bluuebunny/crossref_metadata_2025 huggingface dataset:
THE DAILY BALANCE PROJECT: AN INQUIRY INTO THE INTRAINDIVIDUAL DYNAMICS OF PERCEIVED AND ACTUAL FALL RISK
Authors: Mejia Shannon T , Hsieh Katherine , Fanning Jason , Sosnoff Jacob
Published: November 2019

An accurate understanding of one’s abilities and limitations allows adaptive response to the challenges that are faced in daily life. However, older adults may over or under estimate their actual abilities. The Daily Balance Project examined the intraindividual dynamics of older adults’ perceived balance with objective measures of balance and physical activity. For 30 consecutive days, following a comprehensive fall risk assessment, 20 older adults rated their balance confidence (Activities Balance Confidence scale) at that moment and then performed five standardized balance assessments measured via smartphone accelerometer held to their chest. Physical activity was measured with an activity monitor. Baseline measurements of fall risk differentiated the extent of intraindividual variation and co-variation of balance and physical activity. For some participants, actual and perceived balance became more closely aligned as the study progressed. The implications of the findings for life-span perspectives on aging and fall prevention are discussed.
LONGITUDINAL EVIDENCE FOR DISCREPANT CHANGES IN NEGATIVE AFFECT REACTIVITY AND BLOOD PRESSURE REACTIVITY WITH AGE
Authors: Koffer Rachel E , Kamarck Thomas W
Published: November 2019

Both affective and blood pressure (BP) reactivity are associated with long term risk of chronic disease and mortality. Thus, understanding age-related changes in negative affect and BP responses to everyday demands is vital for promoting healthy aging. However, few studies have examined both psychological and BP reactivity simultaneously, which would provide more comprehensive understanding of regulatory processes at play. For the present study, 232 adults aged 50-70 years were assessed at baseline and 6 years later with ambulatory BP monitoring and momentary electronic diaries. Reactivity coefficients were output from multilevel models and used to test changes in negative affective and ambulatory BP reactivity to task demand, longitudinally. Results indicate that both systolic and diastolic BP reactivity increase with age, while negative affect reactivity does not change with age. Results are discussed in the context of life course theories of role strain and role changes and socioemotional theories of aging.
INTERVENING IN THE LONGEVITY NETWORK
Authors: Mendenhall Alexander , Sutphin George L
Published: November 2019

This session will focus on interventions to delay biological aging with the goal of in increasing lifespan and healthspan.
NUTRITIONAL NEEDS AND PREFERENCES AMONG AFRICAN AMERICAN CUSTODIAL GRANDMOTHERS: A QUALITATIVE STUDY
Authors: Mayfield Kellie E , Whitley Deborah , Kelley Susan J
Published: November 2019

This presentation summarizes a qualitative analysis from focus groups with African American, urban dwelling grandmothers raising grandchildren in parent-absent households. Nutritional needs of custodial grandparents are an under explored area of research. Previous studies on custodial grandparents have acknowledged the physical, social, and familial burdens they endure as caregivers of their grandchildren. Limited financial support is a consistent concern. One manifestation of having scarce monetary resources is not being able to meet daily nutritional requirements. As a result, adverse health outcomes related to the onset of diet-related diseases (e.g., obesity, hypertension, diabetes) are too common, especially for custodial grandparents of color. The present study qualitatively explores grandmothers’ (N=9) experiences and ideas about food choices/options, decisions about when and where to purchase food, and the involvement of grandchildren in food-related practices and traditions. Grandparent participants were recruited from a community-based intervention, a program that provides health and social support services to grandparents raising grandchildren in Atlanta. Each of the focus groups consisted of 4-6 custodial grandmothers , facilitated by a doctoral-level community nutritionist. The major themes summarized from the qualitative group interviews were framed within a feminist/race theoretical context. Dominant themes from the focus group encounters include traditional gender roles related to food purchase and preparation, prioritizing food options to meet family preferences, available/accessible urban-based food options, food knowledge deficits, and sustaining cultural identity and nutritional health. Findings suggest implications for food and health policy, community-level programming, and nutrition education interventions.
FAMILY COHESION MODERATES THE RELATIONSHIP BETWEEN ACCULTURATION AND HEALTH AMONG OLDER CHINESE AMERICANS
Authors: Wang Kaipeng , Zhang Anao , Sun Fei , Hu Rita X
Published: November 2019

Migration and resettlement are major life events that affect immigrants’ functioning and health status. Previous research has well-established the influence of acculturation and family cohesion on Chinese Americans’ mental health and health behavior; however, the moderation effect of family cohesion on the relationship between acculturation and self-rated health – a robust measure of an individual’s general health – has not been examined among this population. The purpose of this study is to examine the association between family cohesion, acculturation, and self-rated health among older Chinese Americans. Data came from a survey of 385 Chinese Americans aged 55 and older living in a large metropolitan area in Southwest America through face-to-face interviews. We used logistic regression to examine the association between acculturation, family cohesion, and self-reported health. In general, acculturation was significantly associated with higher odds of reporting excellent or good health after adjusting for demographic and psychosocial covariates; however, the association between acculturation and self-reported health differed by family cohesion. We found that acculturation was positively associated with self-reported health only among those with medium or high family cohesion, but not among those with low family cohesion. Findings highlighted the significance of involving family members and strengthening family support for providing acculturation services, such as language class and healthy literacy education, to older Americans. Family cohesion needs to be considered by health and mental health care providers for older Chinese Americans to further understand the resources and barriers that influence their health service use and health behaviors.
GRIEF EXPERIENCE PATTERNS AMONG OLDER ADULTS IN RURAL CHINA: A LATENT PROFILE ANALYSIS
Authors: Pan Haimin
Published: November 2019

Grief experiences among older adults in China are understudied, though a variety of negative bereavement outcomes have been delineated. The present work sought to explore grief patterns among Chinese older people in rural areas, as well as the factors influencing the bereavement results. Participants were 352 older residents who responded to a face-to-face interview and lived in rural areas in Zhejiang Province of China. Latent profile analysis (LPA) was used to identify subtypes of class membership in combing complicated grief (CG), depression, anxiety, and meaning in life. Afterwards, these subgroups were compared on demographic characteristics and meaning making variable. The LPA model best fitting the data was a three-class solution comprised of “adaptive” (n=235; 66.8% of the sample), “moderate maladaptive” (n=83; 23.6% of the sample), and “severe maladaptive” groups (n=34; 9.7% of the sample). Compared to the “severe maladaptive” group, participants in the “adaptive” group had better physical functioning, higher education and incomes levels, and less meaning making engagement, while participants in the “moderate maladaptive” group had longer bereavement duration, better physical functioning, and less meaning making activities. Relative to the “moderate maladaptive” group, participants who were adaptive to the loss possessed longer bereavement duration better physical functioning, higher education and incomes levels, and less meaning making engagement. Findings suggest three distinct patterns of bereavement outcomes among Chinese older adults. Multiple factors impacting the results were taken into consideration. Future replication is necessary to validate these subgroups, and professional services should be provided to bereaved older Chinese in need.
WHEN I’M 75: COLLEGE STUDENTS’ SELF-PERCEPTIONS OF AGING IN AN INTRODUCTORY GERONTOLOGY COURSE
Authors: Hahn Sarah J , Kinney Jennifer
Published: November 2019

This presentation examines college students’ self-perceptions of aging using written essays from the assignment “When I’m 75” that was assigned at the beginning and end of the semester in an introductory gerontology course. Despite robust literature on people’s attitudes toward aging and older adults, far less is known about attitudes toward one’s own aging, especially among college students. Interpretive Phenomenological Analysis was used to analyze the students’ perception of their aging experience in their written assignment. Three overarching superordinate themes were identified: challenges of aging, proactive steps to avoid negative consequences of aging, and housing considerations. Findings suggest that after completing an introductory gerontology course, students demonstrated an understanding of some age-related changes yet still had a stereotypical understanding of what it is like to be age 75. This suggests the need to engage students in moving beyond stereotypes and to better link older age with their own future experience.
STRAIN AMONG CAREGIVERS OF OLDER BREAST CANCER PATIENTS
Authors: Overcash Janine A , Fugett Susan , Tan Alai , Ginther Jane , Williams Nicole
Published: November 2019

Caregiver strain is the emotional and physical demands associated with providing care, particularly when the needs exceed the resources. The purpose of this presentation is to illustrate the predictors of strain among caregivers of older breast cancer patients. Relationships among caregiver strain (Modified Caregiver Strain Index), age, employment status, patient characteristics and scores on the comprehensive geriatric assessment (grip strength, Timed up & Go, Mini Nutritional Assessment, MiniCog, Geriatric Depression Scale, Pittsburgh Sleep Quality Index, and Brief Fatigue Inventory) are described. This cross sectional study included women who were diagnosed with breast cancer, over the age of 69 years, receiving any type of treatment and seeking an initial assessment in a geriatric oncology program.. Dyads (N=39) had a mean patient age of 77 and caregiver age of 64 years. Most patients were diagnosed with infiltrating ductal carcinoma 30 (76.9%), most had lumpectomy 23 (59%), and were stage 1 15 (38.5%). Most patients had one caregiver 22(56.4%) who worked full-time 12(30.8) and rated their health as very good 16 (25.4%). Increasing age of the caregiver was associated with less caregiver strain (r = -0.45, p=.02). Employment status of the caregiver was significantly related to caregiver strain -0.35 (p=.03). Caregivers employed full time 3.5 (p = .08), and part time 5.9 (p=0.3) experienced greater strain (mean±SD: 9.4±8.8) than those employed full-time (4.7±3.4). Patient depression, caregiver employment status and age of the caregiver are related to caregiver strain. Healthcare providers must assess for strain in cancer givers of cancer patients.
GENETIC INFLUENCES ON LUNG FUNCTION CONTRIBUTE TO SUBSEQUENT AGE CHANGES IN MOTOR FUNCTION
Authors: Finkel Deborah G , Ernsth-Bravell Marie
Published: November 2019

Researchers have striven to determine whether the age changes in physical and cognitive functioning are coincident, or does change in one domain precede functioning in the other. Dual change score models (DCSM) facilitate testing of hypotheses about temporal patterns of aging. Previous investigations in the Swedish Adoption/Twin Study of Aging (SATSA) indicate three directional effects: age changes in processing speed contribute to subsequent age changes in cognition, age changes in lung function contribute to subsequent age changes in processing speed, and age changes in motor function contribute to subsequent age changes in processing speed. In the current analysis we apply DCSM to twin data to examine the nature of the longitudinal relationship between motor functioning and lung function. Three motor functioning factors were created from 20 performance measures: balance, flexibility, and fine motor movement. Peak expiratory flow measured lung function. Participants were 829 adults aged 50-88 at the first of 9 waves of testing (mean = 4.4 waves) covering a 27-year follow-up period (mean = 13.1 years). Model comparisons indicated that genetic influences on decline in lung function contributed to subsequent decline in motor function. Combined with previous results, these results suggest a pathway that may start with age declines in lung function, which then contribute to declines in motor function, which in turn contribute to subsequent declines in processing speed and then cognitive decline. These data indicate that interventions focusing on improving or maintain lung function should have the added effect of maintaining motor and cognitive function.
ASSOCIATION BETWEEN BLOOD PRESSURE AND COGNITIVE FUNCTION OF COMMUNITY-DWELLING OLDEST OLD IN OKINAWA, JAPAN
Authors: Namihira Yukihiro , Tokashiki Takashi , Ishida Akio , Ohya Yusuke , Dodge Hiroko H
Published: November 2019

Background: Adults 80 years and older are the fastest-growing segment of the Japanese population and face a high risk of cognitive decline. There are some evidences connecting hypertension to cognitive decline. In mid-life hypertension is known to have influence the cognitive decline in older age. However, a few study have examined the association between hypertension or vascular stiffness and cognitive function among elderly over 80 years old. We analyzed the associations between vascular stiffness and cognitive function among relatively healthy community-dwelling non-demented oldest old. Method: Data came from the Keys to Optimal Cognitive Aging (KOCOA) study; an ongoing cohort of relatively healthy volunteers aged over 80 years old, living in Okinawa, Japan. In 2017, 105 non-demented (Clinical Dementia Rating < 1) subjects completed three kinds of examination for vascular function (75 % female, mean age (SD) 84.0 (3.0)). We categorized subjects into low and high cognitive function groups using Montreal Cognitive Assessment (MoCA) (25/26 as a cutpoint). Logistic regression models were used to examine the association between cognitive and vascular functions. Results: Narrower pulse pressure, an indicator of lower arterial stiffness, was associated with better cognitive function among subjects, after adjusting for gender, age, and education (p≦0.05), although systolic and diastolic blood pressure were not. Conclusion: Our findings suggest that narrower pulse pressure is related with cognitive preservation. The present study supports the hypothesis that lower arterial stiffness is related with better cognitive function even among the oldest old.
EFFECT OF INFLUENZA VACCINE ON TWEAK LEVELS IN THE ELDERLY: IMPLICATION IN CARDIOVASCULAR PROTECTION
Authors: Tavenier Juliette , Ouyang Min , Li Huifen , Leng Sean X
Published: November 2019

Substantial evidence suggests a protective effect of annual influenza immunization on cardiovascular diseases (CVD). The inflammatory mediator TNF-related weak inducer of apoptosis (TWEAK) is thought to be involved in the pathogenesis of CVD. We previously showed that administration of a standard-dose influenza vaccine reduced circulating TWEAK levels. This study aimed to test the hypothesis that a high-dose vaccine would have greater impact on TWEAK levels than the standard-dose. Two groups of participants matched on age and sex were included in the study. One group (n=25) received standard-dose vaccine during 2008-2009 season, the other group (n=25) received high-dose vaccine during 2014-2015 season. Soluble TWEAK (sTWEAK) levels were assessed using ELISA in serum samples collected immediately before vaccination and during the 4th week after vaccination. Vaccine-induced strain specific antibody titers were measured by hemagglutination inhibition assay. The participants had a mean age 86 years and 68% were women. Our preliminary results thus far demonstrated no statistically significant change in sTWEAK levels after vaccination in either group (Wilcoxon matched-pairs signed rank test: standard-dose group: median change [interquartile range]=11.2 [-92.2–197.1] pg/mL, p=0.72; high-dose group: -24.8 [-58.9–87.3] pg/mL, p=0.70). Pre-vaccination sTWEAK levels tended to be negatively associated with age (unadjusted linear regression of log2(x) transformed TWEAK levels on age: estimate [±SE]=-4.6% [±2.7%] change in TWEAK level per year, p=0.08). We continue to evaluate more pre- and post-vaccination samples. We have also begun exploring TWEAK expression by circulating immune cells (T and B lymphocytes and monocytes) and potential impact of influenza immunization in older adults.
THE ASSOCIATION BETWEEN VITAMIN K STATUS AND CARDIOVASCULAR DISEASE IN OLDER ADULTS
Authors: Shea M Kyla , Weiner Daniel , Matuszek Gergory , Booth Sarah L , Kritchevsky Stephen , Cushman Mary , Barger Kathryn
Published: November 2019

A role for vitamin K in cardiovascular disease (CVD) has been proposed because vitamin K-dependent proteins are present in vascular tissue. We evaluated the association between vitamin K status and incident CVD and mortality in older adults from the Health, Aging, and Body Composition Study (Health ABC), and conducted a replication analysis using the Multi-ethnic Study of Atherosclerosis (MESA). In both cohorts circulating phylloquinone (vitamin K1), measured from baseline fasting blood samples, was categorized as ≤0.5nM, >0.5-≤1.0nM, and >1.0nM. Multivariable Cox proportional hazards models assessed the association between circulating phylloquinone and risk of a composite of CVD and mortality. In Health ABC (n=1246, mean age 74 years, 57% female, 58% Caucasian), over a median 11.5 follow-up years, participants with ≤0.5 nM plasma phylloquinone (n=351) had a 27% higher risk for CVD and mortality compared to those with >1.0nM (n=457) [adjusted hazard ratio (95% confidence interval) (HR(95%CI)): 1.27(1.06-1.52)]. However, the risk for CVD and mortality did not differ between those with >0.5-≤1.0nM (n=438) and with >1.0nM plasma phylloquinone [HR(95%CI): 1.03(0.87-1.52)]. Serum phylloquinone was similarly associated with CVD and mortality in MESA, over a median 12.1 follow-up years (n=764, mean age 62 years, 54% female, 35% Caucasian) [HR(95%CI), compared to those with >1.0nM (n=368): <0.5nM (n=253): 1.54(1.03-2.32); 0.5-≤1.0nM (n=153): 1.23(0.76, 1.98)]. Lower circulating phylloquinone was associated with a higher CVD and mortality risk in two independent cohorts. Additional studies are needed to corroborate our findings and clarify if certain segments of the population can derive cardiovascular benefit from improving vitamin K status.
CARDIOVASCULAR HEALTH AND SUCCESSFUL AGING: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS
Authors: Lan Tzuo-Yun , Krefman Amy , Bancks Michael , Shea Steven , Liu Kiang , Allen Norrina
Published: November 2019

Individual risk factors have been shown to be associated with successful aging. However, the combined effect of behaviors and biomarkers on successful aging remains unclear. By using the Multi-Ethnic Study of Atherosclerosis (MESA) dataset, this study was to examine the association of AHA’s Cardiovascular Health (CVH) with successful aging. A total of 1,597 who were followed from baseline (2000-2002) at age 49-64 through exam 6 (2016-2018) at age 65-80 were included. CVH, including smoking, body mass index (BMI), physical activity, diet, blood pressure, cholesterol, and blood glucose, was measured at baseline. The CVH score, ranging from 0-14, was divided into ideal (11–14), intermediate (9–10), and poor (0–8) groups. Normal or successful aging, defined as avoiding major disease (including cancer, cardiovascular, or severe lung or kidney diseases), no disability, high cognitive function, high physical functioning, and engagement with life, was assessed at exam 6. We compared the cumulative incidence of successful aging among three groups. Modified Poisson regression model was employed to estimate relative risk (RR) adjusting for age, gender, race, education, income, marital status, and alcohol consumption. Among study participants at baseline, 36% were in ideal, 39% in Intermediate, and 25% in poor CVH. By exam 6, only 18% met the criteria for successful aging. Compared with the poor group, the adjusted RRs (95 % CI) of successful aging for the intermediate and ideal groups were 1.78 (1.23-2.56) and 2.56 (1.79-3.67). Our data suggest that CVH in midlife is associated with successful aging in later life.
IDENTIFYING COGNITIVE IMPAIRMENT WITH PRIMARY CARE IMPLEMENTATION OF THE BRIEF INTERVIEW FOR MENTAL STATUS
Authors: Gilbert Karen L
Published: November 2019

Overview: An estimated 5.7 million Americans are affected by Alzheimer’s disease (AD; 2018 Alzheimer’s disease facts and figures, 2018, p. 367). Cognitive impairment fails to be identified in the primary care setting as often as 76% of the time (Moyer, 2014, p. 793). Screening can identify patients with emerging impairment who might otherwise appear cognitively intact Grober, Wakefield, Ehrlich, Mabie & Lipton, 2017, p.191). Early identification of cognitive impairment promotes evaluation of treatable causes (Possin et al., 2018, p. 150), and access to early treatment for irreversible disease, facilitating future planning (Swallow, 2017, pp. 57, 63). Methods: This quantitative study’s aim was to identify patients with occult cognitive impairment. After training staff in a Palm Beach County Florida primary care practice, the Brief Interview of Mental Status (BIMS) was administered to patients aged 45 years and older. Results: Seven of 120 screened patients, with no known AD diagnosis, scored as moderately impaired. One of these patients was 64 years of age, the remaining six ranged from age 71 to 93. Fourteen patients scored at the lowest range of “cognitively intact,” eight were under age 65. Conclusion: Cognitive screening of primary care patients with no known diagnosis of AD identified approximately 7% scoring as moderately impaired; an additional 12% scored at the lowest range of “cognitively intact,” suggesting a potentially emerging cognitive impairment warranting follow up evaluation for treatable causes, developing AD, or a related neurocognitive disorder.
PARALLEL DEVELOPMENT OF MEMORY, DISABILITY, AND COMORBIDITY IN U.S. ADULTS AGE 65 AND OLDER
Authors: Bishop Nicholas J , Wang Kaipeng
Published: November 2019

Cognitive health, physical function, and chronic disease represent interdependent health outcomes that may exert influence on the course of each other’s development. To investigate the association between baseline health in each domain and developmental change across domains, we estimated trajectories of working memory, mobility limitations, and comorbidity among US adults age 65 and older over 18 years. We drew observations from the nationally-representative Health and Retirement Study with an analytic sample consisting of 5,963 adults age 65 and over in 1998. Immediate word recall, an 11-item Nagi scale of mobility limitations, and a summary count of eight doctor-diagnosed chronic conditions were measured biennially from 1998 to 2016. Parallel-process quadratic growth models with individually-varying time scores were used to estimate non-linear trajectories of each health measure, allowing identification of associations between baseline health and developmental change in each health process at both earlier and later stages of older adulthood. All estimates adjusted for covariates, complex survey design, and missing data. Greater baseline immediate word recall was associated with less rapid increase in mobility limitations at earlier ages. More baseline mobility limitations were associated with faster increase in comorbidity at earlier ages. Greater baseline chronic conditions were associated with more rapid increase in mobility limitations at later ages. These results highlight the importance of conceptualizing health among older adults as an interdependent and developmental process and should help clinicians recognize that single-domain health status may influence the progression of other health outcomes at different stages of older adulthood.
TUNING ENVIRONMENTAL LIGHTING TO IMPROVE SLEEP QUALITY AND COGNITIVE PERFORMANCE IN OLDER ADULTS
Authors: Shishegar Nastaran , Boubekri Mohamed
Published: November 2019

Sleep is important for memory consolidation, hence the disruption of normal sleep patterns as a result of age-related changes in the circadian system could be one of the contributors to memory impairment among older adults. It is now well-established that light is the main environmental element that synchronizes circadian rhythms. An appropriate lighting condition can be considered as a non-pharmacological solution to improve the sleep quality of individuals and consequently their overall health and well-being. The present study investigates the effectiveness of two proposed whole-day lighting interventions (L1 and L2) applied by Tunable White Lighting Technology (TWLT) on sleep quality and cognitive performance in older adults. Both lighting interventions provide a high illuminance level (500 lux) in the morning and then the illumination is dimmed gradually throughout the day and reached 100 lux in the evening. However, while L1 offers a constant Correlated Color Temperature (CCT) of 2700K, during the L2 intervention, the CCT is changing in the range of 6500K – 2700K from morning towards evening. Fifteen healthy older adults (mean age = 73.2 years; 12F) participated in a 41-day counterbalanced crossover study. Participants were exposed to each lighting condition for 9 days. Actigraphy, standard questionnaires (PROMIS and PSQI), and tests (Trail Making Test (TMT) A & B and Digit Symbol Substitution Test (DSST)) were employed to measure sleep quality and cognitive performance before, during, and after lighting interventions. Significant improvements in sleep quality and cognitive performance were found for both lighting interventions with better outcomes for L2.
STORY CIRCLES AS A METHODOLOGY: A PILOT STUDY EXPLORING COGNITIVE PROBLEMS IN AGING
Authors: Sweeder Logan A , Hill Nikki , Whitaker Emily , Tiwari Anushka , Doan William
Published: November 2019

A Story Circle refers to a group of individuals in a comfortable social environment sharing personal experiences through stories to explore problems shared by a community and facilitate artistic representation of experiences of interest. In this pilot study, we examined the feasibility of Story Circles to facilitate qualitative inquiry of the experience of cognitive problems among older adults. A convenience sample of six cognitively intact, community-dwelling older adults (M=72.5; SD=5.09 years; 83% female) with self-reported cognitive complaints participated in a 90-minute Story Circle as well as a follow-up phone call. Each shared a personal story of experiencing a cognitive complaint and related these experiences to those shared by others in relation to a prompt provided by the group facilitator. Participants reported enjoying the Story Circle experience (M=8.5/10; 10 = extremely positive) and interest in participating in future Story Circles (M=9.3/10; 10 = extremely likely). Common themes included a sense of community established during the group that persisted after its conclusion as well as a normalization of the experience of occasional cognitive problems. Story Circles may be a useful data collection method to enhance understanding of complex phenomena within a social context.
THE IMPACT OF PARTICIPATION IN SOCIAL HEALTH NETWORKS
Authors: Faul Anna , Huff Mona , Cotton Samantha G , Yankeelov Pamela , D’Ambrosio Joe , Austin Megan
Published: November 2019

Stress and compassionate fatigue are common among graduate level students working in healthcare professions, however, few studies focus on preventative self-care and its’ impact on these learners. As part the University of Louisville’s Behavioral Health Workforce Enhancement Training Program (BHWET), graduate students are trained to work with older adults in rural communities. The focus of our BHWET program is to provide holistic, behavioral health care through our FlourishCare Network. As part of the student’s weekly curriculum, an interdisciplinary group of learners from counseling psychology, social work and psychiatric nursing were invited to the attend the sessions were invited to participate in a 2-semester Microclinics and Health Matters course that was designed to promote self-care and harness the power of social networks to promote health. A total of 15 students completed the program. Biomarkers including BMI, Cholesterol, A1C, Blood Pressure were taken every week time the course was offered. Cortisol levels were taken every 4 months to measure stress levels. Across the initial 12 weeks of programming, there were positive outcomes for the participants in terms of either maintenance of healthy goals or biomarkers. Additionally, the program had an impact on the older adult clients that were being served by the students compared to students that did not participant. In a review of the plan of care items, which is central to our work with FlourishCare clients, plan of care items showed a stronger focus on connecting clients to social health interventions and a stronger connection to education about health-related content.
IS ME IMPORTANT TO US? ACTOR AND PARTNER EFFECTS OF SELF-ACCEPTANCE ON SPOUSAL SUPPORT
Authors: Lee Kyuho
Published: November 2019

Marital relationship is influenced by substantial and perceived support exchange. Therefore, it is important to find predictors of support-giving and support-receiving. However, very few studies attempted to do so. As some previous studies reported, individuals’ personality-related characteristics seem to play a significant role in the support exchange within couples. This study aimed to assess the effect of individuals’ self-acceptance on support exchange within older couples. Data of 2,082 heterosexual older couples aged between 50 and 85 in 2006 from the Health and Retirement Study were assessed utilizing an actor-partner inter-dependence model and growth curve model. For the actor effects, both husbands’ and wives’ higher levels of self-acceptance predicted their own perception of the support from a spouse. For the partner effects as well, individuals’ self-acceptance positively predicted their spouse’s perception of the received support. Husbands’ self-acceptance, however, was associated with a decrease in wives’ perceived support. We discuss the possible mechanism with regard to older adults’ self-acceptance and marital support. The findings of the current study contribute to the theories of spousal support and personality as well as in the practical settings of couple therapy and education.
INCREASING THE POWER OF INTERGENERATIONAL NETWORKS: ADVANCING A NEW EVALUATION TOOL
Authors: Jarrott Shannon , Juckett Lisa A , Naar Jill Juris
Published: November 2019

According to a 2018 national survey of intergenerational (IG) care providers, practitioners identified as their number one concern a need for evidence-informed evaluation tools to demonstrate their impact on older and younger participants. The Best Practices Checklist is a 14-item (yes/no) measure grounded in evidence of effective intergenerational strategies. Trained evaluators complete the checklist based on their observations of facilitators’ behaviors during IG activities. Exploratory factor analysis (promax rotation) of the Checklist for 132 IG activities offers insight to factor structure and item construction. An adequate two-factor structure was achieved; seven Checklist items were retained with factor loadings greater than .39. Seven items were deleted due to non-variance, high missing data, or double loading across factors. Factors reflect dimensions of: (a) person-centered strategies (e.g. selecting activities based on participants’ interests) and (b) creating a positive physical environment (e.g., grouping participants into intergenerational pairs or small groups). Findings indicate that a Best Practices Checklist with fewer items may offer a suitable tool for assessing the utilization of Best Practices during IG activities. Given the demand for IG evaluation tools, the 7-item BP Checklist can be a brief, easy-to-use measure that documents IG facilitators’ implementation of evidence-informed practices. Its use could be especially helpful if connected to varied indicators of program effectiveness and participant outcomes.
SERVING UNDERSERVED VETERANS AND THEIR CAREGIVER: DEVELOPING TAILORED CULTURALLY RELEVANT INTERVENTIONS
Authors: Freytes I Magaly , Magda Schmitzberger , Naiomi Rivera-Rivera , Janet Lopez , Daniela Mylott , Keryl Motta-Valencia , Uphold Constance R
Published: November 2019

Family members of stroke survivors experience high rates of depression and burden. The majority of stroke survivors return to their homes and need assistance to perform activities of daily living. These demands coupled with the lack of preparedness for their new roles lead to a high risk for developing depression and other negative outcomes among caregivers. Studies indicate that Hispanic caregivers report higher levels of depression compared to others. However, no interventions have focused on this population. Our objective is to develop culturally-relevant interventions to help reduce disparities Hispanic Veterans post-stroke and their caregivers. We tailored our Spanish RESCUE intervention for the Puerto Rican population. The goal of the problem-solving telephone support & educational intervention is to reduce caregiver burden and depressive symptoms by teaching them a creative and optimistic approach to solving caregiving related problems. The intervention was developed to reflect specific characteristics of the target population. To enhance the cultural relevance of the intervention, we used recommendations from Key Stakeholders and guidelines from authoritative sources such as: 1) involving persons from the target population in all phases of the project; 2) emphasizing themes valued by the PR culture; 3) assuring that the language and wording of the materials is at appropriate reading level; 4) using certified translators and Spanish-speaking experts, and 5) having Hispanic research members, fluent in Spanish, and knowledgeable about the PR culture conduct the intervention and assessments. The intervention is currently been tested in a RCT.
A DECADE OF STROKE CAREGIVER RESEARCH: THE RESCUE CREST STUDY
Authors: Uphold Constance R , Freytes I Magaly , Jennifer LeLaurin , Magda Schmitzberger , Eliazar-Macke Nathaniel , Orozco Tatiana , Klanchar S Angelina , Dang Stuti
Published: November 2019

Stroke caregivers need education and support to care for suddenly disabled family members. To address this need, we are conducting a nurse-led intervention, called RESCUE CREST, to teach caregivers problem-solving skills using an educational website and an online messaging center. In our first, preliminary study, we pre-tested an investigator-created, senior-friendly website called RESCUE (Resources and Education for Stroke Caregivers’ Understanding and Empowerment) using focus groups and interviews with clinicians and caregivers. We refined the website based on additional surveys, a cognitive usability study, and Webtrends analysis. In the second study, we used a single-group pre- and post-test design to evaluate the content and outcomes of the problem-solving intervention. Third, we conducted a four-arm RCT (4-week intervention, 8-week intervention, attention control, standard care) to refine our methods. We will describe the lessons learned and results of our 10 years of stroke caregiver research that provide background for the RESCUE CREST study.
SOCIAL ENGAGEMENT MEDIATES THE ASSOCIATION BETWEEN ROLE OVERLOAD AND NIGHTTIME AWAKENING OF DEMENTIA CAREGIVERS
Authors: Liang Jiaming , Aranda Maria P , Lloyd Donald
Published: November 2019

Caregivers tend to report role overload and nighttime awakening given the burden of caregiving. Previous research has not explored the association between role overload and nighttime awakening among dementia caregivers. Social engagement has been found to be associated with physical and psychological health outcomes of caregivers. Thus, the present study aims to examine whether role overload is associated with nighttime awakening of dementia caregivers and whether social engagement will mediate the association. We conducted a cross-sectional study by using the 2015 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC). Six-hundred-and-sixty-nine dementia caregivers were included in the analysis. Relevant factors were controlled as covariates including age, gender, race/ethnicity, etc. Nearly 45% of participants reported suffering from nighttime awakening at “some” or “more” nights within one month, among which half of them reported “almost” or “every” night. Role overload was found associated with caregivers’ nighttime awakening (β=.135, 95%CI: .094 to.176, p<.001). The mediated model shows 7.4% of association between role overload and nighttime awakening could be explained by the mediation of social engagement (β= .010, 95%CI: 0.99x10-2 to 1.01x10-2, p<.05). The study suggests that dementia caregivers with high levels of role overload tend to experience nighttime awakening more than those who reported low role overload. A modest mediated effect indicates that role overload of dementia caregivers can predict their nighttime awakening partly through decreasing their social engagement. Other factors and longitudinal models shall be discussed to further explore the theoretical mechanisms of caregiver stress.
PATH ANALYSIS OF EDUCATION AND DISEASE BURDEN IN DEMENTIA VULNERABILITY
Authors: Hubner Sarah B , Kim Hyeon Jung , Boron Julie Blaskewicz
Published: November 2019

When considering the various extrinsic variables that may affect disease vulnerability, it is valuable to study temporal ordering of factors to identify areas for disease intervention efforts. This study sought to inform improvement of networks for the purposes of education and health by attempting to better define the causal ordering of ethnicity, age, gender, education, disease burden, and dementia diagnosis with the Aging, Demographics, and Memory Study, a sub-study of the Health and Retirement Study. Participants and/or proxies self-reported total number of chronic conditions, subsequently regarded as disease burden. Assessments occurred over four waves; participants were not reassessed after dementia diagnosis. The current study categorized participants as demented (n=414), identified in any wave, or normal (n=117), identified in the final wave. Cognitively-impaired-not-demented and deceased participants were not considered due to lack of diagnosis. Cross-sectional weighting was used. A path model was developed; ethnicity, age, and gender were antecedent to education, and education was casually ordered before disease burden, which was antecedent to dementia diagnosis. A series of logistic and linear regression analyses were conducted. Results revealed that being non-white (Σβ=0.643, all p’s<.001), of older age (Σβ=0.250, all p’s<.001), female (Σβ=0.180, all p’s<.001), and having increased disease burden (Σβ=0.118, p<.001) all demonstrated a positive total effect on dementia diagnosis. Conversely, more years of education (Σβ=-0.245, p<.001) had a negative total effect on diagnosis. The education to disease burden pathway was non-significant. Ultimately, these results may indicate a need for dementia interventions that target those with low education or high disease burden.
IDENTIFY THE BARRIERS THAT FAMILY CAREGIVERS FACE IN MANAGING PATIENTS’ PAIN: A LITERATURE REVIEW
Authors: Chi Nai-Ching , Fu Ying-Kai , Barani Emelia , Summerson Elizabeth
Published: November 2019

Most Americans enrolled in palliative and hospice care receive care at home and thus rely on their family caregivers (FCs) to manage their pain. However, FCs encounter many barriers to pain management. Previous studies focused on barriers faced by FCs of cancer patients. However, as palliative and hospice care evolves, the populations and diagnoses become diverse, and more barriers have been identified. Hence, the purpose of this study is to comprehensively investigate FCs’ barriers to pain management. A literature review was conducted to search available articles published before June 2018 in databases including PubMed, CINAHL, PsycINFO, and Scopus. Search strategies used index and keyword methods. The inclusion criteria were peer-reviewed, research studies published in English that explored barriers that FCs faced in managing pain. Eighty-six studied were identified: 76% of the studies focused on cancer pain and 6% focused on dementia pain. The identified barriers included: (1) caregivers’ limited knowledge in drug/non-drug pain management and verbal/non-verbal pain assessment; (2) caregivers’ issues (e.g. function, fear of analgesic, misbeliefs in pain management); (c) caregivers’ organizational skills (treatment recording and tracking); (d) patients’ issues (e.g. inability to verbalize pain); (e) communication issues with care teams. This is one of the few literature reviews that comprehensively investigate the barriers that family caregivers experience beyond cancer pain management. The results can be used to develop a screening questionnaire for palliative and hospice providers to assess and resolve FCs’ barriers to pain management, thereby improving the quality of pain management and patients’ and FCs’ outcomes.
BURDEN OF POTENTIALLY INAPPROPRIATE MEDICATIONS AMONG OLDER VETERANS WITH PAIN AND DEMENTIA
Authors: Allore Heather , Gnjidic Danijela , Han Ling
Published: November 2019

Among 115,869 Veterans ≥65 years old with a history of moderate to severe musculoskeletal pain (numerical pain intensity rating ≥4) admitted to Veterans Health Administration hospitals in fiscal year 2013, we tested whether medication use is potentially inappropriate (defined using the 2015 Beers Criteria; categorized as central nervous system (CNS) or other drugs) according to Alzheimer’s Disease and Related Dementias (ADRD) status based on ICD-9 codes. We used Poisson regression to estimate the association of the number of CNS Beers Criteria drugs (anticholinergics, antidepressants, antipsychotics, benzodiazepines, sedative hypnotics, pain medications, and opioids) and other Beers Criteria drugs according to ADRD status. The mean age of the cohort at the index hospital admission was 74.5 (SD 8.2), with 19.0% having ADRD and a Charlson comorbidity index of 3.9±3.0. After adjusting for age, sex, race/ethnicity, marital status, body mass index, 16 diagnostic criteria for pain and chronic conditions, mental health conditions and use of other system Beers Criteria drugs, we found that the mean number of CNS Beers Criteria drugs were 25% higher among Veterans with ADRD, with an adjusted risk ratio (aRR) of 1.25 (95% CI 1.23, 1.27; P <.0001). On the other hand, the mean number of other Beers Criteria drugs appeared to be 2% lower among ADRD group compared with inpatients without ADRD (aRR: 0.98 (95% CI: 0.97, 0.99), p<0.004). Clinicians need to be aware of potential side effects of using CNS Beers drugs in people with ADRD and whether there are alternatives to their use.
PAIN, AFFECT, AND OBJECTIVE ACTIVITY LEVELS IN OLDER ADULTS WITH OSTEOARTHRITIS
Authors: Behrens Emily A , DeCaro Jason A , Smith Dylan M , Parmelee Patricia A
Published: November 2019

This research examined the relation between physical activity, pain, and mood among older adults with osteoarthritis (OA). Physical activity is associated with long-term maintenance of function in persons with chronic pain (Dunlop et al., 2014), but less is known about the association between objective measures of activity and transient mood states. Therefore, we captured the activity and mood levels of 218 older adults with knee OA over a seven-day period. Wrist and waist accelerometers captured small and large motor movements. Self-reported momentary pain and affect were collected through phone calls four times daily. We examined average and peak activity levels over the 4-hour windows between self-reports. Cross-sectionally, there was no association between momentary pain and activity. Average large motor movement was positively associated with positive affect and negatively associated with negative affect. Analyses revealed one association between affect and average previous activity; small motor movements predicted greater positive affect. Peak levels of both movements predicted greater positive affect, but only peak wrist activity predicted negative affect. Peak small motor movement at the previous call was associated with both positive and negative affect. These results provide insight into the unique contributions of small and large motor activity to mood and pain states. It appears that average large motor movements and prior small motor activity may have the greatest impact on momentary affect. Further study of distinct activity types and mood will be important for understanding and improving the quality of life among individuals diagnosed with OA (Supported by R01-AG041655).
CAN HEART DISEASE SELF-MANAGEMENT EDUCATION ALSO REDUCE PAIN INTERFERENCE IN AFRICAN AMERICAN OLDER ADULTS?
Authors: Janevic Mary R , Allgood Kristi , Ramsay Jessica , Hogan Cainnear , Courser Rebecca , Connell Cathleen M
Published: November 2019

Many older adults with heart disease, especially those from vulnerable populations, live with chronic pain. Self-management strategies for reducing cardiovascular risk (e.g., physical activity, stress reduction) are also recommended for management of chronic pain. It is not known, however, whether self-management education focused on heart health has a beneficial “side effect” on pain-related outcomes. We explored this possibility using data from a randomized controlled trial (n=405) of Take Heart, a group intervention adapted for low-income, African American adults 50 and over with heart disease or significant risk factors. We first assessed the sample prevalence of high-impact chronic pain; i.e., substantial pain-related disability in one or more life domains (National Pain Strategy, 2016). Next, we assessed whether participation in Take Heart resulted in decreased pain interference (PROMIS-29). One-third of participants (n=131) met criteria for high impact chronic pain. Mean pain interference T-score in the entire sample at baseline was 58.1 (SD=9.9), indicating a score one standard deviation greater than population average. Compared to controls, intervention participants had a greater, but non-significant, improvement in pain interference (0.7 vs. -0.8; p=.11). Overall, findings demonstrate that African American adults with cardiovascular conditions have a high burden of comorbid pain. This pain was not greatly improved by an intervention that taught key chronic disease self-management skills but did not address pain specifically. Future research can test whether incorporating pain-management content into heart disease education has a stronger impact on improving pain outcomes -- which may, in turn, promote adherence to behaviors to reduce cardiovascular risk.