bluuebunny/crossref_metadata_2025 huggingface dataset:
Motor and Sensory Function as Predictors of MCI and Dementia in the Baltimore Longitudinal Study of Aging (BLSA)
Authors: Schrack Jennifer , Wanigatunga Amal , Cai Yurun , Wang Hang , Agrawal Yuri , Resnick Susan , Ferrucci Luigi , Tian Qu
Published: December 2021

Motor and sensory impairments are linked with dementia risk, but whether there is a joint effect of deficits in motor and sensory function is unknown. We analyzed 649 BLSA participants (aged 72±11 years; 55% women; 68% white) who had concurrent baseline 6-meter usual gait speed and sensory function (vision, hearing) between 2012-2019. Mild cognitive impairment (MCI) and dementia were adjudicated during an average follow-up of 3 years. We examined the association between baseline gait speed, z-scored sensory function, and a gait*sensory interaction with risk of MCI/dementia using Cox proportional hazard models, adjusted for demographics and chronic conditions. Each .01 m/s faster baseline gait was associated with a reduced risk (HR:0.98 (0.96-0.99)) of MCI/dementia, and each 1 SD higher in hearing and vision z-score was associated with an increased risk (HR:1.84 (1.1-3.1)) increased risk. The was no significant interaction, suggesting motor and sensory impairments may be independently associated with MCI/dementia risk.
Early Retirement and Sensory Impairments: The Modifying Effect of Total Assets
Authors: Morales Emmanuel Garcia , Reed Nicholas
Published: December 2021

Sensory impairments are common among older adults. Little is known on the association between sensory impairments, which impact labor productivity, and the effect modification of wealth. We used the 2006-2018 rounds of the Health and Retirement Study. Hearing (HI) and vision (VI) impairments (self-report) at baseline, and working status throughout the study period was observed. Logistic regression models, adjusted for demographic, socioeconomic, and health characteristics, were used to characterize the association of sensory impairment and early retirement (i.e., before age 65). Secondary analysis stratified by assets. Among 1,688 adults ages 53-64, 1,350 had no impairment, 140 had HI only, 141 VI only, and 57 had dual sensory impairment (DSI). Only adults with HI had higher odds of early retirement (Odds Ratio [OR]: 1.6; 95% Confidence Interval [CI]: 1.0,2.5) relative to those without sensory impairment. Among those with large assets, those with HI had higher odds (OR:2.6, 95% CI: 1.4,5.2) and those with VI had lower odds (OR. 0.37; 95% CI: 0.2,0.8) of early retirement. Among the low asset group, we found no differences across impairment groups for the odds of retirement. In sample of older adults, we provide evidence that the presence of hearing impairment is associated early retirement. Secondary analyses suggest wealth may modify this association which highlights the wealth disparities faced by people with sensory impairments.
Retirement Migration and Precarity: Material and Social Aspects
Authors: Repetti Marion , Calasanti Toni
Published: December 2021

Discussions of precarity in later life have tended to focus on the uncertainties of material resources, and the feelings of anxiety that this evokes (e.g., Lain et al. 2019) as some older people thus face the risk of being excluded from the broader society. Although scholars often point to inequalities, such as those based on class and gender, as having an influence on the likelihood of older people experiencing such precarity, ageism is considered only to the extent that it can exacerbate the impact of these statuses through, for instance, labor market experiences. Here, we expand upon the impact of ageism on the social aspects of precarity: the loss of recognition and respect as a person that is at the core of social bonds. Drawing on qualitative interviews we have conducted among Swiss, British, and U.S. older people who migrated to cheaper countries in retirement, we demonstrate that ageism can influence precarity regardless of classes. We find that even among wealthier older migrants, who otherwise might fit the image of the retiree seeking an active lifestyle in a sunny location, the attempt to escape the devaluation heaped upon older people in their original country plays an important role. In their new countries, retired migrants of all classes felt that they were valued and part of a community, and this differed from the ageism in their home countries. We thus argue that ageism be considered in future analyses of precarity in later life.
Dynamic Relationships Between Perceived Housing and Life Transitions: A Better Understanding of Good Aging in Place
Authors: Oswald Frank , Schmidt Steven , Cutchin Malcolm
Published: December 2021

Housing has gained increased relevance as a central factor for health and well-being. Many countries have implemented ageing in place policies, which provide services focused on improving the physical environment. Housing needs change as people grow older and experience different transitions across their life courses. Studies have demonstrated relationships between housing and health and well-being in later life on the one hand and life transitions and health and well-being in later life on the other hand. However, research on life transitions in combination with perceived housing in relation to indicators of good ageing is virtually nonexistent. This symposiums aims to address the dynamic relationship between perceived housing and life transitions and how they impact health, well-being, functioning, and social/neighborhood participation as people age by data from a mixed-method approach in Sweden and Germany. The first contribution by Slaug and colleagues introduces changes in how older adults perceive their housing following the life transition of a fall at home. Second, Eriksson and colleagues present qualitative results on the experience of relationships between perceived housing, several life transitions and well-being among community-dwelling Swedish older adults. Third, Wanka and colleagues present partially different results from a comparable study in German on the same topic but emphasizing the experience of interrelationships between different life course transitions. Fourth, Granbom and colleagues explore how low-income older adults in Sweden reason about their current housing situation and a future life transition of relocation. Finally, Malcolm P. Cutchin will serve as the session’s discussant.
Association of In-Lab and Free-Living Mobility Measures With Falls and Fear of Falling in Underactive Older People
Authors: Niemiec Stacey Schepens , Vigen Cheryl , Blanchard Jeanine , Niemiec Matthew , Eng Brittany
Published: December 2021

Falls in older adults have significant consequences—a single fall can lead to serious injury, psychological trauma, activity restriction, and increased mortality. This study describes differences in mobility-related characteristics of underactive (<150 minutes/week of physical activity), racially diverse, older adults (65–84 years) classified by self-reported fall status (0, 1, 2+ falls in previous 12mo) and fear of falling (yes/no). We analyzed baseline data from 105 individuals (mean age=72.1 years; 73% female; 64% white, 29% Black, 12% Asian) who participated in a trial of a physical activity smartphone intervention for older people. Total minutes of daily stepping and medium-to-brisk (≥75 steps/min) and brisk (≥100) cadence bouts in free-living conditions was gathered over 3 days via ActivPal activity monitor. Gait speed was determined from a 4-meter walk test for those pretested prior to COVID-19 mandates (n=60). Of the median 81.8 minutes spent stepping daily, very few minutes involved moderate-to-brisk (14.0) or brisk cadence (10.1). Groups classified by fall status (non-fallers n=74, 1x fallers n=18, repeat fallers n=13) differed significantly in daily minutes spent in medium-to-brisk (p=0.04) and brisk cadence (p=0.02), but not in 4-meter gait speed or total minutes stepping. Individuals who reported fear of falling versus those with no fear did not differ significantly on any mobility-related parameters. Four-meter gait speed was significantly negatively correlated with both cadence measures (p=0.02) but not total minutes stepping. This study indicates that faster walking behaviors in everyday activity may be a useful target for intervention to prevent falls in underactive older adults.
Translation of a Falls Prevention Behavioral Intervention for Family Caregiver Administration
Authors: Panzer Victoria , Smith Veronica , Wakefield Dorothy , Fortinsky Richard
Published: December 2021

FallsTalk is a one-month evidence-based falls prevention (FP) program that focuses attention on causes of an individual’s falls and encourages new FP behaviors. We translated the program for family caregivers of persons with cognitive impairment or dementia (PwCID) to administer to the PwCID and examined the number of new FP behaviors (#newFPBs) reported during the intervention period by the Caregiver. Thirty-four Dyads (Caregiver+PwCID) were trained to conduct brief daily FP discussions together using paper (FTCGnoTech) or computerized (FTCGTech, n=20) guidance. Dyads had FallsTalk training, daily discussions and weekly check-in calls. FTCGTech included discussion suggestions tailored to Caregiver concerns. To examine the use of technology, Poisson regression models compared #newFPBs between FTCGnoTech and FTCGTech and included covariates age (<80 or >=80), Mini-Mental Status Exam (MMSE >25 or <=25) and interactions. To evaluate the influence of Caregiver participation, #newFPBs reported by 115 non-demented clinical trial participants (no Caregiver- FT-ClTrNoCG) were compared with the Caregiver outcomes. Dyads using technology reported significantly more #newFPBs (MeanFTCGnoTech=5.34(SEM=0.68), MeanFTCGTech=8.46(SEM=0.76); p=.004) during the intervention month. A significant interaction was observed whereby Dyads with MMSE<=25 using technology, reported significantly more #newFPBs than the non-technology group (MeanFTCGnoTech=4.23(SEM=0.72), MeanFTCGTech=9.01(SEM=0.90); p=.047). Caregiver (n=34) involvement substantially increased #newFPBs (MeanFT-ClTrNoCG=1.39(SEM=0.15), MeanCaregiver=7.21(SEM=0.49); p<.0001), independent of technology. Across studies, participants or Caregivers for those with MMSE<=25 and <80yo reported significantly more #newFMBs (Mean=4.38(SEM=0.55) than those 80+yo (Mean=2.06(SEM=0.30); p=.0026). FallsTalk Caregiver provides an effective means to promote new Dyad FP strategies. The influence of Caregiver involvement and technology show promise in encouraging behavioral change to prevent falls.
The Challenges Faced By Long-Term Care Residents and Their Families During COVID-19
Authors: Avidor Sharon , Ayalon Liat
Published: December 2021

The present research aims to examine the effects of protective measures due to the coronavirus disease (COVID-19) within long-term care (LTC) settings on the residents and their family members. Open-ended qualitative interviews were conducted with 14 family members of older adults who resided in LTC settings during the first wave of the pandemic in Israel. The first theme identified is Rupture, including physical disconnect; the disruption in routine treatment to residents; and decline in the satisfaction with the setting. The second theme is Response, including sharing viewpoints and involvement in decision making, as well as an intense ambivalence shared by family members. Our findings highlight the distress caused to residents and family members by the isolation and restrictions in LTC settings during the pandemic, and underscore values and priorities that are central to them and their family members, including maintaining continuity, transparency, and working in unison with their families.
Dementia Care-Related Stress and Working Memory Performance: Examining the Mediating Role of Sleep
Authors: Blasi Ashley , Falzarano Francesca
Published: December 2021

Dementia Family caregivers often experience significant stress and burden, which has been associated with a myriad of adverse effects on physical and mental health, as well as cognition. The impact of caregiving on health and well-being may have negative implications on the provision of quality and effective care. Specifically, working memory is a key domain of cognition that ultimately underlies logic and decision making processes. Thus, the purpose of the current study is to examine the associations between dementia care-related stress and working memory, as well as potential mediators of this relationship, in a sample of 50 primary caregivers who completed measures examining stress, including burden and overload, and several domains of cognition. Our results showed that higher levels of caregiving overload were associated with worse working memory performance, measured using the N-back task. Additionally, we found that lower sleep quality fully mediated the relationship between overload and working memory performance, such that the negative effects of overload on working memory performance may operate as a result of sleep impairment. By determining the mediating role of sleep while also providing evidence to support the negative relationship between stress and working memory, our results provide support for the development of interventions that target factors such as burden and sleep quality to help mitigate stress in caregivers.
Examining Mental and Physical Health Status Among Sandwich Generation Caregivers
Authors: Kim Hansol , Schulz Richard , Beach Scott , Donovan Heidi
Published: December 2021

With a sample of 54,076 caregivers, the Behavioral Risk Factor Surveillance System (BRFSS, 2015-2017) provides an opportunity to assess the impact of caregiving on U.S. adults varying in age, gender, and race. We focused on sandwich generation (SG) caregivers, aged 30-59, with childcare and eldercare responsibilities (n=8,805). In multivariate regression models of mental and physical health, we evaluated the association of age, gender, race and caregiving factors controlling for marital status, education, housing status, income, employment status, and self-rated health status. SG caregivers were predominantly female (65.6%), white (69.6%), black (13%) and were caring for a parent/parent-in-law (50%) or another relative (26.4%). Age, gender, and race were associated with mental health outcomes such that SG caregivers who were younger (aged 30-39), female, and white reported poorer mental health during the past month (p<.05). Older (aged 50-59), female, and white SG caregivers reported poorer physical health during the past month (p<.05). Caregiving factors were not associated with mental health, but SG caregivers who had been providing care for a longer period of time were more likely to report poor physical health in the past month. Finally, education, income, employment, housing status, and self-rated health status were statistically significant covariates in both models (p<.05). These findings demonstrate that young caregivers are at risk for poor mental health; older caregivers for poor physical health. Being female, white, with lower socioeconomic status is associated with poor mental and physical health. Future research should address the unique needs of SG caregivers with dual caregiving responsibilities.
Exploring the Subjective Caregiving Experience Among Chinese, Korean, and Southeast Asian Communities
Authors: Powers Sara , Schaffer Rachel , Bass David , Le Ocean , Pongan Lauren
Published: December 2021

Although the Asian American community is one of the fastest growing racial groups in the US, members of this group continue to be underserved and understudied, especially when it comes to the needs of family caregivers. Therefore, through a national initiative to understand the lived experiences of diverse family and friend caregivers, survey data was collected from a variety of Asian American ethnic subgroups including Chinese (n=148), Korean (n=131), and Southeast Asian (i.e., Vietnamese, Hmong, Cambodian, Laotian; n=161). Surveys were distributed in-person and online, and also offered in the translated native languages of the abovementioned groups. Caregivers had to be 18 years and older and providing care to a person aged 55 and older who needed assistance because of ongoing health problems or disabilities. For the overall sample of Asian American caregivers (n=440), participants were on average 51.68 years of age (SD=15.98), identified as female (n=336), were not born in the US (n=348), lived with the care receiver (n=247), and reported less than $10,000 in income per year (n=199). As guided by the Stress Process Model and through a series of ANOVA tests, when compared on all major outcomes, Southeast Asian caregivers significantly reported: 1) more difficulty with care related tasks (e.g., financial/legal decisions), 2) a stronger cultural commitment to caregiving, 3) higher work strain, and 4) more depressive symptomology. Discussion will focus on opportunities for professionals to meet the needs of Asian American caregivers through the use of available trainings and programs aimed to support diverse caregivers.
The Relationship Between Place of Death and Immigrant Status
Authors: Franco Yujin , Osuna Margarita , Ailshire Jennifer
Published: December 2021

Increasing attention is being paid to improving care at the end-of-life, including developing a better understanding of where individuals die, and factors related to place of death. The older immigrant population in the United States is increasing rapidly, and while prior research suggests they may differ in their end-of-life experiences, we know relatively little about foreign-born differences in where people die. This study investigates how the place of death (home, hospital, and nursing home) differs between the U.S.-born and foreign-born. We used data on 9,180 U.S.-born and 969 foreign-born respondents from the nationally representative Health and Retirement Study (HRS) for who end-of-life surveys were conducted with a proxy between 2002 and 2016. Approximately one-third of deaths occurred in nursing homes in both groups. Hospital deaths were more common in US-Born decedents (31.9%) than foreign-born decedents (25.2%), while death at home was lower for US-born (35.5%) than foreign-born (40.2%). We used multinominal logistic regression analysis to determine whether sociodemographic characteristics, cause of death, or receipt of family caregiving explained the observed differences in place of death by foreign-born status. Results from fully adjusted multivariate models indicate the foreign-born differences in place of death cannot be explained by socioeconomic, health, or family factors. Our research shows key differences in the end-of-life experience between US-born and foreign-born older adults and highlights the importance of examining end-of-life experiences for this small, but rapidly growing segment of the older U.S. population.
Limitations in Physical Activities and Loneliness: The Role of Guilt for Perceiving Oneself as a Burden
Authors: Chaparro María del Sequeros Pedroso , Cabrera Isabel , Vara-García Carlos , Fernandes-Pires José Adrián , Barrera-Caballero Samara , Mérida-Herrera Laura , Márquez-González María , Losada-Baltar Andrés
Published: December 2021

Loneliness is a prevalent problem associated with negative health consequences for older adults, such as greater cognitive decline. Limitations to perform physical activities have been associated with greater loneliness in older adults. This association could be moderated by maladaptive social cognition or feelings, such as guilt associated with perceiving oneself as a burden. The objective of this study was to analyze the moderating effect of guilt associated with perceiving oneself as a burden in the relationship between limitations in physical activities and loneliness. Participants were 195 community-dwelling people 60 years or older not showing explicit cognitive or functional limitations that prevent activities of daily life, but who may present limitations in some physical activities (e.g., walking a kilometer or more). A linear regression analysis was conducted for testing the interaction between limitations in physical activities and guilt for perceiving oneself as a burden in loneliness, controlling for gender and age. The interaction between limitations in physical activities and guilt for perceiving oneself as a burden was the only significant predictor of loneliness and the model explained 18.30% of the variance. Limitations in physical activities influenced loneliness when people have high levels of guilt for perceiving oneself as a burden. This study suggests that guilt for perceiving oneself as a burden may play an important role in the association between limitations in some physical activities and loneliness.
Effects of a Movement-Based Mind-Body Intervention in Managing Osteoarthritis Symptoms in Older Adults
Authors: Park Juyoung , Herron Carson
Published: December 2021

In a secondary analysis, this study examined differences in age (younger vs. older geriatric groups), gender, and living arrangement (living alone vs. living with others) in elderly patients with osteoarthritis (OA) who utilized chair yoga (CY) as an type of movement-based mind-body intervention (MMBI) for symptom management. A two-arm, assessor-blinded, randomized control trial was used to examine effects of CY (twice-weekly 45-minute sessions for 8 weeks) on pain interference, physical function, and psychosocial outcomes by gender, age, and living arrangement in older adults with OA who could not participate in traditional exercise. A total of 112 older adults completed CY or a health education program (HEP) and participated in five data collection points. Older women in the CY group showed greater reduction in pain interference during the CY intervention than those in HEP, F(4, 86) = 3.255, p = .016, η2 = .131. The younger group (ages 61 to 74) had decreased depression scores during the intervention, F(4, 87) = 2.598, p = .042, η2 = .107. Regardless of the intervention (CY or HEP), depression scores in older adults who were living alone decreased substantially during the intervention. Group-based and supervised CY interventions are recommended for older adults with OA to reduce pain interference, reduce depressive symptoms, and develop social networks. Online-based synchronous CY sessions may address physical activity needs and improve mental well-being in this population in light of physical distancing practices due to COVID-19.
High-Intensity Interval Training in Older Adults With Treatment Naive Chronic Lymphocytic Leukemia
Authors: Bartlett David , MacDonald Grace , Deal Mike , Hanson Erik , Pieper Carl , Weinberg J Brice , Brander Danielle , Sitlinger Andrea
Published: December 2021

Chronic lymphocytic leukemia (CLL) is the most common leukemia, affecting predominantly older adults. Treatment naïve patients (CLLtn) with low physical fitness have poor survival following commencement of treatment. CLLtn is characterized by inadequate immune functions, increased risk of secondary malignancies and infections. The aims of this study were to determine the feasibility and preliminary effects of 12-weeks of high-intensity interval training (HIIT) on CLLtn patients. We enrolled eighteen CLLtn patients (64.9±9.1yrs.). Eleven (5M/6F) were allocated to HIIT and seven (4M/3F) to the control group (CON). HIIT consisted of three 30-minute treadmill sessions/week plus two 30-minute strength training sessions/week. Feasibility was confirmed if >70% of HIIT participants completed >75% of prescribed sessions and prescribed minutes, and if >80% of high-intensity intervals were at a heart rate corresponding to 80% of aerobic capacity (139±19 bpm). Results are presented as mean±SD and effect sizes (d), with 0.2, 0.5 and 0.8 representing small, medium and large effect sizes, respectively. Feasibility was achieved, with HIIT completing 5.0±0.2 sessions/week and 99±3.6% of prescribed minutes/week at 142±19 bpm. No adverse safety events were observed. Compared to CON, HIIT increased leg (d=2.602), chest (d=1.285), and seated row (d=3.323) strength, while aerobic capacity difference between groups was d=0.431. Compared to CON, HIIT increased in vitro natural killer immune cell cytolytic activity against K562 (d=1.586) and OSU-CLL (d=0.917) cancer cell lines, and autologous CLL cells (d=1.362). HIIT is safe and feasible in older adults with CLLtn. Preliminary effects suggest that HIIT increases muscle strength and important components of immune function.
Lessons Learned From Focus Groups and Community Education Provision in the African American Community
Authors: Frazier Robbin
Published: December 2021

The present symposium will synthesize themes derived from eight different projects designed to better understand dementia in Minnesota (MN) within the African American community (where individuals are disproportionately susceptible to dementia and the tolls of dementia care). These projects included focus groups, community outreach, community education, networking with aging service providers, and community forums. Projects were funded by and conducted in partnership with the MN Department of Human Services, the Alzheimer’s Association, the MN Board on Aging, and the MN Leadership Council on Aging’s Diverse Elders Coalition. Themes included the unique ways that African American elders share their viewpoints and the importance of faith-based outreach. Another major theme, which connects to the other symposium talks, was the importance of three S’s: Stigma, Shame, and Silence as cultural considerations in the African American, West African, and Latino/a/x/e communities as they apply to access to information and training to better understand AD/ADRD.
Testosterone Therapy for Men With Age-Related Low Testosterone: Tempest in a Teacup
Authors: Basaria Shehzad
Published: December 2021

Serum testosterone concentrations decrease in men with age, but benefits and risks of raising testosterone levels in older men remain controversial. In the T-Trials, a total of 790 men, age 65 and older, with a serum testosterone concentration of < 275 ng/dL and symptoms of sexual dysfunction, fatigue or physical dysfunction were randomized to either testosterone gel or placebo gel for 1 year. Treatment in the testosterone arm increased serum testosterone levels to the mid-normal range for young men. Testosterone replacement was associated with a significant increase in sexual activity (p < 0.001), libido and erectile function. In contrast, there was no improvement in vitality or physical function. Adverse findings included increases in non-calcified plaque formation and a higher rate of prostate events. In sum, testosterone treatment in older men was associated with modest benefits, while the risk on prostate and cardiovascular health remain unclear.
Assessing Well-Being Among Aging Women: Observations From the Women's Health Initiative
Authors: Pike Kenneth , Rillamas-Sun Eileen , Cochrane Barbara , Woods Nancy
Published: December 2021

Our aim was to develop a profile of well-being preserving the ability to estimate differential effects of both hedonic and eudaemonic dimensions of well-being on health outcomes. Numerous indicators of well-being from over 80,000 aging women included hedonic (enjoyment of life, happiness, satisfaction with life, quality of life) and eudaemonic (personal growth, purpose in life, environmental mastery, control, self mastery) dimensions. Using latent class analysis, we identified groups of women with distinct profiles of well-being. A four-class solution had both good statistical fit and made conceptual sense. Class 1 (n=9,146, 11%) had the lowest scores on hedonic and eudaemonic indicators, while Class 4 (n=38,246 47%) had the highest levels of all well-being indicators. Class 2 (n=7,106, 9%) had higher hedonic and lower eudaemonic scores and Class 3 (n=26,650, 33%) had lower hedonic and higher eudaemonic scores. These classes form a well-being profile useful for estimating differential effects on health outcomes.
Recruitment and Retention in Diverse Cohorts: Lessons From Community-Engaged Efforts
Authors: Nieman Carrie , Han Haera , Rebok George
Published: December 2021

Effective behavioral interventions and associated trials reflect the complexity and context of the communities with which they are tailored and the behaviors they seek to address. Community-engaged methodology can serve to capture these complexities, particularly when focusing on health inequities. Significant health and healthcare disparities persist among racial/ethnic minorities and representation of racial/ethnic minorities is lacking within trials that reflects the diversity of the U.S. population. Novel approaches are needed to increase the diversity of participants within behavioral intervention research. This symposium covers the unique barriers and facilitators related to recruitment and retention across a range of populations, including African American and Hispanic/LatinX older adults with hearing loss to diverse dementia family caregivers and community-dwelling Korean American older adults. Beyond the challenges and opportunities, the symposium will focus on effective recruitment strategies. The discussion will include 1) findings from 10 years of recruiting older Korean Americans into community-based trials, 2) lessons in tailoring recruitment efforts to dementia family caregivers, 3) the integration of human-centered design into a community-engaged hearing care intervention targeting low-income and African American older adults, 4) successful recruitment and retention efforts in a community-based participatory research trial in a borderlands community, and 5) the deployment of strategies to recruit Latino, Asian, and African American older adults with depression and anxiety in the setting of the COVID-19 pandemic. This symposium seeks to build the evidence related to recruitment of older racial/ethnic minorities in diverse settings, which is fundamental to addressing health inequities through behavioral intervention research.
Community Recruitment of Asian, Latino and African American Older Adults With Depression Symptoms During COVID-19
Authors: Bague Irene Falgas , Mukthineni Ravali , Lim Sahnah , Jimenez Aida , Ferreira Caroline , Markle Sheri Lapatin , Alegria Margarita
Published: December 2021

Recruitment and engagement of racial/ethnic minority older adults in clinical trials is crucial to expand implementation of evidence-based interventions for disability prevention. Public Health measures to counteract COVID-19 pandemic have increased the challenges on reaching this population. This study seeks to comprehensively evaluate a set of recruitment strategies to enroll Latino, Asian and African American older adults with symptoms of depression and anxiety during the first year of a randomized clinical trial. A partnership of three academic sites across the U.S. (NYC, MA and PR) involving several collaborations with community agencies recruited racial/ethnic minority older adults using different strategies involving bilingual interviewers calling from hospital research dataset and community agencies’ list of clients, referrals from primary care providers or psychotherapy waitlist. In this presentation we will report various recruitment and retention data including individual and organizational predictors of successful recruitment as well as challenges across all three sites.
Factors Associated With Deficient Housing Among Community-Living Older Adults in the United States
Authors: Okoye Safiyyah , Samuel Laura , Szanton Sarah , Wolff Jennifer
Published: December 2021

Housing quality is a recognized social determinant of health. Qualitative evidence suggests the ability of older adults to maintain their homes is affected by the domains of financial resources, social environment, and functional abilities, but this conceptualization has not been tested quantitatively. This cross-sectional study examined associations between financial resources (indicated by socioeconomic characteristics: education, racial-status, annual income, financial hardship, Medicaid eligibility), social environment (living arrangement, social integration), and functional abilities (lower extremity performance, self-care disability, independent-living disability, homebound-status, dementia, depression) with deficient housing among 6,489 community-living adults ≥ 65 years participating in the nationally representative 2015 National Health and Aging Trends Study. Sampling weights accounted for study design and non-response. An estimated 9.2% (3.2 million) older Americans lived in housing with ≥1 deficiency (any peeling paint, evidence of pests, flooring in disrepair, broken windows, crumbling foundation, missing siding, or roof problems). In bivariate logistic regressions, factors from all three domains were associated with deficient housing. In a multivariable model that included all variables above and adjusted for age and sex, indicators of financial resources and social environment remained associated with deficient housing (including financial hardship, adjusted odds ratio (aOR)=1.48, 95% confidence interval (CI): 1.10,1.98; and living with non-spousal others versus alone, aOR=1.48; 95% CI:1.09, 2.03), whereas indicators of functional abilities did not. To ensure quality housing for all community-dwelling older adults, efforts that increase financial resources and further examine the role of social environment in deficient housing are needed.
Living Alone in Late Life
Authors: Torres Jacqueline
Published: December 2021

Approximately one third of older adults in the United States (US) and 13% of older adults in Mexico live alone. In both countries, the prevalence of living alone is higher for women and increases with advanced age; in the US, an estimated 4.3 million older adults continue to live alone with cognitive impairment or dementia. We will present research from the US and Mexico on the receipt of long-term services and supports and unmet needs for care among older adults living alone, including with cognitive impairment, as well as factors that may modify these outcomes. For the US, we will describe recent findings about the health, health care, and caregiving outcomes of older adults living alone vs. living with others during the COVID-19 pandemic.
Framing Binational Challenges of Mental and Cognitive Health Care in Mexican-Origin Older Adults: Consensus Findings
Authors: Grasso Stephanie , Andrade Flavia , López-Ortega Mariana , Aguila Emma
Published: December 2021

Growth in older populations, and hence in the number of persons living with dementia, is particularly rapid for individuals of Mexican origin living in the U.S. and Mexico. In order to identify influences on cognitive health in this diverse population, the University Texas at Austin and Mexican National Institute of Geriatrics (INGER) organized their second Bridging Conference titled: "Framing Challenges of Cognitive and Mental Health Care in Mexican-origin Older Adults in Mexico and the U.S". In this presentation, we highlight the results of a consensus-building session, during which bi-national expert opinions were generated and synthesized addressing gaps in research, knowledge, and policy, as well as the setting of priorities for immediate action and future research. Reducing barriers to adequate care for those aging-in-place with dementia was a central theme of the identified priorities. Critical areas of identified need, more specifically, included reducing social isolation, caregiver burden, and diminishing retirement income.
Examining the Combined Estimated Effects of Hearing Impairment and Depression on Cognitive Decline and Dementia
Authors: Powell Danielle , Brenowitz Willa , Yaffe Kristine , Lin Frank , Gross Alden , Deal Jennifer
Published: December 2021

Late-life depression is a comorbidity which may co-occur in older adults with hearing loss- each as prevalent and independent modifiable risk factors for dementia. We used data from 1,820 participants (74 ± 2.8 years, 38% Black race) from the Health Aging and Body Composition Study to test if the hearing loss-dementia/cognitive decline (Modified Mini Mental State Exam[3MS] and Digit Symbol Substitution[DSST]) relationship differed in hearing impaired participants who also had depressive symptoms. Depressive symptoms were defined as CES-D 10 ≥10) at one or more visits from years 1-5. Algorithmic incident dementia defined using medication use, hospitalizations and cognitive test scores. Audiometric hearing loss was measured at year 5 and categorized as normal/mild vs ≥moderate loss. In linear mixed models adjusted for demographic and clinical covariates, presence of both hearing loss and depressive symptoms (vs. having neither) was associated with faster rates of decline in 3MS (-0.30, 95% CI:-0.78, -0.19) and DSST (-0.35,95% CI:-0.67, -0.03) over 10 years of follow-up. Both hearing loss and depressive symptoms (vs. neither) was associated with increased risk (hazard ratio (HR):2.91, 95%CI: 1.59, 5.33) of incident dementia in multivariable-adjusted Cox proportional hazards models. Comorbid conditions among hearing impaired older adults should be considered and may aid in dementia prevention and management strategies.
Nonverbal Communication in Dementia Family Caregiving: Using the VNVIS-CG Scale for In-Home Video Observations.
Authors: Coleman Carissa , Williams Kristine , Inderhees Kacie , Richardson Michaela
Published: December 2021

Communication is fundamental for dementia care and identifying communication behaviors is key to identifying strategies that facilitate or impede communication. To measure caregiver nonverbal communication, we adapted the Verbal and Nonverbal Interaction Scale for Caregivers (VNVIS-CG) for second-by-second behavioral coding of video observations. The VNVIS-CG was adapted for computer-assisted Noldus Observer coding of video interactions captured at home by family caregivers from the FamTechCare clinical trial. Operational definitions for nonverbal communication behaviors were developed and inter-rater reliability was excellent (Kappa = .88) using two independent coders. Videos N=232 were coded featuring 51 dyads; caregivers who were primarily female (80%) spouses (69%) of men (55%) diagnosed with moderate to severe dementia (64.7%). Mean caregiver age was 65 years. Emotional tone conveyed by caregivers was primarily respectful, occurring 68.1% of the time, followed by overly nurturing (9%), bossy, harsh, or antagonistic (6.2%), and silence occurred 16.7 % of the time. Caregiver gestures and positive postures (i.e., animated facial expressions, head nodding, or caregiver body movements) were the most commonly occurring overt behaviors (46.5%), followed by changing the environment to help the PWD (19.9%), and expressing laughter/joy (18.9%). The least common nonverbal behaviors were negative posture, aggression, compassion, and rejecting. The adapted behavioral coding scheme provides a reliable measure that characterizes dementia caregiver nonverbal communication behaviors for analysis of video observations. Ongoing research will identify strategies that facilitate communication as well as determine how strategies vary by dementia stage, diagnosis, and dyad characteristics.
Transforming Aging: Increased Access to Care Minimizes Rural and Urban Differences in Cognitive Change
Authors: Ly Timothy , Allen Rebecca , Jackson Barbara , Albright Amy , Bell John , Carroll Dana , Halli-Tierney Anne
Published: December 2021

Rural-urban disparities in cognitive health outcomes, such as greater prevalence of cognitive decline among rural-dwelling older adults, have been linked to inequity in access to care. However, few studies have demonstrated whether longitudinal increased access to care may mitigate such disparities. This paper presents data from ongoing systematically collected behavioral health data on new and returning patients at an interdisciplinary geriatrics clinic at the University of Alabama Medical Center. The aim of this study was to determine baseline predictors of cognitive change across three annual visits (n = 42, mean age of 75.63 years (SD = 9.15)). Adjusting for baseline cognitive status, baseline subjective health literacy, and baseline depression and anxiety, results from a univariate ANCOVA showed that age at first visit (B = -.024, 95% CI [-.041, -.008], t(35) = -2.990, p = .005) and rural-urban status (B = .555, 95% CI [.123, .988], t(35) = 2.608, p = .013) predicted cognitive change at timepoint three (T3). Specifically, individuals from rural areas were less likely to experience cognitive decline and scored .555 points better than individuals from urban areas on cognitive screeners at T3 compared with baseline cognitive status. These results suggest that increased access to and utilization of care may ameliorate traditional disparate rates of cognitive decline between rural- and urban-dwelling older adults. Moreover, behavioral health screenings in primary geriatrics clinic care may help identify patient cognitive needs and facilitate integrated care through combined medical, pharmacological, and behavioral interventions to promote positive cognitive health outcomes.
Disparities in COVID-19 Related Worry Among Older Adults in the United States
Authors: Wheaton Felicia , Scatliffe Terika , Johnson Matilda
Published: December 2021

Racial disparities in COVID-19 exposure, illness, hospitalization and mortality have been well-documented, however, less is known about whether African Americans and other minorities experience greater worry related to the COVID-19 pandemic. Data from the special midterm release of the 2020 Health and Retirement Study (HRS) were used to examine the relationship between race (white, African American, and other) and ethnicity (Hispanic/Non-Hispanic) and COVID-19 related worry among older Americans (N=2,069). Participants were asked, “because of the coronavirus pandemic how worried are you about 1) your own health, 2) the health of others in your family? 3) Your financial situation? 4) Being able to get help if you needed it from family, friends, or others? 5) What will happen in the future?” (0=not at all worried and 10=very worried). Results from OLS regression controlling for age, gender and education showed that compared with whites, African Americans had significantly higher average worry for all items except the last (other race did not differ). On the other hand, Hispanics had significantly lower worry, on average, for each of the five items. In addition, women had significantly higher average worry, while age was negatively associated with all items except the first. These findings indicate that in addition to the previously documented disparities in COVID-19, older African Americans experienced more worry. This has important implications for long-term physical and mental health.
Cross-National Perspectives on Health and Well-Being in Later Life
Authors: Ailshire Jennifer , Zhang Yuan
Published: December 2021

Cross-national comparisons are increasingly being used to re-evaluate whether our theories of aging are dependent on sociocultural context and to develop new insights into both long-standing and emerging issues in aging. The papers in this symposium use harmonized data from the Gateway to Global Aging to examine a range of topics in aging and provide new insights into key questions in aging research. Liu et al., determine whether social relationships mediate the association between early life adversity and later life health and well-being using longitudinal data from the U.S. and England. Considering multiple domains of the social determinants of health, such as socioeconomic status, social relationships, and health care access, Cho et al. identify which are related to self-rated health in China, Japan, and South Korea. Cheng et al. test the age-as-leveler hypothesis for explaining how socioeconomic differentials in health change in older ages in China and 19 European countries to determine if the protective effect of socioeconomic status on multi-morbidity changes with age. Harmonized data facilitate international comparisons papers, but additional efforts are sometimes needed to calibrate specific measures across international surveys. A major challenge in cross-national aging research, for instance, has been the limited ability to compare cognition across countries. Nichols and colleagues present a novel method for cocalibration of cognitive function across the U.S., England, and India that could be used for additional cross-national comparative research. The papers in this symposium demonstrate both the potential and challenges of cross-national studies of health and well-being among older adults.
East Meets West: Community-Based Programs for Dementia Prevention and Support
Authors: Sun Fei , Batchelor Melissa
Published: December 2021

This East Meets West Symposium presents cross-cultural evidence of community-based programs developed to address cognitive health needs of older adults or to support dementia family caregivers. It includes five studies from mainland China, Taiwan, and the U.S.A. The first study explored the adherence to computerized cognitive training to promote cognitive health among Chinese older adults using a qualitative approach. External encouragement, and self-awareness of performance improvement were found influential to older adults’ adherence. The second study spearheaded by American Association of Retired Persons (AARP) in the U.S.A shed further light on technology use in promoting brain health by comparing in-person versus online cognitive training to older Americans during the COVID-19 pandemic. The third study tested the effectiveness of a cognitive health management model for community-dwelling older adults including healthy and mild cognitively impaired (MCI) ones in Shanghai, China. Older adults with MCI who received the management service showed better cognition outcomes compared to their counterparts in the control group. The fourth study focused on a community program named “Carer Café”, developed to support dementia family caregiver in Taiwan. Participants (n=375) reported reduced stress and increased access to service referrals. The last study examined the stakeholders’ perceptions of dementia friendly initiatives (DFI) being implemented in U.S.A, mainland China, and Taiwan to support persons with dementia and family caregivers. The impacts of DFI made, challenges DFI faced, and strategies DFI used during COVID-19 pandemic were discussed. The discussant will comment on each article’s contributions and limitations in the context of literature.
Migration and Health: Freedom of Movement and Social Benefits for Chinese Migrant Workers
Authors: Qiu Fengxian , Zhan Heying , Liu Jing
Published: December 2021

Nearly 30% of China’s workforce consists of China’s rural-to-urban migrant workers, accounting for nearly 300 million of China’s population. Even though they have gained freedom of movement since the 1980s, they still have no access to healthcare in urban areas where they work. This study utilizes a mixed method of a survey with a sample of migrant workers from three Chinese emigration provinces (n=817) in 2018 and follow-up interviews with 30 migrant workers in 2020 to examine factors of migration experience affecting migrant worker’s health and healthcare. Using binary logistic regression, we found that migrant workers’ longer work experience is correlated with poorer self-rated health, their better financial status and level of hopefulness towards the future are positively correlated to self-rated health. Qualitative findings shed light on the cumulative effect of the length of work experience and fear of medical cost on migrant workers’ declining health. The lack of portability in health insurance and different reimbursement rates in health care access are structural barriers in health-seeking behaviors among migrant workers. Policy implications are presented in the global context of social rights and freedom of movement.