bluuebunny/crossref_metadata_2025 huggingface dataset:
OLDER ADULT ENGAGEMENT IN COMMUNITY GERONTOLOGY
Authors: Pope Natalie
Published: December 2022

Community gerontology integrates scholarship on aging and communities through the lens of mesolevel environments, the diverse continua of settings linking micro and macro contexts of aging. This interdisciplinary symposium brings together research exploring the interconnections of older adults’ engagement across and within the socio-ecological levels of their lived experiences, place-based communities, and policy contexts. Yeh et al.’s paper elucidates the promises of visual methods in critical qualitative research with older adults to subvert power dynamics and advance social justice in gerontology. Latham-Mintus’ paper explores how “weak ties” created by the interaction of social infrastructure within geospatial places and spaces can facilitate longer, healthier lives. Reyes’ paper uses an intersectional life course perspective to explore placemaking as civic participation among Latinx immigrants and African American older adults across time and social environments. Plasencia’s paper focuses on aging in community among diverse older adults using a photovoice to assess their perceptions and needs within the lived urban environment. Pope and colleagues explore how a multi-state sample of older adults perceive their roles in age-friendly initiatives at individual, organizational, and community levels. Taken together, the papers discuss and contextualize the multidirectional ways older adults engage their place-based communities within larger macro sociopolitical structures – an analysis that highlights the embeddedness of mesolevel community environments both within and between micro and macro spheres. This session further speaks to the importance of centering older adults’ experiences in community gerontology by illuminating the ways older adults not only age in community but through layers of community.
SELF-ADMINISTRATED ELDER ABUSE INTERVENTION FOR OLDER ADULTS WITH COGNITIVE IMPAIRMENT
Authors: Abujarad Fuad , Edwards Chelsea , Wyk Brent Vander , Mosqueda Laura , Hwang Ula , Neugroschl Judith , Marottoli Richard
Published: December 2022

Many elder abuse interventions and tools designed to screen for abuse exclude older adults with cognitive impairments (CI) due to the challenges associated with screening and whether the older adult with CI can reliably report elder abuse. However, it has been shown that older adults with CI are among the most vulnerable to experiencing elder abuse. VOICES is an innovative, automated tablet-based elder abuse screening and prevention intervention that is self-administered by the older adult in the provider’s waiting room or office. The VOICES Elder Abuse Intervention (EAI) provides screening, educational modules, and brief psychoeducational intervention to enhance and improve identification of elder abuse when there are no visible signs of abuse. The VOICES EAI was already proven successful in terms of feasibility and acceptability in cognitively intact older adults in a busy emergency department setting with (N=1,002). In this study we tested the VOICES EAI with (N=30) participants 60 and above with cognitive impairment at a geriatric center using the Montreal Cognitive Assessment (MoCA) to determine cognitive capacity. Experts in the field of geriatrics and cognitive impairment assisted in grouping participants within three cognitive categories: Mild cognitive impairment (MoCA 23-25), mild dementia (MoCA 16-22) or moderate dementia (MoCA 8-15). Of the (N=30) participants, 29 were able to successfully use the VOICES EAI independently, and most participants were satisfied with the tool. We will discuss the findings of this preliminary study and the implications for future research with older adults with CI.
THE EFFECT OF SELF-PERCEPTIONS OF AGING ON PHYSICAL ACTIVITY: RESULTS FROM THE AGINGPLUS STUDY
Authors: Nehrkorn-Bailey Abigail , Tseng Han-Yun (Heidi) , Rodriguez Diana , Li Kaigang , Rebok George , Roth David , Chung Shang-En , Diehl Manfred
Published: December 2022

The AgingPLUS program targets negative self-perceptions of aging (SPA) as one mechanism to increase physical activity (PA) in adults. This study utilized a mediation model to examine the effect of AgingPLUS on subsequent PA with SPA included as a mediator. Data came from 184 participants (Mage = 59.91 years; SDage = 8.14 years) from the ongoing trial. Although the direct effect from condition to Week 8 PA was not significant, the pathway from condition to Week 4 SPA was significant. Additionally, the pathway from Week 4 SPA to Week 8 PA was marginally significant (β = .11, p = .07). However, the indirect effect was not significant. Given that (1) the AgingPLUS program resulted in significantly more positive SPA and (2) more positive SPA marginally predicted more minutes of subsequent PA, these results provide preliminary support for the efficacy of the ongoing program.
AGING RESEARCH IN CRIMINAL LEGAL SYSTEMS: IMPLICATIONS FOR POLICY AND PRACTICE
Authors: James Jennifer , Williams Brie
Published: December 2022

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EFFECTS OF DISCRIMINATION/VICTIMIZATION ON HEALTHCARE UTILIZATION VIA HEALTHCARE BARRIERS
Authors: Kittle Krystal , Kim Kyungmin , Goldsen Karen Fredriksen , Boerner Kathrin
Published: December 2022

Aging lesbian, gay, bisexual, and transgender (LGBT) adults are a health disparate population with unique healthcare challenges. Using data from the Aging with Pride: National Health, Aging, Sexuality/Gender Study (NHAS; N = 2,560), we examined contextual factors that influence the healthcare utilization of LGBT middle-aged and older adults. Causal indirect, direct, and total causal effects based on counterfactuals were computed to assess mediational links between discrimination/victimization and healthcare utilization via healthcare barriers. Discrimination/victimization had an indirect effect on health screenings via fear accessing health services both inside and outside of the LGBT community, financial barriers to care or medication, and being uninsured. Discrimination/victimization also had an effect on routine checkups and having a regular provider, via fear seeking health services outside of the LGBT community, financial barriers and being uninsured. Findings can be utilized in LGBT cultural competency trainings for health and human service providers serving aging LGBT people.
FACTORS THAT PREDICT LONELINESS FOR MIDDLE-AGED AND OLDER ADULTS DURING THE COVID-19 PANDEMIC
Authors: Curl Angela , Wolf Katie
Published: December 2022

The Protection Motivation Theory (Eberhardt & Ling, 2021; Rogers, 1975) describes factors that influence intention and engagement in preventive health behaviors, including knowledge/experience, threat appraisal, and coping/efficacy appraisal. Public health responses to the covid-19 pandemic were designed to increase knowledge, emphasize potential severity of being infected, and promote preventive health behaviors – all with the goal of reducing infection transmission. However, these efforts may have inadvertently increased loneliness, particularly for older adults. This study used 2020 Health and Retirement Study data (N=1,687 adults over age 50) to examine predictors of loneliness based on the PMT framework, controlling for demographic factors and 2016 loneliness scores. Structural Equation Model results indicate that being at higher risk for covid-19 complications and death was associated with lower feelings of control over health (B=-.09), greater likelihood of knowing someone who died from covid-19 (B = .20), and higher overall concerns about covid-19 (B=.12), all p<.01. Higher concerns about covid-19 and knowing someone who died from covid-19 were associated with more protective behaviors (B=.41, p<.01; B=.05, p<.05; respectively). Not knowing someone who died of COVID-19, and lower perceived control over health and social life were all significantly associated with higher loneliness scores. These results suggest that interventions that promote perceived control over one’s health and social life may be effective in reducing feelings of loneliness in this population, and that feelings of control over health also increases preventive health behaviors that reduce the risk of covid-19 infection.
HISTORY: MINNESOTA FAMILY WORKSHOP TO SAVVY CAREGIVER: CENTRALITY OF SELF-EFFICACY
Authors: Hepburn Kenneth
Published: December 2022

This presentation will trace the development of the Savvy Caregiver program from its beginnings as the Center for Nursing Research-supported Minnesota Family Workshop (1993; PI: Sharon Ostwald) through a further test as the Partners in Caregiving Program (1997; PIs: Hepburn 1RO1NR04517-01) to the Alzheimer’s Association-supported Savvy program (1997; PIs Hepburn & Lewis). Three main developments occurred over this period: the program solidified its identity as a caregiver training program and its mechanism of action as that of self-efficacy development through an active learning approach; it sharpened its focus by concentrating on the principal family caregiver (moving away from a broader family approach and eliminating concurrent care recipient programming); and it developed interventionist training materials and programs to enable broader reach. Since 2002, Savvy has enjoyed wide dissemination as an evidence-based in-person psychoeducation program, fostered by support to sponsoring organizations by the Administration on Community Living.
BRINGING INTERACTIVITY TO FULLY ASYNCHRONOUS PROGRAMS
Authors: Clevenger Carolyn
Published: December 2022

Asynchronous online learning brings both new opportunities as well as challenges to an asynchronous psychoeducation program like Tele-Savvy@Home. While asynchronous learning offers engagement flexibility for time-strapped family caregivers, a lack of scheduled meetings represents a lack of contact and interactivity, threatens accountability, and produces a high incompletion rate. To engage participants in the next generation of this asynchronous, self-paced course, we have implemented a small cohort structure (10 participants each) and created a combination of automated prompts and optional touchpoints. The cohort structure and touchpoints mimic important shared and active learning components of the facilitated sessions. Prompts include weekly messages that nudge learners with reminders of their ideal progress point and offer value propositions for staying on-time. A pacing guide allows caregivers to build the course into their schedule in advance of the course’s start. Optional touchpoints include unit-by-unit post-tests, a cohort-based discussion board, and free text reflective exercises.
SOCIAL HEALTH IN THE CASE OF DEMENTIA: AN INTERNATIONAL PERSPECTIVE
Authors: Wolf-Ostermann Karin , Vernooij-Dassen Myrra , Melis Rene
Published: December 2022

Dementia is one of the major age-related societal challenges and causes enormous demands for persons living with dementia (PlwD) and their families. We do not understand the origins of this multifactorial syndrome and there is still no cure for dementia. New thinking by the exploration of paradigms has scope to improve knowledge about this complex condition. Social health can be understood as a driver for stimulating the use of cognitive reserve through active facilitation and utilization of the individual’s capacities. It allows to slow cognitive impairment or to maintain cognitive functioning in old age and therefore seems to be a promising approach to a better understanding of the developmental mechanism of dementia.In this international symposium we therefore aim to explore the role of social health in the onset and progress of dementia. The first presentation will present a new framework on understanding social health in dementia. The second presentation will describe convoys of care in a family based culturally sensitive ADRD caregiving intervention reducing care burden and family conflicts. The third presentation reports on the role of immune system and neurodegeneration markers in the association between social health and cognitive brain aging in older adults. The final presentation presents newly derived results from a mixed research synthesis on underlying mechanisms of the interrelation of social health and cognitive functioning, elaborated by the international SHARED-consortium. Our discussant will synthesize the research findings and lead a discussion of future directions for research and practice to successfully fight challenges in dementia care.
COMBATING STIGMA: AN EDUCATIONAL RESOURCE ON SUBSTANCE USE DISORDER IN OLDER ADULTS
Authors: Mackiewicz Marissa , Slattum Patricia , Waters Leland
Published: December 2022

Substance Use Disorder (SUD) affects people from all walks of life and age groups. Special considerations for older adults with SUD should be made secondary to the unique pathophysiological and socio-economic complexities of aging populations. Successful SUD treatment and recovery depends on access to essential support systems comprised of interprofessional teams as well as family, friends, and caregivers. Education on SUD for healthcare providers, caregivers and the community is a key component for combating the national opioid epidemic and the stigma that can be a barrier to recovery. A ten-minute video and an accompanying discussion guide were developed to present to clinical faculty and students participating in an interprofessional care coordination wellness clinic servicing low-income older adults living independently in the community setting. The video was designed to highlight stigma and ageism facing older adults with SUD and serve as the basis for discussion among learners. The process for creating and evaluating the video and discussion guide will be shared including the role of older adults with lived experience of SUD in the process. Information will be provided on SUD as a chronic disease and the importance of interprofessional and individualized patient care in recovery. Participants will be able to identify the significance of SUD related stigma in providing and seeking care, asses the role of mental/behavioral health in SUD, and learn about treatment options for SUD. This will allow for better identification of characteristics of older adult populations that place them at greater harm from the consequences SUD.
EPIGENETIC AGING OF THE DEMOGRAPHICALLY NONAGING NAKED MOLE RAT
Authors: Kerepesi Csaba
Published: December 2022

The naked mole-rat (NMR) is an exceptionally long-lived rodent that shows no increase of mortality with age, defining it as a demographically non-aging mammal. Here, we perform bisulfite sequencing of the blood of>100 NMRs, assessing>3 million common CpG sites. Unsupervised clustering based on sites whose methylation correlates with age reveals an age-related methylome remodeling, and we also observe a methylome information loss, suggesting that NMRs age. We develop an epigenetic aging clock that accurately predicts the NMR age. We show that these animals age much slower than mice and much faster than humans, consistent with their known maximum lifespans. Interestingly, patterns of age-related changes of clock sites in Tert and Prpf19 differ between NMRs and mice, but there are also sites conserved between the two species. Together, the data indicate that NMRs, like other mammals, epigenetically age even in the absence of demographic aging of this species.
THE FOXO3 LONGEVITY GENOTYPE PROTECTS AGAINST MECHANISMS OF CELLULAR AGING IN OKINAWANS
Authors: Torioge Trevor , Willcox D Craig , Shimabukuro Michio , Donlon Timothy , Chen Randi , Allsopp Richard , Willcox Bradley
Published: December 2022

The genetic association of FOXO3 genotypes with human longevity is well established, although the mechanism is not fully understood. We now report on the relationship of the FOXO3 longevity variant rs2802292 with telomere length, telomerase activity, FOXO3 expression and inflammatory cytokine levels in men and women. In agreement with earlier work, the FOXO3 longevity variant conferred protection against telomere shortening of peripheral blood mononuclear cells from adults aged 55 and older. This was accompanied by higher levels of telomerase activity in carriers of the longevity-associated FOXO3 G-allele (P=0.015). FOXO3 mRNA expression increased slightly with age in both young (P=0.02) and old (P=0.08) G-allele carriers. Older female G-allele carriers displayed a modest decline in levels of pro-inflammatory cytokine IL-6 with age (P=0.07). In contrast, older male G-allele carriers displayed an age-dependent increase in levels of anti-inflammatory cytokine IL-10 with age (P=0.04). Thus, FOXO3 may act through several different pro-longevity mechanisms, which may differ by age and sex.
THE TOLL OF BINGE EATING ON AGING: THE PHYSICAL FUNCTIONING OF OLDER WOMEN WITH WEEKLY BINGE EATING
Authors: Hooper Savannah , Marshall Victoria , Bridges Preston , Espinoza Sara , Keel Pamela , LaCroix Andrea , Musi Nicolas , Kilpela Lisa
Published: December 2022

Binge eating (BE) is defined as eating an unusually large amount of food while feeling a loss of control; BE prevalence rates range from 12-26% in older adult women. BE is closely linked with obesity, depression, and poor micronutrient intake, as well as with cardiovascular issues and pain in younger populations. Among older adults, such morbidities can negatively affect quality of life and mobility. Yet, little is known about the toll of BE on the aging body in terms of physical function. Thus, the current investigation assessed the physical functioning of older women (60+ years) with clinical levels of BE (i.e., ≥weekly BE). Participants (N = 21) underwent several physical function tests including lower extremity functioning (Short Physical Performance Battery; SPPB), endurance (Six-Minute Walk Test), and grip strength. The majority of participants (76%) had a BE age of onset in midlife or later (age 42+). The average BMI was 35.08±8.64, and 90.48% met criteria for overweight or obesity. On the SPPB, 47.62% scored < 10, suggesting mobility limitations and predicting all-cause mortality. Most women (90.48%) scored >1SD below the age/gender matched norm on the Six-Minute Walk Test (M=355.96±67.04) while 61.9% scored >1SD below the norm for grip strength (M=24.91±6.40). Results indicate that older women struggling with BE also demonstrate diminished physical functioning, which confers risk for future health problems and poorer quality of life. Our findings suggest that intervention development for older populations struggling with BE may need to incorporate physical rehabilitation to promote healthy aging in this population.
IDENTIFICATION AND INVESTIGATION OF SENESCENT CELLS IN SKELETAL MUSCLE AGING
Authors: Zhang Xu , Habiballa Leena , Aversa Zaira , Ng Yan Er , Passos Joao , LeBrasseur Nathan
Published: December 2022

Skeletal muscle aging is marked by the loss and atrophy of resident fibers, and the accumulation of functionally diverse cell types including fibroblasts, adipocytes, and immune cells. Senescent cells amass in multiple tissues with advancing age where they contribute to aging, chronic disease, and physical decline. The role of senescence in mediating muscle aging has become a popular and sometimes contentious topic. However, to date, this concept has not been methodically tested. In this study, we characterized the changes in cell abundance and, importantly, cell-specific transcriptional profiles with skeletal muscle aging using scRNAseq. Interestingly, we identified a small population of p16 positive fibro-adipogenic progenitors (FAPs) which, upon further investigation using immunohistochemical methods, were found to express other senescence markers. This subpopulation of FAPs did not exhibit elevation in p21 levels with age. Instead, terminally differentiated myofibers were the source of the p21 increase. Myofibers with high p21 expression exhibit a strong inflammatory phenotype, which includes activated p53 signaling pathways together with strong cytokine-cytokine receptor interactions. We further identified large amounts of cross-talk between different cell types, suggesting that senescent FAPs and myofibers could contribute to skeletal muscle aging in a paracrine manner. Importantly, these observations in mice were confirmed in human samples, suggesting the strong translational power of these findings.
C-REACTIVE PROTEIN AND BRAIN MORPHOLOGY
Authors: Pearce Rahul , Eyler Lisa , Bell Tyler , Elman Jeremy , Fennema-Notestine Christine , Hagler Donald , Franz Carol , Kremen William
Published: December 2022

The process by which aging leads to increased risk for Alzheimer’s disease and dementia is not entirely understood, but one hypothesized contributor is the occurrence of low-grade inflammation in older age. In this study, we examined how peripheral levels of C-reactive protein (CRP), a measure of systemic inflammation, relate to brain structure and diffusion in a group of older adult men. After excluding twenty-seven participants for confounding medical conditions, we analyzed a final sample of 426 community-dwelling men from the Vietnam Era Twin Study of Aging, who were assessed at average age 68 for plasma levels of CRP and underwent structural and diffusion brain imaging. Linear mixed models adjusting for family relatedness, age, medical morbidity, and BMI examined associations of CRP with whole brain volume, whole gray and white matter volumes, global fractional anisotropy (FA), and global mean diffusivity (MD). Higher CRP was related to lower whole brain volume (β = -.13, p = .006), including lower whole white matter volume (β = -.22, p <.001) but not whole gray matter volume (p = .08). Higher CRP was related to lower global FA (β = -.51, p = .012) but not global MD (p = .203). Regionally, a relationship of higher CRP to lower FA was found in the anterior thalamic radiation (β = -.51, p = .010), which is implicated in a variety of higher order cognitive processes. These results suggest a link between peripheral inflammation and lower white matter integrity in older adult men, the implications of which for cognitive aging and dementia should be further explored.
NOVEL APPROACHES TO MINIMIZE SOCIAL ISOLATION AND MAXIMIZE PARTICIPATION IN OLDER ADULTS WITH DEMENTIA
Authors: Rodakowski Juleen , Rodakowski Juleen
Published: December 2022

Older adults experiencing cognitive decline, including those with Alzheimer’s disease and related dementias, are at-risk for social isolation and participation restrictions, especially given the COVID-19 pandemic. Previously examined research has primarily focused on reducing problematic behaviors and remediating cognition for individuals with cognitive impairments. In this symposium, we will discuss novel intervention approaches and under-studied aspects of lifestyle behaviors that minimize social isolation and maximize participation for older adults with Alzheimer’s disease and related dementias. Information presented in this symposium is intended to inform future intervention research to achieve an optimal quality of life for those with cognitive impairments. The first presentation will describe an analysis of lifestyle behaviors and cognition in an older population. The second presentation will discuss the development of an intergenerational, active music intervention that is delivered virtually to individuals with dementia and their caregivers. The third presentation will describe the effects of an adaptive horseback riding program that is becoming increasingly prevalent and improves the quality of life of persons living with Alzheimer’s disease and related dementia.
TOWARD A NEUROECOLOGICAL MODEL OF FINANCIAL CAPACITY AMONG OLDER ADULTS
Authors: Barnett Michael , Van Vleet Samuel , Prentice Kailee , Wurm Annika , Bass Danica , Mejia Yenifer Morales , Dube Jeanné , Van Vleet Samuel
Published: December 2022

In recent decades, technology has changed how individuals interact with their money and with each other. A combination of financial vulnerability and low technological literacy puts many older adults at risk for identity theft, fraud, and financial exploitation. We reviewed the literature on financial capacity, financial exploitation, and digital literacy. Extant models and measures of financial capacity among older adults emphasize numeracy and basic functional skills, such as writing checks and counting change; these may not reflect the digital nature of contemporary financial activity. We propose the neuroecological model of financial capacity among older adults. This function-led model contends that financial capacity consists of neurocognitive abilities to make sound financial decisions in a complex environment, to use technology to monitor and carry out financial activities, and the ability to protect personal information and guard against fraud. This points to a need for more ecologically valid measures of financial capacity and vulnerability to financial exploitation that addresses the role of technology in everyday financial activities.
LEARN, PLAN, DO: PUBLIC HEALTH PLANNING TO ADDRESS DEMENTIA AND CAREGIVING
Authors: Sands Talyah , Shah Priya , Donnellan Kelsey , Holt Heidi
Published: December 2022

To respond to growing rates of dementia, as well as emerging scientific evidence, there is an urgent need for states to leverage public health strategies to reduce the risk of dementia, promote early detection, and prevent avoidable health issues related to dementia as well as systematically support dementia caregiving. The BOLD Infrastructure for Alzheimer’s Act passed into law on December 31, 2018. The law is designed to promote implementation of CDC’s Healthy Brain Initiative State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map Series and the Healthy Brain Initiative Road Map for Indian Country. Its goal is to create jurisdiction infrastructure and promote planning and action to address dementia across the life-course. With support from CDC, the Association of State and Territorial Health Officials developed an e-learning module to guide public health departments on engaging partners in jurisdiction planning on dementia. The module aligns with the Healthy Brain Initiative Road Map and offers approaches to operationalize health equity throughout its resources. During this session, presenters will overview the module contents and detail the process developed to help jurisdictions assess their dementia and caregiving needs, prioritize actions from the Road Map, and create an action plan. They will also share examples of state planning efforts. Participants will learn how to get started with their own planning process using the tools offered in the module and examples from other states. This presentation complements Tools to Support Needs Assessments on Dementia, Cognitive Health, and Caregiving, abstract ID 1226183.
THE IMPACT OF A FACILITATED DISCUSSION SERIES IN IMPROVING DEMENTIA CAREGIVER STRESS, RESILIENCY, AND WELL-BEING
Authors: Bonifas Robin , Cohen Wendy
Published: December 2022

Emotional stress stemming from the complex grief associated with dementia care takes a greater toll on a family caregiver’s health than the physical effort of providing care. Finding Meaning and Hope, a 10-week workshop for caregivers of persons with dementia designed to promote understanding of grief and teach self-care concepts that mitigate stress. Each session features a video of a dementia care expert sharing strategies, followed by a facilitator-led discussion. Home practice activities help caregivers incorporate focal self-care strategies into their lives. This evaluation research assessed the association between workshop participation and caregiver outcomes in stress and well-being. 208 caregivers, 83 percent age 60 and older, completed the workshops between 2019 and 2021. Two standardized instruments were administered before and after workshop participation: the 12-item Caregiver Self-Assessment Questionnaire (American Medical Association, 2015) and the 11-item Sense of Competence Questionnaire (Vernooij-Dassen, 2008). Multivariate Linear Regression was used to assess factors associated with participant outcomes. Participation in more than half the sessions had a positive impact on stress management, emotional well-being, and coping, but fewer gains were made by caregivers with health limitations and those who began the workshops with lower emotional well-being ( F = 15.923, p < .001). Given that family caregivers’ mental and emotional health has been negatively impacted by the COVID-19 pandemic (Czeisler et al. 2020), strategies to manage stress and bolster well-being are vital in enabling them to continue care provision when isolation may exacerbate the challenges they encounter. Finding Meaning and Hope offers a promising approach.
SOCIAL CONNECTIVITY IS ASSOCIATED WITH INCREASED PERFORMANCE ON MEDIAL TEMPORAL LOBE FUNCTION IN OLDER AFRICAN AMERICANS
Authors: Tan Genesis , Osiecka Zuzanna , Fausto Bernadette , Esiaka Darlingtina , Gluck Mark
Published: December 2022

Research links social connectivity to cognitive function in older adults. However, many of the studies relating social connectivity to cognitive function focused on global cognition—orientation/attention, memory, verbal fluency, language, and visuospatial ability domains. In this study, we aimed to assess the association of social connectivity with generalization, a domain of cognition which relies on hippocampal function, in a population of older African Americans residing in the Greater Newark area. Specifically, we examined the impact of social connectivity on generalization using sensitive measures that tap into medial temporal lobe (MTL) function. Participants (N = 74; M = 73.84) from an ongoing study, Pathways to Healthy Aging in African Americans—a Rutgers University-Newark community partnership fostered over 16 years of community engagement, health education, and public service—responded to measures of cognitive function, social network, social engagement, mental health, and demographic details. Also, they completed a task-based functional Magnetic Resonance Imaging. Results showed that marital status was negatively associated with MTL function, with those that are either single, divorced, or separated outperforming those that are married. Similarly, depressive symptoms had a negative association with MTL function. Further, the linear combination of social network variables and covariates significantly predicted MTL function. Our findings illuminate the benefits of social connectivity and resources on cognitive skills, and amplify the need to study the brain in the social context.
POLICIES AND PERSPECTIVES AROUND SEXUAL ACTIVITIES AMONG RESIDENTS WITH COGNITIVE IMPAIRMENT OR DEMENTIA IN LTC
Authors: Jeong Mijin , Jen Sarah
Published: December 2022

Many older adults remain sexually interested and active in later life. However, little is known about how sexual policies and practices in skilled-nursing facilities (SNF) address sexual activities of residents with cognitive impairment and dementia. This study seeks to identify the current sexual policies and staff’s perspectives related to residents with cognitive impairment or dementia in SNFs in Kansas. Online surveys and mailed surveys were distributed to administrators from all 364 SNFs in Kansas in June 2020. 60 long-term care facilities (16.5%) answered the survey. Of 60 survey respondents, 22 facilities (36.7%) have a policy addressing sexual expression and 19 of those policies (94.7%) address issues related to cognitive impairment, competency, or dementia. 77.4% had trained their staff on the impact on sexual expression for those with cognitive impairment or dementia once or more than once during the past year. 73.3% of administrators stated that their staff would respond differently to sexual expression among individuals with dementia or cognitive impairment compared to other residents, often noting issues related to consent and capacity. 55.2% reported any sexual expression among residents with dementia within the past year. Findings indicated that there is a lack of overall sexual policies, but those that exist are likely to address residents with cognitive impairment or dementia. Although there is evidence of training and attention to issues related to sexual expression in individuals with dementia or cognitive impairment, there is a need for further efforts to establish practice norms and policies around more complex or nuanced situations.
CORRELATIONS BETWEEN OLDER PATIENTS’ FIRST COVID-19 VACCINATION TIMING AND MEDICATION ADHERENCE
Authors: Marano Thomas , Smith-ray Renae , Jones Clifford , Sivakolunthuvel Balamurugan , Schultz Linda , Taitel Michael , Leung Kevin
Published: December 2022

Medication adherence and COVID-19 vaccinations are both essential to improving health outcomes and avoiding hospitalizations. When vaccines first became available in early 2021, the CDC recommended prompt vaccination for patients age 65-and-over. Vaccine hesitant older adults are among those at the highest risk for severe outcomes from a COVID-19 infection. A retrospective study was conducted using prescription and vaccine claims data from a pharmacy chain. Patients were included if they: 1) were age 65+ as of 1/1/21; 2) had at least two prescriptions of RAS antagonists, non-insulin anti-diabetics, or statins (in 2021); and 3) received at least two doses of mRNA COVID-19 vaccine between 1/1/21 and 9/21/21. Patients were then split into two evenly-distributed groups based on the number of days into 2021 when they received their first vaccine dose. The outcome was the proportion of optimally adherent patients (PDC ≥ 80%) by condition as of 12/31/21. Two-proportion z-tests were performed comparing the adherent proportions of the “earlier to vaccinate” group versus the “later to vaccinate” group as of 12/31/21. Age groups analyzed were “65-74” and “75+”. The proportion of adherent patients as of 12/31/21 in the “Earlier to Vaccinate” group is higher than those in the “Later to Vaccinate” group for all three adherence metrics by 4.4% (65 to 74) and 2.2% (75+, p=0.00108*) for Diabetes, by 5.1% and 2.6% for Hypertension, and by 6.0% and 3.9% for Statins (*all other p< 0.00001). The timeliness of a patient’s first COVID-19 vaccination dose was predictive of medication adherence in 2021.
TRIPLE MALADY: OLDER PERSONS WITH MENTAL ILLNESSES AND COVID- 19: INSIGHTS FROM A PSYCHOGERIATRIC CLINIC IN NIGERIA
Authors: Omobowale Olubukola , Elugbadebo Olufisayo , Oyinlola Oluwagbemiga
Published: December 2022

Background

Older persons with mental illnesses have been differentially affected by COVID-19 because of reduced access to routine health care, the adverse social impacts of the preventive strategies, and inadequate knowledge of the ongoing COVID -19 pandemic.Adequate knowledge is crucial to ensuring adherence to the right preventive practices among older persons.

Methods

A hospital-based comparative study was conducted among older persons attending the Psychogeriatric and Healthy Ageing clinics of the Geriatric Centre, University College Hospital, Ibadan. Data were gathered with a semi-structured interviewer administered questionnaire and SPSS version 23 was used to analyze the data. The level of significance was set at 5%.

Results

A total of 390 respondents aged 60 and above were sampled in the two groups: 195 with a psychiatric diagnosis (PD) and 195 with a non-psychiatric diagnosis (nPD). Their mean age was PD: 72.2 (±7.4) years and nPD: 71.0 (±8.0) years. About 14.9% had dementia and mild cognitive impairment; 14.6% psychotic disorders; 13.8% mood disorders and 6.6% anxiety and somatoform disorders. The majority were aware of the ongoing pandemic (PD: 95.9%; nPD: 96.4%). The use of facemask (PD: 89.7%; nPD: 86.7%) was the commonest preventive practice. Male gender (OR:2.09, CI; 1.14-3.86, p= 0.018) and education (OR: 5.10, CI; 1.15-22.67, p= 0.032) were predictors among PD and nPD respectively.

Conclusion

Older persons with psychiatric diagnoses have gaps in their knowledge of COVID-19 compared to those without symptoms. Health education about the ongoing pandemic and prevention programs targeting the older population with mental illnesses would be beneficial.
A NURSING HOME–BASED COVID-19-ONLY REHAB PROGRAM: VARIABLES RELATED TO SUCCESSFUL COMMUNITY DISCHARGE
Authors: Burack Orah , Reinhardt Joann , Mak Wingyun , Spinner Ruth
Published: December 2022

Many COVID-19 patients continue to test positive for COVID-19 beyond the typical quarantine period. Persistent positive testing complicated hospital discharges to nursing home (NH) based rehabilitation facilities when (in May 2020) New York State (NYS) required a negative COVID result prior to NH admissions. To meet the needs of medically stable persistent positive patients, NYS approved 19 NHs as COVID-only facilities (COF). These facilities provided rehabilitation services and allowed hospitals to regain critical space for incoming acute care patients. In the present study we describe the (1) establishment of a 100 bed COF, (2) patients admitted to the COF and care provided, and (3) predictors of successful discharge to the community.Information on the establishment of the COF was obtained from interviews with NH leadership and clinical staff. Patient, treatment, and outcome data were obtained from the NH’s electronic health record. Of 319 COF admissions over four months, 54% were female and the mean age was 80 years (SD=10.56). 51% had cognitive impairment and the mean number of comorbidities was 6.75 (SD=2.47). All patients received physical and occupational therapy while 37% received speech therapy. Medical treatment included: anticoagulants (52%), oxygen (37%), antibiotics (35%), inhaler/nebulizers (31%), and oral steroids (15%). 59% of COF stays resulted in successful community discharges. This outcome was more likely for patients who had fewer comorbidities, less speech therapy, and did not require antibiotics. Implications for COVID care as well as leveraging NH potential during crisis will be discussed.
REIMAGINING END OF LIFE: ALTERNATIVE APPROACHES TO SERIOUS ILLNESS CARE CONVERSATIONS
Authors: Berry-Stoelzle Maresi , Ortiz Cristina , Trepanier Jessica , Murray Sarah , Steffen Melissa , Alexander Bruce , Steffensmeier Kenda Stewart
Published: December 2022

Serious illness care conversations are intended to document and protect patients’ medical treatment wishes. In the outpatient management of chronic diseases, it has been difficult to pinpoint ideal timing for these conversations. The goal of this project is to analyze current practice within a VA health care system for identifying and referring veterans for palliative care services in the last years of life. To develop a targeted intervention, we relied on different forms of information to identify life events which should trigger a goals of care conversation, possibly even a formal palliative care referral. This study describes how we operationalized knowledge gained from: 1) Veteran community members via a project-dedicated engagement panel, 2) semi-structured interviews with providers, and 3) review of patients’ clinic notes written by clinicians during the last 5 years of life. Tapping into the knowledge and experience of multiple parties provided nuance and complexity to our approach to intervention development. From the Veteran community member engagement panel, we learned that trusting relationships were essential. Providers emphasized that having enough time during appointments and timing of the conversation during a patient’s disease trajectory were important. Finally, chart review indicated a need for broaching serious illness conversations early and throughout the duration of their care. The goal of an earlier intervention is to engage veterans when they are medically stable and prior to prolonged hospitalization. These findings structured our ongoing intervention that focuses on identifying and reaching out to Veterans with serious illnesses.
DOES THE MICROBIOME INFLUENCE THE DEVELOPMENT OF DEMENTIA IN OLDER ADULTS?
Authors: Tesema Naomi , Wroblewski Kristen , Pinto Jayant , McClintock Martha
Published: December 2022

Some data implicate microbes in the pathogenesis of Alzheimer’s Disease and Related Dementias (ADRD). Whether the use of antibiotics predisposes to ADRD remains unknown. To investigate the relationship between antibiotics and subsequent cognitive function, we analyzed data from a longitudinal, nationally representative sample of older US adults (N=2,906, the National Social Life, Health and Aging Project). The use of antibiotic medications was collected by home interview at baseline. Five years later, cognition was assessed using a survey adapted version of the Montreal Cognitive Assessment (MoCA). Additionally, ADRD status was measured by a report of a physician’s diagnosis (self or proxy). The association between baseline antibiotic use and an interval dementia diagnosis/MoCA scores was tested using multivariate logistic regression, controlling for age, sex, race and ethnicity, education, co-morbidities (modified Charlson Comorbidity Index), and cognition at baseline (Short Portable Mental Status Questionnaire). Older US adults who used antibiotics had lower MoCA-SA scores at 5-year follow-up (OR=3.94, 95% CI= 1.79-8.66). However, the use of antibiotics did not predict a subsequent diagnosis of dementia (OR=1.48, 95% CI= 0.44-4.95). Thus, antibiotic use may cause deleterious effects on cognitive function, but does not appear to have a clinical impact in terms of diagnosis of dementia. Further study of the role of microbes and drugs that modulate them may be useful in understanding ADRD.
THE PRESCRIPTION DRUG LANDSCAPE OF ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Bangerter Lauren , Clark Callahan , Jarvis Megan , Coates Emma , Sheils Natalie , Wong Alyssa , Cohen Ken
Published: December 2022

Alzheimer’s Disease and Related Dementias (ADRDs) are debilitating conditions that impact cognition and function of nearly 5 million adults in the U.S. This study describes the landscape of prescription drugs to treat cognitive and behavioral symptoms of ADRD among Medicare Advantage Part D enrollees with ADRD (Dementia, Alzheimer’s Disease, Parkinson’s, Frontotemporal Dementia, Lewy Body, Vascular Dementia, or Mild Cognitive Impairment). We assessed prevalence of prescription fills in the years pre- and post-ADRD diagnosis. Prescription fills to manage cognitive symptoms, were assessed by acetylcholinesterase inhibitors and NMDA receptor antagonists. Prescription fills to manage behavioral and psychological symptoms of dementia were assessed by antipsychotics, mood stabilizers and anticonvulsants, antidepressants, sedative-hypnotic z-drugs, and benzodiazepines. The final sample (N=161,368) consisted of 79.2% white, 62.2% female with median age 83 (IQR 77-89). Most drug fills increased from pre-diagnosis year to post diagnosis year including Acetylcholinesterase inhibitor (15.3% to 35.5%), NMDA Receptor Antagonists (5.8% to 16.6%), mood stabilizers and anticonvulsants (15.8% to 18.2%), and antidepressants (19.4% to 24.2%). Benzodiazepine use remained stable (13.0% to 13.6%) as did Sedative hypnotic z- drugs (1.9% 1.8%). Results reveal polypharmacy (median of 11 prescriptions post-ADRD diagnosis) and high healthcare utilization (median of 10 specialty types visited post-ADRD diagnosis). This study shows discrepancies between real-world pharmacologic ADRD management and evidence-based practices. This work highlights the need for innovative care models that simultaneously address polypharmacy and optimally coordinated care for people with ADRD.
ACCEPTABILITY OF A TAILORED MUSIC LISTENING INTERVENTION FOR SLEEP IN OLDER ADULTS WITH DEMENTIA
Authors: Geisser Sophia , Ciccone Isabella , Sefcik Justine , Hodgson Nancy , Petrovsky Darina
Published: December 2022

There is a lack of non-pharmacological interventions aimed at improving sleep disturbances among persons living with dementia (PLWD). In this randomized clinical trial, we examined the acceptability of a tailored music listening intervention on sleep disturbances in PLWD. We recruited 33 PLWD age >60 and their care partners (‘dyad’); 30 dyads completed the study. Dyads were randomly assigned to a wait-list control or intervention group, which included listening to tailored sleep-inducing music 30 minutes every night for 4 weeks. Acceptability outcomes included a questionnaire of perceived benefits and satisfaction with study participation; and a single item examining the PLWD’s level of enjoyment while listening to music. In addition, we conducted semi-structured exit interviews. We used descriptive statistics and conventional content analysis to examine the qualitative data. Most PLWD and care partners identified themselves as female, Black and non-Hispanic. One third responded that the study benefited care partners (n=11, 36.7%) and helped improve PLWD quality of life (n=11, 37.9%). The majority (n=28, 93.3%) felt that this study was clearly explained to them, while a third felt that the study required too much work (n=10, 33.3%). Most dyads enjoyed listening to music that was selected for them (n=38, 93.3%) and reported that the intervention and music selection was acceptable. We identified four themes regarding the music selections: music was relaxing, enjoyable, promoted sleep, and brought back memories. Overall, this intervention shows promise for decreasing sleep disturbances among PLWD. Future studies involving music interventions for sleep should examine the mechanism of action.
DIFFERENCES IN NEUROPSYCHIATRIC SYMPTOMS AMONG RACIAL AND ETHNIC GROUPS LIVING WITH DEMENTIA IN HOME HEALTHCARE
Authors: Lassell Rebecca , Convery Kimberly , Fletcher Jason , Chippendale Tracy , Lin Shih-Yin , Jones Tessa , Durga Aditi , Brody Abraham
Published: December 2022

The relationship between dementia and neuropsychiatric symptoms is well documented. Yet, little is known about the prevalence of neuropsychiatric symptoms among diverse homebound persons living with dementia. Guided by an intersectionality framework we asked: 1) Is there an association between the presence of individual neuropsychiatric symptoms and racial and ethnic groups? 2) If so, do these symptoms differ by dementia stage among groups? We conducted a cross-sectional study of n=190 receiving skilled home healthcare in Utah, New York, and New Jersey and enrolled in the DSM-H trial. We prospectively measured symptom prevalence with the Neuropsychiatric Inventory Questionnaire and dementia stage using the Quick Dementia Rating System. We performed Chi-square tests to determine the association of individual symptom prevalence with race and ethnicity and cross tabs to descriptively stratify individual symptom prevalence by dementia stage among groups. Participants were 11.9% Hispanic, 28% non-Hispanic Black, 56.1% non-Hispanic white (white). The prevalence of delusions was significantly higher in Hispanic and non-Hispanic Black groups than whites (41.7% & 41.8% vs. 22.5%) and elation/euphoria in Hispanic and non-Hispanic Black groups than whites (20.8% &12.7% vs. 5.4%). Delusions were most prevalent in non-Hispanic Black groups with mild dementia (53.8%) and Hispanics with moderate dementia (50.1%), while elation/euphoria was most prevalent for Hispanics with severe dementia (33.3%). Other neuropsychiatric symptoms showed no significant differences. These findings expand our knowledge of differences in neuropsychiatric symptoms among racial and ethnic persons living with dementia, which can inform future studies and targeted interventions that address disparities and improve care.