bluuebunny/crossref_metadata_2025 huggingface dataset:
Internet-Based Cognitive-Behavioral Therapy for Depression: A Feasibility Study for Homecare Older Adults
Authors: Xiang Xiaoling , Sun Yihang , Smith Shawna , Lai Patrick Ho Lam , Himle Joseph
Published: December 2020

This pilot study examined the feasibility of delivering internet-based cognitive behavioral therapy (iCBT) to homebound older adults with symptoms of depression who are recipients of non-medical home care. A feasibility open trial was conducted in the homes of homecare older adults (n=26). When possible, home care workers (HCWs) of older adults (n=13) were recruited to provide external support for iCBT usage. In cases where consistent assistance from the same HCW was not feasible, participants were given the choice of working on the program on their own (n=7) or receiving assistance from a research assistant (RA) (n=6). The mean therapy sessions completed was 4.7 out of 8 total sessions. The mean satisfaction rating was 7.7 (SD=2.9) and 86% would recommend the program to others with depressed mood. Significant reductions in depressive symptoms and anxiety symptoms and improvement on a quality of life measure were observed at post-test. The RA-supported group tended to have the best adherence, satisfaction, and reduction in depressive symptoms, followed closely by the HCW-supported group. The self-guided group had the lowest adherence, satisfaction, and symptom reduction. iCBT is a feasible and acceptable treatment modality for homebound older adults with depressive symptoms and potentially effective. Data from the participant exit interviews suggest a need for refining the existing treatment platform to better meet the needs and capabilities of homebound older adults. Future studies are warranted to examine treatment effectiveness as a function of HCW support.
Age Differences in Self-Continuity in the German Socioeconomic Panel
Authors: Loeckenhoff Corinna , Gerstorf Denis
Published: December 2020

Self-continuity, the sense that one’s personal past, present, and future selves are meaningfully connected, is unique to human beings. Self-continuity varies across individuals with higher levels conveying benefits for mental health and well-being, physical health and health-related behaviors, as well as financial planning and moral choices (for a review see Hershfield, 2019). From a developmental point of view, self-continuity emerges over the course of childhood, but less is known about its development in adulthood. Recent evidence indicates that higher chronological age is associated with higher perceived self-continuity among healthy adults. Studies further suggest that age effects are more pronounced for more distant time intervals but fairly symmetrical for past and future (for a review see Loeckenhoff & Rutt, 2017). However, prior work has predominantly relied on U.S. convenience samples raising questions about generalizability to broader population samples as well as cross-national consistency of the findings. To address these concerns, the present study examined self-continuity in the German Socio-Economic Panel (SOEP, 2017 Innovation Sample, n = 1659, aged 18-92, M = 62.8, SD = 18.1, 53% female). In addition to replicating the previously reported positive association between age and self-continuity (r = .17, p < .001) and testing for curvilinear effects, we report on the role of temporal direction (past vs. future), temporal distance (1, 5, and 10 years), and demographic factors (i.e., gender, education, and wealth). The present findings add to the literature on adult age differences in self-continuity. Practical implications and directions for future research are discussed.
Does Trait Affect Impact Activity Engagement?
Authors: Knight Rebekah , Lothary Allura , Hess Thomas
Published: December 2020

Research has shown the amount of effort we expend towards our goals depends on a sense of self-efficacy, perception of task difficulty, and likelihood of achieving our goal. All of these processes are susceptible to the influence of affect. For example, negative moods may impede goal achievement by increasing perceptions of difficulty (Silvestrini & Gendolla, 2019). Negative experiences (such as past failures) can encourage these negative moods and subsequently impact self-efficacy (Esposito, Gendolla, & Van der Linden, 2014). Findings from self-efficacy research (e.g. Esposito et al., 2014) suggest that older adults may be particularly susceptible to the impacts of negative affect on effort mobilization, especially when tasks already seem challenging, with little chance of success. Perception of task difficulty, then, impacts the amount of effort exerted in completing the task. The present study sought to examine the factors that impact perceptions of difficulty and subsequent effort expenditure, represented by systolic blood pressure responsivity (SBP-R). Younger (N = 41) and Older (N = 163) adults completed a difficult cognitive task as part of a larger, longitudinal study, as well as measures of trait affect before study sessions. Our findings indicate younger adults exert less effort overall than older adults; however, when negative trait affect is considered, we find that higher levels of negative affect in older adults reduced task engagement. These results provide support for an effect of negative affect on task appraisals and posited age-related differences in effort mobilization.
Applying Administrative Linkage to Longitudinal Aging Studies: Boston Early Adversity and Mortality Study
Authors: Antic Mina , Dorame Ashley , Ferrie Joseph , Lopes Maria , Waldinger Robert , Spiro Avron , Mroczek Daniel , Lee Lewina
Published: December 2020

Adverse childhood experiences have been linked to poor adult health, yet the underlying pathways remain unclear. While longitudinal aging studies provide rich data on health trajectories in adulthood, two intrinsic limitations hamper progress in studying causal pathways: (1) reliance on retrospective assessment of early-life conditions, and (2) inadequate data coverage on lifespan developmental processes, especially in childhood. The Boston Early Adversity and Mortality Study (BEAMS) was designed to overcome these limitations by applying high-quality administrative record linkage to three longitudinal studies on aging that are over 50-years-old. BEAMS uses administrative linkage to acquire contemporaneous, early-life information on health, family, and environmental hazards from multiple databases. Our sample includes male participants from the VA Normative Aging (n=2280), Grant (n=456), and Glueck (n=268) Studies. BEAMS extends linkage to siblings, thus including women, so that our combined sample is representative of the early 1900s Northeastern U.S. population. Key steps in administrative linkage include coding identifiers from existing data; linkage to 1900-40 Censes, vital, and military (WWI, WWII, Veterans benefits) records; linkage to public databases for early-life lead exposure data, and later-life health information (Medicare, NDI). By linking records of study participants (74%-94% deceased) to numerous administrative databases, BEAMS will create a cradle-to-grave dataset with prospective data on early socioeconomic, psychosocial, and environmental exposures, and lifespan health data. BEAMS uses human review to achieve high-quality record linkage. Our methodology can be adopted by other longitudinal aging studies to overcome barriers in advancing causal knowledge on pathways linking early-life conditions to lifespan health outcomes.
Mathematics and Relatedness: Predicting Optimal Social Engagement in Late Life
Authors: Williams Christine , Tognoli Emmanuelle , Beetle Christopher
Published: December 2020

Multiple causes converge for older adults to shed social relationships. Lost opportunities for social engagement are tied to weakened cognitive reserve and under-optimal aging in health and disease. For example, a woman, 75, regularly strolls with younger friends. At 80, her reduced motor fitness makes it hard to keep pace and she withdraws her participation. With same-age peers, she might continue this healthy physical and social activity a few more years by unobtrusively shortening the outing or by slowing her pace. A man, 85, loves to debate politics with family, but his turn at talks diminish: his hearing loss (sensory) prevents quick grasp of the discussion; his slower verbal fluency (cognitive) hamper quick-witted replies. Both examples illustrate that social aging is not only a ¬¬¬property of the aging individual. Social context plays an important role. Our recently formed interdisciplinary group (geropsychiatric nurse, mathematical physicist and complexity scientist) is studying the systemic complexities of social aging with experiments and mathematical models. Our aim is to present our model and aging-focused hypotheses, as well as empirical validation in younger adults. Four key variables are group size and heterogeneity, and the strength and adaptability of social coordination. Our current results show that people coordinate better with others like them in pace, but they lose the ability to coordinate with people whose pace is different. We anticipate that our program of research will deliver evidence-based recommendations on social-engineering of activities that maximize opportunities for sustained interactions among older adults.
Social Frailty Is Associated With the Risk of Malnutrition Among Community-Dwelling Older Adults
Authors: Lee Seoyoon Jane , Kim Miji , Shim Hayoung , Jung Heeeun , Seo Yuri , Won Chang Won , Lee Jane
Published: December 2020

Social frailty does not merely affect the level of socialization, but also the means of obtaining resources for the daily lives of older adults. It is highly associated with the quality of life during advanced age. In this study, we analyzed the association between the Mini-Nutritional Assessment (MNA®) score (range 0-30) and 18 singular items and social frailty status of community-dwelling older adults. A total of 2,552 community-dwelling older adults aged 70-84 years (mean age 76.9±4.0, 51.8% female) from the Korean Frailty and Aging Cohort Study (KFACS) were assessed. The social frailty status was assessed in four categories- absence of economic resources, social resources, social activities, and social interactions. A higher MNA® score indicates better nutritional status. The prevalence of social frailty in older adults was 27.9% (mean age 78.1±4.0, 67.7% female). Approximately 40% of the participants were at risk of malnutrition or malnourished (p<0.001), while socially robust group accounted for 23% (p<0.001). They were at a higher risk of a lower MNA® score (odds ratio [OR] 0.90, 95% confidence interval [CI], 0.84-0.96). Socially-frail older adults have a higher possibility of not eating three full meals a day (OR 2.33, 95% CI 1.19-4.55) which increases the risk of malnutrition. In conclusion, social frailty, as a means of linking resources -including economic and social capitals- to the older adult population directly impacts the risk of malnutrition and requires an appropriate intervention.
Assessing the Longitudinal Relationship Between Alcohol Use and Depression Among Older Adult Retirees
Authors: Iriarte Antonia Diaz-Valdes , Sellers Christina
Published: December 2020

Alcohol use and depression are underrecognized problems affecting older adults, and its prevalence has increased for baby boomers compared to prior generations. Approximately 40% of people aged 65+, drink alcohol and approximately 19% experience. Additionally, the loss of important roles in life – such as being an employee, could negatively influence mental health at retirement. Although there is mixed evidence about the direction of the association between alcohol and depression in this population, and little is known about how retirement influence it. Generalized mixed models were performed to test the effect of retirement, alcohol use – drinks per day and binge drinking, and depressive symptoms among older adults. We draw data from the Health and Retirement study (n=11,164). Results suggest that being retired was associated with decreased depressive symptoms (b=-0.04, p<0.05) and increased drinks per day (b=0.01, p<0.05) and binge drinking (b=0.11, p<0.05). Each additional drink per day (b=-0.11, p<0.05) and binge drinking (b=-0.07, p<0.05) lead to decreased depressive symptoms. Similarly, increased drinking or binge drinking were associated to decreased depressive symptoms. Regular drinkers might increase their drinking to occupy the additional free time that comes with retirement, to alleviate anxiety and feelings of loneliness as they lost their working roles and they might have lost relatives, which might increase the craving for alcohol. Given the prevalence of depression and alcohol use, and its detrimental effects among older adults. Further research needs to be done to understands the particularities of this group and to generate interventions focused on prevention.
Occupational Future Time Perspective Mediates Age Differences in Conflict Strategies
Authors: Yeung Dannii , Ho Alvin
Published: December 2020

Building on the theoretical framework of socioemotional selectivity theory (Carstensen, 2006), this presentation reports the findings of two studies conducted in Hong Kong Chinese workers to examine whether occupational future time perspective (OFTP) can account for the age differences in conflict strategies. Study 1 is a cross-sectional study with 416 working adults completed an online survey on conflict management (Mage=39.1 years, SD=12.1), and Study 2 is a laboratory study with 123 workers (Mage=40.1 years, SD=12.1) indicated their behavioural responses after watching hypothetical workplace conflict videos. In both studies, five conflict strategies (integrating, compromising, obliging, avoiding, and dominating) and OFTP (focus on opportunities and focus on limitations) were assessed. Parallel mediation analyses were performed. The results of Study 1 showed that both focus on opportunities and focus on limitations mediated the effects of age on obliging (b = -.006, SE=.002; and b = .006, SE=.002, respectively), avoiding (b = -.005, SE=.002; and b =.008, SE=.002, respectively), and dominating (b = -.014, SE=.003; and b = .009, SE=.002, respectively). Focus on opportunities could only account for the effects of age on integrating and compromising. The results of Study 2 showed that only focus on limitation could account for the age variations in the use of avoiding (b = .196, SE = .058) when facing intergenerational conflicts. The findings of this project reveal that the age-related focus on limitations increases older workers’ likelihood to utilize maladaptive conflict strategies, such as dominating and avoiding, to deal with conflicts occurred in the workplace.
The Effects of Situational Peers and Support Groups on the Well-Being of Grandmothers Raising Grandchildren
Authors: Jeanblanc Alexandra , Musil Carol , Burant Christopher , Wallace McKenzie
Published: December 2020

Grandmothers raising their grandchildren face not only the demands of parenting, but the added burden of parenting a child they did not expect to raise. Similarly, grandmothers living in multigenerational households need to balance expectations and household/caregiving tasks across the generations. As part of a nationwide RCT designed to lessen the stress associated with the caregiving burden of raising grandchildren, we asked 342 grandmothers raising their grandchildren about their engagement with support groups and whether their social network included other grandfamilies. Here, we examine the effect of situational peers and support group engagement on grandmother’s stress, reward, social support, mental health, mindfulness, and resourcefulness. Of our sample, 53.8% (N=184) reported belonging to a support group. The majority of participants (138) belonged to online support groups on Facebook, 41 reported participating in in-person support groups, 3 belonged to both in-person and online support groups, and 8 did not respond. When asked whether and how well our participants knew other families like theirs, 31% (106) said they did not know any, 40.6% (139) knew of at least one, but not well, and 28.4% (97) said they had at least one friend with a family like her own. Knowing other families like their own affected self-appraised stress, but no other outcomes. Grandmothers participating in support groups had lower mindfulness scores, higher stress, and worse mental health scores than grandmothers not participating in support groups, possibly reflecting the higher need for support among those participants.
End-of-Life Decision Making in Chronic Life-Limiting Disease: A Concept Analysis and Conceptual Model
Authors: Levoy Kristin , Tarbi Elise , De Santis Joseph
Published: December 2020

Most deaths from chronic life-limiting diseases are preceded by end-of-life decisions, yet patients and caregivers are ill-equipped to make them. The lack of a common vocabulary surrounding end-of-life decision making and the paucity of conceptual models that explicate its components hamper improvements in clinical practice and research. Walker and Avant’s method for concept analysis was used to investigate uses of “end-of-life decision making” in the literature in order to identify its components (antecedents, attributes, consequences), describe stakeholder roles (patients, family/caregivers, health care providers), and develop a conceptual model. An iterative search strategy resulted in 143 included sources. These encompassed 1,127,095 patients (primarily older adults), 3,384 family/caregivers, and 588 healthcare providers. Evidence revealed that end-of-life decision making is a process, not a discrete event. This begins with preparation (antecedents), which involves the designation of a decision maker and iterative patient, family/caregiver, and healthcare provider communication across the chronic illness. These preparatory processes inform end-of-life decisions, which possess three attributes: 1) serial choices in the terminal illness phase that are 2) weighed in terms of their potential outcomes 3) through patient and family/caregiver collaboration. The components impact patients’ death experiences, caregivers’ bereavement, and healthcare systems (outcomes). The resulting conceptual model highlights the larger context of preparation (beyond advance care planning) and the prominent role of caregivers in the end-of-life decision making process. Enhanced measurement must account for the dose, content, and quality of the preparation and decision components that collectively contribute to outcomes, which holds implications for practice improvements and research.
What Would People Think? Social Norms, Willingness to Serve as a Surrogate, and End-of-Life Treatment Decisions
Authors: Spalding Rachael , Strough JoNell , Edelstein Barry
Published: December 2020

Population aging has increased the prevalence of surrogate decision making in healthcare settings. However, little is known about factors contributing to the decision to become a surrogate and the surrogate medical decision-making process in general. We investigated how intrapersonal and social-contextual factors predicted two components of the surrogate decision-making process: individuals’ willingness to serve as a surrogate and their tendency to select various end-of-life treatments, including mechanical ventilation and palliative care options. An online sample (N=172) of adults made hypothetical surrogate decisions about end-of-life treatments on behalf of an imagined individual of their choice, such as a parent or spouse. Using self-report measures, we investigated key correlates of willingness to serve as surrogate (e.g., decision-making confidence, willingness to collaborate with healthcare providers), and choice of end-of-life treatments. Viewing service as a surrogate as a more typical practice in healthcare was associated with greater willingness to serve. Greater decision-making confidence, greater willingness to collaborate with patients’ physicians, and viewing intensive, life-sustaining end-of-life treatments (e.g., mechanical ventilation) as more widely accepted were associated with choosing more intensive end-of-life treatments. The current study’s consideration of both intrapersonal and social-contextual factors advances knowledge of two key aspects of surrogate decision making—the initial decision to serve as surrogate, and the surrogate’s selection of various end-of-life treatment interventions. Providers can use information about the role of these factors to engage with surrogates in a manner that better facilitates their decision making.
Does Poor Sleep Quality Predict Functional Limitations?
Authors: Friedman Elliot , Teas Elizabeth
Published: December 2020

Previous work from our group (Friedman, 2016) linked sleep complaints to declines in mobility and risk of incident limitations over a 9-10 year follow-up among middle-aged and older adults. While these results suggest that poor sleep might undermine functional capacity, the self-report nature of the data leaves the robustness of this association unclear. The current study addressed this uncertainty by examining links between sleep and mobility limitations using subjective and objective assessments of both. Data were from the Midlife in the United States (MIDUS) study: the biomarker sub-sample (N = 664) from the original cohort (collected 2004-2006) and the Refresher cohort (collected 2011-2013). Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI; subjective) and 7 consecutive days of actigraphy (objective). Functional capacity was assessed by self-report of limitations and measured gait speed, grip strength, and chair stands. In linear regression models adjusting for demographic and health factors, lower PSQI scores (better sleep quality) predicted fewer reported limitations, stronger grip, quicker gait, and faster chair stands (all p<.01). Of the objective sleep metrics, time to fall asleep and time spent awake during the night predicted more self-report limitations, weaker grip (latency only), and slower gait speed and chair stands. These results extend our prior work by showing a) subjective sleep is linked to measured as well as self-reported physical function, and b) objective assessments of sleep predict reduced physical function, albeit to a lesser extent. They also brighten the spotlight on sleep as a key health determinant in older adults.
The Evaluation of a Modified Decision Aid for Older Women With Low Health Literacy
Authors: Cadet Tamara , Schonberg Mara
Published: December 2020

Given the lack of evidence recommending mammography for women >75 years, guidelines recommend that older women be informed of the uncertainty of benefits and of potential harms. The objective for this study was to evaluate the effect of a mammography decision aid (DA) designed for older women with low health literacy (LHL) on their decisional conflict and knowledge of mammography’s benefits and harms in a pretest-posttest trial. Women, 75-89 years were eligible for this study if they had not had a screening mammogram in six months, a history of breast cancer/dementia and had LHL (defined as reporting difficulty completing medical forms on one’s own or obtaining < college education). Forty-four women participated. their mean age was 78, 74% had a high school degree or less, and 53% were non-Hispanic White. Overall, women reported that the DA helped them prepare to talk with their clinician quite a bit (Mean =3.6/5.0 on preparation for decision making scale) and 97% found the DA helpful. Using McNemar’s test, decisional conflict did not change and knowledge on a 10 item true/false test on mammography screening did not change; however, after receiving the DA women were correctly less likely to think that having a mammogram would prevent cancer. With the shift toward shared decision-making for women > 75 years, there is a need to engage women of all literacy levels to make these decisions and we have developed a DA on mammography screening for older women with LHL that these women perceive to be helpful.
Cultivating Generative Connection Through Agricultural Leadership
Authors: Bower Kyle
Published: December 2020

Adult agricultural leadership programs (ALP) address the needs of a diversifying society with pressing social, economic, environmental, and political challenges. Additionally, these programs offer transformative learning experiences that lead to a greater capacity of current and prospective leaders to become change agents in their communities. Our aging society generates a novel opportunity to reframe experiences of professional succession and retirement within the agricultural sector. In a profession where vitality, strength, and perseverance are fundamental, the agricultural industry needs leaders who remain aware of the foundational knowledge contributed by their predecessors. At the same time, it also necessitates innovation that may revolutionize the farming industry for decades to come. In this mixed-method study, we asked participants of an ALP in the Southeastern region of the U.S. to complete the Loyola Generativity Scale (N=45). Survey results (N=45; 60% response rate) indicated average overall generative (40.3; 40-41 scale average) concern. However, there was a considerable variation among participants, scores ranging from 25-57 (scale range 20-55). To understand the range of attitudes, we conducted interviews (N=10) to represent the distribution of scores by varying ages (M=38), gender, and educational background. Generativity Theory provided the foundation of our thematic qualitative analysis. We discuss the findings in terms of generative desire (motivational), beliefs (thoughts and plans), and actions (behaviors and applied meaning). Our quantitative and qualitative findings advance the conversation of the importance of maintaining social capital throughout one’s career and identifying generative connections that assist with difficult transitions, such as retirement, in later life.
Predictors of Change in Osteoporosis Knowledge, Health Beliefs, and Self-Efficacy After an Education Intervention
Authors: Labrias Philippe Ronel , Feinn Richard , Johnson Shanthi , McLeod Katherine
Published: December 2020

Education interventions that increase osteoporosis knowledge and address health beliefs and self-efficacy help older adults make informed decisions to prevent and manage the disease. The aim of this study was to determine if clinical risk factors for osteoporosis moderate the effect of a multifaceted education intervention on osteoporosis knowledge, health beliefs, and self-efficacy. Patients 50 years and older with no prior diagnosis of or treatment for osteoporosis were referred by their primary care provider for bone mineral density testing by DXA and randomized to an osteoporosis education intervention group (n = 102) or usual care group (n = 101). Demographic and health history questionnaires, and validated tools to assess osteoporosis knowledge, health beliefs and self-efficacy were completed at baseline and 6-month follow-up. Results of the linear mixed-effects model showed a significant interaction with younger age (p=.024) on self-efficacy among patients in the intervention group compared to the usual care group. Patients with higher BMI had greater perceived health motivation (p=.026) in the intervention group. Compared to the usual care group, patients in the intervention group with higher vitamin D intake had greater perceived exercise (p=.020) and calcium benefits (p=.012) and those with a family history of osteoporosis had greater perceived susceptibility to osteoporosis (p=.045). By understanding the key factors that predict change in knowledge, health beliefs and self-efficacy after an education intervention compared to usual care, we can better tailor interventions to enhance prevention and management of osteoporosis.
Who Benefits in Vitality After Retirement? Findings From a 3-Year Panel Study
Authors: Vanajan Anushiya , Bültmann Ute , Henkens Kène
Published: December 2020

Background. Past studies have revealed the effect of retirement on various health measures. None, however, have studied retirement’s effect on vitality, a holistic measure of physical and mental health. To boot, very few studies have addressed the heterogeneity in the health consequences of retirement. This study investigates the effect of retirement on vitality, and how this effect is influenced by 1) manual work and 2) baseline vitality. Methods. The analyses were based on two waves of the NIDI Pension Panel Survey, collected in the Netherlands in 2015 and 2018. Data from 4,156 older workers (N=4,156), of whom 1,934 (46.5%) retired between waves, were analysed. Vitality is assessed in three ways, as: 1) a composite measure of vitality, and its sub-components 2) energy and 3) fatigue. Results. Conditional Change OLS Regression Models demonstrate that retirement improves vitality and decreases fatigue. These effects were heterogeneous. Retirement was more advantageous for older workers who experienced poor vitality and increased fatigue before retirement. Likewise, older workers who were employed in manual work before retirement, experienced the largest gains in vitality and deepest declines in fatigue post-retirement. No such effects were found for energy. Conclusions. Older workers experiencing low baseline vitality and high baseline fatigue and those in manual labor may benefit from early retirement. Since early retirement is financially unfavorable, it is essential to provide these groups of workers with workplace vitality interventions that may not only improve their vitality and quality of working life, but also extend their participation in the labor market.
Language and Memory Reserve Mediate Protective Effects of Social Support on MCI or Dementia Risk in Older Women
Authors: Petkus Andrew , Gruenewald Tara , Youan Diana , Wang Xinhui , Gatz Margaret , Espeland Mark , Chen Jiu-Chiuan
Published: December 2020

More supportive social relationships are protective of cognitive decline in older adulthood. Although supportive social relationships are hypothesized to promote cognitive reserve (CR; the cognitive adaption to neuropathology), it is unknown whether CR mediates associations between social support and risk of developing mild cognitive impairment or dementia (MCI/dementia). Data from 815 women (aged 73-87 years) participating in the Women’s Health Initiative Memory Study-MRI cohort (WHIMS-MRI) and Women’s Health Initiative Study of Cognitive Aging (WHISCA) were analyzed to examine whether domain-specific estimates of CR mediate associations between social support and incident MCI/dementia risk. Women completed the Medical Outcomes Study Social Support Scale (MOS-SS) in 2004-2005, a structural MRI (sMRI) of the brain in 2005-06, and annual extensive neuropsychological examinations till 2018. CR (6-months after completing the MOS-SS) was estimated across different domains (e.g. verbal memory, figural memory, language, visuospatial, and attention) as the residual variance after regressing out effects of sMRI variables, sociodemographic factors, and measurement error. Structural equation models were constructed to examine whether CR mediate associations between social support and MCI/dementia risk while adjusting for covariates. Higher social support was associated with lower MCI/dementia risk (hazard ratio=0.85 per 1-SD;p=0.037), higher language reserve (standardized β=0.09;p=0.008) and verbal memory reserve (standardized β=0.08;p=0.025). Language and verbal memory reserve each significantly explained approximately 14% of the protective effect of social support. Findings illustrate the heterogeneous effect of social support on CR, highlighting the importance of language and verbal memory reserve as mediators of the association between social support and MCI/dementia risk.
Pandemic Preparedness of Care Homes Serving Older Adults in the Wake of COVID-19: An Exploratory Study
Authors: Amin Iftekhar
Published: December 2020

Recent COVID-19 pandemic has disproportionately affected the older adult population worldwide. According to CDC, among older adults over 60 years the risk increases with age, with the highest risk of serious illness and death among those over 80 years. While public has been receiving messages about the risks and how to take preventive measures, it is not clear how the care homes serving older adults have been preparing. Data have been collected as part of an ongoing study from 30 independent living, assisted living, and memory care facilities across the United States. The centers were selected with a snowball sampling technique. Administrators of the centers were interviewed with a semi-structured questionnaire. It was apparent that although awareness of risks was high, preparation appears to be inadequate with little resources available at the time of the survey. Variation of preparedness based on the sociodemographic characteristics of the residents suggests that homes that serve predominantly minority and economically disadvantaged have greater likelihood of lacking preventive resources. It is critical that facilities serving older adults be prepared to ensure an effective healthcare response in the wake of novel viruses, such as COVID-19.
Surviving Together by Staying Apart: How Older Adults Experienced the COVID-19 Crisis
Authors: Miller Julie , D’Ambrosio Lisa , Balmuth Alexa , Brady Samantha , Raue Martina , Patskanick Taylor , Rudnik John , Coughlin Joseph
Published: December 2020

The repercussions of novel coronavirus (COVID-19) within the United States and across the globe are vast. Researchers at the MIT AgeLab conducted a national online survey (N=1200) related to COVID-19 in March 2020 with the goal of exploring participants’ COVID-19-related attitudes, hygiene and consumer behaviors, and their use of technology to work, make purchases, stay informed, and stay socially connected. In this presentation, AgeLab researchers will describe findings among a sub-population of study participants deemed to be at highest health risks for the virus: adults ages 60 and over. Findings demonstrate that the largest group of participants stayed informed about COVID-19 primarily through online sources. As a result of the virus, most had made changes to their health and hygiene practices, including implementing social distancing measures, and the majority had changed at least one of their purchasing behaviors, most often buying more products than usual online. Second only to participants’ physical health concerns related to COVID-19 were their financial health concerns, both related to near-term finances and longer-term financial goals. From this study, policy and practice implications emerge across public, private, and non-profit sectors that, taken together, can prepare older adults and their loved ones to survive and thrive during global emergencies.
Creating a Novel Physical Resilience Measure among Older Adults: The Health, Aging, and Body Composition Study
Authors: Wu Chenkai , Li Ya-Xi , Odden Michelle , Marron Megan
Published: December 2020

The concept of resilience has gained increasing attention in aging research; however, current literature lacks consensus on how to measure resilience. We constructed a novel resilience measure based on the degree of mismatch between persons’ frailty level and disease burden and examined its predictive validity. We also sought to explore the physiological correlates of resilience. Participants were 2,457 older adults from the Health, Aging, and Body Composition Study. We constructed the resilience measure as the residual taken from the linear model regressing frailty on age, sex, race/ethnicity, 14 diseases, self-reported health, and number of medications. Participants were classified into three groups—adapters, expected agers, and premature frailers—based on residuals (less than, within, or above one standard deviation of the mean). Validation outcomes included years of able life (YAL), years of healthy life (YHL), years of healthy and able life (YHAL), disability, hospitalization, and survival. The average YHAL was 5.1, 7.7, and 9.1 years among premature frailers, expected agers, and adapters, respectively. Compared with premature frailers and expected agers, adapters had significantly lower rates of disability, hospitalization, and mortality and higher proportion surviving to 90 years. The likelihood of surviving to 90 years was 20.4%, 30.6%, and 39.7% among premature frailers, expected agers, and adapters. We developed and validated a novel approach for quantifying and classifying physical resilience in a cohort of well-functioning white and black older adults. Persons with high physical resilience level had longer healthy life span and lower rates of adverse outcomes.
Patterns of Weight Change in Aging and Dying
Authors: Thielke Stephen
Published: December 2020

Little research has characterized the natural history of weight change in older adults. Different changes may occur during aging and dying. We analyzed 18 years of weight measures from a cohort of 736,361 Veterans, all of whom had died at age 70 or older. We produced summary measures that accounted for both chronological age and number of years before death. Several clear population-level trends appeared. (1) The average weight of the sample declined across all ages at a rate of about 0.18 BMI points per year. (2) Starting about seven years before death, the amount of loss began to accelerate, reaching a decline of 0.75 BMI points in the year before death. (3) Changes in weight relative to years of remaining life were independent of chronologic age. People who died at age 70 experienced, on average, the same type and duration of terminal decline as did those who died at age 95. (4) The dying process involved a cumulative loss of about 1.3 BMI points. (5) The distribution of weights during advancing age both declined and narrowed. (6) Disproportionate deaths occurred at the lower BMI ranges (below a BMI of 24), and especially below 18, regardless of age. (7) The finding in #5 is explained by the entire cohort losing weight, with death of the thinnest members. These findings argue for examining survival time in studies of weight change. They indicate that weight loss may be a natural part of dying, rather than a risk factor for it.
The Need to See the World: Outings and Meaningful Engagement Among Assisted Living Residents With Dementia
Authors: Ciofi Joy , Kemp Candace , Duong Stephen , Hill Andrea , Baidoo Anna Lisa , Wood AprilSpring , Manley Pamela , Bender Alexis
Published: December 2020

Meaningful engagement is a promising avenue for enhancing the lives of persons with dementia. Yet, engagement can prove challenging across care settings. Here, we report on our ongoing 5-year NIA-funded study (R01AG062310) aimed at identifying best practices for promoting meaningful engagement opportunities among assisted living residents with dementia. Guided by grounded theory method, the study involves multiple modes of qualitative data collection, including: participant observation; resident record review; and in-depth interviews with residents (when possible), assisted living staff, residents’ family and friends, volunteers, and others involved in residents’ daily lives. We present analysis of data collected in 4 diverse care settings studied in-depth over a one-year period and focus on “outings” or instances when residents leave the assisted living setting. Findings show the variable nature, content, and frequency of outings and demonstrate the advantages, disadvantages, and challenges associated with taking persons living with dementia out of their living environments. Outings represent an opportunity “to get out,” “see the world,” and “not be stuck inside.” Yet, outings are not universally successful and sometimes create frustration, distress or confusion. Multiple factors intersect to influence residents’ opportunities to participate in and derive benefit from outings, including residents’ cognitive and physical function, and personal preferences, and formal and informal care partners’ knowledge, attitudes, behaviors, and resources. Care setting practices and policies, resources, size and location, and community connections also shape opportunities for and experiences with outings among residents living with dementia. We discuss the implications of our findings for research, policy, and practice.
Intergenerational Relationships, Social Support, and Psychological Well-Being Among Korean Older Adults
Authors: Lee Yooumi , Wilmoth Janet
Published: December 2020

This study investigates whether intergenerational relationships and social support improve the psychological well-being of Korean older adults. We examine whether intergenerational relationships and social support directly influence psychological well-being and the extent to which they mediate the distressing consequences of life events such as declining health and recent widowhood. Using longitudinal data from the 2006 to 2016 Korean Longitudinal Study of Aging, we explore depression trajectories among individuals who are 60 or older with at least one living adult child at baseline. Specifically, we converted data from 5,383 older adults into a person-period file with 24,726 observations over a ten-year period. Then we estimated linear growth curve models of depression trajectories separately for men and women using the Center for Epidemiologic Studies Depression Scale (CES-D). Results from the hierarchical linear models indicate that declining health and recent widowhood are positively related to depressive symptoms. Satisfactory intergenerational relationships and social support in the form of personal interactions and proximate living arrangements with adult children decrease depressive symptoms of older parents, especially among women. We conclude that the psychological benefits of intergenerational relationships and social support are contingent upon the vulnerability of older adults and discuss the implications for public policy.
Social Isolation and Cognitive Function: Evidence From Older Chinese Americans
Authors: Kong Dexia , Chao Ying-Yu , Tang Fengyan , Dong XinQi
Published: December 2020

Chinese older adults are particularly vulnerable to social isolation due to various barriers they face in developing/maintaining social networks (i.e. limited English proficiency and transportation barriers) in the U.S. However, the prevalence of social isolation and its potential health consequences in this rapidly growing minority aging population remain poorly understood. To address this knowledge gap, the current study examines the prevalence of social isolation, and the relationship between social isolation and cognitive function among U.S. Chinese older adults. Data were obtained from the Population-based Study of Chinese Elderly in Chicago collected between 2011 and 2013 (N=3,157). A four-item index (including living alone, not married, lack of confidant, and low participation in social activities) was constructed to assess social isolation (range: 0 to 4, a score of ≥2 was used to identify individuals who were most isolated). Cognitive function was measured by five validated instruments (range: -2.8 to 2.0). Nearly 22% of the sample were socially isolated. Multivariable linear regression analysis showed that social isolation accounted for 44% of variance in global cognitive functioning. Chinese older adults with greater levels of social isolation had poorer overall cognitive function (B= -0.05, SE=0.01, p=0.001). Study findings highlight the importance of addressing social isolation in cognitive aging among older Chinese Americans. Culturally tailored interventions facilitating the development of supportive social networks/ support have the potential to mitigate cognitive decline in this population. Future longitudinal studies need to elucidate potential mechanisms underlying the relationship between social isolation and cognitive function. Practice implications will be discussed.
The Health and Well-Being of African-American Older Adults With a History of Incarceration
Authors: Sneed Rodlescia
Published: December 2020

African-Americans are overrepresented in the criminal justice system. Longer prison stays and release programs for older prisoners may result in an increased number of community-dwelling older adults with a history of incarceration. In recent years, there has been a substantial increase in research on health-related outcomes for currently incarcerated older adults; however, there has been little inquiry into outcomes for formerly incarcerated African-American older adults following community re-entry. In this study, we used secondary data from the Health and Retirement Study to describe employment, economic, and health-related outcomes in this population. Twelve percent of the 2238 African-Americans in our sample had been previously incarcerated. Those who had been previously incarcerated had higher rates of lung disease, arthritis, back problems, mobility problems, and mental health issues than their counterparts. They also had higher rates of hospitalization and lower use of dental health services. Further, while they did not experience lower employment rates than those with no criminal history, those who had been incarcerated had more physically demanding jobs and reported greater economic strain. Given the disproportionate incarceration rates among African-Americans, the aging of the prison population, and the increase in community re-entry for older prisoners, research that explores factors that impact the health and well-being of formerly incarcerated individuals has broad impact. Future work should focus on addressing the needs of this vulnerable population of African-American older adults.
Can Women Have It All: Marriage, Family, Career, and Good Health?
Authors: Cooney Julene
Published: December 2020

Women in the U.S. have been earning more education than their male peers since the mid-1990’s. High power career positions that have historically been dominated by men are increasingly being filled by women. At the same time, since 2000, the U.S. workforce participation rate for women aged 25 – 55 has leveled off and begun to fall. Called the “mommy-wars” in the media, a heated debate has ensued between those women who feel that the role of mother should preempt seemingly selfish desires to engage in career work, while others firmly believe that it is possible to have it all; work, marriage and family. The purpose of this research project is to determine the health implications of each lifestyle for women later in life. Using the Health and Retirement Study, I compare self-rated health trajectories for the subset of women who are married, have children, and have attended college – those who are most likely to have the option to “opt-out” of the workforce for a stay-at-home mother lifestyle. Controlling for income and childhood health, and using growth curves and multivariate regression, preliminary results indicate that educated, married women who work full-time and raise children are the healthiest after age 50, while educated, married women who stay home with their children and do not work are the least healthy. In addition, these health trajectories have changed little since the 1950’s, even as cultural expectations for women have shifted.