bluuebunny/crossref_metadata_2025 huggingface dataset:
Behavioral Health and Learner-Centered Outcomes in Geriatric Primary Care or Community Settings
Authors: Allen Rebecca , Halli-Tierney Anne
Published: December 2020

This symposium presents data from interdisciplinary behavioral health training and research conducted in primary geriatrics care or community settings in the Deep South. The first paper describes mixed-method learner-centered outcomes from interprofessional education case sessions. Survey and qualitative data revealed the most important experiential learning derived from collaboration, problem solving, and learning about various disciplines’ professional roles. The second paper presents longitudinal patient cognitive outcome data from the primary care, outpatient geriatrics clinic in which most of these interprofessional learners learn. Results show that only 26.2% of patients had scores indicating cognitive functioning within normal limits; 32.6% had scores indicative of mild neurocognitive disorder, and 41.2% had scores indicative of dementia. Over 30% of patients reported clinically significant levels of depression or anxiety, and 16.5% of patients reported at least one indicator of hazardous alcohol use at their baseline assessment. The third paper demonstrates that psychological inflexibility is associated with depression and anxiety at baseline, and that symptoms of depression and anxiety do not change one year later. The fourth and final paper considers the impact of hearing loss on quality of life in community-dwelling older adults. Effect size calculations indicated that adults with hearing loss who lived in the most rural regions of Alabama, had lower reported QOL scores than their counterparts who had hearing within normal limits This symposium will show why age matters in behavioral health training. Mental Health Practice and Aging Interest Group Sponsored Symposium.
Immunological Heterogeneity
Authors: Haynes Laura
Published: December 2020

Ease of access to circulating peripheral blood cells (PBMCs) can offer unique insights into human immune function, as well as responses to vaccination and infection. Nevertheless, PBMC heterogeneity has been under-appreciated since results obtained from mixed populations may reflect changes in subset abundance as opposed to true age-related changes involving a specific subset. Technological advances have allowed for the examination of age-related heterogeneity with regards to systemic cytokine levels, immune cell frequencies and chemokine receptor expression by peripheral lymphocytes. Furthermore, introduction of sex as a variable in the examination of human PBMCs adds additional dimorphism to the study of aging and immunity including differences in epigenetic modifications, levels of pro-inflammatory activity and adaptive immunity.
Strong and Ethical Scholarly Writing for Multidisciplinary Audiences
Authors: Meeks Suzanne
Published: December 2020

This presentation will emphasize the importance of plain, good writing. Editors of high impact journals read 10 or more manuscripts per week, and are under pressure to reject 80-90% of them. Regardless of scholarly quality, if the point and contribution are not clear in a quick scan of the paper, it likely will not be reviewed favorably. I will provide tips for strong scientific writing that are commonly violated in manuscript submissions, and provide references for additional writing support. I will also discuss some common publication ethics issues that arise during the review process, including author contributions and embedding your scholarship in the context of prior work.
Predicting Depression in Dementia Caregivers: Do Religious/Spiritual Struggles Play a Role?
Authors: MacDougall Elizabeth
Published: December 2020

Using a stress process framework model, this study is the first to comprehensively examine the role that religious/spiritual struggles play in the lives of informal dementia caregivers. A convenience sample of 156 informal dementia caregivers completed a scale measuring six domains of religious/spiritual struggles, as well as other measures of primary stressors, background/contextual variables, and mental health outcome (depression). Overall levels of religious/spiritual struggle were low, but 26 percent of the sample were classified as possible cases of clinically significant religious/spiritual struggle for at least one of the six domains. Of this group, 49 percent acknowledged struggles with ultimate meaning. Religious/spiritual struggles predicted greater self-reported depression over and above number of care recipient problem behaviors (primary stressor), caregiver sex, and caregiver personality (i.e., emotional stability). Although no individual domain of religious/spiritual struggle emerged as most salient, caregivers reported significantly more ultimate meaning struggles than demonic or interpersonal struggles. These findings support the growing body of research suggesting that religious/spiritual struggles serve as a secondary stressor, adding predictive power to background/contextual factors and to primary stressors for informal dementia caregiver mental health outcomes. Further research in this area may advance efforts to better equip both secular and religious professionals to provide evidence-based counsel to informal dementia caregivers.
Research Literature on the Intersection of Dementia, Spirituality, and Palliative Care: A Scoping Review
Authors: Palmer Jennifer , Smith Alyssa , Paasche-Orlow Sara , Fitchett George
Published: December 2020

Dementia marks an increasingly prevalent terminal illness for which palliative care, including spiritual care, could improve quality of life. Research gaps exist in understanding the intersection of dementia, spirituality, and palliative care. Thus, we conducted the first scoping review examining the nature and breadth of peer-reviewed studies across these three topics. The scoping review followed methods from The Joanna Briggs Institute Reviewers’ Manual (2015). We developed a priori a scoping review protocol outlining the Population, Concept and Context for study, data sources, search strategy, inclusion/exclusion criteria, and procedure for screening, extracting, and analyzing data. The final sample consisted of 19 studies with the following themes: Characterizing Spiritual Needs, Preferences, and Resources; Characterizing Palliative or Spiritual Care; Predicting Provision of Spiritual Care; and Assessing Spiritual Care Interventions. Eighteen studies were published in the past decade, and eleven were based in Europe. The majority of studies focused on long-term care settings, grouped stages of dementia or did not specify dementia stage, and investigated interventions indirectly related to spiritual palliation. Many studies were limited in sample size and in generalizability / transferability and used less sophisticated research designs. Accordingly, research across dementia, spirituality, and palliative care needs to examine distinct stages of dementia; hospital-, home- and community-based settings; and formal spiritual care interventions (e.g., administered by chaplains) and needs to utilize rigorous study designs (e.g., randomized clinical trials). Such research could advance practice and policy that enhance quality of life for tens of millions of persons with dementia and their family members worldwide.
At 75: Coming of Aging with GSA
Authors: Abushakrah Jan
Published: December 2020

This lecture reflects on the highlights of my journey to become a gerontologist: •Joining AGHE in 1998 as PCC explored the development of the first and only Gerontology associate degree in Oregon •Collaborating with community and academic partners to create an applied and evolving curriculum •Empowering older, encore students to translate their experience and compassion into professional careers that embodied their passion •Mentoring hundreds of students to harness their creativity and engage in bold innovation to transform aging lives •Grappling with how to measure and ensure student learning in a way that would make a difference in aging lives •Participating in the working group that developed the Gerontology Education Competencies and currently serving on the founding Board of Governors of the Accreditation for Gerontology Education Council.
Reflections on a Career in Research and Education
Authors: Zarit Steven
Published: December 2020

This presentation will focus on three issues that were important in my career: family caregiving, international collaborations, and mentorship. Having spent considerable time studying family caregiving, I will highlight what I consider are fundamental issues that characterize family care and provide a necessary foundation for generating strong research questions. I will also suggest new directions for improving design and evaluation of interventions. International collaborations can help us broaden our understanding of aging and on care of older people. I had the good fortune to work with a great research team in Sweden. I will describe research we did on functioning and cognition among the oldest old. I also had the opportunity to see first-hand high-quality programs for older people that showed we can do better than accept mediocrity as the norm in care. Finally, I will discuss the importance of mentorship and bringing forward the next generation of researchers.
Distinguished Faculty Award Lectures
Authors: Hancock Cynthia
Published: December 2020

The Distinguished Faculty Award lecture will feature an address by2020 recipient Mary W. Carter, PhD. The Distinguished Faculty Award acknowledges individuals whose teaching stands out as exemplary, innovative, or influential-- or any combination thereof.
Deconstructing Ageism
Authors: Reynolds Laurinda
Published: December 2020

Fifty years of ageism research has identified the psychosocial subconstructs and consequences of ageism and produced over 30 published definitions. However, some educators still define ageism as age discrimination or prejudice against one age group by another age group. This oversimplification provides camouflage for insidious ageism, messages that are not recognized as harmful by their source or by the target of the ageism message. This type of ageism message cultivates implicit fears of aging and negative self-perceptions, and because they are not recognized, they undermine efforts to reframe aging. This presentation deconstructs ageism to make this extremely complex phenomenon clear without oversimplifying its nature or understating its consequences. It differentiates ageism from youthism through their developmental processes, persistence, and consequences. Knowledge will be integrated and synthesized across disciplines using a biopsychosocial lens. Examples of insidious ageism are presented to increase one’s capability to recognize and avoid insidious ageism.
Does Aging Identity Moderate the Impact of Experiences with Familial Ageism on Well-Being?
Authors: Kinkade Emily
Published: December 2020

This study begins to investigate the effects of ageism in the family context. The current literature has documented the negative impacts that negative stereotypes and negative perceptions of aging have on older adults’ health, mortality, and well-being (Levy, 1996; Levy, 2003). However, the majority of extant research on ageism focuses on age discrimination in the workplace and in healthcare despite the majority of peoples’ time being spent in the family context. Therefore examining experiences of ageism sourced from family members merits study. Walker, Bisconti and Kinkade (in preparation) found evidence that the experience of ageism within the family context varies from the workplace context. Past research has demonstrated that older adults who identify as being older and adapt to the changes that arise with aging are associated with higher levels of self-esteem (Whitbourne, Sneed, & Skultety, 2002; Weinberger & Whitbourne, 2010). It is hypothesized that age identification will serve as a moderator for the relationship between familial ageism and well-being. Participants completed a set of questionnaires measuring experiences with familial ageism, depression, self-esteem, and ego strength. Experiences of familial ageism correlated with the well-being outcome variables in the predicted direction. Age identity moderated the relationship between familial ageism and depression and ego strength, such that participants who identified as being younger or identified as their age reported lower depression scores and higher ego strength scores. These findings suggest that age identity may serve as a buffer against the negative impacts that experiences of familial ageism has on well-being.
Challenges and Supports to Aging in Place in a Gentrifying Context
Authors: Kumar Manish , Richman Laura
Published: December 2020

Neighborhoods play a central role in healthy aging, with changes to neighborhoods having a profound impact on older adults’ ability to age in place. Using gentrification as an indicator of neighborhood change and applying the theoretical framework of the Environmental Press model (Lawton and Nahemow, 1973), this study examined the relationship between changing environments, affordable housing, and environmental attributes that support and hinder the health and well-being of older adults. A qualitative, case-study approach was used to interview low-income, majority Black older adults in a gentrifying area of Washington DC. 32 individuals (16 in non-profit and 16 in for-profit affordable housing) aged 55 and older participated in semi-structured interviews on perceptions of gentrification, neighborhood change, and challenges and supports to aging in place. Transcripts were then analyzed using the framework method of analysis. Although participants generally reported that gentrification improved their neighborhood’s built environment, many attributed it to a decline in social capital. Affordable housing provided an ability to age in place, though participants expressed uncertainty over their long-term ability to age in the context of continuing change. These findings suggest that while the physical changes accompanying gentrification may support older adults’ ability to age in place, its detrimental impact on social capital further increases their risk for social isolation. While affordable housing may enable older adults to age in place, fostering a greater sense of permanence and well-being will require additional policies that both increase accessibility to the physical amenities provided by gentrification and preserve older adults’ social capital.
Supportive Built Environment for Active Aging in Korea’s Healthy City
Authors: Hwang Eunju , Hsu Chungwen , Jeong Jinwook , Brossoie Nancy , Song Kimin
Published: December 2020

Many small and medium-size towns in South Korea experience an increasing number of older adults growing older. This medium-size mountain city has been a member of WHO’s Healthy City Alliances and we investigated the impacts of built environment (BE) in the community on active aging. The purpose of the survey was to identify the BE affecting the residents’ physical activity level and quality of life. The survey data (N=630) were collected from the residents aged 40 years and over in May 2019 from a mountain city near a national park in Northeast part of Korea. The average age of the participants was 67.41 years of age and most wanted to stay in their community. Our descriptive data analysis show that the following items are perceived very important to address in creating more supportive environment: benches in public spaces; safe pathways and public transportation station; well-maintained sidewalks; affordable and accessible housing options. Regression models were also developed to examine the impacts of BE on activity level and quality of life. BE factors included the features related to outdoor spaces and buildings, public transportation, streetscape and housing, and found a significant relation between the participants’ activity level and public transportation in addition to demographic factors such as age and health status. Regarding the quality of life, the participants’ perception on outdoor spaces and buildings and safe public spaces were positively related to quality of life. The study showed the importance of supportive and age-friendly environments for active living.
Primary Care Provider Attitudes and Perceptions of Routine Cognitive Screening in Older Adults
Authors: Potenza Giovanna , Mattos Meghan
Published: December 2020

The 2011 Annual Wellness Visit (AWV) Medicare benefit includes a cognitive screening component intended to improve screening of older adults. However, available literature only presents physician perspectives on cognitive screening prior to 2011. The purpose of this study was to explore primary care provider (PCP) attitudes and perceptions of cognitive screening in older adults. An Internet-based survey link was sent to Virginia professional organizations and clinics to distribute to PCPs serving older adults. Likert scale, multiple choice, and free response questions were used to understand current attitudes, perceptions, and practices. The sample (N=39) was comprised of 26 nurse practitioners (NPs), 9 physicians, and four who did not disclose role. Most participants were aware of the AWV (n=31, 88.6%) and agreed that early detection “promotes earlier diagnosis and access to resources” (mean ± standard deviation,1.58±0.69). However, less than half of NPs screened annually (n=10/26, 38.5%) and even less conducted screening during an AWV (n=7/26, 26.9%). About half of MDs conducted cognitive screening during an AWV (n=5/9, 55.6%). Although NPs screened less, they more strongly agreed that screening should occur annually (1.92±1.15 vs. 2.67±1.23) and “additional training would improve [screening] ability” (2.04±1.0 vs. 3.22±1.20). Also, few NPs independently managed impairment (n=5/26, 19.2%) compared to MDs (n=5/9, 55.6%). Our findings demonstrate that NPs screen less and feel less prepared to conduct cognitive screenings. It is important to provide additional resources and training for all PCPs, but especially NPs who are rapidly entering primary care to help improve identification and management of cognitive impairment.
Physical Activity Adherence Rates in Older Kidney Transplant Recipients: A Pilot Randomized Controlled Trial
Authors: O’Brien Tara , Rose Karen , Tan Alai
Published: December 2020

Daily walking activities are associated with improving cardiovascular and well-being in older kidney transplant recipients. Multicomponent interventions using technology and goal setting holds promise for sustaining daily walking activity among this population. The purpose of this randomized controlled trial pilot study was to evaluate the feasibility of a multicomponent intervention called SystemCHANGE™ + activity tracker for daily walking activity in older (age 60 and over) kidney recipients from baseline to 12 months. The intervention group implement a personal-system solution and wore a mobile activity tracker daily for 12 months. The attention-control group received educational information on healthy living as a transplant recipient and was asked to wear a mobile activity tracker daily for 12 months. Participants were randomized 1:1 to the intervention or control group. The sample consisted of 53 participants (n = 27 intervention, and n = 26 control). At the 12-month follow-up visit, the total study attrition rate was 23%. The adherence rates at 12 months were 96.5% in the intervention group and 80.8% in the attention- control group. The intervention group increased their steps from baseline to 12 months by 334 steps per day. The attention-control group demonstrated a decrease in steps by 563 steps per day. We found a mean difference of 1041± 2440 (Cohen’s d = 0.43) in daily steps between the groups from baseline to 12 months. The data suggests SystemCHANGE™ in combination with activity trackers may be feasible for older kidney transplant recipients to enhance and sustain physical activity with daily walking.
Effects of Angiotensin (1-7) Expressing Lactobacillus and Exercise on Gut-Brain Axis in Aged Rats
Authors: Sun Yi , Yang Youfeng , Banerjee Anisha , Verma Amrisha , Li Qiuhong , Carter Christy , Buford Thomas
Published: December 2020

Aging is associated with gut dysbiosis – a condition linked with altered central nervous system function (“gut-brain axis”). Age-related health benefits have been ascribed to the renin-angiotensin system, mediated partially via the angiotensin(1-7) axis. Research has shown exercise altering gut microbiota composition and function. This study explored the effects of a genetically modified probiotic expressing angiotensin (1-7) and exercise on the gut-brain axis. Sixty-two male F344/BN rats were randomized at 24-months-old to receive oral gavage of angiotensin (1-7) Lactobacillus paracasei (LP) or LP-A, wide-type LP, or control 3-times/week for 12 weeks; with or without exercise. Rats in exercise groups were walking on a treadmill 10-minutes/day for 5-days/week. Microbiome taxonomic analysis of fecal samples post intervention was performed via 16S-based PCR. A battery of behavior tests were performed before and after the intervention. PCoA revealed that groups differed in the overall fecal microbiota community structure by weighted UniFrac (p=0.034). Indices of alpha-diversity, including Shannon (p=0.02) and Simpson (p=0.019) indexes, displayed LP-A groups with more diverse microbiome than controls. Grip strength (p=0.042) and exercise tolerance (p<0.001) tests showed exercise groups had more muscle strength and aerobic capacity than the sedentary groups. Exercise groups had more lean mass (p=0.019); both LP-A and LP groups had lower fat mass compared to the controls in body composition measurement. LP-A travelled longer distance in the central area than the control in the open field test showing reduced anxiety (p=0.029). Therefore, we conclude LP-A and exercise have distinct and possibly overlapping beneficial effects on the gut-brain axis.
Social Well-Being and Chronic Disease Condition among Older Adults
Authors: Min Jungkyung , Harvey Idethia , Yeh Yuchen
Published: December 2020

Aging is characterized by the decline in physical health, functional status, and loss of social roles and relationships that can challenge the quality of life. A protective factor that moderates the impact of these phenomena is psychological (e.g., social) well-being. Despite the high prevalence of chronic conditions among older adults, research exploring the relationship between social well-being and chronic disease is sparse. The study aims were to investigate the relationship between social well-being among older adults (N = 1,251, R = 65 – 92 years) who participated in the National Survey of Mid-life in the United States (MIDUS 3). This study used variables for the MIDUS 3 study to test a structural equation model to examine the hypothesized relationships between social well-being, chronic conditions, life satisfaction, self-esteem, active coping, optimism, and religious coping. The findings indicate that perceived control, self-esteem, active coping, optimism, and religious coping were statistically significant for the participants’ social well-being (β =.29, p <.001, β =.16, p<.001, β =.08, p<.05, β =.35, p<.001, and β =.07, p<.05, respectively). However, life satisfaction was not significantly associate with social well-being (β =.04, p >.05). For individuals’ diagnosed with more than one chronic condition, perceived control, self-esteem, and optimism statistically significant impact their social well-being (β = .33, p < .001, β =.17, p < .001, and β =.33, p < .001, respectively). Findings suggested that multiple chronic conditions influence social well-being. Chronic disease management programs may be useful in increasing social well-being among individuals with multiple chronic conditions.
Examining Cognitive Function and Self-Esteem of Middle Aged and Older Adults
Authors: Catarino Daniela , Adams Colin
Published: December 2020

Research shows that self-esteem and well-being have strong correlations to cognitive abilities. People with high self-esteem, compared to those with a low self-esteem, tend to evaluate themselves as more favorable after both high and low performance. However, less research has been conducted on self confidence among the older population and how this can potentially negatively or positively influence the aging process. The purpose of the study was to see if there is an effect of age on cognitive function. The second aim was to see if there is an effect of cognitive function on self-esteem. The first hypothesis was that middle-aged adults would exhibit higher cognitive functioning than older adults. The second hypothesis was that those with lower cognition would exhibit lower self-esteem. A secondary analysis of data from the National Social Life, Health, and Aging Project (NSHAP) was performed on 60 randomly selected individuals from a total of 3,005 participants. A 2 x 2 chi square test revealed that the younger group (63%) compared to the older group (37%) were significantly more likely to exhibit perfect cognitive functions (versus not), χ² (1) = 4.27, p < .05. A One-Way ANOVA revealed no significant main effect of cognitive function on self-esteem, F(1, 58) = 2.97, p = .09. This suggests that cognitive functions are more likely to decline as one ages but cognitive function alone might not strongly influence self-esteem. Future research should aim to understand under what conditions confidence influences cognitive function to promote healthy interventions for successful aging.
Examining the intersection of cognitive & physical function in the Brain Networks and Mobility Function (BNET) Study
Authors: Handing Elizabeth , Miller Michael , Chen Haiying , Baker Laura , Kritchevsky Stephen
Published: December 2020

Cognitive function and physical function are associated however less is known about task complexity and how individual tasks relate to one another. This project seeks to describe the relationship between cognition and physical function measures across 22 tasks ranging in task complexity and difficulty. Data are from the baseline visits of a new longitudinal study, Brain Networks and Mobility Function (B-NET) Study, mean age: 76.0±4.2 years; 55% women, and 90% Caucasian. We hypothesize there would be a set of “complex” tasks that would intersect both cognitive and physical function abilities such as the Four Square Step Test or Dual Task. We conducted principal components analysis on data from the first 110 participants to describe what factors could be identified across cognition and physical function measures. Seven factors, explaining 73% of the variability, were identified: 1) a complex physical function (postural sway on foam, expanded Short Physical Performance Battery, 400 meter walk, Four Square Step Test, Dual Task), 2) physical strength (grip strength and leg press), 3) visual recall (Brief Visuospatial Memory Test- immediate and delayed), 4) Craft story recall (immediate and delayed), 5) global cognition & fluency (MoCA, category and word fluency) 6) auditory recall (Auditory Verbal Learning Test- immediate and delayed), and 7) executive function (Trail Making Test A & B). We did not identify factors that intersected both physical and cognitive tasks. These results may help to inform measurement selection in future studies that seek to evaluate components of function among older adults.
Longitudinal Daily Living Limitations and Cognitive Status: Results from the 1998-2016 Health and Retirement Study
Authors: Wu Benson , Toseef Mohammad Usama , Tarraf Wassim , Stickel Ariana , Kaur Sonya , Ramos Alberto , Gonzalez Hector
Published: December 2020

Data increasingly points to midlife health and modifiable risk factors as critical targets for improving older-age health outcomes and mitigating potential cognitive impairment and disease. We used biennial Health and Retirement Study data (1998-2016) collected on adults ages 50-64 years who did not meet criteria for dementia at baseline and who remained living by 2016 (unweighted-n=4,803). Cognitive status was defined using Langa-Weir criteria: Normal, Cognitively Impaired Not Dementia (CIND), and Dementia. We examined how 18-year patterns in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) predicted cognitive status in 2016. We used latent class analysis to extract longitudinal phenotypes of activities limitations, followed by survey multinomial logistic regressions to examine their associations with cognitive status and test for race/ethnic modifications. We identified three groups of functional impairment: (1) gradually increasing (15.7%), (2) stable elevated (5.6%), and (3) minimal dysfunction (78.7%). After covariates adjustment, both the gradual and stable elevated impairment groups (vs. minimal) had substantially higher relative risk ratios (RRR) for dementia (RRR=5.71[3.89;8.39] and RRR=7.87[4.23,14.64]) and CIND (RRR=2.21 [1.69,2.88] and RRR=1.92[1.16;3.17]). We detected modifications by race/ethnicity such that Hispanics with stable elevated impairment had a higher probability of dementia compared to their White counterparts. The results varied for Blacks and did not significantly differ from Whites. Data-driven methods may improve our understanding of heterogeneous functional impairment patterns among late middle-aged adults and allow for tailored ADRD prevention strategies. Focused risk-based interventions can yield important public health savings and reductions in structural, social, and individual health burdens.
Anxiety and Depression as Predictive Factors of Quality of Life in Old Age: A Longitudinal Analysis
Authors: Ribeiro Oscar , Araújo Lia , Teixeira Laetitia , Rodríguez-Blázquez Carmen , Forjaz Maria Joao
Published: December 2020

Research on the effect of age in quality of life (QoL) is controversial, and doubts remain if this effect is continuous and if it disappears when controlling for other factors. Most studies have verified the association of health-related factors, such as poor physical health, functional impairment, and depression with lower scores of QoL in old age. But studies that analyse such an association in non-clinical samples through longitudinal analysis and including anxiety as a mental health factor remain very rare. This study relies on data from two waves from the Survey of Health, Ageing and Retirement in Europe (SHARE) and focuses on a representative sample of individuals aged 50+ from Portugal. It comprises 1782 participants (baseline), of which 1201 were reassessed. The mean age was 64.8 years (sd=9.3 years) and 55.4% were female. Linear Mixed Effects models were performed to identify potential factors associated with changes of QoL across age. According with the final model (pseudo-R2 equal to 0.421), a significant effect of age as time-dependent factor was verified, observing a decline of QoL with increasing age. Years of education, depression and anxiety at baseline were significantly associated with QoL. Thus, the effect of age on quality of life remains significant even when other factors are considered. The influence of mental health on QoL reinforces the importance of intervening in both depressive and anxiety symptoms in old age.
Trajectories of Health Changes in Older Adults with Chronic Hepatitis B Infection
Authors: Wu I-Chien , Chen Chang-Hua , Yang Yu-Wen , Liu Yen-Tze , Chiu Yen-Feng , Hsu Chih-Cheng , Chuang Shu-Chun , Hsiung Chao A
Published: December 2020

Despite the increasing burden of chronic hepatitis B (CHB) in aging populations, little is known about the course of health-related quality of life (HRQoL) changes during older adulthood in CHB patients. We aimed to assess individual-level longitudinal HRQoL changes in older patients with CHB and to examine their correlates. A 5-year prospective cohort study was conducted in 503 hepatitis B surface antigen-positive community-dwelling adults aged 55 years or older. Participants underwent comprehensive assessments at baseline and serial measurement of HRQoL using the short-form (12) health survey version 2. Of these participants, 82.7% remained in good physical health throughout the study period, whereas 9.1% had declining physical health and 8.2% were in poor physical health. We likewise identified three trajectories of mental health changes (“good mental health” [86.9%], “declining mental health” [6.8%], and “poor mental health” [6.4%]). Three baseline characteristics were independently associated with a lower likelihood of remaining physically or mentally healthy during older adulthood: sarcopenic obesity (odds ratio [OR] with 95% confidence interval [95% CI] of 7.5[2.8-20.5] for poor physical health, 3.1 [1.1-8.4] for declining physical health, 4.3 [1.4-13.0] for poor mental health), higher number of metabolic abnormalities (OR [95% CI] of 3.6 [1.6-8.0] for poor physical health) and depressed mood (OR [95% CI] of 21.7 [5.8-81.0] for poor physical health, 5.3 [1.4-19.9] for declining physical health, 83.1 [19.7-350.2] for poor mental health, 13.6 [2.9-64.8] for declining mental health). In conclusion, we demonstrated the heterogeneity and nonlinearity of HRQoL changes and their associations with variations in specific extrahepatic organs/systems.
Dimensions of Social Isolation and Weight Loss among Older Men and Women in S. Korea
Authors: Bae Youngjoon , Pachucki Mark
Published: December 2020

Older men who live alone are typically believed to be highly susceptible to malnutrition. However, recent studies report their living alone status is associated with frailty negatively and with Type 2 diabetes positively. Meanwhile, older women who live alone are believed to be less susceptible to malnutrition, but qualitative research point out their high likelihood of malnutrition. There is little literature to explain these paradoxes. To evaluate this gap in understanding of how a metabolic process may be shaped by social context, this study examines whether different aspects of social isolation among older men and women (living alone, social contact, loneliness) are associated with adverse weight loss, as well as with indicators of meal frequency and body weight. For this, a data set comprised of 6,680 older adults from the Korean Longitudinal Study of Aging surveyed every two years from 2006 to 2018 was analyzed using panel regression models. Among older men, living alone was negatively associated with logged body weight even when considering loneliness but not associated with meal frequency and 5kg or more weight loss. Among older women, living alone was not associated with logged body weight but associated with fewer meals and 5kg or more weight loss. The association disappeared when considering loneliness. Unexpectedly, social contact was not significant to prevent adverse weight loss.
The reciprocal causal relationship between frailty and physical activity among Korean older adults by age groups
Authors: Sagong Hae , Yoon Ju Young
Published: December 2020

Among associated factors to frailty, physical activity is a highly recommended intervention that prevents the risk factors of the frailty. However, most of the older adults are lack of sufficient physical activity to obtain health-related benefits. The purpose of this study is to investigate the reciprocal relationship between frailty and physical activity among Korean older adults by age groups of middle-old (70-79) and oldest-old (more than 80) between two years using cross-lagged panel analysis. This study is a secondary data analysis of the Korean Frailty and Aging Cohort Study (KFACS) and a total of 1,092 participants were included. Frailty was measured by the FRAIL scale and physical activity was measured by the International Physical Activity Questionnaire (IPAQ). As for the result, in the middle-old group, frailty and high PA had significant reciprocal causal relationships while moderate PA with frailty had no significant relationship reference to low PA. In short, frailty was associated with less high PA, and high PA predicts less frailty after two years. In the oldest-old group, surprisingly, there was no reciprocal causal relationship between frailty and any level of PA reference to low PA which means PA has no effects on frailty and vice versa. This can be explained by the ceiling effect or overestimation of the physical activity. Therefore, further studies on the relationship between frailty and physical activity of the oldest-old population are needed. Also, specific physical activity guidelines and effective measurement of physical activity for older adults by age segment should be developed.
Recruitment and Retention Strategies of Cancer Patients and Their Caregivers in Family-based Intervention Studies
Authors: Guan Ting , Qan’ir Yousef , Jung Ahrang , Xu Shenmeng , Idiagbonya Eno , Song Lixin
Published: December 2020

Family-based psychosocial behavioral interventions (PBIs) that target both the cancer patients and their caregivers may more effectively help them with self-care and improve quality of life; however, family-based PBIs often face unique challenges during study implementation. This systematic review aimed to a) examine the recruitment and retention rates of cancer patients and their caregivers in clinical trials testing family-based PBIs; and b) explore the recruitment and retention strategies. We systematically searched five electronic databases to identify randomized controlled trials that tested family-based psychosocial or behavioral interventions among adult patients with cancer and their adult family caregivers. Our searches yielded 48 studies. The average recruitment rates of patients and caregivers were 56.8% (SD=31.8%; range=8-100%) and 54.5% (SD=32.4%; range=8-100%), respectively. The majority of the studies have focused on white and female patients and caregivers. The average retention rate at end of follow-up times was 69.1%. Only 13 studies reported retention strategies, including providing money/gift cards upon returning of each follow-up survey or study completion, and excluding advanced cancer patients. Reasons for attrition, i.e., dropping out of studies, were classified as: health-related (e.g., death, illness, psychological distress), intervention-related (e.g., intervention does not meet expectation, frustration with group allocation, intervention burden) and other reasons (e.g. lack of time, unable to establish contact). Recruitment and retention of patients and caregivers in family-based PBI are integral to the success of interventions. Researchers need to incorporate effective strategies for optimizing recruitment and retention at the planning stage of their studies.
Screening Older Adults for Hearing Loss in Primary Care: Insights of Patients, Providers, and Staff
Authors: Silberberg Mina , Singh Anisha , Bettger Janet , Dolor Rowena , Smith Sherri , Francis Howard
Published: December 2020

Over one-third of older adults have a disabling hearing loss, with potentially severe implications for well-being. Hearing screening is not routine in primary care (PC) and patients are relied upon to report hearing concerns. We compared outcomes of three approaches to linking telephone-based screening with PC (providing information at PC visit, encouraging at visit, or completing at visit). This poster presents results of focus groups/interviews with providers and staff from participating clinics (n= 35), study enrollees who completed screening and were referred for diagnosis (n=14 ), and enrollees who did not complete screening (n=12). Results show that most patients had prior hearing concerns they had not reported to their PC. Patients forgot or were resistant to completing screening at home. Negative attitudes towards admitting hearing loss and using hearing aids were common; experiences of family and friends influenced many patient attitudes, both negative and positive. PC personnel wish to help, but are challenged by lack of time, space, and reimbursement for screening, and loathe to screen when specialty care and hearing aids are costly. Study results indicate that relying on patients to report hearing concerns is inadequate. Integration of hearing screening into PC would be helped by strengthening reimbursement for screening, specialty care, and hearing aids, and education of both providers and patients on other available treatments for hearing loss. Patients also require education on hearing aid technology. There is a need to address stigma associated with hearing loss, taking into consideration the influence of family and friends on attitudes.
Child’s Developmental Disabilities and Parental Well-being in Midlife and Old Age: Does Race Matter?
Authors: Lee Juha , Gao Manjing , Lee Chioun
Published: December 2020

Having a child with developmental disabilities (DD) compromises parents’ health and well-being. We have little knowledge on whether the association is robust to the presence of exposure-outcome confounders and how it varies by race. Guided by life-course perspectives, we evaluate (1) the association between having a child with DD and parental well-being and (2) racial disparities in the likelihood of having a child with DD (differential exposure), and/or the effect of having a child with DD on parental well-being (differential vulnerabilities). We advance prior studies by including a wide array of parent’s early-life adversities (ELAs, e.g., poverty and abuse), which may link the predictor to the outcome. Using the core, Refresher, and Milwaukee samples from Midlife in the United States (N=9,640, 25% non-Whites), we conducted regression analysis with race as a moderator. Compared to having a healthy child, parents having a child with DD reported lower well-being even after controlling for ELAs. While the likelihood of having a child with DD (around 10%) is similar for both non-Hispanic Whites and African Americans, African American parents are more adversely affected by having a child with DD across most of the eudaimonic well-being indicators (i.e., autonomy, self-acceptance, positive relationships with others, personal growth, environmental mastery). The later-life well-being of racial minorities is disproportionally affected by having a child with DD. Future research avenues include identifying life-course pathways that contribute to this differential vulnerability.
If I’m Worrying About Getting Well, How Can I Get Well? Decision-Making among African Americans with Advanced CKD
Authors: Hamler Tyrone , Schmidt-Sane Megan , Huml Anne , Dobre Mirela , Taylor Donna
Published: December 2020

Objectives: Chronic kidney disease (CKD) is an emerging major public health concern in the United States. Shared decision-making (SDM) has gained attention as an important area of inquiry in chronic kidney disease research. Few studies focus on shared decision-making or preferences of older African Americans during the advanced stages of CKD before the initiation of dialysis. The objective of this study was to understand decision-making preferences and shared decision-making among older African Americans with advanced chronic kidney disease who have yet to start dialysis. Methods: Data were collected from an outpatient clinic sample of older African Americans ≥ 55 years old (N = 10) diagnosed with advanced CKD. Participants were administered a survey with open-ended questions related to shared decision-making, CKD healthcare and general healthcare preferences (both open-ended and closed-ended questions), and participant characteristics. A thematic analysis framework was applied to identify themes and patterns in the data. Results: Several themes emerged in regard to shared decision-making and patient preferences including: complexity of CKD management, uncertainty of prognosis, barriers and facilitators to CKD self-management and SDM, diagnosis and dialysis information, elements of SDM, and the structural and social context of SDM related to racial inequities. Discussion: Participants identified a nuanced understanding of the concerns related to managing CKD. The complex and ever-changing nature of CKD was emphasized as participants discussed how they perceived their care needs. This study provides implications for social work practice, healthcare policy and interprofessional collaboration in the care of older African Americans.
The Importance of Person Centered Coaching on Physical Activity in Older Adults
Authors: Chiang-Hanisko Lenny , Graves Sue , Joseph-Rendel Jean , Newman David , D’Avolio Debroah
Published: December 2020

Osteoarthritis (OA) is the most common form of arthritis and imposes a substantial social and economic burden on American society. Evidence suggests that physical exercise provides health-related benefits to reduced osteoarthritis pain, stress and depression. However, exercise alone may not be sufficient to make necessary lifestyle changes to reduce OA pain. This study aimed to determine the effectiveness of Person Centered Coaching (PCC) and Health Education (HE) on physical activity of exercising older adults with OA pain. 14 exercising older adults were included in this experimental, randomized, pre and posttest study. Age ranged from 69 -88 years (mean = 77) with most participants identifing as non-Hispanic whites, all currently retired and 71% female. Participants completed OA Diary, 3 PROMIS short-form instruments (Pain Interference, Perceived Stress and Instrumental Support) and Personal Growth Initiative Scale. Data was collected over six weeks to include baseline and post-intervention measurements using repeated measures analysis. The result indicated the PCC treatment group had lower scores on pain interference and perceived stress compared to the HE group. The PCC group also had increased higher level on personal growth and instrumental support compared to the HE group. The results suggest that additional interventions are needed to enhance exercise effectiveness in reducing pain, inflammation and stress. The intervention (PCC), has the potential to provide a positive impact on OA outcomes for exercising older adults by increasing self-knowledge and self-monitoring of OA pain, as well as facilitating persistence with exercise.
COVID Impact and Response in Rural Age-Friendly Communities
Authors: Oh Patricia , Wihry David , Crittenden Jennifer
Published: December 2020

Maine is an age-friendly state with 72 communities enrolled in the AARP Network of Age-Friendly States and Communities and another 25+ using a similar approach to engage residents and local organizations in community planning and development that enhances the health and well-being of older people. The majority (83%, n=60) of Maine’s age-friendly communities have fewer than 10,000 residents and only two have populations over 20,000. Before the pandemic, rural Mainers struggled to find safe and convenient transportation options, afford healthy food, access primary and secondary medical care, and participate in activities to stay physically fit and socially connected. Age-friendly community efforts attempted to address those issues by building on community strengths and assets to develop local solutions. The challenges of rural aging were amplified by the pandemic and reliance on older community leaders and volunteers, who were seen as an at-risk population and thus strongly encouraged to avoid social contact. This study offers a narrative exploration of how rural age-friendly communities responded to COVID-19. The leaders of 71 age-friendly communities were contacted by phone, email, or Zoom between May 15 and August 30. Thirty-nine of the communities (54.9%) actively partnered with residents and organizations to address needs during the pandemic. Identified themes described the challenges faced in developing an effective response and new opportunities to expand the age-friendly work in the community. Suggestions for developing new partnerships between age-friendly initiatives and local organizations were highlighted. A key practice implication is the vital importance of intergenerational collaborations in rural areas.