bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond Chronological Age: Frailty and Multimorbidity Predict In-Hospital Mortality in Patients With COVID-19
Authors: Zucchelli Alberto , Marengoni Alessandra , Vetrano Davide , Ferrucci Luigi , Fratiglioni Laura , Bernabei Roberto , Onder Graziano , Romanelli Giuseppe
Published: December 2021

Background: We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age. Methods: 165 patients admitted from March 8th to April 17th, 2020, with COVID-19 in an acute geriatric ward in Italy were included. Pre-disease frailty was assessed with the Clinical Frailty Scale (CFS). Multimorbidity was defined as the co-occurrence of ≥2 of these in the same patient. The hazard (HR) of in-hospital mortality as a function of CFS score and number of chronic diseases in the whole population and in those aged 70+ years were calculated. Results Among the 165 patients, 112 were discharged, 11 were transferred to intensive care units and 42 died. Patients who died were older (81.0 vs. 65.2 years, p<0.001), more frequently multimorbid (97.6 vs. 52.8%; p<0.001) and more likely frail (37.5 vs. 4.1%; p<0.001). Less than 2.0% of patients without multimorbidity and frailty, 28% of those with multimorbidity only and 75% of those with both multimorbidity and frailty died. Each unitary increment in the CFS was associated with a higher risk of in-hospital death in the whole sample (HR=1.3; 95%CI=1.05-1.62) and in patients aged 70+ years (HR=1.29;95%CI=1.04-1.62), whereas the number of chronic diseases was not significantly associated with higher risk of death. The CFS addition to age and sex increased mortality prediction by 9.4% in those aged 70+ years. Conclusions Frailty identifies patients with COVID-19 at risk of in-hospital death independently of age. Multimorbidity contributes to prognosis because of the very low probability of death in its absence.
Building a Model of Advocacy: Improving the Dementia Capability of Managed Care Health Plans in California
Authors: Hollister Brooke , Yeh Jarmin , Ross Leslie , Schlesinger Jennifer , Cherry Debra
Published: December 2021

Given the growing prevalence of Alzheimer’s Disease and related dementias, and the intensity of this population’s care needs, it is imperative that health plans (HPs) increase their dementia-capability. The Dementia Cal MediConnect (Dementia CMC) project proposes an innovative model of health care advocacy that can create dementia-capable systems change. The Dementia CMC project was a partnership (2013 – 2018) between local Alzheimer’s organizations and ten managed care HPs in California. It used the following model of health care advocacy: 1) Identify dementia-capable best practices to set as systems change indicators; 2) Identify and leverage public policies in support of systems change indicators; 3) Identify and engage champions; 4) Develop and advocate for a value and business case to improve dementia care; 5) Identify gaps in dementia-capable practices; 6) Provide technical assistance, tools, and staff training to address the gaps in dementia-capable practices; and 7) Track systems change. Systems change data was collected through participant observation with HPs and interviews with key informants. HPs reported making systems changes toward more dementia-capable practices such as: better pathways for identification and diagnosis; better identification, assessment, support, and engagement of caregivers; and improved systems of referral to Alzheimer’s organizations. Some indicators of systems change were inconclusive as a result of variability in HP practices and the lack of common record systems between HPs and providers. The application of this advocacy model has led to systems changes that can be replicated to improve care for people living with dementia and their caregivers.
Cognitive Impairment Trends Among Older Adults in a Medicaid Home and Community-Based Service Program
Authors: Fortinsky Richard , Robison Julie , Steffens David , Grady James , Migneault Deborah
Published: December 2021

Cognitive impairment (CI) is an important risk factor for nursing home admission, but little is known about CI among older adults in Medicaid HCBS programs. Racial and ethnic group CI disparities are found among community-dwelling older adults, but these CI trends have not been explored in Medicaid HCBS populations. In this study, we determined how CI is associated with older adults’ racial and ethnic group identification and educational attainment in Connecticut’s Medicaid HCBS program. The study cohort includes program enrollees age >65 during January-March 2019 (N=3,520). CI measures include: Cognitive Performance Scale (CPS), ranging from 0-8 (cognitively intact to very severe impairment); and a dichotomous measure incorporating Alzheimer’s disease or other dementia diagnosis (ADRD) and CPS score signifying moderate or severe CI. Study cohort characteristics: 75.7% female; age, mean(sd)=79.1(8.2); Non-Hispanic White=47.8%; Non-Hispanic Black=15.9%; Non-Hispanic Other=2.7%; Hispanic=33.6%; HS education=21.7%; mean(sd) CPS score=2.7(1.9); 36.1% with ADRD/high CPS2 score. In multivariate regression models adjusting for age and sex, CPS scores were not independently associated with race and ethnicity, and the likelihood of having ADRD/high CPS scores did not differ by race and ethnicity (all p-values >0.05). In these same models, persons with more than high school education had significantly lower CPS scores (b=-.12; p<.001), and significantly lower likelihood of having ADRD/high CPS scores (AOR=0.61; p<.001), than persons with less than high school education. We conclude that educational level is independently associated with CI, but race and ethnicity are not in this cohort. Policy and practice implications will be discussed.
Development and Formative Evaluation of a Death Education Program for Community-Dwelling Chinese Older Adults
Authors: Liu Mandong , Chi Iris
Published: December 2021

Planning for end-of-life (EOL) care in advance can enhance one’s quality of life at EOL. Culturally sensitive educational programs are needed in Chinese populations to enlighten the public and encourage advance planning due to a culture of death-denying and avoidance. This study describes the team’s efforts to develop and formatively evaluate a death education program designed for community-dwelling Chinese older adults. The program was designed based on the Knowledge-Attitude-Behavior Model, as a 2-session 3-hour program spreading over two days with 1.5 hours for each day. The content paid attention to discussing the importance of making plans for EOL in Chinese culture and discussing how to have death-related conversations with the family and health care professionals. In 2020, semi-structured interviews were conducted by phone with 12 health care professionals and researchers, and four Chinese older adults in China to obtain their feedback on program content and delivery. The directed content analysis method was used to analyze the data. Although they confirmed multiple challenges in conducting death education in China, such as family avoidance even if an older adult initiates the death-related conversation, health care professionals not feeling comfortable with such discussions, etc., they also felt the urgency and importance of delivering death education among older adults and in society as a whole. Detailed suggestions were categorized into relationship building, program preparation (e.g., setting, materials), multiple ways of recruitment, target population, length, various formats of content delivery, content (e.g., pay attention to spiritual care), and general support from the public.
Exploring the Role of Contextual Factors in Medicaid Nursing Homes' Performance: A Qualitative Perspective
Authors: Lord Justin , Ray Midge , Landry Amy , Lee Heather , Ivankova Nataliya , Herbey Ivan , Weech-Maldonado Robert
Published: December 2021

This study explored the role of tested contextual factors (structural, market, and management) in high Medicaid (under resourced) nursing homes performance. Four nursing homes in geographically diverse states were purposefully selected for site visits based on high and low performance (quality/ profitability) indicators. Eight nursing home administrators and directors of nursing, and twenty-one nursing staff (RNs, LPNs, and CNAs) and providers of support services were interviewed. Data were analyzed using an inductive thematic approach with NVivo 12 Plus. Within and across case analysis was used to compare participants’ perspectives across nursing homes and across administrators and staff. Several themes provide insight into varied influences of contextual factors on these nursing homes’ performance: focus on quality care, team-based approach, community support and engagement, and staffing retention. Providing quality care to residents was strategic priority in all facilities, which was enhanced by an adopted team-based leadership approach, open-door policy and home-like atmosphere. Community reputation and availability of local training opportunities for CNAs affected nursing staffing which some facilities addressed using creative retention strategies. These research findings will facilitate interventions, such as leadership training and organizational development activities, aimed at improving the performance of low performing facilities in terms of lower costs and better quality.
Injustice Squared? An Intersectional Lens to Research on Productive Engagement in Later Life
Authors: Matz Christina , Halvorsen Cal , Matz Christina
Published: December 2021

Social inequalities over the life course shape later life opportunities and outcomes in important ways. However, research on paid and unpaid work in later life has not always captured (and has sometimes mischaracterized) the variety and complexity of lived experiences in later life—in particular for low-income workers, workers of color, women, and others marginalized due to their social position. Further, statistics often obscure the most important information: how the most marginalized older workers are faring. Intersectionality, a term coined by legal scholar, Dr. Kimberlé Crenshaw, describes the overlapping and intersecting social identities that often influence how we move around in society. Some identities garner privilege and power and others oppression and marginalization; we must look at their intersection to better understand complexity and inform solutions. This symposium will apply an intersectional lens to research on paid and unpaid work in later life. The first paper is a scoping review that assesses the extent to which race and ethnicity are investigated in studies of the longitudinal association between workplace demands and cognitive health. The second paper explores how older Black and Hispanic adults’ work engagement is impacted by COVID-19. The third paper considers gender differences in volunteer engagement among Asian-American older adults. The final paper examines the Senior Community Service Employment Program’s role in participant financial, physical, and mental well-being. A discussant will reflect on these studies and the need for continued research that considers intersectionality in opportunities and experiences for paid and unpaid work in later life.
A Mixed-Methods Approach to the Examination of Cancer Treatment Preferences Among Older Latino Adults
Authors: Carrion Iraida , Neelamegam Malinee , Estape Tania
Published: December 2021

Given the growing population of Latino immigrants 60 years and older and the current lack of relevant data, there is an urgent need to understand this population’s cancer treatment preferences to ensure effective interventions and psychosocial care. A study comprising 200 surveys with areas focused on cancer knowledge, attitudes, prevention, early diagnosis, and treatment was developed and administered in Spanish. The survey included a qualitative component consisting of open-ended questions. The mixed-method study gathered quantitative data regarding treatment preferences as well as the voices of older Latino men and women with a history of cancer, including their cancer treatment trajectory. Additionally, the survey data highlighted the lack of knowledge regarding available cancer treatments. The findings suggest that, while older Latino/as have knowledge about the causes of cancer, they lack knowledge regarding cancer diagnoses, which could potentially cause them to avoid treatment.
Using Conversation Analysis to Examine When Educational Videos Are Introduced in Patient Education
Authors: Halpin Sean , Konomos Michael , Roulston Kathryn
Published: December 2021

As the seas of advanced therapies have swelled in the last few decades, multiple myeloma patients have been empowered, encouraged, and sometimes required, to engage in their care. We applied a conversation analysis approach to 12 nurse-led education visits (1011 minutes of audio) containing reference to educational videos. We indexed extracts based on whether the nurse or patient first mention the video. Patients oriented toward the video to demonstrate knowledge (n=15; 88%) and clarify information (n=2; 12%). Nurses oriented toward the video either through positive (n=14; 39%), negative (n=13= 36%), or neutral (n=9; 25%) assessments. Videos created opportunities for patients to pursue their topics of interest during in-person visits. Also, nurses often oriented toward the videos pre-emptively to achieve their teaching goals either by acknowledging the patients’ exposure to upcoming information or by positively or negatively assessing the videos in ways that enable them to re-orient talk to educational scripts.
Physical Activity and Social Relationships on Social Engagement Among Community-Dwelling Older Adults
Authors: Hou Su-I
Published: December 2021

This study examined physical activity (FITNESS) and social relationships (FRIENDS) on social engagement among community older adults. Members from two Florida aging-in-village programs participated. Three five-Likert scales were used: A 5-item FITNESS (weight, endurance, strength, flexibility, health), 4-item FRIEND (family, friends, neighbors, communication), and a 3-item social engagement scales (social-leisure activities, stay involved, healthy independent) (Cronbach alphas: .82~.92). Among the 96 participants, 79% were females, 91% were whites, 56% were married, 86% had college education, and 46% living alone. Mean age was 70.7 (SD=10.10). Participants reported at least 30-min. physical activity about 4.2 days per week. Overall social engagement was high (mean=4.38), FITNESS was median (mean=3.46), and FRINED was high (mean=4.19). FITNESS was significant to more 30-min. physical activity. Yet, higher FITNESS, FRIENDS, age, and volunteers were all significant to social engagement. Results has implications on promoting social engagement among older adults participating in aging-in-community programs.
The Importance of Social Support Networks on Mental Health Status of Custodial Grandparents
Authors: Whitley Deborah , Lee Youjung , Xu Yanfeng
Published: December 2021

This symposium presents a collection of papers that examine the concept of social support and its effect on custodial grandparents’ (CG) mental health state. Each paper explores a different perspective about grandparents’ access to and/or use of social support networks and mental health outcomes; several papers view social support within the context of the COVID-19 pandemic. Nadorff and colleagues explore social support by middle-generation family members and its effects on grandparents’ stress and depressive symptoms. Musil and colleagues report on psychosocial and social support predictors of self-appraised healthcare and financial security by CG during the Covid-19 pandemic. Whitley and Kelley describe current social networks relied upon by a preliminary sample of CG while managing the daily stresses and strains associated with COVID-19 and its restrictive mandates. The final two papers report the use of specialized technology and support services delivered to homebound CG during the COVID-19 pandemic. Lee and colleagues describe a telemental health model using Solution-Focused Brief Therapy to serve socially isolated grandparents experiencing mental health distress as during the pandemic. Mendoza and Park report on program challenges and outcomes of implementing a support service for grandparents living under COVID-19 restrictions. The highlights of the papers will be discussed by Yanfeng Xu and give attention to the ways scholars and practitioners can build upon these works to maximize the mental health outcomes of CG, while managing to live in socially restrictive and challenging environments.
Perceived Accomplishment in Later Life: The Influence of Past Decisions Between Family and Work
Authors: Park Jeongsoo , Larkina Marina , Smith Jacqui
Published: December 2021

Whereas previous studies have investigated life regrets, little attention has been paid to the important accomplishments older adults include in their autobiographic life narratives. Phenomenon such as the memory positivity effect suggest that accomplishments should be observed. We used a Health and Retirement Study 2017 Life History Mail Survey (N = 2,165) to examine the characteristics of participants over age 65 who reported accomplishments (max = 3), what was reported, and whether early-life decisions about balancing family and work are associated with the reports. Women, whites, and people with at least high school education and normal cognitive status were more likely to report accomplishments (67%). We categorized reports as family-related (39%), personal (19%), combined family/personal (25%) or other (16%). Multinominal logistic regression models revealed that participants who themselves favored family over work in early life or whose spouse decided for family, were more likely to report family-related accomplishments.
Bridging the Family Care Gap
Authors: Gaugler Joseph , Schulz Richard
Published: December 2021

This symposium aims to create a scientific and policy roadmap to offset the impending shortage of family caregivers available to assist older adults in the U.S. (i.e., the “family care gap”). Drawing on public health, cultural frameworks, family care science, and policy analysis, this symposium will orient future research, intervention development, dissemination and implementation, and policy innovation to more effectively address the family care gap. The selected presentations will include the need to apply and understand cultural adaptation and humility to support a rapidly diversifying older population (Drs. Nkimbeng and Parker). In addition, systematic review methodology will be applied to obtain insights as to what intervention models/strategies actually reduce caregiving time (Drs. Baker, Jutkowitz, and Gaugler). The next presentation will leverage the existing evidence base of translational efforts that aim to disseminate and implement dementia caregiver interventions into practice (Drs. Hodgson and Gitlin). The final presentation of our symposium will focus in-depth on a potential solution to the family care gap: more systematic approaches to identifying and assessing family caregivers in healthcare systems (Drs. Riffin and Wolff). Our discussant, Dr. Richard Schulz, will bring his extensive and renowned experience in caregiving to summarize the public health and policy implications of the family care gap.
Diverse, Culturally Rich Approaches to Family Care in the United States
Authors: Nkimbeng Manka , Parker Lauren
Published: December 2021

Despite the projected rise in the diversity of caregivers and caregiving in the US, the health system is not prepared to accommodate this growth. Interventions and supports often are not adequately tailored to meet the cultural needs of older adults. Additionally, the limited interventions available for racial/ethnic minority populations frequently fail to capture and report culturally tailored perspectives. Therefore, the purpose of this presentation is to describe how culture influences caregiving in the US. Specifically, it will: (1) provide a contemporary definition of culture; (2) identify cultural domains that impact caregiving; (3) offer examples of how caregiving is influenced by different cultural/demographic backgrounds; (4) provide examples of culturally tailored caregiving programs, and (5) discuss how to approach cultural needs that may not be addressed by current interventions.
Race and Ethnic Group Differences in Social Engagement Among Older Adults
Authors: Quach Lien , Nguyen Uyen-Sa , Pham Van , Burr Jeffrey
Published: December 2021

Social engagement is considered crucial for older adults’ well-being, generating social capital, connecting them to information about healthy lifestyles, and providing coping strategies for addressing daily challenges. Little is known about race and ethnic disparities regarding social engagement. This study examines the relationship between race, Hispanic ethnicity, and social engagement among community-dwelling adults age 65 or older. Data are taken from the Health and Retirement Study (2014) (n=6,221). Race and ethnic status are measured as: non-Hispanic white, non-Hispanic black, non-Hispanic “Asians and other race,” and Hispanic (any race). Social engagement includes frequency of contact with friends and family and participation in social activities (e.g. volunteering and attending religious services). Covariates included age, sex, education, number of co-morbidities, and alcohol consumption. Linear regression analyses were performed using SAS 9.4. The mean age was 74.6, and sixty percent of the sample was female. Race and ethnic distribution were 78.6% non-Hispanic white, 11.9% non-Hispanic black, 7.89% Hispanics, and 1.7% non-Hispanic “Asians and other race.” The mean score for our social engagement index was 3.3 (range 0-6). Hispanic persons, Asian persons, and persons from other race groups had lower social engagement compared with non-Hispanic white persons [β:-0.29, p<.0001; β:-0.27, p=0.04 respectively), after adjusting for covariates. These race and ethnic group differences in social engagement likely contribute to well-document health disparities in later life. Understanding racial and ethnic disparities in social engagement and the factors that create these differences can help identify appropriate social intervention programs regarding improving the well-being of all older adults.
Older Adults and Family Discord or Violence During the COVID-19 Pandemic: Results of a Canada-Wide Survey
Authors: Gutman Gloria , de Vries Brian , Beringer Robert , Gill Paneet , Dault Helena , Karbakhsh Mojgan
Published: December 2021

Child abuse and intimate partner violence rates are known to increase during and in the aftermath of disasters. Research on elder abuse during disasters, including the current pandemic, is limited. As part of an online survey that explored older Canadians’ current experiences and future care plans during the COVID-19 pandemic, we aimed to determine the prevalence, contributing factors and potential outcomes of frequent family discord involving physical violence (FFD/PV) as a proxy for elder abuse. The survey was conducted between Aug 10 and Oct 10, 2021. Respondents (n=4380) were recruited using social media, direct email, Facebook advertising and with the assistance of 85 local community, regional and national organizations. The sub-sample reporting FFD/PV (n=76, 1.8%) was compared with other survey respondents regarding socio-demographic characteristics, negative and positive emotions, difficulty accessing basic needs, food, health care and support. Respondents experiencing FFD/PV were found to be significantly younger and less educated and were more likely to be non-white and not working than other respondents. The subgroup sustaining FFD/PV reported significantly higher rates of feeling depressed, lonely, isolated, anxious, sad, and judged/shamed and felt less happy, relaxed and accepted in their community. They also reported higher rates of challenges in accessing basic material needs such as food, support, medical care, mental health treatment and experienced more changes in life routines. Although only a small percentage reported FFD/PV, our results highlight a disturbing pattern that merits serious attention of adult protection agencies, seniors' advocates and disaster response organizations.
VA Problem-Solving Training During COVID-19 for Clinicians of Patients With Complex Comorbidities
Authors: Beaudreau Sherry , Otero Marcela , Walker Jessica , Gould Christine , Wetherell Julie
Published: December 2021

To address the shortage of mental health providers in geriatrics, VA has implemented clinician training in a VA Problem Solving Training (PST) protocol adapted to the needs of mostly older patients with complex comorbidities. This presentation will summarize PST implementation adaptations during COVID-19, and compare Veteran treatment outcomes before (2019) and during COVID-19 (2020). Sixty-one clinicians attended a workshop and small-group consultation for two training cases. Consultants provided ongoing feedback to program leadership about pandemic-related implementation challenges. Program adaptations during COVID-19 addressed challenges related to delivering treatment by telephone, video, or in-person and recruitment barriers. Veterans in both cohorts (N = 122) had significant reductions in mental health symptoms from baseline to posttreatment in paired t-test comparisons (ps < .01). Flexibilities afforded to clinicians in the training during the pandemic did not diminish the effectiveness of the intervention, thus supporting continued implementation of the training program with added flexibility.
Aligning to a New Normal During COVID-19
Authors: Munoz Lizette
Published: December 2021

The Acute Life interventions Goals and Needs Program (ALIGN) is an inter-professional team of medical and social work providers dedicated to offering time-limited intensive ambulatory care to the most complex, high cost, high needs older patient population at Mount Sinai Hospital in NYC. During the 2020 COVID19 pandemic, ALIGN pivoted to focus on emergency planning actions. Such actions included language and culturally concordant goals of care discussions with patients and family, completion of electronic Medical Orders for Life Sustaining Treatment, reassessment of patient’s social determinants of health, determination of adequate access to food, medication, and emotional support to those alone and isolated, and assistance with video telemedicine. ALIGN’s model of care has shown how adaptable this program and others were during the height of the pandemic.
Feasibility and Acceptability of Tele-Enhance Fitness in Older Adults With Knee Osteoarthritis
Authors: Patel Kushang , Hoffman Elise , Simon Neta , Gell Nancy
Published: December 2021

Enhance Fitness (EF) is an evidence-based, group exercise program for older adults. When COVID-19 halted in-person EF classes nationally, we adapted EF for remote delivery (tele-EF) by engaging key stakeholders. To determine feasibility and acceptability of tele-EF, we conducted a mixed methods study among 42 older adults (≥65 years) with knee osteoarthritis. Participants attended EF classes for 1-hour, 3 days/week for 4-5 months (1-3 months in-person EF and 2-4 months in tele-EF). Attendance for in-person EF was 80.0% versus 91.0% for tele-EF. Nearly all participants (95.2%) reported that they were satisfied or very satisfied with tele-EF. Qualitative exit interview data mapped well onto Social Cognitive Theory constructs. With tele-EF, participants found that livestream classes facilitated accountability and self-efficacy to participate in exercise and that interactive instruction provided encouragement and support to exercise. Thus, tele-EF is a viable remotely-delivered exercise program for older adults that retains many features of in-person EF.
Nurse Staffing in Nursing Homes During Hurricane Irma
Authors: Jester Dylan , Thomas Kali , Peterson Lindsay , Dosa David , Andel Ross , Hyer Kathryn
Published: December 2021

Little is known about the effect of hurricanes on nurse staffing in nursing homes. Hurricane Irma made landfall on September 10th, 2017 in Florida. This study examined daily nurse staffing levels from September 3rd-24th, 2017 in 653 nursing homes; 81 facilities evacuated and 572 facilities sheltered-in-place. Data from Payroll-Based Journaling (PBJ), Certification and Survey Provider Enhanced Reports (CASPER), and Florida’s health providers’ emergency reporting system were used. Among all facilities, we found significant increases in staffing for licensed practical nurses (p=.02) and certified nursing assistants (p<.001), but not for registered nurses (p=.10) before Hurricane Irma made landfall. In comparison to facilities that sheltered-in-place, evacuating facilities increased staffing levels of all nurse types (all p<.001). From one week before landfall to two weeks after landfall, an additional estimated $2.41 million was spent on nurse staffing. Policymakers attempting to reduce the burden of natural disasters on nursing homes should reimburse staffing-related expenses.
Excess Mortality Attributed to Hurricane Irma Among Assisted Living Residents With Chronic Conditions in Florida
Authors: Hua Cassandra , Thomas Kali , Peterson Lindsay , Dobbs Debra , Andel Ross , Dosa David
Published: December 2021

Little is known about the impact of hurricanes on residents in assisted living communities (ALs), especially among individuals with chronic conditions that increase their risk of death after storms. We examined how the association between exposure to Hurricane Irma in 2017 and mortality differed by select chronic conditions. With Medicare data, we identified cohorts of AL residents in 2015 (n= 30,712) and 2017 (n= 29,842 ) and compared their rates of 30-day and 90-day and mortality. We adjusted rates for demographic characteristics and other comorbidities. AL residents with diabetes were at highest risk of death after the storm; between 2015 and 2017 they experienced a 50% increase in their 30-day mortality rates (0.6% in 2015, 0.9% in 2017) and a 43% increase in their 90-day mortality rates (2.1% in 2015, 3.0% in 2017). Policy makers should consider strategies to ensure that diabetic residents maintain continuity of medical care during disasters.
Awareness of Balance as an Intraindividual Dynamic of Objective and Subjective Experiences of Fall Risk in Daily Life
Authors: Meija Shannon , Su Tai-Te , Griffin Aileen , Washington Faith , Fanning Jason , Sosnoff Jacob
Published: December 2021

Falls are life-changing events in older adulthood. With an accurate understanding of balance, older adults can adapt to age-related changes in physical ability without prematurely restricting physical activity. The Daily Balance Project examines the implications of older adults’ awareness of fall risk in daily life. For 30-consecutive days, following a fall-risk assessment, 40 older adults used a smartphone to report balance confidence and then perform four balance assessment and a 30-second sit-to-stand task to measure postural sway and fall-risk. Measures of postural sway showed greater intraindividual variability than balance confidence and fall risk. Multilevel models showed that awareness of balance fluctuated during the study and varied across individual differences in baseline fall-risk. Baseline fall risk also differentiated how balance confidence and postural sway were linked to subsequent momentary fall risk assessments. The findings are discussed within the framework of action-perspectives of adult development and awareness of aging.
Gender Differences in Well–Being Among People Age ≥ 50 in Medication-Assisted Treatment for Opioid Use Disorder
Authors: Angelo Sahil , Mitchell Mary , Perkins Molly , Bender Alexis
Published: December 2021

The impact of Adverse Childhood Experiences (ACEs) on the physical and mental well–being of older adults with Opioid Use Disorder (OUD) is unclear, and we know even less about gender differences. This study explores this association and investigates additional factors (e.g., pain, depression) that may affect physical and mental well–being in this population with a focus on gender. The sample for the present analysis includes 90 adults aged 50 and older from a larger study focused on aging with OUD across eight opioid treatment programs in Georgia. We performed multivariable linear regression analyses by gender. There was a small, but significant, association between ACEs and mental well–being for men only. Other significant predictors of physical and mental well-being (e.g., insurance status, pain, satisfaction with social role, stigma) varied by gender. We discuss the importance of these gender differences in identifying appropriate areas for intervention to improve physical and mental well–being.
Acceptance and Commitment Therapy and Exercise: Can They Help Older Adults Manage Chronic Pain?
Authors: Leung Dara K Y , Fong Annabelle P C , Kwok Wai-Wai , Shum Angie K Y , Liu Tianyin , Wong Gloria H Y , Lum Terry Y S
Published: December 2021

Chronic pain is common among older adults and affects their physical and psychological well-being. While exercise can reduce pain and promote physical functions, psychological interventions may enhance pain management by addressing the psychosocial contributors to the prolonged pain. Acceptance and Commitment Therapy (ACT) is a psychological intervention that emphasizes on psychological flexibility, values, and mindfulness. This approach may be particularly helpful in dealing with chronic pain, where symptoms can be beyond one’s control. This single group pre-post study investigated the feasibility and efficacy of an intervention combining ACT and exercise for chronic pain management in older adults. The intervention consisted of 16 sessions delivered over eight weeks. ACT and exercises were modified according to the individual’s capability when needed. Clinical outcomes regarding pain severity and interference, pain acceptance, value of life, depression, anxiety, and physical functioning were assessed. Twenty-four older adults attended all sessions and completed the assessments. Preliminary results showed that, while participants experienced similar level of pain after the intervention, they reported less pain interference on mood and enjoyment of life, and improved chronic pain acceptance, pain self-efficacy, success at living their values, committed action, depressive symptoms, physical functioning in the lower body strength, aerobic and endurance, agility and dynamic balance, and upper body strength (all p<.050). This study lends support to the feasibility of a combined ACT and exercise intervention for chronic pain management in older adults. The efficacy of ACT may not be directly on reducing pain, but on increased psychological flexibility to co-live with pain.
Senior Centers and LGBT Participants: Engaging Older Adults Virtually in a Pandemic
Authors: Marmo Suzanne , Pardasani Manoj , Vincent David
Published: December 2021

Upon the outbreak of COVID-19, recommendations to cease all non-essential in-person social services were mandated across the United States to prevent transmission to non-infected individuals. As a result, approximately 96% of all senior centers in the United States were closed to in-person programming (National Council on Aging, 2020). LGBT older adults in particular were at higher risk of isolation and declines in overall health as they were more likely to live alone, experience loneliness or have less immediate family support systems when compared to non-LGBT older adults (Yang, Chu & Salmon, 2017). The purpose of this presentation is to explore how LGBT older adult participants in senior centers transitioned to virtual programming during the pandemic. Using a risk-resiliency theory framework, the purpose of this presentation is to share the impact of virtual programming on the health and well-being of LGBT community-dwelling older adults. An exploratory, cross-sectional study was conducted utilizing an online survey to understand their needs, concerns and experiences. Participants reported a relatively easy adaptation to technology, steady participation in programs and services, satisfaction with virtual senior center programming and a consistent sense of engagement with their peers. Higher levels of engagement with senior center programs were associated with greater perceptions of social support. Additionally, stronger perceptions of social support and participation in exercise and fitness programming were associated with higher life satisfaction and lesser symptoms of depression and anxiety. Strategies for outreach, engagement and service provision will be presented.
STEP-HI Study: A Multimodal Intervention of Exercise and Testosterone Therapy: Design and Real-World Challenges
Authors: Binder Ellen , Magaziner Jay
Published: December 2021

Hip fractures are common among older women and can have a devastating impact on their ability to remain independent. Many women who were high functioning before the hip fracture do not return to their pre-fracture level of function, have persistent weakness and mobility impairments, and may require ongoing supportive services. Age-associated androgen deficiency may contribute to deficits in muscle mass, strength and power that are common in older female hip fracture patients. The Starting a Testosterone and Exercise Program after Hip Injury (STEP-HI ) Study is a three-group, randomized, double-blinded, placebo-controlled Phase III clinical trial designed to evaluate a multi-modal intervention aimed at improving functional outcomes in older female hip fracture patients. 168 female hip fracture patients, age 65 yrs. and older are being recruited from 6 clinical sites in the USA. Participants are being assigned to one of three groups: supervised exercise (EX) plus 1% testosterone topical gel; EX plus placebo gel; or enhanced usual care. The primary outcome is six-minute walk distance. This symposium will present information related to key aspects of the design of the STEP-HI trial, including recruitment of a frail patient population during a period of injury recovery, the testosterone and exercise interventions and related fidelity procedures, and implementation challenges for this multi-modal intervention prior to and during the COVID-19 pandemic. In addition, the underlying mechanisms by which testosterone and exercise are expected to have a synergistic effect on muscle strength and function will be discussed.
Expression of Emotions and Genes: Proinflammatory Gene Expression Rises With Spousal Distress
Authors: Wilson Stephanie , Cole Steven , Shrout M , Kiecolt-Glaser Janice
Published: December 2021

Marital quality shares ties to inflammation-related conditions like cardiovascular disease and diabetes. Lab-based studies implicate hostility during marital conflict as a mechanism via inflammatory reactivity. However, developmental theories suggest that conflict declines with age. Spousal distress is an important but overlooked context for aging couples as networks shrink and assistance needs increase. To examine the effects of spousal distress on changes in proinflammatory gene expression, 38 adults ages 40-81 witnessed their spouse relive an upsetting personal memory aloud, rated their mood before and after, and provided blood samples at baseline and twice post-task. Those whose negative mood increased more in response to spousal disclosure showed larger elevations in proinflammatory gene expression 40 (p=.022) and 80 minutes (p<.0001) after the task. Effects were robust to race, gender, age, alcohol, smoking, and body mass index. These novel findings identify spousal distress as a key marital context that may escalate inflammation-related health risks.
Orofacial Pain Symptoms Among Chinese Older Adults in the Last Year of Life
Authors: Pei Yaolin , Qi Xiang , Chen Xi , Wu Bei
Published: December 2021

The aims of this study were to examine the prevalence of orofacial pain symptoms and its associated factors in Chinese older adults in the last year of life. We retrospectively followed 1,646 participants (60 years or older) in the last year of life to death from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The 6-month prevalence of toothache and jaw joint pain or facial pain for older adults in the last year of life to death were 14.1% and 4.5%, respectively. Older adults who had lower socioeconomic status, were smokers, and had any chronic disease tended to have orofacial pain symptoms. This study generated interesting but counterintutive findings that Chinese older adults who brusehed their teeth at least daily and those who had at least one natural teeth were more likely to have orofacial pain. It is important to include dental care as a part of end-of-life medical treatment.
Shared Decision-Making and Colorectal Cancer Screening Behaviors Among Older Adults With Low Health Literacy
Authors: Cadet Tamara , Halmo Rebekah , McDonold Siobhan , Schonberg Mara
Published: December 2021

National guidelines recommend adults >75 engage in shared decision making (SDM) around colorectal cancer (CRC) screening because of the uncertain benefit to risk ratio. There are no decision tools to support CRC decision making for adults >75 years with low health literacy (LHL). The purpose of this mixed-methods study was to better understand the perspectives of adults >75 with LHL on SDM around CRC screening and to obtain their feedback on an existing higher literacy CRC decision aid. Utilizing the Brief Health Literacy Screening Tool to identify participants with LHL, semi-structured interviews were conducted with 30 adults. Findings indicate that 80% of participants were non-Hispanic Black and 42% had < high school degree. 76% felt they would benefit from CRC screening despite their age. Themes related to CRC screening included lack of knowledge of options and harms, but a desire to understand more to better take care of their health.
National Cancer Institute's Cancer and Aging Priorities
Authors: Guida Jennifer
Published: December 2021

Modern improvements in cancer detection and treatment coupled with the implementation of population-based cancer prevention and control strategies have contributed to a sustained decline in overall cancer mortality rates. Although this trend is promising, challenges at the nexus of cancer and aging are, in turn, becoming more prominent. Older adults (age 65 years and older) are the largest growing segment of the U.S. population, and aging into older adulthood is disproportionally associated with the incidence of common cancers. Many survivors of childhood cancer will live for decades after cancer treatment and mature into older age. Strategic investments in aging research will contribute to population health by preserving or improving healthspan and ensuring equitable access to – and benefit from – advances in cancer prevention, control, and population science. This presentation will describe ongoing cancer and aging efforts at the National Cancer Institute, including programmatic priorities and current funding opportunities.
The New Faces and New Places of Geroscience
Authors: Sierra Felipe
Published: December 2021

The field of geroscience is rapidly evolving, as well as expanding worldwide. The Program will highlight new approaches and players in the field. Notably, geroscience was initiated as an effort to improve recognition of the role played by basic aging biology in our efforts to improve the health of older adults. Substantial recognition by multiple players of that role of basic aging biology have resulted in significant interest on the part of clinicians and translational biology practitioners. The program will highlight examples of hand-picked efforts in industry and academia, both in the US and in Europe, and will bring into the same stage researchers interested in the various facets of geroscience, from basic biology, translation, clinical and, ultimately, industry viewpoints.
The Rise and the Death of Senescent Cells: From Mechanisms to Interventions
Authors: Demaria Marco
Published: December 2021

Aging is at the root of age-related diseases and therapies targeting basic age-associated mechanisms have the potential to extend healthy lifespan. A common feature of older organisms is the accumulation of senescent cells – cells that have irreversibly lost the capacity to undergo replication. Senescent cells are characterized by an irreversible cell cycle arrest and by the Senescence-Associated Secretory Phenotype (SASP), which include many tissue remodeling and pro-inflammatory factors. Senescent cells are intermittently present during embryogenesis and in young organisms. On the contrary senescent cells accumulate and persist in aging tissues. Significantly, these persistent senescent cells can drive low-grade chronic inflammation, and their genetic or pharmacological elimination is sufficient to delay a number of diseases and to improve health span. Here, I will discuss the mechanisms by which senescent cells can promote tissue aging and dysfunction and the potential of targeting senescent cells to delay human aging.
Exploring Social and Assistive Domestic Robots for Older Adults: Robot Sociability, Trust, and Acceptance
Authors: Kadylak Travis , Bayles Megan , Rogers Wendy
Published: December 2021

Older adults prefer to age in place, to live independently while maintaining social connection and engagement with the community. Though older adults can encounter barriers to these goals, social and assistive domestic robots hold promise for promoting independence and online/offline social engagement. However, social robots must be designed to meet their needs and preferences. Open questions remain regarding how to facilitate the development of trust and acceptance in robot support. We investigated the associations between robot social characteristics, sociability, trust, and acceptance for instrumental activities of daily living. We used an online survey to assess older adults’ perceptions towards social and assistive robots. Robots with more social abilities were rated as more acceptable and trustworthy across different task types. We discuss design implications that may promote the development of robot trust and acceptance by older adults, and ultimately help enable aging in place and social engagement.
The Vertical and Horizontal Relations of Korean and Korean American Older Adults and Their Well-Being
Authors: Kim Meeryoung , Park Nan Sook , Hong Michin
Published: December 2021

Various relationships are important for the well-being of older adults. This session focuses on the vertical and horizontal relations of Korean and Korean American older adults and their well-being. The purpose of this session is to highlight the importance of intergenerational relations and social involvement of Korean and Korean American older adults. For vertical relations, two studies focus on intergenerational relationships and solidarity. The first study investigated whether intergenerational relationships and social support mediate the distressing consequences of life events, and how this improved the psychological well-being of Korean older adults. The second study developed a standardized measurement tool for intergenerational solidarity because intergenerational conflicts caused by rapid socioeconomic changes have highlighted the importance of strengthening intergenerational solidarity. The third and fourth studies focus on horizontal relations involving social isolation and social involvement. Guided by the double jeopardy hypothesis, the third study examined the health risks posed by the coexistence of social and linguistic isolation in older Korean Americans. As the opposite of social isolation, social involvement was an important factor of social integration of older adults. The fourth study examined volunteering as an example of social involvement by focusing on older adults’ volunteering on the social integration and role identity. Implications of this study suggest not only the importance of social involvement but also the intergenerational relationships on older adults’ well-being.