bluuebunny/crossref_metadata_2025 huggingface dataset:
“I’M INDEPENDENT. SO FAR...”: INVESTIGATING INFORMAL CAREGIVING PATTERNS OF OLDER ADULTS WITH PRIMARY LIVER CANCER
Authors: Watman Deborah , Perez Sasha , Chen Yingtong , Lubetsky Sara , Woodrell Christopher
Published: December 2023

Older adults with advanced stage hepatocellular carcinoma (HCC) are living longer given improved treatment effectiveness. Little is known about their unmet supportive care needs and their caregivers’ needs, some of which may be addressed by palliative care. Previous studies of palliative care in populations facing liver disease have cited difficulty with recruitment. This is a cross-sectional study at a single academic medical center in NYC that uses validated survey instruments and qualitative interviews to explore caregiver support for those receiving treatments for HCC. We recruited patients with liver disease, and caregivers of patients 60 years or older. Validated survey instruments were used to collect data and a qualitative interview is conducted that focuses on the experience of supporting a loved one with HCC. 65% (13/20) participants were over the age of 60. PDSA framework was used to improve recruitment to four caregivers thus far. Results showed that language matters. Recruitment materials were updated from “palliative” to “supportive” care, to reduce stigma and fear of worsening health status and the perception of burden. Older adults value their independence and are not likely to identify a “caregiver”. They may be more willing to identify a loved one who is there to help. 90% of older adults identified a caregiver using the Duke Social Support Index. Thoughtfulness and adaptability are necessary when recruiting amongst this vulnerable yet increasingly independent population. Furthermore, older adults facing liver disease may be solo agers with no caregiver, increasing the need for supportive care as their disease progresses.
BUILDING RESILIENCE USING PHOTOVOICE AMONG FAMILY CAREGIVERS
Authors: Ramos Mary Dioise
Published: December 2023

Filipino Americans remain one of the most underrepresented groups in research. It is challenging to identify the healthcare needs related to palliative and end-of-life care, especially among family caregivers. Palliative care is not yet well known in general, including among Filipino immigrants. Most people seem to adjust to the caregiver role and recover from Trauma/Emotional strain. However, some experience a long-lasting decline in their mental and physical health. This study will fill the gap in our understanding of the experiences of bereaved Filipino American family caregivers who have provided palliative and end-of-life care to their loved ones. This study aimed to explore the opportunities and challenges faced by Filipino American family caregivers who provided palliative and end-of-life care to their loved ones in the United States. The study also examined the impact of Photovoice as an intervention to build resilience, social support, and health-related quality of life among caregivers. The findings revealed that caregivers engaged in self-care activities, sought support from their social networks and healthcare providers, used coping strategies to manage emotional stress, found meaning in their caregiving experiences, and faced physical and emotional demands associated with caregiving. The Photovoice intervention was found to improve caregivers’ resilience and HRQOL significantly, but not their social support. Caregivers need assistance to manage the demands of providing care, including preparing for the future, securing help, and navigating agencies and relationships. Healthcare providers need to provide adequate support and resources to help caregivers manage the physical and emotional demands associated with caregiving.
PERSPECTIVES TOWARD ADVANCE CARE PLANNING IN FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA: Q METHODOLOGY STUDY
Authors: Cho KyungAh , Shin Myoung Hwan , Lee Jung-Ah , Heo Seongkum , Baek Sang Yi , Yang Jisun , Park SeongHu , Kim JinShil
Published: December 2023

Background

Family caregivers’ perspectives toward advance care planning (ACP) is critically important to reflect end-of-life wishes of people with dementia (PWD). Purpose: To explore the ACP perspectives among family caregivers of PWD using a Q methodology. Methodology: Q sample with statements regarding the characteristics of caregivers’ perspectives toward ACP was constructed. P sample of 25 caregivers completed each grid with a statement for Q sorting table. Data analysis was done using the PQ Method program (Ver. 2.35).

Results

Three factors emerged through a Varimax rotation and explained 53% of the total variance. Factor 1 (n = 12) (General cases: Planned preparation of pre-care planning (PPP) and understanding and thoughtfulness of the behaviors of PWD) consisted of caregivers who knew the importance of PPP and willingly tried to understand and manage dementia. Factor 2 (n = 7) (Severe cases: Unplanned preparation of PPP and feeling of responsibility and burden for management of PWD) consisted of caregivers who did not have PPP and had concerns and anxiety about management of PWD. Factor 3 (n = 5) (Mild cases: Optimistic preparation of PPP and proudness for caring PWD) consisted of caregivers who were optimistic about dementia care, were proud of their duty of caring PWD, and thought meeting patients’ needs and caring them as valuable.

Conclusions

Caregivers of PWD had different ACP perspectives based on the severity of cognitive impairment in patients. Clinicians should consider the levels of patients’ cognitive impairment to provide effective ACP education to caregivers of PWD.
RURAL CAREGIVER PERSPECTIVES OF SUPPORTING PATIENT ENGAGEMENT IN VIDEO VISITS
Authors: Gately Megan , Waller Dylan , Maynard Matthew , Moo Lauren
Published: December 2023

Rapid integration of telehealth in response to the COVID pandemic highlighted digital divide issues, specifically for video, which is a live, synchronous encounter. Older patients may have difficulty navigating a video session due to age, health-related impairment, or low technical competence. Further, specialty services which involve hands-on care, such as occupational therapy (OT), are more complex to translate to video, potentially necessitating a second person to assist with set-up or delivery of clinical care. Caregivers may aid in bridging the digital divide between patient and clinicians in a video session. However, little is known about caregiver willingness and capacity to assume a support role in video, particularly caregivers of rural patients, who have more complex care needs and face more issues accessing needed technology than urban patients. To understand the caregiver role supporting older rural patient engagement in video sessions, we conducted interviews with caregivers (N=25) of older rural veterans with an OT video visit. Interview topics included caregivers’ prior use of and general attitudes toward technology, and experiences of the video visit, including set-up and operation of technology and experience participating and supporting patient engagement. Findings revealed a range of rural caregiver perspectives about the role of technology to facilitate patient access to care, including enabling factors which highlighted caregivers’ education and training support needs. This study deepens our understanding of the importance of caregivers to support rural patient access of video sessions, informing development of strategies to optimize caregiver participation.
DO OLDER ADULTS APPRAISE ELDERSPEAK COMMUNICATION AS PATRONIZING OR RESPECTFUL IN HOSPITAL DEMENTIA CARE?
Authors: Shaw Clarissa , Ward Caitlin , Weimar Lisa
Published: December 2023

Elderspeak communication is speech that sounds like babytalk to older adults. The Iowa Coding Scheme for Elderspeak (ICodE) contains 11 elderspeak attributes: diminutives, childish terms, collectives, short words, directives, reflectives, minimizers, exaggerated praise, laughter, tag questions, and exaggerated prosody. Thirty-one older adults (aged 74.5±7.8 years) listened to 41 clips of nursing staff providing care to hospitalized patients with dementia and rated each clip using the 5-point Emotional Tone Rating Scale for patronizing and respectful (5=very, 1=not at all). Each clip was classified using the ICodE as either neutral (no elderspeak), containing a single attribute, or containing an attribute with exaggerated prosody. Linear mixed modeling was used to evaluate the differences in patronizing and respectful ratings between neutral clips and each attribute, and clips with each attribute and exaggerated prosody, while controlling for within-subjects correlation and adjusting for multiple comparisons. Mean ratings for neutral clips were 4.0±1.1 for respectful and 1.7±1.0 for patronizing. Ratings for elderspeak attributes ranged from 2.1 to 2.9 for patronizing and 2.8 to 3.8 for respectful. Ten of the 11 attributes, excluding exaggerated praise, were rated as significantly more patronizing and less respectful than neutral. The addition of exaggerated prosody was significant in comparison with the elderspeak attribute alone for exaggerated praise (more patronizing and less respectful), laughter (more patronizing), short words (less patronizing, more respectful), and diminutives (less respectful). This analysis validates that the attributes of the ICodE are considered more patronizing and less respectful by older adults compared to neutral communication in hospital dementia care.
EARLY WARNING SYSTEM SCORE FOR URGENT ET TUBE OR UNPLANNED ICU ADMISSION FOR ELDERLY PATIENTS IN GENERAL WARDS
Authors: Suwanpasu Sunee , Poonsap Sukanya , Praparpak Werapattra
Published: December 2023

Early warning system scores are tools used to identify the early signs of physiologic deterioration in order to initiate early intervention and management. This study aims to investigate the efficacy of the National Early Warning Score (NEWS) score and Search out Severity Score (SOS) in predicting urgent ET tube or unplanned ICU admission. A Prospective analytical study of 85 patients aged 60 years and over in general medical wards, was conducted to assess the ability of SOS and NEWS. Prediction ability was assessed using sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC). The NEWS and SOS systems at 4 hours before the event were the most effective, with the cut-off values of NEWS> 7 and SOS> 4 giving the best accuracy (sensitivity 71.4%, 64.3% specificity 98.2%, 98.2%. Respectively). The area under the ROC curve [AUC]) was 0.90 (95% CI 0.81-0.99) and 0.86 (95% CI 0.75-0.97), respectively. The prediction efficiency decreased over time before the event. However, at 8, 12, and 24 hours before the incident, it was still accurate at a good-fair level (AUC 0.82, 0.82, 0.74, and 0.77, 0.79, 0.72, respectively) The NEWS system provides excellent accuracy, while the SOS system gives a good accuracy level. Therefore, the NEWS system should be used for the early detection of abnormalities and as a guideline for the rapid response to changes in the vulnerable elderly. It keeps patients out of the crisis and is safe and able to predict worsening patients.
INVESTIGATING ADVERSE OUTCOMES OF LONG-TERM STEROID IMMUNOSUPPRESSION IN ELDERLY RENAL TRANSPLANT RECIPIENTS
Authors: Johnson John , Stevenson Heather , Mujtaba Muhammad , Kueht Michael
Published: December 2023

Steroids are widely used in renal transplantation to prevent allograft rejection; however, long-term steroid use is associated with adverse side-effects such as hyperglycemia and osteoporosis, which elderly patients are especially susceptible to. Our study analyzed the adverse effects of long-term steroid immunosuppression in elderly renal transplant recipients using the TriNetX database. TriNetX was used to perform a propensity-score matched case-control study of 5-year outcomes in elderly renal transplant recipients (≥ 65 yrs) who either underwent an early-steroid withdrawal (ESW) or steroid-continuous (SCI) maintenance immunosuppression regimen. ESW patients were maintained long-term (5 yr) on tacrolimus and mycophenolate and discontinued prednisone 7 days post-transplant. The SCI cohort was maintained on 5yr tacrolimus + mycophenolate + prednisone. Cohorts were matched on age, sex, race/ethnicity, BMI, diabetes, cardiovascular disease, and bone disorders. Primary outcomes included rejection, drug-induced diabetes, bone fractures, and malignancy 5 years post-transplant. There were 197 patients in each cohort after matching (ESW, SCI). SCI patients had significantly higher incidences of 5-year drug-induced diabetes (4.53% vs 15.73%, p < 0.01) when compared to ESW. There was no significant difference found for incidences of rejection (33.02% vs 33.91%, p = 0.86), bone fractures (12.27% vs 16.29%, p = 0.19), or malignancy (11.57% vs 15.78%, p = 0.26). Our study found that elderly SCI patients had significantly higher incidences of drug-induced diabetes when compared to ESW. More insight is needed into differences in average glucose, blood pressure, and cholesterol throughout the duration of the study and dosage differences within the SCI cohort.
PARO ROBOT INTERACTION DECREASES PAIN AND AGITATION SCORES IN HOSPITALIZED OLDER ADULTS WITH ADRD AND/OR DELIRIUM
Authors: Cacchione Pamela , Munsterman Ellen , Walke Lisa , Triantos Lisa , Johnson Michelle , Cheeks Jodi
Published: December 2023

Hospitals are stressful for persons with Alzheimer’s Disease and Related Disorders (ADRD) and/or delirium. Therapeutic robotic animals, used in long-term care, are gaining traction in hospitals to decrease agitation. The purpose of this RCT was to 1) test the effectiveness of the PARO Robot in decreasing agitation (CMAI-OT) and pain, (PAINAD); 2) quantify the interactions (SIT) with PARO over 2 visits in persons with ADRD and/or delirium. We enrolled 45 intervention and 42 attention control (2 one-hour PARO interactions vs. research assistant interactions) participants. The CMAI-OT and PAINAD were completed at baseline and every 20 minutes X 3 in both groups. No differences between groups on age (M=83.7), gender (63% female), race (77 % Black) number of antipsychotics prescribed [M=1.2 vs M1.5, p=0.14], or baseline CMAI-OT scores PARO vs control [M=9.3 vs M=9.4, p=0.94]. CMAI-OT decreased at 20 minutes in the PARO group [M=3.9 vs. M=7.0, p= .004] and remained lower for the hour but not significantly. PAINAD scores were similar at baseline [M=2.0 vs M=2.2, p=0.65]. PAINAD scores decreased for PARO vs. control [M= 1.64 vs. M= 2.28, p=0.02; M=0.9 vs. M= 1.8, p=0.03] at 20 & 60 minutes day one without differences day two. Participants held PARO; engaged physically; talked to; smiled; and agreed to have PARO return. We demonstrated improved agitation for first 20 minutes of PARO interaction as well as lower pain over the first 60 minutes day one. Findings did not persist through day two. Next steps are to measure emotional responses to PARO.
COMMON INFECTIONS IN RELATION TO SLEEP DISTURBANCES BY RACE IN A POPULATION-BASED COHORT OF ADULTS
Authors: Rabinowitz Jill , Yue Yiwei , Chen Diefei , Yolken Robert , Jackson Chandra , Maher Brion , Eaton William , Spira Adam
Published: December 2023

Common infections (e.g., human herpesviruses and Toxoplasma gondii (TOX)), are associated with poor health outcomes, but less is known about associations between these infections and sleep. Due to, for instance, structural racism leading to policies and practices resulting in relative economic disadvantage and subsequently poorer living condition, sleep disturbances and common infections are more prevalent in minoritized populations. We investigated the cross-sectional associations of common infections (i.e., herpes simplex virus type 1 (HSV-1), cytomegalovirus (CMV), varicella zoster virus (VZV), Epstein-Barr virus (EBV), and TOX with sleep disturbances, and determined whether these associations differed by race in 602 adults enrolled in the Baltimore Epidemiologic Catchment Area Study (mean age=59.0±12.8 years, 36.9% male, 35.6% minoritized). Participants donated a blood sample and were asked whether they had the insomnia symptoms “trouble falling asleep, staying asleep, or waking up too early” and reported on their habitual sleep duration. We measured immunoglobin G (IgG) antibodies to HSV-1, CMV, EBV, VZV, and TOX. After adjusting for sociodemographics, body mass index, comorbidities, household income, and household size, there were no associations between common infections and any sleep outcomes ; however, we observed interactions with race. Among White participants only, CMV seropositivity was associated with a lower odds of insomnia symptoms (OR = 0.26, 95% CI 0.10, 0.69) and TOX seropositivity was associated with shorter sleep duration (OR = 0.65, 95% CI 0.09, 1.21). Further research is needed to investigate mechanisms that may account for associations of CMV and TOX with sleep among White but not minoritized participants.
MICROBIOME MODULATORS IN THE PREVENTION AND MITIGATION OF CANCER TREATMENT-INDUCED ACCELERATED AGING BIOLOGY
Authors: Miller Brandi , Mishra Sidharth , Chaudhari Diptaraj , Yadav Hariom , Jain Shalini
Published: December 2023

Advancements in oncology research have led to increased survivorship in patients with cancer. However, cancer treatments like chemotherapy cause debilitating side effects including multi-organ dysfunction and increased risk for chronic diseases, which mimic accelerated aging. Abnormalities in the gut microbiome composition (dysbiosis) increase inflammation, resulting in accelerated cognitive impairment with aging and a poor quality of life (QOL), which are all exacerbated by cancer treatments. We have screened, evaluated, and optimized our previously isolated human-origin live bacteria (probiotics) as well as pasteurized probiotics (postbiotics) for their anti-aging potential using Caenorhabditis (C.) elegans and mouse models. Probiotics improved the healthspan in C. elegans when given live and when fermented. Interestingly, PFM and LpD3.5 significantly protected from body weight loss, microbiome dysbiosis, and cognitive impairment in mice receiving 5-fluorouracil chemotherapy and protected from intestinal damage. We are planning a clinical trial where we will (1) cross-sectionally analyze the gut microbiome, leaky gut, and inflammation in cancer survivors with and without brain distress and (2) determine the safety, tolerance, and efficacy of PFM and LpD3.5 on microbiome diversity, inflammation, and cognitive health in cancer survivors with brain distress, using a 60-day open-label, randomized comparison study. These studies will improve our understanding of how cancer treatment-induced changes in the gut microbiome, inflammation, and gut permeability contribute to accelerated aging. Furthermore, they will establish the utilization of probiotics and postbiotics to improve QOL and mitigate cancer treatment-induced accelerated aging, which constitutes a debilitating public health concern among the increasing population of cancer survivors.
LIVING LONGER WITH MODERATE AMOUNTS OF OXYGEN RADICALS IN FRUIT FLIES
Authors: Kim Man Su , Ghimire Saurav
Published: December 2023

The role of reactive oxygen species (ROS) in aging is complex and paradoxical. While the free radical theory of aging suggests that ROS cause cellular damage and senescence, some studies have shown that moderate ROS levels can enhance cellular adaptation and longevity. In this research, we used Drosophila as an in vivo model to investigate the optimal level of ROS that can promote healthy aging. We exposed flies to different concentrations of paraquat (PQ), a herbicide that generates superoxide anions, and measured their lifespan, stress resistance, and gene expression. We found that intermediate PQ levels (0.1 mM) extended lifespan and improved stress tolerance, while high PQ levels (0.5 mM) shortened lifespan and impaired stress response. We also observed an up-regulation of ROS scavenger genes, such as superoxide dismutase 1 and glutathione peroxidase, in the intermediate PQ group, suggesting a homeostatic mechanism to balance ROS levels. Our findings challenge the conventional view of ROS as harmful agents and provide novel insights into the molecular mechanisms of aging.
SEROTONIN AND DOPAMINE CIRCUITS MODULATE AGING IN RESPONSE TO FOOD CUES AND AVAILABILITY
Authors: Leiser Scott
Published: December 2023

An organism’s ability to perceive and respond to changes in its environment is crucial for its health and survival. Multiple studies have shown that modifying this perception through genetic or environmental alterations can extend or shorten lifespan cell non autonomously. These results provide the rationale for identifying “longevity circuits” that could be used to extend healthspan and lifespan by using these signaling pathways. Here we reveal how the most well-studied longevity intervention, dietary restriction, acts in-part through a cell non-autonomous signaling pathway that is inhibited by the presence of multiple food cues. Using an intestinal reporter for a key gene induced by dietary restriction but suppressed by attractive food cues, we identify three compounds that block food cue effects in C. elegans, thereby increasing longevity as dietary restriction mimetics. These compounds and our additional data clearly implicate serotonin and dopamine circuits in limiting lifespan in response to food cues. We further identify multiple neurons, receptors and downstream signals within these circuits. Aspects of these pathways are conserved in D. melanogaster, suggesting at least some “longevity circuits” are conserved. Together, our results show that modulating food cue signaling through serotonin or dopamine circuits is a plausible approach to mimic the benefits of dietary restriction.
TARGETING MITOCHONDRIAL FUNCTION USING NOVEL RHO/MRTF/SRF INHIBITORS
Authors: Patyal Pankaj , Zhang Xiaomin , Azhar Gohar , Wei Jeanne
Published: December 2023

Altered mitochondrial metabolism is one of the major hallmarks of aging. Notably, age is the biggest risk factor for numerous cancers. Studies suggest that cancer cells shift from anaerobic respiration to oxidative phosphorylation for increasing energy needs. Therefore, this upregulation is a vulnerability that can be targeted using Rho/MRTF/SRF inhibitors. Recent advancement identified a novel series of oxadiazole-thioether compounds that disrupt the SRF transcription. Among those compounds CCG-203971 and CCG-232601 are most metabolic stable, soluble and have no toxicity. They have been shown efficacious in multiple animal models of acute fibrosis, including scleroderma. However, the direct molecular target of these compounds is unclear. Therefore, we investigated the molecular mechanisms of these inhibitors transcription mediated by RhoA which modulates actin dynamics to induce the nuclear accumulation of Myocardin-Related Transcription Factors and their activation of SRF/p49. Our findings suggest that, CCG-203971 and CCG-232601, inhibit Rho/MRTF/SRF/p49 mediated transcription in different cell lines. They contribute to H4 hyperacetylation at K12/16 while no change was observed at H4 acetylation at K5 and K8. Moreover, SRF also regulates cell metabolism by maintaining mitochondrial function. Thus, we further investigated the role of these drug molecules in targeting mitochondrial function. We found that these compounds inhibit the genes involved in mitochondrial function and dynamics. Further, these inhibitors repress the mitochondrial function at varying concentrations, investigated using Agilent Seahorse XF Analyzer. Herein, we propose that CCG-203971 and CCG-232601 may prove to be a promising approach therapeutically to target aberrant bioenergetics in aging and cancer.
EFFECT OF DEPRESSIVE SYMPTOMS AND WORK-RELATED FACTORS ON TRANSITION TO RETIREMENT IN OLDER ADULT
Authors: Saucedo Jennifer , Newsom Jason , Trubits Em , Kroeck Mallory , Botoseneanu Anda , Allore Heather , Nagel Corey , Quiñones Ana
Published: December 2023

Work demands can spillover to family domains (work-to-family conflict; WFC) and family demands may spillover to work domains (family-to-work conflict; FWC). This spillover between domains may help explain the relationship between depressive symptoms and decision to retire among older adults. This study examined the influence of depressive symptoms on likelihood of retirement transition through WFC and FWC using data from the Health and Retirement Study (HRS 2008-2018; N = 1031). Participants included adults age 51+ employed in 2008 and reported a transition to partial- or full-retirement by 2018. Cox survival models investigated whether WFC and FWC mediated the effects of depressive symptoms (CESD) on the likelihood of retirement transition, controlling for participant sex, age, education, insurance coverage, and race/ethnicity. Higher depressive symptoms were associated with higher FWC (B = 0.06, p < 0.01) and likelihood of retirement transition (B = 0.07, p < 0.01). Higher FWC was related to lower likelihood of retirement transition (B = -0.89, p < 0.01). The indirect effect of FWC was significant (B = -0.06, p < 0.01). Higher depressive symptoms were associated with higher WFC (B = 0.37, p < 0.01) and likelihood of retirement transition (B = 0.09 p = 0.04). However, there was a nonsignificant effect of WFC on retirement transition (B = -0.19, p = 0.07). WFC had no indirect effect on retirement transition (B = -0.04, p = 0.08). Results suggest that the experiences outside of work for older adults may explain the relationship between depressive symptoms and retirement decisions.
RETIREMENT TRAJECTORIES AND HEALTH IN JAPAN
Authors: Mizuochi Masaaki , Raymo James
Published: December 2023

The relationship between retirement and health is a key issue in aging societies. However, it is unclear whether the nature of retirement from full-time regular employment makes a difference in subsequent health. This study examines the relationship between the trajectory of retirement from full-time regular employment and subsequent health. Using the Longitudinal Survey of Middle-aged and Elderly Persons 2005–2019 collected in Japan, we employ sequence analysis to identify distinct retirement trajectories from full-time regular employment between ages 59 and 66. We then estimate the causal relationship between retirement trajectories and health using instrumental variable methods. Sequence analysis classifies the retirement trajectories into four groups: gradual retirement, abrupt retirement, continued non-standard employment, and continued regular employment. Instrumental variable estimation shows no statistically significant differences in the effects of these retirement trajectories on health, but suggests that gradual retirement may be more beneficial to health than other three retirement trajectories. Several robustness checks also show no statistical difference in the effect of retirement trajectories on health. These findings provide an empirical foundation for understanding the possible implications of heterogenous retirement pathways for health in later life and labor market policies in very old populations.
BEHAVIORAL HEALTH INTERVENTIONS IN THE HOSPICE SETTING: A SCOPING REVIEW
Authors: Brody Lilla , Sadowska Karolina , Holllingsworth Alexis , Ong Michael , Subramanian Tejas , Wright Drew , Reid M Cary , Shalev Daniel
Published: December 2023

Hospice is a model of care for individuals with a life expectancy of less than six months who choose to focus their treatment on quality-of-life rather than extending life. In 2019, half of all Medicare decedents elected to receive hospice care. Behavioral health comorbidities are prevalent in hospice patients; approximately 40% experience significant depression and/or anxiety. Such comorbidities are associated with poor outcomes including increased physical symptoms, worse function, and lower quality-of-life. Despite the impact of behavioral health comorbidities on hospice patient outcomes, little research has focused on the use of behavioral health interventions in the hospice setting. We conducted a scoping review to characterize the types of behavioral health interventions administered to patients receiving hospice care. We searched four databases, generating 6,842 unique citations over any time period. 70 texts were reviewed and 31 were retained for analysis. Studies examined both psychotherapeutic (n=10) and psychopharmacologic (n=10) interventions, as well as other non-pharmacologic interventions (n=11). Duration of study follow-up was available for 17 of the studies, ranging from six days to six months. 14 studies reported information on interventionists, who were most commonly music (n=3) or massage therapists/acupuncturists (n=3). Average interventions were 47 minutes for six sessions. 18 studies presented statistically significant results related to primary outcomes, most commonly depression (n=9), anxiety (n=6), and pain (n=4). Our findings demonstrate a dearth of behavioral health interventions targeting hospice patients, suggesting the need for increased research and clinical focus on developing, evaluating, and implementing behavioral health interventions in the hospice setting.
PROGNOSTIC ACKNOWLEDGEMENT IN OLDER ADULT CANCER PATIENTS
Authors: Maggiore Sophia , Koch Mary Kate , Bylund Carma , Bluck Susan
Published: December 2023

Even with improved prognostic transparency (Chochinov et al., 2000) individuals struggle to acknowledge a serious-terminal prognosis. Patients who acknowledge their condition, however, show less distress and increased end-of-life planning (Ray et al., 2006). Aims were to: (1) examine extent older adults with serious cancer acknowledge their illness, and (2) identify factors predicting acknowledgement. Individuals receiving outpatient palliative care (N=204; Mage=65.78 years; SDage=7.43) completed measures of Symptom Severity, the Patient Dignity Inventory (DPI; Chochinov et al., 2008), and Illness Acknowledgement (i.e., healthy, seriously ill, terminally ill). Participants with Stage 4 cancer were more likely to acknowledge serious or terminal illness than Stage 1-3 patients, X2 (2,181)=12.93, p <.01), though only 31% of Stage 4 patients reported being terminally ill. In addition, ANOVA showed Symptom Severity, F(2, 190) = 9.86, p < .001 differed by level of acknowledgement. Those rating themselves as relatively healthy had less severe symptoms than seriously or terminally ill groups. To further predict acknowledgement, DPI subscales were examined. Dependency predicted acknowledgement of serious-terminal illness (Odds Ratio = .75, p <.05). A final model, controlling for age and education, showed Symptom Severity (OR = 1.03, p <.01) and DPI Dependency (OR = .79, p <.05) predicted acknowledging serious-terminal illness versus lack of acknowledgement. Though often relied on in communicating to patients, cancer stage alone may not help older adults with cancer to acknowledge their prognosis. By identifying influences leading to illness acknowledgement, future research can examine positive and negative outcomes during end-of-life coping.
THE IMPACT OF DEMENTIA ON SLEEP QUALITY DURING COVID-19
Authors: Beltran Susanny , Hakim Talib , Suntai Zainab
Published: December 2023

Sleep disturbances are documented among older adults, and it is well-known that COVID-19 disproportionately affected older adults. Yet, studies on sleep quality among older adults with dementia, specifically, tend to focus on caregiver sleep. The purpose of this study was to examine sleep quantity and quality among older adults during 2020. Data were taken from the 2020 National Health and Aging Trends study, an annual study of Medicare beneficiaries aged 65 and older. Chi-square tests were used for bivariate analysis, and multivariate logistic regression models were used to assess differences in sleep quantity and quality between dementia and non-dementia older adults in the national sample. Results revealed that during 2020, the year the COVID-19 pandemic appeared in the U.S., older adults with dementia reported less sleep, and lower quality of sleep compared to those without dementia. This study demonstrates that sleep disturbances are significant among dementia patients. Poor sleep has previously been linked to other risks affecting quality of life, such as falls and caregiver stress, and nonpharmacological approaches are preferred for dementia patients given risks associated with psychotropics. Thus, there is a need for further study to explore changes in sleep quality over time, and to develop non-pharmacological interventions to support dementia patients’ sleep quality and quantity.
FACILITATORS OF PHYSICAL ACTIVITY IN OLDER ADULTS AND THE IMPACT OF FEAR OF FALLING: WHAT KEEPS US MOVING?
Authors: O’Leary Bryant , Whitten Justin , Graham David , Tarabochia Dawn
Published: December 2023

Habitual participation in physical activity provides many well-documented health benefits for older adults. It has been suggested that high self-efficacy and internal motivation are facilitators of sustained participation, however, the findings are equivocal. Moreover, research suggests that fear of falling may negatively impact self-efficacy, leading to diminished physical activity levels. Therefore, the purpose of this study was to identify factors associated with sustained participation in physical activity and the potential influence of fear of falling on participation in physical activity for older adults. A phenomenological study was conducted with a convenience sample of 19 community-dwelling older adults aged 55-85. Participants completed an online, open-ended survey to identify potential facilitators influencing habitual physical activity in older adults. Van Manen’s (1990) hermeneutical approach was employed to analyze data. Transcripts were analyzed for themes by two members of the research team. Trustworthiness was established by a peer reviewer who assessed theme accuracy. Self-motivation and life-long participation were identified as facilitators of sustained participation in physical activity. This study supports internal motivation as a facilitator; self-efficacy was not identified. Instead, lifelong participation was identified. For this study lifelong participation was defined as participating in physical activity from childhood throughout adulthood and into older adulthood. Furthermore, modification of habitual physical activity was reported due to fear of falling, namely those associated with outdoor activities. All other reported forms of physical activity were maintained. The influence of these modifications on sustained participation in physical activity for older adults is unclear and warrants further investigation.
LEISURE ACTIVITIES, LIFE SATISFACTION, HAPPINESS, AND HEALTH PERCEPTION OF OLDER KOREAN IMMIGRANTS
Authors: Lee Juwon , Kim Yongseop , Kim Jaehyun , Kim Junhyoung
Published: December 2023

The number of Korean immigrants in the United States has been increasing rapidly, with many facing psychological challenges due to cultural differences, limited resources, and language barriers. These challenges can lead to increased stress, which negatively affects mental health. However, research has shown that leisure activities can have positive effects on health outcomes, particularly for older adults. This study aimed to investigate the relationships among leisure activities, life satisfaction, happiness, and health perception in older Korean immigrants. Convenient sampling was used to recruit 51 Korean adults aged 50-85 from community centers and churches. Results showed that participation in leisure time physical activity (LTPA) predicted life satisfaction and happiness, with outdoor physical activity being positively associated with psychological well-being. Furthermore, education was significantly related to life satisfaction and health perception among those who engaged in LTPA. The findings suggest that LTPA may be linked to higher levels of happiness, life satisfaction, and health perception in older Korean immigrants. Therefore, offering recreational programs for Korean adults in the United States could potentially improve their overall well-being. By providing opportunities for older Korean immigrants to engage in leisure activities, such as outdoor physical activity, their mental and physical health may be positively impacted. These findings contribute to the growing body of research on the importance of leisure activities for older adults’ well-being and highlight the potential benefits of providing recreational programs for minority populations.
RELIGIOSITY, DEATH EXPOSURE, AND HEALTH LITERACY AS PREDICTORS FOR ATTITUDES TOWARD MEDICAL AID IN DYING (MAID)
Authors: McIntyre Alissa , Albright Amy , Allen Rebecca
Published: December 2023

Only legal in ten states (Death with Dignity, 2023), Medical aid in dying (MAID) is the current term for requesting lethal medication through a physician to end one’s life. Research has explored individuals’ characteristics who request MAID and whether they complete the prescribed medication process (Ganzini et al., 2009). However, little research explores relations between health literacy, religiosity, and individuals’ attitudes toward MAID. We hypothesized that participants with high health literacy and greater death exposure would hold greater support for MAID, while greater religiosity would be associated with lower support. Having implemented attention checks, participants (N = 265) completed measures via MTurk, assessing for health literacy, religiosity, death exposure, and attitudes toward MAID. Ages ranged from 19 to 83 (M = 37.81, SD = 12.55), with 17.7% of the sample over the age of 50. The majority were self-reported female (62.6%), non-Hispanic white (79.6%), and indicated adequate functional health literacy (82.6%). Significant correlations were observed between religiosity, attitudes toward MAID, and MAID support. Although there was no direct effect on MAID support, health literacy and death exposure remained in the path model to ensure adequate model fit. The results of this study help us understand the effect of individuals’ experiences and their attitudes toward MAID, indicating the importance of tailoring health literacy towards supporting autonomous choices in end-of-life care.
UNDERSTANDING HEARING LOSS AMONG COMMUNITY-DWELLING OLDER ADULTS FROM AN ENGAGING WITH AGING PERSPECTIVE
Authors: Ge Shaoqing , Wu Kuan-Ching , Jin Jessica , Park Suah , Chien Shao-Yun , Primomo Janet , Belza Basia
Published: December 2023

Engaging with Aging is an emerging framework proposed by Carnevali which provides a new lens to understand an active, conscious daily living process of coping with age-related changes (ARCs) taken on by older adults. The study aims were to 1) describe the challenges related to hearing loss experienced by community-dwelling older adults, especially during COVID-19; 2) identify the strategies and resources used by older adults to accommodate the daily living challenges caused by hearing loss. We conducted semi-structured interviews with 29 participants aged 64 to 98 online due to COVID-19 restrictions. We used a virtual card sort to assist with data gathering. Hearing loss was mentioned by 18 participants (62%) and their corresponding adaptations were discussed. We found that older adults linked their adaptations to hearing loss based on their changing hearing capacities and needs. Commonly used adaptations included lip reading, volume adjustment, and wearing hearing aids. The challenges caused by COVID-19 in implementing the adaptations were also discussed (e.g., increased difficulty in understanding others due to mask-wearing). While most participants reported making adaptations to hearing loss, some mentioned that hearing loss was “no biggie” to them so no adaptations were needed. This study substantiates the EWA framework by showing the commonality among older adults in linking hearing loss, as one of the common ARCs, with corresponding adaptations. Implications for clinicians and researchers include using EWA to help older adults identify personalized solutions that fit their hearing capacity.
HOW WIDOWHOOD SHAPES THE EFFECT OF ADULT CHILDREN’S EDUCATION ON MOTHERS’ PSYCHOLOGICAL WELL-BEING
Authors: Frase Robert , Bauldry Shawn , Suitor J Jill , Gilligan Megan
Published: December 2023

Despite a growing interest in the effects of adult children’s education on older parents’ health and well-being, few studies have focused on how family structure may shape these processes. Drawing on data collected from 160 married and 180 widowed mothers ages 73-85 as part of the Within-Family Differences Study, we explore how mothers’ widowhood status moderates the association between their adult children’s education and mothers’ depressive symptoms. Drawing on past empirical work and Socioemotional Selectivity Theory, we develop and test two competing hypotheses. First, empirical research on depression and financial strain suggests that widowed mothers may be especially reliant on their adult children’s resources and, therefore, that adult children’s education would have a larger impact on widowed than married mothers’ mental health. Alternatively, principles of Socioemotional Selectivity Theory suggest that widows may place less value on their children’s material accomplishments, like educational attainment, and instead emphasize the socioemotional aspects of their relationships with their children. Therefore, children’s education may exert a smaller influence on the psychological well-being of widowed than married mothers. Results of linear regression models stratified by widowhood status supported our second hypothesis. Specifically, the association between adult children’s education and mothers’ psychological well-being was significantly larger among married mothers relative to widowed mothers. Our findings highlight the importance of considering family processes and family structure when studying educational attainment and health across generations.
LATER LIFE AS A DARING EXPERIENCE: FACTORS ASSOCIATED WITH OLDER ADULTS’ RISK PERCEPTION
Authors: Lifshitz Rinat , Bachner Yaacov , Nimrod Galit
Published: December 2023

Risk perception refers to people’s subjective judgments about the possibility of negative occurrences and the extent to which they are concerned with them. Previous studies have found that older adults who were exposed to ongoing terror threats developed later-life and terror risk perceptions. These studies showed that high risk perception has negative psychological and physiological consequences. This study aimed to identify the factors associated with the development of both later-life risk perception and terror risk perception in later life. Data were collected via an online survey with 306 Internet users aged 50 years and over, half resided in a high-risk zone while the remainder lived in a low-risk zone. The Perceived Risk Scale, measures of depressive symptoms, life satisfaction, social support, spirituality, internet use, and personal background were applied. Low self-rated health was associated with terror and later-life risk perceptions, regardless of the risk zone. After controlling for personal background, only depressive symptoms significantly correlated with high risk perceptions. These findings suggest that older adults with poorer self-rated health, secular beliefs, and elevated depressive symptoms may be susceptible to developing high risk perceptions. Clinicians should encourage older adults to identify preserving resources to improve adjustment to late life stressors.
PERSONAL FACTORS AFFECTING OLDER ADULTS’ INTERPRETATION OF STRESS: MODERATING ROLE OF DIFFERENT LEISURE TYPES
Authors: An Jaesung , Kwon Soonhyung
Published: December 2023

Holistic stress model (Nelson & Simmons, 2003; 2011) offers the most updated framework to understand how individuals’ differences in characteristics (e.g., locus of control, optimism, hardiness) determines their interpretation of the given stressor, whether as eustress or distress. However, dearth of literature exists to further validate this framework, and barely any study has been conducted among older adult population. While daily leisure engagement is one of the most valued activities among older adults, which helps them navigate healthy aging process (An et al., 2022), it also has positive relationships with older adults’ sense of control, positive emotions, and resilience (Son et al., 2021). Therefore, the purpose of this study was to examine whether individual differences (sense of control, optimism, social support, spiritual belief) have effects on how older adults respond to given stressor and to investigate whether there is a moderating effect of participating in different types of leisure activities. This study used the Health and Retirement Study (HRS) data and study participants (n=3,038) aged 64.52 years old on average. Multiple linear regression was used for analyses using SPSS. Findings indicated that higher social support, optimism, and sense of control were significantly associated with lower response to chronic stress, whereas higher spiritual belief was related to higher response to chronic stress. In terms of specific moderator effects, physical leisure was a significant moderator between social support, optimism, sense of control, and spiritual belief and response to chronic stress. Further discussion, implication, and future recommendations will be presented.
ISOTEMPORAL SUBSTITUTION OF 24-HOUR MOVEMENT BEHAVIOR AND FRAILTY STATUS IN OLDER ADULTS
Authors: Lai Ting-Fu , Liao Yung , Hsueh Ming-Chun , Lee Chung-Sheng , Lin Kun-Pei , Chan Ding-Cheng (Derrick) , Chen Yung-Ming , Wen Chiung-Jung
Published: December 2023

Background

Properly distributing twenty-four hours (24-h) movement in daily life may provide older individuals chances to prevent frailty. This study aimed to investigate the effects of replacing sedentary behavior (SB) with light physical activity (LPA) and moderate to vigorous physical activity (MVPA) on risks of pre-frailty and frailty in older adults.

Methods

We recruited 196 older adults (48.5% men; 80.3 ± 7.1 years old) to wear a triaxial accelerometer on the waist. Pre-frailty and frailty were assessed by a modified version of Fried’s criteria. Isotemporal substitution analysis was performed to investigate the association between 24-h movement and risks of pre-frailty and frailty.

Results

After adjusting confounding variables, the results also indicated that only reallocating 60minutes of SB per day to MVPA was less likely to have pre-frailty (OR = 0.01, 95% CI = 0.01, 0.20) and frailty (OR = 0.02, 95% CI = 0.02, 0.36). In addition, each 5-min increment in MVPA from 20 min as part of total physical activity (40 min in LPA) to replace 60 minutes of SB per day resulted in being less likely to have frailty (OR = 0.546, 95% CI= 0.301, 0.992).

Conclusions

This study demonstrated that using 60-min MVPA to substitute SB daily may theoretically reduce the risk of being pre-frailty and frailty. Moreover, replacing 60-min SB daily with mixed 40-min LPA and 20-min MVPA was able to reduce frailty risks. Therefore, those findings may provide alternative approaches with acceptable intensity and feasibility when promoting the physical health of older adults.