bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation of a Remote Fidelity Oversight Program for a Multi-Site Exercise Intervention
Authors: Stevens-Lapsley Jennifer
Published: December 2021

The STEP-HI exercise protocol is a supervised, 2 phase, multimodal, high-intensity exercise program that emphasizes resistance training. Exercise sessions are conducted at an exercise facility and occur on two non-consecutive days/week for 6 months. During specified exercises, the exercise interventionist targets the participant’s eight-repetition maximum (8-RM), defined as the greatest resistance that can be moved 8 times through full range of motion with good form. A rigorous, remote fidelity monitoring program maximizes consistency of the intervention across sites. This fidelity oversight program is a model for future exercise studies because of its unique remote, hierarchical structure. All exercise interventionists are initially certified by written examination and direct observations. Some exercise sessions are also video recorded and reviewed using fidelity checklists. After initial certification, repeated direct observation and video-based verification of fidelity are repeated at prescribed intervals for each interventionist to ensure sustained consistency of implementation across sites.
A Dyadic Latent Profile Analysis of Older Couples’ Psychological, Relational, and Physical Health
Authors: Novak Josh , Ermer Ashley , Wilson Stephanie
Published: December 2021

The present study explored the heterogeneity of older couples’ psychological, relational, and physical health using a sample of 535 couples above the age of 62. A dyadic latent profile analysis was conducted to identify and predict unique clusters of couples’ relative psychological (depressive symptoms and daily hassles), relational (problematic affective communication and marital satisfaction), and physical health (number of health problems and self-reported health satisfaction). Predictors of class membership included relationship length, age, income, and hours worked outside the home. Results revealed 4 distinct classes: Happy & Healthy Together (63.5%), Individually & Relationally Strained (14.7%), Relationally Happy with Strained Wives (12.3%), and Relationally Happy with Strained Husbands (9.3%). Typology descriptions and predictors of class membership will be discussed. These findings highlight that health promotion efforts should be tailored to the specific psychological, relational, and physical health concerns of both partners rather than a one-size-fits-all approach.
Effects of Own and Partner Pain on Spousal Caregivers’ Marital Quality
Authors: Nah Suyoung , Martire Lynn
Published: December 2021

Little is known about whether care recipients’ and their spousal caregivers’ own pain influence the marital quality perceived by caregivers. Considering that experiencing and witnessing pain may be related to marital distress, we hypothesized that care recipient and caregiver pain would be associated with caregivers’ greater increases in marital conflict over time. We focused on 264 spousal caregivers of older adults with chronic illnesses or disability from the 2015 and 2017 National Study of Caregiving. Sixty-nine percent of care recipients and 54% of caregivers in this study were bothered by pain at baseline. Findings revealed that caregiver (b = 0.25, p = .02) and care recipient pain (b = 0.34, p < .01) at baseline were both associated with caregivers’ higher marital conflict at follow-up. These findings suggest the importance of accounting for not only care recipients’ pain but also spousal caregivers’ own pain when examining caregivers’ marital quality.
Challenges of Implementing the PRISM 2.0 Trial for Supporting Social Connectivity Through Technology
Authors: Boot Walter , Czaja Sara , Plude Dana
Published: December 2021

Following the success of the Personal Reminder Information and Social Management (PRISM) trial, which found that a specially designed computer system for older adults can enhance social connectivity and reduce loneliness among older adults at risk for social isolation, the PRISM 2.0 trial sought to replicate and extend these results to a new technology platform (tablet rather than desktop) with expanded social features and diverse populations of older adults, including older adults living in rural areas, assisted living communities, and senior housing. This symposium discusses the aims of the trial conducted by the Center for Research and Education on Aging and Technology Enhancement (CREATE), challenges encountered (including challenges related to the COVID-19 pandemic), and solutions to those challenges. S. Czaja will begin with an overview of the PRISM 2.0 system and the trial. J. Sharit will discuss challenges encountered working within the context of assisted living facilities and with impaired participants. This will be followed by a discussion of technical challenges encountered during the course of the trial presented by N. Charness. W. Rogers will present training issues involved (both with respect to participants and assessors). Finally, W. Boot will describe challenges encountered with measuring and quantifying technology use during the trial. Lessons learned are applicable to many types of technology interventions administered in diverse contexts. D. Plude, Deputy Director in the Division of Behavioral and Social Research of NIA, will serve as discussant.
PRISM 2.0: A Technology System to Support Resource Access and Social and Cognitive Engagement
Authors: Czaja Sara , Boot Walter , Charness Neil , Rogers Wendy , Sharit Joseph
Published: December 2021

Social isolation and lack of engagement are common among older adults and present a risk for emotional, physical and cognitive decline. Technology offers the potential of remediating these risks and enhancing opportunities for connectivity. In this paper we present an overview of the PRISM 2.0 multi-site RCT, which evaluated a simple to use Personalized Reminder Information and Social Management System (PRISM) among a sample of two hundred and forty-eight adults age 65+ in diverse contexts (Rural Locations, Assisted Living Communities and Senior Housing). PRISM 2.0 is a tablet-based system, intended to provide support for access to resources and information, new learning, social and cognitive engagement, and memory. We describe the goals and content of PRISM, the user-centered design process, and measurement strategies. We also discuss the challenges of conducting the trial during the COVID-19 pandemic and the strategies used to adapt the trial protocol within the three contexts.
Challenges of Quantifying PRISM 2.0 and Tablet Use
Authors: Boot Walter , Charness Neil , Moxley Jerad
Published: December 2021

As with the PRISM 1.0 trial, an important outcome of the PRISM 2.0 trial is use of the PRISM system and use of the PRISM system compared to the control condition (a standard tablet without the PRISM software). Frequent use over time is an important measure of system success. Further, use data provide key measures of system usefulness and usability. What features do participants use most and how often? Within those features, what activities do they engage in? What are the patterns of use throughout the trial, and how does PRISM system use compare to the control condition? However, quantifying use is not an easy task. This talk presents the challenges of quantifying use of a complex, multi-faceted system, and of making meaningful comparisons in use between two very different systems. Analysis approaches and solutions are discussed.
Cognition-Mortality Associations Are Stronger When Estimated Jointly in Longitudinal and Time-to-Event Models
Authors: Aichele Stephen , Cekic Sezen , Rabbitt Patrick , Ghisletta Paolo
Published: December 2021

Objectives: With aging populations worldwide, there is growing interest in links between cognitive decline and elevated mortality risk—and, by extension, analytic approaches to further clarify these associations. Toward this end, some researchers have compared cognitive trajectories of survivors vs. decedents while others have examined longitudinal changes in cognition as predictive of mortality risk. A two-stage modeling framework is typically used in this latter approach; however, several recent studies have used joint longitudinal-survival modeling (i.e., estimating longitudinal change in cognition conditionally on mortality risk, and vice versa). Methodological differences inherent to these approaches may influence estimates of cognitive decline and cognition-mortality associations. These effects may vary across cognitive domains insofar as changes in broad fluid and crystallized abilities are differentially sensitive to aging and mortality risk. Methods: We applied each of the above analytic approaches to data from a large-sample repeated-measures study of older adults (N = 5,954, of whom 4,453 deceased; ages 50–87 years at assessment). Results: Cognitive trajectories indicated worse performance in decedents and when estimated jointly with mortality risk, but this was attenuated after adjustment for health-related covariates. Better cognitive performance predicted lower mortality risk, and, importantly, cognition-mortality associations were stronger when estimated in joint models. Associations between mortality risk and crystallized abilities only emerged under joint estimation, confirming the greater power of this statistical approach. Discussion: These results suggest that joint estimation of cognition-mortality associations may be beneficial for research in cognitive epidemiology and cognitive reserve in adult development.
Conducting Research in Persons With Dementia During the COVID-19 Pandemic: Challenges and Strategies
Authors: Jao Ying-Ling , Berish Diane , Kolanowski Ann
Published: December 2021

The COVID-19 pandemic has caused a health crisis for vulnerable older adults, physically and psychologically. Despite the urgent demand for clinical research for people with dementia, research activities are restricted due to the pandemic. This symposium will share the experiences of researchers conducting studies with older persons with dementia during the COVID-19 pandemic. The presenters share their strategies to overcome challenges at different stages of the study process during the pandemic. The research projects include work conducted in acute care, assisted living, nursing homes, and the community. The presentations include perspectives from different geographic areas and across countries in North America. The first presenter reports the challenges in continuing an ongoing research project, and shares strategies to engage stakeholders and plan a new protocol for recruitment and in-person data collection with residents with dementia in nursing homes. The second presenter reports on the barriers and facilitators of conducting an ongoing clinical trial with older adults with dementia across hospital and community settings and discusses strategies to meet project goals which include modifications to the protocol and analytic plan. The third presenter describes adaptations made to a study intervention designed to promote quality resident-staff interactions in assisted living and alterations to stakeholder engagement. The fourth presenter describes challenges and strategies to engage older adults with dementia via technology. The discussant will synthesize the findings across studies and highlight policy and research implications for the COVID-19 pandemic as well as other emergency situations.
Clinical Research in the Hospital During the Pandemic: What’s Worked and Not Worked?
Authors: Boltz Marie , Kuzmik Ashley , Best Irene , Mogle Jacqueline
Published: December 2021

Under normal conditions, the hospital setting presents multiple challenges to research with persons with dementia and their care partners. This presentation describes the additional barriers posed by the COVID-19 pandemic, as well as the strategies to meet those challenges, in a cluster randomized controlled trial that examines the efficacy of a nurse-family partnership to promote functional recovery of persons with dementia. In response to research restrictions, the research team altered their plan for recruitment, implementation of the intervention, data collection, and analytic approach. This presentation describes these alterations and discusses the plan to meet the aims of the project while meeting the requirements of the Institutional Review Board, accountability to the funder, and university regulations. Modifications in staffing patterns, staff training, and procedures will also be discussed, as well as the study timeline. Finally, strategies to maintain a positive attitude and productivity within the team will be discussed.
Supporting Patient Engagement in Dementia Research via Technology During the COVID-19 Pandemic
Authors: Hung Lillian , Yang Sophie , Gregorio Mario , Phinney Alison
Published: December 2021

The COVID-19 pandemic brings challenges to patient partnerships in research. In-person research meetings with patient partners were prohibited. In this presentation, we outline specific issues we encountered in a patient-led dementia research project, which involved a literature review study and gathering community stakeholders to identify the top 10 local priorities in the development of a dementia-friendly community. We will describe how we found shared solutions to complete the project. In response to COVID, computers and training were provided for patient partners to maintain team connection, plan project activities, conduct team analysis, and host a community workshop in the lockdown time. The drastic shift to virtual research methods created barriers and opportunities for co-research with older people with dementia. Virtual meetings can generate inequities for those who do not have a computer and knowledge in videoconferencing. Practical strategies to overcome barriers to using virtual technologies will be explored.
Aging in Place Since the COVID-19 Pandemic Onset: A Qualitative Study of Neighborhood Engagement
Authors: Finlay Jessica , Kobayashi Lindsay , Cannon Melissa , Meltzer Gabriella
Published: December 2021

The COVID-19 pandemic may fundamentally change neighborhood environments and ways of aging in place. This research aimed to investigate perceptions of and engagement in neighborhoods since the pandemic onset among online survey respondents of the COVID-19 Coping Study. We analyzed a random stratified sample of 500 open-ended responses collected July-September 2020 with quotas for age, gender, race/ethnicity, and education to match the US population aged 55+. Qualitative thematic analysis identified both increased and decreased local activity and varying levels of social interaction, support, and civic engagement. Community characteristics including age structure, socioeconomic diversity, density, housing patterns, weather, and social infrastructure were related to neighborhood perceptions. These interacted with personal characteristics such as duration of residence, living arrangements, family closeness, health status, and preferred lifestyle. Results highlight coping strategies among aging adults and their neighbors, sources of individual and community vulnerability, and opportunities to strengthen social infrastructure and resiliency within neighborhoods.
Lessons Learned From Clinical Recruitment of Older Adults With MCI for an Internet-Delivered Intervention Study
Authors: Mattos Meghan , Quigg Mark , Manning Carol , Davis Eric , Sollinger Ann , Barnes Laura , Ritterband Lee
Published: December 2021

Clinical research involving participants with mild cognitive impairment (MCI) presents challenges to recruitment that may be further compounded by concerns when delivering a behavioral intervention via the Internet. The purpose of this talk is to describe recruitment adaptations for an Internet-delivered behavioral intervention study with older adults living with MCI and insomnia. Over the course of study recruitment, unforeseen barriers to recruitment were discovered, including fewer older adults with MCI endorsing sleep concerns than expected. The most substantive changes made to improve clinical recruitment were related to eligibility criteria, yielding 50% of the overall sample. Anticipated concerns of older adults with MCI using technology or accessing the Internet were not significant barriers to recruitment. Study findings support Internet-delivered intervention use in this population, which in the context of the COVID-19 pandemic, presents a potentially efficient and effective method for recruiting and delivering behavioral interventions in this difficult-to-enroll population.
Engaging Rural and Racial-Ethnic Populations in Gerontological Research
Authors: Williams Ishan
Published: December 2021

Older adults from racial/ethnic populations, as well as rural-dwelling older adults, are often at heightened risk for experiencing health disparities. Reasons for these disparities may include access issues, language barriers, distrust, lack of awareness, and of culturally appropriate materials. Racial/ethnic populations and rural-dwelling populations are also less likely to be included in research to help minimize the impact of these disparities. Shifting from reducing disparities to eliminating disparities will require attentiveness to designing programs and research that focus on increasing representation of racial/ethnic groups in research, integrating diverse populations (particularly rural and other marginalized groups) into the development of ideas and projects, and finally a commitment to culturally appropriate and inclusive approaches to research and education. Applying these strategies can provide guidance on how to best facilitate inclusive and equitable research, collaborative partnerships, and equitable healthcare for everyone, especially those from populations often underrepresented.
Resources and Services for Family Caregivers in the Time of COVID-19
Authors: McGhan Gwen , McCaughey Deirdre , Flemons Kristin , Hindmarch Whitney
Published: December 2021

COVID-19 has led to increased burden on family caregivers (FCGs) for people living with dementia (PLWD), while simultaneously limiting the resources available to them. Our study surveyed Alberta, Canada FCGs to assess their needs and generate recommendations to inform policies about care access, resources, and agency supports. We conducted a mixed methods study using a sequential triangulation design (QUANTITATIVE + qualitative). Our Community Advisory Committee was involved in all stages of study planning, execution, and dissemination. Survey results informed the qualitative data collected from focus groups with FCGs. A total of 230 FCGs participated in the survey, with an average age of 59. The average age of PLWD was 75. The majority were women (77%), 46% were spouses and 41% were adult children. Respondents reported feeling more isolated (69%), more strain (66%) and decreased quality of life (55%) compared to pre-pandemic. Resource use by FCGs decreased from an average of 5 resources pre-pandemic to 1.6 during COVID-19. Services including day programs and home care were no longer available or reconfigured, leading to greater strain and heightened need for respite, which was also unavailable. Focus groups highlighted that system navigation and accessing services during COVID-19 was overly burdensome, leaving FCGs feeling abandoned by the system. FCGs reported an increase in caregiving responsibility and less access to services resulting in PLWD experiencing a decline in wellness and function. As such: 1) resources should be consistently available for FCGs and 2) FCGs require clear, correct, and concise information about COVID-19.
Promoting Inclusivity in Dementia Education and Screening in an Ethnically Diverse, Rural Community During a Pandemic
Authors: Wiese Lisa , Williams Ishan , Schoenberg Nancy , Galvin James , Lingler Jennifer
Published: December 2021

Rural, ethnically diverse older adults experience disparities in dementia detection/management. The Covid-19 quarantine exacerbated these disparities, and threatened faith-based dementia education and screening activities. We investigated the effectiveness of a telephone-based outreach for increasing dementia knowledge and detecting cognitive risk among a rural, diverse, underserved community of 89% African American, Hispanic, and Haitian Creole residents, Faith-based health educators, trained using virtual Alzheimer’s Association resources, contacted church congregants who responded to radio worship service announcements. Participants completed telephone measures of basic dementia knowledge and cognitive risk. Of the estimated 120 persons across five churches who received an invitation, 75% (n = 90) participated in dementia education and memory screening via telephone. Twelve (80%) of the 15 participants assessed as being at risk followed up with their provider. Rural residents are known for preferring face-to-face contact. Their willingness to complete health-promoting research activities by telephone highlighted the community’s interest in dementia awareness.
A Scoping Review of Financial Elder Exploitation Interventions
Authors: Skees Stephanie
Published: December 2021

Elder financial exploitation (EFE), defined by the National Center for Elder Abuse (2021) as “the misappropriation of an older person’s money or property,” is a continuing public health crisis shown to cost individuals at least $2.9 billion a year (MetLife Mature Market Institute, 2011). Many believe this impact will increase exponentially due to the effects of COVID-19. In fact, a recent study conducted by Chang & Levy (2021) found that the prevalence of elder abuse as a whole increased from 1 in 10 older adults to 1 in 5 in the past year. Although increased collaboration between state attorneys general, Adult Protective Services, and financial institutions has driven progress in the field; there is still little known regarding EFE interventions. To address this issue, this study conducts a scoping review of the EFE intervention literature. This approach was chosen over a systematic review primarily due to the lack of a universal definition of EFE, as well as the limited number of studies available delineating between EFE and elder abuse as a whole. The main findings of the review reveal that current EFE intervention practices are focused on preventing abuse before it occurs by addressing risk factors for abuse in older adults; and are largely reliant on Adult Protective Services and the legal system. This finding is significant because state policies differ in their qualifications of EFE, thus leaving many older adults vulnerable and unprotected. Further interventions that address EFE while it is occurring and alignment across governing bodies are needed.
Older Victims of Mass Marketing Scams: An Analysis of Data Seized From Scammers
Authors: DeLiema Marguerite , Langton Lynn
Published: December 2021

Mass marketing scams are some of the most common frauds in America, and include scams perpetrated through the mail. A growing body of research indicates that older adults face a greater risk of victimization due to age-related changes in cognitive functioning and social isolation, and may be more likely to fall victim repeatedly. The aim of this study is to determine the frequency of repeat mass marketing fraud (revictimization) among older adults and patterns of victimization associated with age, scam type, seasonality, and geography. We use two decades of non-public administrative data from the United States Postal Inspection Service (USPIS). These databases were seized during law enforcement investigations of mass mailing scam organizations and contain more than 2 million unique U.S. victims and their transactions with four different fraud organizations. Victims were matched across datasets using name, address, and a change of address file. We find that revictimization rates increase with age in psychic scams. The 10,000 victims who responded the most times (between 82 and 562 times) were 78 years old on average and suffered $4,700 in total losses per person. Other significant trends emerged for lottery and sweepstakes scams. Unlike prior fraud victimization studies, inferences on victim characteristics are based on actual victim experiences with fraud rather than hypothetical scenarios or surveys where victims must self-report fraud. Findings provide valuable policy-relevant information regarding older victims and the patterns of chronic victimization.
Sleep and Loneliness as Mechanisms Through Which Marital Quality Predicts Depression Among Older Adults
Authors: Marini Christina , Martire Lynn , Buxton Orfeu
Published: December 2021

Pathways through which spousal support and strain influence older adults’ well-being are poorly understood. We examined sleep quality and loneliness as mechanisms through which support and strain predict depressive symptoms across ten years utilizing National Social Life, Health, and Aging Project data. Our sample included partnered participants at waves 1 and 2 (N = 1,293; 39% female, M age = 66, SD = 6.93). Support (e.g., rely on spouse) and strain (e.g., spouse criticizes you) were measured at W1, loneliness (UCLA) and sleep quality (restless sleep) were measured at W2, and depression (CES-D) was measured at W3. We estimated latent-variable structural equation models, controlling for age, gender, and W1 depression. Indirect effects of support and strain on depressive symptoms through loneliness were significant. There was an additional trend-level indirect effect of spousal strain on depressive symptoms through restless sleep. Findings highlight multiple pathways through which marital quality predicts later-life well-being.
Improving Policy and Legislation Related to Healthcare Workplace Violence
Authors: Mistler Lisa , Taylor Rosemary , Shippee-Rice Raelene , DiNapoli Pamela , Armenti Karla
Published: December 2021

Our group conducted the first known New Hampshire survey on healthcare staff experience of workplace violence. Study questions focused on experiences of workplace violence, incident reporting mechanisms, and the availability and benefit of workplace violence training programs. Results were consistent with recently published literature: violence against healthcare workers remains a serious public health problem that is under-reported, understudied, “tolerated and largely ignored.” We will discuss the aspects of policy and legislative responses to workplace violence that have been insufficient to address this problem. We also will present some strategies that, if implemented, could lead to improved policy and legislation that may be more proactive in reducing such violence.
Nationwide Inequities in Nursing Home Palliative Care Services
Authors: Estrada Leah , Harrison Jordan , Dick Andrew , Stone Patricia
Published: December 2021

Inequities exist in nursing home (NH) quality of care for racial/ethnic minorities, but the extent of palliative care (PC) disparities in unknown. We used cross-sectional national survey data (2017-18) from 869 NHs to measure PC services (summative score: 0-100). Survey linked to Minimum Data Set and Area Health Resources Files. Descriptive statistics and NH-level, multivariable regressions examined regional differences in NH PC services by varying concentrations of Black and Latino residents. Substantial regional differences were recorded in mean PC score and by concentration. Mean PC services were highest in the Northeast and lowest in the South: Northeast (× ̅=50.45, SE=1.50); West (× ̅=49.96, SE=1.74); Midwest (× ̅=48.18, SE=1.17); South (× ̅=44.71, SE=1.30). After adjusting for urbanicity and county level poverty, NHs in the Northeast and West with increasing concentrations of Black and Hispanic residents offered significantly fewer PC services. Overall, NHs serving predominantly serving minority populations offer fewer PC services.
Case Management in Primary Care Associated With Service Use by Adults With Dementia and Comorbidities
Authors: Quach Emma , Moo Lauren , Hartmann Christine , Zhao Shibei , Ni Pengsheng
Published: December 2021

Community-dwelling adults with dementia are at higher risks than counterpart without dementia of poor health outcomes, and those with dementia and co-occurring conditions face even greater risks. Optimal treatment for dementia includes functional and psychosocial support through long-term services and supports (LTSS), but use remains low. Our study investigated whether case management provided in primary care and in dementia care settings facilitated LTSS use for Veterans with dementia and comorbidities. We performed a cross-sectional analysis of 2019 VA-paid health care on a cohort of Veterans with dementia, defined by clinical diagnoses (International Classification of Disease, Tenth Revision). Receipt of case management was measured by whether or not a Veteran enrolled in a VA (1) home-based primary care, (2) geriatric primary care, or (3) dementia clinic. Comorbidities were measured by an adapted Elixhauser comorbidities index and dichotomized as ≤ 3 or ≥ 4 comorbidities. LTSS use was measured by whether or not Veterans used home health, home respite, adult day care, hospice, or veteran-directed care. Multivariate logistic regressions showed that LTSS use was higher for enrollees in each case management program compared to Veterans not enrolled in any. LTSS use was also higher for enrollees in each primary care program with more comorbidities than program counterparts with fewer comorbidities. Case management in primary care settings may facilitate functional and psychosocial support to meet dementia and non-dementia related needs for adults who have dementia with comorbidities.
Habitual Sleep, Sleep Duration Differential, and Weight Change Among Adults
Authors: Liu Yin , Palta Mari , Barnet Jodi , Roberts Max , Hagen Erika , Peppard Paul , Reither Eric
Published: December 2021

We assessed longitudinal associations between diary-measured sleep duration and clinically assessed body mass index (BMI) among 784 men and women enrolled in the Wisconsin Sleep Cohort Study (mean [SD] age = 51.1 [8.0] years at baseline). The outcome was BMI (kg/m2). Key predictors were habitual sleep duration (defined as average weekday nighttime sleep duration) and sleep duration differential (defined as the difference between average weekday and average weekend nighttime sleep duration) at each data collection wave. Men with shorter habitual sleep duration on weekdays had higher BMI than men with longer habitual sleep duration on weekdays. Participants with larger differentials between weekday and weekend sleep duration experienced more rapid BMI gain over time for both men and women. Inadequate sleep, characterized as shorter habitual sleep during weekdays and larger weekday-weekend sleep differential, is positively associated with BMI levels and trajectories among men and women in mid-to-late life.
Pharmacist-Led Interventions to Improve Medication Adherence in Older Adults: A Meta-Analysis
Authors: Marcum Zachary , Jiang Shangqing , Bacci Jennifer , Ruppar Todd
Published: December 2021

As pharmacists work to ensure reimbursement for chronic disease management services on the national (e.g., Medicare) level, summative evidence of their impact on important health metrics, such as medication adherence, is needed. The objective of this study was to assess the effectiveness of pharmacist-led interventions on medication adherence in older adults. In April 2020, a comprehensive search was conducted in six databases for publications of randomized clinical trials of pharmacist-led interventions to improve medication adherence in older adults. English-language studies with codable data on medication adherence and diverse adherence-promoting interventions targeting older adults (age 65+) were eligible. A standardized mean difference effect size (intervention vs. control) was calculated for the medication adherence outcome in each study. Study effect sizes were pooled using a random-effects meta-analysis model. Moderator analyses were then conducted to explore for differences in effect size due to intervention, sample, and study characteristics. The primary outcome was medication adherence using any method of measurement. This meta-analysis included 40 unique randomized trials of pharmacist-led interventions with data from 8,822 unique patients (mean age, range: 65 to 85 years). The mean effect size was 0.57 (95% Confidence Interval [CI]: 0.38-0.76). When two outlier studies were excluded from the analysis, the mean effect size decreased to 0.41 (95% CI: 0.27-0.54). Moderator analyses showed larger effect sizes for interventions containing medication education and when interventions had components delivered at least partly in patients’ homes. In conclusion, this meta-analysis found a significant improvement in medication adherence among older adults receiving pharmacist-led interventions.
Effect of a Biobehavioral Environmental Approach on Sleep in Low-Income Older Adults
Authors: Li Junxin , Okoye Safiyyah , Sciarratta Lena , Szanton Sarah
Published: December 2021

Low socioeconomic status and disability are independent risk factors for disturbed sleep. The CAPABLE intervention used a multidisciplinary team approach of occupational therapist, nurse, and handyworker to reduce functional disability in low-income older adults. The 6-month intervention may benefit sleep as the intervention addressed multiple individual factors associated with sleep quality, including pain, depression, communication, mobility, strength, and balance. This study examined the effect of the CAPABLE intervention on actigraphy-measured sleep in a sub-sample of 73 older adults from the CAPABLE trial (26 intervention vs. 47 control). The sample was aged 75.8±7.45 years, 86.3% female, and 84.9% African American. No significant group differences in sleep parameters were found at 6-month, controlling for baseline values. The intervention resulted in a 5.56% increase in sleep efficiency (95% CI= [1.39, 9.71], Cohen’s d=0.54), and 7.39 minutes decrease in sleep onset latency (95% CI= [0.10, 14.5], Cohen’s d=0.41) within the intervention group at 6-months.
Finding a Composite Measure for Data From Wrist Actigraphy in Bipolar Disorder
Authors: Kaufmann Christopher , Lee Ellen , Wing David , Ancoli-Israel Sonia , Depp Colin , Yoon Ho-Kyoung , Eyler Lisa
Published: December 2021

Actigraphy can objectively measure sleep in studies on Bipolar Disorder (BD) where subjective sleep ratings might be influenced by affect. Actigraphy data are complex necessitating data reduction approaches. We created a composite score of actigraphy sleep metrics (total sleep time [TST], wake after sleep onset [WASO], and percent sleep [PS]) in BD. We computed z-scores of sleep measures for n=51 BD vs. n=80 healthy subjects and averaged scores. We examined associations with participant characteristics and used LASSO to identify metrics best explaining composite variability. Higher composite scores (better sleep) were seen in employed vs. unemployed (t=2.40, df=34, p=0.02), and correlated with higher medication load (r=0.41, p=0.004), lower mania symptomatology (r=-0.33, p=0.04) and lower interleukin (IL)-6 levels (r=-0.32, p=0.02). TST best explained variability in medication load and PS best explained employment, mania symptoms and IL-6. Given observed specificity of associations, selecting theory-driven sleep metrics may be more appropriate than a composite.
Aerobic, Strengthening, and Balance Activities Performed by Community-Dwelling Older Adults
Authors: Wingood Mariana , Levi Bonnell , Gell Nancy
Published: December 2021

Little is known about whether older adults meet the recommended physical activity (PA) guidelines, including aerobic, strength, and balance components. Given this gap, we examined self-report PA data from 1,352 older adult participants of the Adult Changes in Thought (ACT) study. We classified participants as meeting some components, meeting the full guidelines, or being insufficiently active. Multinomial regression was used to identify factors associated with meeting PA guidelines. Despite performing 9.5 hours of weekly PA, only 11% met the full guidelines, 13% met the aerobic, and 26% met the balance or strength recommendations. Increasing age and body mass index, needing assistance with instrumental daily activities, heart disease, and low income were associated with decreased odds of meeting PA guidelines. Older adults primarily perform aerobic PA and lower intensity PA with fewer participating in strength and balance activities. Interventions targeting strength, balance, and higher intensity PA should be developed.
Ambient Air Pollution and Increasing Depressive Symptoms in Older Women: The Mediating Role of The Prefrontal Cortex
Authors: Petkus Andrew , Wang Xinhui , Younan Diana , Beavers Daniel , Espeland Mark , Millstein Joshua , Gatz Margaret , Chen Jiu-Chiuan
Published: December 2021

Exposure to air pollution may accelerate brain aging and increase risk of late-life depressive symptoms (DS). Brain structures underlying these associations are unknown. Longitudinal data from 829 community-dwelling women without dementia (baseline age 81.6 ± 3.6 years old) who participated in both the Women’s Health Initiative Memory Study Magnetic Resonance Imaging study (WHIMS-MRI; 2005-06) and the WHIMS-Epidemiology of Cognitive Health Outcomes (2008-16) were analyzed to examine whether volumetric measures of brain structures mediated associations between long-term exposure to ambient air pollutants and annual increases in DS (as measured by annually assessed 15-item Geriatric Depression Scale). Annual PM2.5 (fine particulate matter of aerodynamic diameter <2.5) and NO2 were estimated at the participants’ residence using regionalized universal kriging models and aggregated to the 3-year average prior to the WHIMS-MRI. Structural equation models were constructed to estimate associations between exposure, structural brain variables, and trajectories of DS (standardized on baseline mean and SD). Living in locations with higher NO2 (standardized β = 0.023; 95% Confidence Interval (CI) = 0.004, 0.042) or PM2.5 (standardized β = 0.021; 95% CI = 0.004, 0.038) was associated with larger annual increases in DS (~60% larger annual increase in DS). Higher NO2, but not PM2.5, was associated with smaller prefrontal cortical volumes (standardized β = -0.431; 99% CI = -0.518; -0.344). Prefrontal cortical volume explained 30.4% of the total association between annual DS increase and NO2. These findings underscore the importance of the prefrontal cortex in associations between NO2 exposure and increasing DS in later-life.
Social Connection in Times of Physical Distancing
Authors: Lee Jeongeun
Published: December 2021

COVID-19 has been especially devastating to older adults. To prevent the spread of the virus, physical distancing has become the norm. As a result, there are fewer opportunities available for face-to-face interaction and social activities, which may be particularly harmful to older adults, given their existing loneliness levels. Thus, this symposium brings together a collection of papers that exemplify the interplay of social connection, activities, and mental health outcomes among older adults facing loneliness. The first paper will discuss how activity diversity is linked to higher loneliness and depressive symptoms among heterosexual and LGBTQ older adults. The second paper will present findings on the changes in social connectedness due to physical distancing and their associated impact on the mental health outcomes among older adults. The third paper will present qualitative findings on the effect of physical distancing on older adults' social connectedness using a mixed-method study. The final paper discusses the challenges faced by older adults in their use of digital media for social connection in the present pandemic and highlights some of the population's untapped strengths, which can be leveraged to help them live prosperous online lives. All papers will address practical tips and recommendations for actions, which key stakeholders can take to support older adults during the pandemic. The discussant, Dr. Kahana, will integrate the four papers and highlight the potential and limits of the current effort to address these issues and consider future inquiry routes.
2020 Editor's Choice Articles From JGMS: Focus on Vulnerable Populations
Authors: Lipsitz Lewis , Baker Tamara
Published: December 2021

This symposium will present four 2020 “Editor’s Choice” articles from the Journal of Gerontology Medical Sciences that focus on issues relevant to vulnerable older populations. Justin Golub and colleagues, in their article “Audiometric Age-Related Hearing Loss and Cognition in the Hispanic Community Health Study”, broaden the scope of age-related studies on audiometric hearing loss by using a large Hispanic cohort, a community largely excluded from previous hearing loss studies. By examining audiometrically-defined hearing loss and cognitive measures, Golub found links between hearing loss and lower neurocognition. Janice Atkins and colleagues, in “Preexisting Comorbidities Predicting COVID-19 and Mortality in the UK Biobank Community Cohort”, challenge the practice of simple age-based targeting of older adults to prevent severe COVID-19 infections, and show that specific high-risk comorbidities are better indicators of hospitalization and mortality. “Comparison of Recruitment Strategies for Engaging Older Minority Adults: Results from Take Heart”, by Jessica Ramsay and colleagues, examines methods used to recruit older adults of color from primarily low socio-economic households for behavioral and clinical health research. Ryon Cobb and coauthors, in their article “Self-reported Instances of Major Discrimination, Race/Ethnicity, and Inflammation among Older Adults: Evidence from the Health and Retirement Study”, investigate whether self-reported lifetime discrimination is a psychosocial factor influencing inflammation in older adults. Tamara Baker, the discussant, will highlight commonalities and lessons learned from these studies, including links between racial, socio-economic, or disease-related vulnerabilities of older adults and their health status, as well as best practices to account for these factors in future clinical trials.
The COVID-19 Pandemic and Intergenerational Support: Results Based on the Health and Retirement Study COVID-19 Module
Authors: Feng Guanggang , Cong Zhen
Published: December 2021

This study examined relationships between COVID-19 exposure and intergenerational support patterns. The data was from the 2020 Health and Retirement Study (HRS) COVID-19 Module (N=3266). The latent class analysis (LCA) was used to identify the types of intergenerational support based on respondents’ reports on whether they provided and received financial and instrumental support from either coresident children or non-coresident children. Two classes were identified, namely, the high interaction group and the low interaction group. Logistic regression showed that respondents who had COVID-19 and had increased spending as a result of COVID-19 were more likely to be in the high interaction group. Other types of COVID-19 exposure, i.e., knowing someone being diagnosed or knowing someone who died from COVID-19 were not significant.
Disrupting Othering: A Continuum of Age-Integrated Strategies for Gerontology Education
Authors: Borrero Lisa , Borrero Lisa
Published: December 2021

Given the extensive negative impacts of ageism, it is incumbent upon institutions of higher education to lead the charge in promoting age inclusivity and dismantling ageism, particularly in the classroom. Traditional teaching approaches are insufficient to meet the needs of our increasingly diverse student population or our aging post-COVID society. Gerontology classrooms require new, innovative, and purposeful ways of engaging students in course content. This symposium brings together faculty who intentionally promote age inclusivity by immersing students in age-integrated experiences to varying degrees and in different ways. These approaches fundamentally reject the idea of older adults as “other” by promoting an age-inclusive reality in which individuals of all ages are equally valued. Dr. Lyn Holley will describe a new course which requires projection of a future, older self and two systematic life interviews – one of a real US elder and one of an imagined counterpart in a different country; comparative analysis reveals how aging is shaped by society. Dr. Skye Leedahl will discuss challenging ageism by examining existing age-focused policies and programs and having students engage in six intergenerational discussions and reflective writing. Dr. Tina Newsham will describe a newly revised practicum in which immersive, real-world experiences with older adults are incorporated, along with meaningful reflection and the development of an e-portfolio. Finally, Drs. Laura Donorfio and Lisa Borrero will explain the ways “othering” is disrupted when students imagine themselves as older adults, and use creative approaches that demonstrate how to negotiate key aspects of the aging process.
Disrupting Othering by Fostering Light-Bulb Moments in Immersive Practical Experiences
Authors: Newsham Tina K
Published: December 2021

Fully immersive experiences (i.e., practica, internships, clinicals) with older adults are one successful strategy to reduce ageist beliefs among students, as long as the experiences are high quality and students are given an opportunity to reflect on their observations, feelings, and application of classroom knowledge. Representing a more intensive level of engagement than single-session interviews or multisession intergenerational activities, such experiences are not without challenges. Instructors are not present on-site continually (or at all) to observe what the student is seeing or doing, therefore providing limited opportunity to recognize and reframe situations that may reinforce the “othering” of older adults. Through creating carefully curated reflection prompts and assessment strategies (such as eportfolios), this presenter will discuss how instructors can ensure students completing practica, internships, and clinicals recognize the breadth and diversity of aging experiences, engage ethically and appropriately with older adults in non-ageist ways, and avoid reinforcing “othering” and ageism.
Getting to Know Yourself Across the Lifespan
Authors: Donorfio Laura
Published: December 2021

New teaching and learning methods must be developed to accommodate exclusive online environments. The utilization of experiential learning in an aging course is a key teaching method that helps tap into the affective domain of learning (i.e., feelings, values, and attitudes). In a society where ageist attitudes abound and are often internalized, purposeful challenges to the "othering" of older adults is needed to disrupt this cycle. This presentation will share an experiential/age inclusivity activity that can be utilized in any teaching environment. Over a semester, students are required to write themselves four separate letters from their older selves at varying ages to their younger selves. They must research and provide a snapshot of what their life will be like at these ages in predetermined areas (i.e., health, mobility, family/friends, policy, and cultural variables, etc.) Worksheets will be provided capturing this "Getting to Know Yourself Across the Lifespan" experiential learning activity.