bluuebunny/crossref_metadata_2025 huggingface dataset:
CANCER HISTORY AND FRAILTY LEVEL IN OLDER ADULTS AND THEIR HEALTHCARE UTILIZATION: EVIDENCE FROM THE NHIS IN THE US
Authors: Su Mingzhu , Liu Siqi , Lao Jiahui , Liu Li
Published: December 2023

Previous studies didn’t compare effect measures of frailty between cancer survivors and counterparts without a cancer history, and this makes us unable to judge whether the impact of frailty is more substantial in cancer survivors. This study aimed to examine the association between cancer history and frailty level with healthcare utilization among older adults. A descriptive survey design consistent with the STROBE guidelines was used. 14,562 old adults were identified in the 2019 and 2020 National Health Interview Survey (stratified by old cancer survivors [N=3,944] and older adults without a cancer history [N=10,618]). Frailty was assessed by Fatigue, Resistance, Ambulation, Illness, and Low BMI. Healthcare utilization was measured by urgent care, emergency care, hospitalization, delayed care, and needed but did not get care. Multivariable logistic regressions were used to examine the association between frailty-cancer characteristics and healthcare utilization. Participants with cancer (vs without) were older (75+: 49.7% vs 36.8%) and more likely to be frail (23.8% vs 14.5%) and pre-frail (36.0% vs 33.7%). The strength of associations between cancer and health utilization (emergency care and hospitalization) among older adults was significantly modified by their frailty status. Compared with robust older adults, frail cancer survivors were more likely to report emergency care (OR=4.7, 95% CI: 3.9–5.8) and hospitalization (OR=5.6, 95% CI: 4.5–7.0). Our findings are essential for risk stratification and informed decision-making in future healthcare service provision planning.
CARE COMPARE STAR RATINGS AND FAMILY SATISFACTION IN MARYLAND NURSING FACILITIES
Authors: Millar Roberto , Diehl Christin , Kusmaul Nancy , Stockwell Ian
Published: December 2023

Nursing facilities provide critical services and supports to individuals with long-term care needs. The quality of care in nursing facilities varies depending on facility structural characteristics. Moreover, the measurement and perceptions of what constitutes quality of care varies across stakeholders. We used publicly available data to examine the association between family satisfaction with care and the Centers for Medicare & Medicaid Services’(CMS’s) Care Compare five-star quality ratings in the context of facility characteristics. Facility-level data of family satisfaction with care were merged with CMS’s five-star star ratings of 220 Maryland nursing facilities in 2021. Using univariate and bivariate statistics, we explored differences in family ratings and five-star ratings across facility ownership (for-profit vs. non-profit), geographic location (urban vs. rural), and average resident occupancy (1-60, 61-120, and 121+). Relationships were examined across overall ratings, as well as across subdomain of the two quality rating frameworks (e.g., staffing, autonomy, health inspections). Family members of residents in non-profit, rural, and low-occupancy facilities rated facilities higher. Non-profit and low-occupancy facilities were statistically more likely to be rated four or five stars, while no significant association was observed across geographic location. The association between subdomain-specific family satisfaction and star ratings varied across facilities of different structures. Findings emphasize the need for comprehensive quality of care frameworks that consider views of quality across stakeholders and types of facilities. A clear understanding of nursing facility structure and quality of care is critical to advance data-driven decision making.
CARE COORDINATION INTERVENTIONS FOR DEMENTIA CAREGIVERS: AN INTEGRATIVE REVIEW
Authors: Layne Diana , Logan Ayaba , Lindell Kathleen
Published: December 2023

Alzheimer’s disease is a serious illness with an extended caregiving experience however care coordination interventions often lack integration of palliative care. The aim of this integrative review is to identify existing care coordination interventions which integrate palliative care for community dwelling individuals with dementia and their caregivers. An integrative review guided by the Whittemore and Knafl framework was conducted, and the Mixed Methods Appraisal Tool was utilized to assess study quality. The systematic search was initially conducted in June 2021 and repeated in May 2023 to ensure no additional studies were available in collaboration with a medical informationist. Nine interventions across eighteen publications were identified that incorporated informal family caregivers and were aimed at improving care coordination for community dwelling PLWD and their caregivers. Only a single intervention used the term palliative care while the remaining interventions included traditional components of palliative care such as advance care planning, symptom management, and emotional support. Many existing care coordination interventions are not grounded in theory or conceptual models and have been studied in a homogenous sample which is not representative of the population. Further study of the existing interventions in a more heterogenous sample is needed. Additional research is necessary to better understand the lived experience of those persons with dementia and their caregivers to reduce burden associated with care coordination activities.
CASE STUDY - TREATMENT OF AMIODARONE-INDUCED THYROID DYSFUNCTION IN LONG TERM CARE PATIENT WITH DEMENTIA
Authors: Chen John , Cheng Ling Ling
Published: December 2023

Pharmacodynamic and pharmacokinetic changes in geriatric population warrant a stepwise, patient-focused and interdisciplinary approach for treatment with potent, class III anti-arrhythmic Amiodarone by reviewing 1) benefits of cardiac tachyarrhythmia treatment, 2) risks of adverse drug events (ADE) i.e. pulmonary, hepatic and thyroid dysfunctions, 3) alternative treatment option(s) with consultation1. 81 years old African American female with history of stroke with vascular dementia, non-ST-elevation myocardial infarction (NSTEMI) and Atrial Fibrillation residing in long term care (LTC) was transferred via 911 for intractable supraventricular tachycardia (SVT) stabilized with Amiodarone treatment. The peak level of Thyroid Stimulation Hormone (TSH) 36.67 (reference range 0.35-4.0) reflexed the initiation of Levothyroxine for ADE Amiodarone-induced hypothyroidism, albeit thyrotoxicosis can also result2. Countering the prescribing cascade and polypharmacy, gradual uptitration of Levothyroxine and weaning of Amiodarone resulted in the nadir level of TSH 8.19 (reference range 0.35-4.0)2. Virtual consultation with Cardiology and Endocrinology Teams provided alternative treatment options with recommendations 1) taper off Amiodarone, 2) substitute with beta-blocker Bisoprolol for heart rate control and 3) continue Levothyroxine trending thyroid function tests. Further interdisciplinary research in vulnerable, older patients in LTC settings is imperative to align the risks, benefits, and alternative treatment option(s) of acute and chronic disease with fundamental geriatric principles, including continuous medication reconciliation, shared decision-making, and life care planning. 1 Basaria S, Cooper DS. Amiodarone and the thyroid. Am J Med. 2005;118(7):706-714. doi:10.1016/j.amjmed.2004.11.028 2 Danzi S, Klein I. Amiodarone-induced thyroid dysfunction. J Intensive Care Med. 2015;30(4):179-185. doi:10.1177/0885066613503278
CHARACTERIZING SYMPTOM BURDEN AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: McKay Michelle , Bernhardt Paul , O’Connor Melissa , Leveille Suzanne
Published: December 2023

One-third of symptoms reported by older adults are unexplained and not directly related to a chronic disease diagnosis. This ambiguity contributes to undertreatment and chronic functional burdens in vulnerable older patients. Previous studies have found that older adults often experience multiple co-occurring symptoms that contribute to disablement. Symptom burden in older adults increases healthcare utilization, decrease physical performance, and leads to poorer quality of life. This study aimed to characterize symptom burden in a population-based cohort of community-dwelling older adults enrolled in the MOBILIZE Boston study (n=765). We used descriptive statistics for symptom prevalence including pain, balance, weakness, endurance, sleep difficulty, depression/anxiety and sensory impairments. We used latent class analysis to identify 4 distinct classes based on overall symptom burden: 1) mild (26.6%), 2) moderate (53.8%), 3) moderate-severe (12%) and 4) severe (7.5%). Moderate to high levels of pain, the most prevalent symptom, were reported in all symptom burden classes except the mild class. Older adults with severe symptom burden, group 4, experienced worse levels of all symptoms compared to other classes. They also experienced moderate endurance and weakness symptoms, and mild and/or severe balance symptoms. Older adults in the moderate-severe class tended to also report mild endurance, balance, and weakness symptoms. Understanding overall symptom burden, both in terms of numbers and severity of symptoms, is the first step in determining the impact of symptom burden as a possible new clinical indicator for fall risk and other detrimental health outcomes.
CIRCULATING IMMUNE CELLS ARE ASSOCIATED WITH BRAIN MRI MEASUREMENTS IN THE FRAMINGHAM OFFSPRING
Authors: Cao Yumeng , Doyle Margaret , Chen Jiachen , Ragab Ahmed A Y , Murabito Joanne , Lunetta Kathryn
Published: December 2023

Mounting evidence supports the role of the immune system in brain health, yet little is known about the role of circulating immune cells in brain health. We investigated the association of immune cell phenotypes with brain MRI phenotypes in the Framingham Heart Study Offspring participants who attended Exam 7 (mean age 61, 52% women). Immune cells (43 analyzed here) were determined by flow cytometry and previously published. Analysis of the immune cell phenotypes with MRI measurements of 13 brain regions revealed several significant associations, adjusting for age, sex and CMV status (Model 1) in the full sample (n=703) and the CMV+ stratum (n=327). In the full sample, higher senescent/exhausted CD8+ cells (CD8+CD45RO-CCR7-CD27-(Teff), CD8+CD45RA+CD28-CD57+(TEMRA), CD8+CD27-CD28-) associated with higher cerebrum and frontal gray volumes. These associations were strengthened when cardiovascular risk factors were included in the model (Model 2). In the CMV+ stratum, two CD8+ cell types (TEMRA, and Teff) were significantly associated with higher cerebrum gray and frontal gray matter volumes in both models. Also in the CMV+ stratum, higher levels of CD8+CD45RO+CCR7+CD27+ (Central Memory) were associated with lower frontal gray matter, and higher CD3+ (T cells) cells were associated with higher temporal gray matter and higher CD8 Teff associated with lower cerebrum white volumes. There were no associations of CD4 subtypes with brain MRI measures in the full sample or the CMV+ stratum. These associations with brain volumes in adults aged 40-88 may improve understanding of the role of the immune system early in the brain aging process.
COHORT CHANGE AND LIFE COURSE SOCIOECONOMIC DIFFERENCES IN COGNITIVE HEALTH TRAJECTORIES
Authors: Cha Hyungmin
Published: December 2023

The combination of socioeconomic gains and losses during a lifetime contributes to a large inequality in cognitive capacity in later life. Although studies have examined the connection between an individual’s socioeconomic status over the life course and cognitive health trajectories, it is unclear how historical contexts may have influenced these associations. In light of the dynamic macro-social environment in Korea, this study utilizes data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2018. I explore the variation in the socioeconomic patterning of cognitive health trajectories based on the benchmarking of socioeconomic status across the life course. The study reveals three main findings. First, I find cohort-specific cognitive health trajectories based on socioeconomic status across the life course. Notably, childhood socioeconomic status leaves an indelible mark on levels of cognition only among earlier cohorts born during the Japanese Occupation period. Additionally, socioeconomic disparities in the rate of cognitive health decline widen among earlier cohorts, while this trend is not observed among more recent cohorts. Second, compared to childhood and later-life socioeconomic status, education consistently shows a positive association with higher levels of cognition rather than slower cognitive decline, regardless of whether the cohorts are earlier or more recent. Third, there is a notable gender difference in socioeconomic disparities in cognitive decline, with women experiencing more pronounced disparities compared to men, especially among earlier cohorts. These findings underscore the significance of historical and contextual factors when examining the association between socioeconomic status and cognitive health across the life course.
COMMUNITY ENGAGEMENT IN OLDER ADULTS WITH COGNITIVE DECLINE: THE USAGE OF INFORMATION COMMUNICATION TECHNOLOGY
Authors: Zhan Rong-Fang , Mpofu Elias , Olanrewaju Sherif , Sutherland Laura
Published: December 2023

Background

Cognitive decline is typical among older adults, affecting their activities of daily living and community participation. However, the advent of cognitive function support information technologies may improve their community engagement, perhaps more than memory training alone. This study examined information communication technology usage as a mediator of associations of cognitive decline and community engagement in older adults.

Methods

We sampled older adult cases from Round 11 of the National Health and Aging Trends Study data set (N=3817) with cognitive decline in community dwelling (mean age =81.38, SD=6.266), male (n= 1313) and female (n=1771). We utilized multi-level Structural Equation Model (SEM) to examine the mediation of cognitive decline and community connection through the ICTs, as well as direct relationships among memory, orientation, and executive function.

Results

From SEM analysis, an increase of ICTs usage has statistically significantly effects on older adults’ cognitive ability overall (Estimate = 0.103, S.E. = 0.023, C.R. = 4.438, p < 0.001). Cognitive function has a direct impact on the activity orientation function (Estimate=1, p < 0.0011.000). The greater usage of ICTs by older adults is associated with higher levels of community engagement (Estimate = 1.230, S.E. = 0.284, C.R. = 4.338, P < 0.001).

Conclusion

This finding highlights the potential role of ICTs in fostering older adults’ cognitive function for their social interactions and community involvement. Digital age older adults may have greater cognitive function than previous cohort, reducing demand for care services their community participation.
COMPARISON OF DNA METHYLATION IN SALIVA, BUFFY COAT AND PBMC SAMPLES IN CATSLIFE
Authors: Evans Donald , Smolen Andrew , Reynolds Chandra
Published: December 2023

The design of the Colorado Adoption/Twin Study of Lifespan behavioral development and cognitive aging (CATSLife) allows for separation of genetic and environmental factors affecting health and cognitive aging. Currently, this sample is transitioning through midlife. One goal of this study is to identify epigenetic changes associated with aging, however methylation profiles differ across tissue types. Therefore, we describe here the analysis of DNA methylation in three CATSLife sample types: saliva, buffy coat, and peripheral blood mononuclear cells (PBMCs). Obtaining saliva is least invasive, although it may be less informative about brain and cognitive aging processes. In contrast, while buffy coats and PBMCs may be more informative, obtaining blood is more invasive. Buffy coats are less expensive to obtain than PBMCs, however they contain more cell types which may complicate analysis. Our analyses of 91 participants, suggested that saliva samples were less likely to pass initial quality control (< 96% CpGs detected). Unsurprisingly, the buffy coat and PBMC DNA methylation signatures are more similar to each other (r=0.97) than either is to saliva (rs=0.88—0.92). In initial analyses, each sample type demonstrated expected familial/heritable patterns of similarity across sites (MZ twins > DZ twins > biological & adoptive siblings). Given the additional cost of isolating PBMCs and computational methods to account for complex cell mixtures, the use of buffy coat DNA increases accessibility to analyze epigenetic changes longitudinally, enabling the early identification of epigenetic biomarkers of cognitive decline and the effect of both genes and environments on this process.
COMPREHENSIVE MALNUTRITION ASSESSMENT IMPROVES HEALTH OUTCOMES AMONG HOMEBOUND OLDER ADULTS
Authors: Saffel-Shrier Susan , Covington Amy , Wang jing
Published: December 2023

Approximately 30 percent of older adults are malnourished upon hospital admission while others develop malnutrition during hospitalization and subsequent discharge. High hospital readmission rates are associated with malnutrition. Malnutrition is common among older adults discharged to home and receiving home delivered meals. However, there is limited research on the appropriate malnutrition care for this population. The aim of this study was to investigate the effectiveness of a novel social determinants of health (SDOH)-based comprehensive malnutrition assessment (CMA) on malnutrition treatment and functionality. A pilot study of 46 participants recruited from northern Utah Area Agencies on Aging Nutrition Programs was conducted. The SDOH-CMA was performed during home visitations by a registered dietitian nutritionists for both the intervention and control groups over a six-month period. Logistic regression was then conducted to compare the effect of the SDOH-based CMA on malnutrition as assessed by the Nutrition-Focused Physical Exam (NFPE) between intervention and control groups. Odds ratios (OR) with p values were reported. At baseline, 91.4% of participants were white, 54% were female, 76% were unmarried, 67% lived below the federal poverty level, 61% lived alone, 51% received home health, 51% had anxiety, 33% had PHQ-2 screened depression, 22% were unable to cook, and 13% were unable to shop. The intervention group had significant improvements in the NFPE (OR=10.1, p=.02), calorie intake (OR= 19.6, p=.02), protein intake (OR=36.7, p =.007) and the Timed Up and Go test (OR=7.7, p=.05) than the control group. The intervention was significantly effective in improving nutritional status and functionality.
CO-PRODUCING A BOARDGAME TO LEARN AND ENGAGE ABOUT DEMENTIA INEQUALITIES: THE DEMENTIA INEQUALITIES GAME
Authors: Giebel Clarissa , Hanna Kerry , Tetlow Hilary , Gabbay Mark , Cannon Jacqui
Published: December 2023

Receiving a diagnosis and accessing care after a diagnosis of dementia, both for the person and their carer, are fraught with inequalities. Finding different ways to address these inequalities is important. The aim of this public engagement activity was to co-produce a boardgame about dementia inequalities to facilitate learning, dialogue and educate about different barriers, and facilitators, to diagnosis and care. Two virtual and two face-to-face workshops with people with dementia, unpaid carers, health and social care professionals, and Third Sector representatives were held between October 2022 and June 2023. The virtual workshops were split into discussions of inequalities and how a boardgame may feature inequalities. The first face-to-face workshop was split into the same activities, aided by outcomes from workshops 1 and 2. Workshop 4 attendees tested the prototype. Attendees were reimbursed for their time. Nine brief remote interviews with attendees were conducted to evaluate their experiences in the co-production of the boardgame. Forty stakeholders attended four workshops. Workshops provided step-by-step thoughts on how the game could be designed or modified. The final game, prototype tested in Workshop 4, consists of a one-sided, two-half board depicting the pre-diagnosis process (left half) and post-diagnosis process (right half). Interviews with nine attendees reported on their reasons for attending the workshops, experiences of being involved, and the game design and purpose. The game can be used to improve knowledge about dementia inequalities for health and social care professionals, carers, people living with dementia, decision makers, and the general public.
CORRELATES OF SUPERAGING IN TWO REPRESENTATIVE SAMPLES OF HISPANIC OLDER ADULTS
Authors: Doyle Cassidy , Andel Ross , Saenz Joseph , Crowe Michael
Published: December 2023

‘SuperAgers’ are generally defined as people 80+ years old with episodic memory performance comparable to those 20 years younger. Understanding what distinguishes SuperAgers from those who age normally is valuable for designing population-wide strategies to promote health with aging. Limited knowledge exists to describe characteristics of SuperAgers, and even less is known about Hispanic SuperAgers. We examined indicators of cognitive, physical, and psychological resilience in relation to the likelihood of being a SuperAger. We used data from two population-based studies including Hispanic older adults [Puerto Rican Elder: Health Conditions (PREHCO) study; Health and Retirement Study (HRS)]. SuperAgers were defined as 1) ≥80 years old, 2) recall scores ≥ the median for Hispanic respondents aged 55-64, and 3) no cognitive impairment at any wave (2002-2003, 2006-2007, 2021-2022 in PREHCO; 2002, 2006, 2018 in HRS). In all, 640 PREHCO participants and 180 HRS participants met criteria, of whom 45 (7%) and 31 (17%) met SuperAging criteria. Logistic regressions controlling for age and sex demonstrated that higher education (PREHCO: odds ratio[OR]=1.20, p<.001; HRS: OR=1.14, p=.044) and fewer IADL limitations (PREHCO: OR=0.79, p=.019; HRS: OR=0.58, p=.077), fewer ADL limitations (PREHCO: OR=0.72, p=.031; HRS: OR=0.67, p=.068) (physical resilience), and fewer depressive symptoms (psychological resilience) (PREHCO: OR=0.84, p=.015; HRS: OR=0.69, p=.007) were associated with SuperAging. In addition, number of chronic conditions, self-rated health, or BMI, known indicators of physical health, did not relate to SuperAging, potentially highlighting resilience in aging rather than resistance to aging. These findings highlight potential pathways to promote aging among older Hispanics.
DEMAND-ABILITIES FIT AND PRESTIGE INFLUENCE OLDER WORKERS’ INTEREST IN ALTERNATIVE JOBS
Authors: Baker Nathan , Van Fossen Jenna , Schuster Amy , Chang Chu-Hsiang , Ford J Kevin
Published: December 2023

With the increasing displacement of workers due to technological innovations, many older workers may need or want to make career transitions. Therefore, it is critical to understand the factors that influence older workers acceptance of potential alternative careers. In this study, long-distance truck drivers (n=202), a profession at-risk of technological disruption, completed an online survey where they rated six alternative transition occupations (e.g., machine setting, operator and tender, cargo and freight agent) to understand what makes them interested in alternate jobs. Using multilevel modeling (with occupations nested in participants), we evaluated the role of perceptions of demand-abilities fit and prestige, as moderated by age, on interest in alternative careers. Demand-abilities fit and job prestige were positively associated with rated job appeal, which was positively associated with interest in the job as a transition occupation. Older drivers, relative to younger truck drivers, found job prestige to be more appealing, which appeared to make them more interested in transitioning into these jobs. Our results extend person-environment fit and socio-emotional selectivity theory by showcasing how age relates to evaluations of occupations for career transitions, an area that is rising in importance given the increases in an aging workforce and potential disruptions from automation. Results carry practical importance for preparing the workforce for career disruptions given automation by identifying qualities that may shape workers’ willingness to transition, and identifying how these qualities differ based on age.
DEMENTIA-RELATED STIGMA, KNOWLEDGE, AND WILLINGNESS TO UNDERGO COGNITIVE SCREENING AMONG OLDER ADULTS
Authors: Kasenetz Whitney , Crisci Alex , Rote Wendy , O’Brien Jennifer
Published: December 2023

Screening for dementia such as Alzheimer’s Disease may be most beneficial at the earliest detectable stages of disease presentation, yet there is no definitive recommendation for routine cognitive impairment screening and dementia remains underdiagnosed. Identifying perceptions of cognitive screening, stigmatized beliefs, and misconceptions about dementia could be beneficial for creating interventions that promote dementia knowledge to improve early screening and diagnosis and empower older adults to seek treatment sooner. Thus, we examined the extent to which attitudes, beliefs, and knowledge about cognitive screening and dementia predict willingness to undergo screening and subsequent screening behavior. 295 subjects aged ≥ 60 years completed online surveys containing the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) questionnaire to assess attitudes about dementia screening and diagnosis, as well as the Alzheimer’s Disease Knowledge Scale (ADKS). Participants were then invited to complete the Montreal Cognitive Assessment in a university psychology laboratory. 94% of participants reported willingness to undergo screening, but only 69% completed one. Logistic regression analysis revealed that the screening acceptance scale of the PRISM-PC significantly predicted reported willingness to undergo screening but not the pursuit of screening. The other PRISM-PC subscales (perceived benefits of dementia screening, stigma of dementia screening, suffering from dementia screening, and impact of dementia screening on patient’s independence) and the ADKS did not predict willingness or pursuit of screening. While most were willing to undergo screening, significantly fewer completed screening within the study. The factors that predict pursuit of cognitive screening require further investigation.
DEVELOPMENT AND VALIDATION OF THE COUPLE EFFICACY TO BALANCE WORK AND ELDERCARE SCALE
Authors: Cho Eunae , Allen Tammy , Cheng Grand
Published: December 2023

This study developed and validated a measure of couple efficacy to balance work and eldercare (i.e., a couple’s shared belief in their conjoint abilities to achieve work-eldercare balance as a couple), a key cognitive factor for work-eldercare arrangements, individual well-being, and work and couple outcomes. Survey data were collected from 408 dual-earner couples in Taiwan who care for an older adult. Exploratory factor analysis identified three factors with eigenvalues greater than 1, but parallel analysis suggested extracting two factors. After considering item contents and factor loadings, a final 2-factor scale comprising 10 items was selected. The first dimension, task-oriented, reflects couple efficacy concerning the execution of various tasks to balance paid work and eldercare (e.g., “I am confident that my spouse/partner and I can work together as a team to devote enough attention to important job and eldercare activities”; α=.81). The second dimension, relationship-oriented, reflects couple efficacy concerning the maintenance of intimate relationship while balancing paid work and eldercare (“I am confident that my spouse/partner and I can work together as a team to support each other in times of stress in trying to balance paid work and eldercare”; α=.87). Confirmatory factor analysis indicated that a hypothesized 2-factor outperforms an alternative 1-factor model. The nomological network involving generalized self-efficacy and life/job/marital satisfaction supported the validity of the new scale. This study contributes to the literature by introducing a new construct and offering a psychometrically sound measure that propels more empirical research on the important population of working informal caregivers.
DEVELOPMENT AND VALIDATION OF THE NOVEL MEDICATION TAKING INSTRUMENT - FOUR FACETS OF ADHERENCE (MTI-4)
Authors: Ryan Candace , Schutte Debra , Daugherty Ana
Published: December 2023

Medication adherence is critical for disease management among aging African-Americans who are at greatest risk for poor adherence and affliction with chronic diseases. However, medication adherence is a complex behavior with distinct facets (frequency, pattern of adherence, barriers, and beliefs related to adherence), which current instruments cannot comprehensively measure in this underrepresented population. The Medication Taking Instrument – Four Facets of Adherence is an instrument developed to measure all facets of adherence among diverse, community-dwelling aging adults using the innovative application of the “Nursing Rights” of medication administration. Items were developed following a scoping review of the literature. Validation was obtained from medical professionals in Canada and the United States who prescribe medications to diverse patient populations. 12 of 13 medical professionals responded to the survey request (67% Nurse Practitioners, 33% Physicians) and rated each item (0=Low Agreement to 5=High Agreement) for clarity and validity of each item representing the specific facet. Most instrument items obtained high agreement (response rating > 3) for both validity and clarity from 83% or more of respondents. Experts’ feedback augmented items for two facets (barriers and beliefs), improved clarity, minimized jargon, and supported instrument use in the clinical setting. The resulting instrument will comprehensively characterize medication adherence, direct more targeted research aims, and guide interventions to augment adherence among aging African Americans. Ongoing data collection in the Detroit Aging Brain Study will provide additional tests of factor structure, internal scale reliability, and convergent validity using other indicators of medication history and symptom control.
DIFFERENCES IN RESILIENCE AMONG MIDLIFE AND OLDER ADULTS BY SEXUAL AND GENDER IDENTITY AND BY GENERATION
Authors: Nelson Christi , Fredriksen-Goldsen Karen
Published: December 2023

Sexual and gender minority (SGM) (i.e., lesbian, gay, bisexual, sexual diverse, and transgender) midlife and older adults face specific health, social, and structural inequities in addition to the late-life challenges experienced by older adults in general. Extant research had largely examined health disparities and related risk and protective factors among SGM individuals as a homogeneous group, without attending to the heterogeneity among the subgroups and differing generations. Most research has also focused on stress with limited attention to resilience, even though higher resilience is associated with better health when facing adversity. Using baseline data from Aging with Pride: The National Health, Aging, and Sexuality/Gender Study, we identify historical/environmental, psychological, and social risk and protective factors that are associated with resilience in midlife and older SGM adults (n=2,450), aged 50-102, and examine differences in the associations between the factors and resilience by SGM and generational subgroups (i.e., Invisible, Silenced, and Pride). The results revealed differences in significant factors associated with resilience by SGM and generational subgroups. Identity affirmation was positively associated with resilience in all but the bisexual and transgender groups. Day-to-day discrimination was negatively associated with resilience for all but bisexual women. Community belongingness was positively associated with resilience for gay and bisexual men and the younger generations (Silenced and Pride). These results suggest that factors associated with fostering resilience, and in turn better health, may differ by SGM subgroup as well as by generation. Assessing differences in factors that promote resilience can help develop responsive interventions for targeted subgroups.
DIFFERENCES IN SEX-RELATED PERSONALITY TRAITS AND POLYPHARMACY AMONG OLDER ADULTS WITH DEPRESSIVE DISORDERS
Authors: Tsai Tsung-Yu , Wang Tzu-Yun , Wang Yi-Hsin , Chen Kao Chin , Tseng Huai-Hsuan , Chiu Ching-Ju
Published: December 2023

This cross-sectional study aimed to explore the potential correlations between personality traits and the occurrence of polypharmacy (defined as the use of five or more medications) in older adults diagnosed with depressive disorders. In this study, 90 participants (30 males, 60 females) with an average age of 71.3±5.0 years were included. Personality traits were evaluated using the short version of the 50-item International Personality Item Pool, while medication usage data were retrieved from the National Health Insurance Pharma Cloud Database. Hierarchical regression models were employed for data analysis to examine the associations between personality traits and polypharmacy. The results showed that the mean number of medications taken was 10.9 ± 6.8 and that 84.4% of the participants satisfied the criterion for polypharmacy. Notably, low levels of openness significantly correlated with a higher number of medications taken (B=-0.38, p< 0.01). Gender-specific analyses demonstrated that low levels of conscientiousness (B=-0.07, p=0.01) and openness (B=-0.49, p=0.03) correlated with polypharmacy among males, whereas these personality traits displayed no significant correlations with polypharmacy in females (B=0.05, p=0.77, and B=-0.28, p=0.07, respectively). The findings underscore the elevated risk of polypharmacy among older adults diagnosed with depressive disorder. Additionally, the study highlights the necessity of considering gender differences in the interplay between personality traits and medication utilization patterns.
DISRUPTING THE NEGATIVE AFFECT AND PAIN CONNECTION IN OLDER ADULTS: THE ROLE OF SOCIAL INTERACTIONS AND ENJOYMENT
Authors: Graham-Engeland Jennifer , Witzel Dakota , Harrington Erin , Engeland Christopher , Martire Lynn , Van Bogart Karina
Published: December 2023

Although it is well-established that negative affect is bi-directionally linked with pain, little research has examined their relationship in daily life among older adults. Even less is known about what social factors may help attenuate the affect-pain connection. We examined whether social interactions and reported enjoyment in daily life were associated with an attenuated link between negative affect and two important pain outcomes (pain intensity and perceived interference from pain). This was examined among a socioeconomically and racially diverse sample of 317 older adults aged 70+ (Mage = 77.45 ; 67% women; 40% Black; 13% Hispanic) who were recruited from the Bronx, NY as part of the Einstein Aging Study and who completed ecological momentary assessments five times daily for 14 days. Three-level multilevel models were estimated, controlling for mild cognitive impairment (MCI) status, gender, age, education, body mass index, and average level positive affect for models that did not include enjoyment. In given moments, higher negative affect and lower enjoyment were associated with higher pain intensity and pain interference (ps<.05). Moment-level negative affect and enjoyment significantly interacted to predict both higher pain intensity (p=.005) and pain interference (p<.0001), with patterns suggesting a buffering effect of enjoyment. In addition, a three-way interaction emerged such that during moments when no interactions occurred and negative affect was lower than a person’s average, there was a buffering effect of momentary enjoyment on pain intensity. Findings extend understanding of the affect-pain connection and the potential mitigating impact of social interactions and moments of enjoyment.
EGG CONSUMPTION: TRENDS OVER TIME, PATTERNS ACROSS THE LIFESPAN, AND PREDICTORS OF INTAKE
Authors: Kritz-Silverstein Donna , Bettencourt Ricki
Published: December 2023

Eggs are an excellent nutritional source. However, the historical association of dietary cholesterol with serum cholesterol and thus, cardiovascular disease, along with restrictive dietary guidelines may have served as a barrier to egg consumption. This study examines trends over time, and predictors and patterns of egg consumption in older individuals followed for over 45 years. Participants were 6326 men and women enrolled in the Rancho Bernardo Study in 1972-74 when they were asked about the number of eggs consumed/week. Subsequent egg intake information was collected with food frequency questionnaires from subsamples attending clinic visits in 1988-91 (N=1627) and 1992-96 (N=1385), and with the original question on a 2021 mailed survey (N=710). Mean(□SD) eggs consumed was 3.6□3.0 in 1972-74, 1.8□2.1 in 1988-91, 1.8□2.2 in 1992-96, and 3.4□3.5 in 2021. Comparisons within 5-year categories of baseline age (< 20, 20-24, 25-29, 30-34, 35-39, >40) showed no differences in egg intake between 1972-74 and when older in 2021. Men consumed more eggs than women at all timepoints (p’s< 0.0001). Those with higher education (p< 0.0001) and diabetes (p=0.0009) consumed more eggs; those with high cholesterol or taking cholesterol lowering medication consumed fewer eggs in 1972-74 (p’s< 0.0001), but there were no differences by these factors by 2021. Egg consumption appears responsive to dietary guidelines, decreasing over time then increasing by 2021 to levels similar to the early 1970s. Among those young and middle-aged at baseline, egg intake patterns were similar 45 years later, when older. Cholesterol and cholesterol-lowering medication use are no longer factors in egg intake.
EMPOWER@HOME:CONNECTED - TESTING A PILOT GROUP INTERVENTION FOR DEPRESSION AND LONELINESS IN OLDER ADULTS
Authors: Kayser Jay , Turner Skyla , Xiang Xiaoling
Published: December 2023

Homebound older adults experience high rates of depression, social isolation, and loneliness, which adversely impacts physical and mental well-being. Accessing psychotherapy to address these concerns can be logistically challenging and cost prohibitive. This study examined the feasibility and preliminary effect of a novel group-based internet cognitive-behavioral therapy program called Empower@Home:Connected. The intervention was implemented over nine consecutive weekly sessions in small virtual groups (4-6 participants). These sessions were facilitated by trained mental health professionals and incorporated psychoeducational material, cognitive-behavioral therapy exercises, and socialization. Measurements on primary and secondary outcomes were gathered before and after completion of the intervention. In this preliminary pilot trial (NCT05732740), participants averaged 68 years and of those that attended the first session (n = 25), nearly all completed the program (n = 24). Session attendance was high, with an average session attendance rate of 94.70%. Following program completion, participants had statistically significant reductions in depressive symptoms (Cohen’s d = 1.01). Participants also had reductions in loneliness that trended towards statistical significance (p = 0.07); changes in social isolation were not statistically significant. Of the participants, 21 out of 23 expressed satisfaction with the program and would recommend it to peers. For secondary outcomes, analyses revealed significant improvements in anxiety and health-related quality-of-life. In this pilot feasibility trial, Empower@Home:Connected reduced depressive symptoms among older adults. The high adherence and satisfaction rates suggest acceptability. While the intervention produced improvements on several measures, further exploration is warranted to determine long-term impact and efficacy relative to other existing interventions.
EVALUATING AGING IN PLACE LONG-TERM CARE REFORMS: A SCOPING REVIEW
Authors: Vroomen Janet MacNeil , Vullings Isabelle , Langendam Miranda , Wammes Joost , Kringos Dionne , Wouterse Bram , Hoogendijk Emiel
Published: December 2023

There is a global trend of reforming long-term care to enable aging in place making it one of the most pressing health policy issues in both high- and low-middle income countries. However, there is no agreement on what is a successful aging in place reform. A holistic perspective that includes clinical, social and economic indicators is required to evaluate these reforms. In this scoping review, we aim to determine the extent of literature on evaluating aging in place reforms. We used the guidance of the JBI Scoping Review Methodology Group to conduct the scoping review. Articles on evaluation of aging in place reform and reporting on any outcome, process or structure quality indicator were eligible for inclusion. The search strategy was performed in Ovid Medline, Ovid Embase, and Ebscohost Academic Search Premier. There were no restrictions on publication year, language, and study design. The search identified 8,107 records. A total of 84 articles met the inclusion criteria and were included in the scoping review. Most studies were quantitative, observational studies from high income countries, using national population level data or larger cohorts. Frequently reported indicators were: total expenditures on long-term care, program spending per capita, hospitalization rates, length of stay, and home care utilization. Less reported were older adult and informal caregiver related indicators like: health, well-being, informal caregiver hours, and sleeping hours. Policy makers can use our findings to develop appropriate strategies to evaluate and monitor their own aging in place reforms.
EXAMINATION OF STAFFING STABILITY IN LONG-TERM CARE
Authors: Sun Winnie , Calver Jen , Rahman Farzana
Published: December 2023

Background

Long-term care (LTC) homes in Ontario, Canada face challenges of recruiting and retaining qualified staff prepared to address resident care needs.

Objectives

To gain knowledge of the barriers and facilitators associated with recruiting and retaining nurses (RPNs/RNs) and personal support workers (PSW) in LTC.

Method

Online survey questionnaires were distributed to staff working in a municipal home, and to PSW and nursing students. Staff participants (n=93) ranked how they perceived their work in LTC during COVID-19 to inform staffing stability efforts, and were invited to elaborate further on their responses using open-ended questionnaire. Nursing student participants (n=11) ranked how they perceived working in LTC.

Results

Findings revealed that staff participants (57%) reported intentions to remain in their LTC employment, leaving about 43% of the workforce at risk of leaving. Four themes emerged from this study: (1) Embracing resident centred care as the top priority; (2) Rebuilding a health workplace through enhanced leadership and organizational support; (3) Promoting quality of care through open communication and professional development opportunities; and (4) Transforming work scheduling policies and staffing practices to support workforce retention.

Conclusion

Senior leaders and LTC organizations play a critical role in refocusing staffing stability efforts. To help make LTC a workplace of choice, major changes must be considered to include greater visibility and presence of leadership, ongoing training and education, and revisit scheduling policies and practice with input from part-time and casual staff.
EXAMINING AGING AMONG GUANAJA, HONDURAS ISLANDERS THROUGH THE UTILIZATION OF SOCIAL EXCLUSION FRAMEWORKS
Authors: Ferguson Lee Ann
Published: December 2023

Guanaja is an island municipality of Honduras located approximately 70 miles from its parent island . Of the country’s three main island municipalities, it is the second largest. The central municipality of Guanaja is located less than half of a mile from the coast of Guanaja and is a 100-acre floating island city built over two smaller cays which consists of densely compacted, stilt-built homes and houses approximately 3,000 people. It is estimated that 6.6% of the total population are over the age of 65. The current body of both spatial and social exclusion research considers environmental conditions may act in ways which may restrict or deny access or choices for aging inhabitants. Due to its remote geographic location, the island of Guanaja reflects key risk factor for age-related social and spatial exclusion. Framed by two social exclusion frameworks, this study, which was the cornerstone of this author’s dissertation, presents the reality of island aging among Guanajan residents as relayed by them during this focused ethnographic study. The results of this work will describe the influences on Guanajan aging from factors including geographic environment and location, neighborhood and community, civic engagement and participation, social relationships, material and financial resources, socio-cultural practices, and governmental policies and practices.
EXAMINING THE PREVALENCE OF UNDIAGNOSED SLEEP APNEA AND ITS ASSOCIATION WITH BLOOD BIOMARKERS FOR ALZHEIMER’S
Authors: Roberts Mitchell , Sappington Erica , Jaffee Michael , Lowenkron Jeff , Dagum Paul , Iliff Jeffrey , Levendovszky Swati Rane , VandeWeerd Carla
Published: December 2023

Obstructive sleep apnea (OSA) prevalence increases with age, but is often undiagnosed. Recent findings suggest association between OSA and Alzheimer’s Disease (AD). OSA may impact alterations in amyloid-beta (Aß) protein possibly through interactions with the glymphatic system, thereby unraveling underlying AD mechanisms. In a crossover study conducted 06/22-04/23, older adults (55-65, mean 61.9) without diagnosis of OSA or cognitive impairment(N=33) completed MRIs and blood draws for AD-biomarkers across evening, morning, and midday time points. Polysomnography (PSG) using Philips Sleepware measured Apnea-hypopnea-index (AHI). Morning Trails A&B assessed cognitive function, and abeta40-42-42/40 levels were calculated using Immunoprecipitation-Mass-Spectrometry (IP-MS). Descriptive statistics, ANOVA, and linear regression were utilized. AHI scores averaged 10.5(SD:10.09), with 30% meeting ‘normal’ (0-5) and 52% mild (5-15) criteria. While not significant(p=.113), males(M:12.5,SD:9.7) averaged higher AHI scores than females (M:8.2 SD:10.3). AHI had a linear relationship with Abeta40 values(R2=0.18,F(2,33)=6.71,p=0.012). However, no significant association between AHI, Abeta42(p=0.09), and Abeta42.40(p=0.54) was found. Neither AHI sum scores [Trails A(p=0.09), Trails B(p=0.67)], nor severity rankings [TrailsA(p=0.74),TrailsB(p=0.14)] were significantly associated with Trails A&B performance. Elevated AHI was associated with higher levels of Aß40 but not cognitive test performance. Though implications are limited by sample size, findings suggest connection between OSA and initiation of AD processes, necessitating additional research.