bluuebunny/crossref_metadata_2025 huggingface dataset:
ONE-LEGGED STANCE BALANCE OF OLDER ADULTS WITH AND WITHOUT FALLS
Authors: Vieira Edgar R , Oliveira Márcio , Gil Andre , Fernandes Karen , Teixeira Denilson , Amorim Cesar F , Silva Rubens da
Published: November 2019

Balance impairment is a common problem among older adults. Poor balance in older adults is often associated with mobility impairments, activity limitations and fear of falling in older adults. Thus, balance assessment is useful for early detection of postural control deficits to prevent mobility impairments and falls in older adults. The aim of this study was to assess if balance measures based in center of pressure (COP) parameters during one-legged stance could differentiate between older adults with and without falls in the past 12 months. One-hundred and seventy older adults (50 fallers and 120 non-fallers, age range: 63-72 years) performed three 30s one-legged stance trials with eyes open on a force platform with 30s of rest between each trial. The following variables were evaluated: COP 95% elliptical area, COP velocity in the anterior-posterior and medio-lateral directions, and test duration (how long the participant was able to stay in one-legged stance, up to 30s). Fallers had poorer balance than non-fallers (P ≤0.004). The COP parameters presented an area under the curve between 0.65-0.72, with sensitivity varying from 66 to 78% and specificity from 54 to 68%. There were no significant differences between fallers and non-fallers on test duration (17 vs. 18s, respectively). The findings showed that the fallers had similar duration time, but poorer balance than the non-fallers during one-legged stance. The COP parameters were able to differentiate the balance between fallers and non-fallers with acceptable area under curve, sensitivity and specificity.
CHARACTERISTICS OF MALADAPTIVE FALL RISK APPRAISAL AMONG OLDER ADULTS AGES 60 YEARS AND OLDER
Authors: Thiamwong Ladda , Ng Boon Peng
Published: November 2019

Even though one-third of older adults have maladaptive fall risk appraisal (FRA), no studies has examined this discrepancy between perceived fall risk and physical fall risk among older adults in Thailand. We examined the characteristics of fall risk appraisal (FRA). 433 community-dwelling older adults were randomly selected from two provinces in Southern Thailand. Physical fall risk was assessed by a full tandem stand test and perceived fall risk was assessed by the Fall-Efficacy Scale International. We classified FRA into: 1) Rational FRA means low physical fall risk and low perceived fall risk; 2) Irrational FRA means low physical fall risk but high-perceived fall risk; 3) Congruent FRA means high physical fall risk and high-perceived fall risk; and 4) Incongruent FRA means high physical fall risk but low perceived fall risk. Irrational FRA and Incongruent FRA are a maladaptive FRA. About 60% of the participants had maladaptive FRA, which consisted of irrational FRA (57.3%) and incongruent FRA (2.3%). 20.8% were in rational FRA and 19.6% in congruent FRA. Among those with rational FRA, incongruent FRA, irrational FRA, and congruent FRA, 27.8%, 60%, 41.1%, and 74.1% reported having at least one fall in the past year, respectively. After covariate adjustment, participants in the congruent FRA group were 3.29 times more likely (p=0.006) to fall than those in rational FRA. High proportion of participants had maladaptive FRA so screening individuals with maladaptive FRA and prevent them to transition into the congruent FRA group is important efforts to mitigate health and economic burdens.
FALL RISK BEHAVIORS AND INTRINSIC RISK FACTORS FOR FALLS IN INDIGENOUS AND NON-INDIGENOUS RURAL OLDER ADULTS
Authors: Bouweraerts Andre G , Ortega Justus
Published: November 2019

Within California, older adults living in rural counties have reported higher rates of falls than urban dwelling older adults. Although many Indigenous people live in rural areas, it is unclear whether the rate of falls among Indigenous older adults is similar to that of non-indigenous older adults living in rural areas. Thus, the purpose of this study was to examine fall risk behaviors and intrinsic risk factors for falls in rural dwelling Indigenous (N = 89), and non-Indigenous (N = 68) older adults 60-95 years of age living in California. Results showed that both Indigenous and non-Indigenous older adults share similarly high fall rates, but there are a much greater number of Indigenous older adults falling multiple times a year. Moreover, fall risk behaviors and intrinsic fall risk factors were significantly different between Indigenous and non-Indigenous rural-dwelling older adults. Future studies should investigate falls and fall risk factors in different tribes/locations of Indigenous older adults to better understand whether these risk factors differ among tribes. Moreover, it would be beneficial for future studies to assess the effectiveness of fall prevention exercises on fall risk in these communities. Information gained from this study helps to inform clinicians and researchers alike about the prevalence of falls and factors contributing to falls among Indigenous older adults living in rural communities; and helps to influence decisions in the future of programs for reducing fall risk in this often neglected population.
NEURAL CORRELATES OF COMPLEX WALKING TASKS IN OLDER ADULTS
Authors: Chen Nemin , Rosano Caterina , Karim Helmet , Studenski Stephanie , Aizenstein Howard , Rosso Andrea
Published: November 2019

Walking on a narrow path challenges attention and balance control but its neural correlates are unknown. We assessed the association between gray matter microstructural integrity and gait speed along a 6 m long and 20 cm wide path in participants from the Health, Aging, and Body Composition Study (n=155; mean age=83, 53% women, 35% black). Micro-structural integrity was measured by mean diffusivity (MD) in gray matter computed from diffusion weighted imaging (DWI); higher MD indicates lower integrity. We conducted general linear models to assess this association with gray matter microstructural integrity of regions of interest (based on known associations of usual pace gait speed): middle frontal gyrus; caudate; putamen; anterior, middle, and posterior cingulate; hippocampus; precentral gyrus; and supplementary motor area. We adjusted for total brain atrophy, usual pace gait speed, age, sex, race, and education. The average narrow-path gait speed was 0.97 m/s (standard deviation: 0.21). Average usual pace gait speed was 1.1 m/s (standard deviation: 0.21). After adjusting for covariates, we identified significant negative associations between narrow-path gait speed and gray matter MD of left posterior cingulate, left and right hippocampus, and left precentral gyrus (p<0.05). Narrow-path gait speed is associated with lower microstructural integrity in gray matter related to network connectivity (posterior cingulate), spatial cognition (hippocampus), and motor function (precentral gyrus).
ACHIEVING THE TRIPLE AIM THROUGH A FALLS PREVENTION INNOVATION IN LONG-TERM CARE
Authors: Gray-Miceli Deanna L , Ratcliffe Sarah J , Smith Matthew L , Rogowski Jeannette
Published: November 2019

Falls disproportionately burden frail older adults in long-term care, which is evidenced by the 60% fall rate annually in this setting. Our health systems improvement model, framed by the Health Outcomes Model for falls prevention, is targeted to achieve the triple aim of better health, better care, and better value. Highlighting evidence from three inter-related studies, this presentation describes the impact of a practice change model and its impact on patient, unit/staff, and organizational level factors as related to facility-wide falls prevention. In study one, we used an evidenced-based practice approach and assessment tool to achieve total and recurrent falls reduction over one year by 32% and 25%, respectively (p<0.001). In study two, the annual savings of using this approach was assessed and showed a total savings of $53,531.00, which equates to $700.00 per falling person. In pilot study three, a convenience sample of 15 older adults who were interviewed about their fall by nurses using this approach stated they felt valued and that the nurse cared about their story (n= 6; 40%). Purposive efforts to embed the model and effective strategies for adoption and implementation are presented.
STRATEGIES TO PREVENT FRAILTY: THE POWER OF EARLY DETECTION AND TRAINING OF PROFESSIONALS
Authors: Bleijenberg Nienke , de Wit Niek
Published: November 2019

Aging in place is an important goal for both older adults as well as many health policies worldwide, as it is in the Netherlands. Within an aging society, the number of frail older people with complex care needs living at home is increasing. Despite the various definitions of frailty, it is important to early identify who is at risk in clinical practice in order to prevent functional decline, enhance quality of life, and reduce health care costs. Furthermore, an important requirement is effective collaboration between primary care professionals. Various factors are associated with frailty. However, early detection of frailty and its risk factors such as oral health, nutrition and medication related problems is not part of routine care of professionals. To recognize frailty and its risk factors we started a large proactive integrated primary care program that successfully identified frail older people living at home based on routine care data in the Netherlands. After two-year follow-up, a reduction in acute visits at the emergency department was observed. Next, we performed additional studies focusing on early detection and prevention of risk factors of frailty such as oral health, nutrition, and medication related problems among older people living at home. During this symposium we will present the results of the program, followed by our studies that investigated frailty or frailty related risk factors. Additionally, we will show how we enhanced and evaluated the knowledge and skills of professionals working with frail older people in primary care.
NATIONAL IMPLEMENTATION OF A VHA DIFFUSION OF EXCELLENCE GOLD STATUS PRACTICE
Authors: Garner Kimberly K , Jensen Jamie , Nabholz Lisa , Harding Melissa , Taylor Laura
Published: November 2019

Advance care planning (ACP) is a health behavior that requires in-depth discussions support by trained professionals and motivational strategies to promote goal-setting and actions. Group visits in the healthcare setting can effectively increase an individual’s motivation and self-efficacy for ACP. The Department of Veterans Affairs (VA) has developed the Diffusion of Excellence Initiative to identify and spread innovative practices such as Advance Care Planning via Group Visits (ACP-GV), which uses an interactive group session to engage Veterans in thinking about and planning for their future medical decisions. In these sessions, social workers, nurses, psychologists, and chaplains, facilitate group discussions to increase the chance that a Veteran’s care preferences are known and reflect with their wishes. This also can relieve trusted others of having to make these tough decisions without much guidance. In addition, ACP-GV increases the effectiveness of advance care planning through allowing Veterans to discuss and process this complex topic with their peers. To date, 36 VA Medical Centers (VAMCs) are currently adopting, implementing or sustaining this practice and more than 15,250 Veterans have attended ACP-GV sessions. In addition, another 40 VAMCs are exploring participating this practice. Of those participants, approximately 18-20% develop a new advance directive and 86% set a smart goal to take steps toward advance care planning. Continued dissemination and implementation of this innovative practice is ongoing. After the session, attendees will have practical guidance for implementation of ACP-GV discussions in integrated (VA) or fee-for-service (Medicare) settings.
THE NATIONAL ELDER MISTREATMENT STUDY 8 YEARS LATER: VICTIM MENTAL HEALTH OUTCOMES AND PROTECTIVE FACTORS
Authors: Hernandez-Tejada Melba , Acierno Ron , Anetzberger Georgia , Loew Daniel , Muzzy Wendy
Published: November 2019

The purpose of this study was to conduct an 8-year follow-up of the National Elder Mistreatment Study (NEMS) and specify risk ratios for negative outcomes of elder abuse, including DSM-5 defined depression, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and poor self-reported health. Methodology: Attempts were made to re-contact, via Computer Assisted Telephone Interview, all 752 NEMS participants who reported mistreatment since age 60 at Wave I, as well as a randomly selected sample of non-mistreated NEMS participants Results: 183 NEMS Wave I elder abuse victims and 591 non-victims provided data. In bivariate analyses, elder mistreatment 8 years earlier increased risk of negative outcomes by 200-700%. However, multivariate analyses revealed that Current (Wave II) social support was highly protective against most negative outcomes (excepting PTSD), and even appeared to nullify effects of mistreatment on GAD and poor self-reported health. Conclusions: Outcomes of elder mistreatment have not been studied prospectively in a national sample. The NEMS 8-year follow-up findings indicate a strong relationship between elder mistreatment at Wave I and negative emotional and physical health 8 years later. Fortunately, current (Wave II) social support appears to be both consistently and powerfully protective against most negative outcomes.
A SYSTEMATIC REVIEW AND META-ANALYSIS OF AGE-RELATED DIFFERENCES IN TRUST
Authors: Bailey Phoebe E , Leon Tarren
Published: November 2019

This systematic review and meta-analysis quantifies the magnitude and breadth of age-related differences in trust. Thirty-eight independent data sets met criteria for inclusion. Overall, there was a moderate effect of age group on trust (g = 0.22), whereby older adults were more trusting than young adults. Three additional meta-analyses assessed age-related differences in trust in response to varying degrees of trustworthiness. This revealed that older adults were more trusting than young adults in response to neutral (g = 0.31) and negative (g = 0.33), but not positive (g = 0.15), indicators of trustworthiness. The effect of age group on trust in response to positive and neutral cues was moderated by type of trust (financial vs. non-financial) and type of responding (self-report vs. behavioral). Older adults were more trusting than young adults in response to positive and neutral indicators of trustworthiness when trust was expressed non-financially, but not financially. There was also an age-related increase in self-reported, but not behavioral, trust in response to neutral cues. Older adults were more trusting than young adults in response to negative indicators of trustworthiness regardless of the type of trust or type of responding. The reliability of information about trustworthiness (superficial vs. genuine cues) did not moderate any effects of age on trust. Implications of these findings and directions for future research are discussed.
TECHNOLOGICAL AND FINANCIAL PREDICTORS OF FEAR OF FINANCIAL ABUSE AMONG OLDER ADULTS
Authors: Alves Shaina , Grinshteyn Erin
Published: November 2019

Much research has focused on elder abuse. Less research focuses on fear of abuse. This analysis examines the associations between feelings of technological competence and variables assessing financial confidence with fear of financial victimization. Data were collected among community dwelling older adults in Nevada (n=467). Questions were asked regarding technological competence, confidence in navigating the financial system, asset protection, trust in financial institutions, and previous financial abuse victimization. The outcome was assessed by asking how afraid the respondent was of becoming a victim of financial abuse. Multivariate logistic regression models were run controlling for confounding. Controlling for all covariates, those who reported feeling unconfident in their technological competence had 2.5 times the odds of being afraid of financial abuse compared with those who felt confident (p<0.02). Those who reported feeling like their assets were at risk had 4.12 times the odds of being afraid of financial abuse (p<0.0001). Older adults who reported feeling vulnerable to financial victimization had 9.4 times the odds of being afraid of financial abuse compared with those who felt invulnerable (p<0.0001). Those who were previously victims of financial abuse had 4.33 times odds of being afraid of financial abuse compared with those who had no history of financial abuse (p<0.0001). Feeling confident in the financial system, asset protection, fear of credit card use, and trust in financial institutions were not associated with fear of financial abuse. These data provide a better understanding of fear of financial abuse, which will allow for better prevention of this issue.
A PROACTIVE CARE PROGRAM FOR FRAIL OLDER PEOPLE LIVING AT HOME: A 2-YEAR EVALUATION
Authors: Bleijenberg Nienke , Rijksen Jonna , Schuurmans Marieke J , de Wit Niek J
Published: November 2019

This study presents the long-term evaluation and impact of a proactive primary care program that aims to reduce acute healthcare consumption and preservation of daily functioning of frail older people living at home. For nine years the program has been adapted and evaluated. We present the results of our implementation study with two-year follow-up. 53 general practices (GP) participated. They provided care to approximately 35000 people aged 65 years and older. Data was extracted from routine primary care data, hospital data and social care data from the municipality. Important outcomes were: number of GP visits, house visits by GP, out-of-hours primary care visits, emergency room (ER) visits, hospital admission, social support, self-sufficiency and wellbeing. After implementing the program, a significant reduction in acute visits (ER and out-of-hour visits) was observed. GP contacts and visits were also significantly increased. The program was well perceived by professionals.
PERPETRATOR DEMOGRAPHICS ASSOCIATED WITH ADULT PROTECTIVE SERVICES—CONFIRMED FINANCIAL EXPLOITATION CASES
Authors: Enzler Cassandra J , Reyes-Ortiz Carlos , Burnett and Jason
Published: November 2019

Financial exploitation (FE) in older adults is a significant public health problem linked to outcomes including depression, financial ruin and early mortality. Studies have demonstrated risk factors associated with FE, but less is known about perpetrator characteristics. We performed a secondary data analysis of over 16,000 reported cases of FE utilizing a cross sectional design. Using multivariate logistic regression, confirmed and unconfirmed cases of FE were predicted from the following perpetrator demographics: age, gender, marital status, ethnicity, relationship to the victim, living status, and histories of drug abuse, alcohol abuse, and mental illness. Significant perpetrator demographics predicting confirmed FE were separation/divorce (OR=1.48), identifying as White (OR=1.33) or Black (OR=1.44), being a daughter (OR=1.61), son (OR=1.75), grandchild (OR=2.72), or other family member (OR=1.41), not residing with the victim (OR=2.32), and having a history of drug abuse (OR=2.56), alcohol abuse (OR=1.80), or mental illness (OR=1.91). These findings are based on a large statewide dataset and describe important perpetrator characteristics that could potentially be targeted for both intervention and prevention programs. This is especially important as many victims are reluctant to seek criminal action against a family member or trusted individual. This information is valuable as it may help APS, who has limited funding and staff, investigate and intervene in more difficult elder abuse FE cases.
COMPARABILITY OF BIOLOGICAL AGING MEASURES IN THE NATIONAL HEALTH AND NUTRITION EXAMINATION STUDY, 1999-2002
Authors: Hastings Waylon J , Belsky Daniel , Shalev Idan
Published: November 2019

Biological processes of aging are thought to be modifiable causes of many chronic diseases. Measures of biological aging could provide sensitive endpoints for studies of risk factors hypothesized to shorten healthy lifespan and/or interventions that extend it. However, uncertainty remains about how to measure biological aging and if proposed measures assess the same thing. We tested four proposed measures of biological aging with available data from NHANES 1999-2002: Klemera-Doubal method (KDM) Biological Age, homeostatic dysregulation, Levine Method (LM) Biological Age, and leukocyte telomere length. All measures of biological aging were correlated with chronological age. KDM Biological Age, homeostatic dysregulation, and LM Biological Age were all significantly associated with each other, but were each not associated with telomere length. NHANES participants with older biological ages performed worse on tests of physical, cognitive, perceptual, and subjective functions known to decline with advancing chronological age and thought to mediate age-related disability. Further, NHANES participants with higher levels of exposure to life-course risk factors were measured as having older biological ages. In both sets of analyses, effect-sizes tended to be larger for KDM Biological Age, homeostatic dysregulation, and LM Biological Age as compared to telomere length. Composite measures combining cellular- and patient-level information tended to have the largest effect-sizes. The cellular-level aging biomarker telomere length may measure different aspects of the aging process relative to the patient-level physiological measures. Studies aiming to test if risk factors accelerate aging or if interventions may slow aging should not treat proposed measures of biological aging as interchangeable.
ASSOCIATION BETWEEN GRIP STRENGTH AND COGNITIVE FUNCTION AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: Chang Milan , Ramel Alfons , Jonsson Palmi V , Thorsdottir Inga , Geirsdottir Olof
Published: November 2019

Background: Decline in both physical function and cognition among older adults has been associated with increased risk of dementia. Physical activity (PA) is beneficial for the improvement of both physical and cognitive function. The purpose of the study was to investigate the association between baseline physical function and cognitive function after 12 weeks of resistance training among older adults. Methods: Two hundred and thirty-seven community-dwelling older adults (N=237, 73.7±5.7 years, 58.2% female) participated in a 12-week resistance exercise program (3 times/week; 3 sets, 6-8 repetitions at 75-80% of the 1-repetition maximum), designed to increase strength and muscle mass of major muscle groups. Body composition, physical activity status, grip strength, cardiovascular risk factors, 6 minutes walking distance (6MWD), and Mini-Mental State Examination (MMSE) were measured at baseline and endpoint. The linear regression model was used to examine the association. Results: Mean MMSE score was 27.5±2.1 at baseline and 28.1±2.2 after the exercise intervention. After the intervention, 57 declined, 55 remained the same, and 120 have improved in MMSE scores. We found that the MMSE score after the intervention was significantly associated with baseline grip strength (beta=.03, P<.05) among healthy older adults, after adjusting basic characteristics, cardiovascular risk factors and mobility at baseline. Conclusion: Our study found that baseline grip strength was strongly associated with cognitive function after the 12 weeks of resistance training. Muscle power, such as grip strength may play an important role in the effect of exercise intervention on cognition even among healthy independent older adults.
EFFECTS OF MEDICARE COMORBIDITIES, SELF-REPORTED FACTORS, AND POLYGENIC RISK SCORES IN RISKS OF AD/ADRD
Authors: Akushevich Igor , Yashkin Arseniy , Kravchenko Julia , Ukraintseva Svetlana , Yashin Anatoliy
Published: November 2019

At this time there is no consensus on the origin, development, and progression of Alzheimer’s Disease and related dementias (AD/ADRD) and the extent to which variation in the effects of potential risk factors affects the risk for this disorder is underexplored. In this paper we used HRS-Medicare-genetics data to evaluate the effects of risk factors from three groups: i) Medicare-based indicators of chronic diseases that have shown an association with AD/ADRD in the literature, ii) individual heath state, behavior, functional status, education and socioeconomic status, and iii) polygenic risk scores that incorporate known-to-date genetic risk factors for AD/ADRD. We found that: i) the effects of Medicare disease indicators are higher than the effects of self-reported diseases; ii) heart diseases, cerebrovascular diseases, and depression had a strong impact on AD/ADRD, while the presence of cancers sometimes decreases the risk of AD/ADRD; iii) systemic hypotension, chronic kidney disease, and chronic liver disease showed unexpectedly strong effects; iv) compared to females, males are affected by a lower number of risk factors albeit at higher magnitudes; v) BMI, alcohol, drinking, income, and number of education years are protective, vi) genetic scores associated with neurotransmitters (synapse functioning and loss) and neuroinflammation demonstrated strong significant effects, and vii) Blinder-Oaxaca decomposition demonstrated the important role of genetic factors in racial disparities in AD risk. The analyses show the extent to which links between the distinct differences in comorbidities, behavioral and socioeconomic factors can predict the risk for AD/ADRD.
LONGITUDINAL ASSOCIATION BETWEEN SERUM 25 HYDROXY VITAMIN D AND COGNITIVE FUNCTION AMONG ICELANDIC OLDER ADULTS
Authors: Eymundsdottir Hrafnhildur , Chang Milan , Geirsdottir Olof , Jonsdottir Maria , Jonsson Palmi V , Gudnason Vilmundur , Ramel Alfons
Published: November 2019

Studies have indicated that low levels of serum 25 hydroxy vitamin D (25OHD) are associated with lower cognitive function among older adults while longitudinal studies have revealed controversial results. The aim was to investigate the longitudinal associations between 25OHD and cognitive function among older adults with 5-years follow up. The Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study (N=3411) assessed cognitive function measuring memory function, speed of processing and executive function. 25OHD was measured using the Liaison chemiluminescence immunoassay and used as a continuous variable. Multivariate linear analysis, adjusting for numerous confounding factors, was used to calculate the longitudinal associations. All analyses were performed separated by gender. There was a high tendency for low levels of 25OHD i.e. 29.6% men and 37.7% women had hypovitaminosis D (<50 nmol/l). Both men and women had significantly lower scores in all aspects of cognitive function at the follow-up time period. Unadjusted correlations between 25OHD and cognitive functions showed a stronger correlation for women, whereas women had lower scores in all aspects of cognitive function associated with low 25OHD. After adjusting for potential confounders, e.g. age, education, lifestyle and health-related factors, 25OHD and cognitive function were not significantly associated. Observational studies indicate that lower levels of vitamin D are associated with lower cognitive function. Intervention studies are yet to show a clear benefit from vitamin D supplementation. More longitudinal- and interventional studies, with longer follow-up duration, are needed.
BODY COMPOSITION ACROSS THE LIFESPAN IN AFRICAN CARIBBEAN MEN: FINDINGS FROM THE TOBAGO LONGITUDINAL STUDY OF AGING
Authors: Santanasto Adam J , Miljkovic Iva , Cvejkus Ryan K , Kuipers Allison L , Wheeler Victor , Zmuda Joseph M
Published: November 2019

Body composition changes vary by age and ethnicity and have a major impact on health and physical function. However, little is known about the magnitude, tempo and patterns of these changes in African-ancestry populations, particularly outside the U.S. Thus, we examined age-specific rates-of-change in lean and fat mass in a unique population-based, longitudinal cohort study of 2621 African-ancestry men on the Caribbean island of Tobago (age: 62.0±11.8 years, range: 32-99 years). Body composition was measured with DXA at study entry and after an average of 4 and 9 years. Annualized rates of change and 95% confidence intervals were calculated using all 3 time-points with Generalized Estimating Equations stratified by 5-year baseline age-groups. Lean mass declined at a fairly constant rate in age-strata up through age ≤64 years (-0.72; -0.76, -0.67%/yr), but accelerated to -0.92 %/yr (-1.02, -0.82 %/yr) among those aged 65-69, and to -1.16 %/yr (-1.30, -1.03 %/yr) among those aged 70-74 years – plateauing in those aged 75+. This pattern of age acceleration was observed in arm but not leg lean mass. The age-specific rates of decline in lean mass in this cohort of African Caribbean men appear to be lower than those reported in older African American men. In contrast to lean mas, fat mass increased by 2.93 %/yr (2.72, 3.15 %/yr) and this rate of increase was fairly uniform across the lifespan. Additional research is needed to better define the lifestyle, medical and biological factors contributing to body composition changes across the lifespan in African-ancestry populations.
GRANDPARENTS RAISING GRANDCHILDREN IN KOREA: CULTURAL UNDERSTANDING OF MULTIGENERATIONAL CAREGIVING
Authors: Lee Youjung , An Sok
Published: November 2019

Korean grandparents raising their grandchildren play significant roles as social and family resources in Korea. They experience caregiving stress that negatively influences their mental health while struggling with limited social support from peers, and minimal respite care and community resources. Despite a need for resources and information concerning this growing population, there is limited knowledge on Korean custodial grandparents, especially the distinctive cultural factors influencing their multigenerational caregiving experiences. This qualitative study explored Korean custodial grandparents’ experiences of raising grandchildren and cultural meanings of multigenerational caregiving. Using a phenomenological approach, semi-structured interviews with 23 custodial grandparents were conducted from December 2018- January 2019 in two urban and three rural places in Korea. Among the grandparents, five were grandfathers. The mean age of the grandparents was 72 years old (range: 61-82), and the mean age of their grandchildren was 13 years old (range: 1-21). On average, the grandparents had raised 1.5 grandchildren (range: 1-3) for 11 years (range: 1.5-20). Four key themes emerged from the general structure of the lived experiences of Korean grandparents: a) intensive child care support from the grandchildren’s uncle and aunt; (b) stigma of a child’s divorce and custodial grandparenting; (c) different social expectations toward maternal grandparents; and (d) increased needs on financial educational support for grandchildren. The finding reinforces the significant function of collectivistic and family-based Asian culture in understanding experiences of Korean custodial grandparents. It also highlights society’s view of only men carrying forward family lineage and its implications on grandparents’ perceptions about multigenerational caregiving.
USING A STRESS PROCESS MODEL TO EXAMINE RACIAL DIFFERENCES IN CAREGIVER WELL-BEING AND HEALTH
Authors: Badana Adrian , Haley William E
Published: November 2019

Current research must utilize nationally-representative samples of older adults and their family caregivers to accurately reflect the growing diversity of the United States. This study aims to use a stress process model to examine potential racial differences in caregiving in a population-based sample of 844 White and 389 Black family caregivers in the United States. We conducted 3 x 2 x 2 (relationship type x race x dementia care status) factorial ANOVAs to examine potential differences in caregiving stressors, appraisals, resources, and mental and physical health outcomes among primary family caregivers. Results indicated significant racial differences in caregiving on several stress process measures. Although Black caregivers reported more caregiving stressors, compared to White caregivers, they tended to report more positive appraisals of caregiving and more caregiving resources. Dementia caregivers tended to report greater caregiving stressors and worse measures of appraisal compared to non-dementia caregivers. There was a significant two-way interaction among relationship type and dementia care status for the caregiving stressor, hours of care. A stress process model can allow researchers to investigate various factors associated with racial differences in caregiving.
EXPERIENTIAL AVOIDANCE IN A SAMPLE OF DEMENTIA CAREGIVERS
Authors: Houston Amy M , Harfmann Elisabeth , Olzmann Amy , Brewster Glenna , Ottmar Hannah
Published: November 2019

Given the rapidly changing demographics, there will be an increasing number of individuals with dementia who will need significant support from informal caregivers. Providing care for an individual with dementia has been associated with negative outcomes in a number of domains including physical health, mental health, financial status and social functioning. There is a small but growing base of literature suggesting that fostering psychological flexibility, including acceptance, with dementia caregivers may be a helpful intervention. Experiential avoidance, which is the less adaptive alternative to acceptance, is the aversion from negative internal experiences including thoughts, feeling and physical sensations. Experiential avoidance has been found to be significantly related to depression and negative affect. The present study utilized online dementia caregiver support group samples (n = 158) to evaluate the relationship between experiential avoidance and general demographics, other aspects of psychological flexibility, and caregiver distress. Experiential avoidance was positively correlated with cognitive fusion (r(134) = .231, p < .01), caregiver burden (r(127) = .258, p < .01), and distress associated with dementia related behaviors (r(140) = .225, p < .01). Experiential avoidance was negatively correlated with engaged living (r(133) = -.244, p < .01), mindfulness (r(123) = -.187, p < .05), and self-rated health (r(138) = -.193, p < .05). Additionally, experiential avoidance was significantly higher for male caregivers (t(136)=2.462, p=.015) and those age 65 and over (t(134)=-2.421, p=.017). These findings support previous research that suggests experiential avoidance may be an important construct to target in future interventions with dementia caregivers.
CHANGING NURSES’ BEHAVIOR TOWARD NUTRITIONAL CARE WITH A SNACK-SIZED LEARNING INTERVENTION
Authors: Ten Cate Debbie , Dikken Jeroen , Ettema Roelof , Schoonhoven Lisette , Schuurmans Marieke J
Published: November 2019

Nurses play an important role in the prevention and treatment of malnutrition in older adults. However, research shows that nurses lack the motivation to give adequate nutritional care. In order to change this motivation a learning intervention about nutrition in older adults targeted at nurses would be desirable. The aim of this study was to assess the development, validation, and reliability of a learning intervention about nutrition in older adults. The results show that this learning intervention has a good construct and content validity, and is psychometrically sound. Questions of the learning intervention can be presented at once or in a snack-sized way, where the questions are presented over a period of time. This learning intervention can be used for developers of similar interventions, and as part of educating programs for nursing professionals and nursing students about nutritional care for older adults.
THE ROLE OF COLLECTIVISM IN EXPLAINING LIFE COURSE HEALTH DISPARITIES IN OLDER AGES
Authors: Saad-Lessler Joelle , Richman Karen
Published: November 2019

Collectivism refers to the social practice of investing in and relying on one’s social network, rather than formal institutions, to ensure personal security. Using the re-engineered 2014 Survey of Income and Pension Participation (SIPP), we investigate how collectivist practices affect life course health disparities at older ages in the US. Indicators of Collectivism include measures of caregiving, inter and intrahousehold financial and material support and help from charities, friends and family members. Regression results indicate that increased collectivist interactions are associated with improved self-reported health status outcomes. Government support for collectivist behaviors can thus yield a low cost means of improving health outcomes among the elderly.
ILLNESS PERCEPTION AS A DETERMINANT OF SELF-RATED HEALTH AMONG OLDER CHINESE AMERICANS WITH TYPE 2 DIABETES
Authors: Huang Ya-Ching A , Garcia Alexandra
Published: November 2019

Self-Rated Health (SRH) has been used as a proxy to evaluate individuals’ quality of life, overall well-being, and mortality. However, little is known about how illness perception influences SRH in Chinese American patients with type 2 diabetes (T2DM). This study, guided by Leventhal’s Self-Regulatory Model, explored the association between illness perception and SRH beyond socioeconomic and health factors. A cross-sectional survey from 109 community-dwelling foreign-born Chinese Americans with T2DM (60-95 years old; 51.4% females; Mean age= 74.17, SD=6.83). In addition to descriptive and correlation analysis, hierarchical regression models of SRH was estimated by subsequently entering the following set of predictors: (1) demographics (age, gender, marital status, education, financial status, and acculturation), (2) health factors (insulin usage, length of diabetes, number of chronic condition, depression, and diabetes distress) and (3) illness perception (timeline, disease consequence, personal and treatment control). SRH was measured by asking “How would you rate your overall health?” with a likert response scale: 1 (poor) to 4 (very good). Only 50.5 % of participants rated their health as good or very good. Participants with lower acculturation, higher number of chronic health conditions, higher diabetes distress, and a belief that illness will have more negative consequences were highly correlated with worse SRH. The total amount of variance explained by the entire model was 56% (F = 6.07, p < .001). These findings suggest that the modifiable factors such as acculturation, diabetes distress, and the belief of diabetes consequences should be incorporated into integrative health promotion efforts for this population.
PATTERNS OF PERFORMANCE ON QUALITY OF CARE AMONG U.S. HOME HEALTH AGENCIES, 2015-2017
Authors: Ma Chenjuan
Published: November 2019

Home healthcare is a critical care source for community-dwelling older adults. As the fastest growing healthcare sector in the US, quality of home healthcare is under increasing scrutiny. The purpose of this study is to examine patterns of performance on quality of care among US home health agencies. This is a 3-year cohort study using 2015-2017 Home Health Compare data and Provider of Services (POS) Files. In the dataset, each HHA was assigned a star rating (1-5) to reflect the overall quality of care. This indicator was calculated based on two process measures (timely initiation of care and drug education) and six outcome measures (e.g., hospitalization). We examined 8,020 HHAs in the US. Over the 3-year period, the number of HHAs receiving a star rating of 4 or 5 increased from 27% in 2015, 31% in 2016, to 32% in 2017. Roughly, 32% of the HHAs received a lower star rating and another 32% received a higher star rating from 2015 to 2016. Similarly, 30% of the HHAs received a lower star rating and 29% of the HHAs received a higher star rating from 2016 to 2017. Hospital-based HHAs were less likely to receive a star rating of 4 or 5. Larger HHAs (OR 1.34; 95% CI, 1.13-1.59) and HHAs with ownership changes (OR, 1.38; 95% CI 1.20-1.59) were more likely to improve their star ratings overtime. Our finding indicates dynamic changes in the quality of care within the US home healthcare sector.
TRENDS IN HEALTHCARE COSTS AND UTILIZATION ASSOCIATED WITH HEARING LOSS DIAGNOSIS OVER 10 YEARS
Authors: Reed Nicholas , Deal Jennifer A , Lin Frank , Yeh Charlotte
Published: November 2019

Hearing loss affects 38 million Americans and is associated with cognitive and physical decline. Moreover, hearing loss limits communication between patients and providers. In this study, we aimed to determine whether hearing loss diagnosis impacts healthcare cost and utilization. In the OptumLabs Data Warehouse insurance claims database (January 1, 1999 to December 31, 2016) we identified cases of age-related hearing loss (i.e. excluding conductive, ototoxic-induced, surgical-related hearing losses) in adults over the age of 50 years. Hearing loss cases were propensity-matched (nearest neighbor) to persons without hearing loss on multiple socioeconomic (income, region), demographic (age, sex, race, education), and health status (comorbidity count, cancer, dementia, baseline resource utilization) indices. There were 154,414, 44,852, and 4,728 subjects, respectively, at the 2-, 5-, and 10-year follow-up time points. We used regression modeling to examine healthcare cost (total expenditures), inpatient hospitalization, length of inpatient stay, outpatient visits, 30-day readmissions, and emergency department visits. Among 4,728 matched adults, hearing loss was associated with $22,434 (95% CI $18,219-$26,648) or 46% higher total healthcare costs over a 10-year period compared to those without hearing loss. Persons with hearing loss experienced more inpatient stays (Incident Rate Ratio, 1.47; 95% CI 1.29-1.68) and were at-risk (44% higher risk) for greater 30-day hospital readmission (Relative Risk, 1.44; 95% CI 1.14-1.81) at 10-years post index date. Similar trends were observed at 2- and 5-year time points across all measures. Importantly, these pathways may be amendable to hearing treatment via amplification which warrants future research preventative strategies.
HEALTH, WORRY, AND FOOD INSECURITY IN LOW-INCOME U.S. ADULTS: AN EXPLORATION OF MIDLIFE VULNERABILITY
Authors: Miller Lisa
Published: November 2019

Food insecurity, defined as the inability to afford and access nutritious foods to eat, is associated with poor health, higher healthcare costs, and increased risk of mortality (Gundersen et al., 2018). Moreover, food insecurity appears to accelerate aging processes. For example, food insecurity is associated with inadequate nutrition, which expedites the loss of muscle mass, increases mobility problems, increases financial worry, and increases the risk of frailty. While a good deal is known about food insecurity in later life, far less is known about midlife, which may be a time of unexplored vulnerability. We examined food insecurity in a sample (n=17,866; 2014 NHIS) of low-income (PIR<3) young, early-middle, late-middle, and older adults (18-84), focusing on health challenges (chronic conditions, functional limitations) and financial worry as predictors and whether their effects varied with age. Multinomial logistic regression was used to assess the association of predictors with food insecurity and determine whether associations differed by age group, adjusted for covariates (e.g., sex, race/ethnicity, education, social security). Food insecurity rates were highest in late- (37.5%) and early- (36.0%) midlife followed by young (33.7%) and older (20.2%) adults. Age moderated the relationship between food insecurity and risk factors (p < .05 for both) such that health was stronger- but financial worry was weaker- in midlife (due to higher food insecurity in low- and high- worry groups). Midlife is a period of increased vulnerability to food insecurity, particularly for those with health challenges. Research is needed to inform prevention strategies to help ensure optimal aging.
SEX DIFFERENCE IN EARLY FRAILTY TRANSITIONS, HEALTHCARE USE, AND MEDICARE PAYMENT IN OLDER MEXICAN AMERICANS
Authors: Li Chih-Ying Cynthia , Karmarkar Amol , Chou Lin-Na , Snih Soham Al , Kuo Yong-Fang , Ottenbacher Kenneth
Published: November 2019

This study investigated sex difference in early frailty transitions on one-year follow-up healthcare utilization and Medicare payment. We used the linked Medicare claims data and the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) survey, using longitudinal analyses for 789 older Mexican Americans ≥70 years old in 1998/99. Participants were divided into five transition groups: 1) remain non-frail, 2) improve (pre-frail to non-frail, frail to non-frail, frail to pre-frail), 3) remained pre-frail, 4) remained frail, 5) worse (non-frail to pre-frail, non-frail to frail, pre-frail to frail) based on their frailty status between Wave 3 (1998/99) and Wave 4 (2000/01). Main outcomes were: (a) healthcare utilization (hospitalization, emergency room admission, physician visit) and (b) Medicare payment (total and outpatient payments) from 2000/01 to 12 months after. Mean age was 78.8 (SD=5.1) and 60.3% were female in 1998/99. We found sex had significant interaction effects on one-year follow-up hospitalization and Medicare outpatient payment. Compared to the remained no-frail group, males who remained pre-frail (Odds Ratio [OR]= 3.62, 95% CI=1.18-11.2), remained frail (OR= 7.59. 95% CI= 1.74-33.1) and worse (OR=4.54, CI=1.74-11.8) had higher risk for hospitalization. Males in the worse group also had significantly higher Medicare outpatient payment (OR=2.58, CI=1.46-4.56). Same associations were not observed in females. However, both genders used similar frequency and type of outpatient services, as the top services were evaluation and management services. Our results suggested research is needed to examine balance between sex differences, frailty improvements, resources needed and total care expenditure in this population.
THE EFFECT OF DUAL ELIGIBILITY ON IMPROVEMENT IN MOBILITY: VARIATION BY PATIENTS’ PRIMARY DIAGNOSIS
Authors: Vaughan Molly W , Broyles Ila H , Ingber Melvin J , Palmer Lauren A , McMullen Tara , Anderson Karyn K , Deutsch Anne
Published: November 2019

Dually eligible individuals (i.e., eligible for Medicare and Medicaid) often have worse health and greater functional limitations than patients eligible for Medicare only. For dually eligible patients receiving inpatient rehabilitation services following a major illness or injury, improvement in function may be lower than for Medicare-only patients. To our knowledge, this is the first study to examine the relationship of dual eligibility on improvement in mobility for inpatient rehabilitation facility (IRF) patients by 13 primary diagnosis groups (e.g., Stroke, Amputation). Data was collected on the IRF-Patient Assessment Instrument at admission and discharge for all IRF patients discharged during 2017 (N = 428,631). A generalized linear model was run for each primary diagnosis group to examine the effect of dual eligibility on change in mobility during an IRF stay, adjusting for sociodemographic factors, clinical factors, and comorbidities. The proportion of patients who were dually eligible varied among primary diagnosis groups (9.6% for Hip/Knee Replacements, Fractures and Multiple Trauma to 21.7% for Amputation). Compared to patients who were non-dually eligible, dually eligible patients had lower improvement in mobility across all 13 diagnostic groups. The strongest effect of dual eligibility on lower improvement in mobility was among patients with hip and/or knee replacements (β: -1.99, p<0.001) and patients with non-traumatic spinal cord dysfunction (β: -1.83, p<0.001). This research indicates that dually eligible patients may have worse functional mobility outcomes than non-dually eligible patients for some IRF primary diagnosis groups, and these patients may need additional support after discharge.