bluuebunny/crossref_metadata_2025 huggingface dataset:
A STEPPED WEDGE CLUSTER RANDOMIZED TRIAL OF THE STRIDE SUPERVISED WALKING PROGRAM IN VA HOSPITALS
Authors: Hastings Susan , Stechuchak Karen , Coffman Cynthia , Choate Ashley , Van Houtven Courtney , Wang Virginia , Meyer Cassie , Kappler Caitlin
Published: December 2022

In trials, hospital walking programs improved functional ability after discharge, but little evidence exists on their effectiveness under routine practice conditions or their implementation across health systems. We conducted a Type III hybrid implementation-effectiveness, stepped-wedge cluster randomized trial (SW-CRT) in 8 Veterans Affairs hospitals examining a hospital-based walking program known as STRIDE. Based on the SW-CRT design, hospitals were randomized to a sequence (timeline) for STRIDE, and additionally randomized 1:1 to receive implementation support according to the Replicating Effective Programs (REP) framework only or REP plus additional team-based communication training known as CONNECT. The study was powered to examine impact of STRIDE on discharge destination to home vs other (primary outcome); hospital length of stay (LOS) was a secondary outcome. Patient-hospitalizations in pre-STRIDE time periods (n=8167) were similar to post-STRIDE time periods (n=9070) (e.g., mean age 73, 97% male, 28–30% Black race). In adjusted models, odds of discharge to home were higher among eligible patients hospitalized in post-STRIDE time periods (OR 1.6; 95% CI 1.3–2) compared to pre-STRIDE. Findings were robust to 3 sets of sensitivity analyses. There was no difference in LOS (IRR 1.01; 95% CI 0.94,1.09). Hospitals randomized to CONNECT had higher program reach (mean 13% vs 3%) but lower daily fidelity (mean 25.7% vs 37.5%). Despite limited direct program reach, implementation of a hospital walking program was associated with higher odds of discharge to home. Implementation strategies like CONNECT that enhance teamwork and communication may improve patient access to clinical programs being implemented in new settings.
SURVIVAL OF THE FITTEST OR FRAILEST? COMPARING THE HEALTH OF CENTENARIANS OVER A 10-YEAR PERIOD
Authors: Pat Lian Ying Chun , Lau Bobo Hi Po , Cheung Karen Siu Lan , Chan Grace Man Yee , Kwan Joseph Shiu Kwong , Luk James Ka Hay , Martin Peter , Chan Cecilia Lai Wan
Published: December 2022

The first centenarian study in Hong Kong was conducted in 2011 and examined the multidimensional health of adults aged 95 or older. The 2011 study found that, among a population of about 3,000 centenarians, a significant proportion enjoyed a high degree of autonomy in their daily functions in relatively good health. The study has been repeated in 2021/22 (i.e., born in 1926 or before) when the city had more than 11,000 centenarians. Comparison of the two samples (2011: Nf77; 2021/22: Nf120) who lived with their family shows a significant difference in functional health, but not as much for physical health, favouring the 2011 cohort. More than 75% of the 2011 cohort demonstrated autonomy in activities of daily living (Bathing: 77.9%, dressing: 85.7%, toileting: 90.9%, indoor transfer: 89.6%; continence:75.3% and feeding: 94.8%). Only about half of the 2021/22 cohort were autonomous in these areas (40.0%, 44.3%, 54.7%, 42.5%, 63.2%, 46.7%, respectively). The number of chronic illnesses between the two cohorts were comparable (Mean(SD): 2011: 2.7 (1.6); 2021: 3.26 (1.60), yet dementia and frailty were more prevalent in the 2021 cohort (dementia: 44%; frailty: 9.1%) then the 2011 cohort (41.0%; 23.4%). Our findings alert metropolitans worldwide to the fast-increasing population of adults of advanced age with significant personal care and health needs in the community. Existing care for older adults has to be reframed and overhauled to provide comprehensive home- and personal-care support which will be essential for realizing ageing-in-place for adults in advanced age, especially after social distancing policies in COVID-19.
DEVELOPING A NOVEL FRAILTY INDEX TO STUDY FRAILTY OF SEXUAL AND GENDER MINORITY OLDER ADULTS IN THE ALL OF US DATABASE
Authors: Wong Chelsea , Wilczek Michael , Bosse Jordon , Smith Louisa , Manjourides Justin , Orkaby Ariela , Olivieri-Mui Brianne
Published: December 2022

Prevalence of frailty among older sexual and gender minority adults (OSGM) is unknown despite disparities in mental health, medical comorbidities, and physical function. The NIH-funded All of Us Program was launched May 2018 aiming to enroll 1 million US participants focusing on those underrepresented in biomedical research, including OSGM. Using validated methods, we developed an All of Us deficit accumulation frailty index (AoU-FI) consisting of 33-items using baseline survey responses of adults aged 50+. Deficit domains include comorbidities, physical functioning, mental health, cognition, and sensory impairment. AoU-FI was valid if ≤20% of items were missing and ≤70% were comorbidities. OSGM self-identified or had discordance between gender and sex responses. OSGM (n=5,678) and non-OSGM (n=66,325), were similar in age (mean (IQR) = 66.7 (60–73) vs 66.9 (60–74)) but were more diverse (White 78% vs 82%, Black 7.5% vs. 6.5%, Hispanic/Latino 6.9% vs. 5.9%). AoU-FI had an expected gamma distribution across groups. OSGM frailty had a narrower range (0–0.67 vs. 0–0.75) and higher mean of 0.19 (sd=0.11) vs 0.17 (sd=0.1) compared to non-OSGM. To our knowledge, this is the first study of frailty among OSGM. Findings suggest OSGM experience worse frailty, highlighting the need to understand disparities in frailty, identify interventions, and develop policies to support OSGM. Additionally, our novel AoU-FI creates opportunities to apply frailty to diverse participants and types of data from digital health to genomics within the All of Us database.
THE IMPACT OF A DIGITAL CANCER SURVIVORSHIP PATIENT ENGAGEMENT TOOLKIT ON OLDER CANCER SURVIVORS’ HEALTH OUTCOMES
Authors: Nahm Eun-Shim , McQuaige Mary , Steacy Katarina , Corbit Nancy , Zhu Shijun , Seong Hohyun
Published: December 2022

Cancer is a disease that predominantly affects older adults. The median age at diagnosis is 66 years and 62% of the 15.5 million American cancer survivors are age ≥65 years. Provision of supportive care after treatment is critical to this group due to their complex care needs; however, limited resources are available to them. As increasing numbers of older survivors adopt technology, digital health programs have significant potential to help them improve their health and communicate with their providers. Previously, we developed/tested a digital Cancer Survivorship Patient Engagement Toolkit program for older adults, CaS-PET Silver. The aim was to examine the preliminary impact of CaS-PET Silver on older survivors’ health outcomes. This was a 2-armed RCT with two observations (baseline, 8 weeks) on a sample of 60 survivors age ≥65 years (mean age, 70.1±3.8), who were treated with curative intent within 12 months from enrollment (02/2020-01/2022, COVID-19 pandemic). Outcomes included health-related quality of life (HRQoL), self-efficacy for coping with cancer, symptom burden, health behaviors, and patient-provider communication. Data were analyzed using descriptive statistics, linear mixed models, and content analysis. The majority of participants were black (68.3%, n=41) and female (56.6%, n=34). At 8 weeks, CaS-PET Silver group showed significantly improved physical HRQoL (p < .001, ES=0.64) and symptom burden (p=.053, ES= -0.41). Self-efficacy (ES=0.56), mental HRQoL (ES=0.26), and communication (ES=0.40) showed a tendency to improve. Most participants reported benefits from the program on health management (mean, 19.41±2.6 [3–21]). Further research is needed with larger, diverse older cancer populations.
DIABETES MELLITUS AND HARD BRAKING EVENTS IN OLDER DRIVERS
Authors: Liu Difei , Chihuri Stanford , Mielenz Thelma , Hill Linda , DiGuiseppi Carolyn , Strogatz David , Li Guohua
Published: December 2022

There are an estimated 37 million people with diabetes mellitus (DM) in the United States, including 16 million older adults. DM can impair patients’ driving safety due to diabetic peripheral neuropathy, hypoglycemia, or hyperglycemia, and eye diseases. However, few studies have examined the association between DM and driving safety based on naturalistic driving data. Data for this study came from the Longitudinal Research on Aging Drivers (LongROAD) project, a multisite naturalistic driving study of 2990 drivers aged 65–79 years at baseline. Driving data for the study participants were recorded by in-vehicle recording devices for up to 44 months. We used multivariable negative binomial modeling to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of hard braking events (i.e., proxies for unsafe driving behavior defined as maneuvers with deceleration rates ≥ 0.4 g) associated with DM. Of the 2856 study participants eligible for this study, 482 (16.9%) reported having DM at baseline. The overall incidence rate of hard braking events was 1.16 per 1000 miles. Adjusted for age, race/ethnicity, marital status, education level, annual household income, urbanicity, history of stroke, and number of medications, drivers with DM had a 10% increased rate of hard braking events compared to drivers without DM (adjusted IRR 1.10; 95% CI: 1.08, 1.12). Results of this study indicates that DM is associated with a significantly increased rate of hard braking events in older drivers, suggesting less safe driving. Driving safety should be incorporated into DM management and care programs.
DEVELOPMENT OF OPEN EDUCATIONAL RESOURCES FOR AN AGING AND MENTAL HEALTH COURSE
Authors: Ambrose Madison , McGee Jocelyn , Wood Sinai , Zakrzewski Chris
Published: December 2022

The financial pressures associated with a gerontological education are significant given the rising costs associated with education. This fact is particularly relevant for economically vulnerable university students. One source of stress is the cost of textbooks and other required course materials. Indeed textbook prices have increased at a rate faster than other educational expenses. Additionally, the perspectives of diverse and underrepresented scholars are often not as readily available in some textbooks. In this presentation, our process of adapting an undergraduate Aging and Mental Health course to reduce cost and also showcase diverse perspectives is described in detail. The goals of this project were to: 1) adapt a preexisting course to include low- and no-cost content through the integration of open educational resources (OER); 2) provide the most up-to-date evidence based information for content and skills development in the area of aging and mental health; and 3) highlight the perspectives of diverse or traditionally underrepresented scholars in this field of study. We will also share the process of developing an interactive Pressbooks webbook from a strengths-based perspective wholistic perspective.
HOPE PARTIALLY MEDIATES STRESS AND PERCEIVED BURDEN IN FAMILY CAREGIVERS OF PERSONS LIVING WITH A DEMENTIA
Authors: McGee Jocelyn , Myers Dennis , Meraz Rebecca , Polson Clay , Ke Weiming , McClellan Angela
Published: December 2022

Recent research suggests that hope may positively impact perceived burden in family caregivers of persons living with a dementia. However, there are few studies that have examined hope, as a multidimensional construct, on perceived burden. The purpose of this study was to investigate the relationship between objective and subjective stressors, hope and perceived burden in a sample of caregivers using taking into consideration multiple hope dimensions—specifically hope-agency and hope-pathway. Hierarchical multiple regression and mediation analyses were utilized in a sample of one-hundred and fifty-five family caregivers. Multiple regression analysis revealed that low hope-agency predicted high levels of perceived burden after controlling for known burden correlates. Hope-pathway did not impact perceive burden. Objective stress on perceived burden was partially mediated by hope-agency. The multi-dimensional aspects of hope should be taken into consideration when assessing this population. Hope-related psychosocial interventions aimed at bolstering multiple aspects of hope among family caregivers of persons with a dementia should be further developed and assessed in clinical intervention research.
65 &THRIVE: TRANSFORMING OLDER ADULT CARE IN THE EMERGENCY DEPARTMENT
Authors: Vien Tracey , Bobroff Stella
Published: December 2022

Kaiser Permanente Los Angeles Medical Center’s (LAMC) Utilization Management Department expanded our geriatric initiative throughout the hospital with emphasis in the Emergency Department (ED). The ED is the first point of patient contact in the hospital, early identification and initiation of interventions needed for potential discharge barriers will assist in timely discharges. LAMC obtained Geriatric ED Accreditation (GEDA) Level 2 this year, the first in the Los Angeles County to achieve this title. This was done by implementing ten new policies with quality improvement (QI) metrics, conducting age sensitivity trainings for our staff, and enhancing our ED rooms to be geriatric friendly. Two of the ten interventions in our ED include 1) volunteers to provide support to our geriatric patients prevent functional decline, prevent delirium and readmission rates, and 2) palliative care consults initiated in the ED prevent suffering and promote the best possible quality of life for patients who are facing a serious illness. Between 2020 and 2021, there has been a 15% increase for the census of 65+ patients. 21% increase of number of older adults with ED readmissions, and a 13% increase in number of older adults staying in the ED for more than 8 hours. With the increasing older adult population, we see a rise in our admission and readmissions of older adults in our ED. This indicates a need for geriatric specialized care and Kaiser plans to obtain GEDA for all Southern California Hospitals.
EXPLORING FRONTLINE PERSONNELS’ PERCEPTIONS OF SUPPORT, KNOWLEDGE, AND RESOURCES FOR ELDER ABUSE
Authors: Marrs Sarah , O’Hara Courtney , MacDonald Catherine , Yelvington Miranda , Gendron Tracey
Published: December 2022

In Virginia, the number of both reported and substantiated cases of abuse in later life have grown steadily over the last several years (DARS, 2021; O’Connor, 2019). Unfortunately, the resources provided to combat elder abuse have not maintained the same steady increase; in many cases, funding to agencies that work to prevent abuse in later life has even been reduced (DARS, 2021). To better understand the gap that exists between need and available resources in Virginia, we conducted an exploratory sequential mixed methods study [QUAL → quan] (Creswell & Plano Clark, 2018). In the qualitative strand, we conducted a series of interviews and focus groups with professionals who often are called upon to respond/intervene when elder abuse is suspected: aging and victim services (n = 9), healthcare providers (n = 7), law enforcement (n = 8). Three themes emerged from the qualitative data: increasing capacity, prevention/coordination, and ageism. Findings from the qualitative strand were then used to guide implementation of the quantitative strand. These participants (N = 2,891) worked in a variety of frontline settings with older adults or in aging services, mostly in health care, law enforcement, social services. Project findings point to a need for increased resources for and training on elder abuse, a shift from reaction to prevention of abuse, improved care coordination and case management, and a need to reduce harmful ageist beliefs. Moreover, our findings highlight the effect structural and societal ageism at the policy level perpetuates the prevalence of abuse in later life.
ENGAGING IN CQI TO ENHANCE ADULT PROTECTIVE SERVICES INTAKE AND SCREENING: A QUALITATIVE ANALYSIS
Authors: Davitt Joan , Brown Jocelyn , Zhang Peiyuan , Barry-Dutro Erin , Sesek Greg
Published: December 2022

This qualitative evaluation study was part of a larger Continuous Quality Improvement initiative implemented by the Maryland Department of Human Services Office of Adult Services to improve the Adult Protective Services (APS) screening and intake process statewide. Researchers conducted two 90-minute focus groups via Zoom with 21 intake and screening staff from 14 counties in Maryland in the summer of 2022. Focus group participants were mostly White and African American women with an average of 6.5 years working in adult services. Interviews focused on understanding challenges in APS intake/screening and strategies to overcome those challenges. Each interview was recorded and transcribed verbatim and three researchers used open and axial coding to identify themes. The key challenge expressed by all participants was the difficulty obtaining adequate information from referral sources, in order to discern whether the adult was vulnerable and if the alleged abuse/neglect/exploitation was being committed by a trusted caregiver or fiduciary as defined by state law. Inadequate referral information results in supervisors/screeners making time-consuming follow-up calls to obtain additional information or cases inappropriately screened in for investigation. This challenge was exacerbated by intake workers inexperienced in APS, understaffing, unclear policies and screening tools for APS, and community partners’ and the public’s unfamiliarity with APS services and policy. Strategies to overcome these challenges included additional staff training, public education, additional resources for APS, clearer policies, and improving the APS screening tool. Quality improvement strategies developed from this study that are relevant to APS systems nationwide will be discussed.
ELDER ABUSE SCREENING PRACTICES IN THE VETERANS HEALTH ADMINISTRATION: RESULTS FROM A NATIONWIDE EVALUATION
Authors: Makaroun Lena , Halaszynski Jaime , Smith Kathrine , Dichter Melissa , Rosland Ann-Marie , Thorpe Carolyn , Rosen Tony
Published: December 2022

Elder abuse (EA) is common and has devastating health consequences yet is rarely detected by healthcare professionals. Veterans are at high risk for EA, and the Veterans Health Administration (VHA) has experience screening for complex psychosocial phenomena including intimate partner violence. While the VHA has national policy regarding mandatory reporting of EA cases, little is known about the extent to which VHA sites currently screen for EA in a standardized fashion and what approaches are used. To address this knowledge gap, we conducted a national survey of all 170 parent station VHA medical centers from January to August of 2021. Surveys were distributed electronically to the Social Work Chief at each site, as social work is responsible for interpersonal violence response in VHA. The survey assessed the presence and characteristics of EA-specific screening practices as well as general abuse/neglect screening conducted with patients of all ages, including older adults. Follow up emails were sent to sites who reported conducting screening requesting additional details not included in the initial survey. Overall, 138 sites (81%) responded to the survey. Among respondents, 3% reported screening older adults for EA using a previously published tool, while 2% reported screening for EA with an unstudied or locally-developed tool. Forty-three percent reported doing general abuse/neglect screening using unstudied questions/tools for patients of all ages, and 41% reported no EA screening at their site. The wide variability in current EA screening practices in VHA presents an important opportunity to standardize and improve EA detection practices.
‘IT RESTORED A BIT OF THEIR HUMANITY”: BRIDGING THE GAP THROUGH HANDS-ON INTERGENERATIONAL LEARNING
Authors: Meszaros Katherine , Beard Renee
Published: December 2022

The Covid-19 pandemic laid bare many of the social inequities and vulnerabilities within the American nursing home industry. Intergenerational learning is thought to be an effective approach to debunking ageism and addressing social isolation, especially in institutional care settings. This study used a mixed method approach to explore the benefits of intergenerational learning, here between college-aged students and nursing home residents. We analyzed qualitative observational data, including 56 hours of participant observation during TimeSlips™ sessions with 32 students and 30 residents at a nursing home in Worcester, Massachusetts. A content analysis of 68 student reflections on the classroom community-based learning (CBL) experience was also performed. This poster reports on the findings from the students who participated in the intergenerational learning project in 2020–2022. A series of common themes emerged. Many students began their experience as skeptics, but retrospectively reported that it was transformative. Personal interactions with elders revealed to students the shared humanity that had with older generations, which then forced them to confront their own ageism and ableism. Intergenerational learning also encouraged students to reflect on their lives, ask what type of person they want to be, what world they would like to live in, and gain new life lessons and perspectives on now to age meaningfully. The value of intergenerational learning far exceeds providing nursing home residents with social stimulation. It can be just as formative to the personal philosophies and outlooks of college-aged students. Intergenerational learning provides tangible and intangible “in-the-moment” benefits to those who participate.
THE RELATIONSHIP BETWEEN AGE DISCRIMINATION AND QUALITY OF LIFE OF DEPENDENT COMMUNITY DWELLING OLDER PERSONS
Authors: Garrido Felipe Sandoval
Published: December 2022

The objective of this study is to examine the age discrimination suffered by dependent older adults and its effects on their quality of life, using a large representative cohort study. Dependency is defined as having difficulties with activities of daily living, both basic (ADL) and instrumental (IADL). To identify perceived ageism, we used data collected by the English Longitudinal Study of Ageing (ELSA) in 2010–2011 (wave 5) that asked respondents about being discriminated because of their age. Quality of life was measured using the CASP-19 scale. We performed both cross-sectional and longitudinal analyses using the subsequent 2012–2013 (wave 6) and 2018–2019 (wave 9) follow-ups. Multivariable logistic regression analysis was used to estimate the odds ratios of experiencing perceived age discrimination. The results show that a quarter (22%) of all respondents experienced age discrimination. Those suffering from dependency and age discrimination had independently significant lower quality of life scores. Perceived age discrimination was cross-sectionally associated with being male, white, in poor physical and mental health, highly educated, with lower wealth. Longitudinally, with being male (odds ratio -OR-: 1.5), highly educated (OR: 1.3), and poor mental health (OR: 1.7). However, quality of life change was not statistically significant among dependent older persons in subsequent waves. Understanding ageism is important to create policies for future interventions. The present results reinforce the idea of previously documented groups at risk of age discrimination in order to protect them, but also the complex panorama of bio-psychosocial determinants involved in tackling it.
OLDER, ENTITLED, & EXTREMELY OUT-OF-TOUCH: DOES “OK, BOOMER” SIGNIFY THE EMERGENCE OF A NEW OLDER ADULT STEREOTYPE?
Authors: Frey Katelyn , Bisconti Toni
Published: December 2022

“OK, Boomer” is a phrase used online by younger adults to dismiss an older person for their perceived out-of-touch or offensive beliefs (Lorenz, 2019). An initial study utilizing content analysis techniques with a younger adult sample (N = 316) explored how two theoretical frameworks from the age stereotype literature, the Stereotype Content Model (Fiske et al., 2002) and Hummert et al.’s (1994) age stereotype categories, could explain this phenomenon and the enduring online references to “Boomers.” We found that neither theory adequately captured how younger adults view the titular “Boomer;” the low-competence/low-warmth quadrant of the Stereotype Content Model was the only quadrant with support (N = 32), albeit not a large amount, whereas the age stereotype category data revealed that “Boomers” partially overlapped with elements of the “Shrew/Curmudgeon,” the “Severely Impaired,” and the “John Wayne Conservative” to varying degrees. This necessitated a second study that used an open-ended, interpretative phenomenological analysis approach to better understand younger adults’ perceived age-related stereotypes of “Boomers.” Results identified seven unique characteristics ascribed to “Boomers” and older people in general: closed-minded, argumentative, out-of-touch, offensive, critical, nostalgic, and/or conservative, all of which seem to possess a decidedly hostile ageist undertone. Future work should examine exactly how synonymous “Boomers” are with older adulthood, the potential underlying hostile and/or benevolent ageism associated with using this phrase, and how derogatory age-based internet jargon influences age stereotype development and intergenerational relations given the heightened ageism following the COVID-19 pandemic.
NOT ONE AND THE SAME: VARIED EXPERIENCES OF BENEVOLENT AGEISM IN OLDER ADULTHOOD
Authors: Sublett Jennifer , Bisconti Toni
Published: December 2022

Prior work has explored benevolent and hostile attitudes toward older adults (Chasteen & Cary, 2015) and their paternalistic, mixed incompetent-warm perceptions within the Stereotype Content Model (SCM; Fiske et al., 2002); however, older adults’ perspectives of these attitudes have not received similar attention. This study assessed older adults’ experiences with benevolent and hostile ageism using an adapted version of the Ambivalent Ageism Scale (AAS; Cary et al., 2017; α=.85) and using a mean split, examined if there are differences among the younger- and older-older adults. Within a sample of older adults (Nf202) that ranged in age from 65–90 (M=71.6), we found that when comparing those aged 65–70 and 71 and above, those who were older (M=1.76, SD=.44) reported more experiences with benevolent ageism than their younger counterparts (M=1.56, SD=.42), t(200)=3.30, p =.001). These groups did not significantly differ in hostile ageism, t(200)= -.05, p = .96. When participants were asked why they have been treated thusly as described by the AAS items, 18% of the participants believed it was due to their age, in comparison to those who attributed it to personality (41%), gender (9%), or unknown factors (11%). Benevolent ageism is clearly not a monolithic experience for older adults as those who are older report more patronization, and not all participants felt age was the defining reason for their treatment. Further work should assess how these experiences are qualitatively different across diverse age groups of older adults, as ageism reduction interventions may need to be tailored appropriately.
ASSOCIATIONS BETWEEN ATTITUDES TOWARDS AGING AND CLINICAL DECISIONS AMONGST INTERNAL MEDICINE RESIDENTS
Authors: Schell Brent , Carr Megan , Katz Jesse , Hasan Maryam
Published: December 2022

It has been shown that physicians-in-training can develop negative attitudes towards caring for older patients. Little is known about how these attitudes develop throughout training or if they are associated with ageist clinical decisions. In this pilot study, Internal Medicine (IM) residents completed the Expectations Regarding Aging (ERA-12) survey, a validated instrument that assesses expectations regarding physical health, mental health, and cognitive function in older adults. Residents then completed a survey that included simulated clinical scenarios as part of an educational intervention on Ageism. Of the 72 residents invited to participate, 48 residents (67%) completed the ERA-12 survey. Responses were obtained from all training levels including 24 PGY-1 (50%), 10 PGY-2 (21%), and 14 PGY-3 (29%). When grouped by training year, there were no statistically significant differences found with regards to total ERA-12 scores or expectations regarding physical health, cognitive function, or mental health of older adults. When grouped by responses to clinical scenarios, residents with more biased clinical responses were associated with lower total ERA scores (73 vs. 91, p = 0.015). Those with lower total ERA scores indicated they were inclined to initiate CODE STATUS discussions earlier with older adults and were less inclined to consider coexisting depression. Despite limitations in sample size and the subjective nature of simulated clinical scenarios, this pilot study suggests a possible association between expectations regarding aging and clinical decision-making. More research is needed to assess the strength of this association and if it can be modified through educational initiatives.
MACHINE LEARNING TO PREDICT HOMEBOUND STATUS IN OLDER ADULTS USING CANADIAN LONGITUDINAL STUDY ON AGING DATASET
Authors: Khan Shehroz , Cui Can (Shirley) , Iaboni Andrea
Published: December 2022

Individuals who are unable to leave their home or with great difficulty are considered homebound or semi-homebound. Homebound status is strongly associated with disability, social isolation, healthcare use and costs, and mortality. Most homebound older adults have multiple chronic conditions and poor health. There is not enough information about homebounded older adults in Canada. The Comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA) presents an excellent opportunity to study the complex factors associated with homebound status and the interplay between physical, social, psychological, and environmental determinants over time. This is a population-level study which makes use of provincial healthcare registration data to sample older adults across the country. We obtained the first wave of CLSA dataset containing samples from 21667 individuals over 3223 variables. We developed a definition of ‘homeboundedness’ in using life-space index variables present in the CLSA datatset. The dataset contained numerical, categorical and missing values. After preprocessing, we selected 1101 Homebound and 20521 Non-Homebound individuals, and 1771 variables. We showed that Random Forest classifier (with missing values) provided an AUC ROC and PR of 0.89 and 0.49. The missing value imputation did not improve the results significantly. Using feature hashing, we converted the dataset to numerical values; the AUCs improved to 0.96 and 0.71 at the cost of losing interpretation. In future, we will consult clinical experts in choosing the relevant features and use analytical methods to select features and compare. We will also test these predictive models on the next wave of this dataset.
GEOGRAPHIC AVAILABILITY OF SUBSIDIZED SENIOR HOUSING AND NEIGHBORHOOD DISPARITIES IN MISSOURI
Authors: Ryu Byeongju , Baek Jihye , Park Sojung , Chun Yung , Amano Takashi , Kim BoRin
Published: December 2022

Subsidized senior housing (SSH) provides an affordable option to low-income older adults for economic stability and aging-in-place. To date, limited attention has been given to the geographic availability of SSH and its relation to neighborhood characteristics (e.g., socioeconomic characteristics and availability of supportive services). The current study aims to describe (1) the availability of government-subsidized senior housing (SSH-availability) in Missouri and examine (2) to what extent the housing availability is associated with county-level neighborhood characteristics. First, SSH-availability in each county was measured with the number of subsidized units for older adults divided by the eligible population (i.e., aged 65 or over, income below poverty level, and spending 30% or more of income on housing). The Geographic Information System (GIS) was used to examine the distribution of SSH in Missouri. Second, based on existing literature, we used principal component analysis with multiple indicators to create two neighborhood characteristics (i.e., socioeconomic deprivation and health and social service indices). Non-parametric bivariate analyses (Kruskal-Wallis tests) were conducted with the availability quartiles and each index. Our findings showed that in 66 counties (57% of entire counties in Missouri), SSH-availability was below 20%. Bivariate analyses showed SSH-availability was significantly associated with both neighborhood characteristics: counties with higher SSH-availability were more likely to be socioeconomically deprived and face a lack of health and social services. The current study suggests the government should address the geographic disparities in SSH for low-income older adults. Also, more supportive services are needed around SSH to facilitate aging-in-place of vulnerable older adults.
THE IMPACTS OF NURSING HOME COVID-19 SOCIAL ISOLATION POLICIES ON RESIDENTS LIVING WITH DEMENTIA
Authors: Buron Bill , Killian Tim , Eng Cassy
Published: December 2022

Using reports from 31 nursing home activity directors (AD) from across the United States, we examined responses to COVID-19 social isolation policies/practices in relation to AD’s perceptions of the impact on residents living with dementia (RLWD). AD’s perceptions are particularly valuable because they are generally responsible for bolstering social connectedness. We approached this study from the sociological perspective of personhood (Buron, 2008; Kitwood, 1997) that suggests social isolation may threaten personhood status, lead to increased agitation, and other behaviors as mechanisms to preserve self. Most ADs reported that social isolation protocols began in March 2020 and were still ongoing through the beginning of 2022. Over 90% reported a 50% or more reduction in family member/guest visits, with over 30% reporting a 90% or more reduction in visits. Systemic content analyses were applied to open-ended responses. These patterns suggested ADs had concerns about (1) poor quality care as a result of a) a reduced workforce leading to caregiver burnout, and b) less accountability of caregivers (to families/visitors in their absence) for resident care, and (2) increasing signs of depression and negative behaviors among RLWD. Some ADs felt that Isolation policies disrupted routines of RLWD, leading to confusion and a greater progression of their dementia. Some ADs felt the need to “fill-in” as an attempt to make up for the loss of interactions with family members. The results of this study indicate a need to consider future pandemic policies and potential impacts on residents living with dementia in nursing home settings.
THE IMPACT OF 12 WEEKS OF ADAPTED DANCE ON BALANCE, GAIT, AND LOWER EXTREMITY FUNCTION AMONG PERSONS WITH DEMENTIA
Authors: Quijano Keara , Bennett Crystal
Published: December 2022

Person’s living with dementia commonly experience difficulty with mobility. Difficulties with these activities can lead to an increased fall risk, resulting in an increased loss of independence. Dance engages various parts of the brain including the cerebellum that is primarily involved in coordinating balance, posture, body positioning, and voluntary movement. An aim of this study was to assess whether 12 weeks of adapted dance improves balance, usual walking speed, and lower extremity function among persons living with dementia. An experimental design was used to randomly assign persons with dementia to either a 12-week adapted dance or social stimulation group. The convenience sample consisted of 12 participants, ages ranging from 62–97 years. The adapted dance is low impact where one foot is always in contact with the floor and is appropriate for older adults with cognitive and physical limitations. At baseline and at 12 weeks, measures of balance, gait, and lower extremity function were assessed. From baseline to posttest, the dance group had greater increased times for maintaining tandem balance (+47.5%) and faster times for usual gait speeds (+15.1%); compared with the social stimulation group tandem balance time (+0.98%) and usual gait speed times (+10.5%). A limitation of this study is the small sample size.
R1P DISPERSION IN WHITE MATTER CORRELATES WITH COGNITIVE IMPAIRMENT IN OLDER ADULTS
Authors: Adelnia Fatemeh , Davis Taylor , Acosta Lealani Mae , Puckett Amanda , Wang Feng , Zu Zhongliang , Harkins Kevin , Gore John
Published: December 2022

Alzheimer‘s disease is the most frequent form of dementia in older adults and has a total estimated worldwide cost that rises to $2 trillion by 2030. Much previous neuroimaging research in AD has focused on the roles of amyloid and tau proteins using PET, but there have also been several studies that have implicated microvascular changes as an early indicator of damage related to later dementia. Here, we developed and refined a non-invasive 3D-R1ρ dispersion imaging technique using different locking fields to quantify microvasculature changes within brain tissues in persons with mild cognitive impairment (MCI) compared to healthy controls. The fractional difference in R1ρ comparing different locking fields provides a unique way of characterizing changes in the geometry and structure of microvasculature. After providing informed consent, 40 adults aged 62 to 82 years (n=17MCI) underwent cognitive assessments and MRI scan at 3T. We found the fractional change in R1ρ of the whole brain white matter is significantly greater in persons with MCI, and the correlation remained significant (ß=-0.4, p-value=0.01) after introducing age (ß=0.2, p-value=0.2) and sex (ß=-0.1, p-value=0.5) as covariates. The white matter hypertonicity lesion volume measured from conventional MRI was also correlated with the health status (p-value < 0.05); however, the size of the regression coefficient was substantially smaller (53% lower), and it was no longer significant (p-value=0.14) after adjusting for age and sex. This work establishes a new non-invasive method that can potentially characterize changes in microvasculature anatomy with the progression of cognitive impairment regardless of an age effect.
PREDICTING DYADIC RELATIONSHIP STRAIN IN INDIVIDUALS WITH DEMENTIA
Authors: MacNeil Amanda , Judge Katherine , Bass David
Published: December 2022

Recent literature has addressed the perceptions of individuals with dementia to understand how they experience their illness, with evidence suggesting these perceptions are impactful. Few studies, however, have used a conceptual model to explore different aspects of the illness. One aspect to consider is dyadic relationship strain, or feelings of tension, manipulation, and stress between the individual and caregiver. Little work has addressed this strain from the perspective of the individual with dementia who may have different feelings about the quality of the relationship. Cognition and function are two hallmark symptoms in dementia, however little work has addressed how the perception of these two areas impacts the illness experience. Perceptions of difficulties in these two areas may impact dyadic relationship strain as they necessitate increased care and changes in the relationship. Guided by the Stress Process Model for Individuals with Dementia, this study assessed potential predictors of dyadic relationship strain, finding personal activities of daily living (PADLs) to be impactful. In a multiple regression, PADLS (b=.319, p = 02) predicted strain above and beyond two measures of cognition: objective cognitive impairment (b =-.011, p =.93) and perceived memory difficulty (b=.003, p=.311) suggesting that perceived function is impactful for dyadic relationship strain. Because PADLS include more hands-on assistance, the perception of difficulty may create more feelings of embarrassment or stress and impact the perception of relationship strain. Future intervention work may target perceptions of function to improve the dyadic relationship by using techniques such as open communication about difficulties.
PARTNERING WITH DEMENTIA CAREGIVERS TO DEVELOP AND REFINE THE ENACT INTERVENTION
Authors: Eaton Jacqueline , Neller Sarah , Cajavilca Moroni Fernandez , Johnson Julene , Ellington Lee
Published: December 2022

The behavioral symptoms of dementia negatively affect family caregivers. Several interventions have been developed to support caregiver needs, and evidence suggests improved outcomes when interventions actively engage caregivers. However, the strategies to implement active engagement techniques have not been sufficiently studied. Enhancing Active Caregiver Training (EnACT) is an arts-based intervention aimed at actively engaging dementia caregivers as they view and interact with participant-informed vignettes that portray caregiving experiences. We conducted a series of three iterative focus groups with dementia caregivers (n=9) to identify scenarios and refine activities for inclusion within the EnACT intervention. We analyzed the data in three cycles, using structural, descriptive, and pattern coding. From the first focus group, we coded 182 items as what went well, illustrating how caregivers resonated with video content, applied scenarios to individual experiences, and appreciated the “informative” vignettes that facilitated learning, processing, and awareness of the realities of caregiving. We coded 42 items as needing to change, including considerations for caregiver impact, confusing components, accessibility, and missing content. Participants identified eight specific vignettes that resonated and focused on the topics of respite, behavioral symptoms, validation, burnout, and communication. Intervention revisions were made based on focus group feedback, including: 1) selecting video vignettes for intervention use and 2) creating an index of vignette topics to facilitate multiple discussion pathways to align with dementia caregiver training and support groups. Partnering with dementia caregivers has the potential to make intervention activities engaging and applicable to participant needs.
NUMBER OF CHILDREN AND RISK OF ALZHEIMER’S DISEASE AND DEMENTIA: EVIDENCE FROM THE UK BIOBANK
Authors: Zhang Yan , Fletcher Jason
Published: December 2022

This study uses a large-scale dataset of half a million respondents aged 39–73 from the UK Biobank to examine how parity (i.e., number of children) may influence parents’ risk of Alzheimer’s Disease and dementia (AD/D). We use respondents’ (i.e., children’s) reports of their parents’ dementia status as the outcome variable. 38,040 respondents in the sample reported that their mother had AD/D, and 20,304 respondents reported their fathers had AD/D. Fixed effects logistic regression models suggest that compared to parents who had one child, high parity (> 4 kids) is associated with a lower risk of AD/D for both mothers and fathers. Moreover, as the parity increases, the protective effects become larger. This study advances prior dementia literature with two contributions. Methodologically, largely representative AD/D cases can increase the power of analysis. Also, children’s reported AD/D cases are very likely through the observation of parents’ entire life span, which can reduce misclassification of AD/D status and measurement errors from selective samples or self-reported cases. Empirically, this study provides important evidence suggesting protective effects of high parity on the risk of AD/D for both fathers and mothers. It implies that parity, as one of the life course contexts, may link to the risk of dementia in later life. More future work is needed to explore potential mechanisms.
LONELINESS IS INVERSELY ASSOCIATED WITH EXERCISE AND SLEEP APNEA IN OLDER WOMEN AT RISK FOR ALZHEIMER’S DISEASE
Authors: Danish Madina , Shepherd Alyx , Lui Kitty , Malhotra Atul , Hartman Sheri , Lee Ellen , Sundermann Erin , Banks Sarah
Published: December 2022

Background

Modifiable risk factors (MRF) for Alzheimer’s disease (AD) include sedentary behavior, sleep apnea, and loneliness; however, how these MRFs influence one another is unclear. We examined correlations among loneliness, physical activity and sleep apnea among older women at higher risk for AD.

Methods

Data were collected as part of the Women: Inflammation and Tau Study, which recruits women age 65–85 with higher AD genetic risk and mild impairment on the Montreal Cognitive Assessment. Participants completed the UCLA Loneliness Scale and home sleep tests to derive the Apnea Hypopnea Index (AHI), a measure of sleep apnea severity. Women wore ActiGraph accelerometers for one week to measure average Moderate-Vigorous Activity per day (MVPA). We used Spearman correlation to examine the relationships among AHI, MVPA and Loneliness Scale score.

Results

Preliminary data were available for 12 women (mean age=72.4 [SD=2.8], 100% non-Hispanic White). MVPA ranged from 0.3–52.8 minutes (mean=9.38 [SD=14.1]; AHI ranged from 1.5–28.3 (mean=14.0 [SD=9.0] and Loneliness Scale score ranged from 0–34 (mean=9.8 [SD=x]). Significant, positive associations were observed between AHI and Loneliness (rho=.80, p=.006) and a moderate relationship at trend level was notable between higher MVPA and less Loneliness (rho=-9.53, p=.07). AHI did not relate to MVPA.

Conclusion

Results suggest that loneliness independently relate to both sleep apnea severity and sedentary behavior in older women. Combined interventions that target loneliness in addition to physical activity and sleep may be important in women at-risk for AD.
IMPLEMENTING VISUAL VIDEOS AND IMAGES WITH PEOPLE WITH DEMENTIA IN CARE SETTINGS: A SCOPING REVIEW
Authors: Lok Karen , Wong Yi , Bayani Mario , Mann Jim , Berndt Annette , Wong Lily , Wang Carly , Pan Diane , Hung Lillian
Published: December 2022

There is limited literature on using visual videos and images with people with dementia in care settings. We conducted a scoping review on this topic to fill this literature gap. Our scoping review adopted the Joanna Briggs Institute scoping review methodology. We eventually included eleven papers for the review and conducted the content analysis. We found the facilitators for implementing visual videos and images with people with dementia in care settings: 1. Matching people’s interests 2. Being congruent with people’s cognitive abilities 3. Support from families and staff 4. Using in a group setting. We also found the barriers: 1. Staff is unwilling to support 2. Lack of resources 3. Not congruent with the cognitive or other abilities of the people. We found benefits of using visual videos and images with this population: 1. Encourage expression 2. Facilitate discussions with other people 3. Improve well-being. We also found drawbacks: the potential of arousing negative emotions and memories. We suggest future research should include the voices of people with dementia, staff should be trained to support the people in case negative memories and emotions are aroused, and there should be consideration of using visual videos and images to tackle isolation and loneliness in care settings. With these findings, this scoping review should shed light on implementing visual videos and images in care settings.