bluuebunny/crossref_metadata_2025 huggingface dataset:
REGARDS: A Case Study in Aging and Disparities Research, Mentoring, and Data Sharing
Authors: Howard Virginia , Manly Jennifer , Glymour Maria
Published: December 2020

Investigators in the NIH-funded REGARDS (REasons for Geographic and Racial Differences in Stroke) project have taken a novel approach to break the paradigm of epidemiologic studies limited to clinic-based convenience samples, by developing a national cohort of 30,239 black and white participants recruited from communities across all lower 48 US states, including 1,855 of the 3,033 counties. Mean age at enrollment (Jan 2003-Oct 2007) was 65.3 years. The four initial aims were to further understanding of: 1) geographic and racial differences in stroke risk factors; 2) geographic and racial differences in stroke incidence and mortality; 3) association of stroke risk factors and stroke risk (incidence and mortality) focusing on effect modification by race or region; and 4) establishment of a repository of serum, plasma, urine and DNA for use in future studies. When the grant was awarded, the study goals were broadened to include longitudinal remote assessment of cognitive function. A second in-home visit was completed May 2013-Dec 2016 including measures of functional status. The cohort is in its 17th year of follow-up. We will detail recruitment and enrollment methods, characteristics of the cohort and status, with brief overview of the biological, medical, psychosocial, environmental, and contextual data collected in the parent study. Speakers will discuss in more detail the stroke and cognitive data, ancillary studies focused on caregiver and heart disease outcomes, and provide examples of national and international mentoring that has leveraged REGARDS data. Finally, we will describe opportunities for additional data sharing and new ancillary studies.
REGARDS Cognitive Assessment and Approaches to Defining Cognitive Impairment and Change in Cognitive Function
Authors: Manly Jennifer , Unverzagt Frederick , McClure Leslie , Judd Suzanne , Rhodes J David , Howard George
Published: December 2020

Since 2003, REGARDS participants have taken part in telephone-based cognitive assessments. Global cognitive status is assessed annually with the Six-item Screener. Between 2006 and 2009, measures of learning and memory (CERAD Word List) and language/executive function (Animal and Letter Fluency) were implemented, and are administered biennially. A Brain Health Substudy, conducting in-home clinical examinations of neuropsychological, neurological, and functional status among 1000 participants, is underway to validate telephone assessments and estimate prevalence of VCID in REGARDS. Approaches to defining incident cognitive impairment and cognitive change, including definitions employed for case/cohort studies using stored blood samples, will be described. We will discuss psychometric and methodological considerations for characterization of risks for cognitive impairment across race and region, as well as longitudinal trajectories of cognitive function.
Opportunities for More Aging and Disparities Research, Mentoring, and Data Sharing With REGARDS
Authors: Judd Suzanne , Howard Virginia , Cushman Mary , Manly Jennifer , Howard George
Published: December 2020

One of the benefits of this large, national cohort study with black and white participants is the opportunity to involve a breadth of researchers in the science. REGARDS actively solicits and engages early career and minority investigators to lead or participate in manuscripts as well as ancillary studies. REGARDS has provided opportunities for >175 ancillary studies, including those that enrich existing outcomes, provide new outcomes, assess new exposures, link with other national data, support extended analyses, and assess genetic associations. Over 70% of the 500+ publications to date have a lead author who was not a funded REGARDS investigator. In this presentation, we will discuss some of the innovative ancillary studies and high-impact manuscripts that have grown out of REGARDS, the processes for developing an ancillary study/manuscript, and the procedures for obtaining REGARDS data. We will describe opportunities for mentored research for junior investigators, as well as independent research projects.
Reversing Cognitive Decline in Aging: Reversible Mechanistic Defects and a Novel Nutritional Intervention
Authors: Sekhar Rajagopal , Taffet George
Published: December 2020

Aging is the biggest risk factor for cognitive-decline and Alzheimer’s disease (AD), but underlying mechanisms are not well-understood and interventions are lacking. Cognitive-decline in AD has been associated with deficiency of glutathione, (the most abundant, intracellular, antioxidant protein), elevated oxidative-stress, insulin-resistance and increased inflammation. We identified and reported that glutathione-deficiency and oxidative-stress in older-adults occur due to decreased availability of precursor amino-acids glycine and cysteine, and can be corrected with GlyNAC (a combination of glycine and the cysteine precursor N-acetylcysteine). We hypothesized that cognitive decline in older-adults is linked to glutathione-deficiency, mitochondrial-dysfunction, oxidative-stress, insulin-resistance, and inflammation. The first abstract discusses the rationale and findings of an open-label clinical trial: compared to young-humans, older-adults had cognitive-decline, glutathione-deficiency, mitochondrial-dysfunction, abnormal glucose-metabolism and insulin-resistance, oxidative-stress, endothelial-dysfunction and inflammation. These defects were improved/reversed by supplementing GlyNAC for 24-weeks, but benefits receded on stopping GlyNAC for 12-weeks. The second abstract presents a study in 8 young (20-weeks old) and 16 aged (90-weeks old) wild-type male C57BL/6J mice where we found that aged-mice had naturally-occurring cognitive-impairment, and brain defects in glutathione-deficiency, oxidative-stress, glucose-transport, mitochondrial glucose-oxidation, insulin-resistance, endoplasmic-reticulum stress, autophagy, mitophagy, inflammation, senescence, genomic and telomere damage. Aged-mice received either GlyNAC or isonitrogenous-placebo supplementation for 8-weeks, and only GlyNAC-fed mice improved cognition and brain defects. Collectively these data highlights the discovery of novel and reversible mechanistic defects in older-adults and aged-mice with naturally-occurring cognitive-decline, and identifies that supplementing GlyNAC can improve brain-health and cognition. These findings could have important implications for reversing cognitive-decline in older-adults, and AD.
Reversing Mitochondrial, Metabolic and Molecular Defects in the Brain Improves Cognition in Aged Mice
Authors: Sekhar Rajagopal , Kumar Premranjan
Published: December 2020

Age-associated cognitive-decline is a risk factor for Alzheimer’s disease (AD), but mechanisms are not well understood, and interventions are lacking. Rodent studies on AD have not led to therapeutic breakthroughs for cognitively-impaired humans. In an open-label trial in older-adults we found that supplementing GlyNAC (glutathione precursors glycine and N-acetylcysteine) improved cognitive-decline, defects in whole-body mitochondrial-function, and systemic insulin-resistance, oxidative-stress, and inflammation. We hypothesized that aged-mice will have similar defects in the brain, and studied male C57BL/6J mice as follows: young-mice (20w) were compared to two-groups of aged-mice (90-weeks) receiving either GlyNAC or isonitrogenous-placebo diets for 8-weeks. GlyNAC-supplementation improved cognition, and the following measures in the brain: glutathione-concentrations, glucose-transporters in blood-brain-barrier and neurons, mitochondrial glucose-oxidation, oxidative-stress, endoplasmic-reticulum stress, autophagy, mitophagy, inflammation, senescence, genomic and telomere damage. These data provide mechanistic insights into the novel and beneficial role of GlyNAC supplementation to reverse cognitive-decline in aging, and holds promise for human AD.
Health-Related Quality of Life Factors in African American Caregivers of Persons With Dementia
Authors: Brewster Glenna
Published: December 2020

African American caregivers of persons living with dementia have a high prevalence of caregiving compared to other caregiving groups. The goal of this study was to explore health-related quality of life factors in a sample (n=25) of African American caregivers with a body mass index of more than Caregivers were female (87%). Caregivers were an average age of 63.2 (±6) years, had 16.6 (±2) years of education, and were providing care for 4.3 (±4) years. Care-recipients were on average 79.1 (±11) years and mothers (52.2%). 74% of the caregivers reported good-to-excellent quality of life. Caregivers reported low anxiety and depression but high perceived stress and strain. Higher anxiety and depression were correlated with greater strain and lower quality of life. Healthcare providers need to examine specific situational caregiving factors that can affect African American caregiver outcomes; since, their stress and strain may not reflect in their response to psychological questionnaires.
Workplace Adaptive Technologies for Working Adults With Cognitive and Physical Disabilities
Authors: Heyn Patricia
Published: December 2020

Individuals with disabilities usually have difficulty in finding and maintaining employment prospects and thus, they are extremely underrepresented in the workforce. These challenges are even greater when the person has both cognitive and physical disabilities. While there is evidence supporting the benefits of employing individuals with disabilities in the workforce, employers are usually unprepared to hire individuals with disabilities. They are also concerned that the work productivity may be impacted by the employee with a disability. Thus, technology can play an important role in helping a person with cognitive and /or physical impairment work on tasks that require memorization and assembly performance. We will present a mobile technology system that was planned and piloted with working adults with physical and cognitive impairments. Founded on our pilot study, mobile technologies hold the potential to help people with disabilities to perform jobs that require memorization as well as systematic assembly tasks.
Barriers and Facilitators for Older Adults with Serious Mental Illness to Utilizing Medicaid Smartphone Services
Authors: Myers Amanda , Fortuna Karen
Published: December 2020

As increasingly more older adults in the general population utilize smartphones to access health services, the digital divide between older adults with serious mental illness (SMI) and the general older adult population continues to widen. The purpose of this study was to examine older adult peer support specialists’ and older people with SMI’s perspectives of barriers and facilitators to utilizing Medicaid Safelink smartphone services. Data from two focus groups and five semi-structured interviews from older adult peer support specialists (N=10) and older adults with SMI (N=15) were analyzed using the Consolidated Framework for Implementation Science Research. A mixed methods convergent design integrated quantitative with qualitative data. Older adults with SMI (N= 15) had a mean age of 55 years and were mainly women (70%) and White (100%). Certified peer specialists (N= 10) had a mean age of 52 years (age range 45-67) and were mainly female (75%), 66% identified as White, and 33% identified as African American. Four themes that were identified across different aspects of barriers included technology knowledge, technology adoption, design features (i.e., smartphone size, option to increase font sizes, multi-modal capacity, navigational architecture, 508 compliance), and Safelink policies and procedures. Facilitators included free and continuous services, access to technical support, and smartphone capabilities to enable healthcare communications and facilitate the delivery of services. Improving upon the themes identified as barriers to utilizing Safelink may promote a continuum of care for older adults with SMI, closing the gap of services that occurs between in-person therapy and other interventions.
Sibling Death in the Family and Dementia Risk
Authors: Cha Hyungmin , Thomas Patricia , Umberson Debra
Published: December 2020

Growing evidence points to the role of stress in contributing to dementia risk, and experiencing the death of a family member is a particularly stressful life event. Sibling relationships are typically life-long relationships and the death of a sibling is likely to be a stressful event in the life course; however, there is little research illuminating the possible consequences of sibling loss for dementia risk. This study considers whether experiencing the death of a sibling before midlife is associated with subsequent dementia risk and how such losses, which are more common for Black and Hispanic than for White populations, may add to racial/ethnic disparities in dementia risk. We use discrete-time event history models to predict dementia incidence among 9,590 non-Hispanic white, 1,669 non-Hispanic black, and 1,109 Hispanic respondents from the Health and Retirement Study, 2000-2014. Losing a sibling during the observation period is associated with increased risk for later dementia. The death of a sibling is robust to the inclusion of a variety of biosocial factors that contribute to subsequent dementia risk. The death of a sibling is a life course event with consequences that appear to increase dementia risk for Black and Hispanic older adults, and this increased risk is explained by biosocial processes likely activated by bereavement. However, Black and Hispanic Americans are further disadvantaged in that they are more likely than White Americans to experience the death of a sibling, and such losses add to the already substantial racial disadvantage in dementia risk.
Hiram J. Friedsam Mentorship Award Lecture
Authors: Hancock Cynthia
Published: December 2020

The Hiram J. Friedsam Award lecture will feature an address by the 2020 award recipient, Karen Kopera-Frye, PhD, MPA, FGSA, FAGHE. Hiram J. Friedsam was the professor, co-founder, and director of the Center for Studies in Aging and dean of the School of Community Service at the University of Northern Texas. Dr. Friedsam was an outstanding teacher, researcher, colleague, and mentor to students, faculty, and administrators, as well as a past president of AGHE. The purpose of this award is to recognize those who emulate Dr. Friedsam’s excellence in mentorship.
M. Powell Lawton Award Presentation
Authors: Dobbs Debra
Published: December 2020

“The lecture will be given by the2019 recipient, Barbara Resnick, PhD, CRNP, FGSA of the University of Maryland. The session will also include the presentation of the2020 Lawton Award to recipient Sara J. Czaja, PhD, FGSA. The M. Powell Lawton Award is presented annually to an individual who has made outstanding contributions from applied research that has benefited older people and their care. The Lawton Award is generously funded by the Polisher Research Institute of the Madlyn and Leonard Abramson Center for Jewish Life.”
M. Powell Lawton Award Presentation
Authors: Resnick Barbara
Published: December 2020

Dr. Lawton focused his life work, starting in the 1960s, on improving the lives of older adults, particularly those with dementia. He did this at a time when care was custodial at best. He was innovative and initiated new thoughts about how to best care for individuals in institutional settings. He raised our awareness about the importance of the environment and the value of individualized care. We build on that work today. The focus of this 2019 Powell Lawton award presentation is on sharing my lifetime work, starting in 1972, on helping older adults, particularly those who are institutionalized and may have cognitive changes, maintain their functional ability and increase time in physical activity. Along with Dr. Lawton’s experiences, I and the teams I have worked with, have met challenges ranging from the use of Houdini vests to bed alarms and wheelchairs, to the persistent call out by caregivers to older adults-“don’t get up you might fall.” I will share information, resources and data from over a 20 year period developing and testing Function Focused Care, an approach to care that helps caregivers optimize function and increase physical activity among institutionalized older adults. Further, the process for how to disseminate and implement Function Focused Care across multiple settings and how to be a resilient researcher will also be reviewed. Participants will be able to take the findings and resources from this presentation and implement this approach into their own settings of care.
Perceptions of mandatory reporting among family physicians to protect victims of elder abuse in Mongolia
Authors: Bagaajav Ariunsanaa
Published: December 2020

Every year, approximately 10% of older adults worldwide experience elder abuse (EA), a serious violation of human rights. A wide range of consequences of EA have been identified including increased vulnerability to morbidity and mortality. Some countries have regulations to protect victims of EA either under stand-alone EA laws or relevant laws such as mandatory reporting. As of 2016, family physicians (FPs) in Mongolia became mandatory reporters of domestic violence alongside other human service workers under the newly amended Law to Combat Domestic Violence. Evidence shows that health providers who report abuse cases have greater awareness of their mandatory obligations to report. No rigorous study has explored the extent to which FPs in Mongolia know about mandatory reporting and their perceptions about its effectiveness to help victims of EA. An exploratory qualitative study was conducted. Through purposive sampling, 15 FPs participated in semi-structured in-depth interviews. The data collection took place over Skype. All interviews were recorded, transcribed verbatim and analyzed using thematic analysis. Surprisingly, all participants were aware of their mandatory obligations to report cases of domestic violence including EA. However, the study revealed that FPs were doubtful that potential victims of EA would be effectively protected under the new regulation due to the public perception that services and legal resources are designed primarily for women and children. Addressing this misconception is critical for ensuring that resources are appropriately utilized for potential victims of EA as well.
Judging Older Adult Speakers: Only Young Adults Low in Ageism Notice the Nuances
Authors: Turner Jennifer , Hayslip Renee , Stanley Jennifer
Published: December 2020

Ageism negatively impacts hiring and electability success, as well as intergenerational relationships (Levy,2003;2009). The current study sought to examine whether personality cues influenced performance ratings of older adult (OA) speakers whose behavior had been modified by an embodiment intervention (i.e., “power posing”). One-hundred-and-three young adults (YA; Mage=19.6, SD=2.06; 49.5% women) rated the performance of 9 OA speakers performing 5-minute campaign speeches, and reported the cues that influenced their ratings. Two independent raters coded the cues (i.e., introversion and extroversion; coded by two independent raters, κ = .72 [moderate-to-substantial interrater reliability; Chen, 2019; McHugh, 2012]). Participants also completed the Refined-Aging Semantic Differential (Polizzi & Millikin, 2002) as a measure of ageism endorsement. Greater ageism was associated with lower performance ratings (F(1,101)=15.97, p<.001, R2=.14); performance was reduced by .12, 95%CIs[-.018,-.006] for each additional point of ageism endorsement. Next, we investigated whether personality cues would modify this relationship using Hayes PROCESS Model 1 (2018). A significant interaction emerged between ageism and introverted cues (b=.015, p=.05, 95%CIs[.006,.023]), suggesting that greater perceived introversion was negatively associated with performance ratings. Additionally, individuals lower in ageism were more likely to calibrate their performance judgments based on the pose condition of the speaker, with participants lower in ageism exhibiting greater variability across pose conditions (Ms=3.96-4.37), than individuals higher in ageism (Ms=4.21-4.31), suggesting that individuals lower in ageism were attending to nuances in the speech (e.g., pose influence), while higher ageist individuals relied more heavily on age-related judgments.
Improving Aging in Place for Older Adults with Low Incomes: Perspectives of Home Health Aides
Authors: Jahan Momana , Hentschel Claudia , Pandit Sonia , Akhiary Mona , Wisdom-Goulbourne Tiffany , Resnick Barbara , Reid Carolina , Brown Rebecca
Published: December 2020

Older adults with low incomes experience disproportionate rates of cognitive and functional impairment and an elevated risk for nursing home admission. Home health aides (HHAs) can help older adults to age in place by optimizing function and engaging them in routine physical activity. Despite this potential role, little is known about HHAs’ perspectives on how to facilitate aging in place for this population. We conducted 6 focus groups with 21 English-speaking and 10 Spanish-speaking HHAs working in Philadelphia and New Jersey. Transcripts were analyzed using qualitative thematic analysis. HHAs described wearing multiple hats and pushing the boundaries of their role as a HHA to provide a “comfortable and safe” environment through nursing and emotional support. Many HHAs shared that they serve as surrogate family, often spending more time in clients’ homes than family members or other healthcare providers. This unique position provides HHAs with valuable insights into clients’ changing health which allows them to detect early warning signs of clients’ functional and cognitive decline, including falls, depression, and confusion. HHAs noted several factors that worsened clients’ decline including a lack of adaptive equipment, social isolation, and limited HHA input into clients’ care plans. They also pointed to factors that facilitated clients’ aging in place, including utilization of community-based services, family support, and communication between healthcare team members. Our findings suggest that HHAs have important insights into improving aging in place for older adults with low incomes and should be incorporated into care planning and intervention delivery.
Including Caregivers in the Community Aging in Place, Advancing Better Living for Elders Program
Authors: Fields Beth , Yanes Caylee , Ennis Molly , Toto Pamela
Published: December 2020

Older adults frequently turn to informal caregivers for support to age independently in their home as long as possible. Yet, many evidence-based programs designed to support aging in place do not include caregivers, including the well-known Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program. The purpose of this qualitative study was to adapt CAPABLE to include caregivers using a grounded theory approach. Data collection occurred with stakeholders from an Area Agency on Aging (AAA) in Pennsylvania. Two, 60-minute focus groups were conducted with frontline providers (n=7) and administrators (n=7). Eight, 30-minute individual interviews were conducted with AAA consumers including older adults and their caregivers. Constant comparative analysis of the data were completed using NVivo 12 Pro. Stakeholders described three considerations for adapting CAPABLE to include caregivers: older adult preference and caregiver willingness, clear guidelines and expectations, and hands-on training. Older adults and caregivers recognized the need to “allow them to decide when and why family should be involved in the program.” Frontline providers and administrators explained the importance of “determining whether older adults and caregivers should have shared or separate goals for the program.” All stakeholders expressed that including caregivers would “reaffirm the hands-on training like fall prevention.” These perspectives shed light on how and why to include caregivers in CAPABLE. Information gleaned from this study may help researchers think about ways in which to adapt other evidence-based programs to include caregivers, and help healthcare providers target and support caregivers in the delivery of their services.
Association between late-life hypercholesterolemia and progression of dementia severity among older adults
Authors: Sin Mo-kyung , Cheng Yan , Ahmed Ali , Zamrini Edward
Published: December 2020

Progression of dementia severity varies widely by individuals and multiple factors might influence the progression. The aim of this study was to examine the relationship between late-life hypercholesterolemia and progression of dementia severity in older adults. We used prospectively collected longitudinal data from 2,686 adults aged ≥65 years in the National Alzheimer’s Coordinating Center. Progression of dementia severity was measured using both Clinical Dementia Rating (CDR) - Sum of Boxes (SOB) and Global scores. Kaplan Meier curves were plotted to estimate the association between hypercholesterolemia and progression of dementia severity. We also conducted multivariate Cox regression models to estimate the association of hypercholesterolemia with the outcomes adjusting for age, gender, race, ethnicity, marital status, living status, education, smoking, heart failure, atrial fibrillation, blood pressure, and diabetes. Hypercholesterolemia had significant association with CDR-SOB ≥ 1 point increase (unadjusted HR, 1.23; 95% CI, 1.13-1.35; p<0.001; adjusted HR, 1.17; 95% CI, 1.07-1.28; p<0.001). In addition, hypercholesterolemia had significant association with CDR-Global ≥ 0.5 point increase (unadjusted HR, 1.14; 95% CI, 1.04-1.25; p<0.001; adjusted HR, 1.11; 95% CI, 1.01-1.22 p=0.036). If these findings can be replicated in future studies, future studies need to examine if proper management of cholesterol may reduce the risk of Alzheimer’s dementia in late-life older adults.
Development and Pilot of a Newly Developed Tool for Assessing Research Participation for Individuals with Dementia
Authors: Judge Katherine , Minyo Morgan , MacNeil Amanda , Lucas Kaitlyn , Grant Claire
Published: December 2020

Research supports the inclusion of individuals with mild to moderate dementia (IWDs) as study participants in providing reliable and valid self-report information about their illness experience. However, no clear guidelines or tools exist for determining study eligibility with many studies relying on brief cognitive measures (e.g., MMSE). The literature suggests not all individuals with mild/moderate dementia can participate and some individuals with severe symptoms of dementia can participate. This study piloted a new measure designed to assess whether IWDs can participate in self-report data protocols. The measure consists of 10 questions that assess relatively in-tact cognitive processes hypothesized for successful participation. Example questions include: “What is your favorite holiday?” and “Give an example of a sad occasion/event”. Questions are scored as ‘correct’ or ‘incorrect’ and summed for a total score. To examine the descriptive characteristics of the measure, IWDs (n=18) completed the measure along with the MMSE and, for some IWDs (n=12), several self-report measures. Scores on the new measure ranged from 0-10, with a M=7.61; SD=2.75. MMSE scores ranged from 2-22, with a M=13.39; SD=6.47. A significant correlation (r = .86, p< .001) was found with the MMSE, indicating a high degree of relatedness but not complete construct overlap. Results also highlight the variability of the measure, with incorrect responses ranging from 3 to 6 across participants. Additional properties of the measure will be discussed along with highlighting how study findings fit with recommendations from 2020 NIA Research Summit on Dementia Care and next-steps in refinement and testing.
Does Anxiety Affect Performance on Attention Task (digit span forward) on the MOCA Test? A clinical correlation study
Authors: Patel Rima , Nair Anil
Published: December 2020

It is unknown if anxiety affects performance on Digit span forward (DSF) in memory clinic patients. We performed a retrospective chart review of memory clinic patients in the south shore of Boston from 2010 to 2020. We correlated anxiety screen data (GAD7) to Digit Span Forward (DSF) scores obtained from the MoCA. As the data were not normal, we performed univariate analyses with Spearman correlation. A multivariate regression model estimated the relationship of DSF to covariates of GAD7, age, sex, and race. We hypothesized a negative correlation between anxiety levels scored by GAD7 and DSF. H0: Digit span forward DSF ~ GAD7+Age+Sex+Race. A chart review found 965 patients attending the memory clinic between 2010 to 2020 had analyzable data. 433 patients with available DSF and 737 had available GAD7. The patients were 58.7% female and 84.7% caucasian. The mean age was 70.1±14.4, DSF 0.8±0.4 and GAD 5.6±5.7. DSF correlated significantly to race (⍴=-0.25, p=<0.001), but not to gender (⍴=0.05, p=0.149), age (⍴=-0.04, p=0.3), or GAD7 (⍴=-0.018, p=0.71). There was no significant association of DSF to race, age, gender or GAD7 on the multivariate model. In memory clinic subjects there exists no correlation between anxiety levels scored by GAD7 and DSF performance.
Earning the Trust of African American Communities to Increase Representation in Dementia Research
Authors: Portacolone Elena , Palmer Nynikka , Lichtenberg Peter , Waters Catherine , Hill Carl , Keiser Sahru , Johnson Julene K
Published: December 2020

Black/African American populations are underrepresented as participants in dementia research. A major barrier to participation of African American older adults in dementia research is a tendency to distrust research institutions owing to a legacy of racism. Building on the Ford framework, the objective of our study was to examine factors that influence participation in dementia research among African American older adults and caregivers, with an emphasis on understanding factors related to trust. Data were collected from 10 focus groups with African American older adults (n=91), 5 focus groups with caregivers (n=44), and interviews with administrators of community-based organizations (n=11), and meetings with our Community Advisory Board. Inductive/deductive content analysis was used to identify themes. The results identified an overall tension between distrust of researchers and a compelling desire to engage in dementia research. This overarching theme was supported by six themes that provided insights about the multiple layers of distrust, as well as expectations about the appropriate conduct of researchers and academic institutions. Strong commitment to the community was identified as a priority. The findings suggest that a paradigm shift is needed to increase the representation of African Americans in dementia research. In this new paradigm, earning the trust of African American communities becomes a systemic endeavor, with academic, state and national institutions deeply committed to earning the trust of African American communities and guiding researchers in this endeavor. The findings also generated actionable recommendations to help improve representation of African American older adults in dementia research.
Psychometric Properties of the PHQ-9 and CESD-R Depression Measures with Older Adults
Authors: Katz Emma , Spalding Rachael , Edelstein Barry
Published: December 2020

Our understanding of older adult depression has been impeded by the paucity of assessment instruments with validity evidence for older adults. Therefore, measures of depression that were initially developed for use with younger adults are commonly used with older adults as well, such as the Center for Epidemiological Studies Depression Scale-Revised (CESD-R; Eaton et al., 2004) and Patient Health Questionnaire-9 (PHQ-9; Kroenke, Spitzer, & Williams, 2001). The CESD-R (Jiang et al., 2019; Van Dam & Earleywine, 2011) and PHQ-9 (Indu et al., 2018; Levis, Benedetti, & Thombs, 2019) have strong psychometric support for their use with young adults, and are two frequently used depression measures. In light of age-related differences in the experience and presentation of depression (e.g., Balsamo, et al., 2015; Fiske, Wetherell, & Gatz, 2009; Hybels, Laderman, & Blazer, 2012; Wuthrich, Johnco & Wetherell, 2015), the present study examined the psychometric properties of these instruments with older adults. Two-hundred-and-seventy-seven older adults (ages 65 and older) completed an online survey including the PHQ-9, CESD-R, and instruments measuring several other constructs with anticipated relations to depression (anxiety, general depression, positive and negative affect, self-esteem, personality traits, and satisfaction with life). The relation between the two depression scales and measures of the other constructs were examined. Both the PHQ-9 and CESD-R evidenced good internal consistency reliability (a = .82 and .83, respectively) and strong correlations in anticipated directions with many of the related constructs. These results support the use of the CESD-R and PHQ-9 with community-dwelling older adults.
A Narrative Review on the Relationship between Female Reproductive Factors and Longevity
Authors: Costanian Christy , Farah Raymond , Bahous Sola , Sibai Abla
Published: December 2020

This review presents findings on the role of female reproductive factors on longevity.A comprehensive systematic literature search was conducted using four electronic databases: OVID Medline, Web of Science, PubMed and Google Scholar from inception until May 2020 and restricted to English language articles that tackle the relationship between reproductive factors and longevity in its various definitions. Our search yielded a total of 306 articles. After screening based on the eligibility criteria,37 articles were included for review. The majority of studies were prospective and conducted in Western populations. The most consistent findings were between parity and increased longevity. The role of ages at menarche and menopause, premature menopause, as well as reproductive lifespan on longevity were not conclusive. Whether gender of offspring is related to maternal longevity is yet to be fully elucidated.Variations in findings are in the majority due to differentials in the definition of longevity as an outcome. Further longitudinal studies based in developing countries are needed to examine reproductive factors related to longevity.
A mobile app for tracking non-motor symptoms of people with Parkinson’s disease: A usability study
Authors: Lee JuHee , Suh Yujin , Kim Yielin
Published: December 2020

Smart phone-based technology for people with Parkinson’s disease has been developed worldwide. Unmonitored non-motor symptoms decrease quality of life of people with Parkinson’s disease, so the needs for technology to manage non-motor symptoms are increasing. The technology is needed to detect subtle changes in non-motor symptoms by healthcare professional. There is no mobile app which manage comprehensive symptoms of Parkinson’s disease including non-motor symptoms. It is necessary to develop a new tracking system that can effectively manage non-motor symptoms as well as motor symptoms of Parkinson’s disease. We developed a prototype of mobile app for Android smartphones, with cooperation with Mazelone company. we also have shaped functions for monitoring of motor symptoms and medication adherence. It also provided a section for caregivers to use on behalf of people with Parkinson’s disease who have difficulty to use app due to hand tremor. Through Delphi technique, we obtained content validity from eight medical and nursing experts on the contents of the application. We provided regular telephone counseling to improve and encourage their app usage. Fifteen participants used the app for 6 weeks. To evaluate usability of mobile app, we provided constructed questionnaire and conducted individual telephone interview. A mobile app for tracking non-motor symptoms demonstrated high usability and satisfaction. We learned lessons about facilitators and barriers when implementing an app such as perception and acceptance of mobile technology. The mobile app will improve continuum of care. Future studies need to improve the contents and refine technical approach for people with Parkinson’s disease.
Review of type-2 diabetes mellitus illness perceptions and associations with illness management
Authors: Hatala Samuel , Shields Cleveland
Published: December 2020

Objective: Determine illness perceptions associated most frequently with measures of type-2 diabetes mellitus (T2DM) maintenance. We measured illness perceptions using the Illness Perception Questionnaire (IPQ) and variants (IPQ-Revised and Brief IPQ) Design: Review of literature from publication of IPQ to September 2020. Searched for articles utilizing IPQ but no other models of illness perception and studying T2DM Main Outcome Measures: Glucose control (measured by HbA1c levels), adherence to medications, and adherence to diet, exercise, and other lifestyle recommendations Results: Symptom attribution and fear of consequences are frequently associated with worse T2DM management and sense of control of illness progression and positive emotional valence are frequently associated with better T2DM management. Other subscales have less frequent but generally positive associations with the exceptions of recurring thoughts about T2DM duration, which had a negative association with management, and understanding the causes of T2DM, which had no associations at all. Other reviews found similar associations and highlighted a need for more general T2DM education. Conclusion: Future T2DM management interventions should promote sense of control over illness progression and positive emotional valence and provide education regarding symptoms to expect. Interventions should also consider managing patient fear, which has many associations with worse management.
Within-Guideline Alcohol Consumption Protects Against Dementia?: Offset Effect of History of Drinking Problems
Authors: Brennan Penny
Published: December 2020

Research on the prospective relationship between older adults’ alcohol consumption and their subsequent risk of dementia and cognitive impairment, no dementia (CIND) has been limited by inconsistent definitions of “moderate” drinking, use of short follow-ups, and an exclusive focus on either amounts of alcohol, or history of drinking problems, as predictors. To overcome these limitations we analyzed a longitudinal, 18-year Health and Retirement Study cohort (n=4,421) to determine how older adults’ baseline membership in one of six drinking categories (Non-Drinker, Without and With a History of Drinking Problems (HDP); Within-Guideline Drinker, Without and With a HDP; and Outside-Guideline Drinker, Without and With a HDP) predicted dementia and CIND 18 years later. Among participants with No HDP, 12.6% of Non-Drinkers, 5.2% of Within-Guideline Drinkers, and 8.8% of Outside-Guideline Drinkers were classified as having dementia at the 18-year follow-up; among participants With HDP, 14.1% of Non-Drinkers, 8.9 % of Within-Guideline Drinkers, and 6.9% of Outside-Guideline Drinkers were classified with dementia. Being a baseline Within-Guideline Drinker with No HDP reduced the likelihood of dementia 18 years later by 45%, independent of baseline demographic and health characteristics; being a baseline Within-Guideline Drinker With a HDP reduced the likelihood of dementia by only 13% (n.s.). Similar patterns obtained for the effects of baseline drinking group membership on likelihood of CIND at follow-up. These findings suggest that consuming alcohol at levels within validated guidelines for low-risk drinking may protect against dementia and CIND, but only among older adults who have no history of drinking problems.
Life review on psycho-spiritual outcomes among older adults with life-threatening illness: A systematic review
Authors: Liu Mandong , Wang Ying , Chi Iris
Published: December 2020

Life review has been widely conducted to help older adults enhance well-being and cope with burdens. Spirituality is an important part of an older adult’s overall well-being, especially for those with life-threatening illnesses. However, there is no review study examining the effectiveness of life review interventions on psycho-spiritual outcomes among this population. The aim of the study was to examine the effectiveness of life review on psycho-spiritual well-being among older adults with life-threatening illnesses. A systematic review with meta-analysis consistent with the recommendations of the Cochrane Collaboration was conducted. Database searches included PubMed, PsycINFO, the Cochrane Library, the Campbell Library, EBSCO, CNKI, and the Airiti Library up to March 2020. Grey literature and reference lists from relevant articles were also searched and reviewed. 34 studies were included in the systematic review and 33 were included in the meta-analysis for outcomes of anxiety, depression, and quality of life. Other psycho-spiritual outcome measures that were not included in the meta-analysis due to the small number of studies included mood, apathy, life satisfaction, meaning in life, spiritual well-being, and some multi-dimensional instruments. The studies greatly varied in program design, content, format, length, interventionist, and more. The meta-analyses demonstrated standardized mean differences in favor of life review compared with the control with small to moderate effect sizes. The reviewers call for including more psycho-spiritual well-being measures among interventions for older adults with life-limiting illnesses, as well as studies with adequate sample size and rigorous designs in future research.
Influence of Provider Characteristics on Geriatric Mental Health Workforce Training Needs
Authors: Mitchell Travis , Sorocco Kristen , Wyman Mary , Vincent Andrea , Wray Laura , Slaughter Lindsey
Published: December 2020

Approximately half of VA users are 65 years of age or older, with a substantial subset having complex and interacting medical, neurocognitive, and behavioral disorders. The goal of the present study was to assess knowledge and training gaps of VA mental health staff using a Web-based training needs assessment developed specifically for VA personnel. Provider characteristics, confidence in working with older adults with and without cognitive disorder, and geriatric training needs were assessed. VA psychologists, psychiatrists, social workers, nurses, and peer support specialists (N=3313) were invited to participate via email. Respondents were 489 mental health providers, a response rate of 13.8 percent. Respondents reported less confidence in treating and assessing older adults with cognitive disorders then older adults in general. This did not differ by any of the examined provider characteristics, including age, gender, or professional experience. Training need endorsement was high across most of the training categories; however, a few differences according to provider characteristics were noted. Providers under the age of 50 endorsed a greater need for training in psychotherapy with older adults with cognitive disorder (p = .02). Female providers endorsed a greater need for training on providing psychoeducation about cognitive disorder, such as dementia, to older adults and their families (p = .02). In sum, VA MH providers in general reported strong interest in a wide range of geriatric MH training topics, indicating a need for universal geriatric-related staff education. For some topics, endorsing geriatric expertise predicted stronger interest in training.
Fear of Falls & Quality of Life in Community-Dwelling Older Adults: Is Diabetes an Effect Modifier?
Authors: Whitehouse Christina , Mensinger Janell , McKay Michelle
Published: December 2020

Prior research suggests that diabetes is a risk factor for falling. Moreover, older adults with diabetes are more likely to experience hip fractures when compared to older adults without diabetes. Research has also shown a relationship between fear of falling and quality of life. This study aimed to examine the moderating role of diabetes in the relationship between fear of falling (FoF) and quality of life (QoL) among older adults in a program for all-inclusive care for the elderly (PACE). This was a retrospective single cohort study that included 84 older adults in a PACE program located in the Northeastern United States. Participants were 55 years of age or older (M=70.33; SD=6.46) and cognitively intact. Diabetes diagnosis (n=46) was determined according to chart review. Fear of Falling was assessed with the Falls Efficacy Scale-International, and the Short Form 12v2 (SF-12v2) was used to measure the quality of life, including physical and mental domains. Hayes’ Process Macro was used to conduct moderation analyses (model 1) controlling race, gender, age, and comorbidities. Alpha was set at .10 to account for low power to detect interaction effects with small groups. Our results indicate the interaction between diabetes status and FoF was significant for mental QoL (p=.09) and not significant for physical QoL (p=.99). The association between FoF with lower mental QoL was stronger for patients with diabetes than for patients without diabetes; this finding was not replicated for physical QoL. Regardless of diabetes status, physical QoL significantly decreased as FoF increased.
Implementation of an Opioid and Benzodiazepine Deprescribing Program for Older Adults in an Outpatient Setting
Authors: Armistead Lori , Busby-Whitehead Jan , Ferreri Stefanie , Henage Cristine , Hughes Tamera , McBride Jack , Roberts Ellen , Urick Ben
Published: December 2020

The United States spends $50 billion each year on 2.8 million injuries and 800,000 hospitalizations older adults (age 65 years and older) incur as the result of falls. Chronic use of central nervous system (CNS)-active medications, such as opioid and/or benzodiazepine (BZD) medications, increases the risk of falls and falls-related injuries in this older adult population. This Centers for Disease Control and Prevention (CDC)-funded randomized control trial uses electronic health record (EHR) data from primary care outpatient clinics to identify older adult patients at risk for falls due to chronic opioid or BZD use. The primary program aim is to test the efficacy of a targeted consultant pharmacist service to reduce the dose burden of these medications in the targeted population. Impact of this intervention on the risk of falls in this population will also be assessed. Licensed clinical pharmacists will review at-risk patients’ medical records weekly and make recommendations through the EHR to primary care providers for opioid or BZD dose adjustments, alternate medications, and/or adjunctive therapies to support deprescribing for approximately 1265 patients in the first two cohorts of intervention clinics. One thousand three hundred eighty four patients in the control clinics will receive usual care. Outcome measures will include reduction or discontinuation of opioids and BZDs and falls risk reduction as measured by the Stop Elderly Accidents, Death and Injuries (STEADI) Questionnaire. Primary care provider adoption of pharmacists’ recommendations and satisfaction with the consult service will also be reported.