bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding the Role and Value of Process Quality Indicators in Hospitalized Older Surgical Patients
Authors: Thillainadesan Janani , Hilmer Sarah , Mudge Alison , Aitken Sarah , Naganathan Vasi
Published: December 2021

Background Despite the development of geriatrics surgery process quality indicators (QIs), few studies have reported on these QIs in routine surgical practice. Even less is known about the links between these QIs and clinical outcomes, and patient characteristics. We aimed to measure geriatrics surgery process QIs, and investigate the association between process QIs and outcomes, and QIs and patient characteristics, in hospitalized older vascular surgery patients. Methods This was a prospective cohort study of 150 consecutive patients aged ≥ 65 years admitted to a tertiary vascular surgery unit. Occurrence of geriatrics surgery process QIs as part of routine vascular surgery care was measured. Associations between QIs and high-risk patient characteristics, and QIs and clinical outcomes were assessed using clustered heatmaps. Results QI occurrence rate varied substantially from 2% to 93%. Some QIs, such as cognition and delirium screening, documented treatment preferences, and geriatrician consultation were infrequent and clustered with high-risk patients. There were two major process-outcome clusters: (a) multidisciplinary consultations, communication and screening-based process QIs with multiple adverse outcomes, and (b) documentation and prescribing-related QIs with fewer adverse outcomes. Conclusions Clustering patterns of process QIs with clinical outcomes are complex, and there is a differential occurrence of QIs within older vascular surgery patients, suggesting process QIs alone may be unreliable targets for quality improvement. Prospective intervention studies are needed to understand the causal pathways between process QIs and outcomes to help prioritize care processes that are most clearly linked to improved outcomes.
The Corporeality of Late Age
Authors: Gilleard Chris
Published: December 2021

In a study of over a thousand Germans, Paul Baltes and his colleagues observed that most respondents saw age 80-84 as the preferred age to reach before dying. Living beyond 85 was only desired by a minority. Perhaps this is because this age seems to many the point when bodily disease and physical weakness render life not just unpleasant but actively burdensome. Such views underpin the social imaginary of an undesirable fourth age. This paper discusses the significance of corporeality as both representation and lived experience, raising the question of whether the disparity between real and imagined corporealities resides as much from an ‘other’ within as without.
A Multi-Method Examination of Ageism in Children Before and During the Pandemic
Authors: Bellingtier Jennifer , Jaquet (née Bauer) Jenny , Schenker Lena-Emilia
Published: December 2021

The pandemic has made age more salient. Access to vaccines, mandates to wear masks, and recommendations for contact restrictions have all varied by age. Developmental intergroup theory proposes that greater salience of a feature can lead to greater stereotyping and prejudice. We investigated this with a multi-method assessment of ageism in children (N = 57, ages 4-8), where data collection occurred both before and during the pandemic. In simulated behavioral measures, children preferred to sit closer to younger adults (mean distance = 1.8 seats) versus older adults (mean distance = 2.8 seats), and, for a simulated treasure hunt, they chose 3.36 younger, versus 1.63 older, teammates. Explicit (picture ratings) and implicit (IAT) ratings also significantly favored younger adults. These preferences were not exacerbated by the pandemic. Although ageism is present at young ages, we found no evidence that this has thus far worsened in the pandemic.
Are Stakeholder Prioritized Post-Acute Care Practices Documented and Do They Improve Outcomes?
Authors: Leland Natalie , Rouch Stephanie , Skidmore Elizabeth
Published: December 2021

The receipt and intensity of rehabilitation services, such as occupational and physical therapy, have been associated with lower risk of readmissions. Yet, little is known about the care. This study quantified the frequency of documented post-acute care (PAC) stakeholder-prioritized practices and their associations with hospital readmissions. A PAC stakeholder advisory board (e.g., physicians, rehabilitation providers across settings) prioritized key practices to evaluate. Medicare claims and electronic medical records were used to construct an episode of care for patients age 65 or older. Eligible patients were discharged from one of nine acute hospitals to a PAC setting (i.e., inpatient rehabilitation, skilled nursing, home health) within one large health system between August 2016 and August 2018. Descriptive statistics characterized the cohort and frequency of documented practices. Logistic regression examined associations among the practices and readmissions, by setting. Stakeholders prioritized (a) education, (b) cognition assessment and treatment, and (c) medication management. Among these PAC patients (n=3,227) there was variation in documentation for each practice by setting. Documentation of medication management at any point during the stay ranged from less than 1% to 54% of patient stays among settings. There was a significant relationship between the practices and readmissions. Within inpatient rehabilitation, every additional day patient and caregiver education was documented by occupational therapy was associated with 21% lower odds of readmission (p<0.05). This study highlights the variability in documentation of stakeholder-prioritized practices across PAC and their associations with readmissions. Future work is needed to enhance the systematic delivery and documentation of these practices.
Assessing Frontline Personnel’s Recognition of and Response to Cases of Abuse in Later Life
Authors: Marrs Sarah , O'Hara Courtney , Young Ruth Anne , Yelvington Miranda , Patterson Deijah , Rhodes Annie , Ansello Edward
Published: December 2021

Abuse in later life is experienced by 10% of adults over age 60 (Acierno et al., 2010). Unfortunately, it is estimated that for every one reported case, around 20 remain unreported (APA, 2012). A primary reason for this disparity is the absence of training provided to professionals working at the frontline of elder abuse, such as law enforcement professionals, health care professionals, and aging and victim service providers (e.g., Rose et al., 2016). This leaves the workforce best positioned to intervene in cases of abuse in later life lacking knowledge around what constitutes the different types of abuse and what they should do if they suspect abuse (Rosen et al., 2018). A critical first step to developing the evidence-based training needed to reconcile this gap is to gain a better understanding of the current landscape within this workforce. This qualitative study explored the knowledge and attitudes towards abuse in later life as well as current practices and policies for reporting abuse among law enforcement professionals (n = 1), health care professionals (n = 2), and aging (n = 5) and victim (n = 4) service providers. Participants (N = 12) represented urban (n = 4), suburban (n = 5), and rural settings (n = 2). Themes emerging from the focus groups highlight a number of barriers to identifying and reporting abuse for professionals in each discipline. Our findings also provide strong evidence of the need to intervene and diminish the impact ageist attitudes and behaviors can have on older adults.
Neighborhood Deprivation and Incident Alzheimer's Disease: A Regional Cohort Study of Electronic Medical Records
Authors: Dalton Jarrod , Pfoh Elizabeth , Berg Kristen , Gunzler Douglas , Mourany Lyla , Krieger Nikolas , Kahana Eva , Perzynski Adam
Published: December 2021

The prevalence of Alzheimer’s disease (AD) is anticipated to increase drastically. Neighborhood socioeconomic position (SEP) has been related to multiple processes of health. Understanding whether SEP is related to AD can inform who is at greatest risk of developing this disease. We analyzed electronic medical records of 394892 patients from the two largest health systems in Northeast Ohio to evaluate the relationship between Ohio Area Deprivation Index quintiles (defined at the census tract level) and hazard for a composite outcome of AD diagnosis or primary AD death. We included residents of Cuyahoga and neighboring counties, and used the first outpatient visit beyond age 60 occurring between 2005 and 2015 as study baseline. Outcome data were censored at the earlier of a) the beginning of any 3-year time period without visits or b) non-AD death. We estimated a Cox proportional hazards regression model, adjusting ADI quintile effects for the interaction between age at baseline, sex and race as well as birth year. We used quadratic terms for continuous predictors. After adjusting for these factors, ADI quintile was significantly related (χ2 = 83.0 on 4 d.f.; p < 0.0001) to the composite time-to-event outcome. Compared to the lowest-deprivation quintile, ADI quintiles 4 (adjusted hazard ratio [95% confidence interval]: 1.18 [1.10, 1.26]) and 5 (1.37 [1.28, 1.47]) had significantly higher hazard for the composite outcome. In conclusion, neighborhood deprivation may be a risk factor for AD independent of demographic factors. Preventive efforts should target individuals living in neighborhoods with high levels of deprivation.
Positive and Negative Affect influences Attitudes Toward Aging
Authors: INTRIERI R , Goodwin Paige
Published: December 2021

The Aging Semantic Differential (ASD; Rosencranz & McNevin, 1969) is one of the most widely used measures in the aging literature to measure attitudes rather than knowledge or beliefs about aging. Originally 32-items the ASD has been reduced through careful factor analysis to 20-items representing 4 factors representing: Instrumentality, Autonomy, Acceptability, and Integrity. Latent summary scores were created for each factor, with lower scores representing more positive attitude toward older adults. Despite its widespread use there are no published studies that examine the relationships between the four ASD factors and Positive and Negative affect. Positive and Negative affect are related to and represent the core aspects of Extraversion and Neuroticism. The prime objective of this study was to assess the relationships between Positive and Negative affect and the four ASD factors. The sample comprises 1189 undergraduate participants with a mean age of 22.02 (SD=6.27). The sample included 611 men and 578 women. Results showed the path model fitted the data well (CFI = 953, TLI = .944, RMSEA = 0.066, SRMR = 0.035). Positive affect was significantly related to Instrumentality, Acceptability, and Integrity (β= -0.073, (SE= 0.034); p=0.034; β= --0.141 (SE= 0.033), p=0.0001; β= -0.146 (SE= 0.032), p=0.0001). These results show that higher positive affect was related to more positive beliefs about Instrumentality, Acceptability, and Integrity. Negative affect was significantly related to Integrity (β= 0.079, (SE= 0.032); p=0.012) indicating that greater negative affect was related to more negative beliefs about bodily integrity.
Embodying the Aging Experience: How Virtual Reality Is Transforming Medical and Nursing Education
Authors: Gugliucci Marilyn , Saunders Pamela , Washington Erin
Published: December 2021

Virtual reality (VR) has long been standard in healthcare education. Recent advances in VR hardware and software applications have coalesced to allow for higher fidelity, more highly realistic simulations that are also deployable at scale -- not just in highly specialized, single location simulation labs. In tandem, there has been an examination in both the corporate and academic sectors around the efficacy of VR training and learning. While VR has been long proven to be effective in training students and workers in hard skills, its lack of realism has been a barrier to explore efficacy in simulations related to soft skills and emotional intelligence. This symposium will discuss the implementation of virtual reality “labs”, where learners embody in a live 360 film environment the first-person point of view of an older adult -- interacting with gaze, voice, and natural hand motions – into four university’s medical and nursing curriculum. Lab outcomes include decreased ageism and stereotyping, and increased empathy, sensitivity, cultural competency, and disease knowledge. The first paper reports outcomes of increased understanding, comfort, compassion and empathy of students and informal caregivers after experiencing various labs. The second discusses comparative data on knowledge and attitudes of medical students experiencing the virtual labs individually vs. the group distance mode. The third reports the results of an initial study on how embodying an older adult with sensory impairment affects participant empathy using a standardized scale. The fourth discusses how one university transitioned to delivering immersive labs to nursing students remotely during COVID19.
Evidence-Based Integrative Health Care to Promote Quality of Life in Older Adults With Cancer
Authors: Majeski Robin , Chiaramonte Delia
Published: December 2021

Cancer disproportionately affects older adults and presents significant challenges to patients’ quality of life. Use of complementary medicine is increasing among older adults with cancer and these modalities have the potential for both benefit and harm. Thus, it is important that health care professionals are knowledgeable about the evidence-supported benefits and risks of complementary and integrative health approaches in the care of older adults with cancer. Integrative cancer care provides a comprehensive approach to reducing symptom burden in patients suffering with cancer symptoms and side effects of cancer treatment. Symptoms such as pain, fatigue, nausea, sleep disturbance, mood disorder, perceived stress, and reduced quality of life are common in this population.This session will discuss an evidence-based integrative approach to cancer care which incorporates both pharmacologic and non-pharmacologic modalities to decrease symptom burden, enhance patient well-being, and improve quality of life. Non-pharmacologic modalities used in the integrative approach to care will be described and relevant evidence for risks, benefits and indications will be presented. Case studies will be discussed to demonstrate the integration of these techniques into conventional western medical treatment plans for older adults with cancer. Diversity and inclusion issues relevant to integrative medicine for underserved cancer patients will be addressed, as well as recommendations for future research to expand access of underserved populations to evidence-supported integrative cancer care. A resource list will be provided to participants.
Factors Related To The Loneliness Of Older Women With Hypertension In Tehran
Authors: Kakhki Ali Darvishpoor , Mohammadi Sona , Miri Reza
Published: December 2021

Older women have longevity and face with common chronic diseases such as hypertension longer than men. In addition the refusal to accept older women into the mainstream of society can affect the loneliness of older women particularly in developing countries such as Iran. This study was conducted to describe factors related to loneliness of older women with hypertension in Tehran. This descriptive, correlational study was conducted on a sample of 300 older women above age 60 in five regions of Tehran in 2020. A socio-demographic questionnaire and the Russell Loneliness Scale were used for data collection. Content validity and Cronbach’s alpha were used for evaluating the validity and reliability of questionnaires. 61% of older women were widowed and 37.3% lived alone with a mean age of 72.16(± 8.5) year. The mean score for loneliness was 66.26 (±13.44) on a 20 to 80-point scale. The scores of loneliness were influenced significantly by not having an income source, no living companion, chronic diseases, hospitalization in last year, family history of hypertension, and duration of hypertension. The best predictors of loneliness were hospitalization in last year, duration of hypertension, family history of hypertension, and chronic diseases. The findings of this study showed that loneliness is very common in older women with hypertension and is related to a number of factors. Monitoring modifiable factors such as hospitalization in the last year and non-modifiable factors such as duration of hypertension will help us to prevent or reduce loneliness in older women with hypertension.
Health trajectories after age 60: the role of individual behaviours and social contexts
Authors: Calderón-Larrañaga Amaia , Hu Xiaonan , Haaksma Miriam , Rizzuto Debora , Fratiglioni Laura , Vetrano Davide
Published: December 2021

This study aimed to detect different health trajectories after age 60, and to explore to what extent individual and social factors may contribute to healthier ageing. Twelve-year health trajectories were identified in subjects from the Swedish National Study on Aging and Care-Kungsholmen (N=3108), integrating five indicators related to diseases, physical and cognitive function, and disability by means of nominal response models. Growth mixture models were applied to explore health trajectories in terms of rate and pattern of change. Baseline information about health-related behaviours and social context was collected through standardized questionnaires. The strength of the associations was estimated using logistic regression, and their impact through population attributable fractions (PAF). Three trajectories were identified grouping 78%, 18%, and 4% of people with respectively increasing rates of health decline Compared to the best trajectory, subjects in the middle and worst trajectories became functionally dependent 12.0 (95%CI:11.4-12.6) and 12.1 (95%CI:11.5-12.7) years earlier, respectively. Insufficient physical activity (OR:3.38, 95%CI:2.58-4.42), financial strain (OR:2.76, 95%CI:1.77-4.30), <12 years education (OR:1.53, 95%CI:1.14-2.04), low social connections (OR:1.45, 95%CI:1.09-1.94), low social participation (OR:1.39, 95%CI:1.06-1.83) and a body mass index ≥25 (OR:1.34, 95%CI:1.03-1.75) were associated with belonging to the middle/worst trajectories. The highest PAFs were observed for insufficient physical activity (27.1%), low education (19.3%) and low social participation (15.9%); a total PAF of 66.1% was obtained when considering all significant exposures together. Complementarily considering life-long factors belonging to the socioeconomic, psychosocial, and behavioural dimensions should be central to any strategy aimed at fostering health in older age.
Association of Body Compartment Shrinkage with Subsequent Health Care Utilization in Older Men
Authors: Schousboe John , Langsetmo Lisa , Kats Allyson , Taylor Brent , Ensrud Kristine
Published: December 2021

Both height loss and weight loss among the very old are associated with adverse health outcomes including fractures and mortality. However, it is not clear whether the associations between weight loss and health outcomes are attributable to specific compartmental (fat vs. fat-free) loss or whether they are attributable to overall shrinkage. Our objective was to estimate the associations of compartmental loss and height loss with subsequent total health care costs, acute hospitalizations, and skilled nursing facility (SNF) stays over a three-year follow-up period, adjusted for each other and important covariates (age, race, multimorbidity, IADL impairment, depressive symptoms, walk speed). Our analytic cohort was 1505 older men (mean [SD] age 79.3 [5.2] years) who attended the 3rd Osteoporotic Fractures in Men (MrOS) study visit (V3) and who were enrolled in Medicare Fee for Service (FFS). Annualized changes in fat-free and fat mass (measured with dual-energy x-ray absorptiometry) and height were assessed over a mean (SD) 6.8 (0.3) years prior to V3. Total health care costs, acute hospital stays, and SNF stays were ascertained during 3 years after V3 using linked Medicare FFS claims files. Fat-free mass loss (per SD) was associated with total health care costs (cost ratio 1.10, 95% CI 1.01, 1.19), but not with acute hospital or SNF stays. Fat mass loss and height loss were not associated with health care utilization outcomes after multivariable adjustment. Loss of fat-free mass is modestly associated with higher total health care costs after accounting for age, race, multimorbidity, and IADL impairment.
Virtually Transformative Experiences in Geriatric Education: Lessons Pre and Post Pandemic
Authors: Saunders Pamela
Published: December 2021

Georgetown University medical students have the option of selecting a two-week rotation in Geriatrics during their third-year. Since Fall 2019, the curriculum has included three immersive virtual reality (VR) labs: hearing & vision loss, Alzheimer’s disease, and end-of-life conversations created by Embodied Labs. The curricular goals include increasing empathy and sensitivity of learners to the perspective of older adults, decreasing ageism & stereotyping, and increasing clinical knowledge. In each lab, students are immersed in a live film, first-person point of view of an older adult. They interact with the immersive environment via gaze, voice, and natural hand motions. Pre-pandemic, students viewed the labs in-person using a commercial VR headset. Since the pandemic, March 2020, students accessed the VR labs through the virtual modality of Zoom. This abstract summarizes data on knowledge and attitudes examining differences in knowledge and attitudes pre and post-pandemic.
Cost Reduction Behaviors and Cost-Related Medication Nonadherence in Older Adults with Atrial Fibrillation
Authors: Bamgbade Benita , McManus David , Briesacher Becky , Lessard Darleen , Mehawej Jordy , Tisminestzky Mayra , Gurwitz Jerry , Saczynski Jane
Published: December 2021

While factors such as forgetfulness may result in medication nonadherence, 2.7 million older adults in the US experience cost-related nonadherence (CRN). Limited research has explored CRN and associated cost-reduction behaviors (CRB) in older adults with atrial fibrillation. The objectives of this study were to 1) describe the prevalence of CRN, CRB and spending less on basic needs to afford medication and 2) examine factors associated with CRB among older adults with atrial fibrillation. Data were drawn from the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF), a prospective cohort of older adults with atrial fibrillation (>65 years). Using a self-administered survey, all participants completed a validated CRN measure. Chi-square and t-tests were used to evaluate differences in participant characteristics across CRB and significant characteristics (p<0.05) were entered into a logistic regression model. Participants (N=1244) were on average 76 years and 49% were female. Among all participants, 4.2% reported CRN; 69.1% reported CRB; and 5.9% reported spending less on basic needs. Compared to participants who did not engage in CRB, participants who engaged in CRB were less likely to be cognitively impaired and more likely to be a race/ethnicity other than non-Hispanic white; have Medicare insurance; and have comorbidities. CRB were common among older adults with atrial fibrillation and was associated with in-tact cognitive function, the presence of medical comorbidities and non-White race. Clinicians might consider providing patients with cognitive impairment additional support such as patient assistance programs or referrals to pharmacists for medication therapy management to assist with CRB.
Metabolic comorbidities among patients with peripheral artery disease: a national population-based study
Authors: Ryu Gi Wook , Choi Mona , Park Young Shin
Published: December 2021

Peripheral artery disease (PAD) is a chronic disease which is associated with old age. PAD was known as an age-related chronic condition. Metabolic comorbid conditions which include hypertension, diabetes, and hyperlipidemia can have negative impacts on blood vessels aggravating PAD in elderly patients. Therefore, metabolic comorbidities need be considered in order to develop intervention for patients with PAD. The aim of this study is to find the characteristics of PAD patients with metabolic comorbidities. This is a retrospective study that used the national claim data of South Korea from 2009 to 2018. The inclusion criteria were adults (20+) and patients diagnosed with PAD as a primary or secondary diagnosis from 2011 to 2017. The frequency of hypertension, hyperlipidemia, diabetes, and metabolic comorbidities in PAD patients was examined. In addition, the difference in the number of metabolic comorbidities according to sex was identified using the chi-squared test. Among the total PAD adult patients(n=8,478,876), the number of elderly patients over 60 years old was 4,124,592(48.7%). Among the total patients, PAD patients with hypertension were the most common at 958,329 (11.30%). Sex was significantly related to having metabolic comorbidities and women showed higher proportion of metabolic comorbidities compared to men (χ2 =5.02, p<.001). As the frequency of PAD patients with hypertension were the highest, it is necessary to develop a health management program that considers metabolic comorbidities, especially hypertension, in order to manage PAD disease. In addition, there is a need for special interest in intervening metabolic conditions of female patients with PAD.
Intrinsic, extrinsic and interaction theories on falls and aging-in-place: A C-T-E scoping review
Authors: Albright Bonnie
Published: December 2021

As aging in place increases in popularity, it is important to understand potential negative outcomes related to the trend. For this presentation, the conceptual-theoretical-empirical (C-T-E) scoping review technique was used to organize research on in-home falls of community-dwelling older adults. Research and theory were included from the fields of social gerontology, disability, policy, social justice, medicine, rehabilitation, and housing. While research from these multiple fields overlaps, an overarching conceptual framework for organizing this literature was found to categorize the theories into three main conceptual areas. The three conceptual areas are: intrinsic (related to the person only), extrinsic (related to external factors only), and interaction between intrinsic and extrinsic (related to the interaction between the person and external factors). This conceptual framework shares similarities with work by others in use of the terms intrinsic and extrinsic, and it draws on the larger influence of Bronfenbrenner's socio-ecological model. However, this review extends previous work by providing a framework for organizing the contributions to falls research across multiple disciplines.
Moves to age-restricted housing and functional health trajectories among independent living older adults
Authors: Webster Noah , Brauer Simon
Published: December 2021

Where independent living older adults live has been found to have strong links with disability. For example, older adults living in age-restricted housing contexts (e.g., retirement communities) have been found to have worse functional health compared to those living in non-age-restricted settings. Theories and empirical research demonstrate positive and negative aspects of living in age-restricted housing. Recent availability of population-level longitudinal data with sufficiently large samples has made examination of this heterogeneity possible. In this study we examine whether a move to age-restricted housing is associated with functional health trajectories and whether age at time of move moderates this link. We examine these questions using nine waves of longitudinal data from a representative sample of 8,687 U.S. adults age 65 and older from the National Health and Aging Trends Study. Spline-like growth curve models were estimated to determine the intercept, slope prior to move to age-restricted housing, and slope after the move. We also tested whether these processes are conditional on age at time of move. Results indicate that regardless of age all respondents experienced a decline in functional health following a move to age-restricted housing. However, there is variation in the steepness of this decline by age at time of the move. People who move to age-restricted housing earlier experience a less steep decline in functional health post-move compared to those who move later. Findings suggest moving to age-restricted housing earlier may enable older adults to utilize resources often available in these settings to prevent steep health declines.
Testing frailty, accessible housing, and changes in living arrangements using the Health and Retirement Study
Authors: Albright Bonnie
Published: December 2021

This study examined housing accessibility elements of community-dwelling older adults using the Health and Retirement Study (HRS). Housing accessibility elements were tested as moderators in the relationship between prior frailty and later living arrangements. HRS physical measures were used to construct the Physical Frailty Phenotype and the Continuous Frailty Scale. The analytic method for the study was multinomial logistic regression. Latent class analysis was also used to identify housing accessibility element use-types. Study findings will be presented. Strengths and weaknesses of using the HRS to measure home accessibility and construct frailty scales will also be discussed.
The relationship between family and residential settings: Aging in place vs long term care facility in South Korea
Authors: Min Joohong , Oh Seung-eun , Kim Bon
Published: December 2021

Objective: This study aims to explore the factors influencing long-term-care beneficiaries’ decisions between home health care and institutional care in South Korea. This study further investigated the association between these two types of long-term care services and emotional, financial, and physical burden alleviation among the beneficiaries and their family members. Methods: We analyzed data from 2019 Long-Term Care Survey. Out of 5,606 respondents, 4,079 long-term care beneficiaries and family members were included in this study. Logistic regression models were conducted to understand factors associated with types of long-term care services, and the association between types of long-term care services and burden alleviation. Results: Having a spouse, having children, or a shorter geographic distance between the beneficiaries and their family members were factors associated with higher likelihood of receiving home health care rather than institutional care. Also, more sever mobility limitation, outpatient care, and fall experiences were associated with higher likelihood of receiving institutional care. Utilization of institutional care was significantly associated with higher alleviation of physical burden. No significant differences between home health care and institutional care were found on emotional and financial burden alleviation. Conclusions: The findings suggest that family resources may be beneficial for older adults to pursue aging in place in later life. However, the physical toll of their family members may exist. Our findings provide evidence to inform public policy decisions on long-term care services for older adults and their family members.
Validation of a Measure of Loneliness for Homebound Older Adults
Authors: Chan Keith , Marsack-Topolewski Christina , LaFave Sarah , Ratnayake Maggie , Graves Jillian , Fenske Diane
Published: December 2021

The pandemic has disproportionately impacted older adults, highlighting the need to address social isolation for this population. Homebound older adults are at risk for loneliness, which is a correlate of poor mental and physical health. COVID-19 has exacerbated effects of social isolation by limiting contact with family and other visitors. In-depth empirical validation of loneliness scales is needed to examine the measurement of this construct for homebound older adults who are aging in place. This study examined the reliability and validity of the UCLA Loneliness Scale (v3) for a community-dwelling population of older adults who received home-based support services due to their homebound status or have chronic illness resulting in ADL limitations. Using in-home interviews, data were collected for 175 older adults using the UCLA Loneliness Scale. Reliability and confirmatory factor analyses were conducted to examine its psychometric properties. Findings demonstrated the scale had good internal consistency reliability (ɑ = 0.91). Confirmatory factor analyses indicated a two-factor solution, 1) disconnectedness and 2) connectedness, accounting for 92% of the variability in the 20 items. The lack of meaningful relationships (ƛ = 0.73, p < 0.05) or having someone to turn to (ƛ = 0.68, p < 0.05) substantively contributed to disconnectedness. Feeling that there were people to talk to (ƛ = 0.67, p < 0.05) and turn to (ƛ = 0.76, p < 0.05) contributed to connectedness. Future research can further examine how quality of relationships and benefits of being connected to others can address loneliness and isolation for this population.
A Relationship-Oriented Model of Research Participation: The Brain Health Community Registry
Authors: Bykovskyi Andrea Gilmore , Fuhr Haley , Mullen Shannon , Block Laura , Benson Clark , Harris Danielle , Cotton Quinton , Kendall Jessica
Published: December 2021

Historically excluded and minoritized populations are significantly under-included in health studies of Alzheimer’s disease and related dementias (ADRD) despite bearing a disproportionate burden of disease—evidenced by higher incidence, prevalence, and poorer health outcomes. Meaningful progress toward identifying and alleviating causes of health disparities in ADRD necessitate effective and scalable approaches for broadening inclusion in research. Rigorous studies evaluating research participation among minoritized populations are limited and have predominantly focused on individual-level factors and behavioral change (i.e. religiosity, willingness). These approaches frequently overlook the influence of unequally distributed structural and social determinants on participation despite the compounded financial, social, emotional, and logistical consequences that result from ADRD. Using an intersectional and social justice lens, we developed the Participant and Relationship-Oriented Research Engagement Model, which characterizes research as a form of relationship and extends social determinants frameworks to the context of research participation. We report core components of the model and its application in the design and preliminary evaluation of the Brain Health Community (BHC) Registry, which features proactive and systematic evaluation of potential unmet needs among prospective participants, and connections to relevant services (i.e. respite care, adaptive devices). Preliminary testing of the model and participant feedback on the BHC suggest it is a feasible approach to research engagement, and that associated assessment tools and resource protocols are acceptable and sufficiently adaptable to heterogeneous sets of unmet needs. Primary challenges include ongoing assessment of engagement and routine changes in service ability, which can be addressed through community-based resource networks.
Chronic Diseases and Self-Reported Health Status Among American Indian/Alaska Native Older Adults
Authors: Danielson Ramona , Adamsen Collette , Mason Agnieszka
Published: December 2021

Background: In the 1800s and 1900s, U.S. federal “Indian” policy (e.g., boarding schools, relocation) created historical trauma with impacts that reverberate today, such as the significant health challenges experienced among American Indian/Alaska Native (AI/AN) populations. Our study seeks to better understand the burden of chronic disease, and also resilience, among AI/AN older adults. Methods: Data came from Cycle VII (2018-2020) of the National Resource Center on Native American Aging’s “Identifying Our Needs: A Survey of Elders” survey of AI/AN adults ages 55+ from primarily rural tribal survey sites (N=20,642). Analysis explored self-assessed health status (very good/excellent, good, fair/poor) and looked for significant differences in prevalence of chronic conditions a doctor ever told them they had (e.g., high blood pressure, diabetes, depression, arthritis, asthma). Results: Self-reported health among AI/AN adults age 55+ was: 26% very good/excellent, 39% good, and 35% fair/poor. 87% of respondents had 1+ chronic illness; 37% had 3+. Among those reporting very good/excellent health, 75% had 1+ chronic illness and 19% had 3+. High blood pressure was the most common chronic disease, at 56% (44% for very good/excellent compared to 67% for fair/poor), followed by diabetes, at 36% (24% for very good/excellent compared to 46% for fair/poor). Conclusions: All of the chronic conditions examined showed significantly higher prevalence among AI/AN adults 55+ with fair/poor health. Notably, 1 in 5 respondents with 3 or more chronic conditions indicated very good/excellent health, reinforcing that successful aging can still be experienced by those with chronic health conditions.
Circadian rhythm for female entering old age: exploration on the effect of eating behavior
Authors: Tang Hsiao-Han , Chiu Ching-Ju
Published: December 2021

Unhealthy lifestyle and eating behavior are associated with circadian rhythm disruption which contributes to numerous harmful outcomes. The relationship between circadian rhythm and eating behavior remains unclear. The study aims to investigate different types of eating behavior in middle-aged women and their variation in circadian rhythm. A descriptive, cross-sectional design was used. We recruited a convenience sample of 150 female aged 45 years or over from the community in southern Taiwan. Sociodemographic status, sleep diary and eating behavior were collected by questionnaires; behavioral circadian rhythm were monitored with the wrist-worn application. Four middle-aged participants were interviewed. Preliminary data show three main findings: (1) Sleep efficiency was decrease with age, (2) First meal within 2 hours after waking up was associated with higher amplitude (2.24 vs 1.43 log count), relative amplitude (0.92 vs 0.71), middle to vigorous physical activity time (101.22 vs 58.41 minute), lower lowest active 5 hr midpoint (2.63 vs 4.34 hour) and acrophase (13.67 vs 15.75), (3) Participants with morning chronotype have less sedentary behavior and higher most active 10 hr during wake time. Age and timing of first meal after waking up seem dominating circadian rhythm. Chronotype might be a significant factor for physical activity level. More data is needed to further confirm the association.
Novel Technology Support Program for Older Adult Program With Interprofessional Geriatrics Students
Authors: Olsen Bonnie , Segal-Gidan Freddi , Thayer Erin , Guardia Yeini , Penate M Christina , Kogan Alexis Coulourides
Published: December 2021

During the COVID-19 pandemic, many older adults were not receiving primary care services because they could not negotiate the technology for telehealth visits. Coupled with persisting pandemic physical distancing, increased social isolation in older adults was- and continues to be a significant problem. To combat these issues, we aimed to 1) prepare older adults for longitudinal isolation by encouraging social connectedness, and 2) enable older adults to safely access remote primary care services during the pandemic. We paired older adults from 9 housing sites in Los Angeles, CA with health professions graduate students from 9 programs at USC (N = 88 dyads) and provided iPhones to participants without a smartphone. Students educated and supported older adults about the use of technology to access primary care services and to socially connect with family/friends. When requested, 3 additional students provided enhanced 1:1 technology support. Among the 45 participating older adults who received iPhones (51.1%), 22 requests were made for enhanced technology assistance during the 6-month program. Most requests related to initial setup/navigation of iPhone (81.8%) or video calls (27.3%), where others requested help with Wi-Fi (13.6%), composing emails (4.5%), and adding language/translation features (4.5%). Nineteen (83%) technology support requests were successfully resolved; the remaining were unresolved due to loss to follow-up. Our findings demonstrate that older adults can successfully cross the digital divide when technology support is provided. Additionally, pairing older adults with health professions students is an effective strategy to enable access to remote primary care and social connectedness.
Pilot study of a new telehealth program for depressed older adults: The Positive Experience Project (P.E.P.)
Authors: Gallagher-Thompson Dolores , Morioka-Douglas Nancy , Fogg B J , Le Keck Mei-
Published: December 2021

Social isolation, logistical challenges, and limited access to mental health providers who accept Medicare contribute to older adults having a higher risk for untreated depression. Primary care providers (PCPs) are strained due to time demands and lack of training in behavioral activation and similar therapies. This study was designed to reduce depression in older adult primary care patients without burdening their PCPs. We evaluated whether outpatients age 65+ with mild to moderate self-reported depressive symptoms (measured by PHQ-8) benefited from a brief evidence-informed program, the Positive Experience Project(PEP). This is derived from the tenets and practices of both behavioral activation and the “tiny habits” program. The former emphasizes the value of increasing engagement in everyday positive activities to lift mood; the latter provides a method to enhance success by encouraging patients to link these activities with existing habitual behaviors, and to celebrate completion. A script was written for each of four 30-minute sessions conducted in small groups using a telehealth platform. An analysis of patients of the first author yielded 50 eligible patients. 8 were invited to participate and 7 did. The group’s mean PHQ-8 score pre-intervention was 10.1; post-intervention (4 weeks later), the average was 6.1 (P=.039). The use of “scripts” that guide the PCP through the visit enhances adoption. And PCPs can bill for these 30-minute sessions, making it feasible to help patients receive treatment for their depression. These promising results are currently being replicated by additional PCPs and their data will be included in the poster presentation.
The 4Ms of Age-Friendly Care: Successful Infusion into Electronic Medical Records Leads to Improved Care
Authors: Tobey Leah , McAtee Robin
Published: December 2021

Electronic Medical Records (EMR) and Health Information Technology (HIT) have changed the daily operations of the healthcare industry. For primary care systems/clinics, it has meant the purchase and tailoring of systems to fit specific needs of users and patients. As one of the HRSA funded Geriatric Workforce Enhancement recipients, the AR Geriatric Education Collaborative (AGEC) worked with a rural federally qualified healthcare clinic system for over a year to help them become IHI certified in Age-Friendly Care and the EMR has been a critical link. The system was crucial in identifying compliancy to the clinical Merit-based Incentive Payment System (MIPS) measures which helped identify the areas where most improvement was needed. Included in the process was a new geriatric screening tab in the EMR system. This tab contains 8 screenings including: depression, anxiety, alcohol use, prescription opioid use and recreational drug use, mentation, medication and mobility. This is in addition to asking “what matters” so that all four of the 4M’s age friendly framework components were included. Clinicians are successfully using the systems and improvements in outcomes are beginning to be noted. The outcome MIPS measures are obtained quarterly from an EMR report and data is shared with the staff and new quality improvement projects are developed using PDSA (plan, do, study, act) cycles based on the outcomes of the data. Next steps with the EMR will be the development of flags that will notify the clinicians when a screening is needed.
Decoupling of Global Brain Activity and Cerebrospinal Fluid Flow Is Linked to Alzheimer's Pathology
Authors: Han Feng , Chen Jing , Belkin-Rosen Aaron , Gu Yameng , Luo Liying , Buxton Orfeu , Liu Xiao
Published: December 2021

Alzheimer’s disease (AD) is the most common cause of dementia in the old adult population. AD pathogenesis has been linked to the aggregation of toxic proteins, e.g., amyloid-β and tau. The glymphatic system may play an important role in clearing out these proteins via cerebrospinal fluid (CSF) flows through perivascular and interstitial spaces. Recent studies have suggested low-frequency (<0.1 Hz), sleep-dependent global blood-oxygenation-dependent-level (gBOLD; global resting-state functional MRI signal) during resting state is coupled with CSF movements, suggesting their potential link to glymphatic function. Here, we directly investigated whether the coupling between the gBOLD and CSF signals is related to AD-related pathology. By analyzing neuroimaging, neurobiological, and neuropsychological data from 118 human subjects (58-90 years of age; AD, early-stage AD, and control subjects included) collected in the Alzheimer's Disease Neuroimaging Initiative project, we found a strong coupling between the gBOLD and CSF signals. More importantly, the strength of this gBOLD-CSF coupling was significantly correlated with cortical amyloid-β level (p = 0.019), cognitive decline in the subsequent two years (p = 0.013), disease severity (p = 0.035), and several AD-related risk factors, including aging (p = 0.011), and gender (p = 0.026). These findings provide initial evidence for the critical role of resting-state low-frequency (<0.1 Hz) neural/physiological dynamics in AD pathology. They also suggest that the gBOLD-CSF coupling may serve as a non-invasive imaging marker for gauging the glymphatic function.
Significant Associations of the Interplay Between Stress Related Genes With Alzheimer’s Disease
Authors: Yashin Anatoliy , Wu Deqing , Arbeev Konstantin , Bagley Olivia , Akushevich Igor , Duan Matt , Yashkin Arseniy , Ukraintseva Svetlana
Published: December 2021

The lack of efficient medication against Alzheimer’s disease (AD) is the most important problem for this health disorder today. One possible reason for this -- the implementing medical interventions “too late in the disease stage” – has been recently addressed in the initiative that defined the preclinical AD stage by measuring changes in preclinical AD biomarkers. According to this definition, beta amyloid (Aβ) is one of the key preclinical AD biomarkers. Experimental studies showed that Aβ results from proteolytic cleavage of APP by β- and γ-secretases. Production of β-secretase involves BACE1 gene, activated by cellular stress response. This suggest that AD might be initiated by cellular stressors and that multifactorial regulation of AD is likely to be driven by genes involved in cellular stress response. In this paper we investigate whether interplay between SNPs from the EIF2AK4 gene involved in sensing cellular stress signals and the APP gene dealing with Aβ production may be associated with AD in human data. For this, we evaluated association of the interactions of the pairs of SNPs from these genes with AD in the analysis of HRS data. We found that interactions between several SNPs have statistically significant associations with AD. The results of this analysis confirm that the interplay between gene served as a sensor of cellular stress and gene involved in production of preclinical AD biomarker in response to stress may influence human AD. This analysis illustrates an important step towards translation of the results of experimental AD studies to human applications.