bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EXPERIENCES OF OLDER ADULTS IN HAITI AND THE UNITED STATES AT THE ONSET OF COVID-19
Authors: Blackman Laurie , Krase Kathryn , Wang Donna
Published: December 2023

From the early onset of the COVID-19 pandemic, there was a disproportionate risk and impact of the disease on older adults and communities of color. This article explores the differences in experiences of older Haitian and older US adults at the onset of the COVID-19 pandemic. Since wealth creates accessibility to needed resources, including the best healthcare and support services, the disproportionate risk and impact of COVID-19 on older adults required a focused look at how older adults in vulnerable countries such as Haiti faired when compared to older adults in the United States. Using data collected from a sample of 240 Haitian older adults in August 2020 and 204 US older adults in June 2020, the findings indicated that Haitian older adults experienced more significant psychological, financial, and emotional distress due to the COVID-19 outbreak than their US older adult counterparts. The results of this study revealed the challenges that older adults faced at the onset of the pandemic, which was more pronounced in developing countries. However, the surge in violence in Haiti in the first quarter of 2023 killed more people than the COVID-19 outbreak. This research provides important insight for developing and framing policies and interventions that are not modeled on the measures taken elsewhere but adapted to a country’s reality and the population’s actual needs.
THE UNIQUE CHARACTERISTICS OF “FAMILIES OF CHOICE” AND BIOLOGICAL FAMILIES OF LGBT ADULTS
Authors: Cohn-Schwartz Ella , Gooldin Sigal , Bachner Yaacov
Published: December 2023

This study joins a growing body of research on the unique families of aging individuals in sexual minorities. We explore the “families of choice” (who are close enough to be considered as family) and biological families of LGBT adults and their associations with mental health. Data for this study was collected via an online survey with self-identified lesbian, gay, bi-sexual and transgender (LGBT) adults aged 50+ in Israel (n=483). The participants were asked about characteristics of the relationship with their families of choice and biological families and about experiencing depressive symptoms. Descriptive results indicated that most participants had a family of choice, numbering five people on average. These families of choice were mostly composed of partners and friends, but also of the family members of one’s partner, and of ex-partners and colleagues. They reported having about four close biological family members, mostly children, parents, siblings, and nieces. Several differences emerged when comparing the two types of families: The relationships with biological families were more stable and their biological family members were contacted more often. On the other hand, families of choice were more likely to accept their sexual orientation and the relationship with them had fewer negative aspects. Regression analyses showed that individuals had more depressive symptoms if the relationship with their families of choice was less stable and if there were more negative relationships with both types of families. These findings shed light on the unique sources of support among LGBT adults and their associations with mental health.
TUMOR NECROSIS FACTOR-Α, INTERLUKIN-6, AND VISFATIN LEVELS IN OLDER PATIENTS WITH MALNUTRITION
Authors: Huang Hsien-Hao
Published: December 2023

Introduction

Proinflammatory cytokine is associated with malnutrition status. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were pro-inflammatory cytokines stimulated by nutritional deficiency. Visfatin is an adipokine with a strong correlation with inflammation. The relationships of TNF-α, IL-6 and visfatin are not consistent, and no study have investigated them in the older patients with malnutrition.

Methods

This prospective study included patients aged ≥ 75 years at the emergency department and all patients underwent Mini-Nutritional Assessment-Short Form (MNA-SF) and blood tests for fasting plasma TNF-α, IL-6 and visfatin levels.

Results

We enrolled 106 older patients with a mean age of 87.3 years, including 43 (40.5%) patients in at risk of malnutrition group (MNA-SF between 8 to 11), 24 (22.6%) patients in the malnutrition group (MNA-SF < 8), and 39 (36.7%) patients in normal group. Compared to the normal group, both at risk of malnutrition and malnutrition group had significantly lower Mini-Mental State Examination (MMSE). Furthermore, TNF-α was significantly higher in at risk of malnutrition group. In contrast, IL-6 was significantly higher in malnutrition group. Visfatin levels was not correlated to the malnutrition status. Both TNF-α and IL-6 negatively correlated with Barthel index and MMSE. Backward and stepwise multiple logistic regression analyses showed that the independent predictor for both at risk of malnutrition and malnutrition was MMSE.

Conclusion

The nutrition deficit status was correlated with proinflammatory cytokines, serum TNF-α and IL-6. The independent predictor of both at risk of malnutrition and malnutrition group was MMSE in older patients.
TWO NATIVE SOUTH AMERICAN MALE POPULATIONS EXHIBIT CROSS-SECTIONAL INCREASE IN REGIONAL BRAIN VOLUME WITH AGE
Authors: Imms Phoebe , Chaudhari Nikhil , Chowdhury Nahian , Gatz Margaret , Gurven Michael D , Finch Caleb , Irimia Andrei ,   The Tsimane Health and Life History Project
Published: December 2023

Features of industrialized environments such as consumption of processed foods and sedentarism are associated with faster brain atrophy. Studying brain volume trends with age in non-industrialized populations can elucidate environmental correlates of brain health. Indigenous to the Bolivian Amazon, the Tsimane and Moseten (T&M) are highly active forager-horticulturalists with some of the lowest rates of dementia. Tsimane have minimal interaction with mainstream Bolivians; Moseten are semi-acculturated. Age-related trends in regional brain volumes were estimated from T&M’s (N = 1,024; age range: 46-83) computed tomography and compared to trends estimated from Britons’ magnetic resonance images (UK Biobank, N = 19,973; same age range). In T&M males, parietal and occipital structures mediating visuospatial abilities exhibit small but significant rates of volume increase with age. Structures recruited during visuospatial navigation are important for survival in Amazonian rainforests. Frontal and temporal structures whose volumes decrease with age in Britons do not trend negatively with age in T&M males. T&M females, however, exhibit steeper cross-sectional rates of volume decrease with age compared to their industrialized counterparts. This suggests that brain volume trajectories, which can reflect dementia risk, are impacted by sex-specific aspects of non-industrialization. Despite T&M females’ higher rates of regional brain volume decrease with age compared to UK females, dementia rates in T&M females remain extremely low. Trends demonstrating increases in brain volume with age, such as those observed in T&M males, have not been reported in industrialized populations, suggesting that factors associated with being a male forager-horticulturalist may constrain regional brain atrophy.
UNDERSTANDING THE IMPACT OF AGEISM AMONG HEALTHCARE PROFESSIONALS AND STUDENTS
Authors: Finn Laura , Sukumar Kavitha , Fasola Serena , Phan Dennis , Bautista Kirsten , Hon Michelle , Oswald Catherine
Published: December 2023

With our population aging, the need for healthcare practitioners trained in caring for older adults is urgent. The anticipated shortage of geriatric-trained providers may further the impact of age-related discrimination. Little data is published about the understanding of ageism by healthcare professionals and students. The comparison of these different groups became the focus of the conducted survey, and the presenting research analyzed a total of 467 respondents including dental, nursing, pharmacy, occupational therapy, and physical therapy professions across 2 universities. When comparing demographic differences in studied populations, 69% of faculty/preceptors and 12% of students were over 35 years old. Overall, 33.8% reported being unable to define ageism with 27.7% of all students unable to do so. In looking specifically at pharmacy, 34.3% of students and 37.9% of faculty were unable to define ageism. Understanding ageism and its effects on healthcare for older adults is important for pharmacists as 82.1% of pharmacy faculty reported regularly interacting with older adults and 67% said that primarily occurred at work; yet only 37.5% had taken a class or course in geriatrics. Among pharmacy students, 71.4% interacted regularly with older adults with 41.4% saying this occurred primarily at work. Differences were noted in student education with 50% of pharmacy and 86.9% of physical therapy students having taken a geriatric course. Analysis and conclusions interpret the impact of ageism and emphasize a need for education to address age-related disparities and potential for bias in healthcare.
UNMET NEEDS OF OLDER FEMALE VETERANS AND GENDER DIFFERENCES USING THE PROSPECTIVE HERO CARE SURVEY DATA
Authors: Dang Stuti , Tyagi Pranjal , Garcia Sandra , Bouldin Erin , Trivedi Ranak , Intrator Orna , Pugh Mary Jo , Leykum Luci
Published: December 2023

Aging female Veterans face unique healthcare needs which are yet to be well-described. We analyzed round one data from HERO CARE, a prospective survey, to describe the medical, psychological, and social unmet needs of female Veterans and compare them with those of male Veterans. We received survey responses from 8,056 community-dwelling Veterans (227 (2.8%) females and 7,829 (97.2%) males) from San Antonio, Palo Alto, Miami, Salt Lake City Veterans Affairs (VA) Medical Centers, and Veteran Integrated Service Network 8 in July 2021. We compared difference in needs between the female and male respondents using chi-square tests and difference in age in years using t-tests. Respondents were classified as having an unmet need if they responded that they needed “a little” or “a lot more help” for specific needs. Female respondents were 74.3 (SD: 14.5) years-old on average, and 7.9% Hispanic, 15.4% non-Hispanic Black, 72.7% non-Hispanic White. Male respondents were older 80.3 (SD: 9.8) years-old on average (p< 0.01), with no significant difference in race/ethnicity. Female Veterans reported unmet needs in ADLs (14.1%), IADLs (40.1%), nursing tasks (7.1%), pain management (17.6%), communicating with the healthcare team (10.6%), and social needs like legal or housing (16.3%). All unmet needs were like those of male Veterans (all p>0.05). Among female Veterans, 20.1% screened positive for anxiety (GAD-2 score >2) and 22.8% for depression (PHQ-2 score >2), compared to male Veterans: 15.2% (p< 0.01) and 21.6% (p=0.41), respectively. Routine assessment of aging female Veterans, specifically focusing on mental health and IADLs, may better address their needs.
UNVEILING THE COMPLEX REALITIES: UNDERSTANDING SLEEP AND FATIGUE CHARACTERISTICS OF END-OF-LIFE CAREGIVERS
Authors: Park Hyeyoung , Lee Sunghoon , Bailey Amelia , Liu Yunda , Jacelon Cynthia
Published: December 2023

This mixed methods multi-case study explores sleep and fatigue characteristics among end-of-life caregivers. The research sample encompasses cases aiding individuals with advanced (n=4) and chronic illnesses (n=1), including various caregiver demographics such as gender, age groups (19-64 and 65+), and health conditions. Data collection involves comprehensive surveys capturing demographics, care recipient symptom intensity, caregiver depressive symptoms, caregiving stress, caregiver sleep quality, and caregiver fatigue level. The study integrates data from a 30-day Personal Sleep Monitoring Device (PSMD) and a 14-day sleep journal, enriched by insights from semi-structured interviews and field notes. The outcomes indicate a PSQI (Pittsburgh Sleep Quality Index) score of 6.1, accompanied by 7.44 hours of sleep recorded by the PSMD. There were approximately 20.5 nocturnal awakenings within 30 days, with average fatigue at 55.28 and daily fatigue at 49.66. Objective sleep outcomes were consistent among caregivers, while their own sleep ratings ranged from “Fairly Bad” to “Very Good.” Themes for each case were formulated to delve into the context of these sleep and fatigue characteristics. These themes encompass adaptive leadership, linchpin roles, emotional labor management, self-reliance, and vigilance. A prevailing overarching theme is the perception of “Not having control.” A significant finding underscores the dynamic influence of care recipients’ daily statuses on caregivers’ sleep quality and fatigue levels, leading to unpredictable outcomes. This study offers profound insights into end-of-life caregivers’ intricate journeys, highlighting individual differences and the dynamic nature of caregiving roles, while recognizing the importance of tailored interventions for enhancing caregiver’s well-being and caregiving effectiveness.
USING MULTI-LEVEL MODELING TO EXAMINE RACIAL DISPARITIES IN PALLIATIVE CARE AMONG OLDER ADULTS WITH HEART FAILURE
Authors: Han Ling , Abel Erica , Zhan Yan , Akgün Kathleen , Feder Shelli
Published: December 2023

Studies have found persistent disparities in guideline-concordant cares for heart failure among patients who self-identify as Black. We investigated how the guideline-concordant specialist palliative care (SPC) varied with race among older adults with advanced heart failure (AHF). We identified 16,464 older adults aged ≥65y (median: 74y) with AHF by ICD-9/10 codes seen between 1/1/2018-7/1/2020 in 83 Veterans Affairs Medical Centers (VAMC). In conventional logistic regression without accounting for between-VAMC variation, Black (28%) race was less likely to receive SPC services than White (70%) race [adjusted odds ratio (aOR) of 0.91 (95% Confidence Intervals (CI): 0.84,0.99); predicted probability: 27.6% vs. 29.5%], independent of age, sex and comorbidity. This association diminished to null [aOR: 0.99 (95% CI: 0.90,1.08)] after adding a random intercept for VAMCs (multi-level model (MLM)). Expanding the MLM with specific VAMC characteristics (SPC team staffing (p< 0.05), facility complexity and urbanicity) as fixed effects improved overall model fit (area under ROC: 0.68 vs 0.61, p< 0.05), and accounted for 17% of the VAMC-level variance (intraclass correlation coefficient: 0.069 vs 0.083). There were no cross-level interactions between race and VAMC characteristics. These findings suggest that variation in the individual probability of receiving SPC between Black and White race in this older AHF cohort may be partially explained by between-VAMC differences in SPC staffing and other facility characteristics. To promote equitable access to SPC for older adults with AHF, further research is needed to examine service delivery characteristics and broader contextual determinants of health, such as area socioeconomic disparity of healthcare facilities
UTILIZING VALID, RELIABLE, AND PRACTICAL MEASURES OF HEALTH STATUS IN PRIMARY GERIATRIC CARE: TRANSLATING RESEARCH INTO USUAL CARE WITH THE SENIOR’S HEALTH ASSESSMENT REPORT AND PLAN (SHARP™)
Authors: Rosenberg Ted
Published: December 2023

Introduction

To better support evidenced-based care, we combined 9 valid, reliable, and clinically useful tests into a single health status and risk assessment tool, performed by a Team nurse, called the Seniors Health Assessment, Report and Plan (SHARP™). These tests include: CFS, EQ5D-5L, EQ-VAS, MoCA, GDS, Months of the Year Backwards, Gait Speed, Grip Strength, Water Swallow Test, and MNA-6. A published study, with 18 months of follow-up for a primary geriatric home-based practice demonstrated that these tests were stronger predictors of death, nursing home transfer (NHT), or hospital admission(HA) compared to any medical diagnosis, multiple comorbidities, or polypharmacy. Hazard Ratios for SHARP™ vs medical diagnoses were: Death (median HR 5.9 vs. 1.6), NHT (median HR 4.6 vs.1.4), and HA (median HR 6.0 vs. 1.6). The research presented here will provide several case-based studies to demonstrate how we have translated this research into “usual care” for a primary home-based interdisciplinary geriatric medical practice. Specifically, we will demonstrate how we: 1. share this data with patients and caregivers to motivate them for Team interventions, 2. share a summary report of an individual’s health with the hospital and other community care providers, 3. use these tests to guide and evaluate Team interventions for individual patients (e.g. changes in gait speed), 4. Track changes in health status and risk, and 5. use aggregated data at a program level for benchmarking, defining population needs, and for planning and evaluation.

Conclusions

Standardized testing is acceptable to patients, efficient, supports evidenced-based care, and is useful for program planning and evaluation.
WHAT DO NURSING HOMES RECEIVING HIGH COMPLAINTS GOT TO DO WITH RESIDENTS’ QUALITY OF LIFE?
Authors: Kwon Jenny , Qiu Xiao
Published: December 2023

Residents’ quality of life is important to understand nursing home (NH) quality. Official complaints are another NH quality indicator. However, little research has examined the two quality measures together. To fill this gap, this study aims to investigate the association between resident satisfaction and NH complaints. 2018–2019 complaints data from the Ohio Department of Health, 2017 Ohio Biennial Survey of Long-Term Care Facilities, and 2017 Ohio Nursing Home Resident Satisfaction Survey were merged (N=629). Eight outcome variables were used: overall resident satisfaction score and seven individual domain scores. They range from 0 (low) to 100 (high). For independent variables, we labeled NHs received 6 or more complaints per 100 residents in both 2018 and 2019 as ‘high complaint repeaters.’ Multiple linear regression was conducted. There is a statistically significant relationship between official complaints and resident satisfaction. High complaint repeaters had lower overall satisfaction score by 1.48 (p < .01); lower moving in score by 2.16 (p < .01); lower spending time score by 1.30 (p < .05); lower caregivers score by 1.20 (p < .05); lower meals and dining score by 2.18 (p < .05); lower environment score by 1.13 (p < .05); and lower facility culture score by 2.14 (p < .01) than non-high complaint repeaters. However, there is no association between complaints and care and services domain score. State policy makers need to consistently monitor high complaint repeaters and support them to reduce complaints. Also, providers should allocate resources and design strategies to improve residents’ experiences.
WHO’S ON YOUR TEAM? DEMENTIA FAMILY NETWORKS AND CAREGIVER WELL-BEING
Authors: Leggett Amanda , Haldar Srabani , Tsuker Sophia , Choi HwaJung
Published: December 2023

While caregivers are typically enmeshed in broad networks of family and friends assisting with care, this network is largely neglected, in favor of examining a “primary” caregiver. This study examines types of family/unpaid friend networks for persons living with dementia and how one’s network type relates to caregiver well-being. Data are drawn from the nationally representative 2017 National Health and Aging Trends Study and associated National Study of Caregiving. The sample includes 336 dementia care networks (Network size mean=2.9). We first identified network types using Latent Class Analysis and then examined the extent to which network type is associated with outcomes of caregiver well-being (emotional difficulty, overload) and support (social/care-related support from family and friends) using ANOVA and linear regressions adjusting for caregiver demographics. The three network types identified were: “Specialists”- small networks with little task sharing between members (29.8% of networks), “Small but mighty”- small networks with high task sharing (23.0% of networks), and “Sharers”- large networks with diverse membership and members who share and who specialize in task assistance (47.2%). “Small but mighty” network membership was associated with significantly greater emotional difficulty of caregiving (F=4.0, p<.05) and marginally greater overload (F=2.8, p=.06) than “Specialist” and “Sharer” membership. However, in regressions, only social support significantly differed, with “Sharers” (B=-0.1, p<.01) and “Small but mighty” (B=-.2, p<.05) networks receiving significantly more support than “Specialists”. Networks with more task sharing may require more social support, yet smaller network size, while carrying complex caregiving responsibilities, may take a greater emotional toll.
CONTEXTUALIZING ATTITUDES TOWARD MEDICAL AID IN DYING IN A NATIONAL SAMPLE OF HOSPICE CLINICIANS
Authors: Becker Todd , Cagle John , Davitt Joan , Sacco Paul , Kusmaul Nancy , Cain Cindy
Published: December 2023

Research on the contextual characteristics informing the care that hospice professionals offer patients interested in medical aid in dying (MAID) is lacking. Thus, we aimed to explore MAID attitudes vis-à-vis hospice values and state law. This cross-sectional study recruited a convenience sample of 450 hospice-based physicians, nurses, social workers, and chaplains from national hospice and palliative care membership associations. Controlling for covariates, we fit a partial proportional odds model with clustered standard errors to examine the associations between participants’ professional experience working in a MAID-legal state, orientation toward patient-centered care, and commitment to the hospice philosophy of care, and their MAID attitudes (0 = “oppose,” 1 = “neither support nor oppose,” 2 = “support”). Results indicated that experience working in MAID-legal states (vs. not; OR = 2.42, p = .002) and increased orientation toward patient-centered care (OR = 1.38, p < .001) were significantly associated with higher odds of greater MAID support across thresholds. Conversely, the direction and statistical significance of commitment to the hospice philosophy of care depended on the threshold of the dependent variable (odds of MAID support higher than “oppose”: OR = 0.98, p = .326; odds of MAID support higher than “neither support nor oppose”: OR = 1.05, p = .043). Findings provide the first quantitative evaluation of a predominantly theoretical debate concerning perceptions of MAID’s concordance with hospice values. Noting legal protections for conscientious objection, higher support from clinicians in states where MAID is legal may suggest training opportunities as levers to improve patient access.
ENABLING AGING IN PLACE: THE IMPACT OF HOME MODIFICATIONS ON NURSING HOME ADMISSION RISK
Authors: Levchenko Yuliana
Published: December 2023

In an era where the built environment profoundly shapes the ability to age in place, this study aims to investigate the relationship between home modifications and the risk of nursing home admission. Using data from the 2000-2018 Health and Retirement Study, Cox proportional hazard models are employed to analyze the impact of various modifications on admission risk for older adults in the United States (N = 31,133). The home modifications considered include the presence of ramps, railings, wheelchair modifications, grab bars/shower seats, and an emergency call system. The results indicate that having a grab bar/shower seat in one’s home is consistently associated with a decreased risk of nursing home admission (HR = 0.42, CI = 0.34, 0.52). However, there is mixed evidence for the remaining modification. These findings underscore the potential significance of incorporating grab bars and shower seats into building codes and promoting their installation in homes. Such modifications may play a vital role in promoting independent living and reducing reliance on institutional care. Further research is needed to explore the underlying mechanisms by which home modifications influence the risk of nursing home admission.
SOCIALIZING CARE FOR OLDER PEOPLE ACROSS THE COUNTRIES: A COMPARATIVE STUDY OF THE LOCATION OF CARE
Authors: Jang Aeji , Lee Yeonjung , Choi Young
Published: December 2023

As more people are likely to prefer to age in their own place, where and how the care in later life is provided become more important. This paper aims to compare the degree of socialization in care for older people among different countries, especially focusing on the location of care (i.e., home care and institutional care). We applied the Fuzzy-set Ideal Type Analysis to classify the countries depending on how the formal care is provided between home and institutional settings. Measures of socialization in home care include the national expenditure on home care and the number of formal care workers at home, whereas formal care workers and the number of beds in residential LTC facilities are indicators for socialization in institutional care. The four different types of formal care will be classified: HI where both home and institutional cares are highly socialized; Hi where home care is highly socialized but institutional care is not; hI where institutional care is highly socialized but not home care; and hi where neither are socialized. Results show that Denmark, Australia, and the Netherlands belongs to HI; Japan to Hi, New Zealand, Switzerland, and Germany to hI; and Korea and the United States to hi. Findings suggest that countries with high level of socialization of home care are likely to have a care management system for coordinating and monitoring services. This study provides implications for considering the unique cultural, institutional, and policy contexts among the countries in regards to the degree of socialization of care.
MUSIC CREATIVITY INTERVENTION FOR OLDER ADULTS WITH AND WITHOUT MCI: COGNITIVE BENEFITS AND NEURAL MECHANISMS
Authors: Fagundes Christopher , Wu-Chung Lydia , Brandt Anthony , Bonomo Melia , Denny Bryan , Frazier Jefferson , Blench Karl
Published: December 2023

Alzheimer’s and related dementias are debilitating conditions, and at this time, no cure has been identified. Older age is associated with cognitive decline and dementia. Developing and testing innovative non-pharmacological interventions to delay the loss of functional ability and understand the neurobiological mechanisms underlying the intervention’s efficacy is imperative. We conducted a semi-randomized clinical trial evaluating the effects of a novel music creativity curriculum on cognitive and neurological outcomes. Eighty older adults with and without a mild cognitive impairment (MCI) diagnosis were randomized to a 6-week music creativity intervention or a 6-week no-treatment control condition. Before and after the six weeks, both groups participated in a series of self-report and cognitive assessments; they also participated in resting-state fMRI scans to quantify whole-brain network patterns of modularity and flexibility. Those randomized to the music group exhibited improved overall cognitive function and working memory relative to the control group (assessed using standard clinical neuropsychological assessments). The association between being randomized to the music group and increased cognitive function was more robust among those who exhibited greater neural flexibility at baseline. The study shows that music creativity interventions may positively affect cognition, especially among those whose neural network structure is more dynamic or flexible. This study is innovative as it is among the first to identify possible neural mechanisms underlying why music creativity interventions confer a more significant cognitive benefit for some older adults than others.
CONTEXTUALIZING HOW DAILY DISCRIMINATION EXPERIENCES IMPACT EVERYDAY METAMEMORY
Authors: Ly Timothy , Allen Rebecca , Cundiff Jeanne , DeCaro Jason
Published: December 2023

Examining day-to-day responses to everyday stressors, such as discrimination, contextualizes how cognitive aging trajectories may vary across the lifespan. Furthermore, recent research investigating stress-induced impairment of metamemory may address the relationship between discrimination experiences and cognitive impairment. This study sought to articulate the association between daily experiences of discrimination and impaired metamemory across the lifespan, as defined by the number of subjective cognitive complaints, using data collected from the Midlife in the United States Refresher Study Daily Diary Project (N = 782; ages 20-75; M = 47.91 years, SD = 12.67 years). A two-level linear mixed model was conducted to examine the within and between-persons relationships concerning lifetime and daily experiences of discrimination, daily affect balance, baseline objective cognitive performance, and sociodemographic variables (age, race, ethnicity, and sex) on impaired everyday metamemory. Results from linear mixed model analyses showed significant within-person fixed effects of daily discrimination and daily affect balance on metamemory accuracy, as well as significant between-persons fixed effects of race and ethnicity on metamemory accuracy. Furthermore, significant interactions were found between race and daily discrimination experiences, ethnicity and daily discrimination experiences, daily affect balance and daily discrimination experiences, daily affect balance and age, and endorsement of lifetime experiences of discrimination and daily discrimination experiences on day-to-day metamemory accuracy. These findings extend our understanding of how discrimination experiences may impair metacognitive processes and demonstrate the need for more research into understanding metamemory accuracy as an underlying mechanism by which the psychosocial stressor of discrimination impacts cognition across the lifespan.
DO DEPRESSIVE SYMPTOMS MEDIATE SEGREGATION’S IMPACT ON COGNITIVE AGING IN OLDER MEXICAN AMERICANS?
Authors: Morris Emily , Grant Jeremy , Clark Alexandra , Esiaka Darlingtina , Ajrouch Kristine , Tarraf Wassim
Published: December 2023

Segregation in the United States has important implications for cognitive aging among Mexican Americans as a social determinant of health. Because segregation is systemically engrained, identifying more immediately modifiable mechanisms, such as depressive symptoms, that may underly segregation-cognition associations could point to intervention targets to reduce cognitive aging disparities. We used path mediation modeling to test whether depressive symptoms mediated (indirect effect) the segregation-cognition associations. We used H-EPESE data on older Mexican Americans from the first (n=3,050) wave and returning at wave 5 (n=1,167) combined with Census data from the National Neighborhood Data Archive, which provided indicators for county level segregation (isolation, interaction, dissimilarity). Cognition was operationalized as baseline MMSE, MMSE at wave 5, and change between baseline and wave 5. Depressive symptoms were measured by the CESD at baseline. Covariates included age, sex, and years of education. The sample was 58% female with an average age of 73.6 (SD=6.2) and an average 5-years education (SD=3.9). Higher dissimilarity (i.e., less exposure to non-Hispanic Whites) was associated with better baseline (B=.078, SE=.031, p=.012) and wave 5 cognition (B=.130, SE=.037, p<.001), independent of depressive symptoms. More depressive symptoms were associated with worse baseline and wave 5 cognition, independent of segregation indices (CESD B values range from -.063 to -.142, ps <.05). Depressive symptoms did not mediate segregation-cognition associations. Results suggest that there may be an enclave effect that is protective for both depressive symptoms and cognition in older Mexican Americans. Future research should examine additional biopsychosocial mechanisms underlying segregation-cognition associations.
TECHNOLOGY-SPECIFIC AGEISM AS A PREDICTOR OF NOT OFFERING TECHNOLOGY-BASED PHYSIOTHERAPY FOR OLDER ADULTS
Authors: Mannheim Ittay , Neiertz Cynthia , Wouters Eveline
Published: December 2023

Incorporating digital technologies in healthcare can potentially improve the quality and accessibility of older persons’ care. However, ageist attitudes among healthcare professionals can lead to discrimination in treatment decisions and deprive older patients of technology-based treatment. This study explores whether technology-specific ageism influenced physiotherapists’ decisions to use technology-based healthcare with older patients. Seventy-eight physiotherapists in Luxembourg filled out an online survey. Technology-specific ageism was measured by the Attitudes Towards Older Adults Using Technology (ATOAUT-11) scale. Additional measures included the Expectations Regarding Aging scale, attitudes towards technology use in the work environment, and whether physiotherapists had not offered technology-based treatment in the past because of a patient’s age. Thirty-one percent of the participants reported that they had not offered technology-based treatment to a patient in the past because of the patient’s older age. Importantly, using logistic regression, it was found that higher levels of technology-specific ageism predicted not offering technology-based treatment, such that participants with more negative attitudes (1 standard deviation) were two times more likely not to offer treatment. Positive attitudes toward using technology in the work environment were also found to be a significant predictor. All other characteristics (gender, age, work experience, and percentage of patients over 50) did not predict not offering treatment. This study provides initial evidence that technology-specific ageism may lead to discrimination and deprive older persons of receiving optimal treatment. More research is needed to identify the magnitude of ageism in using technology-based treatment in healthcare and develop interventions to mitigate it.
METABOLOMIC PROFILES OF DEMENTIA RISK AND MOBILITY DECLINE IN A BIRACIAL COHORT OF OLDER ADULTS
Authors: Tian Qu , Yao Shanshan , Ferrucci Luigi , Murthy Venkatesh , Shah Ravi , Newman Anne
Published: December 2023

Age-related mobility decline precedes future cognitive impairment and dementia. Blood biomarkers underlying this connection are less clear. This study aims to examine metabolomic profiles of dementia risk and mobility decline in the Health, Aging and Body Composition Study. Dementia diagnosis was determined by race-specific decline in Modified Mini-Mental State Examination scores, medication use, and hospital records. 2450 participants were free of dementia at year 2 and had 613 targeted plasma metabolites. 534(22%) developed dementia during a mean follow-up of 9.3(SD=4.1) years. 2028 participants had repeated 20-meter usual gait speed up to 10 years follow-up. We performed Cox regression and linear regression with LASSO models to determine which metabolites would predict dementia risk and gait speed decline, respectively. After adjustment for age, sex, race, and education, 30 metabolites were significant predictors of incident dementia. Top-ranked metabolites included glyceric acid, niacinamide, androsterone 3- glucuronide, phosphatidylcholine (P-34:4)/PC(O-34:5), aminobutyric acid, xanthine, sphingomyelin (d18:1/14:0) (hazard ratios< 1), suberic acid, lysophosphatidylethanolamine (18:1), threitol, and andrenic acid (hazard ratios>1). These metabolites were enriched in arginine biosynthesis, alanine, aspartate and glutamate metabolism, glyoxylate and dicarboxylate metabolism and arginine and proline metabolism(p< 0.05). Of these metabolites, threitol, sphingomyelin (d18:1/14:0), adrenic acid, and phosphatidylethanolamine (P-36:0)/PE(O-36:1) were also significant predictors of mobility decline in a consistent direction. This longitudinal study reveals unique and shared metabolomic risk profiles for dementia and mobility decline. Several metabolites in amino-acid pathways and urea may be important in the development of dementia and certain sugar and lipids with long-chain and very long-chain fatty acids also predict mobility decline.
EXPERIENCES OF VETERANS, CAREGIVERS, AND VA HOME-BASED CARE PROVIDERS POST-HURRICANE IAN
Authors: Haverhals Leah , Manheim Chelsea , Hernandez-Lujan Deisy
Published: December 2023

On September 28, 2022, Hurricane Ian pummeled parts of south Florida. Disaster and climate change research has shown that disasters exacerbate inequalities, especially amongst older and physically vulnerable people. Florida has a large population of Veterans managing multiple chronic health conditions and receiving long-term services and supports in-home. Many such Veterans receive care from the Veterans Health Administration (VA) Home Based Primary Care (HBPC) or Medical Foster Home (MFH) programs. To describe how VA staff provided high quality care during and post-hurricane, and how Veterans and caregivers accessed needed healthcare and supports post-hurricane, we conducted a site visit to the Fort Myers, Florida area in May 2023. We conducted N=25 in-person interviews with VA HBPC and MFH staff, Veterans, and family and VA MFH caregivers. Findings from qualitative thematic analysis showed that Veterans and caregivers felt highly supported by VA care teams who made proactive changes in the days prior to and the months post-hurricane. Staff efforts post-hurricane focused on improving care coordination in anticipation of future disasters, especially around communicating with Veterans and their caregivers, and a VA workgroup formed to implement changes. Some Veterans and caregivers experienced significant challenges during and post-hurricane, with a few displaced and having to relocate, and others having difficulty accessing needed oxygen and suffering injuries related to the hurricane. As climate change causes more severe natural hazard events, lessons learned from this project can inform how to better support healthcare staff, older adults, and their caregivers pre-and post-major disasters.
ENHANCED SUPPORT FOR CHINESE AND KOREAN AMERICAN DEMENTIA CAREGIVERS: INSIGHT FROM SERVICE PROVIDERS
Authors: Wang Jing , Johnson Min Kyoung , Leong I tek , Pei Yaolin , Mittelman Mary , Epstein Cynthia , Lee Kyung Hee , Wu Bei
Published: December 2023

As members of two large Asian immigrant populations in the U.S., Korean and Chinese American family caregivers of persons with dementia (PWD) have unique challenges impacted by their cultural background. Many of them prefer to and are relying on social services providers who speak the same language as they do for support and assistance. As part of the project to inform the cultural adaptation of NYU Caregiver Intervention-Enhanced Support (NYUCI-ES) program for Chinese and Korean American caregivers with multiple chronic conditions, we explored the perspectives of 13 Chinese and 12 Korean services providers (physicians and social service staff). During focus group discussions, services providers shared their perspectives on care challenges facing these populations, including challenges in initiating advanced care planning, family conflict in decision making and caregiving, insufficient community resources, staffing shortage associated with the pandemic and some care aides’ stigmatic beliefs about providing dementia care. We identified nuances in the following aspects: utilization of home health aides’ help, attitudes towards diagnosis and education, approaches to selfcare, preferences for engagement settings, trust-building, and family involvement. For instance, Korean services providers highlighted Korean caregivers’ strong preference for home health aides of the same gender as PWD and having individual rather than group session to learn about dementia. What we found from services providers largely echoed our findings from family caregivers but also provided unique insights from their work experiences. These findings will inform cultural adaptation of the content of the NYUCI to improve its applicability to Chinese and Korean American caregivers.
POSITIVE EMOTION LANGUAGE PREDICTS IMPROVING DEPRESSION TRAJECTORIES AFTER DEMENTIA CAREGIVING ENDS
Authors: Wells Jenna , Scheffer Julian , Shdo Suzanne , Yee Claire , Possin Katherine , Levenson Robert
Published: December 2023

There are striking differences among caregivers of people with dementia (PWDs) in how their health and well-being changes during active caregiving; however, less is known about these differences after caregiving has ended. One important factor influencing caregiver health is the emotional quality of the caregiver-PWD relationship. The present study evaluated caregivers’ emotional connection to the PWD (during caregiving) and associations with caregivers’ depression both concurrently (N = 326 active caregivers) and longitudinally (n = 91 former caregivers). Active caregivers described a recent time they felt connected to the PWD, and their responses were transcribed verbatim. Caregivers’ emotional connection to the PWD was operationalized by summing the number of positive and negative emotion words from the transcripts using text analysis software and dividing each figure by the total number of words in the response. Results indicated that neither positive nor negative emotional language was significantly correlated with caregivers’ concurrent depression. However, two-wave latent change score modeling revealed that caregivers’ greater positive emotional language (adjusting for caregivers’ baseline depression and negative emotional language) predicted steeper declines in depression (i.e., improvements in depression trajectories) after the death of the PWD (ß = -.11, SE(ß) = 0.04, p = .033). Negative emotional language was not significantly associated with changes in caregivers’ depression. This finding highlights positive emotion expressed by caregivers when describing their connection with the PWD as a potential resilience factor and underscores the important role that positive emotional qualities of the caregiving relationship play in improving caregivers’ mental health after caregiving ends.
SOCIAL PARTICIPATION AND DEPRESSIVE SYMPTOMS ON THE RELATIONSHIP BETWEEN COGNITIVE FRAILTY AND DISABILITY
Authors: Ning Hongting , Feng Hui , LI Junxin , Li Mengchi
Published: December 2023

To explore the multiple mediating effects of social participation and depressive symptoms on the relationship between cognitive frailty and functional disability. A total of 6122 participants from four waves of the China Health and Retirement Longitudinal Study (CHARLS) were included. Functional status was assessed by activities of daily living (ADL) and instrumental ADL (IADL). Analyses were restricted to middle-aged and older adults free of functional disability at baseline. Competing-risks regression and multiple mediation effects analysis adjusted for covariates were conducted. Cognitive frailty (hazard ratio [HR] 1.27, 95% confidence interval [CI] 1.09, 1.48), social participation (HR 0.87, 95%CI 0.79, 0.97), and depressive symptoms (HR 1.75, 95%CI 1.56, 1.95) were associated with the incidence of ADL disability. These factors were also found to predict the occurrence of IADL disability. Cognitive frailty was found to be associated with ADL disability, not only through the pathways of social participation (β = 0.009, 95% CI 0.001, 0.018) and depressive symptoms (β = 0.094, 95% CI 0.062, 0.131) separately, but also through social participation and depressive symptoms sequentially (β = 0.002, 95% CI 0.001, 0.003). Similar findings were also observed for the outcome of IADL disability. Cognitive frailty has been associated with functional disability, wherein social participation and depressive symptoms partially mediate the association. To prevent functional disability, it’s suggested to implement integrated and comprehensive intervention measures, including preventing and managing cognitive frailty, promoting social participation, and improving depressive symptoms.
THE IMPACT OF INFORMAL CARE ON FORMAL CARE UTILIZATION AMONG ELDERLY AMERICANS
Authors: Ke Yemiao , Zhang Yun
Published: December 2023

Objectives

This research aims (1) to examines the impact of informal care on the utilization of formal care among elderly Americans, and (2) to investigate how probable dementia affect this relationship.

Method

Using cross-sectional data from the National Health and Aging Trends Study (NHATS 2011 & 2015), we build a correlated Tobit model to analyze the quantity of informal and formal care received by elderly individuals, which not only handles the censored nature of the dependent variables, but also allows a more flexible error structure. To address endogeneity concerns, instrumental variables derived from the characteristics of the elderly’s children are incorporated.

Result

Participants who did not live in long-term care facilities (N = 7,090) were included. Our estimation results indicate that when monthly hours of informal care received are below 83 hours, the monthly hours of formal care decrease with an increase in informal care. Conversely, when monthly hours of informal care received exceed 83 hours, the monthly hours of formal care increase with additional informal care. Probable dementia increases the monthly hours of informal care by 31.2 hours and the monthly hours of formal care by 6.4 hours.

Conclusion

Informal care substitutes for formal care when elderly individuals require only a low to moderate level of informal care. However, informal and formal care become complementary when the elderly requires more intensive care. Probable dementia has a significant impact on both informal care and formal care.
CARDIOVASCULAR AND MORTALITY RISK WITH COEXISTING HYPERTENSION, DYSLIPIDEMIA AND SYSTEMIC INFLAMMATION
Authors: Karadimas Thomas , Meier Helen
Published: December 2023

Hypertension and dyslipidemia are established risk factors for cardiovascular disease (CVD), but are often insufficient alone in predicting CVD. Inflammation also contributes to CVD, but research on the co-occurrence of inflammation, hypertension, and dyslipidemia and CVD risk is limited. Prospective data from the Health and Retirement Study, a representative cohort of US adults over 50 years of age (n = 1,527) were used. Hypertension, dyslipidemia, and elevated C-reactive protein (CRP) were used to create a CVD risk: low (0-1 factors), medium (2 factors), or high (all 3 factors). Weighted logistic regression models estimated the odds ratio (OR) of 1) prevalent and incident CVD for medium and high-risk groups versus the low-risk group and 2) 4-year mortality adjusting for covariates. Cross-sectionally, high-risk participants had significantly higher odds of CVD prevalence compared to participants with low-risk (adjusted OR = 1.68, 95% CI: [1.12 - 2.53]). Prospectively, medium and high-risk participants had higher odds of 4-year CVD incidence (medium: OR = 1.41, 95% CI: [0.71 - 2.79]; high OR = 2.05, 95% CI: [0.93 - 4.53]) compared to those with low-risk, but not statistically significant. Risk of 4-year mortality was higher in both medium (OR = 2.00 95% CI: [1.21 - 3.30]) and high-risk (OR = 2.11 95% CI: [1.15 - 3.86]) participants vs. low-risk. Co-occurrence of hypertension, dyslipidemia, and elevated CRP was associated with CVD prevalence and 4-year mortality in older US adults, emphasizing the importance of multifactor screening for CVD risk.