bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of Home Health Care Between Finland and South Korea in Long-Term Care Services
Authors: Park Jihyun , Kim Suhyun
Published: December 2020

Population aging is one of the significant global issues. Long-term care is emphasized as “aging in place,” and it is known that home and community-based service is a cost-effective way to achieve this. Over ten years have passed since the introduction of long-term care insurance in Korea, and it is necessary to improve home health care in long-term care. The aim of this study was to identify the measures that must be undertaken for enhancing home health care in Korea by comparing it to the home health care in Finland. The data were collected via a literature review, expert interview, and field survey in Kuopio, Eastern Finland, from March 16 to 23, 2018. Based on the comparison between Korean and Finnish home health care, some issues related to home health care in Korea that need to be resolved were identified: the complex process involved in availing home health care, low utilization rate, higher cost than home health aide services in long-term care, and undifferentiated roles in home health care between registered nurses and nurse assistants. Several strategies could be utilized to enhance home health care in Korea, such as a simplified procedure to use home health care, clarification of roles between registered nurses and nurse assistants in home care, supervision of the integration of home care services by registered nurses, and an expansion of home health care into comprehensive assessment and nursing activities for chronic illness care and health promotion.
Substance Use Disorder–Related Hospitalizations and ED Use in Those Returning to Community From Prison in Later Life
Authors: Barry Lisa , Steffens David , Covinsky Kenneth , Conwell Yeates , Byers Amy
Published: December 2020

High rates of substance use disorders (SUDs) in persons age 50 and older are concerning. Those reentering the community in later life after incarceration are especially at risk. We determined if later-life prison release increases risk of SUD-related hospitalizations and ED visits in a national sample of veterans (N=7,671) released from prison between 2012 to 2014 and matched never-incarcerated controls (N=7,671). Later-life prison release was associated with increased risk of any SUD-related hospitalization/ED visit (2907.1 vs. 465.0 per 100,000/year; adjusted HR=2.67; 95% CI, 2.11-3.36) and 3-fold risk of hospitalizations/ED visits due to alcohol use disorder (1955.4.1 vs. 282.6 per 100,000/year; adjusted HR=3.04; 95% CI, 2.24-4.13) and drug use disorder (1586.1 vs. 252.0 per 100,000/year; adjusted HR=3.09; 95% CI, 2.23-4.30). Those reentering the community in later life after prison are at higher risk of experiencing SUD-related hospitalizations or ED visits. Prevention and intervention efforts targeting later-life prison-to-community care transitions are needed. Part of a symposium sponsored by the Aging, Alcohol and Addictions Interest Group.
Caregiving Arrangements and Health Outcomes of Chinese Older Adults With Disability in Cross-National Settings
Authors: Wang Jing , Wu Bei
Published: December 2020

This symposium focuses on the wellbeing of older adults with disability/cognitive impairment and their family caregivers. More specifically, it aims to understand how familly support, community resources utilization, internal migration, and immigrant status impact older adults’ caregiving arrangement, health outcomes and end-of-life preferences and family caregivers’ caregiving burden in China and the U.S. The first study explored how perceived spousal relationships and support impact dyadic experiences of living with cognitive impairment through a person-centered care lens during a three-year period. The second presentation examined the association between adult children’s support and the trajectories of depressive symptom level among Chinese older adults with disabilities. The third investigated how family relationship and immigrant status matter in advanced care planning (ACP) engagement and end-of-life preferences over burial plan among US-born and foreign-born older Chinese Americans living in Honolulu, Hawaii. The fourth study study explored family caregivers’ caregiving burden for community-dwelling patients with dementia and its associated factors. The last study conducted an inventory of longitudinal aging survey datasets to stimulate research on intersection of migration and caregiving arrangement. It paved the way to use existing high-quality datasets to examine the significant impact of massive rural-to-urban migration on caregiving arrangement among Chinese older adults. This symposium presents empirical evidence of the impact of family, migration and culture-related factors on caregiving arrangement and health outcomes of Chinese older adults. The presenters emphasize the importance of providing family-centered care and design culturally sensitive interventions to improve the health outcomes of older adults.
Caregiver Burden of Family Caregivers of Patients With Dementia in a Shanghai Community
Authors: Li Juan , Liu Zhijian , Yin You
Published: December 2020

This study explored the level of and factors related to Chinese dementia family caregiver burden. We recruited 109 dyads of patients with dementia and their family caregivers from communities in Shanghai, China. Caregiver burden was assessed by Caregiver Burden Inventory. We used multivariate linear regression model to investigate factors associated with caregiver burden, including patients’ socio-demographic information, cognitive function, ADL, neuropsychiatric symptoms, caregivers’ depression, coping strategy, social support and community service utilization. The level of caregiver burden was moderate (65.92±16.74). The patients’ cognitive function and social support were negatively associated with caregiver burden (β=﹣0.850, p＜0.01, β=﹣1.787, p=0.044, respectively). Caregivers’ depression and community service utilization were positively associated with caregiver burden (β=2.109, p＜0.01,β=1.215, p＜0.01, respectively). These findings suggest enhancing social support and reducing depression of caregivers may have the potential of decreasing caregiver burden.
Analyzing Nursing Home Complaints: From Substantiated Allegation to Deficiency Citations
Authors: Bhattacharyya Kallol Kumar , Peterson Lindsay , Bowblis John , Hyer Kathryn
Published: December 2020

Complaints provide important information to consumers about nursing homes (NHs). Complaints that are substantiated often lead to an investigation and potentially a deficiency citation. The purpose of this study is to understand the relationship between substantiated complaints and deficiency citations. Because a complaint may contain multiple allegations, and the data do not identify which allegation(s) lead to a complaint’s substantiation, we identified all substantiated single allegation complaints for NHs in 2017. Our data were drawn from federally collected NH complaint and inspection records. Among the 369 substantiated single-allegation complaints, we found most were categorized as quality of care (31.7%), resident abuse (17.3%), or resident neglect (14.1%). Of the deficiency citations resulting from complaints in our sample, 27.9% were categorized as quality of care and 19.5% were in the category of resident behavior and facility practices, which includes abuse and neglect. While two-thirds (N=239) of the substantiated complaints generated from 1 to 19 deficiency citations, nearly one third had no citations. Surprisingly, 28% of substantiated abuse and neglect allegations resulted in no deficiency citations. More surprisingly, a fifth of complaints that were categorized as “immediate jeopardy” at intake did not result in any deficiency citations. We also found a number of asymmetries in the allegation categories suggesting different processes by Centers for Medicare and Medicaid Services (CMS) region. These results suggest that the compliant investigation process warrants further investigation. Other policy and practice implications, including the need for better and more uniform investigation processes and staff training, will be discussed.
Resilience in Incident Hemodialysis: Characterization and Outcome Prediction
Authors: Bandeen-Roche Karen , Zhu Jiafeng , Crews Deidra , McAdams-DeMarco Mara , Buta Brian , Varadhan Ravi , Walston Jeremy
Published: December 2020

The Resiliency in Dialysis Initiation (ReDI) Study aims to develop physical resilience signatures in older adults initiating hemodialysis. Study design—comprising a pilot, confirmatory study, and secondary data analyses—will be presented. So also will a method for characterizing resilience phenotypes—using mixed-model analysis of SF-36 subscale trajectories—among participants of age 55 and older who had undergone hemodialysis in the Choices for Healthy Outcomes in Caring for ESRD study (n=485). Analyses revealed stable, improving, and declining phenotypes. In Cox models, both baseline phenotypic status and trajectory type predicted mortality after adjusting for age, CVD status, and CHF (global Wald test for trajectory type P-value=0.020 for vitality; 0.030 for general health). These analyses evidence usefulness of resilience phenotypes as markers of adverse outcome risk and foreshadow application to novel ReDI data.
Risk Factors for Poor Recovery After Total Knee Replacement Among Older Adults in the FORCE-TJR Cohort
Authors: Laskow Thomas , Zhu Jiafeng , Buta Brian , Sieber Frederick , Bandeen-Roche Karen , Walston Jeremy , Franklin Patricia , Varadhan Ravi
Published: December 2020

Total knee replacement (TKR) is a common procedure in older adults with broad variability in outcomes. We sought to identify factors that contribute to resilient outcomes in 7,239 older adults (age 60 or older) who underwent TKR in the TJR-FORCE, a prospective registry of total joint replacement. Outcomes utilized were bodily pain and physical component score (PCS) from the Short Form 36 Health Survey (SF-36), at pre-op, 1-year, and 2-year post-procedure. Participants were grouped according to their outcome trajectories as “improving”, “worsening”, “variable,” or “stable.” Multinomial regression (with 4 outcome categories) was used to evaluate demographic risk factors (age, gender, BMI, marital status, education, smoking history, comorbidity count, household income). Older age, larger comorbidity count, low-income, smoking, and being unmarried were significant risk factors for poor recovery (not “improving”) in terms of bodily pain and physical component score. Next steps include evaluating risk factors for resilience outcomes in prospective studies.
Digital Interventions to Promote Health and Well-Being of Older Adults
Authors: Gutman Gloria , Shade Marcia
Published: December 2020

The population of older adults is on the rise and so is their adoption of technology. According to the Pew Research Center, growing numbers of older adults are using smartphones, tablets, and the internet. Technology can also be an innovative and accessible way to deliver interventions that promote positive health outcomes. But implementing and evaluating digital interventions, especially those targeted to cognitively frail or otherwise vulnerable older adults, is not easy. The first presentation in this international interdisciplinary symposium sets the stage for discussing some of the barriers encountered. Specifically, it addresses the issue of compliance of adults with Mild Cognitive Impairment (MCI) while using internet-based cognitive behavioral therapy for sleep disturbance. The second presentation described a digital tool to screen and interview older adults in a hospital emergency department who may be experiencing mistreatment. This is followed by a study of use of voice assistant reminders to help aging adults adhere to daily completion of a diary to self-monitor pain symptoms. The fourth presentation describes a feasibility study of a digital screen-based device to calm long-term care home residents exhibiting disruptive Behavioral and Psychological Symptoms of Dementia. Symposium speakers and participants will be encouraged to dialogue on how some of the implementation and evaluation barriers described might be overcome or avoided as well as to share success stories from their own research on digital interventions for older adults living at home, in congregate housing or in hospital settings.
Dopaminergic Signaling: Driver of Mobility Resilience and Moderator of Response to Pharmacotherapy
Authors: Rosano Caterina , Rosso Andrea , Bohnen Nicolaas
Published: December 2020

Although effective mobility is the end result of the functional capacity of multiple systems, some adults appear resilient and maintain higher mobility later in life. Epidemiological studies suggest up to 20% of adults aged 65 and older maintain fast walking speed in the presence of multi-system impairments. What could be the reason for such mobility resilience? In this symposium, we focus on the brain dopaminergic signaling as a potential driver of mobility resilience. We examine the genetic val158met polymorphism of catechol-O-methyltransferase (COMT), an enzyme regulating dopaminergic signaling in the brain. The Met allele results in higher tonic dopamine levels; the Val allele results in lower tonic dopamine levels. The influence of COMT polymorphism on mobility is known for Parkinson’s disease (PD) and neurodegenerative conditions, but it not clear for asymptomatic adults aged 65 living in the community. We present data from the Cardiovascular Health Study, the Health Aging Body Composition Study, and several neuropharmachological studies with extensive information on PD ascertainment, medications, and health characteristics. We test the hypothesis that the Met allele of the COMT gene is associated with a) lower fall risk (Rosso), b) slower decline in gait reserve (Sprague), c) less gait slowing due to frailty (Mannon), d) more favorable response to pharmacotherapy in older adults without PD (Bohnen). Our results suggest a unique modulatory capacity of dopaminergic-related genes that may favor mobility resilience and predict better response to therapy. Our data provide clues for novel targeted interventions to delay physical disability in older adults.
Correlates of Skilled Nursing Facility (SNF) Performance in the SNF Value-Based Purchasing Program
Authors: Andersen Dan , Binu Sherly , Sacca Mike
Published: December 2020

We examined the results of the 2020 skilled nursing facility (SNF) value-based purchasing (SNF VBP) program to identify correlates and potential drivers of SNF performance in this program. The SNF VBP program provides incentive payments to SNFs based on their performance on a risk-adjusted hospital readmission measure (i.e., the rate at which SNF residents are admitted back to the hospital within 30-days of being admitted to the SNF). SNFs are assessed on this measure for both improvement compared to their historical baseline and overall achievement compared to their peers. All SNFs that are covered under Medicare’s prospective payment system are included in the SNF VBP program. We performed analyses to assess the correlation between individual SNFs’ performance in the 2020 SNF VBP (n=15,201), which is based on actual performance in fiscal year 2018, with contemporaneous matched data related to SNF health inspection results, staffing, and performance on quality measures (these data form the basis of the five-star quality rating system on the Nursing Home Compare website). We also examined longitudinal trends in these non-SNF VBP program variables and their association with changes in SNF performance in the SNF VBP program. We controlled for important SNF-specific factors (e.g., for-profit status, connected to a hospital). We found strong contemporaneous and longitudinal associations between SNF VBP program performance and some, but not all, of these factors. Our findings are supported by decades of empirical research in SNF quality and highlight potential policy alternatives that could further incentivize high quality care in SNFs.
Dyads in Dementia Care: An International Perspective on Research Challenges and Opportunities
Authors: Boltz Marie , Wolf-Ostermann Karin , Maslow Katie
Published: December 2020

Dementia poses a societal challenge that is life-changing not only for persons with dementia (PWD) but also for family members and friends (informal carers) directly involved in the care arrangement. Informal carers (IC) have typically poorer outcomes in terms of well-being, quality of life (QoL), health status, and use of health care resources. Dyads of PWD and IC living with dementia are characterized by strong reciprocal relationships and complex living contexts. Therefore, research should investigate home based dementia caregiving from a dyadic perspective to yield interventions that support the PWD, the IC, and the unit as a whole. However, it is an ongoing challenge to investigate dyadic needs and preferences in daily practice and develop effective interventions. Challenges are related to incomplete understanding of dyadic characteristics, attitudes and beliefs within the dyad, as well as how to adapt research approach to engage and retain the dyad in research. This international symposium will therefore address these issues. The first presentation will describe a typology of dementia care dyad characteristics and needs in Germany. The second presentation will examine the challenges and opportunities associated with recruiting and retaining dementia dyads. The third presentation will explore ethical challenges posed in communication with dyads and possible solutions for the researcher. The final presentation reports on the Meeting Centre Support Program as an example of an effective psychosocial intervention employing research strategies that transcend cultural barriers. Our discussant, Katie Maslow, will synthesize the presentations and lead a discussion of future directions for policy and practice.
Design and Main Results of STURDY: A Randomized Clinical Trial of Four Vitamin D3 Doses to Prevent Falls in Older Adults
Authors: Appel Lawrence , Schrack Jennifer , Michos Erin , Mitchell Christine , Juraschek Stephen , Miller Edgar , Roth David
Published: December 2020

STURDY was a Bayesian, response-adaptive trial with dose-finding and confirmatory stages. Participants (n=688; ≥70years with serum 25(OH)D of 10-29ng/mL) were randomized to 200 (control), 1000, 2000, or 4000 IU/day of vitamin D3. The primary outcome was time to first fall or death over 2 years. During dose-finding, the best non-control dose was determined to be 1000IU/day based on higher primary outcome event rates in the 2000 and 4000IU/day doses than the 1000IU/day dose (posterior probability of being best dose=0.90; hazard ratios[HR] were 1.86 [95%CI: 1.16-2.97] and 1.68 [95%CI: 1.05-2.69], respectively). Participants were then switched from other non-control doses to 1000IU/day, and event rates did not differ between the pooled higher doses and control groups (HR=1.02, P=0.84). There was no heterogeneity by baseline 25(OHD). In conclusion, high-dose vitamin D supplementation ≥1000IU/day did not prevent falls. Whether vitamin D doses >2000IU/day increase the risk of falls is uncertain.
Vitamin D Supplementation on Detailed Fall Characteristics
Authors: Wanigatunga Amal , Sternberg Alice , Blackford Amanda , Cai Yurun , Schrack Jennifer , Miller Edgar , Roth David , Appel Lawrence
Published: December 2020

Evidence suggests Vitamin D supplementation may reduce fall risk in older adults, but effects on fall location and severity are less well described. We used STURDY trial data to examine whether Vitamin D supplementation reduces indoor, outdoor, “consequential” (falls resulting in injury or medical care), and repeat fall risk. Participants (77[SD=5.4] years; 44% women) were randomized to receive 200 (n=339) or 1000IU/day (n=349) of vitamin D3. Indoor, outdoor and consequential fall rates were similar between the ≥1000IU/day and 200IU/day groups (rate ratio [RR]:1.22, 95%CI:0.96-1.55; RR:0.85, 95%CI:0.65-1.10; and RR:1.16, 95%CI:0.93-1.45, respectively) during follow-up. The proportion of repeat fallers was similar between ≥1000IU/day versus 200IU/day groups over 3 months (7.8%[27/346] versus 6.5%[22/336], p=0.22), 6 months (18.8%(60/319) versus 16.2%(51/315), p=0.40), 12 months (29.9%(81/271) versus 31.2%(84/269), p=0.78) and 24 months (48.2%(66/137) versus 49.6%(66/133), p=0.90). In conclusion, Vitamin D supplementation ≥1000IU/day did not reduce indoor, outdoor, consequential or repeat fall risk.
Vitamin D Supplementation and Change in Objectively Measured Physical Performance
Authors: Guralnik Jack , Schrack Jennifer , Wanigatunga Amal , Sternberg Alice , Mitchell Christine , Appel Lawrence
Published: December 2020

Change in usual gait speed (GS) was a prespecified secondary outcome in STURDY and additional physical performance measures were also assessed. Over 12 months, gait speed declined slightly in both the 200IU/d (control) and the intervention groups receiving 1000 or more IU/d, with identical declines in both groups. However, at month 24 GS declined 0.09 m/s from baseline in controls and 0.03 m/s in the intervention group (p=0.03). Subgroup analyses of persons receiving just 1000IU/d throughout the trial compared to controls did not reach significance (p=0.07). Neither SPPB, balance, chair stand tests, or 6-minute walk test showed differences between controls and intervention at any follow-up point. The timed up and go (TUG) test showed a significantly greater improvement in the intervention group at 2 months (p=0.004) but not 12 or 24 months (p=0.17 and 0.79, respectively). Effects of long-term vitamin D supplementation on physical functioning remain unclear.
Pilot Study to Implement a Resident and Family Decision Guide
Authors: Wolf David , Sopcheck Janet
Published: December 2020

In this first stage of an 8 state initiative designed to assist nursing homes in reducing unnecessary hospital readmissions, 16 nursing homes were identified and invited by CMS and state agency advisors to participate in the pilot study of the effects of intervention (use of the Guide). Selected facilities received an online orientation to the project and onsite visit from project team leadership prior to launch. Pre and post implementation data were uploaded to a secure section of the project website by the facilities. Three facilities withdrew due to change in top management and a fourth facility provided incomplete data resulting in data for analysis from 12 pilot facilities. Results show the average reduction in readmissions was 31.2% for the project period as compared with the 3-month pre-project period. This presentation will include facility reports of the effect of Guide use on resident and family decision making.
Preparing Pharmacy Students for Practice to Support Underserved Older Persons
Authors: Mansour Daniel
Published: December 2020

Interprofessional collaboration is needed to ensure high quality care. Effective programs teaching necessary team-based care skills are under investigation. This study evaluated the Aging in Place program, an interprofessional practice experience (IPE), in preparing pharmacy students for practice with underserved older persons. The Assessment of Interprofessional Team Collaboration Scale (AITCS) and Team Decision Making Questionnaire (TCMQ) were administered to students before and after their experience. The number of disciplines represented, campuses involved, resident sessions, resident interactions, and health screenings performed were documented. Overall, AITCS and TDMQ scores improved after participation in the program. Since the program’s inception, there have been 7 disciplines represented, 2 campuses involved, 125 student participants, 2 housing buildings, 90 resident sessions, and 370 health screenings performed. The Aging in Place program has grown and shown that an IPE program is feasible to better prepare pharmacy students for collaborative care with older residents of affordable housing buildings.
Cognitive and Neuroimaging Profiles of Individuals With Dual Decline in Memory and Gait
Authors: Tian Qu , Resnick Susan , Davatzikos Christos , Studenski Stephanie , Ferrucci Luigi
Published: December 2020

Across 6 aging cohorts we showed that dual decline in memory and gait speed was associated with increased risk of dementia compared to memory or gait decline only. We now characterize dual decliners. Using longitudinal BLSA data, we examined associations of phenotypic groups with changes in cognition, depressive symptoms, and brain volumes in areas important for cognitive (dorsolateral prefrontal, medial temporal) and motor functions (precentral gyrus,striatum,thalamus,anterior cingulate cortex) using linear mixed effects models (usual agers=reference), adjusting for covariates. Compared to usual agers, dual decliners had faster decline in card rotation score, greater increase in CES-D, and greater atrophy in thalamus and anterior cingulate cortex. Rates of change in these parameters did not differ among the other three groups. Dual decliners experience faster decline in visuospatial ability, greater atrophy in selected motor areas, and greater increase in depressive symptoms, suggesting potential mechanisms underlying increased dementia risk in dual decliners.
Engaging Underrepresented Caregiving Communities in Dementia Research
Authors: Gilmore-Bykovskyi Andrea , Williams Ishan
Published: December 2020

Family and friend caregivers of persons with dementia from underrepresented and traditionally underserved backgrounds are significantly underrepresented in dementia and caregiving research despite heightened disease risk, poorer outcomes, and disproportionate use of services within these populations. Efforts to develop and disseminate methods that foster greater inclusion of underrepresented caregiving populations in research are essential to ensuring that culturally specific understandings, priorities, and needs of these groups are systematically understood and addressed. In this symposium, we present a variety of studies that illustrate successful efforts to include dementia caregivers from underrepresented backgrounds in research. Two presentations focus on African American caregivers, one on caregivers residing in highly under-resourced areas, one on Latino caregivers, and one on sexual and gender minority (SGM) caregivers. The first presentation describes a capacity building approach through African American faith communities to develop a research registry and address informational needs regarding dementia. The second presentation focuses on eliciting African American caregivers experiences of crisis events. Presentation three describes a coalitional, community-informed approach to engaging caregivers in highly under-resourced areas to investigate experiences with post-acute care. The fourth presentation describes a community-network approach to implementing a text-message based support intervention among Latino caregivers; and the fifth presentation illustrates the utility of digital methods for engaging SGM dementia caregivers. Collectively, these presentations demonstrate a variety of approaches to engaging dementia caregivers from underrepresented and traditionally underserved backgrounds in research that are specific to individual communities and local contexts – as well as the findings that result from these efforts.
Engaging Dementia Caregivers in Under-Resourced Areas to Examine Disparities in Post-Acute Care Quality and Access
Authors: Gilmore-Bykovskyi Andrea , Block Laura
Published: December 2020

Dementia disproportionately impacts racial/ethnic minorities and individuals from under-resourced environments, yet these groups are under-represented in research. For caregivers, managing dementia often involves navigating frequent post-acute care (PAC) transitions. Despite evidence of segregation-associated disparities in PAC access and quality, the perspectives of caregivers from under-resourced areas regarding these disparities and how they are experienced, are poorly understood. We engaged a coalitional, community-informed approach to engaging caregivers in highly under-resourced areas to elicit experiences surrounding PAC through semi-structured interviews (N=25; 65% African American; 25% White; 88% female). Data were analyzed using thematic analysis. Caregivers spontaneously connected issues in PAC quality to racial/ethnic disparities and discrimination citing differences in geographic availability, financial barriers, eligibility, access to information, and transportation. To mitigate these challenges caregivers remained highly involved in the care recipient’s PAC, describing the need to continue to “advocate” and “supervise.” Collectively, these perspectives can help inform future, targeted policy interventions.
Translating Exercise Benefits Over Telehealth
Authors: Padala Kalpana , Lensing Shelly , Evans Tammy , Pearson Megan , Morey Miriam , Padala Prasad
Published: December 2020

Background: Gerofit-Geriatric walking clinic is a home-based program that helps older veterans engage in regular walking via different platforms to improve access. The objective was to compare the outcomes of face-to-face visits to telehealth visits. Methods: Older Veterans (N=646) and walking-buddies (N=154) were seen either face-to-face or via telehealth at baseline, 2-, and 6-months. The primary intervention, pedometer feedback and motivational phone calls were delivered remotely. Results: Demographic data were similar in both Veteran groups and 47% were seen via telehealth. Compared to face-to-face, a higher proportion in the telehealth group had walking buddies (10% vs. 27%; p<0.001), received exercise counseling (75% vs. 95%; p=0.001), and reported perceived barriers (40% vs. 67%; p=0.004). There were statistically significant improvements in step-counts at 2- and 6-months compared to baseline (57% and 99% improvement; p<0.01) with no significant between-group differences. Conclusion: Tailored activity promotion programs via telehealth are effective in reaching older veterans.
Gerofit Decreases Medication Use Among Older Veterans
Authors: Intrator Orna , Li Jiejin , Veazie Peter , Wesgate Sara
Published: December 2020

We examined whether Veterans enrolled in Gerofit for at least 12 months between 10/2012-3/2017 saw reductions in their medication utilization (5 sites, 226 Veterans). VA outpatient pharmacy data was used to identify medications used 12-months prior, and 12-months following Gerofit enrollment. Seven drug classes were identified (cardiovascular, diabetic, lipid, mental health, opioids, vitamins, other medications). Nearest-neighbor propensity-matched analyses was conducted with exact match on number of baseline medications and site. At baseline, Gerofit participants were taking, on average, 11.6 medications (1.7 cardiovascular, 0.6 diabetes, 0.7 lipid lowering, 0.7 mental health, 0.5 opioids, 0.6 vitamins, 7.0 other). At 12-month follow-up, Gerofit patients were taking fewer medications: any (-2.7 [-4.4, -1.0]); cardiovascular (-0.5 [-0.7, -0.3]); diabetes (-0.7 [-1.2, -0.2]); mental health (-0.9 [-1.5, -0.2]); and other (-2.4 [-3.5, -1.4]) compared to matched comparisons. No significant differences at 12-months were found for lipid lowering, opioids, or vitamins. Conclusion: Gerofit participation reduced medication use.
An Effectiveness Trial of STEADI in an Outpatient, Primary Care Practice
Authors: Rein David , Hackney Madeleine , Dougherty Michele , Vaughan Camille , Imhof Laurie , Johnson Theodore ,   The Emory Clinic at St. Josephs STEADI Implementation Group
Published: December 2020

The STEADI Options trial uses a randomized, controlled-trial design to assess the effectiveness and cost-effectiveness of the STEADI Initiative . Beginning March, 2020, we will randomize 3,000 adults ≥ 65 years of age at risk for falls seen in an Emory Clinic primary care practice to: (1) full STEADI; (2) a STEADI-derived gait, balance, and strength assessment with physical therapy referrals; (3) a STEADI-derived medication review and management; or (4) usual care. This presentation will discuss decisions made by the study team to facilitate implementation of STEADI including electronically conducting screening prior to the date of encounter, the use of dedicated nursing staff to conduct assessments, implementation of strength, balance, orthostatic hypotension, and vision testing, methods to facilitate medication review, and communication of assessment information to providers. The results from this study will be used to estimate the impact of STEADI on falls, service utilization, and costs over one year.
Exploring Inner Strength in People Aging With Serious Illness and Cognitive Impairment
Authors: Morgan Brianna
Published: December 2020

Inner strength is a psychological resource that supports people as they move through challenging life events. Understanding how people living with serious illness conceptualize inner strength is key in informing person-centered healthcare. This concept analysis used dimensional analysis methods to explore the nature of inner strength in people aging with serious illness to define a situation specific theory. 1212 abstracts and articles from the published literature were reviewed. 30 articles were included and analyzed as data sources. The resulting explanatory matrix conceptualized inner strength in people as an inward and outward process of “meeting me” – an authentic version of oneself – in the context of shifting health. Of note, while other serious illnesses were represented, no literature focused on dementia. Understanding inner strength in people with dementia is the next step for further inquiry. A pilot study exploring feasibility and informing further research is planned.
Race and Regional Differences in Risk Factors for Cognitive Impairment From a Combined Cohort Analysis
Authors: Windham B Gwen , Griswold Michael , Henegan James , Knopman David , Lirette Seth , Mielke Michelle , Petersen Ron , Mosley Thomas
Published: December 2020

Few studies examined race-regional influences on mild cognitive impairment (MCI) and dementia risk factors. We examined 14 risk factors in 5 race-regions, e.g. cross-sectional age- and sex-adjusted relative prevalence ratios (RPR) from multinomial regression comparing associations of low education (<12yrs) with MCI and dementia (versus normal cognition) across 3 race-region groups, average age 76yrs: whites in the Mayo Clinic Study of Aging[MCSA, Olmsted County, MN—MCSA-MN-Whites); Atherosclerosis Risk in Communities(ARIC) whites in suburban Minneapolis, MN—ARIC-MN-Whites); ARIC-African Americans in Jackson, MS—ARIC-MS-AA. Among 3,787 MCSA-Whites, low education exerted a 2-fold risk for MCI, RPR=2.09(95%CI: 1.57,2.78). Conversely, low education was not a supported MCI risk factor for ARIC-MN-Whites (n=1,901—RPR=0.63(0.31,1.28) or ARIC-MS-AA, (n=1,416—RPR=.0.81 (0.60,1.10)), with substantially differential race-region effects. Low education RPRs for dementia also differed by race-region: RPR=4.43(2.68,7.31-MCSA-MN-W), RPR=0.70 (0.16,2.99-ARIC-MN-Whites), and RPR=2.54 (1.74,3.72-ARIC-MS-AA). Understanding why risk factors differ by race and region likely requires diverse samples and harmonized methods using culturally-appropriate assessments.
Global Council on Brain Health: Consensus and Recommendations for Promoting Brain Health Through Music Engagement
Authors: Mintzer Jacobo
Published: December 2020

This presentation will summarize the points of consensus reached by the experts and describes the major points of discussion that led to their recommendations for men and women age 50 and older. The GCBH considered questions surrounding what happens in the brain when listening to music as well as creating music. Topics such as music therapy and the clinical dimensions of introducing music into caring for patients will be addressed. Alongside the consensus points, recommendations and practical tips will be presented. Moreover, we will also identify gaps in our knowledge that currently exist in the evidence base surrounding music and brain health.
A Preliminary Measurement and Understanding of Movement-Evoked Pain in African American Elder Adults
Authors: Booker Staja
Published: December 2020

Osteoarthritis (OA) is a principal cause of disabling knee pain, and movement is a known exacerbator of pain in African Americans (AAs). Still, research has neglected to understand the relationship between pain with movement and its impact on function and mobility. Our previous study found significantly higher movement-evoked pain between AAs and White American (WAs). Therefore, this case-control observational study investigated inter-racial and intra-racial differences in movement-evoked pain in AAs and WAs (N= 28) who were 55-78 years-of-age (M= 65.75, SD= 6.23). We measured pain intensity (0-10) pre/ante/post multiple performance-based functional activities; we report preliminary results for 7-meter GAITRite® walk and Stair climbs. Pain intensity was higher before and after the 7-meter walk and stair climbs in AAs, although not significantly different than WAs. We will conduct additional statistical tests for the remaining functional activities to identify potential differences and ethnic-specific factors that distinguish movement-evoked pain and function by race.
Applying Engagement Frameworks to Case Scenarios: A Retrospective Analysis
Authors: McGaffigan Erin
Published: December 2020

The LeadingAge LTSS Center @UMass Boston has worked with the Patient-Centered Outcomes Research Institute (PCORI), service recipients, researchers, and providers since 2017 to understand the obstacles and creative solutions for meaningful and effective engagement in research. The LTSS Center’s work has been informed by multiple engagement frameworks, including Dr. McGaffigan’s 2011 PAE Attention Framework, the result of a multi-state, multi-site research study examining the factors to user engagement in Cash & Counseling programs. In this presentation, we will apply the PAE Attention Framework (2011), the PCORI Engagement Rubric (2014), and the NHS INVOLVE Framework (2015) to three research study case scenarios to understand the strategies used, outcomes realized, and factors influencing engagement success. Lessons learned from each and their application to future research will be discussed, including ethical considerations. Part of a symposium sponsored by the Patient/Person Engagement in Research Interest Group.
Physical Activity and Health: Does the Pattern Matter?
Authors: Koster Annemarie , Stenholm Sari , Gardiner Paul
Published: December 2020

It is well-known that physical activity is key in the prevention of many diseases and disability in old age. Much less is, however, known about the pattern of activity in relation to health. While there are differences in how people spread their activity and sedentary behavior over the day or over the week, we don’t know which activity pattern of most beneficial for health. This symposium focuses on patterns of physical activity and sedentary behavior and health in five different studies with accelerometry data in Europe and the USA. Dr. Rosenberg will show how sedentary behavior patterns are associated with various health outcomes in the Adult Changes in Thought (ACT) study. Using data from The Maastricht Study, Dr. Vandercappellen will present how weekly activity patterns, in particular comparing regularly actives to weekend warriors, are associated with arterial stiffness. Dr. Shiroma will show how patterns of physical activity and sedentary behavior, taking the volume, intensity, and frequency of sessions into account, are associated with mortality in the Women’s Health Study. Dr. Caserotti will present the association between physical activity fragmentation and physical function in the SITLESS Study. Dr. Stenholm will present data from the Finish Retirement and Aging Study, using latent class trajectory analyses to identify daily activity patterns and how these patterns are associated with health-related physical fitness. Taken together, this symposium will provide insight into different ways patterns of activity can be operationalized using accelerometer data and if the patterns of activity and sedentary behavior are associated with health.
Patterns of Sedentary Behavior in a Community-Based Cohort of Older Adults
Authors: Rosenberg Dori , Walker Rod , Greenwood-Hickman Mikael Anne , Richmire KatieRose , Bellettiere John , Wing David , LaCroix Andrea
Published: December 2020

Few epidemiologic studies have examined device-measured sitting patterns by demographics and health status. The Adult Changes in Thought (ACT) study is an on-going epidemiologic study of adults age ≥65 years. We conducted a sub-study that added a thigh-worn activPAL device and sleep logs for 7 days to the measurement protocol. A total of 997 had valid wear time (≥4 days with 10-20 hours of data per day) and covariate data. activPAL sedentary pattern measures included number of sitting bouts lasting 30 minutes or more and mean sitting bout duration. On average, participants (56% female, 57% > age 75, 89% non-Hispanic white) sat in bouts lasting 17 minutes (SD = 12) and had 5.9 (SD = 1.7) bouts of sitting lasting 30 minutes or more. Participants who were older, were male, had obesity, had worse self-rated health, had depression, and had difficulty walking had longer sitting bouts and more prolonged bouts.
Daily Physical Activity Patterns and Their Association With Health-Related Physical Fitness Among Aging Workers
Authors: Stenholm Sari , Pulakka Anna , Leskinen Tuija , Pentti Jaana , Heinonen Olli , Koster Annemarie , Vahtera Jussi
Published: December 2020

This study aimed to identify accelerometer measured daily physical activity patterns and to examine how they associate with health-related physical fitness among 258 participants (mean age 62.4 years, SD 1.0) from the Finnish Retirement and Aging Study. Wrist-worn ActiGraph accelerometer was used and health-related physical fitness measures included body composition, cardiorespiratory fitness and muscular fitness. Based on latent class trajectory analysis, six different patterns of daily physical activity was identified on workdays and two on days off. Having low activity throughout the workday was associated with poorest health-related physical fitness, whereas a combination of low or moderate activity during working hours and increase of activity level in the evening was associated with most favorable body composition and better physical fitness compared to the other trajectories. In conclusion, a large variation in the workday physical activity patterns and health-related physical fitness was observed among aging workers.
fNIRS Outcomes for a Pilot Clinical Trial Combining Frontal tDCS With Walking Rehabilitation in Older Adults
Authors: Clark David , Chatterjee Sudeshna , Skinner Jared , Lysne Paige , Wu Samuel , Cohen Ronald , Rose Dorian , Woods Adam
Published: December 2020

This pilot study assessed a novel intervention to enhance both walking and executive function in older adults. The primary hypothesis was that eighteen sessions of frontal lobe tDCS combined with walking rehabilitation would be feasible, safe, and show preliminary efficacy. Eighteen participants were randomized to one of three intervention groups: active tDCS and rehabilitation with complex walking tasks (Active/Complex); sham tDCS and rehabilitation with complex walking tasks (Sham/Complex); or sham tDCS and rehabilitation with typical walking (Sham/Typical). Outcome measures included multiple tests of walking function, executive function, and prefrontal activity during walking as measured by functional near infrared spectroscopy (fNIRS). Of the three groups, the Active/Complex group demonstrated the broadest improvements across outcome measures including for prefrontal activity. The functional range of prefrontal activity in this group was increased considerably, as conceptualized by the Compensation Related Utilization of Neural Circuits Hypothesis. Frontal tDCS is a promising adjuvant to walking rehabilitation.
Source of Purchased Medications and Its Impact on Medication Mistakes and Hospitalizations: The NHATS 2017
Authors: Coates Martha , Granche Janeway , DiMaria-Ghalili Rose Ann
Published: December 2020

Older adults self-administer prescribed medication regimens to treat chronic diseases which can lead to mismanagement, medication related harm and hospitalizations. We examined the extent to which source of purchased medications influenced the occurrence of self-reported medication mistakes and hospitalizations in community-dwelling participants who managed medications independently (N= 3899). The majority (65%) picked-up medications, 18% had medications delivered, and 17% used both (picked-up and delivery). Compared to those picking up their medications, those using delivery only were less likely to have a hospital stay (OR=0.691 [95% CI 0.507-0.943]) and no difference in odds of medication mistakes (OR=1.051 [95% CI 0.764-1.445]), while those using both methods were more likely to report hospital stays (OR=1.429 [95% CI 1.106-1.846]) and medication mistakes (OR = 1.576[95% CI 1.078-2.304]). Older adults who picked-up medications from a local pharmacy and had medications delivered were more likely to report medication mistakes and hospitalizations.
Self-Reported Energy Trajectories Predict Adverse Health Outcomes in Older Adults
Authors: Sprague Briana , Zhu Xiaonan , Ehrenkranz Rebecca , Tian Qu , Gmelin Theresa , Glynn Nancy , Rosso Andrea , Rosano Caterina
Published: December 2020

Declining energy may indicate homeostatic dysregulation and predict adverse health outcomes. We hypothesized that declining energy would predict greater frailty (1-10), greater mortality, and faster mood (CES-D) and cognition (3MS) decline over time. This observational cohort studies included 2,443 older adults (mean age=74.6, 62.5% White, 47.8% men) from the Health ABC Study with up to eight years of data. Energy was assessed using a single-item question about prior month’s energy (baseline mean=6.7, SD=1.7, range=0–10, lower=less energy). We used linear mixed models to create energy change scores (mean=-.07 points/year, SD=.05, range=-0.32-0.21, negative=decreased energy). In regression models adjusting for baseline outcome performance and energy and demographics, declining energy predicted greater frailty (β=-2.72, 95%CI = -3.39,-2.06), greater mortality (hazard ratio=.07, p<.001), and faster CES-D (β=-.93, 95%CI=-1.10,-0.75) but not 3MS decline. Energy changes are easy to assess and predict clinically-relevant outcomes. Future work should consider mechanisms of declining energy on disability-related outcomes. Part of a symposium sponsored by Brain Interest Group.
Scaling Geriatric and Telemedicine Care for Older Adults in Rural Areas Through Clinical Strategies and Training
Authors: Hung William , Powers Becky , Dang Stuti
Published: December 2020

Telemedicine, the use of electronic information and communication technologies to deliver care, has grown substantially over the past few years, potentially benefiting older adults who have difficulty accessing and traveling to care locations. Given that providers and interprofessional staff with training in geriatric medicine often practice in urban rather than rural areas, older adults’ access to quality geriatric care is limited. Prior experiences with telemedicine adoption for geriatric team consultation, though limited in scope, were well accepted by older adults and demonstrated benefits such as identifying and meeting care needs for older adults. Bringing geriatric team care to large regions across the country requires further consideration of population needs, local contexts and training and enhancement of an interprofessional workforce to deliver geriatric care through telemedicine. The Veteran healthcare system has been a pioneer in telemedicine care and considers the use of telemedicine necessary for all providers in its system. This symposium aims to discuss approaches to identify and target older adults who may benefit from geriatric consultation, how care delivery is scaled through identifying common approaches and local adaptations, what the important elements are for providers and teams to deliver care effectively for the older adult population, especially those with multiple complex chronic conditions and functional limitations, and considerations for training the next generation of providers to provide care for older adults with complex conditions, particularly in rural areas with limited access.