bluuebunny/crossref_metadata_2025 huggingface dataset:
Moderating Effect of Social Support Between Loneliness and Depression: Young-Old and Old-Old Adults
Authors: Cho Sunghwan , Chung Kyuhyung
Published: December 2021

Depression increases suicidal risk lowers quality of life in older adults. However, it is unknown how loneliness and depression are associated with young-old and old-older adults. This study examined association of loneliness and depression from the National Social Life, Health, and Aging Project (NSHAP) (2015-2016), estimating moderating effects of social support. The sample of this study was community dwelling Medicare beneficiaries aged 65+ (n=1,532): young-older adults (n=903) and old-older adults (n=629). Loneliness was measured by the Revised University of California, Los Angeles Loneliness Scale short form (3 items; young, M=.86, SD=.73; old, M=.87, SD=.67; range 0-3). Social support consists of two variables each measured by 4 items, spouse/partner support (young, M=2.29, SD=.50; old, M=2.26, SD=.51; range 0-3) and family support (young-old, M=2.19, SD=.52; old-old, M=2.23, SD=.52; range 0-3). Depression was measured by Center for Epidemiological Studies Depression scale (11 items, young, M=1.41, SD=.42; old, M=1.45, SD=.42; range 1-4). Multiple linear regression was used in this study, including relevant covariates. Findings indicated loneliness in both groups (young, p<.001; old, p<.001), spouse support in both groups (young, p<.001; old, p<.001) had statistical significance in depression. Family support in young-older adults (p<.05) had a statistical significance for depression. Interaction of loneliness and spouse support moderated the relationship between loneliness and depression in old-older adults (p<.05). Findings suggest old-older adults’ loneliness and depression could be soothed by spousal support. Spousal support could be important in that the informal caregiver is likely to focus on older adults with fragility at the end of their lives.
Biological Aging in Breast Cancer Survivors and the Role of Sleep
Authors: Carroll Judith
Published: December 2021

Although cancer treatments can prolong life, they may lead to long-term changes in physical health and well-being. The lasting symptoms experienced after cancer treatment include greater fatigue, pain, cognitive complaints, and functional decline. Cancer and its related cytotoxic treatments are proposed to directly altering biological aging pathways. Our recent findings support this hypothesis, suggesting that women with breast cancer exposed to therapy have alterations in indicators of biological aging, including elevated DNA damage, reduced telomerase activity, and more rapid epigenetic aging. There was variability in risk for signs of biological aging, and given the high prevalence of sleep problems among breast cancer survivors, we sought to examine whether healthy sleep might be protective. Results suggest that those with good sleep quality had less accelerated biological aging than those with sleep problems. Results point to healthy sleep as a modifiable target to protect women with breast cancer from experiencing biological aging.
Well-Being Factors That Relate to Facebook-Using Older Adults’ Perceived Social Support on Facebook
Authors: Schuster Amy , Kadylak Travis , Cotten Shelia
Published: December 2021

The majority of literature on Facebook use and well-being focuses on younger demographics. The number older adults using Facebook continues to increase. Facebook use by older adults has been found to increase well-being and decrease feelings of depression. This study investigates the effect that perceived social support on Facebook may have on loneliness, depression, social support (offline), and fear of missing out (FOMO) for older adult Facebook users. Older adults aged 65 and older in the U.S. completed a Qualtrics survey (N=798). Participants were, on average, 74 years old. Perceived social support on Facebook had a positive association with social support, depression, and FOMO. The results suggest that among Facebook using older adults, higher levels of perceived social support on Facebook were associated with higher levels of social support, feelings of depression, and FOMO. Future research should investigate the possibility that depression could be driving perceived social support on Facebook.
A Study on the Development and Validation of an Intergenerational Solidarity Measuring Tool Using Mixed Methods
Authors: Chae Joosuk , Nam Seok In
Published: December 2021

Intergenerational conflicts caused by rapid socioeconomic changes have highlighted the importance of strengthening intergenerational solidarity, emphasizing the necessity of tool designed to measure intergenerational solidarity. This study developed a standardized intergenerational solidarity measurement tool using mixed methods. In the qualitative research stage, 27 main survey questions were derived through literature research, in-depth interviews, and content validity verification. In the quantitative research stage, based on the results of a survey of 1,109 adults, both exploratory and confirmatory factor analyses of the questions were conducted, and the validity of the questions was confirmed. The analysis results were used to develop a 10-item measurement tool consisting of two factors: “recognition of intergenerational solidarity in the family” and “recognition of social intergenerational solidarity.” This study is the first attempt to develop a standardized measure of intergenerational solidarity, and it can be used for nationwide panel surveys in academic and policy research.
Health Risks Posed by Social and Linguistic Isolation in Older Korean Americans
Authors: Park Juyoung , Jang Yuri , Yoon Hyunwoo , Park Nan Sook , Chiriboga David , Kim Miyong
Published: December 2021

Guided by the double jeopardy hypothesis, the present study examined the health risks posed by the coexistence of social and linguistic isolation in older Korean Americans. Using data from the Study of Older Korean Americans (SOKA, n = 2,032), comparisons of four isolation typologies (no isolation, social isolation only, linguistic isolation only, and dual isolation) were made, and their impacts on physical (self-rated health), mental (mental distress), and cognitive health (cognitive performance) were examined. The ‘dual isolation’ group exhibited greater sociodemographic and health disadvantages. The odds of having fair/poor health, mental distress, and cognitive impairment were 2.21-3.17 times higher in the ‘dual isolation’ group than those in the group with no isolation. Our findings confirm that both social relationships and language proficiency are key elements for older immigrants’ social connectedness and integration, deprivation of which puts them at risk in multidimensions of health.
The Effect of Traumatic Brain Injury on Alzheimer’s Disease and Cognitive Decline in Veterans and Non-Veterans
Authors: Akushevich Igor , Yashkin Arseniy , Nikitin Stanislav Kolpakov , Kravchenko Julia
Published: December 2021

We assess the differences in the effect of traumatic brain injury (TBI) on the decline in cognitive status and the risk of Alzheimer’s disease and related dementia (AD/ADRD) between veteran and non-veteran respondents of the Health and Retirement Study (HRS) and measure the sensitivity of these differences to the incremental introduction of controls for associated risk factors. Three groups of AD/ADRD risk-related variables were used: i) demographic/socioeconomic factors, including gender, race, marital status, education, income, and the number of limitations in activities of daily living; ii) comorbidities, including co-existing depression/post-traumatic stress syndrome (PTSD), substance (alcohol, tobacco and/or prescription drug) abuse, diabetes mellitus, stroke, and heart failure; and iii) genetic factors, including the presence of at least one pair of the APOE4 allele and a series of polygenic risk scores associated with AD hallmarks. The dynamics of changes in cognitive impairment in response to TBI, PTSD, and mild cognitive impairment were validated against respective measures estimated using the Department of Defense Alzheimer’s Disease Neuroimaging Initiative (DoD-ADNI) data. The results of the analyses showed that TBI and PTSD were strongly associated with cognitive decline and the risks of AD/ADRD in both veteran and non-veteran subpopulations in HRS data and the difference between them was not statistically significant. Effect magnitude decreased with the addition of risk-related control variables but remained associated with the increased risks. Prevalence of mild cognitive impairment was associated with TBI at baseline in DoD-ADNI data, but no cognitive decline was observed during one year of follow-up.
Caregivers Clinic at Memorial Sloan Kettering Cancer Center
Authors: Applebaum Allison
Published: December 2021

The mission of the Caregivers Clinic at Memorial Sloan Kettering Cancer Center (MSK) is to assure that no caregiver of an MSK patient experiencing significant distress as a result of their caregiving responsibilities goes unidentified and deprived of necessary psychosocial services. This presentation will cover the steps taken and barriers faced in the development of the Clinic, including advocating for caregivers to receive their own unique medical records. Data regarding the number of caregivers seen for psychotherapy and for medication management will be presented, as will data regarding presenting complaints and average length of care. Also included is a discussion of the challenges faced in expanding and maintaining the capacity of the Clinic, especially in the setting of the pandemic during which caregivers' use of psychosocial care at MSK is notably higher than in years past. Several current adjunct approaches to address capacity needs currently being piloted will be discussed.
Child’s Developmental Disabilities and Parental Health in Later Life: Do Parental Race and Gender Matter?
Authors: Lee Juha , Gao Manjing , Lee Chioun
Published: December 2021

Parents, particularly mothers, who experienced early life adversities (ELAs) are more likely to have a child with developmental disabilities (DD). We have little knowledge about how parental health varies across race-gender groups among those with a DD child and the role of ELAs in the associations. Using Black and White adults (n = 8,778; 25% Blacks) from the Midlife in the United States (MIDUS) study, we examine racial disparities in the impact of having a child with DD (vs. having healthy children) on parental health outcomes. This study questions (1) the extent to which parents’ ELAs (e.g., poverty and abuse) are associated with having a child with DD and (2) how considering early-life factors reveals racial and gender disparities in the impact of having a child with DD. We found that as the number of ELAs increases, the probability of having a healthy child decreases for all race-gender groups, but most dramatically for Black women. Having a DD has adverse effects on chronic illnesses and functional limitations more for mothers than fathers. Black women are most adversely affected, with no effect on Black men. There is no gender difference in the impact of having a DD child on depressive symptoms, yet White parents are more vulnerable than Black parents. After controlling for ELAs, the adverse effects of having a DD child on both physical and mental health remain significant. Future research should identify life-course circumstances that reveal why the impact of having a DD child varies by race and gender.
Distinct Influences of Social Activity and Social Connectedness on Depressive Symptoms in Older Adult Couples
Authors: Steele Joel , Miller Lyndsey , Wu Chao-Yi , Dodge Hiroko , Kaye Jeffrey , Lyons Karen
Published: December 2021

This study aimed to simultaneously examine the associations between social activity and connectedness and depressive symptoms in older adult couples. Using SEM and data from 116 community-dwelling couples (age 76.18 ± 8.49), we found that engagement in social activities was associated with lower depressive symptoms in men (p = 0.014), whereas more close friendships were associated with lower depressive symptoms in women (p = 0.018), controlling for partner effects, age, education, and cognitive function (CFI: 1.00, TLI: 1.35, RMSEA: 0.00 [0.00, 0.08]). Unexpectedly, we also found better female physical health to be associated with greater depressive symptoms in males (p = 0.029). When examined as dyadic physical health, more incongruence between the physical health of partners was associated with greater depressive symptoms in men (p = 0.007). Discussion will focus on distinct influences of social activity and connectedness on mental health, and the context of gender, marriage, and dyadic health.
Caregivers' Loss of the Dyadic Experience After Their Care Partner's Death
Authors: Buck Harleah
Published: December 2021

One emerging dyadic concept is the experience of family caregivers when their care partner dies and their dyadic relationship comes to an end. This study qualitatively examined and characterized the loss of the dyadic experience for the caregiver after the death of their care partner. Data was accrued as part of a randomized clinical trial in 29 older hospice caregivers. Iterative thematic analysis focused on dyadic processes before, during and post death. Using two relational parameters from Relational Turbulence Theory resulted in a preliminary characterization of a new concept - dyadic dissolution as a cognitive and affective process whereby a remaining member of a dyad experiences relational uncertainty and partner interference while adapting (or not) to the death of their care partner. Findings suggest that asking several open-ended questions about the dyadic relationship will enable assessment for any continuing impact of relational uncertainty and partner interference on bereaved caregivers.
Social Contact Prior to COVID-19 and Longitudinal Mental Health Trajectories During COVID-19 Among Adults Ages ≥55
Authors: Gan Daniel R Y , Best John , Finlay Jessica
Published: December 2021

Social support protects mental health during a crisis. We examined whether prior contact with social organizations and friends/neighbors was associated with better trajectories of loneliness, depression and self-rated memory during the COVID-19 pandemic. We conducted latent class analysis and regression analysis on longitudinal data from the COVID-19 Coping Study of US adults aged ≥55 from April-October 2020 (n=3105). Overall, prior contact with friends(B=-.075,p<.001), neighbors(B=-.048,p=.007), and social organizations(B=-.073,p<.001) predicted better mental health amid COVID-19. Three classes were identified: Class1 had the best outcomes, whereas Class3 had the worst outcomes and were most likely to live alone(B=.149,p<.001). For Class1, prior contact with social organizations(B=-.052,p=.044) predicted decreasing loneliness. For Class2, prior contact with friends(B=-.075,p<.001) predicted decreasing loneliness and better memory(B=-.130,p=.011). Conversely, prior contact with neighbors(B=-.165,p=.010) predicted worsening loneliness among Class3. Our findings pose new questions on the role of neighborhood networks to mitigate poor mental health outcomes among older adults during a crisis.
COVID-19’s Impact on Burden and Nutrition for Family Caregivers of People With Parkinson’s Disease
Authors: LoBuono Dara , Robin Rachel , Uygur Mehmet
Published: December 2021

The COVID-19 pandemic has worsened Parkinson’s disease (PD) symptoms; however how COVID-19 has impacted family caregivers of people with PD (PwPD) is unknown. A 38-item open-and closed-ended online survey that explored caregiver burden and nutrition behaviors during COVID-19 was completed by 34 caregivers. Quantitative variables related to how COVID-19 has impacted caregiver burden are reported as percentages. Responses to open-ended questions related to COVID-19’s impact on caregiver burden and dietary behaviors were double-coded by two researchers, differences in codes were discussed until consensus was reached, and themes were finalized. The mean age of caregivers was 67.2±8.7 (47-82 years of age) and the majority were female (64.7%). Since the COVID-19 pandemic, 61.7% of caregivers felt their relationship with their PwPD stayed the same or slightly improved, 41% reported having to make a slight or increased number of adjustments to their schedules to provide care and experienced a slight or increased physical strain because of providing care. 58.8% reported a slight or increased number of times they felt sad/hopeless and 76.5% reported a slight or increased number of times they felt anxious/worried. Themes related to COVID-19’s impacts on caregiver burden included: fear, stress, and isolation; increased caregiver responsibilities; no change in caregiving. Themes highlighting COVID-19’s impact on dietary behaviors included: healthier dietary patterns; increase in snack foods and boredom eating; no change in dietary patterns. Results suggest COVID-19 has negatively impacted caregiver well-being and further exploration in changes in dietary intake are warranted.
Determining the Impact of COVID-19 on End-of-Life Experiences of Family Caregivers for People Living With Dementia
Authors: Mithani Sameer , McGhan Gwen , McCaughey Deirdre , Flemons Kristin
Published: December 2021

COVID-19 has impacted all of our lives, but the population most at risk are older adults. Family caregivers (FCGs) for people living with dementia (PLWD) face challenges in providing care, which are compounded with the introduction of COVID-19 public health policies. The purpose of this study was to examine the experiences of FCGs where the PLWD died during the COVID-19 pandemic. FCGs were invited to participate in an online survey to examine their caregiving experiences during the COVID-19 pandemic, with the option of participating in a follow-up focus group. Sixteen FCGs whose family members with dementia died during the pandemic participated in the survey. A follow-up focus group was conducted to further examine how COVID-19 policies impacted their role as a caregiver in long-term care (LTC) and affected their ability to grieve. The results of the survey and focus group suggest that a lack of role clarity and inadequate communication channels between the FCG and LTC due to COVID-19 increased the strain FCGs faced during end-of-life care. At the end of life, public policies, such as reduced or no visitation, led to feelings of inadequacy and regret. Several participants also expressed appreciation for completing Advanced Care Planning documentation prior to COVID-19. Based on these results, policymakers can help ease the increased turmoil faced by FCGs during end-of-life care in future public health emergencies by involving FCGs of PLWD in the decision-making process. The completion of Advanced Care Planning documentation can also ease the burden FCGs may experience during end-of-life care.
Deprescribing Blood Pressure Treatment in VA Long-Term Care Residents
Authors: Odden Michelle , Lee Sei , Steinman Michael , Rubinsky Anna , Jing Bocheng , Fung Kathy , Graham Laura , Peralta Carmen
Published: December 2021

There is growing interest in deprescribing of antihypertensive medications in response to adverse effects, or when a patient’s situation evolves such that the benefits are outweighed by the harms. We conducted a retrospective cohort study to evaluate the incidence and predictors of deprescribing of antihypertensive medication among VA long-term care residents ≥ 65 years admitted between 2006 and 2017. Data were extracted from the VA electronic health record, CMS Minimum Data Set, and Bar Code Medication Administration. Deprescribing was defined as a reduction in the number of antihypertensive medications, sustained for 2 weeks. Potentially triggering events for deprescribing included low blood pressure (<90/60 mmHg), acute renal impairment (creatinine increase of 50%), electrolyte imbalance (potassium below 3.5 mEq/L, sodium decrease by 5 mEq/L), and fall in the past 30 days. Among 22,826 VA nursing home residents on antihypertensive medication, 57% had describing event during their stay (median length of stay = 6 months). Deprescribing events were most common in the first 4 weeks after admission and the last 4 weeks of life. Among potentially triggering events, acute renal impairment was associated with greatest increase in the likelihood of deprescribing over the subsequent 4 weeks: among residents with this event, 32.7% were described compared to 7.3% in those without (risk difference = 25.5%, p<0.001). Falls were associated with the smallest increased risk of deprescribing (risk difference = 2.1%, p<0.001) of the events considered. Deprescribing of antihypertensive medications is common among VA nursing home residents, especially after a potential renal adverse event.
Novel Applications of Accelerometry Data for Health Outcomes in Older Adults: Thinking Beyond MVPA
Authors: Schrack Jennifer , Urbanek Jacek , Manini Todd
Published: December 2021

Physical activity is a well-established predictor of health and longevity. Wearable accelerometers produce high-frequency, time series data that capture multiple aspects of daily physical activity across the spectrum of intensity. Historically, the majority of accelerometry-based physical activity research has employed summary threshold metrics such as moderate-to-vigorous physical activity, or “MVPA.” Although these measures are important for understanding compliance with physical activity guidelines, they underutilize the potential of this data. To advance the science of physical activity in older adults, more sensitive, clinically translatable measures are needed. This symposium will examine the associations between novel measures of accelerometry-derived physical activity and various aging-related health outcomes. Dr. Wanigatunga will discuss the association of physical activity volume and fragmentation with the frailty phenotype in the Study to Understand Vitamin D and Fall Reduction in You (STURDY). Dr. Cai will present evidence on the association of physical activity quantities and patterns with measures of visual impairment in the Baltimore Longitudinal Study of Aging. Ms. Qiao will present a novel accelerometry-derived measure of performance fatigability in the Developmental Epidemiologic Cohort Study. Finally, Dr. Urbanek will discuss the role of accelerometry-derived free-living gait cadence in defining fall risk in STURDY. Collectively, these presentations highlight critical associations between objective measures of physical activity and health outcomes in older adults and illuminate the need for thinking beyond MVPA to improve prevention and intervention efforts.
Associations of Habitual Sleep Duration and Sleep Stages With Speech-in-Noise Performance
Authors: Jiang Kening , Spira Adam , Full Kelsie , Garcia Emmanuel , Lin Frank , Reed Nicholas , Lutsey Pamela , Deal Jennifer
Published: December 2021

Speech-in-noise performance involves central auditory and cortical processing and is fundamental to communication. We investigated cross-temporal associations of habitual sleep duration and stages (1996-1998) with speech-in-noise performance (2016-2017) in a subset of the Atherosclerosis Risk in Communities Study participated in the Sleep Heart Health Study(N=755, 61±5 years, 53% female). Speech-in-noise performance was measured by Quick Speech-in-Noise Test; range:0-30; lower scores=worse performance. Time spent in each stage (stage 1;2;3/4;rapid eye movement (REM)) was measured by polysomnography. Habitual sleep duration was calculated by self-reported duration on weekdays and weekends. In models adjusting for demographic and disease covariates, every 10-minute increase in REM sleep was associated with better speech-in-noise performance (0.10 points,95% CI:0.00,0.21); every 1-hour increase in habitual sleep duration was associated with worse speech-in-noise performance (-1.28 points,95% CI:-2.49,-0.08) among participants sleep >8 hours. Long sleep duration might be a risk marker of speech-in-noise performance, but REM sleep might be a protective factor.
Stakeholder-Based Methods to Develop a Toolkit to Promote Engagement in Assisted Living Safety
Authors: Beeber Anna , Anderson Ruth , Hoben Matthias , Chamberlain Stephanie , Bartoldus Victoria , Palmertree Stephanie
Published: December 2021

This presentation provides and overview of a mixed-methods stakeholder engaged study to develop a toolkit to encourage resident and family engagement in the safety of assisted living (AL). This study uses stakeholder-based data and stakeholder engaged processes to adapt existing tools and strategies from other settings to encourage resident and family engagement in the safety of AL. We will improve resident safety in AL by developing an evidence-based tool to implement these engagement tools/strategies in AL. The presentation will outline the theoretical base, the approach for this study, including efforts to recruit and retain stakeholders throughout the study, and stakeholder engaged process to develop the toolkit. The presentation will include challenges and strategies to encourage participation of AL staff, residents, and family caregivers in the study. The presentation will conclude with a discussion of implications for future design and research efforts aiming to impact AL care, policy, and research implementation.
Unbiased Proteomics and Targeted Biomarkers Associated With Exceptional Longevity and Multimorbidity in Humans
Authors: Odden Michelle
Published: December 2021

Biomarkers ideal for geroscience trials could be those simultaneously identified using targeted and discovery assays and which strongly associate with complementary disease (multimorbidity) and longevity (exceptional survival) outcomes. To identify a tractable set of biomarkers for use in geroscience trials, we used the Cardiovascular Health Study (CHS), whose participant makeup closely aligns with the Targeting Aging with MEtformin (TAME) trial. In ~4800 CHS participants, quantitative assays of nine a priori-identified biomarkers were used to construct a biomarker index which strongly associated with the TAME primary outcome of mortality and multimorbidity over 6 and 10 years of follow-up. In ~3000 CHS participants, 1300 proteins were measured with unbiased aptamer proteomics and associated with survival to age 90 over 25 years of follow-up. Proteins in the biomarker index were identified as some of the strongest associated with survival to 90. This convergent evidence suggests these biomarkers may be well-suited for geroscience trials.
Alzheimer’s Disease Among American Minority Populations: An Ecological Exploratory Study
Authors: LaQuaglia Maria , de Souza Marina Celly Martins Ribeiro , Borges Carolina Marques
Published: December 2021

A significant public health concern with regards to increasing rates of Alzheimer’s is that it disproportionately affects minority groups in the United States. The present ecological exploratory study uses secondary aggregate data from the fifty United States in the year of 2019. The purpose of this study was to address the disparities in Alzheimer’s in minority populations in the US and explore associated factors. The “minority” populations considered were African American and Latino populations, and the “majority” population was referred to as “white”. The data was extracted from the United States Census Bureau, the CDC National Center for Health Statistics, and the Behavioral Risk Factor Surveillance System (BRFSS) Dataset. The prevalence rates of Alzheimer’s disease are greatest in both older Latinos (12.2%) and African Americans (13.8%), compared to older whites (10.3%) in the investigated time period. Our results showed that being over 65 years old (p=.009), with a below-average ($62,843) median household income (p=.024), history of stroke (p=.029), and being a part of the Latino population (p=.036), were significantly associated with Alzheimer’s mortality rates in the United States. By identifying disparities in access to Alzheimer’s healthcare and at-risk communities, more comprehensive intervention strategies can be developed to promote change and advocate for more Alzheimer’s education and resource allocation for minority populations.
Disrupting the Status Quo: The New Normal of Family Caregivers’ Service Use
Authors: Moss Karen , Cimarolli Verena , Rose Karen
Published: December 2021

Family caregivers are essential partners in chronic disease management for older adults. However, being a family caregiver can have negative mental and physical health consequences, making it important for some caregivers to rely on supportive services, either for themselves (e.g. support groups) or to get help with caregiving tasks (e.g. home care). Supportive service use by family caregivers is well documented; yet, this research has often not included specific subgroups of caregivers (e.g. the racially/ethnically, or geographically diverse). Hence, the purpose of this symposium is to share new findings from research on supportive service use in understudied caregiving populations. First, Dr. Cimarolli presents findings from a study on the types of supportive services long-distance caregivers use for themselves and the factors associated with supportive service use in this caregiver population. Then, Dr. Wyman reports findings from a survey on the use of home and community-based resources by family caregivers in a Native American community. Dr. Wright will share the results of a systematic review of self-care interventions designed for caregivers of African Americans living with dementia. Finally, Dr. Mavandadi presents the results of a study examining the effectiveness of a telephone-based, collaborative dementia care program for improving outcomes in caregivers of military veterans living with dementia. Dr. Karen Rose will discuss the implications of each of these study findings for the development and evaluation of supportive interventions for these specialized family caregiver groups.
A Systematic Review of Self-Care Interventions for African American Family Caregivers
Authors: Wright Kathy , Ko Eunjung , Moss Karen , O'Brien Tara , Wold Loren , Rose Karen
Published: December 2021

African Americans (AA) family caregivers provide the bulk of unpaid care to persons living with dementia (PLWD). This role leaves little time for the adoption of self-care behaviors—critical to the prevention and management of chronic diseases. In this systematic review, we appraise caregiver self-care interventions that include AA caregivers of PLWD. PubMed, CINAHL, PsycINFO, Cochrane, and Embase databases were searched. Terms included AA/Black, self-care, caregiving, lifestyle, intervention, psychological stress, and faith/community. We initially found 250 references and after application of exclusion criteria and removal of redundant references, 18 articles were analyzed. Most interventions focused on impacting levels of caregiver burden, depression, physical activity, anxiety, or wellbeing. Psychoeducation, physical activity, and spiritually-focused interventions were most effective in improving outcomes in caregivers. Future studies should examine the impact of interventions on the prevention and management of chronic disease in AA caregivers of PLWD.
The Moderating Effect of Caregiver Engagement in Transitional Care Intervention Outcomes: A Meta-Analysis
Authors: Levoy Kristin , Rivera Eleanor , McHugh Molly , Hanlon Alexandra , Hirschman Karen , Naylor Mary
Published: December 2021

As chronically ill adults age, increased fluctuations in health status result in frequent care transitions. Caregiver engagement is often a core component of evidence-based transitional care interventions, yet little is known about the relative contribution of this element to observed outcomes. This meta-analysis aimed to synthesize evidence of caregiver engagement in randomized control trials (RCT’s) of transitional care interventions, estimate the overall intervention effects on all-cause hospital readmissions, and test caregiver engagement as a moderator of interventions’ effects. Relative risk was the effect size, and the overall effect was estimated using inverse variance weighting. Fifty-four studies met criteria, representing 31,399 participants and 65 effect sizes. The weighted sample mean age was 64 years. The majority (64%) of interventions targeted participants with specific diagnoses, such as heart disease, but more than half (54%) lacked caregiver engagement components. Among all reviewed studies of transitional care interventions, the overall effect on all-cause readmissions at 1 month was non-significant (p=.123, k=28). However, intervention effects at 2 or more months were significant (RR=0.89, 95% CI: 0.82, 0.97, p=.007, k=26), indicating a 12% reduction in the relative risk of all-cause readmissions among intervention participants compared to controls. Caregiver engagement was found to moderate intervention effects (p=.05). Specifically, interventions that included caregiver engagement produced more robust effects (RR=0.83, 95% CI: 0.75, 0.92, p=.001), than those without such engagement (RR=0.97, 95% CI: 0.87, 1.08, p=.550). Findings suggest that transitional care interventions need to more explicitly engage caregivers as active partners in order to optimize patient outcomes.
Connecticut’s Veterans-Directed Care Program Outcomes Compared to HCBS Waiver Participants: HCBS CAHPS Results
Authors: Kellett Kathy , Porter Martha , Wakefield Dorothy , Robison Julie
Published: December 2021

Connecticut (CT) Veterans Directed Home and Community Based Services Program (VDC) is an innovative Veterans Administration (VA) services option providing veterans at risk of institutionalization with person-centered consumer-directed long-term services and supports at home. Funded by an Administration for Community Living grant, the CT Department of Aging and Disability Services partnered with the VA, the five CT Area Agencies on Aging, and UConn Health Center on Aging (UConn). UConn researchers conducted the Consumer Assessment of Healthcare Providers and Systems in Home and Community Based Services (HCBS CAHPS) survey with VDC participants (n=36) from October 2019 through March 2020. The standardized, validated HCBS CAHPS survey, which Connecticut administers to individuals in most CT Medicaid HCBS programs, is a universal, cross-disability tool to assess/improve the quality of HCBS programs. Analyses compared VDC participants’ program experiences to survey results from individuals in the Connecticut Home Care Program (CHCP) (for older adults) (n=629), Personal Care Assistance (PCA) (n=282), and Acquired Brain Injury (ABI) (n=327) waiver programs. Notably, more VDC participants (91%) knew who their support broker was, compared to CHCP, ABI, and PCA (82%, 79%, and 72%, respectively) who knew their case manager; 91% of VDC participants gave their support broker the highest rating, compared to 66% to 74% of participants in other programs who rated their case manager. This study provides strong evidence that the CT VDC program is positively impacting veterans and that the AAAs and support brokers are effectively helping them receive the HCBS they need in a consumer-directed way.
NIA Division of Behavioral and Social Research Priorities in Health Disparities
Authors: Bandiera Frank
Published: December 2021

This presentation will include priority research areas in health disparities in the NIA Division of Behavioral and Social Research (BSR). It will include a portfolio analysis and description of BSR program and research in health disparities. Specifically, the 2019 BSR National Advisory Committee on Aging (NACA) recommended BSR’s number one research priority in health disparities. In 2020 BSR held a workshop on structural racism. BSR supports funding announcements in health disparities in Alzheimer’s Disease and Related Dementias, sleep, Native American Health, and immigration among others. Key themes for BSR include racial disparities that often center on context and resources, that is, factors such as residential segregation, rurality, individual and neighborhood SES, and access to health care; persistent racial differences in chronic health conditions; disparities in health systems; immigration and nativity closely linked with race and health outcomes; and racial discrimination linked to poorer mental health and psychological stress.
Faculty Perceptions of Engaging Older Adults in Higher Education: The Need for Intergenerational Pedagogy
Authors: Dauenhauer Jason , Hazzan Afeez , Heffernan Kristin
Published: December 2021

Institutions of higher education need to become more age friendly. Creating an on-campus lifelong learning program can offer older adults opportunities to audit classes and engage in multigenerational classrooms, but can also promote intergenerational learning when instructors consciously use pedagogy that fosters engagement between learners from various generations. Promoting intergenerational learning to facilitate reciprocal sharing of expertise between generations is also the fourth principle of the Age Friendly University framework. This qualitative interview study examines the perspectives of 27 faculty members who have opened their face to face classrooms to older adult auditors to 1) Explore perceived benefits and challenges associated with having older adults in the college classroom and to 2) Determine what levels of intergenerational learning may be taking place. Compared to lecture-based courses, faculty whose pedagogy promotes discussion, sharing, and small group work reported detailed examples of older adult learners and traditionally-aged college students engaging in course-related discussion. The unique, historical and diverse perspectives of older adults improved the quality of education for students, and fostered in-depth learning. Challenges related to older adult auditors included poor/limited attendance, sharing of strong opinions/dominating class discussion, sensory/mobility and technology accessibility. Recommendations include training to promote intergenerational engagement in college classrooms.
FOXO3, Telomere Dynamics, and Healthy Brain Aging: A COBRE Study
Authors: Kallianpur Kalpana , Willcox Bradley , Masaki Kamal , Allsopp Richard
Published: December 2021

Human longevity is linked to genetic, cellular, and other complex biological and psychosocial traits. Aging is typically accompanied by gradual brain atrophy and cognitive decline, but the mechanisms are unclear. Cellular aging, characterized by telomere shortening and altered telomerase activity, is related to mortality and brain aging. Decelerated brain aging is associated with greater peripheral blood leukocyte telomere length (LTL) and, we hypothesize, may be linked to FOXO3 genotype. We will use MRI to assess brain structure and function cross-sectionally in 100 Kuakini Honolulu Heart Program Offspring. Atrophy and disrupted functional connectivity, markers of brain aging, will be examined in relation to FOXO3 and LTL. Associations between brain structural and functional differences, FOXO3 genotype and LTL will be investigated over a wide range of ages, controlling for other biological and psychosocial factors. Results may provide insight into mechanisms influencing the rate of brain aging, and may eventually extend human healthspan.
Effects of Self-Perceptions of Aging on Social Disconnectedness and Loneliness in Older Adults
Authors: Hu Rita Xiaochen
Published: December 2021

Research shows that self-perceptions of aging (SPA) predict physical, mental, cognitive, and emotional well-being in older adults. Few studies have examined SPA’s effects on social well-being. Using data from the 2014–2018 Health and Retirement Study, we examined SPA’s effects on older adults’ social connectedness and loneliness (age 65+, N = 3,808). SPA was measured by eight items. Social connectedness was operationalized by network size, social contact, and social participation. The UCLA Loneliness Scale assessed loneliness. Linear regression results show that more positive SPA is correlated with increased social connectedness (b = 0.05 SE = 0.01 p = 0.0003) and decreased loneliness (b = -0.09 SE = 0.02 p < 0.0001) in four years, controlling for sociodemographic and health characteristics. Further, loneliness is a mediator between SPA and social connectedness. Findings suggest that older adults with negative SPA are at risk of both objective and subjective social isolation.
Neuronal Excitatory State Is Linked to Stress Resilience
Authors: Zullo Joseph , Yankner Bruce
Published: December 2021

The aging human brain is a study in both the importance and limitations of human stress response factors. Individual neurons can maintain functionality for 80 or more years, testifying to the potency of their stress response pathways. However, failure of these pathways during aging drastically increases the risk of neurodegenerative diseases. The transcriptional repressor REST is induced in the brains of long-lived humans but is lost in neurodegenerative disease. Here, we explore one modality of REST’s protective effects: regulation of neuronal excitability. We show that excitatory capacity and stress response are inversely correlated in the human brain. We find that REST and its C. elegans orthologs repress neuronal excitation in response to stressful conditions. Further, exogenously suppressing neuronal excitation restores stress resistance to REST-deficient animals, while enhancing stress response in wildtype ones. Thus, regulation of neuronal activity is an important aspect of neuronal stress response and a potential therapeutic modality.
Improving Self-Care of Informal Caregivers of Adults With Frontotemporal Degeneration
Authors: Massimo Lauren , Sharkey Michelle , Fisher Lauren
Published: December 2021

Frontotemporal degeneration (FTD) is a common cause of young-onset dementia that results in progressive deterioration in executive functioning and social comportment. A tremendous burden is placed on young caregivers, typically spouses, who often sacrifice their own self-care needs in order to manage the cognitive decline and subsequent functional impairments of their loved one, contributing to extraordinarily high levels of stress and depression in caregivers of individuals with FTD. Very few interventions have been tested specifically in FTD caregivers, and those that exist have generally focused on education around patient behavior management. In this session, we will discuss how we adapted the iCare4Me study, originally designed for heart failure caregivers, for caregivers of persons with FTD and we will share initial findings from iCare4Me for FTD, a randomized controlled trial which evaluates the efficacy of a virtual health coach intervention aimed at increasing self-care behaviors and reducing stress in FTD caregivers.
Planning for Seniors Housing in Changing Cities: Lessons Learned From a Cross-National Exchange
Authors: Sheppard Christine , Perry Tam , Kobayashi Karen , Cloutier Denise , Mehmood Yasir , Helfand-Green Emma , Hitzig Sander
Published: December 2021

Across North America, a growing number of older adults have a core housing need and lack access to affordable, suitable or adequate housing. Although federal, state/provincial and local backdrops vary across Canadian and American contexts, seniors’ housing providers in both countries face similar challenges and must develop innovative policy and program responses to help older adults age in place. We hosted an international seniors’ housing conference to create a platform for cross-national collaboration among multidisciplinary seniors housing experts. This event offered an opportunity to exchange best practices, emerging research, and policy solutions, and establish a set of shared priorities for advancing seniors housing that were applicable to two nations with different social systems. This paper will reflect on the exchange of knowledge and best practices related to housing preservation, eviction prevention, and access to supports during COVID-19, and the lessons learned fostering a cross-national collaborative network of seniors housing experts.
Sleep Disturbances and the Speed of Multimorbidity Development in Old Age
Authors: Calderón-Larrañaga Amaia , Pérez Laura , Vetrano Davide , Triolo Federico , Sjöberg Linnea , Darin-Mattsson Alexander , Inzitari Marco , Sindi Shireen
Published: December 2021

Sleep disturbances are prevalent among older adults and are associated with various individual diseases. The goal of this study was to investigate whether sleep disturbances are associated with the speed of multimorbidity development among older adults. Data were gathered from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K), an ongoing population-based study of subjects aged 60+ (N=3363). The study included a subsample (n=1189) without multimorbidity at baseline (<2 chronic diseases). Baseline sleep disturbances were assessed using the Comprehensive Psychiatric Rating Scale, and categorized as none, mild, moderate-severe. The number of chronic conditions throughout the nine-year follow-up was obtained from clinical examinations. Linear mixed models were used to study the association between sleep disturbances and the speed of chronic diseases accumulation, adjusting for sex, age, education, physical activity, smoking, alcohol consumption, depression, pain, and psychotropic drug use. We repeated the analyses including only cardiovascular, neuropsychiatric, and musculoskeletal diseases as the outcome. Moderate-severe sleep disturbances were associated with a higher speed of chronic disease accumulation (ß/year=0.142, p=0.008), regardless of potential confounders. Significant positive associations were also found between moderate-severe sleep disturbances and neuropsychiatric (ß/year=0.041, p=0.016) and musculoskeletal (ß/year=0.038, p=0.025) disease accumulation, but not with cardiovascular diseases. Results remained stable when participants with baseline dementia, cognitive impairment, or depression were excluded. The finding that sleep disturbances are associated with faster chronic disease accumulation points towards the importance of early detection and treatment of sleep disturbances as a possible strategy to reduce chronic multimorbidity among older adults.
Sleep Phenotypes of Caregivers for Persons Living With Dementia
Authors: Brewster Glenna , Pierpaoli Christina , Epps Fayron , Johnson Kalisha Bonds , Yeager Kate
Published: December 2021

Sleep disturbance is prevalent among caregivers of people living with dementia. Gaps exist regarding when caregivers begin to experience sleep disturbance along their caregiving trajectory. This study aimed to identify and describe phenotypes of current caregivers’ sleep patterns before and during caregiving and describe caregivers’ perception of their current sleep quality relative to their pre-caregiving sleep. We conducted semi-structured interviews with 19 caregivers participating in a larger, randomized controlled trial. Interviews were about caregivers’ sleep patterns and were conducted after caregivers completed the first 6 months of the study. Interviews were audio-recorded using a videoconferencing platform and ranged from 20 to 45 minutes. We conducted thematic analysis of the interview transcripts. Four distinct caregiver-sleep phenotypes emerged from the qualitative data: Changed and Dissatisfied, Changed and Satisfied, Unchanged and Dissatisfied, and Unchanged and Satisfied. Caregivers whose sleep was categorized as Changed experienced a difference in their pre-caregiving sleep, usually from good to poor sleep. Caregivers whose sleep was Unchanged had poor sleep pre-caregiving and continued to have poor sleep during caregiving. Caregivers also reported being Satisfied or Dissatisfied with their current sleep pattern, defined in terms of daily distress and impairment. These 4 subtypes highlight the heterogeneity of caregivers’ sleep experiences and debut a useful clinical framework with which to identify, categorize, and target caregivers at risk for sleep disturbance. Identifying caregivers’ sleep phenotypes will enable healthcare providers to determine caregivers’ needs and readiness for interventions.