bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurement Opportunities and Challenges With Long-Term Care Residents With Dementia
Authors: Holmes Sarah , Galik Elizabeth , Resnick Barbara
Published: December 2020

Measuring clinical outcomes among older adults with moderate to severe dementia present practical and psychometric challenges. Proxy report surveys, direct observations, chart abstraction, and objective measures, such as actigraphy are frequently used with this population. The purpose of this paper is to describe issues related to measurement in the FBFC trial. Challenges to actigraphy included the resistance of residents and removal of devices, inability to detect limited movement and/or the type of activity performed. The combined use of the three measures to optimize understanding of physical activity will be addressed. Behavioral outcome measures included the Cornell Scale for Depression in Dementia, the Cohen Mansfield Agitation Inventory, and the Resistiveness to Care Scale. Despite the use of these multiple measures, limited behaviors were identified due to timing of assessments and items included within the measures. Optimal ways in which to capture behavioral symptoms will be reviewed.
Implementation of Function and Behavior Focused Care
Authors: Resnick Barbara , Galik Elizabeth
Published: December 2020

There are many challenges to engaging long term care residents with dementia in physical and functional activities. Resident factors include age, comorbidities, cognitive impairment, motivation, sedation and polypharmacy. Facility factors include the environment, policies and culture within the setting such as a focus on safety versus function. Commonly used non-evidence based interventions include discouraging residents from walking by repeatedly telling them to sit down, and limiting recreational activities to seated positions. De-implementation to remove inaccurate care practices and implementation approaches are needed to facilitate implementation of Function and Behavior Focused Care. This paper will describe the use of the Synthesis Model for the Process of De-Adoption and the Evidence Integration Triangle implementation strategy in the development of the Function and Behavior Focused Care intervention to alter behavior among staff and cognitively impaired residents and optimize function and physical activity in long term care.
Frailty Phenotype and Healthcare Costs in Older Community-Dwelling Men: The MrOS study
Authors: Ensrud Kristine , Kats Allyson , Langsetmo Lisa Lisa , Vo Tien , Schousboe John
Published: December 2020

To determine the association of the frailty phenotype with subsequent healthcare costs, we studied 1514 men (mean age 79.3 years) participating in the 2007-2009 exam linked with their Medicare claims data. The frailty phenotype (5 components) was categorized as robust, pre-frail or frail. Multimorbidity and a frailty indicator (approximating the deficit accumulation index) were derived from claims data. Functional limitations were assessed by asking about difficulty performing 5 IADL. Total direct healthcare costs were ascertained during 36 months following the exam. Mean annualized costs (2018 dollars) was $5707 among robust, $8964 among pre-frail and $20,027 among frail men. Compared with robust, pre-frailty and frailty were each associated with higher costs after accounting for demographics, multimorbidity, functional limitations and the frailty indicator (cost ratio 1.18 [1.02-1.36] among pre-frail and 1.87 [1.47-2.39] among frail). Findings suggest that assessment of the phenotype may improve identification of individuals at increased risk of costly care.
Older Adults’ Subjective Age as a Potential Psychological Resource in Clinical Management of Chronic Illnesses
Authors: Prasad Anyah , Roldan Nidya Velasco , Hendricksen Meghan , Shellito Natalie
Published: December 2020

Subject age is predictive of future morbidity and mortality and can be potentially viewed as a psychological resource. However, there seems to be a reciprocal relationship between subjective age and health. In a series of analyses, we demonstrated that various measures of health status such as number of chronic illnesses, self-rated health and sensory impairment have an adverse association with older adults’ subjective age. Specifically, chronic illnesses seem to have a period effect and age effect. Living with chronic illness over a period of time seems to attenuate its association with subjective age. Similarly, the association between chronic illnesses and subjective age gets weaker with increase in older adults’ chronological age. Therefore, asking those living with chronic health conditions and specifically younger older adults about their subjective age and providing appropriate resources, counseling and reassurance about chronic illness management may prevent the downstream negative health effects of increased subjective age.
Association of Psychological Resilience and Depressive Symptoms in Adults With Cardiac Disease
Authors: Ketcham Amy , Matus Austin , Riegel Barbara
Published: December 2020

Depressive symptoms predict hospitalization and mortality in adults with cardiac disease. Psychological resilience may protect against depressive symptoms, but benefits are not yet conclusive. We conducted a systematic review to examine the association between resilience and depressive symptoms in adults with cardiac disease. Seven databases were searched from inception to December 2019 using the search terms “cardiac disease,” “depressive symptoms,” “depression,” and “resilience.” The 623 articles identified were narrowed through title, abstract and full-text review leaving 13 studies for final analysis. Resilience and depressive symptoms were inversely related in 10 of 13 studies. The three studies with poor quality sampling techniques or significant loss to follow-up found null results. The major gap identified in the literature was poor understanding of the longitudinal pattern between resilience and depressive symptoms. If the direction of causality functions as expected in longitudinal research, optimizing resilience could help attenuate depressive symptoms.
Lifelong Engagement: The Role of Cognitive Reserve and Physical Health in Very Late Life
Authors: Martin Peter , Willcox Bradley , Willcox D Craig
Published: December 2020

At the end of a very long life, older adults often experience a significant decline in cognitive function. However, there are older adults who have maintained high levels of cognition and physical health. The purpose of this symposium is to illuminate interdisciplinary findings of cognitive engagement with late-life benefits of cognitive functioning and physical health. Components of cognitive reserve include sociodemographic variables (e.g., education, occupational complexity and responsibility), psychosocial variables (e.g., engaged life style and activity) and physical and genetic reserve (e.g., strength, APOE4). Based on three major research studies (the Japanese SONIC study; the Honolulu Asia Aging Study, HAAS; and the Georgia Centenarian Study, GCS), we highlight important aspects of building cognitive reserve and the implications for cognitive and physical health. The first presentation evaluates the importance of work complexity as a predictor of cognitive and physical health among participants of the SONIC study. Multiple group analyses yielded strong associations of occupational complexity with cognitive functioning for men. The second presentation reports logistic regression findings from the HAAS including education, strength and genetic markers, as well as mental health and their relatedness to cognitive abilities and physical health. The final presentation evaluates a structural equation model from the GCS, highlighting the interrelationship of cognitive reserve components (i.e., education, occupational responsibility, engaged lifestyle, social support, and activity) with cognitive and physical health in very late life. We will summarize and integrate the findings for their theoretical and practical implications and provide future directions.
Does Race or Ethnicity Modify the Impact of Age on Cognition in Middle- and Older-Aged Adults?
Authors: Turney Indira , Rentería Miguel Arce , Lao Patrick , Brickman Adam , Manly Jennifer
Published: December 2020

We compared verbal list learning, verbal memory, animal fluency, and letter fluency in 1407 education-matched participants from two community-based, intergenerational studies of cognitive aging and dementia. WHICAP participants are sampled from Medicare-eligible people aged 65+ and the Offspring cohort includes their middle-aged children. WHICAP participants (n=1218) were 72.1±6.5 years old and Offspring participants (n=189) were 53.7±8.4 years old at baseline. WHICAP participants had lower scores on most cognitive measures than Offspring participants; however, these differences were not uniform across race/ethnicity. Compared to non-Hispanic Whites, non-Hispanic Blacks in WHICAP had disproportionately lower scores on letter fluency compared to their offspring. On delayed verbal memory, non-Hispanic White and Hispanic offspring obtained higher scores than the parent generation – but among Blacks, memory scores were relatively low regardless of cohort. Racial disparities in cognition are apparent in both mid- and late-life and may be amplified in older age, particularly in Blacks.
Racial and Ethnic Disparities in Structural Measures of Brain Aging: A Systematic Review
Authors: Godina Sara , Turney Indira , Zahodne Laura , Moody Danielle Beatty , Deters Kacie , Manly Jennifer , Rosso Andrea
Published: December 2020

Examining the neural correlates underlying racial differences in cognitive functioning is necessary to help clarify mechanisms and to improve the generalizability of findings related to brain-behavior relationships. This systematic review aimed to determine whether there are racial differences in structural markers of brain aging among community-dwelling, neurologically healthy adults aged 18 and older. We identified studies (n=5,399) from searches in Ovid Medline, Ovid PsychINFO, and Elsevier EMBASE published until February 13, 2020. We included original articles that examined structural markers of brain aging and neuropathology across individuals from more than one race or ethnicity. These measures included magnetic resonance imaging, positron emission tomography amyloid and tau, cerebrospinal fluid amyloid, tau, and neurofilament light chain and computed tomography. Two reviewers independently screened full-text articles. We will present ongoing results and discuss the current state of knowledge, quality of existing studies, and gaps in the literature and highlight potentially key next steps.
Relationship of Indicators of Cardiovascular Health With Change in Cognition in Older Blacks
Authors: Lamar Melissa , Fleischman Debra , Leurgans Sue , Arfanakis Konstantinos , Barnes Lisa
Published: December 2020

Older Blacks perform more poorly on cognitive testing than older Whites. Increased prevalence of cardiovascular disease risk factors (CVD-RFs) among Blacks compared to Whites contribute to these disparities. We investigated whether white matter hyperintensities (WMHs) in late-life, a consequence of mid-life CVD-RFs, modify the association between late-life CVD-RFs and cognition in 167 Blacks (age~75yrs; non-demented at baseline). Participants were evaluated for blood pressure (BP) markers of cardiovascular health (systolic/diastolic BP, pulse pressure, mean arterial pressure (MAP) hypertension), WMH volumes adjusted for intracranial volume, and cognition (global and domain-specific at baseline and annually, ~8yrs). Adjusted models revealed differential associations between BP markers and baseline cognition; diastolic BP and MAP predicted faster decline in episodic memory. Hypertension was not significant in any model; however, when adding WMH, the hypertension*WMH interaction was significant for baseline cognition. Cognition among older Blacks is a complex function of BP markers of cardiovascular health and WMH.
The Relationship Between Personality and Perceived Mental Fatigability
Authors: Allen Hannah , Gmelin Theresa , Smagula Stephen , Boudreau Robert , Cauley Jane , Glynn Nancy
Published: December 2020

Several personality traits are known to be protective against global fatigue, however perceived mental fatigability (PMF, Pittsburgh Fatigability Scale 0-50) specifically measures an individual’s susceptibility to cognitive tiredness and is associated with mobility decline. We assessed whether optimism, conscientiousness, goal reengagement and goal disengagement contributed to greater PMF in 1,812 men (mean±SD age 84.4±4.2 years, 90.4% white) in the Osteoporotic Fractures in Men Study 4th visit (2014-2016). Covariates included demographic, psychological/behavioral factors, health conditions, physical activity and function. Prevalence of higher PMF (score ≥13) was 25% (n=448). In a covariate-adjusted regression model, each SD lower conscientiousness and lower optimism were associated with 0.93 and 0.61 SDs greater PMF, each p<0.01. Goal disengagement and goal reengagement were not associated with PMF. These findings warrant further investigation into how personality traits may help clinicians design targeted and effective interventions to reduce fatigability, and consequently lower the risk of adverse aging-related health outcomes.
Changes in Self-reported Energy and Brain Volumes
Authors: Tian Qu , Rosso Andrea , Glynn Nancy , Zhu Xiaonan , Rosano Caterina
Published: December 2020

The brain demands and consumes more energy than any other organ. Lower perceived energy may indicate compromised brain health. Little empirical data exists on the association between perceived energy and brain structure. Neuroimaging was obtained in 300 participants (mean age=83±3 y/o, 40% blacks, 57%women) with repeated self-reported energy measures(scale0-10) in the past decade. Energy decline was computed as rate of change by linear mixed models(-0.06/year). Associations of energy decline with volumes of cognitive (dorsolateral prefrontal cortex, hippocampus) and motor (precentral gyrus, putamen, caudate) areas were examined using linear regression, adjusted for demographics and total gray matter atrophy. A steeper decline in energy was associated with smaller volumes of right putamen (p=0.013) and caudate (p=0.043), a trend in right precentral gyrus (p=0.085), but not in prefrontal cortex or hippocampus. Declining energy by self-report may indicate atrophy localized in subcortical motor areas. Studies to identify the mechanisms underlying these associations are warranted.
Uncovering the Influence of Psychosocial Factors on Pain-Related Brain Responses in Older Adults With Chronic Pain
Authors: Terry Ellen , Booker Staja , Roach Keesha , Cobb Sharon , Robinson-Lane Sheria
Published: December 2020

Psychosocial factors such as experiences of discrimination, pain catastrophizing and perceived stress are associated with poor osteoarthritis-related pain and disability outcomes across sex and ethnic/race groups. However, the mechanisms that mediate these psychosocial factors and knee osteoarthritis outcomes across race and sex are unclear. A cross-sectional correlational design identified the associations between everyday discrimination and clinical pain, disability and functional performance among 188 non-Hispanic Black (NHB) and non-Hispanic White (NHW) persons with knee osteoarthritis. In a serial mediated model, perceived stress and pain catastrophizing mediated the relationship between discrimination and osteoarthritis-related outcome variables in female participants. Using magnetic resonance imaging, findings suggest that experiences of discrimination differentially affect structural brain regions based on both race/ethnicity and sex in older adults with knee osteoarthritis. Given this, we are also currently investigating the extent to which pain catastrophizing on pain-related brain structure differs across race/ethnic groups in older adults with knee osteoarthritis.
AVPR1A and Stress in Adults With Sickle Cell Disease–Related Chronic Pain
Authors: Roach Keesha , Dyal Brenda , Chamala Srikar , Yao Yingwei , Fillingim Roger , Wang Zajie , Molokie Robert , Wilkie Diana
Published: December 2020

Purpose: Emotional stress is a known pain trigger in patients with sickle cell disease (SCD). The Arginine vasopressin receptor 1A gene (AVPR1A), SNP rs10877969, is associated with acute pain and stress-related pain. Our study investigated the association between AVPR1A genotype with stress and age in adults with SCD pain. Methods: 169 participants with SCD and chronic pain (100% African descent; mean age 36.4 ± 11.6 years [range =18-74 years]) completed the Perceived Stress Questionnaire. The SNP was evaluated as the imputed score was R2>0.8. ANOVA compared stress by genotype and age. Findings: Mean stress scores were significantly lower (p<0.05) for the older adults (0.35 ± 0.18) than the younger adults (0.41 ± 0.17). Mean stress scores were not significantly different by genotype for younger or older adults. Discussion: The rs10877969 genotype frequency was not different by age. In contrast to prior research, there was no association between genotype and stress.
Partnerships Matter in Successful Aging: Collaborations That Put Research Into Practice Across the Community
Authors: Sadarangani Tina , Wu Bei
Published: December 2020

Healthy aging begins and ends in the community with age friendly health systems and communities. In order to promote healthy aging and help older adults make healthy choices we must engage them as partners in healthcare with access to appropriate information and resources. This symposium will examine four community based studies that engage stakeholders to improve care quality through evidence-based interventions for older adults. These programs are all novel as they seek to engage stakeholders, perform pragmatic interventions, and improve outcomes in non-academic, community-based settings which are often overlooked. Promoting healthy behavior through peer coaching, using early detection and treatment to impact cognitive decline in social day care programs, evaluating the feasibility of screening for palliative care in assisted living and implementing evidence-based dementia care in hospice settings are all explored. Analysis of these initiatives showed improvements in perceived-health, reductions in unnecessary healthcare utilization, and improvements in the physical and emotional health of caregivers, and positive changes in health behaviors. Our discussion will underscore the importance of engaging key stakeholders in study design and implementation to yield better outcomes. Community engagement is an essential part of facilitating aging-in-place, and findings illustrate that this can be achieved through innovative collaborations between researchers and community-based organizations across a variety of settings.
Partnering With Hospices to Develop, Test, and Implement Aliviado Dementia Care in a 25-Site Pragmatic Trial
Authors: Brody Abraham , Sadarangani Tina , Bristol Alycia , Jones Tessa , Convery Kimberly , McCabe Donna , Durga Aditi , Lin Shih-Yin
Published: December 2020

Almost half of hospice patients currently have a diagnosis of dementia. However, few pragmatic, evidence-based, programs have been developed and tested in this setting overall, and targeting persons living with dementia and their caregivers specifically. Furthermore, limited academic-hospice research partnership exist. We thus undertook efforts to develop and test Aliviado Dementia Care-Hospice Edition, a complex multi-modal quality improvement intervention, as part of the HAS-QOL Trial, a 2-phase, 25 site embedded pragmatic clinical trial, through partnership and engagement with hospice and caregiver stakeholders. We discuss methods for engagement and barriers to implementation. Stakeholders assisted with alignment of the intervention to their needs and how to flexibly implement, substantially strengthening the intervention. They also provided important input regarding how to sustain the intervention through technological, mentorship and communication support mechanisms. Barriers found include the nature of implementing in limited resource settings with multiple competing priorities and little research infrastructure.
Outcomes of Just-in-Time Patient and Stakeholder Engagement at 1 Year
Authors: Geary Carol , Eilers June , Leon Melissa , McClay James , Estabrooks Paul
Published: December 2020

The University of Nebraska Medical Center’s Rural Patient and Stakeholder Engagement in Research project used a novel approach to patient engagement in research: just-in-time engagement. In this approach, patients were identified and matched with researchers with shared research interests without preemptive patient and stakeholder education and training. Ten research teams initiated engaged research design between August and October of 2019. In this presentation, we will share process and outcomes measures of the just-in-time approach: measures of ongoing engagement at 6 and 9 months; evidence of research productivity, and patient and stakeholder satisfaction with their research involvement. We will also address ethical challenges, including challenges to engaging a diverse population. Part of a symposium sponsored by the Patient/Person Engagement in Research Interest Group.
Practical, Methodological, and Ethical Considerations of User Involvement
Authors: O’Sullivan Roger
Published: December 2020

Traditionally, older people were seen simply as ‘subjects’ of research but increasingly the case for utilizing the knowledge and insights of older people in planning research, policy, and services is gaining momentum. This presentation explores the nature of user involvement, focusing not just on the practical and methodological considerations, but the ethical aspects, which are often under-discussed. Prof O’Sullivan argues that the increasing focus on user involvement is welcomed but we need to understand and debate how it can be appropriate, meaningful, and beneficial for all involved. Using desk research as well as the results of a web-based survey and semi-structured interviews with researchers, government, and NGO representatives, Prof O’Sullivan will set out the practical as well as the ethical aspects of user involvement. He will recommend how researchers, funders, professional bodies and older people’s organizations and older people themselves can best advance the user involvement agenda. Part of a symposium sponsored by the Patient/Person Engagement in Research Interest Group.
GRECC Connect Increases Access to Geriatric Specialty Care for Rural, Older Veterans With Complex Care Needs
Authors: Nearing Kathryn , Dang Stuti , Dryden Eileen , Kernan Laura , Moo Lauren , Pimentel Camilla
Published: December 2020

A higher percentage of Veterans in rural areas are older, have multiple chronic conditions and select the VA for healthcare. To address the needs of rural older Veterans with complex needs, GRECC Connect hubs use case finding approaches combined with regular outreach and education to VA community-based outpatient clinic (CBOC) providers serving rural Veterans and caregivers. Alignment of GRECC Connect services with needs of providers and patients promotes establishment of therapeutic alliances in caring for medically complex older Veterans. After identifying high risk, high need patients, hubs use the following strategies to increase access to geriatric specialty care through telehealth modalities: 1) Co-management of patients through e-consultation and telehuddles (GRECC Connect interprofessional geriatric specialty care teams extend support to CBOC providers); 2) Clinical video telehealth to CBOCs and Video on Demand to Veteran homes (to reduce travel burden); and, 3) Tele-group visits (especially for behavioral health and caregiver support).
Telehealth Competencies for Interprofessional Teams Caring for Older Adults and Care Partners
Authors: Powers Becky , Nearing Kathryn , Dang Studi , Hung William , Lum Hillary
Published: December 2020

Providing interprofessional geriatric care via telehealth is a unique clinical skillset that differs from providing face-to-face care. The lack of clear guidance on telehealth best practices for providing care to older adults and their care partners has created a systems-based practice educational gap. For several years, GRECC Connect has provided interprofessional telehealth visits to older adults, frequently training interprofessional learners in the process. Using our interprofessional telehealth expertise, the GRECC Connect Education Workgroup created telehealth competencies for the delivery of care to older adults and care partners for interprofessional learners. Competencies incorporate key telehealth, interprofessional and geriatric domains, and were informed by diverse stakeholders within the Veterans Health Administration. During this symposium, comments will be solicited from attendees. Once finalized, these competencies will drive the development of robust curricula and evaluation measures aimed at training the next generation of interprofessional providers to expertly care for older adults via telehealth.
Sensory Loss and Delirium Among Medicare Beneficiaries
Authors: Morales Emmanuel Garcia , Reed Nicholas
Published: December 2020

Sensory impairment is prevalent among older adults and may increase risk for delirium via mechanisms including sensory deprivation and poor communication which may result in confusion and agitation. In the Medicare Current Beneficiary Study (MCBS), delirium was measured using a validated algorithm of claims data. Sensory impairment was defined as any self-reported trouble hearing or seeing, with the use of aids, and was categorized as no impairment, hearing impairment only (HI), vision impairment only (VI), and dual sensory impairment (DSI). Among, 3,240 hospitalized participants in 2016-2017, 346 (10.7%) experienced delirium. In a model adjusted for socio-demographic and health characteristics, those with HI only, VI only, and DSI had 0.84 (95% CI: 0.6-1.3), 1.1 (95% CI 0.7-1.7), and 1.5 (95% CI 1.0-2.1) times the odds of experiencing delirium compared to those without sensory impairment. Future research should focus on mechanisms underlying association and determine the impact of treatment of sensory loss.
Understanding Medicare With Hearing Loss
Authors: Willink Amber
Published: December 2020

Medicare has become an increasingly complex program to navigate with numerous choices available to beneficiaries with important implications on their financial exposure and access to care. While research has identified poor health literacy as a barrier to understanding Medicare, little information is available on the experience of individuals with hearing loss. Using the Medicare Current Beneficiary Survey (2016), a nationally-representative sample of 10,841 beneficiaries, we examined if difficulty understanding Medicare was associated with reported trouble hearing, while controlling for socio-demographic and health literacy factors. Compared to no trouble, Medicare beneficiaries with a little or a lot of trouble hearing had 44% (95% CI OR:1.34-1.55) and 63% (95% CI OR: 1.44-1.83) increased odds of reporting greater difficulty with understanding Medicare. The existing tools to support Medicare beneficiaries understand and navigate the program must evolve to meet the needs of those with hearing loss- a highly prevalent condition among Medicare beneficiaries.
Physician Suitability of an EHR Interface for Depicting Ecological Symptoms Derived From a Smartwatch
Authors: Manini Todd , Alpert Jordan , Mendoza Tonatiuh , Prabhakar Satya , Solberg Laurence , Rashidi Parisa
Published: December 2020

Physicians desire an electronic health record (EHR) interface to visualize data from mobile devices in rapid and unobtrusive manner. We developed an EHR interface after performing semi-structured qualitative interviews with 12 physicians. These interviews led to creating an EHR graphical interface that allowed seamless viewing of the top ranked patient attributes of pain, falls, hydration and mobility patterns. Physicians then evaluated the interface using the International Standard ISO 9241, Part 110— a survey to evaluate the design of human computer interactions. The median response for each of domains were as follows: suitability = 18.5 out of 24 (range: 9-24); conformity=34 out of 40 (range: 16-40); self-descriptiveness=25 out of 32 (range: 13-31); controllability=19.5 out of 24 (range: 8-23); error tolerance=5 out of 8 (range: 1-8). The median total score of 111.5 out of 140 (range: 88-128) indicated a relatively high level of usability of the EHR interface depicting smartwatch data.
Social and Behavioral Factors, Oral Health, and Dental Care Utilization
Authors: Wu Bei , Shuman Stephen , Ghezzi Elisa
Published: December 2020

Oral health status and dental care utilization is strongly associated with social and behavioral factors and health outcomes. The five papers in this symposium address how several of these factors affect oral health and dental care among diverse groups of older adults. Using data from the Health and Retirement Study, the first paper examined the impact of early childhood disadvantages on oral health in later life among adults age 51 and above in the U.S. The second paper used large-scale epidemiological data that addressed the relationship between acculturation and subsequent oral health problems. It also tested the moderating role of neighborhood disorder in such a relationship among older Chinese Americans. The third paper demonstrated the importance of examining different pathways among foreign-born and native-born Chinese older adults with regard to offspring’s support on their oral health outcomes. While increasing evidence shows that cognitive function is associated with oral health, limited studies have been conducted to examine the impact of cognitive impairment, e.g., Alzheimer’s Disease (AD) and related dementias (RD), on dental care utilization and costs in older adults. The fourth paper aimed to address this knowledge gap. Results showed that AD and RD had different impacts on different types of dental care utilization and costs. The fifth paper further displayed that individuals with cognitive impairment face a significant challenge in handling dental-related medications. This symposium provides policy and clinical implications on improving oral health and dental care utilization among older adults in the U.S. Oral Health Interest Group Sponsored Symposium.
Beta Test of a PAC Dementia Knowledge Training Module Included in a Nursing Home Orientation Curriculum
Authors: Brown Jerry , Baylie Peter , Nwakasi Candidus , Reddy Pranay , Ehlman Katie , Nolan Beth , Snow Teepa
Published: December 2020

Providing quality care for older adults in long-term care can be challenging, and this issue appears to be more pressing with people living with dementia. Using the Positive Approach® to Care (PAC) model, a 2-hour module for new staff nursing home orientation curriculum was designed to help introduce the concept of working with people living with dementia. Twelve undergraduate students participated in a beta-test of the nursing home orientation. A pre-and-post 38-item survey was administered to measure knowledge level and improvement. Participants also responded to qualitative semi-structured questions after the orientation. Descriptive statistics and bivariate analysis were conducted. Results indicated an improvement on dementia-related knowledge in most of the survey items (21 of 34 items). Examples of statistically significant differences in the pretest and post-test identified are knowledge on the effect of pressure in the palm to comfort a person with dementia (p-0.039), vision as the most powerful sensory input during dementia caregiving (p-0.001), and functionalities lost when the left temporal lobe shrinks (p-0.014). The qualitative evaluation showed that most of the participants indicated a change in dementia caregiving views — including how to pause if permission is not given to engage, and to respect personal space. These findings prove important because the PAC orientation curriculum was successful in improving the students’ knowledge and perspectives on dementia. This training program could be a useful tool if implemented into nursing home employee orientation.
Navigating the Treacherous Waters of Geriatric Complexity and Heterogeneity With the Help of Team Science
Authors: Kuchel George
Published: December 2020

Multifactorial complexity and heterogeneity challenge the care of older adults and research into the pathophysiology of common geriatric syndromes. Multicomponent interventions matching intervention components with individual risk factors are grounded in precision medicine by ensuring that interventions may be offered to those who will more likely beneﬁt, sparing expense and side effects for those who will not. Nonetheless, the development of mechanism-guided interventions has been hampered by failure to identify single mechanisms for effective targeting within this multifactorial complexity, a problem worsened by historical barriers between research disciplines and silos. Geroscience-guided interventions target biological hallmarks of aging representing mechanisms that geriatric syndromes share with aging. We will present examples of multidisciplinary bench-to-bedside translational science seeking to transform the care of common geriatric conditions as diverse as frailty, voiding disorders and immunization against influenza and pneumococcal infections via geroscience-guided therapies applied with a greater emphasis on heterogeneity of aging and targeting.
Deprescribing in Older Adults: Is Evidence for Continued Medication Use Generalizable Beyond Age 75?
Authors: Niznik Joshua
Published: December 2020

Older adults over the age of 75 are severely underrepresented in many of the clinical trials used to justify the continued use of medications for chronic disease prevention in advanced age. The gaps in evidence in this population have fueled an interest in research to better understand the potential benefits and harms associated with the continued use of medications with uncertain benefit in advanced age. Deprescribing, the intentional reduction or discontinuation of medications, has recently gained traction as an important component of the prescribing process, but raises questions about the safety of stopping medications. This presentation will provide an overview of the evolution of deprescribing research and how this has shaped my career as a geriatric health services researcher. Specifically, I will address early studies that defined the field, challenges and opportunities for studying deprescribing in older adults, and future directions and priorities in deprescribing research.
The Past, Present, and Future of Health Sciences Research
Authors: Brown Cynthia , Batsis John
Published: December 2020

The health sciences have experienced an evolution in research over the past 75 years, moving along the translational spectrum from bench to bedside to the community. This transformation has impacted health outcomes for older adults at a global and public health level. Expansion in geroscience and implementation science research has changed the lens through which we view how aging occurs, precision management of disease, and has allowed the integration of tested interventions into healthcare systems. This Presidential symposium will showcase investigators, ranging from junior to senior researchers, who will share where their science began, how their research has built on the past, provide insights into their own work, and share their perspectives on the continuing trajectory of their scientific work.
Transitional Care Management: Evidence for Novel Implementation Models and Rehabilitation Implications
Authors: Danilovich Margaret , Danilovich Margaret
Published: December 2020

The transition between healthcare settings is a complex process presenting challenges for effective and consistent communication between older adults, their caregivers, and healthcare providers. These challenges often result in adverse health events and re-hospitalizations. Further, once transitioned to home, older adults often need ongoing care management and support and evidence for models remains unclear as to the precise parameters of supports needed for comprehensive care. This symposium will provide an overview of the evidence for both interdisciplinary care management models and transitional care programs, present the implementation of a care management program for low income older adults at one social service agency, and provide evidence-based tools for older adult functional assessment and decision-making for transitional care. The speakers will present new tools from the American Physical Therapy Association home health toolbox that promote patient-centered health care decision-making to facilitate successful transitions that reduce resource use and hospital readmission. The speakers will also discuss the implementation of a care management program for older adults in a care gap (having too much income for Medicaid home and community-based services, but still <200% of the federal poverty line). An implementation framework for the needs assessment will be highlighted and 1-year program outcomes will be presented. Attendees will learn strategies for interprofessional collaboration, enhanced communication, and advocacy within the interprofessional team to facilitate improved care management and transitional services for older adults.
Understanding the Sensory Loss–Cognitive Function Relationship in Older Adults: Biomarker or Causal Risk Factor?
Authors: Deal Jennifer , Whitson Heather
Published: December 2020

Sensory impairment in older adults is common, over 55% of Americans 60 years and older have either hearing or vision impairment, and it is linked to accelerated cognitive decline and increased risk of incident dementia in population-based observational studies. However, whether sensory impairment is a marker or a cause of cognitive decline and dementia is unknown. Both sensory impairment and cognitive decline/dementia may be caused by a common underlying pathology (e.g., microvascular disease), or sensory impairment may be a marker of dementia-related pathological changes in the brain. Alternatively, causal mechanisms include increased cognitive load, changes brain structure/function, depression, social isolation and/or reduced activity. This session will investigate the role of sensory impairment in cognitive decline and dementia in older adults and discuss the ramifications of these different possibilities for risk prediction and stratification, and potentially, for disease prevention. The co-occurrence of multiple sensory deficits will be described, and the potential utility of the use of retinal signs as predictive markers for cognitive decline/dementia will be discussed. We will also describe current evidence for both non-causal and causal relationships between sensory impairment and cognition with a focus on hearing impairment. Finally, we will describe the relationship of dual sensory (both hearing and vision) impairment on cognitive performance and dementia in a biracial population-based study.
Policy Series: Illuminating the Intersection Between Employers and Experienced Employees: Current Research and Policy Directions
Authors: Kaskie Brian
Published: December 2020

Population aging, resulting from the combination of longer life expectancy and lower birthrates, has widespread implications for both employees and employers across the United States. By2040, age55-plus workers are projected to account for more than25 percent of America’s workforce. Yet, even though we have gained a better understanding of the needs and preferences of aging workers, we know far less about the organizations which employ them. This symposium presents the latest research concerning: age discrimination in the workplace, intergenerational workplace arrangements, work ability and performance, and the increasingly varied pathways older persons are taking from work to retirement. We also examine how employers have addressed these issues, and consider why one type of employer may be more likely to adopt and implement a policy or program supporting older workers. Panelists then discuss policy alternatives that may increase and expand current employer efforts to support experienced employees.
Employer Perceptions and Responses to an Aging Workforce: Differences by Industry, Occupation, and Size
Authors: Clark Robert
Published: December 2020

Employers are facing significant demographic changes in their workforce as the US population continues to age and older workers seek to delay retirement until later ages. The challenges associated with workforce aging vary substantially across the economy and vary by industry, occupation, and size of the organization. This analysis highlights the findings from employer surveys and workshops of senior HR leaders. The article summarizes the findings from our three-year research project including whether employers perceive that workforce aging is a challenge to their organization and if so, what changes in compensation and working conditions are being made to accommodate the changes in age structure
The Sense of Smell and Aging: What We Have Learned From Population Studies
Authors: Pinto Jayant
Published: December 2020

Decline of the sense of smell with age causes a marked impact on older adults, markedly reducing quality of life. Olfactory dysfunction impairs nutrition, decreases the ability to experience pleasure, and results in depression, among other burdens. Large-scale population studies have identified impaired olfaction as a key heath indicator that predicts the development of decreased physical and mental health, reduced physical activity, weight loss, mild cognitive impairment and dementia, and mortality itself. These data have been generated via analyses of data from several aging cohorts, including the National Social Life, Health, and Aging Project (NSHAP); the Beaver Dam cohort; the Atherosclerosis Risk in Communities project; the Rush Memory and Aging Project; the Health, Aging, and Body Composition project; the Washington Heights/Inwood Columbia Aging Project; among others. In this presentation, we will review the close connection between olfaction, health, aging, including discussion of insights from these studies. We will also discuss emerging data from NSHAP on the effects of sensory function on cognition, mental health, and social interaction, which demonstrate that sensory function plays a vital role in the lives of older adults. Part of a symposium sponsored by Sensory Health Interest Group.
Electronic Assisted Living Technology in CCRC, Assisted Living, and In-Home Care
Authors: Hall John , Lee Linh , Littlejohn Joshua
Published: December 2020

A qualitative study based on structured interviews with 21 healthcare leaders from CCRC’s, In-Home Care Agencies, or Medicare PACE facilities was conducted. Implications of electronic assisted living technologies on caregiver workforce were assessed. The use of assisted living technology was shown to have implications for workforce support and the alleviation of demands on caregivers. Communication and assessment tools were also found to be useful in the reduction of caregiver stress. There is optimism regarding the effectiveness of high-tech platforms in easing caregiver burden but there is skepticism about the return on investment given the initial cost and time needed for onboarding and data organization. The lack of user-friendliness and the required time to train to use tech are also barriers. The use of technology for remote check-ins and to monitor vitals is desirable. Also predicting dementia risk and monitoring for wandering are other opportunities for tech adoption. The enthusiasm for technology is tempered with caution for who will keep tabs on remote monitoring and who bears the responsibility to respond to the information gathered. Labor shortages, time constraints, and disorganized documentation are incentives for tech adoption. High-tech solutions for would ideally be user-friendly and help reduce staff demands. Except for the prevention of re-hospitalization by monitoring vitals the benefits of adopting new tech are not perceived as cost-effective.
Music Is Healing: Developing a Music Module for a Pain Management Intervention for African American Older Adults
Authors: Janevic Mary , Robinson-Lane Sheria , Hassett Afton , Courser Rebecca
Published: December 2020

Music has a known analgesic effect. Our multidisciplinary team is developing a music-focused module for Positive STEPS, a pain self-management intervention based on principles of positive psychology. The priority population is African American older adults with disabling chronic pain. Positive STEPS is delivered via website and phone calls from community health workers. To inform program design, we conducted two focus groups with older adults in Detroit (n=16; 100% female and African American; 75% age 70+). All participants said they would enjoy using music to cope with pain. Content analysis revealed the following themes regarding music for pain management: it elicits positive memories, reduces stress, motivates exercise and daily activities, and promotes relaxation. Participants offered ideas for music-focused activities, including learning about unfamiliar genres and using music for meditation/relaxation. Findings will inform the design of a new music module, to be pilot-tested for its effect on participant engagement and pain-related outcomes.
AAA Research Methodology II: Innovative Observational and Intervention Studies
Authors: Li Wenjun , Lou Vivian
Published: December 2020

Asians are the largest and the fastest growing segment of the world population, and the second largest immigrant population in the U.S. A high proportion of Asians live in developing countries or are immigrants to developed countries. Studies on age-related social and health issues of Asians have lagged. To advance research into aging among Asians living in the U.S. and elsewhere in the world, sound methodologies can be adopted from those well-developed in other settings while novel methodologies are to be developed to meet the unique needs of Asian studies. This symposium brings together five abstracts that address a variety of innovative methodological issues in social and health studies among Asian older adults. The topics range from use of wearable devices to measure travel patterns, life space and physical activity in late-life Asian immigrants in the U.S.; use of Ecological Momentary Assessment method to examine influences of social contact satisfaction on neighborhood affect in Chinese in mainland China; use of multilingual age-friendly touch-screen device for cognitive intervention in Singapore; use of GIS to evaluate potential influences of accessibility to neighborhood living resources on attitudes towards aging among the oldest old in Shanghai; and use of a multi-phase complex mixed methods to evaluate a Chinese cancer screening program in Taiwan. Together, these studies showed that innovative methods can be adapted for context relevance and linguistic and cultural appropriateness, and successfully executed in studies on aging among Asians. This symposium is a collaborative effort of the Aging Among Asians Interest Group.