bluuebunny/crossref_metadata_2025 huggingface dataset:
UNCIVILIZED CHILDREN OR VICTIMS OF DEMENTIA: INTERPRETATIONS OF AGGRESSION IN ASSISTED LIVING
Authors: Funk Laura M , Herron Rachel , Spencer Dale
Published: November 2019

There is increasing interest in examining aggression in older adults and persons living with dementia (PLWD) in nursing homes. Relational or indirect aggression between tenants is also of concern in assisted living (A/L). However, there is a dearth of knowledge about how people interpret the meaning of aggression in older adults in A/L. Such interpretations inform responses within interactions as well as in management, practice and policy. This study explored interpretations of aggression in older tenants of A/L through thematic and narrative analyses of qualitative interview data from 32 participants: 13 tenants and 19 staff. Tenants downplayed the existence of ‘bullies’ but spoke of (or themselves enacted, in the interview) relational aggression in tenant conflicts with ‘troublemakers,’ complainers, slackers and PLWD. Dementia was not universally interpreted as excusing inappropriate or aggressive behaviours, and tenants expressed discomfort interacting with PLWD. The narratives of both groups (tenants and workers) drew on and reproduced stigmatizing and/or patronizing views of dementia and aging. Workers commonly positioned dementia (or other conditions such as physical illness, changes in routine, isolation, and loss of independence) as mitigating culpability for aggression. They did so in part to avoid taking aggression personally; some were also concerned about protecting tenants from disciplinary measures. Narratives about aggression reflect and further reinforce relations of power within A/L, with implications for everyday interactions of life and work in these settings. A/L facilities can address relational aggression in part through addressing talk and actions that perpetuate ageism and dementiaism.
ESPO/ BIOLOGICAL SCIENCES SECTION SYMPOSIUM: EMERGING INSIGHTS IN INTERACTIONS AND NETWORKS IN THE BIOLOGY OF AGING DEVELOPING C. ELEGANS TO STUDY AGE-RELATED EXTRACELLULAR VESICLE SIGNALS
Authors: Russell Joshua , Kaeberlein Matt
Published: November 2019

All cells release vesicles into their extracellular environment. These extracellular vesicles (EVs) contain multiple classes of molecules, including nucleic acids, proteins, and lipids. EV-signaling has been shown to be impacted by many age-related physiological processes such as inflammation, mitochondrial stress, and autophagy as well as directly mediate critical functions in cellular senescence and aging. The isolation and analysis of EV cargos from mammalian cell culture and liquid biopsy samples has become a powerful approach for uncovering the messages that are packaged into these organelles. Caenorhabditis elegans is a premier model for dissecting the genetics of aging however, EV analysis has not been tenable in invertebrate model systems due to lack of methods for obtaining sufficient amounts of pure EVs. We developed a method for isolating pure EVs from C. elegans with yields sufficient for mass spectrometry and RNAseq. Here we present the analysis of the genetic and protein cargos of EVs collected from wild type and long-lived mutants collected at different time points across their lifespans. As the first investigation of age-related EV signals in an invertebrate model system we believe these results will provide insights into cell non-autonomous mechanisms of aging.
A FAIRNESS LENS TO LATER-LIFE PLANNING
Authors: Stum Marlene
Published: November 2019

Being “fair” is often a desired goal when individuals are planning for financing future care, leaving an inheritance, and selecting an attorney-in-fact for financial and/or health care. However, differing perceptions about the fair use of an older parent’s resources (paying for formal care, leaving an inheritance, compensating family caregivers, rewarding a sense of entitlement), and issues of who can or should be involved in decision processes, can lead to avoiding planning and be a source of family conflict. The complexities of fair decision rules for distributing resources, and important criteria for determining fair decision processes will be discussed, guided by interpersonal social justice theories, and findings from a qualitative study of inheritance involving older adults and adult children from the same family system (N= 18). Implications for helping family members, and professionals working with them, navigate “being fair” and increase later life planning will be shared.
USE OF ANALYTIC METHODS AND MEDICARE DATA IN THE ANALYSES OF DISPARITIES IN AD/ADRD HEALTH OUTCOMES
Authors: Akushevich Igor , Yashkin Arseniy , Ukraintseva Svetlana , Yashin Anatoliy
Published: November 2019

We demonstrate how application of analytic approaches developed in demography, biodemography, epidemiology, and population studies to Medicare and Medicare-linked data allows to identify causes and mechanisms of disparities in AD/ADRD. Our studies i) confirmed geographic disparities in AD mortality (e.g., existence of hot spots, West-East gradient) but did not detect them in Medicare data, ii) confirmed racial disparities in AD/ADRD incidence and survival (e.g., higher incidence and better survival in Black population) and demonstrated that they can be partly explained by heterogeneity in diagnosis severity and partly by genetic factors, iii) detected unexpectedly strong effects of systemic hypotension, chronic kidney and liver diseases on the risk of AD/ADRD. We concluded that further progress in understanding of mechanisms and causes of the disparities in AD/ADRD is possible by clarifying the role of cause-of-death coding, the effects of comorbidity and their treatment, dynamics in cognition scores before AD/ADRD diagnosis, and genetic factors.
TESTING HEALTH DISPARITIES IN COGNITIVE AND BIOLOGICAL AGING IN OLDER ADULTS IN THE UNITED STATES
Authors: Belsky Daniel
Published: November 2019

We conducted analysis to test if health disparities in cognitive aging were parallel to or different from health disparities in patterns of aging in other systems in the body, and if race/ethnicity-related disparities could be accounted for by differences in socioeconomic circumstances across the life-course. We analyzed data from more than 10,000 adults participating in the US NHANES and US Health and Retirement Study. We measured cognitive aging using neuropsychological tests of processing speed and memory. We measured aging in other systems using composite indices of biological aging based on organ-system function tests and blood chemistries. We conducted analysis to (i) quantify and compare health disparities in cognitive aging and biological aging; (ii) test if individuals exhibiting accelerated cognitive aging were also exhibiting accelerated biological aging; and (iii) test if race/ethnic disparities in cognitive and biological aging could be explained by measured socioeconomic resource differences in childhood and later life.
REDUCED ENDOTHELIAL FUNCTION IS ASSOCIATED WITH DEEP WHITE MATTER LESION VOLUMES AMONG HEALTHY OLDER ADULTS
Authors: Wright Regina S , Bygrave Desiree
Published: November 2019

Reduced endothelial function (EF) is a subclinical cardiovascular disease (CVD) risk factor and precursor to hypertension and atherosclerosis. Among older adults with CVD, reduced EF has been associated with poorer outcomes in a number of cognitive domains, partly explained by the presence of white matter lesion volumes (WMLV) detectable on brain magnetic resonance imaging (MRI). The role of EF as a key, early predictor of brain decrements among older adults without CVD, however, is not well understood. Therefore, the objective of the study was to examine associations between endothelial function and WMLV among cognitively intact older adults free of CVD. A diverse sample of 138 community-based older adults (30.4% male; mean age=68.54y) enrolled in the Healthy Heart & Mind Study underwent cognitive and psychosocial assessment, vascular testing, and brain MRI. Multiple regressions were run to examine associations between endothelial function, as measured by % change in brachial artery flow-mediated dilation (FMD), and MRI-assessed WMLV in brain regions of interest, after controlling for age, sex, race, education, depression, mean arterial pressure, total cholesterol, and hypertension medication use. Results showed a significant inverse association between % FMD change and deep WMLV (p<.05), but no other regions of interest. Results suggest that reduced EF is associated with greater deep WMLV, an outcome variable attributable to small vessel disease and linked to Alzheimer’s disease in previous studies. The implications of this finding for predicting risk for cognitive impairment among healthy older adults will be discussed.
HARNESSING THE HEALING POWER OF WESTERN AND NON-WESTERN HEALERS: IMPLICATIONS FOR SOCIAL WORK PRACTICE
Authors: Gupta Rashmi , Pillai Vijayan
Published: November 2019

Non Western therapies have played a vital role in dealing with a variety of crisis such as physical, emotional and existential over the last few centuries (Ejaz, 2000). Since the introduction of Western medicine in India as early as the eighteenth century, the two systems of medicine have coexisted and influenced each other. Mutual recognition of the therapeutic values of the two systems was further bolstered when American medicine recognized the role of alternative therapies as viable option for healing in the early eighties. The purpose of this paper is to examine the roles two kinds of healers (western and non- western) play in the Asian Indian Hindu context. For this qualitative study, 30 physicians (trained in Western medicine) and 5 sadhus (holy men) were interviewed in the city of Allahabad, during the Kumbh Mela. Open ended questions ranged from: a) field of practice (physicians), sadhus (mystics), b) years of practice, c) number of patients/followers, d) treatment offered (physician –surgery or medications), sadhus (prayers, fasts, charitable donations), e) adverse reactions. In-depth interviews were recorded and transcribed by two researchers from Hindi to English and coded into themes. Results indicate that about a quarter of Western trained physicians not only sought assistance from the sadhus for their emotional/spiritual issues, but also referred patients with terminal disease. Besides individual consults, the mystics conduct lectures on climate change, on holistic diet, meditation, yoga practices, and healing. Social workers need to assess the value Hindu immigrant families in United States attach to Non-Western therapies.
SOCIAL ENGAGEMENT, COGNITIVE IMPAIRMENT, AND MOBILITY IN THE BOSTON REHABILITATIVE IMPAIRMENT STUDY OF THE ELDERLY
Authors: Quach Lien , Gagnon David , Moye Jennifer , Cho Kelly , Bean Jonathan
Published: November 2019

This study examined how social engagement (SE) and mild cognitive impairment (MCI) influence changes in mobility over three years of follow-up. We performed a secondary analysis of longitudinal data among primary care patients aged >64 years (N=430). Mobility outcomes include performance-based function via the Short Physical Performance Battery (SPPB) and patient reported function via the Late-Life Function Instrument (LLFI). Independent variables include: 1) MCI determined by a comprehensive cognitive battery and scores 1.5 SD < age-adjusted mean; 2) SE measured by standardized self-report of social activities. Multivariate linear mixed regression models demonstrate that MCI is associated with lower scores on SPPB and LLFI (β= -0.76, p<0.0001; β= -1.47, p=0.005 respectively). SE is associated with higher scores on SPPB and LLFI (β=0.56, p<0.0001; β= 1.95, p<0.0001 respectively), and partially mediates the association between MCI and on each outcome. SE is linked to mobility decline especially among participants with MCI.
FEASIBILITY AND ACCEPTABILITY OF AN EXERGAMING INTERVENTION FOR OLDER ADULTS AT RISK FOR FALLS
Authors: Ogawa Elisa F , Huang Haikun , Yu Lap-Fai , Gona Philimon N , Fleming Richard K , Bean Jonathan F , Leveille Suzanne G , You Tongjian
Published: November 2019

This study examined the feasibility and acceptability of an exergaming program that utilized custom exergames, and compared it to a traditional physical exercise (control) program in older adults at risk for falls. A quasi-experimental study was conducted in older adults who lived in senior living communities. Participants enrolled in either program offered twice weekly for 8 weeks based on their residential site. Thirty-five participants enrolled in the study (mean age 77±7y) and 29 (82%) completed the follow-up assessment (exergaming: 93%; control: 73%). Overall attendance was 73% (exergaming: 79%; control: 68%), and 22 participants returned their program satisfaction form. There were no significant between-group differences in ratings of overall quality, enjoyment, instructors, peers, and facility of their assigned exercise programs. The exergaming intervention was well received and perceived as enjoyable. This study demonstrates that an 8-week exergaming intervention is feasible and acceptable for older adults at risk for falls.
SHRINKING AND GROWING SOCIAL NETWORKS IN THE SYDNEY MEMORY AND AGEING STUDY
Authors: Casey Anne-Nicole S , Kochan Nicole A , Sachdev Perminder , Brodaty Henry
Published: November 2019

Gerontological research suggests that shrinking social networks are characteristic of older age. Socioemotional selectivity theory suggests that older adults proactively reduce their networks over time. Core relationship networks consist of friends and family who are contacted at least monthly. Studies of perceived social support indicate that shrinking networks increase risk of isolation, loneliness, and associated ill health effects. Our research aimed to investigate change in size of older adults’ core relationship network over time, and to explore associations between network size and participant characteristics, using data from the first four waves of the Sydney Memory and Ageing Study. Participants completed: assessments of cognition, depression, personality; surveys of health-related quality of life, medical conditions, number of friends and relatives contacted at least monthly. Of 1037 participants aged 70 to 90 years surveyed at baseline 476 provided network data at all four time-points. Just over half of the participants (n=252, 52.9%) had smaller networks at wave 4 compared to baseline; nearly half of participants had stable (n=65, 13.7%) or larger networks (n=159, 33.4%), some doubling in size (n=65, 13.7%). Chi-square test indicated that more males (59.1%) had decreasing networks [X2(1, 476)=2.26, p=.02, phi=.11]. T-tests indicated: group differences in baseline neuroticism [t(276)=2.31, p=.02, Eta2=.02]; no significant difference in age, education, wave 4 global cognition, depression, quality of life, number of medical conditions. Results complement previous literature, yet challenge assumptions that shrinking social networks are a defining characteristic of older age. Future examination of our mental and physical engagement data may elucidate these differences.
NOVEL AGING BIOMARKERS IN THE HRS
Authors: Crimmins Eileen
Published: November 2019

In addition to the broad panel of aging related biomarkers available in HRS, we will describe measurement of novel aging biomarkers such as telomere length and mitochondrial DNA copy number in 4000 HRS participants. Both these biomarkers were measured in DNA obtained from whole unsorted blood using quantitative real time polymerase chain reaction (PCR) and were adjusted for individual cell composition measured from flow cytometry. We will describe the relationship between these two biomarkers and other measures of biological age available in HRS. Differences in these two novel aging biomarker by socioeconomic status, race/ethnicity, and exposure to early life hardships will be presented to clarify the value of the data to further unravel how social factors get under the skin to affect the process of aging.
TRANSCRIPTOMIC AGING IN THE HRS
Authors: Thyagarajan Bharat
Published: November 2019

Since age related perturbations in gene expression profiles have been described and transcriptomic changes in specific biological pathways have been implicated in the aging process, we performed whole transcriptome sequencing on 4000 HRS participants using RNA obtained from Paxgene tubes collected during the 2016 interview. We will describe design and implementation of innovative quality control procedures to minimize technical variability in transcriptomic measurements and monitor analytical variation in large population studies such as HRS. We will also report the distribution of transcriptomic profiles according to various demographic characteristics (age, sex, racial/ethnic and socioeconomic differences) and describe the prevalence of previously reported aging related transcriptomic signatures in HRS. We will describe the associations between transcriptomic profiles and other measures of biological aging in HRS and report how changes in cell composition can affect transcriptomic profiles observed in population studies such as HRS.
EPIGENETIC AGING IN THE HRS
Authors: Faul Jessica
Published: November 2019

Biological aging can be characterized by molecular, cellular, and epigenetic changes that in addition to being related to chronologic age, are also associated with social disadvantage and associated morbidity and mortality. These biological markers can help explain at a biological level why socially disadvantaged individuals are at greater risk of aging-related disease and premature death. From DNA extracted from venous blood collected from over 4,000 HRS participants we measured array based DNA methylation. These assessments were made from unsorted cells, but are adjusted for individual cell composition measured from flow cytometry. We present genome-wide methylation differentials by age, race/ethnicity and SES using the largest, nationally representative sample with these data available to date. Understanding basic biological changes related to age and social disadvantage is essential for identifying translational opportunities to improve health.
NOVEL FINDINGS TWO DECADES FOLLOWING COGNITIVE TRAINING: FINDINGS FROM THE ACTIVE TRIAL
Authors: Gross Alden L , Rebok George W , Boot Walter
Published: November 2019

Although the only demonstrated panacea against cognitive decline, behavioral cognitive training usually fails to demonstrate transfer either to untrained cognitive abilities or to distal outcomes like everyday functioning. No such trials, however, have leveraged more than a decade of follow-up to adapt life-course perspectives. The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study remains the largest NIA-funded clinical trial of cognitively normal older adults. Efforts to re-invigorate the cohort after 20 years with external data linkages have coalesced around renewed interests in how training-related cognitive improvements affect long-term dementia risk, health care utilization and costs, credit scores, and active years in later life. The first presentation by Rebok overviews ACTIVE and its 20-year follow-up plans. Next, Gross and colleagues tested whether cognitive training attenuates the relationship between IADL difficulty and mortality; negative findings suggest proposed relationships between cognition and IADL difficulty are correlational, not causal, which has implications for transfer and trial outcomes. Third, Thomas tests a novel algorithm for classifying MCI, ushering opportunities to examine training effects on incidence of MCI after up to 20 years post-training. Marsiske then evaluates temporal transfer of training in reasoning ability, concluding that reasoning training and age, but not other baseline demographics, predict maintained alterations in reasoning abilities. Finally, Felix evaluates the stifling role of depressive symptoms on ability to benefit from training. Dr. Wally Boot, a recognized thought leader in transfer of cognitive training, will provide an illuminating discussion of promises and pitfalls of these lines of research.
ADDRESSING THE NEEDS OF INCARCERATED INMATES WITH DEMENTIA: CREATING DEMENTIA-FRIENDLY PRISONS
Authors: Gruss Valerie , Hasnain Memoona
Published: November 2019

U.S. prisons are experiencing a graying of their population, with many older inmates experiencing chronic conditions, including dementia. Older prisoners now represent 10% of the U.S. prison population and 18% of Illinois’ prison population. Aging inmates cost more to incarcerate due to their medical needs. Bureau of Prisons data estimate $881 million (19%) of its budget was spent to incarcerate aging inmates. Prisons are seeking solutions to address the unmet needs of older inmates, especially those with dementia. These older inmates with dementia face discrimination and exploitation within the prison population, and Correction Officers and clinicians lack training to understand and address their complex needs. Utilizing the Alzheimer’s Association’s, ACT on Alzheimer’s Toolkit we implemented four phases guiding communities’ adoption of dementia-friendly practices: we convened meetings with Illinois Department of Correction leaders, assessed community strengths and gaps by surveying prison wardens, analyzed findings and created an action plan to provide dementia training of prison staff to create a dementia friendly community. Our “Dementia-Friendly Prisons” program trains prison staff on understanding and providing supportive care and management to inmates with dementia, enabling staff to meet inmates’ needs, thereby creating an environment where inmates with dementia are safe and treated respectfully. Our program used an Appreciative Inquiry Four-D cycle approach (Discover-Dream-Design-Destiny) to engage and empower learners from a highly diverse workforce to develop into collaborative teams. Our program remedies a problem in the delivery of prison healthcare, serving a particularly vulnerable population and creates an adaptable model for other prisons and communities.
CARING FOR OLDER INDIGENOUS PEOPLE WITH DEMENTIA: ATTENDING TO THE PERSONALITY
Authors: Mason Kathleen R , Moeke-Maxwell Tess H , Gott Merryn
Published: November 2019

Māori, the indigenous people of New Zealand, are living longer and dying older. The prevalence of conditions associated with older people, such as Dementia are expected to increase amongst the Māori population. Pae Herenga, a qualitative research project investigating traditional Māori end-of-life care customs, identified an indigenous narrative of Dementia care, as carried out by their families. Sixty participants took part in face-to-face interviews to systematically record the traditional care customs employed by Māori families. Of these families, five experienced caring for someone with dementia. A traditional Māori family values approach based on biological connections, relationships, empathy, love, patience and inclusiveness aimed to care for the individual with Dementia as an important member of the family, and sought to maintain as much of the person’s autonomy as possible, for as long as possible. Sharing care roles between family members and maintaining connections to Māori communities helped to prevent isolation of the person with Dementia and their family members caring for them. Involvement in family and community activities, and attending to the individual’s personality and their spiritual needs were just as important as tending to their physical care needs. These findings emphasize the importance of a holistic approach to caring for indigenous people with Dementia.
INSIGHTS FROM AFRICAN AMERICAN OLDER ADULTS ON BRAIN HEALTH RESEARCH ENGAGEMENT: NEED TO SEE THE NEED
Authors: Bardach Shani H , Yarbrough Markeda , Walker Charlene , Alfred Doris L , Ighodaro Eseosa , Jicha Gregory A
Published: November 2019

Recruitment of African American (AA) participants into clinical research trials in the area of aging and dementia is a major problem facing the field. Although AAs are at a significantly elevated risk of developing Alzheimer’s disease (AD), they are underrepresented in clinical trials and research studies. While previous research has identified a number of barriers to participation, relatively little is known about how to overcome these barriers and engage AA individuals in research. Photovoice may provide a novel approach to advance our understanding of AA perceptions in regards to barriers and strategies to increase AA engagement in brain aging research. The purpose of this project is to add to existing understanding of barriers and facilitators and identify strategies to enhance engagement. Three AA research advocates served as community facilitators to identify and guide groups of AA adults though an 8-10 session photovoice project. Group sessions involved discussions and sharing of images pertaining to various prompts in the area of brain health and research participation. Sessions were audio-taped and transcribed verbatim and photos were uploaded. Participants identified four categories of barriers to AA research participation: Mistrust, the belief that all research involves medication, avoidance and fear of acknowledging problems, and seeing the risks of research but not the need. Participants had various suggestions and approaches for ameliorating each of these barriers. This photovoice community engagement process revealed unique insights into barriers and opportunities for increasing AA engagement in brain aging research.
SYSTEMATIC REVIEW AND META-ANALYSIS OF RACIAL AND ETHNIC DIFFERENCES IN DEMENTIA CAREGIVER WELL-BEING
Authors: Liu Chelsea , Badana Adrian , Burgdorf Julia , Fabius Chanee D , Haley William E , Roth David L
Published: November 2019

Studies comparing racial/ethnic differences on psychological and physical outcomes of dementia caregivers have often reported differences in well-being for minority groups compared to Whites. However, due to issues with enrolling minorities into studies, recruitment methods often differ for minority and White participants and may lead to biased comparisons. We conducted a systematic review and meta-analysis to examine racial/ethnic differences in dementia caregiver outcomes and to determine whether any differences vary among studies with population-based samples compared to convenience samples. We systematically reviewed articles with primary data from PubMed, Google Scholar and PsycINFO, and included studies comparing either African American (AA) or Hispanic/Latino dementia caregivers to White caregivers on measures of psychological health (e.g. depression, anxiety, burden) and physical health (e.g. self-rated health, cardiovascular measures, stress biomarkers). Reviewers screened titles and abstracts, reviewed full texts and conducted risk-of-bias assessments. A total of 207 effects were extracted from 40 studies. Random-effects models showed that Hispanics/Latinos reported significantly lower levels of well-being than Whites (ps < .05) for both psychological outcomes (37 effects) and physical outcomes (15 effects), while AAs were not significantly different from Whites in either domain. No differences were observed for population-based studies (N=3; 23 effects) or convenience-sample studies (N=37; 184 effects). Although some previous studies with convenience samples found better psychological well-being in AA caregivers, that pattern was not confirmed in our meta-analysis. Additional analyses for the different indicators of well-being and the relationship of quality ratings to effect sizes will be discussed along with implications for future research.
NUMBER OF FRIENDS AND THE RISK OF DEVELOPING DIABETES: A REPLICATION USING NSHAP AND HRS
Authors: Hawkley Louise , Schumm Phil , Huang Elbert , McClintock Martha
Published: November 2019

The epidemic increase in diabetes prevalence (primarily type 2) is a public health crisis. We hypothesized that the rates of movement among diabetic states depend in part on one’s social relationships and environment. Using population-based samples from both NSHAP and HRS, collected in 2005–15, we found that having more friends was associated with a lower risk for acquiring diabetes over the next 4-5 years. As an independent replication, separate logistic models for NSHAP and HRS data yielded similar odds-ratios for the protective effect of having friends (OR = 0.82 and 0.92 respectively), adjusting for gender, age, race/ethnicity, and BMI. This effect was concentrated entirely between 0–4 friends; differences in the number of friends above 4 were not associated with differences in diabetes risk.
FOR BETTER AND WORSE? THE IMPORTANCE OF CLOSENESS AND AGE FOR SPOUSES’ CARDIOMETABOLIC SIMILARITY
Authors: Wilson Stephanie J , Peng Juan , Andridge Rebecca , Jaremka Lisa M , Fagundes Christopher P , Malarkey William B , Belury Martha A , Kiecolt-Glaser Janice K
Published: November 2019

Spouses share age-related disease risks: a person’s diabetes or hypertension raises the partner’s odds for the same condition. To probe the importance of partners’ closeness, marital satisfaction, and age for spouses’ similarity in cardiometabolic health, 43 disease-free couples ages 24-61 provided fasting glucose, fat and carbohydrate oxidation, and blood pressure at two study visits. Couples who felt closer had more similar rates of carbohydrate oxidation compared to those who felt less close. Likewise, happier couples had more similar carbohydrate and fat oxidation. Fasting glucose and blood pressure were more similar within middle-aged couples compared to younger pairs. In follow-up analyses, partners’ health behavior concordance did not explain these effects. In sum, closer, happier, and older couples shared more similar cardiometabolic profiles, perhaps driven by joint stress and emotional spillover. Findings suggest that closer, happier relationships may confer both larger health risks and benefits, and increasing age may raise the stakes.
RACE-ETHNICITY AND HOPELESSNESS IN OLDER AMERICANS: WHO’S AT GREATEST RISK AND WHY?
Authors: Mitchell Uchechi
Published: November 2019

Racial and ethnic minorities are more likely to experience adversity throughout their lives, which puts them at greater risk feelings of despair and powerlessness. This study uses data from 5,500 respondents from the Health and Retirement Study to assess racial/ethnic differences in hopelessness and test whether older blacks and Hispanics experience greater increases in hopelessness as they age. Hopelessness was assessed using 4-items that capture the extent to which a person has a negative outlook towards the future and believes they are powerlessness to overcome the obstacles they face; it is measured at three time points: 2006/2008, 2010/2012 and 2014/2016. Linear regression models were used to assess differences in hopelessness by race/ethnicity and linear mixed models were used to assess racial/ethnic differences in trajectories of hopelessness over time. Older blacks and Hispanics were more likely to report feelings of hopelessness at each timepoint of the study. Differences between blacks and whites were completely explained by differences in education and poverty status, while differences between Hispanics and whites remained. Although minority elders had higher levels of hopelessness at each time point, older whites experienced steeper increases in hopelessness over time. These findings suggest that structural factors influence feelings of hopelessness among minority elders. However, older blacks and Hispanics may develop resilience to hopelessness as they age.
STRENGTH IN AGE: HARNESSING THE BENEFITS OF NIA’S 45 YEARS
Authors: Bernard Marie A , Hodes Richard , Barr Robin A
Published: November 2019

The National Institute on Aging at the National Institutes of Health was established in 1974 with a mission to support and conduct research on aging processes, age-related diseases, and special problems and needs of the aged. Shortly thereafter, the Institute was designated by Congress as the lead research agency in Alzheimer’s disease. During this symposium, NIA’s scientific leadership will reflect on major accomplishments to improve the health of older individuals over the past 45 years and look to the future of the NIA and aging research. This symposium will describe progress led by NIA’s extramural divisions, the intramural program, and the Office of Special Populations. A brief panel discussion will ensue, followed by an informal reception and opportunities for networking in celebration of NIA’s 45 years
VIEWPOINT FROM THE DIVISION OF NEUROSCIENCE
Authors: Masliah Eliezer
Published: November 2019

Dr. Masliah will review accomplishments of the Division of Neurosciences and make projections for the future.
VIEWPOINT FROM THE DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH
Authors: Haaga John
Published: November 2019

Dr. Haaga will review accomplishments of the Division of Behavioral and Social Research and make projections for the future.
STRENGTH IN AGE: INCREASING THE POWER OF FAMILY CAREGIVERS
Authors: Young Heather , Harvath Theresa , Cothran Fawn
Published: November 2019

This session addresses approaches to strengthening the capacity of family caregivers in the context of intense and complex care. Recognizing the increasing role that families play in delivering complex care at home to individuals with multiple conditions, this symposium highlights approaches to enhancing support and increasing the power of family caregivers. In the first half of the symposium, the papers elucidate characteristics of the caregiving situation that put caregivers at risk and suggest potential areas for intervention by health systems. The second half explores system level approaches to enhancing capacity for family caregivers. On the demand side, the first paper will examine the social network of family caregivers, highlighting effects of social isolation on caregiver health. The second paper uses national data to understand the relationship between higher demand caregiving situations and the strain and challenges that caregivers experience. On the potential solutions side, the third paper addresses a collaborative design of an intervention to enhance supports for family caregivers of persons with dementia at a critical time, during hospitalization. The last paper provides an overview of evidence-based technological solutions to support family caregiving. Taken together, these papers establish some of the demand characteristics of the caregiving situation and provide potential health system solutions to improve capacity of family caregivers. In the final segment, three discussants will reflect on the implications of these papers for clinical practice, education, research and policy.
AN ACADEMIC-HEALTH SYSTEM COLLABORATION TO DEVELOP A PROGRAM FOR FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Siegel Elena , Hinton Ladson , Rice Elizabeth , Shah Nilpa , McElroy Vanessa , Lacsamana Jasmine DeGuzman , Young Heather M , Maynard Gregory A
Published: November 2019

Hospitalization of persons with dementia can pose specific challenges for family caregivers, with post-discharge issues in managing acute clinical care needs coupled with dementia-related care that can exacerbate caregiver fatigue and capacity. We established an academic-practice collaboration to develop an evidence-based and innovative multi-component health system-level program to support family caregivers of persons with dementia in transition from hospital to community. Using an implementation science approach aimed to decrease the gap in translation of caregiver research into practice, we co-designed the program/implementation plan as a quality improvement initiative reflecting an integration of evidence from family caregiving literature and the health system’s unique context, workflows, stakeholder perspectives, resources, and values/priorities. This paper highlights insights gained and lessons learned in establishing a successful academic-practice collaboration, including time/investment to establish a shared project vision and identify/leverage existing organizational capacity to successfully deliver a program to improve the health and wellbeing of family caregivers.
WHY DO OLDER WORKERS WITH CHRONIC HEALTH CONDITIONS PREFER TO RETIRE EARLY?
Authors: Vanajan Anushiya , Bültmann Ute , Henkens Kène
Published: November 2019

Older workers experiencing chronic health conditions (CHCs) are more likely to retire early. Current literature, however, lacks knowledge on the different pathways through which CHCs stimulate retirement preference. Earlier research is highly fragmented. Some studies have found CHCs to impact vitality, work limitations, or subjective life expectancy. Others have found vitality, work limitations, or subjective life expectancy to predict retirement preferences. We present a comprehensive model in which we hypothesize that the effects of four CHCs - arthritis, cardiovascular disease, sleep disorders, and psychological disorders - on retirement preferences are differentially mediated by vitality, health-related work limitations, and subjective life expectancy. We analyzed data from 6,294 older workers (60 – 65 years) in the Netherlands. Effects of CHCs on older workers’ retirement preferences were mediated by vitality, health-related work limitations, and subjective life expectancy. The main mediation pathway differed for each CHC. Severe health-related work limitations among older workers with arthritis (65.6% mediated) and cardiovascular disease (44.0%) predominantly guided their retirement preferences. Lower vitality levels mainly mediated retirement preferences of older workers with sleep (59.1%) and psychological disorders (52.9%). Lower subjective life expectancy was a significant mediation pathway (13.7%) for older workers with cardiovascular diseases. Extending working lives is a key public health and policy challenge. We show that health-related work limitations and vitality play a major role in determining retirement preferences of older workers experiencing CHCs. Since both mediators are modifiable, targeted interventions may not only extend the working lives of older workers, but also improve its quality.
TWO TALES OF TRANSLATION: EVIDENCE-BASED CAREGIVER PROGRAMS THROUGH COMMUNITY-BASED ORGANIZATIONS
Authors: Coon David , Whitlatch Carol
Published: November 2019

This presentation reports findings from on different translation approaches that embedded into the community two evidence-based interventions for family caregivers of people with dementia. CarePRO was embedded into the community after completion of a clinical trial, whereas EPIC was embedded from the program’s inception. CarePRO is a group and telephone coach call intervention targeting family caregivers and EPIC is a group dyadic intervention for both early-stage people and their care partners. Available in English and Spanish, these programs are still being delivered across two states through community-based organizations. Findings from both CarePRO and EPIC demonstrate significant levels of participant benefit (e.g., reduced negative mood states, negative coping strategies, and negative network interactions as well as increased positive mood states, self-efficacy, care preparedness). Presenters will share lessons learned from the translation process regarding design modifications, training and supervision of interventionists, participant recruitment and retention, and adaptation of outcome assessments.
HOME AND COMMUNITY-BASED CARE FOR A DIVERSE AND GROWING POPULATION: WORKFORCE POLICY AND PRACTICE IMPLICATIONS
Authors: Scales Kezia , Sturgeon Jodi M , Iezzoni Lisa I , Espinoza Robert , Campbell Stephen , Cook Allison , Gallopyn Naomi I
Published: November 2019

Most Americans would prefer to continue living in their homes and communities as they age, even when they require support with daily activities due to illness or disability. Much of this support is provided by unpaid caregivers, but the paid home care workforce also plays an essential role. Due to demographic changes and poor job quality, however, the home and community-based services (HCBS) sector is struggling to attract and retain enough workers to meet demand. Drawing from an extensive analysis of HCBS in the United States, this paper examines key factors impacting the home care workforce, including: supply and demand trends; financing policies; service-delivery models; and policies and practices defining workers’ compensation, training, and career development. From these findings, we provide recommendations for addressing the home care workforce crisis and maximizing home care workers’ contribution to the delivery of high-quality supports for a growing and evolving population of HCBS consumers.
WE’RE NEVER TALKING ABOUT IT: POLICY AND PRACTICE ABOUT END OF LIFE IN ASSISTED LIVING
Authors: Bender Alexis A , Vandenberg Ann E , Kemp Candace L , Burgess Elisabeth O , Perkins Molly M
Published: November 2019

Increasing numbers of people are aging in place and dying in assisted living (AL) and AL is increasingly becoming a site of end-of-life care in the US. Consequently, AL staff frequently experience death and decline of the residents they care for. Using data from ethnographic observations and in-depth qualitative interviews with 14 direct care workers and 16 administrators participating in a 5-year NIA-funded study (R01AG047048) examining end-of-life care in four diverse ALs, we used thematic analysis to examine how AL administrators and staff implement and understand policies and norms around death and dying (e.g., training or use of advance care directives). We found there is limited training regarding death and bereavement and limited formal grief support for staff. These findings identify gaps in communication between administrators and direct care workers with implications for increasing communication about death and dying and improving support for direct care workers experiencing grief and bereavement.
SENSORY LOSS AND THE HEALTH CARE SYSTEM
Authors: Reed Nicholas , Yeh Charlotte
Published: November 2019

Communication is fundamental to patient-centered care. However, sensory impairment may limit communication among older adults. Specifically, hearing impairment strains communication via degraded auditory encoding while vision impairment distresses ability to read and interpret visual cues. The presence of dual sensory impairment, defined as concurrent hearing and vision impairment, may exacerbate these effects. The potential consequences of age-related sensory loss on health care interactions and outcomes are beginning to surface in epidemiologic studies demonstrating poorer patient-provider communication, higher incurred health care costs, increased risk of 30-day readmission, and longer length of stay when compared to individuals without sensory loss. Importantly, these associations may be amenable to intervention via sensory aids; however, uptake to sensory care is low. Notably, less than 20% of persons with hearing impairment have hearing aids and over 55% of Medicare Beneficiaries with reported vision problems have not had an eye examination in the prior year. Affordability and access may contribute to lack of sensory care uptake as Medicare explicitly excludes coverage of vision and hearing services. In this symposium, we will review current and new evidence for whether sensory loss affects health care outcomes, including satisfaction with care and medical costs, and present data on how persons with sensory loss interact with the health care system based on the need and reasons for accompaniment to care visits. Further, we will discuss and provide evidence for how sensory care may mitigate these associations. Lastly, we will place these results within the context of quality care and policy initiatives.
EXPLORING THE POWER OF COMBINATORIAL HEALTH TECHNOLOGIES TO SUPPORT SELF-MANAGEMENT OF COPD AMONG OLDER PEOPLE
Authors: Varey Sandra , Dixon Mandy , Hernandez Alejandra , Mateus Ceu , Palmer Tom , Milligan Christine
Published: November 2019

Ways to address the increasing healthcare needs of older people are a priority for the National Health Service (NHS) in England. The NHS England Test Bed programme was designed to trial new models of care that are supported by digital health technologies. This paper reports on findings from one Test Bed programme, the Lancashire and Cumbria Innovation Alliance (LCIA) – a partnership between NHS England, industry and Lancaster University, which ran from 2016 to 2018. A key aim of the LCIA Test Bed was to explore the extent to which supported self-care telehealth technology helped older people with long-term conditions to better self-manage their own care, promoting independence and enabling them to remain at home for longer. Each patient received a combination of health technologies over a six-month period. This paper presents results from the qualitative data that formed part of a large-scale mixed-methods evaluation. Specifically it draws on the analysis of 34 observational interviews with 17 participants with chronic obstructive pulmonary disease (COPD) to understand the role of these technologies in the self-management of their care. The data revealed that the majority of participants felt more confident about self-managing COPD as a result of their participation in the programme. These increases in confidence were the result of participants’ increased knowledge and skills in managing their COPD. The paper demonstrates how patients learned to better manage their respiratory condition, the impact of this learning on their daily lives and that of their family carers, and the implications for healthcare practice.
EAST MEETS WEST: BUILDING DEMENTIA-FRIENDLY COMMUNITIES: REFLECTIONS ON GLOBAL EXPERIENCES
Authors: Sun Fei , Hooyman Nancy
Published: November 2019

The emergence and rapid development of dementia friendly initiatives (DFIs) represents growing global awareness of needs of persons living with dementia (PWD). Policy and practice efforts across regions and countries made to make physical and social environments more friendly, inclusive, and capable for PWD vary. When designing, implementing and evaluating DFIs, countries at different socioeconomic development stages need to set priorities based upon their local needs and cultural norms. This East Meets West symposium aims to understand the variability and progress of the DFI in the global context, highlighting experiences from two countries: U.S.A. and China, where about one third of the world’s total estimated 47 million PWD live. The first study from Shanghai emphasizes efforts by local health care professionals to promote dementia screening and improve diagnosis, with the ultimate goal to improve dementia literacy and build a dementia friendly city. The second paper describes a community-based participatory approach to develop dementia friendly communities in Beijing, highlighting the significance of non-governmental and governmental collaboration. The DFI in Florida underscores the partnership among multiple sectors with an emphasis of the involvement of PWD, while the DFI in rural Michigan stresses care system coordination. The last paper based upon an online survey of DFI stakeholders from six WHO regions echoes successful features of DFIs (i.e., involvement of PWD, multi-sectorial partnership) identified in Chinese and U.S. examples, and identifies variations in strategies used to modify physical and social environments across countries. Invited panelists from different sectors will share comments in the end.