bluuebunny/crossref_metadata_2025 huggingface dataset:
THE LONG ARMS OF CHILDHOOD INTELLIGENCE AND EDUCATION ON TERMINAL DECLINE: EVIDENCE FROM LOTHIAN BIRTH COHORT 1921
Authors: Cadar Dorina , Cadar Dorina , Robitaille Annie , Pattie Alison , Deary Ian J , Terrera Graciela Muniz
Published: November 2019

We investigated the heterogeneity of cognitive trajectories at the end of life by assigning individuals into groups according to their cognitive trajectories prior to death. Data were from the Lothian Birth Cohort of 1921. Growth mixture modelling was employed to identify groups of individuals with similar trajectories on the Mini-Mental State Examination in relation to time to death, accounting for childhood intelligence, education, hypertension, diabetes and cardiovascular disease. Two distinct groups of individuals (classes) were identified: a smaller class (18%) of individuals whose MMSE scores dropped linearly with about 0.5 points per year, and a larger group (82%) with stable scores across the study period. Childhood intelligence was associated with an increased probability of belonging to the stable class of cognitive functioning prior to death. These findings support a protective role of childhood intelligence, a marker of cognitive reserve, against the loss of cognitive function prior to death.
SURVIVAL ADVANTAGE OF APOE2
Authors: Seshadri Sudha
Published: November 2019

Apolipoprotein E is a glycoprotein mediator and regulator of lipid transport and uptake. The APOE-ε4 allele has been associated with higher risk of Alzheimer’s disease and of mortality, but the effect of the less prevalent APOE-ε2 on survival remains elusive. We aggregated data of 38,537 individuals of European ancestry (mean age 65.5 years; 55.6% women) from six large population-based cohorts to determine the association of APOE-ε2, with survival in the general population. During a mean follow-up of 11.7 years, 17,021 individuals died. Compared with homozygous APOE-ε3 carriers, APOE-ε2 carriers were at lower risk of death (hazard ratio,95% confidence interval: 0.94,0.90-0.99; P=1.1*10-2), whereas APOE-ε4 carriers were at increased risk (HR 1.17,1.12-1.21; P=2.8*10-16). Risk was lowest for homozygous APOE-ε2 (HR 0.89,0.74-1.08), and highest for homozygous APOE-ε4 (HR 1.52,1.37-1.70). Results did not differ by sex. The association was unaltered after adjustment for baseline LDL or cardiovascular disease. Larger, multiethnic collaborations are ongoing.
REDUCED COGNITIVE DECLINE WITH THE APOE ε2/ε2 GENOTYPE IN THE LONG LIFE FAMILY STUDY AND NEW ENGLAND CENTENARIAN STUDY
Authors: Sweigart Benjamin , Sweigart Benjamin , Andersen Stacy L , Cosentino Stephanie , Schupf Nicole , Perls Thomas T , Sebastiani Paola
Published: November 2019

A growing body of evidence has suggested a protective effect on cognition of the ε2 allele of APOE. To determine if APOE ε2 is associated with protection against cognitive decline, we analyzed repeated measures of the Telephone Interview for Cognitive Status (TICS) from 2,933 Long Life Family Study subjects and 679 New England Centenarian Study subjects using a multivariable linear mixed effects model. The median age at first TICS administration was 73 (interquartile range [IQR] 64, 83). Subjects had a median of 3 TICS assessments (IQR 2, 4) and a median follow-up time of 5.0 years (IQR 2.9, 7.0). Carriers of the ε2/ε2 genotype had a significantly slower rate of decline in TICS score compared to the ε3/ε3 reference group (-0.05 points per annum for ε2/ε2 carriers compared with -0.15 points for ε3/ε3 carriers, p-value for difference 0.017). These results support a protective effect of the ε2 allele.
A SERUM PROTEIN SIGNATURE OF APOE GENOTYPES IN CENTENARIANS
Authors: Monti Stefano , Monti Stefano , Sebastiani Paola , Gurinovich Anastasia , Tanaka Toshiko , Jennings Lori L , Glass David J , Perls Thomas T
Published: November 2019

The discovery of treatments to prevent or delay Alzheimer’s disease is a priority. The gene APOE is associated with cognitive change and late onset Alzheimer’s disease, and epidemiological studies have shown that the e_2 allele of APOE has a neuroprotective effect, and it is associated with increased longevity. We correlated APOE genotype data of 222 New England Centenarian Study participants, including 79 centenarians, 84 centenarian offspring and 55 carriers of APOE e_2, with aptamer-based serum proteomics (SomaLogic technology) of 4783 human proteins corresponding to 4137 genes. We discovered a signature of 16 proteins that associated with different APOE genotypes, and replicated the signature in 3 independent studies. We show that the protein signature tracks with gene expression profiles in brains of late onset Alzheimer’s disease vs. healthy controls. Finally, we show that seven of these proteins correlate with cognitive function changes. Therefore, targeting APOE e_2 molecularly may preserve cognitive function.
DO WARMED BLANKETS CHANGE PAIN, AGITATION, MOOD, OR ANALGESIC USE AMONG NURSING HOME RESIDENTS?
Authors: Kovach Christine
Published: November 2019

Warmed blankets have not been empirically tested for use in long-term care. The purpose of this study was to describe the use of warmed blankets in a nursing home setting and to determine if use was associated with changes in pain, agitation, mood, or analgesic use. Short-term measures were compared from baseline to post warmed blanket use and longer term differences were compared between those receiving warmed blankets and a randomly selected comparison group. Excluded from eligibility were those using a transdermal drug, with an acute injury, acute inflammatory process, multiple sclerosis, open skin wound, or other condition that could be worsened by superficial heat. Measures included the Revised Faces Pain Scale, PAIN-AD scale, the Brief Agitation Rating Scale, and from the electronic medical record one month measures pain complaints, pain severity, and analgesic use. Long-term measures were taken from the electronic medical record. Of the 141 eligible residents, 24.1% (n = 34) received a warmed blanket over the one month study period. There were statistically significant decreases in both pain level and agitation between baseline, 20 minutes after application, and the subsequent shift assessments (p < .001). There were also long-term changes in the number of pain complaints (p = .040), severity of pain complaints (p = .009), and prn analgesic use (p = .011). There were no statistically significant differences between the treated group and comparison group on any long-term measures. Warmed blankets are a low-cost intervention with a high potential for bringing comfort to nursing home residents.
ACCESS TO HEALTH CARE FOR LGBT PEOPLE
Authors: Bristowe Katherine
Published: November 2019

LGBT people have higher risk of life-limiting illnesses and unmet needs when facing advanced illness.The ACCESSCare research programme aims to improve health and social care for LGBT people. ACCESSCare-A explored experiences of 40 UK LGBT people facing serious illness. Discrimination, heteronormative assumptions, and insensitivity influenced whether individuals disclosed relationships to professionals and place-of-care decisions. Professionals must go beyond anti-discrimination to proactive inclusion: 10 evidence-based recommendations were developed to improve care for LGBT people. Our sister study in Zimbabwe explored the healthcare experiences of key populations (LGBTI people, sex workers). Access to healthcare was dependent on conforming to ‘sexual norms’ and care was negatively affected by professionals’ attitudes to key populations. There are two ongoing research projects in the ACCESSCare programme: ACCESSCare-B, a mixed-methods population-based comparative study of LGB and heterosexual bereavement outcomes; and ACCESSCare-C a qualitative study to develop communication guidance for professionals supporting LGBT people facing serious illness.
END-OF-LIFE EXPERIENCES AND CARE NEEDS IN THE LIVES OF OLDER LGBT PEOPLE
Authors: Almack Kathryn
Published: November 2019

The socio-cultural and legal position of LGBT citizens varies across nations. However, even in the most liberal countries, an historical legacy of stigma impacts on older LGBT people’s access to care. This paper draws upon the qualitative strand of a two-year UK project exploring the end of life experiences and care needs of older LGBT people. (N = 60 in-depth interviews with LGBT participants aged 60+). Findings highlight that the majority of respondents reported ways in which they manage their personal networks to minimize any vulnerability to discrimination. In planning or needing end-of-life-care, respondents identify new ‘layers’ of decisions about disclosing or hiding their sexual or gender orientation; informed by past experiences and fears about discrimination or exclusion from service providers. In conclusion, older LGBT people’s histories and a legacy of stigma have ongoing profound influences on the means of support available to them at the end of life.
SOCIAL AND BIOLOGICAL PREDICTORS OF HOSPITAL ADMISSIONS FOR A FALL IN THE ENGLISH LONGITUDINAL STUDY OF AGEING (ELSA)
Authors: Abell Jessica G , Lassale Camille , Steptoe Andrew , Batty G David , Zaninotto Paola
Published: November 2019

Falls are the most frequent type of accidents among older people, with one in three people aged over 65 falling each year. Falls serious enough to result in hospital admission are especially problematic, since they can lead to an increased likelihood of future disability, loss of independence, and premature mortality. Understanding the factors that may determine the risk of experiencing a fall, which requires admission to hospital, is therefore an important priority. This paper seeks to examine this issue using Hospital Episode Statistics (HES) data – administrative data from English hospitals in the National Health Service (NHS). These data have recently been linked with the English Longitudinal Study of Ageing (ELSA). We examine the association between a range of predictors (demographic, social environment, physical and mental functioning) drawn from wave 4 of ELSA with the first occurrence of hospitalisation due to an accidental fall, identified using ICD-10 codes. Analysis using Cox regression suggest a range of factors are negatively associated with admission to hospital with diagnosis of a fall, such as living alone (HR=1.42; 95% CI: 1.19, 1.68), urinary incontinence (HR=1.33; 95% CI: 1.09, 1.61) and depressive symptoms (HR=1.50; 95% CI: 1.23, 1.82). High walking speed (HR=0.30; 95% CI: 0.23, 0.39) and good hand-grip strength (HR=0.97; 95% CI: 0.96, 0.98) were found to be protective. The prevention of serious falls amongst older people will require determinants to be identified and managed effectively by health and social care services.
NON-FAMILIAL INTERGENERATIONAL NETWORK TIES: MOVING THE NEEDLE ON MEASUREMENT
Authors: Jarrott Shannon E
Published: November 2019

GSA and other professional organizations recognize the threat that ageism poses to the country’s health and welfare, from its youngest to oldest citizens. Reframing Aging involves communication and outreach strategies to inform the conversation about aging and its implications. Non-familial intergenerational relationships can support the Reframing Aging initiative. By fostering positive, intentional, and mutually beneficial interactions, intergenerational exchange can achieve a variety of individual, relational, and community goals. Measures of their impact should reflect these goals; unfortunately, intergenerational network ties are typically represented by measures of young people’s attitudes towards older adults. Practitioners, researchers, policy makers, and funders need additional indicators to document the best practices and potential impact of non-familial intergenerational programs. Reflecting recent systematic surveys of measurements and 20 years of intergenerational research, the current paper addresses challenges of measuring non-familial intergenerational relationships and presents select measures appropriate for common network ties.
EVALUATING THE IMPACT OF STAR-VA ON VETERANS’ PSYCHOTROPIC MEDICATION USE IN CLCS
Authors: McConeghy Kevin , Curyto Kim , Jedele Jenefer M , Mach Jennifer , Intrator Orna , Wiechers Ilse R
Published: November 2019

The impact of STAR-VA on psychotropic drug use among residents with behavioral symptoms of dementia was evaluated through a difference-in-differences framework. STAR-VA residents enrolled 2013-2017 were evaluated longitudinally pre-post intervention. The primary outcome was the number of as needed administrations with an indication of ‘anxiety’ or ‘agitation’. The analytical cohort included 214 training cases and 1,870 controls from untrained sites meeting eligibility criteria. STAR-VA cases were less white (48% vs. 54%), less black (11% vs. 14%), and had significantly longer median length of stay (830 vs. 261 days), respectively. STAR-VA cases had on average 3.5 as needed doses/month of psychotropic medication before the intervention and 1.7 after, controls averaged 1.8 doses/month. After adjustment for person-time-fixed effects, enrollment was associated with 55% (95% CI:30, 68) reduction or an average 0.8 as needed psychotropic doses/month. Findings demonstrate effectiveness in decreasing as-needed psychotropic drug use among CLC residents, supporting continued implementation of STAR-VA.
THE ASPREE STUDY: DISABILITY-FREE SURVIVAL, UPDATED RESULTS, SUB-STUDIES, AND IMPLICATIONS FOR ASPIRIN USE
Authors: Murray Anne M , McNeil John , Eldadah Basil
Published: November 2019

The NIA/NCI ASPREE (ASPirin in Reducing Events in the Elderly) Study was a landmark RCT of 19,114 healthy adults aged 70 (whites) and 65 (US minorities) in Australia and the US that demonstrated lack of effect of low dose aspirin (LDA:100 mg/d) on the novel primary end point of Disability- Free Survival (life free of disability and dementia) over a mean treatment of 4.7 years. Surprisingly, LDA was associated with a trend toward increased all cause mortality, driven by cancer deaths (results published NEJM September 2018). After the LDA intervention was halted in June 2017, ASPREE was extended as an observational cohort follow-on study, ASPREE-XT, to measure potential delayed LDA effects on ASPREE outcomes. The ASPREE study primary results will be summarized, and the rationale for and performance of the novel DFS geriatric outcome discussed. New results of the analysis of dementia as a secondary outcome will also be presented (both for overall dementia and Alzheimer’s disease). We will also examine the unexpected increased all-cause mortality attributed to cancer deaths, despite no significant difference between groups for all incident cancer, and effects of LDA on incident metastatic disease. The important implications of the ASPREE results for prescribing LDA for primary prevention in health elderly will be discussed, and the ASPREE-XT study design and progress described. Lastly, the breadth of the ASPREE sub-studies including the Biobank, Brain Imaging studies and Genomics, and opportunities to access the rich ASPREE data and collaborate with ASPREE investigators will be reviewed.
EFFECT OF INITIATING ASPIRIN ON CANCER EVENTS IN THE HEALTHY ELDERLY
Authors: Chan Andrew T , Gibbs Peter , Lockery Jessica E , Polekhina Galina , Orchard Suzanne G , Ford Leslie , Umar Asad , McNeil john J
Published: November 2019

In ASPREE, we previously reported a surprising increase in cancer-related deaths associated with initiating aspirin. We now report primary incident cancer events. Aspirin was not associated with risk of incident cancer (HR=1.04, 95% CI 0.95-1.14), including non-metastatic cancer (HR=0.99, 95% CI, 0.89-1.11) and colorectal cancer (HR=1.02; 95% CI, 0.81-1.30). However, risk of incident metastatic cancer was elevated with aspirin (HR=1.18; 95% CI,0.96-1.46), although this could be attributable to chance. In ASPREE, the increase in cancer deaths associated with initiation of aspirin was not accompanied by a significant increase in overall incident cancer after 4.7 years. However, there did appear to be an increase in the incidence of advanced cancer in the aspirin arm. These data support the possibility that aspirin may adversely affect short-term outcomes among elderly participants with undiagnosed cancers (e.g. prevalent tumors at enrollment or early incident tumors) and/or may have differential effects according to age.
THE ASPREE STUDY: DEMENTIA DUE TO ALZHEIMER’S DISEASE OUTCOMES
Authors: Shah Raj C
Published: November 2019

In the ASPREE clinical trial, aspirin 100mg daily in health older adults did not delay onset of dementia, a pre-specified secondary outcome over a period of 5 years. We examine whether low-dose aspirin versus placebo is related to incident dementia due to Alzheimer’s disease. Older community-dwelling participants free of dementia, physical disability, and conditions requiring aspirin treatment were recruited (n=19,114). Participants were administered a cognitive test battery during follow-up and participants with suspected dementia underwent a more extensive dementia assessment. An expert international panel adjudicated dementia according to DSM-IV criteria, with sub-classification according to NIA-AA criteria. Over a median 4.7 years, 575 participants had a confirmed dementia diagnosis. In analysis of the 41% of cases classified as dementia probably due to Alzheimer’s disease, no difference in the incidence between the treatment arms was found (HR=0.96, 95% CI =0.74, 1.24). Plans for continued assessment of cognition in ASPREE-XT will be presented.
POTENTIAL IMPLICATIONS OF ASPREE ON ASPIRIN PRIMARY PREVENTION GUIDELINES
Authors: Murray Anne M
Published: November 2019

The 2016 USPSTF guidelines for aspirin to prevent CVD and colorectal cancer noted insufficient evidence to assess the balance of benefit and harm in those 70 and older. The long-awaited ASPREE trial, conducted in healthy elderly aged 70 and older (65 for US minorities), evaluated aspirin’s effect on disability-free survival, a composite of death, dementia, or persistent physical disability. CVD and cancer were pre-specified secondary endpoints, positioning ASPREE’s results to substantially inform the evidence gap noted in the USPSTF guidelines. Low-dose aspirin over 5 years did not lower CVD events or colorectal risk, but significantly increased bleeding. The ASPREE-XT observational follow-up study over the next 5-7 years will observe for potential legacy effects of aspirin on the primary and secondary outcomes of ASPREE, thus adding further evidence to define the risk-benefit profile of aspirin for primary prevention in healthy elderly.
FOOD INSECURITY AND COST-RELATED MEDICATION NON-ADHERENCE IN OLDER ADULTS: A SYSTEMATIC REVIEW
Authors: Boss Lisa L , Caouette Shaunna
Published: November 2019

Food insecurity (FI) is defined as having limited access to nutritional and safe foods due to lack of financial resources and is believed to negatively influence health outcomes. Older adults, in particular, face rising healthcare costs and may be forced to choose between purchasing prescribed medications and using their limited financial resources for basic needs, such as food. The purpose of this systematic review was to examine the relationship of food insecurity (FI) and cost-related medication non-adherence (CRN) in older adults living in the community setting. A comprehensive, electronic review of the literature was performed. Criteria for inclusion were original quantitative or qualitative research, written in English, human participants ≥60 years, and published from January 2000 through January 2019. The total number of studies included was six. Main findings from the studies largely indicate that FI and CRN are significantly and positively correlated in older adults living in American communities. Further, CRN increases with the severity of FI. Most participants in these six studies were female, non-Hispanic white, with an annual household income <20k, and with less than a high school education. Although preliminary evidence is promising, research with more rigorous design is warranted to better understand the relationship of FI and CRN in older adults, and to develop appropriate interventions and programs for this growing public health concern.
INNOVATIONS IN HOME MODIFICATION RESEARCH: THE STATE OF THE ART
Authors: Nabors Emily , Renfro Mindy , Pynoos Jon , Szanton Sarah L , Sanford Jon , Stark Susan
Published: November 2019

The overwhelming preference of older adults is to stay in their homes for as long as possible (AARP). However, most housing lacks supportive features and presents barriers that jeopardize residents’ ability to successfully age in place. Only 1% of houses have five key features to ensure accessibility: no-step entry, single-floor living, lever door handles, accessible electrical controls, and extra-wide doors and hallways (Harvard Joint Center for Housing Studies), making the vast majority unsuitable for persons who use wheelchairs and problematic for the growing number of people with activity limitations. Persons least likely to have such features in their homes need them the most: old-old, low income, frail, and residents in older housing stock. Although home modification can support people as their needs change and preclude the need to move, often to institutional settings, the majority of older adults lack these supports. Recent studies have demonstrated the role of home modification in health, safety, and cost effectiveness. This symposium will convene a panel of researchers to share evidence-base in home modification, recent cost-saving innovations including the CAPABLE Program, and policy change to improve service delivery.
GERONTOLOGICAL EDUCATION: APPLIED PERSPECTIVES AND PEDAGOGICAL APPROACHES
Authors: Niles-Yokum Kelly
Published: November 2019

The art and science of gerontological pedagogy is a balance of multidisciplinary paradigms that provide students with a pathway to the depth and breadth of the field of gerontology. This session will explore a variety of issues, including possibilities and challenges within the context of pedagogical approaches to gerontology education both in and out of the classroom. Topics include applied and theoretical perspectives and the what, why, and how gerontological educators do what they do and how it can impact the learning environment not only for students but for the community at large.
THAT’S MY CREATOR’S REALM: UNDERSTANDING AFRICAN AMERICAN ASSISTED LIVING RESIDENTS’ END-OF-LIFE PREFERENCES
Authors: Kemp Candace L , Bender Alexis A , Quest Tammie , Coyle Mary H , Perkins Molly M
Published: November 2019

Assisted living, one of the fastest growing formal long-term care options for older adults in the U.S., increasingly is a site for end-of-life care.. Most residents are non-Hispanic and white, yet African Americans reside in these settings and relatively little is known about their end-of-life preferences. In this paper, we present an analysis of data collected as part of a larger five-year mixed-methods NIA-funded study (R01AG047048) examining end of life in assisted living. We analyze longitudinal qualitative data collected over two years in a large (>90 beds) care community catering to African American older adults. Drawing on 850 hours of participant observation, in-depth interviews with 25 residents, and record review data, we seek to: (a) understand residents’ end-of-life preferences; and b) identify how and why preferences vary. Guided by principles of grounded theory, our analysis shows that most preferred a death where “you go to sleep and never wake up.” Yet, residents varied in their preferences for the timing and location of death, nature of end-of-life care, and use of advanced directives. Age, health, health literacy, perceived quality of life, and not wanting to be a burden all influenced preferences. For most, religious beliefs were a key factor shaping these preferences. Perceiving that end of life, including how, when, where one dies, and the nature of suffering and care, ultimately is their “creator’s realm,” led to the near universal conclusion: “I got no control over it.” We discuss implications of these findings for improving end-of-life care for African American residents.
DEVELOPING AND TESTING AN ASSISTED LIVING ENVIRONMENT MODEL
Authors: Holmes Sarah D , Galik Elizabeth , Resnick Barbara
Published: November 2019

The assisted living (AL) environment plays an important role in supporting residents’ life satisfaction and helping them to age in place. Guided by ecological theory, the AL environment is multidimensional and has many interrelated components including staffing (e.g. direct care workers, nursing, activity staff), services provided (e.g. medical, mental health, pharmacy), amenities offered at the setting (e.g. beauty salon, computer room, exercise facilities), and built environment features (e.g. walkability). Moreover, evidence suggests that aspects of the AL environment can enhance or detract from the physical function, well-being, social engagement, and behavioral outcomes among residents. The purpose of this study was to develop and test an integrative AL environment measurement model that includes indicators of staffing, services, amenities, and the built environment. Baseline data was used from a study testing the Dissemination and Implementation of Function Focused Care in AL. A total of 54 AL facilities across three states were included in the sample. Settings ranged in size from 31 to 164 beds with an average size of 82.2 (SD=26.2) beds and the majority were for profit facilities (n=41, 74.5%). Structural equation modeling was used to test the proposed model. Results showed that the model fit the data (chi-squared/df=1.86, p<.05; CFI=.858, RMSEA=.126). Having an integrative AL environment measurement model will advance future research that explores the impact of the environment on resident outcomes. In addition, findings from this study can inform interventions and programs designed to modify AL environments to optimize residents’ ability to age in place.
RURAL RETIREMENT MIGRATION AND ACTIVE CITIZENSHIP: MOTIVATIONS, PRACTICES, AND PROCESSES
Authors: Winterton Rachel
Published: November 2019

Within rural settings, older adults play a significant role in ensuring community age-friendliness through their engagement as active citizens. However, the increasing heterogeneity of rural older adults is challenging expectations around how, and in what circumstances, this cohort will engage as active citizens. Given that rural retirement migration is a key contributor to this increasing heterogeneity, there is a need to understand the motivations for, and practices associated with active citizenship among older in-migrants. Drawing on qualitative data from two rural regions in Victoria, Australia, this paper draws on concepts from the rural citizenship literature to investigate how active citizenship practices of rural retirement migrants align with traditional rural codes of conduct. Semi-structured interviews were conducted with 39 rural retirement migrants (aged 56-76 years), which explored engagement in, and motivations for, active citizenship. Findings indicate that in line with traditional expectations around rural citizenship, most rural retirement migrants had assumed responsibilities associated with community governance, and engaged in protest aimed at defending the rights of rural people. However, conflict with traditional codes of conduct was observed in relation to both how active citizenship was enacted, and motivations for engagement. Additionally, rural retirement migrants highlighted barriers that had precluded their involvement as active citizens. These findings are discussed in relation to their implications for both the capacity of rural settings to meet the needs and expectations of older in-migrants, and the experience of ageing in place for resident older adults.
INVESTIGATING THE RELATIONSHIP BETWEEN SOCIAL SUPPORT AND COGNITION AS MEDIATED BY HEALTH AND POSITIVE AFFECT
Authors: Falzarano Francesca , Siedlecki Karen L , Salthouse Timothy
Published: November 2019

Decreased social networks are common in old age after major life events such as retirement, loss of loved ones, and declining health (Shankar et al., 2013). Diminished social ties are associated with increased feelings of loneliness and perceived isolation, which can have negative effects on cognition and physical health. The current study examines the relationship between social support (assessed via the Social Network Questionnaire) and overall cognitive performance (assessed as a latent construct comprising indicators that represent mean verbal episodic memory, processing speed, reasoning, and spatial visualization), and investigates positive affect and self-rated health as mediators of this relationship. The current study included 5,125 participants between the ages of 18-99 years from the Virginia Cognitive Aging Project (VCAP). Cross-sectional analyses were conducted using structural equation modeling. After controlling for age and education, results showed that a social support construct (comprising indicators representing each social network subscale) significantly and positively predicted cognitive performance (.59, p< .001). This relationship was reduced to .22 (p <.001) when positive affect was included as a mediator, and to .14 (p< .001) when self-rated health was included as a mediator. When the variables were included in a joint mediation model the relationship between social support and cognition was .20 (p < .001). Thus, health and positive affect are partial mediators of the relationship between social support and cognition and may help explain the relationship between social support and cognition. Furthermore, these findings provide additional evidence that social networks may play an important role in successful aging.
DOES CHANGE IN COGSTATE MONTHLY COGNITIVE MONITORING OF OLDER ADULTS TRACK WITH 2-YEAR CHANGE IN GLOBAL COGNITION?
Authors: Atkinson Taylor J , Andel Ross
Published: November 2019

CogState is a repeatable, accessible online cognitive testing suite with evidence of low practice effects that could be used as a monitoring tool to detect cognitive decline early. We compared participants’ change in CogState to change in the Telephone Interview for Cognitive Status (TICS). Participants (N = 41, age M = 75.5, 66% female) completed monthly CogState and two TICS assessments over two years. Reaction time on a psychomotor speed task, attention task, and working memory task, and accuracy on a memory task were assessed. A TICS difference score was calculated to measure change. Standardized scores were used. Covariates were age, sex, and education. Paired t-tests indicated that participants performed worse on the TICS the second time, p = .02, Cohen’s d = 0.39, but better on their last working memory task, p = .007, Cohen’s d = 0.45, and their last memory task, p = .001, Cohen’s d = 0.56. Growth curve models indicated CogState memory and working memory scores improved over time, ps < .05, by 0.17 SD accuracy units and 0.16 SD speed units, respectively. There were no significant TICS difference score by time interactions, indicating that changes in CogState were not related to change in TICS. CogState monthly repeat assessment did not track with change in the TICS, indicating that participants may become more proficient in task performance with repeated testing even while global cognition worsens. Despite prior evidence of low practice effects, less frequent assessment may still be warranted to avoid losing sensitivity to change.
EFFECTS OF MINDFUL FELDENKRAIS EXERCISES AND STRENGTH TRAINING ON COGNITIVE EXECUTIVE FUNCTION IN OLDER ADULTS
Authors: Ullmann Gerhild , Li Yuhua , Ray Meredith A
Published: November 2019

Decline in cognitive function associated with aging is one of the greatest concerns of older adults and often leads to significant burden for individuals, families, and the health care system. This 3-arm randomized controlled trial (RCT) responds to the urgent need to identify strategies which can enhance and/or maintain cognitive vitality in older adults. The study is funded by the National Institute on Aging, and aims to examine the effects of both the mind-body exercise Feldenkrais and strength training on cognitive executive function in independent living older adults (N=90) age 65 to 85. Participants of the first wave (n=45) were randomized to a (1) Feldenkrais group, (2) strength training and (3) no-intervention control group. Intervention groups met twice a week for 12 weeks. Cognitive and physical performance measures of the NIH-Toolbox were used at baseline, post-intervention and at a 3-month follow-up. Results of changes in cognitive executive functions within and across groups will be presented. The findings will suggest if such interventions would be a viable low-cost option for older adults to maintain cognitive vitality and thereby impact the development of programs and guidelines for combatting decline in cognitive function.
CHANGES IN COGNITIVE FUNCTION AMONG SENIOR AMERICANS: TRENDS AND DIFFERENCES BY RACE
Authors: Zhang Keqing , Zhang Wei , Wu Yanyan
Published: November 2019

Improvements in health and increase in life expectancy have contributed to the increasing proportion of older population over the past century. It is estimated that by 2050, the number of older adults with cognitive impairments in the United States will increase by 2.5-4 fold, while age-specific rates remain constant. This paper uses data from 10 waves (1996-2014) of the Health and Retirement Study (N= 33213) to crystalize the trends in cognitive function changes and cognitive impairment rates in a nationally representative sample of older adults. OLS and logistic regressions are used to estimate the trends and determine the contribution of sociodemographic variables to decreasing trends in the prevalence of cognitive impairment over time. Results show that with the increase of age, the cognitive function of older adults decline in all races, after adjustment for age, gender, education, and other sociodemographic factors. Also, the annual decline rate of cognitive function is larger for African Americans and Hispanic Americans, while smaller for white and other races. A further investigation of the possibility of cognitive impairment reveals a different scenario: as individual ages, the Hispanic are the least likely to suffer from cognitive impairment, followed by the white, other and black. Improvements in educational level contribute to declines in cognitive impairment across all races, particular the Hispanic Americans. Race-specific findings suggest that future research need to take into account the racial diversity and possibly cultural influences when examining the cognitive functions of older adults.
ALCOHOL CONSUMPTION AND MEMORY: A LONGITUDINAL ANALYSIS OF RECIPROCAL IMPACTS ACROSS OLD AGE
Authors: Schilling Oliver K
Published: November 2019

Research on the association of alcohol consumption with cognitive aging revealed mixed evidence: Whereas a u-shaped relationship has been found in many studies, suggesting that low to moderate alcohol consumption predicts more favorable cognitive outcomes than abstinence, other findings suggest that alcohol is a more linearly related risk factor for cognitive decline. These inconsistencies may partly be due to methodological variation in the statistical modeling of intraindividual changes in both, alcohol consumption and cognition across old age. The present study analyzed longitudinal change in and the mutual effects between alcohol consumption habits and verbal episodic memory (word list recall), using vector autoregressive (VAR) mixed models with nonlinear cross-lagged effects. Data from the English Longitudinal Study of Ageing was examined, including N=13388 aged 50+ (M=67.6, SD=9.25; 54.7% female), assessed at up to eight occasions with two-year follow-up intervals (2002/3–2016/17). The self-reported one-year frequency of alcohol drinking days (ADD) served as indicator of alcohol consumption. Basically, ADD predicted follow-up memory performance in a reverse u-shaped fashion, indicating best memory performance after moderate ADD, compared with both ends of the ADD continuum (i.e., drinking never vs. every day). Considering moderators, most notably age did not interact with cross-lagged effects, suggesting that those observed across an older age-range were not more (or less) vulnerable to effects of alcohol consumption on memory performance. Thus, this study adds further support for non-detrimental, if not beneficial, effects of moderate alcohol consumption on cognitive aging – regarding in particular age-related loss of episodic memory.
RACIAL-ETHNIC DIFFERENCES IN THE EFFECTS OF POSITIVE AND NEGATIVE AFFECT, AND DEPRESSION ON COGNITIVE TRAJECTORIES
Authors: Park Soohyun , Shin Su Hyun , Allen Rebecca S , Kim Giyeon
Published: November 2019

Purpose of study: This study investigated (1) whether positive affect(PA), negative affect(NA), and depression are related to trajectories of cognitive functioning among older adults, (2) whether PA or NA could moderate the relationship between depression and cognitive trajectories, and (3) whether there are racial/ethnic differences in the relationships among PA, NA, depression and cognitive trajectories. Design and Methods: Growth-curve modeling was conducted using the sample of 10,289 individuals in the U.S. aged 50 or older from the 2006-2014 Health and Retirement Study. Racial/ethnic groups in this study were non-Hispanic Whites (NHW, n=8.009), African Americans (AA, n=1,428), Hispanics (n=611), and others (n=241). Results: After adjusting for covariates, PA showed positive effect, and depression had negative effect on cognitive functioning trajectories (p < .05, z = 8.76, 95% CI= 0.27, 0.43; p < .05, z = -6.38, 95% CI= -0.19, -0.10). Racial/ethnic minorities (i.e., AA, Hispanics, others) exhibited lower cognitive functioning over time compared to NHW. PA significantly moderated the effect of depression on cognitive trajectories (p < .05, z = - 8.04, 95% CI = -0.19, -0.11), and the protective effect of PA against cognitive decline was pronounced for AA (p < .05, z = 2.75, 95% CI = 0.10, 0.63). Conclusion: Findings suggest that PA may protect against cognitive decline in older adults, providing a buffer against the negative effect of depression or racial/ethnic minority status on cognitive trajectories. Potential intervention strategies are discussed to assist older adults in maintaining and improving PA to promote cognitive health.
SUBJECTIVE MEMORY COMPLAINTS AND COGNITIVE PERFORMANCE: THE MODERATING ROLE OF DEPRESSIVE SYMPTOMS
Authors: Gallagher Elizabeth A
Published: November 2019

Cognitive health is a rising public health concern in the U.S. Currently, approximately 5.7 million older adults suffer from Alzheimer’s disease (AD), and by the year 2050 this number is expected to increase to 14 million. Subjective memory complaints (SMC) are shown to be an early indicator of cognitive decline, and accordingly included as a clinical criterion for diagnoses of MCI, an indicator of pre-dementia states, and a research criterion for AD diagnoses. Among older adults, depressive symptoms hinder the accuracy of memory self-ratings. However, there has yet to be consensus regarding the nature of how depressive symptoms may condition the relationship between SMC and cognitive performance. The aims of the present study are to both investigate whether SMC is related to episodic memory and to determine whether depressive symptoms act as a moderator for the relationship between SMC and episodic memory among older adults. This research used nationally representative sample of 8,123 older adults aged 65 and older who completed the Leave Behind Questionnaire in the 2012 and 2014 waves of the Health and Retirement Study. Linear regression was performed and results showed that there was a significant main effect of SMC on episodic memory performance, in that older adults with increased SMC have worse episodic memory. There was also a significant moderating effect of depressive symptoms, in that depressive symptoms cause older adults to underestimate their memory abilities. In order to use SMC as a tool for early detection efforts it is critical to understand these complex relationships.
VISUAL IMPAIRMENT AND ENGAGEMENT IN COGNITIVELY STIMULATING ACTIVITIES
Authors: Swenor Bonnielin , Munoz beatriz , Simonsick Eleanor M
Published: November 2019

We examined the relationship between visual impairment (VI) and engagement in cognitively stimulating activities using data from 924 participants in the Cognitive Vitality Sub-Study of the Health ABC Study. At Year 3 (baseline for these analyses), vision was assessed as: visual acuity (VA), contrast sensitivity (CS), and stereo acuity (SA). Participation in cognitively stimulating activities was determined based on responses to 12 questions (administered at Years 3, 5, 7, and 9) assessing frequency of participation ranging from none to daily. We calculated the total number of activities engaged in at least monthly. In cross-sectional analyses adjusted for age, race, and sex, impaired VA (≤20/40, 8%), CS (<1.55, 5%), and SA (<80 secs arc, 29%) was associated with participation in fewer cognitive activities (β=-0.54, 95% CI:-1.06, -0.03; β=-0.59, 95% CI:-0.12, 0.06; β=-0.40, 95% CI:-0.81, -0.18, respectively). Longitudinally, change per year in the number of activities differed by baseline participation levels. Those participating in ≥5 activities at baseline (population median) had a significant decline in the number of activities, irrespective of VI status. However, for those participating in <5 activities at baseline, the increase in these activities tended to be lesser in the VI than in non-VI groups, and for SA this increase was significantly lower for the impaired group (βimpaired=0.004; 95% CI:-0.05, 0.05; βnot-impaired=0.06; 95% CI: 0.03, 0.10; time x SA interaction p=0.0496). These data indicate that older adults with VI participate in fewer cognitive activities and the change in participation over time differs from than those without VI.
THE ASSOCIATION OF MILD TBI WITH EARLY ONSET DEMENTIA IN POST-9/11 VETERANS
Authors: Pugh Mary Jo , Sagiraju Hari Krishna Raju , Eapen Blessen , Swan Alicia A , Wells Margaret , Soble Jason R , Marceaux Janice C
Published: November 2019

Evidence produced by studies using ICD-9 codes to identify dementia suggests that mild traumatic brain injury (mTBI) can accelerate age-related neurodegeneration and dementia risk. However, ICD-9 codes are unreliable in identifying early onset dementia (<65 years; EOD) in civilian (positive predictive value [PPV]=58%) and VA (PPV=28%). From 1,724 Veterans <65years of age with 2 or more dementia diagnoses based on ICD-9 codes recommended by VA Dementia Steering Committee, we validated dementia diagnoses in 153 randomly selected cases using medical chart abstractions and reviews by a neuropsychologist panel. We matched valid cases based on age, sex, race/ethnicity, year of entry to VA care, and branch of service to 2490 controls with no indicators of dementia or cognitive impairment. TBI severity was defined using multiple DoD and VA data sources. We also identified diagnoses for mental (e.g., depression, post-traumatic stress disorder, substance use disorders) and other medical conditions (e.g., stroke) associated with dementia. We used conditional logistic regression to examine the association of TBI severity with EOD controlling for comorbidity. After controlling for mental health and other comorbid conditions mild TBI (mTBI) was significantly associated with validated EOD [aOR( 95%CI): mTBI-4.5(2.4-8.9), moderate/severe TBI-21.3(8.4-54.3)]. Stroke, depression, PTSD, and headache were also associated with higher odds of EOD. These findings suggest that Veterans with mTBI are at risk for dementia, and clinicians should consider brief screening for cognitive dysfunction to ensure that they receive timely treatment to mitigate and address the impact of dementia on the individual, caregiver, family, and health care system
TRAINING SENIOR VOLUNTEERS TO IMPLEMENT A GROUP MUSIC INTERVENTION FOR PERSONS WITH DEMENTIA
Authors: Orsulic-Jeras Silvia , Nicolay Sarah , Kane Cristen
Published: November 2019

The Retired Senior Volunteer Program (RSVP) is a national program with many regional offices that offers a variety of volunteer opportunities for seniors. Research demonstrates the importance of volunteering and social participation on the well-being, health and longevity of older individuals. Further, studies of RSVP volunteers have demonstrated marked improvement in their perceived physical, mental health and quality of life (McDonald et al., 2013). Little evidence exists, however, supporting the effectiveness of using senior volunteers to assist with or even lead activities programming for persons with dementia (PWDs). Seniors Making Connections through Music, a group program designed to engage persons in the moderate to advance stages of dementia, included the training of 21 RSVP volunteers to lead or assist with the program. Volunteers were mostly female (95%) and educated (80% college/advanced degree), with more than half reporting professional or personal experiences with dementia (62%). Data were gathered through structured interviews and post-session debrief meetings. Findings suggest volunteers felt they were able to use existing knowledge and experience, received good and helpful supervision, and reported increased knowledge of dementia after volunteering for the group. Other results summarize: Volunteer satisfaction with program, role, tools and materials used, the program’s impact on the community, and willingness to volunteer for the program in the future. Programmatic features, training protocols, and the impact of using retired senior volunteers to strengthen program sustainability will be discussed. Volunteer testimonials and video demonstrations will also be shared.
ADVANCING POLICY TO BUILD A BEHAVIORAL HEALTH WORKFORCE THAT ADDRESSES THE NEEDS OF OLDER ADULTS
Authors: Kietzman Kathryn G , Palimaru Alina , Frank Janet C
Published: November 2019

California’s Mental Health Services Act has infused funding for workforce education and training into the public mental health system. However, funding has not kept pace with an existing behavioral health workforce shortage crisis, the rapid growth of an aging population, and the historical lack of geriatric training in higher education for the helping professions. This study draws on findings from a recent evaluation of how older adults are served by California’s public mental health delivery system, and a review of state planning documents and academic literature, to describe gaps and deficiencies in the workforce that serves older adults. While California has more than 80,000 licensed behavioral health professionals in a variety of disciplines, very few have specialized training in geriatrics. Across the U.S., there are fewer than 1,800 geriatric psychiatrists and only about 3% of medical students take any geriatrics electives during their training. Very few nurses (1%), psychologists (4%), or social workers (4%) have training in and/or specialize in geriatrics. Of additional concern in California is the lack of representation of ethnic and racial minorities, and rural/urban geographic disparities in the distribution of the behavioral health workforce. Recommendations for advancing policy change to improve the preparation and distribution of the geriatric behavioral workforce are presented to three distinct audiences: state policymakers and administrators; educational institutions, accrediting bodies, and licensing boards; and county mental health/behavioral health departments and their contracted providers.