bluuebunny/crossref_metadata_2025 huggingface dataset:
An optically accessible secondary combustion zone for the transverse injection of reacting jets into a high-speed, vitiated crossflow within a staged, gas turbine model combustor
Authors: Rodrigues N S , McDonald C T , Busari O O , Satija A , North A J , Laster W R , Meyer S E , Lucht R P
Published: December 2020

Advanced gas turbine combustion strategies, such as axially staging the fuel, are of great interest due to their potential to increase cycle efficiency while maintaining low levels of pollutants. In our previous work within a staged gas turbine model combustor, we used exhaust gas emissions measurements to demonstrate a significant NOX reduction by increasing the combustor exit Mach number, even at a constant residence time. In this paper, the development of an optically accessible secondary combustion zone (SCZ) to further study the injection of a reacting jet into a high-speed vitiated crossflow is described. Measurements were targeted for a nominally 1700 K vitiated crossflow, a premixed jet at an unburnt temperature of nominally 500 K, and a combustor pressure of 500 kPa. Key aspects of this design challenge include the high-speed and high temperature crossflow leading to relatively high convective heat flux at the inner surface of the windows and the necessary use of a narrow channel for the combustion gas. Emphasis is placed on the critical design features: a double-windowed design, an air-cooling scheme based on forced convection of air between the inner and outer windows, and intricate water-cooling circuits for the metal hardware. These design features have enabled long-duration, steady-state operation despite elevated pressure, high combustion gas temperatures, and high-speed reacting flows. The SCZ has survived operation at MW thermal powers over several hours of continuous operation and over a dozen test days to date; a set of windows retained good transparency without discoloration for typically 3–4 test days. Survivability of the windows through the air-cooling design has enabled us to study the reacting jet-in-crossflow at the desired high-speed conditions, without risking disturbing the physics with a window film-cooling flow. The capability to acquire useful measurements is illustrated using chemiluminescence imaging, pressure measurements, and emissions sampling.
Angiotensin II and Amyloid-β Synergistically Induce Brain Vascular Smooth Muscle Cell Senescence
Authors: Bai Hui-Yu , Min Li-Juan , Shan Bao-Shuai , Iwanami Jun , Kan-no Harumi , Kanagawa Motoi , Mogi Masaki , Horiuchi Masatsugu
Published: December 2020

BACKGROUND

Amyloid-β (Aβ) induces cerebrovascular damage and is reported to stimulate endothelial cell senescence. We previously demonstrated that angiotensin II (Ang II)-promoted vascular senescence. We examined the possible cross-talk between Ang II and Aβ in regulating brain vascular smooth muscle cell (BVSMC) senescence.

METHODS

BVSMCs were prepared from adult male mice and stimulated with Ang II (0, 0.1, 1, 10, and 100 nmol/l) and/or Aβ 1–40 (0, 0.1, 0.3, 0.5, 1, 3, and 5 µmol/l) for the indicated times. Cellular senescence was evaluated by senescence-associated β-galactosidase staining.

RESULTS

Treatment with Ang II (100 nmol/l) or Aβ (1 µmol/l) at a higher dose increased senescent cells compared with control at 6 days. Treatment with Ang II (10 nmol/l) or Aβ (0.5 µmol/l) at a lower dose had no effect on senescence whereas a combined treatment with lower doses of Ang II and Aβ significantly enhanced senescent cells. This senescence enhanced by lower dose combination was markedly blocked by valsartan (Ang II type 1 receptor inhibitor) or TAK-242 (Aβ receptor TLR4 inhibitor) treatment. Moreover, lower dose combination caused increases in superoxide anion levels and p-ERK expression for 2 days, NF-κB activity, p-IκB, p-IKKα/β, p16 and p53 expression for 4 days, and an obvious decrease in pRb expression. These changes by lower dose combination, except in p-IκB expression and NF-κB activity, were significantly inhibited by pretreatment with U0126 (ERK inhibitor).

CONCLUSIONS

Ang II and Aβ synergistically promoted BVSMC senescence at least due to enhancement of the p-ERK–p16–pRb signaling pathway, oxidative stress, and NF-κB/IκB activity.
Completing the Picture—Capturing the Resistome in Antibiotic Clinical Trials
Authors: Stewart Adam G , Satlin Michael J , Schlebusch Sanmarié , Isler Burcu , Forde Brian M , Paterson David L , Harris Patrick N A
Published: December 2020

Despite the accepted dogma that antibiotic use is the largest contributor to antimicrobial resistance (AMR) and human microbiome disruption, our knowledge of specific antibiotic-microbiome effects remains basic. Detection of associations between new or old antimicrobials and specific AMR burden is patchy and heterogeneous. Various microbiome analysis tools are available to determine antibiotic effects on microbial communities in vivo. Microbiome analysis of treatment groups in antibiotic clinical trials, powered to measure clinically meaningful endpoints would greatly assist the antibiotic development pipeline and clinician antibiotic decision making.
Decrease in Enteroviral Meningitis: An Unexpected Benefit of Coronavirus Disease 2019 (COVID-19) Mitigation?
Authors: Kies Kami D , Thomas Amber S , Binnicker Matthew J , Bashynski Kelli L , Patel Robin
Published: December 2020

Enteroviral meningitis is seasonal, typically exhibiting a rise in prevalence in late summer/early fall. Based on clinical microbiology laboratory testing data of cerebrospinal fluid, the expected August/September/October peak in enteroviral meningitis did not occur in 2020, possibly related to coronavirus disease 2019 (COVID-19) mitigation strategies.
Age-Friendly University Campus Inventory
Authors: Claver Maria , Weathersby Adriana , Wilkinson Alexandra , Smith Nicole
Published: December 2020

An increasing number of older adults are turning to educational institutions to provide career training, intellectual stimulation and social interaction. Response to the educational needs and interests of this emerging population calls for new opportunities and innovative practices of teaching, research, and community engagement that colleges and universities are poised to offer. In Summer 2018, CSULB became the third university in California to be designated an Age-Friendly University. This study aimed to identify strengths and opportunities for growth at CSULB as related to each of the 10 Age-Friendly University principles. This study is part of a larger, national study conducted by researchers from UMass, Boston. Interviewees were asked to indicate on the Campus Inventory survey tool the activities and programs offered by the university. Data were collected from CSULB administrators through email after a phone introduction and entered into an Excel document for analysis using qualitative methods. Results provided a clear overview of the types of activities and programs available to older adult students and guided the identification of gaps in services, from the perspective of administrators on campus. The results of this CSULB survey will be compared with results from several AFU campuses across the United States. Additionally, results will be compared with a future Campus Climate survey, which will assess the age-friendliness of CSULB from the perspectives of faculty, students and community members.
A Pilot Study on the Effect of a Self-Training Program on Asian American Caregivers
Authors: Li Tongtong , Jiang Yufu , Chi Iris
Published: December 2020

This presentation reports an exploratory study evaluating the effect of Asian Care Training (ACT) Manual on Asian American (AA) caregivers’ care capacity and knowledge growth. A total of 65 AA caregivers were recruited from community-based organizations in Los Angeles and passed the screening questionnaire, in which 44 (37 females and 7 males with an average age of 61) completed the evaluation process. Participants were given autonomy to choose topics they desired to learn out of 25 topics in ACT manual and completed one-month learning. The data were collected via structured questionnaires before and after the self-learning and were analyzed with paired t-test on 5 questions about care capacity and 4 about caregiving knowledge. One-month self-learning of ACT manual enhanced participants’ care capacity in 4 out of 5 sectors: confidence in caregiving (t=-2.2, p=0.015); ability to deal with emergency (t=-1.88, p=0.032); to solve concerns of the care recipients (t=-4.54, p<0.001); to communicate more smoothly (t=-2.85, p=0.0028). Improvements were found in 3 out of 4 sectors in knowledge: knowledge of Alzheimer’s disease (t=-4.43, p<0.001); appropriated approach to displacing care recipients (t=-5.03, p<0.001); and information about caregiver support resources (t=-7.25, p<0.001). This self-learning method of ACT manual was feasible for AA caregivers to broaden knowledge and care capacity while adapting with their intensive workload. This study constitutes an important step towards establishing culturally tailored self-training programs for Asian American caregivers for frail older adults via multiple platforms such as online curriculums and mHealth app.
Caregiver-Centered Care Health Workforce Competencies: Developing Consistent Support for Family Caregivers
Authors: Parmar Jasneet , Anderson Sharon , Poole Lisa , Duggleby Wendy , Holyroyd-Leduc Jayna , Brémault-Phillips Suzette , Cheryl Pollard , Haq Anwar
Published: December 2020

Family caregivers [FCGs] are the backbone of the health system. They provide over 80% of the care for people with dementia, chronic illnesses and impairments. Despite evidence of their contributions and consequences of caregiving, support for FCGs has not been a health system priority. Education to prepare health providers to effectively identify, engage, assess, and support FCGs throughout the care trajectory is an innovative approach in addressing inconsistent system of supports for FCGs. We report on development and validation of the Caregiver-Centered Care Competency Framework to help with curricular design and subsequent evaluation of effectiveness of care providers working within healthcare settings to engage and support FCGs. We used a three round modified Delphi approach. An expert panel of 42 international, national, and provincial stakeholders agreed to participate. In the first 2 rounds, multi-level, interdisciplinary participants, rated the indicators in terms of importance and relevance. In the 3rd round consensus meeting, participants validated the six competency domains, including indicators in small group sessions. Thirty-four experts (81%) participated in the round 1, 36 (85.7%) in round 2, and 42 people (100%) in round 3. There was stable consensus across all three rounds, 96.07% of participants rated the indicators as essential or important (Round 1, 95.81%; Round 2, 94.15; Round 3, 98.23%). FCG research has been primarily focussed on educating FCGs to provide care. These competencies will shape the design of educational curricula and interdisciplinary training programs aimed at supporting the health and social care workforce to provide caregiver-centered care.
Overcoming Ethical Challenges in Conducting Research Among Persons With Dementia
Authors: Cho Jeanine Yonashiro , Avent Elizabeth , Peterson Roberta , Mosqueda Laura , Gassoumis Zachary
Published: December 2020

By 2060, the number of older adults with Alzhemier’s Disease or related dementias (ADRD) is expected to encompass approximately 13.9 million Americans. Recognizing this, the federal government has prioritized research on ADRD and their effect on the physical, emotional, and psychological well-being of persons with dementia (PWD). Such research is complicated by disease-associated decline in cognitive and functional capacity among PWDs which can impair participant ability to process and communicate information, potentially increasing their exposure to negative research-related experiences and compromising the accuracy and reliability of provided data. Nevertheless, as a key stakeholder group, PWD should have the right to participate in research on ADRD. This session will present a case study of ethical issues that emerged in an NIH-funded study utilizing mixed-methods to examine caregiving and care dyad relationships between PWD and their care partners over an 18-month follow-up period. Ethical issues examined will include: (1) PWD capacity to consent to research at baseline and (2) during follow-up visits, (3) Obtaining accurate and reliable data from persons with mild to moderate dementia, (4) Assessing PWD distress while engaging in data collection processes, and (5) Reporting of negative caregiving and life experiences, such as elder mistreatment. The discussion of these topics and presentation of lessons learned holds promise for improving research methodology in studies involving PWD and enabling researchers to increase the involvement of persons with mild to moderate dementia in research on ADRD.
Prosecution of Elder Neglect: A Close Examination of Cases From King County, Washington
Authors: Gogia Kriti , Elman Alyssa , Clark Sunday , Ulrey Page , Connolly Marie-Therese , Bloemen Elizabeth , Johnsson Billie , Rosen Tony
Published: December 2020

Elder neglect is common and can have catastrophic consequences. Cases may benefit from integrated responses from multiple sectors. Little research exists describing prosecutorial involvement and its impact, but existing evidence suggests neglect is seldom criminally prosecuted. Our goal was to closely examine neglect prosecution in a jurisdiction that has been a leader in using prosecution to attempt to address it. We quantitatively and qualitatively analyzed legal case files of felony elder neglect prosecuted in King County, Washington from 2008-2011. 13 cases were prosecuted, with a total of 10 victims. 90% of victims were female, with a median age of 88. 90% were unable to ambulate, and 90% had dementia. Defendants were commonly the victim’s adult child (38%). 23% had previous criminal citations/convictions. 46% of cases occurred in an Adult Family Home. 15% of cases went to trial, and all trial cases ended in conviction of some charge. Themes identified included: (1) perpetrators were either professional caregivers receiving compensation or non-professional caregivers financially dependent on the victim, (2) victims were malnourished and severely injured at time of reporting, and (3) medical expert contribution is imperative given complexity of these cases. Victims were unable to participate in prosecution in any case. This research shows that these cases are seldom prosecuted, even in a jurisdiction focusing on this phenomenon, but highlights characteristics of cases and demonstrates they may be prosecuted without victim participation. Future research is needed to examine prosecution’s impact on elder neglect to better understand how it may be optimally used.
Regional Variation in Healthcare Use Among Medicare Beneficiaries With Alzheimer’s Disease and Related Dementias
Authors: White Elizabeth , Rahman Momotazur
Published: December 2020

In this national prospective study we describe regional variation in healthcare utilization among Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) in the six years after diagnosis. We use 2008-2015 Medicare claims and other administrative data to map nursing home, home health, hospital, and hospice use across hospital referral regions; and examine the relationship of state and county supply-side factors to time beneficiaries spend in different settings. The sample includes 1,158,655 Medicare fee-for-service beneficiaries diagnosed with ADRD in 2008 and 2009. Nationally, beneficiaries spent a mean of 70.6% of survived days in the community, 23.9% of days in nursing home, and 5.4% of days in hospital. 37.2% of beneficiaries who died within six years had received hospice. Distinct regional patterns emerged. Adjusting for beneficiary and local characteristics, beneficiaries in Midwestern states spent the most time in nursing homes, while beneficiaries in Western states spent the most time in community. The probability of receiving hospice was generally highest in Western and Southern states, and lowest in the Midwest and Northeast. Controlling for beneficiary, local, and state characteristics, we found the following factors to be associated with beneficiaries spending less time in nursing homes: fewer nursing home beds in the county, higher state Medicaid long-term care spending for home and community-based services (HCBS), and state use of Certificate of Need laws. These findings illustrate that state investment in HCBS, and state and local regulation of provider supply are important factors influencing where individuals with ADRD receive care.
An Evaluation of the Dementia Friends USA Program in Nevada: Changes in Knowledge and Behavioral Intent
Authors: Carson Jennifer , Reed Peter , Gibb Zebbedia
Published: December 2020

Dementia Friendly Nevada (DFNV) aims to develop and promote communities in becoming more respectful, educated, supportive and inclusive of people living with dementia and their care partners. To date, six communities are engaged, representing urban, rural and tribal communities. Each community convened an action group comprised of volunteers from a range of sectors, including people living with dementia as key participants. Each group used a participatory action research process to assess community needs, develop specific goals and actions, and document community change. As part of this process, five of the six communities adopted the Dementia Friends program for community education and awareness raising. This program is licensed nationally by Dementia Friends USA. From June 2018 – September 2019, these communities achieved widespread dissemination of this program, training 68 Dementia Friends Champions (i.e., trainers), who in turn delivered 55 training sessions to 607 new Dementia Friends (i.e., completers) across Nevada. To evaluate the impact of the program, DFNV partnered with the Sanford Center for Aging to conduct a pre-post survey (n = 504) to assess program-related knowledge change as well as commitments to take action. Results showed a statistically-significant (p <.001) increase in participant knowledge, with 17% higher scores at the post-assessment. In addition, given 10 options for specific actions, responses ranged from 12% of participants committing to “start a dementia friendly effort” to 70% committing to “support dementia friendly efforts.” Overall, the early impact of this ongoing effort to educate the public about dementia across Nevada has been very successful.
Children’s Education and Parents’ Cognitive Aging: Evidence From the Compulsory Schooling Law in China
Authors: Lin Zhuoer , Chen Xi
Published: December 2020

This paper investigates the effect of promoting children’s education on level and trajectory of parents’ cognition. Using three waves of China Health and Retirement Longitudinal Study (2011, 2013, 2015), we decompose the longitudinal measures of parents’ cognition into baseline level of cognitive deficit and rate of cognitive decline through a standard linear mix-effect model (aged 45-100, N=9,736). Exploiting the temporal and geographic variations in the Chinese compulsory schooling law enforcement, we identify the causal effects of children’s education on parents’ baseline level of cognitive deficit and rate of cognitive decline using instrumental variable (IV/2SLS) approach. Our estimates suggest that children’s education not only reduces parents’ level of cognitive deficit (0.17 SD/year less), but also decreases their rate of cognitive decline (0.08 SD/year less). These novel evidence offers new insights into the intergenerational effects of children’s education on parents’ cognition, stresses the importance of lifting literacy in improving accuracy of cognitive diagnosing, and provides another policy option to delay cognitive aging and related diseases.
Does Length of Time Caregiving Affect Net Worth? Caregivers Approaching Retirement Age
Authors: Porterfield Shirley , Quinn Linda , Dare Patricia Stoddard , DeRigne LeaAnne , Tedor Miyuki Fukushima , Collins Cyleste
Published: December 2020

Using a nationally representative sample of N=3,659 adults (mean age 55.6 in 2016) from the 2008, 2012, and 2016 rounds of the National Longitudinal Survey of Youth 1979, we examine the impact of work-limiting health conditions, caregiving, and the length of time spent in a caregiving role inside and outside the home on total family net worth. Repeated measures analysis finds having a chronically ill or disabled household member (CIOD), or caring for a household member with a CIOD inside the home was associated with reduced total family net worth (TFNW; -$146.7, p<0.002), on average, across the three time periods. In-home caregiving across time periods does not have an additive effect, but rather appears to result in a one-time drop in TFNW. Respondents who provide care for out-of-home family or friends report higher TFNW on average over time ($73.3K, p<0.001). Respondents with a work-limiting health condition report a lower mean TFNW over this time span (-$53.1K, p<0.005). Caregiving inside the home has 2-3 times the impact on TFNW as having a work-limiting health condition, though in the overall model, the effect of the two variables together on TFNW is additive. An adult is at the greatest disadvantage with respect to financial preparedness for retirement if they are both a caregiver (or have a CIOD in their household) and have a work-limiting health condition than if they have only one of these characteristics or have neither characteristic. Even a single time period of caregiving reduces total family net worth over time.
Technology Implementation in Persons With Dementia: A Systematic Review and Meta-Analysis
Authors: Hubner Sarah , Boron Julie Blaskewicz , Nguyen Brenda
Published: December 2020

Maintaining independence and quality of life (QOL) is a primary goal for adults. To support this goal, assistive and interactive technology (AIT) has been implemented to improve function and mitigate disease. To assess AIT effect on QOL in community-dwelling persons with dementia and mild cognitive impairment (MCI), a systematic review was performed, and articles were prepared for meta-analysis. Electronic database searches were carried out in PubMed, Cumulative Index for Nursing and Allied Health Literature, PsychINFO, and Web of Knowledge/Web of Science. Peer-reviewed journal articles published in English between January 2010 and February 2020 were included in the search. Studies investigated personal AIT use aimed at improving QOL (i.e. satisfaction/mood, functional ability, psychological/social function, independence). Technology was implemented in the home in everyday life. Studies were limited to those including community-dwelling participants aged 65+ with a diagnosis or report of MCI or dementia. Initial search resulted in 2624 total titles. After duplicate deletion, 1546 unique articles were identified. After title and abstract deletion, 60 articles were screened at full-text. After full-text screening, five usable articles remained. Usable studies presented: 1) a digital tablet companion, 2) a digital reminder calendar, 3) a medication-adherence bottle, 4) an automatic medication dispenser, and 5) a comprehensive tele-care computer system. These studies provide outcome measures focused on functional improvement and/or subjective QOL, informing future research in AIT implementation. Additionally, the severe paucity of applicable studies indicates a need for increased primary research on intersections between dementia and technology in the home environment.
The Disparities in Accessing Online Health Information and Health Care Utilization Among Older Americans
Authors: Liu Darren , Yamashita Taka , Burston Betty , Keene Jennifer
Published: December 2020

Digital divide or unequal access to internet and other technology result in health disparities among older adults. This study examined possible disparities in accessing online health-related technology, and the associations between the online health-related technology use and health care utilization among older adults in the U.S. The data comprised a sample of 1,497 older adults aged 51 and older which were obtained from the 2014 Health and Retirement Study (HRS)’s supplemental module (Health behaviors). We used the survey-weighted negative binomial regression and binary logistic regression for the analyses. The results showed that older age, racial/ethnic minorities (e.g., Black and Hispanic vs. Whites & Other), being married, lower educational attainment, lower-income, being uninsured and reporting poorer health were associated with lower utilization of online health-management tools. In Addition, the use of online health-management tools was associated with 34% greater mean number of doctor visits (Incidence-Rate-Ratio = 1.34, S.E. = 0.10, p < 0.05) than non-use. However, the use of online health-management tools was not associated with hospitalization. Indeed, only health care needs - the self-rated health (Odds-Ratio = 0.58, S.E. = 0.18, p < 0.05) and the number of chronic conditions were associated hospitalizations (Odds-Ratio = 1.68, S.E. = 0.07, p < 0.05). More research is needed to clarify the purposes (e.g., prevention vs. treatment) and outcomes of health care service utilization within the context of health care technology use. Yet, it is important to proactively address digital divide as one of upstream strategies for reducing health and health care disparities.
The Influence of Organizational Climate on the Enrollment of People of Color Into Clinical Trials
Authors: Blinka Marcela , BrintzenhofeSzoc Karlynn , Zabora James
Published: December 2020

A significant need exists to improve enrollment of people-of-color (POC) in randomized clinical trials as the gold standard for evaluating new therapies so that health disparities can be reduced. Improving representation in clinical trials is expected to improve the applicability of clinical findings more broadly, especially for minority subgroups. This cross-sectional study assessed the perception of organizational climate (OC) among staff in five cancer research groups (CRGs) of a mid-Atlantic NCI-designated comprehensive cancer center. The Organizational Climate Measure (OCM), a measure of four OC models of the Competing Values Framework, was used. Enrollment data were obtained from the 2016 Cancer Research Management System data and 2017 enrollment rates. A statistically significant difference in mean scores was found in the Pressure to Produce Scale (F = 4.21, p < .05). One CRG’s staff reported lower pressure to meet targets than three other CRGs (p < .05) and trending towards significance for the fourth CRG (p < .08). This suggests that organizational priorities considering all patients as potential clinical trial participants increases accrual. A statistically significant negative relationship between the Outward Focus sub-scale and POC enrollment (r = -.228, p < .05) was also found, suggesting that an external organizational focus, alone, is insufficient to increase POC accrual. Implications for future research include 1) does the organizational priority of decreasing the pressure to produce influence accrual of POC? and 2) does an OC that is flexible and externally focused lead to a more effective means of accruing POC as clinical trial participants?
Immigrant Status Predicts Worse Subjective Memory Complaints
Authors: Franco Yujin , Jeong Yujin
Published: December 2020

The “Immigrant Health Paradox” suggests that immigrants experience better health and lower mortality than the U.S.-born population despite their lower average socioeconomic status. However, it is unclear whether this health advantage extends to all areas of cognitive functioning. This study investigates cognitive functioning and Subjective Memory Complaints (SMCs) as a function of immigrant status and identifies predictors of cognitive decline as well as SMCs among the immigrant population. Data were drawn from the 2010 wave of the Health and Retirement Study. The sample consisted of 9,812 older adults aged 65 and older (8,873 U.S.-born and 939 foreign-born). Logistic regression was used to examine whether immigrant status was associated with cognitive functioning and SMCs, controlling for socio-demographic (age, gender, education, and marital status), health conditions (diabetes, depression, hypertension, and stroke), and functional limitations. Being foreign-born was not a significant predictor of dementia (OR:1.18, 95% CI: 0.83-1.67). However, immigrants were 41% more likely to report SMCs compared to U.S.-born respondents (OR:1.41, 95% CI: 1.17-1.69). Among the immigrant population, immigrants with less than a high school education showed four- and two-times higher odds of having dementia and reporting SMCs than those with more than high school. It is necessary to provide dementia education and screening to immigrants, especially those with low education, as this may contribute to reducing disparities in cognitive functioning within the older population.
More Than Meets the Eye: Income and Racial Disparities in Vision Health of Older Adults
Authors: Iqbal Asif , Sarker Ananya
Published: December 2020

By the end of this decade, the USA is projected to experience an increase of more than 50% in the number of people with poorer vision health as the population grows older. Using data from the NHANES III (1988–1994) for 7,186 White, Black, and Hispanic adults of ages 50 to 90 (Mean=68.23, SD=10), this paper examines the racial/ethnic, and socioeconomic disparities in vision health in the older adult population. The focus of this paper is on Visual Impairment indicators: full/partial blindness and trouble seeing with glasses to demonstrate vision health disparities in these race/ethnic groups in terms of family income using logistic regression analysis. Controls include demographic characteristics like age, gender, marital status, region, education and behavioral features like alcohol consumption and smoking. We explore another component of vision health: days since last visit to healthcare provider to evaluate the inequalities in access to health care using OLS regression analysis. In Whites (OR=.85) and Blacks (OR=.63), people with less family income are more likely to experience blindness, however, there exists no significant variability in blindness in terms of family income among Hispanics. In Black (OR=.82) and Hispanics (OR=.85), people with less family income are more likely to have trouble seeing even with glasses, however, this relationship does not exist among Whites. Days since last visit can be explained by income for Whites (Beta=-92), not for Blacks and Hispanics. This compounded disparity puts a disproportionate economic burden on minority groups, but the current Medicare policy fails to address that.
The Role of Intergenerational Relationships: Applying the Family Stress Model to Grandfamilies
Authors: Scott Rachel , Nadorff Danielle , Yancura Loriena , Barnett Melissa
Published: December 2020

The Family Stress Model (FSM) of Economic Hardship (Conger, Rueter, & Conger, 2000) was developed to explain the impact of financial stress on families through links between economic difficulties, parental emotional distress, marital conflict, disrupted parenting behaviors, and child maladjustment. The FSM has been cross validated in samples of custodial grandparents (i.e., grandparents who provide substantial care for their grandchildren; Smith et al., 2017). The current study modified the FSM by replacing inter-parent relationship difficulties with inter-generational relationship problems between the custodial grandparents and their children to ultimately examine the adjustment of the grandchildren. This change to the model is supported by prior research conducted on intergenerational stress impacting the parenting and subsequent development of children in grandfamilies (Barnett, Mills-Koonce, Gustafsson, & Cox, 2012). Using a nationwide sample of 317 custodial grandparents aged 40 and older (M = 61 yr) the fit of the modified model was tested using AMOS 26. Latent variables in the model included Economic Pressure, Caregiver Distress, Disrupted Parenting, Intergenerational Relationship, and Child Adjustment. Moderate fit was achieved (χ2(308) = 574.88; CFI = .896; RMSEA = .052). All pathways were significant with the exception of Disrupted Parenting to Child Adjustment. These results indicate that intergenerational relationships are an important predictor of child adjustment, and an applicable substitute for inter-partner relationships when modeling family stress in custodial grandfamilies. Details and clinical implications will be discussed.
Job Strain and Late-Life Cognition: Findings From the Puerto Rican Elderly Health Conditions Study
Authors: Vigoureux Taylor , Nelson Monica , Andel Ross , Small Brent , Crowe Michael , Davila Ana Luisa , Drury Taylor
Published: December 2020

Chronic stress at work, represented by job strain, has been associated with adverse late-life cognitive outcomes in the United States and Western Europe. We examined the relationship between job strain and change in cognition in a less affluent, Hispanic sample of adults aged 60-100 from mainland Puerto Rico. Job strain indicators (i.e., job demands/job control/job strain) were quantified from (a) standardized occupation-based job strain scores from Karasek’s Job Content Questionnaire (JCQ; n=1102), and (b) O*Net variables forming factors of job demands and job control (n=1639). Occupation information, covariates, and cognition came from the Puerto Rican Elderly Health Conditions (PREHCO) Study conducted in 2002-2003, with cognition follow-up in 2006-2007. All analyses controlled for age, sex, baseline depressive symptoms, baseline financial problems, and childhood economic hardship. Across both operationalizations of job strain indicators, higher job control was associated with less decline in late-life cognition (JCQ: b=.18, p<.05; O*Net: b=.31, p<.001) until controlling for education (JCQ: b=.09, p=.248; O*Net: b=.12, p=.097). Job strain was associated with more decline in cognition (JCQ: b=-.75, p<.05; O*Net: b=-.87, p<.05) until controlling for education (JCQ: b=-.49, p=.098; O*Net: b=-.46, p=.262). For Karasek’s measure, the relationships were driven by more educated participants. Job control was related to less cognitive decline whereas strain related to more decline among older Puerto Ricans over four years, whether assessed with JCQ-based or O*Net-based scores. However, education emerged as more important for change in late-life cognition than job strain indicators overall, suggesting results that diverge from countries with higher average socioeconomic status.
Depression Screening and Rates of Mood Disorder Diagnosis and Suicide in Younger and Older Adults
Authors: Lutz Julie , Conner Kenneth , Hasselberg Michael , Fear Kathleen , Van Orden Kim
Published: December 2020

Rates of suicide are elevated among older adults in the U.S. and around the world, with the highest rates in older men (CDC, 2019; WHO, 2014). More than half of older adults who die by suicide were in contact with a primary care physician within the month prior to death, and almost one-third within the prior week (Luoma et al., 2002; Stene-Larsen & Reneflot, 2019), demonstrating the importance of better identification and treatment of mental health issues among older adults across healthcare systems. Depression, a well-established risk factor for suicide, goes under-diagnosed and under-treated, especially among older adults (Bryant, 2010). The University of Rochester Medical Center has led integration of patient-reported outcomes assessment via large-scale implementation of PROMIS measures across multiple departments. We compared results of PROMIS depression screening from 1/1/2015 to 8/31/2019 with mood disorder diagnoses within the year prior and year following screening. Twenty-six percent (39491/154669) of adults under age 65 and 23% (11694/51702) of those age 65 and older screened positive for mild, moderate, or severe depression. Whereas 29.0% of younger adults who screened positive received mood disorder diagnoses, 22.1% of older adults received a diagnosis (χ2(1)=214.69, p<.001). Suicide outcomes using National Death Index data will also be reported. Results confirm depression is underdiagnosed (and, by extension, likely undertreated) at all ages, but show a distinct disparity for older adults, which may put them at greater risk for negative outcomes such as suicide.
Effects of Pain and Depression on ADL Disability Over 6 Years of Follow-Up Among Older Adult Americans
Authors: Sodhi Jaspreet , Snih Soham Al
Published: December 2020

The objective of this study was to examine the effect of co-occurring pain and depression on ADL disability over 6-years of follow-up among older adult Americans. We studied 5,236 participants aged 65 years and older from the National Health and Aging Trends Study (2011-2017) The primary outcome was ADL disability defined as any limitation in ADLs (eating, bathing, transferring, dressing, moving inside, and out of bed). The independent predictors were self-reported pain and depression. Covariates included socio-demographics (age, gender, marital status, race/ethnicity and years of formal education), body mass index, and comorbidities. Participants were categorized into four groups according to pain and depression: no pain and no depression, pain only, depression only, and depression and pain. Generalized Estimation Equation model was used to estimate the odds of ADL disability as a function of pain and depression. All variables were analyzed as time-varying except for age, race/ethnicity, and education. The odds of ADL disability as a function of pain only and depression only was 1.62 (95% CI 1.38-1.91) and 2.13 (95% CI 1.54-2.95), respectively. The odds of ADL disability as a function of pain and depression were 3.92 (95% CI 3.13-4.92). Older age, being married, Hispanics, and comorbid conditions were also predictive factors of ADL disability over time. Female participants and those with higher levels of education were less likely to report ADL disability over time. The findings suggest that both pain and depression significantly increased the risk of ADL disability in this population over 6-years.
A Confluence of Policy Inequality: Health Disparities in Old Age Among American Indian and Alaska Native Populations
Authors: Giles Sadie
Published: December 2020

Racial health disparities in old age are well established, and new conceptualizations and methodologies continue to advance our understanding of health inequality across the life course. One group that is overlooked in many of these analyses, however, is the aging American Indian/Native Alaskan (AI/NA) population. While scholars have attended to the unique health inequities faced by the AI/NA population as a whole due to its discordant political history with the US government, little attention has been paid to unique patterns of disparity that might exist in old age. I propose to draw critical gerontology into the conversation in order to establish a framework through which we can uncover barriers to health, both from the political context of the AI/NA people as well as the political history of old age policy in the United States. Health disparities in old age are often described through a cumulative (dis)advantage framework that offers the benefit of appreciating that different groups enter old age with different resources and health statuses as a result of cumulative inequalities across the life course. Adding a framework of age relations, appreciating age as a system of inequality where people also gain or lose access to resources and status upon entering old age offers a path for understanding the intersection of race and old age. This paper will show how policy history for this group in particular as well as old age policy in the United States all create a unique and unequal circumstance for the aging AI/NA population.
A Screening and Referral Intervention for Food Insecurity Among Older Emergency Department Patients
Authors: Aylward Aileen , Platts-Mills Timothy , Wardlow Liane , Sullivan Conor , Anderson Jessa Engelberg , Morris Andrea , Shams Rayad
Published: December 2020

Food insecurity is prevalent among older adults, negatively impacts health, and may increase healthcare utilization. Risk factors include poverty, lack of transportation, and social isolation. Community-based services may mitigate food insecurity and other social risk factors. However, identifying those at risk and connecting them to services can be challenging. We implemented a screening and referral program in an Emergency Department (ED) to identify older adults facing food insecurity and connect them to a local Area Agency on Aging (AAA), which arranged and tracked delivery of community-based services. ED nursing assistants used the Hunger Vital Sign screener to assess food insecurity in patients aged 60 years and older. ED Care Managers (CMs) saw all who screened positive and made referrals to the AAA. The AAA conducted an intake assessment and arranged services. Patients were contacted three months after their ED visit to evaluate health, quality of life, and satisfaction with services. Of 423 patients screened over 7 months, 45 (11%) reported food insecurity. Of those, 25 were referred to the AAA. Patients were not referred to the AAA due to CM inability to make a referral (7), declining services (4), or other reasons (11). The AAA reached 21 patients and 9 received at least one service. Of those, 5 were reached for follow-up and reported satisfaction with services. The most frequently requested service was Meals on Wheels (10). Food insecurity is common among older ED patients. An ED-AAA partnership is feasible and connects older adults to beneficial services in their communities.
Risk Profiles of Older Rural Residents With Functional, Nutritional, and Social Needs
Authors: Weaver Raven
Published: December 2020

Community-based service organizations are well positioned to address social determinants of health by offering a range of services/supports to community residents. To identify health needs and service delivery gaps among a geographically and economically diverse eight-county region, a needs assessment was conducted to support community-based agencies efforts to better support aging residents. A random sample of adults responded to the survey, with 1,280 respondents aged 60+ (mean age=71); the majority of participants were White, female, retired, reported at least some college education, and lived with at least one person. Cluster analysis distinguished three groups of residents, informed by typical enrollment-type data and a social engagement index. A series of one-way ANCOVA and chi-square analyses were conducted to examine how low-, moderate-, and high-risk groups differed on social, nutritional, and functional health needs. High-risk respondents were significantly more likely to report needing social, nutritional, and functional health services, compared to moderate- and low-risk respondents. High-risk respondents were more likely to experience barriers to seeing a physician (X2=34.054, p<.001), a non-emergency ED visit (X2=22.799, p<.001), and an unplanned hospital visit (X2=14.484, p=.001) compared to members of either low- or moderate-risk groups. Ongoing efforts to identify high-risk residents and proactively target moderate-risk residents support low-cost community interventions (i.e., assessing residents for services in locations regularly attended, such as senior meal centers), rather than high-cost interventions (e.g., emergency care, hospitalizations) are essential. Findings inform community-based outreach approaches that target social, economic, and environmental factors essential in improving health and achieving health equity.
Daily Stressors and Physiological Reactivity: The Role of Perceived Stress, Stress Reactivity, Neuroticism, and Age
Authors: Hughes MacKenzie , Hertzog Christopher
Published: December 2020

Exposure to stressful events is an inevitable aspect of everyday life, such as encountering work deadlines or interpersonal conflicts. The body’s physiological stress systems can become activated when exposed to stressors, resulting in increases in cortisol from the hypothalamic-pituitary-adrenal axis and/or increases in the alpha-amylase enzyme via the sympathetic-adrenal medullary system. We predicted physiological reactivity measured by salivary assay in an ecological momentary assessment (EMA) design, using The Perceived Stress Scale (PSS; Cohen, 1988), Perceived Stress Reactivity Scale (PSRS; Schulz, Jansen, & Schlotz, 2005), neuroticism, (Big Five Inventory; John, Donahue, & Kentle, 1991), and age. Adult participants (N=163) ages 20–80 years old (M=51.8 years) completed the individual differences measures and then provided seven saliva samples per day for 10 consecutive days while also completing five stress-related surveys per day via random-prompted EMA (Scott, Sliwinski, & Blanchard-Fields, 2013). Mean aggregate alpha-amylase correlated with the PSRS (r = -.20, p < .05) but not with the PSS or with neuroticism, suggesting alpha-amylase may be a more sensitive measure of subjective stress reactivity. In contrast, mean cortisol levels were not correlated with any of those measures. Age correlated with subjective stress (r = -.23, p < .05) and stress reactivity (r = -.20, p < .05) but not with hormone levels. Multilevel modeling will be used to evaluate within-person and between-person variation in stress hormones and EMA measures of daily stress in relation to the PSS, the PSRS, neuroticism, and age.
The Effects of Word Use and Personality Pathology on Depression and Suicidal Behavior in Older Adult Inpatients
Authors: Park Hyunyoung Ellen , Geramian Helene , Ho Jennifer , Aronov Avner , Mak Wing Jin , Yenko Ira , Francois Dimitry , Zweig Richard , Park Hyunyoung
Published: December 2020

Few prior studies have examined whether word use is associated with personality pathology or is linked to depression and suicidal behavior in older adult inpatients. In this study, older adult depressed inpatients (N = 51; age M= 67, SD = 8.9; mean years of education = 15.49, SD = 2.6) provided narratives about high and low points in life, health challenges, and interpersonal conflicts, and completed measures of personality pathology (NEO Five Factor Inventory, Inventory of Interpersonal Problems-Personality Disorders-25), depression (Geriatric Depression Scale), and suicidal ideation or behavior (SCID-5). The Linguistic Inquiry and Word Count (LIWC) text analysis tool was used to examine the frequency of self-referential, negative emotion, or absolutist word use. After adjusting for word count, age, and occupational and marital status, the use of self-referential words in narratives about high points of life predicted suicidal behavior (OR = .563, p = .002), but word use did not predict depression or personality pathology. In regression analyses, neuroticism and maladaptive interpersonal functioning predicted depression (ß = .417, p = .002; ß = .364, p = .009, respectively) but not suicidal behavior. Together, these preliminary findings suggest that in depressed older adult inpatients, depression and suicidal behavior may have qualitatively different predictors.