bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Participation and the Risk for Developing Mild Cognitive Impairment and Dementia Among Older Adults
Authors: Eymundsdottir Hrafnhildur , Sigurdardottir Sigurveig , Ramel Alfons , Jonsson Palmi , Gudnason Vilmundur , Launer Lenore , Chang Milan
Published: December 2021

Introduction: We aim to investigate the longitudinal associations between social participation and the risk of developing mild cognitive impairment (MCI|) and dementia over 5 years of follow-up among cognitively normal older adults. Methods: A total of 2802 participants had complete follow-up data from Age-Gene/Environment-Susceptibility-Reykjavik-Study. Social participation was assessed by a questionnaire asking the frequency of contact with children, relatives, friends and neighbors. MCI and dementia were diagnosed according to international guidelines and by a team composed of a geriatrician, neurologist, neuropsychologist, and neuroradiologist. Logistic regression analysis was used to assess the associations. Results: At baseline 8% (n=225) reported no social participation. Among cognitively normal participants at baseline, 5.6% (n=243) developed mild cognitive impairment and 2.4% (n= 103) developed dementia during a mean follow-up time of 5.2 years. After full adjustment with covariates including age, gender, education, marital status, vitamin D levels, depression and APOE ε4, those with no social participation at baseline were significantly more likely to develop MCI at follow-up (OR=1.953, P=0.001). However, social participation at baseline was not associated with higher dementia diagnosis at follow-up (OR= 1.490, P=0.194). Conclusions: Community-dwelling old adults who are socially inactive are more likely to develop MCI than those who are socially active. Social participation might independently indicate impending changes in cognitive function among older adults.
Predictors of Disenrollment Among Medicare Fee-for-Service Beneficiaries With Dementia
Authors: Rivera-Hernandez Maricruz , Castillo Aaron , Trivedi Amal
Published: December 2021

Medicare enrollment among people with Alzheimer’s Disease and Related Dementias (ADRD) has reached an all-time high with about 12% of beneficiaries having an ADRD diagnosis. The federal government has special interest in providing healthcare alternatives for Medicare beneficiaries. However, limited studies have focused on understanding disenrollment from fee-for-service, especially among those with high-needs. In this study we identified predictors of disenrollment among beneficiaries with ADRD. We used the 2017-2018 Medicare Master Beneficiary Summary File to determine enrollment, sociodemographic, clinical characteristics and healthcare utilization. We included all fee-for-service beneficiaries enrolled in 2017 who survived the first quarter of 2018. Our primary outcome was disenrollment from fee-for-service between 2017 and 2018. Regression models included age, sex, race/ethnicity, dually eligibility to Medicare and Medicaid, chronic and disabling conditions (categorized by quartiles), total health care costs including outpatient, inpatient, post-acute care and other costs (categorized by quartiles) and county fixed-effects. There were 1,797,047 beneficiaries enrolled in fee-for-service with an ADRD diagnosis. Stronger predictors of disenrollment included race/ethnicity and dual eligibility. Disenrollment rates were 7.9% (95% CI, 7.2 – 8.5) among African Americans, 6.6 (95% CI, 6.2 – 7.0) among Hispanics and 4.3 (95% CI, 4.2 – 4.3) among Whites. Duals were 1.9% (95% CI, 1.4 – 2.3) more likely to disenroll from fee-for-service to Medicare Advantage (MA). The inclusion of MA special need plans and additional benefits for those with ADRD and complex chronic conditions may be valuable for those beneficiaries with ADRD, and who may not have Medigap coverage when enrolling in fee-for-service.
Factors Associated With Older Adults’ In-Hospital Mobility: A Comparison Between Israel and Denmark
Authors: Zisberg Anna , Petersen Janne , Andersen Ove , Shadmi Efrat , Shulyaev Ksenya , Gil Efrat , Agmon Maayan , Pedersen Mette Merete
Published: December 2021

Low levels of in-hospital mobility and excessive bed rest are widely described across the globe as a major risk factor for hospital associated disabilities. Different predictors of in-hospital and post-discharge mobility limitations have been proposed across studies, including age, admission diagnosis, physical performance, cognitive impairment, performance of activities of daily living, and length of stay. However, it is unknown whether similar risk factors across countries are associated with in-hospital mobility given different mobility measurement methods, variations in measurement of predictors and differences in populations studied. In the current study, we investigated the relationship between in-hospital mobility and a set of similar risk factors in functionally independent older adults (65+) hospitalized in acute care settings in Israel (N=206) and Denmark (N=113). In Israel, mobility was measured via ActiGraph and in Denmark by ActivPal for up to seven hospital days. Parallel analysis of covariance (ANCOVA) in each sample showed that community-mobility before hospitalization, mobility performance at admission and length of stay were associated with in-hospital mobility in both countries, whereas age and self-reported health status were associated with mobility only in Denmark. This comparison indicates that despite slightly different measurement approaches, similar risks are attributed to older adults’ low in-hospital mobility and emphasizes the contribution of commonly used pre-hospitalization mobility measures as strong and consistent risk factors. This knowledge can support a better understanding of the need of both standard risk assessments and country-based tailored approaches.
Correlates of Perceived Stress Among Community-Dwelling Older African Americans Without Dementia
Authors: Glover Crystal , Capuano Ana , Wilson Robert , Bennett David , Barnes Lisa
Published: December 2021

The purpose of this study was to identify correlates of perceived stress among older African Americans without dementia. We grouped correlates into four levels – environmental, sociocultural, behavioral, and biological – guided by the National Institute on Aging’s (NIA) Health Disparities Research Framework. We performed a cross-sectional data analysis with the Minority Aging Research Study using ordinal logistic regression analyses. Participants were 722 African Americans without dementia [mean age = 73.61 years (SD=6.33)]. Correlates from environmental (e.g., larger life space), sociocultural (e.g., larger social network size), behavioral (e.g., more purpose in life), and biological (e.g., higher global cognition) levels were associated with lower odds of having greater levels of perceived stress. Perceived stress was associated with correlates from every level. Future research is needed to examine how changes in these correlates may be related to perceived stress in older African Americans.
Living With COVID-19: Descriptions of African American Custodial Grandparents Mental Health Stress and Social Support Networks: A Pilot Study
Authors: Whitley Deborah , Kelley Susan
Published: December 2021

Research suggests custodial grandparents (CG) with chronic health conditions, limited economic resources, and restricted social connections are at risk for adverse mental health outcomes. The growing uncertainty surrounding COVID-19 seems to accentuate these findings. This paper presents preliminary descriptions of mental stress by a small sample of CG (n=26) surveyed after the onset of COVID-19. They described the social groups comprising their networks, and the methods used to engage with them. A majority of the sample (96.2%) reported experiencing mental stress since the onset of the virus; based on Brief Symptom Inventory results, five CG scored in the clinical range for stress. Food access, fear of getting sick, and grandchildren’s school requirements are leading sources of stress. Despite such challenges, CG report varying levels of social engagement with their support networks. The reported descriptions give preliminary insight how CG can maximize their social networks to build/sustain positive mental health well-being.
Measurement for Something as Personal as Dressing is Not Personalized
Authors: Prizer Lindsay , Zimmerman Sheryl
Published: December 2021

In 2018, the Alzheimer’s Association set forth Dementia Care Practice Recommendations in nine domains, one being support for activities for daily living (e.g., dressing, toileting, eating/nutrition). For example, preservation of dressing independence is important for dignity, autonomy, and to decrease caregiver burden. Measurement is necessary to guide care and assess outcomes related to dressing, but availability of related measures to assess processes, structures, and outcomes of care has not been examined; more so, the extent to which the related measures are person-centered is completely unexplored territory. This session will present a critical assessment of available measures grounded in the Donabedian Model. Of 21 identified measures, 4 assessed dressing alone, 16 included dressing as part of a larger scale, and 1 included dressing as a part of a scale to screen for dementia; none were person-centered. This session will suggest modifications to and need for new measures for person-centered dressing.
Testing a Preference Tool in Different Care Settings in Germany: Descriptive Results
Authors: Bergmann Johannes , Stacke Tobias , Rommerskirch-Manietta Mike , Purwins Daniel , Manietta Christina , Stroebel Armin , Roes Martina
Published: December 2021

Background: The tool “Preferences for Everyday Living Inventory” (PELI) for Nursing Homes (NH) was developed in the USA. In our project PELI-D, the PELI was translated from English into German and piloted in three care settings: Nursing Home (NH), Home Care (HC) and Adult Day Care (AD). Objective: The objective is to provide insights in preferences of importance of older adults in need of care in Germany. Methods: Data collection was carried out in 2019 on multiple measurement points: n=48 baseline (T0) and n=41 two-week follow-up (T1). Results: The results indicate that the importance of certain preferences distinguishes between the care settings: In NH preferences for body care and aspects of professional care are important. Additionally, in HC the aspects of social contact and eating/drinking are perceived as important. Comparing T0 and T1, importance of the item’s daily routines, social contact and aspects of privacy seem to be reliable.
Delivering Person-Centered Care During a Pandemic: Stakeholder Perspectives
Authors: Abbott Katherine , Corazzini Kirsten
Published: December 2021

Person-centered care (PCC) is an approach to care that both nursing homes (NH) and assisted living (AL) communities strive to provide. PCC is a philosophy that recognizes knowing the person and honoring individual preferences. However, when COVID-19 emerged, the NH and AL environments were ground zero for infection spread and disproportionate numbers of deaths among residents. As a result, many practices changed dramatically in efforts to reduce the transmission of COVID-19 in these communities. The purpose of this symposium is to discuss several projects that can speak to the impact of the pandemic on stakeholder efforts to provide PCC. First, Dr. Roberts presents feedback from residents and family members on the challenges COVID-19 created for family involvement in care conferences. In the second study, Dr. Behrens examines focus group data from direct-care nurses on their perceptions of delivering PCC related to risk of harm to staff and residents. The third study presents the voices of activities professionals who were implementing a PCC quality improvement project to communicate resident preferences, which illustrates both the importance of PCC during the pandemic, but also the challenges implementing during the pandemic. Fourth, the Kansas PEAK 2.0 program used provider feedback to direct and inform program responses through components such as consistent staffing. Finally, Dr. Zimmerman presents qualitative data from over 100 AL administrators, medical, and mental health care providers on their experiences pivoting during COVID-19. Our discussant will explore the implications of these studies in terms of the future of PCC in residential settings.
Nursing Staff Perceptions of Risk Outcomes in Delivering Preference-Based Person-Centered Care
Authors: Behrens Liza , Boltz Marie , Kolanowski Ann , Sciegaj Mark , Abbott Katherine , Madrigal Caroline , Van Haitsma Kimberly
Published: December 2021

Effective management of the perceived risks associated with delivering preference-based person-centered care (PBPCC) is historically challenging for nursing home staff. Existing research lacks the granularity needed to guide clinicians who fear negative health and safety outcomes for residents. This study examined direct-care nursing staff perceptions of outcomes associated with delivering PBPCC. Participants (N=27) worked in NHs experiencing 6-12 health citations, were mostly female (85%), and represented diverse ages, race, education, and collective work experience in NHs. Content analysis of verbatim transcripts from 12 focus groups identified an overarching theme of: “person-centered outcomes related to risk engagement”; and sub-themes of: harms to staff (e.g. fear, frustration, guilt); harms to residents (e.g. negative moods and behaviors, physical discomfort); and positive shared outcomes (e.g. building nurse-resident relationships, positive care environment). Implications for risk management that improves quality of care and life outcomes in a post-COVID era will be discussed.
Binge Drinking and Heavy Drinking Among Older Military Veterans: Applying the Theory of Intersectionality
Authors: Suntai Zainab , McDaniel Justin , Albright David , Wallace Julianne
Published: December 2021

The post-service impact of military experiences include post-traumatic stress disorder, depression, substance misuse and several other adverse outcomes that persist well into older adulthood. As such, older military veterans are at risk of developing alcohol dependency and those with existing stressors from other identities are at the highest risk of engaging in binge drinking or heavy drinking. This study used the theory of intersectionality to examine alcohol misuse by veteran status and age, veteran status and race and veteran status and sex. Data were derived from the 2016, 2017 and 2018 Brief Risk Factor Surveillance System (BRFSS) from the Centers for Disease Control and Prevention (CDC). The BRFSS is an annual survey conducted over the phone in all 50 states and territories. Survey-weighted logistic regression models were used to examine alcohol misuse among adults aged 65+ by veteran status and the intersection between age, race, and sex. Results showed no interaction between veteran status and age, and no interaction between veteran status and sex. However, there was a significant interaction between veteran status and race, in that Black/Other race veterans were more likely to engage in both binge drinking and heavy drinking compared to White veterans, White nonveterans and nonveterans of the same race. Interventions geared towards this population should therefore engage culturally sensitive approaches that consider the historical and systemic factors that contribute to these disparities in rates of alcohol misuse among older military veterans.
New AI Technologies to Enrich Electronic Health Record Data Sets With Self-Report Scores in Geriatrics
Authors: Pietrobon Ricardo
Published: December 2021

Although electronic health record data present a rich data source for health service researchers, for the most part, they lack self-report information. Although recent CMS projects have provided hospitals with incentives to collect patient-reported outcomes for select procedures, the process often leads to a substantial percentage of missing data, also being expensive as it requires the assistance of research coordinators. In this presentation, we will cover Artificial Intelligence-based based technologies to reduce the burden of data collection, allowing for its expansion across clinics and conditions. The technology involves the use of algorithms to predict self-report scores based on widely available claims data. Following previous work predicting frailty scores from existing variables, we expand its use with scores related to quality of life, i.e. mental health and physical function, and cognition. Accuracy metrics are presented both in cross-validation as well as external samples.
Understanding Technology Adoption, Troubleshooting, and Telehealth Among the Lifestyle Leaders
Authors: Rudnik John
Published: December 2021

The COVID-19 pandemic has prompted widespread adoption of and greater reliance on digital technologies across the generations. In interviews and focus groups, the Lifestyle Leaders reported increased use of teleconferencing services, especially for virtual programming, socializing, and telehealth. Approximately 61% of Lifestyle Leaders had attended between one and five virtual or phone-based healthcare appointments since March 2020. Beliefs about telehealth across interviews varied: appointments were convenient but lacked the “in-person feedback and understanding” of an in-person visit. Half of the Lifestyle Leaders (50%) agreed with the statement, “Telehealth is the future of personalized medicine.” This presentation will also report on the Lifestyle Leaders’ challenges associated with using technology during the pandemic. These included concerns about: having devices able to keep up with the demands of the pandemic; using technology-enabled grocery services; and troubleshooting technology. Many were concerned about their growing dependence on technology because of the pandemic.
Innovative Multidisciplinary Care Models Provided via Telehealth During the COVID Pandemic
Authors: Baharlou Shahla , Lindquist Lee
Published: December 2021

Integrated and collaborative care lead to better care. Addressing the behavioral and mental health care needs of patients results in better health outcomes. Interdisciplinary and multi-disciplinary approaches to health care delivery yield more effective health care planning. A holistic approach to healthcare sees the individual as more than the sum of diseases. Research studies have supported these assertions and yet, in actual practice, they are often more aspirational than actualized. The COVID-19 pandemic has made it even more difficult to implement collaborative care delivered by varied professional disciplines. This symposium describes efforts to provide more holistic and multidisciplinary care in the primary care geriatrics practice of the Dept. of Geriatrics & Palliative Medicine, Icahn School of Medicine. This New York City practice has 4,500 patients with diverse backgrounds and a median age of 85. In the first paper, Baharlou and her colleagues describe the establishment of an IMPACT collaborative care depression model in the middle of the COVID-19 pandemic. It was adapted to be provided by telephone and uses a different psychosocial intervention than is usually implemented. Hinrichsen and Leipzig outline the successful integration of Cognitive Behavioral Therapy for Insomnia into geriatrics primary care to improve insomnia in older adults and deprescribe sleep medications. Munoz and her colleagues describe the ALIGN program which is an interdisciplinary team effort, informed by the social determinants of health framework, to facilitate access to an array of services delivered virtually because of the pandemic.
Age-Related Differences in Clinical and Psychosocial Predictors of Unmet Needs in Bladder Cancer Survivors
Authors: Mohamed Nihal , Leung Tung Ming , Ornstein Katherine , Alpert Naomi , Brown-Hughes Travonia , Taioli Emanuela , Kyprianou Natasha
Published: December 2021

Understanding of unmet needs and their predictors among bladder cancer (BC) survivors is critical to optimize health care planning for patients. This study compares between younger (<65 Years) and older (≥65 Years) BC patients across seven domains of unmet needs (e.g., informational, psychological, supportive care, daily living, communication, logistic, and sexuality needs) and their demographic, clinical, and psychosocial predictors. BC survivors (N=159; 47% women) were recruited from the Bladder Cancer Advocacy Network and completed a questionnaire that included the needs assessment survey (BCNAS-32), hospital anxiety and depression scale (HADS), coping (BRIEF COPE), social provisions scale (SPS), and self-efficacy beliefs (GSE) scale. Although no significant group differences in all reported needs emerged, both groups reported more communication (IQR = 50 (62.5) and less sexuality needs (IQR =13 (52.1). Older patients reported higher depression and anxiety (IQR = 32 (11.5); N = 68) than younger patients (IQR = 28 (11.0); p < .01; N = 88). Multivariable analyses stratified by age showed significant effects of gender among older patients with women experiencing more psychological, care, communication, and sexuality needs than men. Multivariable analyses also showed age-related differences (p < .05) in the predictors of needs controlling for covariates (e.g., gender). Among older patients both higher depression and anxiety and lower self-efficacy beliefs were associated with more psychological, care, and communication needs. Among younger patients, higher depression and anxiety were associated with more psychological, logistic, daily living, and communication needs. Results emphasize the importance of tailoring care planning for patients based on age.
The South East Texas Geriatric Workforce Enhancement Program: Reach, Teach, Innovate
Authors: Asghar-Ali Ali
Published: December 2021

Through collaboration between academic and community partners, the South East Texas Geriatric Workforce Enhancement Program (SETx GWEP) aims to promulgate the 4Ms framework via a range of educational initiatives. The faculty and audience is interprofessional and diverse, representing the residents of South East Texas. Specific initiatives focus on Alzheimer’s disease and related dementias, elder abuse, geriatric mental health, patient priorities, transitions of care, and geriatric dental care. Training modalities include online modules, Project ECHO sessions, webinars, discussion forums, and simulation. During the COVID19 pandemic the SETx GWEP adapted to meet the needs of its stakeholders, including increasing the number of online activities, hosting town hall meetings, and developing training to address the impact of COVID19 on the older adult population. The SETxGWEP trained over 1000 people in 2020. To address healthcare disparities among older adults, SETx GWEP developed training on the practice of cultural humility in older adult care.
The Role of Hospice in Florida Nursing Homes Post-Hurricane Irma
Authors: Dobbs Debra , Skarha Julianne , Gordon Lily , Jester Dylan , Peterson Lindsay , Dosa David
Published: December 2021

There is little known about the effect of hospice post-disaster. This study utilized exposure to Hurricane Irma (2017) to evaluate the differential mortality effect of the disaster on Florida NH residents (N=45,882) compared to a control group of residents in the same NHs in 2015 (N=47,690) by hospice status. We also examine the difference in hospice utilization rates post-storm for short- and long-stay (LS) residents. There was an increase in mortality for those in the cohort not on hospice within 90 days in 2017 compared to 2015 (OR= 1.06, 95% CI: 1.01, 1.11). For the rate of hospice enrollment post-storm among residents previously not on hospice, there was an increase among LS residents within 30 days (OR =1.15, 95% CI: 1.02, 1.23) and 90 days (OR= 1.12, 95% CI: 1.05, 1.20). It is important to further examine the increase in the rate of hospice enrollment in LS NH residents post-storm.
Neighborhood Conditions, Self-Management Abilities, and Psychological Well-Being Among Chinese Older Adults
Authors: Zhang Keqing , Wu Bei , Zhang Wei
Published: December 2021

Abstract Few studies have examined the associations between neighborhood conditions and psychological well-being for Chinese older adults in the U.S. This study examined how neighborhood conditions were associated with psychological well-being through self-management abilities as a pathway among Chinese older adults in Hawaiʻi. Survey data were collected in 2018 and ordinary Least Square regressions and mediation analysis were conducted. For the whole sample, both neighborhood physical conditions and social cohesion were significantly associated with psychological well-being, and the associations were significantly mediated by self-management abilities. The foreign-born subsample shared similar results with the whole sample. For the U.S.-born subsample, psychological well-being was only significantly associated with neighborhood physical conditions, and the association was mediated by self-management abilities. Our findings suggest that both physical and social neighborhood conditions are associated with psychological well-being, particularly for foreign-born older adults, and psychological resources such as self-management abilities could mediate the associations.
The Implications of Aging Couples’ Linked Lives: Dyadic Associations in Health and Well-Being
Authors: Wilson Stephanie , Marini Christina , Rauer Amy
Published: December 2021

Older adults age in the context of their intimate partnerships. Partners’ lives—their emotions, behaviors, and health—are intricately linked as they navigate the challenges associated with aging. This symposium presents research that illuminates ways partners influence one another later in life. The talks are diverse with regard to their timescale (e.g., years vs. hours) and context (e.g., dementia vs. pain). Dr. Martire will examine associations between declines in one spouse’s physical health over 5 years and the other’s mental health. This talk will further consider whether discussing health concerns exclusively with one’s spouse intensifies such associations. Ms. Nah will show how the pain of both partners (care providers and recipients) contributes to escalating marital conflict over 2 years. Dr. Wilson will demonstrate that emotional reactivity to spousal distress in the lab is associated with increased proinflammatory gene expression up to 80 minutes later, a risky pattern for health if repeated over time. Dr. Monin will examine actor and partner associations of affect and depressive symptoms among people with early-stage dementia and their spouses; the absence of partner associations suggests that emotional spillover may operate differently in early-stage dementia dyads. Dr. Novak will identify correlates of four latent profiles derived from couples’ physical, psychological, and relationship well-being: happy, healthy couples; unhappy, unhealthy couples; and two groups with blissful marriages despite individual problems. Dr. Amy Rauer, an internationally recognized scholar of relationships and health, will discuss ways in which this research advances our understanding of couples’ linked lives.
Effects of Late-Life Health Transitions on Spouses’ Psychological Well-Being
Authors: Martire Lynn , Zhaoyang Ruixue , Marini Christina
Published: December 2021

Declining physical health likely affects not only older adults’ own well-being, but also that of their spouse. Using two waves of data from 610 couples in the National Social Life, Health and Aging Project, we examined effects of health declines over five years on change in self and spousal psychological well-being. Actor-Partner Interdependence Model findings showed that declines in spouses’ physical health (i.e., increased pain and decreased physical and cognitive function) predicted increases in older adults’ anxiety. Given the increasing importance of later-life social ties outside of marriage, we further considered the role of non-spousal health confidants. Preliminary findings suggest that effects of health declines on both partners’ well-being depend on the availability of these confidants. When older adults have people in addition to their spouse with whom they can talk about their health, detrimental effects of spouses’ declining health on older adults’ well-being are weakened for some health outcomes
Older Americans Act Supports and Services: Adapting to the Pandemic
Authors: Gotwals Amy
Published: December 2021

This session provides insights into how the pandemic challenged the capabilities and ingenuity of the Older Americans Act (OAA) programs and the aging network. Speakers will include key aging network stakeholders, who will discuss the overnight evolution of programs serving often isolated older adults.
Integrative Analysis of Molecular and Physiological Data to Quantify Biological Aging
Authors: Belsky Daniel
Published: December 2021

Development of reliable and valid measurements to quantify biological aging is a critical frontier geroscience. Originating in accumulations of molecular changes, biological aging undermines resilience within cellular networks and organ systems, driving disease, disability, and mortality. Measurements of biological aging have been proposed at several molecular and physiological levels of analysis. But agreement between measures implemented at different levels of analysis is low. The timing at which aging processes manifest at different levels of biological organization may vary, with the result that signs of aging manifest in one level of analysis are not yet observable in another. And different aging processes may be most apparent in different molecular levels of analysis. In midlife humans, aging-related changes are manifest at multiple molecular and physiological levels, making this population ideal for development of measurements that integrate information across levels of analysis to more precisely quantify the state and pace of biological aging.
Neighborhood Greenspace and Cognition: The Cardiovascular Health Study
Authors: Godina Sara , Rosso Andrea , Lovasi Gina , Besser Lilah , Hirsch Jana , Platt Jonathan , Fitzpatrick Annette , Michael Yvonne
Published: December 2021

Access to greenspace has been positively associated with cognition among older adults, however prior research has been limited in temporal and geographic scope. We evaluated associations between neighborhood greenspace and incidence of dementia and change in cognitive functioning using a longitudinal sample of non-demented adults (n=2,465) from the Cardiovascular Health and Cognition Study. Percent greenness (1-km radial buffers) was derived from the National Land Cover Dataset. Cognitive function was measured using the Mini-Mental State Examination (3MSE) and dementia status was clinically adjudicated. Cox proportional hazard and logistics regression analyses were used to examine associations of baseline greenness with risk of incident dementia and risk of mild cognitive impairment, respectively. Generalized linear mixed models accounting for within-subject correlations were used to examine the association between greenspace in the neighborhood at baseline and 3MSE score (1991-1999). Ongoing results will be presented, along with modifiers and mediators of associations.
Breaking New Ground: Incentivizing Innovative Caregiving Programs
Authors: Whiting C Grace , Harvath Theresa
Published: December 2021

Caring for someone with chronic illness is a demanding job, and as a result 46% of caregivers caring for adults with chronic illnesses report a significant level of burden (AARP and National Alliance of Caregiving, 2015). Recent reviews note a prevalence rate of 31.2% for depression (Collins & Kishita, 2019) and 32.1% for anxiety (Kaddour & Kishita, 2020). In addition, most caregivers also report high levels of negative emotions including frustration, guilt, and a sense of hopelessness regarding the future (Schulz & Eden, 2016). This symposium will focus on innovative programming to address caregiver needs and concerns. The first presenter will set the foundation as she explores her caregiver journey and the issues she experienced as a caregiver. Using her personal experience, this healthcare professional will explore her interactions with the medical system as a caregiver, including the unique issues experienced during the pandemic. The second presenter will examine why are caregiver program needed, what benefits can be expected, and what is considered best practices when addressing the unmet needs of family caregivers in caregiver programs. The third and fourth presenters will discuss two exemplar caregiving programs - Caregiver Clinic at the Memorial Sloan Kettering Cancer Center and the Caregiver Initiative from the Rush University Medical Center. They will describe the program, the process of creation, funding, barriers experienced, and working solutions. Pertinent data regarding the integration of the programs within the medical systems, the programs scope, and the effects of the pandemic on the programs will be shared.
The Impact of Growth Mindset on Older Adults’ Cognitive Functioning in a Multi-Skill Learning Intervention
Authors: Sheffler Pamela , Kürüm Esra , Sheen Angelica , Ferguson Leah , Bravo Diamond , Rebok George , Strickland-Hughes Carla , Wu Rachel
Published: December 2021

Motivational factors, such as perceived control and self-efficacy, have been shown to affect older adults’ cognitive functioning. Growth mindset, the belief in the malleability of intelligence and abilities, represents a related but distinct factor that has been widely studied in children and young adults’ learning but less applied to the older adult population. Two studies investigated growth mindset, motivation, and cognitive functioning in a 3-month multi-skill learning intervention that incorporated weekly discussions on growth mindset and successful aging. Participants reported on their growth mindset, general pursuit of novel skill learning, and intrinsic motivation to learn, and completed a cognitive battery before, during, and after the intervention. Study 1 (n = 15, 67% female, M age = 68.67 years, SD age = 8.68, range 58-86) included both an experimental and control group and indicated that from pretest to post-test, intervention participants increased their growth mindset, while control participants did not. Study 2, which included a larger, all experimental sample (n = 28, 68% female, M age = 69.36 years, SD age = 7.00, range 58-86) revealed strong positive associations between growth mindset, pursuit of novel skill learning and intrinsic motivation. Further, participants showed a significant increase in growth mindset from pretest to post-test. Participants with higher pre-existing growth mindset showed larger cognitive gains at post-test, although growth mindset change did not affect post-test change in cognitive functioning. These findings suggest that growth mindset may facilitate older adults’ continued learning and cognitive gains, and they may complement older adult learning interventions.
Anti-Racism and Health Equity as Missing Values to Productive Aging: Implications for Emerging Professionals
Authors: Gonzales Ernest
Published: December 2021

Productive aging scholarship has grown in scope and rigor over the last four decades, yet anti-racism and health equity have not been formally integrated into the conceptual framework. Furthermore, there is a dearth of research that explicates heterogeneity among a growing diverse older adult population. This presentation will integrate anti-racism and health equity as core values to productive aging scholarship in order to explore risk and protective factors to employment, volunteering, and caregiving among a growing diverse older adult population. Part of this presentation will include major findings from longitudinal population-based studies as well as key findings from a Consensus Statement by the National Academies of Sciences, Engineering, and Medicine (NASEM) on work and retirement trajectories. Dr. Gonzales will also share professional strategies (e.g., grant submissions, publishing, teaching) with ESPO members who want to center anti-racism, health equity, and social justice in their scholarship.
Childhood Abuse and Caregiving for Perpetrating Parents: Impacts on Adult Child Well-Being
Authors: Goldberg Jaime , Kong Jooyoung , Moorman Sara
Published: December 2021

Combining the stress process model of caregiving and life course perspective, this study examined the long-term influences of childhood abuse on perpetrating parent-adult child relationships and adult child well-being in the context of caregiving. Using a sample of family caregivers from the Wisconsin Longitudinal Study (969 caregivers of mothers; 280 caregivers of fathers), we investigated whether contact frequency and emotional closeness with an abusive parent mediate the longitudinal effects of parental childhood abuse on adult child caregivers’ depressive symptoms and the moderating effects of self-acceptance and mastery on this mediational association. Key findings indicate that maternal childhood abuse may negatively affect emotional closeness between an adult child caregiver and perpetrating mother (b = -0.24, p < .001). This could lead the adult child caregiver to experience increased depressive symptoms (b = 0.02, p < .05). Although the mediation paths for the effect of maternal childhood abuse on depressive symptoms via emotional closeness with mothers did not differ by caregivers’ level of psychological resources, we found that psychological resources significantly moderated the association between maternal childhood abuse and depressive symptoms (b = -0.08, p < .05). Further research may explore this phenomenon in light of the heterogeneity of contemporary families. Practitioners working with adults with a history of parental childhood abuse who are caregiving for their perpetrator are encouraged to employ a trauma-informed approach to maximize the caregivers’ health and well-being.
Duration of Family Caregiving and Its Effects on Inflammation in the Caregiving Transitions Study
Authors: Roth David
Published: December 2021

Sustained caregiving for older adult family members with disabilities can be a chronically stressful experience that may adversely affect the health of caregivers. Systemic inflammation is thought to be one mechanism by which caregiving stress might impact health, but previous studies of inflammation in caregivers have generally found inconsistent or very small effects with questionable clinical significance when comparing caregiving and non-caregiving control samples. The Caregiving Transitions Study (CTS) enrolled 283 family caregivers and 283 carefully-matched controls from an ongoing national epidemiologic study. This population-based sample of caregivers included an unusual subsample of 32 long-term caregivers who had been providing care to the same care recipients for over 9 consecutive years. Analyses of covariance indicated that these 32 long-term caregivers had statistically significant (p < 0.05) elevations on three circulating biomarkers of inflammation – C-reactive protein, Interleukin-6, and D-dimer – compared 1) to their 32 individually-matched non-caregiving controls, and 2) to the 248 caregivers who had been providing care for less than 9 years. Covariates in the analytic models included age, sex, race, and body mass index. Similar effects were observed for caregivers of persons with or without dementia. Polynomial regression models across all caregivers revealed significant curvilinear associations of inflammation with caregiving duration. Inflammation was not markedly elevated throughout the first several years of caregiving but then begin to increase more dramatically at around 10 years of caregiving. These findings suggest that long-term caregiving, in particular, may be associated with specific physical health risks through chronically elevated systemic inflammation.
Virtual Geriatric Education Preferences of Rural Social Workers
Authors: Ilardo Joan , Haque Raza , Zell Angela
Published: December 2021

Older adults in rural communities need access to comprehensive healthcare services provided by practitioners equipped with geriatric knowledge and skills. The Geriatric Rural Extension of Expertise through Telegeriatric Service (GREETS) project goal is to use telemedicine and telehealth to expand geriatric service options to underserved Michigan regions. GREETS educational programs train health practitioners to provide geriatric care for vulnerable older adults. To determine gaps in geriatric competencies, the team conducted an online survey of health professionals including behavioral health practitioners. Respondents identified educational topics and preferred virtual delivery methods. Demographic information included respondent’s professional position, practice setting, and county. The respondents were asked to indicate level of educational need using a scale ranging from a low, medium, or high need. Fifty (47%) of 106 total responses were from social workers. We compared the percent of social workers to other practitioners’ responses in our analysis. Four topics emerged for both groups as medium or high educational needs: 1) transitional care when changing residential settings or post-hospitalization; 2) assisting family caregivers cope with caregiving responsibilities; 3) incorporating community-based services into care plans; and 4) and managing frail older adults. Social workers noted higher need than the other respondents for: 1) managing chronic pain; 2) managing care of patients with multiple chronic conditions; 3) having serious illness conversations; 4) diagnosing dementia; and 5) discussing advance care planning. Both social worker and other respondents indicated interactive case-based webinars; published tools, toolkits, tip sheets; and didactic webinars as their top three learning formats.
Reframing Older Adults’ Violence Toward Staff as Self-Protection
Authors: Shippee-Rice Raelene , Taylor Rosemary , Mistler Lisa , DiNapoli Pamela , Armenti Karla
Published: December 2021

One of the first studies on workplace violence in nursing homes was published in 1985. Forty-five (45) years later, resident violence against staff continues to increase in incidence and severity. At the request of a state senator, a New Hampshire psychiatrist formed a research group to conduct the first New Hampshire survey on staff experience of workplace violence. Study questions focused on experiences of workplace violence and incident reporting, and the availability and benefit of workplace violence training programs. Results were consistent with recently published literature: violence is an expected, normalized element when providing care; potential repercussions and perceived resident lack of intent were major reasons for incident non-reporting. Analysis of study results and review of the literature led to the question: Are older residents’ violent behaviors towards staff an act of self-protection?
Metformin Suppresses Monocyte Inflammation and Metabolic Reprogramming by SARS-CoV-2 Spike Protein
Authors: Pence Brandt , Cory Theodore , Emmons Russell , Yarbro Johnathan
Published: December 2021

COVID-19 disproportionately affects older adults, and a hallmark of the disease is a hyperinflammatory state that is associated with severity. Various anti-inflammatory therapeutics have shown mixed efficacy in treating COVID-19, and the mechanisms by which hyperinflammation occurs are not well understood. Previous research indicated that monocytes, a key innate immune cell, undergo metabolic reprogramming and produce inflammatory cytokines when stimulated with SARS-CoV-2. We hypothesized that binding by the viral spike protein mediates this effect, and that drugs which regulate immunometabolism – including the geroprotector drug metformin – could inhibit the inflammatory response in monocytes. Monocytes stimulated with recombinant SARS-CoV-2 spike protein subunit 1 showed a dose-dependent increase in glycolytic metabolism that was associated with production of pro-inflammatory cytokines including interleukin-6 and tumor necrosis factor-alpha. This response was dependent on hypoxia-inducible factor-1alpha, as chetomin inhibited glycolysis and cytokine production. Inhibition of glycolytic metabolism by 2-deoxyglucose (2-DG) or glucose deprivation also inhibited the glycolytic response, and 2-DG strongly suppressed cytokine production. Glucose-deprived monocytes rescued cytokine production by upregulating oxidative phosphorylation, an effect which was not present in 2-DG-treated monocytes due to the known effect of 2-DG on suppressing mitochondrial metabolism. Finally, pre-treatment of monocytes with metformin strongly suppressed spike protein-mediated cytokine production in monocytes, and abrogated glycolytic and mitochondrial metabolism. In summary, the SARS-CoV-2 spike protein induces a pro-inflammatory immunometabolic response in monocytes that can be suppressed by treatments that interfere with glycolytic activation, including metformin. This has potential implications for the treatment of hyperinflammation during COVID-19, which disproportionately affects older adults.
Maxwell A. Pollack Award Lecture
Authors: Pillemer Karl
Published: December 2021

The lecture will feature an address by the 2020 Pollack Award recipient, Karl Pillmer, PhD, FGSA of Cornell University. The 2021 Pollack Award recipient is Namkee G. Choi, PhD, FGSA, of the University of Texas at Austin. The Maxwell A. Pollack Award for Contributions to Healthy Aging Award recognizes instances of practice informed by research and analysis, research that has directly improved policy or practice, and distinction in bridging the worlds of research and practice.
Past, Present, and Future of Human Rights in Gerontological Education
Authors: Howe Judith
Published: December 2021

The rights of older persons, essential to our work as gerontologists, were discussed in the World Assembly on Aging (1982) and adopted through the United Nations Principles of Older Persons and followed by the Madrid International Plan of Action on Aging (MIPPA) in 2002. Although it has been endorsed by the General Assembly of the United Nations, in contrast to conventions, it is not binding on member states. This paper discusses the rights of older persons and our obligations as educators and researchers to focus on core issues associated with the rights and quality of life of older people. We will review the role of education in meeting this call to action through examples like the UN Decade of Healthy Ageing where education is a required element to accomplish the action areas and the Age-Friendly University movement. Both have involved multiple university communities on a global scale.