bluuebunny/crossref_metadata_2025 huggingface dataset:
Adapting Nutrition Programming for Intergenerational Implementation
Authors: Jarrott Shannon , Scrivano Rachel , Naar Jill Juris , Bunger Alicia
Published: December 2021

Practitioners frequently tailor programming to meet participant characteristics and logistic constraints, or to incorporate diverse participants, such as intergenerational programming. Adapted programming may be responsive but reduce impact on outcomes. With growing interest in and limited availability of intergenerational protocol, implementation science guides program tailoring to ensure that youth and older adults mutually benefit from adapted programming. We integrated guidelines for tailoring interventions (Framework for Reporting Adaptations and Modifications-Expanded: FRAME) and evidence-based intergenerational practice. We illustrate how program fidelity can be supported in intergenerational settings using examples from an adapted USDA-approved preschool nutrition curriculum delivered intergenerationally. Program acceptability, appropriateness, and feasibility were rated favorably by program stakeholders, and observational implementation data suggest fidelity can be maintained using evidence-based intergenerational strategies. Our findings support the potential for protocol developed for one age group to benefit youth and older adults when it is adapted using implementation and intergenerational guidelines.
Detroit Needs Assessment Study: A Community Academic Partnership With the Detroit Area Agency on Aging
Authors: Hopp Faith , Keys Fay , Chapleski Elizabeth , La Wicker Cheryl , Rencher Patricia , Thomas Shirley , Davis Anne , Taylor Ronald
Published: December 2021

This presentation discusses a comprehensive needs assessment to inform long-term strategic planning for the Detroit Area Agency on Aging. The goal was to provide in-depth input from the older population (age 60+) and key agency stakeholders, using surveys (413 community participants), listening sessions (132 participants), 23 interviews with homebound older adults, and online surveys (94) targeting medical, church, government, academic, media and HSO stakeholders. Findings indicate that many participants were not aware of available community services. For example, one-third (33.3%) had not heard of Medicaid waivers providing services outside of nursing homes, while nearly one in five (22.0%) had not heard about senior employment services. The most common areas of unmet need were for caregiver workshops (16.3%) and diabetes management classes (15.7%). Community services most often noted as ‘extremely important’ included health and wellness programs (68.8%), services to help access health and supportive services (71%), easy to find service information (67.7%), home care and housekeeping services (66.4%), and caregiver support (63.7%). Stakeholder findings provide insight regarding this lack of awareness. Asked “How familiar do you think the general public is with DAAA?” , 10.8% answered ‘very familiar’ and 33% ‘unfamiliar’. Findings related to an “Age-Friendly City” suggest the importance of access to supportive community services, transportation, safety, housing, and healthcare. Engagement of older adults in needs assessments plays a vital role in Area Agencies on Aging meeting the needs of emerging aging cohorts by developing ‘age friendly’ strategies to address increasing racial, ethnic, socioeconomic, and cultural diversity.
Corporate Policy, Male Breadwinners, and Their Family Care in Aging Japan
Authors: Costantini Hiroko , Roberts Glenda
Published: December 2021

A rapidly emerging set of carers are men who combine care for older relatives with employment. In Japan, a 2015 government initiative aimed at reforming work to make employment and care compatible by 2020 failed to reduce the approximately 100,000 annually quitting employment mainly due to care for older relatives. This paper aims to evaluate the initiative’s limited impact through a multilevel understanding of the roll-out of the family care policy. Stakeholder views, based on 32 interviews including with employers, the Japanese Business Federation, local care providers and NPOs, are juxtaposed with the perspectives of employed male family carers drawn from 37 qualitative in-depth narrative interviews complemented by participant observation in the Tokyo area in 2019. The ethnographic fieldwork evidences informants’ diverse engagement with care for older relatives underpinned by strongly held cultural views of care provision being a ‘private’ issue, which contrasts with government attempts to make family care a ‘social’ issue by broadening stakeholder participation. Further, corporates tend to have tacit reluctance to transform working practices to accommodate care. Thus, employed men’s devotion to work competes with the culturally embedded notion that carers should be committed to care provision. In conclusion, such a disjuncture is a major factor in the government initiative’s failure. Although cultural values and meanings in policy evaluation theories are often neglected, this research points to the significance of ongoing (re)construction of the socio-cultural notions congruent with social policy enablement.
Doing Everything: Intersections of Gender and Sexual Orientation in Caregiving for a Spouse With Dementia
Authors: Calasanti Toni , de Vries Brian
Published: December 2021

Gender inequalities are rooted in and drive the division of labor over the life course, which result in heterosexual men and women acquiring different resources, skills, and identities. Gendered differences in caregiving reflect these varying gender repertoires. Whether and how these repertoires vary by sexual orientation is lesser understood. Our qualitative study seeks to explore the ways that sexual orientation and gender, and the related division of both paid and unpaid labor, shapes caregiving for a spouse or partner with Alzheimer’s disease and related disorders (AD). Our data, obtained from in-depth interviews conducted among lesbian (n=9), gay (n=6), and heterosexual spousal and partner (23 women and 14 men) caregivers of those with AD, reveal that, although all the caregivers spoke about “having to do everything,” with a particular focus on decision-making, they interpret this experience differently based on the intersections of gender and sexuality. The heterosexual women reported they were used to managing daily household life, yet they described having to make decisions as quite stressful: “I don’t like to be the boss.” Heterosexual husbands also lamented that they “had to do everything,” but commenting that they hadn’t realized what it took to “manage a household.” The concerns reported by lesbian and gay spouses and partners were similarly situated but more varied, as each group tended to report their previous divisions of labor as “less well-defined.” Our findings reflect both the influence of gender inequalities on how respondents experience “doing everything,” and their potential modification in same-sex relationships.
Perceived Control and ICD Concerns in Older ICD Recipients: Sex as a Moderator
Authors: Latimer Abigail , Miller Jennifer , Chung Misook Lee , Hammash Muna , Moser Debra
Published: December 2021

Implantable cardioverter defibrillators (ICDs) reduce the risk of sudden cardiac death for those with a history of or high risk for lethal arrhythmias. In 2016, 105,000 ICDs were implanted in older adults (age ≥ 60) in the US. Approximately 25% of ICD recipients report significant ICD concerns with women reporting higher levels than men. Little is known about the experience of older adults living with life-saving/extending medical technologies, particularly related to sex differences in ICD concerns. Perceived control may decrease ICD concerns, but sex differences have not been explored. The aim of this cross-sectional study was to determine the moderation effect of sex on the association between perceived control and ICD concerns in older adults (age≥ 60). Participants completed a questionnaire on ICD Concerns (ICDC-8) and the Control Attitudes Scale-Revised, a measure of perceived control. We conducted a moderation analysis using Hayes’ PROCESS for SPSS with 5,000 bootstrap samples. Of the 99 participants (73.7% male; age 70 + 7 years; education 13 + 3 years), most participants were white (79.8%) and married (69.7%). There were no differences in participant characteristics, perceived control, or ICD concerns, by sex. We found an interaction between sex and perceived control (b= -.5715, p= 02), indicating that for women (-.5801, p =.007), as perceived control increased, ICD concerns decreased. For men (-.0089, p =.9439), ICD concerns remained the same despite level of perceived control. Future clinical and research interventions to decrease ICD concerns should include ways to increase perceived control particularly for older women living with ICDs.
NC CAN COVID-19 Action Network: Project ECHO in North Carolina
Authors: Blomberg Ben , Henage Cristine , Hubbard Jennifer , McBride J Marvin
Published: December 2021

Experts in geriatrics, infection control and nursing home administration joined the ECHO Hub team led by The Carolina Geriatrics Workforce Enhancement Program (CGWEP) at the University of North Carolina at Chapel Hill (UNC). Ninety-two of North Carolina’s 423 nursing homes enrolled in a 16-week videoconference series designed to address clinical, logistical, and leadership issues related to COVID-19. The CGWEP coordinated recruitment with two other Training Centers at UNC Family Medicine and the Mountain Area Health Education Center, reaching 58% of all NC nursing homes (N=245). Faculty used curriculum and pre-recorded videos provided by the Institute for Healthcare Improvement (IHI). Discussions demonstrated real-world problem solving as participants applied what they learned to local conditions. Quality Improvement (QI) experts from IHI mentored participants in gathering data and completing Plan, Do, Study, Act cycles to better respond to the challenges of COVID-19 among a critically vulnerable population.
Virginia’s Response to the Nursing Home COVID Action Network
Authors: Waters Leland , Rhodes Anne , Arnette Shannon , Bluestein Dan , Ihara Emily , Inoue Megumi , Tompkins Catherine
Published: December 2021

The Virginia Geriatric Education Center’s GWEP recruited 195 of Virginia's 273 eligible nursing homes, using two Project ECHO Nursing Home Training Centers located at George Mason University and Virginia Commonwealth University. These sessions promoted collaboration, allowed for sharing of successes and challenges, and nurtured quality improvement projects. Our next steps are to survey Virginia’s nursing homes to see if they are interested in future ECHO sessions with other topics. We plan to share these results with the Institute for Healthcare Improvement so that we may be able to continue to enhance this national network of Training Centers with faculty and staffing dedicated to quality assurance and performance improvement. The program has initiated new collaborations with nursing homes across many healthcare disciplines, strengthened connections between nursing homes and research institutions, and will help foster innovative ways to collaborate in this post-pandemic virtually connected world.
Living Arrangements and Gendered Work Prospects Among Chinese Grandparents
Authors: Ye Jing , Chen Feinian
Published: December 2021

Recent literature on grandparenthood in China overwhelmingly focuses on the role of grandparents as caregivers for grandchildren. However, many become grandparents at an age when they are still active in the labor force. Using data from the China Health and Retirement Longitudinal Study (2011-2015), this study examines the extent to which coresidence with grandchildren affects grandparents’ labor force participation and work hours. Results from our fixed-effect models show that, living with grandchildren has a positive effect on men’s work participation and hours worked, especially for those with flexible jobs. For women with inflexible jobs, coresidence with grandchildren has a negative impact on their work prospect. Furthermore, grandparents in skipped generational households are less likely to scale back in work than those in multigenerational households, indicating a high level of double burden from both work and caregiving responsibilities. Our study extends prior work by emphasizing grandparents’ role as active workers and highlights the importance to understand work and caregiving demands in a gendered and dynamic household context.
GWEP Successes and Lessons Learned From Making Communities Age Friendly
Authors: Thompson Katherine , Catic Angela
Published: December 2021

Geriatrics Workforce Enhancement Programs (GWEPs), funded by the Health Resources and Services Administration have a strong focus on age friendly care and community engagement. With a wide range of populations, locales, and health systems served, GWEPs have significant experience working with a wide variety of communities to implement age friendly care. In this symposium, we present successes and lessons learned from GWEP projects representing diverse populations and approaches to achieving age friendly communities. For instance, one GWEP is utilizing Patient Priorities Care to lay the framework for What Matters in clinical decision-making. Another GWEP is focusing on What Matters by uniquely embedding Area Agencies on Aging care coordinators within primary care settings to invite the participation of aging patients in advance care planning, among other health interventions. A third GWEP is using the 4Ms to educate patients and caregivers in geriatric psychiatry clinics in a population of veterans. Another GWEP is pairing Age Friendly Health System efforts within a health system with community-based efforts to become an age friendly and dementia friendly city. A final GWEP is using multiple educational modalities to create Age-Friendly Communities and assure that health systems, community-based organizations, and older adults and families are educated about the 4Ms. By exploring successes and lessons learned in making communities age friendly, we can improve existing and future programs centered on age friendly care for older adults.
Distinguishing Features of AAA-Healthcare Partnerships: Business Acumen Is Necessary but Not Sufficient
Authors: Curry Leslie , Cherlin Emily , Ayedun Adeola , Rubeo Chris , Wilson Traci , Brewster Amanda , Straker Jane
Published: December 2021

Stronger relationships among service providers in the health care and social service sectors may contribute to positive outcomes such as lower health care use and spending. Such partnerships have grown in recent years, including Area Agencies on Aging (AAAs) contracting with health care organizations, and their impact on health care utilization has been demonstrated. Nevertheless, knowledge about how AAAs establish and manage successful collaborations is limited. This study was designed to understand how AAAs in regions with low levels of avoidable health care utilization develop and sustain partnerships with health care organizations. We conducted an explanatory sequential mixed-methods, positive deviance study. In the quantitative phase, we identified 8 AAAs with multiple health care partners serving areas with little utilization of nursing homes by residents with low-care needs, and 3 with few partners and high utilization for comparison. In the qualitative phase, we identified key informants within AAAs and their partners for in-depth interviews (total n = 123). We used the constant comparative method of analysis to identify 5 factors that characterized partnerships in the highly-partnered, low-utilization sites: 1) Regional context (e.g., breadth of health care provider market, cross-sectoral coalitions), 2) AAA human resource assets (e.g., community expertise, business acumen), 3) AAA organizational culture (e.g., visionary leadership, risk taking), 4) Interdependence among organizations (e.g., mutual benefit, alignment), and 5) Interpersonal dynamics (e.g., trust, relationships). The importance of these regional, organizational, and relational factors suggests that AAA business acumen is necessary but not sufficient to build and sustain robust cross-sectoral partnerships.
An Innovative Mental Health Model for Treating Culturally Diverse Older Adults
Authors: Abramson Tobi , Berman Jacquelin , Gates Madison
Published: December 2021

The mental health needs of older adults are largely unmet, a finding even more prevalent within culturally diverse older adult populations. Added to this is the high rate of social isolation. Research has indicated increased connection to mental health services when services are embedded within physical health care settings. For those attending community centers, 85% indicate that they are socially isolated, 68% indicate they are lonely, and 53% have a mental health need (compared to 20% nationally). The need for innovative programming is evident. When examining the needs of diverse older adults, it is increasingly important that new and innovative approaches address social isolation, loneliness, and mental health problems experienced by this cohort. Utilizing this knowledge an innovative model of embedding and integrating mental health services, provided by bilingual and bicultural clinicians, into congregate sites (older adult centers) was implemented. Those that participated were mainly female (72.1%), 68.5% English-speaking, 14.5% Spanish-speaking, 13.6% Chinese-speaking and 3.4% other. Spanish-speakers had more depression than English-speakers and both had more depression than Chinese-speakers. English and Spanish-speakers reported more social isolation and Chinese-speakers compared were more likely to participate in engagement. Chinese-speakers were less likely to be in clinical services with a positive screen compared to English-speakers. Overall, 75% engaged in treatment; 37.3% and 41% showed a 3-month improvement of depression and anxiety, respectively. This presentation focuses on the innovative components of this model, how to engage diverse older adults to utilize treatment, steps needed for replication, and policy implications around integrated mental health treatment.
The Long Arm of Child Maltreatment and Mental Health in Later Life: The Effects of Maltreatment and Family Context?
Authors: Han Chengming , Bhatta Tirth , Kahana Eva , Gran Brian
Published: December 2021

Purpose. This article examines the role of family context in shaping the influence of childhood maltreatment on later life psychological well-being in the cultural context of Chinese society. Method. Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) baseline. Maltreatment was measured by corporal punishment by either mother or father in childhood. We used family violence, parents’ family socioeconomic status (SES) and mental health to represent family context. Result. Our ordinary least square regression analysis shows that corporal punishment administered by a mother was associated with higher depressive symptoms (b=0.308, p<0.05) in later life while being hit by father did not result in higher depressive symptoms. Family contexts had residual (“long arm”) influence on respondents’ mental health: violence in the family, including being hit by siblings (b=0.657, p<0.001) and witnessing violence between parents (b=0.658, p<0.001) contributed significantly to higher depressive symptoms. Conclusion. Corporal punishment by parents had long term effects on mental health of their children in later life. Cultural values, such as filial piety did not eliminate the negative impacts of being hit in childhood on mental health in later life. Family contexts including violence between parents also played important roles in shaping the relationship between child maltreatment and mental health in later life. Implication. Our study offers important insights about the complex matrix of cultural traditions, social circumstances and diversity in dealing with child rearing stress and their consequences for later life mental health.
Psychology of Aging Podcast: Public Education Tool for Sharing Evidence-Based Mental Health and Aging Information
Authors: Koepp Regina
Published: December 2021

Psychology of Aging Podcast, created and hosted by Dr. Regina Koepp, Clinical Geropsychologist, is the first podcast of its kind devoted solely to mental health and aging. The goal of the Psychology of Aging podcast is to facilitate access to information and education about mental health and brain health among older adults with the hope of de-stigmatizing mental health care for older adults, reducing ageism, highlighting diversity, and promoting access to mental health and dementia care. The format includes a combination of expert interviews and “solo-casts”. Topics range from depression and suicide prevention to Alzheimer’s Disease and related dementias to the unique needs of LGTBQ older adults and caregivers to health disparities experienced by African American and Latin-X communities related to dementia and the COVID-19 pandemic. During this session, Dr. Koepp will discuss the role podcasts play in public education and share tips for starting an evidence-based podcast.
Cumulative Dis/Advantege, Structure, and Change: Three New Directions for CDA Research
Authors: Dannefer William , Han Chengming Hengming
Published: December 2021

Over the past several decades, evidence for cumulative dis/advantage as a regular feature of cohort aging has continued to cumulate, while new questions concerning the underlying dynamics continue to emerge. This paper reviews the accumulated knowledge base, and focused on three recently emerging lines of inquiry that hold great promise for expanding more fully our understanding of CDA processes: 1) the intersection of class stratification and race in the operation of CDA processes, 2) factors accounting for cross-national variations, and 3) the intersection of robust intracohort processed that generate cda with intercohort processes and the impact of historical and social change. These three new directions are briefly discussed.
Comparing Cannabis Use Across Diagnosed Conditions: Apples and Oranges?
Authors: Kaskie Brian
Published: December 2021

Although researchers have identified medications that relieve symptoms of Multiple Sclerosis (MS), none are entirely effective and some persons with multiple sclerosis (PwMS) use alternatives. Our study compared cannabis use among PwMS (N=135) and persons diagnosed with arthritis (N=582) or cancer (N=622) who participated in the Illinois medical cannabis program. We tested for significant differences across psychological well-being, quality of life and three behavioral outcomes, and also considered effects of co-occurring prescription opioid use. A majority of all individuals used cannabis to address pain and improve quality of sleep. PwMS reported lower levels of productivity, exercise and social activity, and cannabis was less helpful with improving these particular outcomes. Most persons used cannabis for sleep or digestive problems and we found no differences across groups in terms of well-being and quality of life. This comparative evaluation suggests cannabis mechanisms are not specific as much as they impact common processes.
Long-Term Variability in Body Weight in Relation to the Risk of Dementia: A Prospective Cohort Study
Authors: Chen Hui , Zhou Tianjing , Ma Yuan , Yuan Changzheng
Published: December 2021

The prospective association of body weight variability with dementia remains unclear. We aimed to investigate whether long-term variability in body weight is associated with the risk of late-life dementia and to explore their potential temporal relationship using data from a nationwide prospective cohort study of the United States. A total of 5,556 participants free of dementia in 2008 (55.66% women; mean [SD] age, 71.1 [3.1] years) were followed up to 8 years for doctor-diagnosed dementia reported biennially. Body weight variability was assessed as the coefficient of variation utilizing the body weight information collected over 16 years before 2008. Cox proportion hazard model was applied to estimate hazard ratio (HR) of dementia associated with body weight variability. Higher body weight variability was associated with an increased incidence of dementia after controlling for sociodemographic factors, lifestyle, mean body weight, and body weight change. The multi-variable adjusted HR of dementia of the highest quartile of body weight variability was 2.01 (95% CI 1.01-1.87) compared with the lowest. Every 1% increment in variability was associated with a 6.2% higher risk of dementia (HR=1.06, 95%CI 1.04,1.09, p-trend<0.001). Such association was observed for both Alzheimer’s disease and other types of dementia, with stronger association observed when body weight variability was assessed closer to dementia assessment.
Selective Autophagy: A Link Across the Hallmarks of Aging
Authors: Cuervo Ana Maria
Published: December 2021

Autophagy function has been closely linked with the loss of proteostasis that characterizes most old organisms and tissues. However, the cellular functions of selective types of autophagy such as chaperone-mediated autophagy (CMA) go beyond cellular quality control. CMA can degrade fully functional proteins to terminate their function and thus contribute to regulation of multiple cellular processes. To fully understand the consequences of loss of CMA function with age, we have developed genetic and pharmacological ways to modulate this pathway in old mice. Our data supports involvement of CMA in other hallmarks of aging such as metabolism, senescence, cellular response to stress, epigenetics and cellular stemness. This interconnection among the cellular processes that drive aging highlights the potential of acting on only some of them with geroprotective effects.
Improving Care for Individuals Living With Intellectual Developmental Disabilities and Dementia
Authors: Barrett Donna
Published: December 2021

Ultimately, transformation of communities can only occur through educational efforts delivered to specific community sectors. Although the portion of people with Intellectual Developmental Disabilities who develop dementia as they age is equal to that of the general population, individuals with Down syndrome are at a much higher risk. This symposium will describe how a county health department partnered with the local County Board of Developmental Disabilities to systematically incorporate Dementia Friends for Intellectual Developmental Disabilities with Alzheimer’s disease training to their staff and provider network. We will describe who to get on board with the idea, how to organize, and how to deliver specific trainings. Outcomes related to increase in participant knowledge, increases in service provision and outcomes related to staff mentoring will be discussed.
Dyadic Relationships Between Self-Rated Health and Cognition Among Older Adults and Their Spousal Caregivers
Authors: Liu Ruotong , Chi Iris , Wu Shinyi
Published: December 2021

This study examines spouses who are in a caregiving situation to discern how they influence each other’s health. Previous studies reported health concordance and cross-domain effects among caregiver and care-recipient dyads. However, it is less understood of the health dyadic relationships among spouses who are in a caregiving situation. No studies have specifically looked into the relationship between self-rated health (SRH) and cognitive functioning among spousal caregiving dyads over time. In this study we analyzed the longitudinal reciprocal relationships between SRH and cognitive functioning measured by the Telephone Interview for Cognitive Status among older adults and their spousal caregivers, and whether the relationship differed by whether husband or wife was the caregiver. Longitudinal data from the Health and Retirement Study (2010-2016) on 540 dyads were pooled and analyzed using structural equation modeling under an actor-partner interdependence model. Results revealed cognitive concordance among older spouses in which caregivers’ cognition is associated with care-recipients’ cognition subsequently (β=0.05, p<.05). SRH concordance was not significant. Cross-domain results showed only one significant direction, that is, care-recipients’ cognition in the subsequent time was significantly correlated with caregivers’ SRH, regardless of whether husband (β=0.09, p<.05) or wife (β=0.08, p<.05) was the caregiver. Our study found that married couples in a spousal caregiving situation displayed cognitive but not overall health concordance, and cross-domain effects of caregiver’s SRH on spousal care recipient’s cognition subsequently. The reciprocal associations suggest that addressing and improving either partner’s physical health and cognition may benefit both dyad members.
The Education of Family Members and Older Adult Cognitive Health: Differences Across Racial Groups
Authors: Vasireddy Sindhu , Yahirun Jenjira , Hayward Mark
Published: December 2021

Education is a strong predictor of cognitive health among older adults, and recent research indicates that apart from one’s own education, the educational resources of family members also play a crucial role in shaping cognitive health over the life course. We add to this literature by investigating whether the advantages of highly educated family members matter for both Blacks and Whites in the U.S. Specifically, we ask whether the resources of family members-parents and offspring-partially explain the racial gap in both the prevalence and incidence of cognitive health across both groups. For this, we employ logistic regression models to examine the prevalence of cognitive impairment at baseline, and discrete-time event history models to assess the incidence of cognitive impairment, using data from the Health and Retirement Study (HRS) for the years ranging from 2000 to 2012. Preliminary results indicate that at the baseline, respondent’s own education is predictive of cognitive impairment among Whites, but not Blacks. Once respondent-level health conditions and behaviors are taken into consideration, parental or offspring education is not associated with the prevalence of cognitive impairment. For respondents who are not impaired at the baseline, our results from the incidence models align with the “adjacent generations” literature suggesting that both parental and offspring education has a salient positive effect on later-life cognitive health. However, we find notable differences across groups to suggest that the education of parents and offspring may play a larger role in mitigating cognitive decline among African Americans, compared to Whites.
Current Research on Suicide in Older Adults
Authors: Owsiany Montgomery , Conwell Yeates
Published: December 2021

Rates of suicide are elevated in middle- and late-life, yet studies focusing on suicidal ideation and behavior in older adults are limited compared to research in younger adults. The studies included in the present symposium offer valuable findings on suicide in older adults across the span of late-life. Owsiany et al. focus on age differences between older and younger adults in the association between anxiety symptoms and suicide risk. In Heisel et al., an online intervention is assessed for improving the outcomes of psychological well-being and suicide risk in older adult men who are transitioning into retirement during the COVID-19 pandemic. Crnek-Georgeson and Wilson reviewed the link between retirement patterns and psychological effects, including suicidal behaviors, among older adults. Additionally, this review includes recommendations for policy makers and employers in an effort to assist older adults with the transition into retirement. Utilizing baseline data from the Helping Older Adults Engage study, Fenstermacher et al. research the association between volunteering and suicidal ideation in a predominantly lonely older adult sample across the span of late-life. Together, these studies provide foundation for future research on suicide in late-life to build upon. Future studies should continue to focus on risk and protective factors for suicide in older adults and aim to improve screening and intervention for suicidal thoughts and behaviors in this population. Yeates Conwell, M.D., Director of Geriatric Psychiatry and Co-Director of the Center for the Study and Prevention of Suicide at the University of Rochester Medical Center, will serve as discussant.
Characterization of a Mouse Model of Inducible Frailty: The Humanized IL-6 Mouse
Authors: Nidadavolu Lolita , Abadir Peter M , Walston Jeremy , Le Anne , Yenokyan Gayane , Florea Liliana , Antonescu Corina , Foster D Brian
Published: December 2021

The cytokine interleukin-6 (IL-6) has pleiotropic effects in aging and is elevated in frail older adults. We have developed a conditional mouse model to better characterize the role of IL-6 in promoting frailty and age-related mitochondrial dysregulation. The human IL-6 (hIL-6) knock-in mouse (TetO-hIL6) was developed utilizing CRISPR/Cas9 technology with transgene donor vector containing a tetracycline response element promoter driving expression of hIL-6 cDNA. Male TetO-hIL6 mice were treated with doxycycline-containing water for six weeks starting at 8 months old. RNAseq analysis of whole blood demonstrated significant upregulation of pro-inflammatory related markers at 6 weeks compared to baseline and upregulated cell proliferation and metabolism pathways. Physical testing of TetO-hIL6 mice before and after hIL-6 induction demonstrated decreased grip strength (p =0.003), decreased running capacity (p = 0.02), and 40% increase in falls off of the treadmill (p = 0.001). Induced mice also demonstrated decreased basal body temperature (p < 0.001). Given the significant dysregulation of metabolism-related genes in RNAseq analysis and changes in basal body temperature following hIL-6 induction, we next performed untargeted metabolomics on plasma from mice at baseline and 6 weeks post-induction to better evaluate metabolic changes associated with hIL-6 elevation. We found changes in key serum metabolites, including circulating adenosine triphosphate (56% reduction, p = 0.02), pyruvate (35% reduction, p = 0.0006), alpha-ketoglutarate (47% reduction, p = 0.04), and succinate (306% increase, p = 0.001). The TetO-hIL6 mouse model allows for induction of hIL-6 at various timepoints across the lifespan and demonstrates features of a frailty phenotype.
Loss of Awareness or Urinary Dysfunction? Investigating Amyloidosis and Urinary Physiology in a Transgenic Mouse
Authors: Hardy Cara , Ramasamy Ramalakshmi , Rosenberg Dawn , Scarpa Philip , Hu Xiangyou , Kuchel George , Smith Phillip
Published: December 2021

Alzheimer’s disease (AD) is a devastating disorder primarily affecting older adults and is the most common neurodegenerative disease in the US. More than one in three AD patients experience AD-associated urinary dysfunction (ADUD), which directly contributes to their institutionalization. While ADUD has been clinically regarded as a result of poor cognitive control over urinary function, the physiology underlying loss of urinary control remains unknown. We hypothesize that amyloidosis in the CNS results in pathologic changes in urinary structure and function. Tg-APP/PS1DE9 mice were used before plaque deposition (4-6 months) and after plaque accumulation (8-10 months) and compared to WT littermates. Behavioral assays (open field testing and voiding spot assays) were performed to assess cortical function. Pressure-flow cystometry was conducted under urethane anesthesia to assess autonomic control of urinary function without cortical influence. Pharmacomyography of bladder strips was used to determine tissue-level changes in the absence of CNS input. In Tg-APP/PS1DE9 mice, plaque accumulation resulted in significant cystometric changes to voiding phase parameters, but not storage phase parameters. Pharmacologic studies showed decreased sensitivity to adrenergic stimulation without change in muscarinic sensitivity. Behavioral assays demonstrated significant differences between transgenic animals and WT in locomotion and voiding spot sizes. We interpret our data to support AD-related pathology of Aβ accumulation results in a distinct urinary phenotype in our model, analogous to the ADUD observed in AD patients. Establishing and verifying models of ADUD may improve the efficacy of treating ADUD and increase quality of life for patients and their caregivers.
COVID Challenges and Adaptations Among Home-Based Medical Practices: Lessons for an Ongoing Pandemic
Authors: Ritchie Christine , Sheehan Orla , Gallopyn Naomi , Sharieff Shanaz , Brody Abraham , Leff Bruce
Published: December 2021

Home-based primary care (HBPC) practices rapidly adapted to maintain care during the COVID-19 pandemic. This mixed-methods national online survey of HBPC practices probed responses to COVID-19 surges, COVID-19 testing, the use of telemedicine, practice challenges due to COVID-19, and adaptations to address these challenges. Seventy-nine practices across 29 states were included in the analyses. Eighty-five percent of practices continued to provide in-person care and nearly half cared for COVID-19 patients. Most practices also pivoted to concurrent use of video visits. The top five practice challenges were: patient familiarity with telemedicine, patient and clinician anxiety, technical difficulties reaching patients, and supply shortages. Practices also described creative strategies to physically support the needs of patients. These findings illustrate the need to balance in-person and virtual care for this population, and attend to the emotional needs of patients and staff.
Loneliness and Isolation Versus Wisdom and Compassion During the Pandemic
Authors: Jeste Dilip
Published: December 2021

Our studies of US national-level samples across adult lifespan as well as older adults in California and in Italy’s Cilento region have found a consistently strong inverse correlation between loneliness and wisdom, especially its compassion component. Loneliness and social isolation are associated with worse physical and mental health while the reverse is true for wisdom and compassion. Follow-up of older adults in San Diego during the Covid-19 pandemic showed no change in this pattern. While the effects of the pandemic and the necessary social distancing were heterogeneous, older adults generally handled these stresses better than younger adults, with less loneliness and greater compassion. Our recent studies assessing EEG responses to emotional stimuli as well as alpha and beta diversity in gut microbiome showed opposing biological patterns characterizing loneliness and wisdom. I will also present preliminary data from a compassion training intervention to reduce loneliness among older adults.
Addressing Systemic Racism by Creating a Diversity, Equity, and Inclusion Department Initiative
Authors: Chow Stephanie , Brown Katherine , Sanon Martine , Perez Sasha , Kelley Amy , Javier Noelle Marie
Published: December 2021

Background: Catalyzed by social injustice and worsening racial inequities highlighted by the COVID-19 pandemic, a diverse academic geriatrics and palliative medicine department in NYC launched a DEI initiative. This report presents key program components and lessons learned in launching this initiative in the interprofessional academic medicine setting. Methods: First, DEI core and departmental administration met 2-4 times/month to plan and review program activities, vision, and mission. The team conducted confidential roundtable discussions about DEI issues and 1:1 interviews to assess needs. A monthly Humanities, Arts, and Books (HAB) Initiative provided a safe space for discussion and learning. The HAB platform supported a longitudinal curriculum emphasizing (1) group discussion and self-reflection on DEI concerns, (2) knowledge dissemination including a “Learning Pathway” series, and (3) skill-based workshops. With each event, we collected anonymous feedback. Comments were systematically recorded and an engagement evaluation was conducted to iteratively shape future sessions. Departmental administration was engaged to track DEI-focused measures of recruitment, career advancement, and retention. Finally, we centralized DEI activities on a departmental website, including an anonymous online feedback box. Results: Quantitative and qualitative assessment of DEI initiatives are forthcoming. Metrics include DEI and professional development surveys, departmental demographic and diversity measures, increase in DEI-related projects and grants, and individual participation in DEI programs. Conclusions: Creating a strong and sustainable DEI initiative within an academic medical setting requires a passionate and diverse core team, deliberate backing by administration, and thoughtful dissemination of sensitive content in the midst of a highly charged social justice landscape.
Exploring the Impact of COVID-19 on Family Caregivers of Persons Living With Dementia in the Community
Authors: McAiney Carrie , Conway Emma , Koch Melissa , Middleton Laura , Keller Heather , Dupuis Sherry , Dupuis Kate , Boger Jennifer
Published: December 2021

COVID-19 public health measures have significantly impacted persons living with dementia (PLWD) and family caregivers (FCGs). Given the restrictions on in-person services, many PLWD were not able to access their usual supports and activities, resulting in FCGs stepping in to support exercise, leisure, socialization, spirituality, and activities of daily living. At the same time, FCGs’ own support networks were significantly reduced or no longer available. We conducted in-depth qualitative interviews with 20 FCGs of PLWD in the community to explore the impact of COVID-19 on their well-being. Data were analyzed using thematic analysis. Caregiving during COVID-19 was described as ‘draining’ and ‘stressful’, with the support needs of PLWD increasing at a time when fewer supports were available. Reaching out to others, using technology, and setting boundaries were strategies FCGs used to cope. Despite the considerable impacts of COVID-19, FCGs of PLWD demonstrated their resilience in supporting themselves and their PLWD.
The M. Powell Lawton Award Lecture: The Person-Environment Fit Framework, Older Adults, and Technology Interactions
Authors: Dobbs Debra
Published: December 2021

The lecture will be given by the 2020 recipient, Sara Czaja, PhD, FGSA of Weill Cornell Medicine. The 2021 M. Powell Lawton Award recipient is David Roth, Phd, FGSA, of Johns Hopkins University. The M. Powell Lawton Award is presented annually to an individual who has made outstanding contributions from applied research that has benefited older people and their care. The Lawton Award is generously funded by the Polisher Research Institute of Abramson Senior Care.
The Cost Efficiency of Home Modifications to Reduce Health Care Costs
Authors: Abraham Jesse
Published: December 2021

The existing quantity of housing dedicated for older adults is not sufficient to meet the needs of this growing population. And even as the Centers for Medicare and Medicaid Services reimbursement structures are shifting from traditional inpatient and outpatient settings to care in the home, it is a commonplace that most homes were not designed or built to support the needs of aging residents or the provision of healthcare. It is time for America’s 100 million existing houses to be made as safe and accessible as possible for aging in place. Falls cost over $50 billion a year in medical expenses. This paper distills current knowledge regarding healthcare cost reductions from home modifications, and then calculates the cost efficiency to society and to the federal government of providing government subsidies for home modifications for older adults at the ages of 50, 65 and 75. Cost sharing among insurers, government and the beneficiary is one way to achieve the positive social returns.
Financial Changes and Health During COVID-19 in the National Health and Aging Trends Study
Authors: Samuel Laura , Hladek Melissa , Cudjoe Thomas , Drazich Brittany , Li Qiwei , Szanton Sarah
Published: December 2021

This study tested associations between income decline and financial difficulty with mental health (lack of feeling anxious/depressed, recurring thoughts/nightmares, avoiding activities/thoughts, feeling jumpy/on guard) and sleep quality during COVID-19 among a national sample of 3,188 older adults. Approximately 8% of US older adults reported income decline and 6% reported financial difficulty. Although income decline and financial difficulty rates were both statistically significantly higher among those financially strained before COVID-19 (19% and 34%, respectively), income decline was more common among those with incomes ≥200% of the poverty threshold (9%) whereas financial difficulty was more common among those with incomes <200% poverty (10%). Adjusting for sociodemographic, health and depressive symptoms before COVID-19, financial difficulty was associated with worse mental health (b= -2.39, p<0.001) and sleep quality (b=-0.820, p<0.001), but income loss was not (b= -0.685, p=0.092 and b= -0.405, p=0.082, respectively). Timely interventions are needed for older adults reporting COVID-19 financial difficulty.
COVID-19 Recommendations for Assisted Living: Implications for the Future
Authors: Vipperman Andrew , Zimmerman Sheryl , Sloane Philip
Published: December 2021

Similar to nursing homes, COVID-19 has challenged assisted living (AL), given its congregate nature and vulnerable residents. However, COVID-19 recommendations have not consistently recognized differences between nursing homes and AL, and in so doing present implications for the future of AL. This project examined COVID-19 recommendations from six key organizations and compared them across nursing homes and AL. Differences include recommending more flexible visitation and group activities for AL, while similarities suggest that AL may best integrate health care into offered services (e.g., work with consulting clinicians who know residents and the AL community). Primary points to be discussed are that COVID-19 may accelerate the closer coordination of social work and medical care into AL, because recommendations suggest AL would benefit from the services and expertise of nurses, social workers, and physicians. There seems to be an unmet need to mitigate loneliness in AL, which warrants specific attention moving forward.
Exploring the Concept of the Ethical Will as a Way to Leave a Legacy of Values: A Scoping Review
Authors: Neller Sarah , Towsley Gail , McFarland Mary
Published: December 2021

Ethical wills communicate a legacy of values through non-legal emotional and supportive instruction to others and are distinct from legal or living wills. Employed for centuries, little is known about how and why ethical wills are used. We conducted the first scoping review on ethical wills to survey the breadth of published information and identify how they are defined and utilized. We followed the Joanna Briggs Institute methodology for scoping reviews employing an a priori protocol and PRISMA-ScR reporting guidelines . We searched 14 databases in November 2019 and January 2021 without filtering publication date or type. Our final extraction form included frequently used terms describing content, purpose, and outcomes. Two reviewers independently screened 1,568 results. Final extraction included 51 documents from 1997-2020, which were primarily published in lay or peer-reviewed journals within law, estate and financial planning, and religion; only 6 research articles were identified. Most frequently, descriptors characterized ethical wills as a non-material legacy of values, beliefs, wisdom, and life lessons learned written to family or future generations. Ethical wills were utilized most to be remembered, address mortality, clarify life’s meaning, and communicate what matters most. They provided opportunity to learn about self, were considered a gift to both writer and recipient and fostered intergenerational interaction and transcendence. Our findings highlight interdisciplinary utilization and dearth of research on ethical wills. Gerontological research is needed to explore ways ethical wills can be used to enhance generativity and intentional living as individuals age and prepare for the end of life.