bluuebunny/crossref_metadata_2025 huggingface dataset:
Methods Training to Advance Integrative Science on Minority Aging
Authors: Mezuk Briana , Firestone Monica , Tarraf Wassim
Published: December 2021

Minority aging is an inherently interdisciplinary field. However, it can be difficult for early-career investigators to develop skills on how to integrate data sources, study designs, measurement approaches, and analytic tools from disparate fields into their research programs. This session will illustrate how the biopsychosocial framework has been used to structure the content and delivery of methods training related to minority health/aging research in two NIH-funded exemplar programs: the MCUAAAR Analysis Core, and the Michigan Integrative Well-Being and Inequality (MIWI) Training Program. This talk will illustrate how the 20-year history of MCUAAAR informed the development of MIWI, and how both initiatives approach early-career scientist training through: i) centering learning within a mentorship structure to model team science, ii) avoiding false dichotomizes and hierarchies in study designs and data sources, and iii) attending to the unique challenges faced by scientists working in minority health through knowledge sharing.
Association Between Late-Life Hypertension and Resilience to Alzheimer Dementia Among Older Adults
Authors: Sin Mo-kyung , Cheng Yan
Published: December 2021

While midlife hypertension is known as one contributing factor for cognitive impairment and Alzheimer dementia in late-life older adults, less is known about the role of late-life hypertension in resilience to Alzheimer dementia. We examined the relationship between late-life hypertension and Alzheimer dementia resilience among older adults using the National Alzheimer’s Coordinating Center data from 2005-2020 (n=3,170). Hypertension, captured within 5 years prior to death, was defined as blood pressure (BP) ≥ 140/90 mmHg in at least two visits and/or ever treated with anti-hypertensive agents. Resilience was defined as positive Alzheimer disease (AD) pathology (CERAD score moderate or severe and BRAAK stage V or VI) from autopsy and Clinical Dementia Rating (CDR) - Sum of Boxes (SOB): 0.5-2.5 or CDR global (0-0.5) from last data point before autopsy. Student’s t-tests and Chi-square tests were conducted to compare patients with and without resilience. A multivariate logistic regression was conducted to estimate the association between late-life hypertension and resilience, adjusting for covariates of demographics and neuropathological characteristics. We had 55 resilient cases among 1,195 positive AD pathology cases. Those resilient were older (88±6.7) and had higher systolic BP (136 ± 18.2 mmHg) than non-resilient (82±7.9 years old, 130±20 mmHg. Untreated hypertension had a protective effect on resilience (adjusted OR: 3.69 (1.10-13.5, p=0.05). Patients with a systolic BP in the range of 135-145 mmHg and a diastolic BP in the range of 65-75 mmHg had the highest resilience possibility. Unlike midlife hypertension, late-life hypertension may have different effect on dementia, prompting further studies.
The Long and Winding Road: A Caregiver’s Journey
Authors: Gallagher-Thompson Dolores , Harvath Theresa
Published: December 2021

In a discussion about innovative caregiving programs, it is important to hear the voice of the caregiver. In this section, using her personal experience, this healthcare professional will explore her interactions with the medical system as a caregiver for her partner. She will discuss her caregiver journey from the cancer diagnosis in 2014 through her partner’s final days in hospice, which occurred during the pandemic. She will discuss pertinent issues regarding in what ways the healthcare system response was helpful, which responses were problematic, and where it outright failed to address caregiver needs. Issues, such as caregiver perceived invisibility during the hospital stay, how ageism affected policy decisions and what effect those policies had on her as the caregiver, and other important issues will be explored, including the how the pandemic affected her as a caregiver.
Training Challenges for Effectively Implementing a Technology Clinical Trial: A Snapshot From PRISM 2.0
Authors: Rogers Wendy , Mitzner Tracy , Cohen Kara , Moxley Jerad
Published: December 2021

Technology interventions can only be adequately assessed for efficacy if participants are adequately trained to use the technology. Only then can an evaluation be made about whether the technology intervention affects the outcome of interest. In the PRISM study, our goal was to teach inexperienced older adults to use either a tablet computer (control) or the PRISM 2.0 system. In this presentation we will discuss the training processes we used for both groups (e.g., segmenting sessions, providing homework, observations), to enable us to evaluate the relative benefits of PRISM for social connectedness. We will describe the training challenges and the need for assessors to be able to troubleshoot technology issues. We will evaluate individual differences in training success and drop-outs to provide insights for other technology intervention studies. Understanding these individual differences can provide guidance for the deployment of new technologies that may benefit health, social interaction, or cognitive engagement.
Effects of Health-Promoting Lifestyles in Midlife on Cognitive Functioning in Later Life
Authors: Kim Eunsaem , Lee Yunhwan , Shin Jonggak , Kim Gyeonghui , Yoon Jihye
Published: December 2021

Maintaining cognitive function in later life is key to healthy aging because cognitive impairments compromise everyday functional abilities, impeding independent living. Numerous studies have discovered early life experiences and lifestyle behaviors over the lifespan to have substantial influences on cognitive functioning with age. Especially, subtle brain changes related to dementia occur as early as midlife, and lifestyle factors in midlife influence neuropathological development, suggesting that midlife is a critical period for preserving cognitive health in later life. This study investigated the association between lifestyle behaviors in midlife and cognitive performance in later life using 12-year follow-up data from the Korean Longitudinal Study on Aging (KLoSA). Cognitive function was assessed with the Harmonized Cognitive Assessment Protocol (HCAP) for KLoSA. Eight thousand respondents from the KLoSA sample were administered HCAP neuropsychological tests. Hierarchical multiple regression analyses were used to examine whether health-promoting lifestyles at baseline (2006) predicted cognitive function in 2018 after controlling for health-related covariates. We identified a positive influence of health-protective behaviors (non-smoking, moderate drinking, regular exercise, weight management, and health screening) at baseline on language abilities in 2018 (β = .05, p < .05). In addition, health-promoting behaviors covering interpersonal relationships, social engagement, optimistic outlook, and positive attitudes at baseline were predictive of language abilities (β = .08, p < .01), executive function (β = .06, p < .01), and the visuospatial ability (β = .06, p < .05) in 2018. This study highlights the importance of midlife health-promoting lifestyles in maintaining cognitive health in later life.
Older Adults’ Engagement in Cognitively Stimulating Activities Prior to the Pandemic Predicts Loneliness
Authors: Azer Lilian , Salinas Isaac Quintanilla , Kürüm Esra , Ferguson Leah , Davis Elizabeth , Zhang Weiwei , Strickland-Hughes Carla , Wu Rachel
Published: December 2021

Loneliness, which may be more prevalent in older than younger adults, may lead to increased subjective cognitive decline and cognitive impairment may in turn predict perceived loneliness. COVID-19 physical distancing restrictions may exacerbate perceived loneliness, especially that experienced by older adults. The present study investigated whether self-reported cognitive abilities (i.e., executive functions) would predict loneliness during the COVID-19 pandemic. Younger (YA; n = 136, 18-35 years), middle-aged (MA; n = 126, 36-54 years), and older (OA; n = 171, 55-88 years) adults completed questionnaires assessing self-reported executive functions (EF) and perceived loneliness using the BRIEF-A and UCLA Loneliness scale respectively. Forty-nine of the 171 older participants partially completed a cognitive learning intervention, which has previously been found to increase EF. In the current study, age group did not significantly predict perceived loneliness. However, OA who participated in the prior intervention reported less loneliness than those who did not participate in the intervention. Additionally, OA who participated in the intervention and self-reported worse EF during the current study, also reported feeling lonelier than adults who did not participate in the intervention. Although results from our prior research found most OA who participated in the intervention improved their EF, the results from the current study suggest that it left them more susceptible to the negative effects of physical distancing restrictions if they had lower self-reported EF during the pandemic. Decreased engagement, real or perceived, in cognitively stimulating activities due to the pandemic strengthens the relationship between lower self-reported EF and perceived loneliness.
Coping With COVID-19: Challenges and Resilience
Authors: Mitchell Lauren , Mitchell Lauren , Mroczek Daniel
Published: December 2021

COVID-19 has introduced unprecedented challenges for older adults. At the same time, older adults have adapted to meet the challenges of the pandemic. In this symposium, we explore a number of difficulties brought about by COVID-19, while also investigating the ways in which individual, social, and community resources and strengths have bolstered older adults' resilience through the pandemic. Paper 1 investigates family caregivers of older adults with dementia living in long-term residential care facilities, a group that has been especially heavily affected by the pandemic. Using longitudinal data spanning Fall 2017-Spring 2021, the authors estimate caregivers' trajectories of well-being pre-and-post pandemic. With an exceptionally large qualitative data sample, Paper 2 examines the influence of COVID-19 on older adults' neighborhood engagement. Thematic analysis has revealed diverse patterns of response to the pandemic, as well as community and personal characteristics that have facilitated older adults' coping and resilience. Papers 3 and 4 examine how older adults' personality traits may influence their responses and adjustment to the pandemic, each using assessments of personality taken before the pandemic. Specifically, Paper 3 investigates the relationship between Big Five personality traits and older adults' concerns, precautions, and preparatory behaviors. Paper 4 explores how optimism predicts older adults' emotional responses, including worry, loneliness, and benefit-finding. Using a variety of methods and populations, these studies illustrate the challenges that older adults and their families have faced over the past year, as well key factors at the level of individuals, relationships, and communities that have contributed to their resilience.
Optimism Is Prospectively Associated With Resilience During the COVID-19 Pandemic
Authors: Chopik William , Oh Jeewon , Purol Mariah , Kim Eric
Published: December 2021

Emerging research has identified how protective factors—like optimism—are associated with resilience to stress during the COVID-19 pandemic. However, the majority of research is cross-sectional, which creates ambiguity around the causal direction because these very protective factors might have also changed due to the pandemic. In the current study, we used longitudinal data from the Health and Retirement Study (N = 921; Mage = 64.54, SD = 10.71; 59.6% female; 57.5% White) to examine how optimism measured in 2016 predicted adjustment during the pandemic (in 2020). Higher baseline levels of optimism were subsequently associated with less worrying and stress resulting from changes in social contacts (βs > |.10|), less loneliness and not feeling overwhelmed (βs > |.16|), and greater COVID-related resilience and benefit-finding (β = .21). The findings will be discussed in the context of mechanisms that facilitate the protective functions of optimism and other psychological characteristics.
Emerging Concepts in Dyadic Research
Authors: Lyons Karen , Rauer Amy
Published: December 2021

This session includes four papers that explore and expand upon emerging concepts in dyadic research in health, illness, and end-of-life. First, Dr. Karen Lyons and colleagues examine the concept of dyadic mental health in mid-late life couples living with lung cancer. The paper examines the impact of having optimal versus poor dyadic mental health at diagnosis on the physical health of the couple over time, but also explores the ways we examine the concept of dyadic health in research and potential implications of these methods. Second, Dr. Lyndsey Miller and colleagues take a dyadic approach to understanding the roles of social activity and connectedness on depressive symptoms in a sample of community-dwelling older couples. The paper not only highlights important gender differences, but also the salient role of incongruent dyadic physical health. Third, Dr. Ranak Trivedi and colleagues describe the findings of a novel pilot intervention targeted at improving dyadic self-management in care dyads where one member is a Veteran with chronic conditions. The paper draws upon concepts of collaboration and dyadic coping to conceptualize self-management as a dyadic phenomenon. Finally, Dr. Buck and colleagues explore the novel concept of dyadic dissolution in a sample of family caregivers after the death of their care partner. The paper explores the concept as a cognitive and affective process with implications for how the surviving partner adapts over time. Speakers and Discussant, Dr. Amy Rauer, will focus on implications of these concepts for advancing dyadic science of health and illness across the lifespan.
Engaging Isolated and Underserved Older Adults in 4Ms Care: Age-Friendly Care, PA
Authors: Berish Diane , Fulmer Terry
Published: December 2021

Older adults, the largest segment of the US rural population, face significant disparities in health and healthcare compared to their non-rural peers, including more chronic health conditions, financial challenges, and social isolation. They have limited access to healthcare and social services for prevention, management and treatment of chronic conditions. Age-Friendly Care-PA, a partnership between Primary Health Network and Penn State College of Nursing, aims to reduce these disparities in care and services for rural older adults through co-designing their Geriatric Workforce Enhancement Program. Age-Friendly Health Systems, an initiative of the John A Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, equips providers, older adults, and their care partners with the support necessary to address What Matters, Medication, Mentation, and Mobility. This symposium describes how the 4Ms are integrated into clinician training and competencies, older adult education, operations, care delivery, and quality improvement. Year two outcome data will be shared. Drs. Hupcey and Fick will provide an overview of the project and its reach. Dr. Berish will describe the process of engaging stakeholders in co-developing our 4M metrics and the data generated. Jenny Knecht, CRNP, will describe a pilot study to extend the reach and acceptability of telehealth to hard-to-reach older persons. Finally, Dr. Garrow will detail a new initiative focused on equity in care. Our discussant, Dr. Terry Fulmer will lead a discussion of this work as well as next steps and policy implications.
Age-Friendly Care, PA: A Geriatric Workforce Enhancement Program
Authors: Husser Erica , Fick Donna , Hupcey Judith , Boltz Marie , Kitko Lisa
Published: December 2021

Age-Friendly Care, PA is co-led by Primary Health Network, the largest Federally Qualified Health Center in Pennsylvania, and Penn State College of Nursing that aims to bring reliable, high-quality, age-friendly care to all older adults living in rural PA. Sponsored by HRSA through its Geriatric Workforce Enhancement Program, Age-Friendly Care, PA utilizes the ECHO, all-teach-all-learn, platform to engage isolated rural providers in incorporating the 4Ms (IHI) into their practice. Age-Friendly Care, PA reaches out directly to rural older adults and their care partners to co-design education and support. We have hosted 28+ events and reached 450+ individuals. Results include tracking and improvement in quality indicators assessed including support for individuals living with dementia and their care partners (NA-66.7%), risk for opioid misuse (NA-78%), high-risk medication management (NA-47.8%), fall-risk management (NA-9.4%), and advanced care planning (NA-8.9%). We will discuss the creation, co-development, implementation, lessons learned, and future of Age-Friendly Care, PA.
Unsung Heroes: How Senior Centers Have Adapted to Provide Essential Services in the Face of COVID-19
Authors: Somerville Ceara , Mutchler Jan , Coyle Caitlin
Published: December 2021

This presentation will describe the ways in which senior centers in Massachusetts have adapted during the COVID-19 pandemic. Three surveys (distributed in April, August, and November, 2020) were conducted with 342 senior centers in the state to learn about current operations through the pandemic, challenges faced, and steps taken to solve those challenges. Results suggest that almost all senior centers (91%) continued to provide limited programming or essential services during the pandemic. Senior centers are prioritizing socialization and nutritional needs as critical services, but are changing the way they operate to continue to meet those needs. Despite facing uncertainty about the future, senior centers continue to adapt to changing conditions as they seek to meet their core mission. This presentation will discuss effects of COVID-19 on how senior centers will continue to operate through and post-pandemic times as well as local and state policy implications.
Using Advisory Boards to Develop a Faith-Based Toolbox to Support African American Families Facing Dementia
Authors: Epps Fayron
Published: December 2021

For this project, we are designing and testing the feasibility of employing components of a Faith-based Home Activity Toolbox (Faith-HAT). The goal of this NIH stage 1 intervention development project is to go beyond the four walls of the church to find ways to meet the spiritual needs of persons living with moderate and severe dementia “where they are” to help them remain religiously and spiritually engaged. This mixed-methods project is designed in 2 phases: (a) developing a prototype Faith-HAT and (b) testing the feasibility and exploring preliminary effectiveness. To successfully conduct this project, we have included a community advisory board of church leaders, caregivers, and persons living with dementia as members of the research design team to advise on the design and implementation of the Faith-HAT. Brainstorming workshops with the board are used to ensure the research is meeting the needs of the African American families affected by dementia.
Stuck in Stage 3: The Case of an Effective Depression Intervention for African American Older Adults
Authors: Gitlin Laura
Published: December 2021

Beat the Blues (BTB) is a culturally tailored depression program for older African Americans. Tested in an NIA Stage 3 efficacy trial, findings showed statistically and clinically significant benefits, including decreased depressive symptoms, improved depression knowledge and symptom recognition, and behavioral activation. The multi-component intervention was co-constructed in partnership with a large senior center. Drawn from previously tested depression programs and tailored to preferences/needs of the targeted population, its five components included care management, depression education and symptom recognition, resources/referrals, and stress reduction and behavioral activation techniques. Despite significant findings, strong effect sizes and high acceptability, moving BTB to NIA Stage 4 (effectiveness) or 5 (dissemination) has been challenging. Challenges that will be discussed include lack of senior center funding to support training and delivery and infrastructure to embed BTB in community-based programs, and reluctance of health systems to adopt BTB because of its focus on one racial group.
Bonding in Sisterhood: A Qualitative Study of a Virtual, Health-Related Program for Women of Color Amid COVID-19
Authors: Rhodes Shanae
Published: December 2021

My Sister’s Keeper is an online education and support group created by women of color in response to disproportionate stresses related to COVID-19 experienced by women of color. The current study aims to examine the Stage 2 evidence that an online support group formed by members of the community may help mediate inequity-related stressors and increase receptiveness to health-related recommendations. To begin to develop this evidence, a thematic analysis of 8 in-depth individual interviews was performed. Resulting themes included: 1) feeling empowered; 2) solidarity in sisterhood (e.g., shared ownership of a virtual community); 3) being focused (on women of color) yet being inclusive; 4) currency of knowledge (e.g., responsibility to share knowledge with others); and 5) preferring virtual accessibility to stay connected. Preliminary data suggest that social support offered through an online platform dedicated to women of color can promote health during the pandemic and possibly beyond.
From Care Manager to Researcher: Addressing Health Disparities in Long-Term Services and Supports
Authors: Fabius Chanee
Published: December 2021

Racial and socioeconomic disparities are prevalent in long-term services and supports (LTSS). There is a need for innovative research with practical application informing aging and disability policies to reduce health care disparities for older adults and people with disabilities using LTSS. This presentation will provide an overview of the career trajectory of Dr. Chanee Fabius, whose research agenda is informed by applied care management experience, where she helped older adults remain at home and delay the need for nursing home care. She will also present findings from work that (1) examines networks of care used by older adults (e.g., paid care and/or support from family and unpaid caregivers) and how they vary by race and socioeconomic status and (2) describes the effect of LTSS utilization on quality of life and health service utilization across diverse groups of older adults.
Recruiting Older Adults With Cognitive Impairments for a Smartphone Intervention During COVID-19
Authors: Niemiec Stacey Schepens , Schneider Lon , Blanchard Jeanine , Wagas Rafael , Teodoro Liberty , Dagerman Karen
Published: December 2021

The Coronavirus disease 2019 (COVID-19) pandemic has introduced numerous challenges to the global scientific community and has been particularly disruptive to the conduct of ongoing clinical trials. Gerontological studies that focus on older adults with cognitive impairments have endured additional challenges ranging from increased vulnerability of this group to COVID-19, thereby prohibiting study participation, to difficulties in participant engagement as a product of a worsening Digital Divide. The purpose of this talk is to describe the pandemic-related factors that have influenced recruitment and enrollment of older adults with mild cognitive impairment and mild dementia in an ongoing feasibility study of a physical activity smartphone app. We discuss the changes we made to recruitment procedures and the impact those changes have had on the success of enrolling individuals in the study. We conclude with a discussion of feasible strategies and procedural alterations moving forward that may facilitate achievement of enrollment goals.
Effects of Intergenerational Relationship and Support on mHealth App Adoption Among Older Adults
Authors: Tung Yi-Hsuan , Wu Shinyi , Chi Iris
Published: December 2021

As a growing body of literature examining the effects of mHealth for older adults’ diabetes self-management, how relational factors affect seniors adopting mHealth is still unclear. Guided by the transactional approach of intergenerational relations and the technology acceptance model, this study aims at investigating the perceived ease-of-use, perceived usefulness, and intention-to-use of a mHealth app among older adults with Type-2 diabetes in relation to familial (parent-child) relationship and to e-learning support from child/ren or from external youth volunteering tutors. Using data from the Intergenerational Mobile Technology Opportunities Program (IMTOP), 304 Taiwanese participants (an average age of 64.6 years, 43% female, and 62.5% received at least a high school degree) who had at least a child were included for analysis using structural equation modeling. Results showed that perceived ease-of-use (β = .58, p < .001) and perceived usefulness (β = .27, p < .001) are significant predictors of intention-to-use. Positive associations are found only between external intergenerational, but not familial, e-learning support and perceived ease-of-use (β = .45, p < .001) and perceived usefulness (β = .42, p < .001). Parent-child relationship is positively associated with both familial (β = .73, p < .001) and external intergenerational support for e-learning (β = .36, p < .001), as well as directly (β = .12, p = .030) and indirectly related to intention-to-use. Our findings suggest the importance of intergenerational relationship and appreciation of both familial and external support to facilitate and sustain older adults’ adoption for mHealth programs.
Prevalence and Characteristics of Subjective Cognitive Decline Among Caregivers, 2015-2019
Authors: Jeffers Eva , Patel Roshni , Bouldin Erin , Knapp Kenneth , Guglielmo Dana , Taylor Christopher , McGuire Lisa
Published: December 2021

Approximately 20% of U.S. adults provide unpaid care to family members and friends with a health condition or disability, and 20% of caregivers reported being in fair or poor health themselves. Much of the assistance caregivers provide have cognitive components, such as medication or financial management, yet little is known about caregivers’ cognitive functioning. Subjective cognitive decline (SCD), or self-reported worsening of memory over the past year, among caregivers could impact the quality of care they provide. This study assessed prevalence of SCD by caregiving status and, among caregivers, the distribution of sociodemographic and other characteristics by SCD status. The study included 93,851 community-dwelling adults aged ≥45 years in 22 states who completed both the Behavioral Risk Factor Surveillance System Cognitive Decline and Caregiving modules during 2015-2019. All data were weighted; comparisons are based on modified Rao-Scott chi-square tests (α=0.05). Among caregivers (n=21,238), 12.6% (95%CI:11.7-13.5) reported SCD, compared with 10.2% (95%CI:9.7-10.7) of non-caregivers (p<0.0001). Caregivers with SCD had more chronic health conditions, lower educational attainment, and were less likely to be married or employed than caregivers without SCD, despite a similar age distribution. Caregivers with SCD were also more likely than caregivers without SCD to report fair or poor health, frequent mental distress, a history of depression, and frequent activity limitations. SCD may negatively impact caregivers’ health, function, and ability to provide care. With the anticipated increases in the need for caregiving, it is critical to understand the cognitive health of caregivers to better support caregivers and care recipients.
I Mind My Own Business and Expect Others to Do the Same: Conversations About Declining Financial Capacity
Authors: Zheng Mingyang , DeLiema Marguerite
Published: December 2021

Introduction: One of the smartest ways to prepare for declines in financial decision making capacity is to appoint an agent under power of attorney for finances and to share important financial information and preferences with trusted family or friends. Yet only 12% of older Americans with children think that they’ll need help with their finances as they age, and more than half are uncomfortable talking about their finances with children. Method: We conducted four in-depth interviews with older adults and four focus groups with Black, Latino, low income, and low-middle income adults aged 65 and older. An average of 9 participants were in each 2-hour focus group. Results: Barriers included lack of awareness, denial of future changes in capacity, lack of trustworthy surrogate decision-makers, shame about one’s financial situation, desire for privacy, fear of being a burden, and resistance to overtures by children. Barriers differed by ethnicity and socioeconomic status, with lower income older adults having less knowledge of advance planning and Powers of Attorney. Implications: Significant education is needed around Powers of Attorney and how to begin the advance planning process. Study findings informed the Thinking Ahead Roadmap, a guide to facilitate planning and communication around future money management. The Roadmap uses an empowerment framework to motivate individuals to appoint trusted financial advocates and prepare them for a smooth transition in money management, thereby reducing risk of exploitation, costly mistakes, and family conflict.
Identity Theft and Older Adults: How Minorities and the Poor Suffer the Worst Consequences
Authors: Burnes David , DeLiema Marguerite , Langton Lynn
Published: December 2021

Society’s growing reliance on technology to transfer and store private information has created more opportunities for identity thieves to access personal data. Prior work using data from the National Crime Victimization Survey (NCVS) Identity Theft Supplement (ITS) showed that baby boomers were significantly more likely than Millennials to be victims of identity theft and that older people and minorities experience more severe economic and psychological consequences. This study examines how socioeconomic status, demographic characteristics, and incident-specific factors relate to how much money is stolen during identity theft, the likelihood of experiencing out-of-pocket costs, and emotional distress among identity theft victims age 65 and older. Using combined data from the 2014 and 2016 NCVS-ITS, this study examines the correlates of financial and psychological consequences of identity theft among 2,307 victims age 65 and older. Older Black victims are more likely to have greater amounts of money stolen and are more likely feel distressed than older non-Latino white identity theft victims. The most disadvantaged older adults living at or below the federal poverty level are nearly five times as likely to suffer out-of-pocket costs. The length of time information is misused and the hours spent resolving identity theft are significantly associated with emotional distress. More than one-third of older victims experience moderate to severe emotional distress following identity theft, and those who can least afford it suffer out-of-pocket costs. Greater advocacy and psychological support are needed to help older adults recover, in addition to tools to protect their personal information from misuse.
Using Voice and Touchscreen Technology to Protect Vulnerable Clients in Residential Care Facilities
Authors: Brown Jocelyn , Davitt Joan , Luby Pam , Adams Dorinda
Published: December 2021

Due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) issued a memorandum for long term care facilities to restrict visitation by all nonessential personnel, including guardianship case managers. To enhance caseworker access to their guardianship clients, an eastern seaboard state agency distributed Amazon Echo Show devices to clients in long term care facilities. These touchscreen and voice-activated devices have both video and audio capabilities. This study reports the results of the first phase of a comprehensive evaluation, pilot testing the devices via a group of “superuser” case managers to understand the potential challenges and benefits of using these devices. Sixteen case managers participated in two virtual focus groups before and after the installation of an Echo device with one of their guardianship clients. Participants were asked to discuss experiences in accessing clients and client engagement before and after device installation. The focus groups were audio-recorded and transcribed verbatim and two researchers independently identified themes using open and axial coding. Major themes identified included: challenges to device installation and use, strategies to overcome challenges, benefits to using Echo devices, and ethical concerns. These findings suggest that touchscreen or voice-activated devices with video capability can assist case managers in protecting vulnerable clients and ensuring their well-being when in-person access is restricted. Additionally, the devices can be used to enable isolated residents to connect to the outside world, including family, friends, and case managers through technology. Strategies for replication of this innovative program will be discussed.
Addressing Needs of Older Adults in Low-Income Independent Living Facilities in Community Health
Authors: Dudley Nancy , Rauch Lisa , Adelman Toby , Canham Daryl
Published: December 2021

Access to quality care in long-term care settings including independent living facilities is needed for a diverse high-risk aging U.S. population. There is an urgent need to assess and address complex care needs of older adults living longer with chronic conditions and serious illness. However, a system to assess and identify health problems, intervene, and evaluate outcomes is lacking. This session presents learnings from a pilot study developed in collaboration with Nurse Managed Centers at low-income independent living facilities for older adults and undergraduate nursing students in community health practice. We will discuss the adaptation of the Omaha System for provision of care in independent living facilities to address complex care needs. Finally, we will discuss the impact of this project and its potential for healthcare transformation in independent living facilities and transformation of education in undergraduate nursing programs.
Hospice Care Inequities in Individuals With Alzheimer's Disease and Related Dementias
Authors: Brody Abraham , Estrada Leah , Durga Aditi , Lin Shih-Yin , Ford Ariel
Published: December 2021

Despite known benefits of hospice, inequities exist. Using data from a multi-site pragmatic trial in a representative groups of hospices, we examined inequities in length of stay (LOS) and general inpatient use (GIU) for 12,153 patients with dementia (primary and secondary diagnosis) using descriptive statistics and association tests. There were significant associations between race/ethnicity and GIU and LOS (p< 0.001). In those with primary diagnosis of dementia, Asian (31%) and Black/AA (24%) individuals had significantly greater utilization of GIU than Hispanic (19%) and white individuals (21%). Greater inequities were found in those with a secondary diagnosis. LOS amongst Asians were shortest with 78% having an LOS ≦14 vs 50-59% in other groups. Differences in long-stay >60 days (7%) vs 14-22% in other groups were found. There were similar differences examining by primary vs. secondary diagnosis. These inequities point to cultural and systems factors that require further study and intervention.
Links Between Personality and Sleep Midpoint in Older Adults in the National Social Life, Health, and Aging Project
Authors: Patel Krishna , Rojo-Wissar Darlynn , Duggan Katherine , Hisler Garrett , Hasler Brant , Spira Adam
Published: December 2021

Chronotype has been linked to poor cognitive outcomes and mortality among older adults. Although previous studies indicate an association between personality and sleep, little is known about associations between personality and chronotype in older adults. We examined the association between personality and objective sleep midpoint (a measure of chronotype) in 463 older adults aged 73.5 ±7.7 from the National Social Life, Health, and Aging Project who completed the Midlife Developmental Inventory Personality scale and three nights of wrist actigraphy, from which we derived participants’ average sleep midpoints. After adjusting for demographics, higher conscientiousness was associated with earlier sleep midpoint (B=-0.53, SE=0.02, p<0.01). Associations for other traits were not significant. Findings link conscientiousness to chronotype and raise the possibility that earlier sleep timing may partially account for associations of conscientiousness with health outcomes. Further studies are needed investigating the role of personality in links of sleep and circadian factors with health.
Sleep and Working Memory: Short-Term Links in Daily Life and Long-Term Associations
Authors: Lücke Anna , Wrzus Cornelia , Gerstorf Denis , Kunzmann Ute , Katzorreck Martin , Schilling Oliver
Published: December 2021

Sufficient sleep is relevant for both momentary cognitive functioning and long-term cognitive developments. However, which factors make people particularly vulnerable to the cognitive consequences of sleep loss remains an open question. Here, we obtained data from 122 young-old (66-69 years) and 35 very old (85-89 years) adults who provided six daily ambulatory assessments of working memory performance and daily sleep over one week, and long-term trajectories in processing speed and working memory performance. Our results add to current knowledge in three ways: First, results from multilevel structural equation models showed both too little and too much daily sleep was associated with poorer working memory in everyday life. Secondly, this association was independent of cognitive aging over the preceding four years. Thirdly, average sleep duration did not predict cognitive changes over the next year. Participants’ age and health as well as emotional functioning are discussed as further influences on the associations.
Genetic and Phenotypic Evidence for the Causal Relationship Between Aging and COVID-19
Authors: Ying Kejun , Zhai Ranran , Pyrkov Timothy , Shindyapina Anastasia , Mariotti Marco , Fedichev Peter , Shen Xia , Gladyshev Vadim
Published: December 2021

Epidemiological studies revealed that the elderly and those with comorbidities are most susceptible to COVID-19. To understand how genetics affects the risk of COVID-19, we conducted a multi-instrument Mendelian Randomization (MR) analysis and found that the genetic variation that supports a longer life is significantly associated with the lower risk of COVID-19 infection, as well as being hospitalized after infected. The odds ratio is 0.31 (P = 9.7e-6) and 0.46 (P = 3.3e-4), respectively, per additional 10 years of life. We further applied aging clock models and detected an association between biological age acceleration and future incidence and severity of COVID-19 infection for all subjects and individuals free of chronic disease. Biological age acceleration was also significantly associated with the risk of death in COVID-19 patients. A bivariate genomic scan for age-related COVID-19 infection identified a key contribution of the Notch signaling pathway and immune system. Finally, we performed MR using 389 immune cell traits as exposure and observed a significant negative correlation between their effect on lifespan and COVID-19 risk, especially for B cell-related traits. More specifically, we discovered the lower CD19 level on B cells indicates an increased risk of COVID-19 and potentially decreases the lifespan expectancy, which is further validated in clinical data from COVID-19 patients. Our analysis suggests that the factors that accelerate aging and limit lifespan cause an increased COVID-19 risk. Thus, the interventions target these factors (e.g., reduce biological age), after further validation, may have the opportunity to reduce the risk of COVID-19.
Maxwell A. Pollack Award Lecture
Authors: Harootyan Bob
Published: December 2021

The lecture will feature an address by the 2020 Pollack Award recipient, Karl Pillmer, PhD, FGSA of Cornell University. The 2021 Pollack Award recipient is Namkee G. Choi, PhD, FGSA, of the University of Texas at Austin. The Maxwell A. Pollack Award for Contributions to Healthy Aging Award recognizes instances of practice informed by research and analysis, research that has directly improved policy or practice, and distinction in bridging the worlds of research and practice.
Opioid Use Among Rural Medicare Beneficiaries
Authors: Jonk Yvonne Catharina , O'Connor Heidi , Pearson Karen , Croll Zachariah , Gale John
Published: December 2021

This study examines differences in opioid prescribing rates among a nationally representative sample of Medicare beneficiaries across rural and urban areas, as well as among beneficiaries with chronic overlapping pain conditions (COPCs). We assess whether prescribing patterns exceed the Centers for Disease Control and Prevention guidelines for dose and duration, and identify socioeconomic and health risk factors associated with opioid prescribing using logistic regression analyses. Data were from the 2010-2017 Medicare Current Beneficiary Survey files. Rural-Urban Commuting Area codes were used to identify patients’ residential location. The Area Health Resource Files were used to identify market characteristics such as primary care and mental health shortage areas. With the exception of 2010, over years 2011-2017, higher percentages of community-dwelling rural beneficiaries received opioid prescriptions (21.8-25.4%) compared to their urban counterparts (19.1-23.7%). During the same time period, facility-dwelling rural beneficiaries were more likely to receive opioid prescriptions (39.8-47.2%) compared to their urban counterparts (28.8-35.0%). Higher percentages (18.8%) of the community dwelling population in rural had COPCs compared to urban (15.2%), and a higher percentage of rural beneficiaries with COPCs (31.4%) received an opioid prescription than their urban counterparts (22.2%). Previous research points to other factors contributing to a lack of alternatives to opioids for pain management in rural areas, including greater reliance on primary care providers, lack of access to chronic pain specialists and alternative therapies, and travel barriers. Improving the capacity of rural primary care to deal with COPCs and expanding access to specialists via telehealth warrants further attention from policymakers.
Accelerometer-Derived Patterns of Physical Activity and Incident Frailty
Authors: Wanigatunga Amal , Cai Yurun , Urbanek Jacek , Roth David , Walston Jeremy , Bandeen-Roche Karen , Appel Lawrence , Schrack Jennifer
Published: December 2021

Low physical activity (PA) is a common phenotype of frailty, but whether disengagement of daily lifestyle PA signals impending frailty remains unexplored. Using STURDY (Study to Understand Fall Reduction and Vitamin D in You) data from 499 robust/prefrail adults (mean age=76 + 5 years; 42% women), we examined whether accelerometer patterns (activity counts/day, active minutes/day, and activity fragmentation) were prospectively associated with incident frailty over 2 years of follow-up; 48 (10%) participants developed frailty. In Discrete-Cox hazard models adjusted for demographics, medical conditions, and device wear days, every 30 min/day higher baseline active time, 100,000 more activity counts/day, and 1% lower activity fragmentation was associated with a 13% (p=0.003), 10% (p=0.001), and 8% (p<0.001) lower risk of frailty, respectively. Our results show that both reduced amounts and fragmented patterns of daily PA captured from accelerometry are associated with phenotypic frailty and might signal frailty onset.
Presidential Symposium: From Global to Local: An Age-Inclusive and Rights-Based Approach to Gerontological Education
Authors: Bradley Dana , Howe Judith
Published: December 2021

In June 2020, the Gerontological Society of America (GSA) joined in solidarity in the movement to condemn the entrenched racism undermining American society and build upon a gero-rich international historical base of supporting human rights. However, as gerontological educators, we need to expand on the conversation of racism to the broader global discussion of inclusivity and elimination of discrimination. A global focus on human rights of older persons, which began in 1982 at the World Assembly on Aging and has led to the current discussion of the proposed UN Convention on the Rights of Older Persons. The Academy of Gerontology in Higher Education (AGHE) is GSA's education group of colleges and universities that offers education, training, curricular innovations, and research programs in the field of aging. The work of this group is grounded in an age-inclusive and rights-based perspective, and members are committed to an international view demonstrated through AGHE’s tagline Global Leaders in Advancing Education on Aging; This symposium explores the role of age-inclusivity and a rights-based perspective in gerontology and geriatrics education and offers both challenges and best practices for moving forward. The first presentation explores the meaning of age-inclusivity in aging education in a global context and asks how do we build upon our international roots? Our second presenter shares a proposed framework for a rights-based approach to gerontology education. The third presentation explores an example of a rights-based training program. We conclude with a lively discussion focusing on how to take action through education.
A Proposed Framework for Implementing a Rights-Based Approach to Gerontological Education and Training
Authors: Bradley Dana , Allen Laura
Published: December 2021

This paper uses the nine general principles that underpin human rights (Non-discrimination, Respect, Dignity, Autonomy, Equality, Self-fulfillment and Personal development, Full and effective participation, Intergenerational solidarity, and Recognition of intrinsic value and worth as a human being) to frame a right’s based approach. This framework looks beyond the older person and the issues they are facing to the structure and culture of the society itself and the ways in which it is contributing to challenges. Using this lens, we will discuss how to develop definitions and standards of right’s- based education that are culturally and contextually appropriate, define right’s based competencies and recognize, that despite the universal rights of older persons, the implementation may need to be adjusted for unique sociocultural environments. . Lastly we will outline a strategy to identify and train multidisciplinary teaching and research teams using this proposed framework.
Bringing Rights of Older Persons to the Real World: Lessons Learned From a Rights-Based Training
Authors: Stoeckel Kimberly , Fitzgerald Kelly
Published: December 2021

When gerontological education and training are grounded in a rights-based approach, this framing provides a tool to ensure the rights of older people are advocated for and experienced. A “train the trainer” program was given to non-governmental organizations (NGOs) providing services to refugees in Jordan. The goal of the training was to educate NGOs on how to use a rights-based approach when responding to and supporting older refugees. The training covered a range of topics in ensuring the rights of older people in the provision of care, protection, and inclusion. Training outcomes revealed an increased awareness of the rights of older people. Skills and knowledge gained as a result of this training empowered participants to further develop their own work, within their cultural context, to reflect a rights-based approach to services and programs.