bluuebunny/crossref_metadata_2025 huggingface dataset:
Cross-Lagged Panel Analyses of Reciprocal Effects of Social Isolation, Perceived Loneliness, and Solitary Activity
Authors: Li Ke , Tang Fengyan
Published: December 2020

Social isolation and perceived loneliness are major issues as they may place older adults at greater risks for health problems. The objective status of social isolation and the subjective perception of loneliness may have distinct meanings, and their longitudinal reciprocal relationship remains unclear. The purposes of this study were to examine the reciprocal effects of social isolation and loneliness among U.S. adults aged 50 and above and to explore the moderating effect of solitary activities by using the data from three waves of the Health and Retirement Study (HRS) collected in the year 2008, 2012 and 2016. The index of social isolation was created by summing five commonly used indicators, including marital status, living arrangement, and three types of social contact. Loneliness was assessed by a summary score of 11 items. Solitary activities included 13 activities with limited or no social interaction. The results estimated by the cross-lagged effects model showed positive reciprocal relationship of social isolation and perceived loneliness across waves: respondents with a higher level of social isolation were predicted to have increased loneliness, and more perceived loneliness was significantly associated with a higher level of social isolation in the following waves. The results also indicated that solitary activity had a direct effect on decreasing loneliness. This study improves the understanding of reciprocal effects of social isolation and perceived loneliness over years and indicates that practice needs to address the issues of social isolation and perceived loneliness at the early stage and provide more opportunities of solitary activities.
The Association Between Health, Social Engagement, and Psychological Well-Being Among Older Adults in China
Authors: Li Yuekang
Published: December 2020

Psychological health and health-related quality of life of older adults have been long minimized by caregivers, service providers and the society in developing countries, such as China. According to the Stress Process Model, the stress of physical disadvantages influences mental health outcomes directly and indirectly. However, being socially engaged has the potential to reduce disease burden and improve psychological wellbeing of older adults. The purpose of this study is to examine the role played by social engagement in the pathway through which physical health predicts mental health. Using the WHO Study on Global AGEing and Adult Health China wave 2010, 6,276 individuals ages 60 years and older were included for analyses. Structural equation modeling was used to construct a directional path leading from the functioning and chronic disease, impacting the social engagement, in turn impacting the psychological wellbeing. All variables in this model are latent constructs. Functioning and chronic diseases in later life were associated with social engagement and psychological wellbeing, and the link between social engagement and psychological wellbeing was also significant. The effect of function was greater than that of chronic diseases. Though the significant indirect effect of physical health on psychological wellbeing was not supported in this study, this study suggests the multiple roles of social engagement as coping resources in the stress process of physical impairment and illness of older adults. This present study also adds to the existing literature by exploring how SEM methods can be applied to studies of social engagement.
#Dementia: An Evaluation of the Worldwide Dementia Twitter Network
Authors: Ayyaswami Varun , Padmanabhan Divya , Prabhu Arpan
Published: December 2020

Social media engages an international network of healthcare stakeholders. Our study characterized the #dementia community on Twitter, which we hypothesized has increased substantially in the last six years. Symplur Signals, a healthcare social media analytics platform, was used to analyze public #dementia tweets between 1/1/2014 and 12/31/2019. Spam or users unclassified by the platform were excluded. Tweet activity, content, user characteristics, engagement, associated hashtags, sentiment, and network analysis metrics were obtained. Exactly 2,149,494 tweets made by 105,938 users resulted in 21,460,413,770 impressions. There was a 44.6% and 29.1% compound annual growth rate of tweets and users, respectively. The five most frequently tweeted words were people, care, help, living, and support. Among users with identifiable locations, the United Kingdom, United States, and Canada had the greatest number of users. Healthcare associated individuals (17.8%), health advocacy organizations (17.6%), non-healthcare associated individuals (17.0%), and non-healthcare associated organizations (13.8%) were among the top 500 influencers based on tweet number. Hashtags related to caregiving (#Caregiving, #carers, #care, #caregivers, #caregiver, #dementiacare) and Alzheimer’s disease (#alzheimers, #Alzheimer, #Alz, #EndAlz) were among the top 15 associated hashtags. Analysis of the 1,000 most recent tweets shows more tweets with positive (71.0%) than negative (29.0%) sentiments. Network analysis mapping connections between users shows advocacy organizations (i.e. @ASAging) and other health individuals (i.e. @LEAD_Coalition) were central conversation hubs in 2019. The #dementia network discusses themes important to older adults. The network’s rapid growth has enabled increased dissemination of dementia-related information by both healthcare and non-healthcare associated individuals and organizations.
Care Me Too: A Mobile App for Engaging Chinese Immigrant Caregivers in Self-Care and Its User-Experience Testing
Authors: Liu Mandong , Jiang Tongge , Yu Kexin , Wu Shinyi , Jordan-Marsh Maryalice , Chi Iris
Published: December 2020

Caregiving and self-care are challenging for Chinese immigrants in the U.S. due to limited accessible support and resources. The team developed a Care Me Too app for engaging Chinese immigrant caregivers in self-care and conducted a user-experience test to assess its usability and acceptability. The aims of this paper are to report the testing results and develop guidelines to support mHealth app design for immigrant caregiver populations. Twenty-two Chinese caregivers participated in the test, which consisted of two parts: in-lab testing and one-week at-home testing. In-depth face-to-face interviews and follow-up phone interviews were used to test the app’s usability and acceptability and solicit participants’ feedback for app design and functions. Directed content analysis was used to analyze testing transcripts. Participants reported uniformly positive ratings of usability and acceptability of the app and provided detailed suggestions for app improvement. We generated some mHealth app design guidelines, including weighing flexibility vs. targeting majority preferences, increasing text sizes, using colors effectively, providing engaging and playful visual designs and functions, simplifying navigation, simplifying login process, design functions to cater to the population’s context, etc. We concluded that culturally and linguistically appropriate mHealth apps are appealing to immigrant caregivers for health promotion.
Role of Health Information Technology in the Engagement Process of Older Adults’ Cancer Treatment Decision Making
Authors: Zaidi Maryum , Gazarian Priscilla , Mattie Heather , Sheldon Lisa Kennedy , Gakumo C Ann
Published: December 2020

This study investigates the role of Health Information Technology (HIT) in the process of patient engagement in treatment decision making in older adults in cancer care. Despite the role of HIT in patient engagement processes and government incentives for HIT development, research regarding HIT is lacking among older adults. The following study is a secondary data analysis of a subset of the Health Information National Trend Survey (HINTS 4, Cycle 3), including individuals 65 years old and above. Chi-square tests, logistic regression, and linear regression models were fit to study several sociodemographic, socioeconomic, and psychosocial variables in this study. The results show that education, poverty status, and self-management domain of the patient activation (which is a precursor of the engagement process) were significantly associated with access to and utilization of HIT. No significant differences between access to and utilization of HIT and the diagnosis of cancer were found. However, fatalistic beliefs about the diagnosis of cancer significantly impacted the use of HIT in all models, including those controlling for cancer diagnosis and access to HIT. Specifically, a one-point increase in cancer fatalism score is associated with a 59% decrease in the utilization of HIT, giving evidence that fatalistic beliefs about cancer can drive engagement behaviors regardless of a diagnosis of cancer. Our study provides vital information for providers and policy researchers to take into account for future implementation and development strategies of HIT in cancer care for older adults.
Bridging the digital divide for vulnerable patient telehealth
Authors: Ali Diab , Gillie Monica , Carstarphen Kathy Jo
Published: December 2020

In New Orleans, Louisiana, 61% of advanced age patients have low health literacy, 50% report financial insecurity, and more than one-third have high hospital readmission rates and medical complexity scores. This population has been disproportionately impacted by the COVID-19 pandemic and the system-wide transition to remote, virtual visits. While COVID-19 has accelerated needs for impactful remote care and research, this has been impeded by low telehealth literacy and structural barriers, such as lack of internet and devices. There are major gaps in the literature regarding telemedicine services in geriatric and complex populations and efficacy rates are variable in these populations. There is currently no telehealth literacy screening tool designed for identifying patients with barriers requiring additional interventions to succeed, no uniform understanding of the factors affecting use or how to increase engagement, and telehealth models requiring fluent use of technology for older adults have been met with poor rates of completed visits and associated harm. Following a dedicated 358.5 hours to training 309 geriatric, complex patients in telemedicine using our pre-existing telehealth model, averaging 4.78 hours per patient, only 18.8% of these patients were subsequently able to connect to the provider virtually. Here we describe lessons learned and tools developed from the Ochsner MedVantage Network Innovation project, including the development of a telehealth literacy screening tool, the adaptation and provision of simplified, user-friendly tablets, and a randomized control trial to determine if increased accessibility to telehealth leads to improved healthcare outcomes, such as decreased hospital admissions and emergency department utilization.
Intergenerational connections through technology: Insights from the Technology Use in Later Life multi-site study
Authors: Freeman Shannon , Marston Hannah R , Musselwhite Charles , Olynick Janna , Genoe Rebecca , Kulczycki Cory , Xiong Beibei
Published: December 2020

With enhanced challenges to maintain social connections especially during times of social distancing due to the COVID-19 pandemic, the need for technology solutions grow. Technologies have become interwoven into the daily lives for many older adults. The Technology Use in Later Life (TILL) study investigated how the perceptions and use of technology both can foster new and leverage existing intergenerational relationships. Through a mixed methods study engaging older adults aged 70 years of age and greater across rural and urban sites in Canada and the UK (N=37), participants described how the interconnection between technology and intergenerational relationships was an integral component to social connectedness with others. Through a qualitative descriptive approach, it was noted that older adults leveraged intergenerational relationships with family and friends to adjust to new technologies and to remain connected to adult children and grandchildren especially when there is high geographic separation between them. Especially during times of COVID-19, younger family members can play an important role to introduce and teach older adults how to use, technologies such as digital devices, computers, and social networking sites. Participants emphasized the benefits of intergenerational connections to adopt and use technology in later life noting flexibility and willingness to overcome barriers to technology adoption and remain connected across the generations. The adoption and uptake of technologies may continue as viable options during times of social distancing to support older persons to remain independent, age in place, in both age-friendly cities and across rural geographies during and post COVID-19.
#BoomerRemover: COVID-19, Ageism, and the Intergenerational Twitter Response
Authors: Skipper Antonius , Rose Daniel
Published: December 2020

In March 2020, COVID-19 was declared a pandemic and frequently presented as a virus primarily affecting older adults. News headlines led with statements such as, “Coronavirus deaths are so far mostly older men” (Ramzy, 2020). Although later determined inaccurate, this perspective contributed to openly ageist views and exchanges from people around the world. On the social media platform of Twitter, #BoomerRemover was used as a hashtag to express views related to older adults, and particularly baby boomers, as the primary targets of COVID-19. This study uses qualitative methods to analyze the messages of Twitter users that discuss COVID-19 with the use of the hashtag #BoomerRemover. A total of 1,875 tweets posted in English and including the hashtag “#BoomerRemover” from March 16, 2020 to March 30, 2020 were analyzed. Analytic methods employed an open coding procedure consistent with grounded theory and Numeric Content Analysis (Marks, 2015). Salient themes include: (1) COVID-19 is Politically Driven (2) There’s a Real Intergenerational Divide, (3) Young People are Dying Too, and (4) #BoomerRemover is Simply Disrespectful. Findings suggest that only about a fourth of #BoomerRemover tweets could be considered ageist, and the large majority of tweets using the hashtag were related to politics and elections. Further, several of those using the #BoomerRemover hashtag to defend older adults were inadvertently causing it to remain relevant (trend) as a Twitter topic. This study recognizes the importance of considering Twitter – primarily composed of young adults – as a place where intergenerational attitudes vis-à-vis COVID-19 may be expressed.
Community environment and COVID-19 related stress among older adults with disabilities in Taiwan
Authors: Yu Meng-Hsuan , Chao Shiau-Fang
Published: December 2020

The outbreak of the COVID-19 pandemic at the beginning of 2020 forced many countries to implement social distancing policies such as the suspension of activities and gathering. Taiwan is the leading country which took active epidemic prevention measures in local communities, including closing the community centers and programs for older adults. Older adults with chronic health conditions are particularly vulnerable to the COVID-19 pandemic because they have disproportionally been affected by it. This study examined the associations between community environment and COVID-19 related stress of community-dwelling older adults with disabilities. Data were collected from a sample of 547 community-dwelling older adults aged 65 and over with disabilities in Taiwan between April and July, 2020. Multiple Regression Analysis was applied to test the hypothesized relationships. The analytic results suggested that: First, participants who were younger and with better cognitive functioning had higher levels of COVID-19 related stress. Second, as the confirmed case number dropped by month, participants interviewed in the later months expressed lower levels of COVID-19 related stress. Third, older adults who perceived more obstacles in their environment reported higher levels of COVID-19 related stress. In conclusion, although restrictions during the pandemic is inevitable to secure the safety of the public, programs should be designed for older adults with disabilities to remove the obstacles and to make information, policies and services more accessible in the communities to mitigate their COVID-19 related stress.
Comparing the Protective Value of Human and Pet Social Support on Well-Being of Older Adults During COVID-19
Authors: Sobering Juliet , Brown Lisa
Published: December 2020

Older adults are vulnerable to particular risk factors that contribute to lower well-being and poorer functioning. With the COVID-19 pandemic, the importance of social support has been highlighted in media reports because of its well-known beneficial effects on overall well-being. However, as adults age, social networks, contacts, and activities naturally decrease. These age-related losses are often difficult, if not impossible, to replace. Pets have recently been recognized as a valuable source of social support for many older adults, providing both physical and psychological benefits through mutual connection and behavioral activation. Previous studies have examined how human social support or pet social support enhance older adults’ well-being (i.e., positive emotions, engagement, relationships, accomplishment, and meaning). However, there is a gap in our scientific knowledge as previous research has not evaluated if pet social support can serve as a protective factor in the absence of adequate human social support. Current analyses, with 141 older adult participants, suggests that pet owners with a positive attachment to their pet experience higher well-being as pets serve as a coping resource that protects against common life stressors. Similar to human social support, pet social support appears to be a protective factor that also promotes and fosters a sense of well-being in older adults. Support in late life is especially important for families and agencies to be attuned to, especially during a global pandemic.
COVID-19-Related Changes in Potential Risk Factors for Elder Mistreatment Reported by Caregivers of Older Adults
Authors: Makaroun Lena , Beach Scott , Rosen Tony , Rosland Ann-Marie
Published: December 2020

In previous studies, caregiver (CG) stress, substance use, poor physical health, poor mental health, financial problems, and social isolation have been associated with increased risk of elder mistreatment (EM) for older care recipients (CR). This study aimed to assess how the COVID-19 pandemic has impacted these CG-related risk factors for EM in a community sample of CGs. A non-probability sample of 433 CGs caring for adult CRs age ≥60 years with physical (76%), cognitive (34%) and mental health (14%) conditions completed a survey on COVID-19 impacts in April-May 2020. CGs had mean age 61 (range 21 – 91), were 75% female and 92% non-Hispanic White. Over 40% of CGs reported doing worse financially since COVID-19. Compared to before COVID-19, 15% reported drinking more alcohol and 64% reported somewhat or greatly increased feelings of social isolation and loneliness. CGs reported that COVID-19 had made caregiving more physically (18.7%), emotionally (48.5%) and financially (14.5%) difficult, interfered with their own healthcare (19%), and led to family conflict over caring for CR (13.2%). Younger CGs (age <65) and those with annual income <$50,000 were more likely to report negative COVID-19 impacts. This study suggests CGs of older adults may be experiencing increased stress, alcohol use, social isolation and negative impacts on their own health and financial situation. Healthcare and social service providers should assess for these EM risk-factors in caregivers and connect them and their care recipients with resources and services to address these stressors to reduce risk of EM during the COVID-19 pandemic.
Fireside Chats During COVID-19: Caregiver Community-Based Education
Authors: Dassel Kara , Rupper Rand , Butler Jorie , Telonidis Jacqueline , Witt Catherine , Edelman Linda
Published: December 2020

The Utah Geriatric Education Consortium (UGEC) provides education about Age-Friendly Health Care and Dementia-Friendly Communities to both informal and professional caregivers. As such, we have collaborated with our community partners to hold 12 “Fireside Chats” (2 in person, and 10 virtually due to COVID-19) between December 2019 and September 2020. Our expert speakers and panelists have given presentations on a variety of topics, specifically focused on coping with COVID-19, such as physical, music, and arts-based activities to do in the home, advance care planning, local services and supports, resiliency, and mindfulness. A total of 463 participants attended the Fireside Chats. A total of 169 attendees completed evaluations regarding the programs (a completion rate of 37%). Attendees were primarily White (86%), non-Hispanic (95%), well educated (86% had a college degree or higher), about half of the group were community caregivers (55%), while the other attendees were primarily from health professional backgrounds (e.g., nursing, social work, physical therapy). We obtained evaluation data in seven domains based on a 5-point Likert scale (1=strongly disagree to 5=strongly agree). The mean level of agreement in the seven following domains were: satisfaction (M=4.68/SD=.53), effectiveness (M=4.72/SD=.52), met stated goals (M=4.70/SD=.53), met educational needs (M=4.64/SD=.6), will improve the care they provide (M=4.57/SD=.70), included useful examples (M=4.59/SD=.66), and was better than similar trainings (M=4.23/SD=.86). These results along with steady attendance of our “Fireside Chats” demonstrate the need and satisfaction with our community-based education based on improving geriatric care practices within the community and in long-term services and support programs.
Functional Status, Meanings of Life Activities, and COVID-19 Related Disruptions among Disabled Older Adults
Authors: Yu Meng-Hsuan , Chao Shiau-Fang
Published: December 2020

Participating in meaningful activities has been proven beneficial to the well-being of disabled older adults. However, social distancing policies and restrictions on public activities have been implemented since the outbreak of COVID-19 at the beginning of 2020 in Taiwan. These restrictions not only prevent older individuals from performing meaningful activities but also have actual impacts on their daily life. This study aims to elucidate the intervening role of meanings of life activities on the relationship between functional status and COVID-19 disruptions. Data were collected from a sample of 526 community-dwelling older adults with disabilities in Taiwan between April and July, 2020. Utilizing Multiple Regression Analysis, the research findings were as follows. First, participants with better functional status experienced more COVID-19 related disruptions to their daily routine. In the meantime, they also valued their life activities as more meaningful than those with worse functional status. Second, higher levels of meanings in performing life activities also positively related to COVID-19 disruptions. Third, meanings of life activities fully mediated the relationship between functional status and COVID-19 disruptions. That is, disabled older individuals with better functional status may experience more COVID-19 related disruptions because their accessibility to meaningful activities was limited. Since preventive approaches to control the spread are necessary during COVID-19 epidemic, efforts should be made to sustain meaningful life activities participation among disabled older adults. Based on the findings of this study, this would be especially critical to the well-being of more capable older individuals with disabilities during the pandemic.
Material Hardship, Mental Health, and Parenting Stress among Grandparent Kinship Providers in COVID-19
Authors: Xu Yanfeng , Wu Qi , Levkoff Sue , Jedwab Merav
Published: December 2020

The COVID 19 pandemic has exposed the vulnerability of many families, including grandparent kinship families, to deal with a health/economic crisis. The fear of COVID-19 plus stay-at-home orders have increased individuals’ psychological distress. Moreover, school closures and homeschooling further increased parenting stress among caregivers. This study examined the relationship between material hardship and parenting stress among grandparent kinship providers and assessed grandparents’ mental health as a potential mediator to this relationship during the COVID-19 pandemic in the United States. Grandparent kinship providers (N=362) that took primary care of their grandchildren participated in a cross-sectional survey via Qualtrics Panels in June 2020 in the United States. Descriptive and bivariate analyses, binary logistic regression, and mediation analyses were conducted using STATA 15.0. Experiencing material hardship (OR = 1.67, p < 0.001) was significantly associated with higher odds of parenting stress among grandparent kinship providers, and grandparents’ mental health (indirect effect = 0.11, 95% CI [0.01, 0.25]) partially mediated this association. Addressing material and mental health needs among grandparent kinship providers is critical to decreasing their parenting stress.
Precautionary Measures Against COVID-19 in Residential and Community-Based Facilities: Singapore’s Response
Authors: Yong Vanessa
Published: December 2020

The COVID-19 pandemic has disproportionately infected older adults who are also at higher risks of developing severe health complications and having case fatality if infected. In particular, older adults in residential and community-based facilities are at greater risks of contracting COVID-19, in part due to close proximities and frequent human interactions in these facilities. In Singapore, the Ministry of Health and its implementation agency, the Agency for Integrated Care (AIC), together with long-term care service providers, have jointly developed a number of precautionary measures against COVID-19. This paper defines and describes Singapore’s response in terms of the ‘ABC’ of COVID-19 safety measures for facilities, namely, safe Access, Behaviors, Compounds (i.e. spatial surroundings). These included infection prevention and control measures, access to PPE, distancing and zoning measures, suspension of visitors, alternative accommodation for long-term care workers, and testing to monitor people with long-term care needs and care workers. Incident response teams to support facilities providers in responding to COVID-19 infections were also swiftly set up. The outreach arm of AIC, the Silver Generation Office, further provided information and services support to older people during the pandemic. We share these measures as a set of practices and learning points for other countries undergoing the current pandemic and for future references.
Understanding contributors to quality of care in long-term care and changes under COVID-19
Authors: Luck Sara , Aubrecht Katie
Published: December 2020

Nursing home facilities are responsible for providing care for some of the most vulnerable groups in society, including the elderly and those with chronic medical conditions. In times of crisis, such as COVID-19 or other pandemics, the delivery of ‘regular’ care can be significantly impacted. In relation to COVID-19, there is an insufficient supply of personal protective equipment (PPE) to care for residents, as PPE not only protects care staff but also residents. Nursing homes across the United States and Canada have also taken protective measures to maximize the safety of residents by banning visitors, stopping all group activities, and increasing infection control measures. This presentation shares a research protocol and early findings from a study investigating the impact of COVID-19 on quality of care in residential long-term care (LTC) in the Canadian province of New Brunswick. This study used a qualitative description design to explore what contributes to quality of care for residents living in long-term care, and how this could change in times of crisis from the perspective of long-term care staff. Interviews were conducted with a broad range of staff at one LTC home. A semi-structured interview guide and approach to thematic analysis was framed by a social ecological perspective, making it possible to include the individual and proximal social influences as well as community, organizations, and policy influencers. Insights gained will improve the understanding of quality of care, as well as potential barriers and facilitators to care during times of crisis.
Innovative Partnership Between Primary Care, AAA, and Academia Connects 4Ms and Social Determinants of Health
Authors: Leahy Suzanne , Ehlman Katie , Maish Lisa , Conrad Brad , Hall Jillian , Wells Ron , Holscher Laura
Published: December 2020

Nationally, there is a growing focus on addressing geriatric care in primary care settings. HRSA’s Geriatric Workforce Enhancement Program (GWEP) has called for academic and health system partners to develop a reciprocal, innovative, cross-sector partnership that includes primary care sites and community-based agencies serving older adults. Through the University of Southern Indiana’s GWEP, the College of Nursing and Health Professions, the Deaconess Health System, three primary care clinics, and two Area Agencies on Aging (AAA) have joined to transform the healthcare of older adults regionally, including rural residents in the 12-county area. Core to the project is a value-based care model that “embeds” AAA care managers in primary care clinics. Preliminary evaluation indicates early success in improving the healthcare of older adults at one primary clinic, where clinical teams have referred 64 older adult patients to the AAA care manager. Among these 64 patients, 80% were connected to supplemental, community-based health services; 22% to programs addressing housing and transportation; and, nearly 10% to a range of other services (e.g., job training; language and literacy; and technology). In addition to presenting limited data on referred patients and referral outcomes, the presentation will share copies of the AAA referral log, to illustrate how resources were categorized by SDOH and added to support integration of the 4Ms.
Age Differences in COVID-19 Stress and Social Ties during the COVID-19 Pandemic: Implications for Well-being
Authors: Birditt Kira , Turkelson Angela , Fingerman Karen , Polenick Courtney , Oya Akari
Published: December 2020

The experience of the COVID-19 (coronavirus) pandemic and its implications for well-being may vary widely by age group across the adult lifespan. The purpose of this study was to examine age differences in stress related to the pandemic and social ties, and whether those experiences are linked to well-being. Participants included a total of 645 adults (43% women) ages 18 to 97 (M = 50.8; SD = 17.7) from the May 2020 nationally representative Survey of Consumers. Participants reported the extent to which they felt stress related to the pandemic in the last month as well as social isolation, negative relationship quality, positive relationship quality, and frequent depression, anxiety and rumination in the past week. Results showed that older people reported less COVID-19 related stress, less social isolation, and lower negative relationship quality than younger people. Greater stress, social isolation, and negative relationship quality were associated with poorer well-being and greater social isolation, and negative quality ties exacerbated the effects of stress on well-being. Although many researchers have indicated that older adults may be more vulnerable to COVID-19 related stress and social isolation, this study indicates that young adults may be relatively more vulnerable. Because isolation and negative relationship quality appear to exacerbate the effects of stress, reducing social isolation and negative relations are potential targets for intervention.
Long-Term Sequences of Intergenerational Living Arrangements Among Older Americans
Authors: Kim BoRin , Liang Jersey , Xu Xiao , Ofstedal Mary Beth , Raymo James
Published: December 2020

Living arrangements are critical for intra-family exchanges such as physical, financial, and emotional supports influencing older adults’ health and well-being. Existing research is largely based on short-term observations of living arrangements. This study aims to explore longer term dynamic patterns of intergenerational living arrangements among older Americans and their sociodemographic and health determinants. Data came from the 1998-2016 Health and Retirement Study. Sequence analysis was employed to identify long-term patterns of intergenerational living arrangements for 3,025 individuals who were age of 51-64 at the baseline (ages of 69-82 at the last wave), have at least one child, and were observed 10 consecutive times (Obs.=30,250). Living arrangements were categorized into co-residence, proximate residence (i.e., 10miles from children), and nursing home. Multinomial logistic regressions were used to evaluate the associations of individual characteristics with the different living arrangements sequences. Four patterns of eighteen-year living arrangement trajectories were identified: Transition to proximate residence (17%), stable in distant residence (24%), stable in proximate residence (38%), and stable in co-residence (22%). Younger age and working (vs. retired) status were associated with stable coresidence rather than proximate or distant residence. Respondents who retired during the study period were more likely to move close to their children. Contrary to expectations, changes in self-rated health and functional status had no significant effect in long-term living arrangement sequence patterns. These findings suggest that intergenerational living arrangements among older Americans tend to be stable and not to be significantly affected by their caregiving needs.
Meaning of Life and Well-Being: Preliminary Results of the Successful Aging Study
Authors: Gellis Zvi , McClive-Reed Kim , Kenaley Bonnie , Kim Eunhae
Published: December 2020

Meaning in life for older persons has become a focal research point, with findings that a greater sense of meaning is associated with better outcomes on a range of health and well-being factors. Our study examined relationships between scores on several personality scales, including the Meaning in Life Questionnaire (Steger et al., 2009) and the WHO-5 Well-Being Index, a proxy measure of mood/depression. Community-dwelling members (N=535) of Osher Lifelong Learning Institutes aged 50 and up (mean age 71.4, SD = 6.93) at 3 U.S. sites completed surveys. Higher wellness levels were significantly correlated with increased resilience, optimism, life satisfaction, and presence of meaning in life, while lower levels were associated with greater searching for meaning in life. A multivariate linear regression model (F = 55.597, df = 4, p = .000, R = .566, R2 = .320) showed that wellness scores increased with higher scores in optimism (ß = .348, p =.000), resilience (ß = .183, p = .000), and presence of meaning in life (ß = .106, p = .019). However, searching for meaning in life significantly predicted decreases in wellness scores (ß = -.084, p=.019). These results support those of previous studies, suggesting that for older persons, an ongoing search for meaning in life is linked to negative outcomes than a perception of existing meaning in life. A variety of available interventions aimed at increasing meaning and purpose in life (Guerrero-Torelles et al., 2017) may contribute to better health and well-being in older adults.
Defining the Response of Caenorhabditis elegans to Multiple Simultaneous Stressors
Authors: Sutphin George , Dang Hope , Turner Emily , DeNicola Destiny , Hamming Sage , Furtmann Amanda , Kelser Delaney
Published: December 2020

Cells are constantly subjected to a variety of intrinsic and extrinsic stresses—oxidative, protein misfolding, osmotic—and respond by activating a range of molecular pathways to mitigate and repair damage—oxidative stress response, unfolded protein response, osmotic stress response. While individual stress response pathways have been described in detail, and some interventions improve resistance to multiple forms of stress (e.g. dietary restriction, insulin signaling inhibition), surprisingly little is known about how these responses differ when cells are challenged with multiple types of stress simultaneously. The molecular architecture underlying multi-stress response has broad implications for aging and age-associated disease. One characteristic of aging is a progressive increase in multiple categories of cellular stress accompanied by a decline in cellular stress response capability. Human diseases rarely involve a single form of stress—Alzheimer’s disease is characterized by neuroinflammation, oxidative stress, and misfolded proteins, while cancer exhibits oxidative stress, DNA damage, and localized hypoxia. Determining how cells respond differently to one form of stress in the presence of another is critical to building an accurate model of the aging cellular environment. We are using Caenorhabditis elegans to systematically evaluate the molecular network that cells employ when challenged by multiple simultaneous stressors and how different stress combinations impact organismal survival and health. Here we present our initial characterization of C. elegans response to multiple categories of cellular stress (oxidative, osmotic, ER, Golgi, heavy metal), which stressors elicit non-additive interactions when combined, and how these combinations impact survival, health, and established stress response pathways.
Late-Onset Pharmacological or Dietary Interventions Improve Healthspan and Lifespan in Male and Female Mice
Authors: Mitchell Sarah , MacArthur Michael , Kane Alice , Torrence Margaret , Mehmet Huseyin , Vath James , Manning Brendan , Mitchell James
Published: December 2020

While late-onset dietary or pharmacological interventions can extend longevity in rodents, whether or not they can be used to reverse or forestall onset of aging-related symptoms (i.e. frailty) remains untested. Here, we employed three interventions to test this hypothesis. Male and female C57BL/6 mice were randomized to one of four groups: control, 15% calorie restriction (15CR), 0.1% Methionine Restriction (MR)or ZGN1062 (1.5mg/kg, drug in feed) starting at 21mo. Healthspan measurements (mouse clinical frailty index (FI), blood collection, and hematology) were performed every three months, and survival was assessed for all mice. At baseline there were no significant differences in frailty index. After 6mo FI increased consistent with reduced healthspan in control males (0.23□0.01 to 0.34□0.01 A.U, p<0.0001) and females at this age (0.19□0.03 to 0.24□0.01, p<0.0001). Male 15CR, MR and ZGN1062 mice had significantly lower FI scores at 27mo age (15CR: 0.32□0.01, p=0.02; MR: 0.31□0.01, p=0.0009; ZGN1062: 0.30□0.01, p<0.0001). Female mice were less frail than males at 27mo, suggesting sexual dimorphism in the timing of frailty onset in mice. ZGN1062 significantly extended lifespan in males (HR=0.56, p=0.007) and females (HR=0.46, p=0.001). There was a sexual dimorphism in the ability of 15CR and MR to extend lifespan, and a trend towards increased lifespan in males (HR=0.69, p=0.057 and HR=0.71, p=0.09) but not in females. Histological analysis for cause-of-death is ongoing. Taken together these data suggest that a pharmacological intervention associated with weight loss, which may be a more practical therapeutic strategy towards mitigation of age-related healthspan decline than dietary restriction-based interventions.
Epigenetic Signatures of Cell States in Aging
Authors: Leung Diana , Levine Morgan
Published: December 2020

Epigenetic clocks based on DNA methylation (DNAm) show striking age correlations and predict various outcomes. Patterns of DNAm also reflect critical mechanisms in differentiation and proliferation. As such, an outstanding question is whether part of the signal epigenetic clocks are capturing represent shifts in the proportions of somatic stem cells, senescence cells, and/or tumorigenic cells. Here, we assembled various methylation datasets that captured relevant phenomena, including pluripotent stem cells, differentiation, senescence, and cancer, and performed weighted network analysis to cluster and compare DNAm modules. We find overlapping clusters between in vitro samples and in vivo tissue samples, suggesting that cell-level phenomena like cell replication, senescence, and cancer intersect with age-related epigenetic signatures. While the effects of aging manifest at multiple systems levels, from the genome to clinical phenotypes, these analyses may help provide insight to the contribution of cell phenotype dynamics to the general aging phenomenon.
Translating Research Findings Into an Evidenced-Based Approach to Improve Hospital Practices for Malnutrition
Authors: Deer Rachel , Lehe Janna , James Colleen , Hommel Erin
Published: December 2020

Malnutrition is a common problem that often goes unrecognized. In a recent UTMB-OAIC funded pilot, we found 49% of older adults were at risk of malnutrition at hospital admission. Malnutrition is associated with increased length of stay, poorer patient outcomes, and higher risk of mortality. Also, malnutrition severity alters hospital reimbursement rates. In 2018, the UTMB health system recognized the need for institutional guidelines to help identify, diagnose, document, and code mild/moderate/severe malnutrition. At baseline, compared to similar academic medical centers, UTMB ranked in the bottom quartile for malnutrition diagnosis. A multidisciplinary committee formed with physicians, nurses, researchers, dieticians, coding, and information technology. Preliminary data from the pilot study found the Nutritional Risk Screen (NRS) had the best sensitivity, specificity, positive and negative predictive values. The NRS was made more user friendly with scripting/prompts in the electronic medical record (EMR) to improve consistency/compliance among nurses. The Subjective Global Assessment was used in EMR by dieticians to document malnutrition diagnosis. A Best Practice Advisory was created to give physicians the option to easily add malnutrition diagnosis to the problem list. Since “go-live” in February 2019, NRS completion improved from 10.6% to 70.0%. Coding of malnutrition increased from 3.7% to 5.8%. In a 6 month follow-up, 113 patients were found to have direct benefits from the new process, resulting in an estimated financial impact of $945,605. Going forward, we have identified multiple areas of continued education needs to further improve the implementation and uptake of the new screening tool and diagnostic processes.
Causes of Time Trends in Prevalence and Mortality of Major Cancers Among U.S. Older Adults
Authors: Akushevich Igor , Yashkin Arseniy , Kravchenko Julia , Yashin Anatoliy
Published: December 2020

The time trend of prevalence and mortality of major cancers is the result of three competing processes: changes in the incidence rate, stage-specific survival, and ascertainment at early stages. Partitioning approach allows for evaluating the relative contribution of each of these competing processes to the overall trend. In this report we applied the partitioning methodology developed for the SEER registry data for prostate, colorectal, lung, female breast, bladder, ovarian, stomach, pancreas, kidney, liver cancers and melanoma. The analysis involves the design and estimation of four models for each cancer site: i) incidence rate using the Armitage-Doll model with individual predisposition modeled by the gamma distribution, ii) probability of relative survival after cancer diagnosis using the Weibull model for time after disease onset, iii) frequencies of stage at onset, and iv) mortality in the general population using the Gompertz model. B-splines are used to fit the time patterns of model parameters obtained for each year Relative contributions of the partitioning components were evaluated for individual cancers (e.g., increase of prevalence in prostate cancer in 2000 was due to increased incidence (59%), improved survival (29%), and improve stage ascertainment (12%)) and compared among all considered cancers. The results were discussed in the light of the effect of the accumulation of survivors occurring in early years (due to improving survival) and their higher mortality (because of higher prevalence of survivors) in later years (i.e., mortality is transferred to latter time periods due to overall improvements in survival).
Screening Neurocognitive Disorders in Primary Care Services: The Quick Mild Cognitive Impairment Approach
Authors: Paul Constanca , Sousa Susana , Santos Pedro , O’Caoimh Rónán , Molloy William
Published: December 2020

Neurocognitive Disorders (NCD) is an increasingly common condition in the community. The General Practitioner (GP) in Primary Care Services (PCS), have a crucial role in early detection of NCD and is usually the first professional to detect the signs of MCI. The objective of this study was to test the feasibility and utility of the cognitive screening instrument QMCI in Primary Care. A community sample of 436 people 65+ living in the community was randomly selected from a larger group of old people with mental health concerns (N=2734), referred by their GPs. The mean age of the sample was 75.2 years (sd 7.2), with 41.3% men and 58.7% women; 60.4% married followed by 28.7% widows. The education level was low with 21% illiterate and 69,8% people with 4 years education. The QMCI mean was 37.1/100 (sd 16.2). The amount of people screening positive for cognitive impairment QMCI (<62/100) was 94.2%. In the distribution of people with cognitive impairment by Global Deterioration Scale (GDS) three recoded categories, of the 286 people 76,1% where classified as having very mild or mild impairment, 19,4% moderate or moderately serious and 4,5% severe or very severe impairment. These results confirm the perception of GPs about their clients having mental health concerns and the ability of QMCI accurately discriminate MCI. The QMCI is very brief (3-5mins) fitting the short time of GPs to assess cognitive status and timely refer clients to nonpharmacological interventions that could postpone NCD symptoms.
Dementia Adjudication Triggers Associated With Increased Mortality for Older Australians: Evidence From ASPREE
Authors: Banaszak-Holl Jane , Lin Xiaoping , Xie Jing , Ward Stephanie , Brodaty Henry , Shah Raj , Murray Anne , McNeil John
Published: December 2020

Research Aims: This study seeks to understand whether those with dementia experience higher risk of death, using data from the ASPREE (ASPirin in Reducing Events in the Elderly) clinical trial study. Methods: ASPREE was a primary intervention trial of low-dose aspirin among healthy older people. The Australian cohort included 16,703 dementia-free participants aged 70 years and over at enrolment. Participants were triggered for dementia adjudication if cognitive test results were poorer than expected, self-reporting dementia diagnosis or memory problems, or dementia medications were detected. Incidental dementia was adjudicated by an international adjudication committee using the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) criteria and results of a neuropsychological battery and functional measures with medical record substantiation. Statistical analyses used a cox proportional hazards model. Results: As previously reported, 1052 participants (5.5%) died during a median of 4.7 years of follow-up and 964 participants had a dementia trigger, of whom, 575 (60%) were adjucated as having dementia. Preliminary analyses has shown that the mortality rate was higher among participants with a dementia trigger, regardless of dementia adjudication outcome, than those without (15% vs 5%, Χ2 = 205, p <.001). Conclusion: This study will provide important analyses of differences in the hazard ratio for mortality and causes of death among people with and without cognitive impairment and has important implications on service planning.