shanghai China
Authors: Ye Minzhi , Chen Lin
Published: December 2020

This study examined the relationships between several attributes of living environment and attitudes towards aging among persons of age 75 years and older in Shanghai, China. The data were collected using self-administered surveys in a study of successful aging in 2018. Respondents included 139 persons of age 75 years and older living in 12 neighborhoods in Shanghai. Attitudes towards aging were measured by indices of happiness, time use and worry about the future. Using BaiduMap and GIS ArcPro, we quantified accessibility to neighborhood living resources as numbers of recreational facilities, medical facilities, parks, and grocery stores located within 500 meters of each respondent’s home. The analysis found that more positive attitudes towards aging were correlated with less depressive symptom as measured by CES-D and greater numbers of neighborhood resources near home, especially greater number of grocery stores near home. In conclusion, accessibility to neighborhood resources may influence attitudes towards aging.
Who’s in and Who’s Out? Selection Bias in Aging Research
Authors: Mayeda Elizabeth Rose , Hayes-Larson Eleanor , Banack Hailey
Published: December 2020

Selection bias presents a major threat to both internal and external validity in aging research. “Selection bias” refers to sample selection processes that lead to statistical associations in the study sample that are biased estimates of causal effects in the population of interest. These processes can lead to: (1) results that do not generalize to the population of interest (threat to external validity) or (2) biased effect estimates (associations that do not represent causal effects for any population, including the people in the sample; a threat to internal validity). In this presentation, we give an overview of selection bias in aging research. We will describe processes that can give rise to selection bias, highlight why they are particularly pervasive in this field, and present several examples of selection bias in aging research. We end with a brief summary of strategies to prevent and correct for selection bias in aging research.
Meaning and Late-Life Vulnerability: A Philosophical Practice-Based Approach
Authors: Laceulle Hanne
Published: December 2020

The quest for meaning constitutes one of the fundamental human existential motivations. At first glance, late life vulnerability appears to pose a threat to meaningfulness. Sources of meaning associated with certain activities or relations may seem less accessible once vulnerabilities, caused by social losses or diminishing health, start to dominate people’s daily life experience. On the other hand, some theorists have argued that it is particularly in the confrontation with our human vulnerability that the need for meaningfulness is most urgently felt. This paper presents a philosophical-conceptual exploration of meaning as a dynamic, context-dependent social practice. Contrasting theoretical approaches that analyse meaningfulness and/or meaninglessness in terms of the presence or absence of certain components or qualities, a practice-based approach enhances our sensivitity for concrete ways in which people manage to find or create meaning in situations of vulnerability, thereby integrating this vulnerability in their life narratives and sense of self.
Vitamin D Metabolites and the Gut Microbiome in Older Men
Authors: Kado Deborah , Thomas Robert , Jiang Lingjing , Adams John , Knight Rob , Orwoll Eric
Published: December 2020

We examined the bidirectional impact of vitamin D on the composition and diversity of the gut microbiome in 567 MrOS men. Vitamin D metabolites were measured using LC-MSMS and stool sub-operational taxonomic units defined from 16S ribosomal RNA sequencing data using Deblur and Greengenes 13.8. Men’s mean serum level of 25(OH)D was in the sufficient range. Faith’s Phylogenetic Diversity and non-redundant covariate analyses revealed that 1,25(OH)2D explained 5% of variance in α-diversity; the other non-redundant covariates of site, race, recent antibiotic and antidepressant use explained another 6%. In β-diversity analyses using unweighted UniFrac, 1,25(OH)2D was the strongest factor assessed, explaining 2%. Random forest plot analyses identified 12 taxa, 6 in the phylum Firmicutes, positively associated with either 1,25(OH)2D and/or [1,25(OH)2D/25(OH)D] activation ratio. Higher levels of the active 1,25(OH)2D, but not 25(OH)D, were associated with butyrate producing bacteria. Men with favorable vitamin D activation profiles also had greater gut microbial diversity.
Promoting Adherence to Exercise Prescription Using Mobile Health Technology: Lessons Learned from Older Adults
Authors: Zlatar Zvinka , Nebeker Camille
Published: December 2020

We will present the implementation approach used to evaluate a novel mobile health (mHealth) exercise intervention designed to improve older adult’s fitness and brain health. A randomized controlled trial design evaluated if the use of mHealth strategies improved walking speed in real world environments to help participants achieve current physical activity guidelines. Cognitively healthy older adults were randomized to a 12-week, unsupervised, exercise prescription condition or to a healthy aging education condition. Participants used a heart rate tracker programmed to provide haptic feedback when they fell outside of their prescribed heart rate target during an exercise session. Participant’s perceptions regarding the mHealth technology device, as well as their feedback regarding the privacy of their data when using mHealth devices will be presented. Recommendations to improve the design of future mHealth exercise trials will be discussed.
Ageism in HIV Research
Authors: Taylor Tonya
Published: December 2020

Sex and sexuality are important determinants of health and wellbeing across the life course. The desire and capacity for sexual intimacy and pleasure among older adults are neglected areas of research due to ageist assumptions that they no longer engage in sexual activity. These assumptions are most pronounced in HIV research, where we aggressively studied intimate details of sexual behaviors of people living with HIV until they became “old.” Interest in the sexual behaviors among older adults with HIV has waned in HIV prevention, suggesting an inherent ageism within the field. We will discuss emerging new HIV and STI risks for older adults, declining trends in gerosexuality funding, HIV media campaigns targeted for older adults, and new evidence that suggest that interventions that engage older adults with HIV in conversations about sexual health, menopause, and erectile dysfunction may be an effective strategy for promoting overall successful aging
The Background and Rationale Behind the Establishment of the First AIDS and the Elderly GSA Interest Group
Authors: Tepper Lynn
Published: December 2020

Although HIV became known during the decade of the 1980’s, it was not until 1987 that the WHO launched the Global Program on AIDS to raise awareness, generate evidence-based policies, and provide technical and financial support to conduct research, promote NGO participation, and promote the rights of people living with HIV. It was then also that robust educational and prevention initiatives began to take place. At this time, a Columbia University study, led by Dr. Lynn Tepper, a gerontologist, initiated a study to see if the older population fully understood the disease and the practice of prevention behaviors, as they were not a specific target for AIDS education and prevention. This led to the establishment of the AIDS and the Elderly Interest Group, sponsored by GSA, in an attempt to know more about the impact of AIDS in the older population. Part of a symposium sponsored by the HIV, AIDS and Older Adults Interest Group.
Evidence-Based Exercise Interventions and Fitness Technologies for Older Adults With Intact or Impaired Cognition
Authors: Heyn Patricia , Andersen Stacy , Boot Walter
Published: December 2020

Effective exercise training and regular physical activity (PA) practice are important for healthy aging and are key modalities for chronic disease management. Approaches that enhance exercise prescriptions and adherence for older adults should be innovative and based on evidence. Thus, the exercise prescription should be tailored accordingly to the person’s health status, functional capacity, and living arrangements. To properly achieve the desirable health outcomes, the PA should be performed at higher intensity, greater frequency, and longer duration. National PA Guidelines recommend at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity and at least two days of muscle-strengthening activities per week. Each prescribed modality (aerobic exercise, strength training, flexibility/stretching exercises, and balance training) has unique benefits. Therefore, it is critical to investigate and integrate novel techniques and tools to ensure adherence to the recommended PA guidelines. One of the presentations in this symposium, will highlight the research that has been evaluating for the last 15 years the effectiveness of the exercise randomized trial for older adults with/out cognitive impairments. The second presentation will introduce a novel technology paradigm designed to improve guidelines for exercise training as well as our understanding of how technology may motivate exercise behavior for older adults. The last presentation will discuss the design and methodological flaws that impact the outcomes of the exercise intervention by addressing the interpretations of non-findings and key factors affecting the desirable outcomes.