bluuebunny/crossref_metadata_2025 huggingface dataset:
META-ANALYSIS OF INTERVENTIONS TO REDUCE SEDENTARY BEHAVIOR AMONG OLDER ADULTS
Authors: Otmanowski Jennifer A , Rowland Sheri A , Cooper Pamela S , Chase Jo-Ana D
Published: November 2019

ABSTRACT BODY Sedentary behavior (SB) is associated with substantial health risks such as increased risk of cardiovascular mortality, diabetes, and cognitive and physical functioning decline. Older adults are particularly at risk as they are the most sedentary population. The purpose of this meta-analysis was to determine the overall effects of interventions designed to reduce SB among older adults. A comprehensive literature search of online databases, bibliographies, and author searches located published and unpublished studies. Included studies tested interventions to reduce SB time, were written in English, and focused on community-dwelling adults age 60 years or older. Data were extracted on sample, study design, and intervention characteristics using an investigator-developed tool. Study effect sizes were synthesized using a random effects model. Heterogeneity of effects across studies was examined; however, moderator analyses were not conducted due to the small number of included studies. Of the 2,408 reviewed citations, 22 reports were included representing 17 distinct studies, eight of which were included in the two-group post-test meta-analysis (n= 1,024 participants). Interventions overall modestly reduced SB time among older adults (d=-.25, 95% CI [-.50, .00], p=.05); however, significant heterogeneity of effect size was observed across studies (Q=22.34, p<.01). Our findings demonstrate a need for more research targeting SB reduction in this high-risk population. Future research should include measures of breaks in sedentary time and types of SB (e.g., watching TV, reading) which are also critical indicators of health risk. Moreover, further exploration of relationships between health outcomes and SB intervention effects is needed.
PREDICTORS OF SUICIDE IDEATION AMONG OLDER GHANAIAN WOMEN: RESULTS FROM THE STUDY ON GLOBAL AGEING AND ADULT HEALTH
Authors: Muruthi James , DeLouize Alicia , Biritwum Richard , naidoo Nirmala , Kowal Paul , Snodgrass Josh
Published: November 2019

The World Health Organization (WHO) estimates that 79% suicides occur in low- and middle-income countries (LMICs) in 2016 (WHO, 2018) putting a spotlight on the topic of suicide in these countries. While the rates are highest among individuals ages 15 to 29 years, suicide affects individuals, families, and communities throughout the lifespan. The topic of suicide among older adults, especially those living in LMICs, has unfortunately received limited attention. Using a sample of 228 women with depression from the first wave of the WHO’s Study on global AGEing and adult health (SAGE, Ghana), the present study sought to identify predictors of suicide ideation among aging African women. Binominal logistic regression results revealed that wealth (negatively) and health (negatively) were associated with suicide ideation in the sample; indicating that the women who were poor and unhealthy were more likely to have suicidal thoughts. Implications of the findings for aging Ghanaian women will be addressed.
BACTERIAL PNEUMONIA IS A POSSIBLE RISK FACTOR FOR ORAL CANDIDIASIS IN OLDER ADULTS: A RETROSPECTIVE COHORT STUDY.
Authors: Nakajima Masato , Umezaki Yojiro , Yamaguchi Masahiro , Makino Michiko , suzuki Nao , Yoneda Masahiro , Hirofuji Takao , Morita Hiromitsu
Published: November 2019

Both aspiration pneumonia and oral candidiasis are caused by opportunistic infection of intraoral commensals and have many similar risk factors linked to oral health in older adults. Candida albicans forms biofilms with respiratory bacteria such as Klebsiella pneumoniae and Pseudomonas aeruginosa. The aim of our study was to determine the relationship between bacterial pneumonia, including aspiration pneumonia, and oral candidiasis in older patients who were hospitalized with several systemic diseases in a community-based acute care hospital without a dental unit. We retrospectively analyzed 228 older patients (male: 105, female: 123) using multiple logistic regression. The mean age of the patients was 81.3 (SD: 11.1) years. Forty-four patients were oral candidiasis positive, and 78 patients suffered from bacterial pneumonia, including aspiration pneumonia. Results showed that bacterial pneumonia had the strongest statistical relationship with oral candidiasis (p=0.000, OR: 5.173, 95 % CI: 2.368–11.298). This was followed by poor oral hygiene (p=0.001, OR: 6.095, 95 % CI: 2.003–18.545) and severe dry mouth (p=0.043, OR: 2.507, 95 % CI: 1.031–6.098). Other conventional risk factors for oral candidiasis, such as diabetes mellitus, denture wearer, dysphagia, malnutrition, requiring care, use of inhalation steroids, were not statistically significant in this study. Fifteen species of bacteria, including Klebsiella pneumoniae and Pseudomonas aeruginosa, were detected by pharyngeal sputum culture in 24 of 31 patients who were diagnosed with both oral candidiasis and bacterial pneumonia. In conclusion, bacterial pneumonia is a possible new risk factor for oral candidiasis in older adults.
THE IMPACT OF “TELE-SAVVY” ON THE CAREGIVING EXPERIENCE OF DEMENTIA FAMILY CAREGIVERS: QUALITATIVE FINDINGS
Authors: Epps Fayron , Maloch Elizabeth , Griffiths Patricia , Hepburn Ken
Published: November 2019

Tele-Savvy is a 3-arm randomized controlled trial (RCT) of a psychoeducation intervention that equips family caregivers of people living with dementia with the knowledge and skills they need to provide care to their person, while also caring for themselves. This RCT is currently underway, with cohorts rotating through over a period of 12 months. The purpose of this presentation is to describe the effectiveness of Tele-Savvy (active) versus Healthy Living Intervention (attention control) or usual care (wait-list) on the caregiving experience among dementia family caregivers. We conducted semi-structured interviews with 16 caregivers at the 6 month time point and after their initial participation in either the active, attention control, or usual care groups. Interviews elicited caregivers’ perceptions regarding the program’s influence on their caregiving experience. Caregivers who participated in Tele-Savvy reported positive experiences such as recognizing that their experience has become more pleasurable and happier. They also shared that the program expanded their knowledge and allowed them to become patient while implementing caregiving strategies learned. Majority of caregivers who participated in the Healthy Living program indicated that nothing changed related to their caregiving experience. Half of the caregivers in the usual care group, expressed frustration and unhappiness, while the others expressed no change in their caregiving experience. Results suggest that psychoeducation caregiver interventions are meaningful and can enact positive changes in their outlook on caregiving. Thus, results of this study may guide future policies and further development of caregiver programs and interventions.
DIFFERENTIAL EFFECTS OF VARYING DOSES OF DIETARY NITRATE ON MUSCLE FUNCTION AND BLOOD PRESSURE IN OLDER SUBJECTS
Authors: Coggan Andrew R , Gallardo Edgar , Gray Derrick A , Hoffman Richard , Moorthi Ranjani
Published: November 2019

We have recently demonstrated that dietary nitrate, a source of nitric oxide via the enterosalivary pathway, can improve muscle contractile function in healthy older men and women. Nitrate ingestion has also been shown to reduce blood pressure in older individuals. However, the optimal dose for eliciting these beneficial effects is unknown. We therefore performed a randomized, double-blind, crossover study to determine the effects of ingesting 3.3 mL/kg of beetroot juice (BRJ) containing 0, 212, or 425 µmol/kg of nitrate in six healthy older (age 69±3 y) subjects. Maximal knee extensor speed (Vmax) and power (Pmax) were measured 2 h after BRJ ingestion using isokinetic dynamometry; blood pressure was monitored periodically throughout each study. Mean arterial pressure (in mmHg) was lower (P<0.05) after the high (80±4) vs. the low (84±3) or placebo (88±2) doses. Vmax (in rad/s), however, was higher (P<0.05) after the low dose (11.7±0.8), but not the high dose (10.8±1.0), compared to the placebo (10.5±1.0). Pmax (in W/kg) also tended to be higher (P=0.11) in the low (3.9±0.5) compared to the placebo (3.7±0.5) or high (3.7±0.5) trials. Five out of six subjects achieved a higher Vmax and Pmax after the low vs. the high dose. We conclude that dietary nitrate has differential effects on muscle function and blood pressure in older individuals. A high dose of nitrate intake further lowers blood pressure but does not enhance muscle contractility as much as a lower dose. Supported by Indiana University Purdue University Indianapolis and by the NIA (R21 AG053606)
CREATIVE STORIES FROM A MEMORY CARE COMMUNITY: VALUES, NORMS, IDENTITIES, AND EXPERIENCES
Authors: Chee Kyong Hee , Gerhart Olga , Kim Seoyoun , Caldwell Sara
Published: November 2019

As an arts-based, creative storytelling program for persons living with Alzheimer’s Disease and related dementias (ADRD), TimeSlips involves a facilitator showing a picture to participants, who then exercise their imagination to create a story. The program has shown to benefit participants’ well-being, possibly because of the opportunity to express themselves. Although they may reflect participants’ values and identities, the content of such stories had not been the focus of investigation. The aim of this study is, therefore, to identify major themes of such stories through a qualitative content analysis. We implemented a creative storytelling program at Silverado Onion Creek Memory Care Community (currently, The Auberge) in Austin, and offered 6 weekly sessions with 4 small groups of residents. A total of 26 residents participated in the study, creating 24 collective stories in total. Three researchers first open-coded these stories and then met to reach consensus concerning the themes that emerged. Ten themes were identified: family values, generativity, religious reference, reference to love, reference to home, cultural norms, uncertainty and worries, positivity, negativity, and dissonance and disagreements. The first 6 themes represent the values, beliefs, and norms of the participants, with the remaining 4 reflecting their personal identities, personalities, and experiences. The findings suggest that they continue to value families and religion, care about others, and make judgements about people, things, and circumstances that they face. Researchers, practitioners, and care partners can benefit from “listening to” creative storytellers more closely to learn about their opinions, expectations, and preferences.
USABILITY OF AN ONLINE DISCUSSION PLATFORM: DEVELOPMENT OF A CODING SCHEME
Authors: Han Soojeong , Teng Andrew , Lin Shih-Yin , Chu Frances , Demiris George , Zaslavsky Oleg , Chen Annie T
Published: November 2019

Online discussion platforms have the potential to support or even improve older adults’ well-being. Nonetheless, potential health benefits are often shaped by the usability of such platforms. Improving usability is imperative to maximize these potential benefits. As a part of a qualitative analysis of a study of an online community for older adults with frailty symptoms, we developed and refined a coding scheme targeting usability. The scheme was derived by reviewing contemporary literature on user experience, usability, and health information technology in older adults. Our review revealed challenges to apply commonly used terms to summarize our qualitative data. For example, the concept of perceived usability has different meanings and definitions in existing frameworks as they pertain to user engagement and technology adoption (specifically, the Technology Acceptance Model) than usability in an online discussion context for older adults. Because none of the meanings of usability fully encompassed the breadth of this concept for older users, we developed a coding scheme that is practical and captures a broad range of older adults’ perceptions of usability. Through qualitative analysis of the online discussion content using the newly developed coding scheme, new themes emerged such as confusing layout (e.g., difficulty in locating discussion boxes), insufficient instruction or training (trouble posting discussions), unwanted results (e.g., pressed a wrong key), and memory issues and cognitive burden. This presentation describes the process of developing a coding scheme, illustrates nuances of meanings in concepts related to usability, and presents preliminary results of our qualitative analysis.
DEMENTED OLDER ADULT’S SALIVARY CORTISOL LEVELS AND PHYSICAL STRESS INDEX AS STRESS INDICATOR
Authors: Kwon Eunji , Cho Eunhee
Published: November 2019

Demented older adults experience many internal and external stress inducers that are thought to be a source of behavioral and psychological symptoms of dementia(BPSD). The purpose of this study was to compare the stress index among older adults through salivary cortisol levels and physical stress index. This study was cross-sectional design, including 139 participants who recruited until May of this year(104 demented older adults who visited hospital outpatient neurology and 35 non-demented older adults as control group). The physical stress index was measured by heart rate variability and salivary cortisol levels(4 samples/day, 1 days). Salivary cortisol levels were measured at four times after wake up, after breakfast, before dinner and after dinner. The data were analyzed using independent t-test and generalized estimating equations. In salivary cortisol levels measured after wake up, the demented older adults reported about 1.5 times higher than non-demented older adults(p=.042). And the salivary cortisol levels measured after breakfast were about 2.3 times higher in the demented older adults than in control groups(p=.002). Accordingly, the results can be concluded that demented older adults have higher stress levels than control groups in the morning. Also the physical stress index through heart rate variability(HRV) in the demented older adults(6.30±0.65) had higher than control groups(6.00±0.55, t=2.45, p=.016). There are significant differences in salivary cortisol levels and physical stress index between demented older adults and control groups. As stress inducers affects BPSD for the demented older adults, nursing intervention should be tailored to proper way based on their stress inducers.
THE EFFICACY OF CASE-BASED INSTRUCTION ON STUDENT ATTITUDES TOWARDS PAIN AND OPIOID RISK ASSESSMENT IN OLDER ADULTS
Authors: Aggarwal Aarushi , Sanchez-Reilly Sandra , Mader Michael J , Ross Jeanette
Published: November 2019

A survey of US medical schools found that only 10-12 hours of the 4 year curriculum are dedicated to instruction in pain management in older adults. Since chronic pain afflicts 100 million Americans, and older adults have a higher risk of prescription medication misuse, there is urgency regarding proper education.This study evaluates the success of case-based instruction on the topics of pain management and opioid risk assessment, with a goal of increasing instructional hours in a format other than didactic. 200 fourth-year medical students were split into groups of 20, with 2 instructors in each room. A survey was administered pre/post workshop asking participants to rate 10 statements using a Likert scale. The 2 hour workshop involved case studies to work through while using a created pain instructional card.The case-based instruction format demonstrated high efficacy in shaping the beliefs and personal evaluations of medical students. Prior to the workshop, only 34% of students were positive about their pain assessment abilities. 9.5% were positive about their opioid conversion skills, and only 4% were positive about opioid risk assessment skills. After the workshop, these positive evaluations increased to 97%, 95%, and 92% respectively. The McNemar test proved these findings to be statistically significant (p<.0001). Case-based instruction with small-group discussion is a reliable tool in teaching medical trainees about pain management and opioid risk assessment in adults aged 65 and older. This workshop needs to be run with geriatric/palliative care residents to evaluate clinical incorporation of session concepts through resident charting.
FACILITY AND RESIDENT LEVEL DIFFERENCES: ANTIBIOTIC USE IN NURSING HOMES FOR RESIDENTS WITH ADVANCE DEMENTIA
Authors: Hendricksen Meghan , Habtemariam Daniel , Mitchell Susan
Published: November 2019

Previous studies have shown that there is a high frequency of antibiotic use in NH for advance dementia patients. However, research has shown limited clinical benefit from antimicrobial use for this population, and antimicrobial exposure increases colonization with drug-resistant bacteria in nursing homes. The aim of this study was to identify NH and resident level characteristics associated with antibiotic use for patients with advance dementia. Using data from an ongoing cluster RCT in 28 Boston NHs; Trial to Reduce Antimicrobial use in Nursing home residents with Alzheimer’s disease and other Dementias (TRAIN-AD), testing a program intervention to improve management of infections in advanced dementia. These data are taken from baseline measurements 2 months prior to intervention, and individual nursing home residents with advance dementia are units of analysis (n = 425). We ran multivariable logistic regression model with antibiotic use as the outcome, adjusting for clustering at NH level, with NH (#beds, profit status, staffing, #cognitively impaired, etc.) and individual patient characteristics (age, gender, race, etc.) as independent variables. Analyses found residents were more likely to receive antibiotics if they resided in nursing homes that employed less intense infectious disease practices prior to baseline (AOR = 2.34; 95% CI 1.08, 5.05), and full-time nurse practitioners or physician assistants (AOR= 3.68; 95%CI 1.49, 9.04). Female patients also had higher odds of receiving antibiotics (AOR=2.16; 95%CI1.10, 4.67). These findings provide potential insight into the importance of education regarding stringent infectious disease practices for practitioners, particularly for patients with advanced dementia.
DISCUSSING SPIRITUAL HEALTH IN PRIMARY CARE IN ENGLAND
Authors: Whitehead Ishbel Orla
Published: November 2019

The organisation that regulates doctors and family physicians’ professional body in the UK both require doctors to consider patients’ spiritual health, especially towards the end of life. Discussion of spiritual health can encapsulate positive aspects of patients’ lives, and may be valuable for older people as physical and mental health decline. Tools are available for doctors to structure discussion of spiritual health in consultations but anecdotal reports suggest that this seldom happens. This study aimed to understand the barriers to GPs discussing spiritual health and their knowledge and views of current tools, particularly the HOPE tool by Anandarajah and Hight. Narrative literature review using systematic methods and mixed methods investigation into current practice, An online survey was conducted with 177 family physicians in England, investigating how doctors define spiritual health, their comfort with the topic, and their knowledge and acceptability of the HOPE tool, using patient vignettes. Definitions of spiritual health were heterogeneous, within three themes: self-actualisation and meaning; transcendence and relationships beyond self; and expressions of spirituality. Doctors felt more comfortable discussing spiritual health after a patient-led cue. Introduction of the HOPE tool increased doctors’ comfort with the topic. Discordance between doctor and patient beliefs and cultural backgrounds influenced views and practice. Concerns about regulator disapproval was a major barrier to discussions. Spiritual health does not appear to be a routine part of family practice in the UK. Tailored education, containing a structured tool such as HOPE, with regulatory approval, may help overcome barriers to discussion of spiritual health.
BARRIERS AND SOLUTIONS TO IMPROVE AGE-RELATED SERVICE ACCESS IN UTAH: A QUALITATIVE STUDY
Authors: Schiwal Alex T , Fauth Elizabeth B
Published: November 2019

Utah is projected to be in the top 10 states for growth in the aging population, but it is among the most rural. Local and regional contexts guide policy and practice, and these perspectives will inform solutions as more older adults require services in rural and other under-served areas in the coming decades. Guided by Bronfenbrenner’s Process-Person-Context-Time model, this study used a qualitative participatory research orientation involving stakeholders in Utah’s aging service system in order to identify local barriers and solutions to accessing rural aging services. The stakeholders included service providers, caregivers, older adults, state-administrators, and other community members. There were 3 male and 7 female participants ranging in age from 40 to 80. Thematic analysis revealed that communities faced barriers common to rural areas (local service insufficiencies, distance and time concerns, systemic issues such as healthcare and ageism, finances - both personal and programmatic were deemed a recurrent barrier, in addition to transportation issues. However, participants reported assets in rural areas, such as a strong sense of belonging in the community and creative problem solving. Solutions for improving access to age-related services included strategies for making information more available, publicized, and centralized and increasing access to telehealth or internet-delivered services and health information. These barriers and solutions were nested across the levels of context in Bronfenbrenner’s model, with both person, time, and in interactions (processes) having influence, but localized analysis of the barriers is necessary to ensure that the solutions are appropriate in a specific context.
USING SPATIAL ANALYSIS TO OPTIMIZE DISASTER PREPAREDNESS FOR FRAIL OLDER ADULTS
Authors: Bond Megan , Tice Jessica L
Published: November 2019

The Florida Department of Elder Affairs (DOEA) provides programs and services for over 65,300 older people and adults with disabilities. These individuals are uniquely vulnerable and may be disrupted, displaced, and disoriented during the natural disasters common to Florida. DOEA clients are homebound or dependent upon community-based services to provide supervision or direct assistance to perform basic self-care. Often, clients are unable to complete personal care independently, which makes sheltering in place a unique challenge, yet they can only evacuate with special transportation and support arrangements in the shelter. It is critical to DOEA to accurately predict clients likely to be seriously affected by storms, plan for relocation before an event, and arrange for the provision of extended care after. DOEA responded by utilizing ArcGIS mapping software to join client residence locations to evacuation zone polygons and developed a methodology to prioritize clients with personal and functional barriers to evacuation. Proven during Hurricane Michael (2018), local emergency managers were able to use this tool to complete wellness checks on survivors before outside aid arrived. This initiative is evolving with the challenges posed by each storm season. Hurricane Dorian (2019) required the addition of latitude and longitude of client locations for when traditional street navigation became unavailable. Importing and overlaying primary data on secondary emergency management resources is a strategy that could be replicated by other organizations that have similar needs to reconcile individual locations in context of local threats, making this methodology transferrable to other disaster and flood-prone communities.
THE ASSOCIATION BETWEEN D3CR MUSCLE MASS AND MORTALITY IN COMMUNITY-DWELLING OLDER MEN
Authors: Cawthon Peggy M , Blackwell Terri , Cummings Steven R , Orwoll Eric S , Duchowny Kate A , Ensrud Kristine E , Cauley Jane A , Evans William J
Published: November 2019

We have shown that men with low muscle mass assessed by D3Cr (deuterated creatine) dilution are more likely to have worse physical performance and incident fractures, injurious falls and disability. However, the relation between D3Cr muscle mass and mortality is unknown. With data from Year 14 Visit of the MrOS study (N=1400, mean age 84.2 yrs), proportional hazards models estimated the risk of mortality (hazard ratio and 95% CI) by quartiles of D3Cr muscle mass (standardized to body mass); we calculated p for trend across quartiles. Models were adjusted for age, race, clinical center, alcohol use, smoking status, comorbidities, activity, percent fat, exhaustion, and cognitive function. Cause of death was centrally adjudicated. Over 3.3±0.8 years of follow-up, 197 (14.1%) men died. Men in the lowest quartile of D3Cr muscle mass/wgt were 2.8-fold more likely to die than men in the highest quartile (HR: 2.8, 95% CI: 1.6, 4.9; p for trend<.001). The HRs for each cause-specific mortality outcome were of similar magnitude to the HR for overall mortality: cancer death (HR, Q1 vs Q4: 2.2, 95% CI: 0.7, 7.1; p trend =0.140); CVD death (HR, Q1 vs Q4: 3.7, 95% CI: 1.3, 10.5; p trend =0.008); or non-cancer non-CVD death (HR, Q1 vs Q4: 2.4, 95% CI: 1.0, 5.6; p trend=0.019). We conclude that low muscle mass assessed by D3Cr dilution is a strong risk factor for mortality in older men, providing additional evidence that low muscle mass is an important risk factor for adverse health outcomes.
ASSOCIATION BETWEEN GAIT SPEED MEASURED USING A WEARABLE DEVICE AND SARCOPENIA
Authors: Kang Min-gu , Kim Kwang-il , Kang Joon Koo , Kang Seong-Ji , Roh Hye-Kang , Jung Hwa-Young
Published: November 2019

As slow gait speed is a major feature of frailty and a diagnostic criterion of sarcopenia, gait speed measurement is widely used. Nowadays, with development of wearable devices, it is possible to measure daily-life gait speed without additional effort just by wearing the device. It is meaningful to measure daily-life gait speed and to analyze the association between the speed and sarcopenia. Participants were men over 50 years of age who visited the university hospital. Daily-life gait speed was checked using a smart belt (WELT) for 4 weeks. Afterwards, a survey about past medical history, usual gait speed measurement, handgrip strength measurement, and dual energy X-ray absorptiometry were performed. A total of 217,548 daily-life gait speed measurement data were analyzed for 106 participants. The mean daily-life gait speed was 1.23 ± 0.26 m/s. The mean age was 71.1 ± 7.6, and daily-life gait speed was significantly slower as people get older. (P<0.001) Additionally, weekday gait speed (1.23 ± 0.26 m/s) was significantly faster than weekend gait speed (1.22 ± 0.26 m/s). (P<0.001) Participants with sarcopenia (1.15 ± 0.25 m/s) had significantly slower mean daily-life gait speed than normal subjects (1.23 ± 0.26 m/s). (P<0.001) In analyzing factors related to gait speed, age and skeletal muscle mass of lower limbs were significantly associated with mean daily-life gait speed. Additional information about the gait speed can be obtained by measuring daily-life gait speed, and the daily-life gait speed has a significant association with the skeletal muscle mass of lower limbs.
COMBATTING LONELINESS: SERVICE USE AMONG RURAL FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Hoyt Emily K , Roberto Karen A , Savla Jyoti
Published: November 2019

According to a 2018 AARP study, 42% of unpaid caregivers experience loneliness. While findings across multiple studies suggest that caregivers experience loneliness either because they lack intimacy in close relationships (i.e., emotional loneliness) or they feel disconnected from their social network (i.e., social loneliness), little is known about how aspects of dementia caregiving influence loneliness, particularly among rural caregivers. The purpose of this study was to examine the association between in-home service use and caregivers experience with both types of loneliness. Eighty-eight co-residing dementia caregivers in rural Appalachia (Mean Age = 68 years; 91% White; 58% Spouses) completed telephone interviews that included questions about their use of formal services and perceptions of emotional and social loneliness. More than half (58%) of the caregivers accessed 1 to 4 formal services. Regression models revealed that caregivers who experienced greater social loneliness were more likely to access personal care services (p=0.013) and respite services (p=0.004) compared to caregivers who experienced less social loneliness. Further, caregivers who experienced greater emotional loneliness were also more likely to access personal care (p=0.028) and respite (p=0.039) services compared to caregivers who experienced lower emotional loneliness. These associations remained robust even after controlling for relationship to the PwD (spouse vs. non-spouse). Findings suggest that beyond assisting with the care of the PwD, the use of formal services may help family caregivers manage loneliness and relieve social isolation. Discussion will focus on the importance of service accessibility and use for the health and psychological well-being of rural family caregivers.
COGNITIVE AND SUBJECTIVE EFFECTS OF OXYCODONE IN OLDER ADULTS WITH HEALTHY AND UNHEALTHY ALCOHOL PATTERNS
Authors: Cherrier Monique , Terman Gregory , Shen Danny , Shireman Laura , Saxon Andrew , Simpson Tracy , Kooner Preetma , Wicklander Katie
Published: November 2019

Chronic unhealthy levels of alcohol use, may predispose adults to use illicit substances and/or modify their response to prescribed medications, such as pain medications. We examined the cognitive and side effect response of older adults who met criteria for healthy and unhealthy alcohol drinking patterns after exposure to 10mg of oxycodone. Using a human laboratory model, eligible participants were characterized on cognitive, side effect measures and cold-pressor pain test (CPT) at baseline and repeated 90 minutes, 3 and 5 hours post dosing (10mg oxycodone). Blood samples were taken at regular intervals to measure drug levels. One-hundred twenty-five adults completed the study day, eighty participants with heavy alcohol consumption and 45 with healthy. Middle age (MA) group had a mean age of 51 (11.2) years, older adults (OA) 72 (4.2) years. Between group (unhealthy vs healthy drinkers, middle age vs older adult) comparisons for cognitive performance indicate a significant decline at 90 min. However, MA and OA heavy alcohol consumers evidenced less decline on sustained attention (D2) and working memory, but more decline on a measure of balance (berg). Anti-nocioceptive effects were greatest in healthy (MA,OA) in comparison to heavy, however there were no differences on pupil miosis. Subjective rating of side effects were rated more severe in the OA unhealthy group compared to MA and healthy. These findings indicate unhealthy alcohol consumption attenuates the impact of opioid medication. Results indicate that alcohol consumption patterns should be considered when using opioids in older and middle age adults.
USING ECHO TO SUPPORT DEMENTIA DIAGNOSIS IN THE PRIMARY CARE NETWORK
Authors: Lindauer Allison , Wild Katherine , Natonson Andrew , Wolf Miriam , Mattek Nora , Messecar Deborah
Published: November 2019

Approximately 60% of those with dementia do not carry a diagnosis, undermining patient participation in clinical trials and family access to support. Under-diagnosis is driven by lack of knowledge about dementia, stigma, clinician inexperience and therapeutic nihilism. To address clinician-based contributors to under-diagnosis, we developed and implemented “Dementia 360,” a telementoring program modeled on the ECHO (Extension for Community Health Outreach) framework. Remote participants (n=67) learned about the diagnostic process, pharmacological management, family support and dementia-related resources. The video-conference-based one-hour sessions occurred weekly over 2 months. Instruction was provided by a multi-disciplinary faculty team with extensive clinical experience. Didactic presentations were followed by case studies offered by participants. Physicians, nurses, psychologists and social workers from 40 organizations participated, of which 62% were from medically underserved rural clinics. Participants were administered pre- and post-program questionnaires about their level of confidence in assessing and treating individuals with memory loss and dementia-related behavioral symptoms. Of the 54 clinicians who completed pre-intervention confidence assessments, 30 completed post-assessment. The clinicians had significantly increased confidence in diagnosing and treating dementia and managing behavioral symptoms of dementia (p ranging from .0002 to .003). Qualitative feedback from focus groups was generally positive, for example, “Knowing the diagnosis criteria and steps to take to rule out other diagnoses will help me more accurately diagnose and rule out dementia for my patients.” Our findings suggest that delivering case-based education via ECHO has potential to increase clinician workforce confidence in diagnosing and managing dementia.
MOVE UP STUDY RESULTS: WEIGHT LOSS POSITIVELY AFFECTS HEALTH-RELATED QUALITY OF LIFE BUT NOT DEPRESSIVE SYMPTOMS
Authors: Venditti Elizabeth M , Boudreau Robert M , Newman Anne B , Danielson Michelle E , Kieffer Lori A , Rager Judith R , Albert Steven
Published: November 2019

Obesity is prevalent among older adults as are increases in depressive symptoms and declines in health-related quality of life (HRQOL). Healthy weight loss and mitigating mild depressive symptoms (MDS) and HRQOL could have critical public health significance. The Mobility and Vitality Lifestyle Program (MOVE UP) led by Community Health Workers delivered 32 healthy aging/weight management group sessions over 13 months. Data from 240 participants were evaluated to assess program impact on CES-D (20-item) depressive symptom and SF-36 HRQOL scores. Participants were 88% female, 28% black/other race, 42% ≥ college-educated. Mean (SD) age was 67.6 (4.1) and BMI was 34.7 (4.7). At baseline, average CES-D score was 7.9 (7.2) and 27.9 % (N = 67) had MDS, scoring 17.1 (6.2). Results show significant mean (SD) weight change of -12.7 (13.3) lb from baseline (p<0.0001). Overall, CES-D mean (SD) score change was -0.4 (6.7) (p=0.33); participants with MDS had an average CES-D decrease of -4.4 (7.8) points (p<0.0001). Further, HRQOL improved significantly in all realms, particularly the physical component score (p<0.0001). SF-36 (SD) total score improved +1.1 (7.6), mental + 2.1 (11.7), and physical + 5.0 (16.7). Regression analyses (age/sex adjusted) demonstrate that for each 5 lb of weight loss there was an average (SEM) 3.35 (1.49) point increase in SF-36 total score (p=0.03). The mitigation of depressive symptoms in the MDS subgroup was not significantly associated with weight loss but may reflect other positive effects of the intervention experience. Conversely, positive HRQOL changes appear to be driven strongly by weight loss.
CUSTODIAL GRANDPARENTS: AN ANALYSIS OF PARENTING AND ITS IMPACT ON HEALTH
Authors: Clark Karen C , Lane Kari R , Bullock Linda
Published: November 2019

In the United States, there are 2.7 million grandparents raising grandchildren without a biological parent present (U.S. Census, 2014). Caring for grandchildren can present challenges and stressors to custodial grandparents as they find themselves adjusting to this unanticipated role. Despite the growing knowledge base related to custodial grandparents, there has been limited research into the relationship between parenting self-efficacy and psychological well-being. This study was guided by the Parenting Self-Efficacy Theory derived from Bandura’s Social Cognitive Theory. The purpose of this study was to examine the relationship between parenting self-efficacy and psychological well-being (anxiety and depression) among custodial grandmothers. Additionally, self-reported general health was examined to determine if it moderated the relationship between parenting self-efficacy and psychological well-being. Sixty-eight custodial grandmothers recruited across the United States participated in the study. Their mean age was 58 years old; 57% were Caucasian, 35% African American, and 3% Hispanic. With a mean income of $26,000.00, most were retired (32%) or working full-time (29%). Participants responded to psychometrically sound instruments measuring anxiety, depression, general health and parenting self-efficacy. Findings indicated parenting self-efficacy scores were not significantly associated with anxiety scores (r = .029; p = .816) or depression scores (r= -.207; p = .090) among participants. Furthermore, general health did not moderate a relationship between parenting self-efficacy, anxiety (R2= .030; p= .5753) or depression (R2= .051; p= .3376). Further research is needed to determine whether the role of parenting self-efficacy in custodial grandparents. Implications for policy will also be discussed
EXPLORING PROMISING PRACTICE MODELS FOR HOUSING OLDER PERSONS EXPERIENCINGHOMELESSNESS
Authors: Walsh Christine , Canham Sarah L , Humphries Joe , Burns Victoria F , Dharshi Natasha , Sussman Tamara , Hangar Jackson
Published: November 2019

The numbers of older persons experiencing homelessness (OPEH) is on the rise globally Yet housing and shelter options that support the varied and complex needs of this population are scarce. In order to understand effective solutions for housing OPEH, it is critical to explore promising practices that support aging in the right place for OPEH. In an effort to inform this critical gap, 100 OPEH and service providers were purposefully selected and invited to attend one of three World Café workshops held in three major urban cities in Canada: Vancouver, Calgary, and Montréal. Participants engaged in facilitated discussions aimed at supporting knowledge exchange and generating dialogue about gaps, opportunities and promising local housing options. Thematic analyses of audiotaped deliberations revealed three themes: 1) The limited nature of current housing options and programs in each locality; 2) The importance of supporting integrative housing models that increase access to formal health and social support staff, transportation, and income supports; and 3) The significance of supporting sustainability, by conducting regular program evaluations, increasing public awareness of homelessness issues, and involving multi-sector stakeholders. Findings highlight how meeting the unique health and psychosocial needs of OPEH requires a nuanced understanding of the development, design, and sustainability of effective housing options. World Café dialogues revealed that identifying and sustaining existing promising practice models provides an avenue to supporting aging in the right place for OPEH.
LOW-INTENSITY EXERCISE ENHANCES MUSCULAR ANDROGEN/ANDROGEN RECEPTOR TO INHIBIT MYOSTATIN PATHWAY
Authors: Son Bo-Kyung , Eto Masato , Oura Miya , Akishita Masahiro
Published: November 2019

Background: Physical exercise is well documented to induce muscle size, strength, and energy metabolism. Although the contribution of systemic or local androgen in exercise-adapted muscle hypertrophy has been suggested, less is known about the molecular pathway of androgen in response to exercise. In the present study, we examined roles of androgen/androgen receptor (AR) after exercise, especially for the suppression of myostatin, a potent negative regulator of muscle mass. Methods and Results: To examine the effects of exercise, we employed low-intensity exercise in mice and electric pulse stimulation (EPS) in C2C12 myotubes. Both mRNA and protein levels of AR significantly increased in skeletal muscle of low-intensity exercised mice and C2C12 myotubes exposed to EPS. Production of testosterone and DHT from EPS-treated C2C12 myotubes was markedly increased. Of interest, we found that myostatin was clearly inhibited by EPS, and its inhibition was significantly abrogated by flutamide, a specific antagonist of AR. Furthermore, IL-6 and phospho-STAT3 (pSTAT3) expression, the downstream pathway of myostatin, were decreased by EPS and this was also reversed by flutamide. Similar downregulation of myostatin and IL-6 was seen in skeletal muscle of low-intensity exercised mice. Conclusion: Muscle AR expression and androgen production were increased by exercise and EPS treatment. As a mechanistical insight, it is suggested that AR inhibited myostatin expression transcriptionally, which downregulates IL-6/pSTAT3 pathway and thus contributes to the prevention of muscle degradation.
ANALYSIS OF THE EFFECTS OF SOCIAL CAPITAL ON SMOKING BEHAVIOR AMONG OLDER ADULTS IN CHINA
Authors: Sun Xiaojie , Yuan Linlin
Published: November 2019

By 2030, China will become the most aging country in the world. At the same time, China is the world's largest producer and consumer of tobacco, also the largest victim of tobacco. Tobacco exposure is one of the most important risk factors for many chronic non-communicable diseases among older adults. Based on the data from China Health Retirement Longitudinal Study(2011&2015), we aim to analyze the effects of base-period social capital on current smoking behaviors among Chinese older adults of 60 and above (N=7686) with univariate analysis and ordered logit model. Resluts show that, older adults with high social trust (OR=0.783) preferred to choose not to smoke ; those who had emotional support (OR=0.933) and financial support (OR=0.967) would be more possible to choose not to smoke; and older adults were more likely to choose heavy smoking if they had two or more types of social participation (OR=1.223). This study demonstrates that social trust and social support are the protective factors of smoking behavior among Chinese older adults, while social participation was a risk factor. The Chinese government has launched "the 2030 Plan for healthy China" to promote people’s healthy behaviors, and this study will provide good evidence for actions aiming at reducing smoking behaviors among Chinese older adults.
CEREBRAL ATROPHY CORRESPONDING TO TOOTH LOSS IN ELDERLY INDIVIDUALS
Authors: Umezaki Yojiro , Egashira Rui , Makino Michiko , Naito Toru
Published: November 2019

Recent advances in the aging of Japanese society, have meant that the chance of encountering dementia patients in dental clinics is dramatically increasing. Many studies have shown that the brain volume decreases along with the progression of dementia. Although previous studies have reported a relationship between tooth loss or periodontitis and the onset of dementia, the pathological mechanisms underlying this association have not been elucidated. In this study, we focused on the relationship between the oral condition and brain atrophy to discuss how to adequately deal with dementia patients. This study included fifteen participants who underwent brain MRI (magnetic resonance imaging). We obtained information on the oral condition, lifestyle, cognitive function and brain atrophy. The cognitive function was assessed using the Mini-Mental State Examination (MMSE). MR images of each patient were analyzed with the Voxel-based Specific Regional Analysis System for Alzheimer's Disease to quantitate the degree of brain atrophy. The study population included 4 male and 11 female patients. The mean age was 75.9 years. The mean number of present teeth was 15.0. The median MMSE score was 26. The degree of atrophy of the whole brain was significantly correlated with the number of present teeth (r=-0.72, p<0.05) and the presence of a daily exercise habit (r=-0.66, p<0.05). This study showed that the number of present teeth could be an indicator reflecting the progress of dementia. Preserving the teeth as well as the acquisition of a regular exercise habit might be important for preventing dementia.
HEALTHCARE ACCESS AND SOCIAL ENGAGEMENT OF OLDER MINORITY ADULTS: EXPERIENCES NAVIGATING TRANSPORTATION BARRIERS
Authors: Maxwell December , Mauldin Rebecca L , Kao Dennis
Published: November 2019

Transportation is vital in the daily lives of older adults and provides access to health care services and health enhancing activities, such as social engagement. Disparities in mobility exist for older African American and Hispanic adults compared to non-Hispanic Whites, including higher likelihood of driving cessation at an earlier age and having a higher risk for reduced life space. This poster presents findings from a qualitative analysis of data from the Using Geo-Ethnography to Explore the Spatial Accessibility of Health Services for Aging Minorities Study (GeoSAS), a mixed methods study of older minority adults in Houston, TX. Using interpretive phenomenological analysis, the transcripts of semistructured interviews with 23 older adults (13 African American and 10 Hispanic; 17 female; mean age = 71.3 yrs, SD = 6.3 years) were analyzed to address the research question: What are the mobility experiences and perceptions of minority older adults regarding healthcare access and social engagement? Based on an ecological systems theoretical framework, we found reciprocal influences of (1) healthcare systems and transportation utilization and (2) participants’ health and well-being, mobility, and social engagement. Support from family members and financial capacity were critical for participants’ mobility. Implications of this research include educating health care providers about patients’ transportation experiences and barriers, optimizing social support to increase mobility, and addressing systematic disparities in transportation access to enhance health and well-being for older minority adults.
THE EFFECTS OF FRAILTY, POLYPHARMACY, AND COGNITION ON HEALTH OUTCOMES: A STUDY ON INTERRAI RESIDENTIAL CARE DATA
Authors: Zou Macy , Kelly Ronald , Chinda Betty , Braley Mckenzie , Zhang Tony , Arvan Tara , Mcdermid Robert , Song Xiaowei
Published: November 2019

Frailty Index (FI), polypharmacy and cognition status are significant health concerns in older adults. We conducted this study to investigate the interplay of frailty, polypharmacy, and cognition, in determining health outcomes. InterRAI Residential Care (RAI-RC MDS2.0) data were retrieved from residential care homes in Surrey, BC, Canada. Older residents (65+ years) who had RAI-RC records between 2016 and 2018 were used in the analysis (n=976). A deficit accumulation-based FI was generated using 36 variables. Information on polypharmacy and cognition were obtained by accounting the total number of medications and the cognitive performance scale. Information on falls, emergency visits, and mortality were followed. Multivariate Cox proportional hazard models were used to examine the effects of these variables on different outcomes. The FI showed a near Gaussian distribution (median= 0.370 mean= 0.372 SD= 0.143), and increased linearly with age on a logarithm scale (R=0.75, p<0.001). Residents with cognitive impairment showed a higher level of the FI (KW= 863.3, p<0.001). A higher FI was associated with an increased risk of death (HR=15.2 p=0.006) and emergency visits (HR=2.72 p=0.048), adjusting for age, sex, medications, and education levels. Frailty, polypharmacy, and cognition levels are associated and have interactive effects on health outcomes. Ongoing research is to validate the findings with large samples in different health settings, and to understand the underlying processes of the effect. The close relationships between frailty, polypharmacy, and cognition with health outcomes call for effective integrated strategies for healthcare of older adults with multiple complex health problems.