bluuebunny/crossref_metadata_2025 huggingface dataset:
Genome assembly of the common pheasant Phasianus colchicus, a model for speciation and ecological genomics
Authors: Liu Yang , Liu Simin , Zhang Nan , Chen De , Que Pinjia , Liu Naijia , Höglund Jacob , Zhang Zhengwang , Wang Biao
Published: November 2019

The common pheasant (Phasianus colchicus) in the order Galliformes and the family Phasianidae, has 30 subspecies distributed across its native range in the Palearctic realm and has been introduced to Europe, North America, and Australia. It is an important game bird often subjected to wildlife management as well as a model species to study speciation, biogeography and local adaptation. However, the genomic resources for the common pheasant are generally lacking. We sequenced a male individual of the subspecies torquatus of the common pheasant with the Illumina Hiseq platform. We obtained 94.88 Gb of usable sequences by filtering out low-quality reads of the raw data generated. This resulted in a 1.02 Gb final assembly, which equals the estimated genome size. BUSCO analysis using chicken as a model showed that 93.3% of genes were complete. The contig N50 and scaffold N50 sizes were 178 kb and 10.2 Mb, respectively. All these indicate that we obtained a high-quality genome assembly. We annotated 16,485 protein-coding genes and 123.3 Mb (12.05% of the genome) of repetitive sequences by ab initio and homology-based prediction. Furthermore, we applied a RAD-sequencing approach for another 45 individuals of seven representative subspecies in China and identified 4,376,351 novel single nucleotide polymorphism (SNPs) markers. Using this unprecedented dataset, we uncovered the geographic population structure and genetic introgression among common pheasants in China. Our results provide the first high-quality reference genome for the common pheasant and a valuable genome-wide SNP database for studying population genomics and demographic history.
ACCESS TO CARE ROUNDS: A UNIQUE FORUM FOSTERING HEALTH SYSTEM AND SOCIAL SERVICE PARTNERSHIPS FOR OLDER VETERANS
Authors: Nearing Kathryn A , Lum Hillary D , Kamper Heather , Cannizzaro Kaily A , Bauers Courtney , Sussman Joleen C
Published: November 2019

Colorado Veteran Community Partnership (VCP) aims to connect Rocky Mountain Regional VA Medical Center front-line teams with diverse community partners to create integrated networks of support for older Veterans with complex needs and their family members and caregivers. To accomplish this goal, VCP launched Access to Care Rounds in January 2018 to build bridges between the healthcare system and community-based organizations. Each Access to Care Rounds features a cross-sector panel that discusses specific efforts to link a medically-complex, older Veteran to resources. This model was developed with stakeholder input and has highlighted topics related to chronic pain management, suicide prevention, homelessness, adult protective services, transportation, home-based primary care, hospice care, and firearm safety. Each Access to Care Rounds focuses on connecting VCP members, sharing expertise and resources, and highlights lessons learned related to care coordination, communication, and key processes that others can adopt/adapt to better serve older Veterans. On average, 30 individuals attend each session. Access to Care Rounds draw diverse audiences representing social services, mental health and other healthcare specialties. The latter include Social Workers (47%), Physicians (11%), Psychologists (8%), Registered Nurses (6%), and students/trainees (6%). Participants receive a description of the Veteran situation; the names, credentials, organizational affiliations and roles/expertise of each panelist; and, a resource list relevant to the constellation of issues addressed to enhance access to information and resources. Over 38% of respondents to session evaluations reported intentions to change their professional practice as a result of what they learned during an Access to Care Rounds.
DEPRESSION AND MEDICAL COST OF CARDIOVASCULAR DISEASES
Authors: Wang Guijing , Park Chanhyun , Joo Heesoo , Hawkins Nikki , Fang Jing
Published: November 2019

Prevalence of cardiovascular disease (CVD), the leading cause of death worldwide, increases with age. Depression is a prevalent comorbidity with CVD. This study investigates the medical costs of CVD associated with depression using a nationally representative data, 2015 Medical Expenditure Panel Survey. Patients aged ≥18 were identified by using the International Classification of Disease, 9th Revision codes of 390-459 for CVD and 296 or 311 for depression (N=23,755). Medical costs were actual payments received by providers and classified by service types and payment sources. We estimated the medical costs for each service type and payment source using economic modelling techniques controlling for various potential confounders. Overall prevalence of depression was 11.4%; 17.0% in persons with CVD and 8.7% in persons without CVD (p<0.001). Medical cost with depression was estimated at $6900 (p<0.001) for persons with CVD and $2211 (p<0.001) for those without. Costs on depression-related prescription medicines accounted for the largest portion of medical costs among persons with CVD ($3095, p<0.001). For persons with depression but without CVD, costs on outpatient visits accounted for the largest proportion ($1179, p<0.001). Medicare payments accounted for the largest portion of the depression-associated costs at $3338 (p=0.014) for persons with CVD. Compared with persons without CVD, those with CVD demonstrated doubled rates of depression. Depression-associated medical costs among individuals with CVD were tripled what they were for persons without CVD. Increased costs associated with depression were mainly for prescribed medicines and were financed by Medicare programs for persons with CVD.
CUSTODIAL AND CO-RESIDENT GRANDMOTHERS SERVICE USE AND NEEDS: 10 YEARS APART
Authors: Jeanblanc Alexandra B , Wallace McKenzie , Musil Carol M
Published: November 2019

The period between 2008 and 2017 spans a period of economic and societal flux in America, including the 2008 recession, the Affordable Care Act, and the emergence of the opioid crisis. These changes have had profound effects on families, including the rise in grandparent-headed and multigenerational households and their financial, resource, and service needs. We compared the service needs and utilization patterns of 334 co-resident grandmothers who were participants in two independent NIH-funded studies of grandmothers raising grandchildren, conducted 10 years apart (2008-2009:n=145 and 2018-2019:n=189) Researchers asked both samples whether they received or had an unmet need for 16 types of services (ex: financial, legal, substance abuse, respite care). There were statistically significant differences between the samples on 8 of 16 services received, and 15 of 16 unmet, but recognized, service needs, with our current sample reporting higher usage and need. The largest percentage increases in need were financial assistance (31.5%), respite care (29.9%), exercise/fitness (26.4%), and family therapy (25%). Although there is a 7% increase in legal services received between the samples, 48.1% of the 2018-19 sample still report unmet legal needs, compared to 16.6% of the 2008-09 sample. We observed a significant difference in an unmet need for help to families dealing with drug and alcohol abuse, with 23% of current participants reporting unmet need, compared to 9% in the prior study. Our results highlight a gap in resources available to grandfamilies and highlight the need for intervention and evaluation research targeting service needs to inform policy change.
EVALUATING A CONSUMER-DIRECTED HEALTH CARE PILOT FOR OLDER PEOPLE IN THE COMMUNITY
Authors: Phelan Amanda A , Duggan Alice , O’Donnell Deirdre , Gerard and Fealy
Published: November 2019

In an ageing society with a policy focus on community (Oireachtas 2017), providing choice and self-determination in home care provision for older people is fundamental. Consumer directed care has increased in popularity in many countries (Low, Yap & Brodaty, 2011). In 2016, planning began in Community Healthcare Organisation 3 to pilot a CDHC pilot for community based older people. This study presents the findings of this pilot project. The study used the Moore et al.’s (2015) evaluation approach. Data collection methods were via descriptive questionnaires with qualitative investigation of stakeholder experiences as well as an economic review. Findings demonstrated the need for additional clarity in understandings of the CDHC. Care recipients and caregivers did report satisfaction with care, however, it was the accessibility of care rather than choice that was considered important. There were also issues related to capacity to manage the CDHC as well as capacity to give a choice of providers, particularly in rural areas. Although, broadly cost-neutral, processes and structures also require additional alignment to enhance both effectiveness and efficiency. Empowering care recipients and enabling greater choice, flexibility and autonomy in care organisation and delivery was a central focus of the CDHC pilot. However, additional consumer awareness and programme enhancement is needed to fully realize the potential of the CDHC. Study recommendations focus on areas of increased clarity about the CDHC, implementation enhancement, complementarity and incorporation of CDHC with existing home support service provision arrangements
HIGH ON SMI: QUALITY CONCERNS ABOUT NURSING HOMES SERVING HIGH PROPORTIONS OF SERIOUSLY MENTALLY ILL RESIDENTS
Authors: Jester Dylan J , Hyer Kathryn , Bowblis John R
Published: November 2019

The proportion of nursing home (NH) residents that have serious mental illness (SMI) has increased over the least two decades. Residents with SMI tend be younger and have different medical needs than traditional residents. To better understand this population, our study examined the facility, staffing, and resident characteristics of NHs that were more likely to specialize in SMI. Utilizing the Certification and Survey Provider Enhanced Reports, low-SMI (N = 3,616) and high-SMI (N = 3,615) NHs were defined as the first and fourth quartile of the distribution of the proportion of SMI residents, respectively. We performed bivariate tests and multivariate logistic regression to compare facility, staffing, resident, and star-ratings characteristics between NHs. High-SMI NHs were less likely to be Not-For-Profit, have fewer beds, have more Medicaid-paying residents, lower registered nurse staffing, and lower certified nurse aide staffing levels (p’s<.001). Residents in high-SMI NHs were more likely to require behavioral healthcare (p<.001) and be treated with psychoactive medications (any psychoactive, antidepressants, antipsychotics, anxiolytics (p’s<.001), hypnotics (p<.01)). Finally, high-SMI facilities had lower overall quality, health inspection, quality measure, staffing, and registered nurse staffing star-ratings (p’s<.001). High-SMI NHs have characteristics that are associated with lower quality-of-care (e.g., For-Profit, more Medicaid), lower staffing, prescribe more psychoactive medications, and have lower star-ratings. As the SMI population grows, large numbers of SMI residents will concentrate in a few NHs. While further research is needed to understand the implications of these trends, policy-makers must be aware of this population when affecting the resources and staffing of NHs.
PSYCHOSOCIAL STATUS, RESILIENCE, AND DEPRESSION OF OLDER CAREGIVERS IN TAIWAN
Authors: Kuo Tsuann , Ng Hei-Yin , Han Der-Yan
Published: November 2019

A rapidly increasing older population and changing family structures in Taiwan have resulted in a significant shift in caregiving resources; there are now more older caregivers, and their psychosocial well-being and quality of life may be affected as a result of their new responsibilities. This study used secondary data from the 2018 Survey of Elderly Mental Health (N=1,113) to examine the psychosocial status, resilience, and depression of caregivers who were 65 years old and older. The results showed that the typical older caregiver was 74.15 years old, likely to be married and living with a spouse (63.6%), retired (57.4%), and had a monthly income less than 30,000 NT (30.7%). Compared with caregivers under 65 years of age, older caregivers had higher co-morbidity and lower quality of life as well as greater resilience and higher levels of depression. Both positive emotions (p<0.05) and self-assessed health (p<0.001) were found to be significant variables affecting depression and resilience. And negative emotions (p<0.001) also influenced depression. This study was the first in the nation to tackle issues related to aging caregivers that can identify policy, research, and practice implications to improve the general health and lives of older caregivers. Future research can use the results to explore opportunities for older caregivers that will minimize negative emotions in order to build resilience and combat depression.
DEPRESSION AND HYPERTENSION AS RISK FACTORS OF CARDIOVASCULAR EVENTS AMONG MIDDLE-AGED AND OLDER ADULTS IN CHINA
Authors: Li Lydia , Zhang Zhenmei , Xu Hongwei , Liu Jinyu
Published: November 2019

Objectives: 1) Examine effects of depression and hypertension on cardiovascular events (CV) in a two-year period. 2) Explore urban and rural differences Methods: Data from the first two waves of Chinese Health and Retirement Longitudinal Study, with a national sample of 14,560 adults age 45+, were used. The dependent variable is whether a CV (defined as heart attack or stroke) occurred between baseline and W2 (1=Yes, 0=No), based on respondents’ report at W2. Depression was dichotomized using a score of 12 on the 10-item CES-D. Hypertension was based on self-report. Logistic regression was conducted. Covariates included sociodemographic characteristics and nine other chronic conditions. All independent variables were measured at baseline. Results: About 5.3% (n=768) of the sample had a CV between baseline and W2. Depression increases the risks of CV by 67% for rural (OR=1.67, 95% CI=1.3, 2.12) and 42% for urban respondents (OR=1.42, 95% CI=1.05, 1.91). Hypertension increases the risk by 51% for rural (OR=1.51, 95%CI=1.18, 1.94) but is not statistically significant among urban respondents. Interaction effects of hypertension and residential areas are statistically significant (χ2 (1) = 6.44, p = .01) Conclusion and Discussion: Given the high cost associated with heart attack and stroke, treating depression is an effective approach to reduce health care cost. Hypertension increases the risk of CV for rural but not urban respondents. It may be that hypertension is not as well managed among rural residents as in their urban counterparts. Improving hypertension management among rural residents should be a priority in China.
MINORITY & DIVERSE POPULATIONS I UNWAVERING STRENGTH IN THE FACE OF ADVERSITY: THE STRONG BLACK WOMAN, DEPRESSION, AND BEREAVEMENT
Authors: McDuffie Danielle L , Allen Rebecca S , Black Sheila , Crowther Martha R , Whitlow Ryan , Acker Laura
Published: November 2019

This study sought to investigate grief outcomes among older African American (AA) women following the recent loss of a loved one. Whether or not the “strong Black woman” (SBW) schema of presenting unwavering strength despite adversity was present in recently bereaved older AA women, specifically related to depressive outcomes, also was explored. Eleven AA women aged 46 years and older (M=64.2), completed one time, in-person semi-structured interviews detailing their grief experiences. Interview transcripts were then coded by a team using an inductive qualitative approach. Four themes emerged throughout the women’s bereavement experience: 1) Acceptance of Loss and Preparation, 2) Coping as a Gradual Passing of Time, 3) Engaging in Other Activities to Cope with Loss, and 4) Helping Others Cope. About a third of the women in the sample reported being clinically depressed in accordance with the specifications for Major Depressive Disorder reported in the DSM 5. AA women in the sample were found to portray not only the stoicism consistent with the SBW schema, but also themes consistent with embodying the schema during their bereavement experience. More research and attention should be paid to AA women’s manifestations of depression, under the knowledge that AA women may have nontraditional depressive symptom presentations. Further, the tendency for the SBW schema to emerge during bereavement should be addressed with AA women in clinical practice, as lack of awareness of the use of this mechanism could lead to exacerbated, adverse adjustment.
PSYCHOSOCIAL FACTORS ASSOCIATED WITH SLEEP QUALITY AND DURATION AMONG OLDER ADULTS WITH CHRONIC PAIN
Authors: Zaidel Catherine , Musich Shirley , Karl Jaycee , Wang Shaohung , Kraemer Sandra , Yeh Charlotte
Published: November 2019

Sleep complaints are common among older adults with pain. Due to the risk of side effects, sleep medications are not recommended. Little is known about the association between psychosocial factors and sleep, but further awareness could support non-drug strategies for poor sleep. Our objective was to determine prevalence of self-reported poor sleep and duration among older adults with pain; and examine associations of positive psychosocial characteristics on sleep. This study analyzed surveys and claims from older adults with AARP® Medicare Supplement plans insured by UnitedHealthcare. Participants were 65+ with diagnosed back pain, osteoarthritis and/or rheumatoid arthritis; 12-months plan enrollment. All participants responded to a survey in May 2018 assessing sleep quality. Prescriptions were determined from claims. Propensity weighting was used to adjust for non-response bias. Results were weighted to generalize to those with pain. Multivariate logistic regression was used to evaluate associations. Short sleep duration was most common (39%), followed by poor quality (22%), and long duration (9%). Higher resilience and diverse social networks were associated with good quality and duration. Strongest associations with bad quality and short duration were stress, depression and sleep medications. Psychosocial factors were strongly associated with sleep quality and duration among older adults with pain. Results underscore the importance of social factors on sleep and need for non-drug sleep strategies.
ELECTRONIC USE AND SLEEP, SURPRISING BEDFELLOWS: RESTFULNESS EFFECTS OF ELECTRONICS USE PRIOR TO BEDTIME FOR THE 40-PLUS
Authors: Rainville G , Lampkin Cheryl
Published: November 2019

Getting restful sleep is essential to well-being but stress and poor sleep habits may make sleeping through the night challenging. This research explored life event stressors and pre-sleep activities among 2,464 randomly selected Americans age 40 and older (using Ipsos’ KnowledgeNetwork panel) to determine their joint effects on mental well-being. Respondents reported how often they engaged in twelve individual behaviors within an hour of going to sleep. These behaviors (found to be inter-correlated) were combined using EFA into four factors representing levels of engagement in each of four classes of pre-sleep activities: pre-sleep electronics use (e.g. texting/e-mail before bed), deep relaxation activities, reliance on sleep-aids, and “nightowl” behaviors (i.e., snacking). Counter to expectations, only electronics use had significant conditional effects on the path between a life events stressor index (a count of current, potentially stressful life events) and scores on the positively-framed Warwick Edinburgh well-being scale (WEMWBS). How often one sleeps through the night also had unexpected effects in a conditional path analysis. A somewhat-involved relationship emerges between each of the theoretically-relevant measures. First, the negative impact of stress is moderated by sleeping through the night. Sleeping through the night is, counter to previous studies on electronics use and sleep, mediated by the use of electronics prior to sleep. We propose that mechanisms (such as the nature of backlighting used in electronics) that hamper restfulness may be offset by relaxation effects or by setting one’s ducks in a row by texting/emailing before going to sleep.
THE ISOLATION OF OLDER ADULTS: A COMPARISON OF JAPANESE GENDERS AND HOUSEHOLDS
Authors: Katagiri Keiko
Published: November 2019

As the aging population increases, large changes have occurred among household structures in Japan. Half of older adults lived with their children’s families in 1980. Now around 60 percent of them live by themselves: 27% in single households and 31% as older couples alone. Older adults in single households are said to be at higher risk of social isolation. A Japanese white paper reported that they had scanty of social interactions compared to other types of households. This study examines differences in the social relationships and health statuses among household types by gender and explores the risk factors of social isolation. Nationally representative 2012 Japanese Social Survey data were used for analyses; a subsample comprised participants aged 60 to 74 years. A series of ANCOVAs were conducted. The distribution of the gender and household types were single male 105 (10.0%), married male 387 (36.8%), single female 180 (17.1%), and married female 381 (36.2%); the main effects were being female and married. An interaction effect between them (single males were less happy than married males) was observed. Neighborhood relationships were better among females and married participants. Married participants were more active in community meetings, social participation, and volunteering. However, no difference was observed in social network size. Thus, network size alone was not related to social isolation, but being active in social relationships and the quality of relationships influenced social isolation and well-being. Being married and female may facilitate higher quality relationships and may lead to activity and buffer social isolation.
AGING-FRIENDLY COMMUNITY INITIATIVES: HARNESSING NETWORKS FOR CHANGE FROM THE LOCAL TO THE GLOBAL
Authors: Greenfield Emily , Reyes Laurent
Published: November 2019

Aging-friendly community initiatives (AFCIs) represent multi-sectorial efforts to systematically make localities better for long lives. AFCIs typically work toward progress in multiple domains of community life, focusing both on social and built environments. Despite tremendous growth in AFCIs worldwide over the past decade, there has been little empirical research on how they develop and work toward their aspirational goals. This paper presents findings from a community-partnered study on the development of nine philanthropically supported AFCIs in northern New Jersey. Drawing on fives waves of in-depth interview data collected with leaders over three years, the paper addresses the role of the leaders’ interpersonal and interorganizational networks as they work toward aging-friendly community change. Findings on the centrality of networks across various levels of geographic scale for the development of AFCIs has implications for program theory, as well as broader issues concerning inclusion and equity within community-level responses to population aging.
PHYSICAL ACTIVITY, FALLS, AND FALL INJURIES: THE STUDY OF WOMEN’S HEALTH ACROSS THE NATION
Authors: Ylitalo Kelly , Gabriel Kelley
Published: November 2019

Physical activity (PA) is positively associated with physical functioning, but relations of domain-specific PA with falls is less clear. In 2015, women (n=1,962) self-reported fall history and PA. The Kaiser Physical Activity Survey (KPAS) assessed sports, non-sports leisure, household/caregiving, and total activity. Risk ratios (RR) were generated from poisson regression. One-third (29.7%) of women (mean age=65.1 years [SD 2.7]) reported ≥1 fall and 18.3% reported ≥1 fall injury in the previous 12 months. Women in the highest quartile of sports activity had an increased risk of ≥1 fall (RR=1.19;95%CI:1.00,1.41;p=0.049). Women in the highest quartile of total activity had an increased risk of injurious falls (RR=1.31;95%CI:1.04,1.65;p=0.021), but there was no association for domain-specific indices. KPAS may identify women and activity domains, such as sports, at high risk for falls and injuries. Future work should incorporate device-based PA assessments within domains to understand fall patterns among community-dwelling older adult women.
RACIAL-ETHNIC DISPARITIES IN PHYSICAL PERFORMANCE: THE STUDY OF WOMEN’S HEALTH ACROSS THE NATION
Authors: Karvonen-Gutierrez Carrie , Colvin Alicia , Stewart Andrea , Appelhans Bradley , Cauley Jane , Dugan Sheila , Khoudary Samar El , Sternfeld Barbara
Published: November 2019

Racial/ethnic disparities exist in physical performance among older adults, but little is known about the factors leading to these differences. We evaluated how sociodemographic, health, behavioral, and psychosocial factors mediated the relationship between race/ethnicity and physical functioning performance among 1,855 Black, Chinese, Hispanic, Japanese and White postmenopausal women from the Study of Women’s Health Across the Nation. White women had better mean physical performance scores (decile-based score including relative performance on grip strength, timed 4-meter walk, and timed repeat chair stand tasks) as compared to Black, Hispanic and Chinese women but slightly poorer scores vs. Japanese women. In Blacks and Hispanics, 75% and 95% of that disparity, respectively, was through mediators, particularly education, financial strain, BMI, physical activity and pain. Addressing issues of poverty, racial inequality, bodily pain and obesity could reduce some racial/ethnic disparity in functional limitations as women age.
FACTOR STRUCTURE OF NEUROPSYCHIATRIC SYMPTOM FREQUENCY IN HOME-RESIDING PERSONS WITH DEMENTIA
Authors: Hodgson Nancy , Regier Natalie , Gitlin Laura
Published: November 2019

This study evaluated neuropsychiatric symptom clusters in a sample of home residing persons with dementia, and the impact of distinct clusters on family caregiver outcomes. The expanded Neuropsychiatric Inventory (NPI-C), including measures of frequency, was collected at baseline from 250 caregivers enrolled in Reducing Agitation in People With Dementia: the Customized Activity Trial [NCT01892579]. Principle component analyses were conducted resulting in an eight behavioral clusters, accounting for 44% of total variance: 1=agitation/aggression; 2=anxiety; 3=apathy/withdrawl; 4=impulsivity; 5=psychosis; 6=restlessness; 7=circadian disturbance; 8=depression. In multiple linear regressions caregiver burden was significantly influenced by the anxiety cluster. Caregiver depression was significantly influenced by apathy/withdrawal cluster, and quality of life was significantly associated with anxiety and circadian disturbance clusters. Dimensional representation of neuropsychiatric symptom clusters can be useful in assessing the effect of multiple co-occurring symptoms (versus discrete individual symptoms) on caregiver outcomes and for planning personalized intervention strategies for persons with dementia.
CHANGE IN DEMENTIA FAMILY CAREGIVERS’ WILLINGNESS TO PAY FOR A NONPHARMACOLOGIC INTERVENTION
Authors: Jutkowitz Eric , Scerpella Daniel , Prioli Katherine , Marx Katherine , Gitlin Laura N , Pizzi Laura , Popp Jonah
Published: November 2019

Family caregivers provide a majority of care for persons with dementia (PwD); however, little is known about caregiver’s willingness to pay (WTP) for an intervention to help them manage dementia symptoms. To fill this gap, caregiver/PwD dyads (n=223) were recruited to participate in a randomized trial evaluating tailored activities to minimize behavioral symptoms and functional decline. At baseline and 6-months caregivers were asked their WTP per session for the 8-session 3-month program compared to caregiver education/support only. At baseline, treatment caregivers were WTP $26.20, which was $11.50 (95%CI:-$12.70, -$10.3) less per session compared to control group caregivers WTP $37.30. At 6-months, treatment caregivers were WTP $22.90 and control caregivers $27.30. From baseline to 6-months, a change in WTP was $7.00 (95%CI:$5.80, $8.30) greater than the change in WTP for control group caregivers. Caregivers WTP slightly decreases over time in both groups but decrease is less for TAP following program participation.
SELF-REPORTED VISION IMPAIRMENT AND SUBJECTIVE WELL-BEING IN OLDER ADULTS: A LONGITUDINAL MEDIATION ANALYSIS
Authors: Ehrlich Joshua R , Xiang Xiaoling , Shah Khushali , Hu Rita X , Stagg Brian C , Freedman Vicki A
Published: November 2019

Vision impairment (VI) in older adults is associated with declines in well-being. However, the pathways through which poor vision leads to declines in well-being have not been well described. The purpose of this study was to determine whether activity limitations and social participation restrictions mediate the impact of self-reported VI on subjective well-being. This study used data from the National Health and Aging Trends Study (NHATS), a nationally-representative longitudinal study of Medicare beneficiaries 65 and older that includes detailed measures of the disablement process. We conceptualized a longitudinal mediation model linking self-reported VI and subjective well-being. Structural equation modeling was used to test the mediating effects of activity limitations and social participation restrictions while adjusting for covariates. The final sample included 5,431 respondents. At baseline, 8.0% of Medicare beneficiaries had self-reported VI. Subjective well-being scores were significantly lower among respondents with self-reported VI (15.7, 95% CI=15.2, 16.2) compared to those without VI (17.6, 95% CI=17.5, 17.7). Self-reported VI had a significant indirect effect on subjective well-being through limiting mobility (β=-.04, 95% CI=-.07, -.03) and household activities (β=-.05, 95% CI=-.08, -.03), but not self-care limitations (β=0.0, 95% CI=0.0, 0.0) or participation restrictions (β=0.0, 95% CI=-0.01, 0.00). Total indirect effects from all mediation paths accounted for 42% of the effect of VI on well-being. In conclusion, mobility and household activity limitations are significant mediators that explain a considerable portion of the impact of poor vision on well-being. Interventions to promote successful accommodation may result in greater well-being for visually impaired older adults.
A COMMUNITY-BASED INTERVENTION TO IMPROVE COGNITIVE FUNCTION IN RURAL APPALACHIAN OLDER ADULTS
Authors: Katz Benjamin
Published: November 2019

Research suggests that social isolation in Appalachian older adults may be associated with reduced cognitive function. Despite this, few interventions for these individuals incorporate both social and cognitive components in a community-based setting. The “Memory Masterclass” program was developed to address this care challenge, and implemented through an Adult Day Services Center. With 29 community-dwelling older adult participants from western Virginia, the six-week pilot program focused on strategies and practices associated with improving long-term memory or executive function. In addition to the lifestyle-focused curricula, the course included group activities focused on connecting participants to community networks of resources that might enable them to successfully implement lifestyle changes. Findings support the feasibility of implementation with a wider group of rural Appalachian older adults and suggest that individual differences in self-reported memory may be closely tied to improvements following the program.
LEARNING FROM IN-DEPTH COGNITIVE ASSESSMENTS CONDUCTED IN RURAL INDEPENDENT LIVING FACILITIES
Authors: Wiese Lisa K , Williams Christine , Galvin James E , Hain Debra , Newman David
Published: November 2019

Despite benefits to earlier Alzheimer’s disease interventions, efforts to increase dementia detection and treatment in high-risk rural areas are lacking. Barriers include lack of resources, including limited time for providers to conduct in-depth cognitive assessments. A pilot program tested the effectiveness of a home-based approach for increasing rates of AD detection and treatment in a rural retired farmworker community. Depression and cognitive screenings of 139 residents conducted by community health workers were followed up with in-depth geriatric-focused assessments, including the Moca-B, by experienced, culturally diverse adult gerontological nurse practitioners (AGNPs). Their findings were forwarded to primary providers. This approach was evaluated for effectiveness using correlations, regressions, and Chi-square analyses of variables on rates of ADRD screening, referrals, and ADRD diagnosis.
INTEREST GROUP SESSION—QUALITATIVE RESEARCH: INNOVATIVE QUALITATIVE AND MIXED-METHODS STUDIES OF OLDER ADULTS’ LIVED EXPERIENCES IN NETWORKS OF CARE AND CARING
Authors: Washburn Allyson M , Schwartz Abby
Published: November 2019

Researchers are challenged both when querying older adults about their lived experience and later when analyzing these rich interview data to characterize and preserve their truths. This symposium presents innovative strategies to meet these challenges in ways that deepen our understanding of older adults’ lives within their networks of care and caring. Participants in two interpretive phenomenological studies were family caregivers. One examined the impact of the Virtual Dementia Tour® on participants’ perceptions of their family member’s lived experience of dementia, identifying changed realities and approaches to caregiving following their experience. The second analyzed in-depth interviews of aging caregivers about future care for their adult children diagnosed with autism spectrum disorders, finding that they had difficulty identifying caregiving support for the future while feeling the need to make plans and decisions now. Two mixed methods studies explored older adults’ experience of their current environment. In the first, measures of social cognition and engagement informed the interpretation of combined phenomenological-hermeneutic and conventional content analyses of nursing home residents’ responses to questions about their relationships, finding that they valued day-to-day social interactions as connections with longtime friends were maintained. The second study combined focus groups, in-depth interviews, and web-based surveys during the psychometric testing of the Person-Place Fit Measure for Older Adults to assess older adults’ experience of aging in a particular place with people they find important. The strategies detailed in these four papers transformed more conventional approaches to deepen our understanding of older adults’ experiences of their lives with others.
REDUCING HEALTH DISPARITIES IN THE ERA OF VALUE-BASED CARE
Authors: Kumar Amit , Mahmoudi Elham , Rivera-Hernandez Maricruz
Published: November 2019

The US health care system is at a critical moment of transformation. The implementation of value-based models has made significant progress towards improving care quality and coordination, continuity of care and reducing cost. However, concerns have been raised regarding “cherry-picking” healthier people that may negatively impact patients with more complex needs and minority populations. Given that the US is becoming more diverse, there is a need for understanding the impact of social risk factors including ethnicity, immigration status, income and geography on health outcomes and issues of health care disparities. This panel brings together four studies that examine these phenomena in minority populations. These studies will provide novel insight regarding 1) healthcare utilization in Mexican-American Medicare beneficiaries and showing that social determinants of health are associated with a higher risk of hospitalization, emergency room admissions, and outpatient visits. 2) Mortality rates and predialysis care among Hispanics in the US, Hispanics in Puerto Rico, and Whites in the US demonstrating substantial disparities in access to recommended nephrology care for Hispanics in Puerto Rico; 3) Trends in age-adjusted mortality rates and supply of physicians in states with different nurse-practitioners regulation. 4) The impact of social risk factors on disenrollment from Fee-For-Service and enrollment in a Medicare Advantage plan in older Mexican-Americans. 5) Racial disparities in access to physician visits, prescription drugs, and healthcare spending among older adults with cognitive limitation. Studies in this panel will also discuss the effects of changes in care delivery and payment innovations in improving health equity.
RACIAL DISPARITIES IN ACCESS TO AND COST OF HEALTHCARE AMONG OLDER ADULTS WITH COGNITIVE LIMITATION: 2002 TO 2016
Authors: Mahmoudi Elham
Published: November 2019

Using 2002-2016 Medical Expenditure Panel Survey, we examined racial/ethnic disparities in office-visits and prescription-drugs among individuals with cognitive limitation (CL). Medicare beneficiaries (65+) with CL (N=9,369) were included. We used generalized linear models. Prevalence of CL increased overtime among all racial/ethnic groups. Our findings indicate that 96% of Whites vs. 93% of Blacks had at least one office visit (diff=0.03; 95% CI:0.01-0.04). Whites had 2 (95% CI: 1.0-0.4) and 4 (95% CI: 2.5-6.0) more office visits compared with Hispanics and Asians; and used 4 (95% CI: 1-6.9), 5 (95% CI:1.0-9.3) and 6 (95% CI: 1.0-11.5) more prescriptions than their Blacks, Hispanics, and Asians, respectively. Whites had higher annual expenditures for office-visits compared with Asians ($889; 95% CI:409-1,368) and higher expenditures for prescriptions compared with Blacks ($484; 95% CI:$151-$816) and Asians ($546; 95% CI:$28-$1064), respectively. Disparities in care among older adults with CL may put vulnerable subpopulations at a higher risk.
DISABLEMENT IN CONTEXT: DO SOCIAL NETWORKS MODERATE THE IMPACT OF INCREASING FUNCTIONAL IMPAIRMENT ON WELL-BEING?
Authors: McConnell William R , Dembo Robbie
Published: November 2019

Older adults with disabilities face a higher risk of experiencing poor health and social isolation in later life. Prior research has shown that social factors such as supportive relationships can modify disablement trajectories and reduce the likelihood of negative outcomes. Although research has considered the functional benefits of relationships through examining mechanisms like social support provision, the effects of network structure on the disablement process are not well understood. This study examines multiple social network mechanisms to explain the link between disability, health, and social participation among older adults. We ask, do social networks characteristics mediate or moderate the effects of increasing functional impairment on health and social participation? We analyze longitudinal panel data from the National Social Life, Health, and Aging Project 2005 & 2010, including 2,261 adults aged 57-85. Respondents named 9,587 network members in 2005. We model indicators of health and social participation at 5-year follow-up using trajectories of functional impairment and social network characteristics. We find that larger, denser, and more supportive networks are associated with better health and more frequent social activity at follow-up. Furthermore, social network structure mediates the relationship between increasing functional impairment and health, but moderates the effect of impairment on social participation. For example, participants with more dense networks are more likely to maintain high social activity at follow-up, even at relatively high levels of impairment. This study demonstrates that functional impairments are not inherently disabling. Instead, personal and social resources can reduce the potential burdens of impairment in individuals’ lives.
ARE LEISURE AND CIVIC ACTIVITIES REINFORCING WELL-BEING IN OLDER ADULTS AT RISK OF FRAILTY?
Authors: Dury Sarah , Dierckx Eva , De Donder liesbeth , Lambotte Deborah , Duppen Daan , switsers lise
Published: November 2019

A growing body of work suggest that leisure and civic activities may contribute to the understanding of healthy aging. Yet, only a limited number of studies have examined a less healthy population. Moreover, a broad array of leisure and civic activities tend to be lacking. This paper gives insight into the mechanisms underlying the associations between multidimensional frailty, and well-being with the moderating roles of leisure and civic activities. A two-wave interview survey from the D-SCOPE frailty program was derived using 441 participants aged 60 years and older residing in the Flanders region of Belgium. This study offers evidence that leisure and civic activities buffered the negative relationship between multidimensional frailty and well-being. Moreover, our study identified that for different frailty domains the buffering/moderating role of leisure and civic activities differs in relation to well-being.
ESPO/HEALTH SCIENCES: STRENGTH IN NUMBERS: LEVERAGING THE POWER OF NETWORKS FOR RECRUITING OLDER ADULTS AND CAREGIVERS
Authors: Moss Karen O , Prasad Anyah , Epps Fayron
Published: November 2019

Recruitment of older adults and/or their family caregivers for participation in research is challenging. This process is further complicated by population or procedure-specific factors that can impede recruitment efforts. The purpose of this symposium is to describe various recruitment challenges and solutions as well as strategies used to engage older adults and family caregivers in research. Dr. Glenna Brewster will present recruitment strategies used for a multisite telehealth intervention for caregivers of persons living with dementia. Dr. Todd Monroe will examine barriers and solutions for recruitment and retention of persons with Alzheimer’s disease for neuroimaging studies. Dr. Karen Moss will share strategies used to recruit family caregivers of African American older adults with dementia for end-of-life research. Dr. Shiva Prasad will share strategies to recruit LGBT older adults to a study on exploring the idea of an LGBT online senior center, and Dr. Karen Rose will describe stigma associated with recruiting persons with Alzheimer’s disease and other dementias, and their family caregivers, including best practices from the literature coupled with lessons learned from experiences. Shared strategies and solutions will assist researchers in identifying and addressing recruitment challenges and help to ensure recruitment of diverse groups of older adults and/or family caregivers for studies that use various research methodologies, including leveraging the power of professional and community-based networks. Increasing research participation will yield the knowledge necessary for improving health outcomes for older adults and their family caregivers living with serious chronic illnesses such as Alzheimer’s disease and related dementias.
POLICY SERIES: ADDRESSING LONELINESS AMONG OLDER ADULTS THROUGH RESEARCH, COMMUNITY PROGRAMS, AND A NEW FEDERAL POLICY AGENDA
Authors: Solway Erica , Lindberg Brian W
Published: November 2019

Millions of older adults experience feelings of loneliness. A growing body of research has found that chronic loneliness can impact memory, physical well-being, mental health, and life expectancy rivaling the impact on health outcomes of obesity and smoking. Loneliness has been found to impact memory, physical well-being, mental health, and life expectancy. In this session, GSA policy advisor Brian Lindberg will lead a data-driven discussion about who experiences loneliness and isolation and how we might create opportunities for connectedness through new areas of research, forward-thinking policies, and innovative community programs. Presenters include Erica Solway, associate director for the National Poll on Healthy Aging, who will highlight results from a poll conducted in October 2018 among a nationally representative sample of adults age 50 to 80 which found that more than one in three respondents felt a lack of companionships and more than one in four felt socially isolated. Then Catherine Spensley, Director of the Senior Division at Felton Institute, will describe lessons learned in developing and delivering culturally and linguistically appropriate programs and services that foster community and social connections among socially isolated, low income older adults in San Francisco. Finally, Andrew MacPherson, Principal at Healthsperien, LLC, and Director of the Coalition to End Social Isolation & Loneliness will describe stakeholder efforts to advocate for federal legislative and regulatory policy options to address the epidemic including increased funding for and access to supportive services, health care, technology, and public and private research initiatives.
LONELINESS AND HEALTH AMONG OLDER ADULTS: RESULTS FROM THE UNIVERSITY OF MICHIGAN NATIONAL POLL ON HEALTHY AGING
Authors: Solway Erica , Piette John , Kirch Matthias , Singer Dianne , Kullgren Jeffrey , Malani Preeti
Published: November 2019

In October 2018, the University of Michigan National Poll on Healthy Aging conducted an online survey using a nationally representative household sample of adults age 50 to 80. One in three respondents (34%) reported feeling a lack of companionship and 27% reported feeling isolated from others some of the time or often during the past year. Those with fair or poor self-reported physical health, mental health, or hearing were more likely to report feeling a lack of companionship or feel isolated as were those who reported less frequently engaging in healthy behaviors. More than one in four (28%) reported social contact with people outside of their household once a week or less. Given the high prevalence of loneliness and its connection to poor health and health behaviors, research on this important issue and efforts to increase social engagement among older adults deserve increased attention.
SOCIOECONOMIC, BIOLOGICAL, AND COMMUNITY ASSOCIATIONS WITH OLD-AGE MORTALITY IN CHINA
Authors: Zhang Yuan , Strauss John A , Hu Peifeng , Zhao yaohui , Crimmins Eileen M
Published: November 2019

Determinants of mortality may differ depending on context. This study uses a nationally representative sample of persons aged 60 and over in China to determine if socioeconomic factors, early life conditions, community characteristics, biological and physical functioning, and disease burden predict four-year all-cause mortality. We employed a series of Weibull hazard models based on exact survival time to predict mortality. We find that current education and place of residence, physical functioning, uncontrolled hypertension, diabetes, cancer, a high level of systemic inflammation, and poor kidney functioning are strong predictors of mortality among older Chinese. We did not find linkages between early-life experiences or community infrastructure to mortality at older ages. Results from this study highlight the value of incorporating biological and performance measurements and the importance of social and historical context in studying old-age mortality.
SPILLOVER EFFECTS OF A HUSBAND’S RETIREMENT ON A WOMAN’S HEALTH: EVIDENCE FROM URBAN CHINA
Authors: Zang Emma
Published: November 2019

This paper examines the effect that a man’s retirement has on his wife’s mental and physical health. I exploit the large increase in the probability of retirement at the legal retirement age for urban male wage earners in China as a natural experiment, using data from the China Health and Retirement Longitudinal Survey (CHARLS). I have implemented a fuzzy regression discontinuity design to compare the health outcomes of women whose husbands recently retired with those whose husbands are close to retire. My findings indicate that the retirement of her spouse improves physical and mental well-being of the woman, most likely by increasing the frequency of her social interactions and exercising. Although income and marital quality are less likely to be the main channels through which this positive spillover effect operates, decreased marital satisfaction or severe income constraints can be binding.