bluuebunny/crossref_metadata_2025 huggingface dataset:
HOW INTERNET USE MODERATES THE EFFECT OF PHYSICAL LIMITATIONS ON SUBJECTIVE WELL-BEING IN OLDER ADULTS
Authors: Wen Wan , Mejia Shannon
Published: December 2023

Due to geographic barriers and limitations in mobility, older adults with functional limitations are at greater risk of social isolation and lower well-being. The Internet has the potential to help mitigate the negative effects of functional limitations by connecting older adults to health services and meaningful social networks, and thus contribute to their subjective well-being (SWB). This study examined how Internet use could increase access to health behaviors and close friendships and moderate the impact of physical limitations on older adults’ SWB. Using data from 2008 to 2018 U.S. Health and Retirement Study (HRS) (n = 14,178, 76% white, 55% female), this paper used life satisfaction and emotional indicators (positive and negative affect) as measurements of SWB and adopted multilevel random effect models to conduct empirical analysis. The results showed that older adults with physical limitations experienced significant reductions in life satisfaction and positive affect and increases in negative emotions. However, the Internet mitigated the adverse emotional impacts of physical limitations by facilitating the maintenance of older adults’ social networks and health behaviors. These findings support the development of actions to enhance the well-being of older adults with physical limitations and put them as the primary beneficiaries of information and communication technology.
RISKS AND HEALTH OUTCOMES OF NEW ONSET OF UNMET NEEDS FOR HELP WITH ACTIVITIES OF DAILY LIVING
Authors: Sands Laura , Khan Maham , Du Pang
Published: December 2023

Twenty percent of community-living older adults who have difficulty completing mobility and self-care daily activities have unmet need for help with one or more daily activities. Prior research described correlates of existing unmet needs but did not consider which health characteristics and events increase risks for new onset of unmet needs. Data are from the 2011-2019 annual interviews of the National Health and Aging Trends Study. Onset of unmet need was calculated as having more unmet needs in the subsequent year compared to the prior year. Linear Mixed models were computed to assess which health characteristics and events increased risk for new onset of unmet need across 15,334 observations from persons who needed help with mobility tasks and 12,895 observations from persons who needed help with self-care tasks. Characteristics associated with new onset of mobility unmet needs were: age 80+, minority race, female sex, 2+ mobility limitations, 2+ chronic conditions, and dementia. Hospitalization during the yearly interval increased risk for new onset of unmet need for those with dementia (OR=3.01, 95%CI=2.62-3.44) and for those without dementia (OR=2.27, 95%CI=2.03-2.53). New onset of unmet need increased risk for nursing home or residential care placement (OR=1.63, 95%CI=1.31-2.03) and mortality (OR=2.10 95% CI =1.84-2.39) in the year following new onset of mobility unmet need. Results were similar for self-care daily activities. The findings inform the need for regularly assessing care needs, particularly after hospital discharge, with the goal of addressing new care needs to prevent new onset of unmet needs and its health consequences.
EMERITI PROFESSORS’ INTERGENERATIONAL TEAM TALK: REDUCING STUDENTS’ AGING ANXIETY ADDRESSES AFU PRINCIPLES
Authors: Gautam Ramraj , Melillo Karen Devereaux , Abdallah Lisa , Wangwun Patcharee
Published: December 2023

Intergenerational learning is one of the six pillars of the Age-Friendly University (AFU) institutional activity. This study was guided by the AFU principles 9 (involving university’s own retired community) and 4 (promote intergenerational learning between learners of all ages) and Positive Education about Aging and Contact Experience (PEACE) Model (Levy, 2018). A team of 4-5 students (12 teams total) in an undergraduate Introduction to Gerontology course in Fall 2022 conducted two, one-hour in-depth Zoom Intergenerational Team Talk (ITT) interviews with emeriti professors. The objective was to assess the change in students’ aging anxiety (measured using Bousfield and Hutchison’s, 2010, 4-item Aging Anxiety Scale), expectations about aging (measured using Sarkisian et al, 2005, 12-item Expectations Regarding Aging survey), and career and academic trajectories before and after the implementation of the ITT interview. The University IRB approved study sample included 57 students, where 31completed both pre and post surveys. A paired sample t-test showed a significant reduction in students’ aging anxiety [t(29) = 2.45, p = 0.020] and increased positive expectations regarding aging [t(26) = -2.94, p = 0.007], after the ITT interview activity. The results support the PEACE model that included emeriti professors as positive role models in an intergenerational contact. Emeriti were a valuable resource for lowering aging anxiety and increasing positive expectations regarding aging among university students. Engaging emeriti professors can create a more inclusive and age-friendly environment. Future studies should also explore the impact of intergenerational contacts on emeriti professors’ perception of younger adults.
STUDENT EXPERIENCES TEACHING AN INTERPROFESSIONAL COMMUNITY-BASED HEALTH PROMOTION PROGRAM FOR OLDER ADULTS
Authors: Mahanna Allexis , Livingston Marin , Chapman Cara , Howell Britteny
Published: December 2023

Nine (N=9) undergraduate and graduate students collaborated on an interprofessional health promotion program in Spring 2023. Funded by the National Institute on Aging, this student-led program utilized Persuasive Hope Theory with older adult participants to increase their fruit and vegetable intake and exercise patterns in 1-hour weekly sessions. At four community locations for 15 weeks, students gained skills in team-teaching, facilitating group discussions and activities, and engaging in physical activity instruction with older adult participants. At the end of the program, students completed a modified Undergraduate Research Student Self-Assessment (URSSA). As a result of participating in this project, students report understanding and familiarity with the research process, following scientific protocols, problem-solving, and working collaboratively. Students also reported their motivations for joining a research study, satisfaction with working relationships with faculty members and opportunities to present their work, and how these experiences with gerontological research have influenced their career goals. The presenters of this paper are the students themselves, who will lend personal experiences and stories to these survey results. The factors contributing to successful student engagement in this project can be applied by other researchers working in community-based contexts.
GENDER DIFFERENCES IN SKELETAL MUSCLE ENERGETICS EXPLAIN THE MOBILITY IMPAIRMENT DISPARITY IN SOMMA
Authors: Kramer Philip , Distefano Giovanna , Ramos Sofhia , Goodpaster Bret , Newman Anne , Marcinek David , Cawthon Peggy , Molina Anthony
Published: December 2023

An age-related decline in muscle mitochondrial energetics is known to contribute to the loss of muscle function in older adults. Women experience a higher prevalence of mobility impairment compared to men, but it is unknown whether gender-specific differences in muscle energetics underlie this disparity. In the Study of Muscle, Mobility and Aging (SOMMA), muscle energetics were characterized using in vivo 31-Phosphorus Magnetic Resonance Spectroscopy and High-Resolution Respirometry of the vastus lateralis. A Short Physical Performance Battery score ≤ 8 was used to define lower-extremity mobility impairment. In this analysis of 773 participants age 70-94, women had greater odds (OR=1.83, p=0.03) of mobility impairment compared to men, which was largely explained by significantly lower muscle energetics (Maximal OXPHOS in Women= 55.06 +/- 15.95; Men= 65.80 +/- 19.74; p<0.0001) using mediation modeling (adjusted OR=1.25, p=0.45). The mobility impairment disparity could be further explained by BMI, race, physical activity, and number of comorbidities (adjusted OR=0.98, p=0.96). However, none of these covariates, including age, fully explained gender differences in muscle mitochondrial energetics (e.g. Adjusted Maximal OXPHOS in Women= 56.5, 95%CI=54.8, 58.1; Men= 64.4, 95%CI=62.5, 66.2; p<0.0001). Notably, high BMI and low gait speed were associated with lower muscle energetics, though BMI slightly more so in women (ATPmax BMI/gender interaction, p= 0.02) than men, and age was only significantly negatively associated with muscle energetics in men (e.g. Maximal ETS capacity age/gender interaction, p=0.04). In conclusion, women had lower muscle mitochondrial energetics compared to men, which largely explained their greater odds of lower-extremity mobility impairment.
SKELETAL MUSCLE ENERGETICS ARE ASSOCIATED WITH PERFORMANCE FATIGABILITY
Authors: Qiao Yujia (Susanna) , Santanasto Adam , Cawthon Peggy , Forman Daniel , Kritchevsky Stephen , Nicklas Barb , Newman Anne , Glynn Nancy
Published: December 2023

Performance fatigability manifests as insufficient energy to complete daily physical tasks and worsens with aging, exacerbating vulnerability to disability. Skeletal muscle energetics also declines with aging. Thus, we hypothesized muscle energetics may be an important contributor to performance fatigability. In the Study of Muscle, Mobility and Aging (SOMMA), participants completed a usual-paced 400m walk while wearing a wrist-worn ActiGraph, from which raw data were used to derive the Pittsburgh Performance Fatigability Index (PPFI, higher=more severe fatigability) that quantifies percent decline in the entire individual cadence-versus-time trajectory. Maximal oxidative phosphorylation (maxOXPHOS) in skeletal muscle mitochondria was quantified in vitro using high-resolution respirometry in permeabilized fiber bundles from vastus lateralis muscle biopsies. Maximal adenosine triphosphate production (ATPmax) was assessed in vivo by 31P magnetic resonance spectroscopy. We conducted separate tobit regressions to examine associations of maxOXPHOS and ATPmax with PPFI, adjusting for technician/site, age, sex, race, height, weight, and mins/day moderate-to-vigorous physical activity measured by ActiGraph in free-living, in N=795 participants with complete PPFI scores and >1 energetics measure (70-94 yrs, 58% women). Median PPFI scores were 1.4% [IQR: 0-2.9%]. After adjustment, each SD (18.4 pmol/(s*mg)) lower maxOXPHOS was associated with 0.55% (95% CI: 0.26, 0.85) higher PPFI scores, while each SD (0.2 mM/sec) lower ATPmax was associated with 0.54% (95% CI: 0.27, 0.81) higher PPFI scores. Our results indicate that lower skeletal muscle energetics were associated with more severe performance fatigability. This suggests that therapeutics targeting muscle energetics may thereby potentially mitigate fatigability and lessen susceptibility to disability among older adults.
THE RELATIONSHIP BETWEEN LONG-TERM CARE OMBUDSMAN PROGRAM SPENDING AND NURSING HOME OUTCOMES
Authors: Kennedy Katherine , Kosar Cyrus , Thomas Kali
Published: December 2023

As part of the Older Americans Act, State Long-term Care Ombudsman Programs (LTCOP) serve older adults in nursing homes (NHs) and board and care facilities. The National Academies of Science, Engineering, and Medicine called for increased LTCOP funding to improve NH quality. We hypothesized that increases in spending on LTCOP would be associated with a lower prevalence of NH residents with low-care needs who could be cared for in the community and fewer residents taking antipsychotics. We conducted a secondary analysis using the National Ombudsman Reporting System, NH facility-level data from LTCfocUS.org for 15,592 US NHs (2011-2018), and the Area Health Resource File. Using a two-way fixed effects model with standard errors clustered at the facility-level, we examined the relationship between LTCOP spending per LTC bed at the state-level and outcomes, controlling for year, state, facility, and market characteristics. Increased LTCOP spending was associated with a lower proportion of residents in NHs with low-care needs and a lower percent of residents receiving antipsychotics (p < .0001). In 2011, the average share of low-care NH residents (weighted by bed size) was 13.34%, and the share of residents on antipsychotics was 25.95%. For every $25 annual change in LTCOP funds, there was a .84 percentage point decrease in the prevalence of low-care residents for the average NH, and a .80 percentage point decrease in the share of residents receiving antipsychotics. States that have increased funding for their LTCOP observe better outcomes. This documents the need to increase funding to support LTCOP.
USING NETWORK ANALYSIS METHODS TO STUDY MULTIMORBIDITY PATTERNS
Authors: Griffith Lauren , Brini Alberto , van den Heuvel Edwin , John Philip St , Stirland Lucy , Mayhew Alexandra , Muniz-Terrera Graciela
Published: December 2023

Multimorbidity is a risk factor for patient-important outcomes including quality of life and functional decline. Multimorbidity research has focused mainly on disease counts, with less attention to patterns among chronic conditions. Network analysis has been increasingly used to examine multimorbidity clusters, but there are no guidelines for its conduct. In 12 recent studies using network analysis, we found heterogeneity in association measures (10 different measures) and clustering algorithms (5 different methods) used to identify multimorbidity clusters. Using self-reported data on 24 diseases in community-living adults aged 45-85 from the Canadian Longitudinal Study on Aging, we conducted network analyses using the 10 association measures and 5 clustering algorithms to better understand how these choices impact the number and types of clusters identified. We compared the similarity among clusters using the adjusted Rand index (ARI); an ARI of 0 is equivalent to the diseases being randomly assigned to clusters and 1 indicates perfect agreement. Two clinicians independently identified potential disease clusters which we compared to network analyses results. We found results differed greatly across combinations of association measures and cluster algorithms. The number of clusters identified ranged from 1 to 12 and their similarity was generally very low. Compared to clinician-derived clusters, the ARIs ranged from 0 to 0.23 indicating little similarity. These analyses demonstrate the need for a systematic evaluation of the performance of network analysis methods on binary clustered data like diseases. Moreover, diseases may not cluster, and a personalized approach to the care of older adults may be needed.
BIOLOGICAL AGE AND COGNITIVE PERFORMANCE AMONG LATE MID-LIFE WOMEN
Authors: Thurston Rebecca , Kusters Cynthia , Chang Yuefang , Maki Pauline , Carroll Judith
Published: December 2023

Older biologic age, indicated by accelerated epigenetic aging, may place women at risk for poorer cognitive performance as they age. However, findings are inconsistent and based upon limited neuropsychological batteries. Studies of midlife women are few, yet women comprise two thirds of those with Alzheimer’s disease, and midlife is a critical transition and potential window for early intervention. We tested whether greater epigenetic age would be associated with poorer cognitive performance among late midlife women. 224 MsBrain study participants (average age=59 years, 82% White, 14% Black, 4% other ethnicities) underwent phlebotomy, including epigenetic aging clock estimates (GrimAge, DunedinPACE, PCPhenoAGE), and a neuropsychological battery assessing global cognitive function (Montreal Cognitive Assessment), verbal learning and memory (California Verbal Learning Test), working memory and attention (Letter Number Sequencing), letter fluency (P, R, W); semantic fluency (animal task), spatial ability (Card Rotations), processing speed (Symbol Digit Modalities Test), and perceptual speed (Finding A’s). In linear regression models controlling for age, race, and education, older PCPhenoAge was associated with poorer global cognitive performance [B(SE)=-.07(.03), p=.01], verbal memory [B(SE)=-.09(.03), p=.006], working memory [B(SE)=-.12(.03), p=.0001], attention [B(SE)=-.10(.04), p=.02], spatial ability [B(SE)=-.77(.34), p=.02], processing speed [B(SE)=-.24(.09), p=.007], and somewhat lower letter fluency [B(SE)=-.23(.13), p=.07]. GrimAge and DunedinPACE showed similar yet less consistent patterns. Interactions by race (p’s<.05) indicate that associations between older biologic age and poorer cognitive performance (verbal learning, verbal memory, processing speed) was particularly pronounced among Black women in the sample. Older biologic age is associated with poorer cognitive performance across multiple domains among late midlife women, particularly for Black women. Biologic age may serve as an early indicator of risk that could help identify women warranting early intervention to help maintain cognitive function. Supported by NIH RF1AG053504, R01AG053504, K24HL123565
EFFECTS OF GAMIFIED COGNITIVE TRAINING TO DETER THE PROGRESSION OF MILD COGNITIVE IMPAIRMENT
Authors: Yu Doris S F , Li Polly , Two Wung Wai , Waye Mary
Published: December 2023

Mild cognitive impairment (MCI) is highly prevalent condition among older adults, and has a greater risk of progression to dementia. Even cognitive training has great efficacy to delay the onset of dementia, its time-limited offer by professional members reduces its availability. Whereas ‘gamification’ evolves as important concept to enhance treatment engagement, we developed an innovative Sudoku solving algorithm titled ‘T-code’ to assimilates the key domains of cognitive training on attention, logical and deductive reasoning. A single-blinded RCT randomized 288 older adults with MCI to receive the 24-week Sudoku Mind Activation and Revitalizing Training (SMART) Program (n=157) or the usual care (n = 131). A battery of cognitive assessments, the Memory Inventory for Chinese, the Short Form-36 were evaluated at baseline, immediately after the 12-week Sudoku training and after the 12-week home-based self-practice. Focus group interview was conducted to explore subjects’ experience and reasons for its therapeutic effects if any. The results indicated that participants in the SMART Program had greater improvements in global cognitive function, working memory, language, short- and long-term delay recalls, recognition memory, CTT 1 and subjective memory complaints immediately after the 12-week training than the control. These effects, together with executive function, were sustained till the end of the programme. The qualitative findings converged with the outcome evaluation, and improved self-confidence, more active life engagement, and enhanced mood status might sustain the cognitive benefits. This game-based cognitive training is a treatment option of high accessibility, availability and acceptance to prevent MCI from progressing to dementia.
IN-VEHICLE SENSORS TO DETECT CHANGES IN DRIVING BEHAVIORS WITH EMERGENCE OF MCI
Authors: Tappen Ruth , Jang Jinwoo , Moshfeghi Sonia , Yang KwangSoo , Rosselli Monica , Coniff Joshua , Furht Borko , Newman David
Published: December 2023

Driving is a complex behavior requiring attention, judgment, orientation, memory, processing speed, visual acuity, adequate limb strength, and other functional abilities. It has been suggested that a change in driving behavior may be an early indicator of cognitive decline in the aging brain. The literature suggests that older drivers will drive less and more slowly as their cognitive skills begin to decline. In the “In-Vehicle Sensors to Detect Cognitive Change in Older Drivers” study, sensors are installed in participant vehicles and data is downloaded every three months at which time a carefully curated battery of cognitive tests is also administered. Records of those suggesting mild cognitive impairment (MCI) are reviewed by a Consensus Diagnostic Panel for confirmation. In the first 100 participants who have been followed over a year, nine participants evidenced existing or emerging MCI. Of these, six have experienced a decline in cognition in the last year. A comparison of driving behaviors over the year evidenced the previously reported slower, less frequent driving but also a previously unreported increase in hard braking and hard turns. The uniqueness of our longitudinal study is the continuous tracking of vehicle acceleration patterns over time, revealing significant relationships between g-force acceleration and cognition.
ANTIHYPERTENSIVE DEPRESCRIBING AND COGNITIVE FUNCTION IN VA NURSING HOME RESIDENTS: A TARGET TRIAL EMULATION
Authors: Jing Bocheng , Liu Xiaojuan , Odden Michelle , Dave Chintan , Graham Laura , Li Yongmei , Fung Kathy , Steinman Michael
Published: December 2023

Deprescribing is the practice of discontinuing or reducing medication that no longer provides benefits or causes harm. While deprescribing antihypertensives for frail elderly patients has gained interest, its impact on patient-centered outcomes such as cognitive function remains unknown. We emulated a target trial involving 45,183 Veteran Affairs nursing home residents aged ≥65 with stays ≥12 weeks between 2006-2019. Eligible residents must have a 4-week stable medication use period; they were allocated to the deprescribing/control arms, and censored at death, discharge, or two-year follow-up for intention-to-treat analysis. We used the Cognitive Function Scale (CFS) to assess cognitive outcomes, categorizing residents into cognitively intact, mild-, moderate-, and severely-impaired groups. We used an ordinal generalized linear-mixed model to analyze the effect of deprescribing on CFS, adjusting for confounders with 47 baseline covariates using inverse probability of the treatment weights. 1,290 and 11,354 patients were in deprescribing/control arms. At baseline, deprescribing was associated with an increased risk of worse cognitive function (OR=1.168 for being in a higher CFS category [95% CI:1.115-1.224]). Overall, cognition worsened in both arms over time (OR=1.007 per week for progression to higher CFS category, 95% CI:1.006-1.008). However, deprescribing mitigated the time trend, and the residents in the deprescribing arm had significantly decreased odds (improved CFS) at 0.996/week (95% CI: 0.995-0.997), 0.900 (95%CI: 0.881-0.919) over 26-weeks, and 0.811 (95% CI: 0.777-0.845) over 52-weeks. Our findings suggest that deprescribing is associated with a slower decline in cognitive function and can help inform future deprescribing interventions for BP management in nursing home residents.
NUTRITION THERAPY IN DISCHARGED OLDER ADULTS REDUCES HOSPITAL READMISSIONS AND LENGTH OF STAY
Authors: Ramel Alfons
Published: December 2023

The aim was to investigate effects of six-month nutrition therapy on hospital readmissions, LOS, mortality and need for long-term care residence up to 18-months post-discharge in older Icelandic adults. Participants (>65 years) were randomised into intervention (n=53) and control (n=53) before discharge from a geriatric unit. The intervention group received nutrition therapy based on the Nutrition Care Process, including home visits, phone calls, freely delivered energy- and protein-rich foods and supplements for six months after hospital discharge. The Icelandic electronic hospital registry was accessed to gain information on emergency room visits (ER), hospital readmissions, LOS, mortality and need for long-term care residence. One subject from each arm dropped out during the intervention period. The intervention increased body weight (+5.2kg, 95%CI: 3.9-6.5kg) and energy intake (1696kcal, 95%CI: 1557-1834kcal) compared to control. The intervention group had a lower proportion of participants with at least one readmission compared to control (1 month: 1.9% vs 15.8%, P=0.033; 6 months: 25.0% vs 46.2%, P=0.021; 12 months: 38.5% vs 55.8%, P=0.051; and 18 months: 51.9% vs 65.4%, P=0.107). There was also a lower total number of readmissions (significant at 1, 6 and 12 months) and a shorter LOS (significant at all time points) in the intervention group. However, there were no differences between groups in ER visits, mortality and need for long-term care residence. It is of great clinical relevance that a six-month nutrition therapy in older Icelandic adults discharged from hospital reduced hospital readmissions and shortens LOS at the hospital up to 18-months post-discharge.
WEB-BASED COGNITIVE BEHAVIORAL THERAPY FOR DEPRESSION AMONG OLDER ADULTS: DEVELOPMENT AND USABILITY STUDY
Authors: Kayser Jay , Ash Samson , Zheng Chuxuan , Turner Skyla , Xiang Xiaoling
Published: December 2023

Digital Mental Health Interventions (DMHIs) can potentially improve treatment access for older adults experiencing depression, but few tailored web-based interventions exist. This paper describes the design and development process of a web-based cognitive-behavioral therapy program called Empower@Home and reports outcomes from a usability evaluation. The program was developed in collaboration with community agencies, stakeholders, and older adults. Development was guided by user-centered design principles and informed by multiple data sources. A comparative usability evaluation with ten older adults was conducted to assess the usability of Empower@Home. Paired t-tests were used to compare scores on the System Usability Scale (SUS) between three interventions. In addition, field testing was conducted with 4 end-users to detect any further usability issues. The content and design of the intervention was heavily influenced by feedback and recommendations provided by our community partners. Empower@Home involves nine sessions, completed over ten weeks, and a printed workbook. The sessions involve psychoeducation, short video clips, interactive content, an animated storyline, and weekly out-of-session home practices. In the comparative usability evaluation, Empower@Home received statistically significantly higher usability scores than both comparison interventions, and 80% of users preferred Empower@Home over other interventions. In field testing, all participants “agreed” or “strongly agreed” that they liked the procedures used in Empower@Home and felt confident in performing program-related tasks. Empower@Home is highly responsive to end user needs and the implementation setting’s characteristics. Interventions that work with community stakeholders and thoughtfully consider implementation barriers in the design process will likely produce more usable and effective DMHIs.
GERONTOLOGY AND GERIATRICS EDUCATION AND TRAINING
Authors: Liou Chih-ling , Kalaw Karel
Published: December 2023

We draw from our personal insights as foreign-born female faculty in the U.S. to explore how our minority status in the U.S. has affected our experiences/identities in the field of aging. We practiced intersectionality by considering how our understandings of “foreignness” in academia and the aging field are intertwined with other markers of difference, including race, national origin, language, and academic programs. We also draw from tenets of collaborative autoethnography to engage two autoethnographies from two countries in Asia to pool their lived experiences and collaboratively analyze and interpret them for commonalities and differences. We begin by sharing stories about graduate study pursuits and becoming faculty in the U.S. We note how our foreignness shapes our lives as aging scholars in the U.S. academy and our personal views on aging. After exchanging our first set of writings, we identified key experiences to focus on in the subsequent writing periods. Our minority backgrounds, teaching aging subjects, and using qualitative methodology are shared identification. Moreover, the themes that deal directly with identity development and the perception of aging of non-white women can be added to promote a deep understanding of aging among the non-native-born population. This study highlights the value of collaborative autoethnography as a method of inquiry and reflection. Findings demonstrate that non-native-born female faculty members in the field of aging faced multi-faceted challenges in both professional and personal realms. Implications for supporting foreign-born female aging scholars are discussed.
CONTRIBUTIONS TO AGING RESEARCH BY DOCTORATES IN GERONTOLOGY AND GERIATRICS: A PORTUGUESE CASE STUDY
Authors: Ribeiro Oscar , Teles Soraia , Paul Constanca
Published: December 2023

Portugal is home to one of the world’s oldest populations, ranking in the top five OECD countries with the highest share of people aged 65 and over. The PhD in Gerontology and Geriatrics (PDGG) is the first and one-of-its-kind response in Portugal to the need of advanced training in the field. This work describes the contributions of PDGG doctorates from 2009 to 2022. Electronic/paper-based academic records were retrieved to characterize the doctorates’ entry profiles. Documentary analysis of dissertations was performed to describe their research. Related publications and its impact were identified from searches on academic databases/engines. Doctorates (N=36; 88.9% female) were aged between 23 and 54 (M 33.0). The background is in health and social sciences, with more representation from nurses (30.6%) and psychologists (22.2%). Approximately thirty percent (n=10) had a Masters in Gerontology, and all were professionally experienced with older adults (1-29 years). Doctoral research topics included cognitive impairment and mental health, healthcare/social services/interventions; intergenerationally/family relations/informal care; frailty; nutrition and physical activity, minority populations, elder abuse and spirituality. The research of the 36 doctorates involved 12374 participants (9499 older persons). Outputs comprised 153 publications in scientific journals, receiving 1640 citations, 87782 usages (e.g., views, downloads), 9538 captures (e.g., exports) and 541 in social media or news articles (PlumX metrics). Other contributes included 8 original intervention programs, 3 new and 11 translated/culturally-adapted assessment scales. This case study shows the intergenerational and lifelong learning environment of the PDGG, and its many contributions to the the aging field.
DEVELOPMENT OF TWO GERIATRIC CASES TO PREPARE STUDENTS FOR THE NEXT-GENERATION RN LICENSING EXAM
Authors: DiBartolo Mary
Published: December 2023

With the implementation of the Next Generation NCLEX-RN (NGN) national licensing examination in April of 2023, faculty in state of Maryland nursing schools were solicited for participation in a Maryland Nursing Workforce Center grant initiative to develop a repository of NGN case studies. A major change in the exam was the integration of a six-step clinical judgment model using a case-based format with client information presented in an electronic medical record using new question types designated for each of the steps presented sequentially. Twenty faculty “champions” from 13 Maryland schools attended several training sessions and were to develop two peer-reviewed cases for inclusion in the Qualtrics database. Once approved, these cases could then be accessed online via a secure link or QR code by Maryland-based nursing faculty and shared with students for instructional and practice purposes. Two gero-focused cases were developed. The first case focused on an older adult in a long-term care facility admitted to the hospital for a urinary tract infection with potential complication of urosepsis. Another featured a hospitalized older adult client with Alzheimer’s disease admitted from home with dehydration with potential for delirium superimposed on dementia. While a major objective of this innovative and proactive state-wide initiative is to optimize success on the modified NCLEX-RN, it is also hoped that these case examples, when appropriately integrated into the nursing curriculum, will enhance understanding of common geriatric scenarios and better prepare graduates for safe, effective nursing care of older adults.
IMPACT OF AN INTERDISCIPLINARY CLASS ON FIRST-YEAR UNDERGRADUATE STUDENT KNOWLEDGE AND ATTITUDES TOWARD AGING
Authors: Picchiello Matthew , Agran Dylan , Chung Tim , Carpenter Brian , Stark Susy , Morrow-Howell Nancy
Published: December 2023

Undergraduate classes on aging have the potential to challenge ageist beliefs and alter students’ academic and career trajectories. For the past eight years, we have led an introductory, interdisciplinary class on aging, bringing first-year students and older adults together to discuss various facets of aging and share their perceptions and experiences. Both prior to and after the class, students in the class (n = 494), and a group of their age-matched peers not enrolled in the class (n = 620), completed an online survey measuring attitudes and knowledge about aging and older adults. Repeated measure analyses revealed significant group-by-time interactions across several measures. While students who were not in the class did not show statistically significant changes across measures, students in the class displayed statistically significant increases in knowledge about aging, F(1, 760) = 108.133, ηp2 = 0.125; decreases in aging related anxiety F(1, 766) = 51.947, ηp2 = 0.064; and more favorable expectations about their own aging, F(1, 627) = 45.598, ηp2 = 0.068. Moreover, students in the class endorsed fewer ageist beliefs over time, F(1,768) = 135.313, ηp2 = 0.15, all p’s < 0.05. Despite these promising changes, overall intent to engage in an aging-related career did not statistically change across groups, F(1, 113) = 2.948, p > 0.05. Results suggest that exposing students to information about aging in an intergenerational classroom has the potential to mitigate biases against older adults, though challenges remain in maintaining student interest in aging-related careers.
MEDICAL STUDENT MOTIVATIONS TO STUDY GERIATRICS AS MEDICAL SPECIALTY IN ECUADOR: A QUALITATIVE APPROACH
Authors: Cifuentes Daniela Belen Sosa , Guillemot Jonathan
Published: December 2023

Due to a lack of interest in becoming geriatricians in the medical student community and despite studies showing geriatrics as one of the most fulfilling medical specialties, Ecuador, like many countries globally, lacks geriatricians. Although there are insufficient well-established institutions training geriatricians, the issue essentially lies in the lack of student vocations. We conducted a qualitative and participatory study to identify and describe the motivations and barriers associated with medical students’ interests in becoming geriatricians in Quito, Ecuador. Qualitative interviews between medical students after interviewing technique training were conducted. Audio recordings were transcribed and coded, and then analyzed for patterns. Thirty-two students were interviewed, none of which considered geriatrics as their first medical specialty option, and two of which considered the possibility of such a choice, but not as a first option. Among the most significant patterns associated with disinterest in geriatrics was the lack of exposure as well as a general ignorance of the lives of older adults beyond direct relatives. While most participants recognized the fundamental importance of the specialty, barriers appearing unsurmountable emerged: patterns of gerontophobia as well as thanatophobia were strong hurdles, combined with the perception of an emotional toll associated with the care of older adults. This joined with the view that physicians could not be fulfilling their purpose of “saving lives” in the context of geriatrics. As the Global South ages, universities must improve student exposure to older adults and the professions associated with their care as a first step towards promoting new vocations.
NOW SHOWING: THE USE OF FILMS IN ADVANCED GERONTOLOGY COURSES
Authors: VanderWerf Jessica , Greenberg Phyllis , Karasik Rona
Published: December 2023

While the use of films to teach about aging and older adults is not new, current movies and the students who view them are ever-changing. So too are the learning goals and practices for incorporating media into the advanced gerontological classroom. The current undertaking considers the unique aspects of employing movies (including documentaries and international films) and builds on previous works (Cohen-Shalev & Marcus, 2007; Karasik & Hamon, 2014; Markson & Taylor 1993) with an eye toward the more advanced pedagogical goals of upper level undergraduate and graduate courses. This poster focuses on challenges associated with including film in both traditional and emerging classroom delivery formats (e.g., face to face, hybrid, on-line). A matrix of current aging-themed films is provided, along with strategies for successful applications in upper level and graduate courses. Karasik and Hamon (2014) explored the use of popular film in introductory gerontology courses, creating a detailed matrix of films spanning 1951 - 2012. In addition to film descriptions and ratings, the matrix identified content in the following topical areas in (ageism/stereotypes; cognitive impairment; death & dying; diversity; family relationships; health & wellness; sexuality & intimacy; and work & retirement). The current presentation builds on Karasik & Hamon’s work by developing a companion matrix of films including feature films from 2012- 2023 , as well as documentaries and international films across the same time period. In addition to the newly created companion matrix, there are examples of activities and assignments that incorporate movies into the gerontological classroom.
CONNECTING THE HEALTH CARE WORKFORCE THROUGH A VIRTUAL LEARNING COMMUNITY
Authors: Howe Judy , Gottesman Eve , Dorisca Eugenia , Shichijo Yuka , Ko Fred
Published: December 2023

The COVID-19 pandemic highlighted the need for online and virtual educational opportunities and resources. While many healthcare organizations, hospitals and academic medical institutions were forced to quickly pivot from face-to-face training modalities, the Virtual Learning Community (VLC) of the Geriatric Scholars Program, was ahead of the curve. Established in 2014 by the VA Geriatric Scholars Program and the VHA’s Office of Rural Health, the VLC is the primary outlet for information on geriatrics and gerontology for healthcare professionals and staff. The VLC provides webinars, discussion forums, case studies, continuing education accredited programs, and resource materials on a myriad of topics related to aging. During the pandemic, the VLC provided up-to-date information on COVID and continued to augment its virtual offerings, which was vital to providers and staff working remotely. The VLC currently has approximately 5,000 registered users, with 1700 users registering since the pandemic began in March 2020. Many of these users come from rural and highly rural areas, where there is often a lack of geriatric knowledge and expertise. The presentation will present findings about the connections and impact made possible by a pre-existing web-based virtual learning community.
AGING AND MENTAL HEALTH DURING AND AFTER THE PANDEMIC. AND OLDER ADULT SPECIALTY PSYCHOTHERAPY CLINIC FINDINGS
Authors: Hernandez-Tejada Melba , Little Deborah , Desrochers Madeleine , Butte Sarly , Acierno Ron
Published: December 2023

A specialty clinic addressing psychological trauma secondary to elder abuse opened a few months before the pandemic began. The aim was to provide evidence-based psychotherapy for post-trauma psychological sequalae. We leveraged technology in the form of home-based telemedicine, to deliver effective treatment directly into older adults’ homes. We here present psychotherapy retention rates and clinical outcomes of this endeavor. Method: single arm, repeated measures, clinical series case study design. Outcomes: treatment initiation and completion rates; standardized measures of PTSD (PCL5), depression (PHQ9), anxiety (GAD7) and sleep (PSQI) collected at pre- and post-treatment. Results Prior to implementing this specialty clinic, the larger clinic within which it was housed saw approximately 2 older adults per year. Tailoring the program to older adults resulted in an annual census of over 100 per year. Analysis of current data indicates excellent completion rates for evidence-based psychotherapy (above 75% compared to 60% of younger patients) and clinical improvements across symptom areas in excess of one standard deviation. Discussion The success of this specialty trauma clinic for older adults experiencing violence was enhanced by a pre-pandemic decision to use telemedicine to increase reach and ease of accessing care. Initial results indicate that televideo technology was well received, was used by older adults and implemented before and during the pandemic with no issues, even for cases of severe trauma reactions such as PTSD and depression in older adults.
FACTORS ASSOCIATED WITH THE USE OF A PERSONALIZED MUSIC INTERVENTION FOR NURSING HOME RESIDENTS WITH DEMENTIA
Authors: Conard Ryan , McCreedy Ellen , Dionne Laura , Mor Vincent
Published: December 2023

Music offers a promising non-pharmacological alternative for managing behavioral dysregulations in people with Alzheimer’s disease and other dementias (ADRD). Using data from an embedded, pragmatic trial (ePCT) of a personalized music intervention for nursing home (NH) residents with ADRD, we examined resident and NH characteristics associated with exposure to the intervention and dose of music received. Participants were enrolled from 54 NHs (27 treatment, 27 control) between June 2019 and February 2020. The intervention was resident-preferred music delivered at early signs of agitation. Intervention dose was calculated by multiplying song duration and number of plays, averaged over days exposed. Facility and resident-level characteristics were identified using the Minimum Data Set and the Certification and Survey Provider Enhanced Reports. A mixed-effects hurdle model was used. 483 residents participated (67.7% female, mean age 79.8±12.2 years). Female residents (p=0.04) taking antipsychotic medications (p=0.06) were more likely to receive the intervention, as were residents from NHs with greater nursing involvement (p=0.02). Residents with greater health instability received a greater dose (p=0.04). In this ePCT of a personalized music intervention, NHs with more nursing engagement had greater use of the intervention and appropriately chose residents with antipsychotic use to participate. After adjusting for initial selection, staff used the intervention more frequently with residents who had a higher likelihood of death in the next six months, potentially indicating the beneficial use for comfort at the end of life. Our findings offer insights into future tailoring of personalized music interventions to increase the likelihood of successful implementation.
OLDER AGE IS ASSOCIATED WITH TEMPORAL DISCOUNTING OF TIME USE BUT NOT MONETARY REWARDS
Authors: Shavit Yochai , Anderson Brett , Carstensen Laura
Published: December 2023

Age differences in temporal discounting have long puzzled researchers. Although older adults tend to prioritize the present over the future due to more limited time horizons compared to younger adults there is no evidence for an age association with temporal discounting of monetary rewards. Socioemotional selectivity theory posits that as time horizons become more limited goals related to emotional meaning are prioritized over future-oriented goals because they are realized in the present, leading older adults to place more value on experiences than younger adults. A small body of evidence showing age-related preferences for small, immediate, rewards in emotionally meaningful domains is consistent with SST. However, prior studies used hypothetical tasks with vague trade-offs, limiting their interpretability and generalizability. In the present study, we developed a novel paradigm to examine age differences in temporal discounting of rewards related to emotional experience in a controlled environment. 120 participants, aged 22-96 years, came to the lab and made a series of choices indicating if they would prefer to replace 5 minutes of boring tasks with an emotionally meaningful variant of the task today, or a larger amount of time in their next visit in six months. Participants then made similar choices about the timing of receiving comparable monetary rewards. We hypothesized that in contrast to monetary rewards, older adults are less likely than younger adults to wait for rewards related to emotional experiences because time becomes increasingly valued as it grows scarce. Findings support the hypothesis and highlight the role of perceived time-horizons.
THE LONG-TERM RELATIONSHIP BETWEEN BMI AND COGNITIVE PERFORMANCE: A CROSS-LAGGED PANEL ANALYSIS
Authors: Fiscella Andrew , Andel Ross
Published: December 2023

While obesity has traditionally been associated with negative outcomes, an obesity paradox has been observed which suggests that older adults may show some benefit from having a higher weight. This longitudinal study examined the association between body mass index (BMI) and episodic memory performance. Data from 14,639 participants collected as part of the Health and Retirement Study were used in a 10-year random intercept cross-lagged panel analysis. BMI was used to measure obesity while T-scores from tests of immediate and delayed recall were used to represent episodic memory performance. Initially, a higher BMI was associated with lower episodic memory scores in the following wave (β= -.132, p<.001), but this association became positive over time (β=.142, p< .001) with higher BMI related to better episodic memory scores, even after accounting for demographic and health covariates. The association between BMI and episodic memory over time was stronger in older adults (β=.068, p<.05) than middle-aged adults (β=.020, p=.533). Additionally, while episodic memory scores were not significantly associated with BMI at the next wave for middle-aged adults (p=.283), they were for older adults (p<.05). These findings provide support for the obesity paradox and are consistent with previous studies employing more traditional longitudinal designs. The results of this study raise questions as to what is behind the association between episodic memory and BMI and why it appears to trend positively in older adulthood. Further studies are needed to examine potential causal mechanisms.
WITHIN-PERSON ASSOCIATIONS BETWEEN MARITAL DISSOLUTION AND SUBSEQUENT COGNITIVE FUNCTION IN MIDDLE AND LATER LIFE
Authors: Tucker Julia , Han Sae Hwang
Published: December 2023

In light of the growing burden associated with cognitive impairment and dementias on families and society accompanied by the dramatic shifts in late-life family demography, there is growing literature focusing on the relationship between marital biography and cognitive outcomes in middle and late adulthood. This study aimed to contribute to the literature by examining within-person linkages between cognitive outcomes associated with two forms of marital dissolutions experienced in later life—divorce and widowhood. Framed around the key concepts of the life course perspective, we examined within-person changes in cognitive function associated with divorce and widowhood transitions in middle and late adulthood. Drawing from 11 waves of longitudinal data from the Health and Retirement Study (1998-2018), we followed over twenty-three thousand married individuals 50 and older over the study period that spanned nearly two decades (person-wave observations N=128,033). Cognitive function at each wave was evaluated using a modified version of the Telephone Interview for Cognitive Status (m-TICS). Research aims were addressed using within-between random effects models that yielded within-person estimates unconfounded by person-level characteristics. Approximately 4.4% and 17.7% of the study sample experienced divorce and widowhood transitions during the observation period. The model results indicated that divorce transitions were unrelated to changes in cognitive function. Cognitive outcomes associated with widowhood transitions were heterogeneous for women and men, where women who transitioned to widowhood experienced increases in cognitive function, whereas men experienced reductions in cognitive function. These findings are discussed in the context of implications for practice and policy.