bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EFFECT OF CAREGIVING EXPERIENCE ON CARE RECIPIENT OLDER ADULTS’ MORTALITY: A SURVIVAL ANALYSIS
Authors: Pristavec Teja , Luth Elizabeth A
Published: November 2019

Health and demographic mortality risk factors among older adults are well documented. However, less is known about the dyadic relationship between caregiver characteristics and care recipient mortality outcomes. In a nationally representative sample of older adults, we prospectively explore 1) whether and how having an informal caregiver is associated with care recipient mortality, and 2) among those with caregivers, how caregivers’ experiences of burden and benefits relate to care recipient mortality. We match 6 waves of National Health and Aging Trends Study (2011-2016) with 2011 National Study of Caregivers data. We conduct survival analysis on 7,369 older adults and a subsample of 1,341 older adult-informal caregiver dyads to address our research questions. First, we find that simply having an informal caregiver increases mortality risk by 71% (p<0.001) over the 6-year time period, even when adjusting for key demographic, economic and health factors. Second, we find that older adults whose caregivers perceive burden have a significantly higher mortality risk. This risk is reduced if the caregiver also perceives caregiving benefits. The risk of death is 41% higher for older adults whose caregivers report burden but no benefit compared to those with caregivers who report neither burden nor benefit. Further research should investigate possible reasons why merely having a caregiver increases older adults’ mortality risk. Interventions to increase caregivers’ sense of benefit and reduce their burden may be an effective way of decreasing mortality risk for older adults with declining health and functional ability.
WORK ENVIRONMENTS AMONG OLDER WORKING CAREGIVERS
Authors: Carr Dawn C , Taylor Miles G , Jason Kendra , Mingo Chivon A , Washington Tiffany R
Published: November 2019

Many older workers balance paid work with care work. Working caregivers face unique challenges that make them more likely to leave the work force. However work environments may be more or less accommodating to their needs, and in addition, they may need to work for financial reasons. Current research on working caregivers has not explored: a) the work environments of older working caregivers; b) whether particular work environments are likely to influence whether caregivers stop working; and c) whether these effects vary by type of care work (spousal versus parental). This study addresses these gaps. Using data drawn from the 2008-2014 waves of the Health and Retirement Study, we used latent class analysis to develop a typology of work environments of individuals 51-75 who are engaged in paid work. Four classes of work environments emerged: A) balanced, supportive work environments (34%); B) average environments with high job lock (30%); C) poor, unsupportive work environments (21%); and D) highly accommodating, stressful jobs (14%). Logistic regression results showed those in group D were less likely than all other groups to leave their jobs. In addition, relative to spousal caregivers, parental caregivers in class A were significantly more likely to leave the labor force. Results suggest that caregivers may be more likely to continue engaging in paid work in supportive work environments, and work environments may be more likely to retain older working caregivers by identifying ways to help them meet their work needs and maintain their caregiving roles.
INEQUALITIES IN FRAILTY BY SOCIO-ECONOMIC POSITION: IT’S ALL IN THE TIMING
Authors: Jagger Carol , Hayward Mark D
Published: November 2019

A number of studies have found that higher socio-economic position (SEP) appears protective of becoming frail. However, not only can SEP be defined in early, mid or late life, by education, occupational status or income/material disadvantage respectively, but frailty may occur in the young old as well as the very old. Do the same measures of SEP reflect inequalities in frailty in the young old as the very old? Does it matter when in the lifecourse SEP is measured? Have inequalities in frailty between SEP groups changed across the generations of older people? We seek to answer such questions from cohorts across the spectrum of later life. The first presentation, from the 1958 British Birth Cohort Study, examines the association between early-life SEP and frailty at age 50 and whether this association is due to continued disadvantage into mid-life. The second presentation moves to very old age, examining the role of early, mid and late life disadvantage on the progression of frailty between ages 85 and 90 in the Newcastle 85+ cohort. The third presentation, based on the electronic health records of adults aged 75 years and over in England, focuses on whether SEP modifies frailty trajectories in the last year of life. The final presentation examines whether SEP inequalities in frailty have changed over different generations of older people, and utilises data from the Cognitive Function and Ageing Studies. Together these presentations increase understanding of which SEP groups should be targeted for interventions to reduce frailty throughout later life.
SOCIO-DETERMINANTS OF FRAILTY: HAVE THEY CHANGED OVER TIME?
Authors: Matthews Fiona , Mousa andria , Jagger Carol
Published: November 2019

Socioeconomic inequalities are important drivers of negative health outcomes. This study investigates the effect of social determinants on health using frailty from two studies 20-year apart and examines whether socio-economic differences are widening. A 30-item deficit accumulation score from the baseline data from the two Cognitive Function and Ageing Studies, 1991 (n=7,635) and 2011 (n=7,762) was calculated. For each of the two cohorts separately, binomial regression investigated the relationship between frailty and social determinants. Deprivation was most strongly associated with frailty among the other social determinants. The effect of high deprivation, when compared the lowest tertile, increased in CFAS II (CFAS I: RR=1.21, 95%CI:1.11-1.31; CFAS II: RR=1.47(95%CI: 1.36-1.59). Inequalities in frailty have increased over time, particularly in terms of deprivation. This has important implications for health policy as focusing policies including specific interventions and resources in more deprived areas could greatly improve health outcomes for those areas.
MENTAL HEALTH AND HUNGER: RISK FACTORS FOR HOSPITALIZATION AMONG HOME-DELIVERED MEAL PARTICIPANTS
Authors: Juckett Lisa
Published: November 2019

Home-delivered meals (HDMs) provided through the Older Americans Act (OAA) are intended to reduce hunger, promote socialization, and maximize wellness. However, HDM recipients are at increased likelihood of being hospitalized due to their complex health needs and risk for social isolation and depression. Drawing data from the OAA-HDM National Survey, we evaluated the predictors of hospitalization among HDM recipients in 2017. From our sample (n = 578), we conducted random forest classification analyses to identify the most important risk factors related to HDM recipient hospitalization. Our random forest model yielded an accuracy rate of 66.3% with risk factors most indicative of hospitalization being attributed to number of co-morbidities, depressive symptoms, and feelings of social isolation. These findings indicate that although HDMs may help alleviate hunger among older adults, innovate strategies are warranted to address the unmet mental health needs of HDM recipients.
MEDICAID MANAGED LONG-TERM CARE PROGRAMS VS. THE TRADITIONAL MODEL: COMPARATIVE COSTS AND OUTCOMES
Authors: Polivka Larry
Published: November 2019

Several states have adopted Medicaid Managed Long-Term Care (MLTC) programs over the last several years. At this point at least 30 states are either administering such models or have plans to in the near future. We do not, however, know much yet about the relative cost-effectiveness of the MLTC model when compared to the traditional non-profit model of Medicaid LTC. Is the for-profit MLTC model actually generating savings in the Medicaid program while improving the quality of care? This symposia is designed to address the question through three presentations on experiences with MLTC programs in the states of Ohio, Texas and Pennsylvania and a fourth presentation offering a national overview and critique of Medicaid MLTC in comparison to the traditional Medicaid LTC program still administered through non-profit Aging Network organizations. The state focused presentations describe the current status and results of MLTC in three states that vary in their specific features, extent of formal accountability for outcomes and the political contexts in which the programs currently function. The presentations also include discussions of the implications of each states experiences for the future of Medicaid LTC policy at the state and federal levels. The fourth presentation is a critical analysis of the main differences between the traditional non-profit model of Medicaid LTC services and the for-profit MLTC programs in terms of commonly accepted criteria of cost-effective LTC services, such as access, quality of care and per-person costs and differences in the roles of advocacy and accountability.
MEDICAID-MANAGED LTC: A NATIONAL OVERVIEW
Authors: Polivka Larry
Published: November 2019

Most of the states now have Medicaid LTC programs administered by corporate HMOs. Several states, however, still have programs administered by non-profit community based organizations, most of which are members of long standing Aging Networks which grew out of the Older Americans Act in the 1970s. This paper will offer a comparative overview of these models of LTC administration including a typology designed to identify major cultural and political differences between the states with and without corporate managed LTC models and an analysis of the available information regarding their comparative costs and outcomes, mainly access to care and quality of care. The paper will conclude with an assessment of the implications of the information presented for the future of Medicaid LTC policy and politics at the state and federal levels and for the future of LTC advocacy and accountability across the states.
INTEGRATING ACUTE AND LONG-TERM SERVICES: DOES IT WORK, CAN IT WORK, WILL IT WORK?
Authors: Applebaum Robert A , Heston Jennifer
Published: November 2019

The expansion of managed long-term services and supports has generated considerable interest over the last decade. However, studies on the impact of these efforts have produced mixed findings. Additionally, there is limited information about the care management models used in implementation. This lack of data makes it impossible to assess whether differences in managed care plan approaches have an impact on participants. Our study sought to gain better understanding of the integrated care management models being implemented in Ohio’s MyCare Demonstration. Through qualitative interviews with 50 respondents, including area agency care managers, managed care staff, and service providers, we documented strengths and weaknesses of one integrated care management model used in Ohio’s demonstration. Understanding what is inside the black box of managed care/care management model implementation is key to gaining insights into whether such an approach can ultimately improve the health and long-term service systems for older people with disability.
PARTICIPANT AND CAREGIVER VIEWS OF SELF-DIRECTION OF HOME AND COMMUNITY SERVICES 15 YEARS AFTER CASH & COUNSELING
Authors: Mahoney Kevin J , Putnam Michelle
Published: November 2019

Results of the Cash and Counseling controlled experiment are now more than ten years old. This symposium, based on a recent Special Issue of the Journal of Gerontological Social Work on self direction of home and community-based services and supports for people with disabilities, begins with an overview of the status of self-direction in the United States where now over 1.1 million people are managing their own services and supports. After summarizing the six research studies in this Special Issue presenting feedback on the self-direction model from participants, their caregivers, and unpaid representatives followed by participant views on remaining unmet needs, the ideal and undesired characteristics of support brokers, and a research study to develop modules for training care managers and support brokers on person-centered planning and self-direction, papers will be presented focusing on two of these studies highlighting improvements needed in the self-direction approach if it is to become available to all persons with disabilities. The first paper is titled, “Unmet Needs Even When People Have Control of the HCBS Budget”; the second deals with the “Tasks and Characteristics of Supportive Support Brokers”; while the third paper looks at “Present Efforts and Recommendations for Training Support Brokers on the Principles, Values, and Skills to Assist People with Disabilities Who Wish to Direct Their Own Supports”. The session ends with a presentation on the program and policy implications of this research for federal agencies.
PARTICIPANT VIEWS OF THE TASKS AND CHARACTERISTICS OF SUPPORTIVE SUPPORT BROKERS IN SELF-DIRECTION PROGRAMS
Authors: Mahoney Ellen K , Oh Grace , Morano Carmen , Mahoney Kevin J , DeVellis Andrew
Published: November 2019

This qualitative study draws on 76 ethnographic case studies with Cash and Counseling participants, examines what participants and their caregivers saw the support broker doing, and looks at what the participants found helpful and less than helpful. Participants and their caregivers saw support broker duties as Coaching, Problem Solving, Advocacy and Monitoring. Equally important was how the support broker performed these roles. Six attributes that mattered to participants were: Familiarity, Supportive Relationship, Proactive Engagement, Responsiveness, Knowldge and Cultural Friendliness. These findings from the participant and caregiver perspective have great import for the training of present and future care managers and support broker, and have implications for regulatory and even licensure requirements. These results can be a first step in constructing a quality framework for self-directed supports and services.
RESEARCH CAN CHANGE PROGRAMS AND POLICY
Authors: Gerhard Lori
Published: November 2019

In addition to increasing knowledge, research is meant to improve practice and policy. The papers presented in this symposium draw from the experiences and insights of actual participants and their caregivers in major government-sponsored program options for people with disabilities wanting to remain in the community. Many of these programs are administered by our Administration for Community Living. For all, ACL serves as a main source of information for people in the community. These papers give us first-hand knowledge of what participants like and what they want improved. They give us guidance on how consumers define quality; the results can guide efforts to improve program design and the training of support brokers and representatives who assist people who want to manage their own supports and services. I will give a few examples starting with the paper on the Veterans-Directed Care Program and drawing ideas from the other papers.
IS VARIABILITY OF FREE-LIVING ACTIVITY ASSOCIATED WITH PHYSICAL AND MENTAL FATIGABILITY IN OLDER ADULTS?
Authors: Graves Jessica L , Krafty Robert T , Harezlak Jaroslaw , Shiroma Eric J , Glynn Nancy W
Published: November 2019

Greater fatigability in older adults may be moderated by physical activity (PA). However, what features of PA timing are most strongly related to fatigability remains unknown. We examined the relationship between variability of free-living activity patterns and perceived physical and mental fatigability using the Pittsburgh Fatigability Scale (PFS, 0-50pts, higher=greater fatigability) in older adults from the Developmental Epidemiologic Cohort Study (DECOS, n=57, age=70-91yrs, 61% female). We assessed PA using ActiGraph GT3X+ over 7 days. Mean activity, standard deviation (SD) of mean activity across days, and relative activity [(mean at each bin)/(total mean)] were calculated across 24-hours in 4-hour bins , adjusting for estimated rise-time. Lower SD of PA from 0-4 hours after rising was associated with greater PFS physical scores (r=-0.27, p=0.05). No measures of PA correlated with PFS mental scores. In older adults with lower physical fatigability, associations with greater variability in activity may indicate larger energy reserves.
FACTORS THAT INFLUENCE LIFE SATISFACTION IN AL RESIDENTS
Authors: Holmes Sarah
Published: November 2019

Life satisfaction is a multidimensional concept that addresses a personal judgment of quality from the resident’s perspective. Components of life satisfaction include satisfaction related to health, the physical environment, relationships and activities. The purpose of this study was to test if there was a relationship between demographic factors, pain, falls, and use of psychotropics with life satisfaction. The sample included the first two cohorts from the FFC-AL-EIT study including 508 residents from 54 settings across Maryland, Pennsylvania, and Massachusetts. The majority of the participants were female (70%), white (97%) and the mean age was 87.72 (SD=7.47) . Based on a stepwise linear regression analysis there was a significant association between pain (r=-.20, p=.003) and psychotropic use (r=-.19, p=.003) and the model explained 11% of the variance in life satisfaction. Ongoing research is needed to consider the impact of the environment and staff-resident interactions on life satisfaction.
THE INTERSECTION OF VULNERABILITY AND OLD AGE: ETHICAL CONSIDERATIONS FOR LONG-TERM SERVICES AND SUPPORTS
Authors: Niles-Yokum Kelly
Published: November 2019

This session focuses on ethical considerations in the context of long-term services and supports (LTSS) for vulnerable older adults. Long-term supports for vulnerable older adults can no longer adhere to a “one-sized fits all” solution. We will explore the intersection of vulnerability, old age, and community which present a myriad of ethical issues in both the planning and delivery of supports for older adults. The quest for a just society goes beyond understanding and considering the critical issues of the vulnerability of older adults in our society in that this pursuit provides a pathway to develop and implement programs and services that allow all of us the opportunity to live in a world that both protects and can provide the opportunity for self determination and dignity.
APPLIED GERONTOLOGY: HOW STUDENTS ADDRESS LONELINESS IN THE LOCAL COMMUNITY
Authors: Schoenmakers Eric
Published: November 2019

Fontys University of Applied Sciences offers an Undergraduate program in Applied Gerontology. Full-time and part-time students are trained in gerontology and in applying this knowledge in developing and implementing products and services in order to improve quality of life of older adults. In our vision, students learn in practice. Therefore, the educational program largely consists of authentic projects for real organizations in the local community. In one of these ongoing projects, students research loneliness in the local community. A network of organizations, which communicates intensively with the University, is involved. For these organizations, students study how clients and employee’s think about (coping with) loneliness, write testimonials about interventions, and advise in improving the services of organizations. For students, these kind of projects offer opportunities to learn in practice. For the community, students’ involvement means extra manpower to further develop services and society as a whole.
THE ROLE OF COMMUNITY COLLEGES IN PARTNERSHIPS WITH UNIVERSITIES IN PRODUCING QUALIFIED GERONTOLOGY PROFESSIONALS
Authors: Kopera-Frye Karen
Published: November 2019

Today is especially critical for community colleges and universities to work together to allow for pathways in educating professionals in the field of gerontology. At New Mexico State University, Public Health Sciences Department, we have partnered with Dona Ana Community College and Central New Mexico College through articulation agreements to allow transfer of credits and an accelerated pathway to a Gerontology Minor for workforce development. This paper will discuss the steps we took in bridging these educational opportunities as an example for other institutions to consider. By incorporating joint Advisory Boards, faculty and administrators entering into articulation agreements, and coordinated course offerings, we were able to systematize the curriculum and allow for transfer of up to 12 credits from the community colleges into our Public Health Bachelors degree program, with attainment of the Gerontology minor along the way. Lessons learned during this process will be shared.
RACIAL-ETHNIC DISPARITY IN DENTAL CARE IN NURSING HOMES
Authors: Ye Zhiqiu , Wu Bei
Published: November 2019

Minority older adults are at higher risks of poor oral health. Little is known about the extent of and the contributing factors to racial/ethnic disparity in dental care quality in the long-term care settings. Previous studies suggest that organizational and system-level factors are key determinants of oral health among minority older adults. We examined the racial/ethnic disparity in dental care delivery in nursing homes (NHs) by facility and market characteristics. We analyzed the 2000-2016 national Inspection Survey data for all certified-NHs (n=248,975 facility-years). Two designated deficiency citations were used to measure dental care performance. Generalized estimating equations were used to compare the rates of deficiency citations among NHs in different quartiles of the share of minority residents, adjusting for facility characteristics, market characteristics, year and state fixed effects. Overall, compared to NHs in the lowest quartile of the share of minority residents (average % minority residents =0.24%), NHs in the highest quartile of the share of minority residents (average % minority residents = 46.5%) and those in the second highest share (average % minority residents=13.9%) had 46.8% and 31.2% higher odds of receiving dental care citations(p<0.001 for both), respectively. The increased citation rates persisted over time (p=0.40) and were greater among for-profit NHs (p=0.02). Our study suggests that minority older adults in NHs are disproportionately affected by poorer dental care performance. There is a great need to improve quality of dental care in NHs, particularly for those that are for-profit and those that disproportionately serve minority residents.
SCALES FOR MEASURING AGEISM AS EXPERIENCED BY OLDER ADULTS: LITERATURE REVIEW AND METHODOLOGICAL CRITIQUE
Authors: Kang Hyun
Published: November 2019

A growing body of research shows that ageism negatively affects older adults’ psychological well-being and even physical functioning. However, the tools to measure ageism as experienced by older adults are not well developed. This study reviewed the literature on ageism scale with an emphasis on the methodological issues. Most standardized ageism scales have focused on younger people’s attitudes and beliefs toward older adults. We found only one standardized scale that examined how older adults felt and thought about their experiences being treated as a stereotype. However, the scale is incomplete because it does not fully measure ageism and it has received far less rigorous analysis. Many studies have adopted and revised ageism scales that were developed specifically to measure younger people’s attitudes toward older adults, meaning that the scales’ validity has been problematic when administered to older adults. Furthermore, many studies that discussed older adults’ experience of ageism used uni-dimensional or simple measures. Although significant efforts have been made to outline ageism’s various dimensions and constructs, these efforts have not led to a common consensus on ageism and its characteristics. Lack of consensus, in turn, makes it harder to develop a standardized scale. Finally, existing scales are more suitable for Western societies. Socio-cultural uniqueness has not been considered when developing scales, nor has the scales’ cross-cultural reliability and validity been tested. Our findings suggest that a new scale that applies only to measuring ageism as perceived by older adults and corresponds to the significant dimensions of ageism must be developed.
OLDER ADULT HEALTH IN THE CITY OF CHICAGO
Authors: Lange Maia Brittney S , Laflamme Emily , DeMaio Fernando , Shah Raj C
Published: November 2019

In 2012, Chicago was designated as an Age Friendly City. However, city-wide data on the health and health disparities experienced by older adults have been scarce. In order to address this knowledge gap, the Chicago Department of Public Health (CDPH) partnered with the Center for Community Health Equity at Rush and DePaul Universities to create a report describing health status among adults age 65+. Data were from the Healthy Chicago Survey—a population-based health survey conducted by CDPH, the American Community Survey, Hospital Discharge Data, and State Vital Records. The report highlights considerable racial/ethnic diversity in Chicago, as 38% of older adults are white, 37% black, 18% Latinx, and 7% are Asian. Encouraging results exist regarding healthcare access; 96% have a personal health care provider and 89% report being able to get care needed through their health plan. Several areas of improvement are needed regarding root causes of health. More older adults live below the federal poverty level (15.9%) compared to the overall U.S (9.3%), and 45.8% would be unable to pay for an unexpected $400 expense. Disparities were evident as life expectancy at age 65 is 2.5 years longer for Latinx and white older adults (age 85) compared to African Americans (age 82.4). African American and Latinx older adults had higher rates of preventable hospitalizations per 10,000 (801.1 and 678.9, respectively) compared to white (492.4) and Asian (374.1) older adults. Findings from this report will spur Chicago’s continued progress as an Age-Friendly City for all its residents.
THE INFLUENCE OF SOCIODEMOGRAPHIC FACTORS ON GENDER DISPARITIES IN DISABILITY TRENDS
Authors: Chen Ya-Mei , Yu Hsiao-Wei , Chiang Tung-Liang , Chen Duan-Rung , Tu Yu-Kang
Published: November 2019

Objective. In Taiwan as well as in many other aging societies, decreasing disability is a key public health priority. Gender is known to be a significant factor for developing disability. Our study aimed to examine gender disparities in disability trends as well as how sociodemographic factors influence these disparities. Methods. We used multiple-group latent growth curve modeling (MG-LGM) to examine data drawn from the Taiwanese Longitudinal Study of Aging, a longitudinal and nationally representative survey database. Four waves of survey data and 3,429 older adults (mean ages = 50-96) were included for analysis. Disability trajectories among men and women were modeled separately using MG-LGM. Equality constraints were imposed on the six factors assessed: age, education, leisure activities, perceived (self-rated) health, health behaviors, and comorbidities. Results. Baseline disability levels were not significantly different between the two groups, but once disability began, the progression toward greater disability was almost 50% faster among older women. Greater age and more comorbidities added significantly more to baseline disability and speed of progression among older women than among older men (p < 0.001). However, having better health behaviors (e.g., no alcohol, more leisure activities) reduced baseline disability significantly more among women (p < 0.05). Particularly interesting findings include that perceived health reduced baseline disability only among men (p < 0.05), while having a better social network reduced baseline disability only among women (p < 0.05). Conclusion. For older women, disability prevention is crucial, and promoting positive health behaviors and strong social networks are promising strategies.
LIFE EXPECTANCY WITH CHRONIC DISEASE AMONG OLDER MEXICAN AMERICANS
Authors: Emerson Kerstin G , Pan Anqi , Huang Hanwen
Published: November 2019

The Hispanic Paradox research consistently shows a survival advantage among Hispanics, where they have significantly longer life expectancy compared to non-Hispanic Whites. However, less is known about the quality of these additional years of life. Our goal was to calculate life expectancy for older Hispanics in the US, and to determine what proportion of their lives they could expect to live with chronic conditions. We used data from 2004-5 of the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic-EPESE), linked to vital status data through 2016. To determine life expectancy with/without chronic conditions, we used Sullivan’s method. Chronic conditions included: diabetes, stroke, heart attack, arthritis, hypertension, and cancer. Finally, we mapped life expectancy without chronic conditions across neighborhood characteristics. The sample consisted of 2,069 Mexican Americans aged 75 and older. Results showed that at age 75, Mexican Americans could expect to live a large portion of their lives with at least one chronic condition (88%). The largest proportion of life lived with disease was for hypertension (61%), arthritis (59%), and diabetes (33%). There was no pattern by neighborhood characteristics for disease-free life expectancy. Gender differences could not be examined because of small sample sizes. Our findings show that regardless of neighborhood characteristics, Mexican Americans can expect to live a high proportion of their life with at least one chronic condition. This is particularly high for hypertension, diabetes, and arthritis. It is important to consider quality as well as quantity of life when exploring the Hispanic Paradox.
HOW DRIVING STRESS, CONFIDENCE, AND THOUGHTS ABOUT DRIVING ALTERNATIVES AFFECT TRANSPORTATION PLANNING
Authors: Vivoda Jonathon , Cao Jiawei , Harmon Annie
Published: November 2019

Although many older adults will eventually not be able to safely drive themselves, comprehensive planning for a non-driving future is infrequent. To better understand the factors that predict transportation planning, the role played by several different aspects of driving were assessed. We analyzed whether stress about driving, enjoyment of driving, driving confidence, recent experience with negative driving events, and thoughts about how well other transportation modes could meet one’s future needs played a role in planning. Age, gender, race, and income were also controlled for in the models. More transportation planning was significantly associated with experiencing driving as more stressful and with reporting less confidence in one’s driving skills. Level of driving enjoyment and the number of concerning driving events experienced during the past year (e.g., crash, near crash, driving conversations, health issues, etc.) were not significantly related to planning. Respondents were also asked about how well other transport modes (e.g., rides with other drivers, buses, light rail, taxis, etc.) could meet their needs when they can no longer drive. This factor explained more of the variance in the planning outcome than any of the other factors, with a larger number associated with more planning. This result suggests that engaging in more planning may be associated with an openness to non-driving options, but it is unclear if that is a result of more planning, or a precursor to this activity.
A STUDY ON CHANGES IN RESIDENTIAL LIFESTYLE AND AWARENESS OF RESIDENTS IN A HOUSING COMPLEX REGENERATION PROJECT
Authors: ashihara tomoya , Nishino Akiko , Lee yonggeun , otsuki toshio , nishide Kazuhiro , matsuda yuji
Published: November 2019

In Japan, where the ratio of elderly citizens exceeds 27%, there are issues such as the aging of residents and an increase in the number of people living alone. The present study aims to identify the elements required for a community base, based on temporal changes in daily life activities of residents in Housing Complex T, where more than 40% of residents are elderly, and in the surrounding area. A questionnaire survey was conducted with residents of Housing Complex T and residents in the surrounding area in 2010 (856/4,940 responses) and in 2018 (1,194/5,049 responses). The survey results showed that half of the elderly people participated in group circle activities during the day, and there was no change between 2010 and 2018. More than half of the residents of the housing complex utilize the supermarket within the housing complex several times a week. However, only 20% of the residents in the surrounding area use the supermarket. Parks were being utilized by 29.9% of housing complex residents and 37.6% of the residents outside of the complex, while the library was being utilized by 37.1% of housing complex residents and 39.1% of the residents outside of the complex. Public facilities are being utilized. These results show that it is important to provide architectural functions with high public utility within the property of housing complexes; they should be well known by residents of the surrounding area in order to create a community.
YOU CAN’T GET THERE FROM HERE! TRANSPORTATION ISSUES OF OLDER ADULTS AND PEOPLE WITH DISABILITIES
Authors: Zell Angela M , Ilardo Joan
Published: November 2019

Older adults and individuals with disabilities face transportation challenges on a daily basis that differ from the general population. Transportation is critical to all aspects of quality of life yet presents significant challenges. Lack of appropriate vehicles, reliable public transportation, and the high-cost of vehicle ownership lead to missed healthcare appointments, lack of access to proper nutrition, and social isolation. The purpose of the study was to provide information for the Commission on Services to the Aging. It was necessitated by the lack of existing data from the Department of Transportation because Michigan’s transportation systems are locally controlled. An online questionnaire was emailed to public and private organizations serving older adults and people with disabilities to determine transportation services currently available in their geographic areas and innovative solutions employed to address barriers. The questionnaire was adapted from the National Center of Senior Transportation in 2009 that produced the report “Transportation: The Silent Need”. The study analyzed data on current transportation services and innovative solutions piloted in Michigan. Respondents represented every Michigan county and included area agencies on aging, senior centers, councils on aging, healthcare agencies, transportation providers, community action agencies, and job training programs. Information includes: services provided by the agency; barriers to accessing transportation; access to transportation services information; transport services previously used, currently available, and being planned. Many of the 95 respondents commented on persistent lack of funding for viable, reliable transportation options and jurisdictional issues. Most pilots used fixed routes, volunteer drivers, demand response and expanded schedules.
MTOR PROMOTES BBB BREAKDOWN IN A MODEL OF ALZHEIMER’S DISEASE
Authors: Hernandez Stephen F , Skike Candice E Van , DeRosa Nick , Galvan Veronica
Published: November 2019

Cerebral amyloid angiopathy (CAA) is characterized by fibrillar amyloid β (Aβ) association with cerebrovasculature, which leads to impaired brain vascular function, and is present in 87% of people with Alzheimer’s disease (AD). We previously showed that inhibition of mTOR by rapamycin prevented BBB breakdown and reduced vascular fibrillar Aβ in 18-19 month old Tg2576 mice that model AD-associated CAA. This finding suggests that mTOR attenuation restores integrity of the blood brain barrier (BBB) and concomitantly reduces vascular Aβ accumulation in this mouse model. Objective: To determine the mechanisms by which mTOR drives BBB breakdown we measured the abundance of tight junction proteins zonula occludens 1 (ZO-1), occludin, and claudin-5. Methods: We used immunofluorescent confocal microscopy on frozen brain tissue sections of the same Tg2576 mice used in the previous study. Results: We confirm BBB breakdown in Tg2576 mouse brains and showed that some, but not all tight junction proteins measured were decreased in cerebrovasculature of Tg2576 mice. Attenuation of mTOR by rapamycin preserved BBB integrity, decreased vascular Aβ accumulation, and increased levels of tight junction protein abundance in Tg2576 mice, which also showed a reduced numbers of cerebral microhemorrhages. Conclusions: Taken together, these data suggest that mTOR promotes brain vascular Aβ deposition, BBB breakdown and vascular damage in the Tg2576 mouse model. Thus, mTOR inhibitors such as rapamycin – an FDA approved drug - may have promise in the treatment of AD and other dementias with related cerebrovascular dysfunction.
POORER DIET QUALITY OBSERVED IN OLDER ADULTS WITH A GREATER NUMBER OF CHRONIC DISEASES
Authors: Krok-Schoen Jessica L , Fanelli Stephanie , Pisegna Janell , Kelly Owen J , Taylor Christopher A
Published: November 2019

Unhealthy lifestyle behaviors, including poor diet over many years, contribute to the development of chronic diseases, especially overweight/obesity, hyperglycemia, hypercholesterolemia and hypertension. Because poor diet is common to the diseases, it supports the notion of concurrently managing comorbidities through improved diet. Therefore, the purpose of this study was to assess differences in diet quality and nutrient intakes, in adults aged 65 years and older, by the number of chronic conditions. Data from 7,169 adults, aged 65 years and older, from the 2005-2016 National Health and Nutrition Examination Survey were assessed for selected chronic diseases from laboratory data: overweight/obesity (body mass index >25); hyperglycemia (glycated hemoglobin >5.7%); hypercholesterolemia (total cholesterol >200 mg/dL); hypertension (blood pressure >120/80 mmHg). The number of chronic diseases was computed per participant. Dietary intakes and diet quality score were assessed using 24-hour dietary recalls. Few adults had none of the selected chronic disease (n=79;1.4%), with others presenting 1 indicator (n=677;9.8%), 2 indicators (n=1,762;25%), 3 indicators (n=2,741;38.9%) and all 4 indicators (n=1,910;24.9%). Diet quality was significantly lower in those with three or four chronic diseases (P<0.001). Adults without any of the selected chronic diseases consumed significantly more calories, carbohydrates, fiber and added sugars, as well as folate, vitamin C and calcium than those with chronic diseases (P<0.001). Overall, dietary intakes from the day of intake were different for those with or without chronic diseases. These findings strengthen the need to promote healthy eating in older adults with one or more chronic conditions to help improve outcomes.
RECIPROCITY AND INDIVIDUAL DIFFERENCES IN DIET-RELATED SPOUSAL INVOLVEMENT AMONG OLDER COUPLES MANAGING DIABETES
Authors: August Kristin J , Kelly Caitlin S , Markey Charlotte H , Yan Shibin
Published: November 2019

Spouses are commonly involved in supporting and regulating their partners’ diabetic diet. Older spouses also may be managing their own condition that requires changes to their diet. Little is known about the extent to which this spousal involvement is reciprocal and if there are individual differences in the provision of diet-related support and control (regulation). This study sought to understand the reciprocity of diet-related support and both positive and negative forms of control, whether personality traits predicted the provision of diet-related spousal involvement, and whether gender moderated these associations. We used data from a cross-sectional survey of 150 couples (50+ years) in which one member had type 2 diabetes (Mage=65.94; Mmarital length=33.46; 50.7% male patients; 58.7% of spouses had a condition that required changes to their diet). The provision and receipt of social support and two forms of social control were moderately correlated within individuals (patient rs=.36-.45, ps<.001; spouse rs=.41-.73, ps<.001). Using Actor Partner Interdependence Models that controlled for age and responsibility for managing meals, results revealed that being more extraverted or having a partner who was more extraverted was associated with greater involvement, whereas being more neurotic or having a partner who was more neurotic or had more interpersonal problems was associated with less positive and greater negative involvement. Associations were particularly pronounced for men. Results suggest that there is moderate amount of reciprocity, as well as personality differences, in diet-related spousal involvement. These findings highlight the importance of targeting both members of the couple in diabetes intervention efforts.
AVOIDANT FILIAL PIETY IN KOREAN IMMIGRANT FAMILIES: WHEN DO WE TALK ABOUT MOM AND DAD?
Authors: Yoon Joonsik
Published: November 2019

Parental caregiving for older adults is a challenge to most families, not only because of intangible factors such as role-reversals in family dynamics, but due to the many practical difficulties involved. At the same time, family members are important sources of support and care even in wealthy countries with established and relatively efficient social services for the older population. For migrant families from East Asia, where adult children have emigrated while their parents have remained in the country of origin, the distance and the transnational nature of the family ties present additional complications to the challenge of providing parental care within a highly filial culture. In this qualitative study, first-generation Korean Americans were interviewed in open-ended, in-depth interviews about their experiences and concerns surrounding transnational parental caregiving. The results show that none of the study participants or their families plan for parental care. Although most respondents expressed concerns over potential future care needs of their parents, none of them had taken steps to address those concerns or discussed the matter with other family members, who were equally reticent to discuss it. This was even though many stated that they were specifically worried about how to care for their parents in times of need given that they lived far away in another country. The discussion explores why migrant families consistently avoid what they themselves acknowledge to be an important, even necessary, discussion their families ought to have.
Lack of Weight Gain During the First 2 Months of Treatment and Human Immunodeficiency Virus Independently Predict Unsuccessful Treatment Outcomes in Tuberculosis
Authors: Peetluk Lauren S , Rebeiro Peter F , Cordeiro-Santos Marcelo , Kritski Afranio , Andrade Bruno B , Durovni Betina , Calvacante Solange , Arriaga María B , Turner Megan M , Figueiredo Marina C , Rolla Valeria C , Sterling Timothy R
Published: November 2019

Background

Weight change may inform tuberculosis treatment response, but its predictive power may be confounded by human immunodeficiency virus (HIV).

Methods

We prospectively followed up adults with culture-confirmed, drug-susceptible, pulmonary tuberculosis receiving standard 4-drug therapy (isoniazid, rifampin, pyrazinamide, and ethambutol) in Brazil. We examined median weight change 2 months after treatment initiation by HIV status, using quantile regression, and unsuccessful tuberculosis treatment outcome (treatment failure, tuberculosis recurrence, or death) by HIV and weight change status, using Cox regression.

Results

Among 547 participants, 102 (19%) were HIV positive, and 35 (6%) had an unsuccessful outcome. After adjustment for confounders, persons living with HIV (PLWH) gained a median of 1.3 kg (95% confidence interval [CI], −2.8 to .1) less than HIV-negative individuals during the first 2 months of tuberculosis treatment. PLWH were at increased risk of an unsuccessful outcome (adjusted hazard ratio, 4.8; 95% CI, 2.1–10.9). Weight change was independently associated with outcome, with risk of unsuccessful outcome decreasing by 12% (95% CI, .81%–.95%) per 1-kg increase.

Conclusions

PLWH gained less weight during the first 2 months of tuberculosis treatment, and lack of weight gain and HIV independently predicted unsuccessful tuberculosis treatment outcomes. Weight, an easily collected biomarker, may identify patients who would benefit from alternative treatment strategies.
Identification of putative adhesins and carbohydrate ligands of Lactobacillus paracasei using a combinatorial in silico and glycomics microarray profiling approach
Authors: Houeix Benoit , Synowsky Silvia , Cairns Michael T , Kane Marian , Kilcoyne Michelle , Joshi Lokesh
Published: November 2019

Commensal bacteria must colonize host mucosal surfaces to exert health-promoting properties, and bind to gastrointestinal tract (GIT) mucins via their cell surface adhesins. Considerable effort has been directed towards discovery of pathogen adhesins and their ligands to develop anti-infective strategies; however, little is known about the lectin-like adhesins and associated carbohydrate ligands in commensals. In this study, an in silico approach was used to detect surface exposed adhesins in the human commensal Lactobacillus paracasei subsp. paracasei, a promising probiotic commonly used in dairy product fermentation that presents anti-microbial activity. Of the 13 adhesin candidates, 3 sortase-dependent pili clusters were identified in this strain and expression of the adhesin candidate genes was confirmed in vitro. Mass spectrometry analysis confirmed the presence of surface adhesin elongation factor Tu and the chaperonin GroEL, but not pili expression. Whole cells were subsequently incubated on microarrays featuring a panel of GIT mucins from nine different mammalian species and two human-derived cell lines and a library of carbohydrate structures. Binding profiles were compared to those of two known pili-producing lactobacilli, L. johnsonii and L. rhamnosus and all Lactobacillus species displayed overlapping but distinct signatures, which may indicate different abilities for regiospecific GIT colonization. In addition, L. paracasei whole cells favoured binding to α-(2 → 3)-linked sialic acid and α-(1 → 2)-linked fucose-containing carbohydrate structures including blood groups A, B and O and Lewis antigens x, y and b. This study furthers our understanding of host-commensal cross-talk by identifying potential adhesins and specific GIT mucin and carbohydrate ligands and provides insight into the selection of colonization sites by commensals in the GIT.
Inequalities in access to birth by caesarean section in the context of user fee exemption for maternal health services in southwest and north central Nigeria
Authors: Ajayi Anthony Idowu
Published: November 2019

Background

User fee exemption for maternal healthcare services was introduced with a focus on providing free maternal health services, including caesarean sections (CS), in Nigeria. This policy has had a positive impact on access to facility-based delivery; however, the extent to which inequality in access to CS exists in the context of user fee exemption is unclear. The objective of this study was to examine inequalities in access to birth by CS 5 y after the implementation of the user fee exemption policy.

Methods

Data were obtained from 1227 women who gave birth between 2011 and 2015 and were selected using cluster random sampling between May and August 2016 from two of the six main regions of the country. Adjusted and unadjusted binary logistic regression models were performed.

Results

An overall CS rate of 6.1% was found, but varied by income, education and place of residence. Women who earned a monthly income of ≤20 000 naira (US${\$}$150) were 50% less likely to have a birth by CS compared with those who earned more. Compared with women who were educated to the tertiary level, women who had a secondary education or less were 51% less likely to give birth by CS.

Conclusions

This study shows that inequality in access to CS persists despite the implementation of free maternal healthcare services.