bluuebunny/crossref_metadata_2025 huggingface dataset:
CASE STUDY EXEMPLAR OF DETECTING SEVERE DIASTOLIC DYSFUNCTION USING BALLISTOCARDIOGRAM
Authors: Despins Laurel A , Guidoboni Giovanna , Skubic Marjorie , Sala Lorenzo , Enayati Moein , Keller James , Popescu Mihail
Published: November 2019

The specific aim of this case study was to describe how monitoring ballistocardiogram (BCG) waveforms can detect early heart failure (HF) changes. HF significantly impairs quality of life and is the principal cause for hospital readmissions in older adults. HF prevalence in American adults aged 65 years and older is expected to increase over 70% by 2030. Detecting worsening HF is challenging. Invasive arterial waveforms display blood pressure changes with each heartbeat; BCG waveforms display repetitive body motions resulting from ejection of blood into the great vessels. BCG waveforms change as cardiac function changes. Currently, BCG signals can be captured non-invasively using sensors placed under a bed mattress and provide heart and respiratory rates. We have developed a new way to analyze the BCG waveform using an innovative closed-loop physiological model of the cardiovascular system. The subject, a 94-year old female with hypertension, presented to her physician with symptoms associated with a new diagnosis of acute mixed congestive HF. Mean heart and respiratory rate trends obtained from her bed sensor in the prior two months did not indicate HF. We simulated cardiac cycles using normal cardiac function data, mildly impaired diastolic function data, and the subject’s echocardiography data. The results demonstrated BCG waveform changes that correlated with decreasing cardiac output related to worsening diastolic function. New methods for clinically interpreting BCG waveforms present a significant opportunity for improving early HF detection and improving outcomes. Working on a clinical problem from an engineering perspective merges two disciplines, creating a new methodology.
AN ASSESSMENT OF GERIATRIC TTRAINING AND SUPPORT NEEDS FOR CAREGIVERS AND HEALTH CARE PROFESSIONALS IN RURAL TEXAS
Authors: Luk-Jones Susanna , Severance Jennifer J , Green Doni , Smith Donald , Jose Roslin
Published: November 2019

Of the 254 counties in Texas, 69% are rural, and three out of every four counties are designated as whole or partial Primary Care Health Professional Shortage Areas. Rural counties in Texas have a higher proportion of older adults compared to metropolitan counties, and rural older adults with Alzheimer’s Disease and their caregivers face unique challenges of limited access to healthcare and lower earnings, resulting in more health-related problems. As part of a HRSA Geriatrics Workforce Enhancement Program, an academic medical center, two Area Agencies on Aging in North Texas, and an Alzheimer’s Association Chapter partnered to expand access to evidence-based programs into surrounding rural counties for older adults and caregivers of persons with Alzheimer’s Disease. An interdisciplinary workgroup developed focus group questionnaires for older adults, caregivers, and health care providers in rural areas to identify perceived needs, barriers to accessing services, and strategic partnerships. The North Central Texas Council of Governments conducted 11 focus groups in late 2018 and early 2019. Of these, seven consisted of family members caring for persons with memory loss. Four consisted of professionals who treat persons with memory loss. Transcription and thematic analysis identified key themes of training needs (both providers’ and laypersons’), resource needs, providers’ best practices, barriers to quality care, and other support needs. Practice implications of the findings include cross-sector partners and integrating telehealth platforms for program delivery. Collaboration between academic and community partners can expand access to evidence-based programs for rural and other underserved communities and address areas of need.
GERIATRIC WORKFORCE ENHANCEMENT PROGRAM: EDUCATIONAL OUTCOMES OF DEMENTIA CAREGIVER CONFERENCES IN RURAL UTAH
Authors: Dassel Kara B , Rupper Rand , Supiano Katherine , Andersen Troy , Butler Jorie , Telonidis Jacqueline , Edelman Linda S
Published: November 2019

The University of Utah was awarded federal funds to establish a Geriatrics Workforce Enhancement Program (GWEP) focused on integrating geriatric training into 20 long-term care centers across the state of Utah. One specific objective of the GWEP was to: Provide community-based dementia education to 500 community participants from four geographically diverse urban and rural locations. In year four of the project, an interdisciplinary academic and community-based team planned and implemented dementia caregiver conferences in two rural areas in Utah that included American Indian (AI) tribal communities. Educational topics included an overview of dementia, engaging in goals of care discussions, managing caregiver stress, and finding local resources. Demographic surveys and pre-post modified 15-item version of the Alzheimer’s Disease Knowledge Scale (ADKS; Carpenter et al., 2009) were administered. A total of 148 participants attended the conferences. Participants were primarily female (76.6%), white (84.2%), and self-identified as family/informal caregivers (35.0%). Of the participants, 17.8% self-identified as AI. Overall, there were no significant differences on the pre- and post ADKS scores (mean scores of 12.45 and 12.5 out of 15 possible points, respectively). However, AI ADKS mean scores were lower (10.2 and 10.5, respectively; range 9-13) than white participants (12.7 for both, respectively; range 12-13) reflecting a greater need for ADRD education in AI tribal communities. The conferences were well-received with 82.5% of attendees said that the conference met their educational needs and 83.9% reported that the information would improve the type of care they provide to someone with dementia.
ELECTRONIC MEDICAL RECORD ALGORITHM TO IDENTIFY UNDIAGNOSED (PRE)DIABETES: A CASE STUDY FROM HAWAIʻI
Authors: Stupplebeen David , Sentell Tetine L , Ching Lance , Nett Blythe , Taylor Hermina , Lemmen Tiffany , Pirkle Catherine M
Published: November 2019

An estimated one-quarter of United States’ older adults (≥65 years) have diabetes (DM) while half have prediabetes (PreDM). Timely diagnosis can prevent disease progression, but significant proportions of PreDM/DM are undiagnosed. Among Hawai‘i adults, one-third of diabetes and two-thirds of prediabetes cases are undiagnosed; rates for older adults are unknown. Algorithms integrated into Electronic Medical Records (EMR) may improve care by identifying probable undiagnosed cases in patient panels using clinical/laboratory measures. We assessed one algorithm developed by the Hawai‘i Department of Health that identified individuals overdue for screening or with Pre/DM using the records of 20,362 adult patients (51.33% were >65) from a major state health system. 6,371 (31.3%) patients were excluded from analysis; they had no HbA1c screening in the past year or were overdue for screening (70%) based on standard guidelines. Of the remaining 13,991 patients, 7317 were older adults; 6130 (84%) had a PreDM (50.6%) or DM (33.2%) HbA1c value; the rest were controlled or false-positive. Of those older adults with probable PreDM/DM, 38.6% were undiagnosed. Adults >65 were significantly more likely to be flagged with undiagnosed PreDM compared to their younger counterparts (58 versus 54%, p<.001). Notably, 61% of older men flagged with PreDM were undiagnosed. Of the 5,737 patients identified with DM, 22% of those 65 were undiagnosed. Given the recognized high burden of diabetes among older adults, results indicate substantial missed opportunities for the prevention and early treatment of this condition as identified by an EMR algorithm.
THE INFLUENCE OF HUMOR AND SPIRITUALITY ON THE RESILIENCY OF COMMUNITY-DWELLING OLDER ADULTS
Authors: Kenaley Bonnie L , Gellis Zvi D , Kim Eun hae , Mclive-Reed Kimberly
Published: November 2019

Older adults are confronted with many distinct challenges, which require the use of various coping mechanisms to maintain psychological balance, including humor and spirituality (Bonanno et al., 2012; Koenig, 2012). This study examined the influence of humor and spirituality on resiliency of 156 (age 60 years and older) community-dwelling members of an Osher Lifelong Learning Institute located in the western region of the United States who completed a pen and paper and electronic newsletter surveys. The majority of the sample used humor to cheer themselves when feeling depressed, were amused by the absurdities of life, used humor to feel better and to cope with problems, and believed their humorous outlook prevented them from being upset or depressed. Almost three-quarters of the sample looked to a spiritual force for strength, support, and guidance, 58% worked together with a spiritual force and less than 39% thought about how their lives were part of a larger spiritual force. In the final hierarchical regression model (F (5, 143, = 8.895, p .000), only spirituality (beta = -.238, p < .001) and humor (beta = .444, p < .000) were statistically significant; whereas age, gender and living with another were not statistically significant. The findings suggests that humor along with spirituality are two internal resources that promote resiliency in older adults. Humor infused in informal interactions and planned activities as well as spiritual support may contribute to the promotion and enhancement of resiliency in community-dwelling older adults.
FILIAL PIETY AND RELATIONSHIP QUALITY AMONG OLDEST-OLD PARENTS AND OLDER-ADULT CHILDREN IN KOREA: A DYADIC APPROACH
Authors: Lee Kyuho , Min Joohong , Han Gyounghae
Published: November 2019

Objectives: Research has consistently reported the importance of adult children’s filial piety in maintaining relationship quality with their older-adult parents, especially in Asian countries due in large part to the influence of Confucianism. However, less attention has been paid to its effects in their later relationship—oldest-old parents and older-adult children, and very few studies employed a dyadic approach. Methods: In the current study, we examined the effects of actor- and partner effects of the attitudes toward filial piety on intergenerational relationship quality. Data from 105 dyads of very old parents, 81 to 97 years old (M = 87.9, SD = 2.8) and their older-adult children, 65 to 72 years old (M = 65.9, SD = 1.2) were utilized for the analyses. Results: Results showed that children’s attitudes toward filial piety were positively related to the relationship quality reported by both old children (i.e., actor-effects, β = .64, p < .001) and oldest-old parents (i.e., partner-effects, β = .63, p = .001). The effect of actor’s and partner’s attitudes toward filial piety on relationship quality was not significant. Discussion: Findings suggest that children’s attitudes toward filial piety, as compared to parents, may play a more important role in the quality of relationships between oldest-old parents and their older-adult children in South Korea.
THE APOE-ε4 ALLELE AND AGE SYNERGISTICALLY DRIVE DISEASE PROGRESSION IN ALZHEIMER’S DISEASE
Authors: Kleineidam Luca , Zammit Andrea R , DeVito Alyssa , Lipton Richard B , Peters Oliver , Ramirez Alfredo , Wagner Michael , Terrera Graciela Muniz
Published: November 2019

The Apolipoprotein E (APOE)-ε4 allele is the strongest genetic risk factor for Alzheimer’s disease (AD) and other neurodegenerative dementias. Cross-sectional case-control studies suggest that the effect of APOE-ε4 decreases in old age. However, since APOE- ε4 is associated with mortality, these studies might be prone to bias due to selective survival. Therefore, we used multi-state-modeling in longitudinal cohort studies to examine the effect of APOE-ε4 on the transition through cognitive states (i.e. cognitively normal, mild cognitive impairment (MCI) and dementia) while taking death as a competing risk into account. Results from the German AgeCoDe study (n=3000, aged 75-101 years) showed that APOE-ε4 increases the risk for cognitive deterioration in all disease stages. Contrary to results from cross-sectional studies, the effect of APOE-ε4 on the transition from MCI to dementia increased with increasing age (HR=1.044, 95%-CI=1.001-1090). The direction of this effect was confirmed in a smaller sample from the Einstein Aging Study (n=744, HR=1.032, 95%-CI=0.949-1.122). To examine the pathophysiological basis of these results, generalized additive models were used to study AD biomarkers in the liquor of 1045 patients with MCI or AD-dementia. Here, increased amyloid (Abeta1-42) pathology was associated with increased tau pathology (pTau181), consistent with the amyloid-cascade-hypothesis. Interestingly, higher age and presence of the APOE-ε4 synergistically lowered the amount of amyloid required to exacerbate tau pathology (interaction p=0.012). Taken together, our results suggest that the effect of APOE-ε4 on disease progression increases with advancing age. An altered neuroinflammatory response to neurodegeneration should be further explored as potential underlying mechanism.
SMOKING BEHAVIOUR: PATTERNS AND COSTS OF HEALTH SERVICE USAGE USING HAGIS AND LINKED ADMINISTRATIVE HEALTH DATA
Authors: Douglas Elaine , Bell David
Published: November 2019

The associations between smoking and health are well documented. Using the Healthy Ageing In Scotland (HAGIS) survey linked to the administrative Scottish National Health Service (NHS) records this study analyses health service resource usage by older people according to self-reported smoking status. Individual level smoking status (current, ex-smoker, or never smoked), socio-demographic characteristics (age, gender, level of deprivation) and subjective health are sourced from people aged 50+ across Scotland using HAGIS. These responses are then linked to NHS Scottish Morbidity Records to analyse variation in health service usage as measured by the total number of days spent in hospital (daycases and inpatient stays), number of stays, and mean length of stay. Costs are then assigned by medical speciality. We use a two-part model to analyse the i) the probability of having been hospitalised at all, and ii) the quantum of resource usage and its associated cost for those who have been in hospital. Our study provides a conceptual and empirical framework for the associative relationship between smoking status and actual (rather than self-reported) health service usage and expenditure. This study demonstrates the insights to be gained from the linkage of individual survey responses to administrative health service data on resource usage and costs, and discusses the implications for health policy.
FINDING THE ELDERS WHO STAYED- CONDUCTING OUTREACH IN THE AFTERMATH OF HURRICANE MICHAEL
Authors: Tice Jessica L , Bond Megan
Published: November 2019

The Florida Department of Elder Affairs (DOEA) provides programs and services for over 65,300 older people and adults with disabilities. These individuals are uniquely vulnerable and may be displaced, and/or disoriented during natural disasters. DOEA clients are dependent upon community-based services to provide supervision or assistance to perform basic self-care, which often makes sheltering in place alone a danger to their health and well-being. During Hurricane Michael (2018) many older adults who previously were independent sought help for many issues including property damage, utility interruption, food and medicine scarcity, and physical or mental health problems associated with the storm and its aftermath. In normal conditions, DOEA identifies older populations via Census tracts and then conducts outreach events to inform the public how to access social services. However, after the widespread displacement post-storm, traditional outreach approaches were insufficient. A method was needed to remove areas that were rendered uninhabitable and find who remained in place. DOEA identified viable neighborhoods by overlaying property damage locations on base layers of Census tracts with concentrations of older adults and polling places with high percentage of age 60+ voter participation in the subsequent November election. Then in partnership with Feeding Florida, we provided information and registration assistance via local food distribution sites in those areas. This methodology of overlaying Division of Emergency Management property damage records and voter participation records against publicly available Census tract files is a strategy that could be replicated by other disaster and flood-prone communities or organizations that have similar needs.
THE INFLUENCE OF CUSTODIAL STATUS ON MARITAL AFFECTUAL SOLIDARITY AND MENTAL HEALTH AMONG GRANDPARENTS.
Authors: Kim Eunbea , Nadorff Danielle K , Scott Rachel , McKay Ian T
Published: November 2019

Increased life expectancy and the diversity of family structure have resulted in a substantial rise in the number of families with grandparents as the main caregivers (e.g. custodial grandparents). The structures of these families affect the well-being of all family members. After middle age, psychological well-being is associated with marital relationship quality, and raising one’s grandchildren is a known source of strain to relationships. The current study examined adults aged 40 and older (M age = 57.6 yr, 53% female) using a nationwide sample from MIDUS to assess the extent to which custodial grandparenting status influences marital affectual solidarity, depressive symptoms, life satisfaction, and perceived stress. Measures included the Center for Epidemiological Studies Depression Index, Spousal Affectual Solidarity, Satisfaction with Life Scale, and Perceived Stress Scale. Marital affectual solidarity was significantly related to custodial status and psychological well-being, and there were significant differences in marital relationship quality and psychological well-being between custodial grandparents and non-custodial grandparents. However, custodial status failed to moderate the relation between marital affectual solidarity and mental health. Although other factors surrounding custodial grandparents likely affect their marital relationship and mental health, these results suggest that grandparents raising grandchildren are under particular strain in their marriages and are in need of targeted interventions to ameliorate stress and depressive symptoms. These findings will inform the need for more research and supportive educational programs on family relationships and the psychological health of custodial grandparents.
MEN WITH PARKINSON'S MAY HAVE GREATER DISEASE BURDEN IN ASPECTS OF COGNITIVE AND PSYCHOSOCIAL FUNCTION THAN WOMEN
Authors: Hackney Madeleine E , Singh Eeshani , Leeth Ella , Bay Allison , Ni Liang
Published: November 2019

Early in PD, women may experience a more benign disease course than man. Limited research has examined differences between men and women with moderate, treated PD with a mean duration >5 y. Retrospective analyses were performed on data collected from studies, conducted 2011–2019, that assessed motor, cognitive and psychosocial function in 199 people with PD (women=72). We compared performance using univariate analyses, adjusting for age, housing type and education. Men and women patients were not different in PD stage (Stage Mdn= 2, IQR=.5), age (mean±SD; 69.1± 8.9 y), education (16.4 ± 2.3 y), number of medications (5.9±4.1), comorbidities (3.4±1.8), physical function, nor time with PD (6.6±4.6 y). Women were more likely to live in assisted living or senior residences (p=.005). Men gave more correct answers in subtraction, (8.8 ± 4.0 vs. 6.4±3.7; p<.001) but sexes did not differ in percent correct. On the MDS-UPDRS, Men exhibited more burden in subjectively rated non-motor (13.4 ± 7.6 vs. 10.7±7.3; p=.013), and motor experiences of daily living (16.9±8.9 vs. 10.6±7.1; p<.001) and motor symptoms (34.1 ± 12.1 vs. 31.8±12.2; p=.014). Men performed worse at inhibition (6.4±4.6 vs. 7.8 ± 5.0; p=.014) but made fewer errors on inhibition/switching (7.0±3.9 vs.7.8±4.4; p=.05). Men had higher depression scores: 12.5±8.9 vs. 9.4±7.8; p=.016. No differences in performance on spatial cognition were noted. Men with moderate PD were more depressed, had worse motor and cognitive function, non-motor and motor experiences of daily living and motor symptoms than women. Sex-tailored therapies may reduce differences in performance between sexes.
ENGAGING AFRICAN AMERICAN FAMILIES IN END OF LIFE DISCUSSIONS: CHALLENGES AND FACILITATORS
Authors: Cacchione Pamela Z , Gill Le'Roi L , Sefcik Justine
Published: November 2019

Our previous study, African American Preferences Around End of Life, identified that AA Elders wanted to talk to their family about their preferences, but their family tended to avoid discussing end of life topics. We found that African American families often have a difficult time broaching the subject of end of life for a variety of emotional, cultural and religious reasons. Therefore, the purpose of this qualitative descriptive study was: To better understand the challenges and facilitators that influenced end of life conversations within the African American family. Methods: In this qualitative descriptive study, we interviewed 15 AA family caregivers of older adults. Participants were family members of older adults enrolled in an urban Program of All-inclusive Care for the Elderly. Individual interviews lasted on average 50 minutes. Data analysis was completed using conventional content analysis. Results: The majority of participants were between 55 - 65 years of age and adult children of the AA older adult. Two themes emerged for challenges: I’m not comfortable and We just don’t talk about it. For facilitators again, two themes emerged: Another person took the initiative (e.g. health care provider led the conversation) and participants’ previous experience with death led them to initiate EOL conversations. In addition, three participants reported that after participating in the interview they planned to talk to their loved one to find out their end of life preferences. The results of this study provide insight into how health care providers can facilitate these important end of life preferences conversations.
PROBLEMS AND PROSPECTS OF TECHNOLOGICAL AND BIOPHYSIOLOGICAL STUDIES OF TECHNOSTRESS IN MID-LIFE ADULTS
Authors: Mack Elizabeth , Cotten Shelia , Chang Chu-Hsiang , Bauschpies Wenda
Published: November 2019

Long-term exposure to stress places people at risk for chronic diseases including but not limited to obesity, Type-2 diabetes, and heart disease. Various aspects of technology use are associated with stress. Known as technostress, this unique stress is characterized by individuals’ inability to cope with demands generated by computer-related technologies. To date, studies on technostress have focused on young adults and older adults, with an emphasis on self-reported indicators of both technology use and stress. This study differs from prior work in two ways. One, it examines technology use and stress in mid-life adults (50-64), an understudied population in research on technostress. This segment of the population is important because their technostress may negatively affect their successful transition into older adulthood. Second, we use three types of data to elucidate the linkages between technology use and stress: (1) self-reported survey measures of technology use and stress; (2) objective measures of technology use from tracking applications, and (3) biophysiological measures of stress. The study focuses on smartphone use, which was the most commonly used technology by mid-life adults on both weekdays and weekends based on our initial results (N=40). The goal of this pilot study is to highlight the problems and prospects of conducting technostress research through the utilization of multiple data collection modes: self-report, tracking applications (apps), and biophysical indicators.
DEMENTIA WITHOUT BORDERS: BUILDING COMMUNITY CONNECTIONS TO REDUCE STIGMA AND FOSTER INCLUSION
Authors: Phinney Alison , Becker Marigrace , Burnside Lee , Puurveen Gloria
Published: November 2019

BACKGROUND: The concept of social citizenship is gaining traction in the field of dementia studies, but as a practical tool to guide development of supports and services, it remains poorly understood. A one year project to promote collaboration between University of Washington in Seattle and University of British Columbia in Vancouver addressed this very question. Activities were undertaken so these communities could know each other better, with researchers, service providers and people with dementia connecting to share knowledge and expertise. PURPOSE: The project culminated with a public festival to put into practice and share some of what was learned over the year. METHODS: People with dementia and care partners helped plan “Dementia Without Borders”, held at an international park straddling the border between Seattle and Vancouver. 150 people came from the US and Canada, including many people with dementia, family members and friends. The day began with a community walk and gift exchange, followed by a meal and creative activities including poetry readings, music, an art exhibit, and quilt making. RESULTS: Evaluation was overwhelmingly positive with people expressing a sense of hope and belonging. For some, it was their first time to speak openly about having dementia, and meeting others in this space was a joy-filled experience. CONCLUSIONS: This project has leveraged the symbolic power of an international border to raise awareness of the importance of social connection for people with dementia. We further explore how the notion of “dementia without borders” extends theoretical and practical understanding of social citizenship.
EFFECTS OF RESISTANCE EXERCISE TRAINING ON ENDOTHELIAL FUNCTION AND MUSCLE PERFUSION IN OLDER ADULTS WITH DIABETES
Authors: Randolph Amanda , Moro Tatiana , Odejimi Adetutu , Rasmussen Blake , Volpi Elena
Published: November 2019

BACKGROUND: Sarcopenia contributes to frailty, disability, and dependence in older adults, and is accelerated by Type 2 Diabetes Mellitus (T2DM). In addition to its direct role in increasing muscle mass, progressive resistance exercise training (PRET) may also reduce sarcopenia by improving endothelial function and muscle perfusion. METHODS: Fifteen older adults with uncomplicated and well-controlled T2DM participated in a PRET program 3 times weekly for 3 months. Prior to and immediately following the intervention, flow-mediated dilation testing was performed to assess large vessel endothelial function via ultrasound and muscle perfusion via near-infrared spectroscopy (NIRS). RESULTS: Preliminary ultrasound data from 9 subjects show a significant increase (5.21% to 8.73%, p=0.0448) in percent flow mediated dilation (%FMD), suggesting a modest improvement in endothelial function after 3 months’ PRET. Preliminary NIRS data from 7 subjects showed no significant changes in oxygen saturation or reperfusion rates as a result of the intervention. CONCLUSION: Our preliminary data indicate that, in older adults with T2DM, 3 months’ PRET is associated with modestly improved endothelial function in large vessels (as demonstrated by a significant increase in %FMD), but does not appear to be associated with improvements in muscle perfusion
EMERGING ADULT CAREGIVERS: PERCEPTIONS OF OLDER ADULT CARE RECIPIENTS, QUALITY OF CONTACT, AND AGEISM
Authors: Canell Anastasia E , Caskie Grace
Published: November 2019

Approximately 12-18% of family caregivers to older adults in the U.S. are 18-25 years old (i.e., emerging adulthood), yet minimal research has focused on this subgroup of caregivers (Levine, 2005; Smyth, Blaxland, & Cass, 2011). Individuals’ perceptions of an older adult’s social role relate to their attitudes toward older adults as a group (Hummert, 1999; Kite & Wagner, 2002). However, whether perceptions that emerging adult caregivers hold of older adults are specific to the social role of “care-recipient” has not been studied. A sample of 210 informal caregivers (ages 18-25) were surveyed to collect qualitative responses regarding perceptions of an older adult care-recipient (age 65+) and to assess quality of contact with the care-recipient and ageist attitudes. Participants were asked to provide five adjectives describing their older adult care-recipient. Approximately 43% provided a set of adjectives in which 80%-100% were coded as positive adjectives (e.g., “active”, “wise”); similarly, half of the sample’s adjective sets contained 0%-25% negative adjectives (e.g., “helpless”, “obnoxious”). The quality of contact with the care-recipient was significantly correlated (p<.001) with the percentage of positive (r=.47) and negative (r=-.49) adjectives. Scores on the Fraboni Scale of Ageism were also significantly correlated (p<.01) with the percentage of positive (r=-.19) and negative (r=.20) adjectives. Overall, these emerging adult caregivers had generally positive perceptions of their older adult care-recipients, and these perceptions reflected the positive quality of contact with the care-recipient. Less ageist attitudes’ relationship with more positive and less negative perceptions may have implications for experiences within a caregiving dyad.
AMINO ACIDS PREDICT COGNITION BEYOND CLINICAL METABOLIC MARKERS: A MACHINE LEARNING APPROACH
Authors: Alwerdt Jessie , Tian Yuan , Patterson Andrew D , Sliwinski Martin
Published: November 2019

Prior work has suggested that metabolic disorders increase the risk for cognitive decline. Further, studies have identified amino acids (AAs) as potential biomarkers for dementia and diabetes. This study examines AAs and metabolic clinical markers (MCM) as predictors of cognition (Processing Speed (SOP), Working Memory (WM), Fluid (Gf) and Crystallized Intelligence (Gc)). The sample included 241 middle-aged adults from Bronx, NY. Predictors included age, gender, education, ethnicity, smoking, having diabetes, glucose, insulin, triglycerides, diastolic, and systolic blood pressure (BP), and cholesterol. AAs and associated derivatives were obtained from serum using NMR-based metabolomics. Analyses were conducted for each cognitive domain using repeated cross-validation random forests and lasso regressions. Overall, all models had acceptable cross-validation mean squared error except for WM. Several MCMs were specific to each cognitive domain, such as lower triglycerides and glucose associated with better SOP and higher systolic BP associated with better Gc while none were identified for Gf. The Gf model had the least number of AAs with lower serine associated with better FI. Two AAs, higher histidine and alanine, were associated with better SOP. Further, higher alanine, valine, isoleucine, serine, methionine, betaine, and moderate tyrosine were associated with better Gc. These results indicate that AAs were specific to each cognitive domain and ranked similar or higher in importance as several MCMs These results suggest that further investigation of AAs alongside associated MCMs is needed to assess the metabolic contribution to cognitive performance. Such research will help identify specific metabolic targets relating to cognition.
PERSISTENCE OF ACCELERATED VASCULAR AGING FOLLOWING THERAPY IN OLDER CANCER SURVIVORS
Authors: Carlson Barbara W , Craft Melissa , Funk-Lawler Rachel , Keepper Karla , Razaq Wajeeha , Csiszar Anna
Published: November 2019

Chemotherapy destroys cells indiscriminantly and releases proinflammatory factors into the bloodstream that can adhere to endothelial cells (ECs); resulting in phenotypical changes consistent with “accelerated vascular aging”. This pilot study examined associations between markers of EC integrity, vascular aging, and cognition in 15 female breast cancer survivors 12–18 months after chemotherapy (median age: 57 years) and 2 non-cancer controls (58/59 years). EC integrity was evaluated using frequency-dependent electrical impedance (Z4000Hz) and levels of apoptosis (caspase-3/7), inflammation (NFkB activation), and oxidative stress (NRF2 activation) in cultured human endothelial cells (EC) exposed to the subject’s serum. Vascular aging was characterized by low serum insulin growth factor ([IGF1a] <85mg/dL) and laterality in cerebral oxygenation (Lat-FLOX), an in-vivo marker of altered cerebral blood flow (near-infrared spectroscopy). Z4000Hz were higher in cells treated with serum from survivors (520-1100 ohms) than controls (400-450 ohms). Higher Z4000Hz was associated with higher amounts of EC oxidative stress (rNRF2= -.55), inflammation (rNFkB= .43), apoptosis (rcapsase=.76), and Lat-FLOX (r=.39). Higher Z4000Hz (r= -.48) and Lat-FLOX (r= -.66) were associated with lower cognitive function, as measured by the Montreal Cognitive Assessment (MOCA). At lower Z4000Hz, combined Lat-FLOX and low IGF1a characterized persons with cognitive impairment (MOCA < 26). These findings suggest that proinflammatory factors related to cancer and/or its treatment persist for months following active treatment. Cognitive symptoms occur when EC damage results in alterations in cerebral blood flow. With depletion of growth factors, like IGF-1, these symptoms may occur at lower levels of EC damage.
RELATION BETWEEN ERECTILE DYSFUNCTION AND AMNESTIC MILD COGNITIVE IMPAIRMENT ACROSS TWO TIME POINTS
Authors: Vandiver Richard , Lyons Michael J , Cuthbert Kristy
Published: November 2019

Previous research by the Vietnam Era Twin Study of Aging (VETSA) demonstrated an association between erectile dysfunction (ED) and cognitive functioning. That finding supports a hypothesis that cardiovascular dysfunction may underlie both ED and problems in cognitive functioning. The purpose of the current research was to extend these findings by investigating a putative association between ED and amnestic and non-amnestic mild cognitive impairment (MCI). MCI is of particular interest because of its relationship with Alzheimer’s disease and other dementing illnesses. VETSA is a longitudinal study of twins who served in the US military during the Vietnam conflict (N= 960) consisting of data collected at age 20 (enlistment), age 55 (VETSA 1), and 61 (VETSA 2). The results of the current analyses show that ED is related to both amnestic MCI (p=.032) and non-amnestic MCI (p=.009) at VETSA 1. At VETSA 2, however, the relationship between ED and non-amnestic MCI was no longer significant (p=.751) while the relationship between ED and amnestic MCI was stronger (p=.001). These results are consistent with ED and MCI sharing, to some extent, a common etiology. Vascular dysfunction, which is associated with both ED and MCI, is a plausible mechanism responsible for the observed relationship. These results also highlight the potential role that may be played by ED as an early indicator of cognitive impairment and, perhaps, pre-symptomatic AD.
THE RELATIONSHIP BETWEEN COGNITION, FUNCTIONAL ABILITIES, AND THE LATENT DEMENTIA PHENOTYPE AMONG CENTENARIANS
Authors: Sober Jonathan , Woodard John L , Miller L Stephen , Davey Adam , Martin Peter , Poon Leonard
Published: November 2019

Adequate assessment of cognitive abilities and functional capacity is essential for a diagnosis of dementia. However, cognition is only moderately related to functional status, and this relationship is poorly understood among centenarians, a group of older adults with high risk for dementia. A bifactor structural equation model can be used to delineate the variance attributed to dementia-specific related cognitive changes (i.e., the latent variable delta) and the variance due to general intelligence (i.e., g’). This study aimed to determine the validity of delta as a marker of cognitive decline among centenarians. It was hypothesized that delta was correlated with cognitive status, functional abilities and, dementia severity. Overall, 244 community dwelling centenarians (Mage = 100.58, 84.8% female) were recruited through the Georgia Centenarian Study, a population-based study of octogenarians and centenarians from northern Georgia. Older adults were administered measures of cognition and a self-report measure of functional abilities. Latent variable scores (i.e., g’ and delta) were modeled and correlated with standard global cognitive screening measures (i.e., MMSE) and measures of dementia severity. Results indicate that delta was significantly correlated with functional ability and cognitive abilities. Consistent with our hypotheses, delta was also significantly related to dementia severity. Overall, estimates of the latent dementia phenotype, delta, were significantly related to cognitive and functional abilities among centenarians, providing validation of delta as a useful index of dementia severity.
EXPECTATIONS, ROLES, AND EXPERIENCES OF GRANDPARENT-CAREGIVERS OF CHILDREN WITH RARE DISEASE
Authors: Manalel Jasmine , Hollstein Betina , Koehly Laura M
Published: November 2019

Grandparenting can be a rewarding and health-promoting experience for older adults. However, grandparent-caregivers often experience greater stress and poorer health relative to non-caregiving grandparents. Further, little is known about grandparents caring for a child with a rare, chronic illness. This study aimed to extend knowledge of the expectations, roles, and experiences of grandparents providing care to a child affected with an inherited metabolic condition. The sample included 23 grandparent-mother dyads from the Inherited Diseases, Caregiving, and Social Networks Study. The grandparent sub-sample ranged from 49 to 79 years of age (Mage = 64), the majority were female (83%) and married (74%), and almost half (48%) were retired. Social network assessments were analyzed to determine concordance between mother- and grandparent-reports of grandparents’ role in the child’s caregiving network. Fifteen mother-grandparent dyads (65%) agreed on grandparents’ role in the child’s network, with the majority of those (93%) considering the grandparent to be very close and important (versus less close or excluded from the caregiving network). Grandparents whose self-reports of their role in their child’s caregiving networks were consistent with mother-reports appeared more likely to report that they spend enough time caregiving than those whose reports were inconsistent. Content analysis of grandparents’ interviews provided supporting information about the joys and regrets of their grandparenting experience and perspectives on caregiving expectations. This research leverages multi-informant social network and qualitative data to illuminate grandparents’ role in the caregiving networks of chronically ill children and adaptation to non-normative grandparenting experiences.
SOCIAL ISOLATION, LONELINESS, AND CAREGIVER BURDEN AMONG PAID AND UNPAID CAREGIVERS OF HOMEBOUND OLDER ADULTS
Authors: Sun Amy Y , Finkelstein Emily , Ouchida Karin
Published: November 2019

Caregivers of homebound older adults may have high levels of burden and more vulnerability to social isolation and loneliness, given that their care recipients are more physically frail and isolated. Existing literature has not fully investigated differences between paid and unpaid caregiver burden or their experiences of social isolation. We interviewed paid (n=21) and unpaid family caregivers (n=22) of homebound older adults in a hospital-affiliated geriatric house call program. We used validated survey instruments to measure social isolation, loneliness, and caregiver burden, and semi-structured interviews to solicit qualitative data. In our sample, 42% of caregivers helped with 5+ ADLs and 58% with 5+ iADLs. Using the Caregiver Burden Inventory, burden types between caregivers were compared with chi-squared tests. Compared to paid caregivers, unpaid family caregivers experienced more “developmental” burden such as “missing out on life” (p<0.01). Paid caregivers exhibited more “time” burden, such as “not having a minute’s break from caregiving responsibilities” (p<0.01). 44% of caregivers were considered socially isolated according to the Berkman-Syme Social Index. However, using the UCLA 3-item Loneliness Scale, few caregivers felt lonely (14%). Thematic analysis revealed that family caregivers desired support groups but time pressures limited their participation (23%). Interestingly, smart phones were regularly cited as a tool for alleviating loneliness for paid caregivers when alone on the job (19%), a novel finding. Findings suggest that caregivers of the chronically ill and physically isolated may be at particular risk of social isolation. Network based social support interventions may mitigate some of these vulnerabilities.
FEASIBILITY OF A TABLET DESIGNED FOR OLDER ADULTS TO FACILITATE TELEMEDICINE VISITS
Authors: Perissinotto Carla , Zhang Cai , Oseau Tim , Balik Danielle , Sou Caroline , Burnight Claire , Burnight Kerry
Published: November 2019

Introduction: By incorporating age-friendly technology into the care of older adults with high utilization, providers can address complex care needs more efficiently and urgently. Age-friendly technology has the potential to alleviate loneliness that occur with homebound older adults and affect healthcare outcomes. Specific Aims: 1) To evaluate the feasibility of integrating age-friendly telemedicine in a homebased primary care setting using. 2) To evaluate the effects of engaging older adults with age-friendly technology to address loneliness. Methods: UCSF Geriatric Medicine provided GrandPads to 21 patients ages 60 to 94 over a one year period. All research participants were community residing, predominantly low income, and homebound. There was no charge to the patients for the GrandPad. Providers who used the GrandPad with their patients were queried on their experiences. Patient questionnaires included a telemedicine readiness survey, satisfaction and UCLA 3-item loneliness scale. GrandPad tablets are commercially available and underwent an evaluation with the IT Security Risk Assessments team. Results: 100% of providers who used grandpad felt was easy to use and efficient. 83% felt the platform was easier than other platforms. 83% of patients felt the grandpad helped them connect to their providers and 82.5% felt the grandpad was easy to use and 78% felt more connected as a result of using grandpad. Conclusion: Patients and providers are satisfied with an older adults friendly tablet and it can easily be implemented in health care settings. Grandpads may also help older adults feel more connected.
DEPRESSION AND COGNITIVE DECLINE OF OLDER ADULTS IN THE TRANSITION TO WIDOWHOOD
Authors: Zhao Feng , Martin Peter , Lee Gina
Published: November 2019

This study examined the trajectories of depression and cognitive function in the transition to widowhood and investigated the temporal and causal relationship between these two closely related constructs. Respondents were 1,822 widowed adults aged 51 to 91 from a restructured data set (Wave 3 to Wave 12) of the Health and Retirement Study. The results of cross-lagged panel analysis indicated a bidirectional relationship between depressive symptoms and cognition decline, but the effects of cognitive impairment at earlier time points on later depression were larger than the effects of previous depressive symptoms on later cognition. The latent growth curve analysis showed that the cognitive function declined over time, whereas the initial level of depressive symptoms first increased following widowhood and gradually decreased over time. Significant negative associations were found between the initial levels of depression and cognitive function (p < .001) and between the rates of change of these two variables (p = .025). Older adults tended to have lower initial level of cognitive function and they showed faster cognitive decline over time. Female respondents were more likely to report more depressive symptoms and higher cognitive function. White respondents were more likely to report fewer depressive symptoms and higher levels of cognitive function. Higher levels of education were protective for one’s cognitive function but not for depressive symptoms. The study highlighted the reciprocal relationship between depression and cognitive function following widowhood and pointed out that accelerated cognitive decline may precede elevated levels of depression.
DUAL IMPACTS ON MEANING IN LIFE IN OLDER PERSONS VOLUNTEERING FOR ELDERLY MENTAL HEALTH PROGRAM
Authors: Leung Dara K Y , Sing Joyce , Sze Lesley , Tang Jessica , Lu Shiyu , Liu Tianyin , Wong Gloria H Y , Lum Terry
Published: November 2019

Volunteering provides sense of meaning in life. The impact of volunteering on different dimensions of meaning in life and the mechanisms explaining the effects have been rarely researched. This study examined the effects and the mechanism of a formal volunteering program for mental health in older persons, including training, service provision, and supervision, on two dimensions of meaning in life — presence of meaning and searching for meaning — among senior volunteers. A mixed method study was conducted. 103 volunteers (average age=63.3±6.6) completed assessments at three time points: before and after the training, and one-year after service provision. They self-assessed Meaning in Life Questionnaire (MLQ) and reported time use in different tasks. 26 of them participated in focus groups discussing their experience in the program. Volunteers’ search for meaning differed between time points (F(1.87,173.81)=3.20, p<.01) while presence of meaning persisted. Search for meaning reduced from before the training to after service provision (p<.05) as revealed by post-hoc tests. Proportion of home visit during service provision explained 2.7% of the variance of presence of meaning before and after service provision (R2=0.05, F(6,74)=1.376, p<.05). Findings from focus groups revealed that application of trained skills and building trusting relationship with their clients via home visits are sources of meaning. Formal volunteering may have dual impacts on meaning in life in older age: reducing search for meaning and maintaining presence of meaning. For senior volunteers, being able to apply what they learn and building social connects are the key factors for attaining meaning.
CAREGIVERS: PURPOSEFUL AGING LOS ANGELES (PALA) SURVEY OF CITY AND COUNTY EMPLOYEES
Authors: Aguilar Iris , Lloyd Donald A , Trejo Laura , Aranda Maria P
Published: November 2019

The City and County of Los Angeles Age-Friendly Cities initiative, Purposeful Aging Los Angeles (PALA), 2017 needs assessment included an online survey of the workforce expected to implement age friendly policies and programs. The study aim was to describe the rate and characteristics of family caregivers within in the City and County workforce (employees). The overall response rate was 6.5% (City 4.5%, County 7.5%) for a final sample size of 9,071. The family caregiver category was derived from the following survey questions: 1) Are you or someone else in your home caring for a family member or friends who are experiencing problems/thinking that is affecting their ability to work or live a normal life? and 2) Are you a family caregiver? The analysis revealed that 34% of all respondents were family caregivers and of those, 53% cared for adults and 12% cared for children under the age of 18 (minors). Of the 53% caregiving for adults, 40% cared for someone with memory/thinking problems including but not limited to dementia (cognitive impairment). 15% of caregivers of minors were also taking care of an adult with cognitive impairment. The current caregiving research literature suggests that family caregivers experience higher rates of depression, anxiety, and social isolation due to the caregiving demands. Caregiving demands have the potential to create work-family conflicts that are important for employers to consider when designing wellness programs, and other supportive programs. It is critical to identify ways to address caregiving implications on social services, healthcare, and the environment.