bluuebunny/crossref_metadata_2025 huggingface dataset:
EXPERIENCES AND FACILITATORS OF FALLS PREVENTION AMONG ETHNICALLY DIVERSE OLDER ADULTS: A QUALITATIVE STUDY
Authors: Thiamwong Ladda , Conner Norma E
Published: November 2019

Background: Falls increase as people age and decrease the quality of life. Even though fall interventions have received great attention, fall incidence rates have still arisen. In order for older adults to reap the benefits of evidence-based fall interventions, a challenge of implementation in the real world and right context must be met. Understanding experiences, facilitators, and barriers of fall prevention among four major ethnic groups in the Unites States could be extremely valuable. Objective: The aim of this study was to describe experiences and highlight facilitators and barriers on fall and fear of falling interventions among ethnically diverse community-dwelling older adults. Methods: Four ethnically specified (African American, Asian, Hispanic and Non-Hispanic White) focus groups were conducted. A total of 28 older adults and four family caregivers were interviewed. Interviews covered experiences on falls and fear of falling, attitudes, factors, consequences, risk assessment, and interventions. Data were organized and analyzed with the NViVo software. Results: Falls related experiences and behaviors were multifaceted and varied. Three themes related to falls experiences and behaviors were identified, 1) falls prevention versus fear of falling amplification; 2) role identity, culture and family considerations; and 3) take care of you, take care of me. Facilitators of fall prevention were integration of individual learning within a group meeting, providing appropriate assistive devices and promoting environmental safety. Barriers were inconsistent fall risk assessments, low fall risk awareness and acknowledgment, and balance and visual impairment.
A MIXED METHODS SYSTEMATIC REVIEW OF COMMUNITY-BASED GROUPS FOR SOCIAL ISOLATION AND LONELINESS IN OLDER PEOPLE
Authors: Hayanga Brenda A , Kneale Dylan , Phoenix Ann
Published: November 2019

In the UK, many older people from minoritised ethnic groups are vulnerable to social isolation and loneliness. Yet, we know little about which interventions are effective for them. With existing systematic reviews of social isolation and loneliness lacking a theory-based framework of their life-course experiences, we set out to address this gap. This review aims to explore the effectiveness and suitability of community-based group interventions (CBGIs) for social isolation and loneliness in older people. The decision to focus on CBGIs was based on findings from an exploratory study of the friendship networks of older people and narrative interviews with older minoritised people living in the UK. The findings suggested that community groups of shared interests/backgrounds were protective of social isolation and loneliness. To address the objectives, we searched for randomised controlled trials and process evaluations of CBGIs published in English, which included older people living in countries with membership to the Organisation for Economic Co-operation and Development. We identified 4791 studies, 36 of which were eligible for inclusion. In this poster, we present the preliminary findings of this mixed-methods systematic review, which seeks to not only assess whether CBGIs are effective but also to understand the underlying processes that make interventions (in)effective. As this review is guided by findings from two exploratory studies with older people from minoritised ethnic groups, it takes into account their life-course experiences. It is the results of reviews such as this that can produce generalisable findings which are directly applicable to policy.
HOW TO STEADI YOUR PATIENTS WITH THE COORDINATED CARE PLAN TO PREVENT OLDER ADULT FALLS AND EVALUATION GUIDE
Authors: Mark Janice A
Published: November 2019

Falls are common, costly, and the leading cause of fatal and nonfatal injuries for older Americans. Reports show that fall death rates are increasing. Healthcare providers play an important role in fall prevention but few talk to their patients about falls. This lack of communication demonstrates the need for more physician-initiated fall prevention. The Centers for Disease Control and Prevention (CDC) created the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to help providers talk to their patients about falls. Specifically, CDC’s new STEADI-based fall prevention program, the Coordinated Care Plan to Prevent Older Adult Falls (CCP) and Evaluation Guide for Older Adult Clinical Fall Prevention Programs can assist healthcare providers in integrating and evaluating new fall prevention programs that screen older adults for fall risk, assess patients’ modifiable fall risk factors, and implement evidenced-based fall prevention interventions (e.g., medication management, physical therapy). The CCP offers guidance for incorporating a STEADI-based fall prevention program including how to engage leadership, integrate with existing clinic workflow and electronic health records, and strategies on how to obtain reimbursement for fall prevention. The Evaluation Plan offers details on how to engage stakeholders, collect data, interpret findings and how to share results for maximum impact. Both documents were based on lessons learned from successful implementation of STEADI-based programs in primary care. A STEADI-based program in New York found fewer fall-related hospitalizations among at-risk patients who received a fall prevention care plan compared to at-risk patients who did not receive a care plan.
ATTITUDES, EXPECTATIONS, KNOWLEDGE AND INTENTIONS REGARDING ORAL HEALTH: PERCEPTIONS OF OLDER ADULTS
Authors: Hardgraves Virginia M , Henry Jean , Patton Susan K
Published: November 2019

Many adults in today’s aging cohort are maintaining their teeth into their advanced years. The advantages of fluoridated water, dental insurance, greater awareness of preventive oral healthcare, and more restorative dental services, have made this possible. The demand for oral health care services will be greater and more complex than that of previous generations. Evidence of a link between oral health and overall health underscores the need to better integrate dental care into the healthcare system. The aim of this study was to better understand these issues from the perspective of older adults (N = 26) 65 years of age and older and living independently. Semi structured interviews guided by the behavioral constructs of the Reasoned Action Approach Theory were conducted. Results from the qualitative analysis revealed five themes: 1) Difficulties accessing dental care, 2) Stoic independence, 3) Taking care of your mouth as part of overall health, 4) Relationships affecting oral health related quality of life, and 5) Supporting roles. The findings demonstrate a need to increase oral health literacy in the older adult population with attention to reducing modifiable risk factors. Understanding these behaviors and the current level of oral and overall health knowledge from the perspective of older adults, is vital to helping these individuals’ transition into increasing levels of dependency with a high level of oral health related quality of life. Public health program planning can use this information to help older adults prepare for the transitions that come with healthy aging.
GAIT SPEED AND CHILDHOOD-TO-MIDLIFE BRAIN HEALTH: RETHINKING GAIT
Authors: Rasmussen Line , Caspi Avshalom , Moffitt Terrie , Cohen Harvey J , Morey Miriam C , Richmond-Rakerd Leah
Published: November 2019

Background: Gait speed is a well-known predictor of functional decline and mortality in older adults, but little is known about the origins of gait speed earlier in life. We tested the hypothesis that slow gait reflects accelerated biological aging already at midlife, as well as poor neurocognitive functioning in childhood and childhood-to-midlife cognitive decline. Methods: Prospective study of the population-representative Dunedin Study birth cohort (n=1,037), followed to age 45 (until April 2019). We measured age-45 gait speed in 904 (90.7%) participants and tested associations with key life course factors. Results: The mean (SD) gait speeds (m/s) were: usual: 1.30 (0.17); dual task: 1.16 (0.23); and maximum: 1.99 (0.29). Among midlife adults, those with more physical limitations (β -0.27; P<.001), poorer physical functions (β 0.24–0.36; all P<.001), accelerated biological aging across multiple organ systems (β -0.33), older facial appearance (β -0.25), smaller brain volume (β 0.15), more cortical thinning (β 0.09), smaller cortical surface area (β 0.13), and more white matter hyperintensities (β -0.09) had slower gait speed, all P<.05. Participants with lower IQ in childhood (β 0.34) and midlife (β 0.38) and who exhibited childhood-to-midlife cognitive decline (β 0.10) had slower gait speed at midlife, all P<.01. Adults with poorer neurocognitive function as early as age 3 had slower gait in midlife (β 0.26; P<.001). Conclusion: Adults’ gait speed is more than an indicator of geriatric functional status, it is also an index of midlife aging and lifelong brain health.
MEMORY FUNCTIONING AND CAREGIVING: CONTINUITY, CONNECTEDNESS AND METAPHORS IN ALASKA NATIVE PERCEPTIONS
Authors: Rosich Rosellen M , Crouch Maria
Published: November 2019

Biomedical models often define dementia in a negative and diachronic manner, which shape Western, cultural understandings and approaches. However, utilizing a critical gerontological approach has allowed the current study to explore Alaska Natives (i.e., adults who hold “Elder” status and are 50 years or older) perception of memory decline, and the stresses imposed upon caregiving when a Western biomedical model of dementia is utilized. Multitudinous research demonstrates definitions and intersections of health, illness, ethnicity, and family are not universal. Subsequently, it is critical to examine these sociocultural concepts from diverse cultural belief systems and imperative to examine historical processes impacting these constructs to identify specific risk and protective factors regarding holistic health. Recent qualitative data analysis from an exploratory study of Alaska Native Elder’s perception of memory functioning and dementia has yielding themes that are consistent with previous research on indigenous culture. However, themes of continuity, connectedness, spirituality, intergenerational transmission, traditional belief systems, and barriers to cultural continuity such as oppression and historical trauma, are being filtered through Alaska Natives unique cultural lens. This cultural lens allows Alaska Natives to utilize positive metaphors for memory functioning and dementia embedded within their belief systems and these are distinct from Western biomedical definitions. The poster proposed will highlight themes recently uncovered from thematic analysis, code book development, and code matrices as well as present the positive, culturally adaptive and congruent representations that Alaska Native Elder’s utilize in understanding memory changes and forms of dementia that both explain and transcend biomedical models.
DOES PAIN PREDICTS FRAILTY AMONG OLDER ADULT AMERICANS: FINDINGS FROM THE NATIONAL HEALTH AND AGING TRENDS STUDY.
Authors: Sodhi Jaspreet k , Chou Lin-Na , Snih Soham Al
Published: November 2019

Musculoskeletal pain is highly prevalent among older adults and is one of the common causes of disability. The objective of this study was to examine the effect of pain on becoming frail among American older adults over 6 years of follow-up. We studied 5,229 participants aged ≥ 65 years from the National Health and Aging Trends Study (2011-2017) who were non-frail at baseline. Key variables included pain, socio-demographic characteristics (age, gender, race/ethnicity, marital status, and education), depression, comorbidities, and body mass index. The outcome variable was frailty assessed using the frailty phenotype, defined as meeting three or more of the following criterions: shrinking, weakness, exhaustion, slowness, and low physical activity. General estimation equation model was fitted to test the effect of pain on frailty over time. Prevalence of pain in American older adults was 48.9% at baseline. The prevalence of frailty ranged from 6.7 % at baseline to 7.4 % at wave 6 among those with pain. The odds ratio (OR) of becoming frail overtime was 1.07 (95% CI 1.02 – 1.12) over time. The OR of becoming frail over time as a function of pain was 1.76 (95% CI 1.51-2.05), after controlling for all covariates. Other predictor factors of becoming frail were being ≥ 75 years, having one or more comorbid conditions, and with high depressive symptoms. Participants with higher level of education were less likely to become frail. These findings suggest that early treatment of pain may reduce frailty and improve the quality of life in this population
CARDIAC TROPONIN T MEDIATED AUTOIMMUNE RESPONSE AND ITS ROLE IN SKELETAL MUSCLE AGING
Authors: Zhang Tan , Feng Xin , Feng Bo , Dong Juan , Haas Karen , Nicklas Barbara M , Delbono Osvaldo , Kritchevsky Stephen
Published: November 2019

Cardiac troponin T (cTnT), a key component of contractile machinery essential for muscle contraction, is also expressed in skeletal muscle under certain conditions (e.g. neuromuscular diseases and aging). We have reported that skeletal muscle cTnT regulates neuromuscular junction denervation preferentially in fast skeletal muscle of old mice. Here, we further report that cTnT is also enriched within some myofibers, and/or along microvascular walls in old mice fast skeletal muscle. Strikingly, immunoglobulin G (IgG), together with markers of complement system activation, cell death (necroptosis or apoptosis), and macrophage infiltration, were all found to be co-localized with cTnT and IgG in those areas. In addition, elevated cTnT and IgG are associated with lower dystrophin expression on muscle fiber membrane, lower muscle capillary density, and reduced muscle performance (wire hanging test). Using purified recombinant TnT proteins, we confirmed that only cTnT, but not slow or fast skeletal muscle TnT1 or TnT3, was detected by immunoblot using sera from old (but not young) mice with pre-determined elevated cTnT and IgG in their skeletal muscle, indicating the existence of anti-cTnT autoantibodies in sera (previously found in human blood) and skeletal muscle of old mice. Immunoblotting further revealed that the age related changes in skeletaI muscle cTnT and IgG are more prominent in fast skeletal muscle than in slow. Importantly, elevated cTnT and IgG were also detected in skeletal muscles from 4 older adults (65-70 yrs, IMFIT). Our finding suggests a novel autoimmune mechanism mediated by cTnT that underlies age related skeletal muscle abnormalities and dysfunction.
HEPATIC AGO2-MEDIATED RNA SILENCING REGULATES SYSTEMIC GLUCOSE METABOLISM.
Authors: Murakami Kazutoshi
Published: November 2019

Obesity causes various metabolic complications, including insulin resistance and T2DM. However, currently, we have a limited understanding of the pathophysiology in the development of these processes. It’s generally considered that obesity develops when energy intake chronically exceeds total energy expenditure. The liver is a major organ for energy consumption, then mRNA translation accounts for the majority of energy expenditure in liver. While RNA silencing regulates mRNA translation, it’s unclear if RNA silencing regulates glucose metabolism. To investigate the role of RNA silencing in glucose metabolism, we focused on Argonaute 2 (Ago2), which is the main component of RNA-induced silencing complex that carries out RNA silencing. By generating liver-specific Ago2-deficient (L-Ago2 KO) mice, we revealed Ago2 regulates the maturation process of metabolic disease related miRNAs (MD-miRNAs), that silence genes critical for glucose metabolism. In addition, Ago2-deletion enhances ATP consumption associated with mRNA translation. Consequently, inactivation of hepatic Ago2 protect from diet-induced glucose intolerance in mice. Then, to further investigate if these molecular mechanisms are still activated in “older mice”, we employed 34-week of age mice and analyzed. Around this age, despite having the similar body weight, L-Ago2 KO mice fed HFD exhibited lower blood glucose and serum insulin levels. Consistently, expression levels of MD-miRNAs were decreased in the liver of L-Ago2 KO mice fed HFD. These results suggest that hepatic Ago2 function is continuously activated in “older mice” fed HFD, leading to enhanced biogenesis of MD-miRNAs and reduction of their target mRNAs, and these alterations are associated with systemic glucose metabolism.
BIOLOGICAL AGE INFLUENCES HEART FAILURE PATHOGENESIS
Authors: Woulfe Kathleen , Zumo Jacob , Cook Ross , McNair Benjamin , Schlatter Jacob , Schmitt Emily , Chhatre Vikram , Bruns Danielle
Published: November 2019

Heart failure (HF) impacts patients of all ages and is an enormous public health problem. Historically, HF has been treated with a single, multi-purpose approach, despite the observation that biological differences such as age influence HF pathogenesis and therapeutic outcomes. We hypothesized that HF pathogenesis differs across the life-course, a hypothesis which we tested with a mouse model of cardiac dysfunction at three distinct stages of life. C57BL/6 mice at pediatric (5 weeks), adult (3-5 months), and old (18 months) ages were treated with a mini-osmotic pump that eluted isoproterenol (ISO; 30mg/kg/hour) for six days. As expected, cardiovascular morbidity and mortality were significantly worse in the old group. Both pediatric and adult underwent hypertrophic remodeling, as evident by higher LV weight relative to tibia length (TL). However, ISO exposure did not increase LV/TL in old mice. We performed RNA-sequencing to understand pathways and genes differentially regulated by age. 119, 1515, and 33 genes were significantly differentially expressed in pediatric, adult, and old mice exposed to ISO, respectively. Of these, only 2 transcripts were upregulated in response to ISO across all three ages. Expression of pro-fibrotic mediators differed across the life-course, with adults inducing a pro-fibrotic transcriptional program (α-smooth muscle actin, fibronectin, collagen, periostin) that was attenuated in old and absent in pediatric animals. Our data clearly demonstrates that pediatric, adult, and aged hearts activate distinct molecular remodeling in response to ISO, highlighting the significance of age as a biological variable in HF pathogenesis.
POST DISCHARGE WALKING ACTIVITY AND 30-DAY READMISSION IN OLDER ADULTS
Authors: Kemp Noah , Deer Rachel R , Volpi Elena , Fisher Steve
Published: November 2019

The Centers for Medicare and Medicaid Services has determined high rates of unplanned 30-day readmission to be an indicator of substandard care. More research is needed to identify strong, objective markers of readmission risk. The purpose of this analysis was to investigate the utility of average steps per day as a biomarker in determining the 30-day readmission risk of recently discharged older adults. 133 men and women, aged 65 and older, who were capable of walking on their own, recently hospitalized with an acute illness, and discharged to home were given a StepWatch Activity Monitor and monitored for up to 30 days following discharge. Average steps per day and clinical characteristics were assessed and compared with 30-day readmission. 20 of 133 participants were readmitted within 30 days. Those who were readmitted took significantly fewer steps per day overall: 4412 vs. 5948, p=0.027, and had significantly longer stays in the hospital: 4.50 vs. 2.90 days, p=0.002. Survival analysis of our sample, grouped by tertile of mean daily steps, while not statistically significant, p=0.093, demonstrated a trend toward greater probability of readmission over the 30 days post discharge for those who were in the lowest tertile. Walking activity appears to be a moderate predictor of readmission risk. A more extensive study must be conducted to better understand the relationship of walking activity after discharge and readmission.
PREPARATION FOR THE END OF LIFE AND PERCEIVED QUALITY OF CARE PRIOR TO HOSPICE REFERRAL: A SURVEY OF CAREGIVERS
Authors: Prater Laura , Wachowiak Phillip L , Otsubo Masami , Bose-Brill Seuli
Published: November 2019

Lack of preparation for the end of life (EOL) can lead to poor outcomes for caregivers. The purpose of this study was to learn if perceived quality of EOL care and communication provided by the primary clinician prior to hospice referral is associated with caregivers’ perceived preparedness to deal with medical emergencies/complications at the EOL. We conducted a survey of caregivers of patients who died and were referred to hospice in the prior year. Perceived quality, was measured by the Quality of End of Life Care (QEOLC) scale, and “preparedness” was a binary measure asking if caregivers felt unprepared to deal with medical emergencies and/or complications related to the care of the patient at the EOL. We performed a bivariate analysis using a two-sample t-test to determine if QEOLC scores were greater among those indicating they were prepared compared to those indicating they were not prepared. We received a response rate of over 22.8% (49/215). Mean EOL scale scores were 82.0 (SD=3.8) for those reporting that they did not feel unprepared for medical emergencies/compilations that arose near the EOL, and 68.2 (SD=7.3) for those who reported that they did feel unprepared. Results show that the mean difference approached significance (t=1.85; p=0.07). Although results only approached significance, EOL care from clinicians involved prior to hospice enrollment may be perceived as higher quality among those who felt prepared to handle emergencies/complications. This finding suggests that caregivers highly value early EOL education and communication aiding in preparation for emergencies/complications arising after hospice referral.
HEALTH BEHAVIORS ASSOCIATED WITH SUBJECTIVE COGNITIVE DECLINE IN OLDER ADULTS
Authors: Wisniewski Kristi M , Zelinski Elizabeth M
Published: November 2019

Participation in risky health behaviors can increase the potential for cognitive decline. Smoking, alcohol consumption, and minimal physical activity are modifiable risk factors associated with worse performance on cognitive assessments; however, the relationship between subjective cognitive decline (SCD) and risky practices has not been assessed. As a potential early indicator of cognitive impairment, SCD may serve as a screening measure for dementia. The Behavioral Risk Factor Surveillance System is an annual, self-reported telephone survey of Americans that includes fifteen core and twenty-five optional sections. The present study included Behavioral Risk Factor Surveillance System participants age 45 or older who completed the core and cognitive decline modules in 2015 (n=147,243). Roughly 11% of participants endorsed worsening memory in the previous year. Logistic regression examined the impact of smoking, drinking, and inactivity on self-reported cognitive decline. Current or former smokers had greater odds of endorsing cognitive decline compared to those who never smoked (OR=1.4; 95% CI: 1.27-1.52). Individuals who consumed at least one alcoholic beverage in the previous month had lower SCD odds compared to non-drinkers (OR=0.8; 95% CI: 0.72-0.87). Respondents who engaged in little to no physical activity had greater odds of endorsing cognitive decline compared to active respondents (OR=1.4; 95% CI: 1.31-1.57). Individuals who endorsed cognitive decline engaged in unhealthy habits such as smoking or inactive lifestyles; however, low to moderate alcohol consumption may be beneficial for cognitive functioning.
YY1-MEDIATED PROMOTER-SUPER ENHANCER INTERACTIONS REGULATE MSC MULTIPOTENCY DURING REPLICATIVE AGING
Authors: Sun Luyang , McCauley Brenna , Dang Weiwei
Published: November 2019

Mesenchymal stem cells (MSC) are versatile in stem cell therapy and regenerative medicine, due to its capacity of in-vitro expansion and multilineage differentiation. However, how the MSC’s functions and the underlying epigenomic features are affected by aging and cellular senescence remains poorly understood. Here we used culture expanded human MSC isolated from umbilical cord tissue as an ex vivo model to characterize the chromatin 3D conformational changes associated with aging and senescence and correlate these changes to the changes in MSC stem cell functions during aging. By comparing late passage (P15) vs early passage (P5) MSC, no fundamental changes were found on the large-scale chromatin spatial structures including compartment switching and TAD boundaries. However, when focused on super enhancers, which act as major cis-regulatory hubs associated with lineage-specific functions, a large number of significant promoter-super enhancer interaction changes were discovered. Further examination revealed that YY1, a key regulator of promoter-enhancer looping, was highly enriched in these promoters and their corresponding super-enhancers. The expression of the genes involved in such changes is positively correlated with the variation of promoter-super enhancer interaction, indicating that the spatial communications between promoter and super-enhancer positively regulate gene expression. GO-term and TFBS enrichment analysis showed that these genes involved in cell cycle, adipocyte and osteoblast differentiation. Collectively, these results suggest that YY1-mediated promoter-super enhancer looping is an important regulatory mechanism for MSC multipotency during replicative aging.
FRAILTY IN HEALTHY OLDEST OLD: CHARACTERIZING THE FRAILTY INDEX OF SUPER-SENIORS
Authors: Chinda Betty , Song* Xiaowei , Sarveswaran Shirromi , Rockwood Kenneth , Brooks-Wilson* Angela
Published: November 2019

People at advanced ages often have multiple comorbidities and high frailty. We characterized frailty in “Super-Seniors”, individuals 85 or older who have never been diagnosed with cancer, cardiovascular or lung disease, diabetes or dementia. Super-Seniors were enrolled in the Vancouver Healthy Aging Study that consisted of Phase1 (2004-2007; n=486; age=88.6±3.1 years; female=67.5%) and Phase2 (2014-2019; n=167; age=89.2±3.8 years; female=65.3%). A frailty index (FI) that assesses the accumulation of health deficits was calculated as the proportion of deficits present over those considered (here, 30). The FI distribution patterns, mean, median, 99% limit values, relationship to age, and sex differences were analyzed. The FI of Super-Seniors is right-skewed, with a mean of 0.19±0.09 (median=0.17; limit=0.54) in Phase1 and 0.22±0.08 (median=0.21; limit=0.47) in Phase2. Most Super-Seniors (79% and 61% in Phases 1 and 2) had ≤8 of the 30 deficits; FI≤0.24. The FI increased with age (r’s=0.29 and 0.24); women showed a higher mean FI than men. Data demonstrated the known and consistent characteristics of the FI. The Super-Seniors, who are healthier than the general population of oldest old, have a significantly lower FI that is more typical of individuals aged about 65. The low FI of these healthy oldest old is consistent with their health and high physical and cognitive function, and underscores their suitability for study as a healthy aged group. Further research will investigate how the FI of Super-Seniors is related to lifestyle and genetic factors and health outcomes.
FORMAL AND DAILY CARE DECISION-MAKING INVOLVEMENT IN AFRICAN-AMERICAN DEMENTIA DYADS
Authors: Bonds Kalisha , Song MinKyoung , Lyons Karen , Driessnack Martha
Published: November 2019

Decision-making involvement (e.g., verbal and/or nonverbal communication) of persons with dementia (PWD) has been associated with quality of life of PWDs and their caregivers, underscores personhood, and reduces ethical dilemmas for caregivers regarding the PWD’s care. Yet, no study has explored the decision-making involvement in formal and daily care of both members of African-American dementia dyads (i.e., African-American PWDs and their African-American caregivers), limiting our understanding of how these dyads navigate decision-making during the dementia trajectory. This study took a closer look through in-depth, semi-structured interviews with African-American dementia dyads as they reflected on their decision-making surrounding formal and daily care. A pilot study of five dyadic interviews, each averaging 45 minutes, was completed. We used a combination of quantitative content analysis, decision-making matrices and I-poems created from I-statements of the dyad regarding their decision-making involvement. Decision-making matrices (i.e., diagrams of the degree of sharing, the balance of power within the dyad, and the final decision maker in formal and daily care) were constructed across interviews. The pairing of traditional analyses with the novel use of I-poems traces participants’ sense of self, ensuring their voice is retained. There was agreement within all five dyads regarding the final decision maker(s) in formal and daily care. Between dyads, daily decision-making involvement was led by African American PWDs; whereas, formal care decision-making involvement of African American PWDs varied. Findings highlight the importance of a deeper understanding of formal and daily care decision-making involvement within and between African-American dementia dyads and potential clinical implications.
INFLAMMATORY DIET PATTERN AND COGNITIVE FUNCTION IN 5 EUROPEAN COUNTRIES OVER 3-YEARS FOLLOW-UP
Authors: Chocano-Bedoya Patricia O , Vellas Bruno , Kressig Reto W , Orav Endel J , Willett Walter , Bischoff-Ferrari Heike A
Published: November 2019

Diet patterns associated with low chronic inflammation may modulate cognitive decline. We investigated an empirical dietary pattern (EDP) associated with inflammation in five European countries and its association with cognitive changes over 3-years. This prospective study included 2157 community dwelling-seniors 70 years and older, followed for 3 years as part of DO-HEALTH, a randomized clinical trial. At baseline, participants completed a food frequency questionnaire and C-Reactive Protein (CRP) and interleukin-6 (IL-6) was measured. We used the Montreal Cognitive Assessment (MoCA) every year of the study. Based on reduced rank regression, we estimated a dietary pattern associated with CRP and IL-6. To evaluate the association between the EDP and cognitive changes over time, we used repeated measure linear regression models adjusting for age, total calories, BMI, study center, time, alcohol intake, education, physical activity, presence of depression symptoms, hypertension, diabetes or heart disease. The EDP was characterized by higher intakes of red and organ meat, refined grains, legumes, poultry and white fish, and lower intakes of coffee, tea, ginger, nuts and cheese. In multivariate adjusted models, participants with lowest adherence to the EDP (range -7.3 to -0.3) increased their MoCA scores 0.7 points over three years whereas those with highest adherence (range 0.4-10.1) increased their MoCA scores only by 0.2 points (p=0.01). In conclusion, a low inflammatory diet was associated with better cognitive function over time among adults ≥70 years from five European countries. This finding supports the role of diet in the promotion of cognitive health among older adults.
BEING WOMEN AND BEING DEMENTIA CAREGIVERS: SELF-CONCEPTS IN THE MAKING OF VIETNAMESE FEMALE CAREGIVERS
Authors: Nguyen Trang T
Published: November 2019

In Vietnam, the majority of dementia caregivers are women. They play multiple social roles, and confront role conflicts and caregiving burdens with insufficient social supports. Dementia caregiving alters their self-concepts, or who they think they are. This paper aims to explore self-concepts of Vietnamese female caregivers of older relatives with Alzheimer’s Disease (AD). In total, 21 face-to-face, semi-structured interviews, including six follow-up interviews, with 13 Vietnamese female caregivers of older patients with AD were conducted. These 13 caregivers were from 44 to 71 years old, mostly spouses of the patients with AD (n = 8), and retired (n = 9). Thematic coding procedure and the program MaxQDA12 were used for data analysis. Results show that the self-concepts of female caregivers in dementia care were complex, contextualized, and manifested in different aspects. First, self-concepts of these female caregivers were the outcome of the interactions between the guided-self and the performed-self. Their guided-self was the self that their social norms and cultural traditions told them about who they should be, while their performed-self was the self they demonstrated to the outside world. The mismatch between these two types of self caused distress among caregivers. Second, caregivers’ self-concept was the combination of the three key types of the self: the moral-self (a filial daughter or a responsible wife); the feminine-self (a patient and graceful women); and the worthy-self (a devoted and helpful caregiver). Understanding Vietnamese women’s self-concepts associated with their sociocultural context will better inform the development of support programs for them.
EVERYDAY MEMORY IN OLDER AND YOUNGER ADULTS: OUTSOURCING, SOCIALLY-DISTRIBUTED REMEMBERING & CONCEPTUALIZATION
Authors: Lustig Emily , Hertzog Christopher , Pearman Ann , Reynolds Kirsten , Waris Aiman
Published: November 2019

Qualitative interview data about everyday remembering within the context of older adults ages 62-83, (N= 27, M=69.5, SD=5.72) and younger adults ages 18-24 (N=29, M=21.2, SD= 1.77) lives were collected and analyzed using constructivist grounded theory methods. This study sought to compare the processes used by these individuals in their pursuit of everyday memory-demanding goals and their conceptualization of these methods. Older adults typically reported importance beliefs that guided memory-supportive behaviors for things like social engagements or medical appointments, whereas younger adults reported important information as being primarily school-related. There were major differences in the execution and conceptualization for remembering critical information. Younger adults engaged in a form of socially-distributed cognition, wherein they relied on and outsourced remembering to technology and other people via apps. Interestingly, younger adults relied on others to remind them about coursework, extra-curricular activities, and social obligations via social communication platforms (e.g. GroupMe), text messages, and shared calendar alerts. Very few of the younger adults sampled were responsible for reminding others, but relied on the social altruism of their peers who were responsible for disseminating mass reminders. Conversely, technological outsourcing was not as prevalent in the older adults interviewed and only a few shared that they received similar reminders via text or email. Of the few cases that did outsource, a small subset did, however, engage in these processes within small groups or pairs, wherein a friend or significant other reminded them about social gatherings or names but in a much smaller proportion, comparatively.
IMPACT OF SOCIAL SUPPORT AND STRAIN ON DEPRESSIVE SYMPTOMS: MARITAL STATUS AND GENDER DIFFERENCES
Authors: Carr Deborah , Lee Yeonjung Jane
Published: November 2019

Social relationships are a well-established correlate of late-life well-being. Extensive research finds social support is associated with fewer depressive symptoms, yet few studies distinguish fine-grained types of support from spouse, children, other family and friends, nor whether these linkages differ by gender and marital status. Studies exploring coarse associations between support and well-being may conceal gender and marital status differences. We use data from two waves of the Health and Retirement Study (HRS; 2006 and 2010) to study fine-grained linkages between diverse types of relationship strain and support and depressive symptoms (CESD) among adults aged 51+. The results show that the association between support/strain and depressive symptoms varies based on the source of support. For instance, among married/partnered older adults, spousal support is negatively associated with depressive symptoms whereas friend strain is positively associated with depressive symptoms. Among widowed respondents, friend support is negatively associated with depressive symptoms. These marital status patterns differed by gender however, such that the impact of friend strain on depressive symptoms was especially large for divorced men. Our results suggest that no single form of social support (or strain) is uniformly protective (or distressing), so services and interventions to enhance late-life mental health should more fully consider older adults’ social location, including gender and marital status. For current cohorts of older adults, who have lower rates of marriage and childbearing than their predecessors, it is critically important to understand both the levels and impacts of alternative sources of support from other kin and friends.
EXPLORING VIDEO CHAT FOR SOCIAL ENGAGEMENT IN OLDER ADULTS WITH AND WITHOUT COGNITIVE IMPAIRMENT
Authors: Nguyen Lydia T , Nie Qiong , Lydon Elizabeth , Myers Dillon , Gibson Alan , Kerssens Chantal , Mudar Raksha A , Rogers Wendy A
Published: November 2019

Social engagement technologies have the potential to benefit health and quality of life in older adults with and without mild cognitive impairment (MCI). However, technologies are rarely designed to accommodate the interests, capabilities, and limitations of these populations. In the current study, we focused on examining the potential of video chat to socially engage older adults with and without MCI by providing opportunities to link people with shared interests. Eight cognitively normal older adults (Mage: 73.3 years) and five with MCI (Mage: 70.0 years) completed a four-week experiential field trial using a novel online video chat platform called OneClick. System Usability Scale scores at both pre- and post-assessment revealed that OneClick was easy to use for older adults with and without MCI, however individuals with MCI experienced more technical issues and required additional assistance to use the system. Pre- to post- comparisons of questionnaire data revealed positive changes for the Quality of Life, Friendship/Social Isolation, and Loneliness scales in both groups. Of the 13 participants, five cognitively normal and four individuals with MCI reported that they would be interested in continuing to use the video chat system at home to connect with family and friends or to discuss topics of mutual interests. Overall, all participants enjoyed using the video chat system as a means for social engagement and showed trends for social health and quality of life benefits. This field trial illustrates the potential for video chat to provide social engagement opportunities for older adults with and without cognitive impairment.
CONTEMPORARY CORE JOB FUNCTIONS OF NURSING HOME SOCIAL SERVICES DEPARTMENT IN THE UNITED STATES
Authors: Lemke Amy L , Bern-Klug Mercedes
Published: November 2019

Nursing home social services departments (NH SS-Ds) are involved in a myriad of duties i.e., from care manager, patient advocate to counselor. But it is unclear how much variation there is across departments. Begging the question, what are the most common core functions of NH SS-Ds in the United States? A nationally representative cross-sectional sample of 922 NH SS-Ds completed a survey on-line or via mail. They were asked to indicate the extent their department was involved in 46 job functions. The listing of functions was inspired by the literature and pilot tested. The most common core functions would include those whereby at least 2/3s of the respondents would report “always/usually” being involved. 32 of the 46 functions were rated as “always/usually” and therefore qualified as the most common core functions. The five most common were discussing with staff the discharges of long-term as well as short-stay residents; arranging services for residents returning to the community; creating care plans; and mediating issues between residents. There were only two items whereby less than 10% of departments were “always/usually” involved – working with volunteers and helping feed residents. This survey tool successfully represented core SS-D functions as remarkable similarity across SS-Ds in the US existed. Responsibilities associated with care planning and care transitions were heavily featured, thus reflecting recent federal guidelines changes. The study’s results are pertinent to researchers, educators as well as nursing home administrators for role clarification and identification of training domains.
SELF-ACCEPTANCE BUFFERS NEGATIVE SOLITUDE-PHYSICAL ACTIVITY LINKS IN OLD AGE
Authors: Mielcarski Jody , Graf Peter , Ashe Maureen C , Hoppmann Christiane A
Published: November 2019

Loneliness is positively associated with a number of negative psychological and health outcomes. Solitude, a related yet distinct phenomenon, can have positive or negative ramifications depending on the context. As older adults spend significant time in solitude, there is particular need to investigate the effects of solitude on the health of this specific segment of the population. This study investigated everyday life associations between solitude and obstacles to physical activity as well as resources for overcoming these obstacles in order to determine whether and for whom solitude is negatively or positively associated with physical activity. Multilevel modelling was used to analyze data from 138 community-dwelling adults aged 65 years and older. Participants completed three daily questionnaires over a period of ten days concerning social context, activities and obstacles, as well as managing obstacles. Preliminary analyses using a subset of participants with complete data (N = 93) indicate that participants reported more physical activity obstacles when they were in solitude. This only applied to participants low in self-acceptance. Furthermore, self-acceptance was also positively associated with the extent to which individuals who had experienced an obstacle (N = 71) managed to overcome it. Further analyses will examine accelerometry-based movement information as well as the role of additional resources (e.g. living with others) and vulnerability factors (loneliness, anxiety).
DO THE PRESENCE OF ADULT CHILDREN AND THEIR MARITAL STATUS MATTER FOR ACCESS TO THE PUBLIC LONG-TERM CARE SYSTEM?
Authors: Wakui Tomoko , Okubo Suguru , Tamiya Nanako , Watanabe Taeko , Ishizaki Tatsuro , Kai Ichiro
Published: November 2019

Knowing how the presence of family affects access to the public long-term care system is important for evaluating the adequacy of the system. This study examined the relationship between the presence of adult children and their marital status, and access to a public system by examining the gap between self-reported care needs and the official certification as needing care under the Japanese public long-term care insurance system. Data from Japan’s 2016 Comprehensive Survey of Living Conditions were used. A total of 23,466 older adult claimants, aged 65 years and older were analyzed. Outcomes were whether or not claimants were officially certified as needing care under the system, and the relationship of the presence of both live-in and live-out children and their marital status were examined controlling for claimants’ age, gender, education, financial status, and physical and cognitive conditions. Females comprised 64.8% of the sample, and the average age was 83 years (SD=7.8). The percentage of claimants living with a single or married child were 25.2% and 26.9%, respectively, and 60.1% were parents of children who lived independently. The percentage who were officially certified as needing care was 68.5%. Logistic regression analysis revealed that claimants with a live-in child were less likely to be officially certified as needing care, and claimants with live-in a single child were less likely to be officially certified compared with those with a married child. Live-in single children may provide long-term care by themselves, and the excess burden on them needs to be further investigated.
INCREASING VULNERABILITY AMONG OLDER AMERICANS ACT HOME-DELIVERED NUTRITION SERVICE CLIENTS
Authors: Robinson Kristen N , Menne Heather L
Published: November 2019

Older Americans Act (OAA) programs are designed to help frail and vulnerable older adults remain in their homes through the provision of long-term services and supports. Administrative data from the Administration for Community Living (ACL) show that older adults receiving OAA services are three times more likely to live below the poverty level (33.0%) as compared with all older adults (9.2%). In addition, they are almost twice as likely to be living alone (45%) as compared with the general population (28%). Using data from the recently released 2018 National Survey of Older Americans Act Participants, we examine the largest program administered by ACL, the OAA Nutrition Program, to see if the economic vulnerability of home-delivered nutrition service clients has changed over the past 10 years. Results from this study show that recipients of home-delivered nutrition services are more in need of low-cost or free meals in 2018 than they were in 2008 due to a 24% increase in Medicaid eligibility, 41% increase in those who report not having enough money or food stamps to buy food, and 101% increase in those who report receiving food stamps. This increase in economic need may be due to a demographic shift in the marital status and living arrangements of older adults, specifically the 75-84 age group. The increase in the percentage of older adults who are divorced, live alone, and have low income has made the home-delivered nutrition services program even more important today than it was a decade ago.
EVERYDAY ETHICS AND THE UNSEEN MORAL LANDSCAPE OF ASSISTED LIVING
Authors: Kemp Candace L , Lesandrini Jason , Webb Clifvette , Burgess Elisabeth O , Morgan Jennifer C
Published: November 2019

Assisted living (AL) communities are increasingly popular long-term care settings where people live, work and visit, and where social relationships and care, including end-of-life care, are negotiated. In the context of daily life, residents, their family members and friends, AL care workers and other staff, external care providers, and volunteers, continually encounter one another and make choices about a range of matters. AL is fraught with uncertainty and conflict about values, especially given residents’ cognitive and physical frailty. These value-laden issues have important implications for both resident and care partners’ quality of life. Yet, almost no research has examined ethics in this dynamic and complex care environment. We seek to address this important knowledge gap by examining AL through an ethical lens. Drawing on our research and practice experiences, we present a conceptual model that situates everyday ethics within multiple multi-levels of moral decision-making factors and systems involving individuals, the care setting and surrounding community, social norms, and the broader regulatory context. We provide an overview of AL’s moral landscape and present examples of three everyday ethical issues. We first examine informed consent as it pertains to sexual encounters involving residents with dementia. Next, we consider boundary and role issues inherent in care process and relationships. Finally, we discuss resident privacy as an area for value uncertainty in everyday life within AL. We conclude by emphasizing the need for in-depth and systematic identification of ethical issues in AL and development of management strategies for applied practice.