bluuebunny/crossref_metadata_2025 huggingface dataset:
IT BOTHERS ME TO ASK FOR HELP: MODERATION OF SELF RELIANCE ON MASCULINE DEPRESSION AND SUICIDAL IDEATION IN OLDER MALES
Authors: Lohmar Sabine , An Jeongwi , Owsiany Montgomery , Fenstermacher Erika , Fiske Amy
Published: December 2023

Compared to females, males are less likely to seek help and less likely to be diagnosed with depression despite having depressive symptoms. Masculine depression, a ‘masked’ depression is associated with greater endorsement of masculine norms such as self-reliance. Self-reliance, or a preference to not seek help from others, is related to suicidal ideation in males. Although death by suicide remains the highest among adult males over the age of 75, research has yet to examine the role that self-reliance has on suicidal ideation in older males with masculine depression. This study examined the moderating effect of the self-reliance subscale of the Conformity to Masculine Norms Inventory (CMNI-30) on the relation between the Male Depression Risk Scale-22 (MDRS-22) and the Suicide Behaviors Questionnaires-Revised (SBQR). This study included 214 males aged 65 and older surveyed on Mechanical Turk. A multiple regression analysis indicated that self-reliance moderated the relation between the MDRS-22 and the SBQR (β =.220, t = 2.174, p=.031). Graphical representations of these data indicated that the relation between the MDRS-22 and SBQR was stronger in those with higher self-reliance. Thus, older males with masculine depression may be more likely to endorse suicidal ideation if they endorse self-reliance norms, or are less likely to seek help from others. This study illustrates the importance of self-reliance when understanding older males with elevated suicide risk. Future research should address how other masculine norms influence or explain the relation between masculine depression and suicidal ideation.
THE EFFECT OF MEDIA USAGE DURING THE COVID-19 PANDEMIC ON DEPRESSIVE SYMPTOMS IN KOREAN OLDER ADULTS
Authors: Kim Miri , Chung Soondool
Published: December 2023

The current study was conducted to examine the structural relationship between change in the media usage during the COVID-19 pandemic, media use frequency, perception of social connectivity and depressive symptoms among older people in South Korea. The study sought to address the increased use of media among older adults during the pandemic. A cross-sectional dataset with 398 older adults aged 65 to 94 living in Seoul was analyzed using a structural equation model with the bootstrapping method. The findings are as follows. In terms of direct effects, older adults who used more media during the COVID-19 pandemic showed lower level of depressive symptoms (β=-.141,p<.001), older adults who used media more frequently showed an increase in the perception of social connectivity (β=.123,p<.001), and older adults with higher perception of social connectivity showed lower level of depressive symptoms (β=-.371,p<.001). In terms of the indirect effects, the perception of social connectivity had a significant mediating effect in the relationship between change in the media usage during the COVID-19 pandemic and depressive symptoms (95% CI: -0.044, -.001), as well as in the relationship between media use frequency and depressive symptoms (95% CI: -.059, -.033). The findings of the study underscore the importance of social connectivity in promoting mental health among older adults during periods of social isolation and highlight the potential benefits of media usage.
EXPLORING EMOTION CONTROL BELIEFS ACROSS THE LIFESPAN: ROLES OF AGE AND CHRONIC ILLNESS
Authors: Rutledge Jocelyn , Barlow Meaghan
Published: December 2023

Existing theory and research highlights emotion control beliefs have important implications for emotion regulation and psychological well-being. Emotion control beliefs can be subdivided into four categories: the extent to which people believe 1) they can control their emotion (self-can beliefs), they should control their emotions (self-should beliefs), 3) others can control their emotions (others-can beliefs), and 4) other should control their emotions (others-should beliefs). To our knowledge, research has yet to examine how developmental factors are associated with emotion control beliefs in adults (i.e., age and non-normative experience of chronic illness). Past research highlights age related differences in emotional processes, and the influence of non-normative chronic illness on emotional well-being. Therefore, the present study utilized data from a lifespan sample of 47 participants (younger adults: n = 21, age range = 19-35, M = 27.55; older adults: n = 26, age range = 68-81, M = 72.40) to examine differences in emotion control beliefs among younger and older adults, people with and without chronic illness, and the interaction between these factors. Our analyses revealed levels of self-can beliefs were lower in people with chronic illness. In particular, younger adults with chronic illness reported the lowest levels of self-can beliefs. By contrast, among people without chronic illness, older adults reported lower levels of others-should beliefs, relative to younger adults. These findings inform theories of emotional aging, development, and health by suggesting emotion control beliefs vary with age and chronic illness.
CHANGES IN DRIVER’S LICENSE STATUS AMONG MID-AGED AND OLDER CANADIANS OVER THREE YEARS
Authors: Stinchcombe Arne , Hopper Shawna , Gagnon Sylvain , Bedard Michel
Published: December 2023

For older people, driving may contribute to health and quality of life. Conversely, driving cessation is associated with negative outcomes, including poor physical and mental health. We examined changes in driving status over a three-year period among participants in the Canadian Longitudinal Study on Aging (CLSA), which includes Canadians aged 45-85 at baseline. At baseline (data collected between 2011 and 2015) and follow-up (data collected between 2015 and 2018), participants reported whether they had a driver’s license. Using multiple logistic regression, we examined the relationship between covariates and changes in license status (i.e., having a license at baseline but not at follow-up vs. maintaining license). Of the participants who reported having a driver’s license at baseline (n=36,266), 1.19% (n=432) reported no longer having one at follow-up. This change was associated with lower income categories and poorer self-rated health. Age (B=.12, p<.001) and depression symptoms (B =.04, p<.001) were positively associated with no longer having a license. Participants who reported a change had lower scores on a memory task (Rey Auditory Verbal Learning Test; B=-.07, p<.001). Women had greater odds than men to report a change in driver’s license at follow-up (OR=1.5, p<.001). The results highlight the salience of health, cognition, and income as correlates of driving cessation in a sample of mid-aged and older adults. These results may help identify individuals who are likely to stop driving and who may need additional supports maintaining mobility, health, and quality of life.
GOLF CARTS AS A TRANSPORTATION MODE: WHO USES THEM?
Authors: Barrett Anne , Mimbs Hope , Noblitt Jessica , Michael Cherish , Soulie Brianna
Published: December 2023

Golf carts are rising in popularity among older adults, not only for use on the course but also for traveling short distances. Alongside their rising popularity are increases in related injuries, which have been the focus of the relatively small literature on golf carts. Little is known, however, about the frequency or social patterning of older adults’ use of golf carts as a transportation mode. Using data from an online survey of Floridians aged 50 and older that was conducted between December 2020 and April 2021 (n=4,199), we used multivariate regression to examine five sets of predictors of golf cart use: sociodemographics, health, subjective aging experiences, transportation experiences, and social relationships. Sociodemographics predicting more frequent golf cart use included being younger, male, or white. More frequent golf cart use also was associated with lower levels of loneliness but was unrelated to physical health. Other predictors of more frequent golf cart use included reporting older age identities and more frequent walking. Also significant were social relationship measures. Results revealed more frequent golf cart use among married individuals and those interacting more frequently with friends – but less frequently with family members. By examining a variety of factors that may influence golf cart use, our study provides clues about how golf carts may relate to older adults’ transitioning from driving.
LOCATION MODERATES THE EFFECT OF COGNITIVE TRAINING ON CRASH RISK OVER 20 YEARS: AN ANALYSIS OF THE ACTIVE STUDY
Authors: Wheeler Katie , Bell Tyler , Carroll Brooke , Pope Caitlin , Ball Karlene , Clay Olivio , Stavrinos Despina , Black Sheila
Published: December 2023

Driving is a critical everyday function that helps older adults remain independent. The Advanced Cognitive Training in Vital Elderly (ACTIVE) study has shown cognitive training improves driving safety outcomes for older adults. Few studies have examined the longitudinal effects of cognitive training on crash risk beyond 5 years. To address this empirical gap, we aimed to determine the effects of cognitive training on crash risk over 20 years, and how urbanicity moderates these relationships. Using participants from the no-contact control and intervention (speed of processing, memory, and reasoning training) groups in the ACTIVE study (n=2170) and state-recorded crash reports, cox proportional hazards models were used to examine the effect of three cognitive training interventions as predictors of time to first at-fault crash over 20 years. Participants (mean age 73, 73% White, 23% Male) reported driving 90.6 miles/week on average and 12.6% experienced an at-fault crash. Overall, speed of processing training was the only intervention related to lower crash risk, but this varied by urbanicity. Namely, speed of processing training was related to lower crash risk for individuals living in rural environments (HR=.16, 95% CI [.04-.73], p=.018) but not for individuals in urban environments (HR=.89, 95% CI [.54-1.50], p=.679). Findings highlight the safety benefits of speed of processing training for older drivers living in rural environments where more fatal crashes occur. However, interventions are still needed to improve safety in urban environments where more crashes occur generally. Consideration of location in future interventions may help improve safe driving for older adults.
BROADBAND ACCESS, SOCIAL CONNECTEDNESS, AND SELF-REPORTED HEALTH IN A RURAL COMMUNITY SAMPLE OF OLDER ADULTS
Authors: Killian Tim , Garrison Betsy
Published: December 2023

Social connections provide older persons with access to important resources supporting their physical and psychological health. People aging in rural areas may have more challenges to maintaining and developing social connectedness because of geographic separation with friends, neighbors, and family members. One way to mitigate the risk of reduced social connectedness is by using internet-enabled technologies to facilitate social connections. However, these solutions are also limited by internet access, stability, and questions about whether or not technology enabled connections are able to meet needs for social connections. The objective of this study was to examine the role of internet access to (a) social connectedness and (b) self-rated health (SRH) and direct and indirect pathways from internet access to SRH. We used data collected in 2020 during the height of COVID-19 pandemic lockdowns from a random sample of about 450 people aged 50 years old or older living in rural counties in Arkansas. Path analyses were used to regress participants’ self-reported health on social connectedness and examine direct and indirect pathways from internet access to health. Interestingly, we found that internet access was positively related to self-reported health, but was fully mediated through social connectedness. Moreover, these relationships remained significant even after controlling for variabilities in income. Although more research is needed, these results suggest that maintaining social connections using the internet was an effective approach to support the health of the older rural persons and has policy implications for maintaining and continuing to increase stable broad-band technologies for rural areas.
EFFECTS OF SOCIAL ENGAGEMENT ON WELL-BEING AND COGNITIVE FUNCTIONING IN OLDER HISPANICS
Authors: Liao Hsiao-Wen , Kang Hyewon
Published: December 2023

Research on engaged lifestyles demonstrates the importance of social engagement for aging well. The present study examined this thesis in the context of minority aging. With the theoretical lens that Hispanic cultures value social relationships, we tested whether social engagement was particularly important for maintaining well-being and cognitive functioning in Foreign-born (FB-H) and U.S.-born Hispanics (USB-H) relative to non-Hispanic Whites (NHW). Participants (N = 2677) was drawn from older adults in the Health and Retirement Study who completed the 2008, 2012, 2016, and 2020 module at least once. Two types of social engagement were assessed. Social interactions were based on the frequency of interactions with close partners (i.e., children, family members, and friends). Social activity participation was measured by the frequency of volunteering, doing charity, joining clubs, and attending meetings of non-religious organizations. Results of random intercept linear models controlling for covariates showed that, consistent with the literature, social interactions predicted better life satisfaction and that both aspects of social engagement predicted better immediate and delayed recall. Unexpected patterns emerged when interaction effects of race/nativity and social engagement were tested. While the general pattern held for NHWs, we found that greater social interactions predicted lower life satisfaction in USB-H. For FB-H, greater participation in social activities correlated with lower performance on immediate recall. Echoing a recent study that reveals mixed evidence for the well-documented paradox that Hispanic immigrants hold health advantages (Tarraf et al., 2020), we call for more research on lifestyle factors and aging trajectories in racially diverse populations.
STAYING SINGLE INTO VERY LATE LIFE: LONGITUDINAL ANALYSIS OF NEVER-MARRIED ADULTS
Authors: Nemmers Natasha , Martin Peter , Brottman Barbra
Published: December 2023

With the rise in life expectancy, the phenomenon of singlehood has also increased. However, most studies group unmarried individuals together (i.e., divorced, separated, widowed, never-married), and less is known about lifelong singlehood. This study aims to understand gender and never-married/married status differences in cognition, difficulty in activities of daily living (ADLs), and survival rates. Using the Health and Retirement Study (HRS) of older adults 69 years and older, we conducted longitudinal analyses of health from waves 2-5 and a survival analysis with waves 2-14. The never-married group (n=243) had a higher proportion of racial/ethnic minorities and women than the married group (n=7328) at baseline. Survivorship trajectories by marital group were significantly different: χ2(1) =13.26, p < .001, such that married persons had a better chance of survival than never-married persons. We found significant gender differences in physical activities of daily living (PADLs, F=6.75, p<.001) and instrumental activities of daily living (IADLs, F=9.03, p<.001), indicating that women had greater functional difficulty than men. Regarding marital status, never-married persons had significantly more difficulty in ADLs than married persons only in waves 4 (F=10.22, p<.01) and 5 (F=4.66, p<.05). No cognition differences were found by gender or marital status. Consistent with prior work, these findings demonstrate the protective effect of marriage on mortality, though IADL-difficulty and cognition did not differ. This study will add to the sparse literature on lifelong singlehood. Future studies should consider other relevant covariates, like social network and personality, to inform tailored health interventions and policies for this subpopulation.
ASSOCIATION BETWEEN MOTOR ACTIVITY AND TOTAL NEUROPSYCHIATRIC INVENTORY NURSING HOME VERSION SCORES
Authors: Guseva Elena , Iaboni Andrea , Herrmann Nathan , Ismail Zahinoor , Lanctot Krista , Seitz Dallas , Burhan Amer , Wilchesky Machelle
Published: December 2023

Accurate neuropsychiatric symptoms (NPS) assessment monitoring is crucial for person-centered dementia care management. Doing so, however, is challenging, since current assessment tools rely on clinical observations, are time consuming, and are somewhat subjective in nature. The Neuropsychiatric Inventory Nursing Home Version (NPI-NH) is an informant-based assessment of 10 sub-domains of behavioral functioning where total NPI-NH score represents an overall behavioral disturbance level. We investigated the evidence pertaining to the diagnostic test accuracy (DTA) of motor activity tracking obtained via wearable sensor technology (WST) using total NPI-NH score as the gold standard in persons living with dementia (PLWD). This was part of a larger systematic review assessing the use of WST for NPS detection and monitoring carried out from inception until September 2022 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=219917). A systematic literature search carried out in 7 library databases produced 12,928 articles from which 84 titles were retained for analysis. In total, 8 articles examined the validity of WST for assessing and monitoring of overall behavioral disturbance in PLWD, among which 5 studies used motor activity trackers. Dementia participants predominantly had Alzheimer’s, vascular or mixed dementia (40%, 20%, and 40% respectively), with mild-moderate severity. Three studies reported correlations between motor activity and total NPI score that ranged from 0.35 to 0.38. A random effects model indicated that the pooled correlation across studies was 0.37 (0.22-0.51), with no heterogeneity (I2=0%). While our sample reveals WST test accuracy as being consistently moderate, more research is necessary for confirmation.
MIXED-METHODS EVALUATION OF A NOVEL MULTIMODAL COGNITIVE TRAINING “COGMUSE” IN OLDER ADULTS WITH INSOMNIA
Authors: Curtis Ashley , Costa Amy , Musich Madison , Rzeppa Chloe , Zemon Kevin , Schroeder Isaac , Sielert Charles , Wang Fang
Published: December 2023

Lack of pharmacological agents to improve cognition has prompted research on behavioral interventions, such as cognitive training (CT). CT benefit is inconsistent across non-patient populations. However, our recent work reveals multimodal commercialized CT shows promise for improving cognition and sleep in older adults with insomnia. Evaluation of non-commercialized CT allows for easy implementation of test scenarios/variables, monitoring and iterative optimization. This study: 1) created a novel non-commercialized CT for older adults with insomnia (“COGMUSE”) and 2) conducted usability testing/feature evaluation. COGMUSE is a computerized multimodal CT (Star Snatcher: targets spatial attention, perceptual motor skill, processing speed; Worse for Wire: targets spatial attention, inhibition). Ten older adults with insomnia complaints (Mage=69.3±3.3) completed 20 minutes of COGMUSE and the Game User Experience Satisfaction Scale (GUESS-18; rating 1-strongly disagree-7-strongly agree across game features). Open-ended feedback was solicited. Compiled transcripts were analyzed independently (A.F.C./F.W.) through deductive content analysis. Frequent topics/themes were identified. GUESS-18 average scores ranged from 3.5/7.0 (enjoyment) to 5.9/7.0 (personal gratification) for Star Snatcher, and from 3.1/7.0 (audio aesthetics) to 5.5/7 (play engrossment) for Worse for Wire. Feedback themes were largely positive (Star Snatcher: good graphics/sounds, easy/enjoyable; Worse for Wire: enjoyable, good instructions). Negative themes included quick movement and lackluster graphics/gameplay “story” (Worse for Wire) and lack of error consequences and practice trials (both games). Older adults with insomnia evaluated COGMUSE as easy and enjoyable to use with acceptable aesthetics. Improvement themes largely focused on instructions and navigation. Next steps include updating COGMUSE and evaluating its preliminary efficacy on cognition and sleep.
OTC SENIOR STATION: CONSUMER-FACING TECHNOLOGY TO PROMOTE MEDICATION SAFETY
Authors: Hill Jordan , Ganci Aaron , Patel Himalaya , Campbell Noll , Chui Michelle , Abebe Ephrem , Holden Richard
Published: December 2023

Over-the-counter (OTC) medications with anticholinergic effects (e.g. doxylamine, diphenhydramine) are widely used by older adults, despite their association with an increased risk of Alzheimer’s disease and related dementias (ADRD). Authoritative bodies, such as the American Geriatrics Society and National Academy of Medicine, recommend discouraging the use of both prescription and OTC anticholinergics. However, most interventions previously developed and tested have targeted only prescription anticholinergics despite the use rate of OTC anticholinergics being higher in older adult populations. Consumer-facing technology may be ideal for addressing OTC anticholinergic use as it is cost effective, scalable, and can address the constraints of relying on busy pharmacists to intervene during older adult OTC medication purchases; this has become especially relevant as pharmacies face staffing shortages, increasing pharmacist workload and requiring pharmacies adjust their hours of operation. Our interdisciplinary team of pharmacists, engineers, and designers engaged both older adults and pharmacy staff in the co-design of “OTC Senior Station”: a user-centered, consumer-facing kiosk to be placed in community pharmacies to promote reduced anticholinergic use by older adults. Kiosk users are prompted to input brief information, which is used to present safer alternatives to OTC anticholinergics (e.g., for insomnia management). This poster will present OTC Senior Station--what we believe to be the first consumer-facing technology to target OTC anticholinergic use—the participatory design methods used to create it, and the results of studies to assess its usability with older adults.
AN INTERSECTIONAL APPROACH TO UNDERSTANDING COMBINING WORK AND CAREGIVING ON MENTAL HEALTH
Authors: Brady Samantha , Patskanick Taylor , Coughlin Joseph
Published: December 2023

While an increasing number of Americans are providing unpaid care to an adult family member, the majority are balancing family care needs with employment responsibilities. Role conflict theory suggests the experience of combining family caregiving and paid work can detrimentally impact mental health, while role enhancement theory suggests that occupying both social roles can alleviate the burden of caregiving. Prior work finds support for both theories, however, there is currently a lack of causal evidence examining how mental health is affected by combining caregiving and employment roles. Additionally, while gendered differences and differences across racial identities in the family caregiving experience are well-documented, even fewer studies have taken an intersectional approach in understanding shifts in mental health when caregiving while employed. The current study uses a causal methodology to examine how the mental health of working adults is impacted when they transition into a family caregiving role and how these impacts vary at the intersections of racial and gender identity. Data are from the Health and Retirement Study (2004-2018), a nationally representative survey of U.S. adults aged 50+. Results from fixed effects models support role conflict theory, suggesting when working adults begin family caregiving they experience an increase in depressive symptoms. Additional analysis using an intersectional lens finds this result applied only to White working women who transitioned into a parental caregiving role. Combining care with paid work did not appear to impact depressive symptoms for employed Black women, Black men, and White men when they began caregiving.
APPLYING TIME-VARYING EFFECT MODELING TO EXAMINE DAILY VARIATION IN SUICIDAL IDEATION AMONG DEMENTIA CAREGIVERS
Authors: Puga Frank , Poe Abigail , Wang Danny
Published: December 2023

Emerging evidence suggests that caregivers may experience high rates of suicidal ideation. However, relatively little is known about daily contextual factors, including day-to-day depression and anxiety-related symptoms, that increase the severity of suicidal ideation over time. The purpose of this study was to apply time-varying effect modeling (TVEM) to examine daily depression and anxiety symptoms leading up to an individual’s highest suicidal ideation score within a span of 14 days in a sample of community-dwelling ADRD caregivers. The intercept-only model revealed an increase in the mean scores of daily suicidal ideation four days leading up to an individual’s highest score. Additionally, there was a significant decrease four days after the highest suicidal ideation point. The relationship between depression and daily suicidal ideation was significant 1-day leading up to the highest suicidal ideation score. Similar relationships were observed with daily anxiety as a time-varying predictor in a separate model. The results from this study suggest that suicidal ideation can vary between days, with depression and anxiety influencing the intensity of the slope leading to and following an individual’s highest suicidal ideation score. Examining suicidal ideation trajectories over time and factors associated with varying severity can help inform targeted interventions to support dementia caregivers and mitigate the risk of severe psychological distress associated with dementia caregiving.
ENGAGING OLDER ADULTS TO GUIDE LOW-COST NONWEARABLE SENSOR TECHNOLOGY DEVELOPMENT TO AGE IN PLACE: SURVEY FINDINGS
Authors: Schoenfeld Elinor , Trimboli Tracy , Finnerty Kaylyn , Ayisi-Boahene Givenchy , Bruckenthal Patricia , Zadok Erez , Horwitz Shelley , Ye Fan
Published: December 2023

As Americans live longer, a dynamic opportunity has arisen to provide enhanced resources to sustain their well-being. Cost-conscious, convenient in-home sensing will assist with chronic disease management, and become part of a long-term plan to support our aging population and shrinking healthcare workforce. The purpose of this study was to obtain input from older adults about (i) their comfort level and willingness to adopt different sensor technologies, and (ii) opinions on data sharing, security, and privacy to guide our sensor development. Over 4 different survey timeframes (2018-2022), adults aged 60 and older (N=112) completed our survey either in-person (n=77) or via a REDCap online survey (n=35) (53% female; 30% age >80; 78% college graduates; 19% living alone). Though there were significant differences (p< 0.05) in demographics based upon recruitment source, no differences in attitudes towards sensor use were found by age, gender, education, or marital status. Opinions and preferences for sensor type/number/install location, and data sharing preferences significantly differed (p< 0.05) by home living arrangements (independent, 55+ or continuous care communities). Similar to national surveys, changes in technology use were observed pre- versus post COVID. Respondents living in 55+ and continuous-care housing were more comfortable with having sensors installed in their homes than those in community dwelling independent housing. This study highlights the need to include end users throughout the lifecycle of product development and provides insights into preferences by older adults for sensor use and data sharing.
IMPLEMENTING REABLEMENT IN COMMUNITY CARE: HOW DO WE SUCCEED?
Authors: Mouchaers Ines , Buma Lise , Verbeek Hilde , Zwakhalen Sandra , Vlaeyen Ellen , Goderis Geert , Metzelthin Silke
Published: December 2023

In the Netherlands, reablement is high on the agenda for inclusion in future health care policy, resulting in more and more care providers wanting to implement reablement into their everyday practice. So far, it has been implemented, resourced and organized in multiple ways. To support the implementation on an (inter)national level, insight is needed into what preconditions and influencing factors are regarding the successful implementation of reablement. Within a qualitative exploratory research design, four focus group interviews were conducted with stakeholders from three Dutch care organizations that have been providing reablement services for at least 6 months prior. Care staff, as well as project leaders, managers, directors, policymakers, and health insurance company representatives, were represented in the interviews. Data were analyzed using the framework method guided by the Consolidated Framework for Implementation Research. In total, 34 stakeholders, distributed over the four focus group interviews, participated in the study. Facilitators included interdisciplinary collaboration, organizational support in terms of leadership engagement and implementation climate, innovation design, and adaptability of the innovation. Barriers included costs and funding of the innovation, time investment (i.e. reporting, number of care visits), and communication. Some factors were listed as both hindering and facilitating such as knowledge and beliefs of care staff, staff’s and clients’ self-efficacy to change, and motivation of clients and family caregivers. These results enhance the understanding of factors influencing the implementation of reablement in community care. The next step is to identify strategies to overcome the identified barriers.
GLP-1 AGONISTS: EFFECT IN MANAGEMENT OF DIABETES AND WEIGHT LOSS IN OLDER ADULTS WITH OVERWEIGHT AND OBESITY
Authors: Pendrey Anna
Published: December 2023

Prevalence of Diabetes Mellitus Type 2 in older adults in the US is 33%, incidence of newly diagnosed diabetes is highest among those aged 65-79 years. Obesity in older adults impacts not only the morbidity and mortality, but importantly impacts quality of life and risk of institutionalization. Treatment for diabetes with glucagon like peptide 1 (GLP-1) agonists have demonstrated to reduce weight, control glucose, and reduce major adverse cardiovascular events in older adults. This study aims to describe outcomes in the management of older adults with diabetes and obesity with GLP-1 agonists. A retrospective study of 30 older adults with uncontrolled diabetes, overweight and obesity at a local practice that were started on treatment with GLP-1 agonists, since 2022, with ages 65-84 with diabetes mellitus type 2 with initial HbA1C 9.6%-12.6%, and BMI 27-48.2 that were started on GLP-1 agonists with improved results during treatment with current reduction of HbA1C 5.8%-7.7% and BMI reduction 23-39.8. In conclusion GLP-1 agonists have demonstrated significantly improved management of uncontrolled Diabetes Mellitus in older adults as well as a significant reduction in weight improving outcomes.
THE PICTURE WITHOUT THE THOUSAND WORDS—PHYSICIAN AND JUDGE COMMUNICATION IN GUARDIANSHIP CASES
Authors: Factora Ronan , Pawlicki Matthew
Published: December 2023

In Ohio, physicians conducting capacity evaluations in guardianship cases are also asked to complete a Statement of Expert Evaluation (SEE) used by Probate Court to aid in decisions determining that person’s competence. In a prior survey, physicians voiced reluctance to conduct such evaluations because they were time consuming and judges stated that information provided by physicians in guardianship cases was inadequate or incomplete. Communication between the two groups of what information would be most useful in this process would help optimize the time required by physicians to complete their evaluation and improve the quality of information judges receive when making their decision. A survey was conducted of legal professionals (at an Ohio Probate Court Pre-conference session specifically focused on capacity evaluation and SEE completion) which sought to identify elements these legal professionals felt were most and least useful from SEEs provided by completing physicians. With 52 attendees (including judges (active and retired), magistrates, court personnel, and public attendees), 38-42 persons answered the questions that were provided. By far the least valuable information was identified as the medication list, but the most useful was any detailed information/opinion provided by the completing physician explaining the other information included on the form (e.g. cognitive testing, diagnosis). Though potentially more time consuming, highlighting the importance of this information to completing physicians may help them communicate more effectively to legal authorities and facilitate greater understanding of the physician’s opinion in guardianship cases.
ADDRESSING BENZODIAZEPINE PRESCRIBING PRACTICES AMONGST ELDERLY PTSD VETERANS DURING THE COVID-19 PANDEMIC
Authors: Fernandes Deanna , Cheong Josepha
Published: December 2023

Psychotropic medication prescribing amongst elderly veterans has increased over the course of the COVID-19 pandemic despite the fact that psychotropics such as benzodiazepines, when being prescribed for a period over 2 weeks, are considered as relatively contraindicated amongst such patients with an additional Post-Traumatic Stress Disorder (PTSD) diagnosis due to a worsening of disease state symptoms. The objectives of my study are to inform clinicians and healthcare providers regarding the true extent of current benzodiazepine prescribing practices amongst elderly Veterans with PTSD and to provide a clinical aid/tool for education and improvement of such practices within the setting of the Veterans Affairs Medical Center. A one-page summarized aid will be drafted based upon provider feedback as well as from current Pharmacy Benefits Management Network resources to improve clinical practices with regards to the topics of benzodiazepine recommended length of use, risks of use amongst elderly Veterans, and risks amongst PTSD populations. While benzodiazepine prescribing practices have increased recently during the time of the COVID-10 pandemic, clinical tools may be drafted to improve such practices. Further studies are needed to determine the true impacts of such a tool on the national level as well as upon direct patient care.
EMOTIONAL RESPONSE TO THE COVID-19 PANDEMIC: NURSING HOME RESIDENTS’ PERSPECTIVES
Authors: Woods Ashley , Vogelsmeier Amy , Popejoy Lori , Miller Steven , Johnson Alisha , Thompson Roy , Trueblood Amy
Published: December 2023

Nursing home residents were at the forefront of challenges imposed by the COVID-19 pandemic, including being forced into extended periods of isolation, yet little is known about their emotional response. Therefore, the purpose of this study is to describe residents’ emotional responses to the COVID-19 pandemic, including their response to isolation. Twenty-eight residents residing in 22 Missouri nursing homes during the pandemic participated in semi-structured interviews as part of a larger mixed-methods study to understand nursing homes’ response to COVID-19. Interviews were transcribed and analyzed by a team of PhD researchers and doctoral students using a qualitative content analysis approach. Of the 28 resident interviews, most were more concerned about their families, other residents, and staff becoming infected rather than themselves. Many cited their lack of concern was due to trust in nursing home staff to keep them safe. Regarding isolation, a few described being angry about separation from family and friends. Nevertheless, most understood that the restrictions were about “doing what had to be done” and that isolation was “for the greater good.” The majority also responded positively about their relationships with staff during isolation and happiness at the return of visitors after isolation restrictions were lifted. Overall, residents’ emotional responses during the COVID-19 pandemic varied but primarily reflected their concern for others rather than themselves. Their concern for themselves may have been allayed because of their trust in nursing home staff. Their response to isolation seemed rooted in their understanding of the need to protect themselves and others.
NON-COVID-19 UPPER RESPIRATORY INFECTION DECREASES DURING THE COVID-19 PANDEMIC
Authors: Pruchnicki Alec
Published: December 2023

During the Covid 19 pandemic, the Vista on 5th Assisted Living Facility in New York City instituted a wide variety of pharmacological and non-pharmacological interventions (NPIs) to control the spread of the disease. Before and after vaccines were available for Covid 19, this combination of approaches reduced the usual seasonal variation of non-Covid upper respiratory infections (URIs). Almost all residents of the 127-bed facility were seen by the on-site physician with the onset of URI symptoms. Almost all those with symptoms were give an anti-histamine and cough syrup for relief. The single off-site pharmacy which supplied these medications tabulated the total amount of medications dispensed over the four years of 2019 to 2022. During December of 2019, normally the peak month for URIs at the facility, and the last month before significant Covid infections occurred, 67 prescriptions of these two types were dispensed. During 2020 NPIs and these medications kept new Covid 19 infections to about one dozen over the year. Medications being dispensed for all URIs in December of 2020 decreased by 69% to 21. Similar low rates of URI symptoms were seen in December 2021 and 2022 with only 18 prescriptions written in both months. Although some variation from month to month occurred because of other syndromes, the overall burden of URIs during the normally peak respiratory infection season was greatly reduced probably from the strict imposition of NPIs.
BENZODIAZEPINE/Z-DRUG DEPRESCRIBING DEFINITIONS AND FALLS OUTCOMES IN ELECTRONIC HEALTH RECORDS
Authors: Schindler Nicole , Zepel Lindsay , Maciejewski Matthew , Hastings Susan , Clark Amy , Pavon Juliessa
Published: December 2023

Benzodiazepines and Z-drugs contribute to the burden of falls in older adults; however, there is a lack of data examining the association between deprescribing and falls in real-world settings. We explored this association in a retrospective cohort study of adults aged 65+ with chronic benzodiazepine/z-drug use who received care at an academic health system from January 2017-December 2020. Chronic use of benzodiazepine/z-drugs was defined as ≥ 3 medication dispensings and cumulative days’ supply ≥ 45 days within 100 days in 2018 based on electronic health records. Medication deprescribing was defined as having a dispensing gap of either ≥180 days or 90 days within one year of index. Non-deprescribers were matched 4:1 using propensity score methods (180-day gap sample=655; 90-day gap sample=1395). Primary outcome was time until first fall resulting in ED, inpatient, or outpatient visit during 2-year follow-up after meeting deprescriber/non-deprescriber status, modeled using a cox proportional hazards model adjusted for age, gender, and number of comorbidities and chronic medications. Using the 180-day gap deprescribing definition (n=131 deprescribers, and n=524 non-deprescribers), the cumulative incidence of falls-related acute events was 6.9% for deprescribers and 9.7% for non-deprescribers (HR 0.65 [95% CI 0.31, 1.31]). Using the 90-day-gap definition (n=279 deprescribers and n=1116 non-deprescribers), the cumulative incidence was 9.3% for deprescribers and 8.5% for non-deprescribers (HR 1.12 [0.70, 1.77]). In this small single-site sample, neither deprescribing gap definition was associated with falls. There is a need to standardize deprescribing definitions and validate them in larger studies in the context of relevant clinical outcomes.
PREDICTING FALLS IN OLDER ADULTS
Authors: Brown Colleen , Feiler Marina Oktapodas , Simonsick Eleanor
Published: December 2023

Falls are detrimental to older adults causing injury and mortality. Although clinical assessments of balance deficits exist, it is not well understood how well they predict falls. Longitudinal analysis utilized data from 688 men and women aged 60-97 enrolled in the Baltimore Longitudinal Study of Aging with index and subsequent visits approximately 1.7 years apart. Inclusion criteria included objective balance assessment at index visit and answering the question “Have you fallen in the past 12 months?” at both visits. Predictors of interest included thigh muscle strength, progressive static balance test performance, narrow walk, and sway reference with eyes closed/feet together. Tests were parameterized using validated methods. Adjusted logistic regression was modeled to estimate the association between objective measures of balance and fall risk. Adjustment variables included age, sex, race, height, and weight. Results reported those who failed the eyes closed/feet together position had 3.6 (95% CI 1.03, 12.81) times the odds of future falls compared with those who passed. Those who failed the semi-tandem, tandem, and single leg stance, had respectively 3.1 (1.44, 6.75), 3.6 (1.59, 8.06) and 4.8 (1.93, 12.09) times greater odds of history of falls compared with those who did not fail. Progressive standing balance performance did not predict future falls. The eyes closed/feet together test is easily administered, requires no equipment, and takes less than 30 seconds to complete. Failure of eyes closed/feet together may predict future falls, which is clinically relevant as this may suggest shifting the momentum towards proactively preventing an initial fall.
COMPARING THE OUTCOMES OF VIRTUAL VERSUS IN-PERSON DELIVERY OF AN EVIDENCE-BASED FALLS PREVENTION PROGRAM
Authors: Herrick Tamara , Dorsey Kirsten , Hallen Sarah , Wierman Heidi
Published: December 2023

Each year one in four older adults has a fall1 and only about half tell their doctor or healthcare provider2. One way to prevent falls is to provide older adults with the evidence-based tools to prevent them. A Matter of Balance: Managing Concerns about Falls (MOB), is a top tier program for grant funding from the Administration for Community Living Falls Prevention Program. MOB has been shown to reduce the fear of falling and increase activity levels among older adults through cognitive restructuring and balance exercises.8 Prior to 2020, MOB was only offered as an in-person, small group (8-12 participants), community based intervention over 8 two-hour sessions led by 2 volunteer facilitators. In response to the global COVID-19 pandemic, MaineHealth’s Partnership for Healthy Aging adapted the Lay Leader model of MOB for virtual delivery (MOB-V). Review of MOB-V pilot data suggested that it was also effective in reducing the fear of falling and increasing the activity levels of older adults. Based on this success, the MOB-V was more widely disseminated during 2021 and 2022, but to date no comprehensive program evaluation of the MOB-V has been completed. We will present the preliminary results of our evaluation of participant data collected from the National Falls Prevention database between 2021 through 2022.
APATHY IN NURSING HOME RESIDENTS WITH DEMENTIA: ANALYSIS OF WITHIN- AND BETWEEN-PERSON DIFFERENCES
Authors: Jao Ying-Ling , Liao Yo-Jen , Berish Diane , Mogle Jacqueline , Kales Helen , Boltz Marie
Published: December 2023

Apathy commonly occurs in persons with dementia, yet it is often overlooked in nursing homes. It is unclear how apathy symptoms differ within- and between-individuals. This observational study examined the differences in apathy among nursing home residents with dementia. Three videos, 3-10 minutes each, were recorded for each resident to capture caregiving interactions between caregivers and residents with dementia and apathy. Apathy levels were rated second-by-second by trained researchers via video observations using the Person-Environment Apathy Rating-Apathy subscale (PEAR-Apathy). The total PEAR-Apathy score ranges from 6-24, with higher scores indicating higher apathy levels. A total of 17 residents were enrolled from three nursing homes in Pennsylvania. Correlations and multilevel modeling were used for analyses. PEAR-Apathy score was 16.2 on average. Within-video average variability in apathy was 2.28 (range=0.47-4.24). Across-video within-person results showed average variability was 2.27, and the range between people was 1.36 to 3.31. Residents’ baseline apathy and depression, caregiver age, dementia care experience, and experience with the resident were not significantly correlated with apathy variability. Results from multilevel modeling showed that 11.2% of the within-person variance in apathy was accounted for by resident differences. After accounting for the clustering at the resident level, age was significantly associated with apathy variability (t=3.31, p=0.002). Results suggest that residents with dementia have moderate differences in apathy variability. Additionally, variability in apathy tended to increase with age. Future research may further examine factors contributing to individual differences in apathy and develop interventions to minimize apathy in nursing home residents with dementia.
COGNITIVE CHANGE AMONG NURSING HOME RESIDENTS; COGRISK-NH SCALE DEVELOPMENT TO PREDICT DECLINE
Authors: Howard Elizabeth , Morris John
Published: December 2023

Objectives

Chronicle cognitive changes in nursing home residents; develop risk model identifying predictors of decline.

Methods

Using secondary analysis design with MDS data, cognitive status and change measures were calculated based on Cognitive Performance Scale (CPS). Baseline and quarterly follow-up analyses of US and Canadian interRAI data (n=1,257,832) were completed. Risk model from logistic regression analyses identified predictors of decline.

Results

Baseline 15% of residents were cognitively intact (CPS = 0); 11.2% borderline intact (CPS=1), 15% mild impairment (CPS = 2). 58.8% of residents fell into more severe CPS categories (3-6). Over time, increased proportion of residents declined – 17.1% at 6 months, 21.6% at 9 months, at 21 months, 34.0%. Over same time, more residents remained stable than declined. Baseline CPS score was strong predictor of decline. CPS categories 0-2 had 3-month decline rates in mid-teens, categories 3-5 had average decline rate of 9%. Two strata risk model construction was employed – one for CPS categories 0-2, second categories 3-5 and both were integrated into 6-category risk scale (CogRisk-NH). Mean decline rates at 3-month assessment ranged from 4.4% to 28.3%. Over time, distinction among risk categories continued – 6.9% to 38.4.% at 6 months, 16.2% to 61.4% at 21 months. Case distribution had 15.9% in category 1, 26.84% category 2, and 36.7% category 3. Three higher risk categories (4-6) represented 20.6% of residents.

Conclusion

CogRisk-NH scale differentiates among residents and likelihood of decline. Knowledge of risk for cognitive decline enables allocation of resources targeting amenable factors contributing to decline.