bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender, Race, and Immigrant Status: Intersecting Implications for Health in Middle and Later Life
Authors: Penning Margaret , Chappell Neena , Browning Sean , Kadlec Helena
Published: December 2020

Although the negative implications of gender, race and immigrant inequalities for health and well-being in the middle and later years of life are well-documented, there is a lack of research addressing their combined implications as well as the mechanisms linking them to various health-related outcomes. Yet, as intersectionality theory reminds us, the consequences of gender, race, immigrant and other inequalities for physical and mental health outcomes must be understood in terms of these overlapping social identities. Moreover, linking intersectionality to stress process theory provides us with an explanation of the mechanisms potentially linking intersecting structural inequalities to health outcomes. This paper draws on data from the Canadian Longitudinal Study on Aging (CLSA - N=51,338) to assess the additive and interactive implications of gender, race and immigrant status for physical and mental health outcomes, together with the mediating effects of primary and secondary stressors on these outcomes. The results of a series of weighted least squares regression analyses suggest that immigrant status interacts with race and/or gender to influence health outcomes. Socioeconomic and other stressors also play a role in linking these intersecting structural inequalities to health outcomes. Overall, our findings provide initial support for the value of linking intersectionality and stress process frameworks for an understanding of the health implications of structural inequalities in middle and later life.
Too Many Treats or Not Enough to Eat? The Impact of Custodial Grandparents on Food Security and Nutrition
Authors: Nadorff Danielle , Mathews Rahel
Published: December 2020

In the US, 28.5% of seniors are obese, with a BMI of 30 plus. The prevalence of obesity for children is also an alarming 17%, making it one of the primary public health burdens. According to the socio-ecological model, a child’s weight status can be influenced by factors related to parenting style, family, and the community. The literature reflects a significant emphasis focusing on children and their parents. However, according to the US Census, 7.5 million grandchildren are living with their grandparents, with about 1/3 of these residing in skipped-generation households. There are essential age-related differences in food preparation and eating behaviors between middle-aged and older grandparents and younger adult parents that may influence their children’s eating behaviors. Grandparents may provide a positive feeding environment, including role-modeling healthy food intake, teaching children about nutrition, and involving them in mealtimes and cooking, monitoring and encouraging children to eat nutritious foods, especially vegetables and regularly serving vegetables. However, grandparents have also reported providing energy-dense and nutrient-poor food and drinks and used food as a reward or gift. The current study aims to investigate the influence of caregiver type (grandparents only, parents only, or multigenerational households) on children’s nutrition, food security, and BMI. One-way ANCOVAs controlling for SES found that grandparent-headed households had children with more deficient diet and higher BMIs, but also less food insecurity. These results indicate that age-related changes in caregiver type are an important predictor of children’s nutritional health. Details and clinical implications will be discussed.
A Pilot Study of the Effects of Formal Service on Japanese Family Caregivers’ Daily Fluctuation of Stress
Authors: Abe Koji
Published: December 2020

Purpose: Recent studies report daily fluctuations in stress among family caregivers of older individuals with dementia. Several studies focused on daily stressors or behavioral and psychological symptoms of dementia and use of adult day services. Most previous studies on daily fluctuations of caregivers’ stress have used a daily diary approach. This approach involves creating multiple daily reports, making it possible to examine between-person differences and within-person processes of change. However, only few studies used this approach for family caregivers in Asian countries. Therefore, this study examines the applicability of a daily diary approach for Japanese family caregivers and the effects of formal care services on their stress and depression. Methods: Participants were 13 family caregivers of individuals with dementia using formal care services in a rural area in Japan. They were assessed through self-administered questionnaires including use or nonuse of formal care services, caregiving stressors (DASC-8), depressive symptoms (K-6), and caregiving stress for 7 days. Generalized linear mixed models (GLMM) with data nested within persons were used to examine the effects of formal services on stress and depression. Results: For the GLMM procedure, this study used caregiving stressors and stress variables as fixed effects and participants as random effects. Results indicated that use of formal services significantly lowered caregivers’ stress and depression. Conclusion: The findings demonstrate the applicability of a daily diary approach and the effectiveness of formal services on the stress of Japanese family caregivers.
Early- to Late-Life Environmental Factors and Late-Life Global Cognition: The SONIC study
Authors: Ishioka Yoshiko , Gondo Yasuyuki , Masui Yukie , Nakagawa Takeshi , Ogawa Madoka , Inagaki Hiroki , Yasumoto Saori , Ishizaki Tatsuro
Published: December 2020

Life environment across the life course—such as engagement in late-life leisure activity (LA), primary occupation, and early-life education—have been reported to be associated with better late-life cognitive outcomes. However, few studies have included all these factors from the past to the present due to the time-consuming procedure to measure all factors. This study examined (1) whether late-life LA is associated with better late-life cognition, after considering other life environments and (2) whether occupation, education, and childhood intelligence quotient have indirect effects on the late-life cognition through late-life LA. We used baseline data from the groups of 70- and 80-year-olds in the SONIC study (N = 1721 ). Global cognition was measured using the Montreal Cognitive Assessment. As for LA, participants were asked for yes/no answers to questions regarding their engagement in 158 activities. A latent factor representing LA was used in the analyses. We retrospectively evaluated the complexity of work with data, people, and things. As early-life environments, education and language and arithmetic abilities during elementary school were included in the analyses. Age and gender were controlled. A structural equation model showed that late-life LA was significantly associated with higher global cognition, even after controlling for all past factors (RMSEA = .050, GFI = .973, AGFI = .947). Sobel tests showed significant indirect effects of occupation, education, and childhood abilities on cognitive function. Results were robust across age and gender. It is suggested that engagement in LA explains individual differences in late-life cognitive function.
Evidence for an Age-Related Positivity Effect in Metacognitive Confidence Judgments
Authors: Sanders Edie , Berry Jane
Published: December 2020

We examined age differences in metacognitive monitoring of emotionally-valenced stimuli. If older adults (OAs) are more focused on emotionally meaningful goals in late life (Carstensen, 2006), then they should demonstrate attentional and memory biases for positive stimuli over neutral and negative stimuli and, arguably, these cognitive biases should be reflected in their metacognitive judgments of learning. Judgments of learning (JOLs) for memory of positive, negative, and neutral words were collected. Younger adults (YAs) aged 18-23 years and OAs aged 65-90 years (N = 85) studied words in each valence category and made immediate JOLs, followed by a two-alternative forced choice (2AFC) recognition memory task. Analyses of JOLs revealed evidence for a positivity effect (Mather & Carstensen, 2005) in metacognitive confidence for OAs and an emotional salience effect in YAs (Tauber & Dunlosky, 2012; Zimmerman & Kelley, 2010). Predictably, YAs recognized more words than OAs, but valence did not affect number of words recognized and valence did not moderate age differences in recognition memory (p = .055). Memory monitoring as measured by resolution accuracy was equivalent in YAs and OAs (Hertzog & Dunlosky, 2011). Positive affect was higher and negative affect was lower in OAs relative to YAs (Gallant, Spaniol, & Yang, 2019), lending additional evidence to an orientation toward the positive in older adulthood. These results are novel in that they demonstrate an age-related positivity effect that extends beyond the domains of memory and emotion to the domain of metacognitive aging. Discussion will focus on theoretical, methodological, and applied implications.
Information Avoidance in Decision Making: Do the Reasons Vary by Age?
Authors: Deng Stephanie , Nolte Julia , Loeckenhoff Corinna
Published: December 2020

Older adults make up the majority of the U.S. patient population and age differences in information avoidance have potential implications for their ability to participate in informed medical decision making. Meta-analytic evidence suggests that older adults seek less information before making a decision than younger adults do (Mata & Nunes, 2010). However, age differences in explicit information avoidance have yet to be quantified. We hypothesized that older adults would avoid decision-relevant information more strongly than younger adults do. We also examined the self-reported reasons for information avoidance and hypothesized that older adults would express more concern about unwanted information influencing their affect (Reed & Carstensen, 2012) and decision preferences (Mather, 2006), both of which are known predictors of information avoidance (Woolley & Risen, 2018). To test these assumptions, we conducted a pre-registered online study involving three different health-related decision scenarios. For each scenario, an adult lifespan sample (N=195, Mage=52.95, 50% female, 71% non-Hispanic White) chose to either receive or avoid information. Responses were highly correlated across scenarios and results were pooled into a single avoidance measure. Analyses indicated that concerns about consequences for decision preferences positively predicted decision avoidance (p<.001), whereas concerns about consequences for affect did not (p=.079). Contrary to predictions, older age was not significantly associated with information avoidance (p=.827). Further, self-reported concerns about the influence of unwanted information on affect and decision preferences were negatively associated with age (ps<.001). This suggests that interventions to foster pre-decisional information seeking should be tailored to the target age group.
Confirmatory Factor Analysis of the Geriatric Depression Scale to Measure Apathy in Older Adults
Authors: Ceide Mirnova , Cantor Aviva , Verghese Joe , Lounsbury David
Published: December 2020

Apathy is a psychological syndrome characterized by lack of motivation, interest, flattening of affect and social withdrawal; which has been associated with cognitive and functional decline in community dwelling older adults. Many of these associations have been investigated using subscales of depression tools, with varying sensitivity and specificity. The objective of this study was to develop an apathy measurement model, which distinguishes depression and apathy, using the Geriatric Depression Scale Long Form (GDS). We conducted an exploratory factor analysis (EFA) in a memory clinic cohort (N=81) who completed the GDS. Based on the EFA results, we ran a confirmatory factor analysis (CFA) in a community dwelling cohort of older adults (≥65 years old) enrolled in the Central Control of Mobility in Aging study (CCMA) and computed factor scores in both cohorts. CFA of the GDS in the CCMA cohort (N=538) yielded 3 factors: Depression (14 items; Cronbach’s α=0.77), Apathy (10 items; Cronbach’s α=0.63), and Cognitive concern (4 items; Cronbach’s α=0.546). In linear regression models, adjusted for age and gender, the memory clinic cohort had significantly higher Apathy factor scores (β = .18, t(618) = 4.49, p < .001) factor scores compared to the CCMA cohort.Our findings suggest that the CFA derived apathy score is a reliable and valid tool to distinguish apathy from depression in older adults. This novel measurement model can be employed in both clinic and research populations to investigate the role of apathy in cognitive decline.
Depressive Symptom Profile Transitions From Midlife to Late Life in the Wisconsin Longitudinal Study
Authors: Carr Kyle
Published: December 2020

Late-life depression is a significant public health problem among the growing elderly population in the United States. Structural social capital has previously been associated with lowering depressive symptoms in later life, but these results have been inconsistent. However, few studies have investigated this association when investigating different subtypes of depression. The current study used data from the Wisconsin Longitudinal Study (WLS) of 3,197 respondents to examine how structural social capital influences baseline depression statuses and transitions in these depression statuses. Latent class and latent transition analysis (LCA/LTA) were used to identify latent statuses at two time points in the WLS – 1992 and 2011 – as well as transitions between those statuses. Four depression statuses were identified at both time points: Very Depressed, Depressed and Lonely, Agitated and Restless, and Not Depressed. Gender, self-rated health, total assets, structural social capital measures, and polygenic score for depression were all predictors of baseline depression statuses. Transitions between depression statuses were associated with two forms of structural social capital – social support and social involvement. These findings add to the increasing number of studies investigating subtypes of depression in older adults as well as to scholars examining the association between structural social capital and depressive symptoms. Results suggest possible social and behavioral factors policymakers can use to identify risk of depression in mid-life and areas of intervention to improve depressive symptoms for aging adults.
Subjective and Functional Health Literacy Screening in Geriatric Primary Care
Authors: Albright Amy , Dragan Deanna , Halli-Tierney Anne , Carroll Dana , Allen Rebecca
Published: December 2020

The aim of the current study is to provide comprehensive health care to older adults by assessing physical and mental health in a geriatric primary care setting, including evaluation of both subjective and functional health literacy. Health literacy is vital to understanding medical information and making subsequent decisions based on this information. Knowledge of patient health literacy may be particularly important for care providers, as it can provide guidance on how to best communicate with the patient (Nouri & Rudd, 2015). It may be particularly important to monitor health literacy within older adults, as several studies (e.g., Kobayashi et al., 2015) have shown that health literacy decreases with mild cognitive impairment. Approximately 250 patients (mean age = 76; 74% female; 16% African American) attending an interdisciplinary geriatrics clinic in West Alabama have been recruited to take part in a variety of behavioral health screenings. The current study assessed subjective health literacy using questions developed by Chew, Bradley, and Boyko (2004) and functional health literacy using the Newest Vital Sign (Weiss et al., 2005). While there was a significant correlation between subjective and functional health literacy (r = .43, p < .001), 81% of patients reported adequate subjective health literacy, while only 41% demonstrated adequate health literacy on a functional screening measure. Based on these findings, self-reported health literacy may not necessarily be reflective of performance on more functional measures. Given the potential consequences of overestimating health literacy, this represents a serious barrier to patient care.
Assessment of a Potential UTI–Using Videos to Analyze a Simulated Nursing Home Experience
Authors: Owen Donna , Ashcraft Alyce , Johnson Kyle , Song Huaxin
Published: December 2020

In the past, urinary tract infections (UTIs) have been attributed to poor hygiene, the natural course of aging, an unfortunate corollary of nursing home (NH) residence, and a condition routinely treated empirically with antibiotics. Recent UTI management consensus statements foretell a very different future and support the need to consider all UTIs in the NH as complex infections. Improving assessment capabilities of the NH nurse workforce is essential for improving quality of care. This study aimed to determine how, using simulation, licensed vocational nurses (LVNs) integrated a mobile decision-support app (MDS-app) into assessment of a NH resident with a potential UTI. The MDS-app directed the LVN to examine or question the resident (mannequin) to identify signs and symptoms developed as part of a simulated clinical scenario. MDS-app items were based on UTI practice guidelines. A descriptive, participant observation design (video-taped) was used with ten practicing LVNs. An observation checklist was used to examine audiovisual recordings and included frequency of verbal interaction (17.9+/-7.2), and eye contact (10.6+/-4.1). Participants (47%) were “glued to” the MDS-app without making resident eye contact or touching residents during the assessment. 60% of participants deviated from the app to ascertain urine odor and color; irrelevant symptoms for UTI diagnosis. Assessments required 11.20 (+/-4.67) minutes to complete. The MDS-app provided LVNs with needed focus on data driven by guidelines and not individual LVN preferences. Training LVNs should focus on integration of communication, assessment skills, and MDS-app use for evidence-based data collection as a basis for UTI treatment decisions.
Characterizing Mealtime Verbal Interactions Among Nursing Home Staff and Residents With Dementia
Authors: Liu Wen , Williams Kristine , Batchelor Melissa , Perkhounkova Yelena , Hein Maria
Published: December 2020

Mealtime difficulties are common in residents with dementia, leading to negative outcomes. Interaction with staff are critical to engage residents in eating. This study characterized dyadic verbal interactions (descriptive statistics), and relationships among verbal behaviors and between verbal behaviors and individual characteristics (bivariate analyses). This secondary analysis of 110 videotaped mealtime observations involved 25 residents and 29 staff (42 unique dyads) in 9 nursing homes (NH). Verbal behaviors (utterances) were coded using the Cue Utilization and Engagement in Dementia mealtime video-coding scheme, addressing 8 positive behaviors and 4 negative behaviors. Staff spoke three times more frequently (76.5%) than residents (23.5%). Nearly all staff utterances were positive (99.2%). 85.1% of residents’ utterances were positive and 14.9% negative. Staff positive utterances were associated with staff negative utterances (p=.02), and resident positive (p<.001) and negative (p<.001) utterances. Staff negative utterances were associated with resident negative utterances (p=.02), but not with resident positive utterances (p=.39). Resident positive and negative utterances were associated (p<.001). Staff positive utterances were associated with staff race (p=.01), and resident age (p=.01), dementia stage (p<.001), and eating function (p<.001). Resident positive utterances were associated with years staff worked as caregivers (p=.02) and in the current NH (p=.01), resident age (p=.04), comorbidity (p=.04), dementia stage (p=.01), and eating function (p=.003). Resident negative utterances were associated with dementia stage (p=.01). Dyadic mealtime interactions were dynamic, interactive and complex. Multiple resident and staff characteristics were related to mealtime verbal interactions. Findings may inform development of individualized, person-centered mealtime care interventions.
Inter-Individual and Intra-Individual Relationships Between Neuroticism and Cognition: A Coordinated Analysis
Authors: Yoneda Tomiko , Rush Jonathan , Terrera Graciela Muniz , Kok Almar , Johansson Boo , Hofer Scott , Mroczek Daniel , Piccinin Andrea
Published: December 2020

Existing literature indicates a relatively consistent relationship between neuroticism and cognitive functioning (CF). Interindividually, high levels of neuroticism may predispose individuals to cognitive aging and dementia-related neuropathology. Intraindividually, increases in neuroticism may be intrinsic to the aging process or to dementia pathology. These hypotheses are not mutually exclusive, though the relationships are rarely examined using the same individuals, which may contribute to publication bias and confusion regarding the hypotheses as mutually exclusive. Data were drawn from the Origins of Variance in the Oldest-Old (Sweden, Mage=83.6, 67% female), Swedish Adoption/Twin Study of Aging (Sweden, Mage=60.4, 59% female), and Longitudinal Aging Study Amsterdam (Netherlands; Mage=68.1, 52% female). Controlling for age, sex, education, and depressive symptoms, parallel process latent growth models were fit independently in each sample (NT=3293) to simultaneously estimate growth parameters of neuroticism with three measures of CF (processing speed, learning/memory, and reasoning). Multilevel meta-analysis estimated the pooled covariation between neuroticism and CF at baseline and overtime, revealing a significantly negative intercept-intercept relationship across datasets (covariance= -0.46, 95% CIs [-0.90,-0.02], z=-2.02, p=0.04, τ2=0.06). The slope-slope covariances were consistently negative, but the meta-analytic pooled estimate was not significant despite some significant individual estimates across studies. Overall, results provide some evidence for intraindividual and interindividual relationships between neuroticism and CF, such that higher neuroticism is associated with lower CF, and neuroticism tends to increase as CF decreases. Identification of the early indicators and risk factors for cognitive decline may facilitate development of screening assessments and aid in treatment strategies for dementia care services.
Presence and Levels of Resilience and Its Sociodemographic Correlates in Older Chinese Americans
Authors: Zheng Jieyang , Kong Dexia , Li Mengting , Dong XinQi
Published: December 2020

Resilience is defined as a personal quality that enables growth in knowledge, understanding and self-actualization in the face of adversity and life disruptions. Low levels of resilience can dispose older adults to higher risks for negative health outcomes in the aftermath of traumatic events. However, we have limited knowledge of resilience among minority aging populations. This study aims to examine the presence and levels of resilience and its sociodemographic correlates among U.S. Chinese older adults. Data were drawn from the Population Study of Chinese Elderly, an epidemiology study of U.S. Chinese older adults in the Greater Chicago area. Guided by a community-based participatory research approach, a total of 3,036 Chinese older adults aged 60 and above participated in face-to-face interviews from 2015 to 2017. Spearman’s rank-order coefficient was utilized to test correlation. A 10-item validated Chinese version of the Connor-Davidson resilience scale was used to assess resilience. In our sample, 59.7% were female, and the average age was 75. The mean resilience score was 26.9, ranging from 1 to 40. U.S. Chinese older adults who were younger, male, married, had higher education and income, fewer children, better health status and quality of life, and improved health and have lived fewer years in the U.S. reported higher levels of resilience. Future longitudinal research is needed to investigate the protective effects of resilience among older Chinese Americans against mental and physical distress.
Physical Activity and Neighborhood Socioeconomic Disadvantage Among Low-Income African Americans
Authors: McCain Dextiny , Morgan Adrienne Aiken , Phillips Karon , Whitfield Keith
Published: December 2020

Research shows regular physical activity (PA) is associated with better health and longevity; however, few studies consider contextual factors related to PA among African American (AA) older adults living in socioeconomically disadvantaged neighborhoods. The Physical and Cognitive Health Pilot Study (n=50) was used to examine associations between PA and level of neighborhood socioeconomic disadvantage among sedentary, AA older adults from four public housing communities in Durham, NC and Annapolis, MD (mean age=64.5; SD=10.42; 72% women). Participants were administered the Community Healthy Activities Model Program for Seniors (CHAMPS), a self-report questionnaire measuring weekly frequency and duration of PAs. Neighborhood socioeconomic disadvantage was defined by the Neighborhood Atlas Area Deprivation Index (ADI), which ranks neighborhoods according to Census block group/neighborhoods within each state and nationally. For the present sample, two of the Durham housing facilities were located in communities in the most disadvantaged block groups. Meanwhile, one Durham location and the Annapolis community were located in the least disadvantaged block groups. Bivariate correlations showed greater neighborhood socioeconomic disadvantage was associated with less participation in various PAs (p<.05). Next, ANOVA revealed the Annapolis group participated in statistically significantly more PAs, including visiting the senior center, church attendance, and light gardening (p<.05) compared to the most disadvantaged groups. The present findings suggest there are benefits to living in advantaged contexts despite lower-income status. These findings also suggest barriers within disadvantaged neighborhoods that limit access to recreational activities favorable to health status. Future research should address ways to overcome such barriers.
Stress Is a Risk Factor for Shingles Among Older Adults
Authors: Kang Hyewon , Crimmins Eileen , Ailshire Jennifer
Published: December 2020

Stress is a risk factor for shingles. Empirical evidence of how stress affects getting shingles is lacking for the older population. This paper examines how chronic stress and stressful events are associated with incident shingles in a nationally representative sample of the population over age 50, the Health and Retirement Study. Using data for 2010-2016, we tracked 12,628 persons aged 50 and older with no history of shingles at 2010 until the first shingles occurrence and linked shingles to chronic stress appraisal and stressful events in the prior period. Chronic stress appraisal was measured in eight life domains: health, spousal/children, finance, work, residence, relationship, alcohol/drug, and caregiving. Adverse life events including spousal loss, involuntary job loss, residential move, negative wealth shock, and spousal onset of disability were included in an index of stressful events. 3.3% of sample members developed new shingles cases. Regression results suggest that having a higher burden of stressful events significantly increased the risk for shingles (OR:1.13, 95% CI=1.05, 1.22), whereas ongoing chronic appraisal was not associated with shingles onset (OR:0.99, 95% CI=0.96, 1.03). Our findings highlight the importance of preventive efforts on stress management in reducing risks for zoster.
The Effects of Severe and Frequent Back Pain on Mental Health: Does Perceived Socioeconomic Status Matter?
Authors: Mu Christina , Jester Dylan , Cawthon Peggy , Stone Katie , Lee Soomi
Published: December 2020

Back pain and mental health are related. The relationship may differ by socioeconomic status (SES); yet, research has not examined the moderating role of perceived SES. We examined if the association between back pain and poor mental health is more pronounced for older men with lower perceived SES. We used a sample of community-dwelling older men (>65yrs) with back pain from the Osteoporotic Fractures in Men Study (n=4,035). Participants reported their perceived SES in comparison to others in the community and in the nation (1=lowest—10=highest), back pain severity (mild—severe), and frequency (rarely—all of the time). Mental health was assessed with the 12-item Short Form Health Survey. Analyses were adjusted for sociodemographic and health covariates. Greater pain severity and higher pain frequency were associated with poorer mental health (p<.001). Only severe pain was associated with poorer mental health (p<.001). Pain ‘some of the time’ (p=.02), ‘most of the time’ (p=.02), and ‘all of the time’ (p=.001) were associated with poorer mental health. Adverse effects of pain were reduced with greater community SES (p<.001 for severe pain; p=.02 for ‘all of the time’ pain frequency) and greater national SES (p=.01 for severe pain; frequency n.s.). Reports of pain were worse for individuals with lower SES. Adverse associations of severe and high frequency back pain with poor mental health are more apparent in older men with lower perceived SES. Where one ranks oneself within their community or nation can influence the pain and mental health link.
The Impact of Conscientiousness on Participant Drop-Out: A Novel Method for Estimating Missingness
Authors: Yoneda Tomiko , Lewis Nathan , Rush Jonathan , Piccinin Andrea , James Bryan , Hofer Scott , Terrera Graciela Muniz
Published: December 2020

Individuals low in conscientiousness are typically characterized by higher rates of dropout in longitudinal studies compared to individuals high in conscientiousness. Given that low conscientiousness is associated with increased risk of mortality and several adverse health behaviours and outcomes, attrition of individuals low in conscientiousness may result in systematic bias particularly relevant to developmental research focused on morbidity and mortality in older adulthood. Further, methods commonly used to estimate missing data require monotone coding patterns and untestable assumptions (e.g., MAR), and do not typically account for death as a competing risk factor. This project analyzed data drawn from the Memory and Aging Project (N=1156; Mage=79.2 years; 76.1% female) using multistate survival models to estimate the impact of conscientiousness on transitions between study wave participation over time (i.e., response, non-response), and death. With conscientiousness measured at baseline and death status determined by death records, complete state data are available for each study wave, unlike methods commonly used to model and estimate missingness. Adjusting for age, sex, and education, analyses revealed that higher levels of conscientiousness are associated with decreased likelihood of transitioning to non-response (HR= 0.97, CI’s 0.95, 0.99) and death (HR=0.96, CI’s 0.93, 0.99). These results suggest that over-sampling individuals low in conscientiousness during study recruitment may be important to better represent the general population, particularly when data are collected over several years or decades. Discussion will focus on how systematic bias introduced by higher response rates of individuals high in conscientiousness may impact health-related research based on longitudinal data.
Physical Activity, Outcome Expectations, and Social Support in Dyads of Frail Older Adults and Their Home Care Aides
Authors: Yin Lijuan , Muramatsu Naoko
Published: December 2020

Frail community-dwelling older adults increasingly receive home care and continue to face barriers to participating in physical activity (PA) that could help maintain their function. Home care aides (HCAs) are well-positioned to promoting PA among older home care recipients because of their established relationship and regular interpersonal exchanges; yet, the role of HCAs in promoting and supporting PA in home care settings is seldomly studied. Using the quantitative and qualitative data from a 4-month home-based gentle PA intervention delivered by HCAs to their clients in a Medicaid-funded home care setting, the current study examined whether outcome expectations for exercise (OEE) held by HCAs led to client PA outcomes (i.e. functional limitations and physical performance) through social support for exercise (SSE) provided by HCAs. Longitudinal mediation analysis of 46 HCA-client dyads showed that higher baseline OEE held by HCAs were related to greater SSE reported by clients after the intervention (p<.05; bootstrapped standard errors), controlling for client-level covariates, including baseline OEE, age, gender, comorbidity, and whether HCA was client’s family member. Unexpectedly, SSE did not have significant association with client PA outcomes nor mediated the relationship between OEE held by HCAs and client PA outcomes. Qualitative data suggested alternative factors may explain the results, such as clients’ family beliefs in the intervention and clients’ participation experiences (such as expectation fulfillment). Future research should consider older home care clients’ family contexts to enhance our understanding of HCAs’ roles in preserving the function of growing numbers of older home care recipients.
Social Contact and Wellness Outcomes for Older Adults in Different Residential Settings
Authors: Bihary Joseph , Smith Jennifer , O’Connor Dugan , Basic Ajla , Sayer Janis , O’Brien Cate
Published: December 2020

More frequent social contact with others has been shown to be associated with positive well-being outcomes for older adults, who may be at increased risk of loneliness or isolation. The current study investigates whether the potential benefits of social contact might vary by social contact medium and by residence type (senior living (SL) settings vs. the broader community). 5,148 older adults residing in SL communities completed surveys on health and well-being. Data were combined with responses from 1,000 demographically similar older adults residing outside SL settings who participated in a similar study. Participants in both studies reported their frequency of social contact with friends (4 types: in-person meet-ups, speaking by phone, writing or emailing, and communicating via social media), subjective overall health, and life satisfaction. Results of multilevel regression analyses revealed that more frequent in-person social contact with friends was associated with more positive ratings of overall health only for participants in non-SL settings, but not those in SL. More frequent in-person social contact was also associated with higher life satisfaction, and this effect was stronger for non-SL participants. More frequent contact by phone and written letters/emails was associated with better ratings of overall health, regardless of residence type. In contrast, more frequent social media use was associated with lower ratings of overall health. Analyses controlled for age, gender, education, marital status, income, chronic health conditions, and depressive symptoms. The observed patterns of results speak to the possible protective benefits of social engagement for older adults in different residence settings.
The Relationship Between Social Support, Aging Expectations, and Health Behavior in Middle Age
Authors: Yeom Hyun-E , Jung Misook , Park Eunyoung
Published: December 2020

Midlife is a critical period when individuals need to actively engage in healthy behaviors for healthy aging. Although both social relations and attitudes toward aging are factors related to health behavior, little is known about their relationships based on age-related differences. The purposes of this study were to investigate the influence of social support affecting health behavior through expectations regarding aging and to examine how age affects the relationship. A cross-sectional study was conducted with data from 245 midlife Koreans (mean age= 51.5) collected by a self-administered survey. Data were analyzed using the PROCESS macro in SPSS. Social support was significantly related to expectations regarding aging (r= -.135, p=.034) and health behavior (r= .223, p<.000). There was age-related difference in the relationship between social support and expectations regarding aging (β= .007, p=.038), indicating that the relationship was much stronger in the younger group. In addition, the influence of social support on health behavior through expectations regarding aging was significant in relatively young middle-aged individuals. Our findings emphasize the importance of supportive social relationships, which could affect expectations regarding aging linked to health behavior, especially for young middle-aged individuals. It is necessary to develop psycho-cognitive programs to activate social interaction and to improve positive attitudes toward aging for more active engagement in health behaviors in midlife individuals.
A Systematic Review of In-Home Smart Technology Adoption to Improve Older Adult Health and Family Caregiving
Authors: Park Geunhye , Robinson Erin
Published: December 2020

In-home and internet-based smart technologies to improve older adult health has been rapidly developing. Technologies such as in-home sensors and smart homes enable older adults to live independently and age in place. These technologies also assist informal caregivers in their roles, thus reducing caregiver burden. However, technology adoption among older adults and family caregivers has been relatively low and reasons for technology acceptance are complex. Therefore, the purpose of this study was to conduct a systematic review of the literature, examining acceptance and adoption of in-home, internet-based smart technologies that are designed to improve health outcomes of older adults and can assist family caregivers in providing supports. This study utilized the Rew method (2011) and included peer-reviewed research articles published between 1991 and 2019 and available in: ISI Web of Science; PubMed; Scopus; CINAHL; and PsycInfo. A total of 1,227 relevant articles were identified with the search strings used and a final sample of 48 articles were included after the title, abstract, and full article review processes. Findings highlight several facilitators and barriers to technology adoption. Some facilitators to adoption include: technology familiarity, safety/security, personally tailored, non-obtrusive design, easy access, and reduction of caregiver burden. A few barriers include: cost, difficulty to use, time, stigma, privacy, data accuracy, and confidence. Additional findings will also be presented. A more thorough understanding of these facilitators and barriers to acceptance/adoption is crucial for the successful dissemination of in-home, internet-based smart technologies. Increased adoption can improve older adult health and reduce caregiver burden.
Physical Inactivity in Older Adult Couples: A Dyadic Analysis Using Continuous In-Home Monitoring
Authors: Wu Chao-Yi , Miller Lyndsey , Wall Rachel , Beattie Zachary , Kaye Jeffrey , Silbert Lisa
Published: December 2020

Many older adults remain inactive despite the known positive health implications of physical activity (e.g. improved mood, reduced mortality risk). Physical inactivity is a known interdependent phenomenon in couples, but the majority of research identifies determinants of physical inactivity at the individual level. We estimated the average amount of physical inactivity for older adult couples and, using dyadic analysis, identified physical and mental health determinants thereof. Forty-eight heterosexual older adult couples (mean age=70.6, SD=6.63) from the Veterans Integrated Service Network 20 cohort of the Collaborative Aging Research using Technology (CART) initiative were included in this study. Both dyad members wore actigraph devices for a month. The average number per day of inactive periods (defined as no movement or sleep activity for ≥ 30 minutes) was estimated. Multilevel modeling revealed that, within couples, there was no difference between partners in the average number of inactive periods, but on average across couples, males had more inactive periods per day (13.4, SD=4.43) than females (12.3, SD=4.87). For males, older age was the only variable associated with more inactive periods (β=0.13, p=.013). For females, more depressive symptoms in men were associated with fewer inactive periods (β=-0.37, p=.002), and more dependence in completing their own IADLs predicted more inactive periods (β=2.80, p<.001). All models were adjusted for covariates. Viewing couples’ activity as a unit, rather than as separate individuals, provides a novel approach to identifying pathways to reduce inactivity in older adults, especially when focusing on mental health issues and decreased independence within the couple.
Global Sensory Impairment Independently Predicts Decreased Social Function Over Time
Authors: Huang Anna , Wroblewski Kristen , Kotwal Ashwin , Waite Linda , McClintock Martha , Pinto Jayant
Published: December 2020

The classical senses (vision, hearing, touch, taste, and smell) play a key role in social function by allowing interaction and communication. We assessed whether sensory impairment across all 5 modalities (global sensory impairment [GSI]) was associated with social function in older adults. Sensory function was measured in 3,005 home-dwelling older U.S. adults at baseline in the National Social Life, Health, and Aging Project and GSI, a validated measure, was calculated. Social network size and kin composition, number of close friends, and social engagement were assessed at baseline and 5- and 10-year follow-up. Ordinal logistic regression and mixed effects ordinal logistic regression analyzed cross-sectional and longitudinal relationships respectively, controlling for demographics, physical/mental health, disability, and cognitive function (at baseline). Adults with worse GSI had smaller networks (β=-0.159, p=0.021), fewer close friends (β=-0.262, p=0.003) and lower engagement (β=-0.252, p=0.006) at baseline, relationships that persisted at 5 and 10 year follow-up. Men, older people, African-Americans, and those with less education, fewer assets, poor mental health, worse cognitive function, and more disability had worse GSI. Men and those with fewer assets, worse cognitive function, and less education had smaller networks and lower engagement. African-American and Hispanic individuals had smaller networks and fewer close friends, but more engagement. Older respondents also had more engagement. In summary, GSI independently predicts smaller social networks, fewer close friends, and lower social engagement over time, suggesting that sensory decline results in decreased social function. Thus, rehabilitating multisensory impairment may be a strategy to enhance social function as people age.
Volunteering and Cognitive Health Among Middle-Aged and Older Adults: The Mediating Role of Friendship
Authors: Peng Changmin , Burr Jeffrey , Han Sae Hwang , Kim Kyungmin , Mutchler Jan
Published: December 2020

We lack knowledge about the underlying mechanisms that link formal volunteering to cognitive health. Friendships can be formed and improved through volunteering. Friendship is also beneficial to cognitive health as it often involves sharing information and promoting social interactions. This study investigated the potential mediating role of friendship (i.e., the number of close friends and the quality of friendships) for the association between volunteering (i.e., volunteering status and volunteering hours) and episodic memory among middle-aged and older adults in the United States, using data from the 2014 wave of the Health and Retirement Study (N = 6,029). Moderated mediation models were employed to test the mediation role of friendship for the association between volunteering and cognition for two age groups, middle-aged adults (age 50-64, n = 2,441) and older adults (age 65+, n = 3,588). The results showed that the quality of friendships, but not the number of close friends, mediated the relationship between volunteering (both status and hours) and episodic memory for middle-aged adults. However, mediation effects of friendship were not discovered for older adults. Our findings emphasize the important role of the quality of friendship in understanding the cognitive benefit of volunteering among middle-aged adults. For older adults, the nonsignificant effects of friendship may be consistent with socioemotional selectivity theory, suggesting that older adults may not use volunteering to expand their social networks. Instead, they may participate in volunteer work for other reasons in the context of shrinking social networks.
The Relationship Between Subjective Age, Health Status, and Advance Care Planning
Authors: Engel Ilana , Baker Tamara
Published: December 2020

Current data show that how old a person feels, or subjective age (SA), may be associated with improved well-being and functioning, less cognitive impairment, and longer life. Yet, the relationship between SA and advance care planning (ACP) has yet to be examined. This is all the more important when determining the role SA has in end-of-life decision-making. Using data from the Health and Retirement Study (Wave 13, 2016), this study aimed to examine whether SA is associated with having a living will (LW), having a LW with life-limiting care, and having assigned a durable power of attorney. The sample included 3,165 participants 51+ years of age (mean age = 65.67; SD = 11.79). Analyses were conducted assessing the predictive value identified social, behavioral, and health factors have for ACP. Results from binomial logistic regression analyses indicated that participants who endorsed feeling older than their chronological age were similarly likely to have engaged in ACP as those who felt younger. As demonstrated previously, older chronological age was significantly associated with higher utilization of ACP (ps < .05). Those with cancer and women were significantly more likely to have a LW (ps <.05). The present study did not find evidence to support a significant relationship between SA and ACP. Lower overall engagement with ACP and treatment for specific conditions, such as cancer, may be more influential in determining who utilizes ACP. Future research should explore how SA may serve as a protective factor and/or a psychological mechanism that influences engagement in ACP.