bluuebunny/crossref_metadata_2025 huggingface dataset:
Weather-Related Disaster in a Diverse Cohort of Aging Adults
Authors: Michael Yvonne , Clay Lauren , Smilely Kevin , Joshi Rennie , Hirsch Jana
Published: December 2021

As climate change contributes to increasing frequency and intensity of weather-related disasters, it is critical to define characteristics that increase risk of poor health outcomes during and after events. Given the aging of the United States (US) population and over-representation of older adults in disaster-prone areas, disaster-related impacts on older adults present a growing public health challenge. We linked data from the REGARDS study, a cohort of 30,107 Black and White adults (mean age 65 years at baseline, 2003-2007), with community data from the National Establishment Time Series database and longitudinal weather-related disaster data from the Spatial Hazard Events and Losses Database for the US. We calculated disaster exposure for each year for the county in which the respondents lived from 2003 – 2015: 84% of county-years showed at least some impacts, including 16% of counties experiencing medium impacts ($10- $50 property damage per capita or 2 fatalities) and 12% severe (greater than $50 per capital or 3 fatalities); this mirrors that of the continental US (77% some impact, 15% medium, 13% severe). REGARDS participants exposed to moderate or severe disasters were more likely to be Black and low socioeconomic status compared to those who were not exposed. For community characteristics, higher disaster exposure was associated with a greater density of resources including ambulatory care, food stores, social services, and destinations for daily living. Our approach showcases how disaster preparedness systems need better data about specific individual-and community-level factors that increase risk among older adults to better serve communities.
Adapting an Evidence-based Physical Activity Program for The REJOIN Trial for Older Breast Cancer Survivors
Authors: Bluethmann Shirley , Flores Eileen , Grotte Meghan , Heitezenrater Jared , Truica Cristina , Schmitz Kathryn
Published: December 2021

Purpose: Physical activity (PA) is a recommended part of breast cancer survivorship. PA promotes survival and mitigates symptoms in older breast cancer survivors (BCS), especially in reducing joint pain associated with adjuvant hormonal treatment. The purpose of this report is to describe adaptations to Fit & Strong!, an evidence-based curriculum, to meet the needs of older BCS. Methods: First, we reviewed all educational materials with scientific experts, including specialists in breast and exercise oncology. Next, we conducted semi-structured phone interviews with 3 BCS for an in-depth review of educational materials for the trial. All interviews were recorded and transcribed. Constant comparative analysis was used to identify themes and specify required technical changes. Subsequently, we recruited 3 new BCS to pre-test adapted materials and exercise sessions, complete a follow-up interview to refine our final product and rate acceptability with older BCS. Results: Overall, BCS found the materials and experience very acceptable (mean score of 9.5/10). Content changes included simplifying exercise instructions, prioritizing trial-specific content and updating photographs to be more age-appropriate. Due to COVID, the pre-test activity was conducted by Zoom and participants were given additional time and coaching to participate using this technology. BCS said they would prefer to exercise in person but reported the remote experience as very satisfactory. Conclusion: Our multi-step adaptation process provided an acceptable intervention to meet the needs of older BCS. Lessons learned will be applied to the forthcoming clinical trial, which will also be conducted remotely to maximize safety and access.
Are Machine Learning Models Used to Represent Accelerometry Data Robust to Age Differences?
Authors: Manini Todd , Bai Chen , Wanigatunga Amal , Saldana Santiago , Casanova Ramon , Mardini Mamoun
Published: December 2021

Regular and sufficient amounts of physical activity (PA) are significant in increasing health benefits and mitigating health risks. Given the growing popularity of wrist-worn devices across all age groups, a rigorous evaluation for recognizing hallmark measures of physical activities and estimating energy expenditure is needed to compare their accuracy across the lifespan. The goal of the study was to build machine learning models to recognizing the hallmark measures of PA and estimating energy expenditure (EE), and to test the hypothesis that model performance varies across age-group: young [20-50 years], middle (50-70 years], and old (70-89 years]. Participants (n = 253, 62% women, aged 20-89 years old) performed a battery of 33 daily activities in a standardized laboratory setting while wearing a portable metabolic unit to measure EE that was used to gauge metabolic intensity. Participants also wore a Tri-axial accelerometer on the right wrist. Results from random forests algorithm were quite accurate at recognizing PA type; the F1-Score range across age groups was: sedentary [0.955 – 0.973], locomotion [0.942 – 0.964], and lifestyle [0.913 – 0.949]. Recognizing PA intensity resulted in lower performance; the F1-Score range across age groups was: sedentary [0.919 – 0.947], light [0.813 – 0.828], and moderate [0.846–0.875]. The root mean square error range was [0.835–1.009] for the estimation of EE. The F1-Score range for recognizing individual PAs was [0.263–0.784]. In conclusion, machine learning models used to represent accelerometry data are robust to age differences and a generalizable approach might be sufficient to utilize in accelerometer-based wearables.
Barriers and Facilitators Impacting Physical Activity Among Rural American Indian Older Adults
Authors: Pedersen Maja , Harris Kari , Lewis Jordan , Grant Mattea , Kleinmeyer Chelsea , Glass Ashley , Brown Blakely , King Diane
Published: December 2021

Background. American Indian (AI) older adults experience pronounced health disparities and demonstrate among the lowest levels of physical activity (PA) of racial and ethnic groups. Nearly half of AI older adults live in rural areas, indicating distinct challenges to participation in PA. Research to identify factors influencing PA among this population is missing from the literature, yet is critical to inform culturally relevant PA intervention development and implementation. Purpose. To identify barriers and facilitators to PA among rural AI older adults using the ecological model and qualitative methods. Methods. A community-based approach was used to conduct semi-structured interviews with rural AI older adults. Interview questions were based on a multi-level ecological model. Content analysis was performed, using an iterative coding process to identify findings. Results. Participants’ (n=21) mean age was 66 years. Barriers and facilitators to PA were identified across ecological model levels. Barriers included factors such as caregiving and community responsibilities, lack of acceptable areas for walking, and overall lack of community-level support for older adult health. Facilitators included a personal connection to the land and ancestors through PA, multigenerational participation, and supportive tribal policies. Conclusion. This study addressed a critical gap in the literature by identifying barriers and facilitators among rural AI older adults, which can inform PA intervention development. In this way, their voices are uplifted to shape efforts addressing longstanding health disparities through relevant public health interventions.
Factors Associated With Latent Classes of Exercise Motivation Among Physically Active Older Adults
Authors: Bomi Choi , Joo Susanna , Lee Changmin , Kim Kwang Joon , Kim DaeEun , Kim YoonMyung , Jun Hey Jung
Published: December 2021

The objective of this study was to estimate the latent classes of exercise motivation and to find relevant factors in older adults. The sample comprises 179 people who reported practicing physical exercise regularly. We performed Latent Class Analysis (LCA) and multinomial logistic regression. Exercise motivation was observed with six indicators: medical advice, fun, weight loss, leisure, fitness, and socializing. Independent variables of regression analysis included sociodemographic characteristics (age, gender, marital status, education, and household income), health and well-being (subjective health, and life satisfaction), and satisfaction on neighborhood environment (physical, service, and sociocultural aspects respectively). Results of LCA indicated that the three-class model yielded optimal fit indices. Class 1 (7.5%) was labeled as ‘mainly for medical advice and socializing’. Class 2 (46.5%) was labeled as ‘mainly for fun’, while class 3 (46.0%) was labeled as ‘only fitness’. Results of multinomial logistic regression showed that males, people with lower education, and higher satisfaction with their sociocultural neighborhood were more likely to be categorized as ‘mainly for fun’ group compared to the reference group (‘only for fitness’). Subjective health was marginally significant (p<.10): People with positive subjective health tend to be categorized as ‘mainly for fun’ than ‘only for fitness’ group. Satisfaction with their sociocultural neighborhood was marginally significant (p<.10) in distinguishing ‘only for fitness’ and ‘mainly for medical advice and socializing’ group. The results of this study emphasized the heterogeneity in exercise motivation. Significant factors of exercise motivation in this study implied the importance of individualized interventions to promote exercise participation.
Get Moving! Your Brain Will Thank You.
Authors: Nunez Christina , Nuccio Alexandria , Golden Charles
Published: December 2021

Exercise and cardiovascular fitness are important for physical health and well-being. Recent studies show that exercise is associated with cognitive performance across multiple domains including memory, a common complaint for older adults. Data included a ten-word list of delayed recall, a clock drawing activity, and a three-meter walking course derived from the National Health & Aging Trends Study Database (NHATS Round 9). A total of 4977 participants were included in the analysis which was predominantly white (69.7%), non-Hispanic (94.5%), female (59.2%), and between the ages of 70-84 (62.7%). A hierarchical linear regression revealed that performance on the three-meter walking course positively predicted performance on delayed recall, F(4,3999)=300.257, p<.001, and on the clock drawing activity, which is a common screening task for cognitive decline, F(4,3978)=156.433, p<.001; accounting for 23.1% and 13.6% of the variability, respectively, over and above known demographic variables. Findings suggest that fitness may be one of many factors that is associated with memory and overall cognitive decline. These findings are timely as many individuals slowed down as a result of the COVID-19 pandemic, resulting in decreases in exercise and physical activity. Not being physically active or exercising may be related to poorer physical and cognitive health, with specific concerns regarding memory. Taking into consideration the fear and anxiety associated with declining memory in late life, it is crucial to explore this area further along with other factors that may contribute to the association and develop new ways for older adults to exercise safely during the COVID-19 pandemic.
The Association between Leisure and Physical Activity Level with Depressive Symptoms after 5-years of follow-up
Authors: Chang Milan , Eymundsdottir Hrafnhildur , Ramel Alfons , Sigurdardottir Sigurveig , Gudnasson Vilmundur , Launer Lenore , Jonsson Palmi
Published: December 2021

BACKGROUND: Depressive symptoms in older adults are associated with socioeconomic status (SES), medical care, and physical activity. However, there is little evidence on the longitudinal association between level of leisure activity (LA) and physical activity (PA) with depressive symptoms among community-dwelling older adults in Iceland. The study examined an association of LA and PA at baseline with high depressive symptoms (HGDS) assessed after 5 years of follow-up among community-dwelling older adults. METHODS: A large community-based population residing in Reykjavik, Iceland participated in a longitudinal study with 5 years of follow-up (n=2957, 58% women, 74.9±4.8 yrs). Those with HGDS or dementia at baseline were excluded from the analysis. The reported activity was categorized into 2 groups as no-activity versus any-activity. Depressive symptoms were assessed by the 15-item Geriatric Depression Scale (GDS) on average 5 years later. RESULTS: After adjusting for demographic and health-related risk factors, those who reported having any LA had significantly fewer HGDS after the follow-up of 5 years (6 or higher GDS scores, Odds Ratio (OR) = 0.46, 95% Confidence Interval (CI): 0.27 ~ 0.76, P = 0.003). However, reporting any PA at baseline was not significantly associated with HGDS (OR = 0.71, 95% CI: 0.51 ~ 1.00, P = 0.053). CONCLUSION: Our study shows that any LA among older adults is associated with having less depressive symptoms 5 years later among community-dwelling older adults while having any PA was not associated with depressive symptoms after 5 years of follow-up.
Fall-Related Injury in Older Adult Home Care Recipients: A Descriptive Population Study
Authors: Xing Danilla , Zecevic Aleksandra , Lappan Nicolette , Ming Yu
Published: December 2021

Canada is experiencing a growing aging population leading to an increase in the number of individuals receiving home care. More needs to be known about home care clients who experience fall-related injuries. The purpose of this study was to describe the characteristics of Ontario home care recipients (65 and older) who experienced fall-related injury, and the characteristics of those injuries. We conducted a population-based descriptive study using secondary data from the IC/ES data repository for the period of 2010-2014. Person-level characteristics were extracted from the Resident Assessment Instrument - Home Care and injury characteristics from ICD-10 CA codes for falls (W00-W19) in combination with injuries (S00-S99 or T00-T14), available from the NACRS database. Descriptive statistics and rates were calculated using R. Results show the population (N= 88,731) was primarily female (67.0%), the largest age group was 85-89 years old (25.5%) and hypertension was the most prevalent (83.0%) chronic condition. Clinical Assessment Protocols (CAPs) indicated need for support in management of IADLs (75.4%), falls (72.3%) and pain (70.3%). Most patients (55.8%) used nine or more medications. In 90 days prior to home care assessment, 39.6% experienced no falls, 32.4% fell once, and 26.1% fell two or more times. Injuries primarily took place within the home (38.2%). Factures were the predominant injury type (40.8%), followed by superficial injuries (19.7%). These findings create a foundation for fall-related injury prevention in home care and further research on risk identification, the efficacy of CAPs, and home environment adjustments.
Ambivalence Among Intergenerational Relationships In Old Age
Authors: von Humboldt Sofia , Costa Andrea , Silva Sara , Leal Isabel
Published: December 2021

Objective: This study aims to analyze the perspectives of intergenerational relationships between older adults and adult children. For this purpose, a qualitative research was carried out, which analyzes these relations at a cross-national level. Methods: Four hundred and twenty four older participants aged 65-97 years, were interviewed. Participants were of three different nationalities and lived in the community. All the interviews went through the process of verbatim transcription and subsequent content analysis. Results: Two dimensions of generational ambivalence were revealed from the study; support and the conflict dimensions. Findings of content analysis produced six themes, which represent intergenerational relations between older adults and adult children: older adults-adult children interaction quality; family integration; care and support; definition of limits; distance and alienation; and communication difficulties. Conclusions: This study highlighted the diversity of experiences in old age, in relation to intergenerational relationships and underlined the conflicting expectations from older adults in relation to their adult children. Keywords: Adult children, ambivalence; conflict; intergenerational relationships; older adults; support.
Different Experiences of Adult Child and Spousal Caregivers with Family Conflict
Authors: Yun Stacy , Weber Kendall , Ferszt Geffen , Dieker JoAnna , Qualls Sara
Published: December 2021

Previous research indicates that different types of caregivers report distinct levels of family conflict (Dieker et al., 2019). However, as half (52%) of the participants in the previous study did not report family conflict, the purpose of this study was to examine the relationships among types of caregivers, family conflict, and caregiver burden in those who experience family conflict. Participants (N = 277; aged 19 to 87; M = 52.96) comprised of 197 adult child and 80 spousal caregivers. They completed the Caregiver Reaction Scale (O’Malley & Qualls, 2017) to assess different aspects of the caregiving experience. Hierarchical regressions (block 1: demographics, block 2: family conflict) were computed to predict caregiving burden. For spousal caregivers, the final model explained 2.2% of the variance in caregiving burden, F(7, 69) = 0.22, p = .98. None of the variables were significant. Additionally, family conflict did not uniquely influence caregiving burden beyond demographics, Fchange(2, 69) = 0.03, p = .97. For adult child caregivers, the set of predictors accounted for 20.5% of the variance in caregiving burden, F(7, 183) = 6.75, p < .001. Having more family beliefs and support conflict predicted greater caregiving burden (ps < .01). Family conflict scores also significantly explicated caregiver burden beyond demographics, Fchange(2, 183) = 17.60, p < .001. Results suggest that family conflict is a stronger driver of caregiver burden for adult child than spousal caregivers. Findings imply the need for clinicians to target appropriate interventions for adult child caregivers to reduce caregiver burden.
The Shape of Care: Patterns of Family Caregiving Among Chinese Adults in the Middle to Later Stage of Life
Authors: Duan Haoshu
Published: December 2021

Due to the lack of institutional support, families have long been the primary caregivers in China. Most studies to date only focused on one single care activity during a particular life course stage. Nonetheless, older adults today are more likely to care for multiple family members concurrently or sequentially (serial caregivers). The studies on discrete snapshots of care activities failed to capture the patterns of family caregiving overtime. Utilizing four waves of longitudinal data from CHARLS (2011-2018, N=17,039), this study particularly focuses on care activities to grandchildren, parents, and spouse, and maps out the family caregiving patterns overtime. Using latent profile analysis, this study identifies five family caregiving patterns: 1). Light grandchild caregivers (27%), who on average provided 4.3 years’ grandchild care mostly; 2). Heavy grandchild caregivers (11%), who on average on provided 7 years’ grandchild care mostly; 3). Light caregivers for grandchildren and parents (7%), who sequentially provided 1-year care to grandchildren and parents; 4). Heavy serial caregiver (6%), who mostly provided care to spouse and grandchildren with higher overlapping years; 5). Overall light caregivers (49%), who on average provided less than one year of care to any recipient. The preliminary results suggest that heavy serial caregivers (6%) far worst in terms of depressive symptoms and more likely to report worsened self-rated health; and overall light caregivers (49%) have the lowest depressive symptoms and more likely to report good self-rated health.
Gender Differences in the Link Between Informal Caregiving and Subjective Well-Being
Authors: Kim Aeri , Woo Kyungmi
Published: December 2021

Despite existing evidence on the negative association between informal caregiving and caregiver’s well-being, three important knowledge gaps remain. First, the link warrants further scrutiny due to the possibility of individual heterogeneity. Second, less is known about how informal caregiving is related to caregiver’s well-being. Third, there is little consensus in the literature regarding whether caregiver’s gender matters. This study fills these gaps in the literature. Using seven waves of a large-scale, nationally representative longitudinal study of older adults in Korea between 2006 and 2018, this study employed generalized estimating equations models with a lagged dependent variable as well as fixed effects models. Findings from both models revealed that informal caregiving is negatively associated with subjective well-being, and this association is largely driven by female caregivers. To explore potential mechanisms undergirding this association, we examined the mediating roles of a number of health behaviors. We found that engaging in informal caregiving is associated with a reduction in regular exercise. Results from mediation analyses, however, suggested that regular exercise explains only a moderate amount of the observed association (12% for health-related life satisfaction and 8% for self-rated health). While informal caregiving is obviously a rewarding role, it poses a serious threat to caregiver’s well-being. Findings of this study on gender differences in the well-being consequences of informal caregiving lend support to taking a gender-conscious approach in programs aiming to improve the well-being of informal caregivers.
Dynamics of unmet need for social care in England
Authors: Vlachantoni Athina , Falkingham Jane , Evandrou Maria , Qin Min
Published: December 2021

Meeting individuals’ social care needs is a core element of UK social policy. However, the conceptualisation and operationalisation of ‘unmet need’ remain a challenge. This paper advances our understanding by incorporating a temporal dimension in the conceptual framework on unmet need to investigate the dynamics of met and unmet need for social care over time. Using data from Waves 6,7 and 8 of the English Longitudinal Study of Ageing, this paper examines five possible trajectories among individuals with a social care need at baseline: 1) no longer having such a need; 2) having continued needs met; 3) delayed needs met; 4) newly arisen unmet needs; and 5) persistent unmet needs. The results indicate that amongst those with need at baseline unmet need has decreased over time, indicating that some needs may be fulfilled with a delay. However, a significant proportion of older people experienced persistent unmet needs, particularly those who were younger, living alone, with educational qualifications, and with fewer difficulties with Activities of Daily Living at baseline. Understanding the dynamics of unmet need can support policymakers in ensuring that those facing an elevated risk of persistent unmet need over time do not fall through the social care safety net.
Family Caregivers and Support: Implications for Work Strain and Formal Service Use
Authors: Svec Joseph , Lee Jeongeun
Published: December 2021

In the US, many employed caregivers make professional adjustments, exacerbating already tenuous balances between work and life. Using the framework of the Stress Process Model (SPM), current research examines the sources of support (both formal and informal) and the contextual factors that facilitate or impede caregiver support. In this research, we examine whether and to what extent caregiver work strain is ameliorated by the presence of additional family caregivers and formal service use. This study utilizes data provided by the National Study of Caregiving (NSOC) data. Using panel methods for the pooled waves, we analyze the associations between work-strain and the number of additional caregivers with utilization of formal support (such as paid service support). Preliminary analyses align with the Stress Process Model as additional caregivers for each respective care-recipient is associated with lower levels of work strain. On the other hand, utilization of formal services (paid help and Medicaid funding) is positively associated with work strain. These findings suggest that the number of additional caregivers can reduce the negative impact of caregiving on work related strain among employed caregivers. That is, multiple caregivers may be more reflective of cooperative arrangements which offset work disruptions that occur with the onset of caregiving. In addition, formal sources may more frequently be used as a last resort to address caregiver burnout. Ongoing analyses are examining changes in the number of caregivers and its impact on disruptive work event, which could lead to financial outcomes for caregivers.
Social Retribution of Students of Master in Gerontology During the COVID-19 Pandemic: Enhancing Competencies
Authors: Arias-Merino Elva Dolores , Díaz-González Ma Guadalupe , Mendoza-Ruvalcaba Neyda Ma , Vazquez-Arias Martha Elena , Gonzalez-Ulloa José Rosario
Published: December 2021

Introduction: In response to the COVID-19 pandemic older adults were called to lockdown and social isolation. Master in Gerontology (MAGE) in a social retribution action delivered a companion program called “I′m with you, You′re with me”. MAGE competencies encompass those proposed by AGHE. The aim is to analyze competencies acquired by students in gerontology in the companion program during the COVID-19 Pandemic. Method: Participated 16 students of MAGE and 16 older adults selected by their high vulnerability conditions reported by social workers from the Metropolitan Center of Older Adults from DIF-Zapopan city. The program was designed to provide emotional support, was delivered by telephone for 3 months (Ago-Nov 2020). Experiences were obtained through an online-questionnaire, data were analyzed qualitative and quantitatively. Results: Students reported higher development in the competencies: 1) Interactional, that capture the process of knowing and doing across the fields of gerontology, related to stereotypes and discrimination, autonomy and self-determination, and the use of the technology to enhance the communication; 2) Fundamental, that represent the essential orientation to the field of gerontology, related to identify the impact of public policy and the application of intervention strategies and the use of technologies with older adults, families and caregivers; 3) Contextual, related to promote solid social networks for the wellbeing. The meaning of participating in this program was mainly centered in a gratifying professional experience, “small actions that make big gestures”. Conclusion: Gerontologist promote social solidarity through the transference and applying of the knowledge to enhance social development.
Supporting Older Family Caregivers of Young Adults with IDD: A Pilot Program with Socially Assistive Robotics
Authors: Xu Ling , Greer Julienne , Fields Noelle , Tamplain Priscila , Bricout John , Sharma Bonita , Doelling Kristen
Published: December 2021

Introduction: The need for caregiver respite is well-documented for the care of persons with IDD. Social Assistive Robotics (SAR) offer promise in addressing the need for caregiver respite through ‘complementary caregiving’ activities that promote engagement and learning opportunities for a care recipient (CR) with IDD. This study explored the acceptability and usefulness of a SAR caregiver respite program responsive to feedback from both the CRs and their older family caregivers (age 55+). Methods: Caregiver-CR dyads (N =11) were recruited. A mixed methods research design was deployed in three phases: Phase I with four focus groups to inform the program design; Phase II for program demonstration and evaluation with pre- and post-surveys; and Phase III with post-program interviews for feedback and suggestions. Results: Quantitative data analysis in Phase II showed both caregivers and their CRs scored favorably the social presence of the robot (Pepper) and social engagement with Pepper. Caregivers also reported positive perceptions of Pepper in terms of anthropomorphism, animation, likeability, intelligence, and safety. Content analysis from Phase III interviews suggested that the SAR may offer physical/emotional respite to caregivers by providing companionship/friendship as well as promoting independence, safety/monitoring, and interactive engagement with children. Discussion: SAR has potential in providing respite for older family caregiver demonstrated by the levels of CR engagement and learning with Pepper. Future studies need a longer program design and larger sample size to test the feasibility and efficacy of the intervention.
The Wake Forest IASDR: A Resource for Studying the Effects of Caloric Restriction on Health Outcomes in Older Adults
Authors: Houston Denise , Justice Jamie , Newman Anne
Published: December 2021

Over the past 25+ years, a focus of the Wake Forest Claude D. Pepper Older Americans Independence Center (OAIC) has been to study the consequences of and treatments for geriatric obesity. The Wake Forest OAIC has provided support for 18 clinical trials of caloric restriction (CR), with and without various exercise regimens, in 2,545 adults (71% women, 21% African American) with a mean±SD age of 67.5±5.9 years and BMI ≥27 kg/m2. A priority of the Wake Forest OAIC is to collate and store common data (e.g., demographics, physical performance, cognitive function), biospecimens (blood, muscle, adipose), and images (DXA, CT) from these trials in the Integrated Aging Studies Databank and Repository (IASDR; https://www.peppercenter.org/public/dspIASDR.cfm). This IASDR serves as a resource for the scientific community to foster new scientific questions and analyses. This symposium will provide an overview of CR trials and participants included in the IASDR and how the IASDR supports secondary analyses of CR by highlighting several secondary analyses using data and/or samples from the IASDR. Justice and colleagues examined the effect of CR on a geroscience-guided biomarker index using blood samples from the biorepository. Weaver and colleagues examined the effect of different exercise regimens on CT-derived muscle and bone measures during CR. Miller and colleagues pooled data from 11 trials to determine if CR-induced appendicular lean mass loss is associated with changes in physical performance. Finally, Hsieh and colleagues pooled data from eight trials to examine whether the effect of CR on gait speed differed by baseline BMI and inflammation.
Telomere Length and the Transition to Family Caregiving in the REGARDS Study
Authors: Haley William , Armstrong Nicole , Irvin Ryan , Blinka Marcela , Mathias Rasika , Walston Jeremy , Roth David
Published: December 2021

An increase in life expectancy and an aging population has resulted in increased risks and prevalence of age-related diseases. Previous studies have shown that factors, such as chronic stress, are associated with shorter telomere length. When telomeres become critically short, cells enter a state of senescence, which is a hallmark of aging. Several prior studies examining the relationship between caregiving and telomere length have reported mixed results. The present study utilized data from the Caregiving Transitions Study, an ancillary study to the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The difference in telomere length across an average ~8.6 years was compared between 235 incident caregivers and 229 controls. Telomere length was determined using the qPCR telomere-to-single copy gene (IFNB1) ratio (T/S) for each participant at both baseline and follow-up timepoints. Regression models controlling for age, sex, race, and baseline telomere length examined the association between caregiving status (exposure) and the telomere length change (□T/S). Sensitivity models adjusted for potential lifestyle and socioeconomic factors, including income, education, BMI, cigarette smoking, and alcohol use. We did not observe a significant association between □T/S and caregiving (beta=0.041, p=0.615). Adding lifestyle and socioeconomic factors did not change the null relationship (beta=0.062, p=0.455). In conclusion, this study provides evidence against an association between caregiving and the change in telomere length. Ultimately, more research to address the complex relationship between caregiving and telomere attrition is needed in order to prevent or reduce adverse outcomes and improve the well-being of caregivers and care recipients.
A Novel Algorithm for Analysis of Multiple Endpoints Using Risk–Benefit Profiles
Authors: Gouskova Natalia , Kim Dae , Shi Sandra , Travison Thomas
Published: December 2021

Often it is necessary to evaluate effectiveness of an intervention on the basis of multiple event outcomes of variable benefit and harm, which may develop over time. An attractive approach is to order combinations of these events based on desirability of the overall outcome (e.g. from cure without any adverse events to death), and then determine whether the intervention shifts the distribution of these ordered outcomes towards more desirable (Evans, Follmann 2016). The win ratio introduced in Pocock et al 2012 was an earlier implementation of this approach. More recently Claggett et al 2015 proposed a more comprehensive method allowing nonparametric and regression-based inference in presence of competing risks. Key to the method is weighting observations by inverse probability of censoring (IPC) processes specific to participants and event types. The method has seemingly great practical utility, but computation of weights is a non-trivial challenge with real-life data when each event can have its own censoring time. We present a novel recursive algorithm solving this problem for an arbitrary number of events ordered by clinical importance or desirability. The algorithm can be implemented in SAS or R software, and computes IPC weights, as well as nonparametric or parametric estimates and resampling-based measures of uncertainty. We illustrate the approach using data from the SPRINT trial of antihypertensive intervention, comparing risk-benefit profiles for robust, pre-frail, and frail subpopulations, and in analysis of fall as a function of progressive risk factors. More general use of the software tools deploying the method is described.
The First Evaluation of a Geroscience Biomarker Index (TAME-BI) in a Trial of Caloric Restriction and Exercise
Authors: Justice Jamie , Espeland Mark , Houston Denise , Kritchevsky Stephen , Nicklas Barbara , Pajewski Nicholas , Kitzman Dalane
Published: December 2021

We leveraged the WF OAIC biorepository to measure a consensus-derived panel of blood-based biomarkers of aging and constructed a geroscience-guided biomarker index (TAME-BI), testing it for the first time in a clinical trial. We measured IL-6, TNF-α-receptor-I, growth differentiating factor-15, cystatin C, and N-terminal pro-B-type natriuretic peptide in a 20-week randomized trial of caloric restriction (CR), aerobic exercise (EX), CR+EX, or attention-control in 88 patients (67±5years) with heart failure with preserved ejection fraction (HFpEF). We calculated TAME-BI (analyte levels ranked, binned by quintile, and summed) and found a time×treatment interaction for improved TAME-BI with intervention (p≤0.05) and detected associations between change in TAME-BI and change in six-minute walk distance (r= -0.24), usual walk speed (r= -0.23), and left ventricular relative wall thickness (r= 0.31). In sum, CR+EX intervention improved TAME-BI and changes in TAME-BI were associated with changes in key functional measures in older HFpEF patients.
Frailty prevalence and association with mortality across birth cohorts in Swedish registry data
Authors: Wennberg Alexandra , Modig Karin
Published: December 2021

Frailty is associated with poor health outcomes, reduced quality of life, and mortality. To understand how prevalence of frailty may have changed across birth cohorts, we investigated frailty prevalence at ages 75, 85, and 95 in people born in 1910, 1920, and 1930 in Swedish national registry data. Frailty was assessed with the Hospital Frailty Risk Score, a weighted sum of 109 ICD codes, which we calculated for each year leading up to the specified ages. We additionally investigated the association between frailty and mortality in these birth cohorts. We observed, at 75, a decrease in prevalence of frailty across birth cohorts (16.9%, 10.8%, and 8.8%, respectively). Interestingly, at 85, we found a U-shaped pattern, where those born in 1920 (14.1%) had lower prevalence of frailty than those born in either 1910 (27.7%) or 1930 (25.1%). At age 95, we saw a low prevalence of frailty in the 1910 (7.3%) and 1920 (3.8%) birth cohorts –potentially because of selective survival. There were not substantial differences in prevalence of frailty by sex or birth country. In Cox proportional hazard models adjusted for sex, frailty was consistently associated with mortality. We observed the greatest hazard ratios in the 1930 birth cohort at 75 (HR=2.79, 95% CI 2.62, 2.97) and 85 (HR=2.26, 95% CI 2.01, 2.53) and the 1920 birth cohort at 75 (HR=2.19, 95% CI 2.09, 2.29), where risk was double that of those who were not frail. Understanding changes in prevalence of frailty will help inform public health and intervention measures.
Physical Frailty and Cognitive Impairment in Older Nursing Home Residents: A Latent Class Analysis
Authors: Yuan Yiyang , Lapane Kate , Tjia Jennifer , Baek Jonggyu , Liu Shao-Hsien , Ulbricht Christine
Published: December 2021

Physical frailty (PF) has various clinical presentations and often co-occurs with cognitive impairment in older adults. In older adults in nursing homes (NHs), no research has examined the heterogeneous profile of PF and its association with cognitive impairment. Minimum Data Set 3.0 was used to identify older, long-stay, newly-admitted NH residents (2014-16; n=871,801). Latent class analysis was used to identify PF subgroups with FRAIL-NH items as indicators. Logistic regression was used to estimate the association between PF subgroups and cognitive impairment. The final model indicated three PF subgroups (prevalence): “mild PF” (7.6%), “moderate PF” (44.5%), and “severe PF” (47.9%). In all subgroups, residents had high probability of needing help with dressing. Older adults likely to belong to the “moderate PF” or the “severe PF” subgroups had high probabilities of requiring physical assistance to transfer between locations and inability to walk in a room. Additionally, residents likely to be in the “severe PF” subgroup had greater probability of bowel incontinence. Greater cognitive impairment was associated with increasingly higher odds to be in the “moderate PF” and “severe PF” subgroups: older residents with severe cognitive impairment were 20% more likely [adjusted odds ratio (aOR): 1.20, 95% confidence interval (CI): 1.17-1.23] and almost 7 times as likely (aOR: 6.86, 95%CI: 6.66-7.06) to belong to the “moderate PF” and “severe PF” subgroups, respectively. Findings provide new evidence for the interrelationship between PF and cognitive impairment in older NH residents and have implications for the development of interventions tailored to older residents’ specific PF experience.
Promoting Early Assessment of Frailty in the New Normal: An Updated eFI-CGA Software Tool
Authors: Sepehri Katayoun , Low Hilary , Park Grace , Song Xiaowei
Published: December 2021

Frailty is a state of diminished physiological reserves. Being able to detect and manage frailty early is crucial for effective controlling of frailty-related adverse outcomes. Frailty can be assessed using the frailty index that counts the number of health deficits accumulated over time. Our previous research has enabled an electronic Comprehensive Geriatric Assessment (eCGA) and the calculation of the frailty index based on the eCGA (eFI-CGA). While the standalone eFI-CGA has been used by primary care providers in assessing home-living patients, its initial release was prior to the covid-19 pandemic; the associated new challenges were not targeted by the early version. In facilitating effective virtual assessment and care planning during the current “lockdown” and in the upcoming “new normal”, most recently the eFI-CGA version 3.0 was released. In this paper, we 1) introduce the updated electronic frailty assessment tool and its usage, 2) describe the major updates of the software in dealing with challenges due to social isolation and remote assessment, and 3) evaluate the end-user experience with the upgraded methods in frailty assessment. These new developments and implementations allowed a search function to resume disrupted assessment sessions and quickly retrieve previously saved assessment records. The improved user interface promoted the clinicians to conveniently record detailed care plans and management details. The study provided a successful example of moving from disruption to transformation, benefiting the highly demanded healthcare of older adults in this challenging time.
Grandparents Raising Grandchildren: Applying Bioecological Theory to School Relationships and Grandparent Needs
Authors: Black Katharine , Mendoza Nancy
Published: December 2021

This paper examines the development, sustainability and importance of positive working relationships between grandparents raising grandchildren (“grandparents”) and school district staff through the application of Bronfenbrenner’s bioecological theory of human development. Grandparents have unique needs and often lack adequate resources, knowledge, and support when engaging in their new and often sudden role as primary caregiver of a grandchild. Access to educational resources, adequate information, and school district support is critical as a grandchild transitions into their grandparent’s home. This inquiry aims to develop a conceptual framework for understanding how forming and maintaining positive working relationships between grandparents and school district staff will systematically and adequately address the educational needs of grandparents and their grandchild’s academic success. Tenets of the bioecological model include the application of proximal processes that outline the need for frequent and regular interactions between a person and their environment over extended periods of time. The purpose of this study is to develop positive pathways of support through the application of the interconnected elements of proximal processes of the bioecological theory including process, person, context, and time, and the five bioecological interactive (micro-, meso-, exo-, macro-, chrono-) systems of human development. More specifically, educational needs of grandparents as caregivers are addressed through tenets of the bioecological theory to inform school districts and encourage the development of positive working relationships and effective education navigation protocols to better serve this unique and growing population.
The Focus Group Must Go On: Lessons Learned from Conducting Virtual Focus Groups
Authors: Cordell Ashlee , Wilk Christa , Orsulic-Jeras Silvia , Powers Sara , Ejaz Farida , Sanders Lisbeth
Published: December 2021

The Covid-19 pandemic has presented a multitude of challenges in conducting research with human subjects. In response, researchers have found creative ways to complete these studies using alternative methods that incorporate social distancing. Fortunately, numerous technologies exist today that allow individuals to connect with one another over short and long distances. The current study describes the development of LifeBio Memory: an app-based product that utilizes artificial intelligence and machine learning to improve an existing life story intervention designed for persons living with dementia (PWD). Seven focus groups (n=35), originally planned in-person, were successfully converted to a virtual setting. Groups were hosted using a Zoom platform, lasted 75-90 minutes (Mean = 85; SD = 5.3), and consisted of participants from 14 different states: One group of community-dwelling PWDs with early-stage dementia (n=5); two groups of current and former users of the original LifeBio program (n=12); and four groups of residential care staff and directors (n=18). Virtual focus group delivery was determined to be an acceptable and feasible alternative to traditional in-person formats. Topics discussed in this poster will include: 1) recruitment procedures, 2) screening protocols, 3) methods for sharing materials, 4) guidance for providing technology support, and 5) communication strategies to increase retention. Further discussion will focus on challenges faced when collecting data in a virtual setting, tips for successful facilitation, advantages to using virtual alternatives, and other lessons learned from the virtual field.
Room Type and Social Cohesion in Senior-living Facilities
Authors: Wang Zhe
Published: December 2021

Private rooms are generally preferred by senior-living residents. However, having roommates may help residents to build and maintain social networks in the facility, leading to promoted social cohesion and mental health. The differences in social cohesion among senior-living residents who resided in private or shared rooms need investigation. This research collected empirical data from eight senior-living facilities in Beijing and Shanghai, China. Focusing on social cohesion, room type, and personal factors, on-site questionnaire surveys recruited 345 residents receiving independent living, assisted living, or nursing care services. Facility environments were measured and rated by researchers through on-site observation. Controlling for personal and facility factors, ANOVA tests were employed to investigate the differences in social cohesion among residents who resided in private, double, or triple rooms. Room type was found significant to the social cohesion in assisted-living and nursing care residents. At the assisted-living level, compared with private and double rooms, triple rooms were more likely to contribute to social cohesion (p<=0.01). At the nursing care level, residents with less numbers of roommates (private versus double and double versus triple) had stronger social cohesion (p<=0.05). At the independent-living level, no factors significant to social cohesion were found. These findings can be used to guide the new design, renovation, and modification of senior-living environments to promote social cohesion. Recommendations for future research and practice implications for senior-living professionals and facility designers are discussed. Senior-living facilities should be built to be social-friendly through design and planning and within the context of its cultural characteristics.