bluuebunny/crossref_metadata_2025 huggingface dataset:
SOCIAL AND BEHAVIORAL FACTORS IN COGNITIVE AGING: APPLYING THE CAUSAL INFERENCE FRAMEWORK IN OBSERVATIONAL STUDIES
Authors: Leist Anja K
Published: November 2019

Rationale: There is an urgent need to better understand how to maintain cognitive functioning at older ages with social and behavioral interventions, given that there is currently no medical cure available to prevent, halt or reverse the progression of cognitive decline and dementia. However, in current models, it is still not well established which factors (e.g. education, BMI, physical activity, sleep, depression) matter most at which ages, and which behavioral profiles are most protective against cognitive decline. In the last years, advances in the fields of causal inference and machine learning have equipped epidemiology and social sciences with methods and models to approach causal questions in observational studies. Method: The presentation will give an overview of the causal inference framework and different machine learning approaches to investigate cognitive aging. First, we will present relevant research questions on the role of social and behavioral factors in cognitive aging in observational studies. Second, we will introduce the causal inference framework and recent methods to visualize and compute the strength of causal paths. Third, promising machine learning approaches to arrive at robust predictions are presented. The 13-year follow-up from the European SHARE survey that employs well-established cognitive performance tests is used to demonstrate the usefulness of the approach. Discussion: The causal inference framework, combined with recent machine learning approaches and applied in observational studies, provides a robust alternative to intervention research. Advantages for investigations under the new framework, e.g., fewer ethical considerations compared to intervention research, as well as limitations are discussed.
SUBJECTIVE APPRAISALS OF PHYSICAL AND EMOTIONAL HEALTH: EXAMINING AGE DIFFERENCES ACROSS RURAL URBAN COMMUNITIES
Authors: Dorman Hillary , Allen Rebecca S , Parmelee Patricia A , McGuire Lisa C
Published: November 2019

Using the Meikirch model as a theoretical underpinning, the present study aimed to examine population health disparities by discerning age variations within and across rural urban areas. Secondary data analysis was conducted using the CDC’s 2017 Behavioral Risk Factor Surveillance System. The study’s outcome variables included physical health and mental health burden (zero days, 1-13 days, 14+ days). A total sample of 96,568 adults were included with a mean age of 66.05 years (SD = 9.91). Individuals were classified in the following age groups: 43% middle-aged (45-64 years), 33% young-old (65-74 years), and 25% old-old adults (75+ years). The sample was largely female (61%), Non-Hispanic White (86%), and urban (67%). A series of chi-square tests of independence – post hoc tests when applicable – were completed. Overall, rural residents reported a higher prevalence of severe physical and mental health symptom burden. Regarding physical health burden, a significant difference was found within urban settings (X2(4) = 50.74, p < .001), where, unexpectedly, young-old adults reported the best physical health. Regarding mental health burden, a significant difference was found for both urban (X2(4) = 1661.72, p < .001)) and rural settings (X2(4) = 820.65, p < .001), with middle-aged adults reporting greater mental illness and the old-old adults reporting greater mental health resiliency. Findings suggest that a multidimensional framework of health usefully informs public health and clinical service interventions, identifying populations and locations in need (i.e., targeting rural physical health across age groups and mental health among the middle-age, regardless of location).
OCCUPATIONAL MOBILITY AND CHRONIC ILLNESS IN LATE LIFE: A SYSTEMATIC REVIEW
Authors: Fu Rong , Abrahamson Kathleen , Campbell Tara
Published: November 2019

Objectives: Occupational mobility at various stages in the life course may have a cumulative influence on health outcomes in later life. This study aims to (1) systematically review the association between occupational mobility and chronic illness in late life; and (2) identify potential mechanisms underlying this relationship. Methods: A systematic review of literature was carried out by searching two databases (PubMed and SocIndex) and reference lists. Eligible studies examined associations between occupational mobility and at least one measure of chronic illness among adults aged 50 years or above. Occupational disruptions (e.g., job loss) were reviewed as special cases of occupational mobility. Results: Downward occupational mobility and mid-life occupational disruptions have been consistently shown to predict higher risk of chronic illness in older adults. Several potential mechanisms were identified from the literature: (1) health behaviors, including dietary practices and alcohol consumption; (2) psychosocial factors, including stress, stigma, job control, job demands, and job satisfaction; (3) economic factors, including financial incentives or constraints; and (4) other individual characteristics, including personality traits and coping skills. There is also evidence that the timing of job mobility and the duration of (each) occupation modify the association between occupational mobility and health in late life. Discussion: These findings suggest that experiencing involuntary occupational mobility at various stages in the life course can increase the risk of chronic illness in late life. Health professionals and policymakers should target more resources to disadvantaged older adults who experience involuntary occupational transition.
OLDER PEOPLE LIVING WITH HIV: THE RELATIONSHIP BETWEEN COMMUNITY-LEVEL FACTORS AND THEIR HIV HEALTH
Authors: Lee Yookyong , Walton Rick , Jackson Edward , Jackson Lindsey , Batey Scott
Published: November 2019

According to Centers for Disease Control and Prevention, older adults (aged 50 and older) accounted for 17% of new HIV diagnoses in 2016. The number of older people living with HIV (PLWH) is increasing because of antiretroviral therapy that allows a near normal life expectancy with HIV. Consequently, older PLWH are more likely to develop diseases associated with aging and be affected by polymedication. However, their lived experience and challenges that they face have been underexamined. In this study, we focused on community-level factors, which have potential health implications for older PLWH. We examined a subsample of participants who were at least 50 years-old (n=20; Mean=55; range 50–60) from a community-based participatory research study (n=40). Participants, who previously established HIV care, were recruited through word-of-mouth and flyers posted in the community. Interviews were recorded, transcribed, coded, and triangulated through an iterative process during team meetings. In this subsample (n=20), majority of participants were male (75%) and Black (80%). Older PLWH reported crime, social isolation (interacting with crime and stigma), and lack of access to resources (e.g., transportation, grocery store, pharmacy) as factors negatively associated with their physical and emotional health. A more holistic, complex approach to support older PLWH is essential. They should experience a greater quality of life along with longevity. Therefore, more attention to contextual and structural barriers associated with treatment and care is necessary to find a way for higher retention, (re)engagement, and adherence to care among older PLWH.
HEALTH LITERACY, MEDICAL NON-ADHERENCE, AND SELF-REPORTED HEALTH PROBLEMS AMONG OLDER INTERNET USERS
Authors: Seckin Gul
Published: November 2019

The Internet presents new options for the elderly to gather information to support their health care. Health information gathering is among the major motivations for using the Internet among aging baby-boomers. However, insufficient e-health literacy presents challenges for the aging baby boomers. We examined the extent to which health-related internet use and e-health literacy are associated with non-adherence and self-reported negative health outcomes. Respondents were randomly sampled from the largest national online probability-based research panel (N = 710; M= 48.8, SD= 16.4). The age range in our research allowed us to examine the hypothesized associations across the full sample while focusing on older adults (age ≥ 60; N = 194). Older adults with greater e-health literacy reported higher averages for non-compliance because of information obtained from the Internet [(t (194) = 5.06, p ≤ .0001]. Ordinary least squares regression analyses showed that older adults who reported greater averages on health-related internet use reported higher averages on self-reported health problems (β = .292, p ≤ .01). However, women reported fewer health problems (β = -.217, p ≤ .01). Non-adherence with doctor recommendations is a significant positive predictor of self-reported health problem in the full sample (β = .244, p ≤ .0001) but not among older respondents (β = .032, p ≤ .061). Older individuals will make better utilization of the Internet if health professionals guide them to credible sources for health-related information. Empowerment of individuals to utilize the Internet in an informed manner requires addressing their needs for e-health literacy skills.
PERCEIVED STRESS, SOCIAL SUPPORT, AND DRY MOUTH AMONG U.S. OLDER CHINESE ADULTS
Authors: Mao Weiyu , Mao Weiyu , Chen Yiwei , Wu Bei , Ge Shaoqing , Yang Wei , Chi Iris , Dong XinQi
Published: November 2019

Dry mouth is a common condition among older adults that negatively influences oral health, general health, and quality of life. The role of psychosocial factors in oral health conditions and diseases remains largely unknown. We examined the relationship between perceived stress and dry mouth among US older Chinese adults and further investigated the moderating role of social support from different sources in the relationship. Data came from baseline of the Population Study of Chinese Elderly in Chicago between 2011 and 2013 (N = 3,157). Stepwise logistic regression models with interaction terms were used. More perceived stress was significantly associated with a higher likelihood of reporting dry mouth. Friend support was protective against dry mouth. The effect of perceived stress on dry mouth varied by levels of family and friend support. To prevent or reduce dry mouth, interventions need to consider perceived stress and social support in this growing population.
A COMPREHENSIVE DIGITAL SELF-CARE SUPPORT SYSTEM FOR OLDER ADULTS: A MULTIDISCIPLINARY FRAMEWORK
Authors: Nambisan Priya , Lyytinen Kalle , Stange Kurt , Kahana Eva , Kreps Gary L
Published: November 2019

This paper presents an innovative conceptual framework for designing a Comprehensive Digital Self-care Support System (CDSSS) to meet the health needs -physical, mental and social health needs of older adults and their caregivers. Older adults deal with multiple co-morbidities, medications and their side effects, fragmented care and often have poor understanding of their own health and treatments. These challenges call for solutions that lead to better empowerment and pro-active engagement and for support systems that focus on wellness and preventive care. The conceptual model we offer draws on diverse disciplines including health care management and medicine, information systems, communication, consumer behavior, and sociology to identify a set of key design principles for CDSSS. A review and analysis of the literature in the different fields led to the identification of 6 CDSSS design principles: (1) Systems approach; (2) User experience; (3) Ecosystem perspective for shared resources 4) Social and contextual learning; (5) Accessible design; (6) Designing for trust and empathy. The model clarifies how these design principles (or approaches) inform the development of the three main components of a CDSSS (data integration, communication, and resource integration) and enable the key CDSSS deliverables (learning, social & emotional support and care integration). The conceptual model also helps to lay out an agenda for future research on self-care support systems for older adults.
PSYCHOMETRIC PROPERTIES OF THE OLDER ADULT TECHNOPHOBIA SCALE AND SMARTPHONE CHALLENGE TASK
Authors: Martin Kelly J , Lauderdale Sean A , Thorpe Steven , Molhman Jan
Published: November 2019

Older adults are especially prone to anxiety if they are unable to keep pace with technological advances and are generally more technophobic than their younger counterparts. Older adults tend to limit their use of technology, if not avoid it altogether, such as using a smartphone for calls and text messages only, while eschewing more advanced functions. Currently, there is no measure of technophobia in older adults that captures fears and concerns about the use of these up-to-date technological tools. The purpose of this investigation was to evaluate the psychometric properties of a new scale of technophobia and corresponding smartphone challenge task in a sample of older adults. Community-dwelling older adults (N = 42, 81.0% female, Mage = 77.3) completed the following: the Older Adult Smartphone Challenge Task (OASCT), Older Adults’ Technophobia Scale (OATS), Older Adult Social Anxiety Scale, Computer Anxiety Rating Scale, and the IPIP Five Factor Personality Domains. Preliminary data indicate good internal consistency for the OATS (α = .87) and the OASCT (α = .86). The OASCT was negatively correlated with age, computer anxiety, and OATS anxiety/avoidance scores, but positively correlated with education. The OATS scores were positively correlated with social anxiety, social avoidance, and computer anxiety, but negatively correlated with extraversion. To keep pace with the contemporary world, older adults must achieve a level of comfort with the use of technological devices. Administering the OASCT and OATS could be a valuable first step in identifying older adults with technology-related deficits and anxiety for individual and/or community-wide intervention.
USE OF INFORMATION AND COMMUNICATION TECHNOLOGY AND MEMORY PERFORMANCE IN OLDER ADULTS: WHICH COMES FIRST?
Authors: Choi Eun Young , Zelinski Elizabeth M
Published: November 2019

The topic of older adults’ information and communication technology (ICT) use looms large because of the beneficial effects of ICT use on physical health, emotional well-being, and social engagement. Previous research has shown that memory performance is also linked with ICT use, but the direction of influence is yet to be determined. Individuals with higher levels of memory function are more likely to use ICT devices, but ICT use may have protective effects on maintaining memory because using technologies includes mental exercises. The current study examined the temporal sequence of ICT use and memory performance, which can provide insight into the causation. Using three waves (2013, 2015, and 2017) from the National Health and Aging Trends Study (NHATS), a total of 4,048 community-dwelling older adults aged 65 and above were selected for the analysis. Memory performance was measured by summing scores of immediate and delayed word recall. Reciprocal 5-year lagged associations between ICT use and memory were examined, while controlling for age, gender, education, racial/ethnic minority status, and depressive symptoms. The final model showed adequate fit indices (CFI = .979 and RMSEA = .038). Word recall significantly predicted ICT use in later years. Reciprocally, greater use of ICT was significantly associated with better memory performance in following years. The effect of ICT use on memory performance was of greater magnitude in comparison with memory as a predictor for ICT use. These results suggest that ICT can have potential benefits for maintaining memory in old age.
THE INFLUENCE OF TECHNOLOGY ON QUALITY OF LIFE AND AGING IN PLACE
Authors: Mois George , Washington Tiffany R , Beer Jenay M
Published: November 2019

Many of the challenges that often accompany longevity can affect older adults’ quality of life (QOL). Adoption of an assistive technology ecosystem presents the potential to alleviate these challenges and improve QOL. An assistive technology ecosystem refers to the use of multiple assistive technologies to address a set of challenges affecting single or multiple characteristics of older adults’ QOL. However, little is known how technology can influence characteristics of older adult’s QOL. The purpose of this study was to investigate how using technology can improve older adults QOL. Data from the 2016 wave of the National Health and Aging Trends Study (NHATS) were analyzed using four logistic regression models. The sample included are older adults age 65+ (N=5,488). The dependent variables used in this study were QOL indicators such as self-confidence, continue improving life, likes living arrangement, and self-determination. The variables used to measure technology included computer, cell phone, tablet, and internet use. Older adults who used the internet had significantly higher odds of reporting self-determination (OR=1.68), like living arrangement (OR= 1.97) and continue improving life. Tablet users had significantly higher odds of continuing to improve their life (OR= 1.249) and increased self-determination (OR= 1.174). Cellphone users had significantly higher odds of having self-confidence (OR= 2.814). These findings support the need for a network of resources accessed through an ecosystem of technologies to address the challenges encountered by older adults aging in place. This study’s findings can inform technology education programs, interventions, and assist with the development of support networks.
PROBLEM SOLVING SKILLS AND CANCER SCREENING BEHAVIORS IN MIDDLE-AGED AND OLDER MEN IN THE U.S.
Authors: Sahoo Shalini , Millar Roberto J , Yamashita Takashi , Cummins Phyllis
Published: November 2019

Routine cancer screening is widely recognized as an effective strategy for reducing cancer mortality – the second leading cause of death in the U.S. Research shows cancer screening rates need to be improved, and men are less likely to uptake recommended screening than women. Cancer screening requires an array of tasks such as seeking up-to-date guidelines, making appointments, planning a hospital visit, and communicating with health care professionals in the complex health care systems. Importantly, modern health care systems are rapidly adopting technology such as web-based applications for information dissemination and communication with patients. This current study is designed to better understand the roles of problem-solving skills in the technology-rich environment (PSTRE) in two selected cancer screening behaviors among middle-aged and older men. We obtained nationally representative data with a sophisticated PSTRE assessment from the 2012/2014 Program for the International Assessment of Adult Competencies (PIAAC). Binary logistic regression models with survey weights were used to estimate the association between PSTRE scores (1 – 500 points) and two cancer screening behaviors of men who meet the recommended guideline of age between 45 to 74 years old (n = 1,168). Results showed that greater PSTRE scores were positively associated with prostate cancer screening (OR = 1.005, p < 0.05). Improvement in PSTRE may promote the specific cancer screening behaviors. Our findings also inform future interventions that seek to improve cancer screening among a vulnerable section of older populations.
TECHNOLOGY TRANSLATING THE RELATIONSHIP BETWEEN QUALITY OF LIFE AND MEMORY USING A NOVEL EEG TECHNOLOGY
Authors: Roberts Mitchell , Kehat Orli , Gross Michaela , Lasri Nethanel , Issachar Gil , VandeWeerd Erica Sappington , Peremen Ziv , Geva Amir
Published: November 2019

Existing research has postulated a relationship between cognition and quality of life (QoL). Components of QoL such as satisfaction with social support may be particularly influential in memory for those with comorbidities. Additional research is needed to characterize the relationship between memory and QoL domains. Findings are presented from a clinical trial using BNA memory scores to assess brain health. BNA uses EEG technology and machine learning to map networks of brain functioning including working memory. Participants were older adults living in The Villages, an active lifestyle community in Florida, between the ages of 55-85, from 8/30/2017-3/11/2019. Participants were stratified into 2 groups: healthy (no CNS/psychiatric conditions; n=158) and multi-morbid (>1 CNS and/or psychiatric conditions; n=106) and compared across memory and QoL indicators. Subjective QoL was measured by the WHOQOL-BREF across 4 domains (physical, psychological, social, environmental). Scores on QoL domains were divided into 3 levels (high-medium-low) and tested for their relationship to BNA memory scores using ANOVA. Results indicate a relationship between health status, subjective QoL and BNA memory scores. Healthy subjects who scored high in the psychological QoL domain had significantly higher memory scores [F(2,152)=4.30,p=.02)]. In healthy subjects, satisfaction with social support (p=.001) had the strongest impact on memory for social QoL, while body image (p=.06) and concentration (p=.06) were the most salient predictors of psychological QoL and approached significance. Multi-morbid subjects who indicated high social ratings had higher memory scores (F(2,100)=3.75,p=.03) which relied heavily on satisfaction with social support (p=.003). Implications for policy and practice are discussed.
DETECTION OF FORWARD PROPULSION USING A SINGLE ACCELEROMETER DURING WALKING IN OLDER POPULATION
Authors: Zahiri Mohsen , Najafi Bijan , Nguyen Hung , Kang Gu Eon
Published: November 2019

In the geriatric population, diminished ankle joint moment and weak plantar flexor can contribute to inadequate forward propulsion and negatively impact gait performance, which can lead to poor energetic efficiency. Detection of propulsion phase can help identify gait normality and guide rehabilitation therapy to improve functional performance. Current methods have limited application in daily life and unsuitable for continuous monitoring. In this study, we aim to develop algorithms based on a single sensor attached to the shin to accurately detect propulsion phase. Six elderly (age: 73 years, BMI: 30.4) were recruited. Participants walked at their normal pace while wearing a plantar pressure system and an accelerometer on the shin. The pressure data was used to define the beginning of the propulsion phase when the pressure switched from the heel to the forefoot. A wavelet algorithm was developed to automatically detect the start and end points of propulsion phase using an accelerometer. The Bland-Altman method was used to evaluate the agreement between these methods. Pearson’s Coefficient was used to quantify the correlation. Based on the Bland-Altman analysis, A high agreement was obtained between the proposed method using accelerometer and pressure sensor (bias =9 ms, precision = 30 ms). Both algorithms are significantly correlated (r = 0.85, p<0.05). This study presents an innovative algorithm to automatically detect the propulsion phase for older adults during walking. Using wearable could facilitate the capture of propulsion phase during living activity, which might provide more insights into the mechanism of walking during rehabilitation therapy.
WEARABLES REVEAL A GAP BETWEEN GAIT PERFORMANCE IN THE LAB AND DURING 24/7 MONITORING IN OLDER ADULTS
Authors: Hillel Inbar , Avanzino Laura , Cereatti Andrea , Rikkert Marcel Olde , Din Silvia Del , Ginis Pieter , Mirelman Anat , Hausdorff Jeffrey M
Published: November 2019

We compared in-lab usual-walking (UW) and dual-task walking (DTW) to daily-living measures of gait obtained during 24/7 monitoring. In-lab gait features (e.g., gait speed, step and stride regularity) derived from UW and DTW were compared to the same gait features during daily-living in 150 elderly fallers (age: 76.5±6.3 years, 37.6% men). Features were extracted from a lower-back accelerometer. In daily-living setting, subjects wore the device for one week and pre-processing detected 30-second walking bouts. A histogram of all walking bouts was determined for each walking feature for each subject, then each subject’s typical, worst and best values were determined. Statistics of reliability were assessed using ICC and Bland-Altman. As expected, in-lab gait speed, step regularity, and stride regularity were worse during DTW, compared to UW. Gait speed, step regularity, and stride regularity during UW were significantly higher (i.e., better) from the typical daily-living values (p<0.0001) and different (p<0.000) from the worst and best values. DTW values tended to be similar to typical daily-living values (p=0.205, p=0.053, p=0.013 respectively). ICC assessment and Bland-Altman plots indicated that in-lab values do not reliably reflect the daily-walking values. Gait values during relatively long daily-living walking bouts are more similar to the corresponding values obtained in the lab during DTW, as compared to UW. Still, gait performance during most daily-living walking bouts are worse than that measured in-lab and do not reliably reflect each other. That is, an older adult’s typical daily-living gait cannot be estimated by simply measuring walking in a structured, laboratory setting.
ALEXA, ASSESS MY MEMORY: THE FEASIBILITY OF EXTENDED HEALTH MONITORING IN AN OLDER-ADULT-LIVING COMMUNITY
Authors: Davis Jensen , Howard Shannon , King Gregory , Boddu Phanidar , Jyothi Kiran , McDowd Joan
Published: November 2019

The goal of most older adults is to live independently in their own homes, for as long as possible. There are many advantages to aging in place for the individual, but also challenges as changes in cognitive and physical health can occur over time. Especially for older adults living alone, tracking these changes is critical for early intervention and prevention. The relatively easy availability of consumer technology may provide one mechanism for monitoring older adults in their homes. We designed a pilot study to test the feasibility and acceptability of using wearable sensors (Fitbit sensors), in conjunction with automated interactive voice recognition technology (Amazon Echo), to monitor older adults’ physical and cognitive health during daily activities. Participants (7 females, 2 males; 65-80 years of age) were recruited from a housing complex for older adults with low income. They were interviewed about health monitoring technology before and after a 2-week measurement period during which they were expected to wear the Fitbit daily and interact with the Amazon Echo for 8 consecutive days. Feasibility challenges included limited skill in Echo interactions, remembering to do the assessments, and charging/uploading Fitbit data. Qualitative analysis of interviews revealed generally positive attitudes about technology, but low comfort operating the devices. These preliminary findings suggest that with additional training for older adults, sensors and voice recognition technologies could have significant roles in maintaining older adult quality of life by contributing to early detection of decline and timely intervention.
NURSING HOME TELEED INTERVENTION: ADVANCING NEW CARE MODELS
Authors: Quinn Charlene C , Roggio Anthony , Erik Barr , Gruber-Baldini Ann
Published: November 2019

New reimbursement and managed care models demonstrate the need to reduce avoidable Emergency Department (ED) use and limit preventable inpatient admissions for older adults in Skilled Nursing Facilities (SNF). The objective was to develop an ED telemedicine consultation intervention for SNF residents with acute medical problems. Secondary objectives including evaluation of health care utilization, provider satisfaction. Demonstration evaluation in three urban SNFs, telemedicine linked to university medical center ED. Mobile telemedicine cart equipment assessed SNF residents for any change in condition. ED physicians used tablets with secure access to conduct the resident assessment. Provider satisfaction measures imbedded in EMRs were completed at consultation visit end. 460 patients had changes in condition, 327 resulted in 911 calls, 85 deemed eligible for telemedicine consult. Conducted 57 telehealth consults. Forty (70%) telemedicine consult residents remained in the SNF. Fourteen residents were transferred to the ED. Average satisfaction scores were 5.8/7 for SNF nurses (n=49) and 5.6 for ED physicians (n=45). Lower-rated items related to technical equipment problems. ED physicians reported residents transferred to ED after telehealth visit had better continuity of care. The intervention was effective in preventing or delaying transfer of acutely ill, medically complex SNF residents. Implementation of the intervention identified need for SNF admission policy and procedure changes; weekly telemedicine training; SNF clinical advocates; on-site tracking and linkage of EMRs across providers; HIPAA shared medical record concerns. Future research plans include analyses of detailed SNF resident characteristics and business case assessment for reduction of transfers, ED and hospital utilization.
DOES WEARING AUGMENTED-REALITY GOGGLES AFFECT OLDER ADULTS’ KINEMATICS DURING GAIT?
Authors: Vieira Edgar R , Estrazulas Jansen , Civitella Fernanda , Carreno Jorge , D’Souza Newton , Ozer Ebru , Ortega Francisco
Published: November 2019

Virtual-reality (VR) testing can cause motion sickness and impair safety, especially for older adults, but augmented-reality (AR) may allow the testing of holograms embedded into a mixed-reality environment without the VR impediments. However, wearing AR googles may affect the way people walk, but this possibility has not being tested. The objective of this study was to evaluate if wearing AR googles during gait would affect the kinematics of older adults. Ten older adults (68±5 years), who could walk without assistive devices, participated in this study. The participants walked outdoors in a public park with and without the AR googles. The participants were instrumented inertial movement units to track their kinematics (MTw Awinda trackers, Xsens Technologies B.V., Enschede, the Netherlands). The goal of the study was to assess if simply wearing the googles would affect gait, therefore no holograms were displayed. Ten gait cycles were analyzed and the mean of each subject was used to compare the joint kinematics between the conditions (with vs without googles) using T-tests in SPSS 18. The foot, ankle, knee and hip angles were not different between the conditions (p>0.05), but there were significantly less trunk flexion at 44% of the gait cycle (p=0.035) and less forward head flexion throughout the gait cycle (p=0.023) when the participants were wearing the googles vs. when they were not. The findings indicate that wearing AR goggles changed the trunk and head posture cycle, but did not affect the lower limb kinematics during gait.
ASSESSING THE IMPACT OF A GAME-CENTERED MOBILE APP ON COMMUNITY-DWELLING OLDER ADULTS’ HEALTH ACTIVATION
Authors: Crandall Jason , Shake Matthew , Ziegler Uta
Published: November 2019

The objective of this investigation was to evaluate the impact of a game-centered mobile app (Bingocize®) on older adults’ knowledge, skill, and confidence for managing aspects of their healthcare. Rural community-dwelling older adults (N=85) with mobility, not engaged in any structured exercise program, used the app in a group setting for 10 weeks, twice per week, for one hour. Participants were randomly assigned to (a) a version that included health education, or (b) health education and an exercise component. The Patient Activation Measure (PAM-10) was used to assess group changes in knowledge, skill, and confidence for managing aspects of their healthcare. Two (Group: Exercise + Health Education vs. Health Education-only) x Two (Time: Pre- vs. Post-intervention) analyses of variance, with significance p<.05, was used for statistical analysis. Results: PAM-10 values significantly increased from pre- to post-intervention for both groups, as did knowledge of the health topics (all p < 0.05). Attendance was >93% in both groups. Bingocize® engendered high attendance and improved health activation of older adults; however, additional research is needed to examine whether changes in activation result in long-term changes in health behavior. The Bingocize® mobile app is an enjoyable and effective way to increase health activation in community-dwelling older adults.
DO WELFARE RECEIPTS CROWD OUT PRIVATE TRANSFERS FROM FAMILIES AND FRIENDS? EVIDENCE FROM PANEL DATA IN CHINA
Authors: Zhang Yalu
Published: November 2019

Many countries are undergoing an unprecedented challenge to provide financial support to the older generation and guarantee their livelihood and wellbeing. China is no exception. Rural older adults in China have been becoming even more vulnerable to lack of care and inadequate financial resources as the growth of urbanization and labor migration has intensified. Therefore, it becomes increasingly difficult to follow the traditional family support model for the aged. Using the panel data of the China Health and Retirement Longitudinal Study 2011, 2013, and 2015 and a system generalized methods of moment (GMM), this paper examined the dynamic relationship between welfare receipts and monetary transfers from families and friends among rural and urban older adults (n=9,496) in China. The results show that the welfare receipts do not induce any “crowd-out” or “crowd-in” effects on rural older adults’ private transfer receipts. The incidence and amount of private transfers that occurred among rural older adults are more likely to be determined by the private transfers they received in prior waves. The intensity of catastrophic health expenditure itself does not affect the occurrence and size of private transfers. This study, on the one hand, confirms that among rural recipients, public transfers do not substitute private transfers, which most of the policymakers have long been concerned about. However, on the other hand, it also reveals the shortcoming of current public transfer policies—the generosity of public transfers does not enable rural older adults to be financially independent of intra-family transfers.
PROTECTIVE FACTORS IN THE CONTEXT OF SUCCESSFUL AGING IN URBAN-DWELLING ALASKA NATIVE ELDERS
Authors: Kim Steffi M , Lewis Jordan P
Published: November 2019

Recently, researchers have been exploring successful aging in rural communities of Alaska as it is experienced by Alaska Native Elders. Due to outmigration based on economic, medical, or familial influences, many Alaska Native elders leave their home communities to live in urban settings in Alaska, even though research suggests that most elders would like to remain in their home communities to grow old. Very little is known about the relocation process and how it impacts an elder’s views on successful aging. While established protective factors in rural communities involve family and extended family members, community, subsistence, and traditional activities, there is little knowledge of which protective factors exist in urban settlements supporting successful aging. This exploratory, qualitative study presents the protective factors of successful aging in the context of relocation of Alaska Native Elders from rural to urban dwellings. A life course approach and discourse analysis were used to analyze individual interviews asking how Alaska Native Elders experienced relocation and how successful aging was experienced similarly and differently in rural and in urban settings. A community-based participatory approach allowed for collaboration between researchers and communities as equal partners at all phases of the process, both contributing their expertise to enhance understanding of successful aging and supportive factors. Access to informal supports and meaningful community engagement were more important to rural Elders, and access to health care services and family engagement were important to Elders in urban communities. Challenges remain for Elders in urban environments to establish a sense of community.
THE IMPACT OF A PARO INTERVENTION ON DEPRESSION AND WELL-BEING IN OLDER ADULTS WITH DEPRESSION
Authors: Chen Shu-Chuan , Moyle Wendy , Jones Cindy
Published: November 2019

Aim: This study aimed to explore the effect of a social robot Paro intervention on depression and well-being in older adults with depression living in long-term care facilities in Taiwan. Methods: This study was adopted a single group and quasi-experimental with repeated measures design. Each participant participated in two stages: observation and Paro intervention stages. Stage 1 was an 8-week observation stage in long-term care facilities where the purpose was to observe the normal mood, behaviour and activities of older adults with depression. In stage 2, each participant was given a Paro by the researcher to keep for 24 hours for 7 days in for 8 weeks. Outcome measurements were obtained 4 times: a week before the intervention (T1), immediately the end of 8-week observation (T2), mid-point of Paro intervention (T3), and immediately the end of 8-week Paro intervention (T4). Instruments included the Geriatric Depression Scale, the UCLA Loneliness Scale version 3, and the World Health Organization Quality of Life Questionnaire-OLD. Results: There were 20 participants completed the study. The mean age of participants was 81.1years (SD = 8.2). After 8-week Paro intervention, statistically significant differences in changes were found on depression, loneliness, and quality of life from pre-intervention to post-intervention. Conclusion: This study was found that Paro intervention has beneficial effects on depression and mental well-being for older people with depression in long-term care facilities. Paro Intervention might be a suitable psychosocial intervention for older people with depression and should be considered as a useful tool in clinical practice.
ADMISSION AND CARE OF INDIVIDUALS WITH MENTAL ILLNESS IN MASSACHUSETTS NURSING HOMES: A PILOT STUDY
Authors: Barooah Adrita , Nadash Pamela
Published: November 2019

Due to the rising prevalence of mental illness in nursing homes (NHs), the US Congress passed the 1987 Pre-Admission Screening and Resident Review (PASRR) mandate, which aims both to limit inappropriate institutionalization of people with mental illness and to ensure that they are served appropriately when living in NHs. Although the PASRR is a federal mandate, states have considerable flexibility in implementing it, resulting in considerable variation across states. This study explores the Commonwealth of Massachusetts’ policies on admission and care of individuals with mental illness in NHs, focusing on implementation of PASRR regulations. Semi-structured phone interviews were conducted with key informants identified through purposive snowball sampling (N=8). Key informants included representatives from NHs, the State Mental Health Authority, state Medicaid office, and independent contractors and an academic expert. Data were analyzed using qualitative content analysis. Participants agreed that the PASRR tools efficiently identified and screened people with mental illness -- thus achieving PASRR’s first aim, but that the regulations did not successfully ensure appropriate services. Interviewees also identified a lack of services and options for diversion of people with mental illness into the community. Nursing home informants noticed a disconnect between the various supervising departments and felt instructions were unclear on the administration of the tool. This work builds a case for a national study to understand how PASRR implementation varies across states, resulting in variations in the proportion of people with mental illness admitted and served in NHs.
VALIDATING THE PREFERENCES ASSESSMENT TOOL FOR NURSING HOME RESIDENTS USING ITEM RESPONSE THEORY
Authors: Duan Yinfei , Ng Weiwen , Shippee Tetyana P
Published: November 2019

The Preference Assessment Tool (PAT), part of the Minimum Data Set (MDS), assesses residents’ preferences to enable preference-based care in nursing homes (NHs). The two PAT sections including daily routine preferences and activity preferences are assumed to measure autonomy and meaningful activities as the underlying constructs associated with residents’ psychosocial needs. Yet, the validity of this assumption has not been tested. This study examines PAT’s construct validity using item response theory. We fitted graded response models to the two PAT sections using 2017 MDS annual assessments of 8,829 long-stay residents in 291 Minnesota NHs. Most items discriminated well between residents who had at a low versus high intensity of these two types of psychosocial needs (i.e. have discrimination parameters > 1). Two daily routine preference items (family’s involvement in care planning, and having snacks), and three activity preference items (having pets, keeping up with news, and reading) had poor discrimination in measuring autonomy and meaningful activities respectively. Overall, the PAT appeared to be more sensitive in measuring the lower middle range of the two constructs. We estimated the correlation between the two constructs as 0.65. In conclusion, the PAT performs fairly well in measuring the two types of psychosocial needs for NH residents. Nevertheless, more items are needed to capture a broader range of psychosocial needs beyond autonomy or basic leisure activities. The findings of this study brought attention to the utility of the PAT in measuring residents’ psychosocial needs and in guiding resident-centered care.
KEEPING COOL IN FLORIDA ASSISTED LIVING COMMUNITIES: BARRIERS TO POWER RULE IMPLEMENTATION
Authors: June Joseph , Dobbs Debra J , Dosa David , Peterson Lindsay J , Hyer Kathryn
Published: November 2019

In 2018, in response to deaths of nursing home residents after Hurricane Irma, Governor Scott and the Florida legislature enacted an emergency power rule for nursing homes and assisted living communities (ALCs). It mandates these settings to have a generator to regulate ambient air temperatures during loss of primary power by Jan. 1, 2019. However, due to cost and supply challenges the implementation of these plans has been difficult, particularly for small and independently owned ALCs. The purpose of this mixed methods study is to determine the characteristics of ALCs that were able to comply with the rule and concerns raised by ALC administrators. Using data from state regulatory agencies on all Florida ALCs (N=3082), we determine associations between ALC characteristics (size, specialty license, low-income residents) and non-compliance to the rule, using chi-square and t-tests. Additionally, we conducted interviews and focus groups with ALC administrators (N=60) about issues of implementing their emergency power plan. A content analysis approach was used and Atlas.ti v7 was used for initial and axial coding. Some prevalent themes were issues with time frames, coordination between local and state regulations, and financial burden. Themes varied by size and organizational structure of ALCs. Results will inform policy-makers on the barriers faced by ALCs to implement a new regulation that may cause financial difficulties and compromise quality care. This study has implications related to disaster preparedness regulations and their effects on independent ALCs with fewer financial resources.
OLDER ADULTS’ OPINIONS ON DIFFERENT VEHICLE TECHNOLOGIES
Authors: Freed Sara A , Ross Lesley A , Stavrinos Despina
Published: November 2019

Vehicle technologies have the potential to greatly improve road safety. Given normative changes in cognitive, sensory and physical functioning, older drivers may particularly benefit from such technologies. However, little research has examined older adults’ opinions of vehicle technologies, descriptive differences of individuals more likely to have positive opinions of vehicle technologies, and how their opinions may differ depending on the type of vehicle technology. The current study examined older adults’ opinions on vehicle technology in a sample of 72 adults between 65 and 85 years (M = 72.3, SD = 5.36, 48% women). Participants were asked, “How important is [parking assistance, crash avoidance systems, early collision warnings, built-in GPS] in choosing a new vehicle?” on a scale from 1 (“not at all”) to 5 (“must have”). On average, participants rated built-in GPS as the most important (M = 3.81, SD=1.10) with parking assist as the least important (M=1.86, SD=1.13). We used correlational analyses to examine the association between demographic and personality and importance ratings. Women were more likely to rate greater importance for built-in GPS than men (r=.35, p<.05). Age, education, self-reported driving quality, and self-reported average weekly driving miles were not significantly associated with importance rating. In terms of personality, only higher levels of extraversion were associated with more positive ratings of early collision warning systems (r=.24, p<.05). Vehicle technology design and education should take older adults’ preferences into account and consider individual differences, and future work should examine other predictors of vehicle technology preferences such as functional performance.
BASELINE DRIVING MILEAGE PREDICTS STATE-REPORTED CRASHES ACROSS 5 YEARS
Authors: Tian Junyan , Freed Sara A , Ross Lesley
Published: November 2019

Although annual driving mileage has frequently been examined as a predictor of crashes among older adults, most research used cross-sectional design and relied on self-reported crash data. This study used multivariate regression to examine the number of state reported at-fault crashes between groups of low (14,000km) self-reported annual distance over five years. Additionally, key factors of interest including age, gender, and population density were examined as predictors. The sample included 519 healthy older adults aged 65-90 (M=73.17, SD=5.56) across five sites in the United States. 12% of participants experienced a crash across five years, and among those who crashed, the majority (87%) experienced one crash (range 0-3 crashes). After controlling for age, gender and testing site, people in the high annual mileage group had a greater number of crashes compared to the low mileage group (β=.14, t(513)=2.37, p=.02). There was not a significant difference in number of prospective crashes between the low and medium group. Also, people who drove in sites with low population density had more crashes than those who in high population density sites (β=.10, t(513)=2.24, p=.03). Higher age was associated with a greater number of prospective crashes (β=.01, t(513)=3.67, p =.002); however, gender was not a significant predictor of crashes. Our results highlight the importance of examining prospective crashes over time, and taking mileage and population density into consideration. Future research should examine trajectories of driving exposure in relation to prospective crashes using multilevel modeling.