bluuebunny/crossref_metadata_2025 huggingface dataset:
Multidisciplinary Healthcare Providers’ Perspectives on Managing Suspected Elder Abuse in the Healthcare Setting
Authors: Makaroun Lena , Klima Gloria , Nichols Michele , Rodriguez Keri , O’Hare Ann , Rosland Ann-Marie
Published: December 2020

Elder abuse (EA) is common and has devastating health consequences, yet is rarely detected by healthcare professionals. Veterans are at high risk for EA, and the VA has unique resources (e.g., comprehensive social work services) that can help address EA in the healthcare setting. This qualitative study aimed to assess perceived barriers and facilitators to detecting, reporting, intervening on and monitoring EA for VA providers. Providers from two VA facilities were recruited to participate in a one-on-one semi-structured interview. Transcripts of audio-recorded interviews were analyzed using thematic content analysis. Participants (n=22) were 82% female, age 33-64 years, had 4-25 years practicing in VA, and varied in discipline (e.g., nurse, physician, social worker) and practice setting (e.g., emergency department, geriatrics, primary care). For detecting EA, patient and caregiver cognitive impairment were frequently cited barriers, while an interdisciplinary team approach and ability to do home visits were noted facilitators. Common challenges with reporting EA to adult protective services (APS) were perceived lack of APS follow up and discrepancies in VA provider and APS investigator findings. While removing a patient from an unsafe living situation was a frequently cited successful intervention, providers also expressed feeling conflicted when infringing on patient autonomy. Poor communication with APS, patient loss to follow up, and caregiver interference made monitoring EA cases more difficult; intensive case management and in-home services facilitated monitoring. In conclusion, healthcare professionals see interdisciplinary care, in-home care, and better coordination with APS as key facilitators to managing suspected EA in the healthcare setting.
Intersectional Discrimination Attributions and Health Outcome among American Older Adults
Authors: Lu Peiyi , Kong Dexia , Shelley Mack , Davitt Joan
Published: December 2020

Discrimination has been consistently documented to relate to adverse health outcomes. However, most existing research focused on a single discrimination attribution (e.g. ageism). Few studies considered multifaceted discrimination attributions. Guided by an intersectionality framework, this study examined intersectional discrimination attributions and their associations with health outcomes. Older respondents (aged >50) from the Health and Retirement Study in 2014-2015 were included in the analysis (n=6,286). Their experiences and self-perceived reasons (age, gender, sexual orientation, race, national origin, religion, financial status, weight, physical appearance, disability, and others) for everyday discrimination were examined. Latent class analysis was employed to ascertain the profiles of subgroups characterized by their intersectional discrimination attributions. Regression models examined the correlates of the class memberships and the associations with health outcomes. Six classes were identified: class 1 (54.52% of the sample) had no/minimal discrimination experience; Class 2 (21.89%) experienced primarily ageism; class 3 (8.81%) reported discrimination based on age/gender/national origin/race; class 4 (7.99%) attributed discrimination to financial/other reasons; class 5 (5.87%) experienced discrimination based on age/weight/physical appearance/disability; and class 6 (0.92%) perceived discrimination from almost every aspect. Intersectional discrimination attributions were associated with poorer self-rated health, and greater levels of depressive symptoms and loneliness. The associations between intersectional discrimination and cognition were not statistically significant. This study found multiple marginalized identities co-occur and compound to contribute to perceived everyday discrimination among American older adults. Those experiencing discrimination due to multiple reasons warrant particular attention. Results underscore the utility of an intersectional approach in understanding discrimination in later life.
Out-of-Pocket Expenses Related to Aging in Place for Older People Experiencing Frailty: A Scoping Review
Authors: Moody Elaine , Ganann Rebecca , Macdonald Marilyn , Weeks Lori , Orr Liz , Jefferies Keisha , Ploeg Jenny , Misener Ruth Martin
Published: December 2020

Supporting older people to live in the community as they experience health and functional changes has become a priority for policy makers, health system leaders and community members, including many older people themselves. Aging-in-place has been promoted as a way to support the sustainability of health care systems and limit health care and societal costs. However, the expenses borne by individuals and caregivers to support older people to age-in-place when experiencing changes in health and functional ability are often not considered in health care literature and policy. We conducted a scoping review using Joanna Briggs Institute methodology to explore the out-of-pocket expenses for people with frailty living in the community. We included research and policy papers on community-dwelling people over 60 and experiencing frailty. Findings about financial out-of-pocket expenses were extracted. A total of 9669 sources were screened by two reviewers and 42 sources were included. The sources were from 17 countries, most from the US, and had various designs, including 14 qualitative designs, 15 cross sectional, 11 other quantitative and 2 policy discussions. The sources most often reported expenses related to home care (16), medication (12), housekeeping (10), transportation (8), and medical equipment (6). Gaps in the body of literature include lack of a consistent measure of out-of-pocket expenses and cost considerations of co-housing programs. The context—including policy, community and personal—was particularly important to the experience of out-of-pocket expenses for people with frailty, and further research is needed to expand on this knowledge.
Aging Across the Life Course: Research Collections Available From the National Archive of Computerized Data on Aging
Authors: McNally James
Published: December 2020

The creation and maintenance of sustainable data archives can be challenging, but it offers clear advantages. Properly curated data can be used by multiple researchers, testing a variety of hypotheses, and increasing the return on investment to the expensive process of data collection. Having an internally managed archival system also provides greater control and autonomy in the equitable distribution of data resources. This process ensures all researchers will have full use of the data for original research, teaching, and new directions once the data leaves the control of the local investigator’s control. This poster reviews the advantages of having a local strategy geared toward the preservation and sharing of gerontological research data. Using the National Archive of Computerized Data on Aging (NACDA) as a working example, the poster offers an overview of collections at NACDA. Using our metadata tools and variable search database, NACDA can identify studies in its collections that examine aspects of aging and health among adults during their lifecourse. Many of the studies are longitudinal or repeat measure cross-sectional studies. We are also able to identify studies that focus on aging that are not maintained by NACDA but which are available to interested researchers. This poster focuses on newly released work by NACDA that has compared to major aging studies (NHATS and NSHAP) and organized them into quasi-harmonized files for download and analysis by the gerontological research community. These recently available enhancements will allow researchers to obtain user-friendly comparative data for these complex studies.
Change in Body Mass Index is Associated with Change in Cognition in Older Adults
Authors: Douglas Joy , Crowe-White Kristi , Ellis Amy , Bui Chuong , Voruganti Saroja , Yaffe Kristine
Published: December 2020

Background: Alzheimer’s disease and related dementias affect one in ten Americans age 65y and older. Considering the rapid growth of the aging population, identifying modifiable risk factors for cognitive decline is a public health priority. Although weight change later in life is common, its impact on cognition is unclear. The objective of this study was to examine the relationship between change in body mass index (BMI) and cognition among older adults. Methods: The Health, Aging, and Body Composition Study was a prospective study of community-dwelling adults ages 70-79y at baseline (n=3,075; 49% males, 42% African-American). Using baseline and year 10 visit data, we evaluated change in BMI and change in cognition measured by the Modified Mini-Mental Status Exam (3MS) using a linear mixed model. Change in 3MS scores were regressed on changes in time-varying BMI after controlling for blood pressure, glucose, cholesterol, race, education, biological sex, and APOE genotype. Results: At baseline, average BMI was 27.4 (n=3075) and average 3MS was 90.1 (n=3061). At year 10, average BMI was 27.1 (n=1600) and average 3MS was 88.6 (n=1598). Higher BMI was associated with less cognitive decline (ceteris paribus). This finding suggests that weight gain is associated with cognitive maintenance. The effect of an increase in BMI was largest for those underweight at baseline. Conclusion: Among underweight older adults, an increase in BMI may be desirable for maintaining cognition. Although more research is needed, these findings suggest the need for interventions to prevent unintentional weight loss among older adults.
Influences of Dementia on Long-Term Surgical Outcomes in Older Adults After Hip Fracture
Authors: Xue Tingzhong (Michelle) , McConnell Eleanor , Lee Chiyoung , Tsumura Hideyo , Wei Sijia , Pan Wei
Published: December 2020

Older adults with dementia are more prone to have adverse health outcomes following hip fracture surgery. However, individuals with dementia and hip fracture are older and have more co-morbidities; these baseline differences can bias estimates of the influence of dementia. This study aims to investigate how dementia influences disposition, mortality rates and readmission rates at 365 days after hip surgery in older adults over age 65, after accounting for baseline factors such as socioeconomic status, health behaviors, co-morbidities, and type of hip fracture repair. A cohort of 1172 patients who had hip fracture surgery between October 2015 and December 2018 was extracted from electronic health records; among those, 376 had a diagnosis of dementia. Inverse probability of treatment weighting using propensity scores method was used to reduce the influence of factors that may confound the relationship between dementia status and hip surgery outcomes. Logistic regression was applied to estimate influences on discharge disposition and Cox proportional hazards model for one-year mortality. To account for competing risk of death, a Fine and Gray regression model was used to calculate subdistribution hazard ratios of readmission. Disparities in long-term surgical outcomes in patients with dementia were found. Results show that dementia was a significant predictor for being discharged to facilities (OR=1.92, 95% CI 1.09, 3.39, p=.025), death (HR=1.98, 95% CI 1.50-2.62, p<.0001) and being readmitted within one year (HR=1.31, 95% CI 1.15-1.50, p<.0001). These findings call for more efforts in developing effective multidisciplinary perioperative assessments and rehabilitation for patients with dementia.
Pain Intensity and Unpleasantness in People with Vascular Dementia: A Cross Sectional Study
Authors: Humbel Angela , Cowan R , Dietrich Mary , Iversen Wm Larkin , Atalla Sebastian , Moss Karen , Englehart Sydney , Monroe Todd
Published: December 2020

Pain is a multidimensional sensory and affective experience. People with Vascular Dementia (VaD) experience pain more intensely and have negative emotional responses. Further investigation is needed to understand the neurobiology of pain in VaD. We used experimental thermal pain in a cross-sectional design to determine if adults (age>64) with probable VaD experience increased pain intensity and increased pain unpleasantness during “mild” and “moderate” thermal pain. The final sample included 46 sex- and age-matched adults (23 VaD; 12 female) and controls (23 cognitively intact; 12 female) with an average age of 76.5 years (SD=7.5). Participants reported no daily analgesic use. We used a thermode placed on the thenar eminence to assess temperatures perceived as mild and moderate pain (°C) followed by unpleasantness ratings (0-20 scale). We assessed cognition and depression with the Mini-Mental State Exam (MMSE) and the Geriatric Depression Scale. After controlling for depression, and relative to controls, there was no statistically significant difference in the temperature at which people with VaD perceived mild or moderate pain (p = .086; Cohen’s d: mild=0.55, moderate=0.27). However, there was a statistically significant effect of VaD status on pain unpleasantness (p = .003). People with VaD reported mild and moderate pain as more unpleasant than controls (Cohen’s d = 0.79 and 0.60, respectively). Findings support previous work that people with VaD are at risk of experiencing more pain. Assessing pain intensity and affect can avoid under-treated pain in those with VaD.
Sedentary Behavior, Brain-Derived Neurotrophic Factor (BDNF), and Brain Structure in Midlife: A Brain MRI Study
Authors: Zhang Xuan , Gaughan Denise , Qiu Chengxuan , Meirelles Osorio , Launer Lenore
Published: December 2020

Long sedentary time (ST) is associated with poor brain health but the underlying mechanisms are unclear. Studies suggest exercise increases BDNF levels, and that low BDNF levels are associated with cognitive impairment. Limited population-based studies have examined associations among sedentary behavior (SB), BDNF, and brain structures. Here we explore the mediation and interaction effect of BDNF in the association of SB to brain measures. We included 612 participants from the MRI sub-study of the Coronary Artery Risk Development in Young Adults who had plasma BDNF and SB data at the Year 25 examination. SB was estimated by self-reported average ST hours/day spent sitting while watching television, using computers, and riding transportation. Outcome measures were total and selected brain volumes in cubic centimeters (cc). ST was categorized into quartiles. We used general linear regression to examine the following associations, adjusting for age, sex, race, and intracranial volume: Interactions between BDNF and ST on MRI; ST and MRI; ST and BDNF; BDNF and MRI; and ST, BDNF, and MRI. People in the upper 25%ile ST (>8.4 hours/day) had a decreased TB volume of 12.2 cc (p=0.01) compared to the lower 25%ile (<4.3 hours/day). Neither ST nor brain measures were associated with BDNF (p>0.05). Instead, BDNF interacted with ST for TB and WM (p < 0.03): The difference of brain volumes between the upper and lower 25%ile decreased with increasing BDNF levels. Accordingly, higher BDNF levels may protect brain function in the middle-aged and potentially older populations with a sedentary lifestyle.
Daily Stressors Degrade Perceived Cognitive Abilities in Healthcare Professionals
Authors: Drury Rhitik Joshi Taylor , Lee Soomi
Published: December 2020

Stress negatively impacts cognitive functioning. Less is known about whether daily stress is associated with perceived cognitive abilities in healthcare workers who require mental sharpness and attention to provide high-quality patient care. We examined daily associations between stressors and perceived cognitive abilities in nurses and whether the associations differed between workday vs. non-workday. Using 14-day smartphone-based ecological momentary assessment, 61 inpatient nurses at a U.S. cancer hospital reported the frequency and severity of daily stressors (e.g., arguments, accidents). Each day, participants subjectively evaluated their mental focus, memory, and attention. Multilevel modeling examined the within- and between-person associations of daily stressors with cognitive abilities adjusting for sociodemographics, work shift, and workday. Nurses reported experiencing stressors once every other day. More stressors were associated with poorer cognitive abilities. At the between-person level, those with more frequent or severe stressors reported poorer mental focus (B=-22.4, p<.01; B=-0.35, p<.01, respectively), worse memory (B=-24.35, p<.01; B=-0.37, p<.01, respectively), and lower attention (B=-25.47, p<.05; B=-0.40, p<.01, respectively). At the within-person level, on days with more frequent or severe stressors, participants reported poorer mental focus (B=-2.05, p<.05; B=-.03, p<.05, respectively) and lower attention (B=-1.95, p<.05; B=-.04, p<.01, respectively). Some of the between-person associations were more apparent on workdays; those with more stressors reported poorer mental focus and lower attention on workdays than on non-workdays. Nurses’ perceived cognitive abilities at work vary by daily stressors. Disconnecting the linkage between stressors and perceived cognition may help improve work performance in nurses who may encounter frequent stressors at work.
Early detection of cognitive impairment by natural language among outpatients and community dwellers
Authors: Kiyoshige Eri , Kabayama Mai , Takeya Yasushi , Takami Yoichi , Takeda Shuko , Gondo Yasuyuki , Rakugi Hiromi , Kamide Kei
Published: December 2020

Background: Although early detection of cognitive decline has a significant relation to improving the quality of life of dementia patients, this early detection has been difficult due to requires of neuropsychological tests which people generally take when they notice their cognitive impairment. The timing of patients’ notice was reported to be worse cognitive decline already, thus, we aimed to determine if cognitive impairment from a short interview by using Natural Language Processing approach. Methods: The present study used cross-sectional analysis among elderly outpatients and community-dwelling elderly from Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study. Cognitive decline was assessed by Telephone Interview of Cognitive Status for Japanese (TICS-J) and modeled as a binary outcome (cut-off <33 points). Natural language data was collected by semistructured interviews about health conditions and cognitive orientation in space, time, and place. We used an open-source text segmentation library to parse natural language text into bag-of-words and term frequency-inverse document frequency (TF-IDF) representations. Results: There were 38 (19.9%) outpatients and 153 (80.1%) community dwellers, and 60 (31.4%) participants were defined as cognitive impairment. The maximized TF-IDF score was 0.49 in cognitive orientation in time questions. In this question, participants without cognitive impairment could not calculate the score. There were no significant differences in TF-IDF scores between participants with and without cognitive impairment. Conclusions: Elderly without cognitive impairment might not have an episode about cognitive orientation in time, and this may help for early detection of cognitive impairment
Understanding Subjective Comparison of Memory to Peers: A Biopsychosocial Approach
Authors: Walden Allison , Robertson Anna , Lag Madeline
Published: December 2020

Identifying factors that contribute to subjective reports of memory decline may have important implications for interpretation of objective memory performance. Research suggests that subjective memory decline is influenced by affective symptoms such as anxiety and stress that are subsequently associated with poorer performance on neurocognitive tests. Personality is an additional factor, as evidence demonstrates that neuroticism may predict subjective memory decline. More research is needed to understand how factors such as demographics, personality traits, and subjective health impact subjective memory. The present study applies a comprehensive, biopsychosocial approach to identify constructs that predict how individuals view subjective memory decline compared to others their age. Researchers used a national database, Midlife in the United States (MIDUS), due to its comprehensive and diverse sample (N = 3,291). Predictor variables pertained to demographics, personality traits, as well as physical and mental health self-reports, and the outcome variable captured subjective memory relative to one’s peers. A three-step hierarchical regression model indicated that demographic variables, personality traits, and self-evaluated health significantly contributed to 26.7% of the variance of self-evaluated memory compared to others their age, F(35, 2836) = 29.48, p < .001, with each block incrementally adding to the significance of the findings. Results suggest that subjective evaluation of physical health, personality traits, and demographic variables uniquely influence subjective memory decline relative to others of the same age. Awareness of how biopsychosocial factors may contribute to affective symptoms may have implications for the interpretation of neuropsychological testing results.
Types of Insomnia Mediate the Relation between Anxiety and Depressive Symptoms Longitudinally in Late Life
Authors: Bolstad Courtney , Nadorff Michael
Published: December 2020

The current study examined onset and maintenance insomnia as mediators of the relation between anxiety and depressive symptoms over a three-year period in a sample of older adults. We hypothesized that anxiety symptoms at timepoint one would significantly predict depressive symptoms at timepoint four, while controlling for depressive symptoms at timepoint one. We also hypothesized that this effect would be significantly reduced when adding onset and maintenance insomnia at timepoint two and three, respectively, as mediators. Participants included 3,484 older adults, ages 66 to 103 (M = 77, SD = 7), included in the National Health and Aging Trends Study who completed measures of types of insomnia, anxiety, and depressive symptoms at four different timepoints (2012 through 2015). The model showed a significant direct effect of anxiety on depressive symptoms at timepoint four, independent of baseline depressive symptoms. The relation was mediated by onset and maintenance insomnia, though a significant direct effect remained. Therefore, types of insomnia contribute to the development of depressive symptoms in older adults with anxiety symptoms over time, even when controlling for baseline depressive symptoms. Further, onset and maintenance insomnia are unique outcomes and predictors of anxiety and depressive symptoms, respectively, even when controlling for baseline depressive symptoms. Our findings provide a foundation for future intervention research with clinical samples that control for confounding variables in further elucidating the development and change in depressive symptoms among older adults with anxiety through onset and maintenance insomnia.
Licensed Nurse/Certified Nurse Aide Collaboration in the Care of Nursing Home Residents
Authors: Beynon Cynthia
Published: December 2020

This mixed-method study explores how nursing team collaboration is perceived and experienced in four nursing homes (NHs) in the Western United States. Licensed nurse (LN) and certified nurse aide (CNA) participants completed two survey tools to assess their perception of collaboration and teamwork in their current work environment. The LNs and CNAs were paired and interviewed both individually and as a caregiving pair to explore the lived experience of collaboration in the care of NH residents. Quantitative survey results were analyzed using IBM® SPSS Version 25, and participants reported a collaborative working environment with equally strong ratings in the following categories: partnership, cooperation, and coordination; they agreed with statements reflective of teamwork including team structure, leadership, situation monitoring, mutual support, and communication. No significant difference was found between LN and CNA responses or between team members in any of the four participating facilities. Qualitative survey data were loaded in NVivo12 and analyzed using a thematic analysis approach. The findings revealed five primary themes, including essential elements in successful team collaboration—perspective, coworker connection, communication, and mutual support—and ways teamwork and collaboration impact resident care.
Racial Differences in the Impact of Subjective Life Expectancy on Advance Care Planning
Authors: Lou Yifan , Carr Deborah
Published: December 2020

The need for advance care planning (ACP) is heightened during the COVID-19 pandemic, especially for older Blacks and Latinx persons who are at a disproportionate risk of death from both infectious and chronic disease. A potentially important yet underexplored explanation for well-documented racial disparities in ACP is subjective life expectancy (SLE), which may impel or impede ACP. Using Health and Retirement Study data (n=7484), we examined the extent to which perceived chances of living another 10 years (100, 51-99, 50, 1-49, or 0 percent) predict three aspects of ACP (living will (LW), durable power of attorney for health care designations (DPAHC), and discussions). We use logistic regression models to predict the odds of each ACP behavior, adjusted for sociodemographic, health, and depressive symptoms. We found modest evidence that SLE predicts ACP behaviors. Persons who are 100% certain they will be alive in ten years are less likely (OR = .68 and .71, respectively) whereas those with pessimistic survival prospects are more likely (OR = 1.23 and 1.15, respectively) to have a LW and a DPAHC, relative to those with modest perceived survival. However, upon closer inspection, these patterns hold only for those whose LW specify aggressive measures versus no LW. We found no race differences for formal aspects of planning (LW, DPAHC) although we did detect differences for informal discussions. Blacks with pessimistic survival expectations are more likely to have discussions, whereas Latinos are less likely relative to whites. We discuss implications for policies and practices to increase ACP rates.
Difference in Parent-Child Care Experience by Demographic Characteristics: Focusing on Stress, Needs, and Meaning
Authors: Baba Ayako
Published: December 2020

OBJECTIVE: In super aging society, unpaid caregivers play important roles. Therefore, they should be supported to realize the lives they want. However, it is unclear what caregivers’ particular needs are under different conditions. This study aimed to explore the difference in forms of stress and needs of caregivers by demographic characteristics. METHOD: Adult children who were caring for or had cared for their parents at home under the Japanese long-term care insurance system (n=653) completed the three open-ended questions concerning caregiving stress, unmet needs, and meaning, combined with a demographic survey. Data were analyzed using text mining approaches such as correspondence analysis and co-occurrence network analysis, which illustrated differences in description according to demographic variables. RESULT: 1) Caregivers of fathers felt stressed when rebuked by care-recipients, whereas daughter caregivers of mothers felt stressed in coping with care-recipient dementia and complaint, and balancing caregiving with parenting. 2) Caregivers in economic difficulty needed instrumental and financial support, whereas others needed flexible support and accessible consultation services. 3) Caregivers living with care-recipients found meaning in experience and repaying parents for raising them, whereas caregivers living away found meaning in improved parent-child relationships and images of care-recipients. Caregivers of persons with dementia found meanings in sharing time of tranquility with care-recipients. CONCLUSION: The study revealed differences in caregiving experience by care dyads, economic situation, living arrangement, and dementia etc. These results suggest that family caregivers should be provided with services to help find meanings in work and reduce stress levels, according to caregiving conditions.
A Scoping Review of Social Housing Models for Older Adults
Authors: Sheppard Christine , Yau Matthew , Kwon Carol , Rios Jorge , Austen Andrea , Hitzig Sander
Published: December 2020

Access to affordable housing is a rising concern for many older adults, and government-sponsored social housing programs are one approach to support low-income older adult renters; however, these housing models are limited in availability and may not all be well-suited to support aging in place. To better understand how to promote the physical, mental and social wellbeing of older tenants in social housing, this scoping review mapped relevant literature to examine: 1) the characteristics of older adults in social housing; and 2) social housing service models and policies. Seven peer reviewed databases were searched for relevant articles, which were screened by two independent reviewers. A total of 140 articles met the inclusion criteria. Studies were predominately from the US and Canada; spanning over five decades of research, with publications surging in the 1980’s and in the 2010’s. Almost all studies reported on the sociodemographic and health characteristics of older tenants, and two thirds presented findings on social housing service models, including policies, staff positions and training, and access to on-site support services. This review points to a high level of vulnerability among older adult tenants living in social housing and highlights the importance of co-locating support services in social housing buildings, with dedicated tenant-support staff to identify vulnerable tenants and link them to these services. There is an acute need for more research on key issues related to housing retention, such as eviction prevention, in order to identify opportunities for social housing landlords to help older tenants age in place.
Understanding patient and clinician perspectives of antibiotic use for the treatment of UTIs
Authors: Hannum Susan , Heughan Ja Alah-Ai , Gurses Ayse , Katz Morgan , Zenilman Jonathan
Published: December 2020

Background. Multidrug resistant organisms are highly prevalent in post-acute long-term care [LTC] and skilled nursing facilities [SNF], driven by overdiagnosis of urinary tract infections [UTI] and overuse of antibiotics, despite clinical guidelines for UTI management. Using the Systems Engineering Initiative for Patient Safety [SEIPS] framework to understand sociotechnical work systems within LTC/SNFs, we are conducting mixed methodological research to examine work systems gaps that may require structural modification to ensure appropriate prescribing behaviors. Methods. To begin this research, we conducted semi-structured interviews with residents, caregivers, and clinical staff at three LTC/SNF locations. Resident and caregiver interviews queried knowledge, attitudes, and beliefs about UTIs and antibiotics, previous use, and communication with clinical staff. Clinical staff interviews queried procedures for diagnosing UTIs, prescribing decisions, communication with residents/caregivers, and resident/caregiver demand. Findings. Resident/caregiver interviews highlighted three common themes: (1) doctors have the right to deny antibiotics, but communication about decisions is critical; (2) trust doctors’ knowledge and use of objective testing for decision-making; (3) want detailed explanations and education about antibiotics, including potential side effects. Clinical staff described: (1) caregiver as the primary barrier, even with education about antibiotics; (2) using a general protocol for diagnosis, but also prior knowledge and experience with the resident; (3) importance of educating and communicating with residents/caregivers about antibiotic treatment, prescribing recommendations, or side effects. Conclusions. Our study highlights a gap in communication and workflow between residents, caregivers, and clinical staff that may be amendable to improved interventions that decrease inappropriate prescribing of antibiotics for this population.
Body Mass Index and 12-year Mortality Among Older Mexican Americans Aged 75 Years and Older
Authors: Jadhav Reshma , Markides Kyriakos S , Snih Soham Al
Published: December 2020

The objective of this study was to examine the effect of body mass index (BMI) on 12-year mortality among older Mexican Americans aged 75 years and older. Data are from wave 5 (N=1,367) of the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/2005-2016). Measures included socio-demographics, self-reported medical conditions, body mass index (BMI), disability, Mini-Mental-State-Examination (MMSE), short physical performance battery (SPPB), high depressive symptoms, and falls. BMI was classified as underweight (< 18.5), normal weight (18.5 to < 25), overweight (25 to < 30), obesity type I (30 to <35), and morbid obesity (≥ 35).Cox proportional hazards regression analysis was performed to estimate the hazard ratio of 12-year mortality as a function of BMI categories at baseline. The average of the sample was 81.2 years, 17.2% were underweight, 22.7% were normal weight, 27.4% were overweight, 31.9% were obesity type I, and 38.6% were morbid obesity. Mexican Americans aged ≥75 years with overweight or obesity Type I had a reduced hazard ratio (HR) of death (HR=0.80, 95% CI=0.68-0.93 and HR=0.73, 95% CI=0.60-0.88, respectively) over 12-years of follow-up. The HR of death for underweight and morbid obesity participants was 1.78 (95% CI=1.13-2.80) and 1.03 (95% CI=0.79-1.36), respectively. Female participants and those with high scores in the MMSE and SPPB had decreased risk of death. This study confirmed the protective effect of overweight and obesity on mortality seen in this population at a younger age, which might have implications when treating older adults with overweight and obesity.
Dietary Administration of 2-Deoxy-D-Glucose Reduces High Fat Diet Induced Obesity and meta-inflammation in Mice
Authors: Pandey Sanjay , Joshi Diksha , Singh Saurabh , Ray Sushma , Bhatt Anant Narayan , Natarajan K , Dwarakanath B S
Published: December 2020

Obesity is a major risk factor for type 2 diabetes, NAFLD, chronic diseases and cancer. Insulin resistance, oxidative stress, high ectopic lipid levels and meta-inflammation are the mechanisms proposed to play a leading role in the morbidity associated with obesity. Energy restriction mimetics (ERMAs) has also been shown earlier to reduce the scale and the severity of these disorders by mimicking the physiological effects of the Energy Restriction. In present study we propose that the use of 2-DG as ERMA can be effective in regulating the High Fat Diet (HFD) induced obesity. Effect of 2-DG (0.4% w/v in drinking water) on the HFD and Insulin Resistance (IR). HFD induced change in body weight, adipose tissue mass, and ectopic lipid levels was assessed as the measure of obesity.IR and glucose levels were also estimated to evaluate the effect of 2-DG on the insulin sensitivity in HFD mice. 2-DG significantly altered HFD induced increase in the mice body weight, epididymal White Adipose Tissue (WAT) and liver weight. 2-DG fed mice also showed reduced lipid levels in serum and liver. Furthermore, 2-DG also reduced the oxidative damage in the liver with concomitant increase in enzymatic (SOD and Catalase) and non-enzymatic (reduced Glutathione) antioxidant levels. 2-DG fed mice also showed reduced levels of Leptin, IL-6 and TGF-β which are early drivers of the etiology of the metabolic diseases. Our results suggest that 2-DG as ERMA can prevent obesity and etiology of associated disorders. However, more relevant models are needed to further strengthen these observation
Racial Differences of Attitudes Towards Medical Marijuana Use Among American Older Adults
Authors: Ding Kedong , Lou Yifan
Published: December 2020

Background: Extensive evidence documented that medical marijuana (MM) could be used for pain management with fewer side effects. Although MM legalization remains controversial as it is perceived to be a “gateway drug”, more states are striving for MM legalization and calling for health insurance coverage. Racial difference in the use of opioids for pain management is well-documented, which may also exist in the use of MM. This study explored an understudied topic on how people from different racial backgrounds perceive MM and its behind mechanism. Method: Data is from Health and Retirement Study Wave 2018 who answered the special modules on MM (n=1340). The attitude is proxied by two dichotomous measures on whether they think MM is acceptable and would lead to hard drug. Logistic regressions were used to evaluate the relationships between attitude and race, adjusted for sociodemographic, health and mental health, and MM knowledge. Moderating effects of diseases and socioeconomic-status (SES) were tested using interaction terms. Results: Older adults who hold positive attitudes towards MM are more likely to be younger, high SES, using opioids. Hispanics and Blacks are more negative towards MM relative to White counterparts. Blacks with cancer (OR=.30) are less likely to believe MM is acceptable, whereas blacks with arthritis are more likely to accept MM (OR=2.08) compared to Whites. Hispanic females (OR=.26) are more likely to oppose MM while Hispanics with higher education background (OR=4.3) are more likely to hold positive attitudes. Implication: The results may guide development of future guidelines on MM prescription.
The Sunday Effect: How Church Attendance is Related to Daily Pain and Affect in Older Adults with Osteoarthritis
Authors: Condon Shelley , Cheesman Katherine , Smith Dylan , Parmelee Patricia
Published: December 2020

Attending church is related to elevated mood (Law & Sbarra, 2009), greater social connectivity (Obst & Tham, 2009), and purpose in life (Robbins & Francis, 2000). More research is needed on how these relationships function among older adults, especially those living with chronic pain. The current study aimed to explore the effects of attending church on Sunday on the daily pain and affect of older adults with arthritis pain. Using a subset of 185 participants living in Alabama from the Everyday Quality of Life (EQUAL) project, the current study utilized multilevel modeling to examine (1) the main effects of church attendance and day of week (Sunday vs other) on daily pain and affect (positive and negative), and (2) the interaction [Sunday] effect of church attendance and day of week on those outcomes, controlling for sociodemographic variables (i.e., employment status, sex, race, and age). Preliminary covariate analyses revealed that church attendance was higher among participants who were unemployed, female, African American, and older. For the multilevel models predicting daily positive and negative affect, significant main effects were found for day of week and church attendance; however, the interaction effect was not significant. Interestingly, no main or interaction effects were found for the models predicting daily pain. Thus, while church attendance and day of week significantly predicted daily ratings of positive and negative affect, there was no support for the Sunday Effect on those outcomes. Implications and ideas for future research are discussed. (R01-AG041655, P. Parmelee & D. Smith, Co-PIs).
A Comparison of Cognitive Function in Pine Study to Health and Retirement Study & CHARLS Study
Authors: Verma Charu , Zhang Mailun , Li Mengting , Bergren Stephanie , Dong XinQi
Published: December 2020

Healthy immigrant theory assumes that immigrants have better health than natives, while it remains unclear whether this theory applies to older Chinese Americans with respect to cognitive health. The objective of this study was to estimate the differences in cognitive function between the US and Chinese older adults. PINE (n=3,157) (2011-2013) with Chinese older adults was compared to HRS study (2010-2011) (n=22,034) and HRS sister CHARLS (n=17,708) (2010-2011). Cognitive function was assessed by episodic memory, working memory, executive function, and MMSE. Cognition impairment was defined by 1.5 standard deviations below mean of z scores. After 1:1 matched samples determined by propensity score and verified by McNemar and Cohen’s Kappa test, conditional logistic regression model with demographic variables controlled was used to assess the differences between the three studies. Multivariable analyses results showed that participants from PINE are 5.667 (OR= 5.667, 95% CI 3.893-8.248, p < .001) times more likely to have cognitive impairment in comparison to HRS’s and 0.166 (OR= 0.166, 95% CI 0.136-0.203, p < .001) times less likely in comparison to CHARLS’s. Result demonstrated that Chinese older adults living in the US have a higher likelihood of cognitive impairment in comparison to the US older adults but less likely than those living in China. Healthy immigrant theory is partially supported in Chinese Americans. Immigrants with better cognitive health are likely to migrate to the US, but limited social engagement in the receiving communities might be a risk factor for cognitive function, leading to worse cognitive health than natives.
Owners’ Perceptions of Pet influence: Relation to Health Outcomes & Pet Attachment in Community-Living Older Adults
Authors: Friedmann Erika , Gee Nancy , Simonsick Eleanor , Resnick Barbara , Barr Erik , Kitner-Triolo Melissa , Hackney Alisha
Published: December 2020

Pet ownership (PO) has been linked to better health outcomes in older adults, particularly those with chronic health conditions. It is suggested that pets influence their owners lives both by encouraging social interaction and by interfering with owners’ willingness or ability to seek care for themselves. We use data from 6 questions about the positive and negative influence of pets on community dwelling older adults’ administered to pet owners (N=223, age >=50 years) in the Baltimore Longitudinal Study of Aging. We use principal components analysis (oblique rotation) to extract dimensions of owner’s perceptions of pet influences (PPI) and examine the relationship of these dimensions to owners’ cognitive, physical functional, and psychological status. Three dimensions of PPI include: fiscal/health challenges (F1: 3 items, alpha=0.70), wellness promotion (F2: 2 items, alpha=0.80); and reason for social/travel constraints (F3: 1 item). In regression analysis with all factors entered simultaneously, after controlling for age, higher magnitude of F1 significantly independently predicted poor physical quality of life (p=.0007), greater perceived stress (p=0.041), and lower happiness (p=0.014); F2 did not independently predict any health outcome; higher F3 significantly independently predicted lower emotional vitality (p=0.048). Controlling for age, all three factors were independent predictors of pet attachment (p’s=0.001, 0.010, 0.047, respectively). F1 and F3 were positively and F2 was negatively correlated with attachment. PPI was associated with owners’ physical and mental health. Perhaps older adults with higher attachment to pets are more likely to keep them despite higher challenges.
Attitudes Toward Older Adults: A Cross-Cultural Approach Across Residential Towns in Singapore
Authors: Lien Dylan , Chan Clara G H , Yow W Quin
Published: December 2020

Past research identified several variables that affect individuals’ attitudes toward older adults (OA), such as age and experience living with OA. However, the effect of environmental variables on these attitudes, such as ethnic-culture and proportion of OA living in their neighborhood, remain unclear. Additionally, most previous studies sampled specific populations (e.g., undergraduate students), limiting generalizability. To address these limitations, we modified the Kogan’s Attitudes Toward Old People Scale (Yen et al., 2008) and included it in a large-scale cross-sectional survey conducted among adult residents of three residential towns (MT, MaT, YT) in multiracial Singapore. The towns varied in the proportion of OA in residence, with MT having the largest proportion, YT the smallest, and MaT in between. In total, 3134 respondents completed the survey via interview. Exploratory factor analysis identified two factors: Appreciation and Prejudice. Multiple linear regressions revealed main effects of age and ethnicity, qualified by interactions of age with town, and age with ethnicity. Specifically, respondents from MaT showed greater increase in Appreciation with age compared to those from MT (t=-2.04, p=.003) and YT (t=-2.95, p=.042). There were also increases in Appreciation with age among participants of three ethnicities (Chinese, Malay, Others; t=-3.95, p<.001; no increase with age for Indian participants). Separately, there was a main effect of age on Prejudice, where Prejudice increased with age (t=4.21, p<.001). Detailed analysis will be presented to elucidate the role of environmental variables on attitudes toward OA.
Music Interventions for Older Adults in Clinical Trials and Research Studies Across Cultures and Settings
Authors: Rose Tara , Manzo Elyse , Erickson Katherine , Valenzuela Joshua
Published: December 2020

Music interventions and music therapy have become more common globally as nonpharmacological treatment options for memory loss, pain management, reduction of behavioral and psychological symptoms, and increased quality of life. Knowledge of multiethnic interventions is important when creating evidence-based programs within culturally diverse countries, such as the U.S. The purpose of this systematic review is to analyze music interventions for older adults across the globe to better understand emerging best practices. A review of all trials registered at clinicaltrials.gov and registries in the WHO Registry Network containing the key words “music therapy” were included, regardless of intervention type. Of the 627 studies generated, 449 met the eligibility criteria, with 11% enrolling only older adults and 89% enrolling older adults along with other age groups. Studies were conducted in 6 continents, 48 countries (23% in the U.S.), and in 23 languages. Music interventions for specific medical conditions (64%) or medical procedures (24%) were the primary foci in studies. While studies crossed multiple continents, less than 2% referenced ethnicity or culture in the study details. Detailed data on intervention types, demographics, measures, settings, and methodology will be presented. Results suggest that best practices in music therapy are being developed world-wide for the multitude of health challenges faced by older adults and demonstrate the diversity of music interventions in both medical and community settings. Information from this review can be used to improve the implementation of music intervention programs and may be particularly beneficial in countries with diverse multicultural populations.