bluuebunny/crossref_metadata_2025 huggingface dataset:
Hopefulness During COVID-19: Associations With Function, Sleep, and Loneliness in the NHATS
Authors: Hladek Melissa , Li Qiwei , Samuel Laura , Drazich Brittany , Cudjoe Thomas , Szanton Sarah
Published: December 2021

The associations between hopefulness and function, loneliness, and sleep have not been explored in a nationally representative sample of older adults. Additionally, COVID19 dramatically increased stress burden, potentially influencing these relationships. This study used National Health and Aging Trends COVID19 Supplement data (N=2,894 adults aged ≥ 65 years) to evaluate cross-sectional associations between hopefulness about the future during COVID19 with limitations in activities of daily living (ADLs) using a negative binomial model and one-item sleep and loneliness measures using ordered logistic models. Adjusting for age, race/ethnicity, and education and applying sampling weights, increased hopefulness was associated with better ADLs (b= -0.11, p-value=0.021), less loneliness (b=-0.32, p-value=<0.001), and better sleep (b= -0.27, p-value= <0.001). In the midst of a world-wide stressor, hopefulness was associated with better function and symptoms. This relationship is likely bidirectional and further longitudinal research is needed.
Creative Arts Interventions in Addressing Depression in Older Adults: A Systematic Review
Authors: Sajnani Nisha , Dunphy Kim , Baker Felicity , Dumaresq Ella , Caroll-Haskins Katrina , Eickholt Jasmin , Ercole Maya , Kaimal Girija
Published: December 2021

Depression experienced by older adults is proving an increasing global health burden, with rates as high as 27% in the USA. This is likely to increase in coming years as the number and proportion of older adults in the global population rises. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama, and music, are utilized internationally to reduce depressive symptoms in older adults and promote wellbeing. This includes interventions led by trained arts therapists as well as other health and arts professionals. This presentation will include a report of findings from a recent systematic review of the outcomes of four creative arts modalities (art, dance movement, drama, and music) with particular attention paid to processes of change documented in each modality.
An Intergenerational Zoom Music Therapy Group During COVID-19
Authors: Gvili Racheli Lital
Published: December 2021

The COVID-19 pandemic has led to an increase in ageist attitudes and psychological distress and loneliness among older people. The social isolation exacerbated the intergenerational segregation between young and older adults, and has also been expressed within families, since grandparents could not meet their grandchildren in person. The present study involved an intergenerational music intervention, as a vehicle to bridge the gap between grandparents and grandchildren at the COVID-19 pandemic. 41 grandparents aged 56-80, and 45 grandchildren aged 9.9-11.8 took part. Of these, 21 pairs of grandparents and grandchildren participated in a weekly online intergenerational zoom music therapy group for eight weeks, and the rest constituted a waitlist-controlled group. All participants completed the same questionnaires during the same time periods before and after the intervention. The results point to the effectiveness of participation in the sessions in improving intergenerational connections and psychological well-being, and in reducing ageist attitudes and loneliness.
Emerging Telehealth Advances for Mental and Cognitive Health in Late Life
Authors: Woolverton Cindy , Bamonti Patricia , Moo Lauren
Published: December 2021

Over the last year, mental health services offered virtually have increased significantly in response to COVID-19. The rapid adoption of telehealth practices has raised many questions about how to develop and deliver effective interventions for older adults targeting their mental and cognitive health. In this symposium, we present on the feasibility of mental and cognitive health interventions for older adults using telehealth methods with particular focus on how adoption of these telehealth tools have been impacted by the current pandemic. Dr. Touchett and colleagues will present data on the telehealth utilization disparities among older veterans with comorbid disabilities and discuss ethical considerations when providing care for older adults. Dr. Kornblith and colleagues will present pilot data on the feasibility of GOALS, a video telehealth cognitive remediation group intervention for older adults with cognitive and emotional dysfunction related to traumatic brain injuries. Dr. Gould and colleagues will present pilot data on the feasibility and preliminary efficacy of a brief video-delivered self-management intervention BREATHE for older veterans with anxiety disorders. Dr. Weiskittle and colleagues will present their work on the development and dissemination of a brief 8-week telephone group intervention for homebound older adults targeting social isolation. Dr. Jacobs and colleagues will share their findings of a telephone delivered mindfulness intervention for caregivers and persons with dementia. Finally, the discussant, Lauren Moo, MD, an expert in assessing the efficacy of telehealth interventions will tie findings together and provide directions for future research and innovation.
Associations Between Age-Related Changes in Positive Affect and Physical Functioning: The Role of Education
Authors: Blöchl Maria , von Oertzen Timo , Kunzmann Ute
Published: December 2021

Increasing research points to the relevance of educational attainment for positive emotional experiences and physical functioning across adulthood. However, little is known about how age-related developments in positive affect and physical functioning differ by educational attainment. This study used longitudinal data of 10,893 individuals (60–80 years) from the Health and Retirement Study to examine whether educational attainment moderates trajectories of positive affect and physical functioning and their interrelations over 12 years. Initial results from multiple-group bivariate growth models revealed that individuals with less formal education have lower positive affect and poorer physical functioning at baseline. There was, however, no evidence that longitudinal changes in positive affect, longitudinal changes in physical health, and coupled changes between both variables varied with educational attainment. These initial findings suggest that lower educational attainment is primarily related to lower levels of positive affect and physical functioning, but not to greater age-related declines or their interrelations.
Discrete Affective States, Cortisol, and Self-Rated Health in Old Age
Authors: Pauly Theresa , Schilling Oliver , Kunzmann Ute , Wahl Hans-Werner , Ram Nilam , Gerstorf Denis , Hoppmann Christiane
Published: December 2021

Old age is a developmental phase in which physical vulnerability increases and discrete affective states are uniquely important. The current project combines data from four studies (total N = 476 participants) to investigate within-person fluctuations in salivary cortisol (a marker of physiological arousal), seven discrete affective states, and the moderating role of self-rated health. Each participant provided affect reports and collected salivary cortisol 5-7 times a day for a 7-day period, and rated their health status. Multi-level models showed that cortisol levels were decreased in moments when participants felt happier, more relaxed, and more interested than usual and increased in moments when participants felt angrier, more nervous, more overwhelmed, and sadder than usual. Associations of happy, nervous, overwhelmed, and sad with cortisol were more pronounced in participants of better as compared to those of worse self-rated health. Findings suggest that higher HPA reactivity may indicate preserved health in older adults.
Excess Mortality Attributable to COVID-19 Among Assisted Living Residents
Authors: Thomas Kali , Zhang Wenhan , Dosa David , Carder Paula , Sloane Philip , Zimmerman Sheryl
Published: December 2021

This study examines the excess mortality attributable to COVID-19 among a national cohort of assisted living (AL) residents. To do this, we compare the weekly rate of all-cause mortality during 1/1/20-8/11/20 with the same weeks in 2019 and calculated adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs). All-cause mortality rates, nationally, were 14% higher in 2020 compared with 2019 (mean, 2.309 vs. 2.020, respectively, per 1000 residents per week; adjusted IRR, 1.169; 95% CI 1.165-1.173). Among the 10 states with the highest community spread, the excess mortality attributable to COVID-19 was 24% higher, with 2.388 deaths per 1000 residents per week in 2020 during January-August vs 1.928 in 2019 (adjusted IRR, 1.241; 95% CI 1.233-1.250). These results suggest that AL residents suffered excess mortality due to COVID-19.
Assessing Coping Strategies and Outdoor Activities Among Older Adults During the COVID-19 Pandemic
Authors: Sefcik Justine , Coates Martha , Wetzel Sarah , Patel Janvi , Bynum Keyanna , Pham K Linh , DiMaria-Ghalili Rose Ann
Published: December 2021

Information is lacking on how older adults are coping during the pandemic. We explored coping strategies including outdoor activities among community-dwelling older adults (N = 115) 65 and older (mean age 76.45, 71.3% female). Using conventional content analysis, we analyzed responses to: 1) How are you coping with COVID-19? and 2) How often are you going outside during the pandemic and for what reasons? Most common activities are connecting with family and friends (some in person, others on the phone or virtually), reading, tv, game playing, and learning something new (e.g. webinars, online classes). The majority are going outside every day, with walking being the most common activity. Only a few are restricting their out of home activities to essential tasks (e.g. going to the doctors, pharmacy, getting groceries). Findings suggest that many older adults are engaging in positive coping activities. Assessing coping strategies can give insight into wellbeing.
Experiences of Interdisciplinary Providers Deploying Telehealth During the COVID-19 Pandemic
Authors: Coates Martha , Moore Katelyn , Hathaway Zachary , Gonzalez-Kruger Gloria , Montgomery Kymberlee , DiMaria-Ghalili Rose Ann
Published: December 2021

The expansion of telehealth services during COVID-19 is critical for healthcare delivery. This study describes the facilitators and barriers experienced by providers integrating telehealth during COVID-19. The sample consisted of 441 interdisciplinary providers (RNs, APNs, PAs, DPTs, RDs, mental health counselors) who were faculty or alumni of a college of nursing and health professions and completed the online telehealth provider survey. 53% of respondents were nurses/APNs, 59% implemented telehealth within the first week of federal legislation, and 48% received telehealth training once the pandemic started. Respondents reported telehealth changed several services provided during the pandemic (e.g., increased prescription of longer-term medication refills, increased counseling sessions). The greatest reported barrier to utilizing telehealth during the pandemic was the older adults’ ability to utilize technology. Understanding the facilitators and barriers experienced by providers during COVID-19 will lead to more robust healthcare delivery models to enhance health outcomes in older adults.
Action Steps and Strategies Taken by Older Persons to Prevent and Mitigate Effects of Climate Change
Authors: Bial Martha
Published: December 2021

While the vulnerability of older persons to climate change is recognized by many scholars, there has been less attention to contributions older adults make to the fight against climate change, and their motivations to engage in that fight. Motivations include concern for the environment they will leave to their descendants. Contributions include freed up time, and skills gained in personal or work history to educate others on the issues and to organize and advocate for policy change. This presentation will highlight several national and international organizations of older people devoted to educating community groups, monitoring water quality and changes in wildlife habitats, and testifying before legislative bodies in campaigns for increased environmental regulation. Some of these organizations are intergenerational, providing additional benefits in cross-generational social exchange. Such activities are in line with SDGs 13 (action on climate change), 11 (sustainable cities), 12 (sustainable consumption) and 17 (expanding multi-stakeholder partnerships).
Examining Attitudes and Experiences of Ageism During COVID-19: Are They on the Rise?
Authors: Vale Michael , Sublett Jennifer , Bisconti Toni
Published: December 2021

Gerontologists have warned of rising ageism amidst the COVID-19 pandemic. Older adults have been portrayed as a homogenous group given their health vulnerabilities and have been viewed with mixed perceptions. For instance, the pandemic has been viewed as an “old person’s” disease and older adults have been inherently linked to imposing health and safety lifestyle changes. Others have responded with acts of overaccommodative care that have minimized older adults’ autonomy. Taken together, there have been inferences of increased hostile and benevolent ageism. Currently, these claims lack empirical data, and the goal of this study was to examine if attitudes and experiences of ageism are on the rise. Across two studies, we examined young adults’ (N=268) attitudes of older adults and older adults’ (N=65) experiences of ageism before and after the start of the pandemic. In study 1, we examined ageist attitudes at 3 time points (2017, 2019, 2020) from separate, but equitable, college samples and found that hostile ageism was higher during the pandemic (F(2,265)=5.48, p<.001) and benevolent ageism demonstrated no differences. In study 2, we explored older adults’ experiences of ageism pre-and post-pandemic onset (2019, 2020) and, found that they reported experiencing less hostile ageism (t(64)=2.45, p<.05), with no differences in experienced benevolent ageism. Our findings suggest an increase in hostile ageist views, but a decrease in experiences, partially supporting the alleged claims of rising ageism. Nevertheless, the last year of the pandemic is dynamically contextualized and research should elaborate on the extent and consequences of this rise.
Racial Differences in the Effect of Alzheimer’s Disease on Adherence to Medication Therapy for Chronic Diseases
Authors: Yashkin Arseniy , Yashin Anatoliy , Gorbunova Galina , Akushevich Igor
Published: December 2021

Multiple dementia (the presence of one or more types of dementia in a single individual) and multi-morbidity (the presence of multiple chronic diseases in an individual) present a major challenge to the U.S. healthcare system. The reduction in cognitive function associated with neurocognitive disorders such as Alzheimer’s Disease (AD) and Related Dementias (ADRD) reduce the ability of the affected individual to take care of him/herself. This can manifest as reduced adherence to medication regimens designed to manage other chronic conditions, in reduced ability to engage in healthy behavior such as exercise, or in other ways. The result is an increase in the probability of otherwise avoidable adverse health outcomes and related healthcare costs. In this study, we showcase two high impact chronic conditions common in the elderly: hypertension and type 2 diabetes mellitus (T2D). Using a 5% sample of the total Medicare population we identify groups of individuals with AD/ADRD and i) hypertension, ii) T2D or iii) both. Each group is then propensity-score-matched to similar individuals with hypertension, T2D or both but without a diagnosis of AD/ADRD. The primary explanatory variable of interest is the medication possession ratio (MPR) calculated at 1-year intervals for prescribed diabetes and/or hypertension medications. MPRs were compared between the two groups using t-tests and standardized differences each year after baseline and until death/censoring. A Cox proportional hazard model was then used to estimate differences in survival between these two groups and across race/ethnicity-related strata. Reduced adherence with time and notable race/ethnicity-related differences were identified.
Subjective Aging in Context: Neighborhood Social Environment and Self-perceptions of Aging among Older Adults
Authors: Choi Eunyoung , Zelinski Elizabeth , Ailshire Jennifer
Published: December 2021

Self-perception of aging (SPA), one’s attitude toward one’s own aging, has been associated with health and well-being in later life. Whereas existing literature identifies individual-level predictors of SPA (e.g., education and health), little is known about the role of neighborhood context. The present study examines whether 1) neighborhood social environment is related to SPA and 2) age moderates this relationship. Our analytic sample includes 11,394 adults aged 50+ from the 2014 and 2016 waves of the Health and Retirement Study (Mean Age=68, SD=10.14, range 50-98). Indicators of neighborhood social environment include (a) perceived neighborhood social cohesion (the trust and social ties among community residents), (b) neighborhood friends, and (c) relatives living in the neighborhood. Regression analyses were performed to investigate the associations of each neighborhood-level indicator with the positive and negative dimensions of SPA. The models controlled for demographic, socio-economic, and health covariates. Greater neighborhood social cohesion (B=0.13, SE=0.01, p<.001) and having neighborhood friends (B=0.14, SE=0.02, p<0.001) were associated with higher levels of the positive SPA. As for the negative dimension of SPA, neighborhood social cohesion was the only significant predictor (B=-0.13, SE=0.01, p<0.001). Furthermore, we found significant interaction effects between neighborhood social cohesion and age: higher neighborhood cohesion was associated with more positive (B=-.003, SE=.00, p<.001) and less negative SPA ratings (B=-.003, SE=.00, p<.001) at younger ages than older ages. Our findings provide insights into how neighborhood social context shapes subjective aging, suggesting that a socially cohesive neighborhood may promote more favorable perceptions of aging, particularly for younger residents.
Is Cancer History Related to Neurologic Specialty Care in Patients with Dementia?
Authors: Fowler Mackenzie , Triebel Kristen , Rocque Gabrielle , Irvin Ryan , Kennedy Richard , Wright Nicole
Published: December 2021

Background: The incidence and prevalence of aging-related diseases such as dementia and cancer are increasing, as are cancer survival rates. Cancer and its treatments have been associated with cognitive effects for those who later develop dementia. Guidelines have suggested that cancer patients return to follow-up in primary care following remission and be referred to specialists for cognitive complications, but it is unclear how well these guidelines are followed. Methods: Electronic health record data at the University of Alabama at Birmingham were extracted from July 2003 May 2020. Rates of specialty care utilization on or after dementia diagnosis were compared by cancer history status in adults 50 years old or older at dementia diagnosis. Predictors of specialty care utilization were examined using logistic regression. Results: Rate of specialty care utilization was lower for those with cancer history compared to those without on the date of dementia diagnosis (11.3% vs. 17.1%) and after diagnosis (13.5% vs. 19.2%). Older age at dementia diagnosis, non-Hispanic Black race, anticholinergic burden, socioeconomic status, and vascular risk factors were associated with lower odds of specialty care utilization. Dementia medication use was associated with higher odds of specialty care utilization on and after dementia diagnosis. Conclusions: Cancer survivors with a dementia diagnosis are less likely to utilize specialty care than those with no history of cancer. Several factors predicted specialty care utilization. Additional studies should assess potential barriers in referring cancer survivors to specialty care for cognitive impairment.
Associations between Metformin and Aspirin Use on Cancer Incidence and Mortality in Older Adults.
Authors: Orchard Suzanne , Broder Jonathan , Lockery Jessica , Gibbs Peter , Espinoza Sara , Ernst Michael , Woods Robyn , McNeil and John
Published: December 2021

Diabetes increases risk of malignancies, and this association increases with age. Metformin may protect against cancer development and progression, but results are mixed and limited to younger cohorts. We examined whether metformin, in the presence or absence of aspirin, reduces incident cancer and cancer-related mortality in older adults. ASPirin in Reducing Events in the Elderly (ASPREE) was a primary prevention trial of daily aspirin vs placebo which enrolled community-dwelling adults from Australia (70+ years) and the US (65+ years for minorities) followed for a median of 4.7 years. Invasive cancer was adjudicated by an expert panel. Cox proportional-hazards models, controlling for age at randomization and known cancer risk factors, were used to analyse the relationship between baseline metformin use, randomized treatment arm, cancer incidence (first in-trial cancer) and mortality. For participants with controlled diabetes, there was a significant reduction in cancer mortality in metformin users compared to nonusers (Adjusted [Adj] HR=0.24, 95%CI=0.07, 0.80), but not for cancer incidence (Adj HR=0.61, 95%CI=0.29, 1.27). For participants with uncontrolled diabetes, there was no significant difference in cancer incidence (Adj HR=0.95, 95%CI=0.66, 1.38) or mortality (Adj HR=1.18, 95%CI=0.62, 2.26) between metformin and non-metformin users. Uncontrolled diabetes, irrespective of metformin use, increased risk of cancer incidence and mortality compared to non-diabetics. Aspirin did not modify the effect of metformin on cancer incidence or mortality. Our findings show that metformin may have protective effects against cancer-related mortality for those older persons whose diabetes is well-controlled, and underscores the importance of diabetes control to minimise cancer risk.
Sarcopenic Obesity in Older Adults: Findings From the National Health and Aging Trends Study
Authors: Dondero Kathleen , Falvey Jason , Beamer Brock , Addison Odessa
Published: December 2021

Sarcopenic obesity increases risk for dysmobility and loss of independence, (Gandham et al., 2021). However, the national burden of sarcopenic obesity and the resultant impacts for older adults has yet to be described. Within a nationally representative sample from the National Health and Aging Trends Study (NHATS), 2066 community-dwelling older adults were obese, representing 12,136,374 individuals in the United States, or 31.8% of all community dwelling older adults. Based on the European Working Group definition, 18% of the obese older adults were sarcopenic. Sarcopenic obese older adults were more likely to have fallen in the last month and been hospitalized over the prior year. After adjusting for age and sex, sarcopenic obese older adults were 3.7 times more likely (95% CI 2.2-5.0) to have 2 or more comorbid conditions and frailty was 6.4 times more likely (95% CI 4.4-9.5) compared to nonsarcopenic obese older adults. Sarcopenic obese older adults were also more likely to have 1+ ADL disabilities (OR 3.7; 95% CI 2.5-5.4). Further, they were more likely to be socially isolated (OR 2.1; 95% CI 1.3-3.2) and report food insecurity (OR 1.5; 95% CI 0.8-2.9). These findings suggest older adults with obesity and sarcopenia have higher rates of geriatric vulnerabilities, which might indicate a need for caution when recommending weight loss alone as an intervention. A more comprehensive intervention may be necessary to address social and physiological risks. Future studies should examine whether early intervention in sarcopenic obese older adults can reduce chronic health risk and preserve independence.
Impact of Green Space, Air Pollution, and Weather on Cognitive Function in Middle and Old Age in China
Authors: Zhang Lingling , Luo Ye , Pan Xi , Wang Qing
Published: December 2021

Population aging will inevitably bring an increasing burden of poor cognitive function. The risk factors for cognitive decline have been widely studied. Even though environmental hazards have the greatest adverse impacts on older adults and the existing evidence has shown that green space, air pollution, and weather have an impact on cognitive function, most of the studies were conducted in developed countries and limited to cross-sectional analyses. China has the largest aging population in the world so the research evidence from it can offer an insight to the study in other developing countries facing similar issues and inform future public health policy and disease control. Using the data from a nationally representative sample of adults aged 45 years and older from the three waves of China Health and Retirement Longitudinal Study (CHARLS 2011-2015) and China City Statistical Yearbook, this study estimated multilevel growth curve models for the effects of green space coverage, air pollution, and weather conditions on cognitive function and cognitive decline. It showed that after controlling for sociodemographic characteristics, built area green coverage rate was positively associated with cognition score at baseline, and higher annual minimum temperature was associated with faster decline in cognitive function. These effects did not substantially change after weekly total hours of physical activities and levels of social engagement were added and the interaction effects were examined between environmental conditions with them, respectively. More research on the mechanisms of the effects of environmental factors on cognition is needed such as the subgroup analyses.
Race/Ethnicity Moderation on the Relationship Between Neighborhood Minority Composition and Depressive Symptoms
Authors: Cho Seungjong
Published: December 2021

Research showed neighborhood of residence is an important determinant of depressive symptoms. However, the complex effects of neighborhood racial/ethnic composition and individuals’ race/ethnicity on depressive symptoms were not fully explored in previous studies. This study tested whether individuals’ own race/ethnicity moderates the relationship between neighborhood racial/ethnic composition and depressive symptoms. Applying social disorganization theory, this study investigates the relationships between neighborhood racial/ethnic composition (proportion of racial and ethnic minorities), individual race/ethnicity, and depressive symptoms. This study used a merged data from Health and Retirement Study 2016 and the American Community Survey 2014-2018 (N=5,241; all age 50 or older). This study applied a mixed-effects negative binomial regression model. It has four statistical models by race/ethnicity: (a) non-Hispanic Blacks only, (b) Hispanics only, (c) non-Hispanic Whites only, and (d) combined model. Covariates were included two individual-level variables (age and gender) and three census tract-level variables (the proportions of (a) population of income below the poverty level; (b) population of unemployed; (c) population of aged 65 and over). The results showed none of the neighborhood racial/ethnic minority composition was associated with depressive symptoms for the final combined model. The moderation effects of individuals’ race/ethnicity were not significant. Not as a moderator but as the main effect, both non-Hispanic Blacks and Hispanics had higher depressive symptoms, compared to non-Hispanic Whites. Living in neighborhoods with higher poverty rates and females were also related to higher depressive symptoms. This study contributes to explore the subtle nature of depressive symptomatology and race both at individual-level and neighborhood-level.
African-American Race Predicts 1-Year Cognitive Decline Among Adults Without Moderate Dementia
Authors: Babiker Niser , Gonzalez Alan , Soto Jovany , Shi Chengjian , Rzhetsky Andrey , Huisingh-Scheetz Megan
Published: December 2021

Previous literature shows conflicting conclusions about the association between race and cognitive decline, particularly in early impairment. In this study, we aimed to test whether race predicted 1-year change in Montreal Cognitive Assessment (MoCA) score among older adults without moderate-severe dementia. We secondarily explored whether multimorbidity, polypharmacy, depressed mood, antidepressant use, body composition, or frailty changed the association. We analyzed data (n=122) from predominantly African American (AfA, 78.7%) community-dwelling older adults from the south side of Chicago. Participants underwent baseline and 1-year MoCA testing. Age, gender, race, education, monthly income, co-morbidities (Charlson Comorbidity Index), medication use (<5 vs ≥5), depression (PHQ-2), proportion lean mass (DEXA), and the frailty phenotype (range 0-5) were collected at baseline. In a multivariate linear model, we regressed 1-year MoCA score on baseline MoCA score, race, and demographics and then evaluated the impact of each covariate added separately to the model on the race-cognition relationship. The mean MoCA score at baseline was 25.2+/-0.2 (range 18-30) and 41.0% of participants experienced ≥1 point MoCA decline at 1 year. After adjusting for demographics, AfAs experienced a greater 1-year MoCA decline (β= -1.3, p=0.04) compared to other races. The effect size was unchanged after adjusting for multimorbidity and polypharmacy (β= -1.3, p=0.04), attenuated slightly after adjusting for frailty (β= -1.2, p=0.06), depressed mood (β= -1.2, p=0.05), lean mass (β= -1.2, p=0.04), and attenuated notably after adjusting for antidepressant use (β= -1.0, p=0.11). Findings support the need to further explore racial differences in cognitive decline and potentially related anti-depressant underuse.
Association of Social Determinants, Multimorbidity, and Functional Status with Mortality after Pneumonia
Authors: Park Chan Mi , Rhim Hye Chang , Lee Eun Sik , Kim Wonsock , Kim Jong Hun , Kim Dae
Published: December 2021

Social support, multimorbidity, and functional status are important determinants of health in older adults, but their prognostic implications remain unclear after an acute illness. We conducted a prospective cohort study of 201 patients 65 years or older who were hospitalized for pneumonia at a university hospital in Korea in 2019-2020. K-means cluster analysis was performed using social deprivation score (range: 0-5), activities of daily living (range: 0-7), instrumental activities of daily living (range: 0-7), physical limitation score (range: 0-7), and Gagne comorbidity index (range: 0-24) (higher scores indicate higher risk). Four groups were identified: 1) Group A: physically limited and non-disabled group with limited social support; 2) Group B: multimorbid but functional group with social support; 3) Group C: multimorbid and disabled group with social support; 4) Group D: multimorbid and disabled group with limited social support. For Groups A through D, the Kaplan-Meir estimates for 6-month mortality were 10.0%, 18.0%, 34.2%, and 43.6%, respectively, and the 6-month mean survival times were 166.4 days (95% CI: 156.1-176.6), 156.9 days (95% CI: 140.8-173.1), 145.2 days (95% CI: 126.6-163.8), and 125.9 days (95% CI: 107.7-144.1), respectively. After adjusting for sex, age, and pneumonia severity score, the hazard ratios for Groups B through D versus Group A were 2.07 (95% CI: 0.70-6.13), 3.14 (95% CI: 1.17-8.42), and 4.38 (95% CI: 1.73-11.04), respectively. Our results suggest that multimorbidity and disabilities were implicated in higher risk of 6-month mortality after pneumonia, and social support may mitigate this risk among those with multimorbidity and disability.
Does Race/Ethnicity Influence the Health of LGBT Older Adults? An Analysis of Adults Aged 50 and Older
Authors: Magdael Adrielle , Parashar Aditi , Ozair Aisha , Nelson Christi
Published: December 2021

Lesbian, gay, bisexual, and transgender (LGBT) health disparities have been well documented in previous research; however, limited research has been conducted on racial/ethnic differences in health among LGBT older adults. Past research suggests that LGBT adults from racial/ethnic minority groups may encounter more discrimination and stigma than white LGBT adults, resulting in poorer health. This study investigated differences in general health between racial/ethnic groups in LGBT adults aged 50 and older from the 2018 and 2019 Behavioral Risk Factor Surveillance System annual surveys. The average ages were 64.2 years for the lesbian, gay, and bisexual (LGB) participants (n=3636) and 65.4 years for the transgender participants (n=972). For self-rated general health, the chi-square analysis indicated that there were significant differences between the racial/ethnic groups for both LGB and transgender participants, χ2(4, n=3630)=46.47, p<.001 and χ2(4, n=969)=19.03, p=.001, respectively. Logistic regression analyses found that, compared to White LGB adults, Hispanic LGB adults had higher odds (aOR=1.8, 95% CI=1.2-2.5) and Asian LGB adults had lower odds of reporting fair or poor health, (aOR=0.43, 95% CI=0.2-0.9). For transgender participants, Hispanic and Other Race adults had approximately twice the odds of reporting fair or poor health compared to White adults (aOR=2.1, 95% CI=1.2-3.7, and aOR=1.9, 95% CI=1.2-3.0, respectively).In conclusion, the results of this study suggest that cultural differences in racial/ethnic groups may influence the health of the LGBT community, making it an important factor to consider in research on LGBT older adults.
Age-Associated Epigenetic Alterations, Somatic Mutations, and Their Crosstalk in Alzheimer’s Disease
Authors: Markov Yaroslav , Thrush Kyra , Levine Morgan
Published: December 2021

Aging is the major risk factor for Alzheimer’s Disease (AD), and as life expectancy increases, neurodegeneration will continue to afflict an ever-increasing proportion of the population. While numerous theories are attempting to explain the drivers behind AD pathology, what unites them is the observation that AD is reliably associated with a progressive buildup of age-related molecular changes. Because of the varying clinical presentations of AD in patients with similar genetic backgrounds, it has been postulated that epigenetics may be implicated in its etiology. Building on our prior work showing that AD pathology is linked to alterations in age-related DNA CpG methylation (DNAme) across various brain regions, we use state-of-the-art machine learning approaches to identify patterns of molecular damage in postmortem brain samples. We show that alterations in DNAme are associated with accelerated biological aging, AD, and the APOE e4 genotype, which is a major risk factor for AD. We also demonstrate that these associations are present in the PFC but not cerebellum -- in line with the current understanding of AD progression in the brain. Finally, we perform whole-exome sequencing and protein mass spectrometry on the same brain samples to test our hypothesis as to whether AD-associated alterations of DNAme are linked with the accumulation of somatic mutations that affect the structural and binding properties of protein epigenetic regulators.
Phenothiazines to Treat Alzheimer’s Disease
Authors: Litke Rachel , Huang Bik Tzu , Gonzalez Damian , Rampanana Martine , Grimaldi Nicholas , Mobbs Charles
Published: December 2021

Current treatments of Alzheimer’s Disease (AD) are largely ineffective and do not address underlying pathophysiological processes. The model organism C. elegans has been successfully used to discover compounds to treat human diseases, some now in clinical trials. To develop novel drugs and explore pathways to treat AD, we took on a forward pharmacological approach with a C. elegans model for AD, completed with studies to expand results to lifespan as well as healthspan. We screened 2560 drugs from the Microsource Spectrum library for their ability to delay proteotoxicity (indicated by paralysis) in an Abeta transgenic C. elegans muscle model of AD (CL2006) in liquid medium. Among the most protective drugs were phenothiazines, which are orally active and cross the blood-brain barrier, desirable properties of drugs to treat AD. 80 phenothiazines congeners were further assessed; 60% were protective in CL2006 worms. 9/20 tested phenothiazines increased lifespan in N2 worms and 2/3 phenothiazines tested promoted significantly higher pharyngeal pumping rates compared with control till day 10 of adulthood in N2 worms. 2 of the drugs were protective in the C. elegans neuronal model of AD. This phenotypic screening approach led to the discovery of potential drugs to treat AD. These phenothiazines protect against Abeta toxicity, and assessment of efficacy to protect against other forms of proteotoxicity are ongoing. These studies suggest the utility of C. elegans to discover drugs to treat human diseases. Future studies will assess molecular mechanisms mediating the protective effects of these compounds.
Developing Information Technologies to Promote Dementia e-Friendly Communities for COVID-19 and Beyond
Authors: Ruggiano Nicole , Luo Yan , Hurd Amy , Lawlor Kristen , Anderson Monica , Jiang Zhe , Gray Jeff
Published: December 2021

People living with dementia (PLWD) and their caregivers often face barriers to education, support, and services that can improve their health and quality of life. Information technology (IT) has been suggested as a solution to overcoming such barriers, though the development of evidence-based IT for dementia care is still developing. This project gathered stakeholder (e.g., providers, caregivers) perspectives on the development of a proposed IT solution to support community asset mapping that would allow families to self-assess their dementia-related service needs, educate them about available services, and link them with services they need in their community. This proposed IT would create a dementia resource database that relies on crowdsourced data from community stakeholders as well as relevant data mined from existing sources (e.g., CMS certified nursing home data). As part of the planning process, this project conducted qualitative interviews with providers and caregivers in four metro areas in Alabama and their surrounding rural communities to learn more about the content and features that stakeholders perceive as being most effective for the proposed technology. Stakeholders also discussed their experience of utilizing IT solutions during the COVID-19 pandemic to promote access and continuum of care when barriers to service intensified. Thematic findings provide detail on: 1) motivating factors among stakeholders to contribute crowdsourced data that support community members affected by dementia; 2) potential barriers to implementing IT for dementia support, based on experiences with IT use during COVID-19; and 3) how stakeholders envision IT to better connect community members with needed services.
Online Health Information Wants of Caregivers for Persons With Dementia in Social Media
Authors: Tang Alison , Kwak Jung , Xie Bo , Xiao Lu , Lahiri Sucheta , Flynn Olivia , Murugadass Avinav
Published: December 2021

Family caregivers of persons with dementia (PWDs) use social media to obtain and share health information. Yet relatively little is known about the types of information that these caregivers share. We address this gap by analyzing caregivers’ posts (N = 401) in two subreddits, r/Alzheimers and r/dementia, which represent two subgroups on the social media platform Reddit. Our research questions were as follows: (1) What are these caregivers’ main purposes in posting? (2) What types of health information do the caregivers exchange online? (3) What are the characteristics of online posts that receive the caregivers’ greatest attention? Content and correlational analyses revealed that over half of users (57%) posted regarding specific types of health information that they desired to seek and share, whereas the remaining users posted information for sharing only. The health information most commonly posted fell into the following three categories: psychosocial health information, information about patients’ daily care, and characteristics of health conditions. The more health information types that a post contained, the greater the number of people who participated in the subreddit discussions. Further research should examine how social media meet PWD caregivers’ needs for information support.
Are Drugs that Cause Dysbiosis Longitudinally Associated with Cognitive Scores, Cognitive Impairment, & Dementia?
Authors: Resciniti Nicholas , C. Lohman Matthew , McLain Alexander , Merchant Anwar , Friedman and Daniela
Published: December 2021

Recent research has examined how the microbiome may influence cognitive outcomes; however, there is a paucity of research understanding how medication associated with dysbiosis may be associated with cognitive changes. This study used data from the Health and Retirement Study and the Prescription Drug Study subset for adults 51 and older (n=3,898). Continuous (0-27) and categorical (cognitively normal=12-27; cognitive impairment=7-11; and dementia=0-6) cognitive outcomes were used. Prescriptions utilized were proton pump inhibitors, antibiotics, selective serotonin reuptake inhibitors, tricyclic antidepressants, antipsychotics, antihistamines, and a summed dose-response measure. Linear mixed models (LMM) and generalized linear mixed models (GLMM) were used for continuous and binary outcomes. For the LMM model, the main effect for those taking one medication was insignificant; however, the interaction with time showed a significant decrease over time (β: -0.07; 95% confidence interval (CI): -0.14, 0.01). The mean cognitive score was lower for those taking two or more medications (β: -1.48; 95% CI: -2.70, -0.25), although the interaction with time was insignificant. GLMM results showed those taking two or medications had odds that are 612% larger (odds ratio (OR): 7.12; 95% CI: 3.03, 16.71) of going from cognitively healthy to dementia but the interaction with time showed decreased odds over time (OR: 0.92; 95% CI 0.86, 0.97). For cognitive impairment, those who took two or more medications had odds that were 45% larger (OR: 1.45; 95% CI: 1.05, 2.00) of going from cognitively healthy to cognitively impaired. This study indicated a dose-response aspect to taking medications on cognitive outcomes.
Caregiver Singing Intervention: do Emotions and Resistance differ between Vascular dementia and Alzheimer’s?
Authors: Hammar Lena , Engström Gabriella , Swall Anna
Published: December 2021

Persons with dementia in residential care commonly express resistance of aggressiveness. Caregivers Singing (CS) - when caregivers sing for or together with persons with dementia during caring, has shown to reduce these expressions and increase communication and cooperation. Previous studies of CS have included both persons with Alzheimer’s disease (AD) and persons with Vascular dementia (VD), but no studies have been done focusing on possible differences regarding these diagnoses. As disabilities and symptoms differ between these diagnoses, the emotions and expressions, such as resistance may differ regarding response to CS. This polit study aims to describe emotions and resistiveness to care among persons with vascular or Alzheimer’s disease. Participants were five persons with AD and five persons with VD living at two different nursing homes. Video observations (VIO) occurred with them and their caregivers during morning care situations four times without CS and four times with CS. In all, 80 VIOs were rated using the Observed Emotion Rating Scale and the Resistiveness to Care Scale. These were then analyzed with descriptive statistics. Results revealed that for both persons with AD and VD, the positive emotion pleasure were never observed without CS while with CS it increased for both groups. In contrast to the positive emotion effect of CS, the negative emotions and resistiveness decreased more for persons with VD than for persons with AD. For persons with VD, the number of observations without anger increased, while observation without anger or anxiety/fear for persons with AD remind the same.
Longitudinal Association of Fall risk for Community Dwelling Elderly with and without ADRD
Authors: Tyagi Pallavi
Published: December 2021

Falls amongst elderly with ADRD and are a major cause of functional impairment and increased mortality. The primary purpose of this study was to examine if fall status of community dwelling elderly residents with and without ADRD differs over a four year period and additionally does receipt of rehabilitation in any year modifies this association. National Health and Aging Trends Study (NHATS) data from 2015-2018 was used and sample consisted of participants age 65 and older who were community dwellers. Baseline characteristics of individuals in ADRD (n= 264) and non-ADRD group (n=2,971) was compared using chi square statistic. A generalized estimating equation model (multivariate logistic regression) was used to estimate odds ratio of falls in the two groups, adjusted for sociodemographic and clinical conditions that are predictors of fall risk. At baseline, ADRD group comprised of older, frail individuals who reported increased use of assistive device (AD) and presence of depression. Those in the non-ADRD group at baseline had significantly decreased odds for falls however no statistically significant change was observed for fall status over four years in the two groups (non-ADRD vs ADRD) and this association was not modified by receipt of rehabilitation. Those who used AD, had depression and received rehabilitation had increased odds for falls however no differences were found for those who lived alone and were frail. Future studies should examine the bi-directional interplay between falls and rehabilitation in elderly with ADRD with inclusion of other predictors of fall risk to study their unique characteristics.
Lung Function and Dementia Risk in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Shrestha Srishti , Zhu Xiaoqian , London Stephanie , Sullivan Kevin , Lutsey Pamela , Windham B Gwen , Griswold Michael , Mosley Thomas
Published: December 2021

Poor lung function has been linked with adverse neurocognitive outcomes including dementia, but evidence from well-designed prospective studies is limited. We therefore examined the association between lung function, as measured by forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), and dementia risk in 12,688 participants of the ARIC study, a prospective study of adults aged 46-70 years (at index visit, mean age =57y, 45% male, 76% White) from four US communities. Lung function was assessed in 1991-1992 (index visit, 76% normal, 16% obstructive, and 8% restrictive lung function), and dementia was ascertained through 2019 via in-person assessments, telephone interviews, and medical record surveillance, with adjudication of dementia with all in-person exams. A total of 2452 developed dementia over 30 years of follow-up. We used Cox proportional hazards model to estimate hazard ratio (HR) and 95% confidence intervals (CI), adjusting for potential confounders (socio-demographics, behavioral factors, cardiovascular risk factors, APOE ε4). Higher FEV1 and FVC were associated with reduced dementia risk [(HR: 0.86, 95%CI: 0.78-0.98, per 1L increase in FEV1) and (HR: 0.86, 95%CI: 0.80-0.93 per 1L increase in FVC)]. Compared to normal lung function, restrictive disease was associated with elevated dementia risk [(HR: 1.19, 95%CI: 1.01-1.41), n=168 dementia cases]; HR for obstructive disease, though modestly elevated (1.09, 95%CI: 0.96-1.24, n=713 dementia cases), was not statistically significant. Our findings of decreased dementia risk with better lung function may have important implications in reducing burden of dementia that is attributable to environmental exposures and associated lung function impairment.