bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Care Management Utilization
Authors: Danilovich Margaret , Prabhu Sharmila
Published: December 2021

Care management is the process of planning and coordinating care to assist individuals or families in managing their health. This may involve managing inpatient or outpatient medical care or helping with other household, legal, or financial needs. Care management service providers are challenged in knowing how best to allocate limited resources (i.e. care manager time) to best meet client needs. Research shows predictors for increased care management needs include advanced age, multiple comorbidities, frequent care transitions, and private insurance coverage, but the association of objectively measured functional assessments and care management hour utilization is unknown. This secondary data analysis aimed to identify factors that predict the amount of care management service among low-income older adults enrolled in a care management program. We used de-identified care management data from the electronic health record at 1 social service agency. We used multivariate regression to predict the number of hours of care management utilization from demographics, comorbidities, intake ADLs/IADLs, physical health, and self-reported quality of life. We found moderate to strong correlations between physical health and quality of life (r=0.58) and activities of daily living and instrumental activities of daily living (r=0.81). Baseline self-reported quality of life predicted the number of hours of care management utilization (p=.03; beta = 6.75). Quality of life can be useful in predicting the number of service hours that a particular client may require from a care management program and should be considered as an intake question to assist social service providers in allocating hours adequately to clients.
Comparing Loneliness Among Individuals in Long-Term Care Settings and the Community
Authors: Hua Cassandra
Published: December 2021

We used the NHATS COVID-19 module to examine whether individuals in long-term care communities were lonelier than individuals in the community during the pandemic. Additionally, we examined whether individuals in long-term care communities with more restrictive policies concerning visitors and communal activities were more likely to experience loneliness than individuals in communities with less restrictive policies. Approximately 45% of individuals in long-term care communities (n=134) felt at least a moderate amount of loneliness during COVID-19 when compared to 34% of individuals in the community (n= 2,666) (p<.05). However, the association was no longer statistically significant after adjusting for age, race, and sex. Among individuals in long-term care communities with the most restrictive policies, 48% experienced loneliness compared to 44% individuals in less restrictive communities. However, this finding was not statistically significant. Discussion will focus on similarities and differences within these populations that could have led to these results.
Learning Humanities and Ethics of Aging Through the Lens of an Avatar Creation
Authors: Hanna Gay , Kim Yoon Chung
Published: December 2021

The main goal of teaching the humanities and ethics of aging is to understand the perspectives of older individuals as they address the challenges and opportunities presented across the aging spectrum. To encourage understanding of this humanistic and ethical process, students were given an assignment to select a profile of an older person with pre-selected characteristics that they then develop into their avatar, a virtual companion, to accompany them through the course. This assignment included three iterations of the avatar narrative related to what is studied in class around major life transition points related to work, housing, and end of life. These assignments included the creation of Mind Maps which illustrate their avatar’s ongoing concerns related to their environment including their social determinants of health. The avatar’s formative development throughout the course brought forward discussions around identity, safety, autonomy, and person-centeredness in terms of gerontological practice and policy.
COVID-19, Policy, and Nursing Homes: A Health and Aging Policy Fellows Symposium
Authors: Kusmaul Nancy , Miles Toni , Frank Lori
Published: December 2021

COVID-19 significantly impacted older adults, particularly those in long term care. This symposium focuses on policy, and how policies drove many of the outcomes older adults in care experienced during 2020. We begin with a case study of one nursing home describing their operations, how those were impacted by policies at the local, state and federal levels, and operational factors that proved uncontrollable. From there we look more broadly at a national effort as implemented in one state which leveraged clinical and regulatory experts to partner with nursing homes and disseminate emerging and evidence based practice cohorts to address the realities of the COVID-19 pandemic over an extended period. Then we move from the federal to two state level projects. One looks at the experience of embedding advanced practice nurses (APRNs) into long term care facilities in one state over a five year period including during COVID-19. The final presentation describes hands on support provided by one state government to nursing homes and assisted livings during COVID-19, including the coordination of staff testing and the implementation of the use of the antigen testing machines issued through federal policy. We conclude with a discussion of the interplay of federal, state, and local policy on nursing home experiences in COVID-19 and recommendations for more effective policy interventions.
Metabolomic Profile Differences Between Demented and Non-Demented APOE4 Carriers in the Long Life Family Study
Authors: Yao Yujing , Jain Mohit , Murabito Joanne , Zmuda Joseph , Christensen Kaare , Province Michael , Jin Zhezhen , Lee Joseph
Published: December 2021

The apolipoprotein ε4 (APOE4) is the most prevalent genetic risk factor for late-onset Alzheimer’s Disease (AD). Here we assessed the metabolomic profile differences between APOE4 carriers who develop AD vs. who do not in a sample of 142 participants, aged 65-99 years in the Long Life Family Study (LLFS). Of 7,321 metabolites, we applied a generalized estimating equation model and identified 137 metabolites significantly associated with AD. Subsequent multivariate analyses were performed for prediction and clustering recognition. Among annotated metabolites, 8 metabolites in the eicosanoids and docosanoids group, 3 metabolites in the fatty acids group, and arabitol were associated with elevated risks of AD (OR: 1.6-2.3). On the other hand, a different set of metabolites were associated with reduced risks of AD (OR: 0.34-0.64). These metabolomic profile differences can be used to help with early diagnosis in the population of older APOE4 carriers in the pre-clinical stage.
Emergency Department Admissions Among Older Adults Living Alone With Multimorbidity
Authors: Barrenetxea Jon , Chen Cynthia , Koh Woon-Puay , Qiushi Feng , Tan Kelvin Bryan , Chua Kevin , Tong Rachel
Published: December 2021

Older adults living alone are at higher risk of mortality, morbidity and healthcare utilization. As more older adults live alone, Emergency Department (ED) admissions could rapidly increase, particularly among those with multimorbidity. We studied the association of living alone on ED admissions among older adults with multimorbidity. We used data from 16,785 older adults of the population-based Singapore Chinese Health Study (mean age: 73 years, range: 61-96 years) who were interviewed in 2014-2016 for living arrangements and medical history. Participants were followed-up for one year on ED admission outcomes (number of admissions, inpatient days and hospitalization costs). We used multivariable logistic regression to study the association between living alone and ED admission, and ran two-part models (probit & generalised linear model) to estimate the association of living alone on inpatient days and hospitalization cost. We found that compared to living with others, living alone was associated with a higher odds of ED admissions [Odds Ratio (OR) 1.28, 95% Confidence Interval (CI) 1.08-1.51)], longer inpatient days (+0.61, 95% CI 0.25-0.97) and higher hospitalization costs (+322 USD, 95% CI 54-591). Compared to those living with others without multimorbidity, living alone with multimorbidity was associated with higher odds of ED admission (OR 1.64 95% CI 1.33-2.03), longer inpatient days (+0.73, 95% CI 0.29-1.17) and higher hospitalization costs (+567 USD, 95% CI 230-906). In conclusion, living alone is associated with higher odds of ED admission, longer inpatient days and higher hospitalization costs among older adults, particularly among those with multimorbidity.
Uncertain Times: A Continuing Care Retirement Community's COVID-19 Communication Response
Authors: Fisher Kathleen , Sefcik Justine , Coates Martha , Shim Minjung , McEachron Don , DiMaria-Ghalili Rose Ann
Published: December 2021

The purpose of this qualitative inquiry was to explore conversational video recordings by top administrators from a faith based Continuing Care Retirement Community (CCRC) to help residents, staff, and family members manage the associated uncertainties of the pandemic. Six interdisciplinary researchers explored 37 video communiques from March 2020 to February 2021. Data was independently coded using latent content analysis with the team building consensus on major themes. Themes identified were: Building Trust through Transparency, We’re in this Together, Power of One/Individual Responsibility, Converting Challenges into Teaching Moments, and Gratitude/Resilience. Findings suggest attempts to inform, reassure, and encourage maintaining a safe environment (e.g., using masks, restricting visitors, vaccine promotion) for residents, staff, and family members, was met through these conversational videos. Leadership of this CCRC exemplified the mission to provide transparent information during the pandemic, serving as a model to inform other CCRCs’ communication during this pandemic and other crisis situations.
Strategies to Design Technology Promoting Social Participation of People With Dementia and Their Caregivers
Authors: Wolf-Ostermann Karin , Flanagan Jane
Published: December 2021

Community-dwelling people with dementia and their caregivers face increasing challenges to active social participation as the condition progresses. Potential difficulties include disclosing the condition, navigating through available support and sustaining interpersonal relationships. Dementia-friendly support services and interventions targeting caregiving dyads can promote social participation. Interventions serve as a communication channel for the dyads to engage, interact and partake in their community. Technology as a facilitator is gaining momentum; increasing evidence suggests that technological solutions contribute to promoting social health for people with dementia and family caregivers. Patient and public involvement and rigorous evaluations of solutions are needed to ensure successful implementation of dementia-friendly technologies. This symposium, presented as a part of the Marie-Curie Innovative-Training-Network action, H2020-MSCA-ITN, grant agreement number 813196, comprises four pertinent presentations. The first presentation outlines the effectiveness of technological interventions to improve social participation of older adults with and without dementia, and barriers and facilitators these interventions present. The second presentation describes disclosure decisions faced by dyads and Patient and public involvement findings on how an existing empowerment intervention supporting disclosure decision-making can transfer to an online environment. The third presentation reports on findings from a study evaluating a tablet-based activation system designed to engage caregiving dyads in social sessions. The final presentation lifts the focus towards how existing online environments can be adapted through dementia-friendly privacy policy agreements, and thereby support social participation of this user group online. Our discussant, Jane Flanagan, synthesizes the presentations and leads a discussion of future directions for policy and practice.
Technology-Driven Dyadic Interaction Support for Community-Dwelling People With Dementia and Family Caregivers
Authors: Hoel Viktoria , Wolf-Ostermann Karin , Steinert Lars , Shultz Tanja
Published: December 2021

People with dementia and their family caregivers struggling with the impacts of the condition on cognitive abilities, experience deterred social interactions and strained relationships. Technology can potentially sustain the relationship by engaging dyads in joint activities and supporting their interaction. This study aimed to evaluate the impact of a tablet-based activation system, I-CARE, specifically designed to engage people with dementia in meaningful activities. In this intervention, community-dwelling people with dementia and their family caregiver engaged in joint activities supported by the I-CARE system. Quantitative measures on quality of life, relationship quality and caregiver burden are collected, while semi-structured interviews explore the impact of Covid-19, as well as what motivates the participants to invite technology into their dyadic interactions. Our findings provide important insight in how technology can support social health and relationship sustenance of dyads living with dementia, and what implications Covid-19 has for their social participation in society.
Psychological Risk and Resilience of Older People’s Exposure to Climate Change
Authors: Antonucci Toni
Published: December 2021

Climate change places older people at physical and psychological risk. Even small changes in temperature (+/- 1 degree) results in increased morbidity and mortality. Further, the burden of climate change is not borne equally. The stress and mental ill health associated with disasters are especially borne by women, older adults, persons of color, low-income populations, those with preexisting conditions, poor support networks, and those residing in sub-standard housing. Older people are disproportionately represented in these groups, but interventions can ameliorate these risks. At the same time, older people, with the wisdom of experience, can be important assets for families and communities struggling with the effects of climate change. Both addressing the vulnerabilities and enhancing the strengths of older people can serve to meet the immediate needs and the long-term SDGs goals of (3) health and well-being (5) gender equality (10) reduced inequalities (11) sustainable cities and communities (13) climate action.
Subjective Age Changes During the COVID-19 Pandemic
Authors: Terracciano Antonio
Published: December 2021

Aging is associated with an increased risk of COVID-19 morbidity and mortality. In this study, we tested whether the pandemic influenced how old individuals felt by examining longitudinal within-person changes in subjective age. We tested two alternative hypotheses: (a) people felt increasingly older in response to the stress generated by COVID-19; (b) people felt increasingly younger due to psychological distancing from older age. We tested these hypotheses in a large US sample of adults assessed once before and twice during the COVID-19 pandemic. Multilevel analyses indicated that people reported feeling younger with the emergence of COVID-19. We further tested demographic, health, and psychosocial predictors of changes in subjective age. Overall, the findings supported the hypothesis that subjective age partly reflects a coping process of psychological distancing from older age, a process that parallels physical and social distancing.
Oral health-related quality of life in Colombian Older Adults
Authors: Osuna Margarita , Suarez Piedad , Ailshire Jennifer
Published: December 2021

Despite its importance for health and wellbeing, oral health quality of life (OHQoL) has received little attention in lower-income countries, such as Colombia. This study describes the prevalence of older adults’ OHQoL and variability by socioeconomic status. We use data from the 2015 SABE-Colombia (N=18,700), a nationally representative survey of community-dwelling Colombians ages 60 and older. We used the Simple Count Geriatric Oral Health Assessment Index (SC-GOHAI), a self-reported measure of frequent oral health problems such as chewing, swallowing, and speaking designed to assess OHQoL. The scale ranges from 0-12; higher scores indicate worse OHQoL. About 69% of older Colombians reported at least one OHQoL problem. The most common issues were difficulty chewing hard food and speaking. High education and income were associated with better OHQoL and smoking were associated with worse OHQoL. Oral health may therefore reflect another dimension of social and health inequality for older Colombians.
The Influence of Gendered Social Position on Cohort Differences in Smoking Among Older Mexican Adults
Authors: Milani Sadaf , Avila Jaqueline , Wong Rebeca
Published: December 2021

Disparities throughout the life course, including social position, result in gendered pathways to health, which ultimately result in gender disparities in late life. Using data from the Mexican Health and Aging Study, we explore the concept of gendered social position over the life course (educational achievement, marital history, employment history) and its association with smoking status in old age (current, former, never). We compare two cohorts by gender, those aged 60 to 71 in 2001 (n=4,383) and 60-71 in 2012 (n=5,970), as these cohorts experienced vastly different life courses. Overall, current smoking decreased from 2001 to 2012, but men consistently report higher rates of current and past smoking, compared to women. This presentation will widen the lens of gender to consider the influence of social position established over the life course, on gender differences in smoking, a risk factor for poor health and function in old age.
The Life Course Origins of the Race Disparity in Cognitive Functioning in Brazil
Authors: Farina Mateo
Published: December 2021

Background: Cognitive health is a major concern for understanding population health in Brazil. Race inequalities have been found for several health outcomes but less is known about older adult cognitive health. Health inequalities have been tied to several life course factors, but less is known about how the racial stratification in Brazil may contribute to race disparities in cognitive health. Method: Data come from the Brazilian Longitudinal Study of Aging. We used nested regression models to examine the life course origins of the race differences in cognitive functioning. Results: Whites had better cognitive functioning than non-Whites. Education reduced these differences by about half. Health behaviors and cardiometabolic conditions had little to no impact. Discussion: Race differences in cognitive functioning in Brazil are in large part attributable to educational opportunities. These finding point to the importance of cognitive development in childhood to understand racial disparities in later life cognitive health.
Does Familial Educational Attainment Predict Sleep Quality Trajectories for Older Adults in Mexico?
Authors: Sheehan Connor , Osuna Margarita
Published: December 2021

Researchers have stressed the importance of sleep for healthy aging and longevity. However, there are few population-level studies of sleep quality focusing on older adults in Latin America and Mexico in particular. The objective of this study is to examine the associations between personal and familial educational attainment on sleep quality. We utilized data from the 2001-2015 Mexican Health and Aging Study (N=4,164; MHAS). Our sample consisted of older adults (aged 50+), married with children. We predicted longitudinal reports of restless sleep across four waves of MHAS using mixed-effects logistic regression. We found that lower levels of respondents’ education, their spouses’ education, and their children’s’ education were associated with lower levels of sleep quality. When the measures of education were included in the same model, one’s own education and children’s education remained significantly associated with quality sleep. Our results stress the importance of familial educational attainment for sleep in Mexico.
Association Between Music Engagement and Mortality in Middle-Aged and Older Adults in the US
Authors: Fiscella Andrew , Veal Britney , Ji Ming , Meng Hongdao
Published: December 2021

Music engagement is a universal human activity that transcends cultural and geographic boundaries. Current evidence suggests that music engages many diverse brain networks with wide-ranging effects on physiological, cognitive, and affective processes. As a result, music activity engagement may be associated with enhanced cognitive reserves and reduced stress. However, it remains unclear whether music activity engagement is associated with any survival advantage in the general population. This study tested this hypothesis in a nationally-representative sample of middle-aged and older adults in the U.S. A cohort of 3,540 respondents from the Health and Retirement Study was followed from 2002 to 2018. Music engagement was measured by self-reported participation in passive and/or active music activities. Potential confounders included socio-demographics, health and functional status, and health-related behaviors. We plotted the Kaplan-Meier survival curves by music engagement level and used Cox proportional hazards model to examine the independent effect of music engagement on mortality. Musical engagement levels were significantly associated with mortality in both the unadjusted and adjusted analyses. Respondents who reported engaging with music at a moderate or high level had lower mortality risk as compared to those who did not (HR=.83, p=0.015; HR=.78, p=0.003, respectively). These findings suggest that music engagement in the middle to late life may have an independent beneficial effect in promoting longevity. Future research should examine whether this observed effect was causal and existed in other populations. If confirmed, interventions should be designed to promote music engagement among middle-aged and older adults.
Age Norms and the Spirit of Capitalism
Authors: Morelock Jeremiah
Published: December 2021

Adulthood is often associated with hard work, in contrast to childhood and later life, which are associated with play, education, and leisure. Yet the work-fixated sense of adulthood is about more than just age norms. Like any such ethos, it is situated in socioeconomic history. Workers are forced to work hard, the work ethic framing their exploitation within an aura of moral righteousness. According to Weber the normative weight commonly associated with ‘hard work’ derives from the advent of Protestantism in the late middle ages. Weber says that this new worldview birthed the ‘spirit of capitalism,’ and set the stage for the modern world to take shape. In the seventeenth century—hence roughly coinciding with mercantilism and the Reformation—was the invention of the modern concept of childhood, i.e. the radical division of childhood from adulthood. This period also inaugurated the European Enlightenment, where reason was elevated as a supremely honorable aspect of humanity, in many ways as a new source of this-worldly pseudo-salvation. ‘Adulthood’ was infused with these values—the ideal [male] adult is rational, responsible, hard-working, self-sufficient, and financially secure. It was adulthood, more than and in contrast to other times of life (e.g., childhood and later life), that absorbed and normalized the new economic and cultural trends. The moral elevation of hard work, combined with the greater demarcation of adulthood in contrast to childhood and later life, set up children and older adults to take on a status of moral inferiority due to their exclusion from the working world.
Attitudes about Dementia in Different Stages of Adulthood
Authors: O'Connor Melissa , Pedersen Megan , McFadden Susan
Published: December 2021

Research on attitudes toward dementia has often focused on younger and older adults; few studies have also included the age groups of established and middle adulthood. The current study utilized data from community-dwelling adults aged 18-95 (n=567) residing in two Midwestern states. Participants were divided into four age groups: emerging/young adulthood (ages 18-29), established adulthood (ages 30-45), middle adulthood (ages 46-64), and older adulthood (age 65+). ANOVA models were used to examine age group differences on the following outcomes: factual knowledge about dementia (total score on 14 true-false questions); attitudes toward dementia (total score on the 20-item Dementia Attitudes Scale); and a single item, “I am afraid of losing my memory” (rated on a 5-point scale). The effect of age group was significant in all models (p<0.01 for all). Emerging/young adults had significantly more knowledge about dementia, but less positive attitudes toward dementia, relative to established, middle-aged, and older adults. Attitudes and knowledge did not differ between established, middle-aged, and older adults. By contrast, older adults reported significantly more fear of memory loss than emerging/young, established, and middle-aged adults; fear did not differ between the latter three age groups. There were no significant interactions between age group and sex in any of the models. Implications of these findings are discussed.
Blood Pressure Control and Cardiovascular and Mortality Risk in VA Nursing Home Residents
Authors: Liu Xiaojuan , Lee Sei , Steinman Michael , Graham Laura , Li Yongmei , Jing Bocheng , Odden Michelle
Published: December 2021

Optimal blood pressure (BP) control in nursing home residents is controversial and this population has been excluded from trials. We evaluated the associations of BP level with cardiovascular (CV) events and all-cause mortality across antihypertensive medication categories in Veterans Affairs (VA) nursing home residents. Data for 18,589 residents aged 65 years and older was obtained from the VA Corporate Data Warehouse from October 2006 through September 2017. Baseline systolic BP (SBP) and diastolic BP (DBP) were divided into categories and analyses were stratified by antihypertensive therapy (0, 1, and ≥2 medications). Over a median follow-up of 1.8 years, CV events occurred in 3,519 (19%) residents and 15,897 (86%) residents died. In participants on no BP medications, high SBP (>150 mmHg) was associated with a greater risk of CV events (adjusted [cause-specific] hazard ratio, 1.39; 95% confidence interval, 0.94-2.06) compared with normal SBP (110-130mmHg). By contrast, in participants on ≥2 BP medications, the subgroup with low SBP (<110 mmHg) had a higher CV risk (1.38; 1.20-1.57). For DBP, in participants without BP medications, there were no differences in CV risk across DBP subgroups. Whereas among those on 1 or ≥2 medications, DBP <60 mmHg was associated with a higher CV risk (1.26; 1.03-1.55 and 1.35; 1.18-1.54, respectively) compared with normal DBP (70-80 mmHg). Participants with low SBP (<110 mmHg) and DBP (<70 mmHg) had an increased mortality risk regardless of the number of medications. These findings suggest a potential risk of low BP among nursing home residents on multiple antihypertensive medications.
Community-Academic Partnership to Improve Nutrition and Blood Pressure in Seniors: Outcomes & Impact of COVID-19
Authors: Guishard Dozene , Kost Rhonda , Tobin Jonathan , Vasquez Kimberly
Published: December 2021

The Dietary Approaches to Stop Hypertension (“DASH diet”) has been proven in research settings to lower blood pressure, but its implementation is untested among seniors in congregate meals settings. We report the planning, implementation, impact of COVID-19, and results of an Administration of Community Living-funded study to test whether two evidence-based interventions - DASH-alignment of congregate meals, and home blood pressure self-monitoring, can lower systolic blood pressure and increase blood pressure control among community-dwelling seniors.. Congregate meal menus were aligned with the DASH eating plan, through collaboration of Bionutrition professionals on the research team, CBN food services leadership, and the NYC Department for the Aging. Seniors provided feedback on the DASH-modified meal options. The intervention began on October 15, 2019 (Site 1) and February 3, 2020 (Site 2). The study was interrupted by the COVID-19 pandemic in March 2020, when congregate meals ceased, and when approximately 75% of primary outcome data were collected. Modified implementation permitted completion of modified study outcomes. Preliminary analyses suggest that some participants were able to lower their blood pressure in this program. The DASH diet implemented in the congregate meal setting, along with programs to support BP self-efficacy through modification of existing programs, may be a valuable and scalable model to reduce cardiovascular risk among community-living seniors.
Pulmonary and Physical Function Limitations in Aging Men with and without HIV from the Multicenter AIDS Cohort Study
Authors: Abdo Mona , Kunisaki Ken , Stosor Valentina , D'Souza Gypsyamber , Abdel-Maksoud Madiha , Brown Todd , MaWhinney Samantha , Erlandson Kristine
Published: December 2021

We sought to determine effects of age, HIV serostatus, and smoking on the associations between pulmonary function and physical function impairments using Multicenter AIDS Cohort Study data. Associations between physical function outcomes gait speed (m/sec) and grip strength (kg) with normalized pulmonary function tests (diffusion capacity for carbon monoxide (DLCO, n=1,048) and forced expiratory volume in one second (FEV1, n=1,029)) were examined. Adjusted mixed-effects models included interaction terms to assess effect modification. 574(55%) were HIV+, with median age 57(IQR=48,64) and mean cumulative smoking pack-years 12.2(SD=19.0). 349(33%) had impaired DLCO (<80% of predicted) and 130(13%) had impaired FEV1 (<80% of predicted). Participants with impaired DLCO had weaker grip strength than those with normal DLCO (estimate= -3.5[95% CI=-4.6,-2.4]kg; p<0.001). Participants with impaired DLCO had slower gait speed than those with normal DLCO (estimate= -0.04[95% CI= -0.06,-0.02]m/sec; p=0.002). Age modified the DLCO effect on gait (p-interaction=0.01) but not grip (p-interaction=0.09). The association between decreased DLCO and slower gait was more pronounced in older participants. Smoking or HIV serostatus did not significantly modify the DLCO effect on gait (all p-interaction≥0.14) or grip (p-interaction=0.74, p-interaction=0.058, respectively). As with DLCO, participants with impaired FEV1 had weaker grip strength (estimate=-3.0[95% CI= -4.7,-1.3]kg; p<0.001) than those with normal FEV1. FEV1 was not associated with gait speed(p=0.98). Age, HIV serostatus or smoking did not modify the associations between FEV1 and gait speed or grip strength (all p-interaction>0.05). Associations between lower DLCO/FEV1 and decreased physical function suggest that interventions to improve pulmonary function may also preserve physical function with aging.
Illness perceptions and health outcomes among community-dwelling older adults with multiple chronic conditions
Authors: Bankole Ayomide
Published: December 2021

Illness perceptions (IP) has been associated with self-management and health outcomes in individuals with chronic diseases such as heart disease and diabetes; however, there is less research on the relationship between IP and health outcomes in individuals with multiple chronic conditions (MCC). Older adults with MCC are more likely to experience poor outcomes such as hospitalizations and poor self-rated health yet, there is less understanding of the processes associated with these outcomes. The purpose of this study was to (1) explore the relationship between IP and self-rated health among older adults with MCC (2) explore the relationship between IP and the number of hospitalization within the past year among older adults with MCC. Understanding these relationships may be instrumental to designing targeted interventions to improve health outcomes for this population. 116 participants (ages 65-90) completed the illness perception of multimorbidity scale, modified general health subscale of the SF-36 questionnaire, and self-reported number of hospitalizations within the past year. Ordinal logistic regression was used for analysis. Older adults who reported negative IP were likely to report worse self-rated health and this relationship remained significant after controlling for age and number of chronic conditions {-0.032 (95% CI (-0.050 to 0.014) p< 0.05}. There was no significant relationship between IP and the number of hospitalization within the past year. The study results study suggest that IP is associated with self-rated health in older adults with MCC. IP may be useful to design targeted interventions to improve self-rated health in this population.
Neighborhood Walkability and Physical and Mental Health among Older Adults Living in a Deprived Community
Authors: Blackwood Jennifer , Suzuki Rie , Shah Shailee , Webster Noah
Published: December 2021

Background: Identifying the factors to improve the quality of life (QOL) is vital to decrease morbidity and mortality rates among older adults. Although unfavorable neighborhood features have a significant negative impact on QOL, few studies have investigated these relationships in a deprived community. The purpose of the study was to understand how neighborhood walkability is associated with QOL using the SF-36 among urban-dwelling older adults. Methods: This is a cross-sectional survey. Participants were recruited in 2018 and 2019 at regional health clinics in Flint, MI. To be eligible, participants had to be over 65 years old and Flint residents. Results: Of the 132 participants, the majority were female (66%), African American (77%), single, divorced, or widowed (75%), and educated below GED level (84%). After adjusting for gender, assistive device use, medication, and the Supplemental Security Income receipt, multiple regression analysis revealed that those with better perceptions of land-mixed use and accessibility within their neighborhood were more likely to have better physical health (β = .36, p<.05). However, the perceptions of greater pedestrian safety were associated with the poor physical and mental health (PCS; β = -0.19, p <.05; MCS; β = -0.25, p < .05). Perceptions of the presence of walking hazards and crime were not significantly associated with QOL. Discussion: Findings suggest that neighborhood walkability characteristics are associated with physical health. The development of walking programs with accessible neighborhoods will be urgent to improve the health-related QOL for older adults living in a targeted community.
Stages of Change in Physical Activity and Neighborhood Walkability Among Older Adults living in the Urban Setting
Authors: Blackwood Jennifer , Suzuki Rie , Webster Noah , Shah Shailee
Published: December 2021

Insufficient physical activity (PA) is considered an independent risk factor for chronic diseases. Although older adults living in lower-income areas often experience obstacles to walking locally, few studies have compared their walking experiences and the degree of readiness to change on engaging in PA. The purpose of this study was to compare perceptions of neighborhood walkability by the stages of change among older adults living in a lower-income community. Participants were recruited in 2018 at a regional health clinic in Flint, MI. To be eligible, participants had to be over 65 years old and Flint residents. Of the 132 participants, the mean age was 69.74 (SD=5.00) years old. The majority of respondents were female (66%); African American (77%); single, divorced, or widowed (75%); and educated below a GED level (84%). The results showed that older adults at the pre-contemplation/contemplation stage (PC/C) were less likely to perceive the availability of sidewalks on most streets and more likely to complain about much traffic along the street than those at the action/maintenance stage (A/M) (p < 0.05). After controlling for covariates, multiple regression analysis showed that those at PC/C were less likely to state that their neighborhoods were accessible (β = .17*) and to perceive the presence of walking hazard (e.g., lack of sidewalks) (β = -.17*). Those who engaged in PA less than 30 minutes per day perceived the neighborhoods were accessible (β = .23*). Findings suggest that it is essential to develop friendly support systems and accommodations to encourage walking in lower-income communities.
Understanding Multidisciplinary-team Practice in Developing Home Assessment Tools: A Systematic Review
Authors: Yan Mengzhao , Wilber Kathleen , Pynoos Jon
Published: December 2021

As widely used instruments to identify risk factors and lay out preliminary plans of how to improve the built environment, home assessment tools play an important role in the process of modifying homes for older adults. Developed by a variety of disciplines and tailored to meet various needs, home assessment tools focus on features in homes and how they meet or hinder an older person’s ability to accomplish tasks — in other words, person-environment fit. Based on a comprehensive review of ten evidence-based home assessment tools identified by researchers at the USC Leonard Davis School of Gerontology and the National Council on Aging, we found that a common assessment strategy is the use of multidisciplinary teams (MDTs) in developing and testing the assessment tools to ensure the reliability vs validity of different home modification programs. To understand the nature of MDT practice and derive a set of generalizable protocols for developing person-centered home assessment tools, we conducted a systematic analysis of the ten evidence-based home assessment tools and 41 peer-reviewed journal papers about how the tools were developed, used, and modified. In addition, we applied the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to examine the use of MDTs in developing the tools and carrying out the programs. Based on our analysis, we propose a set of preliminary protocols for developing home assessment tools and a logic model for conducting person-centered home modification programs.
Who and Where? The Spatial Context of Racial and Ethnic Disparities in Economic Security among Older Adults
Authors: Li Yang , Mutchler Jan , Roldan Nidya Velasco
Published: December 2021

Many older adults experience challenging financial circumstances and do not have sufficient income to afford a basic budget in their home communities. Far higher proportions of racial and ethnic minority older adults live on incomes that fall short of what is needed to make ends meet relative to their White counterparts. We describe racial/ethnic disparities in late-life economic insecurity, which occurs when an older person lacks sufficient financial resources to cover necessary expenses in their home community. Although nationwide half of older singles are economically insecure, Massachusetts (62%), New York (65%), Vermont (57%), and Mississippi (57%) have the highest shares of older adults who experience economic insecurity. Compared to Whites, minority older adults have higher rates of economic insecurity in nearly every state, but racial/ethnic disparities are higher in some locations (Rhode Island, Massachusetts, Mississippi, Louisiana) and lower in others (Oregon, Arizona, Nevada, West Virginia). Disparities in economic insecurity reflect the precarious financial situations experienced by many older adults, rooted not only in risks and disadvantages accumulated over time, but also in the variable and uncertain social and economic contexts that accompany the aging experience. By situating older adults in their places of residence, we observe that the cost of remaining in community intersect with life-course experiences associated with social identities to produce disparities in economic security at older ages. The geographic variation in cost of living calls for context-specific assessment of economic security to evaluate the adequacy of economic resources and the associated risk of hardship.
Are Anatomical Gift Donors Demographically Representative of the American Aging Patient Population?
Authors: Collins Amanda , Carter Yasmin
Published: December 2021

Body donation for medical education is voluntary and open to all; however, it is undetermined if the donors studied at UMass Medical School (UMMS) are demographically representative of the national patient population. If not, medical students are missing the opportunity of experiencing normal variation within the population, which may promote bias in their clinical years. This cross-sectional study compared data from the UMMS Anatomical Gift Program (AGP) with the Health and Retirement Study (HRS) population data. This study examined sex, race, ethnicity, veteran status, and sexual orientation. 5 years (n=540) of AGP data and 3 waves (n=5,037) of HRS data were examined. The results demonstrate that sex differences between the AGP and HRS populations (55% for females vs. 45% for males; p=.10) are NOT significant. A significant racial difference between populations is noted (p=.000), with 98.3% of the AGP vs. 72.7% of the HRS identifying as white. Veterans are overrepresented in the AGP (22.6% AGP vs. 9.6% HRS; p=.000). 12.3% of HRS participants report Hispanic ethnicity compared to 0% in the AGP. In 2016, HRS included sexual orientation, with 92.7% of respondents identifying as heterosexual, 2.6% gay or lesbian, 1.0% bisexual and 1.3% other. No data were collected by the AGP pertaining to sexual orientation and neither database ask about gender identity. Aging populations are not represented in the anatomy labs at UMMS and likely nationally. Efforts are needed to improve this and enhance the education of the medical professionals, while expanding the end-of-life options for all community members.
Connecting Patient and Provider Burnout to Eye Exam Frequency among Latinx Older Adults with Diabetes Mellitus
Authors: Martinez-Hollingsworth Adrienne , Friedman Theodore , Bazargan Mohsen
Published: December 2021

Among Latinx older adults, our current understanding of barriers to eye exam often fails to consider the impact of patient and provider burnout which can decrease treatment adherence and recommendation receptivity in this group. The purpose of this study was to examine correlates of eye exam frequency among Latinx older adults in South Los Angeles and explore associations reflecting patient and/or provider burnout. Data analysis was informed by the Secret Self-Management Loop and the Burnout Dyad conceptual models. This secondary analysis used data collected from a convenience sample of non-institutionalized Latinx adults 55+ in South LA (n=165) and used multinomial regression analysis. Outcome variable is recency of eye exam, independent variables are self-reported health, including diabetes mellitus diagnosis, and either patient or provider burnout (that are functions of grouped demographic or quality of care variables). Variables associated with Provider Burnout, appear to represent a larger influence on eye examination frequency then variables associated with Patient Burnout, with the most influential factor being provider recommendation. A surprising finding was the number of participants who had never received this recommendation from a provider (21%). One-third (32%) of participants with diabetes mellitus had not had an eye examination within 12 months and almost one-fifth (13%) of participants with diabetes who had received this recommendation had not received the exam. Further exploration is needed to support a better understanding of how both patient and provider burnout impacts adherence to eye examination and other preventive care recommendations for diabetes mellitus among Latinx older adults.
Linking Sleep and Racial Health Disparities: Characterizing Sleep in the National Sleep Research Resource
Authors: Bisson Alycia Sullivan , Redline Susan , Purcell Shaun
Published: December 2021

To address the problem of racial health disparities, prior work has studied differences in environmentally-influenced and modifiable health behaviors, like nutrition and physical activity. Mounting evidence suggests that sleep plays a key role in health, including cardiometabolic and neurodegenerative disease. Thus, studies have begun to characterize sleep differences across racial groups. We aimed to better quantify differences in objective sleep that may contribute to racial health disparities. In preliminary analyses, we examined whole-night polysomnography from 728 individuals between the ages of 7 and 86 (M: 41.39, SD: 19.39) in the diverse Cleveland Family Study (45% males, 57% African Americans; AAs). Linear models examined racial differences in a battery of sleep metrics and tested interactions with age. Microarchitecture metrics included NREM spindle and slow oscillations, important to cognitive-aging and cardiometabolic health. AAs spent relatively more time in lighter N2 (b= 0.295, p<.001) and less time in deeper N3 (b= -0.364, p<.001) sleep. AAs also had lower NREM spectral power across multiple frequency bands (p<.001), and reductions in spindle characteristics including amplitude (b = -0.537, p<.001) and density (b = -0.341, p<.001). Metrics showed qualitatively different patterns of interaction with age: e.g., racial differences in N3 duration increased with age, and differences in spindle amplitude decreased with age (interactions p<.001), despite marked age-related reductions across all individuals. This work may help to identify specific modifiable aspects of sleep as targets for ameliorating health disparities. Patterns of racial differences over the lifecourse may illuminate different mechanisms being active at different points in development.
Meet Caregivers Where They Are: A Remote Intervention Connecting Caregivers to Community Resources
Authors: Thompson Katherine , Winslow Victoria , Pinkerton El , Huang Elbert , De Ornelas Maria , Borson Soo , Molony Jason , Lindau Stacy
Published: December 2021

Informal caregivers of people with Alzheimer’s disease and related dementias (ADRD) are a vulnerable, often isolated population with high rates of financial strain and need for community resource supports. Little is known about how best to connect these caregivers to resources, especially during the COVID-19 pandemic. CommunityRx-Caregiver is an evidence-based intervention that connects caregivers to community resources for basic needs, wellness, and caregiving. Using preliminary data from a randomized trial of CommunityRx-Caregiver (N=344), we examined caregivers’ baseline confidence in finding community resources and their engagement in the CommunityRx-Caregiver intervention. Caregivers enrolled December 2020-February 2021 (n=26) received (1) personalized lists of community resources via text message (HealtheRx), (2) access to an online resource portal (FindRx) and (3) automated texts offering support for finding resources. Most caregivers were female (65%), Black (92%), >60 years old (64%) and 44% reported very good or excellent health. Nearly half of caregivers (46%) were completely confident in finding community resources. Overall, 81% of caregivers engaged with a text message or the FindRx. Nearly two-thirds (65%) of caregivers responded to at least one text message. More than a quarter (27%) used the FindRx tool; 5/7 of those shared FindRx resources with others. Caregivers sought resources including in-home personal care, exercise classes and support groups. Caregivers of people with ADRD, many of whom had low confidence in finding resources, engaged with a multi-modal information technology-based intervention to obtain community resource support. These preliminary findings suggest caregivers were receptive to a remotely-delivered community referral intervention during the COVID-19 pandemic.