bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of the EIT-4-BPSD Intervention on Resident and Setting Outcomes
Authors: Galik Elizabeth
Published: December 2021

The effectiveness of EIT-4-BPSD was based on testing the following hypotheses: (1) Settings exposed to EIT-4-BPSD will demonstrate improvements in Environment and Policy assessments, better quality of care interactions, and more person-centered care approaches for management of behavioral symptoms in care plans compared to Education Only settings; and (2) Residents in EIT-4-BPSD settings will have fewer behavioral symptoms and less pain, maintain or improve function, use fewer psychotropic medications, and have improved quality of life compared to residents in Education Only settings. There was not a significant treatment effect at the setting or resident level. Reasons for lack of effectiveness include limited evidence of behavioral symptoms at baseline, nationally based environment and policy requirements related to behavioral management, and measurement challenges in identifying behaviors and other outcomes. Future work should focus more on process and changing how staff approach care which was demonstrated in this trial.
Person-Centered Care Post-Pandemic in Rural U.S. Settings: Use of WE-THRIVE Measures
Authors: Holmes Sarah , Corazzini Kirsten , Lepore Michael , Kusmaul Nancy , Myer Deanna , Rahmaty Zahra
Published: December 2021

Frontier communities are rural counties that are sparsely populated with limited resources to provide residential long-term care; COVID-19 has heightened these barriers and adversely affected residents, their families and staff. This study describes the feasibility of implementing recommended WE-THRIVE measures in one residential long-term care setting in a frontier community in the rural Midwest, and the capacity for administrative leadership to draw upon results of measures to implement person-centered care post-pandemic. During the COVID-19 pandemic, early efforts to advance person-centered care in the setting were displaced by a focus on infection control and containment. WE-THRIVE measures assess person-centered care following immunization distribution, and are discussed in terms of how to develop a dashboard to ‘de-escalate’ a COVID-19 focus and rebuild momentum towards person-centered care. Particular attention is given to the context of measurement, including data sharing and measurement burden, to inform advancing person-centered long-term care in other frontier communities.
Mobility Performance in Old Age: A Window Into Brain Integrity
Authors: Tian Qu , Rosso Andrea , Rosano Caterina
Published: December 2021

Over two decades of research has established brain aging as a critical component of mobility decline. Studies consistently report that motor slowing predicts cognitive decline and neurodegenerative diseases, but reported associations are often modest. Both mobility and brain aging are complex processes and steady-state assessments are typically used (usual pace gait and structural MRI). We aim to elucidate the complex relations between brain aging and mobility by considering (a) strategies to maintain function such as interlacing periods of activity and rest (fractionation), (b) interventions that target brain and body (motor skill training), (c) multimodal neuroimaging (functional connectivity and cerebral small vessel disease (cSVD)), (d) challenged walking (dual-tasks, uneven surfaces), and (e) reduced resources (hearing loss). This symposium focuses on community-dwelling older adults from observational and intervention studies using state-of-the-art and real-life assessments of gait (quality and fragmentation by tri-axial accelerometry) and brain (near-infrared spectroscopy (fNIRS), resting-state functional MRI). First, we examine activity strategies that modify the relation between slow gait and AD risk (Tian). Second, using fNIRS, we investigate the extent to which motor skill training increases automaticity of gait (Chen). Third, we examine how functional connectivity may compensate for the detrimental effects of cSVD on mild parkinsonian signs (Hengenius). Fourth, we investigate the effects of challenged walking on gait quality and the relation with cognitive function (Suri). Finally, we demonstrate relations of hearing and cognition with mobility (Pupo). We seek to generate discussions on shared pathways underlying motor slowing and the aging brain and future prevention and intervention strategies.
Objectively Measured Physical Activity, Sedentary Behavior, and Incident Fracture in Older Women: The OPACH Study
Authors: Nguyen Steve , Bellettiere John , LaMonte Michael , Crandall Carolyn , LaCroix Andrea
Published: December 2021

Women aged 65 and older experience nearly three-fourths of the 2 million osteoporotic fractures annually in the US, yet whether accelerometer-measured volumes and intensities of physical activity and sedentary behavior (SB) are associated with reduced fracture risk is understudied. We investigated associations of accelerometer-measured light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), sedentary time (ST), and mean sedentary bout duration (MBD) with incident clinical fractures (hip, vertebral, pelvis, lower leg, upper arm, forearm, and wrist) in the WHI OPACH cohort. Participants (N=6248; mean±SD age=78.6±6.7; 34% Black, 17% Hispanic) without prior hip fracture wore the ActiGraph GT3X+ for 7 days between May 2012-April 2014 and were followed through March 2020 for incident clinical fracture (N=711). Cox models estimated hazard ratios (HR) and 95% confidence intervals (CI), adjusting for age, race-ethnicity, education, alcohol, smoking, height, weight, falls history, RAND-36 physical function, diabetes, thiazide use, prescription osteoporotic therapy, and age at menopause. The HR(95% CI) across MVPA quartiles was 1.00(reference), 1.15(0.93-1.41), 0.90(0.72-1.13), and 0.79(0.61-1.02); p-trend=0.01. The HR(95% CI) for a one-interquartile range increment in MVPA (42 minutes/day) was 0.86(0.76-0.97). Associations were modified by prescription osteoporotic therapy [no: HR=0.77(0.66-0.89), yes: HR=1.03(0.85-1.25); p-interaction=0.01] and varied in magnitude by age[<80: HR=0.78(0.64-0.96), ≥80: HR=0.92(0.79-1.07); p-interaction=0.09], BMI [<30 kg/m2: HR=0.85(0.75-0.97), ≥30 kg/m2: HR=0.90(0.67-1.19); p-interaction=0.08], and race-ethnicity [Black: HR =0.63(0.44-0.89), Hispanic: HR =0.78(0.56-1.09), White: HR =0.92(0.80-1.06); p-interaction=0.16]. LPA, ST, or MBD were not associated with incident fractures. These data suggest that MVPA may reduce and not increase fracture risk and that LPA and SB do not increase fracture risk.
Qualitative Analysis of Coaching With Care Partners of People With Cognitive Impairment
Authors: Shieu Bianca , Teng Chiao-Hsin , Chan Ya-Ning , Choi Youngmin , Dictus Cass , Perez Janelle , Wang Jing , Bartoldus Victoria
Published: December 2021

We apply the adaptive leadership framework for chronic Illness in a care partner–assisted intervention to improve oral hygiene of older adults with cognitive impairment. Care partners receive four coaching sessions which we recorded and transcribed verbatim. We will describe how our team of seven investigators codes the data using a priori codes from the framework. The data from 17 care-partners contributes 68 individual sessions for coding. We have two subgroups of 7 individuals with mild dementia (MD) and 10 with mild cognitive impairment (MCI). We will discuss the plan for multiple comparisons such as (a) longitudinal across 3 months of intervention, b) within MD and within MCI and c) between MD and MCI. To illustrate, we will discuss our approaches to reaching coding consensus and rigor and will present results of the within group analyses. Finally, we will discuss next steps and the end products we aim to achieve.
Overweight, Obesity, and Neuropsychological Performance: Results From the Women’s Interagency HIV Study
Authors: Vasquez Elizabeth , Kuniholm Mark , Rubin Leah , Sharma Anjali , Weber Kathleen , Fischl Margaret A , Plankey Michael , Gustafson Deborah
Published: December 2021

Conflicting associations of body mass index (BMI) and waist circumference (WC) with neuropsychological performance (NP) are observed in the general population and among people living with HIV. We examined BMI and WC in middle-aged women living with HIV (WLWH) and without HIV (HIV-) in relation to 10-year trajectories of NP in the Women’s Interagency HIV Study (WIHS). NP assessments occurred biennially from 2009-2019. Demographically-adjusted T-scores were calculated for six NP domains: learning, memory, executive function, processing speed, attention and working memory, and motor function. Multivariable linear models stratified by HIV serostatus examined whether baseline (2009) BMI and WC were associated with NP domains - 1) cross-sectionally and 2) longitudinally over 10 years. The sample included 432 WLWH and 367 HIV- women, >40 years old. Most women (73%) were overweight (BMI=25-29.9kg/m2) or obese (BMI=>30kg/m2). Among WLWH, 28% were overweight, 45% obese; among HIV- women, 26% were overweight; 56% obese. Cross-sectionally at baseline, WLWH who were overweight versus normal weight (BMI=18.5-24.9kg/m2), performed worse on executive function, processing speed, and motor function (all p<0.05). HIV- women who were overweight versus normal weight performed worse on memory, learning, executive function, processing speed and motor function (all p<0.05). Baseline BMI and WC were not associated with worsening NP domains in this younger, primarily overweight and obese sample of WLWH or HIV- women (all p>0.05).Future follow-up of these women will enhance understanding of the age when total and/or central obesity may influence NP trajectories and health of the aging brain.
Daily Cortisol Total Output Mediated Sleep and Affect Among Dementia Family Caregivers
Authors: Liu Yin , Fleming Daniel , Fauth Elizabeth
Published: December 2021

Cortisol is a primary stress hormone associated with sleep. We examined daily cortisol as the potential mechanism linking prior night’s sleep and daily mood among 173 dementia family caregivers (M (SD) age = 61.97 (10.66)) who used adult day services (ADS) at least two days a week. Caregivers self-reported sleep characteristics (bed and wake time, sleep quality, care receiver’s night-time problems) and affect (anxiety, depressive symptoms) across eight consecutive ADS/non-ADS days. Salivary cortisol was collected five times each day. Multilevel mediation analysis suggested that daily cortisol total output (assessed as “area under the curve”) mediated prior nights’ total time in bed and daily anxiety, but only on high-stress (non-ADS) days. Mediation was non-significant on low-stress (ADS) days, and at the between-person level. ADS use is respite from a chronically stressful role. Reducing exposure to stress via respite may protect against harmful processes related to sleep, cortisol reactivity, and daily anxiety.
Intergenerational Contact Experiences and Their Relation to Ageism as a Multidimensional Construct
Authors: Kuball Tim , Jahn Georg , Pollmanns Claas
Published: December 2021

Research on intergroup contact suggests that negative contact experiences affect cognitive representations such as stereotypes more strongly than positive contact experiences. To comprehensively examine the full effect of intergroup contact, the valence of the contact experience as well as the affective and cognitive dimensions of prejudice should be assessed. In ageism research, previous studies typically focused only on contact of positive valence and were limited to the perspectives of younger individuals on older adults. Primary objective of this study is to examine both positive and negative contact frequency and their relation to affective and cognitive dimensions of ageism from the perspectives of younger adults between the age of 18 and 25 (study 1) and older adults between the age of 60 and 92 (study 2). Consistent with previous research on intergroup contact, our results confirm that both types of contact were similarly predictive of affective facets of prejudice. However, only in study 2 that assessed older adults’ agreement with contemporary stereotypes about young men and women, negative compared to positive contact frequency proved to be a stronger predictor of the cognitive dimension of ageism. Our findings emphasize the importance of focusing on all dimensions of prejudice and highlight the need to consider the perspectives of young and old in ageism research.
Clinical Recommendations for Reducing the Risk of Cognitive Decline
Authors: Perez G Adriana , O'Brien Kelly , Sabbagh Marwan , Bruno Michelle
Published: December 2021

As much as 40% of dementia cases can be attributed to modifiable risk factors (Livingston et al., 2020). Much of that risk-reduction can be accomplished by changing behavior in midlife. In light of the emerging evidence that dementia may be preventable, UsAgainstAlzheimer’s convened a workgroup of national experts to develop new recommendations that primary care clinicians and general neurologists can use to initiate primary prevention conversations with their patients about cognitive decline. Few resources address steps that clinicians can take in their routine care to help patients reduce risk. Some relevant resources provide excellent guidance but tend to be more focused on early detection or slowing disease progression rather than primary prevention. The Risk Reduction Workgroup (RRWG) was convened to help address the need for clinicians to know how to discuss cognitive decline with their patients. The workgroup aligned on 11 recommendations for primary care clinicians and general neurologists. In addition the RRWG provide considerations for implementing the recommendations in clinical practice. The recommendations are mindful of social determinants of health, account for cultural differences, and are designed for general accessibility. This effort is part of a broader initiative by UsAgainstAlzheimer’s to address risk-reduction for cognitive decline and early interventions. Under the guidance of a multidisciplinary Provider Leadership Group consisting of representatives from some of the nation's largest health provider serving organizations, three independent workgroups are developing guidance and tools to assist providers in their clinical practice and improve health outcomes for patients at-risk for Alzheimer's and related dementias.
COVID Vaccine Rollout for Older Adults in South Korea
Authors: Park Chan Mi
Published: December 2021

It has just started in South Korea. We will provide detailed information later. The symposium has experts from 8 countries. We will use an interview and dialog format, instead of presentations.
Resolving Dilemmas in ICT-Enhanced Interventions: A Cross-Platform-Mediated Strategy
Authors: Leung Dara K Y , Wong Frankie H C , Wong Gloria H Y , Lum Terry Y S
Published: December 2021

Face-to-face interventions in social care settings are severely disrupted under COVID-19. Previous studies support Information and communication technology (ICT) enhanced intervention as an effective alternative. While difficulties older adults experienced in using ICT were examined extensively, there are fewer discussions on how innate medium characteristics of the delivery mode influence therapeutic interactions. This study explored these embedded challenges in ICT-enhanced psychosocial interventions and possible solutions. We conducted on-site observations and focus groups with 12 participants from two teleconferencing-aided intervention groups for chronic pain with exercise and psychotherapy elements. Observation notes and transcriptions of focus groups recordings were analyzed using thematic analysis. We identified three overarching themes: empowerment, dilemmas, and cross-platform mediated strategy. ICT empowered participants by promoting autonomy and self-management, yet two dilemmas that stemmed from technological affordances undermined the quality of communication. A screen-camera dilemma occurred when participants tried to observe instructions from interventionists while demonstrating their posture in front of the camera for guidance. The blurring boundary between therapy and home settings presented another dilemma. Although teleconferencing increased flexibility and comfort in participation, interruptions from the background environment and intersections of family living spaces disrupted audio-visual communication and jeopardized the sense of security. As a solution, interventionists adopted a cross-platform mediated strategy to bypass the dilemmas. They communicated and delivered supplementary materials through different media, including printed materials and video streamings. Interventionists could consider the unique structural features in different media and the potential impact of participants’ sociodemographic factors, especially those associated with digital literacy.
Effects of Aging Attitudes on Development in Old Age
Authors: de Couto Maria Clara P Paula , Rothermund Klaus
Published: December 2021

This session will focus on aging attitudes and their effects on different aspects of development in old age (e.g., preparation, age stereotypes, age discrimination, and well-being). Cultural differences and how they shape individual aging are also explored. The first two presentations focus on cross-cultural differences in preparation for old-age. Nikitin et al. examine financial preparation and how expectations about support from the state influence it. People’s beliefs about the utility and the risk of aging preparation and their role in preparatory activities is investigated by Kim-Knauss et al. Tsang et al. explore age differences in pursuing autonomy and independence during the COVID-19 pandemic and the role of perceived social obligation. Cultural differences in the accuracy between perceived retrospective changes in well-being and actual changes is explored by Park et al. The last presentation (de Paula Couto et al.) focuses on country- and age-related differences in personal experiences of age discrimination in different life domains. Taken together, findings suggest that attitudes toward, and preparation for aging, are not static. Situational contexts and personal assessments of the contexts can shape such attitudes and behavior.
Personal Experiences of Age Discrimination in Different Life Domains: Determinants and Consequences
Authors: de Couto Maria Clara P Paula , Nikitin Jana , Graf Sylvie , Rothermund Klaus
Published: December 2021

Age discrimination is pervasive in society which bears far-reaching consequences for individuals in terms of decreased psychological and physical health. Age discrimination can be experienced in different life-domains and perceived as a social (others’ experiences) or as a personal phenomenon (own experiences). Our first goal was to examine country- and age-related differences in personal experiences of age discrimination in distinct life domains, reported by 2,817 participants aged 40 to 90 years from the US, China, Germany, the Czech Republic, and Taiwan. As another goal, we investigated the impact of age discrimination on life satisfaction. Personal age discrimination was domain-specific, with more experiences reported in the family, work, and personality domains. Personal age discrimination increased with age and was higher in China and Taiwan. Age discrimination negatively predicted life satisfaction. This negative effect was more pronounced if age discrimination was experienced in domains with high subjective importance.
AUGMENT: Navigation Apps Instruction for Older Adults With Cognitive Impairment
Authors: Charness Neil , Boot Walter , Czaja Sara , Rogers Wendy , Gray Nicholas , Kossowska-Kuhn Dorota , Pervratil Michael
Published: December 2021

Augmenting User Geocordinates and Mobility by ENhanced Tutorials (AUGMENT) is a development project in the ENHANCE Rehabilitation Engineering Research Center aiming to promote community engagement for aging adults with cognitive impairment (CI) from stroke, traumatic brain injury, and mild cognitive impairment. AUGMENT aims include 1) providing proof of concept that a robust instructional package can support successful use of existing, complex navigation apps, Google maps and rideshare app Uber, by a diverse set of people with CI; and 2) providing proof of product by testing performance with and without instruction. We discuss the needs assessment phase and development of new tests to assess wayfinding abilities and reported difficulties with navigation, using a control sample of 384 community-dwelling older adults. We found that self-reported navigation difficulties are predicted (R-square = .28) by gender, a spatial orientation test, self-reported memory ability, and severity of memory difficulty.
Development of the DREAM System: Digital Reminders for Everyday Activity Memory
Authors: Boot Walter , Charness Neil , Czaja Sara , Rogers Wendy , Sanders Edie , Stuart Robin , Andringa Ronald
Published: December 2021

Prospective memory, the ability to remember to execute an intention in the future, is crucial for the performance of many everyday tasks important for independent living. Prospective memory abilities decline with age, and older adults living with mild cognitive impairment (MCI), cognitive impairment due to traumatic brain injury (TBI), and cognitive impairment due to stroke are especially susceptible to prospective memory failures. The goal of the Digital Reminders for Everyday Activity Memory (DREAM) project is first to establish proof of concept for an adaptive cognitive aid to support the prospective memory of older adults with various cognitive impairments, and then establish proof of product in studies examining the use of a working prototype within the lab and within participants’ homes. Data will be presented from initial work verifying product requirements through engagement with stakeholders, including subject matter experts, older adults with cognitive impairments, and their care partners.
Older Americans With Disability Are Vulnerable to Economic and Food Insecurity During COVID-19
Authors: Choi Shinae , Namkung Eun Ha , Carr Deborah
Published: December 2021

This study investigated whether older Americans with physical disability were vulnerable to three types of economic insecurity (difficulty paying regular bills, difficulty paying medical bills, income loss) and two types of food insecurity (economic obstacles, logistical obstacles) during the early months of the COVID-19 pandemic. We evaluated the extent to which associations are moderated by three personal characteristics (age, sex, race/ethnicity) and two pandemic-specific risk factors (job loss, COVID-19 diagnosis). Data were from a random 25 percent subsample of the Health and Retirement Study participants who completed a COVID-19 module administered in 2020. Our analytic sample included 3,166 adults aged 51 and older. We estimated logistic regression models to document the odds of experiencing each hardship. Persons with three or more functional limitations reported significantly higher odds of both types of food insecurity, and difficulty paying regular and medical bills, relative to those with no limitations. After controlling for health conditions, effects were no longer significant for paying medical bills, and attenuated yet remained statistically significant for other outcomes. Patterns did not differ significantly on the basis of the moderator variables. Older adults with more functional limitations are vulnerable to economic and food insecurity during the pandemic, potentially exacerbating the physical and emotional health threats imposed by the pandemic. Our findings reveal an urgent need to promote policies and procedures to protect older adults with disability from economic and food insecurity. Supports for older adults with disability should focus on logistical as well as financial support for ensuring food security.
Toward a Multidimensional Understanding of Later Life Disability: A Latent Profile Analysis
Authors: Peterson Natasha , Lee Jeongeun , Kahana Eva
Published: December 2021

Disability is difficult to define succinctly. Current literature on disability has primarily focused on physical functional limitations. However, relying on a single dimension or index cannot accurately represent disability as the experience of disability is nuanced and complex. To address these gaps, this study aims to understand the multidimensional nature of disability among retired, community-dwelling older adults. Using a sample of 414 older adults between the ages of 72 and 106 years (M=84.84, SD=4.56), latent profile analysis was employed to identify classes based on five indicators of disability across three domains. The five indicators of disability included difficulties with activities of daily living (ADLs), cognitive impairment, physical impairment, sensory impairment, and participation restrictions. Three classes were found to represent the data best. The most favorable and highly functioning group comprised the highest number of participants (n=242, 59.5%). The next group, class 2 (n=157, 37.9%), was characterized by high physical impairment and ADL-difficulty. The smallest group, class 3 (n=15, 3.6%), had the highest ADL-difficulty and participation restrictions but drastically lower cognitive and sensory impairment. Multinomial logistic regression revealed that class membership was related to sociodemographic characteristics. Finally, class membership predicted several mental health outcomes such as depressive symptoms, positive affect, and life satisfaction in the expected direction. If supported by future work, these findings could inform practitioners in developing more specific interventions relevant to older adults based on their disability profiles. Understanding various combinations of disablement has potential implications for services and interventions to be tailored to individuals’ distinct disability-related needs.
New Brain Aging Center
Authors: Lin Feng , Conwell Yeates , Simmons Janine
Published: December 2021

Evidence indicates an association between emotional well-being (EWB) and underlying brain processes, and that those processes change with both normal and pathological brain aging. However, the nature of these associations, the mechanisms by which EWB and its component domains change with brain aging, and how those changes may be associated with common neuropathologies like Alzheimer’s disease and related dementias (ADRD), are largely unexplored. The NIA-funded Network for Emotional Well-being and Brain Aging (NEW Brain Aging) has the goal of developing a nationwide community of investigators dedicated to research that identifies and tests mechanisms by which brain aging influences EWB and how EWB may impact risk for and progression of ADRD. Synthesizing human and animal literature, our premise is that relationships between EWB and ADRD are bidirectional – normal and pathological changes in aging brain influence EWB and EWB contributes to brain health and illness, such as ADRD. NEW Brain Aging will identify and coalesce resources for interested investigators and provide pilot funding opportunities to stimulate research and development of the field. Component presentations of this symposium will include (1) an overview by Dr. Robert Kaplan of the current state of research on EWB; (2) the role of animal studies (Kuan Hong Wang) and (3) human subjects research (Feng Vankee Lin) in EWB and aging; and (4) design of NEW Brain Aging and resources it will provide (Yeates Conwell). Janine Simmons will explain NIA’s vision for EWB research and lead open discussion.
Monitoring Utilization Trends of Glucose-Lowering Drugs for Type 2 Diabetes in Older Adults by Frailty Status
Authors: Gopalakrishnan Chandrasekar , Kim Dae , Kutz Alexander , Patorno Elisabetta
Published: December 2021

Using Medicare fee-for-service data from 2013-17, we identified a cohort of patients with type 2 diabetes (T2D) who initiated a glucose-lowering drug (mean [SD] age, 74.8 (6.9) years). Amongst frail patients (CFI≥0.20), metformin use remained stable from 29.1% to 29.4%, whereas sulfonylureas (25.8% to 22.1%) and insulin (21.2% to 19.0%) use declined. Amongst non-frail patients (CFI <0.20), metformin (35.3% to 33.1%) and sulfonylurea (26.2% to 22.2%) use decreased whereas insulin (11.7% to 10.6%) use remained stable. DPP-4i and glitazones use remained stable whereas the use of newer agents such as SGLT-2i and GLP-1 RA increased steadily over the study period in both frail and non-frail patients, though their use remains low ( <8%). In conclusion, sulfonylureas and insulin accounted for about one-third of initiated glucose-lowering medications and were more frequently used by frail patients, though their use declined steadily over time with the availability of newer agents.
Advancing the Study of Loneliness and Health in Older Adults Through the Use of Integrative Data Analysis
Authors: Ong Anthony , Graham Eileen , Jackson Kathryn , Beck Emorie , Luo Jing , Atherton Olivia , Willroth Emily , Mroczek Daniel
Published: December 2021

Recent work has shown the importance of studying loneliness and social isolation across adulthood for understanding healthy aging. This project explored loneliness trajectories across multiple independent samples. Using coordinated IDA, we estimated and meta-analyzed identical multilevel growth models in loneliness using three samples (ELSA, SHARE, HRS). We found u-shaped change, suggesting that loneliness may decline from young adulthood to midlife, then increase after midlife. These trajectories were significant across all three datasets and not fully explained by demographics or depression. We found that divorce, widowhood, social isolation, and functional limitations were associated with higher overall loneliness. Additionally, divorce and functional limitations, and sex (being male) were associated with deeper dips in loneliness in midlife and steeper increases in old age. These findings suggest that loneliness increases across the second half of life and point to the need for evidence-based strategies for addressing social disparities in midlife and later adulthood.
Stress Processes Over 2 Decades: Findings From the National Study of Daily Experiences
Authors: Almeida David , Mroczek Daniel
Published: December 2021

Daily experiences of stress and the associated sequelae of affective and physiological changes represent the multiple dimensions of a complex, time-dependent process of how stressors unfold in daily life. Daily diaries capture these time-sensitive processes as they occur under real world conditions. Longitudinal changes in stress processes can then be tracked using a measurement burst design: daily diaries repeated longitudinally. Using this design, the National Study of Daily Experiences (NSDE) has generated more than 35,000 days of data from a national sample of over 2,500 adults assessed repeatedly across 20 years of adulthood. The NSDE features details of more than 10,000 reports daily stress including exposure, appraisal and affective responses from adults ranging in age from 24 to 95 years. The current symposium leverages this unique and influential dataset to examine age differences and aging-related changes in daily stress processes with four presentations from the NSDE. First, Dr. Robert Stawski will discuss longitudinal change and age-related differences in exposure to multiple types of daily stressors. Next, Dr. Susan Charles will examine age differences and change in a key element of the stress process: negative affect. Third, Dr. Eric Cerino will describe longitudinal change in appraisals of daily stressors focusing on stressor control. Finally, Dr. David Almeida will examine changes in negative affect reactivity to daily stressors across the 20 years of the NSDE. Dr. Dan Mroczek will discuss the picture these presentations provide of how aging and age-differences impact the daily stress process and future directions for understanding these trajectories.
Age Differences and Longitudinal Change in Exposure to Daily Stressors: Three Waves of Diary Data Across 20 Years
Authors: Cerino Eric , Stawski Robert , Rush Jonathan
Published: December 2021

Exposure to daily stress is an important risk factor for healthy aging. We examined cross-sectional age-related differences and longitudinal aging-related change in stressor exposure across three waves of the National Study of Daily Experiences (N=2,914, M=51.53 years, SD=13.55, 56.35% Female) spanning 20 years. Exposure to six types of stressors (arguments, avoided arguments, work overloads, home overloads, network stressors, other) were obtained from telephone interviews over 8 consecutive days in waves conducted in ~1996, ~2008, and ~2017. Longitudinal analyses revealed declines in stressor exposure across 20 years (p <.01), driven by declines in arguments, work overloads, and network stressors specifically. Cross-sectional analyses indicated that older individuals reported stressors less frequently (p <.01), driven by decreases in arguments, avoided arguments, work overloads, and home overloads specifically. Rates of longitudinal decline did not depend on age at baseline. Results suggest that aging-related changes and baseline age differences inform daily stress trajectories in mid- and later-life.
Perceptions of Social Support Sufficiency Among Older Adults With HIV in Sub-Saharan Africa
Authors: Brennan-Ing Mark , Kaufman Jennifer , Porter Kristen , MacPhail Catherine , Seeley Janet , Karpiak Stephen
Published: December 2021

Globally, the greatest number of older people with HIV (OPWH) are in sub-Saharan Africa (3.7 million). This population will continue to expand with greater access to anti-retroviral therapy. Compared to OPWH in high income counties, these OPWH have constrained access to government and community-based services and largely rely on assistance from family, friends, and neighbors for their social support needs. We examined factors related to perceptions of instrumental and emotional support sufficiency (availability and adequacy) among OPWH age 50 and older in Uganda (n = 101) and South Africa (n = 108). Significant covariates of instrumental support sufficiency included not having an AIDS diagnosis, greater support from family, and less support from friends. Significant covariates of emotional support sufficiency were fewer depressive symptoms, greater support from family, and geographic location (Uganda). Explanation of these findings based on social network characteristics and implications for policy and program development will be discussed.
Stigma Impacts Health Disparities and Inequities in LGBTQ and People of Color Aging With HIV
Authors: Egbert Anna , Nash Paul , Brennan-Ing Mark , Karpiak Stephen
Published: December 2021

The impact of stigmatizing attitudes and discriminatory behaviors on health disparities and inequities in non-heterosexual individuals, people of color (PoC), older adults, and persons living with HIV becomes increasingly recognized. This quartette of stigmatized characteristics elevates the risk of barriers to medical services, burden of disease and unfavorable health outcomes in LGBTQ-PoC aging with HIV. Using data from ROAH 2.0 study (N=723), we explored facets of stigma, barriers to medical services and health status in racial/ethnic minorities of older adults with HIV (OAH) living in California, New York, and Illinois. Stigma was evident in >50% of OAH who expressed reservation to self-disclose HIV status. Importantly, 20%-24% of Asian, Black/African-American, Hispanic/Latinx and Multiracial vs. 7% White OAH withheld this information from at least one health care provider. Over 10% of OAH experienced prejudice/discrimination while accessing service. Non-disclosure and prejudice/discrimination were linked to lower self-rated health status, thus, evidencing stigma-related health burden.
Transition Into LTRC During the COVID-19 Pandemic: An Ethnographic Case Study
Authors: Davies Megan , Zúñiga Franziska , Verbeek Hilde , Staudacher-Preite Sandra
Published: December 2021

COVID-19 has affected long-term residential care (LTRC) disproportionally due to the high-risk population, lack of resources and insufficient preventative measures. Protective measures, including quarantine and strict visitation restrictions have made transitions into LTRC more challenging. Further insight is needed to understand how residents, relatives and staff have experienced this during the COVID-19 pandemic. During four months of fieldwork in a LTRC facility in Switzerland, a rapid ethnography consisting of interviews, observations, informal conversations and document analysis was conducted. This study included a total of 14 residents, 21 healthcare staff from varying departments and 7 relatives of residents. First results indicate that protective measures interfere with a resident’s ability to find meaningful activities and interactions within LTRC as well as the possibility to maintain mobility. This and limited family contact following a move into LTRC prevents a smooth transition from home to LTRC and impacts overall resident quality of life.
Assessing and Tracking Success of Advancing Age Inclusivity
Authors: Silverstein Nina , Gugliucci Marilyn
Published: December 2021

Assessment is an important component of advancing age inclusivity on your campus, and the AFU Principles are a useful guiding framework. Assessment helps move the campus from making a commitment to endorse the principles to actually taking stock of current campus practices and movement toward achieving the vision of an age-friendly institution of higher education. To establish a baseline of campus practices, assessment can be done before or after an institution joins the AFU Global Network. Evaluation also follows periodically to assess how well a campus is adhering to the AFU Principles once measurable goals are established and priorities are integrated within an institution’s strategic plan. The toolkit contains examples from multiple campuses of mapping the principles, conducting an audit, doing a photovoice evaluation, holding listening tours, and using the newly developed AFU Inventory and Campus Climate Survey (ICCS).
Risk of Alzheimer’s Disease and Related Dementia Among Adults With Congenital and Acquired Disabilities
Authors: Mahmoudi Elham , Lin Paul , Kamdar Neil , Khan Anam , Peterson Mark
Published: December 2021

Objective: Adults with congenital (cerebral palsy or spina bifida (CP/SB)) or acquired disabilities (spinal cord injury (SCI) or multiple sclerosis (MS)) have higher incidence of age-related health conditions. There is a gap in the literature about the risk of dementia among adults living with these disabilities. This study aimed to examine time to incidence of Alzheimer’s disease and related dementia (ADRD) among these disability cohorts. Method: Using national private payer claims data from 2007-2017, we identified adults (45+) with diagnosis of CP/SB (n=7,226), SCI (n=6,083), and MS (n=6,025). Adults without disability diagnosis were included as controls. Using age, sex, race/ethnicity, cardiometabolic, psychologic, and musculoskeletal chronic conditions, and socioeconomic variables, we propensity score matched persons with and without disabilities. Incidence of ADRD was compared at 4-years. Cox Regression was used to estimate adjusted hazard ratios (aHR) for incident early and late onset ADRD. Results: Incidence of early and late onset ADRD were substantially higher among people with disabilities compared to their non-disabled counterparts. Adults with CP, SCI, and MS had higher risk for early [CP/SB: aHR= 3.35 (95% CI: 2.18-5.14); SCI: aHR=1.93 (95% CI:1.06-3.51); and MS: aHR=4.49 (95% CI:2.62-7.69)] and late [CP: aHR=1.68 (95% CI:1.38-2.03); SCI: aHR: 1.77 (95% CI:1.55-2.02); and MS: aHR=1.26 (95% CI:1.04, 1.54)] onset ADRD. Conclusions: Risk of ADRD was higher among adults with CP/SB, SCI, and MS compared to their matched cohort without disability. Investment in early screening and use of therapeutic or rehabilitative services that may help preserving cognitive function among these patient cohorts is warranted.
Excellence in Rehabilitation of Aging Persons Award: Developing a Function-Focused Approach to Pain Management for Older Adults with Chronic Low Back Pain
Authors: Hicks Gregory
Published: December 2021

The overarching goal of our research program is to improve physical function and participation in older adults with chronic musculoskeletal conditions, particularly low back pain (LBP). Despite the fact that LBP is a common problem for older adults and is associated with poor outcomes in this vulnerable age group, little research has focused on LBP in people over age 65. With minimal research available, clinicians do not have clear evidence-based guidance regarding management of older adults with LBP. This presentation will focus on our pathway towards developing a focused treatment algorithm designed to prevent and address the pain-related disability found in older adults with LBP. Our work has largely focused on the identification of potentially modifiable "rehabilitation risk factors" that are associated with pain and functional limitations, as well as the development of interventions to address these risk factors. Specifically, we will discuss our findings relative to trunk muscle impairments and clinical hip impairments in the context of the older adult with low back pain.
Undergirding CNAs in LTC: The Experience of Collaborative LN-CNA Caregiving Pairs
Authors: Beynon Cynthia , Supiano Katherine , Siegel Elena , Edelman Linda , Madden Connie , Hart Sara
Published: December 2021

This research explores support provided by licensed nurses (LNs) to certified nurse aide (CNA) coworkers in the nursing home (NH). Using purposive sampling, we interviewed 12 LN and 12 CNA participants individually and as part of an LN/CNA caregiving pair. Semi-structured interviews were recorded, transcribed verbatim, and coded for meaning using NVivo software. LN and CNA participants described anticipated and unanticipated holistic support for CNAs. We applied the term undergirding to this phenomenon , and we present descriptions and examples of undergirding in nine categories: listen and respond, show respect, help with resident care and answer call lights, protect the CNA, support physical needs, and provide emotional support. Undergirding promotes work success for the CNA and the LN, as the LN job includes oversight of CNA responsibilities. Most notably, participants report undergirding facilitates high-quality resident care. These findings may be helpful for educators and administrators, but perhaps are most important for policymakers. CNAs need additional support to decrease turnover, improve retention, and elevate NH residents' quality of care. The study design identified and explored optimal collaboration as it is possible in the current NH setting. It does not represent all LN/CNA caregiving pairs.
Nursing Homes and COVID-19: Staff Experiences
Authors: Cimarolli Verena , Reinhardt Joann , Zimmerman Sheryl
Published: December 2021

Nursing homes (NHs) faced an unprecedented crisis during the rapid spread of COVID-19. This pandemic has had a devastating impact on both NH residents and workers who are often on the frontlines providing hands-on care. These workers are vulnerable to the health risks of COVID-19 due to daily exposure to residents with COVID-19, residence in areas with high infection rates, and challenges specific to low-income workers (e.g. reliance on mass transportation). Research has highlighted the experiences of NH workers during the pandemic to learn how to better support them now and during future pandemics. This symposium will add to this research and present new findings from studies conducted in the United States to capture the unique experiences of NH employees. First, Bryant illustrates specific COVID-19-related challenges that NH frontline workers faced and how these workers’ experiences compare to workers in other long-term services and support settings. Reinhardt reports findings from a qualitative study examining the multi-level challenges experienced by nursing assistants during the pandemic. Cimarolli examines if quality of employer communication and workers’ perceived COVID-19-related preparedness mitigate the impact of work-related stress on NH workers’ decision to resign. Franzosa shares recommendations based on priorities identified by nursing assistants and administrators to build future resilience based on lessons learned. Finally, Simpson identifies factors associated with states’ decisions to adopt COVID-19 testing mandates for workers in NHs. Dr. Zimmerman discusses study findings and their contributions for creating supportive NH work environments to ensure most optimal NH worker and resident quality of life.
Racism and the Life Course: Social and Health Equity for Older Black Americans
Authors: Chatters Linda , Taylor Harry , Taylor Robert
Published: December 2021

Racism and the Life Course: Social and Health Equity for Older Black Americans examines the impacts of systemic racism on adult development and the aging trajectories of Black Americans. Using the life course perspective (e.g., socio-historical events, linked lives), we discuss systemic racism as a structural driver of practices and policies (e.g., racial residential segregation) that have shaped the social and health circumstances of older Black Americans. These life circumstances include high rates of poverty, poor housing and neighborhood conditions, worse health profiles, and relationship loss and social isolation—conditions that, for too many older Black adults, represent the ‘normal’ state of affairs. Creating a ‘new normal’ of social and health equity for older Black Americans requires recognizing and disrupting the operation of systemic racism in our policies and practices. Selected recommendations and actions for achieving health and social equity for older Black Americans are discussed.
Sense of Purpose in Life Promotes Resilience to Memory Deficits Related to Depressive Symptomatology
Authors: Lewis Nathan , Hill Patrick
Published: December 2021

Individuals higher in depressive symptoms commonly present with neuropsychological deficits including poorer memory performance. Sense of purpose in life, a component of psychological well-being, has been shown to promote resilience to cognitive impairment in older adulthood, but it is unclear whether it may also protect against cognitive deficits associated with higher depressive symptoms. This study examined whether purpose in life moderated the effect of depressive symptoms on cognitive functioning in a large longitudinal study of 4599 American older adults (Mage = 74.33 years, range = 65–104 years, 56.84% female) across a 12-year follow-up period. Depressive symptomatology was assessed at each wave using the 8-item Center for Epidemiologic Studies Depression Scale. Multilevel models assessed the influence of depressive symptoms and the interaction with sense of purpose in life on changes in word recall and mental status. Higher depressive symptoms were associated with poorer recall at baseline, but not rate of change over time. A negative interaction was observed between sense of purpose in life and depressive symptoms such that individuals higher in purpose experienced a less negative impact of depressive symptoms on word recall. No significant interaction of sense of purpose and depressive symptoms was observed on mental status. Having a sense of purpose in life may help protect older adults from memory deficits associated with higher depressive symptoms. The present findings underscore the potential for sense of purpose to promote cognitive reserve in older adulthood, allowing individuals to maintain cognitive performance in the face of accruing neuropsychological challenges.