bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Modes of Social Contact and Their Links With Mental Health During the COVID-19 Pandemic
Authors: Finch Laura , Hawkley Louise
Published: December 2021

Amid the COVID-19 pandemic, social distancing has been emphasized for older adults because of their greater physical health risks. Using data from the National Social Life, Health and Aging Project (NSHAP), we examined how older adults may have changed their frequency of contact with others via various modes (i.e., in-person, phone calls, messages, and video calls) since the pandemic started, and how these choices may be impacting their mental health. From September 2020 through January 2021, NSHAP respondents (N=2,554 age 50-94 with data from 2015-16) completed a survey via web, phone, or paper-and-pencil. Although some older adults reported reducing their in-person contact with out-of-household family (38%) and friends (40%) since the pandemic started, some also increased contact with them via remote modes such as phone calls (25% and 16% with family and friends respectively); emails, texts, or social media messages (26 and 21%); and video calls (24 and 18%). Net of demographics, living alone, survey mode, and 2015-16 levels of the respective mental health variables, those who decreased in-person contact with family were less happy (B=-0.12, SE=0.06, p=.035), had higher loneliness scores (B=0.23, SE=0.09, p=.011), and more frequently felt depressed (B=0.10, SE=0.05, p=.055). In the presence of decreased in-person contact, increases in remote modes of contact had no net remediating impact—a pattern also found when analyzing contact with friends. Results indicate a persistent adverse effect of reduced in-person contact on mental health despite increased contact with family and friends via remote means.
Arterial Stiffness and Age Moderate the Association Between Physical Activity and Cognition in Older Adults
Authors: de la Colina Adrian Noriega , Badji Atef , Lamarre-Cliche Maxime , Bherer Louis , Girouard Hélène , Kaushal Navin
Published: December 2021

Background: Evidence supports that time spent on physical activity has beneficial effects on cognition in older adults. Nevertheless, this beneficial effect is likely to change in function of individual modifying factors like age and level of arterial stiffness. This study aims to reveal whether arterial stiffness and age modulate the positive impact of physical activity on cognition by developing a double moderation model. Methods: 110 healthy older adults aged 60 to 75 years old were examined for arterial stiffness (carotid-femoral Pulse Wave Velocity [cf-PWV]), global cognition (composite score of Montreal Cognitive Assessment, and Mini-Mental State Examination), and self-reported physical activity (PACED diary). Using PROCESS macro for SPSS, we evaluated if cf-PWV (moderator 1), and age (moderator 2) moderate the relationship between physical activity (X) and global cognition (Y). The threshold for high stiffness was set at 8.5 m/s based on previous studies that reported this cut-off more appropriate for classifying cerebrovascular risk groups. Results: The interaction of arterial stiffness x age moderated the effect of physical activity on global cognition (β=-.89, SE=.42, p=.037) (Model: R2=.15, p=.018). Physical activity had a positive effect on cognition in younger-older adults (aged 60 to 68.5 years) with cf-PWV>8.5 m/s (β=.57, SE=.222, p=.011, 95% CI.133 to 1.014) and on older-older adults (aged 68.6 to 75 years) with cf-PWV<8.5 m/s (β=.49, SE=.190, p=.010, 95% CI=.116 to .869). Conclusions: Identifying the right age groups and arterial stiffness levels at which physical activity can have beneficial effects on cognition is a key step in providing tailored behavioral interventions.
Evaluation of Minnesota’s Long-Stay Nursing Home Quality Indicators
Authors: Xu Dongjuan , Lewis Teresa , Rurka Marissa , Arling Greg
Published: December 2021

The Minnesota Nursing Home Report Card provides 19 clinical quality indictor (QI) ratings. Currently, face validity and expert opinions are employed to group the 19 long-stay QIs into 10 different domains. However, we do not know whether these domains are supported by the data. Under the current scoring program, some QIs may not discriminate very well between facilities. The objective was to evaluate the dimensionality of the QIs and the current scoring approach used to assign points to the domain and total QI scores. Risk-adjusted facility-level rates for the 19 QIs over the 2012-2019 period were used. Our findings indicate it is reasonable to categorize these QIs into 4 domains. Moreover, the current scoring approach is best suited for a facility QI distribution that is approximately normal. However, 11 QIs display a skewed distribution with facilities tightly grouped at the very bottom (floor) or top (ceiling) of the QI distribution. Our findings suggest that the current scoring approach may distort or exaggerate the differences in the QI rates with skewed distributions, assigning widely varying points to facilities that vary little in their QI rates. We recommend a zero-error approach for highly skewed QIs where the QI outcome is achievable and it reflects a serious quality problem. Our study of the QI scoring system is part of a package of recommendations to improve the Minnesota Nursing Home Report Card and value-based reimbursement system. Lessons learned from the study are readily applicable to Medicare’s Nursing Home Compare report.
Carotid Intima Media Thickness and Comorbid Cardiometabolic Dysfunction in Women: The SWAN Study
Authors: Leis Aleda , Barinas-Mitchell Emma , Baylin Ana , El Khoudary Samar , Jackson Elizabeth , Gutierrez Carrie Karvonen
Published: December 2021

Metabolic syndrome (MetS) and obesity are risk factors for atherosclerosis but their combined impact is unknown. The aim of this study was to quantify the added risk of obesity on carotid artery intima media thickness (cIMT), an early indicator for atherosclerosis, beyond MetS alone. The Study of Women’s Health Across the Nation (SWAN) is a multi-center, multi-ethnic cohort of women traversing the midlife into early late adulthood. cIMT was assessed between 2005-2007 and MetS, obesity and covariates were measured at the same time. This cross-sectional analysis is restricted to 1,433 women with a body mass index ≥18.5 kg/m2 and free of cardiovascular disease (CVD) when cIMT was measured. Mean maximum cIMT was related to obesity, MetS and their interaction using multivariable linear regression models. The average age was 60 years (standard deviation 2.7) and the prevalence of obesity and MetS were 44% and 35%, respectively. Both conditions occurred in 24% of women. After adjustment for age, race, smoking, family history of heart disease, and antilipemic medications, obese women had a 0.051mm (95% confidence interval (CI): 0.033,0.070; p<0.001) larger maximum cIMT versus women not obese and women with MetS had a 0.066mm (95%CI: 0.042,0.090; p<0.001) larger maximum cIMT versus women without MetS. There was a statistically significant antagonistic interaction between obesity and MetS; women with both had a mean cIMT of 0.972mm (95%CI: 0.955,0.989) and MetS alone a cIMT of 0.961mm (95%CI:0.938,0.983). This suggests that there is only a small risk of obesity on augmenting cIMT beyond MetS alone.
Psychological Impacts and Implications of Aging During a Pandemic
Authors: Mikels Joseph , Carstensen Laura , Charles Susan
Published: December 2021

Despite numerous losses associated with advanced age, older adults typically fare better than their younger counterparts in terms of psychological well-being. However, the COVID-19 pandemic has disproportionately threatened the physical and mental well-being of older adults. How have older versus younger adults been doing? The goal of our symposium is to shed light on this question though presentations of intriguing research findings regarding the psychological impacts of the pandemic on older adults. Stone and Mak will describe their work examining momentary changes in affect, activities, locations, and social interactions over time during the first several months of the pandemic for older individuals. Mikels and colleagues will report on completed and ongoing work illuminating the complex ways in which certain older adults have been faring well during the pandemic, whereas others not so much, with attention to underlying factors. Jeste will discuss a diverse line of research that has examined the relationships between loneliness, social isolation, and compassion in older adults before and during the pandemic. Chi and Carstensen will report on completed and ongoing research that links work and prosocial behavior to wellbeing with consideration of associated age differences. Collectively, these presentations will describe the complex and multifaceted psychological impact that the COVID-19 pandemic has had on older individuals, revealing the multiple ways in which they are resilient as well as vulnerable.
Age Differences in Emotion and Coping During the COVID-19 Pandemic
Authors: Mikels Joseph , Young Nathaniel , Minton Alyssa
Published: December 2021

The COVID-19 pandemic unleashed a relentless stressor on the human species with numerous deadly risks. These risks have been disproportionately threatening to the health and wellbeing of older adults. Since April 2020, we have been studying how the pandemic has affected the emotional experiences of older and younger adults broadly in several studies. For instance, in one study, we found that older adults (N=176) experienced fewer negative emotions and coped with greater levels of agency than younger adults (N=181). In additional work, we have been examining how these age differences differ for older workers versus retirees as well as in minority populations. This work broadly supports and illuminates our recent theoretical framework that focuses on how evaluative appraisal processes underlie and contribute to age differences in emotional experience generally, but especially in the context of the stress experienced during a global pandemic.
Epidemiology of Peripheral Vascular Disease in the Long Life Family Study (LLFS)
Authors: Kuipers Allison , Cvejkus Ryan , Barinas-Mitchell Emma , Feitosa Mary , Murabito Joanne , Zmuda Joseph
Published: December 2021

Atherosclerotic occlusion of peripheral arteries is a major contributor to morbidity and mortality in older adults. Our aim was to describe the epidemiology of peripheral artery disease (PAD) and other peripheral vascular disease (OPD) in the LLFS. 3248 individuals from 509 families (1182 probands, mean age 89; 2066 offspring, mean age 60) had doppler ankle-brachial index (ABI) assessment. Measures were performed twice for each posterior tibial artery and minimum of the mean ABI was used. PAD was defined as any ABI<0.9. OPD was defined as any ABI >1.4 or ≥1 non-compressible artery. Stepwise linear or logistic regression determined significant independent clinical and demographic predictors (P<0.05) after adjustment for age, sex, study center, and familial relatedness. Overall, ABI had a median of 1.2 with 7.4% PAD (18.1% probands, 1.2% offspring; P<0.001). OPD prevalence was 10.6% and was more common than PAD in offspring (8.1%). Age-adjusted OPD was higher in men (13.3%) than women (8.3%, P<0.001), while age-adjusted PAD did not did not differ by sex (P=0.45). Predictors of PAD included greater age and systolic blood pressure, lower diastolic blood pressure, prevalent kidney disease, antihypertensive use, and current smoking. Predictors of OPD included greater age, male sex, and current smoking. In these exceptionally long-lived families, PAD was low compared to other epidemiologic studies. However, OPD including non-compressible arteries, a marker of arterial stiffness, was more prevalent than PAD. These findings in long-lived families highlight a need for more epidemiologic research in other peripheral vascular disease in adults from the general population.
Racial-Ethnic Disparities in Access to Preventive Services Among Privately Insured Adults With Disabilities
Authors: Mahmoudi Elham , Groskaufmanis lauren , Kamdar Neil , Khan Anam , Peterson Mark
Published: December 2021

Introduction: Cerebral palsy (CP) and spina bifida (SB) are congenital disabilities. Due to life-long disability, adults with CP/SB are with greater needs for preventative care. Little is known about racial/ethnic disparities in use of preventative services in this population. Our objective was to examine racial/ethnic disparities in use of preventative care. Methods: Using 2007-2017 private claims data, we identified White, Black, and Hispanic adults (18+) with CP/SB [n=11,635; White=8,935; Black=1,457; Hispanic=1,243)]. We quantified the National Institute of Medicine (NAM) definition of disparity by matching health related variables (age, sex, comorbid conditions, and Elixhauser index) between Whites and each minority subpopulation. Generalized estimating equations were used and all models were adjusted for age, sex, comorbidities, income, education, and U.S. Census divisions. Outcomes of interest were: (1) any office visit; (2) any physical therapy/ occupational therapy (PT/OT); (3) annual wellness visit; (4) bone density screening; (5) cholesterol screening; (6) diabetes screening. Results: Rate of recommended services for all adults with CP/SB were low and no significant results were found for most preventative services across race/ethnicity. Compared with Whites, Hispanics had lower odds of annual wellness visit (OR: 0.71; 95% CI: 0.53, 0.96) but higher odds of diabetes screening (OR: 1.48; 95% CI: 1.13, 1.93). Blacks had lower odds of bone density screening (OR: 0.54; 95% CI: 0.31-0.95), and annual wellness visit (OR: 0.50; 95% CI: 0.24-1.00). Conclusions: There were no substantial racial/ethnic disparities in use of preventive services among privately insured adults with CP/SB who had a higher-than-average income and education level.
Tracking Progress on Person-Centered Care for Older Adults: Are We Doing Right by Racial and Ethnic Minorities?
Authors: Tavares Jane , Cohen Marc , Hwang Ann
Published: December 2021

Person-Centered care is integral and necessary to high-quality systems of care, providing a holistic approach and addressing the needs and preferences of individuals. Analyzing the 2014 and 2016 Health and Retirement Survey we measure the extent to which the health care system provides person-centered care, to whom and how its receipt affects satisfaction levels and service utilization. About one-third of individuals’ report that their preferences were only rarely or sometimes takes account. Results vary greatly by race, highlighting great disparities in person-centered care. One in four Hispanics and one in six Blacks report never having their preferences taken into account compared to roughly one in ten Whites. When people report that their preferences are ignored, they are more likely to forgo medical care and report lower satisfaction with the system. Strategies exist to strengthen and assure advancements in person-centered care, something particularly needed for people of color and low-income populations.
Positive Psychology, Activation, and Self-Care Adherence in a Diverse Sample of Adults With Heart Failure
Authors: Meraz Rebecca , McGee Jocelyn , Caldwell Elizabeth Perry , Osteen Kathryn
Published: December 2021

Heart failure (HF) self-care is vital to health and wellbeing, yet more than half of all persons with HF do not adhere to the self-care recommendations of taking medications as prescribed, weighing daily, eating low salt foods, or exercising. It has been suggested that disparities in HF among racial/ethnic groups may be reflective of underlying determinants of health, such as poor engagement in self-care activities, rather than genetic or physiological differences. The purpose of this study was to examine direct and indirect effects of perceived social support, positive psychological (PP) characteristics, and patient activation on self-care behaviors in a diverse sample of older adults with HF. A nationwide survey was conducted in cooperation with the recruitment and sampling company Qualtrics. Stratified random sampling was used where 49% of the 174 respondents were persons of color (POC). The mean age was 60. Logistic regression statistical models were used with a lasso procedure. In this study, PP characteristics and activation level were most predictive of HF self-care adherence, particularly medication adherence. Respondents who were resilient, hopeful, and activated also reported higher medication and self-care adherence. Perceived social support and health literacy levels were not associated with self-care adherence. There were no differences in predictive variables by race/ethnicity, gender, or age. Interventions aimed at increasing resilience, hope, and engagement in care or activation may improve HF self-care adherence among persons with HF. Further research is needed to understand the impact of PP characteristics and patient activation level on HF self-care adherence in POC.
The Importance of Redefining Geriatric Expertise in Nursing Homes to Reduce Unnecessary Hospitalizations
Authors: Zúñiga Franziska , Popejoy Lori , Vogelsmeier Amy
Published: December 2021

Unplanned transfers from nursing homes (NHs) are burdensome, associated with adverse outcomes for residents and costly for health care systems. Internationally, NHs are facing similar issues whereby a lack of geriatric expertise combined with a shortage of NH general practitioners require innovative and adaptable models of care tailored to the organizational context. In this symposium, we will present studies from the MOQI project from the United States, which successfully reduced unnecessary hospitalizations by embedding advanced practice registered nurses (APRN) in 16 US NHs over a 6-year period. We will discuss the influence of race on multiple hospital transfers and present possible interventions to reduce transfers. Next, we will present finding from a study with MOQI APRNs that highlighted their contributions to the COVID-19 pandemic response in NHs and discuss the broader implication or infection control practices. In addition, we will present the INTERCARE project which successfully reduced unplanned hospitalizations in 11 Swiss NHs, by implementing a registered nurse with an expanded role, to compensate for the very limited access to APRNs; which is the case for many European countries. Both MOQI and INTERCARE pinpoint the importance of strategies to support the introduction of a new role in NHs. Both projects will give examples of different models of care which can be feasibly implemented to sustainably decrease unnecessary hospitalizations, in different contexts and with different resources. Finally, data from the INTERCARE study will address the issue of potentially avoidable fall-related transfers and which resources are deemed appropriate to mitigate these.
Multiple Hospital Transfers Among MOQI Nursing Home Residents: The Influence of Race
Authors: Canada Kelli , Fritz Elizabeth , Vogelsmeier Amy , Rantz Marilyn , Popejoy Lori
Published: December 2021

Missouri Quality Initiative (MOQI) was a CMS-funded enhanced care and coordination provider demonstration project (2012-2020) that successfully reduced avoidable hospitalizations and improved nursing home (NH) care quality. Little is known about the influence of race in multiple hospital transfers from NHs. Using a mixed-methods approach we analyzed hospitalization root cause analysis data from 2017-2019 for 1410 residents in 16 MOQI NHs. There were 113 residents who were transferred 609 times. Those with multiple transfers (four or more transfers/year) were compared by race and key characteristics (e.g., code status, diagnosis). A subset of residents with multiple transfers were examined qualitatively to identify and describe key cases. Findings suggest that Black residents have a higher probability for multiple transfers. Findings highlight the need for transfer prevention efforts for Black residents including early assessment and intervention, early/frequent discussion about goals of care, advance directives, resuscitation status, and family/resident understanding of treatment effectiveness.
Work Expectations and Trajectories of Depressive Symptoms and Passive Suicidal Ideation Among Baby Boomers
Authors: Dang Linh , Mezuk Briana
Published: December 2021

Expectations regarding work (e.g., probability of retiring at a certain age), whether realized or not, may influence mental health, however there is limited quantitative research on this question. This study examined the longitudinal relationship between expectations of full-time work after age 62 and depressive symptoms and passive suicidal ideation among Baby Boomers, a generation that experienced the Great Recession as they neared retirement. Data came from the Health and Retirement Study, 2008 - 2016 (N = 8,954, mean age = 55.3, 52.2% female, 77.8% non-Hispanic White). Clinically-relevant depressive symptoms were indexed by the Composite International Diagnostic Interview (CIDI). Expectation (probability) of working after age 62 was modeled continuously (range: 0 to 1). Multivariate mixed-effects logistic regression models of screening positive on the CIDI and passive suicide ideation were fit, separately, adjusting for demographics, household income and wealth, and health characteristics. Respondents working at baseline were less likely to screen positive on the CIDI longitudinally (OR: 0.36, 95% CI: 0.26 - 0.51), and while expectations were inversely associated with screening positive on the CIDI this was not significant after accounting for work status (OR: 0.68, 95% CI: 0.43 - 1.09, p=0.104). Longitudinally, higher expectations of working were inversely associated with passive suicidal ideation (OR: 0.54, 95% CI: 0.32 - 0.92) even after accounting for working status. Future research will examine variation in these relationships by contextual factors like wealth, sex, and race/ethnicity to clarify how these features shape the association between work and mental health for this generation of older adults.
Standards and Guidelines for Associate's Degree Programs in Gerontology
Authors: Macaluso Suzie , Faber Michael
Published: December 2021

Associate degree programs in gerontology occupy a unique space in higher education. They must prepare students for a wide variety of careers and opportunities from technical and vocational training to preparation for further gerontology education at a four-year college. It is widely known that there is great variability among the numerous associate degree programs in gerontology; this presentation gives an overview of the revised standards and guidelines for associate degree programs. Associate degree programs will vary based on the faculty, the leadership, the program, and institutional support, this presentation discusses best practices for a variety of program types paying particular attention to competency-based educational strategies.
Standards and Guidelines for Graduate Programs in Gerontology and Geriatrics
Authors: Masters Julie , Karasik Rona
Published: December 2021

Graduate programs in gerontology prepare students for advanced academic and/or applied careers in aging. Programs at this level offer greater depth, breadth, and increased emphasis on theory and research. Persons completing a master’s and/or doctoral degree in gerontology or aging studies have reached the level of “gerontologist” whereby they have completed the necessary coursework in the physical, psychological, social and built environment in order to understand the unique opportunities and challenges of aging in a scholarly manner. While the depth of treatment of each topic will vary across programs, each of the AGHE Core Competencies should be mastered at a level of “analyzation and evaluation” or higher on Bloom’s Taxonomy of Educational Objectives. The current presentation addresses how the AGHE Standards and Guidelines for graduate programs in gerontology were updated as a competency-based curriculum that includes coursework, practicum, and a culminating project (e.g., thesis, comprehensive exam, and/or dissertation).
Quality Health Professions Programs: Path to Program of Merit Designation
Authors: Gugliucci Marilyn
Published: December 2021

In 2015, the AGHE Program of Merit was expanded to implement a voluntary evaluation process for health professions programs that integrate gerontology/geriatrics competencies within their curriculum. These competencies augment students’ competence and confidence in the field of aging, preparing them to work with older adults and their care partners. All health professions and medical education programs are eligible to apply for the Program of Merit designation. This international process of evaluation: (1) Verifies program credibility and quality; (2) Informs campus administrators of global guidelines, expectations, and practice in aging for their health professions programs; (3) Assures quality graduates from POM designated programs; and (4) Clarifies for employers the knowledge and skills imparted to student graduates of POM designated health professions programs. Additionally, graduates from POM programs receive a certificate from AGHE stating the health profession program is a designated AGHE Program of Merit.
Age-Friendly Communities: Research on Promising and Innovative Practices
Authors: Oh Patricia , Dabelko-Schoeny Holly , Armbruster William
Published: December 2021

Age-friendly community (AFC) leaders engage with community residents, groups, and organizations to enhance social, service, and built environments for aging. Despite the growing number of AFCs, academic research remains in its nascence. During this symposium, U.S. scholars will present research on AFC implementation. The first two papers address promising practices among AFC leaders. The first paper presents results from a content analysis of American AFC progress reports. Results indicate strong evidence of progress achieved and opportunities for improving the evaluation, documentation, and dissemination of accomplishments. The second paper presents findings from a qualitative descriptive study on community events by AFC initiatives in northern New Jersey. Results indicate how age-friendly leaders use community events to enhance older adults’ social participation and inclusion, and as a tactic toward longer-term, multi-domain community change. The third and fourth papers describe the development and testing of innovative technologies to guide AFC implementation. The third paper provides an overview of Safe Routes to Age in Place, a community-engaged mixed methods study using the app MyAmble to examine the needs and utilization of alternative transportation in Franklin County, Ohio. The fourth paper provides a case overview of a university-community partnership to develop a geographical information system (GIS) analytical mapping tool to evaluate the age-friendliness of public amenities in San Antonio, Texas. The symposium will conclude with remarks from AARP Livable Communities leadership about how these studies contribute to building knowledge about AFC implementation and avenues for academic and private partnerships to translate these findings to practice.
Safe Routes to Age in Place: A Focus on Alternative Transportation
Authors: Dabelko-Schoeny Holly , Fields Noelle , White Katie , Highfill Christine , Cao Qiuchang , Murphy Ian
Published: December 2021

Informed by social cognitive theory, Age-Friendly Columbus and Franklin County conducted a community-engaged mixed methods study that examined the needs and utilization of alternative transportation by older residents in three pilot neighborhoods in Franklin County, Ohio (n = 32). Participants were provided tablets and used an app (MyAmble) developed at the University of Texas-Arlington to document their traveling experiences. During a 14-day period, 1,190 trips were recorded by older adults and 71.3% of these trips were completed through driving their own personal vehicles. Participants designated 84.5% of trips as important and 72% of the trips improved their mood. Individual (physical and cognitive functioning, cost, time), environmental (lighting, sidewalk conditions, traffic, location of bus stops, weather), and behavioral (no history of bus use, peer to peer information sharing, tracking led to future planning) barriers and facilitators to alternative transportation use such as riding the bus, walking and biking were identified.
Cohort Differences in Well-Being Among Midlife and Older Women: Role of Self-Perceptions of Aging
Authors: Ryan Lindsay
Published: December 2021

The current study examines how cohort differences across two age-matched groups of midlife and older women from the Health and Retirement Study are associated with well-being and self-perceptions of aging (SPA). Women aged 51–60 (n=2318) and 61–70 (n=1650) were selected from the 2008 and 2018 waves. No significant cohort differences were identified for life satisfaction (Diener, Emmons, Larsen & Griffin, 1985) or positive SPA (Lawton, 1975; Liang & Bollen, 1983). The 2008 cohort of midlife women reported significantly higher negative SPA compared to 2018 (p<.05). Linear regression analyses find that cohort and SPA are significantly associated with life satisfaction in both age groups, and that the association of negative SPA differs by cohort for the midlife women (p<.01). Implications are discussed within the life course developmental framework.
Home and Community Features, Perceived Age-Friendliness, and Intention Toward Aging in Place
Authors: Choi Yeon Jin
Published: December 2021

Promoting age-friendliness of communities and supporting aging in place (AIP) are of great importance in aging societies. However, little is known about the mechanism linking home and neighborhood features, older adults’ global assessment of community, and their willingness to age-in-place despite the importance in developing policies and interventions. This study used the 2015 AARP Age-Friendly Community Survey, which includes 66 home and neighborhood features under the eight domains specified by the WHO’s Age-Friendly Cities Guidelines. A series of linear regression models were estimated to examine the interrelationship between the availability of age-friendly features in eight domains, perceived age-friendliness of community, and intention toward AIP. Overall, a greater availability of age-friendly features was positively associated with perceived age-friendliness of community and AIP intention. The relationship between age-friendly features and AIP intention was mediated by perceived age-friendliness of community (50.3% to 96% of the total effects). When perceived age-friendliness of community was introduced to models, the direct effects of housing, outdoor spaces and buildings, and transportation domains remained significant. Findings suggest that a greater availability of age-friendly features influence older adults’ perception on their community, leading to the development of a desire to age-in-place. Domains of housing, outdoor spaces and buildings, and transportation may be the most importance features in promoting age-friendliness of community and the key determinants of aging-in-place. Policy makers and practitioners may need to prioritize promoting age-friendly built environment before social environment in building age-friendly communities.
Community Mobility in Older Adults: Novel Methodologies, Risk Factors, and Interventions
Authors: Rosso Andrea , Carlson Michelle , Hirsch Jana
Published: December 2021

Community mobility is an individual’s movement outside the home. It is essential for the completion of many instrumental activities of daily living, such as shopping and healthcare, and promotes physical function, social engagement, independent living, and quality of life. Mobility research often focuses on gait speed measured in clinical settings, a critical but not sufficient determinant of community mobility. Here we present four talks that assess community mobility and its determinants using novel methodologies to enhance our understanding of how to maintain independence in older ages. First, Andrea Rosso presents characteristics of individuals with the strongest associations between environmental walkability, as assessed by virtual audits, and walking. Second, Kyle Moored demonstrates associations of self-reported fatigability with life space among older men, independent of their physical functioning. Breanna Crane introduces GPS-based objective measures of community mobility and their associations with cognitive and physical function of older adults. Finally, Pam Dunlap presents results of a randomized clinical trial of a physical therapy intervention to improve walking in older adults on subjective and objective measures of life space. These talks will provide a better understanding of the factors related to community mobility, introduce attendees to novel methodologies in the assessment of both community mobility and risk factors associated with the loss of community mobility, and demonstrate approaches to improve community mobility in at-risk older adults. The discussant, Jana Hirsch, will provide perspectives on how these data inform our current view of community mobility and will lead a discussion with the audience.
What Determines Vulnerability to Neighborhood Walkability in Older Adults?
Authors: Rosso Andrea , Rosano Caterina , Harding Alyson , Studenski Stephanie , Clarke Philippa
Published: December 2021

Environmental influences are recognized as important predictors of walking behaviors in older adults. However, individuals may differ in vulnerability to low environmental walkability. We determined associations of a walkability index (factor analysis of 16 variables; range -1.65 to 2.23) from audits of online images with self-reported walking behaviors in 406 adults mean age=82 (44% male, 39% Black). Effect modification by 12 variables representing sociodemographics, physical and mental health, and neighborhood characteristics was tested in general linear models. Effect modification was evident for knee pain, marital status, and neighborhood socioeconomic status (nSES) (all p-interaction<0.05); associations were present only in those with knee pain, those who were unmarried, and those in the highest race-specific tertile of nSES. For example, a 1 point higher walkability score was associated with 1.06 (CI: 0.78, 1.44) higher odds of walking in those without knee pain compared to 1.91 (CI: 1.25, 2.90) in those with knee pain.
Adjunctive Telehealth Mindfulness Therapy for Persons With Dementia and Their Caregivers in the Rural Deep South
Authors: Jacobs Lindsey , Durkin Daniel , Hilgeman Michelle
Published: December 2021

The emotional care needs of persons with dementia (PwD) and their caregivers are multitudinous. Multicomponent interventions may be necessary to meet their multiple needs. Mindfulness interventions have a positive impact on well-being but are often only offered as a stand-alone treatment and typically are available only to the caregiver. This presentation will describe a telephone-delivered adjunctive mindfulness intervention that was offered to caregivers and dyads in conjunction with care consultation. Participants were 26 caregivers and 22 PwD living in the Deep South. The adjunctive mindfulness therapy included four core sessions and an additional five sessions that were optional. Mindfulness was deemed to be a “good fit” for almost 75% of the sample. Duration of mindfulness sessions ranged from 30 to 65 minutes. Participants attended more sessions as a dyad (M=10.10) compared to caregivers alone (M=6.5). Information regarding attendance and treatment engagement will be presented.
State Regulatory Response to COVID-19 Limited Assisted Living Resident Caregiver Networks
Authors: Smith Lindsey , Lowe Bethany Linscott , Dys Sarah , Thomas Kali , Zimmerman Sheryl , Carder Paula
Published: December 2021

This paper describes a qualitative content analysis of assisted living emergency rules, revised regulations, and executive orders responding to the COVID-19 pandemic. Using key search terms, we identified 36 states that enacted policies between February and October 2020. The following themes occurred most frequently: testing, infection control, access restrictions, suspension of requirements, and reporting. The convoys of care model recognizes internal, external, formal, and informal caregivers as essential members of an AL resident’s care network. We found that non-staff care providers, including external formal caregivers (e.g. home health and hospice) and informal caregivers (e.g. family), were most often addressed in policies limiting access. Informal caregivers were the least often specifically addressed in these policies. Given the importance of these network members in the AL context, these policies have implications for the wellbeing of the resident and care network.
Dissemination of a COVID-19 Rapid Response Telehealth Group Addressing Worry and Social Isolation Among Older Adults
Authors: Weiskittle Rachel
Published: December 2021

In response to the urgent need for virtual mental health treatments during the COVID-19 pandemic, an 8-week group intervention deliverable over video or telephone was developed and disseminated in March 2020. Manual content addressed social isolation and information related to COVID-19. In August 2020, a national web-based provider feedback survey was disseminated to evaluate feasibility of the manual. Respondents (n = 21) across a variety of geriatric mental health clinics reported this intervention to be effective and clinically useful with their patients in providing social support and in mitigating COVID-19 anxieties. The majority of respondents delivered the group in multiple cohorts and found the manual adaptable beyond the early pandemic period.
Advance Directive Completion and Hospital Out-of-Pocket Expenditures
Authors: Zhu Yujun , Enguidanos Susan
Published: December 2021

Healthcare costs remain high at end of life. Although advance directives (AD) have been shown to improve care congruence with patients’ preferences and lower cost of healthcare services, little is known about the relationship between AD completion and hospital out-of-pocket costs. This study examined whether AD completion was associated with lower hospital out-of-pocket spending at end of life. We used the Health and Retirement Study participants who died between 2000 and 2014 (N=9,228) to examine the association through the use of a two-part analytic model that has been widely used in health economics. We controlled for socioeconomic status, death-related characteristics, and health insurance coverage and imputed missing data using multiple imputation by chained equations. Of the 43.9% of decedents who completed an AD, 90.7% chose to limit care or to be kept comfortable; 78.8% indicated that they wanted to withhold treatment, and 5.6% wanted to prolong life. Having an AD was significantly associated with $632 (95% CI: [-$1,116.47, -$146.71]) lower hospital out-of-pocket costs, with greater savings among younger decedents, dropping from $1,560 (95% CI: [-$2,652, -$268]) at age 50 to $230 (95% CI: [-$445, -$14]) at age 110. Decedents who completed an AD 12 months or less before death had higher out-of-pocket spending ($1,591 on average) than those who completed more than a year before death ($1,001 on average). Our findings have policy implications for physician-patient communication about costs of care and may provide an opportunity for physicians to involve cost-sharing discussions when completing ADs with patients.
Big and Mini: A Promising Program to Link Generations to Cope With Social Isolation
Authors: Chen Zhirui , Xu Ling , Fields Noelle , Zhou Allen , Zhou Anthony , Merchant Aditi
Published: December 2021

Introduction: Social isolation disproportionately affected older adults prior to and especially during the COVID-19 pandemic. To help older adults cope with social isolation, a new program “Big and Mini” was created in April 2020 to link young and older adults together (matched through a custom website developed for this program) and to help increase social connectivity through weekly phone calls. Using a survey with both closed and open questions, this study evaluated participant feedback three months after the program was launched. Methods: 63 Bigs (age 50+) and 53 Minis (age 18+) completed the survey. Stress compared to before COVID-19, social isolation, life satisfaction, intergenerational solidarity, and satisfaction with the program were measured for both the Big and Mini participants. Descriptive, bivariate correlation, group comparison and conventional content analyses were conducted. Results: Results showed that 38.1% of Bigs and 37.7% of Minis felt higher levels of stress than before COVID-19. Both Bigs and Minis had medium levels of social isolation. They also reported high levels of satisfaction with life, satisfaction with the program, and intergenerational solidarity. Content analysis suggested that the reasons to join or expectations of the program were curiosity, friendship, mutually beneficial intergenerational connections, and coping with loneliness. Both Bigs and Minis reported benefits from the learning and sharing opportunities that the program offered. Conclusions: The Big and Mini program offers a promising approach with mutual benefits for both Bigs and Minis. Strategies to improve the program and implications for other phone-based intergenerational programs are presented.
Age Differences in Emotion Globalizing Across the Adult Lifespan
Authors: Barlow Meaghan
Published: December 2021

Emotion globalizing, the extent to which current emotions impact satisfaction with life, is associated with poorer psychological well-being. Given extant aging theories and research highlighting age-related changes in emotional experiences and emotion regulation, the present study examined age differences in positive and negative emotion globalizing across the adult lifespan. Participants (N = 145 females; aged 23-79) completed assessments of positive emotion (i.e., amused, energetic, calm, happy, interested, excited, and content), negative emotion (i.e., anxious, lonely, sad, annoyed, angry, and distressed), and life satisfaction for 16 days. Multilevel model analyses revealed age differences in negative, but not positive, emotion globalizing. More specifically, older individuals reported lower levels of negative emotion globalizing, as compared to younger individuals. These findings highlight the need to explore downstream consequences of emotion globalizing across the lifespan, as this could unveil novel pathways towards successful aging.
Transforming Education Using Virtual Reality: Geriatrics Clerkship Before and During Pandemic
Authors: Saunders Pamela
Published: December 2021

Since 2006, the Georgetown University School of Medicine has offered a two-week elective in Geriatrics for third-year medical students. Students rotate through diverse clinical experiences, including general geriatrics, geriatric neurology, physical medicine & rehabilitation, memory disorders, Parkinson’s and dementia, and palliative care. In addition, students learn about arts, humanities & ethics, communication skills, and taking the patient’s perspective. In Fall 2019, pre-pandemic, we added virtual reality (VR) experiences focused on hearing & vision loss, Alzheimer’s disease, and end-of-life conversations created by Embodied Labs. Curricular goals included increasing students’ empathy and sensitivity, decreasing ageism & stereotyping, and increasing clinical knowledge. Findings suggest regardless of pandemic (pre vs. during) or modality (in-person vs. Zoom) that after participating in the VR labs, students are slightly more comfortable taking care of older adult patients with dementia as well as hearing & vision loss, and participating in end-of-life conversations.
Genes Involved in Physiological Dysregulation and Decline in Resilience: Role in Alzheimer’s Disease
Authors: Arbeev Konstantin , Ukraintseva Svetlana , Bagley Olivia , Duan Hongzhe , Wu Deqing , Akushevich Igor , Kulminski Alexander , Yashin Anatoliy
Published: December 2021

Our recent GWAS of a composite measure of physiological dysregulation (PD) in the Long Life Family Study (LLFS) found that the top genes associated with age-related changes in PD are involved in biological pathways relevant to maintaining neural networks and brain resilience. In our prior work, PD itself was linked to resilience-related traits. Alzheimer’s disease (AD) is a heterogeneous trait and it may involve an accelerated decline in resilience with age as a contributing factor. We proposed that genes associated with aging-changes in PD and brain resilience may contribute to AD risk. We investigated interactions between SNPs in such candidate genes with AD in LLFS and Health and Retirement Study (HRS). Our analysis revealed significant interactions between SNPs in UNC5C and other genes with AD, in both LLFS and HRS. These findings support roles of genetic interactions with UNC5C gene (implemented in axon growth and neuronal apoptosis) in AD.
Collaboration With the State Department of Health
Authors: Unroe Kathleen
Published: December 2021

COVID-19 disproportionately affected older adults, creating opportunities for experts in geriatrics and gerontology to support public policy. In Indiana, the Probari team, composed of a geriatrician and a team of nurses with geriatrics and palliative care expertise, supported the state government response to long-term care facilities during the pandemic. The team was involved in helping coordinate all staff testing (534 nursing homes) by the State Department of Health in June and in August, prior to the Federal mandated testing and the distribution of antigen machines. The Probari team also fielded surveys on behalf of the State regarding staff attitudes towards testing and willingness to be vaccinated, to inform state policy and resource efforts. In addition, Probari collaborated with the State Department of Health and the Indiana National Guard by training over 1600 service members to provide non-clinical support in nursing facilities, and monitoring and evaluating that 3 month deployment.
COVID-19 in Long-Term Care Facilities With Advanced Practice Registered Nurses
Authors: Harrison Tracie
Published: December 2021

The purpose of our report is to give our analytical description of COVID-19 response. The study placed two APRNs in each of five participating nursing facilities (NF), 5-7 days/week for up to two years with the purpose of quantifying if employment of a full-time, salaried APRN, as part of the NF care team, improved the quality of care for the NF residents. Secondarily, we studied policies that influenced ability to provide APRN care in the NF. Resident data collected and evaluated to determine if this model of care reduced the rates of adverse events among NF residents. Data included re-hospitalizations, inappropriate prescribing (antipsychotics, antibiotics, opioids and polypharmacy), observational data, and clinical outcomes negatively affecting the quality of life for NF residents (such as falls and pressure injuries). Factors influencing APRN employment in the NF setting were NF mission, environmental aesthetics, resources, NF administrator interactions, state law, and medical director support.
Longitudinal Associations Between Loneliness and Self-Rated Health
Authors: Sol Ketlyne , Brauer Simon , Antonucci Toni
Published: December 2021

Cross-lagged structural equation models examined the bidirectional association between loneliness and self rated health over three time points. We adjusted for age, gender, network size, and depressive symptoms at baseline. At baseline, the sample was 28% Black and 40% male. Average age at time 1 was 46 years, 56 years at time 2, and 63 years at time 3. Results indicated that loneliness at time 1 was associated with loneliness at time 2; loneliness at time 2 was associated with loneliness at time 3. We had similar findings for associations among self rated health. However, only one of the cross-lagged paths was significant. Specifically, more loneliness at time 2 was associated with worse self rated health at time 3. These associations did not vary across black and white race. Findings indicate that loneliness at later midlife may be detrimental to later life health, regardless of race.