bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPACT OF COMBINATIONS OF THE APOE Ɛ4 ALLELE AND TOMM40-APOC1 VARIANTS ON SURVIVAL TO OLDER AGES AND ALZHEIMER’S RISK
Authors: Kulminski Alexander , Jain-Washburn Ethan , Philipp Ian , Arbeev Konstantin , Stallard Eric , Feitosa Mary , Schupf Nicole , Christensen Kaare
Published: December 2022

Multifactorial diseases, health-related traits, and lifespan are polygenic phenotypes with complex genetic architectures. Polygenicity implies that multiple variants can impact the risks of these phenotypes independently or jointly. Recently, we showed that carriers of minor alleles of rs429358 (APOE ɛ4 encoding polymorphism), rs2075650 (TOMM40), and rs12721046 (APOC1) polymorphisms have up to 4.4 times higher risk of Alzheimer’s disease (AD) than APOE ɛ4 carriers without the minor alleles of rs2075650 and rs12721046. Here, we examined the chances of living to older ages—85 years and above—for carriers of compound genotypes combining these three polymorphisms using data from the Long Life Family Study, Framingham Heart Study, Cardiovascular Health Study, and UK Biobank. Consistent with their higher AD risk, carriers of the APOE ɛ4 allele with one or two minor alleles of rs2075650 and rs12721046 had 24.3% lower log odds of living to 85+ years (β=-0.243, p=2.22×10-2) than APOE ɛ4 carriers without either minor allele. Counterintuitively, AD did not mediate this risk. With AD-affected subjects excluded from the analysis, the effect size for the log odds of living to 85+ years (β=-0.352, p=2.35×10-3) was 1.45 times larger for APOE ɛ4 carriers with one or two minor alleles of rs2075650 and rs12721046. The chances of survival could be associated with lipid- and immunity-related mechanisms, whereas the risk of AD may be associated with amyloid-β-related mechanisms, among others. Targeting heterogeneous polygenic profiles of individuals at higher risks of multifactorial phenotypes may be a promising strategy for translating genetic discoveries to health care.
LATE-LIFE MORTALITY GWAS IN FLIES IDENTIFIES DIABETES AND OBESITY REGULATED TO REGULATE MORTALITY AND RESILIENCE
Authors: Hilsabeck Tyler , Bar Sudipta , Wilson Kenneth , Beck Jennifer , Nelson Christopher , Brem Rachel , Kapahi Pankaj
Published: December 2022

Variations in rate of aging in geneticaly heterogenious populations supports the hypothesis that aging is at least partially genetically regulated. However, genetically identical individuals also vary in their time of death. We have observed in D. melanogaster that this variation is genotype-dependent, as specific genotypes have characteristic survival curve shapes that are largely reproducible. Typical aging studies reduce a strain’s lifespan down to a population-level value, i.e. mean lifespan. While these metrics can represent the trends in a population, they are unable to encapsulate the variation in the aging of individuals from the same distinct population. Instead, we used two values that characterize the logistic fit of a strain’s mortality late in life: the risk of initial mortality (α) and the rate of aging (β). To identify regulators of the rate of aging, we performed a Genome-Wide Association Study (GWAS) of β for 160 different fly strains from the DGRP collection on two different diets late in life. This approach identified the candidate gene Diabetes and Obesity-Regulated (DOR), which has known roles in stress response, autophagy, and senescence, as having a role in the late-life mortality. DOR inhibition leads to a significant increase in late-life mortality that is preceded by a reduction in healthspan-related traits. Further, germline-specific inhibition is sufficient to increase senescence-related factors and shorten lifespan. We conclude that a decrease in DOR, a conserved gene, compromises an organism’s resilience through increased inflammation, senescence, and increased mortality, providing a potential target for bolstering the decline seen in human aging.
EVALUATING T-CELL AGE-RELATED IMMUNE PHENOTYPES IN THE CONTEXT OF BIOLOGICAL AGING IN HEALTH AND RETIREMENT STUDY
Authors: Ramasubramanian Ramya , Meier Helen , Vivek Sithara , Klopack Eric , Crimmins Eileen , Faul Jessica , Nikolich-Žugich Janko , Thyagarajan Bharat
Published: December 2022

Cellular changes in the adaptive immune system accompanies the aging process and contributes to an age-related immune phenotype (ARIP) characterized by decrease in naïve T (TN) cells and increase in memory T (TM) cells. However, a population level marker of ARIP associated with biological aging and age-related chronic conditions has not been evaluated previously. We developed two ARIP measures based on well understood age related changes in T cell distribution: TN/ (TCM (Central Memory) + TEM (Effector Memory) + TEFF (Effector)) or TN/ TM in CD4+ and CD8+ T cells. We compared them with more commonly used ARIP measures such as CD4/CD8 ratio and CD8+ TN cells by evaluating associations with chronological age and phenotypic age using linear regression and association with multimorbidity using multinomial logistic regression. CD8+ TN and TN/TM had the strongest inverse association with chronological age (beta estimates: -3.41, -3.61; p-value< 0.0001). CD4+ TN/TM had the strongest inverse association with phenotypic age (beta estimate = -0.74; p-value < 0.0001) after adjustment for age, sex, race and CMV serostatus. CD4+ TN/TM was inversely associated with co-occurring chronic conditions (odds ratio for 2 conditions and 3 conditions vs. 0 conditions: 0.74 (95%CI: 0.63-0.86) and 0.75 (95% CI: 0.63-0.90), respectively) after adjustment for age, sex, race, CMV serostatus, smoking, and BMI. CD4+ TN/TM had a stronger association with phenotypic age and age-related morbidity compared to other ARIP measures. Future longitudinal studies can help us evaluate if CD4+ TN/TM can predict risk of aging related outcomes.
EXPLORING RACIAL DISPARITIES IN AD/ADRD RISK: EVERYDAY DISCRIMINATION AS A SOCIAL STRESSOR
Authors: Gary Katharine , Hoque Masudul , Akushevich Igor
Published: December 2022

Using evidence from the Health and Retirement Study (HRS), we explore racial disparities in Alzheimer’s Disease and Related Dementia (AD/ADRD) risk. From a stress process perspective, there is substantial evidence in the literature that everyday discrimination is a chronic strain for Black individuals that acts as a social determinant of illness. However, few studies have examined specific relationships between this social stressor, race and AD/ADRD risk. Using generalized linear regression and Cox proportional hazard models, we explored racial differences in exposure and vulnerability to everyday discrimination. Results suggest that Black individuals experience more frequent exposure to everyday discrimination than their counterparts, and this chronic strain predicts AD/ADRD risk. However, contrary to the stress process model, White respondents were more vulnerable to the effect of everyday discrimination on AD/ADRD risk. Racial bias from medical professionals during the diagnostic process as well as mortality selection bias may explain these unexpected findings, especially given that racial minorities who experience high rates of everyday discrimination may not live long enough to reach the average age of diagnosis. These results provide further evidence that discrimination is a key factor in explaining racial disparities in late-life disorders, while also taking into consideration that many racial minorities with high rates of this type of stress may not survive to late-life.
LOS ANGELES COUNTY BOLD INITIATIVE: LAYING THE GROUNDWORK FOR STRATEGIC PLANNING ON DEMENTIA
Authors: Kuo Tony , Barragan Noel , Reyes Mariana , Zafar Mateeha , Paz Cinthie Lopez , Thomas Ariane
Published: December 2022

Funded by the Centers for Disease Control and Prevention’s Building Our Largest Dementia Public Health Program through U.S. Congressional appropriations for the BOLD Infrastructure for Alzheimer’s Act, the Los Angeles County BOLD initiative (LA BOLD) was established in 2021 with the goal of addressing the silent but burgeoning epidemic of Alzheimer's disease and related dementias (ADRD) in Los Angeles County (LAC). In 2019, approximately 166,857 LAC residents were living with Alzheimer’s disease; this number is expected to increase 150% by 2040. The initiative brings together a diverse group of multi-sector stakeholders, including two Area Agencies on Aging, two major academic centers, the largest Medicaid health plan in the region, the county’s safety net health agency (Public Health, Health Services, Mental Health), and other key community partners. The primary objectives of LA BOLD are: (i) establish a countywide coalition to address ADRD locally, and (ii) develop a strategic plan to guide the coalition’s efforts. The present study describes the first year of this initiative, highlighting the formation of the coalition’s steering group, identifying the three focus areas for strategic planning – risk reduction, early detection, advance care planning – and sharing lessons learned from navigating the contextual realities of ADRD care and prevention in LAC’s diverse communities. Data and program accomplishments for this early phase of LA BOLD are discussed within the context of medical advancement, the financial realities of ADRD programming and services, and the geo-political factors that are being considered as part of the strategic planning and implementation processes.
CARE TO PLAN: TAILORING RESOURCES FOR DEMENTIA CAREGIVERS ACROSS A HEALTH SYSTEM
Authors: Millenbah Ashley , Louwagie Katie , Baker Zachary , Jensen Christine , Gaugler Joseph
Published: December 2022

Each day, millions of persons with Alzheimer’s disease or related dementias (ADRD) rely on family members for necessary care and support. While there are many well-documented interventions to support ADRD caregivers, they lack individualization for specific caregiver needs and contexts. Care to Plan (CtP) was designed to address this gap in tailoring recommendations to support caregivers. After a Phase I pilot, CtP was refined and implemented within a moderately sized health system in the eastern US. A mixed-methods randomized controlled trial aimed to provide insights into the efficacy, acceptability, and utility of CtP. Twenty-two caregivers were randomly assigned to the treatment group (to review the CtP tool with a senior care navigator) and 21 were assigned to receive usual care. After completion of usual care procedures, 7 participants joined a waitlist control group, following treatment procedures. Three- and six-month outcomes included caregiver self-efficacy and distress, caregiver use of recommended support, and service utilization by the person with memory loss. Most caregivers were white (81%), female (74%), and cared for a parent (56%) or spouse (35%). The majority of caregivers agreed that the tool was helpful (70%) and would recommend it to other caregivers (83%). While 48% of caregivers felt that resources provided by the tool were not new to them, the checklist scores and interviews indicate that the senior care navigators were valuable in discussing the recommendations. Phase II findings will guide future evaluation and dissemination, and inform future models of CtP for health system usage.
MINDFULNESS AND CAREGIVING EXPERIENCE IN ADRD CAREGIVERS
Authors: Tolea Magdalena , Cohen Iris , Camacho Simone , Galvin James
Published: December 2022

Mindfulness (being present in the moment without judgement) has been linked to greater caregiver emotional health. Recent mindfulness-based interventions report improved coping skills, mood, and reduced stress in dementia caregivers. In this cross-sectional study of 141 ADRD caregivers, we assessed whether the relationship between caregiver mindfulness and caregiver experience varies by caregiver gender, relationship to patient (spouse-vs-child), etiology (AD-vs-LBD), or stage (MCI-vs-dementia). A stratified univariate analytic approach was used. Four mindfulness parameters (AMPS scale) were used: global score (GS), decentering (F1), positive (F2), and negative emotional regulation (F3). Outcomes included positive and negative appraisals of caregiving (PANAC), preparedness, care confidence, and depression. GS was linked to positive outcomes in male (rPANAC+=0.32/p=0.005), spouse caregivers (rPANAC+)=0.32/p=0.006 ) of ADRD patients regardless of etiology (rPANAC+=0.31/p=0.013 for AD; rconfidence=0.31/p=0.036 for LBD) and stage (rPANAC+=0.33/p=0.010 and rpreparedness=0.38,/p=0.008 for MCI; rPANAC+=0.29/p=0.011 and rconfidence=0.31/p=0.007 for dementia). Inverse relationships were observed with negative outcomes in male (rPANAC-=-0.46/p=0.002 and rdepression=-0.41/p=0.005), spouse caregivers (rPANAC-=-0.25/p=0.035 and rdepression=-0.30/p=0.009) of AD patients (rPANAC-=-0.25/p=0.043 and rdepression=-0.33/p=0.009) in early stages (rdepression=-0.41/p=0.001). F2 contributed to most relationships, with F3 and F1 significant in some but not all caregiver groups. Specifically, male spouse caregivers of AD patients regardless of stage may benefit from full-scope (F1-F3) programs while those of LBD patients from programs focused on improving emotional regulation (F2-F3). Wives of AD and LBD patients may in turn benefit from programs to improve positive emotional regulation (F2). Findings suggest that tailoring mindfulness-based interventions to specific caregiver groups may be effective in improving caregiver experience and mood.
PSYCHOLOGICAL DISORDERS LINKED TO OSTEOPOROSIS IN A POPULATION-BASED COHORT STUDY
Authors: Chrisco Kanya Godde , Courtney Margaret Gough , Roberts Josephine , Quintero Yadira
Published: December 2022

Psychosocial disorders can stem from or have profound effects on one’s health, having been linked to many negative health outcomes. In this study, we hypothesize psychological disorders are associated with a higher risk osteoporosis diagnosis. Self-reported information from years 2012-2016 of the public-use, longitudinal cohort-based Health and Retirement Study, was evaluated from 11,716 American respondents aged 50-90 years old. The odds of scores on the Center for Epidemiological Studies Depression (CESD) scale, and broader psychological disorders (emotional, nervous, psychiatric) on osteoporosis diagnosis (outcome), were estimated with a logistic regression using survey weights, while controlling for sex, logged age, education level, race/ethnicity, family structure during childhood (number of adults), having thyroid disease, allostatic load, and body weight. A McFadden’s R2 (0.18) shows the model fits relatively well. The results demonstrate that as CESD score goes up, there is a 10% increase in odds (OR = 1.1, P < 0.001) of an osteoporosis diagnosis. Similarly, if a respondent reported a doctor told them they had other psychological disorders, the odds of an osteoporosis diagnosis increased by 52% (OR = 1.52, P < 0.001). It is unknown whether the components of broader psychological disorders are caused by decreased quality of life and/or other limitations from osteoporosis or if they contribute to bone health changes in this sample, or both. However, as CESD is a short-term measure (reflecting on the week prior) it is deduced to be as a result of a decreased quality of life associated with some cases of osteoporosis.
THE IMPACT OF COVID-19 ON SERVICE USAGE IN A RURAL “VILLAGE”
Authors: Cho Joonyoung , Dunkle Ruth , Tarr Julie
Published: December 2022

The Covid-19 pandemic disrupted service access and use for many older adults aging in place. This study focuses on understanding how a rural “Village”, where services are primarily provided by volunteers to older adults, adjusted to Covid-19. The sample is drawn from service users of at least one or more services between January and October 2020 (N=233). Survey and qualitative data were gathered via telephone-interview (N=80). This study examined (1) the impact of Covid-19 on service use and ability to stay at home, 2) services offered, and 3) changes to day to day life. In the sample, 53.75% is 80+ in age, 70% female, and 43.75% lived alone. 15% of respondents reported reduction in service used, 10% an increase, 65% no change, and 6.25% used no services. Some services such as rides to medical care, and grocery delivery increased, other services (e.g., caregiving) were reduced. 26.24% respondents believed that the organization’s services helped them stay at home during Covid-19. Other services were developed to better serve older adults such as phone reassurance and expansion of delivery of medication and food. Open ended responses identified how Covid-19 impacted day to day life. While many reported negative ways such as changing mental health perspectives and limiting medical care, others report life being more peaceful and providing time to enjoy nature. Findings provide an understanding that services while disrupted continued for one volunteer organization with some service users showing resilience in their day to day lives.
COVID-19 CASE AND MORTALITY RATES IN GREEN HOUSES AND TRADITIONAL NURSING HOMES IN NEW YORK STATE
Authors: Young Yuchi , Shayya Ashley , O'Grady Thomas , Chen Ya-Mei
Published: December 2022

Introduction. Green Houses (GHs) have features that distinguish them from traditional nursing homes (NHs) including small size, home-like settings, humane model of care, and a sense of community. Literature shows these features have contributed to lower staff turnover, higher resident satisfaction, and lower COVID-19 case and mortality rates. Few studies use longitudinal data to quantify the differences between GHs and NHs by examining COVID-19 case and mortality rates. Methods. Nursing Home COVID-19 Data from CMS were used to compare case and mortality rates between GHs (n=4) and NHs (n=614) from 5/2020 to 1/2022. Case and mortality rates were calculated for GHs and NHs. Incidence rate ratio (IRR) of case and mortality rates were provided. Results. The preliminary results indicate GHs have lower COVID-19 case (3.76 vs. 6.8 per 1,000 resident weeks) and mortality rates (0.35 vs 1.21 per 1,000 resident weeks) compared to NHs. The IRR for COVID-19 cases is significantly higher in NHs compared to GHs (IRR = 1.8; 95% CI 1.55, 2.11), likewise, for mortality (IRR = 3.45; 95% CI 2.09, 5.75). Conclusions. The findings illuminate key differences in COVID-19 case and mortality rates among GHs and NHs. Factors such as GH size and their unique care model may contribute to the differences observed in COVID-19 case and mortality rates when compared to NHs. Future studies may include facility or resident characteristics in the study design.
APPLYING A COLLABORATIVE, INTERDISCIPLINARY APPROACH TO INCREASE COVID-19 VACCINE EQUITY, ACCESS, AND CONFIDENCE
Authors: Prendergast Alice , Fuller Kristi
Published: December 2022

The COVID-19 pandemic has impacted the health and well-being of older adults, people with disabilities, and caregivers in myriad ways. Subgroups of these populations, particularly people of color, experience higher rates of infection and mortality from COVID-19, and are also at increased risk for social disconnection, depression, economic hardship, and a host of other adverse outcomes brought on or exacerbated by the pandemic. COVID-19 vaccines are effective in preventing serious illness and play an important role in protecting vulnerable groups, yet uptake varies considerably across communities and health disparities are growing. Researchers from the Georgia Health Policy Center conducted a mixed-methods study involving a literature review, secondary data analysis, and focus groups to gather information about drivers of vaccine hesitancy and inequity. The team partnered with a multiagency collaborative, branding firm, and subject matter experts to synthesize and apply findings in the development of a statewide, multichannel vaccine communications campaign. In this session, researchers will provide an overview of the study, highlight key findings, and discuss lessons learned throughout this complex, collaborative project.
COVID-19 CASES AND DEATHS IN NURSING HOMES: ROLE OF QUALITY IN MULTIPLE WAVES
Authors: Wang Xiaochuan , Castaneda Camilo Osorio
Published: December 2022

The COVID-19 pandemic has disproportionally impacted nursing homes in the United States. As of February 2022, nursing homes have reported over 980,000 resident cases and nearly 150,000 resident deaths, accounting for a high share of total COVID-19 cases and deaths in the U.S. Earlier studies have identified various factors that relate to nursing homes’ vulnerability to COVID-19 (e.g., ownership status, facility size). Quality has a critical role in affecting nursing home COVID-19 outcomes. However, research on this topic has been relatively limited and inconsistent. Using publicly available data from CMS COVID-19 Nursing Home Dataset, Nursing Home Compare, Long-Term Care Focus, and The New York Times, this study examines the role of nursing home quality (e.g., infection control deficiency, quality of care deficiency, and five-star quality rating) on COVID-19 resident cases and deaths during multiple waves. Of the over 15,000 nursing homes examined, approximately 64% have had at least one infection control deficiency and 82% have had at least one quality of care deficiency during the two years preceding the COVID-19 pandemic. Results from regression models indicate that the likelihood of having at least one case is more related to facility and resident characteristics (e.g., facility size, percentage of Medicaid residents) and environmental factors (e.g., county case rates) than quality indicators. Whereas the roles of quality on the odds of having resident deaths, and the magnitude of resident cases and deaths, are more consistent in the later waves of the pandemic. Implications for future research and practice will be discussed.
COMMUNICATION DURING COVID-19: A COMPARISON BETWEEN INSTITUTIONALIZED AND COMMUNITY DWELLING OLDER ADULTS
Authors: Dube Victoria , George Mollie , Hubner Sarah , Boron Julie Blaskewicz
Published: December 2022

COVID-19 has created communication and socialization challenges for many older adults (OAs) living in community or institutional settings (CECs, IECs respectively) and their essential contacts (ECs). An essential contact is someone who provides emotional, physical, and social support for an older adult. While social distancing measures have decreased the spread and infection rate, these measures have placed strain upon communication and socialization needed for wellbeing which may increase the risk of loneliness and subsequently depression, cognitive functioning, and mortality among OAs. This study compared how general, in-person, and distanced communication between CECs and IECs has changed due to COVID-19. Self-identified ECs to OAs (N=546) completed a Qualtrics questionnaire via Amazon Mechanical Turk. Respondents (Age Range: 19-77; Mean=44.3; SD=14.2) were generally female (54.8%), white (81.0%), and CECs (57.3%). Pearson chi-square was used to evaluate the association between EC and communication type. Phi and Cramer’s V were used to measure effect size. IECs were significantly more likely than CECs to report much less general (41.6% vs. 10.7; medium effect) and in-person (60.0% vs. 22.4%; medium effect) social interaction due to COVID-19. IECs were significantly more likely to report much more distanced communication than CECs (42.8% vs 5.2%; small effect). Overall, this suggests community dwelling OAs’ communication and socialization were less impacted by COVID-19 distancing than institutionalized OAs. Thus, institutionalized OAs may be at greater risk for negative effects of social distancing. Future efforts need to focus on prioritizing ways for institutionalized adults to communicate with their ECs if social distancing is needed.
THE ASSOCIATION BETWEEN CHRONIC LUNG CONDITIONS AND COVID-19 MORTALITY AMONG 65+ IN CONNECTICUT AND RHODE ISLAND
Authors: Jansen Taylor , Lee Chae Man , Xu Shu , Su YanJhu , Silverstein Nina , Dugan Beth
Published: December 2022

Older adults aged 65 and older have accounted for 81% of all deaths from COVID-19 in the US. Individuals with chronic lung diseases have higher risk for severe COVID-19 and death. The aim of this research is to examine the association between town-level rates of asthma and COPD and deaths from COVID-19 in 208 towns in Connecticut and Rhode Island. This study utilized data from multiple publicly available datasets: the public health departments of Connecticut and Rhode Island, the 2021 Connecticut and 2020 Rhode Island Healthy Aging Data Reports (www.healthyagingdatareports.org), and the Census Bureau’s 2014-2018 American Community Survey (ACS). A multi-step analysis was conducted to examine the association between town-level chronic lung conditions and COVID-19 mortality. Bivariate correlations and mapping found strong, positive associations between town-level asthma prevalence and COVID-19 mortality (rs [206] = 0.15; P = .03) and COPD prevalence and COVID-19 mortality (rs [206] = 0.15; P = .03). After controlling for town-level factors associated with chronic lung conditions and COVID-19 mortality, linear regression models did not find support for an association between chronic lung conditions and COVID-19 mortality. However, town-level factors like percentage of the 65+ African American population (β: 0.19, SE: 249.18, p= .02) and 65+ with low educational attainment (β: 0.45, SE: 278.98, p= .001) were significant predictors of COVID-19 mortality. This research adds to the current knowledge base that high rates of racial minorities and low education among the 65+ population are significant predictors of town level COVID-19 mortality.
UNDERSTANDING OLDER HEALTH CARE WORKERS’ BURNOUT DURING COVID-19
Authors: Woo Jihee , Engel Rafael
Published: December 2022

The prolonged battle against the COVID-19 pandemic has left many health care workers physically, mentally, and emotionally exhausted, exacerbating burnout that was already endemic in the healthcare sector. Burnout places not only an individual's well-being but patient care at risk. In this study, we examine protective and risk factors contributing to burnout specifically among older health care workers during COVID-19. We address these questions using data collected from an online survey conducted on health care workers employed at hospitals in Pittsburgh, Pennsylvania in February 2022. Health care workers ages 50 and older (n=165) –a subset of surveyed health care workers– were included in the analytic sample. Participants were asked a series of questions about burnout, mental health, workplace stressors, intent to leave the job, and demographics. Participants were predominantly female (88%) and white (91%) with a mean age of 57.2 years. Almost 70% were registered nurses and the remaining were service, clerical, and technical workers; the mean years of work experience was 21.5 years. Most participants (77%) experienced moderate levels of burnout. Preliminary regression analysis suggests that perceived inadequate staffing (β=2.12, p<.001) and workplace discrimination (β=1.23, p=.001) were positively associated with burnout while job autonomy (β=-1.77, p<.05) and schedule flexibility (β=-.2.09, p=.001) were negatively associated with burnout. Burnout was in turn positively associated with depression, anxiety, and intent to leave the job. These findings demonstrate the need for workplace support to address older health care workers’ burnout, better accommodate their needs, and keep them safe and healthy in their jobs.
CLINICAL CHARACTERISTICS AND MORTALITY IN ADULTS 85 YEARS AND OLDER HOSPITALIZED WITH SARS-COV-2
Authors: Danesh Valerie , Cho Jinmyoung , Tecson Kristen , Stevens Alan
Published: December 2022

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) places older adults at increased risk of hospitalization and mortality due to coronavirus disease 2019 (COVID-19). To date, research and regulatory data describe adults 65 years and older, with few reporting on characteristics specific to older adults 85 and older (“oldest-old”). A consecutive 12-month case series including 1,510 oldest-old patients hospitalized with SARS-CoV-2 is presented to describe clinical characteristics, Intensive Care Unit (ICU) utilization and in-hospital mortality from 26 urban, suburban and rural-serving hospitals in an integrated health system in Texas. Known predictors of poor prognosis in COVID-19 include older age, male sex, metabolic risk factors (dyslipidemia, obesity, diabetes) and respiratory failure requiring oxygen support. Compared with hospitalized patients < 85 years, oldest-old patients more often had 4+ chronic conditions (31% vs 12%, p< 0.0001), but less often had metabolic risk factors associated with increased risk for mechanical ventilation and mortality. Specifically, diabetes prevalence was similar between age groups (27% oldest-old vs 30%, NS), while obesity prevalence was lower (18% oldest-old vs 55%, p< 0.0001). Oxygen support requirements were largely similar to the general population, with 4 of 5 hospitalized patients requiring oxygenation support. Of 1,510 oldest-old patients hospitalized for SARS-CoV-2, 269 (18%) required admission to an ICU, 1,206 (80%) required oxygen support, and 1,221 (81%) survived. Following hospitalization, 78% required supportive care, including hospice (15%). Hospitalization characteristics across the lifespan suggest an accelerated and compounded need for ICU recovery and post-hospitalization rehabilitation attributed to the COVID-19 pandemic.
SHARED DECISION-MAKING WITH COST INFORMATION IN THE CONTEXT OF AGE-FRIENDLY CARE
Authors: Iny Nicole
Published: December 2022

The proposed poster session will explore shared decision making—the patient-clinician communication to decide on tests, treatment and care based on clinical evidence, balancing risks and outcomes with patient and caregiver preferences and values—and how evidence-based strategies, such as shared decision-making tools, or decision aids, can support older adults and their caregivers/care partners as they navigate the healthcare system. Notably, the session will share findings from FAIR Health’s grant-funded initiatives to advance shared decision making through decision aids, which combine clinical and cost information for specific clinical scenarios, and are freely available for consumers on fairhealthconsumer.org and for healthcare providers on fairhealthprovider.org. As such, the session will offer diverse perspectives and a unique spotlight on the financial and patient- and caregiver-centered aspects of healthcare decision making. Through FAIR Health’s needs assessment for a current project funded by The John A. Hartford Foundation, which has as its goal to advance shared decision making among older adults with serious illness and family caregivers, FAIR Health collected qualitative feedback from older patients, family caregivers and healthcare providers regarding perspectives on navigating the healthcare system. Through a national survey of older patients and family caregivers, FAIR Health found that: (1) though a significant proportion of older adults consider healthcare costs to be an important factor when making healthcare decisions, more than a third have difficulty getting such cost information; and (2) family caregivers/care partners expressed an appetite and need for healthcare information, resources and tools that facilitate better decisions about their care receiver’s care.
REAL-WORLD EFFECTIVENESS ENHANCED INFLUENZA VACCINES IN OLDER ADULTS DURING THREE CONSECUTIVE INFLUENZA SEASONS: 2017–2020
Authors: McGovern Ian
Published: December 2022

Unenhanced influenza vaccines often fail to elicit adequate immune responses in adults ≥65 years due to immunosenescence. Enhanced influenza vaccines, MF59-adjuvanted trivalent inactivated influenza vaccine (aTIV) and high-dose vaccine (HD-TIV), were specifically developed to overcome this problem. The relative vaccine effectiveness (rVE) of aTIV vs HD-TIV and standard, egg-derived quadrivalent influenza vaccines (QIVe) was estimated in 3 retrospective cohort studies during the 2017-2020 US influenza seasons. Influenza-related medical encounters (IRMEs) were identified using diagnostic codes specific to influenza disease (ICD J09*-J11*) from a dataset that integrated electronic primary care medical records with pharmacy and medical claims. rVE was estimated using propensity score methods adjusting for variables including age, sex, race, ethnicity, geographic location, week of vaccination, frailty and health status. Subgroup analyses included specific age groups and those with high-risk medical conditions. aTIV demonstrated a consistent benefit over QIVe and HD-TIV across all three seasons in the overall study populations, and greater rVE versus QIVe was consistently observed over all three seasons in all age subgroups as well (65-74, 75-84, 85+). aIIV3 was comparable to HD-TIV and more effective than QIVe in a subgroup with high-risk medical conditions. These findings lend further support to the use of aTIV to prevent influenza-related medical encounters in older individuals.
REGIONAL VARIATION IN COVID-19 MITIGATION PRACTICES AMONG HOME- AND COMMUNITY-BASED LONG-TERM CARE PROVIDERS
Authors: Lendon Jessica , Caffrey Christine , Singh Priyanka , Lu Zhaohui , Manisha Sengupta
Published: December 2022

Residential care communities (RCC) and adult day services centers (ADSC) were greatly impacted by COVID-19. As state-regulated home- and community-based care settings (HCBSs), they experienced changing regulations, outbreaks among care recipients and staff, and new challenges to safely provide services. Using a nationally representative sample of over 11,600 RCCs and census of nearly 5,500 ADSCs from the 2020 National Post-acute and Long-term Care Study, this study examined the prevalence and regional variation (p<.05) of practices to mitigate COVID-19. Preliminary data show that most RCCs (87%) and ADSCs (72%) screened for symptoms. Most RCCs limited communal activities (83%) and ADSCs reduced hours or temporarily closed (73%). More RCCs used video telemedicine than audio-only (40% vs 34%) to assess, diagnose, or treat users. However, more ADSCs used audio-only than video telemedicine (25% vs 17%). Over 80% of all providers always or sometimes imposed in-person restrictions on family, visitors, volunteers, and non-essential services providers. More ADSCs in the Midwest (82%) and South (80%) screened symptoms than Northeast (68%) and more ADSCs in the Midwest (85%) limited hours/temporarily closed than Northeast (72%). More RCCs in the Midwest (43%) and South (41%) used video telemedicine than Northeast (36%); however, a lower percentage of ADSCs in the Midwest (9%) and South (12%) used video telemedicine than Northeast (25%). Results show a variety of experiences in the first year of the COVID-19 pandemic among these two HCBSs. Practices to mitigate COVID-19 while continuing to provide needed services were common, with some differences across settings and US regions.
PROFILE OF COMMUNITY-DWELLING OLDER ADULTS ONE YEAR INTO COVID-19
Authors: Lach Helen , Stallings Devita , Palmer Janice , Lorenz Rebecca
Published: December 2022

We surveyed community-dwelling older adults in 2020, primarily in the Midwest, to learn about their experiences during the initial months of the COVID-19 pandemic. In summer 2021, we collected quantitative and qualitative one-year follow-up data on 118 participants from the original cohort who agreed to be contacted later (n=246; 48% response rate). Respondents included mostly women (75.2%), White (95%) with a mean age of 76.4 years and 15 mean years of education; half were married (49.5), and 40.7% lived alone. Compared to 2020, participants had a higher mean score on the CESD10 (9.76 vs. 6.97); although self-rated health and quality of life scores were similar (94-95% good-excellent). Mean scores on the Brief Resilient Scale were similar. In this group, 99.3% had been vaccinated, and had a concern score of 3.7 out of 5 that there would be more COVID outbreaks. Themes from their reported adaptations during the pandemic included taking steps for physical and mental self-care, maintaining connections with others, and finding credible sources of information. Connecting with others online was the biggest technological change during this time, and the computer was the most valued technology. These educated, middle class older adults continued to adapt to the COVID-19 pandemic, but those who did not respond to the second survey may have had more health or mental health challenges. These findings suggest a need for health care providers to screen older adults for depression so that early interventions can take place.
FILE OF LIFE: OLDER ADULT PERSPECTIVES AND SUGGESTIONS TO INCREASE FOL USAGE
Authors: Dandrea Kaye , Williams Teresa , Gugliucci Marilyn
Published: December 2022

IntroductionIn a home emergency, an accurate patient medical history is vital for proper medical decision-making. One method to provide medical information in an emergency is through the FILE OF LIFE™ (FOL); a document distributed by local medical centers and public service organizations completed by community adults and placed on their refrigerator in a magnetic folder. To date, there was no known study, until this one, conducted with older adults to check the FOL design suitability for older adults; the goal of this project. MethodsOlder adults were recruited through the UNE COM Geriatrics Education Mentor (GEM) program for this pilot qualitative research. Twenty-one GEMs volunteered to participate in five 90-minute focus groups. Questions were specific for each section - Patient Identifiers, Emergency Contacts, Medical Data, Medical Conditions, Allergies, and Medical Insurance Information, and the usability of the FOL. Qualitative content analysis followed by NVivo 12+ analysis applied inter-rater reliability methods and changes for each FOL section were based on reaching data saturation. ResultsFILE OF LIFE™ comments (N=328) were coded to the following themes: Layout, Font Size, Spacing, and Section Ordering. Sections were edited accordingly with “Identifiers,” Medical Data, Medical Conditions, Allergies, and Emergency Contacts requiring substantive changes. Other minor changes were made throughout the form. ConclusionFurther research will ensure efficient usability by older adults and emergency response personnel. The FILE OF LIFE™, although a trusted resource for older community dwelling residents, has a chance to increase usability by incorporating the suggested changes from this research.
DELIRIUM-LIKE BEHAVIORAL SYMPTOMATOLOGY IN COMMUNITY-DWELLING OLDER ADULTS WITH DEMENTIA
Authors: Vickers Jasmine , Wang Danny , Pickering Carolyn
Published: December 2022

Delirium, a sudden and acute confusional state, is known to be more prevalent and deleterious in older adults with dementia; yet the literature on estimates of delirium in community-dwelling older adults with dementia is scarce. The aim of this study was to determine the patterns and frequency of delirium-like symptoms in community-dwelling older adults with dementia, as reported by their caregivers (n=50) in a 21-day diary study (n=1389 diaries). Caregiver reports of severity scores of care-recipient behaviors that were one standard deviation above the mean were considered outliers, representing a sudden and acute change. Caregivers that reported outlier scores for two consecutive days were considered delirium-like symptoms. Descriptive statistics were used to determine the number of caregivers who reported delirium-like symptoms and the percentage of days with symptoms present. Additionally, chi-square tests and Independent samples T-test were used to determine the associations between delirium-like symptoms and participant characteristics. Caregivers were predominately White/Caucasian (89%), female (94%), and a son/daughter (60%) of the care-recipient. Caregivers had an average age of 52.6 years and were caregiving an average of 3.9 years. The care-recipients had dementia for an average of 4.3 years. Caregivers reported delirium-like symptoms for 12(24%) care-recipients and this rate was consistent with previous research findings. Caregivers reported delirium-like symptoms, on average, for 6.9 days (33%) of the 21-day diary period. More research is needed to understand the occurrence and patterns of delirium in community-dwelling older adults with dementia to improve home care services, outpatient services, and support for caregivers.
QUALITY OF LIFE PREDICTS END-OF-LIFE CARE TRANSITIONS AMONG PERSONS WITH DEMENTIA OVER NINE YEARS
Authors: Sullivan Suzanne , Li Chin-Shang , Chang Yu-Ping
Published: December 2022

Physical, financial, and emotional burdens are profound and affect the quality-of-life of persons with dementia (PWD) and their caregivers, particularly as cognitive decline accelerates and death approaches, which leads to burdensome, non-beneficial transitions in care that can lead to further decline of PWD. Measures of quality-of-life for PWD and their caregivers include important physical, psychological/cognitive, existential, caregiving burden, and socio-demographic factors that may be useful for predicting and preventing these end-of-life transitions. This secondary data analysis of the National Health and Aging and Trends Study (NHATS) linked to the National Study of Caregiving (NSOC) investigates the relationship between quality-of-life factors and end-of-life care transition (overnight hospitalization, hospice use, and place of death) over nine years (2011-2019) among caregiver/PWD dyads using multivariable logistic regression for hospice and place of death and multivariable logistic regression with generalized estimating equations for longitudinal overnight hospitalizations. Overnight hospitalizations are predicted by overall health (p=0.048), pain (p=0.016), and having a regular doctor (p=0.012). Predictors of hospice include health prevents enjoying life (p=0.0002) and receiving food stamps (p=0.008). Place of death is predicted by PWD needing >30 mins to fall asleep (p=0.007), dementia status (p=0.015), health preventing enjoying life (p=0.0005), race (p=0.033), and census division (p=0.012). End-of-life care transitions can be predicted far in advance by quality-of-life and socio-demographic factors of PWD and their caregivers. With this knowledge it may be possible to develop upstream interventions to facilitate appropriate transitions and improve end-of-life quality-of-life far in advance of avoidable care transitions of PWD.
USE OF HIGH COST CARE AMONG VETERANS WITH COMORBID MENTAL ILLNESS AND ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Miller Katherine , Shepherd-Banigan Megan
Published: December 2022

As Vietnam-era Veterans age, VA faces a growing need to manage aging-related conditions, such as Alzheimer’s disease and other dementia (ADRD), for this complex patient population. ADRD is of particular concern as military related factors, such as psychiatric illnesses, increase ADRD likelihood and complicate care management. In particular, decreasing use of low value care (e.g., emergency department (ED) care) is one approach to promote appropriate supportive care for Veterans with comorbid ADRD and psychiatric illness, but is understudied. We describe differences in potentially low value health care among older Veterans with ADRD 12 months after a new ADRD diagnosis. We compare Veterans with mental illness (MI) pre-ADRD diagnosis (major depressive disorder, post-traumatic stress disorder, or generalized anxiety disorder) to those without pre-existing MI. Potentially low value care includes ED use, hospitalization, and 30-day readmissions 12 months after a new ADRD diagnosis. Compared to Veterans with no pre-existing MI, Veterans with pre-existing MI are more likely to be younger (79 vs. 82 years old), male, married, White, Hispanic. In the year after new ADRD diagnosis, 16.9%, 21.6% and 2.6% of Veterans with MI had any ED visit, hospitalization, and 30-day readmission, respectively. In contrast, only 7.3%, 9.5%, and 0.9% of Veterans without pre-existing MI had any ED visit, hospitalization, and 30-day readmission, respectively. Our findings suggest that reducing low-value care may be an appropriate intervention target to improve care quality for Veterans with ADRD and mental illness.
SIGMA PHI OMEGA CHAPTERS AND THEIR COLLABORATION WITH THE PILOTED GSA STUDENT CHAPTERS
Authors: Gugliucci Marilyn
Published: December 2022

Networking is the action or process of interacting with others to exchange information and develop professional or social contacts. The newly piloted GSA student chapters are encouraged to build relationships that can lead to networking and collaboration. While it is important to maintain a unique Sigma Phi Omega institutional chapter identity, the GSA student chapters also focus on the field of aging within a Higher Education Institution. Sigma Phi Omega collaborating with GSA Student Chapters is mutually beneficial in expanding learning, exploring new ideas, building professional connections, creating innovative projects, and gaining insights to other opportunities for professional and personal growth. This session will provide guidance on how to foster collaboration and growth for each of these chapters while honoring respective chapter missions, requirements, and educational experiences.
WORKFORCE DEVELOPMENT: AGING NETWORK CARE MANAGERS AS BEHAVIORAL HEALTH PROVIDERS FOR OLDER ADULTS IN COMMUNITIES
Authors: Mbao Mbita , Keefe Bronwyn
Published: December 2022

Background and Objectives

The population of older adults (65 and over) continues to increase with projections of one in five by 2030. Furthermore, one in four older adults have a behavioral health problem, and over 63% are not receiving behavioral health (BH) services. Many older adults living in the community depend on aging networks for home- and community-based services. However, most care managers' current education and training do not cover the skills and competencies to provide adequate care for older adults with BH needs. This study aimed to evaluate the effectiveness of a training intervention on the perceived self-efficacy of care managers working with older adults with BH issues in the aging network.

Research Design and Methods

The study used a quasi-experimental design with a pre-and post-tests approach. The study used convenience sampling (n=90).

Results

We found a significant difference in the mean self-efficacy scores related to working with clients with mental health problems between pre-test (M=62.31, SD=10.11) and post-test (M=65.88, SD=7.40). In addition, results indicated a significant difference in the mean self-efficacy score between the pre-test (M=59.81, SD=10.68) and post-test (M=65.60, SD=9.85) related to working with clients with substance use problems. Discussion and Implications: The study found that self-efficacy was higher at post-test than pre-test. In addition, there was no difference in the self-efficacy scores of those participants who had previously completed a mental health course or certification and those who had not.
ASSOCIATION BETWEEN PERCEIVED CONTROL AND COGNITIVE FUNCTION AMONG STROKE SURVIVORS IN CHINA: A LONGITUDINAL STUDY
Authors: Liu Zhijian , Zhu Huanzhi , Wang Jing , Wu Bei , Wang Qin , Li Juan
Published: December 2022

This study explored the association between perceived control and cognitive function among stroke survivors in China. We conducted a longitudinal study and assessed perceived control (by Perceived Control in Health Care Questionnaire) and cognitive function (by Montreal Cognitive Assessment, MoCA) of 231 stroke survivors at the acute stage, 3, 6 months after onset from two stroke centers in Shanghai and Linyi from June to December 2020. General linear mixed model was used for analysis. Perceived control was at a moderate level, and the average score of MoCA showed cognitive impairment at 3 waves. Both perceived control and cognitive function improved with time. Perceived control was positively associated with cognitive function (β=0.08, p＜0.001). After controlling for stroke severity, risk factors of cognitive impairment, age, gender, and education, the association was still significant (β=0.04, p＜0.001). These findings suggest that perceived control may be a potential target in cognitive interventions for stroke survivors.