bluuebunny/crossref_metadata_2025 huggingface dataset:
HAVE I GOT A JOB FOR YOU: OCCUPATION-RELATED ASTHMA THROUGHOUT LIFE IN THE UNITED STATES
Authors: Laditka Sarah B , Laditka James N , Arif Ahmed , Hoyle Jessica
Published: November 2019

Work exposures to asthma triggers can cause or aggravate asthma, which affects twenty-five million Americans including many older workers, and retirees who want to work or need to do so for income. Asthma trigger exposures have particular risk for older workers. Older adults who develop asthma have poorer health outcomes than people who had childhood asthma, yet older workers with low incomes may have limited ability to leave a job despite health risks. We studied occupation-related asthma using the nationally representative Panel Study of Income Dynamics (PSID) (1968-2015, n=13,957, 205,498 person-years). We compared asthma outcomes in occupations with likely asthma trigger exposures to those in occupations with limited exposures. Methods included: prevalence ratios; incidence risk ratios (log-binomial regression adjusted for age, sex, race/ethnicity, education, atopy, current and past smoking, and survey design); attributable risk fractions; population attributable risks; and microsimulation. The adjusted prevalence ratio comparing high risk occupations to low was 4.1 (95% confidence interval, CI 3.5-4.8); adjusted risk ratio 2.6 (CI 1.8-3.9); attributable risk 16.7% (CI 8.5-23.6); population attributable risk 11.3% (CI 5.0-17.2). In microsimulations, 14.9% (CI 13.4-16.3) with low trigger exposures reported asthma during working life, compared with 23.9% (CI 22.3-26.0) with high exposures. Asthma triggers at work may cause or aggravate more than 10% of adult asthma, and increase asthma risk by 60%. Lung health contributes importantly to well-being, and the ability to work at older ages. Results highlight needs for policies and employer actions to reduce asthma trigger exposures, and for public education about lung health.
OLDER PARENTS’ PERCEIVED SOCIAL SUPPORT AND STRAIN FROM ADULT CHILDREN AND INTERGENERATIONAL FINANCIAL TRANSFER
Authors: Kim Dahee , Martin Peter
Published: November 2019

The gerontological literature indicates that both positive and negative relationships are dimensions of intergenerational relationships. Moreover, depending on intergenerational financial support, the association between older parents’ perceived social support and strain from adult children can vary. The purpose of the current study is to investigate the association between intergenerational social support and strain. We also examined the impact of intergenerational financial transfers on intergenerational social support and strain. We analyzed data of 1,329 older adults aged 65 to 84 from the Health and Retirement Study collected at 2006(t1), 2010(t2), and 2014(t3). Cross-lagged panel models were performed to examine the reciprocal association between intergenerational social support and strain over time. Multiple group comparisons were conducted to estimate the impact of financial support exchange on social support and strain from adult children. The results demonstrated that social support and strain from adult children were stable over time. Furthermore, social strain had negative effects on the changes in social support from adult children. Multiple group comparisons suggested that in the parents’ groups (financial support provision vs. no provision to adult children, and financial support receipt vs. no receipt groups from adult children) intergenerational social support and strain were stable over time. Additionally, the impact of social strain on subsequent social support from adult children differed depending on intergenerational financial support. These findings highlight the reciprocal association between intergenerational positive and negative relationships. Further, this research suggests the importance of intergenerational support in older parents’ and adult children’s positive and negative relationship quality.
SOCIAL STRATIFICATION AND TRAJECTORIES OF LIVING ARRANGEMENTS AMONG OLDER AMERICANS
Authors: Liang Jersey , Kim BoRin , Xu Xiao , Raymo James , Ofstedal Mary Beth , Zheng Qing
Published: November 2019

Living arrangements are critical to intra-family exchanges that affect older persons’ health and well-being. The conventional conceptualization of living arrangements has emphasized coresidence with children, while overlooking proximate residence from children. Additionally, existing research often relied on cross-sectional data which confound intrapersonal differences with interpersonal variations. This study examined the dynamics of living arrangements in old age by depicting their trajectories as a function of social stratification (i.e., age, gender, race/ethnicity, education, income, and wealth). Data came from the Health and Retirement Study and included a national sample of 7,822 older Americans with at least one living child from 1998 to 2014. Multi-level mixed effects models were employed to analyze the trajectories of living arrangements and their key determinants for the young-old and the old-old separately. Among the young-old (age 65-74, N=4,917), the probability of coresidence increased slightly over time, whereas the probabilities of proximate residence and distant residence decreased slightly and remained stable respectively, and the risk for institutionalization increased moderately. Similar but more accelerated trajectories were observed among the old-old (age 75+, N=2,905). Age, gender, race/ethnicity, education, income, and asset were significantly associated with not only the levels of the probabilities of various living arrangements but also their slopes. For instance, among the old-old, Hispanics had a lower level of nursing home residence as well as a slower rate of increase in the risk of institutionalization than Whites. These findings may inform public policies to strengthen family-based support and long-term care for older people.
TOO HOT OR TOO COLD? EXPOSURE TO EXTREME TEMPERATURES AND COGNITIVE FUNCTION IN OLDER ADULTS
Authors: Khan Anam M , Clarke Philippa , Finlay Jessica , Gronlund Carina , Melendez Robert , Sol Ketlyne , Judd Suzanne , Wadley Virginia
Published: November 2019

Research on temperature and cognition is sparse, including effects of outdoor air temperature on cognitive testing performance. Furthermore, little is known about the modifying role of region and seasonality in temperature-cognition associations. We linked daily temperature data from National Oceanic and Atmospheric Administration weather stations to REGARDS participants by cognitive assessment date. Controlling for season, generalized linear models including spline terms for temperature showed an adverse effect of hotter temperatures on cognition. At higher temperatures (30°C vs 0°C), there was a significant decrease in cognitive performance on the Word List Learning test (β=-0.68; 95% CI: -1.1, -0.25). Results also show regional differences in testing scores on hotter and colder days. The findings provide new understanding of cognitive susceptibility to extreme temperatures and factors that exacerbate or buffer this association. This can inform development of evidence-based public health guidelines and mitigation strategies aimed at reducing temperature-related morbidity in older adults.
A MICROLONGITUDINAL APPROACH TO STUDYING GRANDMOTHER-GRANDCHILD DAILY INTERACTIONS
Authors: Turner Shelbie , Mejia Shannon T , Stawski Robert S , Hooker Karen
Published: November 2019

Research suggests that grandparent-grandchild dyads shift in degree of solidarity over extended periods of time (e.g. Moorman & Stokes, 2016), but no work has considered grandparent-grandchild interactions microlongitudinally. This study utilized microlongitudinal data with an emphasis on intraindividual variability to examine the daily processes associated with relational aspects of grandparenting. Using data from 24 grandmothers in the Personal Understandings of Life and Social Experiences (PULSE) project, we explored how grandmother-reported satisfaction with grandchild interactions impacted grandmothers’ same-day positive and negative affect over 100 days. We first justified the need for microlongitudinal analyses by assessing the degree to which there were within-person shifts in interaction satisfaction over time. Intra-class correlations indicated 86% of the variation in interaction satisfaction was within-persons, warranting an intraindividual variability approach. As such, we then employed multi-level models to examine the within-person and between-person effects of interaction satisfaction predicting same day positive and negative affect. At the within-person level, on days when grandmothers reported higher than their average interaction satisfaction, they reported more positive affect (Estimate = 0.09, SE = 0.03, p = 0.009) and lower negative affect overall that day (Estimate = -0.08, SE = 0.02, p = 0.005). At the between-person level, grandmothers who had, on average, higher interaction satisfaction had more positive affect (Estimate = 0.63, SE = 0.09, p<.0001) and lower negative affect on average (Estimate = -0.53, SE = 0.11, p<.0001).
MENTAL HEALTH OF GRANDPARENTS RAISING GRANDCHILDREN: UNDERSTANDING PREDICTORS OF GRANDPARENTS’ DEPRESSION
Authors: Lee Youjung , Jang Kyeonghee
Published: November 2019

Grandparents raising grandchildren experience caregiving stress, negatively influencing their mental health. They experience limited social supports and suffer from a lack of respite care and community resources. The present study attempts to explore needs of grandparent-headed families and factors related to grandparents’ depression. In 2015-19, surveys with 92 custodial grandparents were conducted in the northeastern U.S. The respondents were primarily white (77%) and 62 years old on average (ranged from 44 through 84) at the time of the interviews. The depressive symptoms ranged from 1 through 45, with the score of 16+ indicating clinical depression (41%). Sixty-three percent of grandparents reported a household income below $40,000 and 40% of them rated their health as poor or fair. Ninety-five percent reported at least one or more concerns in raising their grandchild (i.e., financial concerns, legal issues, and physical health). A multiple linear regression analysis was performed to examine the contributions of age, ethnicity, duration of care, factors related to multigenerational caregiving, social support from family members, social support from friends, and social support from significant others in accounting for grandparents’ depressive symptoms. The model explained 29% of variance in the outcome (R2=.290; adjusted R2=.231). Among the predictors, only one factor was significant: social support from family members (beta=-.352, p=.006). Grandparents with increased social support from family members have lower rates of depression. This finding reinforces the importance of familial support for grandparents raising grandchildren, and recommends the development of family-centered programs to offer support for custodial grandparents to promote caregivers’ well-being.
GRANDPARENTAL CHILDCARE AND ITS RELATIONSHIP WITH SOCIOECONOMIC INEQUALITIES AND HEALTH: EVIDENCE FROM ENGLAND
Authors: Gessa Giorgio Di , Glaser Karen
Published: November 2019

It is well recognised that grandparents play a vital economic and social role in providing grandchild care to families. In the UK, about two million grandparents provide care to their grandchildren for at least ten hours per week. However, to date, little is known about the nature and extent of care they provide and whether, and how, this relates to socio-economic and health inequalities. In this paper, we use wave 8 of the nationally representative English Longitudinal Study of Ageing. Using latent class analysis, we developed profiles of grandparent childcare combining newly collected information on the activities grandparents do with or for their grandchildren, as well as on the extent of (periodicity, frequency, and intensity), and motivations for such care. Using regressions, we then examined the extent to which grandparents’ involvement in childcare is patterned according to current and lifetime socio-economic characteristics and whether such inequalities are an important modifier of the relationship between grandparenting and mental and physical health. Preliminary results suggest that more advantaged grandparents are the ones undertaking less arduous caring tasks and for shorter periods whereas those looking after grandchildren more intensively and for financial reasons are more likely to be of less advantageous backgrounds (not married, low-educated, not homeowners, and poorer). Moreover, undertaking more frequent and challenging grandchild care activities seems to be associated with poorer health but only among grandparents in the more disadvantaged groups. Our results contribute to better understand the nature of grandparental childcare and its effect on health.
THE GREAT AND THE GRAND: THE ROLES OF GREAT-GRANDPARENTS AND GRANDPARENTS IN MULTIGENERATIONAL FAMILIES
Authors: Schuler Emily , de Souza Brito Dias Cristina Maria
Published: November 2019

The increase of Human Aging has been observed rapidly in the whole world, as it has been in Brazil allowing the experience to live several roles within the family for a longer time. As a consequence, more multigenerational families emerge with a more vertical structure, formed by four or even five generations. While the oldest generation adds another generational role to their life, the one of great-grandparents, the youngest generation is born into an intergenerational network of relationships. There are various questions about the differences in the role of great-grandparents and grandparents, which motivated this present study. Thus, the objective of this study was to understand the roles of great-grandparents and grandparents in the family and their intergenerational repercussions. Four families with for generations, totaling 16 participants. One member of each generation was interviewed, using a specific script, which was afterwards analyzed by the Thematic Content Analysis. The results pointed out that both great-grandparents and grandparents have distinct roles that are constructed around the needs of the family; both figures provide emotional and material support to the family; both roles have transgenerational importance in the transmission of family legacies, which are related to faith, solidarity, education and order. It can also be said that the great-grandparents can be compared to the grandparents of the past, as the grandparents can be assimilated to the parents of older days. It is hoped that this research contributes to the visibility of these two generations and to sensitize professionals about this theme.
THE CONTEXTUAL EXPERIENCES OF SOCIAL CAPITAL AMONG OLDER GRANDPARENTS RAISING ADOLESCENT GRANDCHILDREN
Authors: Peterson Tina L
Published: November 2019

Older grandparents raising adolescent grandchildren are an understudied population. Greater understanding is needed of the social capital (e. g. information, emotional support, companionship, practical instrumental support, and influence, power, and control) harnessed by older grandparents raising adolescent grandchildren. This research applied a qualitative, phenomenological approach to explore social capital among older grandparents. Face-to-face interviews were conducted with 19 grandparent caregivers ranging in age from 55 to 88 years. Eligibility criteria were: primary caregiver for a grandchild 12 years or older; grandchild resides in home at least 3 days; grandparent 40 or older and resides in Oklahoma, Alabama, or Kentucky. Participants were recruited by word of mouth, newspapers, and flyers. Grandparents responded to a question prompt, “I am going to ask you some questions about your support system to assist with your concerns about your older grandchild.” Interviews were conducted in public places, audiotaped, and transcribed verbatim. Data were analyzed using a question analysis approach to sort responses into matrices, develop memos, and identify themes. Most older grandparents were female (84.2%), Caucasian (52.6%), married (57.9%), and never attended a support group (68.4%). One overarching theme from these older grandparent caregivers is access to social capital exists on a continuum. Participants’ experiences with social capital pertained to family proximity, evolving perception of friends, limited or no social engagement with neighbors, dynamics of church attendance and size, and familiarity with community resources. These older grandparents raising adolescents shared positive reactions to select social capital with some types emerging as less important or underdeveloped.
BLACK AND WHITE YOUNG ADULTS’ SUPPORT TO MIDLIFE PARENTS
Authors: Wood Kristie A , Huo Meng , Ng Yee To , Fingerman Karen
Published: November 2019

Researchers have observed racial differences in support to midlife parents. Black adults typically provide more support to parents and report greater rewards in doing so. We were interested in whether this differential trend can be observed in young adulthood. Furthermore, we aimed to understand cultural beliefs underlying any racial differences in support provided to parents. We examined support Black and White young adults provided to their parents, and beliefs associated with that support. Young adults (aged 18–35 years; 26%, n=184 Black and 74%, n=525 White) from the Family Exchanges Study II (2013) participated. They reported how often they provided 4 types of support (financial, technical, practical, emotional) to each parent (N =824) on a scale from 1 = once a year or less often to 8 = everyday. Multilevel models revealed Black young adults provided more frequent support to parents than White young adults, mediated by beliefs about familial obligation. Interestingly, we also found that Black young adults report significantly more negative relationship quality with parents and a stronger desire for support from parents when compared to White young adults. Findings suggest that Black young adults may espouse collective and interdependent values such as the ability to provide for a family and to receive support from family. Further, more frequent support may co-occur with conflicts that suggest that congruence between values and support do not necessarily inspire harmonious ties.
SUPPORT AND EDUCATION NEED FULFILLMENT IN INFORMAL DEMENTIA CAREGIVERS
Authors: James Nicholas , Paulson Daniel
Published: November 2019

Caregivers vary widely in their need for and utilization of support services, and there are many reasons for this (e.g., time or financial cost, distance, perception of need). This study explored the disparity between services that are desired and those that are utilized, and examined the hypothesis that unmet needs are a determinant of caregiver burden. An online sample of informal caregivers (N=151) responded to a questionnaire containing a list of common caregiver support services: sharing duties, professional transportation, respite care, non-profit community organizations, financial counseling, caregiver education programs, support groups. Participants were presented with a list of support services and information and asked to indicate A) which they desired and B) which they had received while providing care. Respite care and financial counseling were identified as support that caregivers were unable to obtain, while caregiving education and family/friend support were most commonly fulfilled. A linear regression model controlling for demographic variables was constructed. Unfulfilled support needs accounted for 40.6% of variance in caregiver burden, however the final model included only total ratio of unfulfilled services, transportation services, stress management skills, professional treatment for the caregiver, and behavioral management skills. Results highlight the unique contribution of certain support services in burden reduction. These findings imply a need to improve accessibility to caregiver support, especially those which require payment (e.g., transportation aids and mental healthcare). Further implications and actionable changes related to caregiver support services are discussed.
RELATIONSHIPS BETWEEN INFORMAL CAREGIVERS’ MARITAL SATISFACTION, BURDEN, AND CAREGIVING STRESS
Authors: Ottmar Hannah , Houston Amy , Harfmann Elisabeth , Olzmann Amy , Brewster Glenna
Published: November 2019

Spouses often serve as the primary caregiver of individuals with dementia (Wright, 1991). As caregiving can be a stressful experience, marriage strains may occur. Researchers have found that caregiver spouses reporting low marital cohesion and satisfaction endorsed significant symptoms of depression (Rankin et al., 2001). Lower levels of marital intimacy have been found to be associated with higher levels of depression and strain among caregivers (Morris et al., 1998). The goal of the current study was to better understand the relationships between caregiver (N = 158) marital satisfaction, caregiving stress, and subjective and objective burden. Results indicated that marital satisfaction was a significant negative predictor of subjective burden as measured by the Zarit Burden Interview (F(1,134) = 93.51, p < .001, R2 = .411), subjective burden as measured by the Revised Memory and Behavior Problems Checklist (RMBPC), Reaction Scale (F(1, 146) = 25.65, p < .001, R2 = .149), and role captivity (F(1, 139), P < .001, R2 = .380). Marital satisfaction was a significant positive predictor of caregiver competence (F(1,140) = 32.45, p < .001, R2 = .188). It was also found that marital satisfaction was not a significant predictor of objective burden as measured by the RMBPC Frequency Scale (F(1, 146), p = .065, R2 = .023). The findings have implications for future interventions in that improving marital satisfaction of spouse caregivers may reduce subjective burden, decrease feeling trapped within the caregiving role, and increase caregivers’ sense of competence within the caregiving role.
IMPACT OF ELDER ABUSE ON SUBSEQUENT COGNITIVE DETERIORATION IN OLDER ADULTS WITH COGNITIVE IMPAIRMENT
Authors: FANG Boye , Yan Elsie
Published: November 2019

Objectives: Considering the rapidly increasing older population, elder abuse has become a major public health problem. Using longitudinal data, this study examines the impact of elder abuse on subsequent cognitive deterioration. Methods: At baseline, one-thousand-and-two older adults (aged≥55 years) with a clinically valid diagnosis of mild-to-moderate cognitive impairment were consecutively recruited from the geriatric and neurological departments of three Grade-A hospitals in Guangdong Province of People’s Republic of China from 2015 to 2016 and 958 of them have completed the present follow-up study after two years. The major independent variables were psychological abuse, physical abuse, caregiver neglect, and financial exploitation experienced at baseline. The outcome variable was cognitive deterioration defined by repeated measures using the Mini-Mental State Examination. Covariates included demographic characteristics, neuropsychiatric symptoms, depression, and IADL impairment. Results: According to the mixed-effect model, elder abuse at baseline did not have significant association with baseline cognitive impairment. However, experience of physical abuse (coefficient 0.11; 95% CI 0.06-0.15), psychological abuse (coefficient 0.28; 95% CI 0.09-0.47), and caregiver neglect (coefficient 0.03; 95% CI 0.01-0.05) at baseline predicted greater cognitive deterioration over the two-year observation period. Other contributing factors for greater cognitive deterioration included neuropsychiatric symptoms and depression. Discussion: Although no significant cross-sectional association between elder abuse and cognitive impairment was observed, physical abuse, psychological abuse, and caregiver neglect at baseline was found to have a long-term prominent effect on subsequent cognitive deterioration over the two-year observation period. The present results su
THE EFFECT OF YOGA ON FALL PREVENTION OUTCOMES IN ADULTS 50 YEARS AND OLDER: A SYSTEMATIC REVIEW OF THE LITERATURE
Authors: Nsobundu Chinelo K , Foster Margaret J , Hong Yan
Published: November 2019

Falls constitute a multitude of injuries irrespective of age. To combat these challenges, older adults are encouraged to engage in recreational activities. Yoga has been identified as an effective physical activity to promote mobility and balance for older adults. This study aims to systematically review the literature about yoga as a fall prevention intervention and synthesize the outcomes. Major databases (Ovid Medline & CINAHL) were searched for relevant articles. Studies were included if they met the criteria of 1) being a face to face yoga program, 2) aimed to recruit participants 50 years or older, and 3) reported at least one fall-related outcome (e.g., balance, mobility, fear of falling) as a result of the yoga program. 57 studies were identified: 32 from Ovid Medline and 25 from CINAHL. After removing the duplicates and applying a strict inclusion and exclusion criteria, 11 articles were included in the final analysis. A detailed synthesis of the results will be presented and quality assessment of included articles will be performed using the Modified Downs and Black checklist which appraises the methodological quality of both randomized and non-randomized studies. More research is needed to understand the impact of yoga in preventing falls among older adults at least 50 years of age. Additionally, research should establish a gold standard index that identifies which specific yoga programs ( based on type- individual vs. group; hatha, iyengar, kundalini, ashtanga, and etc.; frequency, and duration) have an enhanced effect on fall prevention.
FALLS AND MOTOR VEHICLE COLLISIONS: A LONGITUDINAL INVESTIGATION OF OLDER DRIVERS
Authors: Pope Caitlin N , Fazeli Pariya , Bell Tyler R , Gaini Meghana , Mrug Sylvie , Ball Karlene
Published: November 2019

Longitudinal research is needed to better understand mobility and aging, as falls and motor vehicle collisions (MVCs) are the top two leading causes of unintentional injury-related deaths for adults 65 and older in the United States. Using a longitudinal sample of older adults, prior falls were assessed as a predictor and moderator of the rate of subsequent MVCs over a 15 year time period. Using a 15-year longitudinal sample of 1,911 older adults recruited from three Maryland State Motor Vehicle Administration (MVA) sites, we conducted group differences and Generalized Estimating Equation (GEE) Poisson regressions. Individuals who reported a fall at baseline were more likely to be female, older, have poorer physical functioning, and reported more situational driving avoidance at baseline compared to those who did not report a fall. Females who reported a fall at baseline had a 2x greater risk rate of subsequently reporting a MVC over the 15 year time period than males. Furthermore, individuals, irrespective of gender, with a prior fall at baseline who drove more days per week over the 15-year time span had a 23% higher risk rate of a subsequent MVC. The current findings further the discussion on aging and mobility as it offers a longitudinal perspective on the association between falls and MVCS. These findings promote the utility of investigating non-traditional driver screening methods to identify drivers who may be at an increased rate for further driving difficulties.
LOWER BACK PAIN AFFECTS MOBILITY-RELATED INJURIES IN OLDER ADULTS
Authors: Bell Tyler R , Fazeli Pariya , Pope Caitlin N , Crowe Michael , Ball Karlene
Published: November 2019

Pain causes functional limitations and might elevate risk for mobility-related injuries in older adults. For this reason, we examined the longitudinal impact of lower back pain on the likelihood of MVCs and falls. Between 1998 and 1999, participants (ages >55 years) completed cognitive and physical measures at three Motor Vehicle departments. Participants then completed a telephone interview (n=1,248) assessing yearly health complications and injuries, which continued annually for 14 years. Separate longitudinal models examined the relationship between lower back pain and MVC and fall likelihood while controlling for demographics and mobility. Overall, those with lower back pain were twice as likely to have a fall than unafflicted peers (95%CI:1.69-2.47) and odds of MVC was just beyond statistical significance (95%CI: 0.97-1.94). In persons with lower back pain, problems in lower-limb function, divided attention, and task-switching were associated with MVCs whereas problems in lower-limb function were related to falls. Addressing limitations from pain might reduce mobility-related injury in older adults.
THE FEASIBILITY OF USING COMMUNITY PHARMACISTS TO COUNSEL OLDER ADULTS ON FALL PREVENTION
Authors: Smith-Ray Renae L , Singh Tanya , Suwalski Michael W , Taitel Michael
Published: November 2019

Despite recognition as a serious public health problem, older adults falls increased 30% between 2007-2016. Numerous evidence-based fall prevention programs exist, but may have inadequate reach. Pharmacists are highly trained and accessible clinicians who have potential to counsel on fall prevention. This study describes the reach of a fall prevention outreach conducted by a large national pharmacy chain in partnership with local area agencies on aging (AAAs). On August 7, 2018, the pharmacy chain held an outreach during which older patients were incentivized to speak with pharmacists about their fall risk and prevention strategies. In Ohio, AAAs provided pharmacists additional support and availability of AAA fall prevention programs. A random sample of pharmacists was sent a follow-up survey to assess the program’s reach, except in Ohio where all pharmacists received the survey. Response rates were 41% (N=111) and 59% (N=160) in Ohio and non-Ohio states, respectively. We estimate that pharmacists discussed fall prevention with an additional 57,642 on 8/7/2018. The difference in older patients counseled on fall prevention on 8/7/2018 vs. a typical day was significantly greater (p=0.03) for Ohio pharmacists (µ=9.28) compared to non-Ohio pharmacists (µ=5.94). The majority of pharmacists in Ohio and non-Ohio states were moderately or extremely confident in their ability to discuss fall prevention with older patients (69.82% vs. 72.72%) and play an important role in fall prevention (59.75% vs. 54.54%). This study demonstrates the feasibility of utilizing community pharmacists, in partnership with AAAs, to reach large numbers of older adults to counsel on fall prevention.
FRAILTY MEDIATES SENILITY IN MEXICAN AMERICANS
Authors: Palmer Raymond F , Royall Donald R , Downer Brian , Markides Kyriakos
Published: November 2019

The latent construct “d” (for “dementia”) offers a continuously distributed transdiagnostic dementia severity metric. Age is significantly associated with “d”. We test whether frailty mediates age’s effect on 6 year prospective change in dementia severity in Mexican-Americans (MA), using data from the Hispanic Established Population for Epidemiological Studies in the Elderly (HEPESE). Age was regressed onto the 6yr prospective slope of change in “d” in N = 880 [mean age = 77.4 (6.1) at wave 3]. Change in “d” was estimated by a latent growth curve (LGC) indicated by latent cognitive measures across three HEPESE waves (i.e., 3, 5 and 6). “Frailty” was assessed by a modified version of Fried et al.’s construct observed at wave 5, and was tested as a mediator of age’s association with change in “d”. The mediation effect was estimated by MacKinnon’s method. “d” at each wave, and the LGC of change in “d” all had acceptable model fit (e.g. RMSEA <.05). Age was significantly associated with change in “d”. 51% of their association was explained by frailty. Frailty mediates the majority of age’s association with dementia severity. Not only does this support the existence of a cognitive “frailty” syndrome in MA, it also implicates an effect of frailty on intelligence (as “d” is derived from Spearman’s general intelligence factor “g”). Their association may be mediated by blood-based serum biomarkers, including somatomedins, which may offer targets for the treatment and /or prevention of senility in frail elderly persons.
MEDIATING EFFECT OF GRIP STRENGTH TRAJECTORY ON THE ASSOCIATION BETWEEN EXERCISE AND WEAKNESS: A DYADIC APPROACH
Authors: Joo Susanna , Chai Hye Won , Jun Hey Jung
Published: November 2019

This study aimed to explore the mediating effect of grip strength trajectory on the longitudinal association between regular exercise and weakness in grip strength using a dyadic approach. We used six waves of the Korean Longitudinal Study of Aging (KLoSA) collected every two years from 2006 to 2016. The sample was middle and old-aged Korean couples who participated in all six waves of the survey (N=1,967). The outcome variables were husbands’ and wives’ grip strength at Wave 6, coded as a binary variable (0=clinically weak, 1=normal). The mediating variables were husbands’ and wives’ trajectories of grip strength across Waves 1 and 5. Independent variables were three dummy variables indicating couple’s participation in regular exercise (both engaged in regular exercise, only husband did, only wife did). Reference group was both not doing regular exercise. Results showed several significant mediational pathways. For husbands, engagement in regular exercise of both spouses and only husband were associated with higher grip strength at Wave 1, and slower decline in grip across waves was related to lower likelihood of having a clinically weak grip strength at Wave 6. As for wives, engagement in exercise of both spouses was associated with higher grip strength at Wave 1 which in turn was related to lower likelihood of having a clinically weak grip strength at Wave 6. These results suggest longitudinal dyadic processes through which engagement in regular exercise affects weakness in grip strength among older Korean couples.
MOTIVATIONAL INTERVIEWING TO ENGAGE OLDER INPATIENTS IN FALL PREVENTION: PILOT RANDOMIZED CONTROLLED TRIAL
Authors: Kiyoshi-Teo Hiroko , Northrup-Snyder Kathlynn , Eckstrom Elizabeth , Cohen Debbie , Dieckmann Nathan , Stoyles Sydnee
Published: November 2019

Motivational Interviewing (MI) is an evidence-based approach for fostering behavior change and holds potential to engage patients in behavior change related to fall prevention. A two-arm, unblinded, pilot randomized controlled trial was conducted in a hospital setting to determine the feasibility (recruitment and retention), establish suitable procedures for the intervention (duration and quality of MI), and to test study measurements (fear of falling, importance and confidence related to fall prevention, patient activation, fall prevention behaviors, and fall rates). Participants were high fall risk older inpatients (age ≥ 65). The intervention arm received MI at one time during hospitalization in addition to routine hospital fall prevention intervention. The control arm received the routine hospital care for fall prevention only. Measures were collected at baseline, 2-days, 1-week, 1-month, and 3-month. A total of 120 inpatients were contacted by the study team and 67 were randomized: intervention arm (n=36) and control arm (n=31). Approximately 66% of participants completed the study at the 3-month data collection and MI intervention took an average of 21 minutes and was of adequate quality. The intervention group reported less fear of falling after the MI intervention and maintained fall prevention behaviors over time (p<.05). The study identified that MI for fall prevention at a hospital setting was feasible to deliver and provided insights into suitable study procedures and beginning evidence for a positive impact of MI.
EARLY FRAILTY PHENOTYPES AND PREDICTIONS OF COGNITIVE AGING: EVIDENCE FROM THE VICTORIA LONGITUDINAL STUDY
Authors: Bohn Linzy , Zheng Yao , McFall G Peggy , Dixon Roger A
Published: November 2019

Frailty is an aging condition that reflects multisystem decline. A prominent approach to frailty assessment is to create an index, whereby responses across multiple indicators of aging systems are summed to create a single score. These studies indicate that frailty is associated with adverse aging outcomes (e.g., mortality, dementia). We employ a data-driven approach to detecting and differentiating emerging frailty phenotypes and examine their associations with non-demented cognitive aging trajectories. Participants (n = 653; M age = 70.6, range 53-95) were community-dwelling older adults from the Victoria Longitudinal Study. Participants contributed (a) baseline data for 30 frailty-related items representing deficits across 7 domains (e.g., instrumental and cardiovascular health) and (b) longitudinal data for latent variables of executive function, speed, and memory. For each participant, we calculated the proportion of deficits present in each frailty-related domain and submitted these data to a latent profile analysis (LPA; Mplus 7.0). We used latent growth modeling (LGM) to test these frailty phenotypes for prediction of cognitive performance and decline. LPA results revealed three profiles, one large normal low-frailty profile and two emerging frailty phenotypes. Whereas the latter represented profiles of individuals with respiratory-type frailty (i.e., marked impairment in respiratory function; 7%) and mobility-type frailty (i.e., marked impairment in mobility function; 9%), the former featured limited impairment across frailty domains (83%). Findings from LGM indicated that these profiles were differentially related to cognitive performance and decline. Data-driven approaches can help detect early differentiation of frailty profiles and contribute to personalized intervention.
PROVIDER AND SYSTEM IMPACTS OF THE UW ECHO IN RURAL AND FRONTIER CARE TRANSITIONS
Authors: Carrico Catherine , Woods Tonja , Barry Robin A , Franke Kevin , McKibbin Christine
Published: November 2019

Background: The Project ECHO model utilizes a hub and spoke approach through which a team of experts co-mentors local providers in the management of complex cases while disseminating information about best practices and evidence-based care. Project ECHO is a promising model for improving patient care through transformation of the care delivery system. The UW ECHO in Rural and Frontier Care Transitions created an online community of practice comprised of local care coalitions dedicated to improving care transitions in Wyoming and Montana. This ECHO network provided a unique opportunity to support system- and provider-level implementation of best practices in care transitions. Methods: Semi-structured interviews were conducted with thirty ECHO attendees following participation in an ECHO session as either a participant or case presenter. Thematic analysis was used to analyze interview data. Results: Two overarching themes emerged 1) impact of the ECHO on the provider or healthcare team and 2) impact on the system. Participants indicated that the impact on the provider/healthcare team included an increased sense of community, increased awareness of community resources, increased knowledge of care transition strategies, and increased confidence in implementing best practices. Additionally, providers indicated increased utilization of community resources. Systemic impacts included increased involvement of interprofessional team members in patient care and utilization of ECHO recommendations to present systemic interventions and changes to colleagues, administration, and leadership. Conclusions: This ECHO network had a particularly strong impact on the provider and healthcare team as participants increased their knowledge, confidence, and use of best practices in care transitions.
HOW MEDICAL EDUCATION ALLEVIATED ETHICAL DILEMMAS IN RESIDENTS DURING END-OF-LIFE FAMILY MEETINGS IN THE SOUTH TEXAS
Authors: Martin Jessica G , Rivera-Burciaga Andrya , Gutierrez Cesar , Dentino Andrew
Published: November 2019

The UTRGV DHR Internal Medicine Program conducted a study addressing end of life (EOL) care focused on our Hispanic community in regards to communication and trust between patients, caregivers, and healthcare providers. Our residents train at a community hospital which cares for an 89% Hispanic population of 1.2 million, spanning over 4 counties of the Rio Grande Valley. Trainees are often involved in family meetings while treating hospitalized, terminally ill patients. Although family meetings are a standard approach in palliative care, Hispanic family meetings tend to occur more often and with a larger, extended family unit. Our intent was to educate our residents to initiate conversations about EOL care choices promoting delivery of patient-centered, family oriented care utilizing culturally appropriate information regarding EOL issues. Baseline surveys were provided to all 39 trainees which assessed anxiety, incompetence, and communication skills in delivering bad news during family meetings. An advanced care planning process was implemented over 3 months with a goal to engage patients in EOL conversations, initiation, and completion of advanced directives. Residents received weekly training on interactive methods and ethical concepts including group discussions, role-playing, and demonstrations which were culturally and linguistically appropriate. We found that physician competence in conducting Hispanic family meetings is vital. Residents completed a post-training survey resulting in 100% improved attitudes and behaviors such as confidence, satisfaction, caring and empathy. They felt more comfortable and prepared to speak to a larger family unit who was likely to ask a lot of questions and request multiple meetings.
EHEALTH PROGRAM BASED ON THE INFORMATION-MOTIVATION-BEHAVIORAL SKILLS MODEL FOR THE ELDERLY: A PILOT STUDY
Authors: Yang Eunjin , Chang Sun Ju , Lee Kyoung-eun , Ryu Hyunju
Published: November 2019

Although the internet is helpful and considered a preferred channel to get health information, some vulnerable populations such as the elderly have a digital divide. The purpose of this study was to test the development and intervention of the eHealth program based on the Information-Motivation-Behavioral Skills (IMB) model for improving internet health information seeking, understanding and utilization behaviors in the elderly. This study was a single group pretest-posttest design, and the eleven elderly aged 67-87 (mean74.6, SD 6.9) participated in 5 session program at a senior welfare center from 25 January to 22 February 2019. Each theory-based constructs of IMB model such as computer/web knowledge (p<.01), attitude toward the internet health information usage (p<.01), and eHealth literacy (p<.01) was significantly improved at posttest than pretest. More than half of the participants (6 of 11) gave up on searching internet health information on pretest; however, all of the participants searched the internet health information accurately on the posttest. Regarding health information understanding, a significant difference was found (p=.03), and participants reported positive behavioral change after the program (6.54 ± 2.42). This pilot study indicated that the theory-based eHealth program might be an effective way to decrease a digital divide for the elderly. Therefore, the preliminary findings show promise for the use of the IMB model-based eHealth program as an intervention to improve internet health information seeking, understanding, and utilization behaviors in the elderly.
IN-PERSON FIDELITY MONITORING: HOME-BASED INTERVENTION DELIVERY FOR PERSONS WITH DEMENTIA AND THEIR CAREGIVERS
Authors: Sefcik Justine S , Hodgson Nancy A
Published: November 2019

The gold standard for ensuring satisfactory delivery of an intervention remains fidelity monitoring. In-person observations for fidelity monitoring has received less attention in the literature compared to evaluating sessions via video and audio-recordings. This presentation focuses on a qualitative analysis of field notes from 15 scheduled fidelity visits of a home-based intervention involving persons with dementia and their caregivers (Healthy Patterns, NCT03682185). The findings of advantages (e.g., being able to complete observations in real time), disadvantages (e.g., additional time needed from staff to coordinate and attend visits), and ethical considerations (e.g., potential intrusiveness in the home when observing staff) with be discussed. Future research recommendation is to explore participant perspectives on having an in-person fidelity monitor in the home.
EMPOWERING OLDER ADULTS IN HEALTHCARE SETTINGS: COMMUNICATION SKILLS TRAINING FOR SURGICAL RESIDENTS
Authors: Roberts Linda , Cornell Charles , Bostrom Mathias , Goldsmith Sandra , Ologhobo Titilayo , Roberts Timothy , Robbins Laura
Published: November 2019

Older adults often perceive themselves as stigmatized and powerless in healthcare settings. Communication with them is complicated by age-related issues and negative stereotypes about older adults and aging. It is therefore vital for physicians and surgeons, who encounter the most vulnerable elderly, to communicate successfully with this population, who wish to maintain quality and dignity in their lives. Successful patient communication leads to better recall of information, compliance, adherence to medications, satisfaction, and overall better outcomes. We developed a two-part training program comprised of small group interactive didactic sessions on aging issues with third year surgical residents, and workshop demonstrations given by the residents to a group of older adults, followed by a question and answer session. Residents were assessed using a 22-item pre–post questionnaire covering medical knowledge of aging, attitudes toward older adults, and personal anxiety about aging. Since its inception, the program has reached 88 residents and 711 older adults. For residents, knowledge scores (p ≤ 0.001), six of nine attitude items (p ≤ 0.01) and one of four anxiety items (p ≤ 0.001) improved significantly. This is notable as well since attitudes and anxiety levels are attributes that are deep-seated and hard to change. For older adults, post surveys showed that 96% strongly agreed/agreed that residents had demonstrated sensitivity toward them and 96% were very satisfied/satisfied with the program. Our replicable, low-cost program enables residents to learn and realistically practice universal underlying communication skills in order to maintain effective and sensitive communication with this vulnerable population.
HOW TO PREPARE PHYSICIAN ASSISTANTS FOR THE CARE OF OLDER ADULTS? PARTNER WITH GERONTOLOGY
Authors: Eaton Jacqueline , Honda Trenton
Published: November 2019

Approximately 80% of older adults have chronic illness which requires complex care. Primary care providers require special training to improve the care they provide older adults. As primary care shortages increase, and the older adult population swells, physician assistants (PA) will increasingly be relied upon to provide care and advocacy for older adults. The purpose of this presentation is to describe the development of a dual degree program that facilitates enhanced gerontological training for students pursuing a Masters of PA Studies degree. The Gerontology Interdisciplinary Program and the PA Program at the University of Utah collaborated to assess program objectives, competencies, and coursework, while identifying student interest in this dual MS venture. Students were interested in increasing their skills to meet the growing need for geriatric care while also saving time and money. In addition, it was important that the combined program of study did not overburden students and accommodated participants off-site. Faculty and administrative buy-in was sought from within departments and colleges. Revisions to the proposed program of study included altering course offerings, changing program start dates, and removing course overlap. A 30-month dual MS was developed that incorporates 87 PA Program credits, 25 Gerontology Credits, and 6 credits shared through practicum, geriatric content, and evidence based practice. Students who graduate will complete a Gerontology focused Masters Project that combines their work from the two programs. This dual MS program prepares students to be competitive in the job market, while also targeting an area of need in primary care.