bluuebunny/crossref_metadata_2025 huggingface dataset:
CATCH-ON Age-Friendly Health System Implementation Across Varied Geographic and System Settings
Authors: Emery-Tiburcio Erin , Golden Robyn , Newman Michelle
Published: December 2020

GWEP program goals include transformation of clinical training environments into integrated geriatrics and primary care systems to become Age-Friendly Health Systems. CATCH-ON, the collaborative GWEP led by Rush University Medical Center, is working with primary care health systems in four highly varied geographic and system settings to achieve this goal. Each of these clinic systems has unique successes and challenges in developing and implementing workflow protocols; engaging providers, patients, families, and community-based organizations in the development of Age-Friendly Health Communities; and modifying the electronic health record to document assessing and acting on 4Ms. Clinic team members participate in monthly Learning Community sessions to learn about and reinforce the 4Ms, along with practical recommendations for implementing with patients. This session will focus on CATCH-ON’s process for implementing the 4Ms in various practice settings, lessons learned in implementation across large and small health systems, and opportunities to bridge AFHS with the community.
Use of a Driving Simulator to Facilitate Older People to Return to Driving
Authors: Unsworth Carolyn , White Megan , Lannin Natasha
Published: December 2020

Driving simulators are a relatively underutilized therapy tool that provide an opportunity for older drivers with a range of health-related problems to participate in simulated driving scenarios in a low cost and safe environment. The aim of this paper is to (i) describe the use of a Forum 8 driving simulator prior to a driver assessment, (ii) detail the story-boarding technique used to develop and grade driving scenes to enable older drivers to increase confidence, practice using vehicle modifications such as a spinner knob (e.g. for one-handed driving following stroke), and train specific skills including visual scanning and attention, and (iii) present five case studies to identify the strengths and limitations of incorporating the simulator into therapy programs with older drivers. of simulator use. The establishment and use of a driving simulator in a rehabilitation unit highlights both the challenges and benefits of using this kind of technology in practice. Part of a symposium sponsored by Transportation and Aging Interest Group.
Implementation of Evidence-Based Practices in Intergenerational Programming: A Scoping Review
Authors: Jarrott Shannon , Scrivano Rachel , Mendoza Nancy , Park Cherrie
Published: December 2020

Intergenerational programs facilitate mutually beneficial interactions between youth and older adults, achieving an array of outcomes. With few exceptions, implementation factors rarely figure into outcome analyses, though researchers frequently gather data on factors influencing outcomes. The resulting practice-evidence gap may deter wide-spread adoption of intergenerational programming. We conducted a scoping review of 35 peer-reviewed articles (2000-2019) to map key concepts and evidence sources of empirically-supported practices impacting intergenerational program outcomes. A scoping review is appropriate when an area is complex, like intergenerational programs that incorporate diverse participants, content, and goals. Primarily qualitative studies involved programs equally likely to involve young, school-age, or post-secondary age youth and independent or frail older adults. Half had sample sizes under 50, frequently measuring both age groups. Implementation practices included co-learning and sharing personal stories. Program content (e.g., technology) and greater exposure amplified outcomes. Rigorous implementation research is needed to advance evidence-based intergenerational practice.
Types of Interpersonal Bias: Measurement and Their Association With Health Among LGBTQ Older Adults
Authors: Prasad Anyah , Goldsen Karen Fredriksen , Kim Hyun , Jung Hailey
Published: December 2020

Increasing diversity and rapidly evolving sociopolitical context is changing the face of bias experiences in contemporary America. Accordingly, literature has evolved into four unique ways of describing bias, namely lifetime discrimination and victimization, everyday discrimination, and microaggressions. However, there is less conceptual clarity on the way these constructs are operationalized, measured, and their relationship to one another and health outcomes. In this paper, we discuss the measurement of these four constructs and report their prevalence among a national sample of LGBTQ older adults (N=2,450). The correlation between these constructs varied between 0.36 to 0.63, which shows that despite considerable overlap they are measuring distinct aspects of bias experiences. Each of the constructs had a significant association with depression, general health and quality of life. When the four constructs were entered into a regression model, everyday discrimination (due to sexual and gender identity and other factors) emerged as the strongest predictor.
Epigenetics, Heredity, and Aging
Authors: Greer Eric
Published: December 2020

Longevity has long been shown to be regulated by genetic and environmental factors. We recently showed that longevity in the nematode Caenorhabditis elegans can also be regulated by the transmission of epigenetic information. We have shown that several chromatin modifying enzymes have a transgenerational non-Mendellian effect in worms on the longevity of their descendants. I will discuss some of our recent work attempting to decipher how epigenetic modifications can regulate complex phenotypes, including longevity, and how this non-genetic information can be transmitted across generations.
Neural Control of Healthy Aging in Drosophila Through Perceptive Experiences
Authors: Pletcher Scott
Published: December 2020

We will describe how neurosensory circuits relate information about nutrition, danger, and mates to initiate rapid changes health and aging, including evolutionarily conserved neural signaling pathways and molecules that extend organism lifespan. These findings provoke the notion that aging may be considered a complex behavior that is acutely malleable, susceptible to sensory influences, and strictly controlled by coordinated sets of neurons.
Physical Impairment, Insurance Coverage, and Healthcare Utilization Among U.S. Chinese Older Adults
Authors: Attilus Jonas , Li Mengting , Le Qun , Dong XinQi
Published: December 2020

The relationship between physical impairment and healthcare utilization is well studied. However, few studies examined this relationship among immigrant older adults whose health insurance status may represent a barrier to healthcare use. This study aims to examine the relationship between physical impairment, health insurance, and types of healthcare utilization. The PINE Study provided data of 3,157 Chinese older adults age 60 and over. Most (70.67%) of them had insurance. Physical function was assessed by Activities of Daily Living and Instrumental Activities of Daily Living. Healthcare utilization was evaluated by the times of physician visit (PV), ER, and hospitalization, separately, in the past two years. Logistic regression was used. After adjusting for covariates, among the insured patients, every one unit increase in ADL impairment was associated with higher odds of ER visit (OR:1.32 [95%CI 1.21-1.45]) and hospitalization (OR: 1.37, [95%CI 1.25-1.50]). Every one greater IADL impairment was associated with higher odds of PV (OR: 1.26, [95%CI 1.12-1.43]), ER visit (OR: 1.21, [95%CI 1.16-1.26]), and hospitalization (OR: 1.23, [95%CI 1.18-1.28]). Among the non-insured, every one unit increase in ADL impairment was associated with higher odds of ER visit (OR: 1.82, [95%CI 1.19-2.78]) and hospitalization (OR: 3.05, [95%CI 1.51-6.16]). Every one unit increase in IADL impairment was associated with higher odds of PV (OR: 1.24, [95% CI 1.09-1.42]), ER visit (OR: 1.33, [95% CI 1.17-1.52]), and hospitalization (OR: 1.53, [95%CI 1.32-1.76]). These findings highlight disparities in healthcare utilization. Longitudinal studies are needed to strengthen causality between physical impairment, health insurance, and healthcare utilization.
Community Health Educator’s Role on the 3D Team
Authors: Santiago Alba
Published: December 2020

As a member of the 3D Team, the bilingual, bicultural Community Health Educator (CHE) addresses needs expressed by study participants related to social determinants of health. Clinical triggers generated by nurse practitioners (NPs) that lead to CHE referral include: social isolation and loneliness; lack of transportation access; lack of resources to sustain nutritional adequacy, purchase medications, and purchase assistive devices; and cultural and linguistic barriers that lead to lack of knowledge about community resources. To date, 50% of study participants randomized to receive 3D Team care have triggered referral to the CHE. In this presentation, the team CHE will provide details on the frequency of different needs expressed by study participants, how she utilizes an ever-growing community resource directory, and specific types of information and guidance she provides to address their expressed needs. Case studies will help illustrate ways in which CHE services have successfully provided assistance to study participants.
Adverse Outcomes, Polysubstance Use, and Polypharmacy in Older Veterans
Authors: Byers Amy
Published: December 2020

This session will provide information about adverse health outcomes, including suicide, suicide attempts and unintended death, that may be related to polysubstance use and polypharmacy in older adults, particularly older veterans. It will further provide information that will help support late-life suicide prevention and intervention efforts. Older veterans (age50 and older) have the highest number of lives lost to suicide, make up majority of the veteran population, and are highly likely to experience conditions (e.g., chronic pain, sleep disorders, musculoskeletal) associated with commonly prescribed medications that are potential markers for suicide risk (hereafter referred to as “high-risk” drug categories), including benzodiazepines, sedative-hypnotics, opioids, antidepressants, antipsychotics, and antiepileptics. The research presented in this session will highlight important patterns in high-risk drug prescribing and use and related outcomes in late life. The presentations will underscore various groups of older veterans that may be important to consider and, yet, neglected in the polysubstance and polypharmacy and suicide prevention conversation, including those who recently attempted suicide, veterans with late-life posttraumatic stress disorder (PTSD), and older veterans transitioning from prison to community. Drs. Maust and Morin will present findings on prescribing and use of high-risk medications in late life, including an overview of trends in polypharmacy and associations with suicide attempts. Drs. Byers and Barry will speak about older veterans with PTSD and those with a history of incarceration, with information on suicide, unintended death by overdose, and substance use disorder-related emergency department visits and hospitalizations, emphasizing importance of care transition models for prevention. Aging, Alcohol and Addictions Interest Group Sponsored Symposium.
PTSD, Risk of Suicide, and Unintended Death by Overdose in Late Life
Authors: Byers Amy , Li Yixia , Maguen Shira , Neylan Thomas
Published: December 2020

Little is known about late-life posttraumatic stress disorder (PTSD) and risk of suicide and apparent accidental death by overdose. We studied 488,044 older veterans (50 and older) with PTSD and propensity-matched comparison group without PTSD (n=488,044), seen in VA 2012-2013 followed to 12/31/2016. There were 5,693 non-fatal and fatal suicide attempts for those with PTSD and 4,310 for those without PTSD (approximately 20% fatal for each group). Those with PTSD had nearly 2-fold increased risk of any attempt [HR=1.55 (95% CI=1.49-1.62)]. While results specific to death by suicide were non-significant, impact of PTSD on method of death (e.g., drug overdose, firearms, hanging) was significant only for drug overdose [HR=1.58 (95% CI=1.22-2.03)]. Intentional and unintentional death by narcotics and such drugs as non-opioid analgesics and autonomic nervous system drugs were most highly associated with late-life PTSD. This study provides important implications for late-life suicide prevention related to PTSD and cause-specific drugs. Part of a symposium sponsored by the Aging, Alcohol and Addictions Interest Group.
Best Practices in Implementing the VA’s Life-Sustaining Treatment Decisions Initiative
Authors: Haverhals Leah , Kononowech Jennifer , Bauers Courtney , Manheim Chelsea , Levy Cari
Published: December 2020

To study use and completion of Life Sustaining Treatment (LST) templates across the Department of Veterans Affairs (VA) healthcare system, we designed a qualitative study to interview VA sites we identified who had high rates of LST template completion between July 1, 2018 (the official implementation start date) and March 2019. We then conducted site visits with two VA sites and phone interviews with nine other VA site to better describe facilitators and barriers to implementation of this new practice and identified factors influencing high rates of LST documentation completion. Researchers who conducted the interviews analyzed interview data through applying the Consolidated Framework for Implementation Research. From these efforts, we identified best practices used, including the importance of a formally appointed implementation leader, gaining leadership support, and engaging staff through education. We will share these recommendations with VA sites across the healthcare system to improve LST documentation.
Availability of Audiology Services in Assisted Living Communities in Florida
Authors: Pupo Daniel , Rouse Hillary , Peterson Lindsay , Hyer Kathryn
Published: December 2020

Florida has one of the largest populations of older adults in the U.S., and as a result the state also has a high prevalence of hearing loss. Given the growth of assisted living as a housing option for older adults, the purpose of this study was to determine the availability of audiology services in assisted living communities (ALCs) across Florida. Data on ALC location, characteristics and audiology service availability were collected from the Florida Agency for Health Care Administration (AHCA). County socioeconomic data were collected from the U.S. Department of Labor. Logistic regression and chi2 tests were used to examine the relationship between county socioeconomics and whether an ALC provided audiology services. We found that of the 3090 ALCs in Florida, audiology services were present in only 57 (3.2%). ALCs with audiology services were significantly more likely to be located in counties with a higher education level and a higher average income. This suggests a shortage of ALCs with audiology services in counties where residents have fewer resources. The results are concerning, given that individuals with fewer resources are less able to pay for audiology services on their own and evidence showing that poor hearing health late in life impacts individuals’ health and quality of life. Policy implications will be discussed, including the need for more ALCs to provide audiology services in counties with fewer resources. One possible solution is tele-audiology, which would enable a single audiologist to diagnose and prescribe hearing aids to patients in underserved areas.
Who Cares for Whom and Is That important? A Typology of Dementia Care Dyads and Health-Related Support Measures
Authors: Wolf-Ostermann Karin , Wiegelmann Henrik , Schirra-Weirich Liane , Verhaert Lisa-Marie , Brannath Werner , Arzideh Farhad
Published: December 2020

In Germany, about 70% of all care-dependent persons are community dwelling. In dementia care arrangements you will commonly find a primary informal caregiver (IC) taking on the decisive role in providing care and support for the person with dementia (PwD). This study aimed to develop a typology of dyads based on typical characteristics of the PwD, the IC and their relationship and to gain a better understanding of home-based dementia care arrangements. A latent class analysis was used to detect different dyad types based on personal, social, care and disease characteristics of 551 dyads of CGs and PwD living at home. A 6-class model was identified. The classes could be differentiated based on IC-PwD key characteristics (gender, age, relationship, living situation, occupation). There are significant differences with regard to observed outcomes. The verification of different types of dyads strengthens the need to develop tailored dyad-centred interventions in dementia care
The Challenges of Recruiting and Retaining Dyads of Hospitalized Persons With Dementia and Their Family Carers
Authors: Boltz Marie , Kuzmik Ashley
Published: December 2020

Persons with dementia (PWD) have high rates of hospitalization, and along with their family caregivers (FCGs), commonly experience negative hospital experiences and outcomes. The recruitment and retention challenges encountered in an ongoing cluster randomized clinical trial in PWDs and FCGs are described. The trial tests the efficacy of a nurse-FCG partnership model that aims to improve: 1) the physical and cognitive recovery in hospitalized PWD, and 2) FCG preparedness and anxiety. Recruitment and retention challenges, identified in team meetings and extracted from team documentation,.include factors in the hospital environment, the PWD, and FCGs. Strategies that address these challenges include careful pre-planning and preparation with the site, strong communication with dyads, and honoring preferences for communication. The recruitment and retention of acutely ill older adults with dementia and FCGs can pose a challenge to investigators and threaten the validity of findings. Recruitment and retention strategies that help improve validity are described
Thigh-Worn Accelerometer Data in the Maastricht Study
Authors: Koster Annemarie
Published: December 2020

This study describes the use of thigh-worn accelerometers to collect high-quality data on sedentary time and physical activity in the Maastricht Study, a prospective cohort study in the Netherlands. Data have been collected in 9000 participants, aged 40-75 years, 49% women, and 25% has type 2 diabetes by design. All participants were asked to wear an activPAL accelerometer for 7 days. Percentage sedentary, standing and stepping time of waking time were calculated. Participants had on average 6.4 valid days (≥14h of monitoring) and 90% wore the device >4 days. Men spent significantly more time sedentary than women (63.3±10.3% versus 57.0±10.1%); standing and stepping time were significantly higher in women (30.1±7.9%; 12.9±4.4%) than in men (24.7±7.4%; 12.1±4.6%). Sedentary time significantly increased with increasing age while standing time decreased; no clear age-gradient in stepping time was found.
Caregiving, Pain, and Dementia: Evaluating the Role of Coping and Adaptation
Authors: Robinson-Lane Sheria , Zhang Xingyu
Published: December 2020

Pain is a stressor that can negatively influence quality of life for caregivers. Dementia caregivers have an increased risk for stress-related health outcomes including death. Few studies have examined the relationships between pain and coping-related outcomes for dementia caregivers. In the present study, Black family caregivers (n=56) completed a survey inclusive multiple health and coping measures. In addition to descriptive statistics, Pearson’s correlation coefficients were completed. 33% of caregivers experienced moderate to severe pain. The majority of participants with pain (72%) also had hypertension and were obese (69%). Pain intensity was significantly correlated with anxiety (p=.001). Effective coping and adaptation was correlated with perceived social support (p=.002) and perceived positive aspects of caregiving (p=.0.027). The primary coping strategies used by caregivers with chronic pain included spiritual coping, information gathering, reliance on past experiences, and maximizing resource use. Improving pain outcomes for caregivers may benefit both caregivers and persons with dementia.
The Impact of Fragmented Physical Activity on Physical Function in European Older Adults in the SITLESS Study
Authors: Caserotti Paolo , Tully Mark , Skjodt Mathias , Blackburn Nicole , Gine-Garriga Maria , Planas Laura Coll , Denkinger Michael , Wilson Jason
Published: December 2020

Patterns of physical activity (PA) may be associated with physical function independently of total volume. The study aim was to explore associations of PA fragmentation (PAF) and function in ≥65-year-old European adults (SITLESS study: n=1360). The ActiGraph wGT3X+ accelerometer was worn for seven consecutive days at the dominant hip. PAF was assessed as the ratio of the number of ≥10-second PA bouts divided by an individual’s total minutes in PA. Physical function was assessed using the 2-minute maximum walk test (2MWT) and short physical performance battery test (SPPB). Multiple linear regression was utilized adjusting for relevant covariates. Lower PA fragmentation was significantly (p<0.01) associated with longer 2MWT distances and better SPPB scores. The model explained 54% and 41% of the variance in the 2MWT distance and in SPPB score, respectively. Increased PAF seems associated with reduced physical function; independent of sedentary behavior and numerous important health and socio-demographic covariates.
Assessment of fNIRS Processing Methods on Active Walking Data: Findings and Implications for Future Research
Authors: Izzetoglu Meltem , Holtzer Roee
Published: December 2020

Functional near infrared spectroscopy (fNIRS) studies utilized a limited and inconsistent number of processing algorithms to assess the prefrontal activity during active walking. To address this critical limitation, we have reanalyzed our large dataset of older adults (n=83) who underwent single and dual-task walking (STW and DTW) protocol by applying different hemodynamic conversion parameters and movement and physiological artifact removal methods. Linear mixed effect model results indicated significant increases in oxygenated-hemoglobin (HbO2) with expected decline in deoxygenated-hemoglobin (Hb) from STW to DTW (range of effect sizes: 0.59 to 0.64 for HbO2, 0.18 to 0.32 for Hb) irrespective of the methods used. In addition, intraclass correlations suggested excellent reliability across methods and task conditions (HbO2 range=0.982 to 0.996; Hb range=0.883 to 0.984). These findings support fNIRS as a robust approach for measuring prefrontal activity in older adults during walking and emphasize the importance for establishing explicit guidelines/principles for fNIRS processing.
Patterns of Prefrontal Activation and Performance During Walking Tasks Among Older Adults
Authors: Chen Nemin , Huppert Theodore , Krafty Robert , Rosso Andrea
Published: December 2020

Differences in prefrontal cortex (PFC) control of walking in older age likely arise from changes in neural capacity and compensation. PFC activation by changes in oxygenated hemoglobin from functional near infra-red spectroscopy was examined in 29 older adults (mean age=76). Tasks included standing with cognitive challenge and walking with and without cognitive challenge on even and uneven surfaces. Three PFC activation-performance patterns were identified using K-means clustering: 1) low activation during walking tasks and high activation during standing cognitive task, with the best performance in terms of walking speed and cognitive performance (n=10); 2) low activation on all tasks, with the lowest performance (n=15); 3) high activation during walking and low activation during cognitive, with intermediate performance (n=5). Associations of patterns with cognitive function and structural neuroimaging were explored, with results informing interpretation of functional changes of PFC during aging process, including compensatory mechanisms for primary network impairment.
Overlap, Commonality, Disparity, and Variability of Frontal Lobe Activation in Aging and Neurodegeneration
Authors: Maidan Inbal , Bernad-Elazari Hagar , Hacham Roni , Hausdorff Jeffrey , Mirelman Anat
Published: December 2020

Recent work suggests that the prefrontal cortex is recruited during complex walking as a form of cognitive compensation to maintain performance in aging and neurodegenerative diseases. Evidence from fNIRS studies is accumulating on different patient groups demonstrating the utility of this method and its sensitivity to neural dysfunction. However a direct comparison that explores the specificity of prefrontal activation patterns has not been conducted. This process is essential towards implementing the use of fNIRS at the individual level. Data collected from four different cohorts; young adults, older adults, PD patients at different stages of the disease, and patients with Multiple-Sclerosis during challenging tasks will be presented. Overlap, commonality, disparity and variability between groups and conditions will be presented and modifiers and moderators that can affect individual performance will be discussed. Understanding individual differences in fNIRS response will enhance data interpretation and promote translation of this technology to clinical care applications.
Preventing and Managing Chronic Conditions In Older Adults: Lessons Learned From the NHATS and NSOC 2017
Authors: DiMaria-Ghalili Rose Ann , Monturo Cheryl
Published: December 2020

According to the Centers for Disease Control, 85% of older adults have at least one chronic health condition, and 60% percent have at least two chronic conditions. This symposium explores strategies to prevent and manage chronic conditions (nutritional status, medication management, wound care, and physical function) using data from the 2017 National Health and Aging Trends Study (NHATS) and corresponding National Study on Caregiving (NSOC). The datasets include a nationally representative sample of US older adults (NHATS) and their caregivers (NSOC). In addition to survey questions, the 2017 NHATS cohort submitted dried blood samples which include inflammatory biomarkers (hs-C reactive protein [hsCRP] and interleukin-6 [IL-6]). All individual presentations report on weighted data from the analysis to more accurately reflect the US population. In the first paper, DiMaria-Ghalili explores the prevalence of and factors related to malnutrition in community-dwelling and residential living older adults. In the second paper Coates examines the extent to which source of purchased medications impacts the occurrence of self-reported medication mistakes and hospitalizations in community-dwelling participants who managed medications independently. In the third paper, Hathaway compares the socio-demographic, nutrition, and inflammatory profile of older adults with and without wounds. In the fourth paper, Sefcik examines the relationship between the frequency of community-dwelling older adults going outside and physical function. Collectively, findings provide insight into the experiences of vulnerable older adults with chronic conditions informed from the NHATS and NSOC datasets. The symposium will conclude with a discussion by Monturo on implications for research, policy and practice.
Prevalence of Malnutrition in a National Sample of Older Adults Residing in Community or Residential Care: NHATS 2017
Authors: DiMaria-Ghalili Rose Ann , Granche Janeway , Coates Martha , Hathaway Zachary , Sefcik Justine
Published: December 2020

The national prevalence of malnutrition in older adults living in the community and residential care (non-nursing home) is not known. We determined the prevalence of malnutrition (Mini-Nutritional Assessment) in a representative sample (N=4472) living in the community (95%) or residential care (5%), and examined known nutrition risk factors (inflammation [hsCRP, IL-6], socio-demographic variables). The majority (68%) were nourished, 26% were at risk, and 6% were malnourished. Those living in residential care vs community were more likely to be malnourished (12% vs 5%, respectively p<.01). Compared to nourished group, those with malnutrition were more likely to have hsCRP greater than median (1.36) (OR = 1.45 [95% CI 1.01-1.92]) and those at nutritional risk were more likely to have IL-6 greater than median (4.22) (OR=1.34 [95% CI 1.09-1.63]). Malnourished older adults were more likely to be older, female, live alone, report worse self-reported health, and use Meals on Wheels (p <.05).
Hearing Loss and Help-Seeking Behavior
Authors: Reed Nicholas
Published: December 2020

Hearing Loss (HL) is common among older adults and is associated with poor health care quality outcomes include 30-day readmissions, length of stay, poorer satisfaction, and increased medical expenditures. These associations may manifest in changes in help-seeking behaviour. In the 2015 Current Medicare Beneficiary Study (MCBS) (n=10848; weighted sample=46.3 million), participants reported whether they knowingly had avoided seeking care in the past year and self-reported HL was measured as degree of trouble (none, a little, or a lot) hearing when using a hearing aid if applicable. In a model adjusted for demographic, socioeconomic, and health factors, those with a little trouble (OR= 1.612; 95% CI= 1.334-1.947; P<0.001) and a lot of trouble hearing (OR= 2.011; 95% CI= 1.443-2.801; P<0.001) had 61.2% and 101.1% higher odds of avoiding health care over the past year relative to participants with no trouble hearing. Future work should examine whether hearing care modifies this association.
The Temporal Relationship Between Ecological Pain and Life-Space Mobility in Older Adults With Knee Osteoarthritis
Authors: Mardini Mamoun , Nerella Subhash , Kheirkhahan Matin , Ranka Sanjay , Fillingim Roger , Cenko Erta , Rashidi Parisa , Manini Todd
Published: December 2020

Older adults who experience pain are thought to have lower life-space mobility (spatial size and frequency of interaction with the surrounding environment). However, there is significant day-to-day variability in pain experiences that offer insights into consequences on life-space mobility that aren't understood. This study examined the temporal association between ecological pain and metrics from Global Positioning System in older adults with symptomatic knee osteoarthritis. Participants (n=19, 73.1+/- 4.8 yrs, 68.4% female) wore a smartwatch for an average period of 13.16 (+/-2.94) days. Participants were prompted in their free-living environment about their pain intensity (range 0-10) at random times in the morning, afternoon and evening. Results suggest that higher level of knee pain in older adults was associated with a 6.4 (2.81, p=0.02) fewer miles traveled per day – indicating a lower life-space mobility. A custom designed smartwatch is effective at simultaneously collecting rich information about ecological pain and life-space mobility.
Early Life Conditions, Adulthood Experiences, and Edentulism at Older Ages
Authors: Lee Haena , Waite Linda
Published: December 2020

The role of childhood in shaping overall adult health has been well documented, especially for physical and mental health, but much less is known about the impact of early disadvantage on oral health in later life. Using data from the 2006 and 2012 Health and Retirement Study, we investigate the link between childhood financial and psychosocial adversity and edentulism over a six-year period among U.S. adults aged 51 and older. We find that those growing up with parents with fewer resources face higher risks of having lost all their tooth at baseline and during the follow-up. Adulthood socioeconomic status and health behaviors are strongly associated with the risk of edentulism, net of childhood conditions. However, the effect of low parental resources on the onset of edentulism persists when accounting for these life course factors. Part of a symposium sponsored by the Oral Health Interest Group.
Technology-Based Applications for the Assessment and Management of Alzheimer’s Disease and Related Disorders
Authors: Massimo Lauren , Demiris George
Published: December 2020

Over the last decade, technological advances have made it possible for people to access health information right at their fingertips. Indeed, technology-based applications (apps) have been developed to tackle a wide range of health-related issues, including Alzheimer’s disease and related disorders (ADRD). As such, there is a critical need to develop and test effective dementia apps that can ultimately be converted in to scalable programs. In this interdisciplinary symposium, we will discuss the development and testing of novel apps for the assessment and management of ADRD. The first session will discuss the development of an online money management credit card task to assess cognitively vulnerable older adults who are at risk for making poor financial decisions. The second session will describe the development and psychometric testing properties of a mobile app to detect the earliest features of preclinical Alzheimer’s disease. The third session will highlight findings from a study testing a smartphone-based prompting app to improve everyday task completion in persons with mild cognitive impairment and mild dementia. The last session will share findings from a study testing a mobile app to increase goal-directed behavior and reduce apathy in persons with dementia. Together, these presentations describe how technology-based applications can be used to assess and manage cognitive and behavioral symptoms of ADRD.
Deficiency Citations in Nursing Homes That Predominantly Serve Residents With Serious Mental Illness
Authors: Jester Dylan , Hyer Kathryn , Bowblis John
Published: December 2020

Studies suggest that nursing homes (NHs) that predominantly serve residents with serious mental illness (SMI) are of worse quality due to poor resources (i.e., high Medicaid-paying census) and lower staffing. We used national Certification and Survey Provider Enhanced Reports (CASPER) data to examine the deficiencies issued to NHs from 37,800 recertification inspections of 14,582 unique NHs from 2014 to 2017. NHs were categorized into “low-SMI” and “high-SMI” facilities using the lowest and highest quartiles, respectively, of the proportion of residents in the NH with SMI. Bivariate analyses were used to assess for differences between low-SMI and high-SMI NHs in the number of deficiencies, the deficiency score (a point-based metric developed by the Centers for Medicare & Medicaid Services), and the scope and severity of deficiencies. In total, there were 245,178 deficiencies issued. In comparison to low-SMI NHs, high-SMI NHs received a greater deficiency score and more deficiencies per survey (p<.001). Deficiencies given to high-SMI NHs were associated with greater risk of harm (p<.001) and were of wider scope (p<.001). High-SMI NHs were cited 215% more often for resident abuse or neglect and 61% more often for the policies that prohibit and monitor for risk of abuse and neglect in comparison to low-SMI NHs. In conclusion, high-SMI NHs were documented for providing worse care to residents, with one particular area of concern being the heightened risk of resident abuse and neglect. Implications for policy and practice will be discussed.
Using Genetic Information to Explore Whether Preclinical Alzheimer’s Disease Affects Hearing Difficulty
Authors: Brenowitz Willa , Filshtein Teresa , Yaffe Kristine , Walter Stefan , Hoffmann Thomas , Jorgenson Eric , Whitmer Rachel , Glymour Maria
Published: December 2020

Underlying AD-related neurodegeneration or shared risk factors may influence hearing loss; in an innovative approach we tested whether genetic risk for AD also influences functional hearing loss. We studied 401,084 UK Biobank participants aged 40-70, with Caucasian genetic ancestry, and enrolled 2007-2010. Participants self-reported hearing difficulty and were followed for AD diagnosis until 2018. A genetic risk score for AD (AD-GRS) was calculated as a weighted sum of 23 AD risk variants. In age-, sex-, and genetic ancestry- adjusted models higher AD-GRS was associated with problem hearing in ages 60+(OR= 1.03; 95%CI:1.00, 1.05), but not ages <60 (p>0.05). Using the AD-GRS as an instrumental variable for AD diagnosis, we estimated that incipient AD increased probability of difficulty hearing at enrollment by 45% (95%CI: 1%, 93%). Higher AD-GRS was associated with slightly higher odds of hearing difficulty in older adults. Genetics that predispose for AD also influence late-life hearing difficulty.
Dementia Knowledge and Caregiving Skills Improvement From Using the PAC Model: A Pilot Comparative Evaluation
Authors: Brown Jerry , Reddy Pranay , Nwakasi Candidus , Nolan Beth , Snow Teepa , Ehlman Katie
Published: December 2020

The diverse needs of persons living with dementia in nursing home settings presents challenges for Certified Nursing Assistants (CNAs) to provide quality care. There is a lack of educational preparedness among nursing home CNAs regarding dementia knowledge and skills required to care for a person living with dementia. As direct caregivers for persons living with dementia, CNAs play an important role in long-term care. This pilot study evaluated the dementia knowledge and caregiving skills of newly trained CNA students. The students were trained by an instructor certified using Teepa Snow’s Positive Approach to Care (PAC) curriculum. Conducted in a rural southwestern Indiana community, this study evaluated CNA students’ knowledge and perception of dementia, as well as their skill performing the Positive Physical Approach™ (PPA™) technique to approach and connect. A 38-item knowledge and perception survey and a 12-step observed skills assessment using a standardized patient encounter were administered to CNA students. Data were analyzed using descriptive statistics and bivariate analysis. Preliminary results indicate that 100% of students correctly answered the survey item regarding non-confrontational body language, while 29% of students correctly performed the corresponding PPA skill. There is a statistically significant association between the knowledge that people find pressure in their palm comforting and the ability to perform the corresponding Hand-under-Hand® and PPA techniques. Incorporation of PAC into current CNA curriculum may equip CNAs with the knowledge and skills required to provide better care, with the potential to improve the overall quality of life for persons living with dementia.
The Importance of Bridge Jobs in America Today
Authors: Cahill Kevin
Published: December 2020

Gradual retirement, consisting of phased retirement, bridge employment, and reentry, has been a persistent feature of older Americans’ work decisions for decades. This persistence is remarkable in light of the many changes to the retirement landscape that have taken place since the mid-1980s, including changes to Social Security incentives, private-sector pensions, and macroeconomic volatility. Our paper addresses two topics related to these retirement transitions. First, using 26 years of data from the Health and Retirement Study (HRS), we quantify the prevalence of bridge employment among the initial group of HRS respondents. For the first time, bridge job prevalence can be calculated for a large cohort of older Americans who have completed their retirement transitions. Second, we comment on what these findings mean for policymakers, with respect to income inequality later in life, barriers to retirement pathways, and public-private sector differences, and what role public employers might be able to play.
Challenges of Implementing the 4Ms in Federally Qualified Health Centers and Private Academic Medical Centers
Authors: Olsen Bonnie , Sivers-Teixeira Theresa , Sadamitsu Kelly
Published: December 2020

As our country increases our capacity to provide quality interprofessional geriatric medical care to older adults, we find challenges that are unique to the setting. Many older adults receive care in Federally Qualified Healthcare Centers where implementing Age-Friendly Care is critical. Implementing the 4M’s in this setting has specific challenges including lack of geriatric trained staff, staff turnover, leadership engagement and financial sustainability. When implementing Age-Friendly Care within a large-scale complex academic health system, equally difficult challenges surface. With less nimble infrastructures, changes in one service area can have a domino effect and create larger barriers in other parts of the system. Instituting the 4M’s in an academic health system environment requires a careful strategic approach and support from many areas of organizational leadership. This talk will focus on strategies to anticipate and adapt implementation plans to best address barriers that are unique to the setting.
Mixed Methods Evaluation - A Chinese Cancer Screening Program
Authors: Hou Su-I
Published: December 2020

This paper introduces the rapidly growing modern mixed methods research (MMR) and its application in a Chinese cancer screening program. While some previous researchers have incorporated quantitative and qualitative data in research, recent mixed methods developments have provided significant clarity that can guide those new to the MMR field. Understanding the context for using MMR and examining a complex mixed methods evaluation study in Taiwan can help illustrate opportunities for and application of mixed methods in Asians. The Taiwan Cervical Cancer Screening Education Program is used as an exemplar of a multi-phase complex mixed methods evaluation study showcasing various MMR designs. These include an exploratory sequential design to develop culturally sensitive study instrument, iterative concurrent and sequential mixed methods for intervention mapping, and an embedded mixed methods evaluation design to assess impact. Visual diagrams are introduced to facilitate communication of mixed methods design procedures and products in each phase.
Bias and Missing Data: Representation of Older Adults With Sensory Impairment in Epidemiologic Studies
Authors: Swenor Bonnielin , Gross Alden
Published: December 2020

Diverse research populations are necessary to maximize the generalizability of results. Differences between people, including age, gender, racial or ethnic origin may impact observed associations in epidemiologic studies or influence the efficacy and safety of interventions in controlled trials. For these reasons, the diversity of research study populations is critical to public health and well-being. While there have been concerted efforts to examine and enhance the representation of older adults in research studies, not all subgroups of these populations, including those with sensory impairments, have been considered. Approximately 55% of adults 60 years and older have a vision and/or hearing impairment, yet despite this high prevalence, little attention has been paid to determining if or how sensory impairment affects research study participation or measurement of outcomes. This symposium aims to address these gaps, with a focus on how vision and hearing impairments may be associated with bias and missing data in epidemiologic studies of cognition and cognitive aging. The objective of this session is to highlight ongoing work in this novel area, and spark discussion and collaborations to catalyze this area of research.
Assessment of Hearing or Vision Impairment in Studies Collecting Cognitive Data in Older Adults
Authors: Liu Chelsea , Assi Lama , Nagarajan Niranjani , Powell Danielle , Jiang Kening , Villavisanis Dillan , Swenor Bonnielin , Deal Jennifer
Published: December 2020

Despite the high prevalence of sensory impairment in older adults, there are no standard practices for its consideration in cognitive studies. We conducted a systematic review to identify and survey prospective cohort studies collecting cognitive data in older adults in order to determine whether and how hearing and vision were considered. Among 81 cohorts that responded, 30 (37%) objectively assessed hearing, with audiometry as the most frequently-used method; 61 (75%) used patient-report and 12 (15%) used provider-report to subjectively assess hearing. Forty-one (51%) cohorts objectively assessed vision, half of which measured distance or near visual acuity; 55 (68%) used patient-report and 10 (12%) used provider-report to subjectively assess vision. Nineteen (23%) cohorts offered hearing accommodations and 30 (37%) offered vision accommodations during cognitive testing. Findings indicate variation in methods used to assess hearing and vision as well as in accommodation practices that could impact estimates of cognition among older adults.
Maintenance of Health Behaviors: Exploring the Construct and Its Implications on Research, Education, and Practice
Authors: Hughes Jaime
Published: December 2020

Modifying health behaviors, including diet, physical activity, sleep, and/or medication adherence, can have a range of positive effects on older adults’ overall health, function, and well-being. Although many evidence-based programs exist to support the initiation of health behavior changes, few address longterm maintenance. Emerging research suggests initiation and maintenance are distinct constructs, each requiring unique skills. Furthermore, maintaining health behaviors depends upon health promotion programs that are sustained, or continually delivered with high fidelity, at community and population levels. The objective of this symposium is to present findings from a series of research projects designed to investigate the concept of behavior change maintenance. Activities were supported by NIA Research Centers Collaborative Network (RCCN) funding and included community listening sessions plus an interdisciplinary think tank of national thought leaders. This symposium will begin with an overview of health behavior change, including the rationale for studying maintenance as a critical yet overlooked phase of successful behavior change (J. Hughes). A proposed conceptual model of maintenance will then be discussed, including constructs distinguishing maintenance from initiation (Raj). These introductory presentations will be followed by a discussion of multi-level barriers and facilitators related to maintenance on individual, community, and population levels (S. Hughes). The session will close with implications for research, education, and practice (Bettger).
Innovative Approaches to Understanding Resilience
Authors: Windham B Gwen , Griswold Michael
Published: December 2020

Physical resilience, generally defined as the ability to recover or resist functional decline following a stressor, holds promise for clinicians to identify patients who are likely to benefit from a planned stressor (such as an elective procedure) or deteriorate after an unplanned stressor (such as heart failure). This symposium will present innovative research approaches that enhance understanding of the constructs of resilience from human and animal models. The symposium will include presentations from leading experts addressing issues in the study of resilience including choices of definitions, study design, comparator groups, and considerations of underlying latent factors. Data from population-based cohort studies and animal models will be presented to inform the discussions. This interdisciplinary symposium will address recommendations for advancing resilience knowledge through elucidating biologic, clinical and environmental influences and optimizing definitions, designs, and analyses. Epidemiology of Aging Interest Group Sponsored Symposium.