bluuebunny/crossref_metadata_2025 huggingface dataset:
PREDICTORS OF DEPRESSION IN KOREAN OLDER ADULT SPOUSAL CAREGIVERS: 2017 NATIONAL SURVEY OF OLDER KOREANS
Authors: Yun Stacy , Qualls Sara
Published: December 2023

Based on the sociocultural stress coping model (Knight & Sayegh, 2010), this study was aimed at examine how factors such as familism, caregiver burden, social support, and coping strategies impact Korean older adult spousal caregivers’ depression. 369 caregiver (aged 69 to 96; M = 80.68) and care recipient (aged 69 to 102; M = 81.86) spouse dyads from the 2017 National Survey of Older Koreans was used for analysis. The model demonstrated excellent model fit indices, χ2(15) = 16.29, p = .36, model χ2 to df ratio = 1.09, TLI = .99, CFI = .99, RMSEA = .02 (95% CI: .00 to .05), and SRMR = .02. Higher levels of depression was significantly predicted by lower perceived social support, β = -.30, Z = -6.35, p < .001, being older, β = .16, Z = 3.12, p = .002, less education, β = -.18, Z = -3.81, p < .001, and having fewer living family members, β= -.12, Z = -2.29, p = .02. Additionally, the relationship between caregiver burden and depression was fully mediated by perceived social support (β = .05, t = 3.23; 95% CI: .02 to .09). Results suggest that perceived social support is a salient factor related to depression experienced by older spousal caregivers in Korea. Findings imply the need for clinicians to devise creative interventions to increase caregiver’s sense of social support, particularly those who may reside in rural areas of Korea who are primarily older, received less education, and have fewer living family members.
GWAS OF BRAIN ENDOPHENOTYPES: ASSOCIATION OF AUTOPSY-BASED LEWY BODY COUNTS WITH MOVEMENT DISORDER RISK LOCI
Authors: Edland Steven , Hernandez Fernanado , Nasamran Chanond , Fisch Kathleen , White Lon
Published: December 2023

We performed a genome wide association study (GWAS) of neocortical Lewy body density. Case material were 308 autopsies of Japanese-American men (mean age at death 87.5 years; 11% with mild, and 30% with severe cognitive impairment prior to death). Lewy bodies were assessed by manual count of alpha-synuclein stained neocortical sections from the frontal, temporal, parietal, and occipital lobes. Genetic association was tested by linear models controlling for age at death assuming an additive genotypic effect. Top hits include a locus on chromosome 1q32 previously associated with amyotrophic lateral sclerosis (p=5.8e-8), intronic variants on the dopaminergic neuron axonal guidance gene EPHB1 previously associated with Parkinson’s disease (PD) (p=8.4e-6), and a locus containing two independent intron 1 variants on CSMD1, a known risk factor for autosomal dominant PD (p=1.5e-6). Complement inhibitor protein CSMD1 is a type 1 transmembrane cell adhesion molecule implicated in axonal guidance and the development, maintenance, and pruning of synapses in the adult brain. Intermediate hits include genes encoding cell adhesion molecules and a second complement inhibitor implicated in the regulation of synapses (TRAPPC9). This converging evidence points to cell adhesion proteins and complement mediated synaptic regulation in the etiology of Lewy body lesions.
AN OUTBREAK OF COVID-19 INFECTION WITH NO MORTALITY IN A GERIATRIC INSTITUTION IN COLOMBIA
Authors: Reyes-Ortiz Carlos , Ocampo-Chaparro Jose
Published: December 2023

Unusually, an outbreak of Covid-19 during the first year of the pandemic in an underserved geriatric institution had no mortality. This cross-sectional study aimed to determine factors associated with COVID-19 infection among 252 institutionalized older adults in Cali, Colombia’s larger geriatric hospital and nursing home, Geriatric Hospital and Nursing Home San Miguel assisting multiethnic, impoverished, and low-educated residents. This population had a median age of 80 years (range 55 to 103) and a median Barthel of 90.0; 50% were women, 19% had dementia, and 2% were obese. 84 (33.3%) were infected, and none died and did not go to the UCI or were referred to a higher-level hospital. In a multivariate logistic regression model, being infected was associated with age 80 and older, a lower Barthel score, and malnutrition. Due to collinearity, separated models showed an association between infection and higher scores on the clinical frailty scale or lower grip strength. All institutionalized older adults with Covid-19 infection in this geriatric institution survived. It was likely related to appropriate general medical and nursing management, including well-controlled comorbidities, and individualized interdisciplinary rehabilitation, attention, and support.
A CONSULTANT PHARMACIST INTERVENTION TO DEPRESCRIBE OPIOIDS AND BENZODIAZEPINES FOR OLDER ADULTS IN PRIMARY CARE
Authors: Niznik Joshua , Busby-Whitehead Jan , Armistead Lori , Urick Benjamin , Zhao Liang , Ferreri Stefanie
Published: December 2023

Long-term use of opioids and benzodiazepines (BZDs) by older adults may cause harm. We evaluated the impact of a targeted consultant pharmacist opioid and BZD deprescribing intervention for older adults. We conducted a pragmatic study in which fifteen primary care clinics were randomized to receive standard care (n=7) or a consultant pharmacist service (n=8) to provide targeted medication review and recommendations for deprescribing opioids and BZDs. The primary outcome was opioid and BZD prescribing in the following year, using average daily morphine milligram equivalents (MMEs) and diazepam milligram equivalents (DMEs). We used generalized linear models to evaluate the association of the intervention with average daily MMEs and DMEs, adjusted for medication exposures in the prior year and demographics. Incident falls were examined as a secondary outcome. We included 961 opioid and 1107 BZD users, with 15.6% and 13.6% being prescribed both medications, respectively. Average daily MMEs and DMEs prescribed at baseline were 23.6 and 7.67. Deprescribing recommendations were made for 71% of opioid and BZD users seen in intervention clinics. We observed non-statistically significant reductions in average daily MMEs (Intervention: -2.42 MMEs, Control: -1.02 MMEs, p=0.71) and DMEs (Intervention: -1.0 DMEs, Control: -0.1 DMEs, p=0.06). There was no significant reduction in incident falls. A consultant pharmacist-driven intervention is a feasible approach to deliver targeted deprescribing recommendations, but did not significantly impact medication use or falls. Future studies should explore whether multimodal interventions would be more effective in achieving deprescribing and reducing medication-related harms.
STRATEGIES USED TO HELP OLDER ADULTS ACCESS VIDEO VISITS DURING COVID-19: A SYSTEMATIC REVIEW
Authors: Haller Landon , Rodriguez Rena , Park Lindsay (Na Yeon) , Lam Kenneth
Published: December 2023

Many articles have described how older adults struggled to access telemedicine during the COVID-19 pandemic, but few have described how that digital divide was bridged. To comprehensively describe strategies used to help older adults access telemedicine during the pandemic, we conducted a systematic review of 4 databases (PubMed, EMBASE, CINAHL, and PsycInfo) for English articles (search terms: “tele*”, “mHealth”, “eHealth”, “video*”, “65 and older”) published from March 2020 to July 2022. We included articles that described any effort to help older persons (or a predominantly older population) access synchronous video visits during the pandemic, without requirements for study design. We categorized strategies as micro-, meso-, or macro-level per the Ecological Systems Theory framework to differentiate strategies implemented by clinicians, health systems, and policymakers. From 3799 records, we included 134 articles published in 2020 (23%), 2021 (51%), and 2022 (26%); most (57%) described strategies from the US. The most common specialties were Geriatrics (24%), Other (i.e. Occupational Therapy; 18%), and Medical Subspecialties (i.e. Cardiology, Oncology; 11%). Macro-level interventions included waivers for privacy regulations and increased reimbursement for telemedicine. Meso-level interventions included mobile vans offering devices and internet connection and protocols to test visits in advance. Micro-level interventions included written signs to troubleshoot sound and adapting clinical examinations virtually. We found many interventions at different levels of society to help older adults access video visits during the pandemic. Appraisals of the feasibility of telemedicine in older persons should consider the extent to which these strategies are used.
SWEET DREAMS INTERRUPTED: HOW COVID-19 CHANGED THE LANDSCAPE OF SLEEP SERVICES UTILIZATION ON AGING POPULATION
Authors: Razjouyan Javad , Kuna Samuel T , Sharafkhaneh Amir
Published: December 2023

We evaluated the impact of the pandemic on sleep test utilization, i.e., home sleep apnea testing (HSAT) and in-laboratory polysomnography (PSG), among aging veterans. We conducted an observational before and during the pandemic study using the national VHA. Electronic medical records from 01/2019 to 09/2022 were gathered for all veterans born with age 50+ by 10/2022. HSAT and PSG utilization were defined based on Current Procedural Terminology codes. Following intervals defined as pre-pandemic (PRE-P, 01/2019-02/2021, 14months), Pandemic-moratorium (PMor, 4/2020-6/2020, 3months), pandemic-pre-vaccination opening (PnoVax, 7/2020-12/2020, 6months), pandemic vaccination (P-Vax, 1/2021-5/2021, 5months), and pandemic post vaccination (P-PVax, 06/2021-09/2022, 15months). We compared the means using univariant analysis. Over the 45 months, 247,817 HSAT and 123,456 PSG were performed. In HSAT, compared to PRE-P (5,669visit/month) as a reference, we observed a significant drop in P-Mor (-70%,P< 0.001), P-noVax (-7%,P=0.166), P-Vax (+9%,P=0.067). However, P-PVax did not differ significantly in average monthly HSAT compared to PRE-P (+6%,P=0.103). In PSG, compared to PRE-P (3,994visit/month) as a reference, we observed a significant drop in P-Mor (-92%,P< 0.001), P-noVax (-61%,P< 0.001), P-Vax (-44%,P< 0.001), and P-PVax (-32%,P< 0.001). PSG per month did not recover to pre-pandemic levels, while the HSAT per month increased, but not to a level that compensated for the reduction in PSG. The pandemic markedly impacted the sleep testing service usage in aging veterans. While HSAT was resilient and increased during the pandemic, the increase did not offset the shift away from PSG. Future research is needed to better understand the reasons for this change in clinical practice among aging populations.
VIRTUAL TAI CHI FOR OLDER VETERANS IMPACTED BY COVID-19
Authors: Dawson Bonnie , Keller Hallie , Sawyer Linda , Gorman Shannon , Sabangan Jerome , McPartlin Adam , Brown Karl , Sullivan Dennis
Published: December 2023

As older Veterans (OV) were at risk for loneliness and deconditioning during the COVID pandemic, they were invited to join a Tai Chi program due to its known benefits in these areas. The objectives of this presentation are to examine outcomes, program adherence and feedback of OV enrolled in a 12-week Tai Chi course conducted virtually twice weekly at three VA sites during the COVID-19 pandemic. Participants completed the 30-Second Chair Stand (30CST) and the De Jong Gierveld Loneliness Scale (DJGS) at baseline and again when they finished the course. Attendance was recorded and end-course evaluations were also obtained. Univariate and multivariate statistics were used to summarize results. One hundred eleven OV aged 60 to 94 enrolled. Most were non-Hispanic (84%), white (72%), males (80%), living independently (92%) with a partner (43%). Of these, 86 (77.5%) completed a final assessment after attending a mean of 18.7 out of 24 sessions. Retention did not differ by site nor other demographics. Among the completers, there was not a significant change in DJGS (n=46, p=0.2748), but only 26.1% showed substantive loneliness at baseline. The 30CST improved significantly (n=72, p=0.0150) after controlling for site and baseline value. Most participants described the virtual course as rewarding, beneficial to their health and balance, and conducive to social connection. They also expressed desire to continue the program. Our results suggest OV achieve objective and subjective benefits from, and can feasibly participate in, a virtual Tai Chi program, which appears to be a valid alternative to in-person courses.
INTERGENERATIONAL CO-PRODUCTION IN DIGITAL DESIGN FOR HEALTH, WELL-BEING, AND SOCIAL CONNECTION
Authors: Hennessy Catherine , Mannion Greg , Haynes Richard , Whittaker Anna , Bradwell Hannah , Tomaz Simone , Ritchie John , Cooper Leonie
Published: December 2023

The benefits of intergenerational practice in bringing different generations together in initiatives and programs to address issues like social isolation and loneliness are well-established. Less frequently employed as a vehicle for using intergenerational contact in the development of interventions and design solutions, intergenerational co-production involving older and younger people with academics and designers, has rarely been tried. Thus, intergenerational co-production is not common and is under-theorised despite holding significant promise for advancing societies for all ages. This paper reports on the experience of intergenerational co-production in the GOALD (Generating Older Active Lives Digitally) project, an interdisciplinary collaboration in Scotland and England using intergenerational co-production methods in the creation of digital tools to support older adults’ health, well-being and social connectivity. It presents GOALD’s multi-year experience of constituting and running intergenerational co-production groups with geographically, socio-demographically and functionally diverse participants to provide feedback and design ideas to business partners for digital devices and applications for health promotion in later life. Mixed methods findings on sources, timing, locations and numbers of participants recruited and retained, their rates of participation, forms, frequency and modes of engagement, as well as organizational partners’ and participants’ motivations, incentives, capacity and constraints to take part demonstrate the barriers and facilitators of implementing intergenerational co-production, particularly during the Covid-19 pandemic. Our findings highlight lessons learned about the need for creative adaptation of this approach on the ground, and suggest GOALD’s potential contributions to new theorisation through enacting and understanding the features of intergenerational co-production and documenting its effects.
TRAUMA AND RESILIENCE AMONG DIRECT CARE WORKERS IN NURSING HOMES
Authors: Boakye Alfred , Morgan Jennifer , Skipper Antonius , Kemp Candace
Published: December 2023

Direct Care Workers (DCWs) face persistent challenges with low pay, few benefits, heavy workloads, and limited access to paid leave. Experiences associated with COVID-19 have increased the precarity of the long-term care system and have increased DCW’s vulnerability. Against the backdrop of systemic racism and political turmoil, DCWs experience high rates of health risks (e.g., burnout, anxiety disorders, depression, and post-traumatic stress disorders) leading to a reduced quality of life. Building resilience within this workforce requires understanding the protective factors, at the community, organizational, and individual levels, to manage demanding work and personal lives. Yet, existing scholarship on how to build trauma-resilient organizations and identify and cultivate individual DCW strategies to support workers remains limited. Using a socio-ecological framework, the aim of this exploratory study was two-fold: (1) examine DCWs understanding of trauma and how it affects their ability to provide care, and (2) understand the strategies and supports DCWs use to cope with trauma and what it means to be resilient. Using purposive and convenience sampling techniques, participants were recruited into the study. Semi-structured interviews with nursing assistants in nursing centers (n=25) were used to gather data and analyzed using modified grounded theory. Findings demonstrate that the impact of COVID-19, work stress, and systemic inefficiencies negatively impact care work and DCWs’ experiences. The study identified strategies that long-term care employers and government agencies can adopt to support resilience-building and ultimately empowerment practices. Implications for retention and support for staff from diverse backgrounds are also discussed.
INTEROCEPTION ACROSS DOMAINS: ASSESSING THE ROLE OF AGE
Authors: Bruni Pietra
Published: December 2023

Interoception plays a prominent role in homeostasis, providing information about the internal state and condition of the human body. It is most typically measured using heartbeat tasks, though there are mounting criticisms against focusing exclusively on signals that originate from the cardiac domain. While prior research has shown that variability in interoceptive ability exists when examined in relationship to numerous health, biological, and psychiatric factors, the role age holds remains largely unexamined. The primary goal of this study was to assess interoception in two distinct domains, cardiac and respiratory, across a community sample (n = 40) of twenty younger (mean age = 24.9 years) and twenty older (mean age = 69.3 years) adults. Two laboratory tasks measured interoception: a Heartbeat Tracking Task and a Respiratory Discrimination Task. Three measures of interoception were extracted: Interoceptive accuracy (IAcc), Interoceptive awareness (IAwe), and Interoceptive sensibility (ISen). Results from this experiment indicated that IAcc and IAwe were not correlated across domains. Of note, a significant difference was found between the two estimates of IAcc, indicating that participants were more accurate at assessing interoception in the respiratory than in the cardiac domain. Furthermore, younger adults (M= 0.49, SD = 0.29) exhibited significantly higher IAcc than older adults (M= 0.67, SD = 0.23); (t(36) = -2.04, p < 0.02) in the cardiac domain. These results indicate dissociable outcomes for two methods of assessing interoception, as well as illustrate the potentially prominent role age may hold when examining variability in interoceptive ability across domains.
A BAYESIAN NETWORK-BASED APPROACH FOR MULTI-OMICS INTEGRATION TO REVEAL UNDERLYING MECHANISMS OF HEALTHY AGING
Authors: Leshchyk Anastasia , Monti Stefano , Sebastiani Paola
Published: December 2023

Previous research on long-lived individuals showed that centenarians significantly delay the onset of the disability and aging-related diseases such as Alzheimer’s, dementia, and cardiovascular diseases to the very end of their lives compared to the general population. Genetic studies of centenarians and healthy agers showed that carriers of the APOE e2 allele had increased odds of reaching longevity compared to the non-e2 allele carriers. In addition, the APOE e2 allele is characterized by distinct serum proteomics and metabolomics profiles that could be useful to understand the mechanism of propagation of the genetic effect of APOE to the molecular level and eventually to phenotypes. We are developing a novel network-based approach of multi-layer data integration to identify shared molecular profiles among the subjects with familial longevity that lead to compression of morbidity, disability, and mortality. This Bayesian network-based approach integrates proteomics, metabolomics, genetics, and multiple phenotype data to decipher the risk factors and pathways contributing to prolonged health span. For example, the preliminary analysis shows that the centenarians with cognitive performance above the average in their age and sex group have lower levels of IL6, GDF15, and PTN proteins than those with below-average cognitive performance. These known inflammation factors might impair the cognitive function of elderly adults contributing to their disability and morbidity, thus affecting their aging.
AGING ACROSS THE LIFE COURSE: RESEARCH COLLECTIONS AVAILABLE FROM THE NATIONAL ARCHIVE OF COMPUTERIZED DATA ON AGING
Authors: McNally James , Lavender Kathryn
Published: December 2023

Creating and maintaining sustainable data archives can be challenging but offers clear advantages. Properly curated data can be used by multiple researchers, testing a variety of hypotheses and increasing the return on investment to the expensive data collection process. An internally managed archival system also provides greater control and autonomy in the equitable distribution of data resources. This process ensures all researchers will fully use the data for original research, teaching, and new directions once the data leaves the control of the local investigator. This poster reviews the advantages of a local strategy for preserving and sharing gerontological research data. Using the National Archive of Computerized Data on Aging (NACDA) as a working example, the poster offers an overview of collections at NACDA. Using our metadata tools and variable search database, NACDA can identify studies in its collections that examine aspects of aging and health among adults during their lifecourse. Many of the studies are longitudinal or repeat-measure cross-sectional studies. We can also identify studies that focus on aging not maintained by NACDA that are available to interested researchers. Using a strategy of archival preservation combined with a strong focus on productive research Innovation in Aging, NACDA has amassed data and metadata covering a wide array of studies worldwide that address the aging lifecourse. Because our collections are multinational, we share these data at no cost to interested users worldwide.
AN UMBRELLA REVIEW OF SYMPTOM-SPECIFIC NONPHARMACOLOGICAL INTERVENTIONS FOR DEMENTIA
Authors: Cho Eunhee , Kim Min Jung , Lee Ji Yeon , Yang Minhee , Jang Jiyoon , Cho Jungwon
Published: December 2023

A variety of non-pharmacological interventions (NPI) have been used for managing behavioral and psychological symptoms of dementia (BPSD), but only a small effect size has been reported. Also, due to a lack of clinical guidelines, individualized BPSD interventions considering each person’s preferences and unique symptom profiles have not been available. This umbrella review aimed to summarize the current evidence of NPI for managing BPSD and to suggest an evidence-based algorithm that can guide future clinical practices on choosing an NPI targeting an individual or cluster of BPSD. We used the Cochrane methodology for umbrella reviews following a predetermined protocol registered. A total of five electronic databases (PubMed, CINAHL, Embase, PsychINFO, and Cochrane Database) was searched based on the PICO formulation. The eligibility was independently screened by two reviewers. The quality of the individual review was evaluated by the two reviewers using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2). A total of 32 reviews were included. The reviews collectively indicated that NPI have shown mixed results in managing an individual or cluster of BPSD. As to the NPI, a wide variety was observed in which a music therapy was most commonly used. Of the various BPSD symptoms, affective/hyperactivity symptoms such as depression, anxiety, and agitation have been most investigated. Based on the effect sizes and quality appraisal results, we created an evidence-based algorithm that can provide several NPI options for each sub-category of BPSD. Future studies are required to provide a more comprehensive clinical practice algorithm.
A SYSTEMATIC REVIEW OF CARE PARTNERS’ PERCEPTIONS OF FALL RISK AMONG OLDER PEOPLE WITH DEMENTIA
Authors: Thakkar Nirali , Zhou Yuanjin
Published: December 2023

Community-dwelling older people with dementia (cd-OPWD) experience a high risk of falling. Care partners have varied levels of involvement in fall risk management for cd-OPWD. However, little is known about what factors may shape their involvement. Understanding care partners’ perceptions of fall risk, associated factors, and impacts will be critical for service providers to effectively engage care partners in fall risk management for cd-OPWD. Utilizing the Common Sense Model of Illness Perceptions, we conducted a literature search among 6 research databases and identified 23 articles using predefined inclusion/exclusion criteria. Our study found that care partners’ perceptions of cd-OPWD’s fall risk comprised beliefs about fall risk management behaviors/programs (i.e., mobility aides, exercise, home modification, fall detector system), their understanding of indicators, causes, consequences, timeline, and controllability of cd-OPWD’s fall risk, and emotional reactions. These perceptions were influenced by care partners’ previous experiences with falls, cd-OPWD’s declining health and functions, experienced care burden, relationships with cd-OPWD, and interactions with healthcare providers. Care partners’ beliefs about fall risk management behaviors/programs and their understanding of indicators, causes, consequences, and timeline of falls are often associated with their adoption of fall risk management behaviors. Their emotional responses to cd-OPWD’s fall risk are associated with increased care burden. These findings point to a need for solution-oriented fall prevention interventions to increase care partners’ perceived benefits of fall risk management behaviors/programs and their knowledge about cd-OPWD’s falls. Future interventions should also try to mitigate the negative impact of care partners’ emotional responses to cd-OPWD’s fall risk.
INCIDENT AND RECURRENT FALLS AMONG NON-HISPANIC BLACK AND HISPANIC MEN WITH CHRONIC CONDITIONS
Authors: Olokunlade Temitope , Sherman Ledric , Benden Mark , Han Gang , Smith Matthew
Published: December 2023

While much is known about the complexities of fall-related risks among older adults, less is known about the risk for falls among men, and especially older non-Hispanic Black and Hispanic men with chronic conditions. This study examined factors associated with incident falls (1 fall) and recurrent falling (2+ falls) among non-Hispanic Black and Hispanic men ages ≥60 years with ≥1 chronic condition. Collected with a web-delivered questionnaire, data were analyzed from a national sample of 779 non-Hispanic Black (58.8%) and Hispanic (41.2%) men. To assess incident and recurrent falls, the number of self-reported falls in the past year was trichotomized (0 falls vs. 1 fall vs. 2+ falls) and used as the dependent variable. A multinomial logistic regression was fitted to assess factors associated with incident and recurrent falls. The model adjusted for sociodemographics, disease characteristics, health status, and social support. On average, participants were age 66.8 (±5.4) years and reported 3.8 (±2.7) chronic conditions. Seventy-three percent of men reported 0 falls, 12.6% reported 1 fall, and 14.4% reported 2+ falls in the past year. Relative to men reporting 0 falls, Hispanic men (P< 0.05), men with worse general health status (P< 0.05), and those with clinical depression (P< 0.05) were more likely to report incident and recurrent falls, respectively. Men with more comorbidities (P< 0.05) and those with less help/support to manage health problems (P< 0.05) were more likely to report recurrent falling. Findings highlight the importance of multi-component interventions to prevent falls by strengthening disease self-management, addressing mental health, and introducing social supports.
PHYSICAL AND EMOTIONAL WELL-BEING AMONG OLDER TRANSGENDER AND SEXUAL MINORITY ADULTS
Authors: Bernstein Laura , Patrick Julie Hicks
Published: December 2023

Health disparities exist between heterosexual adults and those in the LGBTQ+ community. These differences may be exacerbated in late life. However, a comparative approach that includes heterosexual adults as a referent group may obscure important within-group differences among sexual and gender minorities. The purpose of the current study was to examine within-group differences in health and well-being among adults ages 65 and over who identified as LGBTQ+. Data are provided by 2673 adults ages 65+ who completed the Sexual Orientation/Gender Identity module of the 2020 CDC Behavior Risk Factor Surveillance System. Age groups included 1020 young-old adults ages 65 to 70 years, 1056 older adults, ages 71 to 79 years, and 597 old-old adults age 80+. Adults identifying as gay/lesbian (n = 856), bisexual (n=675), transgender heterosexual (n = 135) or some other minoritized sexual identity (n = 1007) supplied assessments of physical, mental, and functional health. A series of 3 (age) by 4 (sexual orientation) ANOVAs examined main effects of age, sexual orientation, and their interaction. Age effects, but not sexual orientation effects, emerged for mental health. Significant effects for functional ability emerged for sexual orientation and for gender, although no interaction was observed. No significant effects emerged for physical health and no interactions emerged as significant for any of the health outcomes. These results emphasize that examining within-group heterogeneity among sexual minority status and age is necessary to localize and address potential health disparities.
FORTY WINKS: PILOT MULTISITE PRAGMATIC CLINICAL TRIAL TO IMPROVE SLEEP FOR NURSING HOME RESIDENTS WITH DEMENTIA
Authors: Smith Kate , Snow A Lynn , Morgan Robert , McCullough Megan , Baier Rosa , McCreedy Ellen , Richards Kathy , Hartmann Christine
Published: December 2023

Sleep disruption in nursing home (NH) residents can lead to difficulties with activities of daily living, falls, depression, and decreases in memory, and mobility. Staff-delivered interventions are the most logical approach to improving NH resident sleep. But it can be difficult for frontline NH staff to implement quality improvement (QI) due to chronic understaffing, limited staff training, and challenges with data collection. We conducted a pilot multisite pragmatic clinical trial of the “LOCK” sleep program in three NHs. LOCK is an evidence-based framework using frontline huddling for QI uptake: “Learn from the bright spots” (local evidence of positive change), “Observe” (collect data through observation), “Collaborate in huddles” (conduct short frontline huddles), and “Keep it bite-size” (limit activities to 5-15 minutes). We used actiwatches to measure day and night activity and conducted 35 group interviews with leadership/champion implementation teams. We used an iterative, rapid-content analytic approach for qualitative analyses, examining factors associated with implementation variation using the Consolidated Framework for Implementation Research. In qualitative analyses, staff indicated the program was highly feasible and acceptable. From actiwatch data, for enrolled NH residents with ≥9 weeks of intervention exposure (n=11), total daytime activity increased an average of 19 minutes per day (SD=95) and total night-time sleep increased an average of 37 minutes per night (SD=39). The LOCK program is a promising approach and framework for NH staff pursuing QI related to sleep or other topics.
HEALTH-RELATED QUALITY OF LIFE IN OLDER ADULTS AFTER A FLOOD
Authors: Bordes Piper , Cherry Katie , Calamia Matthew , Elliott Emily , Sampson Laura , Galea Sandro
Published: December 2023

Exposure to multiple back-to-back disasters may threaten physical and mental health for people who live in geographic areas that are prone to severe weather events. In 2005, coastal residents from south Louisiana lost homes in Hurricane Katrina and many moved inland to presumably higher and safer ground. In August of 2016, historic flooding brought widespread destruction, creating a second round of catastrophic losses for those who had permanently relocated to Baton Rouge, Louisiana after Katrina. The present research is part of a larger longitudinal study on health and well-being after multiple disaster exposures. In this study, we examined associations among current and prior flood experience and health-related quality indexed by the SF-36 Health Survey (Ware & Sherbourne, 1992). Three flood exposure groups were compared across two waves of testing: non-flooded (controls), single disaster (flooded in 2016) and double disaster (flooded in 2005 and again in 2016). Results indicated that the flood exposure groups did not differ in physical health, although mental health was poorer for those whose homes flooded relative to the non-flooded controls at both waves of testing. Correlation analyses revealed that age was negatively associated with intolerance of uncertainty and physical health, but positively correlated with mental health at both waves of testing, consistent with the inoculation view of post-disaster psychological reactions. Implications of these data for understanding health-related quality of life after multiple disaster exposures are discussed.
IMPLICATIONS OF THE COVID-19 PANDEMIC ON ADULT DAY SERVICES
Authors: Marx Katherine , Parker Lauren , Gitlin Laura
Published: December 2023

Covid-19 hit Adult Day Services (ADS) hard with sites across the country forced to close. As part of the ADS-Plus study, two focus groups were conducted to understand the impact of Covid-19 on ADS sites, their participants, and staff. Six sites across the country, represented by nine staff and administration (females=n, males=1) participated in focus groups. Focus groups were recorded, transcribed verbatim, and coded by the authors. Four themes emerged, (1) Ways to stay in touch with families; (2) Issues reopening; (3) Family concerns; and (4) Future of the ADS Industry. Sites stayed in touch with families through a variety of measures, including virtual daycare or activities via zoom, house calls, and help obtaining food. Upon reopening, there were multiple issues with getting the census back for both participants and staff. Families were reluctant to return due to fear of Covid-19, placing their family member in LTC due to decline in functioning or due to work, and using more home services. Staff were reluctant to return due to fear of Covid-19 and salary, some reporting they made more on unemployment. There was a decline in both physical and cognitive health of ADS participants, attributed to the lack of socialization. In looking towards the future, focus group participants felt that the old approach of doing ADS is not sustainable and that the industry needs to expand to include more home options. Also, funding of ADS needs to be addressed as many facilities are not able to keep up with increasing salaries.
WHY DO OLDER WOMEN LIMIT THEIR DRIVING MORE THAN OLDER MEN?
Authors: Barrett Anne , Mimbs Hope , Soulie Brianna , Noblitt Jessica , Michael Cherish
Published: December 2023

Older adults tend to avoid driving in situations like heavy traffic or bad weather, but women do so more than men. Explanations for this gender difference, however, have received limited research attention. Using data from an online survey of Floridians aged 50 and older that was conducted between December 2020 and April 2021 (n=3,726), we examined four potential explanations for women’s greater self-regulated driving: their worse health, their more frequent rides from others, their more negative attitudes about driving, and their less favorable assessments of their driving ability. The results of multivariate regression models predicting a scale of self-regulated driving revealed support for two of the explanations – rides from others and self-assessed driving ability. Women’s more frequent rides from family members accounted for approximately 10 percent of the association between gender and self-regulated driving, while women’s less favorable assessments of their driving ability accounted for nearly a third of it. In contrast, health and attitudes about driving did not operate as mediators. They did, however, predict self-regulated driving; having worse health or more negative driving attitudes was associated with more self-regulated driving. Our study identifies women’s less favorable assessments of their abilities as a primary determinant of their more rapid transition from driving. Older women’s transportation mobility could be better maintained through programs focused on enhancing their skills, as well as driving confidence.
AGEISM IN THE USE AND DESIGN OF DIGITAL TECHNOLOGY: A THEORETICAL MODEL
Authors: Mannheim Ittay
Published: December 2023

Ageism is currently defined as a main societal challenge for successful and healthy aging. Concurrently, the vast development of digital technology in the last decades highlights a newly under-researched intersection of ageism and the use and design of digital technology. However, a theoretical model explicating how ageism may influence the use and design of technology is currently missing. A proposed model was created based on a mixed-methods approach combining findings from 5 studies of a doctoral dissertation. The integrated analysis identified manifestations of ageism in stereotypes, prejudice and discrimination regarding the use and design of technology, appearing explicitly and implicitly, mainly in a negative context and on different levels (micro-individual, meso-social interaction, and macro-design and policy). Use and design of technology were found to be entangled together. Importantly, two main paradoxes are highlighted. First, the fixation on designing care and healthcare technologies, stereotypically disregarding the diversity of other needs of older persons. A second paradox was found in the discrepancy between acknowledging the “ideal” practice of involving older persons throughout the whole design process, and the actual practice of limited involvement. Ultimately leading to biases in the design process and exclusion of older persons. Consequently, emerging technologies often have low adoption rates, which are further (stereotypically) attributed to the incompetence of older persons to use digital technology, and are contrary to the increase in actual use and motivations older persons have to use technologies that can promote their well-being. Implications of the model for policy and future research are discussed.
EXAMINING THE PRELIMINARY EFFICACY OF AN ONLINE ASYNCHRONOUS PSYCHOEDUCATION COURSE FOR BLACK DEMENTIA CAREGIVERS
Authors: Oliver Sloan , Alexander Karah , Cave Nkosi , Epps Fayron
Published: December 2023

Caregiving While Black (CWB) is an online asynchronous psychoeducation course designed to facilitate the growth of caregiver mastery in Black caregivers of persons living with dementia (PLWD), while increasing the PLWD’s quality of life and providing resources. CWB was co-developed by Black caregivers, PLWD, and healthcare professionals who identified the need for a responsive, culturally tailored course to combat specific burdens faced by Black caregivers. Course topics included navigating the healthcare system, managing home, and self-care competencies. This pilot study tested the preliminary efficacy of CWB, which included 8-10 hours of content delivered in 37 short interactive segments. Thirty-two Black caregivers completed the course over a 10-week time frame. Socio-demographic information and measures of psychological well-being and self-efficacy were collected at baseline, midpoint, and end of study. Data were analyzed using descriptive statistics and t-tests. Results confirmed the course’s ability to improve caregivers’ emotional well-being and sense of confidence and mastery in their caregiving role. Pre- and post-course data revealed a significant improvement in caregiver depression (p=.009), burden (p=.034), and role strain (p=.029) within 30 days of course completion. All statistically significant improvements had moderate effect sizes > 0.38 (Cohen’s d). The frequency of behavioral problems in PLWD decreased (p=.033), as did caregiver reactions to those behaviors (p=.0054). Further, caregiver mastery from baseline to course completion increased 0.42 points, on average, with an effect size of 0.26 (Cohen’s d). These results exemplify the need for novel, culturally tailored and responsive courses like CWB.
CULTIVATION OF PROGNOSTIC AWARENESS IS A TEAM TASK: PALLIATIVE PHYSICIAN AND SOCIAL WORKER INSIGHTS
Authors: ODonnell Arden , Gonyea Judith
Published: December 2023

For patients experiencing serious or life-limiting illnesses, informed decision-making depends on understanding prognosis and illness trajectory. Although physicians are viewed as the most appropriate group to share medical information around prognosis, there is growing recognition that other clinicians can contribute to these discussions. Indeed, cultivation of prognostic awareness (CPA) does not happen in a single conversation; it is a series of conversations in which patients continue to redefine medical treatments and broader life goals. The reframing of CPA as an iterative process, coupled with growing palliative care demands, has led to social workers’ (SWs) and nurses’ engagement, and even leadership, in goals of care (GOC) conversations. Using role theory, this qualitative study therefore explored aligned and/or disparate views on professional role boundaries in CPA through interviews with 17 SWs and 14 physicians. Our data analysis was inductive and iterative with the culminating phases being theme generation and interpretation. Key findings revealed a shared perspective by SWs and physicians that CPA is a “team task” and that SWs have essential roles as experts in assessing and supporting patients’ emotional and psychological capacity for processing prognostic information, and as boundary spanners to patients/families and physicians (i.e., translating medical information, increasing effective communication, and reinforcing a holistic perspective). Both professions identified managing patients’/families’ expectations as a shared role. SWs experienced role conflict, however, in their advocacy for patient autonomy. Factors enhancing role consensus were communication, collaboration, professional respect, experience, and trust. Findings support the trend of expanding SWs role in serious illness conversations.
IMMERSIVE VIRTUAL REALITY INTERVENTIONS FOR OLDER ADULTS: A SERIES OF META-ANALYSES
Authors: Walden Allison , Griffith Christopher , Downey Payton , Feliciano Leilani
Published: December 2023

Many older adults desire to age in place, a term used to describe living independently versus transitioning to a residential care facility. Virtual reality (VR) has the potential to positively impact the functioning of older adults as an assessment or intervention to help compensate for lost or declining functions. VR captures a wide variety of technologies ranging from non-immersive to fully immersive, designed to give the user a feeling of presence. To date, VR interventions have been used with older adults including improving health outcomes, improving functional abilities, and for neuropsychological purposes. A handful of meta-analyses (M-As) attempt to summarize the overall effectiveness of VR interventions with older adults, but many contain methodological issues and cover the gamut of VR technology. The present M-A fills a gap in the literature by assessing the literature on immersive VR interventions for older adults. Sixteen articles met inclusion for meta-analysis, and 41 effect sizes (ES) were calculated. ES were grouped by category, neuropsychological, health/mental health, functional, and eight meta-analyses were performed with one exploratory analysis. Results revealed small, significant ES for VR interventions on measures of global cognition, simple attention tasks, executive functioning tasks, anxiety ratings, and pain ratings. Nonsignificant ES were found for stress ratings, gait speed, depression ratings, and TUG task (exploratory M-A). Continuing to develop affordable, safe interventions to assist with aging in place is important as the number of older adults continues to increase. Immersive VR is a promising avenue to continue exploring to better assist the aging population.
RESILIENCE AND VULNERABILITY IN GERIATRIC MEDICAL CENTERS DURING AN ONGOING HEALTH CRISIS
Authors: Lifshitz Rinat , Asher Irit , Eliezer Aya Ben , Geller Tal Prager , Zalyesov Eduard , Shugaev Inna , Mendelson Gad , Sason Adi
Published: December 2023

Coping in stressful times and under cumulative adversities (e.g., health, terror) may lead to emerging vulnerability, diminish resilience and negative psychological consequences. In an organizational framework, this personal vulnerability may also have an impact on organizational resilience. This study examined the resilience and vulnerability indicators during the COVID-19 pandemic and other crises among employees at Geriatric Medical Centers in Israel. Data were collected from a convenience sample of 283 employees from two Geriatric medical centers. The questionnaire included background variables, resilience indicators (personal resilience, morale, wellbeing and a sense of security at home) as well as vulnerability indicators (sense of danger, fear of death and fear of dying, a sense of stress and perception of threats). Administrative workers reported higher vulnerability and lower resilience than workers in other sectors. Longer period of time working with Covid-19 patients was associated with higher resilience and higher vulnerability. After controlling for personal background, death anxiety, sense of danger and health wellbeing significantly correlated with high stress while functional wellbeing and personal morale significantly correlated with low stress. Wellbeing in the workplace was the only indicator associated with high resilience. These findings demonstrate the dialectical experience of employees in geriatrics centers coping with cumulative adversities, combining both vulnerability and resilience. It is recommended for organizations to assist employees in building resilience mechanisms that will help them cope with stressful situations through strengthening their sense of wellbeing, and as a result will help strengthen organizational resilience.
INTRINSIC CAPACITY OF OLDER ADULTS IN SINGAPORE USING WHO INTEGRATED CARE FOR OLDER PEOPLE (ICOPE) FRAMEWORK
Authors: Ma Carol , Leung Angela Y M , Chua Denise , Teo Wai Choo , Tay Laura Bee Gek , Ng Wai Chong
Published: December 2023

The World Health Organization (WHO) proposed the Integrated Care for Older People (ICOPE) approach to guide health systems in better supporting the intrinsic capacity and functional ability of older adults to enable healthy aging (Briggs et al., 2018; de Carvalho et al., 2019). This approach is aligned with Singapore’s Healthier SG initiative, which aims to build a good healthcare system that promotes better health and quality of life for everyone. Recent studies have shown that older adults experience intrinsic capacity decline in various countries, including Singapore, highlighting the importance of targeted interventions to maintain functionality and quality of life in old age (Beard et al., 2019; Liu et al., 2021; Tay et al., 2022). In this cross-sectional study, 367 participants were assessed by 43 ICOPE assessors, of whom 77.4% (n=284) had impairments in intrinsic capacity. The three most prevalent intrinsic capacity impairments were visual impairment (42%), hearing loss (33.5%), and cognitive decline (31.3%), followed by limited mobility (24.3%), malnutrition (16.1%), and depressive symptoms (16.1%). Furthermore, 22.6% of participants were unaware of any elderly care services available in the community, and 8.2% did not know where to seek help in case of problems. These findings emphasize the need for ICOPE assessments at the community level to promote early detection of intrinsic capacity impairments and interventions. More discussion of the care pathway, together with health professionals, older adults, and caregivers, should be the next step to offer diagnostic assessment and guide self-management of intrinsic capacity impairment for among older adults.