bluuebunny/crossref_metadata_2025 huggingface dataset:
Child Maltreatment and The Psychological Consequences of COVID-19 for Older Adults
Authors: Bruefach Tyler , Carr Dawn , Sachs-Ericsson Natalie
Published: December 2021

Traumatic experiences in early life impact adults’ well-being and their abilities to respond to adversities over the life course. Child maltreatment is a particularly salient stressor in childhood and scholars have noted the psychological implications of such experiences that extend into late life. People who experienced maltreatment in childhood have more difficulty maintaining and developing high quality relationships, regulating their emotions, and they engage in poorer coping behaviors amidst major stressors. Our study focuses on how child maltreatment (i.e., emotional abuse; physical abuse; sexual abuse; emotional neglect) shaped older adults’ changes in depression during the early stages of the COVID-19 Pandemic. Using a dataset released in 2021, based on a community sample of older adults collected in September 2018 and June 2020, we found that exposures to emotional neglect (1.630; p < 0.001) and emotional abuse (0.670; p < 0.05) in childhood were both associated with increases in depression scores in association with the pandemic, relative to those without such exposures. In addition, the more forms of maltreatment that individuals were exposed to in childhood, the more they experienced negative psychological health consequences in association with the pandemic. Our results suggest that early life traumas play a role in how older adults respond to stressful situations. Clinical treatments for depression may be more effective if they take into consideration how these early life experiences influence exposures to new stressors in later life.
COVID-19 Teleconferencing Experiences of Caregivers & Spouses with Dementia from QA/QI Support Group Study
Authors: Nicholson Roscoe , Mittelman Mary , O'Connor Maureen , Nguyen Andrew , Salant Rebecca , Donley Tiffany , Epstein-Smith Cynthia , Shirk Steven
Published: December 2021

In summer 2020, researchers conducted a Quality Assurance and Quality Improvement (QA/QI) assessment of the NYU Langone Alzheimer’s Disease and Related Dementias Family Support Program’s adaptations in response to COVID by interviewing 10 participating spouse caregivers of persons with dementia (PWD). The primary adaptations were shifting from in-person to online services, changing support groups from biweekly to weekly, and offering an arts-based group for PWD daily rather than weekly. In the course of these interviews, all respondents described their adaptation to remote teleconferencing programming, and five also contrasted their experiences with those of the PWD. Methods: After transcription and de-identification, a codebook was created from the transcript content that included a priori topics of interest as well as emergent themes using framework analysis. These transcripts were then coded by two independent coders through an iterative process and consultation with the codebook creator, who also resolved any discrepancies between coders. Results: Respondents reported largely successful transitions to teleconferencing for themselves, though missing the physical contact afforded by meeting in-person. However, they also described some interactional challenges related to participants talking over one another, and suggested more active moderating to facilitate greater turn-taking. The respondents’ descriptions of the PWD’s response suggested a much less successful transition to teleconferencing. Challenges and barriers included lack of interest, difficulty following or participating in conversation, and teleconferencing creating confusion, such making it “hard for her to separate out when everybody's in the same place or not."
Effects of Glycine Supplementation on Mitochondrial Function and Protein Degradation in Skeletal Muscle of Old Mice
Authors: Lizzo Giulia , Muller Kamila , Thevenet Jonathan , Christen Stefan , Zarse Kim , Ristow Michael , Bosco Nabil , Gut Philipp
Published: December 2021

Glycine is the simplest amino acid and it has a pivotal role in different metabolic processes, such as being a building block of glutathione, collagen and purine bases, or taking part in methylation reactions, detoxication and ammonia metabolism. Although considered for many years a non-essential amino acid, glycine levels are decreased in certain conditions, as the endogenous synthesis cannot fulfill the needs required to sustain all the cellular processes in which glycine is involved. Here we describe that glycine levels are significantly lower in skeletal muscle of aged zebrafish and mice and in plasma of humans compared to young subjects. We therefore fed healthy old mice for 6 weeks with a glycine-supplemented diet and observed a significant restoration of glycine levels in skeletal muscle and liver towards young mouse levels. Moreover, old mice showed decreased mitochondrial function in glycolytic and oxidative fibers, and a significant increase in oxygen consumption was observed in glycolytic fibers after glycine supplementation. The improvement of mitochondrial function is not associated to an increased mitochondrial biogenesis or an increased antioxidant capacity, but glycine supplementation increases both total GSH and GSSG levels, suggestive of a pro-oxidant environment. Overall, glycine supplementation induced an increase in the cross-sectional area of fibers. Finally, we carried out RNA-Seq study to decipher the impact of higher glycine intake. Our results suggest that age-associated glycine deficiency plays an important role in atrophy of muscle, especially in glycolytic fibers, and is reversible with a dietary supplementation.
Experiences of Rural and Urban Assisted Living Communities in Oregon During COVID-19 Pandemic
Authors: Tunalilar Ozcan , Kyler-Yano Jason , Elliott Sheryl , Dys Sarah , Carder Paula
Published: December 2021

This study presents findings on the impact of the COVID-19 pandemic as reported by a representative sample of Oregon assisted living communities (AL) between December 2020 and March 2021. Of the 559 AL eligible to participate, 346 completed eleven questions related to their experiences since March 2020. These questions covered topics such as access to personal protective equipment (PPE) and accurate information, communication with and support from government agencies, ability to find staff and new residents, ability to address pandemic-related concerns of residents’ families and staff, use of virtual visits and telehealth for residents, and visitor restrictions. Response categories ranged from 0 (strongly disagree) to 4 (strongly agree) and we coded “agree” and “strongly agree” responses as having experienced that issue. Among responding AL, 42% were located in rural or frontier areas. We present three findings. First, most AL experienced adverse impact due to COVID-19, especially regarding issues likely to be outside of their control compared to those within their control. Second, while almost all urban-based AL reported that their residents used virtual communication technologies and tools for telemedicine/telehealth (96%) or virtual social visits (96%), rural AL were less likely to report so (90% and 92%, respectively). Finally, rural AL experienced significantly greater staffing difficulties (75%) compared to their urban counterparts (82%). In sum, while all AL would benefit from better regulatory guidance on policies and access to PPE, rural AL might especially benefit from additional, context-specific resources.
Factors Associated with Attachment and Care Decisions
Authors: Cassie Kimberly
Published: December 2021

It is widely accepted that remaining in the community for as long as possible is preferable to placement in a care facility. For many, this can only be realized with the support of a family caregiver. Previous research on the relationship between attachment and caregiving decisions is sparse, but tends to suggest there is a relationship between attachment and the decision to assume caregiving responsibilities, but more information is needed to better understand this unique relationship. This exploratory research seeks to address gaps in our understanding by asking is attachment related to the decision to care for a parent and what factors are associated with attachment. A convenience sample of 128 individuals caring for older parents was surveyed to answer these questions. Results indicate lower attachment related avoidance was associated with greater odds of caring for a recipient in the community rather than placing the recipient in a care facility. No relationship between attachment related anxiety and placement decisions was observed. Additionally, greater levels of attachment related avoidance were observed among caregivers reporting lower levels of filial responsibility, more adverse childhood experiences, less perceived support, and greater financial stability. Findings from this study can be used to support the development of interventions to strengthen attachment between adult children and their parents before care decisions are necessary.
Factors Driving High-Need High-Risk Vulnerable Veterans Use of Outpatient Healthcare
Authors: Zadeh Ali Vaeli , Tang Fei , Gomez Carlos , Leykum Luci , Intrator Orna , Kinosian Bruce , Valencia Willy Marcos , Dang Stuti
Published: December 2021

Using predictive analytic modeling, the Veterans Affairs (VA) Geriatrics and Extended Care Data Analysis Center (GECDAC) identified vulnerable “High-Need High-Risk” (HNHR) Veterans, as requiring more support and services. We sought to identify variables linked with utilization of our outpatient HNHR C4 clinic offering Comprehensive Geriatric Assessment, Care Planning, Care Coordination, and Co-management". Of 724 HNHR Veterans contacted, 531 were reached and invited to participate; 193 were not reached, 326 were reached but declined the C4 clinic, 205 attended the clinic. We compared these groups. Independent variables were organized using Anderson’s behavioral model into predisposing (age, gender, race, ethnicity), enabling (drive time, service eligibility, Area Deprivation Index, marital status), and need factors (mental health cognitive condition, ambulatory care sensitive conditions, NOSOS, JFI, CAN, etc.). C4 enrollment acceptance was the outcome. Results showed that compared to patients who declined, HNHR veterans who attended C4 clinic had more chronic health conditions(p<0.01), more service eligibility(p=0.01), more driving time to the closest VA clinic(p=0.01), and more were married (p=0.01). Patients who declined C4 clinic might have greater barriers to care access. Accessing needed healthcare among HNHR older adults maybe impacted more by enabling factors that allow the individual to seek care if needed and are the resources that may facilitate access to services, rather than need factors, which include individuals' perceptions of their health and functional state, and healthcare needs assessed by professionals. More social and intermediary determinants of health should be incorporated as enabling factors into models striving to understand drivers of healthcare use.
Older Adults’ Acceptance of Technology During the Pandemic: The COVID Technology Acceptance Model (TAM)
Authors: O'Connell Megan , Haase Kristen , Cammer Allison , Peacock Shelley , Cosco Theodore , Holtslander Lorraine
Published: December 2021

During the pandemic, technology-mediated communication was one of the few ways to maintain social and community connections. We explored how the pandemic impacted older adults’ use and appraisal of technology. In a random sample of 407 older adults (M age = 81.1 years; range 65-105 years) almost half (n = 161) reported they changed how they used technology to virtually connect with others during the pandemic, and 78 of these reported that this was new technology for them. We adapted the technology acceptance model (TAM) for the pandemic, the COVID-TAM, and describe how physical distancing led to new acceptance of technology due to an increased perception of usefulness of technology for maintaining community and social connections. The 71 older adults who denied using technology were asked about the reasons underlying their reluctance to use technology to access social networks and community events during the pandemic. Thematic analysis revealed factors consistent with a double-digital divide; lack of physical exposure to technology creates an additional psychological barrier to adoption of new technology. Of the technology-reluctant subgroup of older adults, few reported lack of perceived usefulness of technology during the pandemic. Instead, most reported lack of self-efficacy or fear of technology underlying their lack of technology use for social and community connections during the pandemic, which we incorporate into the COVID-TAM. Findings indicate that technology training can help mitigate this fear and increase social and community connections that are technology-mediated in circumstances where physical distancing is necessary.
Spouses’ Emotion Regulation Skills and Depressive Symptoms in the Context of Early Stage Dementia
Authors: Piechota Amanda , Monin Joan
Published: December 2021

In older adults, the suffering of a relative with chronic disease or illness can severely impact their caregiver. However, older adults also tend to have better emotional regulation than younger age groups. Very little is known about these dynamics in the context of early-stage dementia in which both spouses are struggling with caregiving or experiencing dementia and need one another for support. In the present study, we hypothesized that when both partners have better emotion regulation skills, each partner’s depressive symptoms would be the lowest. We made the same hypothesis for both the person with dementia and their spouse without dementia. We used self-report baseline data from an intervention study of 70 older adult married couples (N=140) where one spouse has early-stage dementia. Spouses completed questionnaires that measured their emotional regulation habits (Difficulties in Emotion Regulation Scale) and their recent depressive symptoms (CESD). Results from the actor partner interdependence model showed that when both partners had high emotional regulation skills scores there were the lowest levels of depressive symptoms for each dyad member (B=4.31, SE=.94, t(49.9)=4.61, p<.001). Findings suggest couple-focused interventions to enhance emotion regulation skills are important for coping in the early stages of dementia.
State Variation in Potentially Burdensome Transitions among Assisted Living Residents at End of Life
Authors: Wang Xiao (Joyce) , Teno Joan , Gozalo Pedro , Dosa David , Thomas Kali , Belanger Emmanuelle
Published: December 2021

Little is known about the quality of end-of-life care in assisted living (AL), particularly transitions at end of life. This study aims to provide a first national look at potentially burdensome transitions at end of life among AL residents and to examine how those vary by state. This is a retrospective cohort study of Medicare beneficiaries who died in 2018 and resided at a validated 9-digit ZIP code for an AL with 25 or more beds4 on the 120th day before death (N=37,668). Three types of potentially burdensome transitions were considered: 1) healthcare transitions during last 3 days of life, 2) three or more all-cause hospitalizations during the last 90 days of life, and 3) two or more hospitalizations for urinary tract infections, sepsis, pneumonia, and dehydration during last 120 days of life. Hospitalizations and decedents’ locations were obtained from multiple administrative claims records. Out of the 37,668 AL decedents, 7,015 (18.6%, 95% CI: 18.2%-19.0%) experienced at least one potentially burdensome transition. States varied widely in the rate of burdensome transitions, ranging from 30.9% in North Dakota to 8.9% in Wyoming. Our results support quality concerns for end-of-life care among AL residents. Future studies are needed to explain state variation and how it relates to factors such as residents’ co-morbidities, end-of-life care practices in AL, and state regulations. This study had two limitations. First, multiple hospitalizations for Medicare Advantage beneficiaries might be under-reported. Second, the results are not generalizable to persons in ALs with fewer than 25 beds.
Tele-Healthcare in Research and Education: Age Differences in Access and Utilization of Healthcare Resources
Authors: Hills William , Murphy Matthew , Hills Karen
Published: December 2021

Societal needs highlighted during the pandemic have led to significant changes in healthcare, including the rapid development and implementation of tele-care consumer options. This study examined video-based, virtual healthcare access and utilization before and during the pandemic. Participants included traditional college-aged students, middle-aged adults, and retirement-aged persons (n = 685); measures included access to physical and mental health services, consumer satisfaction with type of services accessed, and anticipated use of virtual healthcare following the pandemic. Results showed that approximately half of participants (49.2%) had experience with virtual healthcare, with most of these cases during the pandemic. Virtual healthcare was more often used for physical compared to mental healthcare services, with college-aged participants more likely to use mental healthcare services than adult and retirement-aged participants. Laptop computers were most widely used to access services, with smartphone use proportionally lower in retirement-aged participants (31.4%). Overall satisfaction with virtual services was high (Mdn = 5 on a 6-point Likert scale), but college-aged participants trended toward a lower satisfaction (Mdn = 4.25) than other age categories. These results support that virtual healthcare service development and access experienced significant growth during the pandemic. Age differences in the types of services, types of devices, and satisfaction with virtual services all suggest a similar theme for age-related considerations of life stage, life responsibilities, and comfort and familiarity with technology that must be addressed for virtual healthcare to reach its full potential and reach equitably across the lifespan.
Lessons In Customizing Virtual Communities To Meet The Needs Of Older Adults
Authors: Kosick Lawrence
Published: December 2021

GetSetUp started as a technology learning platform for older adults. During Covid-19 we realized that many adults not only wanted to learn technology but were eager for lifelong learning opportunities. Our specially designed technology platform offered a safe, welcoming space that fosters growth, learning, and community for older adults over 60,000 Michiganders over 60 joined in just 4 months. Case studies show how older adults can benefit from technology to feel empowered, reduce social isolation, and improve wellbeing through a job or volunteer opportunities and new friendships. Reports highlight this ongoing need for those with limited community, mobility issues, or those looking to diversify their communities. A trusted virtual community helps connect the physical world digitally to assure older adults understand processes like vaccine enrollment procedures. Virtual communities will not replace physical communities but offer research opportunities, reach more remote communities, and allow for collaboration with state and aging networks.
Virtual CARE for Caregivers of PWD: Adapting to the New Normal
Authors: Shirk Steven , O'Connor Maureen , McLaren Jaye , Pugh Kendra , Nguyen Andrew , Boucher Sarah , Moo Lauren
Published: December 2021

Caregivers of persons with dementia (PWD) often experience increases in depression, anxiety, and burden as the disease progresses. In fact, as the PWD’s neuropsychiatric symptoms increase and independence in ADLS decrease, caregivers psychological and physical health outcomes worsen. The literature suggests that caregiver interventions that teach specific skills are more beneficial than psychoeducational interventions, particularly regarding the amelioration of the psychological impacts of informal caregiving. However, because of caregiving demands, caregiver’s own physical limitations, and competing obligations, it can be difficult to attend caregiver support or education programs outside the home. With the emergence of the COVID-19 pandemic, arranging such interventions became more complex, Therefore, we report on preliminary qualitative outcomes of a study investigating the feasibility and acceptability of converting an in-person, group dementia caregiver education intervention, CARE, to a telehealth platform. We report the findings of two objectives: 1) lessons learned when attempting to convert an in-person group intervention to telehealth and 2) experience and perceived benefit of attending a virtual group from the perspective of the participants of our first two groups. Briefly, our findings demonstrate the strong need for technological support. Participants report positive experience regarding the convenience of attending the group from their home, the benefits of the assigned exercises, and the support they found from other group members. The COVID-19 pandemic has forced many to embrace the virtual option as they adapt to a new normal. There are undoubtedly hurdles to overcome, but there are also advantages to be leveraged.
A Cloud Infrastructure for Large Scale Health Monitoring in Older Adult Care Facilities
Authors: Noh Yeonsik , David Uchechukwu
Published: December 2021

Technology development in the sub-field of older adult care has always been on the back-burner compared to other healthcare areas. But with increasing life expectancy, this is poised to change. With the increasing older adult population, the current older adult care facilities and personnel are struggling to keep up with demand. To address this matter, we proposed a distributed system infrastructure that will enable large-scale monitoring of vital signals and early detection of emergency situations in nursing homes and assisted living communities in this study. The system is mainly comprised of node devices and cloud infrastructure. The node device collects data from multiple users and forwards this data to the cloud service. Communication between the vital-sensing devices on the users and the node device is accomplished using Bluetooth Low-Energy (BLE). The Node device is implemented on a Raspberry Pi Model 3b+ which has built-in BLE capability. A cloud server consists of back-end and front-end components. The back-end handles all the data processing and logical decisions that drive the front-end. The front-end is the interface provided to the end-users, which can monitor all patients in nursing homes at the same time. We examined our system in terms of scalability, real-time operation, cost, and usability and then found that our system provides not only a smart remote monitoring solution that can provide a better aging experience for older adults and their families, but also increase automation in nursing homes leading to a reduction in running cost and an increase in capacity.
Lessons On Using Health Research & Technology To Broaden Resources For Older Adults Across The State
Authors: Hunt Jennifer , Travis Alexis
Published: December 2021

The vision of the Michigan state unit on aging is for residents to live well and thrive as they age. The COVID-19 pandemic exacerbated the existing problem of older adult social isolation. Social engagement and community involvement are keys to healthy aging. Combining state resources with the GetSetUp virtual community allowed for statewide connections and extended resources, creating an almost around-the-clock virtual senior center. Through customized courses the state was able to offer vaccine navigation sign-up classes, among other classes, to help older adults interact with essential health and aging services. As Michigan continues to work to address health equity and social determinants of health beyond the pandemic, technology designed specifically for older adults is an important component of programmatic offerings. It also allows for a public-private partnership opportunity to support older adults as they age.
Association of Dementia Severity and Assistances Needs on Missed Home Health Visits.
Authors: Knox Sara , Downer Brian , Haas Allen , Ottenbacher Kenneth
Published: December 2021

Individuals with Alzheimer’s Disease and Related Dementias (ADRD) experience barriers to accessing health care services, including services provided during home health care. Additionally, it is not clear if people with ADRD who are admitted to home health care receive all the services needed to maximize their outcomes. Barriers to receiving the optimal care can include the presence or absence of a care giver, behavioral and psychological symptoms of ADRD, or therapists lacking the skills needed to effectively engage patients in therapy sessions. These barriers may vary dependent on the patient’s ADRD severity. The purpose of this study was to examine the relationship between dementia severity and early discharge from home health care. This was a retrospective study of 142,376 Medicare beneficiaries with ADRD who received home health care between October 2016 and September 2017. Early discharge was defined as discharge from home health with more than two missed visits. Early discharge rates were calculated, and multilevel logistic regression was used to estimate the relative risk (RR) of early discharge, by dementia severity level, adjusted for patient and clinical characteristics. 10.4% of beneficiaries had an early discharge. Dementia severity was not associated with risk of early discharge. However, level of medication assistance needed was found to be associated with risk of early discharge (RR=0.849; 95% CI 0.759 - 0.948). Medication management may impact a patient’s ability to adequately attend and engage in home health therapy services. Further studies are needed to better delineate the interaction between medication management and early discharge.
Confirming a Drosophila Melanogaster Model of Huntingtin Aggregation
Authors: Biritwum Akosua , Levy Simon , Frost Bess , Duttaroy Atanu
Published: December 2021

For decades, doctors, psychologists, and psychiatrists alike have struggled to treat the symptomatic effects of Huntington’s disease. Huntington’s disease is an autosomal dominant brain disease that results in the deterioration of a person’s physical and mental state. Once a person inherits the disease, they end up dying from it more often than not. At present, there are 41,000 Americans with symptomatic Huntington’s disease, and 200,000 more are currently at-risk of inheriting the disease. Given its 50/50 chance of inheritance, there seems to be no end in sight to this degenerative ailment. My research study, however, will show that with a more robust approach, finding a cure for this disease is possible. Ultimately, the aim of this project was to test an already established model in Drosophila melanogaster regarding the “huntingtin” protein responsible for Huntington’s disease. This was achieved by first demonstrating that the flies which were modified to produce huntingtin could, in fact, produce the protein. Secondly, an experimental process was created to configure a system through which the amount of protein produced by each fly could be quantified. This quantification was vital in creating a baseline that would allow for the identification of potential therapeutic treatments in the future. In short, by establishing a quantifiable model for huntingtin, this study will pave the way to new insights on huntingtin aggregation and the identification of possible treatments for Huntington’s disease in the future.
Convergent and Construct Validity of a Conversation Difficulties Outcome Measure in Primary Progressive Aphasia
Authors: Santos Haylie , Gill Nathan , Salley Elizabeth , Zhang Hui , Rogalski Emily , Roberts Angela
Published: December 2021

Cognition and language changes, and their impacts on functional communication, are central to many dementias. Thus, functional communication, including conversation difficulties, is an important endpoint for clinical trials. To develop robust outcomes in primary progressive aphasia (PPA), a dementia characterized by communication impairments, we examined the convergent and construct validity of the Perception of Conversation Difficulties-Dementia Alzheimer’s Type (PCI-DAT; Orange et al., 2009). The PCI-DAT is a care partner reported measure of conversation difficulties. Eighty-two care partners with a mean age of 64.8 years (SD=10.61; 85% spouses, 5% adult children, 10% friends/siblings) whose mean relationship duration to the person with PPA was 39.1 (SD=15.1) years completed the study. Pearson’s correlation indicated a significant, modest correlation (r=-0.54, p<0.0001) between the PCI-DAT Perception of Conversation Difficulties subscale and the Communication Effectiveness Index (Lomas et al., 1989) suggesting strong convergent validity. A Rasch analysis conducted on the same PCI-DAT subscale showed high person (0.92) and item (0.95) reliability indicating a robust overall scale structure that adequately evaluates various levels of conversation difficulty severity in PPA. Six items (27%) had minor ‘fit’ issues (defined by Wright and Linacre, 1994 as having infit statistics < 0.6 or > 1.4) relative to the underlying construct. Results suggest strong convergent and construct validity of the PCI-DAT in PPA and indicate items that will benefit from further development. Overall, our results suggest that the PCI-DAT holds promise for use as a functional communication endpoint in PPA clinical trials. Data for all five PCI-DAT subscales will be presented.
COVID-19 Silver Linings - Experience of Spousal Caregivers of Persons with Dementia Engaged in Support Program
Authors: Nguyen Andrew , Stevenson Elizabeth , Mittelman Mary , Nicholson Roscoe , Donley Tiffany , Salant Rebecca , Shirk Steven , O'Connor Maureen
Published: December 2021

Caring for a person with dementia (PWD) has been consistently associated with negative effects on health, including increases in caregiver depression, anxiety, and burden. Emerging studies have shown that the COVID-19 pandemic has increased these factors due to reported increases in caregiver workload and cognitive and behavioral symptoms of the PWD. We interviewed 10 spousal caregivers of PWD from the NYU Langone Alzheimer’s Disease and Related Dementias Family Support Program in Summer 2020 during the COVID-19 pandemic in order to gain feedback about their experiences during the pandemic and the transition from in-person to videoconferencing that could be used to improve services and support. Caregivers discussed the challenges faced during the pandemic but also the unique opportunities the situation presented. We report here on those positive aspects of COVID-19 from the perspective of the caregivers we interviewed. Methods: Interviews of caregivers residing with their spouses in the New York City area were conducted via videoconferencing, transcribed, deidentified, and analyzed using framework analysis methods. Results: We found that caregivers reported some positive reaction to videoconferencing that included increased support group cohesion, increased convenience, feeling less obligated to participate in events, and new opportunities for social contact. Participants also discussed positive inter-couple relationship changes such as increased quality time spent together. Our findings resonate with a body of literature focused on understanding the positive aspects of caregiving. Understanding the full presentation of the caregiver experience, including both positive and negative aspects, is important for developing interventions and resources for this unique group.
Exploring How Neighborhood Characteristics and Psychosocial Resilience Affect Cognition Among Older Black Adults
Authors: Farmer Heather , Thierry Amy , Armendariz Marina , Kirven Sydney , Sherman-Wilkins Kyler
Published: December 2021

Black older adults are at greater risk for poor cognitive health than Whites, and adverse neighborhood conditions may contribute to this disparity. Moreover, limited research examines how resilience is implicated in the relationship between neighborhoods and cognition among Blacks. Using 2006-2016 waves of the Health and Retirement Study, we examine how perceived neighborhood characteristics (physical disorder and social cohesion) and psychosocial resilience (social support, mastery, and sense of purpose) contribute to cognitive functioning among 1,655 Black adults ages 65+. Results from multilevel linear regression models show that greater physical disorder was associated with worse cognitive functioning, and this was attenuated after adjustment for socioeconomic status. We found a positive association between purpose and mastery with cognitive functioning, even after accounting for socioeconomic, psychosocial, and health-related characteristics. Thus, high levels of purpose and mastery may be protective for cognitive functioning among Black older adults in spite of experiencing negative neighborhood contexts.
Foot Mechanics Define Directional Changes in Curved-Path Walking: New Methods to Assess the Motor Skill of Walking
Authors: Hicks Haley , McBroom Anthony , Roscher Patrick , VanSwearingen Jessie , Lowry Kristin
Published: December 2021

Although it is essential to navigating the world, curved path walking is a challenge to mediolateral balance control. The focus of previous curved-path walking research was in spatiotemporal characteristics. We quantified the foot-ground interaction, center of pressure (COP) characteristics during non-linear (eg curved-path) walking important to understand the functional mechanics of directional changes for curved paths. We hypothesized the foot mechanics differ between older adults with better versus poorer curved-path walking (Figure of 8 Walk Test, F8W). Twenty-five older adults (mean age 71.8 ± 8.9 years) completed the F8W on an instrumented walkway (Protokinetics, LLC.) The derived metrics of the foot mechanics included medial/lateral movement of the COP for inside and outside steps, maximum medial and lateral COP excursions, and total medial/lateral COP range. Pearson correlations were used to examine relations F8W (time and steps) and COP metrics; ANOVAs were used to examine differences in COP metrics between older adults grouped by median-split of F8W time. Longer F8W time and more steps were related to lesser total COP range and outside foot lateral maximum excursion (r range -0.415 to -0.706, p<0.04). Older adults with stronger F8W performance compared to poorer F8W performance had larger outside foot total COP ranges (3.61cm vs 4.39cm, p=0.016) and greater lateral excursion (1.60cm vs 2.12cm, p=0,003). Foot-ground interactions offer new insights into control of curved path walking and methods for evaluating efficacy of interventions focused on improving walking skill in older adults.
Latent Classes of First Incident Difficulty in Instrumental Activities of Daily Living
Authors: Feger Danielle , Deal Jennifer , Gross Alden
Published: December 2021

Ability to perform instrumental activities of daily living (IADLs) deteriorates during prodromal Alzheimer’s disease (AD), eventually leading to impaired everyday functioning and dementia. Ordering and timing of IADL difficulty onset may identify individuals at greater risk of cognitive impairment, but most studies only consider total number of difficult tasks. Leveraging longitudinal data from the Advanced Cognitive Training in Independent and Vital Elderly (ACTIVE) Study who entered free of any IADL difficulty (N=1266), we hypothesized that a latent class analysis based on timing of first reported IADL task difficulty would reveal class differences in cognitive functioning . Participants were followed until they self-reported at least one IADL difficulty, study completion (10 years), or loss to follow-up. Discrete-time multiple event process survival mixture (MEPSUM) models were used to simultaneously estimate hazards of incident IADL task difficulty across 7 task groups. Two, 3, 4, and 5 latent class models were fit to the data. Both unadjusted and covariate-adjusted models (adjusted for age, sex, race, education, marital status, and general health rating) were fit. Using the 2-class solution as the most parsimonious model, model entropy was 0.855. The model was able to distinguish a class of participants with lower global cognitive factor scores at baseline (Cohen’s D = 0.23, P = 0.04). We conclude that first incident IADL difficulty may be a useful measure in identifying individuals with worse cognitive functioning.
Perceptions of Medical Cannabis Packaging and Labeling among Middle-Aged and Older Canadians
Authors: O'Connor Melissa , Christiuk Vanessa , Pedersen Megan
Published: December 2021

The use of cannabis for therapeutic purposes is becoming more popular in many countries, including the United States and Canada. In Canada, middle-aged and older adults make up the largest proportion of medical cannabis users. Canadian legislation mandates that medical cannabis be packaged in plain-looking containers with small labels, childproof caps, and required health warnings. This is meant to standardize the way cannabis products are distributed, as well as protect children from accidental ingestion. However, there is limited research on how these regulations affect cannabis users over age 45. In the present study, residents of Winnipeg, Manitoba, Canada aged 45 and older (n=40) were surveyed regarding their experiences with medical cannabis packaging and labeling. Half of the participants (50%) felt they had a hard time opening their medical cannabis container. A majority (60%) thought having an easy-open lid would be helpful. Most participants (78%) reported experiencing difficulties reading the label on their container, and 75% thought it would be helpful to have a printout of the label in a larger font. In addition, 89% of participants who took more than one kind of medical cannabis favored a symbol on their medication bottle that would indicate the type of medical cannabis contained inside. Implications for policy makers and future research are discussed.
Phase 2b Study of an Ad26.RSV.preF Vaccine for Prevention of RSV-mediated Respiratory Tract Disease in Older Adults
Authors: Falsey Ann , Williams Kristi , Gymnopoulou Efi , Bart Stephan , Ervin John , De Paepe Els , Comeaux Christy , Heijnen Esther
Published: December 2021

Respiratory syncytial virus (RSV) may cause serious lower respiratory tract disease (LRTD) in older adults, and there is currently no licensed vaccine. CYPRESS (NCT03982199) is a randomized, double-blind, placebo-controlled Phase 2b proof-of-concept trial of an Ad26.RSV.preF-based vaccine for the prevention of RSV-mediated LRTD in older adults. Adults aged ≥65 years were randomized 1:1 before the RSV season to receive Ad26.RSV.preF-based vaccine or placebo. Acute respiratory infection symptoms were collected through a patient eDiary and/or clinician assessment until the end of the RSV season. The primary endpoint was the first occurrence of RTPCR-confirmed RSV-mediated LRTD according to any of 3 case definitions: (1) ≥3 symptoms of lower respiratory tract infection (LRTI), (2) ≥2 symptoms of LRTI, or (3) ≥2 symptoms of LRTI or ≥1 symptom of LRTI with ≥1 systemic symptom. Immunogenicity was assessed in a subset of approximately 200 participants. A total of 2891 participants in each study arm received study treatment. Vaccine efficacy was 80% (94.2% CI, 52.2-92.9%), 75% (50.1-88.5%), and 69.8% (43.7-84.7%) for case definition 1, 2, and 3, respectively (all P <0.001). In the vaccine arm, geometric mean fold increase in antibody titers 14 days after vaccination was 13.5 for RSV neutralizing antibodies and 8.6 for RSV prefusion F-specific binding antibodies, and median frequency of RSV-F-specific INFγ T-cells increased from 34 to 444 SFC/10^6 PBMC; no relevant changes were observed in the placebo arm. The Ad26.RSV.preF-based vaccine was highly effective against RSV-mediated LRTD through the first RSV season and elicited robust immune responses in older adults.
Sex Differences in Cardiovascular Markers and BDNF between Cerebral Palsy and Mild Cognitive Impairment
Authors: Ng Ted , Carollo James , Tagawa Alex , Pan Zhaoxing , Heyn Patricia
Published: December 2021

Adults with cerebral palsy (CP) have higher risk of developing geriatric syndromes. Mild cognitive impairment (MCI) is an intermediate stage between healthy aging and dementia, often co-morbid with cardiovascular disease (CVD). We recently showed an “accelerated aging model”, where CP shares similar CVD risk factors with MCI, potentially accounting for CP’s increased risk of dementia. In this study, we further examined sex differences between CP and MCI (aim 1) and within CP (aim 2). From an accredited clinical motion analysis laboratory at Children’s Hospital Colorado (CP) and a university in Singapore (MCI), we recruited 72 adults with CP [mean (SD) of age=20 (5.3), Sex: men=47.2% and women=52.8%] and MCI [mean (SD) of age=71.28 (6.03), Sex: men=29.2% and women=70.8%]. We analyzed blood Pressure (BP), Framingham Heart Study Score (FHSS), and brain-derived neurotrophic factor (BDNF). Compared to MCI, women with CP had lower BDNF (β=-3.550, 95% CI=-5.659 to -1.441, p=0.001), while men with CP had lower diastolic BP (β=-28.204, 95% CI=-52.148 to -4.260, p=0.022). Both women and men with CP also had lower FHSS, compared to MCI (β=-2.515, 95% CI=-3.721 to -1.309, p<0.001; β=-3.724, 95% CI=-5.561 to -1.888, p<0.001, respectively). Women in the CP cohort showed lower FHSS (β=-0.172, 95% CI=-0.310 to -0.033, p=0.016). We found sex-related differences in BDNF and CVD markers. Comparing across and within cohorts, although having lower BDNF levels, women with CP had better FHSS. These findings support our accelerated aging hypothesis, and further suggest sex differences in aging-related risk factors in CP, supporting sex-related precision medicine approach.
Single cell analysis reveals stochastic cell-to-cell variation in stress response and senescence program
Authors: Burnaevskiy Nikolay , Mendenhall Alexander
Published: December 2021

Cells have various means to respond to molecular stress. Upon stress, proliferating cells can adopt different fates, e.g. commit to apoptosis, go into senescence or recover from stress and resume proliferation, depending on severity of the stress. Proper balance between these modes of response is critical for maintaining tissue homeostasis with age, as both exacerbated and insufficient response can result in pathology. Remarkably, even genetically identical cells of the same type in the controlled environment can exhibit a spectrum of responses to the same stress challenge. We hypothesized that analyzing response of individual cells in controlled environment can help better understand the mechanisms that ensure a balanced response to molecular stress. We used large scale single cell RNA-sequencing to analyze response of individual human fibroblasts to oxidative stress. Consistent with various fates adopted by individual cells upon stress, we observed different transcriptional signatures, that correspond to those fates. Surprisingly, when we specifically analyzed ß-gal+ senescent cells, we still observed transcriptional heterogeneity, with only a subset of cells exhibiting pro-senescent transcriptional signature (e.g. activated p53 and TNF-a pathways) while another subset exhibits a gene expression signature of senescent-like arrest. Hence, we find that in addition to known stress-related fates (apoptosis, senescence, recovery) senescence-like response is heterogeneous with only subset of cells exhibiting expected pro-senescent gene expression signature. Further characterization of heterogeneity of stress response and senescent-like fates will help better understand the mechanisms of homeostatic control in the face of molecular stress and aging.
The Impacts Of Socio-Economic Challenge On Long-Term Physical and Mental Health In Retirement Age
Authors: Kwon Ilan , Park Sojung , Kim BoRin , Ryu ByeongJu
Published: December 2021

Despite consistent evidence on the negative effect of social and economic challenges on health, little is known about the pattern of economic difficulties people experience and the impact of those challenging patterns on long-term health in later life. This study used the national data, Mid Life in the United States (MIDUS 3 in 2013-2014), to identify the different patterns of socio-economic challenges that older Americans (50-64 ages old) experienced during the Recession in 2008 and to examine the impact of past challenging experiences on physical and mental health in their later life. Socio-economic challenges included twenty-six items such as losing or moving a job, missing rent, selling or losing a home, bankruptcy, having debts, and cutting spending. We conducted the latent class analysis and regression while controlling other social determinant factors (e.g., education, employment status, poverty, etc.). The latent class analysis result found five patterns during the Recession: people who experienced various difficulties during the Recession, who moved their jobs, who experienced financial difficulties, who bought a home with decreased debts, and who experienced no difficulty. Compared to people with no challenging experience, those who needed to move their jobs but could make debt off during the Recession reported physically healthier, but not mentally healthier in later life. Interestingly, among this group, women reported more long-term physical health problems than men. The findings suggest the close connection between physical and mental health and the importance of long-term care for mental health among older adults in recovering from socio-economic challenges.
The Relationship Between COVID 19 Anxiety and Dementia Caregivers Burden and Suffering
Authors: Lucas Kaitlyn , Batista-Malat Eleanor , Park Seho , Johns Shelly , Fowler Nicole , Judge Katherine
Published: December 2021

The impact of COVID-19 on dementia caregivers is gaining new interest. It is unknown how the pandemic has impacted caregivers’ burden and existential suffering. Analyses were performed on data for dementia caregivers (n=89) enrolled in the Indiana University Telephone Acceptance and Commitment Therapy for Caregivers (TACTICs) pilot trials. Individuals were primary caregivers of a family member with dementia and had clinically significant anxiety measured by a GAD-7 score >10 or between 5-9 with reported interference in life. COVID-19 anxiety was measured using the NIH CoRonavIruS Health Impact Survey (CRISIS) questions. Caregivers were on average 55.2 years of age with 56.2% being child or child-in-law, 71.9% were white and 24.7% were Black. Mean burden scores, measured by the Zarit Burden Index, were higher (44.29) compared to means reported across the literature (26.7) indicating the sample experienced higher than normal levels of burden. Mean existential suffering scores measured by the subscale of Experience of Suffering Scale were lower (9.37) compared to means across the literature (11.5) indicating that overall participants experienced lower levels of existential suffering compared to those in previous studies. A significant relationship was found between COVID-19 anxiety and burden levels (x2= 9.07, p<0.05), with higher levels of COVID-19 anxiety associated with greater burden. A non-significant relationship was found between COVID-19 anxiety and existential suffering (x2=5.99, p=0.11). Results highlight the impact of COVID-19 anxiety as an external stressor on dementia caregiving. and the importance of considering context of external stressors when implementing intervention protocols for caregivers of individuals with dementia.