bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Support and Depressive Outcomes in Older Adults: An Analysis of the Health and Retirement Study
Authors: Tucker Julia , Bishop Nicholas
Published: December 2020

Given population aging and impact of both spousal and social support on the health of older adults, the protective role of social support amongst recently bereaved older adults represents an important area of research. The aim of this study is to identify the relationship between recent widowhood and change in depressive symptoms in older adults, and how social support moderates this association. Utilizing observations from the nationally representative Health and Retirement Study, the analytic sample consisted of 2,890 adults age 50 and over who were partnered or married in 2012. Depression was measured using the Center for Epidemiological Studies Depression scale short form (CESD-8). Positive social support was measured as perceived social support from family, friends, and children. Widowhood was a dichotomous measure indicating mortality of spouse between 2012 and 2014. Autoregressive multiple regression was used to determine if widowhood was associated with change in depression from 2012-2104 and whether positive social support moderated this relationship. Widowhood was associated with an increase in depressive symptoms from 2012-2014 (b=0.967, SE=0.145, p <.001) and social support was negatively associated with change in depression (b=-0.021, SE=0.004, p <.001). Social support appeared to moderate the association between widowhood and change in depression (b=0.068, SE=0.026, p =.010), though widowed older adults with higher social support appear to have more rapid increase in depression than those with lower social support. These preliminary findings and implications for supporting bereaved older adults will be discussed.
Association Between Self-Reported Health and Dementia Symptoms Among People With Dementia and Their Caregivers
Authors: Jutkowitz Eric , Mendez Mauricio Lopez , Iskandar Rowan , Pizzi Laura
Published: December 2020

People living with dementia (PwD) can often reliably self-report their health; yet, there are limited data on their and their primary caregiver’s self-reported overall health (excellent, very good, good, fair, and poor). We used data from the Aging, Demographics, and Memory Study (2001-2009) to quantify the association between PwD’s cognitive impairment (Mini-mental State Exam), physical limitations (scale [0-10] of activities of daily living), and behaviors (scale [0-12] of behavioral symptoms on the Neuropsychiatric Inventory Questionnaire) and self-reported health. We estimated two ordered logistic regressions estimating: 1) PwD’s self-reported health (analyzed n=308); 2) primary caregiver’s self-reported health (analyzed n=135; 173 PwD did not have primary caregiver in the survey). We controlled for the PwD demographics, chronic conditions, and if they lived in the community. The regression estimating caregiver’s self-reported health also controlled for the caregiver’s relationship to the PwD, and whether the caregiver lived with the PwD. PwD’s self-reported health was lower (4% excellent; 16% very good; 22% good; 30% fair; 30% poor) than caregivers (14% excellent; 27% very good; 32% good; 23% fair; 4% poor). For PwD, one-additional physical limitation, but not cognition or behavior, was associated with 1.15 (95%CI: 1.01,1.30) times greater odds of self-reporting poor health compared to all other categories. For caregivers, one-additional behavior, but not cognition or physical limitations, was associated with 1.17 (95%CI: 1.01,1.37) times greater odds of self-reporting poor health. For PwD, interventions targeting physical limitations may increase self-reported health, but for caregivers, interventions targeting behavioral symptoms may increase self-reported health.
Exploring the Stress and Strengths Arising From the Complexities Existing Within Grandfamilies
Authors: Tompkins Catherine , Zic Alice , Carlson Ellie , Purvis Ali , Yancura Loriena , Nadorff Danielle
Published: December 2020

The opioid crisis and other social problems continue to increase the number of grandparent-headed households in the U.S. There are challenges and benefits that result from grandparents parenting their grandchildren. Grandparents often report the joy in watching their grandchildren grow but also report on the complexities that may lead to stress. Two-hundred forty-one grandparents were recruited using Qualtrics’ Online Panel Service. In addition to a standardized perceived stress scale and demographic questions, participants responded to open-ended questions related to the benefits and challenges of residing within a grandparent-headed household. This presentation focuses on comparing demographics, perceived stress, benefits and challenges of 108 current grandparent caregivers to 133 grandparents who were no longer the head of household at the time of the survey. Grandparents who currently were raising their grandchildren had a higher perceived stress score (p=.03) compared to grandparents who had raised their grandchildren in the past. An exploration of the demographic variances and responses to the open-ended questions, will begin to explain this statistically significant difference in reported stress. An additional complexity arising for a subsample of 10 current grandparents raising grandchildren, included simultaneously caregiving for an older adult relative. It is imperative to study the complexities existing within grandfamilies, from the perspectives and experiences of the grandparent caregiver, and develop interventions to reduce stress and increase the grandparents’ ability to cope with situational, emotional and relationship changes.
Family Caregiver Assessment in Primary Care: A Nationwide Survey
Authors: Riffin Catherine , Wolff Jennifer , Maisano Julianna , Lee Sylvia , Pillemer Karl
Published: December 2020

Family caregivers play an important role in the healthcare of older adults, but their circumstances, needs, and risks are often unknown to medical professionals. Standardizing how caregivers’ needs are assessed in healthcare delivery can help clinicians design care plans that take caregivers’ capabilities into account and provide targeted recommendations for caregiver support. Despite the potential of caregiver assessment, little is known about its use in primary care practice. The present study surveyed a national random sample of 1,000 U.S. primary care clinicians (physicians, nurses, social workers) to characterize current practices, barriers, and facilitators of caregiver assessment. A total of 231 completed responses were received. A minority of respondents (11%) reported that their practice or clinic had a standardized procedure for caregiver assessment; one in ten (10%) reported that they had personally conducted a caregiver assessment using a standardized instrument in the past year. The most common barriers to caregiver assessment were lack of time (65%), inability to have private discussions with caregivers (36%), lack of access to referral options (30%), inadequate reimbursement (30%), and reluctance of caregivers to discuss their needs (30%). The most frequently endorsed facilitators to aid future implementation included better availability of referral options (77%), easier referral mechanisms (67%), co-location of mental health specialists, care managers, or social workers (65%), and training in how to address caregiver issues (61%). Findings are discussed within the context of emerging healthcare policies and practice initiatives designed to promote caregiver assessment in health care settings.
Long-Term Care Market Trend and Patterns of Caregiving in the United States
Authors: Basu Rashmita
Published: December 2020

Objectives: The current study aims to: 1) identify patterns of the use of long-term care services and supports (LTSS) among community-dwelling individuals; 2) examine if the changes in supply of formal care predict the use of informal care (IC). Methods: Linking the market supply of formal LTSS to individual level Health and Retirement Survey data from (N=7,781), descriptive and regression analysis were performed. Results: Supply of formal home and residential LTSS indicates a stronger upward trend. More than 90% of people used IC and 40% received both informal and formal help. People aged under 60 years, IC from spouse dominates but then falls sharply and an adult child becomes the primary source. More than 20% reported unmet needs. Regression analysis indicates that the formal home care supply significantly predicts the likelihood of using IC. But the rate and intensity of unpaid IC use among individuals aged 85 or older is low and that of paid formal care use are highest. We find that about 20% of care recipients experienced at least one unmet need with ADL assistance in our sample. The prevalence of an unmet need sharply decreases as individuals receive care from multiple caregivers (including paid professionals) but receiving care from too many caregivers contributes to higher unmet ADL needs. Discussion: The findings suggest opportunities to create a holistic system of care for people needing LTSS.
SAVE-CLC: An Intervention to Reduce Suicide Risk in Veterans Who Discharge From VA Nursing Homes
Authors: Simons Kelsey , Luci Katherine , Hagemann Lauren , Jacobs Lindsey , Bower Emily , Eichorst Morgan , Hilgeman Michelle
Published: December 2020

Prior research has established transitions into and out of nursing homes as periods of suicide risk for older adults. Deaths by suicide were found to be 2.4 times as likely among Veterans within six months of discharge from US Veterans Health Administration (VA) nursing homes when compared with gender and age-matched Veterans from the general VA patient population (McCarthy, Szymanski, Karlin, & Katz, 2013). Despite these trends, suicide prevention interventions implemented during nursing home and post-acute care transitions, including those taking place from Centers for Medicare and Medicaid Services regulated nursing homes, are lacking. Suicide Awareness for Veterans Exiting the Community Living Center (SAVE-CLC) was piloted as a quality improvement intervention to reduce suicide risk for older Veterans discharging from VA nursing homes. VA clinicians from three sites provided a friendly contact by phone after discharge (n = 66) to screen for depression, facilitate a strengths-based discussion about service needs, and provide service referrals. Compared to a group of patients discharged prior to the start of the intervention (matched on location, age range, and Care Assessment Need scores), SAVE-CLC patients received more depression screening within 30 days after discharge (chi square = 38.7, p < .001) and were seen more quickly for mental health care (t = 3.1, p = .005) when indicated. Implications for suicide prevention with older Veterans and for the general population of older adults receiving short stay services in US nursing homes will be addressed.
An Innovative Mental Health Model for Treating Culturally Diverse Older Adults
Authors: Abramson Tobi , Berman Jacquelin , Gates Madison
Published: December 2020

The mental health needs of older adults are largely unmet, a finding even more prevalent within culturally diverse older adult populations. Added to this is the high rate of social isolation. Research has indicated increased connection to mental health services when services are embedded within physical health care settings. For those attending community centers, 85% indicate that they are socially isolated, 68% indicate they are lonely, and 53% have a mental health need (compared to 20% nationally). The need for innovative programming is evident. When examining the needs of diverse older adults, it is increasingly important that new and innovative approaches address social isolation, loneliness, and mental health problems experienced by this cohort. Utilizing this knowledge an innovative model of embedding and integrating mental health services, provided by bilingual and bicultural clinicians, into congregate sites (older adult centers) was implemented. Those that participated were mainly female (72.1%), 68.5% English-speaking, 14.5% Spanish-speaking, 13.6% Chinese-speaking and 3.4% other. Spanish-speakers had more depression than English-speakers and both had more depression than Chinese-speakers. English and Spanish-speakers reported more social isolation and Chinese-speakers compared were more likely to participate in engagement. Chinese-speakers were less likely to be in clinical services with a positive screen compared to English-speakers. Overall, 75% engaged in treatment; 37.3% and 41% showed a 3-month improvement of depression and anxiety, respectively. This presentation focuses on the innovative components of this model, how to engage diverse older adults to utilize treatment, steps needed for replication, and policy implications around integrated mental health treatment.
Social Isolation and Hospitalization Risk Factors Among Community-Dwelling Older Adults
Authors: Pomeroy J Mary Louise , Gimm Gilbert
Published: December 2020

PURPOSE: This study examines psychosocial risk factors associated with hospitalization among community-dwelling older adults in the United States. METHODS: Using two waves of the National Health and Aging Trends Study from 2011 and 2015, we conducted descriptive and multivariate analyses of individual-level data from a nationally representative sample of 8,003 Medicare beneficiaries ages 65 and older. Associations between hospitalization and risk factors including social isolation, depression, and anxiety were assessed. Covariates included gender, race/ethnicity, age, region, insurance type, falls, and comorbidities. RESULTS: Overall, about 20.9% of older adults reported a hospitalization within the past year and 22.2% were socially isolated. The odds of hospitalization were higher for socially isolated adults (OR 1.17; p = .02), for depressed adults (OR 1.25; p = .01), and for individuals with anxiety (OR 1.25; p = .02). Individuals living in the Western region had lower odds of hospitalization (OR 0.71; p = .001), whereas men (OR 1.13; p = .03), those requiring assistance with activities of daily living (OR 1.48; p < .001), and those having one (OR 1.41; p = .03) or more (OR 3.05; p < .001) chronic health conditions had higher odds of hospitalization. CONCLUSION: Social isolation, depression, and anxiety represent significant psychosocial risk factors for hospitalization among community-dwelling older adults in the United States. Efforts to reduce health care costs and improve health outcomes for older adults should explore ways to strengthen social integration and improve mental health.
The Role of Geographical Differences and Discrimination in the Cognitive Health of Older Blacks
Authors: Johnson Kimson , Sol Ketlyne , Sprague Briana , Cadet Tamara , Munoz Elizabeth , Webster Noah
Published: December 2020

Where you live in old age matters in the United States in terms of access to health care and potential exposure to discrimination. This is especially important for non-Hispanic Blacks. Everyday experiences of discrimination are known to “get under the skin” but to date few studies have examined if associations between discrimination and cognitive health differ by region and urbanicity. This study aims to fill this gap. Data are from the 2012 and 2014 waves of the Health and Retirement Study (HRS) (N =2,347). Non-Hispanic Blacks over age 51 with complete data on the Everyday Discrimination Scale in either 2012 or 2014 and cognition, residential location were included in the analysis. Regression models included covariates for age, gender, education and examined interactive effects of everyday discrimination, region, and urbanicity on episodic memory in a nationally representative sample of non-Hispanic older Black adults in the U.S. Descriptive analyses revealed that the majority lived in Southern regions and in non-urban areas. Respondents also reported experiencing discrimination a few times a year. Regression analyses indicated that experiencing more everyday discrimination was significantly associated with lower episodic memory when living in urban areas. Among Blacks, the discrimination-episodic memory link did not significantly vary across U.S. regional contexts. Findings highlight the importance of socio-environmental factors in shaping how stressful experiences such as everyday discrimination are linked to cognitive health in later life. Future research should focus on the development of focused upstream interventions that are responsive to racial disparities in cognitive health in urban areas.
Adapting to Health Change: Aging Bias, Sensitivity, and Interprofessionalism in an Aging Sensitivity Training
Authors: Kleszynski Keith , Jennings Lee , Teasdale Thomas , Ciro Carrie , Rogers Carol , Peterson Tina , Swanson Keith , Kay Beavers
Published: December 2020

Adapting to Health Change, a 2-hour aging sensitivity simulation to increase student sensitivity to age-related changes, was delivered to 148 health professions students in March 2020. Five small group stations (hearing loss, neuropathy and dexterity, vision loss and medication management, language and cognitive impairment, and mobility and balance) were facilitated by older adult volunteers and interdisciplinary faculty. Students completed (pre-post) Aging IQ Quiz, Aging Attitudes Assessment, Inter-professional Attitudes Scale (IPAS) Teamwork, Roles, and Responsibilities and Interprofessional Biases subscales, and an overall satisfaction rating. There was a statistically significant but small change in perceived knowledge of aging (mean Aging IQ score changed -0.025 points, p = 0.03). We also found a post-training increase in negative bias (mean Aging Attitudes Assessment score changed +2.68 points, p = 0.0001). While there was no change in attitudes about interprofessional education, this wasattributed to high baseline scores, suggesting students already valued interprofessional interactions. Multiple high satisfaction scores were encouraging. Ninety-four percent agreed that the simulation increased their understanding of age-related changes, while 97% indicated facilitators provided useful insights into the experiences of aging. A high majority (89%) felt they would be better health care providers for older patients than they would have been without the experience. This exercise to increase student empathy about age-related disabilities was well received, but did not achieve the usual intended aims. Simulation content should “re-aim” beyond empathy to teach new knowledge, highlight positive aspects of aging and professional care provision, and reinforce interprofessional roles toward wellness for older adults.
The Age-Dependent Relationship Between Vascular Risk Factors and Trajectories of Depressed Mood
Authors: Blöchl Maria , Schaare Lina , Kunzmann Ute , Nestler Steffen
Published: December 2020

Cardiovascular risk factors (CVRFs) have been linked to depression, but it is still unclear whether this association becomes stronger or weaker from mid- to later life. Thus, our main aim was to investigate the influence of age on the associations between CRVFs and trajectories of depressed mood. Our sample included 6835 individuals (aged 52–89 years) from the English Longitudinal Study of Ageing (ELSA), who were free of manifest vascular disease at baseline and had bi-yearly measurements of depressed mood over ten years. A composite score incorporated the presence of five CVRFs: hypertension, diabetes, smoking, obesity, and hypercholesterolemia. We used second-order latent growth models to examine the effect of CVRFs, age, and their interaction on levels and changes in depressed mood over time. Our results revealed that baseline CVRFs were associated with higher levels of depressed mood. This association decreased with age and was stronger in midlife compared to later life. CVRFs were not related to changes in depressed mood, indicating that these differences remained stable over time. These findings suggest that CVRFs in midlife, but less so in older age, predict stable differences in depressed mood. They are consistent with reports on the importance of CVRFs in midlife and may support the idea that prevention of vascular burden in this age period may be critical to maintain mental health.
The Use of Tag Questions in Person-centered Communication
Authors: Basque Shalane , Savundranayagam Marie , Kimura Maren , Williams Kristine
Published: December 2020

Tag questions are imperative, declarative, exclamative or interrogative statements that have been modified to include a question (e.g.., It is hot out, isn’t it?). Tag questions have been characterized as elderspeak because it suggests an expected response from the person with dementia, thus limiting his/her ability to make a decision independently. However, tag questions serve multiple functions in conversation. There is limited research on the multidimensional nature of tag questions in conversations between formal caregivers and their clients with dementia. Accordingly, the purpose of this study was to investigate the functions of tag questions used by formal caregivers in utterances coded as person-centered. Conversations (N= 87) between formal caregivers and a simulated person with dementia were video-recorded during a 5-minute care interaction involving morning care. Caregivers’ utterances were coded for the use of the following types of person-centered communication: recognition, negotiation, facilitation, and validation. During secondary data analysis, the person-centered utterances were analyzed for the use and function of tag questions. Conversational analyses revealed two broad functions of tag questions: gather information and facilitate a desired action. Tag questions used to gather information included the following specific functions: acknowledge response, establish common ground, state fact or opinion, initiate topic, conversational joking, state what is being done and questions. Tag questions that facilitated a desired reaction included the following specific functions: offers, advice and suggestions and requests and commands. Findings from the current study reveal that tag questions are not exclusively elderspeak and can be used to illicit conversation.
Inpatient Diagnosis of Delirium and Encephalopathy: Coding Trends in 2011-2018
Authors: Franks Jeffrey , Anderson Jami , Kennedy Richard , Yun Huifeng
Published: December 2020

Physicians have long debated the diagnosis of acute confusional states as delirium or encephalopathy, often based on specialty. Recently, CMS assigned a lower severity to the nonspecific behavioral diagnosis of delirium than for the pathophysiological diagnosis of encephalopathy, potentially exacerbating these disagreements. Therefore, we sought to evaluate trends in these two diagnoses among hospitalized adults. Using 2011-2018 IBM MarketScan datasets, we identified delirium/encephalopathy patients who were ≥ 18 years and enrolled with medical and pharmacy coverage for each calendar year. Delirium/encephalopathy were defined using validated ICD-9/10 codes among hospitalized patients. We identified the physician specialties associated with the hospitalization and comorbidities using ICD9/10 inpatient/outpatient diagnosis codes within one year prior to the diagnosis of delirium or encephalopathy. Log-binomial models were used to evaluate the trends adjusting for age, gender, insurance and comorbidities. We identified 10,418 delirium and 87,393 encephalopathy hospitalized patients in 2011-2018. Of these patients, the total number of patients with either diagnosis increased, but the proportion of patients with delirium for each year decreased from 20% in 2011 to 9% in 2018. During the 8 years, neurologists and internists increased their use of both diagnoses, whereas psychiatrists only increased for delirium. Patients with encephalopathy are more likely to be older, female, and have more comorbidities. These shifts in diagnosis complicate the study of delirium and encephalopathy, and can lead to erroneous conclusions about trends in the incidence and prevalence of these disorders unless properly understood.
Local Initiatives to Fund Services for Elders: Increased Community Recognition of the Importance of Social Care
Authors: Koumoutzis Athena , Stemen Sara , Maharjan Renusha , Heston-Mullins Jennifer , Mayberry Pamela , Applebaum Robert
Published: December 2020

Despite the growing number of older adults in the U.S., federal and state funding for non-medical supportive services remains limited. Recent work reports that states with a more generous supply of supportive services, including home delivered meals and personal care, have fewer low care residents in nursing homes. To boost this supply, some local communities across the nation are exploring alternative funding sources. Our review found 400 local communities across 15 states using voter-approved local revenue streams to fund aging services, such as property tax levies and payroll and sales taxes, and that this strategy has been politically popular. In this paper we provide results from the first national survey of these local communities. Study results found considerable variation by state in number and scope of local initiatives, with Ohio and Michigan each reporting about 70 communities with local property tax levies, while California and Washington had only one community each using this approach. Local programs ranged in size from generating less than $25,000 in annual revenue to more than $35 million. The organizational structure for these programs, and the administrative approaches, such as the use of care managers, varied by state and community. Programs provided an array of services, but typically included traditional social care services such as home delivered meals, homemaker/personal care, transportation, and home emergency response systems. Criteria for program participation also varied, but most were targeted to serve older adults with disability who did not meet Medicaid financial or functional eligibility criteria.
Social Assistive Robots for Assisting Activity Professionals
Authors: Zamer Jason , Adams Anne , Beer Jenay , Wu Xian , Komsky Jane
Published: December 2020

Activity Professionals have high expectations for creating engaging and active resident social programming. A socially assistive robot (SAR) specifically designed for community-based settings has the potential to improve social programming. A SAR is suitable for engagement during times with social contact is restricted, such as COVID-19, other infectious outbreaks, weak immune system, or inability to move. We conducted an online survey to determine how a SAR can best support the responsibilities of Activity Professionals. Activity Professionals (N=19) completed the online questionnaire. Respondents (aged M=48.00, SD=12.87; 95% female, 100% native English speakers, 68% White/Caucasian, 21% Black/African American) were highly educated/experienced: 68% had a Bachelor’s degree or above, and 53% had 10-35 years of experience. Respondents worked in Independent Living (68%), Assisted Living (37%), Memory Care (26%), Skilled Nursing (21%), or Personal Care (11%). Respondents rated their job as very demanding (8 out of 10). Differences existed in terms of physical and temporal demands. Job satisfaction was high (average 8 out of 10; SD= 2). Respondents reported enjoyment in preparing, personalizing, and running activities. Least preferred was gathering residents for activities. Respondents wanted more help, but it depended on the task. Qualitative data analysis showed that help was desired for motivating residents to join activities, group communication, and resident devices. A SAR, equipped with the ability to reach every resident’s living quarter, has the potential to provide group communication, deliver engagement programs, and motivate residents to join events, providing Activity Professionals more time to engage with residents for more personal interaction.
A Novel Survey Platform in the Age of COVID-19 to Increase Accuracy and Adoptability While Reducing Selection Bias
Authors: Mendhe Dinesh , Bergren Stephanie , Dong XinQi
Published: December 2020

Given the ongoing COVID-19 pandemic, secure and distanced data collection platforms are critical for reaching vulnerable populations. Commonly used electronic data collection systems lack a myriad of critical features, including a modern technology stack, new data encryption and security standards, study workflows, and reporting algorithms. Moreover, these systems do not have multilingual mapping functionalities of survey and consent forms. All of these components ultimately increase selection bias while simultaneously reducing the security and quality of the response data. In order to directly address the aforementioned issues, we have developed a multilingual and highly secure data management platform. Our application is built using stable, tested, and modular programming frameworks and design patterns targeted at accommodating intricately complex structures of polyglot mapping, large volume of data, encryption and granular user authorization. The statistical accuracy along with the multilingual mapping are the core highlights of this system. The multilingual function of this platform has the ability to eliminate selection biases while creating a well-balanced cross-section of society. Modern survey design workflows and validation checks ultimately prevent data loss and help reduce data collection errors. The platform design was initiated in April 1, 2020 and has been pilot tested for use in multilingual populations. The currently active application version of the system is capable of supporting in-person and telephone interviews, emailing survey links to every registered participant, building family tree architecture, and online consent management. This platform also has built-in report functionality. Additional features are being explored to improve study coordination and monitoring.
A Survey of Older Adults’ Perspectives of In-Person and Virtual Parkinson’s-Specific Exercise Classes
Authors: Bennett Holly , Vincenzo Jennifer , Oholendt Chris
Published: December 2020

Due to COVD-19, many health/wellness programs transitioned from in-person to virtual. This mixed methods study aims to explore older adults with Parkinson’s disease (PD) perceptions of in-person versus virtual Parkinson’s-specific exercise classes. Attitudes, perceptions, and experiences were determined through focus groups (n=9; Male=4; aged 75 years) among older adults with PD and an online survey (n=23; Male=14; aged 74 years). Eighteen respondents attended both in-person and virtually (n=18; Male=9). Four respondents only attended in-person, citing reasons such as difficulty with computer access to virtual classes, limited internet, easier accessibility to in-person classes, and physical injury preventing attendance to any classes. Respondents who participated in both delivery methods preferred virtual classes. Time, convenience, comfort at home, and not having to navigate transportation barriers supported participants’ preference for virtual classes. The majority of respondents indicated their fatigue and mental health were either unchanged or improved. Eighty-nine percent reported improved mobility since attending either class; specifically, in balance (n=8), flexibility (n=7), and coordination (n=3). Older adults with PD who attended both classes had minimal difficulty with computer usage and accessing the virtual program with only one participant reporting difficulty transitioning from in-person to virtual classes. Seventy percent stated they would enjoy a combination of on-site and virtual programming. Eighty-nine percent and seventy-seven perfect felt the virtual-based program was safe and beneficial, respectively. Participants who transitioned from an in-person to a virtual exercise program for people with Parkinson’s disease felt the program was safe, effective, and improved or prevented declines in their mobility.
COVID-19, Social Isolation, and Loneliness in Older Adults: Leveraging Exercise to Age in Place Study
Authors: Reddy Meghan , Shirazipour Celina , Mays Allison
Published: December 2020

Social isolation and loneliness are associated with morbidity and mortality and highly prevalent in older adults. Older adults, a high-risk group for developing serious complications from COVID-19, are asked to shelter-in-place limiting physical interactions. We aimed to determine the effect of the COVID-19 pandemic on social isolation and loneliness among community-dwelling older adults previously enrolled in in-person exercise classes in the Leveraging Exercise to Age in Place (LEAP) study before March 19th, 2020 when California started shelter-in-place. We conducted a pre-post analysis of cognitively intact participants (n=59) >50 years, who had social connectedness, loneliness, and demographic data collected pre- and post-COVID shelter-in-place. Participants’ social connectedness was measured via the 11-question Duke Social Support Index (DSSI) and loneliness via the 3-question UCLA Loneliness Scale (UCLA 3). Participants had an average (±SD) baseline DSSI of 27.2 (± 3.5) and UCLA 3 of 4.8 (± 1.7) and were an average of 76.6 ± 9.2 years, 81% female, 63% white, 29% widowed, 42% living alone, 27% acting as caregivers, and 44% were diagnosed with 3 or more chronic health conditions. We completed post-assessments on average 61 ± 29 days after the start of shelter-in-place. Results of the paired t-tests indicated no statistically significant difference in social connectedness and loneliness pre- and post-shelter-in-place. Reasons for lack of observed change include: limitations of a small sample size, possible protective factors from enrollment in the LEAP program, or insufficient time at post-assessment to develop changes in loneliness and social isolation. Repeated assessments are needed throughout the pandemic.
Evaluation of the VA Medical Foster Home Program: Factors Important for Expansion and Sustainability During COVID19
Authors: Solorzano Nelly , Manheim Chelsea , Haverhals Leah , Levy Cari
Published: December 2020

In 2020, the Center of Innovation for Veteran Centered and Value Driven Care (COIN) continued its monitoring and evaluation of the Veterans Administration (VA) Medical Foster Home (MFH) programs expansion into rural areas. Veterans in MFHs are provided 24/7 care by VA trained and supervised community caregivers and primary care by VA Home Based Primary Care (HBPC) teams. One year after the three-year (2017-2019) expansion funds stopped, COIN continued monitoring remaining programs. Objectives were to understand factors critical for program expansion and sustainability and the impact of COVID-19. Phone interviews were conducted with sixteen coordinators from seventeen programs. A thematic analysis approach was used to address the evaluation objectives using transcript data. Findings showed factors important to program sustainability were: 1) Program fit (finding caregivers in the community); and 2) Local VA facility support (staffing, adaptation, and local leadership support). COVID prompted losing some caregivers and prevented others from joining. Program staffing was not impacted as many program activities ceased. Recreational therapists (RTs) were significant to maintaining Veterans well-being and reducing social isolation through virtual activities. COVID required coordinators transition their supervision of MFHs to new virtual environments and HBPC to increase telehealth to new levels. Local leadership became important to monitoring local conditions and providing support to programs. The evaluation: 1) Found factors important to program sustainability were also critical to keeping programs operational during the pandemic; and 2) Stimulated future research on the suitability of MFH programs to meet challenges to resurgences of COVID or other national emergencies.
Exploration of COVID-19-Based Changes to Caregiver Burden and Caregiving Intensity among Informal Caregivers
Authors: Cohen Steven , Kunicki Zachary , Drohan Megan , Greaney Mary
Published: December 2020

Individuals providing unpaid care of assistance to family members and friends (e.g. informal caregivers), may have been uniquely impacted by the COVID-19 pandemic. Research is needed to examine the pandemic’s effect on informal caregivers’ caregiving intensity and burden. Therefore, this cross-sectional study was conducted to explore self-reported changes in caregiver intensity (CI) and caregiver burden (CB) due to the pandemic to identify factors associated with changes in responsibilities and burdens. In June 2020, informal caregivers providing care to someone aged 50+ (n=835) reported their current and pre-pandemic caregiving intensity and burden. Data were collected via Amazon’s Mechanical Turk. Chi-square tests were used to examine bivariate associations between pandemic time (pre vs. post) differences in CI and CB. Multinomial regression was used to assess multivariate predictors of changes to CI and CB due to COVID-19. Results showed a significant U-shaped association between initial CB and CB change due to COVID-19. Higher levels of initial CB were associated with both a significant decrease in CB during COVID-19 (OR 1.33, 95%CI 1.06-1.67), and a significant increase in CB during COVID-19 (OR 1.22, 95%CI 1.05-1.43). There were no significant associations between initial CB and changes in CI due to COVID-19, although older caregivers were more likely to experience a decrease in CB due to caregiving (OR 1.02, 95%CI 1.00-1.05). These mixed results suggest that caregivers with high initial CB experienced the most extreme changes to CB due to COVID-19. Future planned analyses will focus on understanding the potential drivers behind these unexpected results.
Using Implementation Science to Support a Research and Public Policy Sector Older Adult Social Housing Partnership
Authors: Hitzig Sander , Sheppard Christine , Austen Andrea
Published: December 2020

One quarter of the residents in the City of Toronto is comprised of older adults, and this number is expected to continue to grow dramatically over the next few decades. The development of evidence-based interventions to meet the health and social care needs of Toronto’s aging population can be hampered by failing to account for broader implementation considerations that can adversely affect successful uptake. The present initiative provides a case-example of a research and public policy sector partnership that used an implementation approach to co-design an older adult social housing model for low-income older adult groups. Implementation science is the study of the uptake of research evidence into practice. Our team used the Consolidated Framework for Implementation Research (CFIR) to support the planning, implementation and evaluation process of a new social housing model for older adults by: 1) identifying all relevant stakeholders; 2) generating evidence via qualitative interviews/focus groups, a scoping review, secondary data analysis, and an environmental scan; 3) facilitating large scale stakeholder consultation events with older adults, front-line practitioners and other community agencies; 4) supporting the development of an evaluation framework; and 5) providing opportunities for knowledge exchange and transfer across each phase of the initiative. An implementation science approach has augmented the ability of the City of Toronto to optimize the co-creation of housing strategies aimed at improving the overall wellness of vulnerable older adults living in social housing. Further, a number of valuable lessons were learned on how to foster successful research and public policy relationships.
Factors Associated With Positive Aging and Happiness of the Older People in Hong Kong
Authors: Lai Daniel W L , Lee Vincent , Yan Elsie
Published: December 2020

Happiness is essential to one’s well-being and impact on every aspect of our lives. Happier people are living longer, they are healthier. Happier people are more likely to be physically active and enjoy better sleep habits and practices. While few existing research studies had examined the determinants of happiness of older people, especially in Chinese society. Understanding happiness in the context of social unrest and political instability is thus limited. This study tested the correlates of happiness at interpersonal, psychological and environmental levels at a time when there were extended scale of violence, destructions, and clashes in the community between police and protesters in late 2019 during the anti-extradition campaign. In social unrest, older people, due to their function and mobility, could be emotionally and physically vulnerable. A total of 1,209 older persons aged 55 and above from Hong Kong answered the questionnaire by stratified random sampling. Our findings show that their overall resilience was strongly and positively associated with levels of happiness. Due to the recent political instability Hong Kong, their satisfaction toward social and political situation of Hong Kong also correlated positively to levels of happiness. We suggest that future interventions and policy initiatives should put extra emotional and tangible support to older adults, particularly during social unrests and unstable political conditions, in addition to strategies for the enhancement of resilience and mental capital.
Alzheimer’s Disease-Associated Pathology in a Transgenic Mouse Model Results in Altered Voiding Function
Authors: Hardy Cara , Rosenberg Dawn , Ramasamy Ramalakshmi , Hu Xiangyou , Smith Phillip
Published: December 2020

Alzheimer’s disease (AD) is a devastating disorder primarily affecting older adults and is the most common neurodegenerative disease in the US. More than one in three AD patients experience AD-associated urinary dysfunction (ADUD), which directly contributes to their institutionalization. While ADUD has been clinically regarded as a result of poor cognitive control over urinary function, the physiology underlying loss of urinary control remains unknown. We hypothesize that beta-amyloidosis in the CNS results in pathologic changes in urinary structure and function. Male and female Tg-APP/PS1DE9 mice were used before plaque deposition (4-6 months) and after plaque accumulation (8-10 months) and compared to their WT littermates. Pressure-flow cystometry was conducted under urethane anesthesia to assess urinary performance at the level of the autonomic nervous system in the absence of cortical control. Pharmacomyography was performed on bladder strips to determine tissue-level changes in the absence of CNS input. In Tg-APP/PS1DE9 mice, plaque accumulation resulted in diminished volume sensitivity and decreased voiding efficiency. Pharmacologic studies showed aberrant drug responses, altered cholinergic signaling, and decreased resilience of tissue longevity after plaque accumulation. Based on our findings, we conclude that the AD-related pathology of Aβ accumulation results in a distinct urinary phenotype in our model, analogous to the ADUD observed in AD patients. Establishing and expanding models of ADUD to other mouse models of AD-associated pathology may improve the efficacy of treating ADUD and increase quality of life for patients and their caregivers.
Greater Skeletal Muscle Oxidative Capacity Is Associated With Higher Resting Metabolic Rate: Results From the BLSA
Authors: Zampino Marta , Semba Richard , Adelnia Fatemeh , Schrack Jennifer , Spencer Richard , Fishbein Kenneth , Simonsick Eleanor , Ferrucci Luigi
Published: December 2020

Resting metabolic rate (RMR) tends to decline with aging. The age-trajectory of decline in RMR is similar to changes that occur in muscle mass, muscle strength and fitness. However, while the decline in these phenotypes have been related to changes of mitochondrial function and oxidative capacity, whether lower RMR is associated with poorer mitochondrial oxidative capacity is unknown. In 619 participants of the Baltimore Longitudinal Study of Aging, we analyzed the cross-sectional association between RMR (kcal/day), assessed by indirect calorimetry, and skeletal muscle maximal oxidative phosphorylation capacity, assessed as post-exercise phosphocreatine recovery time constant (tau-PCr), by phosphorous magnetic resonance spectroscopy. Linear regression models were used to evaluate the relationship between tau-PCr and RMR, adjusting for potential confounders. We found that independent of age, sex, lean body mass, muscle density and fat mass, higher RMR was significantly associated with shorter tau-PCr, indicating greater mitochondrial oxidative capacity. In conclusion, higher RMR appears to be associated with a higher mitochondrial oxidative capacity in skeletal muscle. This association may reflect a relationship between better muscle quality and greater mitochondrial health.
Hospitalization and Successful Aging of Community-Dwelling Older Adults: Using the Korean National Survey Data
Authors: Lee Ji Yeon , Kim Bora , Lee Kyung Hee , Park Changgi
Published: December 2020

Hospitalization experience can be an obstructive factor to successful aging. Although older adults who had hospitalization experience has been considered to have poor health status and low participation in one’s life, it is not obviously evident whether hospitalization itself affects successful aging. This study aimed to investigate whether three components of successful aging (i.e., diseases and disease-related complications, physical and mental functions, and engagement with life) were different in community-dwelling older adults who had hospitalization experience for the past one year compared to the counterpart older adults without hospitalization experience. A secondary data analysis was performed using a nationally representative survey data in Korea. A total of 1,812 who had hospitalization experience were matched to 1,812 control counterpart using propensity score matching. Sampling weight of the survey was considered for all statistical analysis. The community-dwelling older adults with hospitalization experience were less likely to be aging successfully than the older adults without hospitalization experience. The older adults with hospitalization experience had more chronic illnesses and malnourishment; they had more impairment in physical function and depressive symptoms; they were less active in working, social activities, and traveling. However, there were no differences in cognitive function and religious activities between the groups. In conclusion, the community-dwelling older adults who had hospitalization experience have poor health status and less engagement in one’s life in general after matching covariates using propensity score matching analysis. Therefore, more attention and assist are needed to the community-dwelling older adults with hospitalization experience to facilitate successful aging.