bluuebunny/crossref_metadata_2025 huggingface dataset:
A Scenario-Based Investigation of Surrogate Decision Making for Older Adults
Authors: Zhao Yuxin , Katz Benjamin , Teaster Pamela
Published: December 2020

Surrogate decisions involve complex, challenging choices; surrogate decision-makers make treatment decisions for approximately 40% of hospitalized adults and 70% of older adults, and up to 95% of critically ill adults of any age. The purpose of our study was to understand how people make decisions for others and how surrogate decision making is linked to people’s cognition, self-efficacy, and demographics, especially differences in acute (e.g., health and medical care, financial management, and end of life) versus general scenarios (spending time with family, contacting an insurance company on behalf of a family member). Participants were recruited through Amazon’s Mechanical Turk. We collected data from 290 adult participants aged 18 years or older. On average, people reported a higher level of confidence in general versus acute scenario. The differences of confidence in scenario-based surrogate decision-making links to decision-makers’ cognition, self-efficacy, the experience of decision-making, the experience of caregiving, and demographic factors.
Disparities in the Access to Different Types of Long-Term Care Services in Taiwan
Authors: Chen Ya-Mei , Young Yuchi , Wu Shih-Cyuan , Chen Hsiu-Hsi , Yeh Yen-Po , Chiu Wan-Yu , Chung Kuo-Piao
Published: December 2020

Taiwan implemented version 1.0 of its 10-Year Long-Term Care Plan (TLTCP 1.0) in 2007, and version 2.0 (TLTCP 2.0) in 2017. The aim was to develop a system of home- and community-based services (HCBS) for long-term care (LTC). This study assessed and compared disparities in access to LTC services using one county’s database that claims made by 14,051 older adults who applied for LTC services from TLTCP 1.0 (n = 5,025) and TLTCP 2.0 (n = 9,026). We assessed LTC disparities related to five sociodemographic factors (age, gender, living status, urbanization, income status) and seven types of LTC services. Older adults who lived in a city were more likely to use multiple HCBS and transportation services. Older adults who lived alone were more likely to use home care and meal services but not other types of LTC services. All disparities in service use increased from TLTCP 1.0 to TLTCP 2.0. Part of a symposium sponsored by International Comparisons of Healthy Aging Interest Group.
Antipsychotic and Psychotropic Prescribing in Assisted Living
Authors: Zimmerman Sheryl , Sloane Philip , Wretman Christopher , Miller Stephanie , Preisser John
Published: December 2020

The Center for Medicare & Medicaid Services has brought national attention to potentially inappropriate antipsychotic prescribing for residents with dementia in nursing homes, but no such attention has been paid to prescribing in assisted living (AL), despite the fact that more than 40% of AL residents have moderate/severe dementia. This study examined antipsychotic and other psychotropic prescribing in AL using a seven-state sample of 250 communities, and examined correlates of prescribing; analyses used weights based on probability proportional to bed size to derive state-level estimates. Overall, 19% of residents were taking an antipsychotic medication (27% of those with dementia); corresponding numbers for antidepressants were 46% (54%) and for anxiolytics/hypnotics were 24% (28%; both p <.001). By way of example, communities that did not have an RN or LPN were more likely to prescribe antipsychotics (34% vs. 17%; p<.001). The discussion will highlight next steps regarding practice, policy, and research.
Reframing Aging-in-the-Right-Place for Housing Insecure Older Adults
Authors: Canham Sarah , Wada Mineko , Golant Stephen
Published: December 2020

Amidst rising costs of housing and changing personal needs, considerations of the availability of appropriate and accessible housing are becoming increasingly salient for older adults. While it has been widely acknowledged that older adults would prefer to age-in-place, recent reframing of this trend promotes the ideal as aging-in-the-right-place. This symposium will provide an updated understanding of how to support older adults’ ability to age-in-the-right-place, regardless of income or physical, mental, or social status. Presenters include international and interdisciplinary researchers representing perspectives from gerontology, social work, community planning, and health sciences. The symposium will begin with Wada examining resilience scholarship, with a focus on older people who are experiencing homelessness, which has been largely neglected. In the next presentation, Humphries will outline distinct, senior-specific needs and shelter/housing solutions for newly and chronically homeless older adults. Following, Canham will describe promising practices of shelter/housing to support aging-in-the-right-place for older people experiencing homelessness in Montréal, Calgary, and Vancouver identified through an environmental scan. Extending these efforts to an international scale, Mahmood will outline findings from a scoping review of supportive shelter/housing options, supports, and interventions. A final presentation will report on how community development practices implemented by a not-for-profit affordable housing provider promote older tenants’ food security and social support needs. Stephen Golant, a leading expert on housing, geography, and long-term needs on older adults, will discuss implications of these studies for policy and practice for supporting housing insecure older adults while advancing scholarship on aging-in-the-right-place for this marginalized population. Environmental Gerontology Interest Group Sponsored Symposium.
Lessons From an Evaluation of a Training Program of Paid Eldercare Workers
Authors: Ayalon Liat
Published: December 2020

The present study is based on a three-year evaluation of an Israeli training program for local paid elder care workers, called “community care.” Interviews were conducted with all stakeholders involved in the program, including program developers, facilitators, funders, trainees, dropouts, employers, and older care recipients. Qualitative thematic analysis was used, supplemented by quantitative data concerning the program’s inputs, outputs and outcomes. The program had multiple strengths, including a substantial funding stream and a highly skilled and committed team. Yet, out of 130 participants (in the 7 training programs evaluated), only 94 completed the program and 31 were later employed as care workers. Three main challenges to the efficacy of the training program were identified. The findings stress the importance of adequately conducting the appropriate needs assessment prior to embarking on a new social program and illustrate the tension between an ideal prototype and real-life constraints.
How Long Do Older Adults Remain Homebound in the Community? Implications for Long-Term Services and Support Systems
Authors: Ornstein Katherine , Reckrey Jennifer , Bollens-Lund Evan , Ferreira Katelyn , Husain Mohammed , Liu Shelley , Siu Albert
Published: December 2020

A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community but are homebound (never/rarely leave home). While homebound status is associated with decreased access to medical services and poor health outcomes, it is unclear how long individuals remain homebound. We used the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries age 65 and over, with survey weighting to assess duration of homebound status in the community. Among the incident homebound in 2016 (n=253) , only 28% remained homebound after 1 year. 21% died, 18% were recovered, and one-third left the home but still reported difficulty. As the locus of long-term care shifts from nursing homes to the community and models of care expand to serve the needs of the homebound, it is critical that we better understand the heterogeneity and transitions of the homebound population.
Variation in Assisted Living Regulations Within and Across States
Authors: Carder Paula , Smith Lindsey , Bucy Taylor , Winfree Jaclyn , Zhang Wenhan , Thomas Kali
Published: December 2020

Assisted living (AL) regulations have been long recognized as being highly variable across states. A new approach developed by our team, Health Services Regulatory Analysis, allows for a more granular identification of within-state variation in AL regulation. We identified 172 licensing classifications from the 50 states and DC representing 58 primary license types, 48 sub-types, and 66 designations that can modify a primary or sub-license. Over two-thirds (72%) of dementia-specific classifications require that all staff receive initial dementia training, compared to only one-third (33%) of general AL classifications. This trend is similarly reflected in cognitive-screening requirements, present in 67% of dementia-specific classifications and 42% of general AL classifications. Regulatory theory describes how licensing agencies respond to various forces and values. Within-state AL regulatory variation reflects a combination of oversight mandates, population-specific needs (e.g., people with dementia), historic policies, and provider influence, with implications for consumers, policy-makers and researchers. Part of a symposium sponsored by Assisted Living Interest Group.
Financing Long-Term Services and Supports: Opportunities for Overcoming Historical Roadblocks to Reform
Authors: Miller Edward , Nadash Pamela , Cohen Marc
Published: December 2020

This presentation documents the continuing failure to tackle the problem of financing long-term services and supports (LTSS)—a failure most recently seen in the only national legislation ever enacted to comprehensively address LTSS costs: the Community Living Assistance Services and Supports (CLASS) Act. The CLASS Act was included in the Affordable Care Act, but was repealed in 2013. Subsequently, policy experts and some Democrats have made proposals for addressing the LTSS financing crisis. Moreover, significant government action is taking place at the state level, both to relieve financial and emotional burdens on LTSS recipients and their families and to ease pressure on state budgets. Lessons from these initiatives could serve as opportunities for learning how to overcome roadblocks to successful policy development, adoption, and implementation across states and for traversing the policy and political tradeoffs should a policy window open once again for addressing the problem of LTSS financing nationally.
Learning From New State Initiatives in Financing Long-Term Services and Supports
Authors: Cohen Marc , Tell Eiileen , Albright Bonnie
Published: December 2020

A number of states are taking concrete action on long-term services and supports (LTSS) financing which provides an opportunity to learn about the reasons why they are doing so, to identify the coalitions that have come together in support of such actions, and to understand factors associated with the choice of particular strategies and approaches. The purpose of the presentation is to report on a comparative qualitative study across six leading-edge states—Washington State, Hawaii, Maine, Minnesota, California, and Michigan—in order to describe their activities and identify and analyze commonalities and differences in their specific approaches and programs. An overarching goal is to help state officials, consumer advocates, and interested LTSS providers understand the strategies and approaches that other states—who may be further along in their development—are taking in this area so that they might have insights into strategies that might be a fit for their state.
First National Data Reporting Nursing Home Social Services Directors’ Training Interests and Needs
Authors: Bern-Klug Mercedes , Cordes Elizabeth
Published: December 2020

A national sample of 924 social services directors reported training needs in three ways. First, their level of interest in 14 topics, second by how much preparation time needed to provide one-on-one training to a colleague about 27 difference issues/tasks (no time needed, up to 2 hours, up to 10 hours, not able to do), and third, by indicating their top training priority. At least 2/3s reported interest in each of the 14 topics with 86% interested in common mental health and psychosocial challenges, and 86% in the psychosocial needs of persons with dementia. Education, social work licensure, and characteristics of the nursing home explained some of the variation, e.g. respondents with a social work degree reported higher interest in more training in trauma-informed care and culturally competent care. Dementia was by far the highest training priority, followed by better understanding of regulations, behavioral health issues, and trauma-informed care.
The Connection of Social Services to Care Transitions and Discharge Planning in Nursing Home Settings
Authors: Galambos Colleen , Rollin Laura , Engelbart Eric
Published: December 2020

Care transitions are critical junctures in the healthcare delivery process. Effective transitions and discharge planning reduce the need for subsequent transfers between healthcare settings (Boutwell et al., 2015). Understanding social services (SS) involvement in these processes is important due to its key role in their success (Fabbre et al., 2011). Facility characteristics from 924 nursing homes were evaluated in relation to SS involvement in care transitions and discharge planning. Chi-square tests indicate associations between SS involvement and level of engagement of SS expertise by the nursing home administrator (p=.004), medical director (p=.002), nursing staff (p=.003), community physicians (p=.049), and family members (p<.001). An association between SS involvement and freestanding SS departments was also observed. Results suggest the level of SS involvement in care transitions and discharge planning relates to structural (i.e. SS positioning within the facility) and relational (i.e. perceptions and utilization of SS designees by key facility leadership) factors.
CDC Healthy Brain Initiative Action Institutes: Innovative Planning and Lessons Learned
Authors: Holt Heidi
Published: December 2020

This presentation will demonstrate an innovative strategic planning effort, coined Action Institutes (AI’s), which are designed to promote the implementation of CDC’s “The Healthy Brain Initiative’s State and Local Public Health Partnerships to Address Dementia” and the “Road Map for Indian Country.” Both of these documents outline how the champions of public health and their partners can create a statewide effort to promote brain health, increase early diagnosis, address cognitive impairment for individuals living in the community, and help meet the needs of care partners. The purpose of these 1-2-day AI’s is to familiarize leaders with the topic, encourage their adoption into current priority setting, and guide participants in creating action plans. The CDC’s Alzheimer’s Disease and Healthy Aging Program is conducting a series of these AIs, which are made possible through partnerships with the Association of State and Territorial Health Officials and the National Indian Health Board.
Framing the Issue
Authors: Lindberg Brian
Published: December 2020

GSA's Public Policy Advisor will lead a discussion of legislative activities related to elder abuse, neglect, and exploitation during the past year. The panel will examine successes and failures and what may still be possible in the lame duck session and the next Congress.
The Elder Justice Coalition and Reauthorizing the Elder Justice Act
Authors: Blancato Robert
Published: December 2020

The presentation and dialogue will focus on the elder justice advocacy community and their work to secure reauthorization of the Elder Justice Act, which was originally passed as part of the ACA. Both grassroots and DC-based efforts have been employed to move this and other legislation forward and to secure much needed funding for the programs designed to end elder abuse.
Interest in Supportive Services Among Black Working and Non-Working Caregivers in the Deep South
Authors: Clay Olivio , Epps Fayron , Scott Cathy , Cothran Fawn , Williams Ishan
Published: December 2020

The current investigation provides information on supportive services caregivers said they would be interested in if they were made available. Participants were recruited from the Birmingham, AL metro area and received a $25 gift card for completing a telephone interview. Of the 38 caregivers enrolled, 18 (47.37%) reported being currently employed and working an average of 33.92 hours per week (range = 5 – 60). Participants were caring for individuals with average scores on the AD8 Dementia Screening Scale of 7.3 and 10.4 on the Clinical Dementia Scale Sum of Boxes (above the cutoffs for probable dementia). Thirty-three caregivers (87%) reported being interested in at least one of the services listed with differences observed for services that would be preferred by working vs. non-working caregivers. These data will be utilized to provide initial support for a multicomponent intervention that may be effective in reducing negative outcomes within Black caregivers.
Looking Ahead: Intersecting Influences on Older Gay Men Living With HIV
Authors: de Vries Brian , Gutman Gloria , Sussman Tamara , Brotman Shari , Dube Denis
Published: December 2020

Older HIV-positive gay men live at the intersection of multiple inequalities—with cascading effects on their present and future lives. This qualitative study explored how they plan for their future, with a focus on Advance Care Planning—the process of reflecting/communicating preferences and values for future health and end-of-life care. Seven French-speaking gay men aged 55+ in Montreal, Canada participated in a focus group that was audio-recorded, transcribed and thematically analyzed in four steps. Findings suggest the intersection of sexual orientation and HIV-positive status exacerbated self-disclosure issues; the further addition of age led to preoccupation with day-to-day living and rendered these men vulnerable to social isolation. These tensions not only interfered with their capacities to talk about future care, but also created barriers to thinking about future care. These findings describe the multiple layers and compounding consequences of inequality among older gay men living with HIV.
Socioeconomic Inequalities in Informal Care Provision and Its Consequences for Well-Being Across Europe
Authors: Quashie Nekehia , Kaschowitz Judith , Deindl Christian , Brandt Martina
Published: December 2020

We assess socioeconomic inequalities in informal care provision and its consequences for the wellbeing of informal caregivers. The literature states that a lower socio economic status (SES) is linked to a higher probability to give care (at higher intensities) which then leads to a higher caregiving burden. People with lower SES additionally have fewer resources to alleviate caregiving pressures. Thus, they are likely to experience decreased wellbeing compared to those with higher SES. Our analyses based on data from SHARE and ELSA confirm, that individuals with lower SES are indeed more likely to provide care all over Europe. They also report a lower wellbeing than people with higher SES, even if controlling for further important influences. In the next step we investigate longitudinally, if taking over care responsibilities leads to a wellbeing decline and if this decline is more pronounced for people with lower SES.
Transforming Gerontological Research by Meaningfully Engaging Persons Living With Dementia
Authors: Lepore Michael , Fortinsky Richard
Published: December 2020

Whereas persons living with dementia have commonly been subjects of gerontological research, participation of persons with dementia in designing and conducting studies and in scientific research meetings has been rare in the United States. In recent years, person-centered research models have arisen which give persons with dementia and their caregivers core roles in the research enterprise. As “co-researchers” with academic/professional researchers, persons with dementia and their caregivers are engaged in all aspects of the research enterprise, jointly developing research questions and study designs, collecting and analyzing data, planning research meetings, and disseminating results. International studies have shown that conducting research in collaboration with the population that is being studied has potential to enhance the quality and appropriateness of research and has been identified as an essential component of studies examining the effectiveness of different approaches to care. This session spotlights innovative advances in gerontological research that meaningfully engages persons with dementia. First, the engagement of persons with dementia in scientific meetings is addressed drawing on the examples of the 2017 and 2020 National Research Summits on Care Services and Supports for Persons with Dementia and their Caregivers (i.e., Summits). Next, a study using a patient engagement framework for caregivers and individuals with mild cognitive impairment living at home is discussed. Finally, the Empowering Partnerships program, which prepares researchers, persons with dementia, and care partners to collaborate in conducting research is reviewed. Outcomes and challenges of these innovations are examined, and the need for academic/professional researcher roles to evolve is discussed.
Saint Louis University Primary Care Age-Friendly Health System Initiative in Rural and Urban Communities
Authors: Berg-Weger Marla , Morley John
Published: December 2020

The Saint Louis University GWEP partners with a rural Missouri critical access hospital and an urban Federally Qualified Health Center to support their transformations into an Age-Friendly Health System in their community. With an emphasis on the 4Ms, programmatic innovations include development and training of: 1) electronic health records integration of the Rapid Geriatric Assessment (RGA) for patients 65+ years old; 2) RGA-based protocol for Medicare Annual Wellness Visits (MAWV); 3) Interprofessional health care team approach; 4) Evidence-based or Evidence-Informed treatment interventions, including Cognitive Stimulation Therapy (CST), exercise and strengthening program, caregiver support, and Circle of Friends, an intervention for loneliness and social isolation. Outcomes will be presented which suggest increased assessment practices and improvement in functional and cognitive status. Successes and lessons learned regarding strategies to develop an Age-Friendly Health System in two different primary care settings will be discussed.
Connecting Generations in Senior Housing: Promising Practices and Challenges
Authors: Henkin Nancy
Published: December 2020

Senior housing can be an ideal platform for high quality intergenerational programming. Often older adults who move to congregate housing settings experience feelings of loneliness and a loss of purpose. Creating long term partnerships with educational and youth-serving organizations can help senior housing providers expand residents’ social networks and create meaningful civic engagement opportunities. A 3-year national initiative involving an environmental scan of intergenerational practice in senior housing communities, the development of a toolkit for senior housing providers, and the piloting of intergenerational partnerships and programs in six national housing communities was conducted by Generations United and Leading Age and supported by the Retirement Research Foundation. Promising practices, challenges, and lessons learned from this initiative will be shared and strategies for “scaling” this work will be discussed.
Historical and Generational Forces and Gender Differences in the Iridescent Life Course of Transgender Older Adults
Authors: Emlet Charles , Goldsen Karen Fredriksen , Fabbre Vanessa , Jung Hailey , Kim Hyun
Published: December 2020

Shifting historical, political, and social times have impacted transgender older adults in experiences and development. Examining how gender identities interact with life events within a historical context elucidates differences by generations and gender. Using a transgender subsample (n=205) from the National Health, Aging, and Sexuality/Gender Study (N=2,450), (logistic) weighted regressions with sociodemographic adjustment were performed to examine generational differences and gender interaction in key life experiences in identity, work, kin, bias, community, and health/well-being. Silenced (born 1935-1949, 18%), than Pride (1950-1964, 79%), Generation disclosed identity later, is less visible, more likely retired and veteran, more likely for lifetime opposite-sex marriage and divorce. Significant gender interactions exist in community engagement, kin relationships, and physical health. Despite small sample size, Invisible Generation (1914-1934, 3%) has unique differences. Findings show complexity of generational differences among transgender older adults, understanding of what helps better serve them as they age with their accumulated life experiences.
Microbiome: Living Well and Thriving With Your Bacteria
Authors: Wang Meng , Ludington William
Published: December 2020

This symposium aims to invite speakers who are the leading experts in the field of microbiome and longevity, and select short talks from abstracts submitted by young investigators, postdoctoral fellows and graduate students. We will discuss new progress in this exciting research area and raise new questions for future studies. Confirmed speakers include Evgeny Nudler from NYU, Will Ludington from Carnegie, Paul O’Toole from University College Cork, Ireland, and Meng Wang from Baylor College of Medicine.
Microbiome-Mitochondria Communication in the Regulation of Host Longevity
Authors: Wang Meng
Published: December 2020

Mitochondria are ancient relatives of bacteria in eukaryotic cells and dynamically interconnected through organelle fusion and fission. Given the close relationship between bacteria and eukaryotic mitochondria during evolution, my group is interested in understanding the critical role of their communication in regulating host’s longevity. We have conducted genome-scale screens to decipher how bacterial genetic composition impacts host longevity, leading to the discovery of specific bacteria-secreted metabolites that fine-tune the mitochondrial fusion-fission balance and consequently promotes longevity across different host species. We have further developed optogenetic approaches to manipulate bacterial gene expression and metabolite production inside the gut of live organisms, in order to investigate the microbiome-mitochondria communication in time and space. Our studies demonstrate a novel mode of signaling communication between bacteria and mitochondria, reveal its vital impacts on host healthy aging, and provide new methods to decipher the spatiotemporal relationship between the microbiome and the host.
Stem Cells, Diet, and Physiology
Authors: Drummond-Barbosa Daniela
Published: December 2020

Nutrient availability, stresses, and aging affect tissue stem cells in multicellular organisms; yet, the underlying physiological mechanisms in vivo remains largely unexplored. Dr. Drummond-Barbosa pioneered using Drosophila to study the physiology of tissue stem cell regulation. Her laboratory played a major role in delineating how diet, brain insulin-like peptides, and the TOR nutrient sensor control the germline stem cell (GSC) lineage. They also discovered that adipocyte-specific disruption of amino acid transport, other nutrient signaling, and metabolic pathways causes distinct germline phenotypes. They also showed that nuclear receptors act in multiple tissues to affect the GSC lineage through direct and indirect mechanisms. More recently, her group has been exploring how other physiological stresses affect the GSC lineage. Her group’s studies point to extensive communication between the brain, adipocytes, hepatocyte-like cells, and the germline, and underscore the complexity of the physiological network that modulates stem cell lineage behavior.
Aging germline stem cells in C. elegans
Authors: Hubbard E Jane
Published: December 2020

Failure to maintain stem cells with age is associated with conditions such as tissue degeneration and increased susceptibility to tissue damage. We use the C. elegans germline stem cell system as a model to study stem cell aging. This system combines a well-established model for aging with an accessible stem cell system, providing a unique opportunity to understand how aging influences stem cell dynamics. The germline stem/progenitor pool in in C. elegans becomes depleted over time. At the cellular level, aging influences both the size of the stem cell pool and the proliferation rate of stem cells. The flux of differentiated cells also affects how aging impacts the pool. This depletion is partially alleviated in mutants with reduced insulin/IGF-like signaling via inhibition of the transcription factor DAF-16/FOXO. In this role, DAF-16 does not act in the germ line, and its anatomical requirements are different from its previously described roles in larval germline proliferation, dauer control, and lifespan regulation. We found that DAF-16/FOXO is required in certain somatic cells in the proximal part of the reproductive system to regulate the stem cell pool. We also find that the degree to which various age-defying perturbations affect lifespan does not correlate with their effect on germline stem cell maintenance. We are investigating additional aspects of aging germline stem cells using this system.
Genetic, Epigenetic, and Metabolic Maintenance of Neural Stem Cells During Aging
Authors: Webb Ashley
Published: December 2020

Tight metabolic regulation is essential to maintain stem cell homeostasis and support healthy aging. With age, metabolic alterations cause neural stem cell (NSC) dysfunction and are associated with a decline in neurogenesis, but the underlying mechanisms are not known. Aged stem cells display defects in the autophagy-lysosomal pathway that may disrupt mitochondrial dynamics, resulting in metabolic disruptions that alter self-renewal and differentiation potential. We have used genomic and functional approaches to investigate the metabolic mechanisms that support NSCs throughout aging. We found that mitochondrial and mitophagy gene networks as well as mitophagy dynamics are differentially regulated between the quiescent and activated states and become dysregulated with age. This work provides new insight into the metabolic regulation of NSCs and may lead to strategies to enhance neurogenesis in the context of aging and neurodegenerative disease.
Model Organisms: Grandeur in the Diversity of Aging Organisms
Authors: Brunet Anne
Published: December 2020

Aging is a complex process that converts vigorous and healthy individuals into frail and decrepit ones, with increased susceptibility to a constellation of diseases. Human aging is influenced by many factors, including genetics, environment, lifestyle, sex, and socio-economic status. While aspects of aging can be studied directly in humans, discovering the causative factors that modulate this process often requires interventions and modeling. Traditional models will likely continue to provide a wealth of translatable information. Studying ‘extremophiles’ has exciting potential for providing new concepts that could be implemented for lifespan regulation. The development of new experimental models uniquely tailored to aging studies is also an essential step. This symposium will discuss African killifish, planarian, naked mole rats, and domestic dogs as new models for aging and exceptional longevity and rejuvenation. The iteration between new models and humans could be particularly helpful in delineating strategies to promote healthy aging and extend the disease-free portion of life.
High-Risk Medication Use and Polypharmacy in Older Veterans Who Attempt Suicide
Authors: Morin Ruth , Li Yixia , Steinman Michael , Wiechers Ilse , Byers Amy
Published: December 2020

Late-life veteran suicide is a public health concern, and may overlap with recent high-risk medication use. We identified use in the 6 months prior to attempt and assessed salient risk factors. 13,872 veterans aged 50 years and older that attempted suicide were compared with demographically-matched controls utilizing VHA healthcare in a similar time period. Medications potentially related to suicide risk were included. Other variables were psychiatric and medical diagnoses, fatality of attempt and means. Compared with controls, veterans who attempted were nearly 3 times more likely to have been prescribed benzodiazepines and opioids, even when controlling for other diagnoses. Those taking 3 or more high-risk medications were between 7 and 11 times more likely to attempt than controls, with a higher risk of death particularly by drug overdose. These findings begin to uncover the complex contribution of prescription medications and polypharmacy to late-life veteran suicide, with implications for prevention. Part of a symposium sponsored by the Aging, Alcohol and Addictions Interest Group.
Associations Between Aging-Related Biomarkers, Interstitial Lung Abnormalities, and Mortality
Authors: Sanders Jason
Published: December 2020

Interstitial lung abnormalities (ILA) exist in ~10% of adults >50 and associate with increased morbidity/mortality. Their pathobiology is poorly understood; age is the strongest risk factor. In the Framingham Heart Study, we determined associations between ILA and 10 blood biomarkers previously robustly associated with aging and mortality. Odds of ILA increased directly with ln-transformed GDF15 (OR [95% CI] = 3.20 [1.74-5.91], p=0.0002), TNF-αRII (2.41 [1.34-4.34], p=0.003), IL6 (1.76 [1.39-2.22], p<0.0001), insulin (1.56 [1.11-2.20], p=0.01), and CRP (1.53 [1.27-1.84], p<0.0001). Causal analysis showed GDF15 (p=0.008), TNF-αRII (p=0.004), and IL6 (p<0.0001) mediate the age effect on ILA. In adjusted survival models, only higher ln(GDF15) and ln(TNF-αRII) were associated with mortality (HR [95% CI] = 4.3 [2.3-8.1], p<0.0001 and 2.9 [1.5-5.8], p=0.002). GDF15 results were replicated in the COPDGene Study. These results suggest aging biomarkers may help risk stratify adults with ILA, and unmeasured ILA may confound prior associations between biomarkers and mortality.
Energy Sensing Pathways in Aging and Chronic Lung Disease
Authors: Thannickal Victor
Published: December 2020

The cause-effect relationships between the various “hallmarks of aging” and chronic lung disease are not well understood. We have determined overlapping pathways involving deregulated nutrient sensing, mitochondrial dysfunction, and cellular senescence that may contribute to the evolution of chronic lung disease. In particular, I will discuss alterations in energy/metabolic sensing pathways and mitochondrial dysfunction as pathobiological mechanisms that may explain the age-related increased susceptibility to the development and progression of idiopathic pulmonary fibrosis (IPF), a disease of pulmonary aging. I will then broaden the discussion to include the potential role of these biologic alterations in other chronic lung disease which burden older adults.
Dyadic Experiences of Living With Cognitive Impairment Through a 3-Year Longitudinal Qualitative Study
Authors: Wang Jing , Wu Bei , McConnell Eleanor , Ding Ding , Corazzini Kirsten
Published: December 2020

The fastest growth of population living with cognitive impairment takes place in China. The estimated prevalence of cognitive impairment among older adults in China is between 13% and 20%. This study focused on persons with cognitive impairment (PWCI) and their spousal care partners to explore how spousal relationships impact dyadic experiences of living with cognitive impairment through a person-centered care lens. We conducted a longitudinal qualitative study of 10 dyads of PWCI and their care partners over three years with three data collection time points. Our findings suggest that the complexity of changing experience of living with cognitive impairment is interpreted in the dynamic nature of their spousal relationship and relationship with others, patterns of communication, daily activities and care during the extended period of cognitive decline. It is crucial to help them nurture the belief that there is a significant meaning in the journey of living with cognitive impairment.
Institutional and Cultural Barriers to ACP: Staff Perspectives
Authors: Gutman Gloria , de Vries Brian , Kwan Helen , Jang Katrina , Soheilipour Shimae
Published: December 2020

This study explored staff knowledge and engagement in assisting residents/families with ACP. Focus groups were conducted at two long-term care homes, one Exclusively Chinese (EC; n = 25); one Multi-Ethnic (ME; n = 41). In each, separate focus groups were held with registered staff, care aides, and support staff who also completed brief surveys providing socio-demographic data and information about their training and experience with ACP. Perceived barriers to engagement in ACP included limited knowledge and inadequate training in facilitating ACP, cognitive impairment of residents, language barriers, lack of openness to discussing ACP, family expectations and misinformation. EC staff also considered cultural and religious beliefs as one of the main barriers to engaging in ACP both for residents and families; staff at ME focused more on timing and the role of family. Support staff and care aides did not perceive ACP as within their scope of practice, deferring to nurses.
Digital Health Tool to Assist Older Adults in Self-Disclosing Elder Mistreatment
Authors: Abujarad Fuad , Choo Esther , Pantalon Michael , Jubanyik Karen , Dziura James , Edwards Chelsea , D’Onofrio Gail , Gill Thomas
Published: December 2020

Elder Mistreatment (EM) is a global health issue that continues to be under detected and inadequately addressed in healthcare settings. In this symposium, we will describe how we built and currently use the VOICES digital health tool to screen for EM. The tool is designed exclusively with older adults in mind and runs on iPads to be used in the emergency department. VOICES screens, educates, uses motivational interviewing to facilitate self-disclosure of EM, and refers patients for in-person screening. The tool includes multimedia components such as videos, audio and animations designed to educate and enhance screening for EM. Patients who screen positive are then guided through an automated Brief Negotiated Interview (BNI) that uses motivational interviewing to help them self-identify and self-disclose. Our tool will help identify cases of EM that otherwise may go undetected and overcomes major challenges associated with traditional methods of screening.
Regional Workshops to Widely Disseminate an Innovative Practice
Authors: Hain Debra , Suriaga Armiel
Published: December 2020

The second stage of the CMS Region IV project involved a series of 20 half-day workshops and five follow-up webinars to introduce Go to the Hospital or Stay Here?, the training resources available (12 videos, 5 case studies and Best Practices summary), and strategies for implementation. Altogether 1124 representatives from long-term care facilities, state agencies, ombudsman groups and hospitals attended these interactive workshops. Polled participants reported that resident and family insistence on transfer to the hospital was a major barrier to successful reduction of acute care transfers for them. Those who implemented the Guide facility-wide reported an average 28% reduction in transfers. Primary barriers to facility-wide implementation were lack of leadership, making a choice to absorb the cost of financial penalties and failure to distinguish the goal of Guide use from those of existing transfer reduction programs. The facilities found the workshops helpful preparation for effective implementation of the Guide.
Utilizing Implementation Science to Accelerate Adoption of a Program to Prevent Avoidable Transfers
Authors: Southard Karen , Kaye Suzie
Published: December 2020

The research team combined their long-term care management experience with feedback from the 16 pilot nursing homes and several hundred workshop and webinar participants’ reports to identify the most effective strategies for implementation of the Guide and smaller Trifold. The learning framework employed to develop these Best Practices was directed to two distinct audiences 1) the licensed staff of the facility and 2) the residents of the facilities and their families. Critical elements identified included: when and how to distribute the Guide; how the Guide can be used to support difficult conversations e.g. about end of life choices; and effective and efficient ways to train staff. The framework for discussion during the symposium will be achievement of organizational readiness and the relevance of the four E’s of implementation science as it applies to long term care organizations.
Engaging Families in Function-Focused Care: Goal Attainment and Associated Outcomes
Authors: Boltz Marie , Jones Joanne Roman , Hermann Robin
Published: December 2020

Partnering with families to develop function-focused plans for hospitalized persons with dementia (PWD) improves both the hospital experience and patient outcomes. This secondary analysis included patients enrolled in the intervention arm of the on-going Family-centered Function-focused Care (Fam-FFC).study. This study examined the goals co-established by family caregivers, PWD, and nurses to prevent hospital-acquired complications and promote functional and cognitive recovery. The influence of goal attainment upon delirium and physical function at discharge was also examined. The majority of patients (N=162) were female (65%), black (53%) with a mean age of 82.7 (SD= 8.2). Goal attainment ranged from -2 to 2; mean = -0.24 (SD= 0.75). The goals (N=432) represent three main areas: mobility, self-care, and cognitive stimulation. Controlling for age and admission function, goal attainment was associated with less discharge delirium (F=3.2, p = .022) but not discharge function. Results support the contribution of function-focused care to improving delirium outcomes.
Pain Incidence, Treatment, and Associated Symptoms in Hospitalized Persons With Dementia
Authors: Resnick Barbara , Boltz Marie
Published: December 2020

A better understanding of the relationships between pain and other syndromes in hospitalized persons with dementia (PWD) will help establish pain as a critical symptom to target. Secondary analyses from the Fam- FFC study describe the incidence and pharmacologic management of pain, and its association with physical function, delirium, and behavioral and psychological symptoms of dementia (BPSD). The sample (N=299) was mostly female (62%), non-Hispanic (98%), and Black (53%), with a mean age of 81.6 (SD=8.5); 166 (56%) received pain medication, whereas 40% (n=43) of 108 individuals who demonstrated pain did not receive analgesics. Regression analyses showed that, controlling for age, gender, cognition, and comorbidities, pain was associated with function (t= -.3.2, p=.001), delirium (t =5.0, p < .000), and BPSD severity (t = 2.3, p=.023). Findings suggest pain may be undertreated in hospitalized PWD but should be considered to optimize function, decrease delirium, and prevent or decrease BPSD.
Early Detection of Age-Associated Cellular Decline: Report of an Expert Consensus
Authors: Guralnik Jack , Cesari Matteo , Beresniak Ariel , Rodriguez-Manas Leocadio , Cherubini Antonio
Published: December 2020

Cellular processes often decline with age and cells lose their ability to function optimally, which may lead to organ-specific dysfunction and the development of systemic age-related diseases. The cellular hallmarks of aging are associated with clinical signs and symptoms and can be termed Age Associated Cellular Decline. An expert consensus study group was convened to provide an initial framework for the development of a tool for adults over 50 years old, which identifies self-reported symptoms and observable signs likely to be early and/or surrogate markers of age associated cellular decline. A total of 16 potential early signs and symptoms of age associated cellular decline were identified and need to be validated in further research.
Occupational Therapy Innovations in Home and Community Practice for People Living With Dementia
Authors: Piersol Catherine , Trudeau Scott
Published: December 2020

Most Americans with dementia live at home and families are commonly responsible for overseeing the daily activities of the person with dementia. Families require support, education, and skill-building to manage caregiving responsibilities. Occupational therapist are ideally suited to teach care partners tailored strategies for obtaining the “just right fit” between the capacities of the person and the demands of the environment, thus reducing behavioral symptoms, optimizing function and safety and enhancing well-being. Care of Persons with Dementia in their Environments (COPE) is an evidence-based intervention designed to address these outcomes. Over three phases, the occupational therapist employs a problem-solving method to identify strategies that address caregiver-reported difficulties related to managing daily activities, behavioral challenges and other caregiver concerns. This presentation describes the development and implementation of COPE highlighting the distinct approaches of occupational therapy in delivering home- and community-based services to persons living with dementia and their care partners.
Multimodal Neuroimaging Predictors of Gait Decline
Authors: Sargent Lana , Tian Qu , Nalls Mike , Singleton Andrew , Studenski Stephanie , Resnick Susan , Ferrucci Luigi
Published: December 2020

Prior studies suggesting associations between cortical brain areas and gait speed has been largely cross-sectional and limited to one modality neuroimaging. Using machine learning from 506 cognitively normal BLSA participants aged 55+ who had repeated measures of brain volumes, diffusion tensor imaging (DTI), and gait speed, we examined multimodal neuroimaging predictors of gait decline, accounting for demographics, body composition, and grip strength. Significant predictors of gait decline included changes in volumes and DTI measures of gray matter in selected frontal, parietal, temporal, and subcortical areas, as well as white matter changes in both fractional anisotropy and diffusivity of tracts connecting frontal areas to subcortical motor areas. This predictive model highlights the importance of atrophy and microstructural deterioration in selected frontal and subcortical motor areas in predicting gait speed decline.
Bile Acids in Dementia: Brain Amyloid, White Matter Lesions, and Atrophy
Authors: Varma Vijay , Wang Youjin , An Yang , Varma Sudhir , Bilgel Murat , Doshi Jimit , Legido-Quigley Cristina , Thambisetty Madhav
Published: December 2020

While Alzheimer’s disease (AD) and vascular dementia (VaD) may be accelerated by hypercholesterolemia, the mechanisms underlying this association is unclear. Using a novel, 3-step study design we examined the role of cholesterol catabolism in dementia by testing whether 1) the synthesis of the primary cholesterol breakdown products (bile acids (BA)) were associated with neuroimaging markers of dementia; 2) pharmacological modulation of BAs alters dementia risk; and 3) brain BA concentrations and gene expression were associated with AD. We found that higher serum concentrations of BAs are associated with lower brain amyloid deposition, slower WML accumulation, and slower brain atrophy in males. Opposite effects were observed in females. Modulation of BA levels alters risk of incident VaD in males. Altered brain BA signaling at the metabolite and gene expression levels occurs in AD. Dysregulation of peripheral cholesterol catabolism and BA synthesis may impact dementia pathogenesis through signaling pathways in the brain.