bluuebunny/crossref_metadata_2025 huggingface dataset:
STRESS AND RESILIENCE ACROSS PHASES OF COVID-19: A QUALITATIVE STUDY WITH OLDER CHINESE IMMIGRANTS
Authors: Tung Yi-Hsuan , Yu Kexin , Liang Jiaming , Wu Shinyi , Chi Iris
Published: December 2022

The COVID-19 pandemic has challenged older Chinese immigrants’ lives in physical, psychological, social, and spiritual aspects. This study employed a socioecological perspective of resilience to examine how older Chinese immigrants perceived and navigated through pandemic-related adversities. We conducted a time-bound retrospective qualitative investigation to capture participants’ lived experiences between December 2019 to August 2021. Three phases of the pandemic-related adversities were identified, including uncertain threats and psychological impacts at the beginning, unmet needs and fatigue at 2nd and 3rd wave of infections, and benefit-risk balance after vaccinated. Despite adversities, the integration of strengths, opportunities, and social services at the individual, interpersonal, and neighborhood levels allows participants to appraise and individualize their problem-focus coping (e.g., risk mitigation), selective engagement (e.g., maintaining habits through other means), or emotion-focus coping strategies (e.g., acceptance). Findings highlight the importance of personal and community resources in fostering resilient responses.
THE RELATIONSHIP BETWEEN PHYSICIAN VISITS AND ADVANCE CARE PLANNING
Authors: Wang YuHsuan (Olivia) , Enguidanos Susan
Published: December 2022

Some studies have shown that advance care planning (ACP), discussions about future care given a serious illness, are associated with improved quality of death and better end-of-life care. Studies also have found that physicians play an important role in ACP. In fact, in 2016 CMS began reimbursing physicians for ACP discussions. However, little is known about the relationship between the number of physician visits and engaging in ACP . This study investigated the association between outpatient physician visits and ACP engagement. Only respondents over 65 were included in our study. We conducted logistic regressions using the 2016 Health and Retirement Study. We used ACP engagement (n=9838), advance directive (AD; eg, living will) completion (n=9746), and healthcare power of attorney (e.g., proxy) assignment (n=9724) as outcome variables. In addition to the frequency of physician visits, we controlled for basic demographics (age, gender, marital status, race, and socioeconomic status), number of chronic conditions, and self-rated health in our models. For each additional physician visit, the probability of having an ACP conversation, (p<.001), AD completion (p<.001), and healthcare proxy assignment (p<.001) increased by 1.6%,1.4%, and 1.9% respectively after controlling for covariates. Number of chronic conditions also was independently and positively associated with ACP-related activities. Additionally, greater perceived health was associated with higher odds of AD completion (OR= 1.08, p<.05) and healthcare proxy assignment (OR= 1.07, p<.05). This study found that frequent encounters with physicians are associated with higher rates of ACP engagement even after controlling for health conditions.
EFFECTS OF PATIENT QUESTION PROMPT LIST USE ON PARTICIPATION DURING OUTPATIENT PALLIATIVE CARE APPOINTMENTS
Authors: McDarby Meghan , Silverstein Hannah , Carpenter Brian
Published: December 2022

Question prompt lists (QPLs) support patients who are seeking information during medical appointments by providing preset questions a patient might ask their provider. Prior research suggests that QPLs promote communication, including question asking, during appointments. The current study evaluated use of a 25-question QPL during initial outpatient palliative care appointments. We applied tenets of Social Cognitive Theory to investigate the relation between question asking and self-efficacy. Participants were patients attending their first outpatient palliative care appointment at an academic hospital. Participants were randomly assigned to receive the QPL before their appointment (n = 29) or to receive usual care (n = 30). Audio recordings of appointments were transcribed and coded for total questions asked. Participants also responded to a single-item measure of self-efficacy in question asking at pre- and post-appointment. On average, participants in usual care appointments asked 9.37 questions (SD = 10.3, range= 0 – 49), and participants in QPL appointments asked 11.24 questions (SD = 10.1, range = 0 – 45), but with no significant difference between groups, F(1,56) = 0.14, p = .71. All participants reported an increase in self-efficacy from pre- to post-assessment, F(1,83) = 18.76, p < .00, but there was no interaction effect of time and condition, F(1,83) = .81, p = .37. Despite their promise in previous studies, our results suggest QPLs may lack potency to shift question asking, at least in palliative care appointments, and that other mechanisms of Social Cognitive Theory may better characterize the relation between question asking and self-efficacy.
INDIVIDUALS' KNOWLEDGE ABOUT A LOVED ONE’S END-OF-LIFE CARE WISHES IS ASSOCIATED WITH THEIR OWN ADVANCE CARE PLANNING
Authors: Zhang Peiyuan , Cagle John
Published: December 2022

Despite evidence that ACP can improve quality of life for both patient and family, it remains underutilized. Only 37% US adults have a complete advance directive (Kuldeep et al., 2017). Existing studies primarily examined factors associated with patients’ ACP engagement but very few explored ACP among patients’ family. The goal of this study is to examine whether individuals’ knowledge about a loved one’s end-of-life (EOL) care preferences is associated with their ACP engagement. Data are from the US arm of the 2015 Four-Country Survey on Aging and End-of-Life Medical Care. The sample included N=609 adults who experienced the death of a family or close friend in the past 5 years.Three binary dependent variables were measured by different facets of ACP: having a serious conversation about EOL medical care wishes (1) with loved ones, (2) with doctors and (3) documenting those wishes. The primary independent variable was participants’ knowledge about their deceased family’s EOL treatment wishes.Three separate logistic regression models were used. Individuals who had a greater knowledge about their loved one’s EOL treatment wishes were twice as likely to have a conversation with family about their own EOL wishes (OR=2.32, P< 0.001) and documented wishes than those who didn’t(OR=2.03, P< 0.05). Results have direct implications for clinicians who work with families in EOL care settings. They may have opportunities to engage individuals – other than patients – in ACP. Focusing the experience of involvement in a loved one’s EOL care may be an effective strategy to enhance ACP engagement.
ADVERSE SOCIAL EXPERIENCES, SOCIAL SUPPORT, AND HEALTH OUTCOMES AMONG BLACK AND WHITE FAMILY CAREGIVERS
Authors: Browning Wesley , Atkins Ghislaine , Bowen Pamela , Crowe Michael , Dreer Laura , Ruggiano Nicole , Clay Olivio
Published: December 2022

Family caregivers provide care for loved ones who have difficulty performing activities of daily living. Previous research has examined the influence of direct and indirect stressors on caregiver’s health outcomes but has often neglected the role of tertiary stressors (stressors that are not caused by caregiving but influence caregivers’ appraisals of stress). This study examined the impact of tertiary stressors called adverse social experiences (ASEs), including negative interaction (criticism from others, excessive demands by others, being taken advantage of, and others prying into caregivers’ personal affairs), experiences of discrimination, and low physician trust on caregiver health outcomes including depressive symptoms along with mental and physical health quality of life (QoL). This study also investigated the effects of social support on health outcomes in caregivers. Linear regression models were used to analyze these relationships within a group of 56 Black and White adult caregivers (18+) recruited online via social media and listservs from April to June 2021. Caregivers provided at least 5 hours of care weekly for recipients aged at least 45 years old. Negative interaction predicted more depressive symptoms, whereas emotional support and satisfaction with support were predictors of less depressive symptoms and better mental health QoL (p’s < .05). Experiences of discrimination and physician trust did not predict health outcomes. These findings suggest researchers should further investigate the impact of ASEs, particularly negative interaction, on caregiver health. Healthcare providers of caregivers should consider how ASEs and social support may affect caregivers’ health and ability to care for their relatives.
FAMILY CAREGIVERS’ PSYCHOLOGICAL WELL-BEING AND PHYSICAL HEALTH IN THE CONTEXT OF THE WORK ENVIRONMENT
Authors: Hodgdon Barbara , Wong Jen
Published: December 2022

As working family caregivers navigate work and care responsibilities, the work environment may contribute to their psychological well-being and physical health outcomes. Working caregivers who provide multi-generational care (e.g., sandwiched caregivers) experience greater vulnerability when compared to non-sandwiched caregivers (e.g., filial caregivers). This vulnerability could be mitigated by supportive work characteristics (e.g., greater decision authority and supervisor support). Informed by the life course perspective, this study compared the psychological well-being and physical health of working sandwiched and filial caregivers, and the moderating role of work characteristics (decision authority and supervisor support). Sandwiched (n=80; Mage=46.3) and filial (n=62; Mage=55.7) caregivers from the Midlife in the United States (MIDUS-II) Survey provided information about their background, caregiving, employment, well-being, and health via a set of questionnaires and phone interview. Regression analyses showed that sandwiched caregivers exhibited lower levels of generativity than filial caregivers. Moderation analyses revealed that sandwiched caregivers with greater decision authority trended toward exhibiting greater autonomy than other caregivers. Sandwiched caregivers with greater decision authority also exhibited significantly less difficulty with instrumental activities of daily living (IADLs) than other caregivers. Finally, sandwiched caregivers with greater than average supervisor support trended toward exhibiting higher level of generativity as compared to other caregivers. Results highlight the impact of sandwiched caregiving on autonomy, generativity, and IADLs in the context of decision authority and supervisor support. Findings may inform workplace programs and policies aimed at enhancing caregivers’ sense of decision making and increasing supervisor support in order to promote caregivers’ psychological well-being and physical health.
CHANGING FAMILY DESTINIES, DIVERGENT FAMILY CAREGIVING PATTERNS: DO BIRTH COHORTS, GENDER, RACE, AND SES MATTER?
Authors: Duan Haoshu
Published: December 2022

Over the past few decades, Americans have experienced a series of demographic transitions include prolonged longevity and rise in the complexities of family structures. The Baby Boomer cohort is at the forefront of these transitions, which has profound implications on their later-life family relations and practices of family caregiving. Most caregiving literature has focused on static care experiences over a short time, while neglecting long-term care experiences. Using 10 waves of longitudinal data from HRS (2000-2018) and latent profile analysis, I identified five prominent long-term caregiving patterns: light parental caregivers (44.1%), intensive spousal caregivers (5.6%), sandwiched caregivers (5.5%), light grandchildren caregivers (38.7%), and heavy grandchildren caregivers (6.2%). Further, I conduct multinominal logistic regression to investigate how birth cohorts, gender, race, and education shaped these patterns. Results suggested that later cohorts have seen a decline in intensive spousal caregivers, light and heavy grandchildren caregivers, but an increase in light parental caregivers. Women are more likely to be sandwiched caregivers than men, and black caregivers are more likely to be intensive spousal caregivers, heavy grandchildren caregivers, and sandwiched caregivers than white. By contrast, white and more educated caregivers are more likely to be light parental caregivers, and this pattern becomes more pronounced in later cohorts. The findings suggest divergent destinies of family caregiving patterns among later cohorts. More disadvantaged groups are shouldering heavier care responsibilities than advantaged groups. Targeted care services should be implemented to ease the care burdens of the vulnerable population.
PERCEPTIONS OF NURSES DELIVERING NURSING HOME VIRTUAL CARE SUPPORT: A QUALITATIVE PILOT STUDY
Authors: Blackburn Justin , Mills Carol , Tran Yvette , Yeager Valerie , Unroe Kathleen , Holmes Ann
Published: December 2022

Avoidable hospitalizations among nursing home residents result in poorer health outcomes and excess costs. Consequently, efforts to reduce avoidable hospitalizations have been a priority over the recent decade. However, many potential interventions are time-intensive, require dedicated clinical staff, and nursing homes are chronically understaffed. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project was one of seven sites selected by CMS as "enhanced care & coordination providers" and was implemented from 2012 to 2020. A virtual program based on the principles of OPTIMISTIC was developed in the spring of 2020 with the goal of expanding the reach of the program’s services. This qualitative study explores the perceptions and experiences of the nurses that piloted a virtual care support project in 11 nursing homes in a midwestern state, and identified the nurses’ perceived facilitators of, and barriers to, the effectiveness of delivering a novel virtual care support program. A key finding from this analysis is that relationships, communication, and access to information were identified as common themes facilitating or impeding the perceived effectiveness of implementation of virtual care support programs within nursing homes, from the perspective of the nurses delivering the services. The experiences and recommendations of the program nurses provide insights into crucial elements important to the implementation of similar virtual care support models, and the role of telehealth in bridging healthcare workforce gaps.
PERCEIVED ROLES IN MEDICATION SAFETY: PATIENTS' PERSPECTIVES
Authors: Jallow Fatoumata , Stehling Elisa , Sajwani Zara , Daniel Kathryn , Xiao Yan , Fulda Kimberly , Espinoza Anna
Published: December 2022

Community-dwelling older adults are vulnerable to medication safety-related harms. Prevention of medication-related harms in the outpatient setting starts with thorough and thoughtful medication reconciliation at each patient encounter. Comprehensive medication reconciliation is challenging for prescribers to provide in busy time-pressured practices. Older adults currently taking five or more daily prescription medications were recruited for this qualitative study. From the participants’ perspective, we explored the role of the prescriber, pharmacist, and patient in medication safety. During the COVID-19 pandemic, interviews were conducted from October 2020 to June 2021. Results from these interviews suggest that older adults recognized their role in medication safety supersedes just taking the pills as prescribed. Older adults understand that they must play an essential role in the coproduction of quality health services. Subthemes that emerged from the patient’s perceived role were “taking fewer medications,” “locking them up,” “keeping appointments,” and “reading the label.” Pharmacists were expected to inform participants of any changes in their medications, such as the color, shape, or dosage, and ensure no drug interactions. Primary care providers are expected to coordinate care between all specialists treating their patients and any medication prescribed by those specialists. There was a high level of trust in the provider’s knowledge, skill, and experience, along with a low level of patient engagement in decision-making around deprescribing. Among older adults, self-perceptions of their role in medication safety varied widely. Educating prescribers and pharmacists about the role expectations of this vulnerable population can help improve medication safety.
LONELINESS DURING THE COVID-19 PANDEMIC AND THE EFFECT ON PSYCHOSOCIAL FACTORS AND HEALTH OUTCOMES
Authors: Dinaj Veronica , Tkatch Rifky , Cheng Yan , Holt-Lunstad Julianne , Perissinotto Carla , Kraemer Sandra , Schaeffer James , Yeh Charlotte
Published: December 2022

Loneliness and social isolation have harmful impacts on health and well-being; thus, the social distancing mandates during the COVID-19 pandemic, meant to protect our most vulnerable populations including older adults, may have had unintended consequences. The current study aimed to assess changes in loneliness (prior to and during the pandemic) and its impact on outcomes such as perceived stress, resilience, purpose in life, quality of life and health outcomes. An annual survey on healthy aging was mailed to a randomly selected national sample (age >65 years) in 2018/2019. Respondents completed the survey again in 2020 (N=3,564) to measure the impact of COVID-19. Measures included well-being and various psychosocial factors. Health care claims data were also used to derive diagnoses for health conditions. Respondents were 52% female and 44% between 65-74 years old. Loneliness symptoms increased for one-fifth of the sample during the pandemic. Respondents lonely at both time 1 and time 2 had lower resilience, purpose in life, and quality of life and higher perceived stress compared to those only lonely at one time point or not lonely. Respondents lonely at both time points had higher rates of health conditions compared to non-lonely respondents. In conclusion, older adults experienced increased levels of loneliness during COVID-19. Those with chronic loneliness had worse outcomes than those who were not lonely or inconsistently lonely and they exhibit lower resilience and purpose and higher stress and health complications. These findings suggest that timing and early intervention for loneliness is important for older adults.
THE GEOGRAPHIC LAYOUTS OF OLDER EUROPEANS’ SOCIAL NETWORKS AND LONELINESS IN THE COVID-19 PANDEMIC
Authors: Sun Haosen , Schafer Markus
Published: December 2022

Many older Europeans sustain core personal networks that are geographically dispersed. The pandemic has brought concerns about their mental health, especially during lockdown periods when travel was not permissible and casual local contact was limited. This study examines whether and how older adults’ loneliness and depressed feelings vary by the prior geographic layouts of their core discussion networks. It uses a sample of community-dwelling respondents aged 50 and above (Wave 6, in 2015) from the Survey of Health, Aging, and Retirement in Europe (SHARE), with a follow-up at Wave 8 in 2020 during the height of the COVID pandemic. Latent Class Analysis and linear regression show that individuals whose networks were comprised mainly of families 5-25km and >25km away were not especially likely to feel lonely or distressed, despite typically lacking nearby confidants. We also uncover groups of people occupying more compositionally diverse networks. While these individuals were generally more likely to perceive loneliness, they tended not to attribute such feelings to the pandemic onset. The exception was individuals sustaining diverse networks comprised mainly of friends and families at intermediate distances (5-25km), who perceived heightened loneliness in the pandemic. Overall, even scattered at longer distances, family-oriented networks demonstrate good protectiveness against loneliness and depression. Meanwhile, diverse networks appeared to fall short in protectiveness under some conditions of geographic dispersion.
THE COMBINED EFFECTS OF LONELINESS AND SOCIAL ISOLATION ON MENTAL HEALTH IN A NATIONAL SAMPLE OF OLDER ADULTS
Authors: Krook Melissa , Mackenzie Corey , Menec Verena , Cameron Jessica
Published: December 2022

Social connections are important to maintain health across adulthood. Loneliness and social isolation are global issues and are linked to negative mental health outcomes worldwide, especially among older adults. Past research focuses primarily on loneliness and isolation separately, though many older people experience them simultaneously. Also, there is a paucity of research examining mechanisms through which combinations of loneliness/isolation result in poor mental health. My first objective examined how combined loneliness/isolation affect psychological distress among a group of older adults, and how grouping this sample into four groups of loneliness (yes/no) and isolation (yes/no) may help identify which group(s) are at the greatest risk for distress. My second objective explored perceived social support and relationship satisfaction as mediators of the effects of combined loneliness/solation on distress. I addressed these objectives with a cross-sectional national sample of 2,745 Canadian older adults, aged 55 to 101 years, who completed self-report measures of loneliness, social isolation, social support, relationship satisfaction, perceived physical health, and psychological distress. Those experiencing greater combined loneliness/isolation also experienced higher levels of distress. For lonely older adults, experiencing isolation simultaneously predicted clinically significant distress, but this was not true for those who were not lonely. Participants who were both lonely/isolated had the poorest mental health because they were less satisfied with their relationships, but not because they had less perceived social support. The present study has the potential to expand what we know about pathways through which combinations of loneliness/isolation may lead to poor mental health in older adults.
DECREASED FREQUENCY OF SMALL TALK DURING COVID-19 PANDEMIC AND MENTAL HEALTH: LONGITUDINAL SURVEYS IN JAPAN
Authors: Murayama Hiroshi , Sugawara Ikuko
Published: December 2022

The coronavirus disease 2019 (COVID-19) has drastically reduced opportunities for small talk. As small talk involves socializing, such deprivation can be stressful. This study examined the association between the change in frequency of small talk before and during the pandemic and the mental health of middle-aged and older people. We conducted web-based longitudinal questionnaire surveys from March to May 2020 and from September to October 2021 among members of a Japanese social networking service. We analyzed 867 responses of people who participated in both surveys (mean age, 68.0 ± 8.0 years; men, 68.1%). This study was approved by the Research Ethics Committee of University of Tokyo. Change in small talk frequency before and during the pandemic was assessed using a single item, “Have the opportunities for small talk (including face-to-face, phone, video call, etc.) with someone other than cohabiting family members changed?” We divided the responses into “increase,” “no change,” and “decrease.” Mental health outcomes included psychological well-being and loneliness. A total of 57.0%, 34.4%, and 8.7% reported “decrease,” “no change,” and “increase,” respectively, from before to during the pandemic. After adjusting for potential covariates, multiple regression analyses showed that people who felt their small talk frequency decreased during the pandemic compared to pre-pandemic period had lower psychological well-being and greater loneliness than those who did not. We observed no interaction between change in small talk frequency and age/sex. Our study quantitatively revealed the importance of small talk during the pandemic in maintaining mental health.
RELATIONSHIPS BETWEEN PHYSICAL/MENTAL MULTIMORBIDITY AND DEPRESSIVE SYMPTOMS AMONG OLDER BLACK AMERICANS
Authors: Cho Seungjong , Hamler Tyrone
Published: December 2022

The purpose of this study was to identify the association between physical/mental health problems and depressive symptoms among older Black Americans (age ≥ 65) using the 2018 Health and Retirement Study (N = 812). People with multiple medical conditions face substantial emotional difficulties including depressive symptomatology. The study of depressive symptoms among older Black Americans is an emerging area of research. Several existing studies reported a higher prevalence of depressive symptoms among this population. They also experience a disproportionate burden of multimorbidity, both physically and mentally. For statistical analysis, depressive symptoms were measured with the eight-item CES-D scale (M = 1.514, SD = 1.916). Physical multimorbidity was measured by asking whether respondents had ever been diagnosed with seven diseases (high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and arthritis; M = 2.876, SD = 1.284). Mental multimorbidity was measured by asking whether they had ever been diagnosed with three diseases (clinical depression, Alzheimer’s Disease, or other memory impairment including dementia; M = .228, SD = .467). Covariates included gender, marital status, and income (logged). A negative binomial regression showed that (a) higher numbers of physical health problems were associated with higher depressive symptoms (Incidence rate ratios [IRR] = 1.073, p = .048); (b) higher number of mental health problems were also related to higher depressive symptoms among older Black Americans (IRR = 2.077, p < .001). These findings underscore the importance of identifying and managing depressive symptoms among older Black Americans, who present with greater physical/mental health multimorbidity.
BECOMING A DEMENTIA CARE PARTNER DURING THE COVID-19 PANDEMIC
Authors: Xu Hanzhang , Fish Laura , Nohria Raman , Christy Jacob , Falkovic Margaret , Dupre Matthew , Anderson Ruth , Østbye Truls
Published: December 2022

Persons with newly diagnosed Alzheimer’s disease and related dementias (ADRD) and their care partners confront multiple challenges. These challenges have been even greater during the COVID-19 pandemic, where supportive resources often are limited or even discontinued. We conducted semi-structured interviews with 21 care partners of persons who were recently diagnosed with ADRD (2019-2020) to explore their lived experiences of adjusting to the new role. Directed and conventional content analyses were used and were informed by the life course theory. Care partners perceived difficulty in accessing medical and social services for their loved ones, particularly during the pandemic. Despite experiencing distress, some care partners chose not to seek help for fear of contracting COVID-19. This study provides insights on the unmet needs of care partners during a pandemic and highlights that effective, long-term strategies are needed to continue providing person-centered care to persons with ADRD and their families.
EXTENDING A HEALTHY LIFESPAN WITH 3-HYDROXYANTHRANILIC ACID
Authors: Sutphin George , Dang Hope , Castro-Portuguez Raul , Espejo Luis , Freitas Sam , Meyers Jeremy
Published: December 2022

Metabolism of tryptophan by the kynurenine pathway is increasingly linked to aging. Kynurenine pathway enzymes and metabolites influence a range of molecular processes critical to healthy aging, including regulation of inflammatory and immune responses, cellular redox homeostasis, and energy production. Aberrant kynurenine metabolism occurs during normal aging and is implicated in many age-associated pathologies including chronic inflammation, atherosclerosis, neurodegeneration, and cancer. We and others previously identified three kynurenine pathway genes—kynu-1, tdo-2, and acsd-1—for which decreasing expression extends lifespan in invertebrates. More recently we discovered that knockdown of haao-1, a fourth kynurenine pathway gene encoding the enzyme 3-hydroxyanthranilic acid dioxygenase (HAAO), extends lifespan by ~30% and delays age-associated health decline in Caenorhabditis elegans. Lifespan extension is mediated by increased physiological levels of the HAAO substrate 3-hydroxyanthranilic acid (3HAA). Aging mice fed a diet supplemented with 3HAA are similarly long-lived. The mechanism of action liking 3HAA to aging is complex and partially overlaps with multiple pathways previously implicated in aging. We recently identified activation of the Nrf2/SKN-1 oxidative stress response and alterations to iron homeostasis as key players in the benefits 3HAA. Ongoing work explores the relationship between 3HAA, Nrf2/SKN-1, and iron in C. elegans and mammalian aging, age-associated immune decline, and cancer. This works provides a foundation for detailed examination of the molecular mechanisms underlying the benefits of 3HAA, and how these mechanisms interact with other anti-aging interventions. We anticipate that these findings will bolster growing interest in developing pharmacological strategies to target tryptophan metabolism to improve health aging.
DELETION OF THROMBOSPONDIN-1 PRESERVES HEMATOPOIETIC STEM CELL HEALTHSPAN DURING AGING
Authors: Ramalingam Pradeep , Gutkin Michael , Poulos Michael , Butler Jason
Published: December 2022

Aging is associated with defects within blood stem cells, termed hematopoietic stem cells (HSC), including a loss of their self-renewal potential and a skewed differentiation towards myeloid lineages at the expense of lymphoid cells. Collectively, these HSC defects manifest as anemias, poor response to vaccines and an increased incidence of myeloid neoplasms in older adults. Unlike other somatic stem cells, aged HSCs have been shown to be refractory towards established anti-aging interventions including caloric restriction, exercise, parabiosis and plasma transfer. Thrombospondin-1 (TSP1) was initially discovered as an anti-angiogenic molecule, and recent studies have identified that TSP1 promotes age-related pathologies including chronic inflammation, reactive oxygen species (ROS) generation, and mitochondrial dysfunction. Notably, each of these TSP-1 regulated processes have been shown to critically influence HSC biology, particularly in the context of aging. However, whether TSP-1 directly regulates HSC activity remains unexplored. Here, we sought to determine whether TSP-1 is essential for HSC development, and whether blocking TSP1 signaling could ameliorate age-related HSC defects. Utilizing murine models, we demonstrate that TSP-1 is dispensable for normal HSC development and hematopoiesis. We show that deletion of TSP-1 is sufficient to preserve HSC fitness during aging, as evidenced by preservation of youthful self-renewal potential and balanced lineage reconstitution during serial HSC transplantation assays. Mechanistically, we identify that TSP-1 adversely impacts mitochondrial metabolism within HSCs, and show that loss of TSP-1 prevents the age-related decline in HSC mitochondrial membrane potential. Our findings identify TSP-1 as a pro-geronic factor that can be targeted to preserve HSC healthspan.
EFFECT OF L-VALINE TREATMENT ON SIRTUIN (SIRT1 AND SIRT2) ISOFORMS
Authors: Sharma Shakshi , Zhang Xiaomin , Azhar Gohar , Wei Jeanne
Published: December 2022

L-valine is one of the essential branched-chain amino acids (BCAAs) required for synthesis of proteins in human body. It promotes muscle growth and tissue repair and is important for immune function. Recent data indicate that BCAAs can activate sirtuins expression and elevate mitochondrial biogenesis and fatty acid oxidation in both adipocytes and myotubes thereby increasing life span. Sirtuins are a conserved family of proteins, play a critical role in maintaining metabolic health by deacetylating many target proteins in numerous tissues, and regulate mitochondrial function and the aging process. Due to multiple effect of sirtuins on aging, we sought to determine whether the addition of valine might enhance sirtuin gene expression. We utilized the C2C12 skeletal muscle cell line grown on physiological normal glucose (100mg/dL) media. The cells were treated with two different concentrations of valine (0.5 and 1.0mM) for different time intervals (18 and 24). Gene expression of sirtuin 1 (SIRT1) and sirtuin 2 (SIRT2) isoforms were determined by RT-PCR. The results showed increased expression of the sirtuin gene isoforms after treatment with valine. Relative expression varies with in different isoforms of SIRT1 (v1 and v2) and SIRT2 (v1, v2 and v3). Among all, SIRT1 v1 and SIRT2 v1 showed maximum expression as compared to the other isoforms used in the study. Our study showed that adequate supplementation of L-valine enhanced sirtuin gene expression, which may promote healthy muscles and healthy aging.
TECHNOLOGY-BASED INTERVENTIONS AND ASSESSMENT FOR OLDER ADULTS WITH COGNITIVE IMPAIRMENT
Authors: Park JuYoung , Hung Lillian
Published: December 2022

During the COVID-19 pandemic, older adults with cognitive impairment experienced social isolation, stress, and challenges to stay healthy at home or in a long-term care facility. Technology-based interventions and assessment can be valuable in managing dementia at home before a crisis situation occurs, which can lessen caregiver burden and stress and improve quality of life for older adults with cognitive impairment. In the symposium, specific technology-based interventions (telepresence robot, online chair yoga, exergames, virtual cycling, video-conferencing platforms) and assessment (IOM2 biofeedback device) were used for older adults with cognitive impairment. We cultivated a novel interdisciplinary approach to emerging clinical entities of technology-based intervention and assessment for older adults with cognitive impairment. In the symposium, we will present a variety of technology-based clinical interventions. Our first study explored the experiences of virtual family visits in four Canadian long-term care homes, using a telepresence robot. Online survey, interviews, focus groups, and observations were conducted to explore the experience. The second study assessed feasibility of a remotely supervised online chair yoga (CY) intervention for older adults with dementia in Florida and explored the preliminary effects of CY on psychosocial outcomes in this population. The third study evaluated the ease of use and quality of cardiac data using IOM2 biofeedback device for older adults with dementia. Cardiac rhythms were analyzed from pulse data measured using the IOM2 biofeedback device (UNYTE). The fourth study was a scoping review to analyze evidence about online group-based exercise programs.
ENGAGING OLDER ADULTS IN HEALTH PROMOTION: PILOT STUDY OF TEAM GAMEPLAY OF AN EDUCATIONAL EXERGAME IN A SENIOR CENTER
Authors: Ruggiero Laurie , Orsega-Smith Elizabeth , Nichols Amy , Varghese Joshua , Getchell Nancy , DeLauder Rachel , Koiler Reza , Barmaki Roghayeh
Published: December 2022

Digital health games offer one innovative approach to engage older adults to support healthy aging. Multiple reviews have described the positive impact of health games. Limited research has examined multi-focus health games implemented in senior centers. Informed by healthy aging theory and community-engaged methods, our multi-disciplinary team developed/refined an educational exergame with a combined focus on educating about healthy lifestyle behaviors (i.e., physical activity, healthy eating), stimulating cognitive functioning, and engaging movement to support healthy aging. A pilot study (Nf13; mean age = 78, 100% female) examined team gameplay (4 sessions in two weeks) in a senior center. Teams (2–3 members) worked together to answer knowledge, trivia, and cognitive challenge questions and competed for the highest score. A post-gameplay survey asked about acceptability, usability (i.e., adapted System Usability Scale), and perceived game impact. Preliminary results suggest team gameplay was engaging and nearly all (>90%) agreed/strongly agreed that they enjoyed playing with others (i.e., on teams); were comfortable doing the physical movements during gameplay; were satisfied with game educational, trivia, and cognitive questions; enjoyed the social part of team gameplay; would recommend the game to others; and the game increased their knowledge and motivation regarding physical activity and healthy eating. The System Usability Scale was above 70, on average, suggesting above average usability for the game. Findings support use of this educational exergame as an innovative way to engage older adults in health promotion. Presentation will describe game development/refinement, senior center pilot, and implications for future research and senior center translation.
DEPLOYING IN-HOME SENSORS TO COMMUNITY-DWELLING OLDER ADULTS: ADOPTION OF TECHNOLOGY AND LESSONS LEARNED
Authors: Robinson Erin , Tefera Gashaye Melaku , Park Geunhye , Skubic Marjorie , Marchal Noah , Popescu Mihail , Keller James , Marilyn Rantz
Published: December 2022

In-home, sensor technologies can promote chronic disease self-management and independence among older adults. However, the translation of these technologies from assistive living/long-term care to community-dwelling older adults is lacking. This study aimed to tailor such technologies for private use by older adults, and gather feedback about adoption/interpretation of sensor-generated health information to make informed health decisions. Participants (Nf33; 72.7% female) aged 60+ (Mean=79.5) had three types of sensors installed: 1) depth sensors that track gait parameters and falls; 2) passive infrared motion sensors that track room activity; and 3) hydraulic bed mats that track sleep, respiration, and heart rate. Participants were also offered a Garmin smartwatch/fitness tracker. A health app was developed for participants to retrieve their sensor-generated health information via an Amazon Echo Show device with touch display and voice-activated capabilities, and a web-based interface. Data were collected over two years, and feedback was solicited during four quarterly interviews and one exit interview. Thematic analysis revealed participants used the Echo Show to retrieve their health information, set medication/health appointment reminders, and for non-health related purposes (e.g. music, weather). Regular retrieval of health information was low, partly due to technology skills, lack of interest, health issues, and technical/internet issues. Despite this, participants reported a sense of security in having the sensors installed and valued the depth sensor’s fall detection abilities. This study yielded many additional findings that will be presented, such as participant recommendations to facilitate greater adoption. Implications can inform technological solutions for older adult health self-management and aging-in-place.
USING HUMAN CENTERED DESIGN TO DEVELOP TWO NEW MEASURES OF LIVING WELL WITH DEMENTIA
Authors: Molony Sheila , Fazio Sam , Zimmerman Sheryl , Sanchez Ricci , Montminy Joe , Barrere Cindy , Montesano Rachel , Van Haitsma Kimberly
Published: December 2022

Background

New measures are needed that can provide a holistic approach to capturing salient outcomes contributing to quality of life in dementia. Purpose: To use human centered design to develop, prototype and evaluate new positive psychosocial measures for persons living with dementia

Methods

This project used a conceptual framework of human centered design to obtain and analyze data from multiple sources, including individual and focus group interviews, observations in the field and related methods to enhance empathy for the lived experience of dementia, and to design prototypes for two new measures.

Results

Qualitative analysis of interview data, integration of data from the theoretical and empirical literature and human centered design techniques including brainstorming and ideation were used to define constructs and create prototypes for a new Living Well with Dementia Inventory and Good Day-Bad Day assessment tool. Results of qualitative analysis, item development, and initial validity assessment will be presented.

Conclusion

Human centered design is a useful method for development of person-centered measures. This method may complement traditional methods of instrument development and CBPR.
FEELING VS BEING CONNECTED: DIFFERENTIATING LONELINESS AND ISOLATION IN NEAR- AND CENTENARIANS
Authors: Ying Lian , Pat Chun , Hi Bobo , Lau Po , Martin Peter , Chung Joey , Siu Yue , Siu Karen , Cheung Lan , Lai Cecilia , Chan Wan , Man Grace , Chan Yee , Ka James , Luk Hay
Published: December 2022

While gerotranscendence theories postulate that older adults tend to orient themselves toward solitude, activity theories highlight the importance of continuing social and meaningful engagement for well-being across lifespan. The distinction between loneliness and social isolation is particularly observable in older adults of advanced age who are often facing accelerated decline in physical and functional health, therefore restricting their opportunities to interact with others. This has been particularly disturbing during the previous two years under COVID. This study utilized data from the 2nd Hong Kong Centenarian Study which interviewed 120 family caregivers of older adults aged 95 or above in 2021–2022 when the city experienced almost an entire year of the outbreak. Using family or friend proxy information as well as caregiver ratings of whether older adults expressed feelings of social isolation and loneliness, we found that 10.7% of older adults reported high levels of loneliness and isolation; 26.7% feeling low in both; 11.5% were isolated but not lonely, and 38.2% were lonely but not isolated. Loneliness ratings were more strongly associated with psychological well-being (Patient Health Questionnaire-4), autonomy, happiness, perceived usefulness, worries, and death anxiety than did isolation, with the latter negatively correlated with optimism. Participants rated in the low isolation/loneliness group were least (death) anxious than the other three groups. Our findings underscore the divergence of isolation and loneliness for adults of advanced age and call for psychological support for oldest-old adults who continue to face social isolation, especially when society gradually recovers from COVID.
CHALLENGING AGEISM IN HEALTHCARE THROUGH INTERPROFESSIONAL EDUCATION
Authors: Park Min Kyoung , Martin Diane
Published: December 2022

Broadly defined as prejudice, discrimination, or stereotyping of older adults, ageism is prevalent in the healthcare system. It is implicated in the over- or under-diagnosis and/or treatments provided to older persons, resulting in decreased quality of life and increased costs of care. In Fall 2021, we developed a virtual interprofessional education (IPE) activity to increase professional health and social care trainees’ awareness of ageism and to biases they may hold. During the asynchronous portion of the training, participants complete the Harvard Implicit Association Test (age), watch a video, and respond to related threads on Blackboard, which provides an opportunity to discuss experiences prior to participating in a synchronous training activity incorporating a presentation on ageism in healthcare. To date, 98 trainees have provided qualitative data on the impact of the ageism training components. Overwhelmingly, trainees indicated the value of information provided; many of whom responded that the test revealed their own biases. Participants commented that the training was an opportunity to open their eyes to ageism and that it made them more aware of the importance of understanding older adults’ capabilities and limitations in a respectful way. More than half (55.86%) of threaded discussions noted that the ageism training helped them to realize their biases against older adults and understand older people’s challenges. Quantitative data from pre/post IPE surveys indicated increased interest in working with older adults. Responses illustrate the need to and value of incorporating anti-ageism content into educational programs of our future health and social care workforce.
SUPPORTING AGING IN PLACE WITH MOBILITY IMPAIRMENTS THROUGH ANNOTATED TELEPRESENCE TECHNOLOGY
Authors: Thompson Ben , Gandy Maribeth , Jordan Kala , Levy Laura
Published: December 2022

Most smarthome and smartphone technologies are designed with younger adults in mind, even though many older adults can benefit greatly from their use. Through our examination of how to make these technologies more accessible to adults aging in place with mobility impairments, we have found remote troubleshooting to be a possible solution to many problems. However, we have found most current teleconferencing solutions to be lacking in the limited perspectives of a single webcam, as well as from a lack of ability to point out specific items and locations within a camera view. As such, Our team developed a prototype system that used multiple desk space and room space views, as well as on screen annotations, to facilitate remote troubleshooting and social interactions through a teleconferencing service. This prototype was then evaluated with adults aging in place with mobility impairments, as well as accessibility experts, in order to see what parts of the system could be utilized for troubleshooting, as well as to see where the system was lacking. The studies tested the system’s ability to be used for troubleshooting, as well as their uses in games and social interactions. We have gathered positive feedback for these prototypes in the areas of troubleshooting, socialization, games, and for use in other accessibility studies. From these results, we have begun development of a mobile deployment kit for use of our teleconferencing solution in other accessibility studies.
USER PERSONAS TO GUIDE TECHNOLOGY INTERVENTION DESIGN TO SUPPORT CAREGIVER-ASSISTED MEDICATION MANAGEMENT
Authors: Linden Anna , Loganathar Priya , Holden Richard , Boustani Malaz , Campbell Noll , Ganci Aaron , Werner Nicole
Published: December 2022

Informal caregivers often help manage medications for people with ADRD. Caregiver-assisted medication management has the potential to optimize outcomes for caregivers and people with ADRD, but is often associated with suboptimal outcomes. We used the user-centered design persona method to represent the needs of ADRD caregivers who manage medications for people with ADRD to guide future design decisions for technology interventions. Data were collected through virtual contextual inquiry in which caregivers (Nf24) sent daily multimedia text messages depicting medication management activities for seven days each, followed by an interview that used the messages as prompts to understand medication management needs. We applied the persona development method to the data to identify distinct caregiver personas, i.e., evidence-derived groups of prospective users of a future intervention. We used team-based affinity diagramming to organize information about participants based on intragroup (dis)similarities, to create meaningful clusters representing intervention-relevant attributes. We then used group consensus discussion to create personas based on attribute clusters. The six identified attributes differentiating personas were: 1. medication acquisition, 2. medication organization, 3. medication administration, 4. monitoring symptoms, 5. care network, 6. technology preferences. Three personas were identified based on differences on those attributes: Regimented Ruth (independent, proactive, tech savvy, controls all medications), Intuitive Ian (collaborative, uses own judgment, some technology, provides some medication autonomy), Passive Pamela (reactive, easy going, technology novice, provides full medication autonomy). These personas can be used to guide technology intervention design by evaluating how well intervention designs support each of them.