bluuebunny/crossref_metadata_2025 huggingface dataset:
Living/Eating Arrangement, Loneliness, and Mental Distress among Older Korean Immigrants: Gender Difference
Authors: Park Nan Sook , Jang Yuri , Chung Soondool , Chiriboga David , Haley William
Published: December 2021

Structural isolation such as living alone poses a mental health risk in diverse groups of older adults, including older immigrants. Given that those living with others might also be disengaged, the present investigation included eating alone as another source of isolation and examined the impact of the combination of living and eating alone. The proposes of the study were to examine (1) how living and/or eating alone would impact mental distress, (2) whether the impact would be mediated by feelings of loneliness, and (3) if there would be gender differences in the mediation effect. The data were drawn from the Study of Older Korean Americans (SOKA), which surveyed older Korean immigrants in five states during 2017−2018. The living/eating arrangement was classified into four-groups: living/eating with others (57%), living with others/eating alone (12.4%), living alone/eating with others (7.3%), and living/eating alone (23.1%). Using the PROCESS macro, we tested the mediation effect of loneliness and the moderation effect of gender in the relationship between the typology and mental distress controlling for background/health characteristics and social capital related variables. Two groups (living with others/eating alone and living/eating alone) had sociodemographic, health, and social capital disadvantages. Analyses demonstrated that mental distress was linked with living with others/eating alone and living/eating alone, of which relationships were mediated by loneliness only among women. Findings suggest that not only structural isolation (e.g., living alone) but also disengagement with others (e.g., eating alone) need to be considered to understand emotional well-being in older immigrant population and gender difference.
Low Friend Connection Leads to Low Functional Capacity of Older Adults: Findings From a 2-year Longitudinal Study
Authors: Takase Mai , Takahashi Kyo , Ogino Ryogo , Tanaka Tomoki , Goto Jun , Iijima Katsuya
Published: December 2021

Maintaining personal connections in geriatric years is important to sustain the functional capacity of older adults. In this study, we define the term functional capacity as the ability to perform tasks and activities necessary for one’s independent life. Meanwhile, the type of personal connection and its effect on functional capacity remain unclear. We classified personal connections into connections with family or friends and examined their association with the functional capacity of independently living Japanese older adults. A two-year longitudinal study (2016 and 2018) was conducted using data from the Kashiwa Cohort Study. The amount of personal connections was determined using the Lubben Social Network Scale. The Japan Science and Technology Agency Index of Competence was used to assess participants’ functional capacity. The change in functional capacity was analyzed by binomial logistic regression analysis (N=638, reference: group with high family and friend connection). The results showed a decline in the functional capacity of the group with low friend and family connections (odds ratio (OR): 0.48, 95%CI: 0.29–0.82). This trend was also seen for the group with a high family connection but low friend connection (OR: 0.43, 95%CI: 0.24–0.78). Meanwhile, there was no significant difference between the reference group and the group with low family but high friend connection (OR: 0.85, 95%CI: 0.47–1.56). The results imply the importance of having a friend for sustainable functional capacity in old age. Interventions that facilitate friend-to-friend interactions or promote new friendships among older adults can be considered as support strategies.
The Association Between Spousal Support And Attitude For Gerontechnology Via Facilitating Conditions
Authors: Joo Susanna , Kim Seong Hee , Lee Changmin , Kim Kwang Joon , Kim DaeEun , Kim YoonMyung , Jun Hey Jung
Published: December 2021

This study examined the mediating effects of facilitating conditions (FC) on the association between types of social support providers and attitude toward using gerontechnology (AUG) or between types of social support and AUG. The sample was 256 older Koreans having a partner and children (N=256; 66-88 years old; M=69.91; SD=4.19). The dependent variable was AUG in terms of an exoskeleton robot for exercise. There were two kinds of independent variables: 1) four types of social support provider (spouse, children, siblings/relatives, and friends/neighbors), and 2) four types of social support (emotional, instrumental, physical, and financial support). Mediating variable was calculated as the mean of FC from five questions. There were two analytic steps: 1) structural equation modeling with four latent variables about types of social support provider, and 2) path analysis with four types of social support if only for significant providers at the first analysis. The results from the first step of analysis showed that only social support from spouses had a significant effect on AUG via FC to use gerontechnology. In the second step of analysis, emotional support from spouses was associated with the higher level of AUG via FC to use gerontechnology. The findings could shed light on the salience of emotional support from spouses in terms of the positive attitude on technology usage in later life through enhancing FC for technology acceptance.
Clinical and Utilization Outcomes of Matched People With and Without HIV Aged 65+
Authors: Olivieri-Mui Brianne , Shi Sandra , Oh Gahee , McCarthy Ellen , Wilson Ira , Montano Monty , Kim Dae Hyun
Published: December 2021

The prevalence of age-standardized comorbidities is significantly elevated for PLWH across an array of cohorts. However, healthcare needs of older people living with (PLWH) and without (PWOH) HIV may be similar if they have similar geriatric conditions. PLWH and PWOH aged 65+ and eligible for Medicare from 7/1/2014-1/1/2015 were matched 1:1 on age, sex, race, and census region (n=7654). Cox regression assessed count of prevalent geriatric conditions (dementia, depression, falls, hip fracture, sensory deficits, osteoporosis, orthostatic hypotension, urinary incontinence, frailty, and polypharmacy), and risk for clinical or utilization outcomes (cancer, kidney disease, muscle wasting, hepatitis C, liver disease, myocardial infarction, stroke; hospitalization, nursing home and home health admission) during follow-up between 1/1/2015-12/31/2016. PLWH and PWOH are similar in count of geriatric conditions. Compared to those with none, those having 2+ geriatric conditions were similar across PLWH and PWOH in their risk of ≥1 clinical outcome (PLWH: HR 1.57 95% CI [1.29-1.90]; PWOH: HR 1.31 [1.02-1.67]), hospitalization (PLWH: HR 2.35 [1.96-2.83]; PWOH: HR 2.07 [1.65-2.60]), and home health admission (PLWH: HR 2.09 [1.58-2.76]; PWOH: HR 2.20 [1.55-3.12]). Having 2+ geriatric conditions, PWOH had 4.45 times the risk (95% CI 3.16-6.26) and PLWH had 2.88 times the risk (95% CI 2.18-3.81) of NH admission compared to no geriatric conditions. In this study, PLWH use nursing homes less than PWOH despite having a similar number of geriatric conditions and clinical outcomes. Further research to understand this apparent discrepancy will be critical to achieve equity in nursing home access.
Closing the Loop: An Environmental Scan of APS-Reporter Feedback Policies and Practices
Authors: Ojelabi Olanike , Campetti Randi , Greenlee Kathy , Haggerty Kristin Lees
Published: December 2021

Abuse, neglect, and exploitation of older adults are prevalent and underreported in the United States. Pathways to identifying and resolving cases of abuse against older adults depend on mandated and non-mandated reporters bringing attention to these cases through reports to Adult Protective Services (APS). However, existing research points to several barriers to reporting. One significant barrier is a lack of communication from APS to reporters about reports they have made (e.g., whether the report is appropriate for APS, the investigation outcome, and services provided by APS). This lack of reciprocal communication likely serves as a disincentive for future reporting. This study aims to promote improved communication between APS and reporters by examining the legal, ethical, and practical barriers and facilitators to communication at key points in the reporting and response pathways. In this first phase of the project, we conducted an environmental scan of policies and practices related to reporting, investigation, and feedback. Early results from the environmental scan suggest most APS agencies (81%) do not currently provide feedback to reporters. Among those providing feedback, 20% provide feedback only to mandated reporters, and 50% provide only procedural feedback, which focuses on the process of receiving and screening reports for investigation and not on the outcome of the investigation. In the next phase of this study, we will supplement these findings through interviews with APS leaders across the U.S. These early results will begin to fill an important gap in the understanding of feedback loops between APS and reporters.
Structural and Individual Ageism Predicts Elder Abuse Proclivity and Perpetration
Authors: Chang E-Shien , Monin Joan , Zelterman Daniel , Levy Becca
Published: December 2021

Considering that elder abuse affects one in six older persons worldwide, a need exists to identify factors that predict this abuse. Previous studies have found that ageism operates at both structural (i.e., societal-level stigmatizing views toward older persons) and individual levels (i.e., negative age beliefs) to affect health. However, it was not known whether and if so, how these two levels work together to impact perpetrators committing elder abuse. Thus, examining the mechanism between ageism and elder abuse was the aim of the current study. We hypothesized that structural and individual ageism would simultaneously predict elder abuse. In addition, following Stereotype Embodiment Theory, the impact of structural ageism on elder abuse would be mediated by individual ageism. In Sample 1, participants described their proclivity to abuse older people if they could do so without punishment (n=1,580). In Sample 2, family caregivers described actual abuse of their older care recipients (n=400). Overall, elder abuse proclivity (33% in Sample 1) and perpetration (56% in Sample 2) were prevalent. As hypothesized, structural ageism and individual ageism simultaneously predicted elder abuse proclivity and perpetration. Also as predicted, individual ageism significantly mediated the association between structural ageism and elder abuse in both samples. This the first study that examined the mechanistic pathways between structural and individual levels of ageism in the context of elder abuse. Effective solutions to prevent elder abuse should incorporate upstream interventions to mitigate the adverse effects of ageism.
Oral Health for Older Adults: Policy Barriers and Opportunities
Authors: de Lazaro Stephanie Sam , Durben Anchee Nitschke , Kline Juliette
Published: December 2021

Tooth decay and gum disease are two of the most common chronic health conditions in the United States, are reversible and preventable, and impact approximately 68% of older adults nationwide (CDC, 2021; World Health Organization, 2020). While the Affordable Care Act added provisions to health prevention services, oral health prevention coverage was only included for children, leaving many adults and older adults without coverage (Nasseh & Vujicic, 2017). The research team used a rapid review process using 17 key search term combinations to identify literature in three medical databases (PubMed, CINAHL, and Consumer Health Complete) to identify system and policy level barriers and opportunities to address oral health equity issues for older adults in the United States. 40 articles met inclusion criteria for thematic analysis. Findings revealed three barrier categories: 1) poor oral health literacy of patients and health care providers, 2) reimbursement variability contributing to access and utilization barriers, 3) workforce and scope of practice variability. In addition, four opportunity categories were identified: 1) community-based oral health programming for older adults, 2) new reimbursement models, 3) medical-dental collaborations, and 4) policy and practice act updates. The COVID-19 public health crisis has impacted the implementation of some system and policy level opportunities. However, new health care initiatives specific to Medicare in discussion at the national level provide an opportunity to make some headway on the policy updates needed to address the oral health of older Americans. Findings and implications will be shared with the audience.
Racial segregation and mental health service use by older adults
Authors: Kim Kyeongmo , Burnette Denise
Published: December 2021

Older adults living in racially segregated neighborhoods often lack access to mental health care. This study assessed the role of racial segregation in mental health service use and examined whether the relationship between segregation and mental health service use differs by race/ethnicity. We linked residential segregation data from the National Neighborhood Change Database to the 2015 Medical Expenditure Panel Survey. The sample included 4,023 adults aged 65 and older. We measured mental health service use as visit(s) to a mental health professional and/or use of prescribed medication for mental health (1=yes, 0=no) during the past year. Residential segregation was assessed using a combined measure of isolation (level of interaction with the same racial and ethnic group members) and dissimilarity (evenness of distribution of racial groups). Indices ranged from 0 (integrated) to 1 (segregated). We adjusted for age, sex, race/ethnicity, marital status, education, income, attitude toward health care, health insurance, and mental health status. Multiple logistic regression analyses showed that older adults living in more segregated counties were less likely to use a mental health service than those living in more integrated counties (OR=0.77, p=.04). The relationship did not differ by race/ethnicity. As expected, Blacks and Hispanics underused mental health services compared to Whites. The findings highlight that racial segregation limits access to mental health care. Practitioners and policy-makers should identify mental health needs and service use patterns to target services effectively and efficiently. Future research should explore the intersection of income and mental health care resources in segregated neighborhoods.
Sedentary Behavior, Sleep Quality, and Subjective Memory Function in Middle-Aged Adults
Authors: Chen Yen , Holahan Carole , Castelli Darla
Published: December 2021

While there is evidence that prolonged sedentary behaviors (SB) are associated with poor memory performance, less is known about the effect of SB on subjective memory. Poor subjective memory could be an early symptom of mild cognitive impairment or dementia. Besides SB, sleep quality has been identified as an essential component of cognitive health. Yet little is known about the effects of different types of SB on sleep quality and how such effects could, in turn, affect middle-aged adults’ subjective memory. The sample included 306 adults ranging in age from 40 to 60 (M = 44.42) from Amazon MTurk. Mediation analysis with PROCESS (Hayes, 2013) was used to examine the mediational path, controlling for demographic variables. Exploratory factor analysis categorized 10 different sedentary activities into Common Engaging SB (e.g., sitting in cars), High Engaging/Leisure SB (e.g., doing hobbies when sitting), and Less Engaging/Passive SB (e.g., watching TV). Common Engaging SB included a variety of behaviors, including transportation, reading, talking on the phone, and socializing. Common Engaging SB had a significant direct effect on sleep quality (B = 0.19, p < .001) and frequency of forgetting (B = -1.61, p < .001), and sleep quality had a significant direct effect on frequency of forgetting (B = -1.90, p < .001). Sleep quality mediated the association between Common Engaging SB and frequency of forgetting (indirect effect = -0.05, 95% bootstrap CI = -0.09, -0.02). Reducing sitting time, particularly Common Engaging SB, could be a useful strategy to improve subjective memory functioning.
Stigma of Dementia During COVID-19: First Insights From a Twitter Study
Authors: Bacsu Juanita-Dawne , O'Connell Megan , Chasteen Alison ,   Sarah Fraser on behalf of CCNA's SSI Working Group
Published: December 2021

Stigma is a critical issue that reduces the quality of life for people living with dementia and their care partners. Despite this knowledge, little research examines stigma of dementia, especially within the context of the COVID-19 pandemic. This presentation aims to: 1) identify the contributing factors of stigma against dementia during the COVID-19 pandemic; and 2) describe actions to challenge stigma of dementia. Using Twitter data, tweets were compiled with Python’s GetOldTweets application from February to September 2020. Search terms included keywords for dementia (e.g., Alzheimer’s) and COVID-19 (e.g., coronavirus). From the 20,800 tweets, filters were used to exclude irrelevant tweets. The remaining 5,063 tweets were analyzed by a group of coders with 1,743 tweets identified for further stigma-related coding. The 1,743 tweets were exported to Excel for thematic analysis and divided among 13 coders. Each tweet was coded independently by two reviewers to ensure intercoder reliability (e.g., 86%). Contributing factors of stigma of dementia included: ageism and devaluing the lives of people with dementia (e.g., ‘old and dying anyways’); misinformation and false beliefs (e.g., ‘COVID-19 vaccine causes dementia’); political dementia-related slander and ridicule (e.g., ‘dementia Joe’); and stigma within healthcare and long-term care organizations (e.g., pushing DNR orders). Globally, there is an urgent need for more dementia education and awareness targeted towards the general public, healthcare workers, and policymakers to reduce stigma against people living with dementia. Further research is necessary to explore the contributing factors and interventions to reduce stigma of dementia during the COVID-19 pandemic and beyond.
Adult Day Service Use among Ethnic Minority Older Adults: An Updated Integrative Review
Authors: Li Yawen , Xu Ling , Liu Jinyu , Sun Fei
Published: December 2021

Adult day services (ADS) are a preferred care option for racial and ethnic minorities compared to other types of long-term care services in the United States. However, there is limited knowledge on minority ADS users. Focusing on minority older adults, this study aims to (a) identify facilitator and barriers of ADS use, and (b) examine ADS’s effect on health and wellbeing. Using Whittemore and Knafl’s methodology of integrative reviews, we searched relevant studies published between 2010 to 2020 in Ageline, PubMed, PsycINFO, CINAHL, Web of Science and Google Scholar and included 8 articles in this review after extensive screening and critical appraisal. Crowe Critical Appraisal Tool (CCAT) was used to assess methodological rigor of the studies included in this review. This review showed that individual factors of ADS use among minority older adult included functional impairment, diabetes, race, gender, and degree of loneliness. Organizational characteristics, such as availability of transportation services, bilingual nurses, peer support, and cultural activities, and structural factors including for-profit status and source of payment were also related to ADS use among minority older adults. Positive outcomes associated with ADS use were improved quality of life and sense of fulfillment. Better understanding of minority older adults’ experience with ADS will help tailor the services to better fit their cultural preferences and needs. Future research should move beyond individual-level factors to identify and address organizational and structural factors such as institutional structure, organization culture and practice impact on disparities and discrimination in services access and quality.
Coresidence Increases Risk of Testing Positive for COVID-19 Among Older Brazilians
Authors: Andrade Flavia , Quashie Nekehia , Schwartzman Luisa
Published: December 2021

Brazil is among the countries hit hardest by COVID-19, and older adults are among the vulnerable groups. Intergenerational coresidence and interdependence among family members, both prevalent in Brazil, likely increase social and physical contact. Using nationally representative data from the COVID-19 module of the Brazilian National Household Sample Survey, collected from July to November of 2020, we examined the association between living arrangements and exposure to and testing for COVID-19 among 63,816 Brazilians 60+. Our multivariate analyses utilize multilevel mixed-effects Poisson regression to examine the association between living arrangements and the COVID-19 outcome measures. Results show that those living alone were more likely to report having symptoms and having had a test for COVID-19. However, older adults in multigenerational (PR=1.532, 95% CI 1.15, 2.04, p<0.001) and skipped generation households (PR=1.607, 95% CI 1.04, 2.48, p<0.001) were more likely than solo-dwellers to test positive for COVID-19. Those with symptoms were more likely to test, regardless of their living arrangement. Among older adults without symptoms, those living alone had a higher probability of testing than those living in multigenerational or skipped-generation households. Overall, our findings suggest that coresidence with younger family members is a risk factor for older adults’ health due to the higher COVID-19 positivity. As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population.
Mentorship Program Content Ratings: Advancing Diversity in Aging and Alzheimer’s Disease Research and Careers
Authors: Thompson Sheri , Pineda Lauren
Published: December 2021

MADURA is an R25 Advancing Diversity in Aging Research (ADAR) undergraduate training program funded by the National Institute on Aging and based at the University of California San Diego. Its objectives are to improve retention and academic success of underrepresented minority (URM) trainees, and to increase graduate/medical school applications and/or entry into Aging/ADRD careers. This multi-component program includes paid research lab experience, research and academic skills training, peer support, faculty-led small groups, guest seminars, and additional professional development opportunities. The Year 1 Cohort of 32 students consisted of Hispanic/Latinx and other students under-represented in collegiate MSTEM studies. Almost ¾ of the mentees also came from disadvantaged backgrounds, per current NIH criteria. Evaluation data have been collected through brief, weekly, anonymous online student surveys, plus more comprehensive quarterly mentee and mentor surveys. This poster will describe the Program structure and 20+ group activities, trainings, seminars, and modalities, and report student ratings of satisfaction and utility. 92% of trainees rated the overall program value as Excellent, and 92% also rated effectiveness in promoting Aging/ADRD careers among underrepresented students as Excellent. Quality ratings of components such as pay, research placements, group training and group mentorship were rated as Excellent or Good by 96%. Relative student component rankings, specific suggestions for improvements, plus Mentee and Mentor perspectives on research-specific training needs, will also be presented. Based upon these experiences and data, the authors will make specific suggestions for future URM research training, mentorship program content, and expanded delivery modalities.
What Happens When the Patient Doesn’t Die? Understanding Live Discharge from Hospice Care
Authors: Wladkowski Stephanie , Coccia Kathryn , Wingo Anna , Al-Juboori Ruaa , Wallace Cara
Published: December 2021

Hospice has been shown to improve end-of-life outcomes, yet with eligibility limited to a six-month prognosis, the hospice system is not structured to meet longer-term needs. Though hospice is strongly associated with death, some enrolled patients do not decline as predicted leading to what is referred to as a ‘live discharge.’ In 2018, 6.3% of all hospice discharges were patients discharged alive due to decertification, or no longer meeting eligibility requirements. The aim of this presentation is to review current literature surrounding live discharge, discuss policy and practice challenges within current discharge practices, and present new research directions from two current NIH-funded studies. Studies of live discharge often do not differentiate between revocation and decertification, yet these are very different phenomena, particularly regarding decision making. Patients discharged from hospice are often referred to as “not dying fast enough,” or “failure to die on time,” yet, they are still dying from chronic illness, just outside the prescribed six-month framework. Affected patients lose access to important supportive services and resources, still require substantial care, and can struggle to process feelings of abandonment and uncertainty. Further, an increased burden is placed on primary caregivers who may be unprepared for this transition. Clinicians across agencies report great variability in managing live discharges with no standardized protocols. These findings demonstrate the complexities of live discharge, the need for more research to support a standardized and reimbursable discharge process and to define unmet needs for both patients and caregivers affected by live discharge.
A remote Tai Chi program for diverse older adults with multisite pain during the COVID-19 pandemic
Authors: Koren Yael , Leveille Suzanne , Moraes Catarina Ambrizzi , Butts William , Wayne Peter , Yeh Gloria , You Tongjian
Published: December 2021

The goal of this study was to evaluate feasibility and acceptability of a remote Tai Chi program in diverse older adults with multisite pain and risk for falls during the COVID-19 pandemic. Adults aged ≥65y living in diverse Boston neighborhoods were invited through mailed letters to participate in a recruitment and screening survey. Eligible adults were re-contacted to join a 4-week Tai Chi or light exercise program offered online twice weekly. We conducted pre- and post-interviews to assess pain characteristics, fall risk, computer use, and satisfaction with the program. Primary outcomes were class attendance, experience, and program safety. Among 335 survey respondents, 105 (31%) were eligible based on multisite pain and fall history or cane/walker use. Of the eligible respondents, average age was 74y, 75% were women, 62% were Black, and 31% had high school education or less. We assigned 32 participants to 4 Tai Chi (Yang-style Tai Chi tailored to older adults with pain) or 2 light exercise (stretching and strength exercise) groups conducted via zoom; of these, 24 (75%) completed the program. Overall, 79% attended ≥6 of 8 classes. There were no adverse events reported. Regarding experiences with remote exercise, 67% reported it was very easy to join, 88%, very easy to see the instructor and 83%, very easy to participate. For future planning, 29% prefer remote classes, 33% prefer in-person classes, and 38% could do either. In conclusion, remote exercise programming is safe and feasible for diverse older adults who have multisite pain and risk of falls.
Age, Body Mass Index (BMI) And Cognitive Difficulties In Appalachian West Virginia
Authors: Romero Camila , Jacobs Moyosoreoluwa , Schreurs Bernard
Published: December 2021

Several known factors exacerbate the risk of cognitive difficulties among older adults. In addition to place-based disparities, body weight also predicts cognitive health. In fact, overweight and Obese BMI (Benito-Leon et al., 2013) and underweight BMI (Xiang & An, 2015) are risk factors for cognitive difficulties. Whether the effect of BMI operates similarly across age among adults facing place-based disparities is not clear. In order to better understand the role of BMI among adults already at-risk for health disparities, we used the 2018 BRFSS data to examine the relations among these variables among the 4817 West Virginian adults in the BRFSS database. Approximately 16.5% had difficulty making decisions or remembering. Approximately 73% were overweight or obese, 26% were healthy BMI, and 1% were underweight. A multinomial logistic regression was conducted to examine cognitive difficulties. Healthy BMI and ages 25 – 44 years were the reference groups. The omnibus test was significant, χ2 (5, N = 4817) = 38.71, p < 0.0001. Age and BMI uniquely contributed to the classification. Post hoc inspection of the Odds Ratios showed that adults ages 60 years and older with obesity were 1.27 times more likely to report cognitive difficulties, while those who were underweight were 3.74 times more likely to report cognitive difficulties. That individuals over age 60 with an obese or underweight BMI report more cognitive difficulties highlights the intersection among age, obesity and location on cognitive health disparities in West Virginia.
Are Genetic and Environmental Contributions to Verbal Fluency and Episodic Memory Solely Moderated by Sleep?
Authors: Vo Tina , Pahlen Shandell , Kremen William , Gue Matthew Mc , Nygaard Marianne , Reynolds Chandra
Published: December 2021

Decreases in sleep duration and cognitive functioning often occur and co-occur in aging although these patterns are not universal. Underlying etiologies, i.e., genetic and environmental factors, contribute to why people differ on cognitive functioning at shorter versus longer sleep durations. The current study tested whether sleep duration alters the genetic and environmental contributions to why middle-aged and older adults vary on cognitive functioning. Using 4 twin studies from the Interplay of Genes and Environment Across Multiple Studies (IGEMS) consortium (Mage=56.5, range=35.0-91.2, N=5,210, 1,083 complete MZ pairs, 1,522 complete DZ pairs) we tested quantitative genetic twin models considering sleep, depressive symptoms, and age as moderators of verbal fluency (i.e., Animal Naming) and episodic memory (i.e., Word List). For verbal fluency, sleep duration and depressive symptoms were significant when dropped together from the model (χ2(6)=15.22, p=0.02) but not individually (χ2sleep(3)=7.17, p=0.07; χ2dep(3)=5.81, p=0.12), indicating that both moderators may affect differences in verbal fluency performance. For episodic memory, sleep duration moderation was only significant via the shared environmental factor (χ2(1)=5.26, p=0.02), indicating that sleep may affect differences in episodic memory performance via environmental influences that make siblings more similar to one another. Overall, results illustrate patterns of higher genetic influences on cognitive function at short sleep (4 hours) and higher shared environmental influences on cognitive function at long sleep (10 hours). These findings may align with associations of upregulation of neuroinflammatory processes at short sleep and common reporting of mental fatigue at long sleep, both of which are associated with poorer cognitive functioning.
Bias Against Older Adults in Young Children and Their Parents
Authors: Jaquet (née Bauer) Jenny , Bellingtier Jennifer
Published: December 2021

Parents are an important source of social learning for their children. However, little is known about whether they play a role in shaping ageist attitudes in children. We investigated how parents’ biases against older adults would relate to those of their children and how preferences would differ depending on the child’s age. Participants were 56 parent-child dyads with the children’s age ranging from four to eight years (parents mean age = 36.95, SD = 5.49). Children were divided into three age groups, preschool (n = 18), early school-aged (n = 18), and middle school-aged (n = 20). Children and parents completed a picture rating task, which included the evaluation of 28 images of younger and older adults faces. Children used a smiley-face rating scale on a touch-screen computer, and parents used a sliding preference scale for their ratings. It was found that both, children (t(55) = 5.47, p < .001, d = 0.73) and their parents (t(55) = 2.05, p = 0.045, d = 0.27), gave significantly more positive ratings to younger than to older adults, which is consistent with an underlying bias for younger adults. Contrary to our expectations, this preference in children held across age groups and was not associated with parental preferences. Nevertheless, it has been shown that ageist preferences can already be detected in childhood. Further longitudinal research is needed to track the development of ageism from childhood on, and efforts to combat ageism should be addressed not only to adults, but to children as well.
Caregiving Patterns and Their Association with Caregiving Burden and Gains
Authors: Ali Talha , McAvay Gail , Monin Joan , Gill Thomas
Published: December 2021

Family and friend caregivers play a critical role in helping older adults live long and healthy lives. Using the construct of "care types" we examine whether caregivers providing more intense care experience higher burden and lower gain compared to caregivers providing less intense care. Data are from the 2015 and 2017 rounds of the National Study of Caregiving (N=2,146), a study of the caregivers of older adults enrolled in the National Health and Aging Trends Study. In a previous analysis, we derived five care types at baseline (2015), that varied in the number and type of care activities, care duration, and regularity of care provided. Caregivers reported whether caregiving was financially, emotionally, and physically difficult for them. Participants were also asked whether caregiving made them more confident, taught them to deal with difficult situations, brought them closer to the recipient, and gave them satisfaction that the recipient was well cared for. We estimated the association between care types derived at baseline and caregiver burden and gains at follow-up using logistic regression. Compared to caregivers in the least intense care type, those in the more intense care types were significantly more likely to report financial and physical burden, as well as increased ability to deal with difficult situations and increased satisfaction that their loved one was well cared for. These associations remained significant after adjusting for confounders. Care types can be used to predict burdens and gains experienced by caregivers and to effectively target caregiver support services and interventions.
Early Clinical Utility Data of a Blood Biomarker Test in the Evaluation of Mild Cognitive Impairment
Authors: Monane Mark , Snider Joy , Drake Jonathan , West Tim , Fogelman Ilana , Braunstein Joel , Holtzman David , Bateman Randall
Published: December 2021

There is an important unmet need for timely, noninvasive, low-burden evaluation of patients presenting with mild cognitive impairment (MCI). The PrecivityAD™ blood test quantifies plasma concentrations of amyloid-β 42 and 40 and apolipoprotein E-specific peptides that are combined with age in an algorithm to identify the likelihood of amyloid plaques in the brain as measured by amyloid PET scans. This test has previously demonstrated 92% sensitivity and 77% specificity. The study objective was to evaluate the clinical utility of the test and the Amyloid Probability Score (APS), the test output value. Eighteen patients (median age 72, 55% male, 88% white) with MCI received the PrecivityAD blood-based biomarker test. The mean APS was 31 (range 0-91): 13 patients had low scores (APS 0-35), 2 had high scores (58-100) and 3 had intermediate (inconclusive) scores (APS 36-57). The mean probability of Alzheimer’s disease (AD) diagnosis was rated by clinicians as 63% (range 25-80) pre-test and 31% post-test (range 5-95) (p < 0.0005). AD probability rated by clinicians was decreased in 12/13 low APS patients and increased in 2/2 high APS patients. Donepezil was discontinued in 5/8 low APS patients on therapy and initiated in 1/1 high APS patients not on therapy, representing a change in treatment management in 33% (6/18) of study patients. In summary, this blood-based biomarker test showed clinical utility in its association with physician decision-making around diagnostic certainty and drug therapy management in MCI patients.
Effects of Relationship Type on Quality of Life in Older Adults with Cognitive Impairment and the Informal Caregivers
Authors: Lai Aiping , Richardson Julie , Griffith Lauren , Kuspinar Ayse , Smith-Turchyn Jenna
Published: December 2021

Purpose: The purpose of this study was to assess whether there was an association between care-recipient relationship type and the QoL of older adults and their informal caregivers, and whether this association pertained to older adults’ cognitive function. Methods: This was a secondary data analysis. Older adults (n=1230) and their informal caregivers (n=1871) were identified from participants in the National Health and Aging Trends Study (NHATS) Round 5 and the National Study of Caregiving (NSOC) II. A series of bivariate and multivariable regression models examined the associations among the care-recipient relationship type and QoL in older adults and their informal caregivers, adjusted for socio-demographic variables as well as cognitive functioning. Results: Both older adults and caregivers’ QoL outcomes varied by the type of relationship. Recipients cared for by adult-child caregivers or multiple caregivers experienced higher functional limitation than those cared by spousal caregivers (β=.79, CI [.39, 1.19]; β=.50, CI [.17, .82], respectively). “Other” caregivers, such as siblings, friends, etc., had lower odds of experiencing negative emotional burden than spousal caregivers (OR=.26, CI [.13, .52]; OR=.53, CI [.35, .81], respectively). "Other" caregivers were also 51% less likely to experience social strain than spousal caregivers. Lower odds of experiencing negative emotional burdens were also found with multiple caregivers. The association between adult-child caregivers and social strain was explained by the recipients’ cognitive function. Conclusions: Care-recipient relationship type impacts the QoL in both recipients and their informal caregivers. This association appears to be affected by care recipients' cognitive function level.
Egg Consumption and 4-Year Change in Cognitive Function: The Rancho Bernardo Study
Authors: Kritz-Silverstein Donna , Bettencourt Ricki
Published: December 2021

The role of dietary cholesterol in cognitive decline is unclear. Eggs are a rich source of nutrients and dietary cholesterol. This study examines the association of egg consumption with 4-year change in cognitive function in 890 older, community-dwelling adults. Participants were 357 men and 533 women aged □55y (means=70.1□8.4 and 71.5□8.8, respectively, p=0.016), from the Rancho Bernardo Cohort who attended a 1988-91 clinic visit. Egg intake was obtained with a food frequency questionnaire. Cognitive function was assessed with the Mini-Mental Status Exam (MMSE), Trails B and category fluency, and reassessed in 1992-96. In this sample, rates of egg consumption ranged from never (14.0% of men, 16.5% of women) to □5/week (7.0% of men, 3.8% of women; p=0.0013). Mean 1988-91 cognitive function scores for men vs. women were 27.5 vs. 27.7 on the MMSE (p=0.08), 105.9 vs. 121.6 on Trails B (p<0.0001), and 20.2 vs. 18.2 on category fluency (p<0.0001). Sex-specific regression analyses examined associations of egg consumption with change in cognitive function. In women, after adjustment for age and education, egg intake was associated with less decline over time in category fluency (beta=-.10, p=0.01), which remained significant after adjustment for smoking, alcohol, exercise, cholesterol, calorie intake, and protein intake (p=0.02). No other associations were found in women, and no associations were observed in men before and after adjustment for covariates. Results suggest that while high in dietary cholesterol, egg consumption is not associated with decline in cognitive function. For women, there may be a small beneficial effect for verbal memory.
Examining the Relationship Between Hospice Agency Characteristics and Complaint Deficiencies
Authors: Wang Xiaochuan , Beltran Susanny , Gammonley Denise , Conner Norma , Leon Milo
Published: December 2021

The U.S. hospice industry has expanded over the last decade. Similar to nursing homes, research guided by the Donabedian framework has documented quality differences in hospice based on agency characteristics, including profit status and rural status. Yet, compared to nursing homes, quality oversight and transparency in hospice remain limited. When families report substandard care, a complaint survey is launched to investigate allegations. Using publicly available regulatory oversight data (e.g., CMS QCOR, Medicare PACPUF, CAHPS HIS, Hospice Compare), and guided by the Donabedian framework, this study describes hospice agency structure and process characteristics associated with care complaint deficiencies (outcome). Of the 4,415 hospice facilities examined, 453 (or 10.3%) have had complaint survey deficiency citations between January 2018 and December 2020. Chi-square and ANOVA tests were conducted to compare facility characteristics (e.g., ownership status, percentage of Medicare beneficiaries in rural zips), nursing and social work involvement, and CAHPS scores between hospices with and without complaint survey deficiencies. Results indicated that the average proportion of beneficiaries with a rural zip for Medicare correspondence was significantly lower in hospices with deficiencies (p<.001). Finding also suggested that weekly total nursing and social work minutes were significantly higher in hospices with deficiencies. Additionally, family ratings of hospice team communication, symptom management, and overall satisfaction were higher in facilities without complaint survey deficiencies. Future research and practice implications will be discussed.
Family Caregiver Health in a Pandemic
Authors: Cassie Kimberly
Published: December 2021

Each year family caregivers provide care and services worth billions of dollars to support the needs of older Americans. Their support is invaluable to keep individuals in the community for as long as possible and to allow individuals to attain and maintain their highest practicable level of well-being. But what impact does caregiving have on one’s health? Does caregiver health decline with the assumption of caregiving duties? Did caregiver health change during the pandemic? If so, how and what factors are associated with declines in caregiver health? To answer these questions, an exploratory survey was conducted among a convenience sample of 195 family caregiver. Almost a third of those sampled reported excellent or very good health, while 44% reported good health, and almost a quarter reported poor or fair health. Forty-eight percent reported their health had declined since they assumed caregiving duties and 29% reported their health had declined during the pandemic. Employed caregivers and those experiencing less depression/anxiety reported better health. Those experiencing a decline in health with caregiving were more likely to be female, not employed, experienced more stress and more depression/anxiety. Those experiencing a decline in health during the pandemic reported less spirituality, greater attachment related avoidance, and greater depression/anxiety. Findings from this research can be used to inform future research on the effect of the pandemic on family caregiving and to plan interventions to protect caregiver health as they provide vital services to maintain individuals in the community for as long as possible.
Adverse Neighborhood Environments and Health Behaviors among Older Americans
Authors: Choi Yeon Jin
Published: December 2021

Maintaining healthy lifestyle, including healthy diet and physical activity, in adverse neighborhood environments may be more difficult for older adults because of changes linked to aging, which make them more vulnerable to their environments. This study aims to investigate the association of neighborhood disorder with diet quality and physical activity in a national sample of older Americans. For this study, we used data from the Health and Retirement Study. Neighborhood disorders include vandalism, boarded houses, abandoned cars, demolished houses, trash, litter, or junk, poorly kept communal areas, homeless people, prostitution, winos or junkies, and drug use or drug dealing near residents’ housing unit (range: 0-11). Diet quality and physical activity were assessed using the Healthy Eating Index 2015 (HEI-2015; range:0-100) and the metabolic (MET) equivalent activity points (range: 0-31 in this sample). Ordinary least squares regression models were estimated to examine an association between neighborhood disorder, diet quality, and physical activity. Neighborhood disorder was associated with poor diet and physical inactivity. For one additional negative neighborhood feature, HEI-2015 scores and MET-equivalent activity points decreased by 0.55 (95% CI: -1.09. -0.01) and 0.69 (95% CI: -1.05, -0.33). Findings of this study suggest that older adults living in adverse neighborhoods are at a greater risk of poor diet and physical inactivity, which are important risk factors for poor health and chronic diseases. Promoting neighborhood environments and perceived neighborhood safety would increase access to health food, encourage healthy diet and physical activity, and support healthy aging.
Age Discrimination and Perceived Work Ability: The Mediating Effect of Self-Efficacy
Authors: Kang Hyun , Kim Hansol
Published: December 2021

As the number of older workers in the U.S. workforce increases, perceived work ability, which indicates a worker’s capacity to perform job-related tasks or to remain employed, becomes increasingly important. However, age discrimination may undermine the ability of older adults to remain active in the workplace as it poses a significant barrier to their work ability. The purpose of this study was to examine how age discrimination affects perceived work ability among older workers. We also evaluated the role of self-efficacy as a potential mediator between age discrimination and perceived work ability. Self-efficacy can contribute to older adults’ productive aging since it helps them view age-related situations more positively. Using 2,011 respondents (aged 50+) data from the 2018 Health and Retirement Study, structural equation modeling analysis was conducted. Our findings indicated that age discrimination had a direct negative effect on perceived work ability (B = -.230, p < .001). Older workers who experienced more age discrimination were more likely to have low levels of perceived work ability. The indirect effect of self-efficacy (B = -.177; 95% CI = -.240, -.135) was significant. Older workers who experienced more age discrimination were more likely to have low levels of self-efficacy, and this relationship led to lower levels of perceived work ability. These results suggest that greater efforts are required to reduce age discrimination and its negative consequence on perceived work ability and self-efficacy among older workers. Furthermore, age discrimination laws should be more explicitly enforced in the policy direction for older workers.