bluuebunny/crossref_metadata_2025 huggingface dataset:
AN INNOVATIVE MODEL OF CARE FOR SUBJECTS WITH DEMENTIA IN ITALY—IL PAESE RITROVATO—THROUGH THE SARS-COV-2 PANDEMIC
Authors: Mazzola Paolo , Ferraguzzi Gaia , Zanetti Mariella , Bellelli Giuseppe
Published: December 2022

“Il Paese Ritrovato” is an innovative long-term facility dedicated to subjects with mild-to-moderate Alzheimer’s disease or other dementias, located in Monza (Lombardia, Italy).By living in a village that resembles a community neighborhood, it aims at people’s wellbeing and represents a shift in the paradigm of traditional nursing home care, allowing the guests to visit the hair stylist, the supermarket, and various activities according to their personal habits, always supported by trained professionals.We performed a retrospective cohort study on 60 subjects, comparing their characteristics before and during the SARS-CoV-2 pandemic, from June 2018 to December 2020. We collected demographic information, cognition, comorbidity, functional status, engagement in the activities through Popularity Index (PI) and Engagement Social Index (ISE), and use of psychoactive medications.The follow-up is performed every 6 months from admission: T0, T6, T12, and T18 are the time-points. The assessment performed during the pandemic is called Tcovid.Compared to a relative stability in cognition before the pandemic, the assessment at Tcovid showed an accelerated worsening of MMSE and CDR scales. We observed an increase in the prescription of antipsychotics (+5%), antidepressants (+11.7%), and benzodiazepines (+1.7%). As expected, engagement in activities dropped (lower PI and ISE). Functional status gradually worsened during the follow-up, according to the natural progression of dementias, but Tcovid slightly accelerated this process and overall worsened the balance performances.Although we are currently unable to quantify the negative effect of this reorganization, future studies need to address the real impact of pandemic on the guests’ performances.
IDENTIFYING ASSISTED LIVING SAFETY PRIORITIES: A DELPHI PANEL WITH RESIDENT, FAMILY, AND PROFESSIONAL STAKEHOLDERS
Authors: Dictus Cassandra , Cho Youngmin , Bartoldus Victoria , Hoben Matthias , Chamberlain Stephanie , Beeber Anna
Published: December 2022

While assisted living (AL) communities emphasize resident safety, one barrier to resident safety is a lack of information about AL stakeholders’ safety priorities. As part of a larger research project to create a toolkit to foster resident and family engagement in safety in AL, we created a stakeholder panel that includes 13 AL residents, family members, and professionals (i.e., direct care workers, administrators, researchers, and policymakers). This paper describes a web-based Delphi process to create a ranked safety priority list with stakeholders. After three rounds involving online surveys and Zoom group discussions, the stakeholder group came to a consensus on a final list of 14 ranked safety priorities. Using verbatim transcripts of the Zoom discussions and chat, we conducted content analysis to highlight the rationales for the 14 ranked safety priorities on the final list. Reasons to prioritize safety concerns included the seriousness of the impact on AL residents and system-level root causes. These findings will be used to guide the development of a toolkit to improve resident and family engagement in the safety of AL. This list can also help AL communities and researchers at large to better understand what safety priorities are most important to a broad range of AL stakeholders and why.
THE SHORT- AND LONG-TERM IMPACTS OF DEMENTIA ON PREVENTIVE CARE UTILIZATION AND HEALTH BEHAVIORS
Authors: Lin Zhuoer , Chen Xi
Published: December 2022

Identifying early and consistent signals of dementia risk may offer people more time to prepare for the future, helping to delay the onset or slow the progression of dementia. Using the 1995-2018 waves of Health and Retirement Study, we offered novel evidence on the impacts of dementia and its precursors on a rich set of preventive care utilization and health behaviors in a longitudinal sample of Americans aged 50 and older. Leveraging both within- and between-individual variations in an event study, we characterized short- and long-term dynamic changes in preventive care and health behaviors relative to the incidence of dementia, suggesting early behavioral indicators of the disorder. 3,488 persons with incidence of dementia were identified and 22,619 consecutive person-waves around the incidence of dementia were included to estimate short-term effect. Individuals who never developed dementia were further included as the comparison group for long-term estimation. Results from statistical models showed that incidental dementia was associated with significant reductions in preventive care utilization, including cholesterol test, flu shot, mammogram, prostate test, and dental visit. Significant declines were also found in physical activities and body weights. Moreover, growing declines were observed in preventive care utilization, physical activities, and body weight 4-6 years prior to the incidence of dementia, with escalating impact over time. These findings highlight vulnerability and costs dementia risk may accrue to disrupt preventive care utilization and health behaviors. Targeted interventions are needed to detect signals associated with dementia risk to shield individuals from adverse behavioral and health consequences.
VIGILANCE, STRESS COPING, AND DISPARITIES IN METABOLIC HEALTH OVER THE LIFE COURSE
Authors: Kalesnikava Viktoryia , Evans Michele , Zonderman Alan , Mezuk Briana
Published: December 2022

Recent investigations of the mechanisms through which stress may impact cardiometabolic health point to the potential importance of cognitive tendencies (e.g., vigilance, coping strategies) in this relationship. This study examined the associations between vigilance and stress coping with metabolic risk, and whether these associations varied by race and life course socioeconomic status (SES). Data come from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, a cohort of urban adults (n=3720, baseline age 30-64 years; balanced by race, sex, age and household income). Vigilance was measured by the MacArthur Reactive Responding subscale; stress coping was measured by the Brief Cope scale. Metabolic risk was operationalized by metabolic syndrome z-scores (MetS-Z). Linear mixed models were used to examine longitudinal associations between cognitive tendencies and MetS-Z; interaction terms were used to examine effect modification by race and life course SES. Black participants reported higher adaptive coping; participants experiencing persistent poverty or downward mobility reported higher vigilance and avoidant coping and lower adaptive coping. Overall, vigilance was not associated with metabolic risk. Avoidant and adaptive coping were inversely associated with baseline MetS-Z and further varied by sociodemographic factors. Higher adaptive coping was associated with lower MetS-Z among White adults, while higher avoidant coping was associated with lower MetS-Z among Black adults. Lower stress coping were associated with higher MetS-Z among White participants with low lifecourse SES or downward socioeconomic mobility. In sum, stress coping may modulate the stress-health relationship, but these associations must be interpreted within the intersection of contextual factors.
LATE-LIFE CARE FOR OLDER ADULTS: FINDINGS FROM NHATS AND NSOC
Authors: Hu Mengyao , Patterson Sarah
Published: December 2022

With the aging of the U.S. population, caregiving has become an emerging public health issue that affects the health and quality of life for millions of care recipients and their caregivers. An increasing number of older adults rely on their family caregiver networks and home-based clinical services for physical, social and emotional support. Caregiving plays an important role in health and wellbeing of older adults both in daily life and in the context of health care, e.g., in post-acute caregiving after hospital discharge. There is a growing interest in identifying caregivers in greatest need of support and developing programs and interventions to help these caregivers. This symposium describes caregiver network and examines the roles of the caregiver network and family caregiving support on care recipients’ and caregivers’ quality-of-life outcomes using the National Health and Aging Trends Study (NHATS) and linked National Study on Caregiving (NSOC). This symposium will 1) evaluate typologies of the structures and compositions of caregiver network and examine their effects on care recipients’ well-being; 2) describe findings on associations between caregiving network and caregiver supports with unmet needs among older adults; 3) describe the role of unpaid caregivers after hospital discharge; 4) evaluate effects of family caregiving support in facilitating the use of home-based clinical services by older adults; 5) examine the effects of family disagreement on caregivers’ emotional difficulty and overload in dementia caregiving. Together, these presentations suggest important public health implications for research, policy and practice for improving late-life caregiving.
WHEN FAMILIES DISAGREE: CORRELATES AND STRESS PROCESS OUTCOMES OF FAMILY CAREGIVER DISAGREEMENT
Authors: Leggett Amanda , Koo Hyun Jung , Lee Hannah , Baker Elaina
Published: December 2022

Dementia caregiving is a family affair, yet prior research suggests that families often disagree about care provision. We explore correlates of such disagreements and how disagreements relate to stress process outcomes of care. The current study examines 552 family caregivers for Medicare-eligible older adults with dementia from the 2017 National Study of Caregiving. We consider demographic and care characteristics as predictors of family disagreement in a multinomial logistic model, and family disagreement as the key predictor of caregiving overload, emotional difficulty, and gains in linear regressions. Females had greater odds of disagreement, while those with friends and family to talk to and providing assistance with household care activities had lower odds of disagreement. Family disagreement was significantly associated with overload (B=0.95, p<.001) and emotional difficulty (B=0.45, p<.05), but not gains. Interventions to help families manage care disagreements and coordinate care may have great impact on caregiver well-being.
OLDER ADULT ENGAGEMENT IN AGE-FRIENDLY COMMUNITY WORK
Authors: Pope Natalie , Cao Katy (Qiuchang) , Greenfield Emily
Published: December 2022

Drawing on 22 interviews with older adults across four states, this qualitative study explores how older adults perceive their age-friendly community work and the personal meaning they derive from participation. Based on iterative coding, findings indicate ways in which geographic differences in the structure and framing of local age-friendly community initiatives set the boundaries, scope, and potential customization of older adult engagement. Across geographies, motivations for starting and sustaining engagement included: perceived personal growth; social connectivity; outlets for advancing skills and passions; and satisfaction from making a difference in the lives of older adults and their broader community. These findings highlight the importance of conceptualizing older adult engagement in age-friendly community work as a dynamic process embedded within intrapersonal, interpersonal, organizational, and community contexts. Demonstrating multiple ways older adults contribute to placemaking, the findings have implications for older adult engagement at various levels and stages of age-friendly community initiatives.
DUALS AND ASSISTED LIVING: EXAMINING ACCESS AND OUTCOMES
Authors: Thomas Kali , Kim Hyunjee
Published: December 2022

Assisted living, a popular long-term care option for older adults needing personal care assistance, is increasingly serving a vulnerable population of low-income older adults dually-enrolled in Medicare and Medicaid (duals). However, we know very little about the needs of this population, their access to assisted living, the quality of care duals are receiving, and how this varies across states and assisted living providers. This symposium will include five presentations using national data and focused on access to assisted living for duals and the quality of care that duals in assisted living settings receive. The first two presentations take different approaches to investigate access to assisted living and how it relates to Medicaid policy: one examines Medicaid policies and their relationship to geographic access, and the other presents results from an analysis examining the association between Medicaid financing and segregation of duals. The next three presentations highlight important findings related to the quality of care for duals in assisted living: one focuses on concentration of duals in assisted living and its relationship with hospitalization and nursing home placement, one examines injury-related emergency department visits among duals, and the final presentation discusses the ability of duals in assisted living to age in place toward the end of life. The discussant, an expert in Medicaid policy, will conclude with a discussion of states’ different approaches for covering services in assisted living through their Medicaid programs, highlighting the opportunities for increasing equitable access and ensuring high quality care is delivered to this vulnerable population.
MEDICAID FINANCING AND SEGREGATION OF DUALS IN ASSISTED LIVING
Authors: Thomas Kali , Cornell Portia , Hua Cassandra , Rahman Momotazur
Published: December 2022

We used 2018 Medicare enrollment data, a national directory of licensed ALs, and Medicaid state policies. We identified a cohort of 474,661 AL residents and a comparison cohort of 58,911,266 community-residing individuals. We compared the distribution of duals across ALs to the distribution of community-dwelling duals across ZIP codes by taking the ratio of AL Gini index for each state over the community Gini index for each state (the “Gini ratio” or GR). On average, states with both waivers and state plans covering services in AL had the lowest Gini ratio (less segregated than community; GR=0.87;) States with no Medicaid financing for AL had the highest Gini ratio (more segregated than community, GR=1.16). Medicaid coverage for home and community-based services in AL is associated with increased access to AL for duals.
RETENTION OF DUALLY ELIGIBLE BENEFICIARIES IN ASSISTED LIVING AT THE END OF LIFE
Authors: Hayes Susan , Rosendaal Nicole , Wang Xiao (Joyce) , Thomas Kali , Belanger Emma
Published: December 2022

To examine to what extent dually eligible beneficiaries (duals) residing in assisted living remain there toward the end of life, we conducted a prospective cohort study of 98,944 Medicare beneficiaries present at validated AL ZIP codes in January 2017, and who died during a two-year follow-up. The outcome was AL residence in the last 30 days of life. We compared decedents who were not duals (80,156 decedents), with those newly dually eligible in 2017-2018 (3,722 decedents), and those already dually eligible in 2016 (15,066 decedents). Only 36.7% of new dual decedents resided in AL in the last 30 days of life, compared to 66.2% among those dually eligible in 2016, and 84.5% of those without Medicaid. While 29 states retained over half of all decedents in AL until death, only 8 states retained a majority of dually eligible decedents.
LGBTQ+ AFFIRMING CARE AND UNDETECTABLE=UNTRANSMITTABLE: EVIDENCE FOR OLDER GAY AND BISEXUAL MEN IN THE US SOUTH
Authors: Akre (she/her) Ellesse-Roselee , McKay Tara , Henne Jeff , Conway Adam , Gothelf Isabel , Kari Nitya
Published: December 2022

One of the most significant innovations in HIV prevention is the use of HIV treatment to prevent HIV transmission. This information has been disseminated as the “Undetectable = Untransmittable” (U=U) message. Despite evidence of effectiveness, U=U awareness, belief, and understanding remain limited in some communities. In this study we examine whether having an LGBTQ affirming healthcare provider increases U=U awareness, belief, and understanding among midlife and older gay and bisexual men in the US South, an understudied and underserved population and region where new HIV infections are increasing. We use data from the Vanderbilt University Social Networks Aging and Policy Study (VUSNAPS) on sexual minority men aged 50 to 76 from four Southern US states collected in 2020-2021. We find that only one in four men report prior awareness of U=U, but awareness is higher among HIV-negative and HIV-positive men who have an LGBTQ-affirming provider. Having an affirming provider significantly increases U=U belief and understanding, improves risk perception accuracy, and increases the likelihood of having ever tested for HIV among HIV-negative men. Improving access to LGBTQ affirming healthcare may improve U=U awareness, belief, and understanding, which could help to curb HIV transmission in the US South.
PARTICIPATORY DESIGN: AN ESSENTIAL PROCESS FOR SOCIALLY ASSISTIVE ROBOTIC ACTIVITIES IN LONG-TERM CARE SETTINGS
Authors: Lorraine Mion , Latshaw Emily , Lin Yi Chun , Migovich Miroslava , Ghosh Ritam , Khan Nibraas , Sarkar Nilanjan , Tate Judith
Published: December 2022

We conducted participatory design research for long term care (LTC) socially assistive robotic activities comprised of social, cognitive and physical components and enhanced human-robot (HRI) and human-human interactions (HHI). Repeated sessions were conducted with 10 geriatric experts (physicians, activity directors, nurses, occupational therapist) and 12 LTC residents (ages 70–92). Two robots, animal and humanoid, were used in combination with virtual reality. Four collaborative activities for paired older adults were designed and evaluated: playing drums to music, completing paintings, a fishing game, and training a dog with simple commands. Within each activity, three levels of difficulty were designed. Stakeholder feedback was obtained through observations and interviews. Numerous modifications were made following each session that addressed hardware, software and activity issues. Modifications were necessary both for the HRI and HHI aspects of the activity. Our experience demonstrates the necessity for participatory design in the deployment of technology for LTC settings.
GENETIC AND PHARMACOLOGIC PROTEASOME AUGMENTATION AMELIORATES ALZHEIMER’S-LIKE PATHOLOGY IN MICE AND FLIES
Authors: Pickering Andrew
Published: December 2022

The proteasome has key roles in neuronal proteostasis, including removal of misfolded and oxidized proteins, presynaptic protein turnover, as well as synaptic efficacy and plasticity. Proteasome dysfunction is a prominent feature of Alzheimer’s disease (AD) (1–3). Artificial impairment of proteasome function can mimic many neurodegenerative phenotypes (4, 5). We report impaired proteasome function to represent an early-stage marker of AD preceding many other markers of the disease. Significantly, we show that prevention of proteasome dysfunction by genetic manipulation in fly and cell culture models of AD delays mortality, cell death, and cognitive deficits. We developed a transgenic mouse with neuronal-specific proteasome overexpression which, when crossed with a mouse model of AD showed reduced mortality and cognitive deficits. To establish translational relevance, we developed a set of novel TAT-based proteasome-activating peptidomimetics. These agonists stably penetrate the blood-brain-barrier and enhance 20S as well as 26S proteasome activity. We show that treatment with these agonists protects against cell death in a cell culture model of AD as well as both cognitive decline and mortality in fly and mouse models of AD. The protective effects observed from proteasome overexpression in our models appear to be driven at least in part by increased turnover of the amyloid precursor protein (APP) by the proteasome. We conclude that the proteasome plays an important role in AD progression. Furthermore, augmentation of proteasome function is protective against AD-like pathogenesis in diverse models of the disease, representing a new therapeutic target for treatment of AD.
A DIGITAL ELDER ABUSE INTERVENTION FOR THE EMERGENCY DEPARTMENT
Authors: Abujarad Fuad , Choo Esther , Dziura James , Edwards Chelsea , Pantalon Michael , Jubanyik Karen , D'Onofrio Gail , Gill Thomas
Published: December 2022

Elder abuse continues to grow as a national issue with significant gaps in standards for identifying victims. The emergency department provides an opportune setting for affected older adults to report abuse privately, but traditional screening methods may miss certain types of elder abuse when there are no visible signs of abuse. Community resources and reporting methods may not be known or can be stigmatized, therefore creating a challenging scenario for victims of abuse to navigate without fear. The VOICES Elder Abuse Intervention (EAI) is a unique self-administrated tablet-based tool with an automated digital coach that combines major components of screening, educational content, and brief psychoeducational interviewing to empower the older adults and encourage self-identification and self-reporting of abuse. The digital format of the tool allows this EAI to be integrated within an existing elder abuse workflow protocol in the emergency department, rather than replacing it entirely. We will discuss our completed study that included (N=1,002) participants over the age of 60, which suggests that patients find the EAI user-friendly and easy to use. For example, 93% of participants agreed that VOICES was appropriate for learning about abuse, and 94% agreed that using VOICES was very easy to use. Informed by these findings, we plan to adapt and evaluate VOICES EAI for use in other older adult populations and healthcare settings.
MENTAL HEALTH RESILIENCE IN SWISS OLDER ADULT SURVIVORS OF CHILD WELFARE–RELATED MALTREATMENT
Authors: Thoma Myriam , Bernays Florence , Maercker Andreas , Rohner Shauna L
Published: December 2022

Minors affected by child welfare practices in Switzerland during the last century had a high risk for exposure to childhood trauma and maltreatment. Several studies with this cohort demonstrated substantially higher levels of clinically-relevant psychopathology in older adult survivors in comparison to non-affected control individuals. However, these studies also revealed that not all affected individuals developed mental health disorders over their lifespan. To date, this mental health resilience in survivors of an advanced age is still insufficiently understood. Therefore, this study aimed to assess and compare the resilience profiles of older adults who were formerly affected by child welfare-related trauma and maltreatment (risk group, RG; n = 132; Mage = 71 years) and non-affected, age-matched controls (control group, CG; n = 125). Within the RG, approximately one-third of the individuals had no current or lifetime DSM-5 mental health disorders. In comparison to the survivors with a history of mental ill-health, these individuals were older, had a higher income, and expressed a higher subjective satisfaction with their socio-economic status. Furthermore, they reported less early-life physical abuse, and had lower levels of neuroticism, as well as empathy-related characteristics. In addition, they showed higher levels of self-esteem and trait resilience. Group differences between the RG and CG highlight the importance of considering past adversity in the understanding of mental health resilience in later life.
GENETIC RISK FOR ADHD ON LATER LIFE EMOTIONAL AND COGNITIVE HEALTH: TESTING MECHANISMS OF EFFECT
Authors: Arpawong Thalida , Huh Jimi
Published: December 2022

Attention Deficit Hyperactivity Disorder (ADHD) is associated with emotional regulation and cognitive processing challenges throughout life. Not well-understood is how ADHD genetic risk (ADHD-GR) affects depressive symptoms (DepSx) and cognitive functioning in older age. Furthermore, less is known about the mechanisms through which some individuals show better outcomes despite higher ADHD-GR. We evaluated potential mechanisms using the Health and Retirement Study with data from 7,871 European Americans (EAs) and 1,226 African Americans (AAs), ages 50-93, and ADHD-GR calculated from a mixed ancestry genomewide scan. Mediators included closeness of parental relationships during childhood, sense of purpose in life in adulthood, and educational attainment. Outcomes included validated scales for DepSx and cognitive functioning. Structural equation models were stratified by race/ethnicity due to potential differences in genetic effects, adjusted for age, gender, ancestry, and health conditions with DepSx and genetic risk for dementia with cognitive functioning. Among EAs, ADHD-GR significantly predicted lower sense of purpose (p<.05) and worse parental relationships (p<.001), with higher levels of both, in turn, predicting less DepSx (p's< 0.01). ADHD-GR also showed significant direct effects on DepSx (p<.01), controlling for mediators. Additionally, ADHD-GR predicted less education (p<.001), but more education predicted better cognitive functioning (p< 0.001). No relationships with ADHD-GR were significant among AAs. Findings imply that among EAs, mediators could be targets to mitigate negative effects on psychological and cognitive health, two hallmark challenges for individuals with ADHD. More work is needed to characterize ADHD-GR on outcomes among older AAs.
POST-TRAUMATIC STRESS AND LONELINESS AMONG OLDER PUERTO RICANS: HOW DOES DISCRIMINATION MATTER?
Authors: Wang Kaipeng , Ortiz Daniel Vélez , Colón Lisa , Sun Fei
Published: December 2022

Loneliness is associated with worse mental health conditions, more functional limitations, and higher mortality among older adults. Almost one third older Puerto Ricans have experienced loneliness. Research has shown that post-traumatic stress has been associated with higher risk of loneliness among older adults; however, such an association has not been examined among Puerto Ricans despite their high prevalence of post-traumatic stress disorder. In addition, perceived discrimination, a critical risk factor of social isolation, is likely to reduce help-seeking behaviors and aggregate loneliness among individuals who have experienced trauma. Nonetheless, few studies have focused on the moderating role of perceived discrimination on the association between post-traumatic stress and loneliness. This study examines the association between post-traumatic stress and loneliness and whether that association differs by everyday perceived discrimination among older Puerto Ricans. Data were collected from 304 Puerto Ricans aged 60 and above living in the Greater Boston area who responded to questionnaires. We used ordinary least squares regression to examine the association between post-traumatic stress, perceived everyday discrimination, and loneliness. We found that post-traumatic stress was significantly associated with higher levels of loneliness; however, the association differed by perceived everyday discrimination. The association between post-traumatic stress and loneliness was stronger for those that perceived a higher level of everyday discrimination. Findings underscored the role that perceived discrimination plays in exacerbating loneliness among older Puerto Ricans experiencing post-traumatic stress and have clinical and public health implications for service delivery and mental health promotion among older Puerto Ricans.
SOCIAL HEALTH AND IMMUNE SYSTEM IMBALANCE: SEX-SPECIFIC ASSOCIATIONS AND CAUSAL LINKS TO BRAIN AGING
Authors: van der Velpen Isabelle , Yaqub Amber , Vernooij Meike , Perry Marieke , Vernooij-Dassen Myrra , Ghanbari Mohsen , Ikram Arfan , Melis Rene
Published: December 2022

Background

We explored whether the balance between innate and adaptive immune system links social health to cognitive brain aging in community-dwelling older adults.

Methods

Social health markers (social support, marital status, loneliness) were measured in the Rotterdam Study in 2002-2008. Balance of the immune system was assessed using white blood-cell-based indices (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII)) during the same visit. Cognitive function and total brain volume were measured at the 2009-2014 follow-up visit.

Results

In 8375 adults (mean age 65.7, 57% female), never married participants had higher NLR, PLR and SII compared to married peers, indicating imbalance towards innate immunity. Widowed/divorced males, but not females, had higher NLR, PLR and SII. Immune system balance did not mediate associations between social health and cognitive brain aging. Discussion: Social health is sex-differentially associated with immune system balance, but does not link to cognitive brain aging through mediation.
AN OPTIMIZED MOUSE PARABIOSIS PROTOCOL FOR INVESTIGATION OF AGING AND REJUVENATIVE MECHANISMS
Authors: Rodriguez Sonia , Carver Chase , Ayasoufi Katayoun , Boynton Felicia Duke , Schafer Marissa
Published: December 2022

Surgical parabiosis is widely used to study the mechanistic influence of the circulating milieu on aging and regeneration. This powerful model presents diverse complications based on age, strain, sex, and other experimental parameters. In young (Y) and old (O) male and female C57BL6 mice, we optimized heterochronic (n=12) and isochronic (n=10 Y-Y, n=7 O-O) parabiosis. Throughout protocol development, we identified several complications including variable responses to anesthesia, external and internal dehiscence, dehydration, and weight loss. We identified and implemented solutions during surgical and post-surgical periods, including titrated anesthesia, reinforced internal sutures, topical agents to promote wound healing, and increased supplementation. By consistently adopting protocol changes we were able to significantly increase survival. Separately, we confirmed the time course of chimerism in heterochronic pairs of C57BL6 and Tg(act-EGFP)Y01Osb (eGFP) mice. Baseline and longitudinal blood samples were collected via tail vein. Flow cytometry was used to visualize GFP-positive cells from the parabiont blood sample. Through blood analysis we found that chimerism occurs as early as 2 days post-operatively. Exploitation of our optimized protocol may enable others to efficiently adopt the surgical parabiosis model to dynamically study mechanisms of aging and regeneration.
CELLULAR RESPIRATION AND RESILIENCE AS A POTENTIAL BIOLOGICAL MECHANISM DRIVING SEX DIFFERENCES IN AGING
Authors: Salmon Adam , Adekunbi Daniel
Published: December 2022

There are substantial differences in the progression of aging between males and females including in progression and prevalence of disease and longevity. Not all can be explained solely by sex-specific endocrine regulation and growing evidence suggests there are basic biological and genetic differences in sex that drive disparity in physiological function. In this study, we describe metabolic differences at the cellular level that both define some of these biological differences as well as provide a potential mechanism for delineating relevant molecular mechanisms of aging. Using HET3 mice, a genetically heterogeneous model with a consistent female advantage in longevity, we show that primary fibroblast lines retain functional metabolic characteristics, including mitochondrial response and stress resilience, which are representative of the sex of the donor animal. These differences persist even after several rounds of passage using standard culturing techniques suggesting these differences are not driven by direct impact of circulating sex hormones. Moreover, we find that differences in these cellular responses have some predictive power to determine both sex- and individual-specific responses to physiological challenge including obesity and longevity. In addition, we are able to use this model to delineate how donor sex affects cellular responses within defined pillars of aging including proteostasis, metabolic function, and adaption to stress. Overall, our model then provides valuable in defining the cellular responses that contribute to the mammalian aging process.
QUALITY CARE AND CONFLICTING RIGHTS AMONG RESIDENTS WITH DEMENTIA, FAMILIES, AND STAFF IN LONG-TERM CARE FACILITIES
Authors: Perone Angela
Published: December 2022

Conflicting rights between residents with dementia and staff pose unique problems for quality of care in long-term care (LTC) facilities. Residents relying on staff for care may be afraid to express concerns. A disproportionate female (and often women of color) staff may be exposed to discrimination that stems from a resident’s loss of executive functioning and inability to control emotions. Family often find themselves somewhere in the middle. This study, thus, poses two research questions: (1) How do residents, families, and LTC staff understand their rights when conflicts arise between residents with dementia and staff?; (2) How can we leverage collective expertise of residents, families, and LTC staff to deliver a more holistic approach for addressing these conflicts? To answer these questions, I employed a multi-method qualitative design using semi-structured interviews (n=90) and participant observation (n=8 months). Building on legal consciousness theory—which explains how individuals invoke (or do not invoke) legal principles to define everyday experiences—findings revealed that staff rarely invoked legal framings to describe interactions whereas residents readily invoked rights rhetoric. Families mostly avoided rights rhetoric and instead focused on storytelling. All groups (residents, staff, and families) employed an array of emotional literacy and life experiences to navigate conflicts that coalesced around empathy. This paper concludes with research, policy, and practice suggestions for invoking principles of empathy to advance quality of care for residents with dementia by improving interactions among residents, staff, and family and workforce conditions for staff that flow from these interactions.
RESULTS FROM A PLATFORM-BASED CLINICAL TRIAL FOR PERSONS DIAGNOSED WITH MILD COGNITIVE IMPAIRMENT
Authors: Gibson Allison , Pope Caitlin , Parsons Kelly , Rhodus Elizabeth , Huffmyer Mark , Johnston Julia , Jicha Gregory
Published: December 2022

The process of receiving a diagnosis of mild cognitive impairment (MCI) is overwhelming. Individuals may experience adaptive or maladaptive responses to the diagnosis. Five specific areas of maladaptive response were previously identified, including 1) failure to plan for future decline, 2) decreased compliance and interaction with medical care providers, 3) decreased confidence and reduced social engagement, 4) increased physical limitations and mobility, and 5) decreased medication compliance. This pilot study reports on the delivery of the platform-based trial for persons diagnosed with MCI with survey data and qualitative focus groups data (n=38). The study consisted of a single-site platform trial examining the intervention group. Using this approach allowed the participants to explore different biopsychosocial arms of the intervention. Second, the platform design allowed researchers to determine the effects of the interventions on patient help-seeking and adherence behavior in real-world care. Feasibility, opportunities, and challenges will be discussed. Opportunities include the group’s cohesion with the group-based intervention, which increased engagement for study group participation. Additionally, participants were most susceptive to intervention components that were novel (i.e., mindfulness) and administered by a professional (i.e., pharmacist, physical therapist) as opposed to self-facilitated activities. Challenges include frequency of study visits, the study partner requirement, and the in-person delivery of the intervention. These challenges were further compounded by the COVID-19 pandemic. Findings from this study offer considerations in implementing support programming and clinical research for persons diagnosed with MCI. The presentation will also include discussion on COVID-19 pandemic-related protocol modifications of this intervention study.
BUILDING A COUNTYWIDE ALZHEIMER’S DISEASE AND RELATED DEMENTIA RESOURCE INVENTORY
Authors: Reyes Mariana , Barragan Noel , Kuo Tony , Thomas Ariane
Published: December 2022

As a BOLD Public Health Program grantee, the Los Angeles County (LAC) Department of Public Health (DPH) was funded to translate national ADRD priorities to the local level. Guided by the social ecological framework, DPH aims to address ADRD by engaging a multi-pronged approach that meaningfully considers the intersection of social, political, and environmental realities when developing and implementing key strategies. As part of this effort, DPH developed a resource inventory and simultaneously created a dedicated website to host and disseminate this information. The target audience for this resource inventory includes the general public; people living with ADRD and their caregivers and families; health professionals; and community-based and allied health professionals. The resource inventory encompasses a wide range of educational information, training materials, local programs, and services related to ADRD such as trainings for healthcare providers to strengthen their knowledge and ability in screening and diagnosing ADRD and legal/financial planning tips for caregivers. In developing the inventory’s scope, DPH relied on multi-sector partners to understand the needs of LAC’s diverse communities especially keeping in mind communities disproportionately impacted by ADRD (e.g., Black and Latinx communities). Stakeholders highlighted the need to ensure that resources addressed both ADRD topics and critical community needs related to the social determinants of health. The final inventory drew extensively from a wide range of existing national, state, and local resources. This presentation will outline DPH’s resource inventory development process and share how results will be used to identify resource gaps and inform local ADRD-focused efforts.
SYMPTOMS CONTRIBUTING TO SLEEP PROBLEMS IN OLDER ADULTS WITH TYPE 2 DIABETES
Authors: Kim Min Jung , Fritschi Cynthia , Cho Eunhee
Published: December 2022

Sleep problems are common in older adults. Those with diabetes are more vulnerable to sleep disorders since diabetes-specific symptoms can interfere with sleep quality. Yet little is known which diabetes symptoms most strongly affect sleep in older adults. This study aimed to examine the associations between diabetes symptoms and sleep and to identity the symptoms that most strongly disrupt sleep in older adults in the United States. Diabetes symptoms were assessed using the Diabetes Symptom Checklist-Revised. Sleep impairment and sleep disturbance were self-reported using The Patient-Reported Outcomes Measurement Information System. Demographic (age, sex, race/ethnicity) and other variables (body mass index, depressive symptoms, diabetes duration, glycemic control) were also assessed. Multivariate regression analyses were used with standardized coefficients. A total of 82 adults aged ≥ 60 years were included (mean age = 68.32 ± 5.29 years, White 76.83%, female 56.1%). After controlling for demographic and other variables, increased hypoglycemia (β = .35), hyperglycemia (β = .38), fatigue (β = .65), cognitive (β = .48), and ophthalmologic (β = .25) symptoms and neurological pain (β = .42) significantly increased sleep impairment. Of these, fatigue was the strongest contributor to sleep impairment. Similarly, increased hyperglycemia symptoms (β = .30), fatigue (β = .34), and neurological pain (β = .37) significantly increased sleep disturbance while neurological pain was the strongest contributor. To improve sleep quality of older adults with diabetes, their diabetes symptoms should be comprehensively assessed, and potential contributor to poor sleep such as increased fatigue and neurological pain should be addressed.
DEPRESSION, ANXIETY, STRESS, AND HEADACHE IN BRAZILIAN OLDER PEOPLE IN THE CONTEXT OF THE COVID-19 INFODEMIC
Authors: Bulgarelli Alexandre , Santos Camila Mello Dos , Cavalcante Ricardo , Frichembruder Karla
Published: December 2022

Objective

The aim of the present study was to analyze the prevalence and factors associated with headaches in Brazilian older people in the context of COVID-19 Infodemic.

Methods

This is a cross-sectional study carried out with 3,307 older Brazilians through a virtual questionnaire, self-completed using a cell phone, tablet, or computer with internet access. The questionnaire was composed of the Geriatric Depression Scale(GDS), Geriatric Anxiety Inventory(GAI), and the Perceived Stress Scale (PSS). Data collection was developed between June 2020 and January 2021. The analysis model consisted of variables distributed into four blocks: exogenous variables, primary determinants, health behaviors, and health conditions. It was used the Goodness-of-fit test to assess the quality of fit of the final model. Poisson regression with robust variance was used to estimate the associations.

Results

The prevalence of headache was 31.7% (CI 95%: 30 – 33). This outcome was associated with the use of psychotropic drugs (p < 0,001), concern with information about COVID-19(p < 0,001), symptoms of depression and anxiety(p < 0,001), and perception of stress(p < 0,001).

Conclusion

Anxiety, depression, and stress are thought to be associated with headaches in older adults who are exposed to excess information and fake news about COVID-19. It is considered that in the COVID-19 Infodemic scenario, headache in older people who have access to information is an important marker of mental health associated with suggestions of depression, anxiety, and stress.
VALIDITY AND RELIABILITY OF THE ROWLAND UNIVERSAL DEMENTIA ASSESSMENT SCALE: IMPLICATIONS OF AN INDONESIAN STUDY
Authors: Komalasari Renata , Mpofu Elias
Published: December 2022

Standardized dementia screening self-report assessments from developing countries are increasingly adopted in developing countries. Yet the cross-cultural transportability of dementia screening tools cannot be assumed. The Southeast Asia region has one of the fast-growing geriatric populations but no locally developed or validated measures of cognitive decline among older adults. This study aimed to determine the validity and reliability of scores from the Rowland Universal Dementia Assessment Scale (RUDAS) for use in the multiethnic older adult population in Indonesia. Participants were 135 Indonesian older adults (females = 61.5%, males = 38.5%; age range = 60-82) who were patients of a geriatric nursing centre. They completed the Indonesian translation of the Rowland Universal Dementia Assessment Scale (RUDAS-Ina). Exploratory factor analysis and confirmatory factor analysis of the scores yielded two factors explaining a total of 55.13% (the first factor explained 38.18%; the second factor explained 16.96%) of the variance for the entire set of variables. The reliability of scores from the RUDAS-Ina was marginally satisfactory (Cronbach α = .61), suggesting a need for locally developed measures for use with the Indonesian geriatric population. Future studies should consider the feasibility of developing and calibrating an adapted RUDAS to the Indonesian setting, which also may be studied in other Southeast Asian countries.
UTILIZATION TRENDS OF GLUCOSE-LOWERING DRUGS FOR TYPE 2 DIABETES IN OLDER ADULTS WITH AND WITHOUT DEMENTIA
Authors: Gopalakrishnan Chandrasekar , Kim Dae , Patorno Elisabetta
Published: December 2022

Dementia is an important consideration in the therapeutic management of older adults with type 2 diabetes (T2D). Given the recent availability of numerous second-line therapeutic agents, there is limited evidence on uptake of these newer medications by dementia status. Using Medicare fee-for-service data from 2013-18, we identified a cohort of patients with T2D who initiated a glucose-lowering drug (N=3,355,725; mean [SD] age, 74.8 (6.9) years) and stratified our analysis based on the presence of a diagnosis for dementia in the year prior to treatment initiation. Amongst patients with dementia (N=511,835; mean [SD] age, 79.9 (7.7) years), metformin use remained stable from 25.8% to 24.8%, whereas sulfonylureas (20% to 17.5%) and insulin (31.8% to 26.2%) use declined. Amongst patients without dementia (N=2,843,890; mean [SD] age, 73.8 (6.3) years), metformin (31.7% to 24.7%), sulfonylurea (22.1% to 19.4%) and insulin use (18.7% to 14.6%) decreased. DPP-4i and glitazones use remained largely stable whereas the use of newer agents such as SGLT-2i and GLP-1 RA increased steadily in both patients with and without dementia though the uptake was much higher in patients without dementia. By the end of 2018, 19.6% of patients initiated either a SGLT-2i or a GLP-1 RA amongst those without dementia whereas only 11.1% did so amongst those with dementia. In conclusion, older medications such as metformin, sulfonylureas and insulin accounted for about two-thirds of initiated glucose-lowering medications and were more frequently used by patients with dementia, though their use declined steadily over time with the availability of newer agents.
ASSOCIATION OF HBA1C WITH BEHAVIORAL SYMPTOMS OF DEMENTIA IN VA NURSING HOME RESIDENTS WITH DIABETES (2013–2019)
Authors: Lee Alexandra , Shi Ying , Growdon Matthew , Yaffe Kristine , Covinsky Kenneth , Lee Sei
Published: December 2022

For people with dementia, behavioral symptoms of dementia are often signs of distress and may be caused by pain, confusion, agitation, or negative moods. In people with diabetes, pain, confusion, and agitation may result from aspects of diabetes management, including poor glycemic control, episodes of very low or high blood sugar (hypo- and hyper-glycemia), insulin injections, or fingerstick pricks to check blood glucose. Few studies have examined how diabetes control contributes to behavioral symptoms of dementia. We conducted a retrospective study in VA nursing home (NH) residents aged 65+ with both dementia and diabetes, and a NH stay>45 days. We used the second assessment of the Minimum Dataset (MDS 3.0) to identify behavioral symptoms of verbal or physical outbursts during the prior 7 days. We conducted mixed-effects logistic regression, with clustering by NH facility. The 5060 residents were overwhelmingly male (99%), had an average age of 78, with mean HbA1c was 7.1 (standard deviation 1.6). The overall prevalence of any behavioral symptoms was 16.7%. Compared to residents with HbA1c < 6%, behavioral symptoms were slightly more common among residents with HbA1c 6-7%, 7-8%, and >9%, but not statistically significantly different. Behavioral symptoms were significantly more common in residents with HbA1c 8-9% (prevalence 19.6%) than in residents with HbA1c < 6% (prevalence 15.5%; odd ratios adjusted for NH facility: 1.35, 95% confidence interval: 1.05-1.75). Additional research is needed to determine which aspects of diabetes management may be contributing to excess risk of behavioral symptoms of dementia.