bluuebunny/crossref_metadata_2025 huggingface dataset:
SYMPTOM BURDEN, POSITIVE AFFECT AND RESILIENCY IN OLDER ADULTS EXPERIENCING NORMAL AGING
Authors: Anctil Reid , Chang Angela , Mitchell Calli , Traeger Lara , Park Elyse , Ahmad Zeba
Published: December 2023

Older adults (age≥65) with multimorbid disease burden may be at chronic risk for bothersome symptoms, which can consequently reduce positive affect (e.g., feelings of excitement and enthusiasm). However, we hypothesized that individuals with more resiliency (the ability to “bounce back” from distress) may experience positive affect despite symptom burden. We conducted secondary analysis of baseline self-report survey data (collected between 8/2023-10/2023) from a prospective study of resiliency in older adults residing in nine continuing care retirement communities (CCRCs) across the U.S. Eligible participants lived independently in CCRCs and scored >11/15 on the five-minute Montreal Cognitive Assessment. Surveys assessed symptom burden (Condensed Memorial Symptom Assessment Scale), resiliency (Current Experience Scale), and positive affect (Positive and Negative Affect Schedule-Positive Affect). Bivariate correlations and multiple linear regression evaluated associations of symptom burden and resiliency with positive affect. Participants (M age =81, SD=5.6) were predominantly White (96%) and female (75%). Greater symptom burden correlated with lower positive affect (r=-.295, p<.001) and lower resiliency (r=-2.56, p<.001). In a multiple regression model, lower symptom burden (β = -.136, p=.003) and more resiliency (β=.626, p<.001) were independently associated with greater positive affect. The overall model accounted for 45.4% of variance in positive affect (F(2, 284) =117.198, p<.001). Lower symptom burden and more resiliency contributed to more positive affect among older adults in senior living communities. Because resiliency and positive affect are both potentially modifiable targets for intervention, longitudinal study and psychosocial interventions should explore the effects of increased resiliency on positive affect and general well-being over time.
SYSTEMS BIOLOGY OF HUMAN AGING - NETWORK MODEL 2023
Authors: Furber John
Published: December 2023

This network is presented to aid in conceptualizing the many processes of aging, the causal chains of events, the interactions among them, feedback, and vicious cycles. It suggests promising intervention points for therapy development. The signs of human senescence are hypothesized to result from several primary causes. This network includes both intracellular and extracellular processes, ranging from molecular to whole-body. Lifestyle, environment, and proposed interventions are highlighted. Important pathways include: Nuclear mutations, transposon insertions, telomere shortening, chromosome breaks, chromatin alterations, epigenetic DNA adducts. Extracellular protein damage results in stiffness, weakness, inflammation. Altered niches for cells cause transdifferentiation, arrested cell division, cell death, cancer, stem cell depletion, tissue wasting, neurodegeneration, organ malfunction. Stiffer blood vessels promote stroke, heart disease. Lysosomes accumulate reactive, crosslinked Lipofuscin, which impairs autophagic turnover of macromolecules and organelles. Lipofuscin leaking into cytosol triggers apoptosis. Mitochondrial DNA Mutates; Lamin-A progerin, accumulates in nuclear scaffold, impairing mitosis and telomere maintenance. Nuclear Envelope Pore Proteins become oxidized, allowing inappropriate traffic of other proteins into and out of nucleus. Oxidized Aggregates in cytoplasm crosslink, resist turnover, inhibit proteasome activity, increase redox poise, and physically interfere with intracellular transport in axons. Proteasomes inhibited, reduce turnover of damaged molecules and expired molecular signals. Increased Redox Poise alters signaling and enzyme activities, and erodes telomeres. Inflammatory Cascades, promoted by damaged molecules and sick cells, further damage tissues. Neuroendocrine and immune systems degrade. Misfolded Proteins accumulate in Endoplasmic Reticulum. This diagram is maintained on the Web as a reference for researchers and students. www.LegendaryPharma.com/chartbg.html
TARGETING HEALTH-PROMOTING ACTIVITY IN OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS AND FUNCTIONAL LIMITATIONS
Authors: Klinedinst Tara , Hollman Nicholas , Ciro Carrie , Kendzor Darla
Published: December 2023

Nearly half of older adults in the U.S. have multiple chronic health conditions in addition to functional limitations (MCC + FL) that restrict health self-management activities. We tested an innovative combination of occupational therapy (OT) and behavioral activation (BA) to improve health self-management using the goal setting, scheduling/monitoring activities, and problem-solving components of the BA approach, as well as skill building, environmental modification, activity adaptation, and focus on daily routines from OT (BA+OT). BA+OT was delivered by occupational therapists over 10 sessions in the homes of participants. We present descriptive statistics from this single-blind randomized control pilot study of 11 older adults with MCC + FL who received BA+OT (n = 6) or enhanced usual care (UC; n = 5). Participants in both groups were given a Fitbit, and the UC group received a handout on managing chronic conditions. The BA+OT group was required to set at least one goal for improving physical activity. On average, participants were 73.1 years old (SD = 8.4), majority female (n = 8), and white (n = 1 Hispanic/Latino). They had an average of 3.9 chronic conditions (SD = 1.5), and 2.0 functional limitations (SD = 1.8). The most common chronic conditions were depression, high blood pressure, and arthritis. Aside from physical activity, the most common participant-identified goal areas were sleep hygiene and positioning, medication routines, and community access. This study is in progress (aiming for n = 40) but shows promise for improving health self-management by targeting meaningful, goal-directed, and health-promoting daily activity.
TARGETING OF P21CIP1-HIGHLY-EXPRESSING CELLS ALLEVIATES NEUROPSYCHIATRIC DISORDERS WITH OBESITY
Authors: Wang Lichao , Wang Binsheng , Gasek Nathan , Xu Ming
Published: December 2023

Obesity remains a major factor for diabetes associated with insulin resistance and increases the risk of neuropsychiatric disorders, such as anxiety, depression, and cognitive deficits, resulting in a shortened in lifespan and healthspan. Cellular senescence, a state of permanent cell-cycle arrest, has been recognized as an important biological process underlying obesity and obesity-associated neurological disorders. My project aims to alleviate metabolic and neuropsychiatric dysfunction in obesity by targeting of p21Cip1-highly-expressing (p21high) cells, a rarely examined senescent cell population. By leveraging a novel transgene containing a p21 promoter driving Cre, we demonstrate the accumulation of p21high cells in brain with obesity, whereas, intermittently clearing p21high cells alleviates anxiety- and depression-related behavior and improve the cognitive function for obese mice. Of note, clearance of p21high cells decreased key factors of the senescence transcriptional program in hippocampus and amygdala. A survival study shows the intermittent clearance of p21high cells extends the lifespan of obese mice fed with high-fat diet. Our findings indicate p21high cells serve as a potential therapeutic target for neuropsychiatric disorders.
TECHNOSOCIAL INNOVATIONS IN THE HEALTHCARE SECTOR: WHAT ETHICAL ISSUES MIGHT WE FACE AS WE AGE?
Authors: Lord Marie-Michele , Drolet Marie-Josee
Published: December 2023

Technosocial innovations are designed to transcend current practices by linking technological development to community well-being. Their dazzling development is gradually transforming health services. Despite their recognized potential, a growing number of studies point to the ethical risks associated with their development. We are currently conducting a study to obtain a comprehensive picture of the ethical issues associated with the use of technosocial innovations for older adults and their care partners in the healthcare sector, and to identify key indicators of the presence of those ethical issues. A prospective design is use and combines a systematic literature review with a Delphi method. Of all the studies looking at the ethical issues involved in deploying technosocial innovations in the healthcare sector, a limited number have focused on those we may experience as we age. Still, six empirically-supported ethical issues have emerged : 1) exacerbation of the digital divide; 2) exclusion at multiple levels; 3) epistemic injustices; 4) infringement of dignity and confidentiality; 5) ageism; and 6) increased dependency dynamics. A number of indicators were identified in the early stages of the Delphi method, including a high rate of abandonment of the use of proposed innovations, and performance indicators with little integration of PREMs and PROMs. It is imperative to translate current knowledge into concrete resources that can be used in order to protect our rights and health as we age. This study is a first step towards identifying indicators that can be concretely used by health organizations wishing to act ethically.
THE ASSOCIATION BETWEEN APOE Ε4 AND EPISODIC MEMORY IN MIDLIFE: TESTING THE COGNITIVE PHENOTYPE HYPOTHESIS
Authors: Park Kyoung Shin , Etnier Jennifer , DuBois Samantha , Kibildis Samuel , Som-Pimpong Hadassah , Vance Jarod , Wahlheim Christopher
Published: December 2023

Carrying at least one ε4 allele of Apolipoprotein E (APOE ε4) is a strong genetic risk factor for Alzheimer’s disease (AD). It is contentious whether the effect of APOE ε4 on memory decline is because of cognitive phenotype or prodromal AD cases. Inconsistent findings on this topic could be due to the presence of AD pathology in older ages and the lack of sensitivity of memory measures. To exclude potential prodromal AD cases, we tested the association between APOE ε4 and episodic memory among cognitively unimpaired adults in midlife. Data from a subset of 103 participants (Mage=57±6 years; 87.4% females) from an ongoing clinical trial (NIH R01AG058919) were analyzed. APOE genotype was assessed from passive drool saliva samples, and participants completed memory assessments. Analyses of covariance compared 39 carriers of APOE ε4 versus 64 non-carriers of APOE ε4 for their performance of mnemonic discrimination, auditory-verbal and visuospatial short- and long-term memory, paired associative memory, and verbal logical memory, while controlling relevant covariates (e.g., age, education, sex, and physical activity level). After covariate adjustments, significant negative relationships between APOE ε4 and mnemonic discrimination were observed while nearly significant negative relationships were observed for auditory-verbal long-term memory. These findings imply that APOE ε4 could be associated with a cognitive phenotype of decline in mnemonic discrimination and auditory-verbal long-term memory, and the phenotype effects on memory decline could start in midlife. This suggests the importance of early lifestyle interventions for cognitive health in midlife, especially in people at genetic risk for AD.
THE ASSOCIATION OF CAREGIVER STRAIN AND NEEDS OF CAREGIVERS AND PEOPLE LIVING WITH DEMENTIA
Authors: Griswold Allison , Moore Miranda , Jungermann Joanna , Perkins Molly , Bender Alexis
Published: December 2023

Caregivers play a vital part of dementia care management and are key to keeping people living with dementia at home. Providing this care can result in caregiver strain, especially among those who live in low or under resourced communities, such as rural or impoverished areas. One instrument for measuring caregiver strain among this population is the BRI caregiver strain instrument, which includes four dimensions of strain including caregiver mastery, relationship strain, health strain and social isolation. To date, little research assessing the validity of the instrument. We assessed the validity using confirmatory factor analysis in a cohort of 930 caregivers providing care to people undergoing assessment for dementia representing four diverse regions in Georgia (Atlanta, Albany, Augusta, and Macon). Then, we examined the associations of the lack of caregiver knowledge of dementia, care recipient function, and challenging behaviors using univariate and multivariate linear regression. We found that the four-factor solution showed good model fit and was appropriate for subsequent analysis with this population. In our regression models, we found that caregiver lack of understanding of dementia significantly predicted caregiver strain (β=2.09, P<.001). When controlling for care recipient function, lack of knowledge decreased in strength, but remained significant (β=1.86, P<.001). When adding challenging behaviors, lack of dementia knowledge lost significance and challenging behaviors became the strongest predictor of caregiver strain (β=2.03, P<.001). Caregiver strain is a multifactorial process and tools to reduce challenging behaviors and increase caregiver knowledge are promising points of intervention early in the diagnostic process.
THE EFFECT OF A DRUG-BURDEN INDEX ON FALLS RISK INCREASING MEDICATIONS DEPRESCRIBING IN VETERANS AT RISK OF FALLING
Authors: Paulsen Michelle , Chen Sunny , Martinez Erica , Ritchey Katherine
Published: December 2023

Falls risk-increasing medications (FRIMs) have negative effects on balance and psychomotor functioning which increase the risk of falling in older adults. Thus, deprescribing of FRIMs is a recommended fall prevention intervention. The Drug Burden Index (DBI) measures total exposure to anticholinergic and sedative medications and has been associated with falling risk in older adults. We evaluated if inclusion of a DBI score would influence deprescribing of FRIMs in older veterans at risk of falling. A pharmacist conducted a medication review for FRIMs in two cohorts of older veterans participating in a fall prevention group. The primary care prescriber (PCP) was alerted to recommendations through the electronic medical record. Inclusion of the DBI was included and shared with the PCP in the second cohort only. Changes to FRIMs and reduction in DBI score was calculated for all participants three months after initial FRIM review. Nearly all (95%) participants (n=44) were prescribed a FRIM. The most common active prescriptions contributing to DBI score were for anticholinergics (37.9%), antidepressants (33.3%) or anticonvulsants (31.8%) agents. DBI improved in both cohorts, but DBI change was greatest in the second cohort (n=18) (first cohort mean DBI change= 0.168; second cohort mean DBI change= 0.189; p 0.002). Percentage of recommendations accepted and acted upon by PCP was similar between both groups (60% vs 59%). Inclusion of a DBI is a helpful measure of FRIM deprescribing and may further encourage deprescribing behaviors. Feedback from PCPs will clarify the role of DBI in fall prevention medication reviews.
THE EFFECT OF FINANCIAL STRAIN AND LANGUAGE OF INTERVIEW ON DEPRESSIVE SYMPTOMS IN MEXICAN AMERICAN OLDER ADULTS
Authors: Hernandez Veronica , Nasser Lucy , Snih Soham Al
Published: December 2023

We used data from the Hispanic Established Population for the Epidemiological Study of the Elderly to examine the relationship of financial strain and interview language to high depressive symptoms among Mexican Americans aged ≥75 years without history of depressive symptoms at baseline over a 12-year period (2004/05-2016; N=1157). Participants scored < 16 in the Center for Epidemiologic Studies Depression Scale at baseline. Measures included age, marital status, years of formal education, body mass index, social isolation, church attendance, self-reported medical conditions, cognitive and physical function, pain, falls, disability, and hand grip strength. We used a generalized estimating equation model to estimate the odds ratio (OR) and 95% confidence interval (CI) of depressive symptoms as a function of financial strain and interview language over time, adjusting for all covariates. We found that participants experiencing financial strain and interviewed in Spanish had greater odds of experiencing high depressive symptoms (OR=2.48, 95% Cl=1.37-4.48) compared to those who were not experiencing financial strain and selected be interviewed in English. No significant association with depressive symptoms was found in participants with financial strain and interviewed in English or those without financial strain and interviewed in Spanish. In conclusion, Mexican American older adults were at a high risk for high depressive symptoms over time if they were experiencing financial strain and preferred be interviewed in Spanish. Early screening for depression may prevent or delay depressive symptoms for individuals in this population at high risk for depression.
THE EFFECT OF PANDEMICS ON TRUST IN DOCTOR IMPROVEMENT AMONG CHINESE OLDER ADULTS: LESSONS FROM COVID-19
Authors: Guo Chao , Hu Xiyuan , Yuan Dianqi , Tang Huameng , Yang Peisen
Published: December 2023

The COVID-19 pandemic has had a major impact on the physician-patient relationship. For older adults, trust in doctors during the pandemic affects their lives and health. This study aimed to estimate the effect of the first wave of COVID-19 transmissibility in China on older adults’ trust in doctors. We obtained individual data from the Chinese Family Panel Studies (CFPS). A total of 2,225 participants aged 65 and older were included in this study. The COVID-19 pandemic was used as a natural experiment. We obtained difference-in-differences (DID) estimates of the pandemic’s effects by exploiting temporal variation in the timing of COVID-19 exposure across participants interviewed from 2018 to 2020 together with the geographical variation in COVID-19 severity at the provincial district level. Overall, the DID estimates showed that the COVID-19 pandemic could significantly increase trust in doctors after controlling for multiple covariates (adjusted β: 0.053, 95% CI: 0.028–0.078). Stratified analyses showed that the effect was only in females and the more educated ones but not in their counterparts. In addition, the COVID-19 pandemic showed a positive effect on trust in doctors among 65-79-year-olds (0.082, 0.056–0.109), but older adults over the age of 80 showed significantly reduced trust in doctors (-0.236, -0.418–-0.055). Our findings confirm the association between the COVID-19 pandemic and trust in doctors among older Chinese people. Hospitals and other medical organizations should pay more attention to improving older adults’ trust in doctors and building a better physician-patient relationship to face the future pandemic.
THE EFFECTIVENESS OF NON-PHARMACOLOGICAL INTERVENTIONS ON SLEEP QUALITY IN RA AND FMS: A SYSTEMATIC REVIEW
Authors: Chin Ching-I
Published: December 2023

Objective

Sleep disturbances can significantly impact the well-being of individuals with Rheumatoid Arthritis (RA) and Fibromyalgia (FMS), leading to daytime sleepiness, fatigue, and increased pain. This systematic review aims to assess the available evidence on the effectiveness of non-pharmacological interventions in improving sleep quality for individuals with RA and FMS.

Method

A comprehensive search was conducted in English electronic databases (CINAHL plus, SPORTDiscus, EMBASE, Medline, PubMed, Web of Science, and Google Scholar) to identify relevant articles. The review includes 15 studies, consisting of 13 randomized controlled trials (RCTs) and 2 non-randomized controlled trials (non-RCTs), published between 2012 and 2022. Primary and secondary outcome measures related to sleep quality were assessed using subjective and objective measures.

Results

Interventions in the studies were diverse, involving physical and mind-body approaches, lasting 6 to 16 weeks with session durations of at least 30 minutes. The total intervention hours ranged from 6 to 32 hours across all studies. Follow-up evaluations were conducted in four studies up to 6 months after the last treatment. While the Arthritis Foundation Exercise Program and Yoga did not report statistically significant improvements in sleep quality for RA, non-pharmacological interventions showed a positive impact on sleep outcomes for RA and FMS populations.

Conclusion

Non-pharmacological interventions show promise as a potential alternative method to improve sleep quality for individuals with RA and FMS. However, there is no evidence to support the superiority of one intervention over another. Keywords: Rheumatoid Arthritis. Fibromyalgia Syndrome. Sleep quality. Sleep disturbance. Exercise. Non-pharmacological intervention.
THE EFFECTS OF EARLY-LIFE ADVERSITY ON WOMEN’S COGNITIVE HEALTH AFTER AGE 50
Authors: Johnson Kimson
Published: December 2023

According to the Alzheimer’s Association, 6 million people age 65 and older are living with Alzheimer’s Disease in the United States, and nearly 4 million are women. Few research studies have examined the impact of adverse childhood events (ACEs) on cognitive health among women over 50. Evaluating gender-specific differences in predictors of cognitive health can help clarify mechanisms that hinder or magnify gender-based health differences and provide information on ways to narrow gender disparities in dementia. The study examined the relationship between ACEs, cognitive impairment, and incident dementia using data from the Health and Retirement Study Cross-wave 2015-2017 Life History Mail Survey (N = 4,980; Mage = 67.6). Cognitive status was measured using the 2016 Langa-Weir three category indicator: Normal, Cognitive Impairment but No Dementia (CIND), and Dementia. Compared to women exposed to 0 ACEs, women exposed to 1 ACE had a higher relative risk for CIND and dementia (RRR=1.71, p<.05; RRR=2.44, p<.05). Women exposed to 3 ACEs had a higher relative risk for dementia (RRR=3.43, p<.05). Non-Hispanic Black women exposed to 3 ACEs had a lower relative risk for dementia (RRR=0.18, p<.05) than white women. Women with 12 years of education have a higher relative risk for CIND and dementia (RRR=2.27, p<.05; RRR=3.45, p<.05) than women with >13 years of education. Although women’s life expectancy has increased over the past few decades, women remain at risk for delayed identification of cognitive decline. Future research should examine how other critical social determinants of health influence women’s cognitive health after 50.
THE EVOLUTION OF NURSING HOME COMMUNICATION WITH RESIDENT FAMILIES DURING THE COVID-19 PANDEMIC
Authors: Hawes Courtney , Brazier Joan , Meehan Amy , Gabois Emily
Published: December 2023

Nursing homes experienced numerous challenges resulting from the COVID-19 pandemic. Among these challenges was ensuring appropriate and effective communication with friends and family members of residents, particularly in light of visitation restrictions. Using qualitative data from 156 in-depth, semi-structured interviews with administrators of 40 nursing homes across the US from July 2020 through December 2021, challenges and solutions to communicating effectively with resident families are characterized. Findings include three themes: 1. Administrators identified best practices regarding the frequency of communicating with families. Particularly early in the pandemic and when visitation was restricted, families expressed a desire for very frequent updates regarding resident well-being and COVID-19. Administrators reported the challenges of balancing family expectations regarding information with their capacity to meet those expectations. 2. Administrators discussed different modes of communication used with families. Existing systems of mass-communication were expanded and new processes were developed. 3. Administrators described challenges in determining the appropriate content to communicate and navigating changing policies. While nursing home staff were required to share data on COVID-19 outbreaks, administrators shared lessons learned regarding specificity of information to be shared, and how they balanced required infection control information with pleasant updates regarding residents and their activities. Strategies identified by administrators may be informative for efforts to promote effective communication for both general day-to-day updates and for future emergency or pandemic crises.
THE FINANCIAL AND EMOTIONAL IMPACT OF COVID-19 FOR DEMENTIA CAREGIVERS: A COMPARISON OF THE NHATS AND HISPANIC EPESE
Authors: Rote Sunshine , Angel Jacqueline , Cantu Phillip , Antequera Felipe
Published: December 2023

During the COVID-19 pandemic, older adults and their caregivers/care partners (hereafter referred to as “caregivers”) experienced social isolation, reduced autonomy, disruptions in medical care and barriers to community-based services such as adult day centers. We compare the extent to which these disruptions affected white, Black, and Hispanic caregivers. We utilize newly released data on adult children caregivers from the Caregiver Supplement to the Hispanic Establish Population for the Epidemiologic Study of the Elderly (HEPESE CG, 2021) and the National Health and Aging Trends COVID-19 Family Members and Friends Dataset (NHATS FF, 2020/2021) to compare caregiver emotional well-being and financial strain among non-Hispanic White (NH White, n=327), non-Hispanic Black (NH Black, n=57), and Mexican American (n=57) adult children caregivers. Results reveal that a larger fraction of NH Black and Mexican American caregivers reported financial strain than NH White caregivers, and that more Mexican American caregivers reported loneliness and depression than other groups of caregivers. For Mexican American caregivers, those reporting lower financial well-being tended to be younger. For NH Black caregivers, there were no significant predictors of financial strain or wellbeing. Finally, NH White caregivers were younger, and more likely to be female and NH White dementia caregivers reported more financial strain and loneliness than NH White non-dementia caregivers. Taken together, this work provides valuable insight into the role of the COVID-19 pandemic in exacerbating caregiver health disparities among caregivers and provides valuable insight as well as to the high-impact intervention points for caregivers from minoritized populations.
THE HIGH PREVALENCE OF OVER-THE-COUNTER MEDICATION MISUSE IN OLDER ADULTS: RESPONSE TO THE CHPA-GSA NATIONAL SUMMIT
Authors: Chladek Jason , Gilson Aaron , Stone Jamie , Lehnbom Elin , Hoffins Emily , Berbakov Maria , Moon Jukrin , Chui Michelle
Published: December 2023

Older adults (65+) are the largest consumer of over-the-counter (OTC) medications and disproportionately prone to adverse drug events (ADEs). Despite perceptions that OTCs are generally safe, OTC misuse can lead to ADEs. However, as identified through the Consumer Health Products Association (CHPA) and Gerontological Society of America (GSA) National Summit, little is known about OTC misuse in older adults. This is the first muti-site study to prospectively quantify how older adults select OTCs in community pharmacies where products are typically purchased. Older adults (n=144) were recruited from 10 community pharmacies. Participants were given hypothetical symptoms and asked to select one or more OTCs. After selection, they were asked to report how they would use the product, their home medications, and their health conditions. OTC selections were evaluated for the following misuse categories: 1) drug-age (Beers Criteria), 2) drug-drug (interactions with home medications), 3) drug-disease (health conditions), and 4) drug-label (product’s indications and directions). At least one type of misuse was identified in 114 (79%) older adults, with 57 (40%) demonstrating misuse in >1 category. Overall, 363 total instances of misuse were identified (x̄=3.18 per participant). There was high prevalence of drug-drug and drug-label misuse, as 107 (74%) demonstrated misuse in one or both categories. The results highlight OTC misuse frequency and complexity in older adults. Knowing older adults’ OTC misuse prevalence is critical for understanding medication-associated risks and developing effective interventions. Importantly, these results are a first step toward addressing the research gaps identified by CHPA and GSA.
THE IMPORTANCE OF ADEQUATE RESOURCES AND EQUIPMENT TO STAFF ENGAGEMENT IN A HEALTHCARE SYSTEM
Authors: Burack Orah , Mak Wingyun , Howard Margret , Isaacs Tanya , Reinhardt Joann
Published: December 2023

During this time of unprecedented staffing challenges, identifying factors impacting staff engagement may be one step towards rebuilding the healthcare workforce. This study was designed to identify work factors differentiating positively engaged employees from others. In May 2023, 350 employees (response rate=30%) from across a healthcare system (including skilled nursing facilities, adult day centers, community services, and assisted living) serving older adults in New York City and Westchester County, completed surveys examining employee engagement and satisfaction with five work factors. Engagement was measured using the employee net promoter scale (eNPS) in which employees rate from 1 (Not At All) to 10 (Very) “How likely is it that you would recommend the organization as a workplace.” Those answering 9-10 are classified as “Promoters” (engaged/positive concerning the workplace), 7-8 “Neutrals”, and 1-6 are “Detractors” (unengaged/negative). Participants also responded 1 “very unsatisfied” to 5 “very satisfied” on work factors: general work satisfaction, having enough resources/equipment, receiving timely information, supervisor support, and coworker respect. Based on eNPS responses, 160 (45.7%) employees were “Promoters”, 65 (18.6%) “Neutrals”, and 125 (35.7%) “Detractors.” A series of one-way analysis of variance and post-hoc Bonferonni analyses then examined work factor satisfaction by staff engagement level. As expected, “Promoters” and “Neutrals” were significantly more satisfied than “Detractors” on all five work factors however, only having enough resources/equipment separated “Promoters” (M=3.63, SD=1.24) from “Neutrals” (M=4.06, SD=89, p <.05). These findings indicate that providing staff with sufficient resources/equipment should be prioritized in the effort to establish a healthcare workforce of “Promoters.”
THE INFLUENCE OF ARTIFICIAL INTELLIGENCE ON CLINICAL DECISION MAKING: GERIATRIC REGISTERED NURSES’ PERSPECTIVES
Authors: Freeman Shannon , Henderson-Betkus Mary , Currie Leanne , Banner Davina , Jackson Piper
Published: December 2023

The emergence of ChatGPT highlights the potential of AI applications used in nursing care. AI in the form of machine learning or deep learning provides the ability to scan through clinical data using various algorithms to predict a clinical outcome for a client/patient and influencing clinical decisions. Registered nurses (RNs) are accountable for their decisions when caring for older adults receiving geriatric services and supports. Therefore, we conducted an online survey online cross-sectional survey from April to July 2023 to evaluate community focused RNs knowledge and awareness of the use of AI within their decision-making process. 233 RNs completed the survey. RNs were aware of AI in healthcare (56.7%) and in nursing (30.9%) with less familiarity with machine learning (ML) in geriatric nursing (16.3%). Source of knowledge of AI and ML came from informal sources such as media and social media and from family and friends whereas formal sources were less common. RNs agreed (69.8%) that automated outcomes to help them prioritize older adult clients and target services would be useful. However, 77.9% were concerned with who would be responsible if AI offered incorrect recommendations. Most RNs (90.2%) identified they should have the competency of how AI can improve processes and outcomes. RNs should be consulted if AI had implications on geriatric practice. Future phases of this research will examine how RNs can be better involved in AI that influences their practice and how they might be better prepared to evaluate AI outputs as part of their decision-making process.
THE PROTECTIVE LIFESPAN BENEFITS OF SOCIAL SUPPORT BUFFERS CHILDHOOD ADVERSITY
Authors: Willard Meredith , Best Ryan , Turiano Nicholas
Published: December 2023

Childhood adversity has negative effects across the lifespan including increased mortality risk. The support we receive from others, social support, has shown to be a protective factor against ACEs. However, little research has investigated the amplifying effects of poor social support, also known as social strain. Individuals with high levels of social strain and low levels of adversity would have the lowest mortality risk, it was hypothesized. Early life adversity was computed using 16 retrospective items assessing emotional and physical abuse, socioeconomic disadvantage, familial instability, and early-life poor health. Social support was computed using four-family, four-friend, and six-spouse items assessing reliability and emotion availability. Social strain was computed using four-family, four-friend, and six-spouse items assessing annoyance and disappointment. Cox proportional hazards models tested whether adversity, social support, and social strain were associated with the 20+year hazard of dying. Adjusting for age, gender, race, education, and marital status, higher ACEs (HR = 1.06) lower social support (HR = 1.07) and greater social strain (HR = 1.06) were all significantly associated with an increased hazard of dying (all ps < .05). A significant ACE x Social Support interaction emerged (HR = 0.95) suggesting the association between ACEs and hazard of dying was strongly positive at low levels of social support, but that the relationship was negative at high levels of support. Thus, high levels of social support buffer the negative effects ACEs have on mortality risk. This provides robust evidence that interventions increasing social support could reduce the harmful effects ACEs.
THE RELATED FACTORS ON HEALTH DEFICIENCIES IN NATIONAL NURSING HOMES USING PANEL LARGE DATASET
Authors: Shin Juh Hyun , Ahn Jinhyun , Lee Soo-Kyoung , Harrington Charlene , Jung Sunwoo , Lee Yeonwoo , Ali Sanna
Published: December 2023

Health deficiencies are considered scientific research outcomes and should be reported as mandatory for all Medicare-Medicaid nursing homes (NHs). However, health deficiencies have been a concern for several decades. Previous studies have focused on regulatory deficiencies or used nurse staffing variables as control variables. This study investigated health deficiencies in relation to nurse staffing, facility size, and ownership across all Center for Medicare and Medicaid NHs in the United States. This study used secondary data analysis using Payroll-based Journal Daily Nurse Staffing data, Area Resource File, and LTCFocus. Data were merged with federal Medicare/Medicaid provider IDs as the basic unit of analysis for the 2019 fiscal year. A total of 7,802 NH data were analyzed using Poisson regression. The average total weighted health deficiencies survey score was 66.12. The average bed size was 114.02, where 74% were profit NHs. The average hours per resident day (HPRD) for each nurse staffing was as follows: 0.57 registered nurses, 0.86 licensed practical nurses, and 2.16 certified nurse aides. As total HPRD increases by 1 unit (exponential 0.83), it is likely that health deficiencies decrease by 17%. The bed size less than 60 (exponential 0.87) and not-for-profit NHs (exponential 0.09) was related with decreased health deficiencies of 13% and 91%. The worsened residents’ acuity was related with 2% more health deficiencies (exponential = 0.98). This large dataset analysis shows that professional nurse staffing is associated with superior NH quality of care with fewer deficiencies and supports the need for age-friendly long-term healthcare systems.
THE RELATIONSHIP BETWEEN INTERNET USE AND LIFE SATISFACTION IN LATER LIFE: A FOCUS ON THIRD-LEVEL DIGITAL DIVIDE
Authors: Khor Ern Chern , Choi Moon
Published: December 2023

The third-level digital divide highlights how social factors can shape disparities in real-life experiences derived from digital use. This study aims to examine how different types of internet use are related to the life satisfaction of older adults with varying health and wealth statuses through the lens of the third-level digital divide. The data for this study came from the 2022 Korea Digital Divide Survey. A sample of 1,165 older adults aged between 65 and 96 years old was grouped into four categories based on their health and wealth statuses, considering that these two factors tend to shape the social positions of older adults in Korean society. Life satisfaction was measured using 5 items from the 4-point Satisfaction with Life Scale (SWLS), while different types of internet use were accessed with 13 dichotomous items. The findings showed that a significant positive effect of internet use was observed only among older adults with good health status, indicating a stronger effect for those with good wealth status. Particularly, online public services (d=1.41, p< 0.001), cloud services (d=1.35, p< 0.001), and social networking services (d=1.27, p< 0.001) exhibited significant effects. No significant effect was observed for older adults with poor health status, except for online entertainment content, which was found to be significantly related to the life satisfaction of those with low wealth status (d=0.87, p< 0.01). The study findings imply diversity in terms of internet use and its association with life satisfaction, while highlighting social disparities.
THE RELATIONSHIP BETWEEN THE CAREGIVING ENVIRONMENT, BURNOUT AND QUALITY OF LIFE AMONG HOME HEALTH AIDES
Authors: Baek Sehyun , Park Soobin , Shin Oejin , Park Sojung , Ko Ahra
Published: December 2023

The well-being of home health aides (HHAs) is affected by the characteristics of their work environment. As South Korea’s population rapidly ages, there is an increasing demand for home aides. However, little is known about how the caregiving environment affects HHAs. Guided by the environment comfort model, we examined the association between care recipients’ home environment and HHA’s quality of life, focusing on how burnout mediates this relationship. Our data came from a national survey of home health aides in 2020 (N=981). We conducted an exploratory factor analysis to identify six factors related to the care environment in three dimensions: physical (1. space; 2. indoor/outdoor conditions), functional (3. home appliances; 4. heating/air conditioning), and psychological (5. satisfaction with the home environment; 6. relationships with care recipients and their families). We then used a path analysis to examine the relationship between these factors, burnout, and quality of life. Our findings show that safe indoor/outdoor conditions and positive relationships with care recipients and their families are associated with lower levels of burnout, leading to a higher quality of life (p< 0.05, respectively). This highlights the importance of considering both physical and psychological aspects of the caregiving environment to prevent burnout and improve the quality of life for HHAs, ultimately contributing to high-quality services for care recipients.
THE ROLE OF OUTDOOR LIGHT EXPOSURE ON SLEEP QUALITY IN OLDER INDIVIDUALS WITH FRAILTY OF DIFFERENT LIVING TYPES
Authors: Hsieh Yi Chin , Chiu Ching-Ju
Published: December 2023

The study investigates the relationship between outdoor light exposure and sleep quality in older individuals with frailty in institutions and the community, where sleep disorders are common, and outdoor light exposure is inadequate.The study includes older individuals with frailty in community and institutions in Taiwan. Participants must be aged 65 or above and have a Clinical Frailty Scale score between 4 to 8. We collect sleep quality and outdoor light exposure data using questionnaires and actigraphy.The study includes 77 older individuals: 29 from day-care centers, 22 from conventional long-term care institutions, and 26 from unit care institutions. The average outdoor light exposure is 15 minutes per day, with an average Pittsburgh Sleep Quality Index (PSQI) score of 8, 74% sleep efficiency, and 125.8 minutes of wake after sleep onset. After controlling for multiple variables. Outdoor light exposure shows no relationship with PSQI, sleep efficiency, and wake after sleep onset.The average PSQI score is > 5, indicating poor subjective sleep quality. Additionally, Wake After Sleep Onset > 60 minutes, and sleep efficiency < 75%, suggesting poor objective sleep quality. The average outdoor light exposure time < 20 minutes, indicating a lack of outdoor light exposure. However, our study does not observe the effects of light exposure, possibly because the average daily light exposure is below the 30-minutes threshold. Older individuals with frailty experience poor sleep quality. It is possible that a longer duration of outdoor light exposure may be needed to observe its impact on sleep quality.
THE SOCIAL STRATIFICATION OF INFORMAL CAREGIVING ARRANGEMENTS IN EUROPE
Authors: Albertini Marco , Zanasi Francesca , Piccitto Giorgio
Published: December 2023

In ageing societies, the increasing quota of older and frail individuals creates unprecedented needs for care. As care is often costly and not adequately covered by the welfare state, care responsibilities for older individuals fall on the shoulders of family members. The study of informal care provision is acquiring centrality both in the social sciences and policy discourse, since the care load can bear negative consequences on a range of outcomes, from health (e.g., the “caregiver burden”) to employment. It is important to gain a better understanding of which individuals are the most likely to provide informal caregiving and face its consequences. In the present study, we explore the educational and income differences in the probability of providing informal caregiving to individuals living outside the household in Europe, using the Survey of Health, Aging and Retirement in Europe (SHARE, 2004-2020). As a contribution to the field, we aim at uncovering the mechanisms behind the socio-economic gradient in caregiving, such as differences in health and longevity and time constraints (due to employment and other care responsibilities) that are unequally distributed across social layers. Results show that individuals with tertiary education, and at the top of the income distribution, are more likely to provide care, net of several other factors. The study concludes with attempted explanations of the results, related to the fact that lower educated, and lower income individuals, can more often rely on publicly provided services and means-tested benefits.
THE SOUTHEAST FLORIDA VETERANS’ COMMUNITY PERSPECTIVES ON THE MEANING OF WELL-BEING: A PHENOMENOLOGICAL INQUIRY
Authors: Birmingham Cheryl
Published: December 2023

The Veterans are a unique community shaped by past military experiences that may have positive and negative effects on their well-being as soldiers. With nearly half of the 18.4 million Veterans in the United States living beyond 61 years the physical and mental health conditions may desolate the Veterans’ well-being. Promoting Veteran well-being has been studied extensively but scant on how they define it. It is critical to understand how Veterans define well-being to inform future program development addressing mental health needs. The purpose of this study is to discover the meaning and the live experience of well-being among Veterans. A qualitative hermeneutic interpretative phenomenological approach was used to understand the meaning of Veterans’ well-being. It allowed the phenomena to surface while exposing the essence of and the experience. Purposive sampling was used to recruit participants, with semi-structured interviews via ZOOM and observations at Veteran Service Organizations (VSOs). Fourteen Veterans participated in this study, 8 males and 6 females with majority greater than 61 years. 64% were White, 21% Hispanic and 15% African American. With the use of Max van Manen’s analysis strategy, 3 major themes emerged: (1) A Connection to a Military Sisterhood/Brotherhood; (2) The Lingering Effects of Military Service and (3) Healthy Companionship/Relationships advocating for Veterans’ well-being. The lingering effects persisted and challenged the Veterans’ emotional well-being; however, they were able express their military camaraderie continued in Veteran life. Programs based on social relationships that allow connections with Veterans and/or their significant others need to be established.
THE VOLUNTEER EXPERIENCE IN THE FAITH CARE FAMILY PROJECT FOR AFRICAN AMERICAN CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Fields Noelle , Xu Ling , Williams Ishan , Epps Fayron
Published: December 2023

African American adults are disproportionately affected by Alzheimer’s disease and related dementias (ADRD). Improving knowledge about ADRD in the African American community is also important for dispelling the myths and stigma about the disease. The Faith Care Family (FCF) Project was developed to help bridge gaps in ADRD knowledge by training volunteers from a predominantly African American church (N = 9) to work with ADRD caregivers in a 6-week, telephone-based pilot intervention. The Alzheimer’s Disease Knowledge Scale (ADKS) and qualitative interviews were used to examine the church volunteers’ knowledge of dementia. Non-parametric McNemar tests and Wilcoxon signed-rank tests were conducted for each item and the sum scores of the ADKS scale, respectively. Qualitative interview data were analyzed using thematic analysis. The results of the quantitative data indicated overall significant improvements in the sum scores of ADKS after the training (p = .008) as well as after the intervention (p = .05). Some specific ADKS items showed a significant increase after the training including items related to high cholesterol, using reminder notes, and mental exercise as well as after the intervention related to prescription medication. Thematic analysis of the interviews revealed six themes: types of ADRD, ADRD symptoms/behaviors of ADRD, early-onset, fatality, dignity, and previous knowledge. Overall findings suggest that the FCF Project is a promising intervention for enhancing knowledge about ADRD for African American church volunteers. Recommendations for future research and strategies for lay provider ADRD interventions in faith communities are offered.
THERANAP: AN EDUCATIONAL SLEEP HEALTH INTERVENTION FOR FRAIL OLDER ADULTS
Authors: Berkley Amy
Published: December 2023

Napping and other daytime sleep is often overlooked and poorly defined in insomnia research. Studies have shown correlations between older adults’ napping habits and increased medical co-morbidities and risks of dementia, but others report napping enhances memory consolidation and broader aspects of cognition in younger adults. Why is napping recommended for younger adults but considered problematic for older adults? In previous a research study, (18 older adults in an independent living facility: 6 men,12 women, mean age 84, SD= 7.62, range 67-96, who self-reported sleep problems) participants reported napping in qualitative interviews but denied daytime sleep on standard sleep assessments. Participants spoke about napping apologetically and expressed dread of its links to functional and cognitive decline. They stigmatized planned napping, which could potentially benefit their cognitive functioning, but seemed accepting of accidental napping, which could well indicate more serious physical or cognitive issues To address these issues, TheraNap teaches intentional napping as a therapy. This sleep health education intervention empowers sleep-deprived older adults to take control of their sleep habits by practicing intentional napping to improve overall sleep health. TheraNap includes: • Short sleep health training session with recommended napping guidelines • Two-week long planned napping routines • A sleep diary • Supplementary sleep meditations • Follow-session to assess perceptions of sleep health More research is needed into the ways napping can improve physical and cognitive function, and more education is needed for older adults, their families and caregivers, and LTC staff about the importance of sleep for older adults.