bluuebunny/crossref_metadata_2025 huggingface dataset:
Family Caregiver Needs and Preferences for Virtual Training to Manage Behavioral Symptoms of Dementia
Authors: Ramirez Maggie , Duran Miriana , Pabiniak Chester , Hansen Kelly , Ralston James , McCurry Susan , Teri Linda , Penfold Robert
Published: December 2021

STAR-Caregivers Virtual Training and Follow-up (STAR-VTF) is adapted from an evidence-based, in-person program that teaches family caregivers to manage behavioral and psychological symptoms of dementia (BPSD). The study objective was to understand the needs of family caregivers for improving BPSD management and the extent to which caregivers perceived that STAR-VTF could address those needs. We conducted 15 semi-structured interviews with family caregivers of people with dementia. We showed caregivers prototypes of STAR-VTF online self-directed materials. We obtained caregiver feedback, focusing on needs and preferences and perceived barriers to using STAR-VTF. We used a hybrid approach of inductive and deductive coding and aggregated codes to develop themes. The idea of a virtual training program for learning to manage BPSD appealed to caregivers. They said healthcare providers did not provide adequate education in the early disease stages about the personality and behavior symptoms that can affect people with dementia. Caregivers found it unexpected and frustrating when the person with dementia began experiencing BPSD, symptoms they felt unprepared to manage. Accordingly, caregivers expressed a strong desire for the healthcare organization to offer programs such as STAR-VTF much sooner. Many were interested in the virtual aspect of the training due to the convenience of receiving help from home and the perception that help from a virtual program would be timelier than traditional service modalities. Given caregivers’ limited time, they suggested dividing the STAR-VTF content into chunks to review as time permitted. Caregivers reported a preference for having the same coach for the program duration.
The Effects of Remote Activity Monitoring on Family Caregivers of People Living With Dementia Over an 18-Month Period
Authors: Gaugler Joseph , Zmora Rachel , Mitchell Lauren , Finlay Jessica , Rosebush Christina , Peterson Colleen , Nkimbeng Manka , Baker Zachary
Published: December 2021

Technology interventions for older persons and long-term care are generally utilized as real-time data capture tools to complement clinical or family care for older persons or as interventions themselves designed to improve important dementia care outcomes. Although research on novel technological interventions for people with Alzheimer's disease and related dementias (ADRD) and their family caregivers has grown considerably in the past two decades, much of this work continues to focus on design, feasibility, and acceptability (with a need for conceptual refinement in these areas) and less on controlled outcome studies. The objective of this experimental mixed methods demonstration was to determine the 18-month effectiveness of remote activity monitoring (RAM) technology in improving outcomes among family caregivers of community-dwelling persons with dementia. We used an embedded experimental mixed methods design, collecting qualitative data within the structure of a traditional randomized controlled trial ([QUAN+qual]→QUAN) over an 18-month period for 171 dementia caregivers. Change in caregiver self-efficacy, sense of competence, and caregiver distress served as the main quantitative outcomes of interest. Individual growth curve models indicated that the RAM technology did not have direct effects on caregiving outcomes, and although the qualitative findings indicated several potential moderators of RAM effectiveness on caregiving outcomes, the inclusion of these qualitatively-identified moderators did not result in statistically significant (p < .05) effects. Ensuring effective human care management alongside RAM technology may help to overcome the barriers reported by dementia caregivers in this demonstration study.
Technology Innovations in Dementia Care: Improvements in Functional Assessments Through Background Sensing
Authors: Smith Matthew , Ory Marcia , Han Gang , Wilson Ashley , Foster Zane , Fitch John
Published: December 2021

Technological innovations are becoming commonplace in research among persons living with dementia (PLWD) and their caregivers. However, few studies attempt to validate technology’s ability to appropriately monitor functional assessment in dementia care research. Bringing together industry, academia, and health care, we demonstrate the feasibility of using a novel in-situ sensor system to continuously and accurately assess daily functions for PWLDs in home or assisted care settings. Phase1 revealed a high accuracy (~85%) of detecting and classifying ADLs between sensors and human loggers across 26 defined activities. Phase 2, which will target 140 PLWDs, has already demonstrated the value of such sensors in detecting safety concerns (e.g., no heat). Technology-driven research for PLWD and their caregivers have practical applications for assessing diverse forms of functional assessment and environmental conditions which can improve measurement precision over time and space and the ability to better tailor care plans for PLWDs and their caregivers.
Deep Longitudinal Proteomics Profiling Reveals Biological Pathways Responding to GRF6019 in Two AD Clinical Trials
Authors: Lehallier Benoit , Nanasi Tibor , Hannestad Jonas , Braithwaite Steven
Published: December 2021

Blood has been widely investigated to discover biomarkers and gain insights into the biology of aging and age-related diseases. Its protein composition provides insights into complex biological processes, as proteins are often direct regulators of cellular pathways. In clinical trials, selected proteins have been used as primary and secondary endpoints, but recent methodological developments allow the measurement of thousands of proteins with very high sensitivity and specificity. In two phase 2 clinical trials testing the safety, tolerability, and feasibility of infusions of the plasma fraction GRF6019 in Alzheimer's disease (AD), we measured more than 7000 proteins in plasma over the course of the clinical trials. Differential trajectories analysis revealed groups of proteins and pathways that were responding to GRF6019. Several pathways were relevant to the biology of aging and AD and our study suggests that deep proteomics profiling can inform on specific biological processes responding to treatment in clinical trials.
Changing Time Horizons and Trust: Experiences of Aging With Hemophilia
Authors: Perry Tam , Schwartz Sara
Published: December 2021

Trust among those who have experienced a lifetime of medical encounters warrants attention to how trust is both cumulative and complex. This study of a historically isolated cohort incorporates interviews (n=25 older adults/professionals) and focus groups uses a lens of trust to highlight the experiences of those aging with hemophilia, individuals who never expected to age. Understood through the lens of trust, the data show evidence of the absence of safe spaces particularly during the early 80s - blood contamination concerns and homophobia-leading often to social withdrawal. Over time, however, some individuals and families created trusted venues to begin demanding research, treatment and policy change. Advocacy re-engaged the community to organize, educate and advance safety protocols for blood product manufacturing and distribution. This presentation will illuminate how experiences with medical providers, contaminated blood supplies, stigma and uncertain in other spheres of one’s life make trust a co-constructed, fragile concept.
Factors Related to COVID-19 Vaccine Uptake in Black American Communities
Authors: Johnson Julene , Harris Orlando , Hill Carl V , Lichtenberg Peter , Keiser Sahru , Perry Tam , Portacolone Elena
Published: December 2021

Black/African Americans represent 13% of the population, yet account for about a quarter of COVID-19 deaths. Black Americans receive COVID-19 vaccines at lower rates than whites. To address this gap, we examined effects of the COVID-19 pandemic among Black Americans, emphasizing understanding trust and vaccines. Data were collected (July to September 2020) using 8 virtual focus groups in Detroit and San Francisco with 33 older Black Americans and 11 caregivers. Content analysis was used to identify themes. The first theme pointed to a sense of feeling abandoned by healthcare providers and the government, which exacerbated uncertainty and fear. The second theme emphasized distrust towards healthcare providers and government. The third theme pointed to a reluctance in receiving the vaccine because of distrust of pharmaceutical companies and government, as well as misinformation. These findings suggest that underlying systemic issues need to be addressed to accelerate vaccine uptake among older Black Americans.
Experiences From Healthcare and Community Organizations Delivering Evidence-Based Dementia Caregiving Programs
Authors: Schaffer Rachel , Ciancibello Alyssa , Bass David , Powers Sara
Published: December 2021

Best Practice Caregiving surveyed 324 healthcare and community organizations that replicated one or more of the 44 evidence-based programs about delivery organization characteristics, delivery staff, caregivers and persons with dementia served, funding sources, delivery challenges, perceived impact, and satisfaction. 211 (65.1%) organizations completed surveys about 30 different evidence-based programs. The most common types of organizations that delivered programs were healthcare organizations (23.8%) and Area Agencies on Aging (23.8%). Results showed on average organizations delivered programs for 49 months and served 68 families/year. The most common program delivery challenges were marketing (69.8%) and engaging participants (66.3%). Organizations generally agreed that programs had positive impacts on caregivers (59.5% strongly agree) but were less positive about benefits for persons with dementia (25.1% strongly agree). Discussion provides insights into successes and challenges organizations face when adopting evidence-based dementia caregiving programs in their communities.
Aspects of Grit Among Dementia Family Caregivers
Authors: Savla Jyoti , Roberto Karen , Margrett Jennifer
Published: December 2021

Dementia family caregivers often show deep devotion and a strong sense of purpose and duty toward their relatives needing care. The concept of grit, which includes aspects of commitment, purpose, perseverance, and resilience, is a novel theoretical approach to expanding understanding of dementia family caregiver strengths amidst the challenges they face. Multiple psychosocial and contextual factors are likely to interact with and influence grit among these caregivers. This symposium addresses commitment to the family dementia caregiver role, willingness to embrace the stressful work of caregiving, and perseverance in finding ways to sustain caregiving roles under typical and adverse circumstances. Blieszner focuses on associations between grit and stressors and strains that challenge caregiver well-being and jeopardize continued caregiving. Wilks considers the impact of spiritual support on sustaining resilience among Caucasian and African American dementia caregivers. McCann explores caregivers’ responses to changes in informal support and social interactions available to assist with home care tasks over the course of the COVID-19 pandemic. Albers examines the strengths and resources caregivers draw upon to manage the challenges of caring for and supporting a relative in long-term residential care during the pandemic. Collectively, these presentations provide new insights into the range of influences on aspects of grit and circumstances in which grit sustains caregiving. Discussant Margrett considers the value of the concept of grit for furthering understanding of caregivers’ abilities to manage typical and unique challenges in their caregiver roles and offers suggestions for future research and interventions to enhance grit among dementia family caregivers.
Taking a Campus-Wide View of Age-Friendly Practices in Higher Education
Authors: Bowen Lauren , Silverstein Nina , Whitbourne Susan , Montepare Joann
Published: December 2021

The first AFU principle is to “encourage the participation of older adults in all the core activities of the university, including educational and research programs.” As this suggests, a crucial goal of age inclusivity in higher education is to resist the siloing of older adults and age-inclusive efforts in age-specific programs and cohorts. In response, the Age-Friendly Inventory and Campus Climate Survey (ICCS) assessment was designed to assess age-inclusivity across seven areas of institutional activity: outreach & engagement, personnel, physical environment, research, services & resources, student affairs, and teaching & learning. By restructuring and expanding the “pillars” of institutional activity outlined by AFU principles, the ICCS presents two key advantages for benchmarking AFU practices: (1) it traces age-inclusivity across many facets of institutional operations; and (2) it prompts participants and report readers to recognize their role in current and potential age-inclusive efforts, regardless of their role or department on campus.
Longitudinal Measurement Properties of the Montreal Cognitive Assessment
Authors: Andersson Björn , Luo Hao , Wong Gloria H Y , Lum Terry Y S
Published: December 2021

Background: The Montreal Cognitive Assessment (MoCA) has started to be widely used in longitudinal investigations to measure changes in cognition. However, the longitudinal measurement properties of MoCA have not been investigated. We aimed to examine the measurement invariance of individual MoCA items across four time points. Methods: We used longitudinal data collected between 2014 and 2017 from a cohort study on health and well-being of older adults in Hong Kong. The Cantonese version of the MoCA was used. We applied multiple group confirmatory factor analysis of ordinal variables to examine measurement invariance by educational level and across time points. Invariant items were identified by sequential model comparisons. Results: We included 1029 participants that answered MoCA items across all time points. We found that items Cube, Clock Hand and Clock Number had significantly different item parameters between participants with and without formal education at all time points. The selected model (RMSEA=0.031; SRMR=0.064) indicated that eight items (Trail, Cube, Clock Shape, Clock Number, Clock Hand, Abstraction, Short-term Memory, and Orientation) did not exhibit measurement invariance over time. However, the differences in item parameter estimate over time were marginal. Accounting for the lack of measurement invariance did not substantially affect classification properties based on cutoff values at the 2nd ( major neurocognitive disorder) and 7th (mild cognitive impairment) percentile. Conclusion: Our findings support using MoCA to assess changes in cognition over time in the study population. Future research should examine the longitudinal measurement properties of the test in other populations with different characteristics.
Chicago Older Adults’ Likelihood of Being Home Before and During the COVID-19 Pandemic
Authors: Compernolle Ellen , Finch Laura , Hawkley Louise , Cagney Kathleen
Published: December 2021

Staying at home has particularly been emphasized for older adults during the COVID-19 pandemic, given their elevated risk of infection and complications. However, little is known about the extent to which this population is indeed spending more time at home during the pandemic, compared to before it began. The present investigation addresses this question, also examining differences by gender and race/ethnicity. We analyzed ecological momentary assessments among 98 older adults (age 65-88 in 2020) who participated in two waves of the Chicago Health and Activity Space in Real Time study. Pre-pandemic data were collected from July-October 2019, and pandemic data were collected from June-September 2020. Participants responded to smartphone “pings” (five per day for 7 days in each wave; n=1,910 and n=2,437 before and during the pandemic, respectively) by reporting their momentary location (e.g., home). Findings suggest that respondents were indeed at home more often in mid-2020 than 1 year prior. Multilevel logistic regression models revealed that net of demographics, marital and employment status, and physical health, respondents were more likely to be momentarily at home during versus before the pandemic (B=0.70, SE=0.08, p<.001). This effect was larger among women than men (B=0.50, SE=0.16, p=.002), but did not differ by race/ethnicity. Additional analyses examine whether and how the observed increased reports of being at home may be associated with increased reports of momentary loneliness across the two waves. Findings characterize where Chicago older adults are spending their time amid the pandemic and how this may relate to their well-being.
Do Individuals Skimp on Health Care After Spouse’s Dementia Diagnosis?
Authors: Chen Yi
Published: December 2021

Dementia is a costly disease that places great burden on individuals and families. The substantial time and financial resources taken away by living with persons with dementia (PWDs) may make their spouses forgo essential health care, thus deteriorating long-term health and increasing downstream healthcare costs. However, such negative externality is understudied. This paper studied the impacts of spouse's incident dementia diagnosis on an individual's use of needed care, defined as annual flu shot and regular doctor visits for those with preexisting conditions. Using HRS linked to Medicare claims, I employed a fixed effects approach to compare the use of flu shot and doctor visit during 1 year before and after the index, for individuals whose spouse had dementia (N=691) and otherwise similar controls (N=5,073). After adjusting for time-varying health, caregiving roles, and other socio-demographic factors, spouse’s dementia onset was associated with greater likelihood of getting flu shot and seeing doctors. Among those transitioning into caregiving, spouses of PWDs had a marginally higher risk of skimping on doctor visits, compared to controls (p=0.053). In this broadly representative sample, there lacks evidence for rationed health care ensuing spouse’s dementia incidence, at least within a 1-year time frame. However, for new spousal caregivers, the impact of dementia is more profound and complex than deprivation of time. This group may face a trade-off between caring for spouses with dementia and caring for themselves, for whom policy support merits further study and consideration.
COVID-19 and Brain Health: Global Council on Brain Health Recommendations
Authors: Lock Sarah , Chura Lindsay
Published: December 2021

With growing evidence that the coronavirus directly harms the brain and indirectly harms mental well-being due to social isolation and new, increased stressors, the GCBH recognized the urgent need to inform adults age 50+ about ways to their protect brain health as the pandemic continues. In our latest report, the GCBH describes the known neurological symptoms occurring in the short and long term for adults, providing 10 recommendations to protect brain health and urging research in 11 different areas. Calling for an all-of-society approach to protect the brain health of everyone, the GCBH described the negative effects of COVID-19 on people living with Alzheimer’s disease and other dementias and to the impact of health care inequalities. For example, people with dementia were twice as likely to catch the virus as those without dementia; African Americans with dementia had nearly three times the risk of COVID-19 as Caucasians with dementia. The GCBH also points out that caregivers for those living with dementia have experienced particular stress and provided resources and guidance. The Council spotlights the disproportionate toll of COVID-19 on the vulnerable, including racial and ethnic minorities and those living in low- to middle-income countries. After attending this session, participants will be able to identify the neurological impacts of COVID-19, understand the various ways to mitigate risks to brain health, and learn which areas of research will be critical in the future. These recommendations were developed and put forth by the Global Council on Brain Health Governance Committee and Issue Experts.
What Happens Next? Conducting Research With Cancer Survivors Who Discontinue Their Post-Treatment Care
Authors: Seaman Aaron , Pagedar Nitin
Published: December 2021

Due to improvements in screening, diagnosis, and treatment, more cancer patients are surviving and living longer. For them, survivorship care provides critical support: surveillance and screening for recurrence and new cancers; physical and psychological symptom management; social and financial management support; management of other chronic conditions; and preventive health and health promotion support. Yet, our pilot data indicates that a substantial number of survivors discontinue their survivorship care with the treating oncology team, a team that often provides critical multidisciplinary support and expertise. While it is important to understand the experiences, outcomes, and needs of these survivors, they can be challenging to engage in research. In this presentation, we will discuss survivors who discontinue, why they might do so, and methods for engaging them in research, drawing upon our work with head and neck cancer survivors.
The Moderation of Middle-Generation Support on the Relation of Stress and Depression in Coresident Grandparents
Authors: Nadorff Danielle , Barnett Melissa , Yancura Loriena
Published: December 2021

Consistent with Cohen & Wills’ Buffering Hypothesis, social support has been found to moderate the relation between stress and depressive symptoms but has yet to be examined among coresident grandparents (CGPs), a population at risk of increased stress and depression. The current study sought to extend the model to this highly prevalent, vulnerable population. Participants were 180 grandparents across the USA living with their grandchildren. Measures included depression, stress, and satisfaction with support provided by the middle generation (MG) parent of the grandchild. After controlling for age, gender, income, and household type (skipped or multi-gen), MG support moderated the relation between perceived stress and depressive symptoms, accounting for 49% of variance. For CGPs least satisfied with support provided by the MG, the more stress, the higher their depressive symptoms. These findings indicate that improving relationships with grandchildren’s parents is an important avenue for interventions focused on grandparent caregivers’ mental health.
Environmental Assessment Tools for Shared Residential Settings for Individuals Living With Dementia
Authors: Calkins Margaret , Kaup Migette , Abushousheh Addie
Published: December 2021

The overarching goal of conducting research in and on settings for individuals living with dementia is to be able to identify associations between features, or set(s) of features, and outcomes of interest. A major challenge to this goal is the disconnect between the rapidly changing arena of LTC design over the past 20 years toward more residential-styled settings and existing assessment tools, many of which were developed over 20 years ago, and which are based on and reflect more traditional models of care, service delivery and design. This session examines the strengths and limitations of both existing and emerging assessment tools from the US, Canada, UK and Australia. More recently developed tools are more directly focused on the values of person-centered care than older tools.
Comparing Young and Old Adults’ Night Hazard Detection With Driving Simulation and on Road
Authors: Dickerson Anne , Leonardo Juliette
Published: December 2021

While there is validity of using driving simulation as a proxy for on-road performance, few studies have examined hazard detection at night. Night driving is a self-restricting practice with little evidence demonstrating the need with healthy older adults. This study’s objective was to analyze night driving using eye-tracking technology examining differences between on-road/simulated drives and older/younger adults. A 2 (old, young) x 2 (simulator, on-road) repeated-measures design measured three roadway “hazards” of pedestrains looking at their cell phone while posed to cross the roadway. Pupil glances were recorded using outcome measures of total fixation duration, number of fixations, and time-to-first fixation for the pedestrains on-road and on a specifically designed scenario matching the on-road route. Thirty-three healthy, community-living drivers age 65+ years (N=16) and drivers age 20-40 years (N=17) completed both drives. Using non-parametric statistics, results demonstrated that night hazard detection was similar across driving conditions except for time-to-first fixation, which was faster on-road for both age groups (p<.001). At some hazard locations, there were significant differences between the two age groups, with older adults taking longer to initially see hazards. Results suggest, older adults detected hazards similarly to younger adults, especially during on-road performance, suggesting avoidance of night driving may not be necessary. Results also support using driving simulation as a proxy for on-road with night driving needing to be incorporated. Additionally, eye-tracking has the potential for research in hazard detection with emphasis on the time-to-first fixation outcomes when considering driving analysis.
The Caregiver Initiative: A Model for Caregiver Health and Wellness in Age-Friendly Health Systems
Authors: Carbonell Ellen , Golden Robyn , Pelton Leslie
Published: December 2021

Health care systems have historically relied on family caregivers to provide long-term care for older adults, often including medically complex care for which they have no medical training. Yet there are few interventions in place to assist them within health care systems. The Rush Caregiver Initiative (Rush-CGI) provides system-level and caregiver interventions. Rush-CGI’s system-level interventions focus on culture change, including modifying workflows, training, and electronic health record data. Rush-CGI caregiver interventions begin with assessment of needs and provision of resources for caregivers, offering interprofessional family-based interventions. Interventions include a Teach-Back Clinic, Family Care Planning sessions, and Goals of Medical Care meetings, all held on an outpatient basis either in person or virtually. Outcomes include decreased caregiver depression and anxiety, and increased caregiving self-efficacy. This presentation will discuss creating system level change and providing customized caregiver interventions, including how the Rush-CGI can be modified to fit a variety of patient populations.
NIA Division of Extramural Activities
Authors: Santora Kenneth
Published: December 2021

Dr. Santora will discuss the work of the NIA Division of Extramural Activities. Dr. Santora will also be available for small group discussion.
NIA Office of Special Populations
Authors: Jones Patricia
Published: December 2021

Dr. Jones will discuss the work of the NIA Office of Special Populations. Dr. Jones will also be available for small group discussion.
NIA Division of Aging Biology
Authors: Kohanski Ronald
Published: December 2021

Dr. Kohanski will discuss research priorities for the Division of Aging Biology. Dr. Kohanski will also be available for small group discussion.
Associations of Mental Health and Chronic Physical Illness During Childhood With Major Depression in Later Life
Authors: Bergmans Rachel , Smith Jacqui
Published: December 2021

While poor health in childhood has implications for mental health years later, less is known regarding its long-term impact. We determined whether childhood chronic physical illness burden was associated with major depression (MD) in later life (i.e., >50 years), and tested mediation by childhood mental health status using path analysis. Data came from the 2016 U.S. Health and Retirement Study (n=18,047). One standard deviation increase in childhood chronic physical illness burden was associated with 1.21 (95% CI = 1.12, 1.30) times higher odds of MD in later life. Childhood mental health status explained 57.8% (95% CI: 35.2, 80.4) of this association. Results indicated that the relationship of chronic physical illness burden in childhood with MD in later life was mediated by childhood mental health status. Whether greater screening for psychiatric-related symptoms in childhood or review of health histories in later life can reduce the burden of MD requires further study.
NIA Division of Neuroscience
Authors: Masliah Eliezer
Published: December 2021

Dr. Masliah will discuss research priorities for the Division of Neuroscience. Dr. Masliah will also be available for small group discussion.
Rising Star Early-Career Faculty Award Lecture and Cyber-Pedagogy Panel Discussion
Authors: Dassel Kara
Published: December 2021

The Rising Star Early-Career Faculty Award lecture will feature an address by 2021 recipient Candace S. Brown, PhD, MA, MEd, of the University of North Carolina, Charlotte. The Rising Star Early-Career Faculty Award acknowledges new faculty whose teaching and leadership stand out as influential and innovative. This event will also feature a panel discussion led by the AGHE Awards Review Panel titled, "Cyber-Pedagogy to the Rescue: Creating Effective Online Programming for Students and Trainees During the Pandemic.”
Cyber-Pedagogy to the Rescue: Creating Effective Online Programming for Students and Trainees During the Pandemic
Authors: Dassel Kara
Published: December 2021

COVID-19 upended in-person educational programming in areas such as classroom instruction within academic institutions, engagement of adult learners, and training of direct care workers. In-person educational offerings were forced, as a result of health restrictions, to pivot into either asynchronous or synchronous web-based instruction. This panel discussion will discuss lessons-learned in cyber-pedagogy in three areas: 1) Faculty Consultation: Faculty who teach online regularly and have completed training in quality online educational practices are experts who were called upon to assist others with transitioning courses to an online format. This presentation outlines the ways in which certified online instructors, at one academic center, tutored and assisted faculty in the health sciences with online instruction. 2) Adult Learning: The rapid transition to online learning has implications for adult learners pertaining to accessibility, diverse learning and technology abilities, and course and peer engagement. This presentation will explore strategies that faculty can utilize to offer adult learners differentiated learning and engagement opportunities. This discussion will also highlight the nexus among these pedagogical strategies and the Age-Friendly University Global Network, providing guidance for how universities can connect online learning methods to the Age-Friendly University principles. 3) Workforce Training: The direct care workforce employed in community-based services and support programs and long-term care settings tend to receive little or no training in geriatric care. This presentation will discuss how educational trainings offered through a Geriatric Workforce Enhancement Program transitioned onto web-based platforms in order to accommodate these ongoing educational needs throughout the pandemic.
Evaluating Risk of Neglect Among Older Adults Using NSHAP Round 3 (2015-2016)
Authors: Howe Melissa , Pierce Grey , Zhong Selena , Piedra Lissette , Choi Won
Published: December 2021

As functional health declines, dependency on others increases along with the risk of neglect and its harmful consequences. In this paper, we use data collected during 2015-16 (Round 3) of the National Social Life, Health, and Aging Project (NSHAP) to identify older adults at risk of neglect and to test the hypothesis that high neglect risk predicts poorer health. Specifically, we use NSHAP’s functional health survey module and follow-up care receiving “loop” to categorize respondents as having either “high” or “low” neglect risk. NSHAP’s functional health module assesses respondents’ difficulties with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Because ADLs and IADLs are integral to the maintenance of physical health, hygiene, and well-being, the unrequited desire for help with such activities could signal neglect. Accordingly, we assign “high neglect risk” to respondents who report either that they: (a) want but are not getting help with an ADL or IADL; or (b) are getting help with an ADL or IADL, but from a helper who is not very reliable. Motivated by current research that documents higher rates of morbidity and mortality among neglected older adults, we examine associations between neglect risk and other key NSHAP measures, including indicators of physical health, mental health, cognition, social support, social strain, and field interviewer assessed respondent hygiene. Results suggest that this method of risk assessment can be useful in identifying vulnerable populations of older adults. Follow-up interviews are needed to further confirm its utility as a risk assessment tool.
Predictors of Depression in Healthcare Patients at Risk of Self-Neglect
Authors: Rose Miriam , Ejaz Farida , Reynolds Courtney
Published: December 2021

More than half of reports to Adult Protective Services agencies nationwide involve allegations of self-neglect. An intensive case management intervention for preventing self-neglect was evaluated in a longitudinal study conducted collaboratively by a large healthcare system, Adult Protective Services, and a gerontological research institute. Patients (444) who were older (60+ years) and/or disabled (18+ years) were randomly selected for participation from 19 primary-care clinics if they had risk factors for self-neglect, including depression, substance abuse, dementia, and/or impairment in activities of daily living. Average age was 68 years (SD=12.5), 68% were Hispanic, 68% had monthly income of less than $1,361, and 67% were female. Clinics were randomized into intervention and control groups. Intervention clinic patients received intensive case management services; control clinic patients received usual care, including social work services. Subjects were interviewed at baseline and four months later. The Stress Process Model guided a multiple regression analysis. Domains of background characteristics, primary and secondary stressors, and support (patients in intervention or control group) were entered in blocks to predict depression levels at post-test. While no significant differences were found in post-test depression levels between intervention and controls, the final model was statistically significant (adjusted R2=.452). Significant predictors of depression were: younger age (disabled adults), poorer self-rated physical and emotional health, greater loneliness, and less social support. Future analyses will examine effects of moderating variables on post-test depression levels. Practice implications of preliminary analyses include addressing disabled adults’ mental health needs, especially if they are isolated and lack social support.
Evaluation of an Advanced Topics Workshop in Geropsychology: The Value of Depth in Training
Authors: Gregg Jeffrey , Rodriguez Rachel , Mehta Priyanka , Gould Christine
Published: December 2021

The Geriatric Scholars Program- Psychology Track (GSP-P) was implemented to address the dire shortage of mental health providers with geriatrics expertise within the VA, a large integrated healthcare system. One hundred and five psychologists participated in the GSP-P introductory geropsychology competencies course. Though they exhibited significant improvements in confidence, knowledge, and skills across geropsychology domains, increased depth (in addition to breadth) of training is needed. In 2019, GSP-P implemented an advanced workshop for graduates of the introductory course. Twenty-one psychologists participated in the workshop, which included 3.5 days of expert-led seminars followed by completion of an individualized learning plan over six months. Results from our evaluation indicated significant improvements in four of five geropsychology domains on the Pikes Peak Geropsychology Knowledge and Skill Assessment Tool. Our findings demonstrate continued enhancement of geropsychology competencies through advanced coursework is feasible and improves depth of training, particularly when combined with individualized learning plans.
Comparing the Emotion Status of Individuals With MCI to Their Cognitively Normal Counterparts: I-CONECT Project
Authors: Yu Kexin , Wild Katherine , Silbert Lisa , Kaye Jeffrey , Dodge Hiroko
Published: December 2021

Socially isolated older adults with MCI are at greater risk of developing ADRD. This study compares the emotional status of older adults with MCI to their cognitively normal counterparts within a socially isolated sample. We used baseline data from the Internet-based Conversational Engagement Clinical Trial (NCT02871921). MCI status was determined according to clinical diagnosis. Three emotion domain scores were calculated: negative affect, social satisfaction, and psychological wellbeing. Linear regressions were conducted for all 17 Emotion Battery measures and 3 domain scores. The 127 participants' mean age was 81.1 (SD=4.6). About 54% were diagnosed with MCI. Older adults with MCI had more negative affect, yet no difference was observed in social satisfaction and psychological wellbeing. Individuals with MCI had higher levels of fear, perceived hostility, perceived stress, sadness, and lower self-efficacy. Better understanding the emotional status could inform the development of behavioral health interventions and early detection of MCI.
Changes in Dementia-Related Behavioral Symptoms Observed by Hospice Staff During COVID-19
Authors: Lin Shih-Yin , Convery Kimberly , Jones Tessa , Durga Aditi , Brody Abraham
Published: December 2021

COVID-19 infection control precautions (e.g., social distancing) and associated isolation and changes to routines can worsen dementia-related behavioral symptoms. A cross-sectional online survey was administered to 101 hospice staff (95% female; mean age 49) to investigate what dementia-related behavioral symptoms in their care recipients had changed from before to after the COVID-19 outbreak. Of the 101 participants, 47 (46.5%) reported changes in symptoms, three (3%) had not been able to physically observe/assess their care recipients, two (2%) reported changes in routines, and 49 (48.5%) reported no changes. The most common changes in symptoms were increased agitation (N=19), depression (N=16), confusion (N=10), and anxiety (N=6). Some participants (N=14) also commented on potential causes, including not having visitors and inability to go outside for normal activities while not understanding why. Interventions to normalize social environments for hospice recipients with dementia are likely imperative to alleviate behavioral symptoms exacerbated by COVID-19-related precautions.
Cognitive Behavioral Therapy for Insomnia in Geriatric Primary Care
Authors: Hinrichsen Gregory , Leipzig Rosanne
Published: December 2021

Insomnia is common in older adults and may have adverse cognitive, emotional, and physical consequences. Some older people are prescribed sleep medications for insomnia despite longstanding concerns about their use with older people (i.e., BEERS criteria). Cognitive Behavioral Therapy for Insomnia (CBT-I) is highly effective in the treatment for insomnia in adults and older adults. However, most studies of CBT-I in late life have been conducted with individuals younger than 70. This paper discusses four years of experience of providing CBT-I to older people in geriatric primary care, two-thirds of whom were older than 75 years of age. Among the subgroup of 29 individuals who completed a full course of CBT-I, almost all of those who had been on sleep medications discontinued them. Treatment outcomes were large and clinically meaningful. This paper will also describe our experience in providing CBT-I via telehealth because of the COVID pandemic.
Virtual Geriatric Mental Health Care Offered Where Needed Most: An Evaluation of a Telehealth Consultation Model
Authors: Filips Julie , Carlson Chalise , Alfaro Ana , Trevedi Ranak , Savell Anita , Gould Christine
Published: December 2021

Many VA facilities serving large rural populations do not have geriatric mental health specialists available to assist with managing the aging Veteran population’s complex medical and behavioral comorbidities. We applied mixed-methods to evaluate an innovative model utilizing a geriatric psychiatrist who provides cross-facility consultation in a 5-state region. During a 3-month period, the consultant completed 135 consults and 20 e-consults to settings ranging from outpatient to long-term care. Leadership stakeholder and provider interviews highlight the importance of the availability of the consultant, collaboration with local care teams, staff education, person-centered approach, and work ethic/passion. The core challenges that the consultant helps manage include complex comorbidities, medication questions, and dementia with behavioral disturbance. Initial provider survey responses (n = 11) show high satisfaction with services (100%) and strong agreement (80%) that providers could follow through with recommendations. Next steps include replication of this model in other VA facilities.
Does Relationship End Precede Cognitive Decline? An Analysis of the Health and Retirement Study
Authors: Hanes Douglas , Clouston Sean
Published: December 2021

Relationship status is thought to be associated with cognitive health in older adults, with married persons performing better on memory assessments than unmarried-cohabitating, single, divorced, and widowed persons. However, questions remain about whether relationship termination causes cognitive decline, is a result of it, or whether they share a cause; and the mechanisms by which such a relationship might operate. To address this gap in the literature, we hypothesized that relationship termination could affect cognition via the following five pathways: (1) post-termination depression; (2) loss of distributed-cognition partner; (3) cognitive depletion from caring for partner in declining and ultimately terminal health; (4) divorce to preserve assets to qualify for Medicaid to cover healthcare for cognitive decline; and (5) post-termination changes in neuropsychiatric symptoms alongside a pre-existing neurodegenerative condition that also causes cognitive decline. Using data from the 2000–2016 waves of the Health and Retirement Study (HRS; N = 23,393), we found that relationship termination, whether due to divorce or widowhood, was associated with cognitive decline. Using mixed-effects regression we found that the rate of cognitive decline increased after relationship termination (widowhood: □ = -0.587, p <0.001; divorce: □ = -0.221, p <0.001), supporting mechanism (5). Using HRS data for respondents and their spouses’ mental and physical health, health insurance, and activities of daily living, we also find support for mechanisms (1) and (3). Relationship termination is a critical juncture in a person’s life course that has multiple implications and may, ultimately, worsen patients’ conditions.
Health Effects of Power Loss After Hurricane Irma on Nursing Home Residents in Florida
Authors: Gordon Lily , Skarha Julianne , Sakib Nazmus , June Joseph , Jester Dylan , Peterson Lindsay , Dosa David
Published: December 2021

Previous research establishes that hurricanes adversely affect nursing home (NH) resident health but specific causal pathways are still unclear. We combined power outage data with Medicare claims to determine the effects of power loss from Hurricane Irma(2017) among NH residents in Florida. Out of 580 facilities, 289 reported power loss. These facilities had higher star ratings; higher beds counts, and were preferentially in the Southeast region of Florida compared to facilities without outages. There were 27,767 residents living in a NH without power. They were comparable in characteristics to residents that did not lose power (N=26,383). We ran adjusted generalized linear models with robust standard errors, clustering for NH. We found power loss was associated with a trend towards increased odds of mortality within 7-days (OR:1.12, 95% CI:0.96, 1.30) and 30-days (OR:1.10, 95% CI:1.00, 1.21) post-storm, but not with hospitalization. Future research should investigate the time-specific effects of power outages.
Short-Term Fluctuation of Subjective Age and its Correlates: An Ecological Momentary Assessment of Older Adults
Authors: Kornadt Anna , Pauly Theresa , Gerstorf Denis , Kunzmann Ute , Schilling Oliver , Weiss David , Luecke Anna , Wahl Hans-Werner
Published: December 2021

We examined short-term fluctuations of subjective age with data obtained from 123 young-old (Mage = 67.19 years) and 47 old-old adults (Mage = 86.59 years) who reported their momentary subjective age six times a day over seven consecutive days as they were going about their everyday lives. Participants felt younger on a large majority of occasions, and 25% of the total variability in subjective age could be attributed to within-person variation. Those with younger trait subjective ages exhibited larger moment-to-moment variation, while chronological age did not impact variability. Furthermore, we investigated relationships between within-day fluctuations of subjective age and daily cortisol fluctuations. Our findings extend the literature on subjective age by showing that how old people feel can vary on a momentary basis, that state and trait components of subjective age are related, and that fluctuations in subjective age are related to biomarkers of stress.
Longitudinal Relations Between Views on Aging and Perceived Stress: Evidence for Mutual Associations
Authors: Wahl Hans-Werner , Kornadt Anna , Wettstein Markus
Published: December 2021

We investigated the reciprocal longitudinal relation between perceived stress and three established domains of views on aging (VoA): (1) subjective age; (2) attitude toward own aging [ATOA]; and (3) aging-related cognitions including social loss, physical decline, and continuous growth. We also examined the potentially moderating role of chronological age. Data of the German Ageing Survey, comprising two measurement occasions (2014 and 2017) and a sample of 4,588 individuals aged between 40 and 95 years, were analyzed. Controlling for socio-demographic and health-related indicators, cross-lagged models indicated mutual longitudinal relations between VoA and stress. Whether the pathway from stress to VoA or the opposite pathway was stronger varied depending on the VoA considered. With increasing age, most VoA domains were less strongly associated with subsequent perceived stress. Our findings suggest that less favorable VoA predict higher perceived subsequent stress, but they are also preceded and predicted by higher levels of perceived stress.