bluuebunny/crossref_metadata_2025 huggingface dataset:
Coping Styles and Stroke Knowledge Mediate the Effect of Social Support and Uncertainty Among Stroke Patients
Authors: Zhang Humin , Gao Jie , Sun Yuyan , Han Ziting
Published: December 2020

Objectives:This study aimed to investigate the mediating roles of coping styles and stroke knowledge between social support and uncertainty in illness among patients with primary stroke in China. Methods:The total of 204 Chinese primary stroke patients recruited using convenience sampling were asked to answer Mishel Uncertainty in Illness Scale for Adult(MUIS-A), Stroke Knowledge Questionnaire(SKQ), Social Support Rating Scale(SSRS), and Medical Coping Modes Questionnaires (MCMQ). Demographics characteristics of the patients were presented using descriptive statistics. We reported the relationship between the study variables using Pearson’s Correlation Coefficients. We performed structural equation modeling to estimate the mediator effect of coping styles and stroke knowledge between social support and uncertainty in illness.Results: The results showed that 92% of patients with primary stroke had moderate above level of uncertainty in illness, with a mean score 75.04 (SD=9.61).Uncertainty was positively associated with coping styles (r=0.232, P＜0.01), and negatively associated with social support(r=-0.237, P＜0.01) and stroke knowledge (r=-0.386, P＜0.01).The structural equation model indicated that the coping styles(19.8% of total effect) and stroke knowledge (38.5% of total effect)respectively acted as mediator role between social support and uncertainty in illness.Conclusions:Most patients with primary stroke present moderate above level of uncertainty in illness. stroke knowledge and coping styles were important mediating factors in the pathway between coping styles and uncertainty in illness. Our findings suggest the provision of stroke knowledge and training of coping styles for patients with primary stroke could alleviate their uncertainty in illness.
Emotional Health and Mortality of Older Parents of Children With Serious Developmental Disabilities
Authors: Hoyle Jessica , Laditka Sarah , Laditka James
Published: December 2020

Caring for a child with serious developmental disability (SDD) involves stress as parents age and anticipate the child’s future welfare. There are few studies of older parents of children with SDD. We followed parents for 18 years using the Panel Study of Income Dynamics (PSID). We defined SDD as: (1) autism, intellectual disability, learning disorder, epilepsy with seizures, attention deficit disorder/attention deficit hyperactivity disorder, or cerebral palsy; requiring (2) qualification for services and serious lasting impairment evidence. We used the PSID and its Child Development Supplement (1997-2007, 2014), linking children’s and parents’ data, with 5,780 parent-child dyads and 45,534 analytic observations. Parent outcomes included physician-diagnosed anxiety or depression, psychological distress (Kessler K6), and death. Discrete-time hazard analysis controlled for child and parent characteristics, and survey design. We identified parents of: Group 1, children without SDD or challenging behaviors; Group 2, SDD without challenging behaviors; Group 3, challenging behaviors without SDD; Group 4, SDD with challenging behaviors. Among parents ages 60+ and compared to Group 1, Group 2 through 4 odds ratios for anxiety/depression were, respectively, 1.28 (95% confidence interval, 0.63-1.92), 1.79 (1.35-2.24), and 2.62 (2.25-2.99), p-trend <.0001. Group 4 mental health risks were particularly high when children lived with the older parent: for anxiety/depression OR 6.75 (3.00-15.21), and distress OR 8.83 (3.58-21.77). At ages 60+ mortality was higher for parents of children with SDD (relative risk, RR 2.38, 1.21-4.67), especially Group 4 (RR 4.64, 1.39-15.47). Parents of children with developmental disabilities need emotional support, respite, and interventions addressing challenging behaviors.
Comparing Elder and Child Abuse Prevention Approaches in Japan: Strategies for Reducing Elder Abuse
Authors: Katsumata Asako , Tsukada Noriko
Published: December 2020

This paper examines trends in elder abuse cases (types of abuse, traits of abusers, victims and their relationships, levels of disabilities and dementia of victims, etc.) by using longitudinal data (2012-2018) collected by Japan’s Ministry of Health, Labour and Welfare since its enforcement. Considering these trends, this paper then compares the Elder Abuse Prevention Law to the Child Abuse Prevention Law to assess differences in policy and program provisions and how those relate to successful prevention outcomes. For example, while reports for both elder abuse and child abuse cases have been increasing, governmental actions taken in response have varied. The Child Abuse Prevention Law has been modified 6 times since its enactment based on abuse cases, but no amendments have been made for Elder Abuse Prevention Law based on case or evaluation data. Moreover, there have been many public awareness campaigns for child abuse prevention, but none for elder abuse prevention. These efforts appear to have positive outcomes including increased reporting of child abuse to police. This analysis aims to compare abuse data, abuse laws and public health efforts for children and older adults in Japan. Findings seek to identify disparities and areas where the public approach to child abuse can inform and strengthen elder abuse policies and programs.
Childhood Trauma and Adult Psychological Adjustment: Resilience in Older Adult Survivors of Institutional Abuse
Authors: Gee Shauna Mc , Maercker Andreas , Carr Alan , Thoma Myriam
Published: December 2020

Several international cohorts of older adults share past experiences of welfare-related adversity. In Ireland, reports of childhood maltreatment, neglect, and abuse within institutional welfare settings included a harsh regime, childhood labour, and physical and sexual assault. Preliminary research with these Irish survivors revealed a high prevalence of psychological disorders in adulthood. A pathological perspective of aging is often applied to such older adults, due to the long-term health consequences associated with childhood trauma. However, little is known about later life resilience or resilience mechanisms in this population. Therefore, using conceptual models of resilience, this qualitative study aimed to investigate factors associated with resilience in older adult survivors of childhood institutional abuse. Participants were 17 Irish older adults, 50-77 years of age, with experiences of childhood abuse in institutional care settings. Semi-structured interviews were conducted, lasting 60-120 minutes. Transcribed interviews were analysed using the Framework Analysis method. Nine themes were derived from the data, including core, internal, and external resilience factors: Individual characteristics, personality characteristics, support systems, goal attainment, adaptive belief systems, processing, influential events and experiences, recognition and collective identity, and access to services. Results suggest that resilience can be understood not only as an inherent trait, but also as a learnable set of behaviours, thoughts, and attitudes, which can be supported by external resources in an older adults’ environment. The identification of personal and contextual factors underpinning resilience in older adults with trauma experiences may help foster a more positive, strengths-based approach to aging in psychological research and practice.
Assistive Relaxation Therapy for Older Adults With Insomnia and Mild Cognitive Impairment: A Pilot Study
Authors: McPhillips Miranda , Li Junxin , Ward III E John , Gooneratne Nalaka
Published: December 2020

Insomnia symptoms are prevalent in older adults with mild cognitive impairment (MCI) and can pose treatment challenges. Our objective was to test the preliminary efficacy of tablet-based assistive relaxation therapy (ART) to improve insomnia symptoms in community-dwelling older adults with MCI. ART involves breath-based relaxation techniques coupled with a physical anchoring task to redirect thoughts and disengage from pre-sleep anxiety-provoking cognitions. Using a pilot randomized controlled non-crossover design, 20 participants recruited from one urban adult day center were allocated in a 1:1 ratio to intervention or education only control group for a treatment period of two weeks. Our final sample (n=20) was balanced on all demographic and clinical variables and consisted of Black (100%), female (75%), older adults (mean age 68.85 ± 7.29) with mean Montreal Cognitive Assessment scores of 21.2 ± 2.48. All participants at baseline had insomnia symptoms (mean Insomnia Severity Index (ISI) score 15.8 ± 3.78) and poor sleep quality (mean Pittsburgh Sleep Quality Index (PSQI) score 12.95 ± 0.70); half had daytime sleepiness (Epworth Sleepiness Scale (ESS) score 10.15 ± 1.07). Compared to baseline, participants improved on ISI (9.83 ± 1.32; p=0.0002), PSQI (9.11 ± 1.02; p=0.0016) and ESS (8.17 ± 0.86; p=0.08). The intervention group had statistically significant mean change scores on ISI compared to the control (-7.5 ± 1.37 vs. -3.88 ± 1.48; p=.0461). There were no statistically significant between group differences on PSQI or ESS. Our preliminary results suggest ART therapy is an effective treatment for insomnia symptoms in older adults with MCI.
Decreasing Social Support Associated With Risk of MCI and Dementia Is Partially Mediated by Hippocampal Volume
Authors: Gruenewald Tara , Petkus Andrew , Wang Xinhui , Youan Diana , Gatz Margaret , Espeland Mark , Chen Jiu-Chiuan
Published: December 2020

Less supportive social relationships are linked to greater risk of cognitive decline in older adulthood. Few studies have examined if declines in social support predict risk of developing Mild Cognitive Impairment (MCI) or dementia and the neurobiological factors that may contribute to these associations. We analyzed data from 926 women in the Women’s Health Initiative Memory Study-MRI (WHIMS-MRI) to examine whether low social support at baseline and declines over an 8-year period predicted subsequent risk of developing MCI/dementia. Social support (Medical Outcomes Study Social Support Scale) was self-reported at the baseline (1994-1998) and closeout (2004-2005) of the parent WHI hormone therapy clinical trial. Annual neuropsychological assessments were conducted in WHIMS (through 2018) to ascertain incident MCI/dementia; structural brain scans were performed in 2005-2006. Structural equation models assessed the association between level and change in social support and risk of incident MCI/dementia and putative mediation of these associations by structural brain variables in women free of MCI/dementia as of the trial closeout, adjusting for demographic, lifestyle, depression, and biomedical covariates. Both low baseline social support (HR=1.24 per 1-SD; p<.05) and declines in support (HR=1.18 per 1-SD; p<.05) predicted incident MCI/dementia risk. Women reporting decreasing social support had significantly lower hippocampal volumes (β=-.070; p<.05) which accounted for ~14% of the total effect of declining support on MCI/dementia risk. We will highlight the implications of these findings for understanding how changes in social support may be linked to risk of MCI/dementia, including potential bidirectional associations of changes in social support and neurobiological health.
Age-Friendly Environment, Social Support, Sense of Community, and Loneliness of Korean Adults
Authors: Kim Miri , Chung Soondool
Published: December 2020

Abrupt industrialization, urbanization, and the emergence of the nuclear family have contributed to the increase of single-person households, placing an emphasis on individualization in society. Because of such changes, more people are living alone and feeling lonely, alienated from society and family. This research examined the association between loneliness and age-friendly environment, a community equipped with policies, settings, services, and structures that promote active ageing and aging-in-place, with the mediating roles of social support and sense of community. The study analyzed a total of 590 respondents aged 45 and above using data from the age integration survey conducted by the OO Research Institute of South Korea. Structural equation modelling and the bootstrapping method were applied. Age-friendly environment was positively associated with social support (β=0.310,p=0.000) and sense of community (β=0.486,p=0.000). Social support was negatively associated with loneliness (β=-0.195,p=0.000). The full mediation effect of social support was observed in the pathway from age-friendly environment to loneliness (95% CI = [̶ 0.112, −0.028]). Social support was fundamental in lowering loneliness, and age-friendly environment could only reduce loneliness by following a pathway that enhances social support. In other words, despite how well an age-friendly environment is established, it would not decrease an individual’s loneliness unless it also enhances social support level. This finding sheds importance in maintaining satisfactory relationships that enable sharing of feelings, and fulfilling emotional and social needs in lowering loneliness. Measures to increase social support level within community are suggested.
Development of a Novel Measure of Informal Caregiver Burnout
Authors: James Nicholas , Paulson Daniel
Published: December 2020

Burnout is a concept which has permutated most settings over recent decades. However, due to its roots in occupational research there exists both theoretical and practical gaps to consider when measuring burnout within non-occupational settings, such as informal caregiving. This study developed and validated a measure of burnout for informal caregivers of individuals with Alzheimer’s disease and dementia, the Informal Caregiver Burnout Inventory (ICBI). Theoretical and methodological implications are discussed. Development included a 10-step method for scale development proposed by Boateng and colleagues (2018). Expert feedback on item appropriateness and clarity was collected from 33 caregivers or related professional experts and used to modify the original item-bank. Following this, a national sample of 255 current caregivers was gathered. This survey included the ICBI, two gold-standard measures of burnout, and measures of depression and caregiver burden. Item reduction analysis was used to remove items with poor item-total and inter-domain correlations. The ICBI shows good item-agreement (Cronbach’s alpha= .88) and principles of Item Response Theory were used to measure item- and scale-wide information captured. Convergent validity was then compared against other measures of burnout using Bland-Altman Plots. Divergent validity was similarly assessed by comparing the ICBI to a depression questionnaire. Finally, the predictive validity of each burnout measure was compared to their association with burden and depression. This study suggests that the ICBI may perform adequately as an index of caregiver burnout, and thus is address a methodological and clinical gap in current efforts to understand the dynamics of caregiving.
Utilization of an Integrated Medicare Advantage Model Is Positively Associated With Medication Adherence
Authors: Smith-Ray Renae , Singh Tanya , Robson Chester
Published: December 2020

An estimated 30% of U.S. healthcare costs are due to waste, inefficiencies, and excessive pricing. Research shows that integrated primary care models (IPC) improve health outcomes and reduce costs. Nearly all IPCs embed ancillary clinicians, including pharmacists, within the clinic. IPCs that embed a primary care clinic within a pharmacy are novel. This study describes the first known IPC for older adults that is based in a pharmacy and examines its impact on medication adherence. In January 2018, Walgreens launched an IPC focused on Medicare Advantage patients at select Kansas City Walgreens locations. Each morning the entire IPC team meets to review needs of patients who will be seen that day. Upon arrival, the patient is first seen by a pharmacist who completes medication and immunization reviews and fall risk screening. If a new medication is prescribed during the physician visit, the pharmacist returns to consult the patient. The IPC team works together to ensure that the Medicare Annual Wellness Exam is completed in entirety. We examined the impact of IPC utilization on adherence to the top seven chronic condition drug groups. IPC patients age 50+ with sub-optimal adherence (<80% proportion of days covered) during the year prior to the clinic opening were included (n=64). A Student’s t-test revealed an 11% improvement in optimal adherence year-over-year between the pre- and post- periods (p<0.001). The pharmacy-based IPC is associated with improved medication adherence. Future research should examine the impact of this model on patient satisfaction and additional health outcomes.
Older Adults’ Adoption of Mobility Devices: Interplay of Predisposing Factors and Precipitating Health Events
Authors: Sharmin Farhanaz , Sands Laura
Published: December 2020

Existing mobility limitations and chronic conditions increase likelihood of adopting mobility-related devices such as canes and walkers. Prior research has not considered how recent acute events such as falls and hospitalizations contribute to the adoption of mobility devices. We studied 4,592 older adults who responded to the 2015 and 2016 National Health and Aging Trends Study surveys, and classified adoption of mobility devices as: (i) Never users (did not use mobility devices either year) and (ii) New users (started using mobility devices in 2016). We determined through chi-square tests, that predisposing characteristics from 2015 that were significantly associated with being a New User in 2016 were: being female, aged 80+, minority race, having a high-school education or lower, living alone, being obese, and having a history of dementia, arthritis, stroke, mobility difficulties, falls, and hospitalization (all P’s<0.05). We used logistic regression to determine the contribution of recent precipitating events on the adoption of mobility devices among older adults after controlling for 2015 characteristics that were significantly associated with being a New user. Precipitating events were significantly associated with being a New user of mobility equipment. Specifically, older adults who, between the 2015 and 2016 interviews, experienced a fall (OR=1.7; 95% CI=1.1-2.9), hospitalization (OR=3.7; 95% CI=2.3-5.9) or increase in mobility difficulties (OR=3.7; 95% CI=2.3-5.9) were more likely to be New users. Study findings reveal the importance precipitating events on the adoption of mobility devices, signaling the importance of assessing for need for mobility devices after these events.
Influence Factors and Life Satisfaction of Types of Older Adults’ Daily Time Use Using Latent Profile Analysis
Authors: Chae Joosuk , Nam Seok In , Won Haesol , Lee Juyoung
Published: December 2020

The purpose of this study is to divide the daily time use of older adults into types, examine the influence factors of each type, and verify the difference in life satisfaction between types. We used a total of six variables, three variables (essential, compulsory, and leisure time use) for weekdays and the same three variables for weekends. We used data from the sixth wave of the Korea Retirement and Income Study (n=3,993). Latent Profile Analysis was used to classify the older adults’ (aged 65 and over) types of daily time use, resulting in a division into three types: essential activity-centered (16%), leisure-centered (26%), and balanced (58%). The weekend and weekday activities of each group did not differ. Compared with the balanced type, the significant factors of the essential activity-centered type were age (p<.01), work status (p<.001), and chronic disease (p<.001). In addition, the significant factors of the leisure-centered type were age (p<.05), gender (p<.05), subjective health (p<.001), work status (p<.001), and chronic disease (p<.001). Life satisfaction was lowest in the essential activity-centered type and highest in the balanced type; differences between the groups were identified (p<.000). Based on the results, we discuss practical interventions and the development of psychosocial programs for older adults. For the essential activity-centered type, living support is required because they spend more time sleeping and eating. In addition, we proposed the preparation of leisure programs applicable to the needs of older adults’ of the leisure-centered type, since their life satisfaction was lower than the balanced type.
Psychosocial Mechanisms of Successful Aging Among Older Women Living With HIV: A Structural Equation Model
Authors: Rubtsova Anna , Wingood Gina , Ofotokun Igho , Gustafson Deborah , Vance David , Sharma Anjali , Adimora Adaora , Holstad Marcia
Published: December 2020

Although older women living with HIV (OWLH) face challenges related to the intersection of HIV and aging, our published research found significant prevalence of self-rated successful aging (SRSA) in a sample of OWLH enrolled in the Women’s Interagency HIV Study (WIHS). Studies in other populations link SRSA to positive psychosocial factors but little is known about SRSA mechanisms among OWLH. The purpose of this study is to test a conceptual psychosocial model of SRSA. Our sample (N=356) included OWLH enrolled in WIHS who participated in the “From Surviving to Thriving” (FROST) substudy and completed psychosocial and cognitive assessments: average age 56.5 years, 73% Black, 55% with annual income ≤ $12,000, 74% having 3 or more comorbidities, median CD4=673 cells/ml (Q1=486; Q3=880). SRSA was assessed using a research-based 10-point scale (higher scores=better outcomes). We conducted adjusted structural equation modeling. The global model included two latent variables -- protective attributes (composite of positive psychosocial factors: resilience, personal mastery, optimism, spirituality) and negative affect (composite of negative psychosocial factors: anxiety, depression, loneliness, internalized HIV-related stigma). The model showed good fit (χ2(65)=72.3, p=0.25; RMSE=0.02; CFI=0.99) and explained 21% of variance in SRSA. Increased protective attributes were associated with improved SRSA both directly (p<0.01) and indirectly, via improved coping with stress (p<0.001). While negative affect did not have a direct effect on SRSA, it was indirectly associated with worsened SRSA via diminished protective attributes (p<0.001). Findings suggest the need for interventions enhancing positive and mitigating negative psychosocial factors to promote SRSA among OWLH.
Family Caregiver Mental Health: Linking Family Care Regime, Intersectionality, and Stress Process Frameworks
Authors: Browning Sean , Penning Margaret
Published: December 2020

Although the implications of family care regime, social location, and stress process factors for the mental health of family caregivers have been well-documented individually, there is a lack of research that integrates these factors. Yet, linking family care regime and intersectionality approaches to stress process theorizing provides us with one possible explanation of the mechanisms potentially linking family care regime and intersecting structural inequalities to mental health outcomes. This paper draws on pooled data from the 2012 and 2016 European Quality of Life Surveys (EQLS - N=6,007) to assess direct and indirect associations between family care regime and the self-reported mental health (SRMH) of family caregivers, together with the additive and interactive associations involving social location (gender, age, socio-economic status, and marital status), and stress process factors (stressors and resources). The results of a series of weighted least squares regression analyses reveal that family care regime has a direct association with SRMH and that social location and stress process factors partially mediate this association. Additionally, the results suggest that additive and interactive social location factors have direct associations with SRMH and that stress process factors also partially mediate the association. Lastly, stress process factors are associated with SRMH as expected. Overall, our findings provide initial support for the value of linking family care regime, intersectionality and stress process frameworks for an understanding of the mental health implications of family caregiving.
The Effects of the BAILAMOS Dance Program on Brain Functional Connectivity of Older Latinos: An Exploratory Study
Authors: Balbim Guilherme Moraes , Ajilore Olusola , Lamar Melissa , Erickson Kirk , Aguiñaga Susan , Bustamante Eduardo , Marquez David
Published: December 2020

Compared to non-Latinos whites, older Latinos are at higher risk of cognitive impairment and engage in less leisure-time physical activity (PA). Resting-state brain functional connectivity (FC) is a putative biomarker for age-related cognitive decline. PA plays a role in FC of brain networks associated with cognitive decline. Objective: Investigate the effects of the BAILAMOS™ dance program on FC in three brain networks associated with age-related cognitive decline (Default Mode [DMN], Frontoparietal [FPN], and Salience [SAL] networks). Methods: Single-group pre-post design. Ten cognitively intact older Latinos participated in the four-month (2x/week for 60min) BAILAMOS™ dance program with four Latin dance styles. MRI was obtained pre- and post-intervention. FC was analyzed using the resting-state fMRI toolbox (CONN) via pairwise BOLD signal correlations and then converted into z-scores. We performed dependent t-tests, computed Cohen’s d and 95%CI for p < 0.05. Results: Within-FPN FC significantly increased (t(9) = 2.35, p = 0.043, d = 0.70) from pre (M=0.49±0.15) to post-intervention (M=0.59±0.13). In the DMN, we observed moderate effect size changes in the ratio of the FC between-networks by the FC within-networks (Mdiff = 0.10; 95%CI = -0.01; 0.21, p = 0.08, d = 0.64). Conclusions: The BAILAMOS™ program increased within-FPN FC, which is a cognitive-control network related to adaptive control and flexibility. Moderate changes between- vs. within-DMN FC suggest BAILAMOS™ also increased whole-brain DMN integration. Taken together, results might signal that Latin dance can combat the disruption of FC between the DMN and other networks, and within-FPN, which are associated with cognitive decline.
Co-Designing and Evaluating a Self-Care Curriculum of an App for Chinese Immigrant Caregivers
Authors: Wang Ying , Liu Mandong , Chi Iris
Published: December 2020

Chinese immigrant caregivers face unique self-care difficulties in the United States due to language barriers, cultural isolation, and occupational stress. This study aimed to conduct a formative evaluation on a caregiver self-care curriculum of an app designed for Chinese immigrants in the United States. Using a co-design approach in 2019, 22 Chinese immigrant caregivers in Los Angeles county were recruited through purposive sampling method. The directed content analysis was adopted to analyze the qualitative data using NVivo 12.1.0 software. We organized the findings under two main contents: self-care and caregiving. Three categories were identified under the self-care content: physical health, emotional and mental health, and support resources. Sixteen subcategories under physical health (e.g., dietary supplements), five subcategories under emotional and mental health (e.g., depression) and eight subcategories under support resources (e.g., support and networking group, senior center) are suggested. Two categories were identified under the caregiving content: caregiving knowledge and skills, and community resources. Fourteen subcategories under caregiving knowledge and skills (e.g., care assessment) and six subcategories under community resources (e.g., medical emergency call) were mentioned. With this useful information, we could further refine the self-care curriculum to be more linguistically, culturally and occupationally sensitive for Chinese immigrant caregivers. Empowerment approach for enhancing the ability to caregiving and self-care should be emphasized in content design for immigrant caregivers. The co-design approach is crucial for planning of the program and intervention curriculum to improve understanding of the users’ needs and better cater them.
Informal Volunteering Helps Older Adults Stay Put Too! But, Does Gender Matter?
Authors: Shen Huei-wern , Perry Tam
Published: December 2020

Many older adults desire to remain in one’s home for as long as possible, and many factors have been identified to be helpful, such as formal volunteering (doing unpaid work for religious, educational, health-related or other charitable organizations). While many older adults volunteer formally, many others volunteer informally (providing unpaid help to friends, neighbors, or relatives who did not co-reside). However, less is known about the relationship between informal volunteering and relocation. Guided by the social and material convoy framework, the present study explores the intersection of gender, informal volunteering, and relocation (no move, move within area, and move out of area). Utilizing data from 2008 and 2010 Health and Retirement Study, 8,361 older adults who were 65 and above in 2008 were included. When older people’s financial resources, health, environment, and demographics were controlled, findings from multinomial logistic regression showed that older adults who volunteered informally were less likely to move within area two years later. When stratified by gender, it was found that female (n=4,832) volunteered informally in 2008 were less likely to move within area within two years, too; whereas for male (n=3,529), those who informal volunteered in 2008 were less likely to move out of area in 2010. According to the findings, informal volunteering helps older adults stay put. Future research is needed to understand why informal volunteering helps reduce short distance moves for women but helps reduce long distance moves for men.
There at Any Distance? Geographic Proximity and the Presence of Adult Children in Older People’s’ Confidant Networks
Authors: Schafer Markus , Sun Haosen
Published: December 2020

Adult children are key members of their aging parents’ close social network, often providing emotional and advisory supports. Still, adult children are not a guaranteed presence in older people’s core discussion networks. Geographical distance is a leading explanation for why some children are excluded from the confidant network, but we hypothesize that certain parent- and dyadic-level factors make these intergenerational ties more resilient to distance. Using wave six of the Survey of Health, Ageing, and Retirement in Europe, we identified whether a living adult child was also a member of the parent’s egocentric confidant network. We modeled the effect of the child (Level 1) and parent (Level 2) characteristics on the exclusion of a child from the core network using hierarchical logit models. We found that fifty-eight percent of children were excluded from a parent’s network. Parents were more likely to exclude those who lived more than 25 km compared to children who lived within 5 km. The impact of distance was exacerbated among parents who were older, partnered, or had four or more children. Parents with higher education and good computer skills were less sensitive to longer distances when listing a child as a confidant. Finally, parents who had confidants outside of the nuclear family and who lived in Northern Europe were less likely to exclude a child over 100 km from their confidant network. Together, results indicate that a number of demographic factors and personal and social resources contribute to the elasticity of parent-child ties across long distances.
Body Mass Index Instability and Incident Mild Cognitive Impairment Among Black Older Adults
Authors: Aiken-Morgan Adrienne , Capuano Ana , Arvanitakis Zoe , Barnes Lisa
Published: December 2020

Despite general negative health effects, elevated body mass index (BMI) can be “protective” against poor health outcomes, including cognitive decline and mild cognitive impairment (MCI), in old age. However, few studies have examined the effects of BMI fluctuations (BMI instability) over time. The purpose of this study was to examine how BMI level at baseline and BMI instability is related to incident MCI in Black participants from the Minority Aging Research Study (MARS; N = 522, mean age = 73.5, mean education = 15.0; 76.5% women). Participants without cognitive impairment at baseline underwent annual clinical evaluations, including measurement of BMI and 19 neuropsychological tests for up to 15 years of follow-up to document MCI. 192 of 522 persons developed MCI. In Cox models adjusted for age, sex, and education, 1) higher baseline BMI, across the range of all values (mean=30.5; SD=6.5), was related to a decreased risk of MCI (Hazard Ratio = 0.97; 95% CI = 0.94-1.00); and 2) BMI instability (with a maximal range of 0-15.7; mean=3.2; SD=2.5) was related to an increased risk of MCI (Hazard Ratio = 1.09; 95% CI = 1.03-1.15). The present findings suggest that while late-life higher BMI level may protect against MCI, BMI instability over the years is detrimental to cognition in Black persons without dementia. Future research should investigate underlying mechanisms.
Dealing With Loneliness Among LGBT Older Adults: Different Coping Strategies
Authors: Peterson Natasha , Lee Jeongeun , Russell Daniel
Published: December 2020

Older lesbian, gay, bisexual, transgender (LGBT) adults may be at risk for high levels of loneliness—a risk factor for worse health behaviors—as a result of historical and social discrimination. Some LGBT older adults may have estranged relationships with family members or have toxic relationships, consequently leaving them without adequate social support. The 2018 Loneliness and Social Connections survey by the AARP Foundation consists of a national sample of non-institutionalized individuals 45 and older, including 2905 individuals who identify as heterosexual and 318 who identify as LGBT. The study indicated individuals had similar levels of loneliness regardless of sexual orientation. However, significant differences between heterosexuals and LGBT participants were found in their communication and time usage when they are lonely. For example, heterosexual individuals socialize with friends in person more than homosexuals (t=-2.393, p<.05), whereas LGBT older adults use technology more to socialize with friends (t=3.749), p<.001. Further, findings revealed that older LGBT adults tend to engage in more risky or unhealthy behaviors when lonely than do heterosexual older adults (t=3.907, p<.001). Overall, the results indicate that while LGBT older adults may spend more time alone (t=7.350, p<.001), they are engaging in different types of activities, particularly involving technology to communicate with friends, suggesting compensation for their lack of in-person contact. By understanding how LGBT older adults cope with loneliness along with the risks and resources that have influences on their health disparities can be useful for developing interventions to improve the health and well-being in these communities.
Association Between Living Arrangement and Acute Care Use in Older Medicare Home Health Patients
Authors: Wang Jinjiao , Ying Meiling , Cai Xueya , Caprio Thomas , Temkin-Greener Helena , Li Yue
Published: December 2020

This secondary analysis used a 10% random sample from the national Outcome and Assessment Information Set (OASIS) of Medicare beneficiaries ≥ 65 years old who received home health (HH) care in 2017 (N=646,109). We examined the risk of hospital admission during a 60-day HH episode among Medicare home health patients in different living arrangements, including living alone at home (23.8%), living with other at home (64.8%), and residing in assisted facility (AL) facilities (11.4%). At the start of the HH episode, AL residents were older, more likely to have cognitive impairment, depressive symptoms, and limitations in activities of daily living (ADL) than those living at home at home (alone/with others). In the multivariable logistic regression model of hospital admission adjusting for demographic status (age, sex, race/ethnicity, Medicaid status), cognitive impairment, depressive symptoms, and ADL limitations, when compared to HH patients living with others at home (reference), AL residents were 15% less likely to have hospital admission (Odds Ratio [OR]=0.85, 95% Confidence Interval [CI]: 0.84, 0.88, p<0.001). HH patients living at home alone were not statistically significantly different from the reference (OR=0.99, 95% CI: 0.98, 1.01, p=0.47). HH patients in AL, despite having worse cognitive, mental, and physical function at baseline, had better outcomes than those living at home. This suggests 1) older adults living at home may have unmet health or personal care needs, and 2) synergies may exist between post-acute care through HH care and long-term care and support at AL that are critical to patient welfare.
The Harmonization of Four Delirium Instruments
Authors: Helfand Benjamin , Detroyer Elke , Milisen Koen , Adamis Dimitrios , Jones Richard
Published: December 2020

Delirium is a clinical syndrome characterized by acute cognitive dysfunction, which is pervasive in older persons. Delirium affects over 2.6 million Americans over age 65 annually. One major problem in detection of delirium is that over 40 different instruments have been created to identify delirium in different clinical settings. There is no single agreed upon reference standard instrument. In previous work, we performed a systematic review to identify the four most commonly cited and well-validated instruments for delirium identification. The aim of this study is to harmonize these four commonly used instruments: Confusion Assessment Method (CAM), Delirium Observation Screening Scale (DOSS), Delirium Rating Scale-Revised-98 (DRS-R-98), and Memorial Delirium Assessment Scale (MDAS). We used data from three separate sources (N = 1623). Participants were rated by multiple and overlapping instruments across studies, allowing us to apply item response theory linking procedures. We fit generalized structural equation models, and found unidimensional factor models fit well. We found the instruments were highly correlated (all r > 0.9) and kappa statistics for delirium case identification were high (range: 0.89 to 0.95). We generated crosswalks to map sum scores on one instrument to another. Our results suggest the same underlying construct, propensity to delirium, is measured across the four instruments. The crosswalks facilitate comparison and combination for immediate clinical use or for future meta-analyses. In future steps, we will use our results to find the optimal cut-points for use across all instruments to identify delirium.
Hyposmia and Neuroimaging Signature in Community-Dwelling Older Adults
Authors: Felix Cynthia , Chahine Lana , Chen Honglei , Cao Zichun , Rosano Caterina
Published: December 2020

Olfaction declines with aging, and hyposmia, or impaired sense of smell, is associated with neurodegenerative disorders including Alzheimer’s Disease (AD) and Parkinson’s Disease (PD). Neuroimaging studies of hyposmia in AD/PD patients have often examined pathology-specific brain regions. Our knowledge of neural correlates in regions that mediate olfaction in community-dwelling older adults, is limited. We quantified mean diffusivity (MD) of the gray matter (GM) using diffusion tensor imaging in a community-dwelling sample of 308 older adults (mean age: 82.9 years, 58% women, 40% black). We focused on total brain and these regions involved in olfaction- olfactory bulb, amygdala, entorhinal cortex, orbitofrontal cortex, and hippocampus. Smell was tested with a scratch-and-sniff validated odor identification test, the Brief Smell Identification Test (BSIT). Hyposmia was defined as BSIT score of ≤8, assessed about 7 years prior to neuroimaging. In our sample, 23% had hyposmia, more in in men (30%) than in women (19%). Hyposmia was not significantly associated with cardiovascular risk factors such as hypertension; diseases such as stroke; age; race; cognitive or mobility functions (all p>0.1). In linear regression models adjusted for demographics and brain atrophy (total brain gray matter volume divided by intracranial volume), hyposmia was significantly associated with higher GM MD (lower microstructural integrity) of the left orbitofrontal cortex (standardized beta: 0.142, t=2.56, p=0.011). Understanding the neural substrates involved in hyposmia in aging is an important step towards advancing research on hyposmia in non-clinic-based, community-dwelling populations.
Olfaction and Physical Function in Older Adults: Findings From Health ABC
Authors: Yuan Yaqun , Luo Zhehui , Li Chenxi , Simonsick Eleanor , Shiroma Eric , Chen Honglei
Published: December 2020

The present study aims to investigate poor olfaction in relation to physical functioning in community-dwelling older adults and potential sex and race disparities. The analysis included 2511 participants aged 71-82 years (51.7% women and 38.4% blacks) from the Health Aging, and Body Composition (Health ABC) study. Olfaction was tested with the 12-item Brief Smell Identification Test (BSIT). Physical function measures included the Short Physical Performance Battery (SPPB), the Health ABC Physical Performance Battery (HABCPPB), gait speed of 20-meter walk, fast 400-meter walking time, grip strength, and knee extensor strength, repeatedly assessed annually or biennially for a follow-up of seven years. We analyzed each of these physical function measures using mixed models, adjusting for demographics, lifestyle, and comorbidities. For all measures except grip and knee extensor strength, poor olfaction was clearly associated with poorer physical performance at baseline and a faster decline over time. For example, at baseline, the multivariate adjusted SPPB was 8.23 ± 0.09 for participants with poor olfaction and 8.55 ± 0.09 for those with good olfaction (P = 0.02), after seven years of follow-up, the corresponding scores decreased to 6.46 ± 0.12 and 7.36 ± 0.10 respectively (cross-sectional P<0.001, and P for olfaction-by-year interaction < 0.001). For grip and knee extensor strength, similar differences were suggested but didn’t reach statistical significance. The overall results were similar by sex and race. In summary, poor olfaction is clearly associated with faster decline in physical functioning in older adults and future studies should investigate its potential health implications.
Age as an Element of Diversity: Intergenerational Discussion to Improve Age-Related Attitudes
Authors: Wagner Lisa , Luger Tana
Published: December 2020

All generations must work together solving societal problems, yet age-related stereotypes are used to divide generations. Age derogation motivates younger people to vote by creating fear of an older White voting generation (Dear young people, don’t vote; 2018), and to belittle older people (“Okay, Boomer…”). Demonizing older people creates prejudice within families asking that people target loved ones, for example, by pitting educational funding for young against health funding for older adults. Neither group wins when divisiveness occurs. Generation to Generation, an intergenerational course for older and younger adults, promotes intergenerational contact. Students discuss topical issues (e.g., racism) in multi-generational groups. Using pretest-posttest design, all students were invited to complete questionnaires at beginning and end of term. Younger adults reported significant increases in affection, comfort, kinship, engagement and enthusiasm for older adults, whereas older adults showed stability over time. Intergenerational discussion may facilitate improved connections between generations.
Living and Learning Partnerships on Age-Friendly University Campuses
Authors: Montepare Joann , Farah Kimberly
Published: December 2020

Campuses and communities have a long and varied history of partnerships around educational efforts. In response to current shifts in age demographics and the number of adults aged 65+ increasing dramatically, new partnerships around living and learning are emerging. In particular, university-based retirement communities (UBRCs) associated with institutions of higher education are growing as housing options for older adults in the United States. The establishment of the Age-friendly University (AFU) initiative offers a guiding framework for how UBRC partnerships may be effectively mounted. This presentation will use the case example of the Lasell University – Lasell Village partnership to demonstrate how AFU principles can be implemented through age-friendly curricular programming and intergenerational exchange. Logistical considerations such as individualized learning plans for UBRC residents, an on-campus location, shared resources, and governance policies will be also be discussed as components of successful partnerships.
AGHE Program of Merit for Health Professions Education
Authors: Weinreich Donna
Published: December 2020

In 2015, the Program of Merit was expanded and adapted to implement a voluntary evaluation process for health professions programs that are choosing to integrate gerontology/geriatrics competencies in order to prepare students for working with older adults as well as their informal care partners. These programs are now eligible to apply for the Program of Merit designation. The Program of Merit for Health Professions Programs is based on the AGHE Standards and Guidelines for Gerontology/ Geriatrics in Higher Education, Sixth Edition (2015), specifically Chapters 11 and 12. This session will provide an overview of the process, review the application content, and provide technical support for interested participants.
Stony Brook University Forging Intergenerational Links Through Life-Story Sharing Project
Authors: Ferguson Giselle , Monahan Caitlin , Levy Sheri , Rajaram Suparna , Richmond Lauren , Scott Stacey
Published: December 2020

According to the World Health Organization, the global population is aging, but ageism may now be the most socially “normalized” of any prejudice, more pervasive than sexism or racism. Ageism produces avoidant and disrespectful treatment of older adults and contributes to a shortage of college students seeking careers with older adults. To foster positive intergenerational contact and combat ageism, we organized life-story sharing by older adult community members in four undergraduate psychology courses with lifespan themes (Psychology of Aging, Memory, Death & Dying, Developmental Psychology; n≅500). A panel visited each class; instructors and graduate students facilitated discussion between students and panelists. Students completed pre- and post-surveys of ageism and attitudes toward aging. A majority of students recommended integrating the activity into future semesters. In free-responses, students also frequently expressed surprise that panelists reported not feeling different than they had at age 20, and that this information challenged previously held stereotypes.
Taking Education to the World: Implementing Aging Curriculum in Faith Communities
Authors: Bouchard Lauren
Published: December 2020

Religious communities are uniquely able to serve the needs of older adults, yet very little aging related training exists for lay people and clergy within religious congregations. This talk will discuss the needs of older adults in faith communities, intergenerational interventions, and formal educational training programs such as the Specialist in Aging Ministries program (SAM) developed by Concordia University Chicago as a way to educate and support caregivers and older adults in real world settings. The speaker will also discuss the ways gerontology curriculum has personally impacted her applied work with elders in faith communities including next steps for building and implementing curriculum and training for caregivers, older adults, and the community at large. Sociocultural implications and future directions will also be discussed.