bluuebunny/crossref_metadata_2025 huggingface dataset:
Adapting Psychotherapy for Comorbid Substance use and Bipolar Disorder in Older Sexual Minorities: A Case Study
Authors: Morehouse Sarah Nanami , Stripling Ashley , Brunson Kirenia , Maccarrone Jodie , Choe Jessica , Garcia Julian , Boston Nicholas
Published: December 2021

Approximately 65 to 95% of individuals with bipolar disorder (BD) are diagnosed with an additional psychiatric condition (Kessler, 1999). Alcohol, the most commonly abused substance amongst individuals with BD (Xiao et al., 2016), has been linked to significant increases in suicide attempts, disability, hospitalizations, and mortality (Baldessarini et al., 2008; Goldberg et al., 1999; Mitchell et al., 2007; Nery & Soares, 2011). Despite these ill effects, little is known about how to effectively treat, or adapt existing treatment appropriately, for the growing numbers of individuals who are dually diagnosed with BD and alcohol use disorder (AUD) and hold the identity of lesbian, gay, bisexual, transgender, or queer (LGBTQ) in late life. Thus, the purpose of this study is to demonstrate how treatment was adapted to a self-identified gay man with comorbid BD and AUD from a relational, culturally sensitive perspective while simultaneously implementing two short-term interventions: cognitive behavioral therapy (CBT) and a behavioral substance use program. In line with Knight & Poon’s (2008) Contextual Life Span Theory for Adapting Psychotherapy with Older Adults (CALTAP) and a multicultural lens that incorporates relevant research on older LGBTQ individuals, modifications were made to the content, structure, language, and duration of therapy while cultivating a safe and empathic space. Idiographic data and progress monitoring measures suggests treatment resulted in substance use and distress reduction, as well as mood stabilization. However, additional booster sessions may be advantageous given the risk for substance abuse relapse and the compounding effect it may exert on persons with BD.
Age Differences in the Association Between Cardiovascular Disease, Depression, and Suicide Risk
Authors: Cui Ruifeng , Shalaby Alaa , Rotondi Armando , Albright Amy , Callan Judith
Published: December 2021

Cardiovascular disease (CVD) is prevalent among older adults aged 60+ (75%). The literature shows a strong bidirectional association between risk for CVD and risk for depression, although there is limited research regarding whether the strength of this association differs by age. CVD may also be related to suicide risk; however, the literature is both limited and mixed, with studies inconsistently finding an association. Additionally, no known studies have investigated age differences in this relationship. The present study examined the association between CVD (assessed via diagnostic checklist), depression (PHQ-8), and suicide risk (SBQ-R), as well as whether these associations differed by age. The current sample consisted of 301 younger adults (aged 18-40) and 432 older adults (aged 60+) recruited online through Mechanical Turk (younger adults: 78.1% white, 46.5% female; older adults 91.4% white, 56.3% female). Older adults had more CVD diagnoses (M=0.9) than younger adults (M=0.3). The association between CVD (i.e., 1+ CVD diagnoses vs. 0 diagnoses) and mental health was moderated by age (depression interaction p<.001; suicide risk interaction p=.033). Among younger adults, presence of CVD diagnosis was associated with 85% higher depression symptoms (M=6.1 vs 11.3) and 48% higher suicide risk scores (M=5.8 vs 8.6) when compared to no diagnoses. CVD had less of a negative impact among older adults and was associated with 64% higher depression symptoms (M=3.1 vs 5.1) and only 14% higher suicide risk scores (M=4.3 vs 4.9). Providers treating CVD may consider assessing and addressing depression and suicide risk, especially among younger patients with CVD.
Collection of free-living accelerometry data in large clinical studies before and during the COVID-19 pandemic
Authors: Urbanek Jacek , Matsushita Kunihiro , Kaplan Robert , Coresh Josef , Schrack Jennifer
Published: December 2021

The recent COVID-19 pandemic had a substantial impact on clinical research, including recruitment and follow-up visits in new and ongoing studies, especially affecting ones focused on older, at-risk adults. As the objective assessment of physical activity with wearables is usually initiated during in-person visits, the collection of these data experienced substantial, unplanned gaps. We report the frequency of data collection (visits-per-month) in studies collaborating with the Accelerometry Resource Core (ARC) at Johns Hopkins Center on Aging and Health. We focus on two, NIH-funded, studies that implemented the ARC accelerometry protocol. The Atherosclerosis Risk in Communities that stopped visit 8 enrollment in early 2020 and reinstated in 2021 for visit 9, and the Peripheral Artery Disease Study of SOL that started the data collection in early 2021, first via the mail-in protocol, then shifting towards in-clinic visits. Through March 2020, ARC processed an average of 125 new accelerometry per month (SD = 54). There was no new data collected for the remainder of 2020. The collection restarted in January 2021 with an average of 55 (SD = 43) files a month in the first and 112 (SD = 53) in the second quarter of 2021. A total of 573 new accelerometry observations were collected across both studies since the first wave of COVID-19 in March 2020 including 282 observations collected exclusively using a mail-in protocol. This recovery of data collection demonstrates that wearable devices allow for safer, remote assessment of physical activity, function, and sleep eliminating the need for in-person visits.
Dementia-Related Care in Acute Care Settings: A Qualitative Meta-Synthesis of Patient and Family Perspectives
Authors: Chunga Richard
Published: December 2021

Researchers have long emphasized the importance of a person-centered approach to health care, especially regarding the treatment of individuals living with dementia. However, the fast pace of acute care settings can be a difficult place to provide such care to patients, where there are tensions between the emphasis on efficient treatment of acute medical co-morbidities and person-centered dementia care. This paper is a meta-synthesis of qualitative studies examining perspectives of patients and their family members regarding their acute care experiences. It takes an interpretive approach, using primarily inductive reasoning to generate themes across available studies’ findings. Emergent themes are organized under two major dimensions of the hospital environment: the physical environment, including sensory and tangible elements, and the social environment, including the hospital atmosphere and communication practices. Persons with dementia feel overly stimulated by the busy physical environment of the hospital, yet they are often left to languish alone, sometimes even physically restrained. Patients reported feeling lonely, fearful, and confused, identifying diverse physical and social environmental attributes like physical clutter, noise, and lack of empathy from care providers as contributors. Based on acute care experiences and reports from patients and family members, although the acute condition is treated, persons with dementia often leave the acute care environment in worse functional condition than when they entered. Given the increasing prevalence of persons with dementia in acute care settings, it is clear that we must prioritize innovations and programs aimed at improving hospital practices, educating staff, and creating more dementia-friendly environmental designs.
Feasibility and Acceptability of VideoChat During Meals in Adults Aging in Place of Average Age 88
Authors: Lyman Alexa , Barre Laura
Published: December 2021

Older adults in the United States prefer to age-in-place. However, living and eating alone are risk factors for malnutrition. Using videochat during mealtimes, i.e., VideoDining, can provide commensality and social facilitation to improve nutritional intake. The objective of this study was to determine if older adults aging-in-place can independently VideoDine with family or friends. We recruited eleven older adults from Full Circle America Steuben, a virtual assisted living program for adults aging-in-place in rural New York. All participants had Amazon EchoShow devices for videochat. Participants were instructed on VideoDining and asked to independently schedule four VideoDine sessions with a family/friend in four weeks. Surveys were collected at baseline, after VideoDine sessions, and end-of-study. Participants were 91% female and 100% white. The average age was 88 years. All participants were widowed and living alone except for one married couple. Overall, 45% of participants VideoDined four times, 36% of participants VideoDined two to three times, and 27% not at all, for an average of 2.7 sessions in a month. Participants VideoDined during all meals, although dinner was most common (66% of meals), and breakfast least common (12% of meals). Average comfort was rated 7.6/10 (1=not comfortable, 10=comfortable), median enjoyment was 9.3/10 (1=not enjoyable, 10=enjoyable), and median ease of VideoDining was 4.1/5 (1=very difficult, 5=very easy). On average, participants rated their VideoDining meal experience a 7.6/10 (1=poor, 10=excellent). With access to videochat technology, older adults can connect with a dining partner and have a favorable experience sharing a meal over videochat.
Feasibility of In-home Saliva Collection of Cortisol and DHEA-S as a Biomarker of Stress in Dementia Care Dyads
Authors: Emami Azita , Engström Gabriella , Kim Hyejin
Published: December 2021

Dementia afflicts affected individuals and their family caregivers worldwide. Although a non-pharmacological intervention has been recommended as a first-line approach to minimize adverse outcomes (e.g., stress) in dementia care dyads (persons with dementia [PWD] and their family caregivers), most evaluations of such interventions have relied on subjective (e.g., self- or proxy-report) rather than objective (e.g., biomarkers) measures. We aimed to explore the feasibility of saliva collection of cortisol and dehydroepiandrosterone sulfate (DHEA-S) as a non-intrusive method in dementia care dyads. Dementia care dyads living at home were recruited from the memory center in Sweden. Prior to the saliva collection, participants received a one-hour education session with a hands-on demonstration led by a trained study coordinator. Participants were instructed to collect saliva three times (two for morning, one for evening)/day, five days/week for eight consecutive weeks. Out of 32 care dyads (32 PWD and 32 family caregivers), 24 (75.0%) completed the saliva collection. On average, 105.5 (87.92%) and 105.9 (88.25%) samples were collected from PWD and family caregivers during eight weeks. There were no statistically significant differences (p>0.05) in the average number of saliva samples (i.e., total samples, morning or evening samples) between PWD and family caregivers. The findings of this pilot study showed that saliva collection of cortisol and DHEA-S as a stress measurement was feasible in dementia care dyads living at home. Robust and person-centered procedures, tailored educational materials, and effective communication with dementia care dyads should be considered in future biomarker research on stress in dementia care dyads.
Financial Impacts of the COVID-19 Pandemic on U.S. Older Adults: Assessing Pandemic-induced Job and Income Loss
Authors: Dawson Walter , Mattek Nora , Gothard Sarah , Kaye Jeffrey
Published: December 2021

The COVID-19 pandemic has greatly impacted the economic security of millions of older adults. Job loss and reductions in personal income were significant in 2020 stemming from pandemic-induced shutdowns that temporarily closed large swaths of the U.S. economy. Yet, the specific financial impacts of the pandemic on older adults, including family care partners, are not well understood. To understand the COVID-19 pandemic’s effects on the health and financial well-being of older adults, we gathered data from the Research via Internet of Technology and Experience (RITE) Study, a longitudinal survey panel providing data from thousands of participants of various ages and backgrounds in the U.S. on their use of healthcare and technology (N=1,365). We measured by population strata including age, sex, and education and other characteristics including caregiver status. Adults between 20-40 years of age experienced the highest rate of job loss and reduction in wages (33%) as a result of the pandemic, while adults aged >70 years experienced the lowest rate (12.5%). However, adults aged 50-60 and 60-70 also experienced relatively high levels of job loss at (28.4% and 25.7%, respectively). Behavior changes and disruptions to typical routines to avoid COVID-19 infections may have contributed to job and personal income loss amongst Individuals aged 50-60 and 60-70. However, these findings suggest potentially high levels of economic insecurity amongst individuals who continue to work into late-life. These results may help policymakers understand how to better tailor interventions and policies to mitigate economic insecurity, particularly for populations disproportionately impacted by the pandemic.
Inflammatory Biomarkers and Sex Hormones Interact to Predict Ecologically-Assessed Cognitive Performance
Authors: Knight Erik , Harrington Erin , Sliwinski Martin , Graham-Engeland Jennifer , Pavlovic Jelena , Engeland Christopher
Published: December 2021

Inflammatory biomarkers and sex hormones have been investigated as independent risk and resilience factors for cognitive decline in older adults. Many sex hormones are anti-inflammatory and there is emerging evidence that sex hormones may buffer the risk for cognitive decline associated with higher inflammation. However, few studies have included concurrent examination of inflammation and sex hormones in studies of cognitive performance and cognitive aging. A diverse sample of older adults (N = 245; 65% female, 42% Black, 13% Hispanic; mean age = 76.8 years) had blood drawn before and after a two-week measurement burst that included three cognitive tests (6x per day) assessing working spatial memory, perceptual speed, and feature binding. Testosterone, estradiol, estrone, and six basal cytokine concentrations were quantified. Composite scores of basal inflammation were calculated. Multilevel modeling indicated that heightened inflammation related to poorer spatial working memory performance (B = 0.213, 95%CI[0.11, 0.414], p = .040). In addition, sex hormones moderated the association of cytokine concentration with perceptual speed (e.g., basal cytokines x testosterone: B = 0.13, [-0.24, -0.03], p = 0.013; similar effects evident for estrogens). Decomposition these interactions revealed that heightened inflammation predicted poorer performance, but only among individuals with lower sex-hormone concentrations. This study provides evidence of immune and hormonal-by-immune associations with performance in two cognitive domains in older adults. Examining the functional crosstalk between immune and sex hormone functioning will improve understanding of risk and resilience factors related to cognitive performance and help predict cognitive decline in older adults.
Like A Dew Drop On A Lotus Leaf: Perceptions Of Aging Well In South Asian American Older Adults
Authors: Khan Mushira , Shah Sheetal , Basic Ajla
Published: December 2021

Past research has underscored four key themes prevalent in popular and scientific discourse on successful aging in North America – the emphasis on individual agency and control; continuing productive activity into old age; the value of independence in late life; and an ideal construction of permanent personhood, wherein the realities of mortality and decline are inadequately addressed (Lamb, 2014). Yet, the meanings attached to successful aging differ across cultures and are not very well-understood. The Perceptions of Aging Well in Diverse Populations study aims to acquire a holistic understanding of the attitudes and beliefs around aging well across cultures and to identify the similarities and differences in these perceptions within diverse racial and ethnic groups. This presentation highlights preliminary findings from in-depth, semi-structured qualitative interviews with South Asian Americans 50 years and older (n=19; 9 men, 10 women). Participants shared that a sense of inevitability and aging with “grace”, “dignity”, and “wisdom” were key components of successful aging. Maintaining good health, keeping a positive attitude, and remaining independent in later life appeared motivated primarily by a desire to remain connected to, but not necessarily “burden” adult children with caregiving responsibilities. Religious faith and spiritual well-being, availability of support systems, and a sense of community were key facilitators. Limited English proficiency and loneliness posed challenges to aging well, particularly in late-life immigrants. These findings provide unique insights into subjective perceptions of successful aging and may help inform programs and policies that support the health and well-being of older South Asian Americans.
Long-Term Care and Wide Effects on Children Caregivers -- New Evidence From Taiwanese Administrative Data
Authors: Chen Kuan-Ming , Hsiang Chen-Wei , Chou Yu-Hsuan , Chao Shiau-Fang , Tseng Kuan-Ju , Lin Ming-Jen , Chen Ya-Mei , Wu Shih-Cyuan
Published: December 2021

Long-term care (LTC) needs have profound impacts on the care-receivers and their children. Past research has focused on primary caregivers' short-term responses to LTC needs on limited aspects. This study brings new Taiwanese administrative data on health insurance, LTC program usages, and tax records. Rich information allows this study to explore long-term impacts on care-receivers' extended families. Event study combined with various regression analyses is the main framework of this study. Using the longitudinal record of more than 23 million individuals older than 65 over 18 years, the present study examines extended family members' various outcomes along the LTC needs trajectory. Among others, these outcomes include labor market participation and health expenditures. There are several findings in this study. Parents' LTC needs decrease all children's average full-time labor force participation by 2.5 percentage points even 10 years after the needs incurred. These needs do not directly increase children's health expenditure. A precise zero effect is found on children's health expenditure before, during, and after parents' LTC needs. Nevertheless, parents' health status or LTC risks, in general, may still pass on to children through other channels. The inter-generational health association is found to be approximately 0.25, indicating some degree of transmission. The results suggest that the impacts of LTC needs on family members are profound and widespread. Policy needs to address multiple aspects to cater to potential difficulties for care-receivers' family members.
Paving the Way for Ageist Attitudes through Children’s Books
Authors: Schenker Lena-Emilia , Bellingtier Jennifer
Published: December 2021

Older adults are underrepresented and rarely appear in major roles in children’s literature. According to developmental intergroup theory, numerically smaller groups are likely to become targets of stereotypes and prejudice. Because parental ageist attitudes are related to those of their children, and parents typically choose their children’s literature, we investigated parental preferences for books featuring older and younger adults and what factors might predict this preference. In an online survey, 176 parents of children aged 12 or younger rated children’s book covers featuring a child and a prominent younger or older adult. There were two identical versions of each book cover on which only the age of the adult varied. Each respondent viewed covers featuring older and younger adults, but only saw one version of each cover (i.e., counterbalanced design). Parents indicated their preference for the books by stating how much they and their children would like the book and how likely they would be to buy it. Stereotypical expectations regarding the books’ storylines were rated on a semantic differential scale (e.g., modern vs. old-fashioned). Results revealed that there were no significant differences in preferences for books featuring younger, compared to older adults. However, a stronger difference in preference for books featuring younger, over older adults was predicted by the extent of stereotypical expectations regarding the storylines. In particular, this preference was stronger in parents who expected stories with older adults to conform to prevailing ageist stereotypes, suggesting that ageist expectations may deter some parents from books featuring older adults.
Predicting Caregiver Reactions to Challenging Behaviors in the Context of Dementia
Authors: Simon Darby , Mast Benjamin
Published: December 2021

Challenging behaviors exhibited by people living with dementia have been associated with a variety of negative outcomes including greater caregiver burden, nursing home placement, and lower quality of life. Although there has been considerable research on psychological and behavioral changes in dementia, little research has explored family caregiver reactions to these changes and what caregiver characteristics are associated with stronger emotional reactions. This research examined the relationship between established indicators of caregiver mental health (depression, burden, grief, well-being) and caregiver reaction scores on the Revised Memory and Behavior Problems Checklist (RMBPC). The sample consisted of 76 family caregivers for people living with dementia, aged 25 to 93, who participated in a study on caregiver burden and grief. Multiple regression was used to predict RMBPC caregiver reaction scores from the Zarit Burden Inventory, Geriatric Depression Scale, Ryff Psychological Well-Being Scale, and Anticipatory Grief Scale while controlling for RMBPC total behavior frequency scores. RMBPC total behavior frequency scores and Zarit Burden Inventory were significant predictors of caregiver reaction scores (F(2,74) = 87.559, p < .001, R2 = .703). More frequent, challenging behaviors were associated with more distressing reactions and higher caregiver burden also predicted more distress on the RMBPC reaction scores. Psychological well-being was associated with lower reactions at the bivariate level but was not significant in the full regression model. Future research is needed to better understand these relationships and implement this knowledge to benefit family caregivers.
Predictors of Nursing Home Covid-19 Cases: a Community Vulnerability Approach
Authors: Peterson Matthew , Lawhorne Larry
Published: December 2021

It is well known that the Covid-19 pandemic has placed considerable burden on nursing homes, including from resident, facility, and community perspectives, among others. This study examined facility and community factors that were related to incident Covid-19 cases in nursing home facilities. N=12,473 US nursing homes were included in this study. Data from June 2020 - January 2021 from several publicly available sources were combined to create a dataset that included facility name, size, ownership, mortality rate, Covid case rate, personal protective equipment (PPE) and staff shortages, % white residents, and % Medicaid residents. Community factors included core-based statistical area (CBSA) Covid case rates, urban/rural, CBSA death rates, and the CDC’s Social Vulnerability Index (SVI). Zero-inflated Poisson regression models were used to determine predictors of 8-month Covid case counts, normalized by facility size. Results indicated that higher staff shortages, poorer facility rating, for-profit ownership, proportionally more Medicaid and non-white residents were all significantly associated with higher Covid case rates over 8 months (all P < 0.0001). Significant community level predictors of higher cases included urban setting and higher SVI. PPE shortages was not associated with higher case counts. Of all the factors included, SVI was the strongest predictor of Covid case counts. This large US study assists in determining critical facility and community factors that predict increasing Covid burden in nursing homes. Particularly, SVI is an important factor in determining facility and public health policy, and targeting resources in large scale health crises such as the Covid-19 pandemic.
Creating Virtual Community For Older Adults: During the COVID-19 Pandemic And Beyond
Authors: Kosick Lawrence , Hunt Jennifer , Solway Erica
Published: December 2021

Combining data on health and well-being from the University of Michigan National Poll on Healthy Aging (NPHA) with case studies and data from GetSetUp, a virtual online learning community, and the Michigan Department of Health and Human Services (MDHHS), this symposium will highlight how virtual community can be created and supported during the COVID-19 pandemic and beyond. Polling data on loneliness and physical environments demonstrate the need for opportunities for connection before and during the pandemic. Other polling data from the NPHA shows telehealth visits increased significantly as did the use of video chat technology. These findings suggest that comfort with technology may help support aging in place. GetSetUp helps to make this possible with customized learning to help older adults overcome hurdles to tech adoption and use. GetSetUp classes focus on supporting social connection and providing information on resources and services. Beyond the pandemic, these services will remain critical for many older adults, including those facing mobility limitations, those with limited community, and those looking to diversify their networks. The Senior Deputy Director of Aging and Adult Services Agency will highlight how Michigan combines data and technology to support Michigan’s aging network. The GetSetUp and MDHHS virtual community allowed for a statewide connection to health and aging services, including programs such as vaccine information sessions. The data and case studies described will highlight the need for connection during the COVID-19 pandemic and how a startup and State worked together to address this need.
Age-Related Ethnic Differences in Self-Reported Hand Function
Authors: Mulayh Ejlal Bin , Logue Rachel , Brown Susan
Published: December 2021

Racial/ethnic differences in the prevalence of disability based on self-reported activities of daily living (ADLs) exist in older Americans, particularly in Hispanic adults. Such studies have relied on large data sets in which disability is measured across a broad range of functional tasks. While useful in generating a global measure of disability, it precludes an ability to differentiate, for example, deficits in upper versus lower extremity function which can provide useful information in targeting therapeutic interventions. Despite known age-related declines in hand function and concomitant ADLs, racial/ethnic differences in hand-related ADL limitations have not been addressed. Using 2011-2018 data from the National Health and Nutrition Examination Survey (NHANES), we identified 3,189 non-Hispanic White and Hispanic adults aged 65 and older, and classified responses based on perceived difficulty to five self-reported tasks requiring hand dexterity. Compared to non-Hispanic Whites, Hispanic males reported 2.2 times higher rates of difficulty for dressing tasks (p<0.01) and 3.3 times higher rates for difficulties preparing meals (p<0.01). Similar rates of difficulty were also observed in females. Additionally, Hispanic females reported 4.6 times higher rates of difficulty in tasks requiring grasping small objects (p<0.01). Deficits in hand function are often under-reported in older adults despite the role of dexterity in maintaining functional independence. The results presented here indicate that difficulties in hand-related ADLs are more prevalent in the Hispanic population and warrant greater attention in health care settings. Future work will include identifying factors contributing to these observed differences in self-reported difficulties in hand-related ADLs.
Allostatic Load Following Short-Term Intervention: Cognition in Older Hypertensive Adults
Authors: Cirilo Anthony , Kohn Jordan , Ang Gavrila , Pung Meredith , Troyer Emily , Pruitt Christopher , Redwine Laura , Hong Suzi
Published: December 2021

Allostatic load (AL), a measure of cumulative effect of prolonged stressors across physiological systems, is consistently associated with adverse health outcomes. Greater AL is correlated with functional decline in aging, but effects of behavioral interventions, such as Tai Chi (TC), on AL in older adults in a short-term is unknown. To investigate the effects of TC practice on AL and cognitive function and an AL-cognition relationship, older adults (60-95 years) with hypertension were recruited and randomly assigned to 12-week TC or Healthy Aging Practice-centered Education (HAP-E) classes. The AL index (ALI) included: SBP and DBP; urinary epinephrine and norepinephrine; plasma inflammatory biomarkers (CRP, IL-6); metabolic biomarkers (HDL, total cholesterol, triglycerides, HbA1c); and BMI. The Montreal Cognitive Assessment (MoCA) was administered to assess cognitive function. Generalized linear mixed-effects models, adjusted for age, race, education, and intervention attendance, was used. Pre- and post-intervention ALI did not change significantly in TC (2.61 (1.48) to 2.76 (1.62)) or HAP-E (2.84 (1.61) to 2.66 (1.86)). High ALI was associated with lower MoCA scores, indicating poorer cognitive performance (IRR=0.96; 95% CI: 0.93-0.98; p=0.002) across the time points. Of note, the MoCA scores did not significantly change across time (25.4 (3.2) to 26.0 (3.0)). 12-week TC or HAP-E interventions did not lead to a significant change in ALI or cognitive performance in our population. However, our findings show greater AL theoretically attributed to chronic stress is associated with cognitive functioning in older adults consistently over about 4 months.
Attachment Style Differences in the Affective Experience of Chronic Pain in Osteoarthritis
Authors: Cheesman Katherine , Parmelee Patricia , Smith Dylan
Published: December 2021

Objective. To examine the role of adult attachment style in the daily affective experiences of older adults with physician-confirmed knee osteoarthritis (OA). Methods. As part of a larger study of racial/ethnic differences in everyday quality of life with OA, 292 persons over the age of 50 completed a baseline interview including the Revised Adult Attachment Scale (RAAS; Collins, 1996). Dimensional RAAS attachment scores were coded into the secure, preoccupied, fearful, and dismissing groups (Bartholomew & Horowitz, 1991). Positive affect (PA), negative affect (NA), and pain were assessed using an experience sampling methodology consisting of 4 daily phone calls over 7 days. These analyses used ANCOVAs to examine 28-call means and SDs for PA, NA, and pain. Results. After controlling for demographics, results indicated significant group differences in average PA, NA, and pain. Pairwise comparisons indicated that participants endorsing a stable attachment style reported significantly more PA and less NA than those with a fearful attachment style. Group differences for pain were marginal and less clear cut. Significant differences also emerged for variability of NA and pain. Individuals with a secure attachment style were significantly less variable in NA than those in the fearful and preoccupied groups. For pain variability, the preoccupied group showed more variability than those with secure or dismissive styles. Implications. Results contribute to a growing understanding of how individual attachment style may underlie the day-to-day affective experience of chronic pain. (Supported by R01-AG041655, D. Smith and P. Parmelee, PIs.)
Fear of Falling, Fall Risk, Depression, and Anxiety in Community-Dwelling Older Adults
Authors: Rossler Aleatha , Thiamwong Ladda , Xie Rui , Stout Jeffrey , Park Joon-Hyuk , Choudhury Renoa , Garcia Oscar
Published: December 2021

Fear of falling is common in the older adult population with an estimated 43% being affected. We aimed to examine the associations among fear of falling, fall risk, depression, and anxiety in community-dwelling older adults. For this study 124 participants ranging from 60 to 96 years of age were recruited from the community settings in Central Florida. Fear of falling, fall risk, depression and anxiety were assessed using the Falls Efficacy Scale International (FES-I), the CDCSTEADI fall risk assessment, the Patient Health Questionnaire (PHQ) for depression, and the Geriatric Anxiety Inventory Short form (GAI-SF) for anxiety respectively. Data was collected via the Qualtrics survey. Comparisons were made for those below age 75 and those aged 75 and older, with 51.6% being under 75. Four ethnicity categories were also used: African American (8.1%), Asian (2.4%), Hispanic (14.5%), and non-Hispanic white (75%). All participants scored above 4 on the STEADI scale indicating fall risk. 42 scored positive for fear of falling on the FES-I scale and of that 42, 35.7% had a history of one or more falls in the last year (p < .01). 46.8% of the participants screened positive for depression and 100% of participants were positive for anxiety. Using one-way ANOVA analysis, we found significant relationships between (1) depression (p<.01); (2) STEADI (p<.01) and FES-I.
Hospice Caregiver Burden and Work Productivity: An Exploratory Analysis
Authors: Hebdon Megan Thomas , Xu Jiayun , Tay Djin , Reblin Maija , Cloyes Kristin , Ellington Lee
Published: December 2021

Hospice caregivers experience burden that impacts their physical, emotional, and social well-being. Little is known about how caregiver burden impacts occupational well-being through employment and work productivity. Thus, our purpose was to explore the relationships between caregiver burden and dimensions of work productivity/impairment (absenteeism, presenteeism, activity impairment, and overall impairment) among working hospice cancer caregivers. This is a secondary data analysis of baseline data from a larger study of caregiver communication and bereavement. Study data including demographics, preparedness for caregiving, caregiver burden, and work productivity/impairment were analyzed using descriptive statistics, correlation analysis, and stepwise multiple linear regression. Dimensions of work productivity/impairment were dependent variables, and age and preparedness for caregiving were covariates. Working caregivers (N=54) had an average age of 52 (SD: 12.65), and were primarily White (83%), female (70%), married (69%), employed full-time (70%) and had a household income of $50,000 or more (65%). Greater caregiver burden was significantly associated with lower preparedness for caregiving (r=-.41, p<.01), and greater activity impairment (r=.50, p<.01), presenteeism (r=.44, p<.01), and overall impairment (r=.36, p<.05), but not absenteeism. Caregiver burden predicted activity impairment (b=1.72 [.72, 2.71], p<.01), presenteeism (b=1.44 [.33, 2.55], p<.01), and overall impairment (b=1.42 [.09, 2.74], p<.05), even after controlling for age and preparation for caregiving. More burdened caregivers may be having more challenges with work productivity. Additional research is needed to examine these relationships in a larger, more diverse sample. Future research should also investigate how supportive work environments and leave policies reduce caregiver burden and promote work productivity.
Physical Activity Programming for Older Adults in Assisted Living: Contextual Factors to Consider
Authors: Webster Katelyn , Larson Janet
Published: December 2021

Sedentary behavior may adversely affect physical and cognitive health of older adults in assisted living (AL). Replacing sedentary behavior with light physical activity (PA) could help them maintain functional abilities and independence. We interviewed AL residents to obtain their guidance regarding the implementation of an intervention to reduce sedentary behavior. Here we report the results of a thematic analysis exploring contextual factors that may influence intervention implementation. We interviewed 20 residents (mean age 83.1; 60% women) and identified 7 themes. The first was attitudes and beliefs about PA. Most residents believed PA was important, but some lacked motivation or confidence to perform PA. Another theme was attitudes and beliefs about aging, as some residents felt discouraged about aging and uncertainty about how much PA they could safely perform. Abilities of AL residents was seen as an important consideration. It was noted that residents have a wide range of abilities and this could present challenges in planning a PA program appropriate for all residents. Social influences for PA should be considered, as residents may find encouragement from family or other residents. Space for being active is another factor because it is typically limited within AL. We found that some residents wanted more challenging exercise classes than currently provided by their facility. Finally, residents described limited opportunities for PA due to the nature of the AL environment. This thematic analysis brings attention to important factors that could influence the implementation of PA interventions with the AL population.
Redefining the Use of Digital Communities: AD Knowledge in an Online Educated Cohort of Midlife and Older Blacks
Authors: Brown-Hughes Travonia , Gamaldo Alyssa , Pettigrew Corinne , Caban-Holt Allison , Mohamed Nihal , Thorp, Jr Roland
Published: December 2021

The normalization of memory loss continues to contribute to diagnostic delays among older adult African Americans with dementia. We utilized an innovative recruitment method to establish a solely online study to examine perceptions and knowledge levels of Alzheimer’s Disease in a highly educated geographically diverse cohort of 223 African Americans aged 50-84. Participants were recruited through largely electronic communications. Sample participants were primarily female (n=196), with 51.1% having completed a master’s degree, and 58.2% of participants with household incomes of $90,000 or higher. Study findings revealed that although highly educated, 42% of sample participants believed significant memory loss was a normal part of aging and 59.6% felt that God’s Will was a possible cause of AD. A sizable majority of participants, 86.5%, felt most family physicians were not trained to diagnose AD. Findings underscore the need for physician and community education within diverse populations, regardless of education and SES status.
Self- and Informant-Reported Loneliness and Cognitive Function: Evidence From Three HCAP Studies
Authors: Lee Ji Hyun , Luchetti Martina , Sesker Amanda , Aschwanden Damaris , Sutin Angelina , Terracciano Antonio
Published: December 2021

Loneliness is defined as a distressing feeling that arises from the discrepancy between one’s desired and perceived social relationships. Theorists have posited that loneliness involves affective, cognitive, and behavioral components that can be noticed by close family or friends. Little is known about whether social withdrawal, a behavioral marker of loneliness observed by knowledgeable others, shares similar associations with cognition as self-reported loneliness. The present study examined whether self-reported and informant-rated loneliness are related to cognitive function in older adulthood. Data come from Harmonized Cognitive Assessment Protocol subsample included in three national aging studies from the US (HRS; N = 2,821, Mage = 75.8), England (ELSA; N = 896, Mage = 73.6), and India (LACI-DAD; N = 2,994, Mage = 69.3). Respondents reported on 1-item loneliness and informants rated the respondent’s withdrawal behavior. Regression models were used to analyze the association between both measures of loneliness and cognition, controlling for respondent (age, gender, education, race/ethnicity) and informant (age, gender, education, spouse, known years, frequency of contact) covariates. Meta-analysis showed that both respondent-reported and informant-rated loneliness were independently associated with lower cognitive functioning (memory, speed–attention–executive, visuospatial ability, and fluency) and global cognition (MMSE). The associations between observed withdrawal and cognition did not vary by informant-level characteristics nor the respondent’s cognitive impairment status. The present study indicates that withdrawal behavior observed by informants is associated with cognitive function, supporting psychosocial observations provided by knowledgeable others can be utilized in detecting cognitive function.
The Impact of Retirement Resources on U.S. Older Female Workers’ Retirement Timing: Theory of Planned Behavior Model
Authors: Kim Hansol , Ekerdt David , Baker Tamara , Watts Amber , LaPierre Tracey , Zhang Yan Bing
Published: December 2021

For older workers, having a retirement plan is important for a successful transition. Social awareness of the problems encountered by older women during retirement remains low. Women have limited retirement resources due to their unequal work experience, and older women with access to fewer retirement resources often postpone their retirement. This research examined how the timing of older women’s retirement was influenced by their retirement resources as well as their marital status. The study used 2014 HRS and RAND data, and collected sample of women aged 50-62 years old who worked either full or part time (n=3,593). Respondents were female (56%), white (63%), married (70%), and working full time (82%). Guided by the theory of planned behavior (TPB), multiple regression analysis examined gender differences in predicting older adults' retirement timing. TPB included three sub factors: attitudes toward retirement, subjective norm, and perceived behavioral control. Logistic regression analyzed the effects of respondents’ expectations of retirement (i.e., with vs without expected timing). The findings indicated that the TPB model works similarly for men and women but there is a difference according to marital status. Unmarried women are less likely to have accumulated financial resources and more likely to anticipate a later retirement (1.4 years) than married women and are also less likely to set an expected timing for retirement (p<05). Such a robust research agenda would provide key information for government agencies and policymakers and contribute to the development of retirement planning models or retirement education programs for older women.
The Mortality of Older Adult Inpatients with Kidney Cancer during the Pandemic: A Retrospective Cohort Study
Authors: Brune Kendall , Yin Cheng , O'Neill Liam , Zhan Rongfang
Published: December 2021

Background: Elderly patients are a vulnerable group during the Covid-19 pandemic, especially those with cancer. Our study aims to identify how Covid-19 impacts elderly inpatients with kidney cancer and determine risk factors associated with increased mortality. Methods: Our retrospective cohort study utilized the PUDF dataset and included inpatients over 60-year-old, diagnosed with kidney cancer, and hospitalized within 30-day. Person’s Chi-Square was used to measure the differences between survivors and non-survivors, and the Mann-Whitney test was for non-normality distribution for continuous variables. Then, a binary logistic regression was employed to identify the association between independent variables and mortality. Results: Five hundred and twenty-two patients were included in the study, of which 7 (1.4%) died during hospitalization. According to the univariate analysis and Mann-Whitney test, expired patients were more likely to experience older age (p = 0.005), longer length of stay (p = 0.009), ICU (p = 0.012), HMO Medicare Risk (p = 0.005), Covid-19 (p < 0.001), paralysis (p < 0.001), and higher illness severity (p < 0.001). The binary logistic regression revealed that older age (OR = 1.120, 95% CI: 1.004-1.249, p = 0.042) and the SOI (OR = 4.635, 95% CI: 1.339-16.052, p = 0.016) had significantly high odds of mortality. Conclusion: The retrospective cohort study reveals that although Covid-19 was not a predictive factor associated with increased mortality, there was a statistically significant difference between the survivor and non-survivor groups. Further studies need to assess its association with kidney cancer or other various types of cancer.
Enhancing Collaborations between our Age-Friendly Community and University Initiatives
Authors: Rogers Wendy , Pastor Brian
Published: December 2021

Community involvement and synergistic partnerships are key to fostering a holistic approach to programming and outreach that assess and meet the needs of the older adults in our communities. The University of Illinois Urbana-Champaign has created an Age-Friendly network to facilitate these partnerships featuring our designation of Age-Friendly City and Age-Friendly University as well as partnerships with our state and local governments, community aging services providers, and continuing care retirement communities. Through these partnerships, we have identified the landscape of the community, assessed the unique needs older adults, and identified novel solutions. We will discuss our plans for activities that will empower older adults in our community and at our university by promotion connection, collaboration, and inclusion.
Creating an Age-Friendly Model System Through a Community and University Partnership
Authors: Revell Andrew , Viveiros Jennifer
Published: December 2021

The University of Massachusetts 5-campus system was the first university system to receive the Age-Friendly University designation in the AFU Global Network (Business West, 2019). Simultaneously, the town of Dartmouth and city of New Bedford became Age-Friendly Communities. This allowed for dynamic collaboration between our university and communities. This presentation highlights several examples. The Ora M. DeJesus Gerontology Center faculty and student researchers developed the original age-friendly survey items for New Bedford’s initial community assessment; and the College of Nursing and Health Sciences faculty and student researchers compiled data for Dartmouth’s survey. Community service during the pandemic has flourished. The Community Companions program, which matches students with community members in social need, went virtual. Nursing students and faculty have been on the frontline in the vaccination efforts in the town of Dartmouth. These partnerships will be presented as examples of potential opportunities for other age-friendly communities. Community-university partnerships are encouraged.
Health Care Utilization in Diverse Older Adults in the Deep South and the Rest of the United States
Authors: Pisu Maria , Martin Roy , Shan Liang , Pilonieta Giovanna , Kennedy Richard , Oates Gabriela , Geldmacher David
Published: December 2021

We examined racial/ethnic (R/E) differences in health care utilization among older adults with Alzheimer’s disease and related dementia (ADRD) from US Deep South [DS] and non-DS, and individual or context-level factors that affect this utilization. Data were 2013-2015 claims for Medicare beneficiaries with ADRD; county-level data were used to define context-level covariates; adjusted analyses were conducted separately for DS and non-DS. Across R/E groups, 33%-43% in DS, 43%-50% in non-DS used ADRD specialists; 47%-55% in DS, 41%-48% in non-DS used ADRD drugs; 42.9%-53.4% in DS, 42%-51.8% in non-DS had hospitalizations in a one-year follow-up. R/E differences were not significant, with few exceptions. Comorbidities, poverty, and medical resources availability were associated with specialist use and hospitalizations; comorbidities and specialist use were associated with drug use. In non-DS only, other individual, context-level covariates were associated with health care outcomes. Research should further examine determinants of health care utilization in these populations.