bluuebunny/crossref_metadata_2025 huggingface dataset:
Dual Caregivers of Relatives with Dementia in Rural Virginia: The Added Stress of COVID-19
Authors: Hoyt Emily , Savla Jyoti , Roberto Karen , Knight Aubrey L , Blieszner Rosemary , McCann Brandy R
Published: December 2020

Family caregivers often find themselves “sandwiched” between caring for an older relative with dementia (PWD) and another person. Serving in a dual caregiving role presents unique challenges and has consequences for caregivers’ physical and mental health. Seven daily diary interviews with 46 dual dementia caregivers assessed their daily stressors and informal and formal supports. Results showed that dementia caregivers who also cared for another older relative reported poorer physical health and used more community-based services to care for the PwD. Conversely, dementia caregivers who also cared for younger relatives reported greater secondary stressors, lower family support, and use of fewer community-based services to care for the PwD. Since the COVID-19 pandemic began, two telephone interviews were conducted with 15 dual dementia caregivers. Caregivers were asked in-depth questions about how the pandemic had impacted their caregiving responsibilities, mental health, and use of community-based services. Guided by stress process and behavior models, a thematic analysis of dual caregivers’ interviews revealed that caregivers had less time for themselves, engaged in self-care activities less often, and felt their social life had suffered. Many of the caregivers reported feeling exhausted, stressed, and had more things to do than they could handle. Of the eight caregivers that used services before COVID-19, six experienced a change in services including loss of services, different workers, or self-selected cancellation of services. Discussion focuses on challenges dual dementia caregivers face and the added stressors they experienced during the COVID-19 pandemic.
Frailty and COVID 19 Infection in Hospitalized Veterans: A Case Series
Authors: Fernandez Marlena , Hart Valerie , Diaz Alma , Burton Lorena , Cevallos Victor , Ruiz Jorge
Published: December 2020

Frailty, a clinical syndrome characterized by vulnerability to stressors resulting from loss of physiological reserve across multiple systems. In patients with COVID 19 infection, the presence of frailty may place older adults at higher risk for poor clinical outcomes including hospitalizations and mortality. The aim of this case-series study was to describe the characteristics of patients with frailty and COVID-19 who were hospitalized at a VA Medical Center. A VA Frailty Index (VA-FI) was generated at baseline as a proportion of variables from electronic health records. The VA-FI categorized Veterans into non-frail (FI<.21) and frail (FI≥.21). We calculated the VA-FI for Veterans admitted at the time of COVID-19 admission date. We compared the characteristics of frail and non-frail Veterans. A total of 137 veterans were admitted, 96.3% (n=132) were male, mean age 66.81 (SD=13.87) years, and 65.7% (n=90) were frail. When comparing Veterans who were frail versus non-frail, there were no differences in age, race, ethnicity, BMI, rates of cardiopulmonary resuscitation, ICU admissions, use of vasopressors or length of stay. There were significant differences in rates of intubation (frail n=10, vs. non-frail n=0), p = 0.018 and non-invasive respiratory support (frail n=9 vs non-frail n=0), p=.025. There were 13 and 7 readmissions in the frail and non-frail groups respectively. Eleven Veterans died during hospitalization, all of whom were frail. Frailty is associated with poor clinical outcomes in hospitalized Veterans with COVID 19 infection. Recognition of frailty may help to optimize the management of COVID 19 related complications.
Mental Health Impact of the Confinement Measures During the COVID-19 Pandemic
Authors: Pauly Claire , Schröder Valerie , Pauly Laure , Krüger Rejko , Leist Anja
Published: December 2020

Background. Mid-March 2020, with exponentially increasing COVID-19 infections, Luxembourg closed schools and businesses, and declared a crisis (état de crise) to implement confinement measures, including orders to not leave the home unless to fulfill essential needs. The psychological consequences of these policy responses to the pandemic on older people, considered a high-risk group, were unknown at the time. The aim of this study was to use the nationally representative CON-VINCE study that assessed mental health at the height of the confinement measures mid-April 2020, to assess the psychological impact of quarantine on older adults. Method. A total of 451 participants aged 60+ years (55.0% male) filled in the CES-D, the GAD-7 and the 3-item loneliness scale that measured depressive symptoms, level of anxiety, and feelings of social isolation. Results. Mean age was 67.7 years (SD 5.5), average number of school years were 13.1 (SD 3.6). The participants were mainly of Luxembourgish nationality (87.8%), and a majority (69.8%) was married. Clinically relevant depression scores were present in 13.1%, generalized anxiety in 1.8%, and self-perceived isolation in 16.9% of participants. Number of depressive symptoms was associated with perceived isolation (p<0.001) and current exercise levels (p=0.02). Discussion. The rate of older adults with clinically relevant impaired mental health was similar to pre-pandemic levels in Luxembourg, suggesting that negative mental health consequences of the confinement measures were largely absent. Possible explanations are that confinement was considered a universal experience, and that the healthcare system remained functional, unlike in other countries at the time.
Nimble Gerontological Interprofessional Education During a Pandemic
Authors: Hebdon Megan Thomas , Wilson Christina , Carney Katherine Bernier , Telonidis Jacqueline , Chase-Cantarini Sue
Published: December 2020

To improve communication and collaboration among health professionals, interprofessional education (IPE) experiences have been offered to students through the Utah Geriatric Education Consortium (UGEC) with the support of long-term care (LTC) partners since 2017. The COVID-19 pandemic presented a unique challenge in delivering in-person IPE training. Here we describe adaptations and student outcomes with our Spring/Summer 2020 training sessions. Students (n=46) from health profession programs were recruited and enrolled in the sessions. A LTC partner helped plan two-hour remote training sessions to introduce students to current issues and health care team member roles in LTC. Moderated small group discussions regarding the 4 Ms Framework and a patient case were completed using virtual breakout rooms. A shared virtual document was used to guide discussions and record insights. Student participants (n=46) were primarily White (85%), female (70%), and enrolled in physical therapy (28%), nutrition (33%), and medicine (15%) programs. Thirty-one students completed post-course satisfaction surveys with Likert-scale and open-ended questions. Most students who completed the survey agreed or strongly agreed that the course was effective (85%) and engaging (81%), and will improve care (88%). Positive course aspects included: comprehensive information with speaker experiences and use of 4 Ms; course structure with moderated small groups; and interprofessional collaboration with common goals and multiple perspectives. Despite the challenges of COVID-19, an IPE experience was effectively delivered using video conferencing technology, community collaboration, and moderated small group discussions. The successes of this IPE delivery model will enhance engagement and accessibility of future gerontological workforce training.
Risk and Protective Factors Associated with Custodial Grandparents’ Psychological Distress in COVID-19
Authors: Xu Yanfeng , Jedwab Merav , Wu Qi , Levkoff Sue , Xu Ling
Published: December 2020

The fear and anxiety of COVID-19 and its related policy measures have increased individuals’ psychological distress. The objective of this study was to examine relationships between material hardship, parenting stress, social support, and resilience and custodial grandparents’ psychological distress during the COVID-19 pandemic and further investigate the moderating role of kinship license status. A cross-sectional survey was administered to collect data from custodial grandparents (N = 362) in the United States. T-tests, chi-square tests, and logistic regression models were conducted using STATA 15.0. Results indicated that material hardship (OR = 1.77, p < 0.001) was associated with higher odds of psychological distress, whereas custodial grandparents’ resilience (OR = 0.08, p < 0.001) and social support (OR = 0.39, p < 0.001) were associated with lower odds of experiencing psychological distress. Increased parenting stress in COVID-19 was not significantly associated with psychological distress. Kinship license status moderated the relationships between social support (OR = 0.23, p < 0.05), resilience (OR = 5.06, p < 0.05) and psychological distress. To address custodial grandparents’ psychological distress, more allocated emergency funds and tailored financial services should be provided to meet material needs, and interventions with a focus on resilience and social support are particularly needed. Although licensed custodial grandparents were more likely to experience psychological distress due to their pre-existing vulnerability than unlicensed counterparts, parallel services should be provided to all kinship caregivers.
The Social Worker in the Nursing Home: A Systematic Review of the Literature from 2010 to 2020
Authors: Miller Vivian , Hamler Tyrone , Beltran Susanny , Burns Jacquelyn
Published: December 2020

Social workers have an integral role in health care and a long-standing history in nursing homes. The novel pandemic, COVID-19, has disproportionately adversely affected nursing home residents, bringing to the fore the importance of practice in this setting. However, the role of the nursing home social worker is often ambiguous. The objective of this study is to (1) identify existing research studies that discuss the role of social work and nursing facilities, (2) synthesize findings to determine what is most often reported in the literature, (3) present recommendations for practice and implications for research and policy change. This rapid review used the PICO framework and PRISMA guidelines to systematically search for articles published in English between 2010 and 2020 across 11 databases. A final sample of 23 articles met inclusion criteria. Relevant details were extracted from these articles, and the following 3 categories emerged as broadly describing the literature: (1) elements of social work practice in NHs, (2) social worker responsibilities, (3) policy impacts on practice. Findings highlight that the literature on NH social workers is limited and outdated, despite the 2016 federal rule requiring increased consideration for resident quality of life, quality of care, and behavioral health, all features of social work practice. The nursing home social work role warrants greater attention, with an emphasis on how to support residents during the current pandemic to ensure the development and implementation of person-centered care. The literature points to research priorities including involving families and residents in data collection efforts.
Understanding Older Adults’ Technology use During COVID-19 to Support Health and Connection
Authors: Bardach Shani , Rhodus Elizabeth , Parsons Kelly , Gibson Allison
Published: December 2020

The COVID-19 crisis has disrupted everyday life as individuals, especially older adults, are encouraged to distance to reduce virus transmission. Remote strategies for connection may ameliorate risks for social isolation, however, older adults’ adoption of such strategies remains unknown. This study involved in-depth semi-structured interviews with 30 older adults (ages 68-94) regarding adaptations to the call for social distancing and use of technology. From a socioemotional selectivity theory lens, findings demonstrate respondents’ positive views of technology, expressing value in the context of supporting emotionally important relationships and goals, e.g. social connection and entertainment, rather than knowledge acquisition. Surprisingly, most respondents were uninterested in technology training. This may be consistent with diminished future time perspectives; several participants referenced their advanced age to explain disinterest in learning new technology and most seemed to have developed a level of technology use that met their needs. Technology resistance was consistent with a focus on emotionally meaningful goals; several respondents conveyed disinterest in social media due to perceived intrusiveness and others indicated a lack of interest in telemedicine and health portals due to the perceived loss in valuable human contact. Personal challenges with social distancing generally reflected limitations in safe human interactions, e.g. a desire for hugs or missing the spontaneity of social get-togethers, which remained emotionally meaningful but outside the scope of how technology could support wellbeing. These results suggest that focusing on older adults’ emotional goals, and highlighting how technology can support their achievement, may support meaningful use to promote health and connection.
Best Practices for Measuring the Social, Behavioral, and Economic Impact of COVID 19 Using Secondary Data
Authors: McNally James , Lavender Kathryn
Published: December 2020

This presentation reviews best practices for using data resources from the NACDA Program on Aging, its projects, and its collaborating partners for measuring the impact of epidemics. The report summarizes resources to identify measures of well-being, social connectedness, and other constructs to measure the social and behavioral effects of the COVID-19 epidemic on population health outcomes. The report suggests data resources to identify pre-crisis measures of social distancing, social networks, consumer confidence, unemployment, and the use of social media. The COVID-19 pandemic presents research challenges for how we measure governmental, community, and population responses to a crisis. COVID-19 represents a unique case because it is a new virus with a novel impact profile and a long latency period. We offer examples of variables and concepts found across multiple studies and multiple years that can provide baseline information on pre-COVID-19 social behaviors using studies managed and distributed by NACDA and ICPSR. This report also provides guidance on how to search for specific topics using the ICPSR generated search tools. Finally, we offer information on how to obtain these data for research purposes. Our hope is this information will be valuable in identifying key baseline measures of social behavior, health, and employment before the COVID-19 epidemic, and this information can allow us to evaluate challenges and recovery once the crisis has passed. Both NACDA and ICPSR remain available 24 hours a day, 365 days a year, to assist researchers in locating and obtaining data related to their research.
The NH Alliance for Healthy Aging: Using a Collective Impact Approach to Advance Healthy Aging
Authors: Rabalais Jennifer , Davie Laura , Rataj Alison
Published: December 2020

The NH Alliance for Healthy Aging (NH AHA) is a statewide coalition of stakeholders building cross sector partnerships that support and promote healthy aging throughout the state. Formed in 2016, NH AHA works to promote its shared vision to create communities in New Hampshire that advance culture, policies and services which support older adults and their families. As the largest coalition focused on the health and well being of older people in the state, NH AHA currently engages over 300 participants representing more than 185 organizations and/or groups statewide. Participants will hear how this collective power has led to early successes in advancing AHA’s five strategic priorities, including early statewide policy successes. A review of the collective impact model will be provided with discussion on how NH uses this model intentionally to align the work in the aging field of NH. NH AHA’s theory of change starts with changing the conversation around aging across NH’s communities and is the foundation for the efforts to advance Reframing Aging principles and recommendations through the work of NH AHA and statewide. NH AHA’s strategic plans to become a resource and hub of Reframing Aging activity in the state will be reviewed. As a result of the presentation audience members will be able to 1) describe the 5 conditions of collective impact 2) give 2 examples of how NH is utilizing these conditions intentionally and 3) describe NH’s efforts to create common measures for the aging field in NH.
Understanding the Pathways of Neighborhood Environmental Influences on Health Among U.S. Chinese Older Immigrants
Authors: Wang Yi , Guo Man , Liu Jinyu , Carter Kara
Published: December 2020

Neighborhood environment has proven to be consequential for older Americans’ physical, mental and cognitive health. However, this topic is much less studied among older Asian immigrants, a fast growing immigrant group who embrace values of collectivism and community connections. The current study used the first wave data (N=2920) of the Population Study of Chinese Elderly (PINE), the largest population-based sample of Chinese older adults in the U.S., 1) to examine the direct associations between neighborhood environment (social cohesion, physical disorder) and health outcomes (self-rated health, depression, and cognitive health); and 2) to identify possible mediators at intrapersonal (sense of hopelessness, sense of mastery) and interpersonal levels (social engagement, cognitive engagement) through which neighborhood environment influences health. The results of Sobel tests from path analysis showed that neighborhood social cohesion was associated with better health outcomes on all the domains: self-rated health (b= 0.050, p<.01), depression (b= -0.202 p<.001), and cognitive health (b=0.092, p<.001), whereas neighborhood physical disorder was associated with poorer self-rated health (b= -0.069, p<.01) and more depressive symptoms (b=0.174, p<.001). Full and partial mediations were detected. For example, neighborhood physical disorder influences depression completely through intrapersonal traits, higher sense of hopelessness (b=1.879, p<0.001) and reduced sense of mastery (b= -2.656, p<0.001). Neighborhood social cohesion contributes to better cognitive health partially through increased social engagement (b=1.696, p<0.001) as well as cognitive activities (b=1.392, p<0.001). The findings identified the ecological component in resilience building processes, and provide evidence for mezzo-level intervention to improve health among aging U.S. Chinese immigrants.
The Effect of Bottleium, a Bottle-Type Aquarium, Ownership on Community-Dwelling Older Adults
Authors: Takase Mai , Ogino Ryogo , Yoshida Keishiro , Kusunoki Hikari , Kenmochi Tetsuya
Published: December 2020

The pet ownership of ornamental fish acts positively towards the well-being of older adults. A Bottleium is an aquarium that uses a glass bottle instead of a tank. Its small size allows older adults to own ornamental fish as a pet. In this study, the effect of Bottleium ownership on the daily life of community-dwelling older adults was explored. A three-hour workshop to build one’s own Bottleium (size: 11cm×11cm×20cm) was hosted at Toyoshikidai housing complex (Kashiwa, Japan). An ornamental fish and a freshwater snail were added to each bottle. Semi-structured interviews were conducted with participants one month after taking the Bottleium home (N=25). The Bottleium ownership acted as a stimulus to older adults. The effects on an individual were “trigger of conversation” and “development of responsibility.” Participants living alone treated the fish as their companions and had light conversations. They carefully looked after the fish as would a pet owner. Furthermore, the Bottleium facilitated “interpersonal interactions.” Basic information was provided during the workshop, but participants assisted each other in complementing the information, and they even visited each other’s residences to observe the fish. Older adults who do not own the Bottleium also visited for this purpose. Two cases were reported where participants looked after each other’s fish in times of hospitalization. The interpersonal interactions might have resulted from the nature of the housing complex, as participants were already familiar with each other. Similar phenomena could be anticipated at places such as apartments and nursing homes.
Carotid Revascularization Improves Balance and Mobility, Particularly in Patients That Are Most Impaired
Authors: Gray Vicki , Desikan Sarasijhaa , Khan Amir , Barth Dawn , Sikdar Siddhartha , Sorkin John , Lal Brajesh
Published: December 2020

Balance and mobility function worsen with age, and more so for those with underlying diseases. Our research has demonstrated that asymptomatic carotid artery stenosis (ACAS) is associated with worse balance and mobility, and a higher fall risk, compared to older adults with similar comorbidities, but without ACAS. Thus, ACAS, with attendant blood flow-restriction to the brain is a potentially modifiable risk factor for balance and mobility dysfunction. The purpose of this study was to evaluate the impact of restoring blood flow to the brain by carotid revascularization, on balance and mobility in patients with high-grade ACAS (≥70% diameter-reducing stenosis). Twenty adults (67.0±9.4 years) undergoing carotid revascularization for high-grade stenosis were enrolled. A balance and mobility assessment was performed before- and six weeks- after carotid revascularization and included: Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Four Square Step Test (FSST), Dynamic Gait Index (DGI) Timed Up and Go (TUG), gait speed, MiniBESTest, and Walk While Talk (WWT) test. Paired t-tests assessed changes in outcome measures between the two-time points. Significant improvements were observed in measures that combined walking with dynamic movements, DGI (P=0.003), and MiniBESTest (P=0.021). Pearson’s correlations examined the relationship between balance and mobility before surgery and change score after surgery. Patients with lower baseline DGI and MiniBest scores demonstrated the most improvement on follow-up testing (r=-0.70, p=0.001, and r=-0.59, p=0.006, respectively). In conclusion, revascularization of a carotid artery stenosis improves balance and mobility; the greatest improvements are observed in those patients that are the most impaired.
Effect of PPARγ Inhibition on Bone in Aged Animals
Authors: Shi Xingming , Ding Kehong , Su Yun , Isales Carlos
Published: December 2020

Aging is accompanied by bone loss and marrowfat accumulation. PPARg is a key factor regulating adipocyte differentiation. Marrowfat secretes large quantities of factors including adipokines, cytokines and chemokines that contribute to bone loss. We hypothesized that inhibition of PPARg would reduce adipocytes and adipose-generated inflammatory factors, and thus decrease aging-induced bone loss. To test this hypothesis, we treated young (6mo) and old (23mo) female C57BL/6 mice with a PPARg antagonist GW9662 (1mg/kg body weight, IP injection for 6wks) and examined the effects on bone, immune cell lineage skewing, and the expression of inflammation related genes. DXA analysis data showed that GW treatment had no effect on vertebral and femoral BMD and BMC in young or old mice. u-CT analysis showed that GW treatment reduced BV/TV in old mice but had no effect in young mice. FACS analysis data showed that GW treatment significantly increased lymphoid (CD3) and decreased myeloid (CD11b) lineage cells only in young mice. GW treatment significantly decreased CD4 and CD8 T cell subpopulations in young mice, but had no effect in old mice. Interestingly, Nanostring analysis of inflammation genes revealed an opposite effects of GW treatment in young vs. old mice, i.e., genes whose expression were downregulated by GW in bone cells of the young mice were upregulated in the old mice. These results suggested that systemic inhibition of PPARg, while enhancing CD3 and reducing CD11b cell populations in the bone marrow of young mice, may have a negative effect on bone architecture in old mice.
Detrusor Underactivity as an HCN-Mediated Failure of Resilience in Aging
Authors: Rosenberg Dawn , Hardy Cara , Ramasamy Ramalakshmi , Smith Phillip
Published: December 2020

Sympathetic relaxation of the bladder wall permits low pressure urine storage and allows central regulation of afferent sensitivity to volume. Impaired regulation of volume sensitivity has been linked to symptoms of underactive bladder and cystometric detrusor underactivity. Hyperpolarization-activated cyclic nucleotide-gated channels (HCN channels) are mediators of sympathomimetic-induced detrusor relaxation in young mouse bladder tissue, however in bladder strips from old female mice, HCN blockade enhanced age-diminished isoproterenol-induced relaxation. We therefore hypothesized that loss of HCN would compromise cystometric function and enhance sympathomimetic responses in old mice. Male HCN1 KO mice (20-22 mo) and their WT littermates underwent pressure-flow cystometry under urethane anesthesia to assess urinary performance at the level of the autonomic nervous system in the absence of cortical control. Following cystometry, bladders were harvested and pharmacomyography was performed on bladder strips to determine tissue-level changes in the absence of CNS input. All mice responded to continuous-fill cystometry by establishing regular filling/voiding cycles. HCN KO mice function showed discrete changes in volume sensitivity vs. WT. Bladder strip studies showed minimal response to isoproterenol regardless of HCN status, and no significant differences in response to carbachol based on HCN status. We conclude that HCN status impacts the brainstem-bladder reflexic control over urine storage/voiding, but not by regulating bladder wall tensions during filling. The absence of HCN influence on the loss of end-organ responsiveness to sympathetic control in old mice points to an increasing dependency on central control mechanisms with aging.
Metabolic Regulation of the Senescence Program
Authors: Potnis Manali , Nacarelli Timothy , Noguchi Eishi , Azar Ashley , Sell Christian
Published: December 2020

Cellular senescence is a cell fate defined by an irreversible cell-cycle arrest and a pro-inflammatory secretory profile. It is a consequence of a shift in metabolism and rearrangement of chromatin. Accumulation of senescent cells is a universal hallmark of age-related pathologies suggesting these cells contribute to age-related susceptibility to disease. Here, we examine the interplay between two metabolic inhibitors of senescence: Rapamycin treatment and Methionine restriction (metR). We report that a combination of methionine restriction and rapamycin induces a metabolic reprogramming that prevents activation of the senescence program in human fibroblasts. The treated cells continue to divide at a slow rate at a high passage and lack senescence-associated markers and inflammatory cytokines. Genome-wide chromatin accessibility analysis reflects chromatin remodeling with distinctly increased accessibility of heterochromatic regions in treated cells. Further, Transcriptome-wide analysis reveals increased expression of specific methyltransferases which alter the trimethylation of H3, one of the strongest hallmarks of open chromatin. This may represent a mechanistic link between a major hallmark of senescence and nuclear events required for senescence.
Pro-inflammatory CD8 T Cells Contribute to Age-Related Large Artery Stiffening
Authors: Trott Daniel , Sharma Sunita
Published: December 2020

We have shown that T cells accumulate around the aorta with advanced age and that both pharmacologic and genetic deletion of total T cells result in improved large artery stiffness in old mice. The purpose of this study was to test the hypothesis that CD8 T cells specifically mediate age-related large artery stiffening. We randomized old (22-24 month) C57Bl6 mice (n=5/group) to treatment with an anti-CD8 or isotype control antibody (100µg every 5 days) for 28 days. We assessed large artery stiffness using pulse wave velocity (PWV) before and after antibody treatment. We found that PWV was similar between isotype (301±14 cm/s) and anti-CD8 (292±18 cm/s) before treatment. Following treatment, anti-CD8 treated mice exhibited lower PWV (272±11 cm/s) compared to the isotype (315±14 cm/s). Following euthanasia, we assessed aortic T cell infiltration by flow cytometry we found that anti-CD8 treated mice exhibited blunted aortic total CD3+ (262±42 vs. 1400±94 cells per aorta) and CD8+ (52±19 vs. 565±139 cells per aorta) cells compared to isotype controls. In a separate cohort of mice we compared interferon (IFN)-γ and tumor necrosis factor (TNF)-α production of aortic infiltrating CD8 cells from young (4-6 months, n=5) and old mice (n=8) using flow cytometry. A greater proportion of CD8 cells from old aortas produced IFN-γ (70±3% vs. 46±6%) compared to young. Similarly, a greater proportion of aortic infiltrating CD8 cells from old mice produced TNF-α (35±6% vs. 17±3%) compared to young. Collectively, these results suggest that pro-inflammatory CD8 cells contribute to cell non-autonomous arterial aging.
Prevalence and Predictors of Mortality for Older Adults Referred to a Hospital Avoidance Program
Authors: Gul Shahzad , Freund Megan , Sanson-Fisher Robert , Clapham Matthew , Webster Penelope
Published: December 2020

A cross sectional retrospective data linkage study of older adults discharged from local hospital avoidance program between January 2017 and January 2018 was undertaken (N=286; mean age 80.5 years). The prevalence of death at 3 months, 6 months, 12 months, 18 months and 33 months was calculated. Patient demographic characteristics associated with participant’s risk of mortality at 33 months after discharge was examined using Cox multivariable regression. Patient demographic and health characteristics associated with participant mortality within 12 months of discharge was examined using multivariable logistic regression for patients with complete health characteristic data (n=195). The mortality prevalence was 17% at six months and the cumulative prevalence at one year, 18 months and 33 months post discharge were 24%, 29% and 36% respectively. Patient demographic characteristics associated with participants’ risk of mortality at 33 months after discharge were gender, age and household arrangements. Health and demographic characteristics associated with mortality within 12 months of discharge were lower cognition, increased burden of comorbidity, decreased physical function, a weight less than 55 kilograms, older age and male gender. These results indicate that a significant proportion of people attending a hospital avoidance program are likely to be entering into the final year of their life. This suggests that hospital avoidance programs should routinely identify patients who are likely nearing end of life, and support advance care planning for this patient group.
Qualitative Experiences of Multi-Sensory Engagement for Acutely Ill Persons With Dementia
Authors: Molony Sheila , Waszynski Christine
Published: December 2020

Delirium occurs in up to 25% to 50% hospitalized patients and the risk is increased for older adults with dementia. Multi-sensory stimulation has been effective in community and nursing home settings to reduce delirium in persons with dementia. This paper presents qualitative findings from field notes, observations and participant/family interviews. A sample of 25 individuals with dementia and were recruited from 2 medical units and randomized to intervention with two sessions in the multi-sensory “Hub” on 2 hospital days or receive usual care. One investigator recorded field notes prior to and during the intervention (or control). An RN in the Hub documented participant engagement. Audio-taped interviews with participants and family were recorded immediately after Hub visits. All data was transcribed and analyzed by two other team members using NVivo 12.0. Both coders reached consensus after independently coding the first 12 transcripts using open coding and descriptive content analysis. Pre-intervention data revealed common symptoms of delirium in both groups and post-intervention fatigue as a prominent theme. Participants in both groups were able to engage with the researcher and respond to interviews. Hub participants demonstrated high levels of engagement with some surprising positive responses and improvement from pre-intervention behavior. Qualitative findings from this pilot study highlight the abundance of delirium risk factors encountered by hospitalized older adults with dementia and demonstrate positive, engaging MMSE experiences, despite these risks. Further study is needed to identify longer-term impact.
Adiposity Is Positively Associated With AD-Signature Cortical Thickness in Older Adults
Authors: Brinkley Tina , Lockhart Samuel , Sachs Bonnie , Cleveland Maryjo , Williams Benjamin , Bateman James , Rogers Samantha , Craft Suzanne
Published: December 2020

Mid-life obesity is associated with a higher risk for Alzheimer’s disease (AD). However, this association is attenuated or even reversed in late-life, when weight loss may be a preclinical sign of AD. While neuropathological changes likely occur alongside aging-related changes in body composition, this has not been largely investigated. We aimed to determine the association between adiposity and a specific pattern of reduced cortical thickness associated with AD risk and progression. Global and regional adiposity (via dual-energy x-ray absorptiometry) and AD-signature cortical thickness (via surface-based cortical analysis of 3T brain MRI scans) were measured in 35 middle-aged and older adults from the Wake Forest Alzheimer’s Disease Clinical Core (mean age: 69.4±7.8 years, 80% female, 91% White, 29% cognitively impaired). Partial correlations adjusted for age, sex, and cognitive status were examined overall and stratified by age (0.59, p≤0.05). No significant associations were observed in middle-aged adults. These findings suggest that AD-related cortical thinning may be accompanied by a global reduction in body fat among older adults.
Compare Breast Cancer Screening, Diagnosis, and Treatment Between Medicare Patients With and Without ADRD
Authors: Weng Xingran , Shen Chan , Vasekar Monali , Gupta Sachin , Wang Li
Published: December 2020

Background: Incidence of both breast cancer and Alzheimer’s disease and related dementias (ADRD) increases with advancing age. Little research has delineated breast cancer screening, diagnosis, and treatment among women with ADRD. Method: Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data were used. Female breast cancer patients diagnosed between 2005-2015 were identified. Chi-square tests were conducted to compare the characteristics of two groups with and without ADRD. Multiple logistic regression models were estimated to explain the diagnosis and treatment differences. Results: A total of 44,112 female Medicare beneficiaries age 65 or older were identified. Patients with ADRD (17.5%) were less likely to receive breast cancer screening (42.8% vs. 46.6% for all data years combined, p<0.0001), more likely to be diagnosed with breast cancer after death by autopsy or death certificate (8.1% vs 2.0%, p<0.0001). Among those who are diagnosed before death, patients with ADRD were more likely to be diagnosed with breast cancer at age 75 and older (84.8% vs. 15.2%, p<0.0001). After adjusting for age, race, poverty level, marital status, cancer stage at diagnosis, cancer screening history, wellness visit history, comorbidity, and rural/urban residence, logistic regressions suggest that patients with ADRD were less likely to receive surgery (AOR=0.48, 95%CI: 0.45-0.52), radiation (AOR=0.41, 95%CI: 0.39-0.44), or chemotherapy (AOR=0.38, 95%CI: 0.35-0.41). Conclusion: Breast cancer screening was less utilized and breast cancer was diagnosed at an older age in patients with ADRD than those without. Treatments (surgery, radiation, and chemotherapy) were given less frequently to patients with ADRD.
Depression Moderates the Effect of Physical Functioning Over Time in Cancer Survivors
Authors: Bamonti Patricia , Naik Aanand , Bean Jonathan , Moye Jennifer
Published: December 2020

Cancer survivors are at-risk for physical functioning (PF) decrements particularly among older adults. However, few studies have examined moderators of PF over time which may guide rehabilitation interventions. This study examined the moderating effect of depressive symptoms on the association between PF at 6 months following cancer diagnosis and PF 18 months after diagnosis controlling for age, education, and treatment status (whether still in treatment). We hypothesized that the association between PF (T1) and PF (T3) would be attenuated by higher depression scores 12 months after diagnosis (T2). Participants (N = 170; Mage 65.3 +/- 9.17, 98.2% male; 81.2% White) with head and neck, esophageal, gastric, or colorectal cancers were recruited from tumor registries at two VAMCs. Self-report measures included demographics, treatment status, depression symptoms (PHQ-9), and physical functioning (PROMIS) were collected. Performance-based measure of PF (SPPB) was administered. Depression symptoms at Time 2 moderated the relation between performance-based PF (SBBP: ΔR2 = .07, F(6, 103) = 10.1, p < .001) but not self-reported PF, PROMIS: ΔR2 = .001, F(6, 110) = 15.3, p =.733. The turning point of non-significance to significance of SBPP T1-T3 was a PHQ-9 score of 7.2. In the absence of depression, the best predictor of future functioning is prior functioning. For those with PHQ-9 scores > 7.2 (28% of the sample), prior functioning does not predict future functioning. Depression should be measured closely with performance-based measures of PF, including gait speed, to improve prediction of future functioning and guide personalized interventions.
Association of Balance Scores With Cognitive Function in Older Adults
Authors: Meunier Claire , Smit Ellen , Fitzpatrick Annette , Odden Michelle
Published: December 2020

Previous research has reported an association between balance and cognitive function; however, there is a paucity of data on this relationship over time. This study examined the cross-sectional and longitudinal association between balance and cognitive function in 4,811 participants aged 65 years and older in the Cardiovascular Health Study (CHS). Cognitive function measures included the Modified Mini-Mental State Examination (3MSE) and Digit Symbol Substitution Test (DSST); measures were collected annually for six years, starting in 1992-1993. A tandem stance balance test was administered at baseline; this test was held for 5 seconds. Cross-sectional and longitudinal models were adjusted for demographics, behavioral and disease covariates. We found that participants with worse balance scores had lower cognitive function scores, and this effect was limited to participant who were above the median age (76 years) (p-value for interaction = 0.03 in a demographic-adjusted model). Participants 76 years and older who failed the balance test had an average adjusted decline of -0.97 (95% CI: 1.20, 2.29) 3MSE scores per year more than participants who completed the balance test. DSST showed similar results; participants with poor balance decreased -0.21 (95% CI: -0.37, -0.05) points per year more than participants who completed the balance test. The adjusted Cox proportional hazard model found participants with poorer balance had a higher risk of cognitive impairment over the six years (HR= 1.72 95% CI: 1.30, 2.29). A better understanding of the pathophysiological link between balance and cognition may inform strategies to prevent cognitive decline.
Contemplative Practices and Later Life Memory Among Women
Authors: Lekhak Nirmala , Bhatta Tirth
Published: December 2020

Contemplative practices such as meditation, yoga, and prayer had been used as coping resources to reduce the adverse impacts of stressful life experiences. Despite emerging scholarship on the benefits of contemplative practices for cognitive health, scant research has examined the influence of such practices on both episodic and working memory among women in later life. While the use of private prayer outside of church or temple has been shown to have statistically significant positive effect on episodic memory among older adults, previous studies have relied on measures that fail to capture various aspects of meditative practices (e.g., mental imagery, relaxation). Drawing from the Study of Women’s Health Across the Nation (n=2245) conducted during 2006-2008, this study investigates the effect of contemplative practices (e.g. meditation / imagery / relaxation technique, yoga, and prayer) on episodic and working memory. Multivariate regression model estimates suggests women who either used meditation, imagery or relaxation techniques had significantly better episodic (b=0.61, p=0.001) and working memory (b=0.32, p<0.05) as compared to those who did not use those methods. Surprisingly, the influence of prayer on episodic memory was negative (b=-0.36, p<0.05), while the influence of yoga on memory was not statistically significant. Our findings underscore the need to incorporate meditative practices in non-pharmacological interventions that are designed to improve later life memory.
Global Cognition Modified the Longitudinal Relationship Between Anemia and Depression in Old Age: The IMIAS Study
Authors: Ahmed Tamer , Vasiliadis Helen-Maria
Published: December 2020

Background: We examined the longitudinal relationships between hemoglobin concentrations or the severity of anemia and depression and whether baseline cognitive function modifies these longitudinal relationships over 4 years of follow-up. Methods: A total of 1608 community-dwelling older adults from the International Mobility in Aging Study (IMIAS) aged 65 to 74 years were recruited in Natal (Brazil), Manizales (Colombia), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). The study outcome was depression, defined by a score of 16 or over in the Center for Epidemiologic Studies Depression Scale (CES-D). Longitudinal associations over four years follow-up were examined using generalized estimating equations. Models reported were either unadjusted and adjusted for research sites, alcohol drinking status, body mass index, chronic conditions, activities of daily life disabilities, and polypharmacy. Results: Longuitinal relationships suggested an evidence of multiplicative interaction by baseline global cognition in which 1g/dL increase in hemoglobin concentrations there was a significant reduction in the risk of depression with a stronger effect among participants with good cognitive function (Odds Ratio (OR)=0.85, 95% CI: 0.78-0.92) compared to those with poor cognition (OR=0.89, 95% CI: 0.80-0.97). Anemia and poor cognition at baseline were associated with an increased risk of depression over 4 years of follow-up (OR=5.80, 95% CI: 1.84-18.23). Global cognition was an effect modifier of the longitudinal association between the severity of anemia and depression. Conclusion: In international samples of older adults, hemoglobin concentrations, as well as the severity of anemia, were independent risk factors for depression and these associations differed by global cognitive function.
Job Strain and Mental Health Among Older Adults: Results From the National Health Interview Survey
Authors: Hatten Christina , DuPont-Reyes Melissa , Gonzalez Tailisha , Murillo Rosenda , Echeverria Sandra , Vasquez Elizabeth
Published: December 2020

Increased life expectancy and retirement age have contributed to a gradual aging of the US workforce. Extant literature has identified job strain (e.g. job demands, work-related stressors etc.) as a risk factor for both physical and mental health outcomes in working populations. However, there is comparatively less evidence examining job strain and mental health among older working adults. We utilized National Health Interview Survey data (2015), which contained detailed information on work conditions, to investigate the relationship between fear of job loss and self-rated mental health among working adults at 25-54 and 55+ years of age. We fit multiple logistic regression models that accounted for the complex survey design. Mental health was assessed using the K6 screening instrument that measures nonspecific psychological distress. In the sample of 16,291 working adults, 11.6% worried about job loss and 13.3% reported moderate/severe mental distress. Overall, we found that the odds of poor self-rated mental health among those who reported fear of job loss were 2.35 times that of respondents with perceived job security after adjusting for age, sex, educational attainment, race and/or ethnicity, body mass index, and smoking behaviors (95% Confidence Interval (CI): 2.01-2.75). Age-stratified results showed that perceived job insecurity corresponds with a 2.33 odds of mental distress among workers aged 25-54, and a 2.44 odds of mental distress among older workers. Our findings highlight the importance of age dynamics in mental health for working adults and suggest that job strain presents a persistent challenge for the wellbeing of workers.
Determinants of Satisfaction With Health Services by Dimensions of Care: An Age-Stratified Analysis
Authors: Vasiliadis Helen-Maria , Pitrou Isabelle , Berbiche Djamal
Published: December 2020

Studies that examined satisfaction with care in older adults are scarce. The aim of this research was to analyse satisfaction among older adults considering mental health, socio-clinical and health system factors and by age category. Data come from the Étude sur la Santé des Aînés Services study including 1,624 adults aged ≥65 years recruited between 2011-2013 in primary care in Quebec. Patient satisfaction was assessed during interviews with questions adapted from the Primary Care Assessment Survey. Mental health (anxiety, depression, suicidal ideation, psychological distress, cognition), social support, quality of life, the presence of pain and chronic conditions were self-reported. Health service use was extracted from administrative registries. Logistic regressions stratified by age were used to examine the associations of low satisfaction in three dimensions of care. For continuity of care, the determinants of low satisfaction were pain and attraction index for psychiatric services in adults 65 to 75 years versus anxiety, cognition and hospitalizations in adults 75 years and older. For patient-provider interactions, the determinants were psychological distress, attraction index for psychiatric services in adults 65 to 75 years versus quality of life and cognition in adults 75 years and older. For adequacy of care, anxiety, psychological distress, social support, pain, quality of life and attraction index for psychiatric services were significant in adults 65 to 75 years versus quality of life and cognition in adults 75 years and older. Results highlight different patterns of satisfaction by age category that should be used to improve care delivered in primary care.