bluuebunny/crossref_metadata_2025 huggingface dataset:
DISCOVERING STAFFING ISSUES AND EXPERIMENTING WITH STAFFING LEVELS IN DUTCH NURSING HOMES
Authors: Prins Marleen , Erp Janne van , Heijkants Ceciel , vries Erica de , Backhaus Ramona , Aarts Sil , Verbeek Hilde , schot Astrid van der
Published: November 2019

Background: In 2017, the Dutch National Health Care Institute developed a quality framework describing what high quality nursing home care entails, aimed to improve nursing home care. The current study focuses on evaluating whether Dutch nursing homes comply to the framework, specifically regarding norms about staffing and formation of care teams (skill mix and educational level). Care teams that were experimenting with new staffing levels were monitored to evaluate what changes in staffing occurred and which obstructing or promoting factors they experienced. Methods: Quantitative data about staffing and team characteristics were gathered. Further, qualitative data about motives for wanting to change, the change approach, obstructing and promoting factors and evaluation of changes was collected. Telephone interviews were held at baseline, after 3 months and after 6 months. Thirty-two teams participated in the study. Results: Challenges for making changes in staffing consisted of attracting new care staff, dealing with sickness leave, communication within and between teams, communication with informal carers and combining care for and having attention for well-being of residents in the daily work routine. Additionally, teams wanted to better adjust the skill mix of staff to the needs of residents. Conclusion: For the formation of care teams, there seems to be no ‘one-size fits all’ approach. A quantitative norm that applies to all nursing homes in the Netherlands as described in the quality framework (e.g. a minimum of two care professionals for eight residents during intensive moments of care) is therefore not always the route to high quality care.
THE ASSOCIATION BETWEEN MODERATE-TO-VIGOROUS PHYSICAL ACTIVITY AND MUSCLE OXIDATIVE CAPACITY IN OLDER ADULTS
Authors: Adelnia Fatemeh , Urbanek Jacek , Osawa Yusuke , Shardell Michelle , Simonsick Eleanor M , Schrack Jennifer A , Ferrucci Luigi
Published: November 2019

Age-related decline in muscle oxidative capacity negatively affects muscle function and mobility, which may lead to disability and frailty. Whether exercise and other life-style practices reduce age-related decline in muscle oxidative capacity is unclear. We assessed whether, after accounting for age, higher daily physical activity levels are associated with greater muscle oxidative capacity. Participants included 384 adults (54.7% women) aged 22 to 92 years from the Baltimore Longitudinal Study of Aging. Muscle oxidative capacity was measured in vivo using phosphorous magnetic resonance spectroscopy. We determined the time constant for phosphocreatine recovery (τPCr, in seconds) after exercise, with lower values of τPCr reflecting greater oxidative capacity. Time spent in moderate-to-vigorous physical activity (MVPA) was assessed using accelerometers that participants wore for 5.9 ± 0.9 consecutive days in the free-living environment. In linear regression models, older age was associated with higher τPCr (β = 0.39, p-value <.001) after adjusting for sex, race, height and weight. After including MVPA as an independent variable, the standardized regression coefficient for age was attenuated by 40% to 0.22. p-value <.001). MVPA was strongly associated with lower τPCr (β = -0.33, p-value <.001) after adjusting for health status, education and smoking history and was only attenuated by 3% after additional adjustment for age. These results suggest that MVPA is strongly associated with muscle oxidative capacity independent of age, providing mechanistic insights into the health benefits of daily physical activity in older persons.
E-LEARNING FOR IMPROVING PERSON-CENTERED ATTITUDE IN PROFESSIONALS WORKING WITH PEOPLE WITH DEMENTIA: PILOT STUDY
Authors: Velden Claudia van der
Published: November 2019

Healthcare professionals working with people with dementia (PwD) have increasingly been moving towards a person-centered care (PCC) attitude. Several studies have showed positive results of PCC on quality of life of PwD. Also, it shows positive effects on self-esteem and work-satisfaction of professionals. An effective way to educate professionals in PCC is by using online-learning-tools. We developed an e-learning - in co-creation with end-users - focusing on well-being and challenging behavior of PwD. The interactive e-learning supports healthcare professionals in developing a PCC-attitude, using practical videos and exercises. In the current pilot-study, the e-learning is evaluated. To date, 32 professionals working in Dutch care homes from different care organizations participated in the study and completed the e-learning. In addition, they filled in online questionnaires before and after completing the e-learning. The questionnaires include the Approach to Dementia Questionnaire, Dementia Knowledge, Person Centered Care, Sense of Competence in Dementia Care Questionnaire. Post-measurement also included questions about satisfaction with the e-learning and user-friendliness. The final participants are currently completing their post-measurement questionnaires and final results are expected in October 2019. Preliminary data-analysis shows promising results. Although no significant effects were found, two-thirds of the participants indicated they had more knowledge about dementia, could better deal with challenging behavior and understood better how their own behavior and actions influence the behavior of PwD. The user-friendliness was also positively evaluated. Preliminary results suggest that the e-learning helps professionals in their approach to PwD and indicate that participants have positive experiences with the e-learning.
THE FRAILTY INDEX CONSTRUCTED USING FEATURE SELECTION METHODS IS THE BEST MEASURE OF BIOLOGICAL AGE
Authors: Kim Sangkyu , Fuselier Jessica , Welsh David , Cherry Katie E , Myers Leann , Jazwinski S Michal
Published: November 2019

No single biomarker can reliably represent the complexity of aging. One way to overcome this shortcoming is to aggregate multiple biomarkers into a composite index. The frailty index (FI), which is simply the proportion of accumulated deficits among a set of various health markers, reflects functional abilities and risks of adverse outcomes. Furthermore, the FI accounts for the variation in mortality among individuals of the same chronological age (CA). Thus, the FI is a reliable measure of biological age (BA). Unlike the FI, other popular BA-estimating algorithms use CA directly as a biomarker or indirectly to derive model parameters. However, genetic, pharmaceutical, and intervention studies have shown that aging is delayable or reversible, indicating that CA is not the direct cause of aging. The popular Klemera-Doubal (K-D) method proposes two equations for BA estimation: BE uses CA to derive equation parameters, and BEC directly incorporates CA as an additional biomarker. BA estimates by the K-D method, especially by BEC, have been shown to outperform CA. Using Louisiana Healthy Aging Study (LHAS) data, we constructed an FI from a battery of health items selected using machine learning methods for their ability to predict mortality. We compared the FI with CA and the two K-D BA estimates and found that the FI was the better predictor of mortality, especially among nonagenarians. The results were replicable with the FI calculated from different sets of selected health items using NHANES and HRS datasets. These results demonstrate the FI as the best-performing measure of BA.
USABILITY ASSESSMENT OF A SENSOR-CONTROLLED DIGITAL GAME FOR OLDER ADULTS WITH HEART FAILURE
Authors: Radhakrishnan Kavita , Julien Christine , O’Hair Matthew , Fournier Catherine , Lee Grace , Baranowski Thomas , Kim Miyong T
Published: November 2019

The inability of older persons with heart failure (HF) to self-manage has contributed to poor health outcomes. Our team from nursing, digital game design, and mobile computing developed an innovative sensor-controlled digital game (SCDG) called ‘Heart Mountain’ to offer a portable, and enjoyable tool to facilitate engagement in HF self-management. We installed the SCDG application, which featured older adult game avatars on the participants’ smartphones. The SCDG utilized data from an activity tracker and weight scale to trigger game rewards, knowledge content and messages based on participants’ real-time behaviors. In this study we assessed the usability of a SCDG prototype with 10 HF older adults in Central Texas. Observations on the usability of the SCDG app by older adults were noted on a usability heuristics checklist. Acceptance and satisfaction were collected by an open-ended survey guided by Intrinsic Motivation Inventory after a week of playing the game. Participants (60% males, 60% white, ages 63-84) were able to play the game and use the devices after a training session that lasted for 15 minutes. We will present results on participants’ ease of use of the SCDG app, satisfaction with the knowledge content, quizzes and rewards features of the SCDG, and perceptions on acceptance and satisfaction with the SCDG for heart failure self-management. Our project will generate insights on designing digital gaming solutions that are acceptable to older adults and can be applied to improve self-management of chronic diseases like heart failure.
CROSS-GENERATIONAL UNDERSTANDING OF AGEISM AND ITS IMPACT ON PERSONAL-PUBLIC HEALTH
Authors: Mayo Diana , Meuser Thomas M , Robnett Regula H
Published: November 2019

In 2016, the World Health Organization (WHO) declared a call to combat ageism, labeling it “pervasive” and having “profound consequences on older adults’ health and well being.” This study explored generational differences in understanding the WHO’s definition of ageism, between baby boomers (ages 65-72) and silent generation members (ages 78-85), as well as the perceived impact on personal and public health outcomes. A focus group protocol built around the WHO framing of ageism was administered to boomer (n=18) and silent generation members (n=11). Discussion was transcribed, reviewed in depth by each research team member, and themes were extracted by consensus. Members of both cohorts initially denied effects of ageism, stating that they reject discriminatory behavior; later sharing explicit examples of ageism’s negative impact on their lives. Boomers conflated the words “ageism” and “aging”, perhaps implying a lack of awareness of the terms and the issues as presented by WHO. A central finding was that older adults in both groups experienced economic and health care disparities due to their age. In both groups, perceived perpetrators of discriminatory behavior were found in various environments including places of employment, healthcare sites, restaurants, public transportation, retirement communities, and at home among family and care services. Our results are critical to understanding what environments to target for public health intervention efforts, which will include establishing future education and training for people of all ages to help society learn about ageism, and to advocate for inclusive and equitable treatment of older adults in the community.
SCHIZOPHRENIA EPIGENETIC AGING PATTERNS REFLECT ALTERED MORTALITY AND CANCER RISKS
Authors: Higgins-Chen Albert T , Vinkers Christiaan , Boks Marco P , Levine Morgan E
Published: November 2019

Schizophrenia (SZ) is associated with large increases in all-cause mortality, high smoking rates, and elevated levels of age-associated proteins—suggesting individuals with SZ may experience accelerated rates of biological aging. Yet surprisingly, multiple previous studies found no association between SZ and biological age using Horvath’s epigenetic clock, a well-recognized and validated biomarker of aging based on DNA methylation (DNAm) levels. However, numerous epigenetic clocks have been developed to date, many of which are better indicators of differential lifespan and healthspan than the original Horvath clock. Thus, we hypothesize that these epigenetic clocks may be better proxies for the presumed accelerated aging rate in SZ. Here we investigate 14 epigenetic clocks using three publicly available DNAm datasets from whole blood, comparing SZ to non-psychiatric controls (NPC). In all data sets, we find SZ age acceleration in three clocks previously shown to be most predictive of age-related morbidity and mortality risk. In contrast, two clocks developed to capture mitotic rate are decelerated in SZ, consistent with low cancer rates despite smoking observed in epidemiological studies of SZ. We use these clocks to investigate the determinants of altered aging in SZ, such as smoking, alcohol, BMI, age-associated proteins, blood cell composition, and psychotropic medications. Principal component analysis suggests mortality clock acceleration, mitotic clock deceleration, and medication effects are independent phenomena in SZ. Our study demonstrates the importance of studying the various epigenetic clocks in tandem and highlights their potential utility for understanding how mental illness influences long-term outcomes including cancer and early mortality.
DO PERSONALITY TRAITS INFLUENCE PERCEPTIONS OF COGNITIVE CHANGE IN COMMUNITY DWELLING OLDER ADULTS?
Authors: Meuser Thomas M , Robnett Regula H
Published: November 2019

Recent research has linked personality traits and risk for cognitive impairment in advancing age. Associations with neuroticism are particularly robust. Both longstanding and recent elevations may predict dementia. Other traits – conscientiousness and openness to experience – also show unique associations. These findings derive mainly from large sample population studies and smaller clinical investigations. Relevance to the general population is unclear. We investigated the “big five” personality traits and cognition in 232 community-dwelling adults (73% female, 97% Caucasian, mean age 72 years). Scores on a self-report screen for dementia – the AD8 – framed the sample: 77% scored 0 points, no dementia; 23% scored 2+, possible dementia. Age and personality were independent variables in a binary logistic regression with AD8 status as dependent. All predictors but one, extraversion, were significant (p < .05), suggesting that personality traits may influence perceptions of cognitive change. Higher agreeableness and neuroticism predicted possible dementia status on the AD8, whereas higher openness and conscientiousness predicted normal cognition. Interestingly, most in the AD8 positive group (70%) denied having “more problems with memory than most” on the Geriatric Depression Scale. These perceptions would seem incompatible, especially for true positive cases. Our findings suggest that the role of personality in dementia screening (and, perhaps, diagnosis) may be more nuanced than indicated in other studies. Longstanding traits and present perceptions are both elements of the evaluative process, as much as test scores and reported history. Our findings speak to the value of a person-centered, context-aware approach in cognitive screening.
IMPORTANCE OF DIAGNOSTIC IMAGING FOR INTERPRETATION OF SELF-REPORTED SURVEYS OF SHOULDER FUNCTION
Authors: Davis Derik L , Almardawi Ranyah , Beamer Brock , Gullapalli Rao , Ryan Alice , Terrin Michael
Published: November 2019

Rotator cuff (RC) tear is highly prevalent in older adults. The American Shoulder and Elbow Surgeon (ASES) survey, which quantifies subjective self-reported shoulder function, was originally validated in adults <60 years, and more recently is suggested to be valid in adults ≥60 years. We tested the hypothesis that ASES score (1) discriminates between adults 60—85 years with and without RC tear and (2) correlates with self-reported health quality and objective shoulder measures. Cross-sectional study: forty-two community-dwelling-older-adult volunteers (mean age, 69.4 ± 5.7 years; range, 61-84 years; male, 45%) with no history of RC surgery completed shoulder magnetic resonance imaging (MRI), shoulder forward flexion (FF) and abduction (ABD) range-of-motion (ROM) testing; and ASES, shoulder-pain and SF-36 (pain/physical function) surveys. Four groups (group-1:-pain,-tear,n=14; group-2:+pain,-tear,n=4; group-3:-pain,+tear,n=12; group-4:+pain,+tear,n=12) were compared using one-way ANOVA with ad hoc pairwise comparisons and Spearman Rank Order Correlation (rho). Age, Charlson co-morbidity index, and SF-36 pain/physical function were not appreciably different among all groups. ASES score (p<0.001), FF-ROM (p=0.032) and ABD-ROM (p=0.018) comparing all groups. ASES score: group-1 versus group-4 (p<0.001); but no difference between group-1 versus group-3 (p=0.999), and group-2 had lowest ASES score. ASES score correlated with SF-36 physical function (rho=0.47,p=0.002), SF-36 pain (rho=0.34,p=0.028), FF-ROM (rho=0.63,p<0.001), and ABD-ROM (rho=0.66,p<0.001). Our results suggest that additional research on ASES score in older adults is needed. Although valid, interpretation of ASES score in older adults should be approached cautiously in studies without shoulder diagnostic imaging tests, since painless RC tears and painful shoulders without RC tear are not rare.
EFFECT OF VISION AND HEARING IMPAIRMENT ON LIFE SPACE MOBILITY AMONG OLDER MEXICAN-AMERICANS
Authors: Monsivais Viridiana Saenz , Downer Brian , Raji Mukaila , Kuo Yong-Fang
Published: November 2019

Background: Poor vision and hearing can restrict an older adult’s life space mobility (LSM). Our objective was to examine if poor vision and hearing differentially impact the decline in LSM over a 2-year period among older Mexican-Americans. Methods: Data came from waves 7 (2010/11) and 8 (2012/13) of the Hispanic EPESE. Our final sample included 452 participants aged >79 years. Participants who said they could not recognize a person across the street, room, or arms-length were classified as having poor vision. Participants who said they could not understand a normal voice in a quiet room were classified as having poor hearing. Participants who decreased >10 points on the Life-Space Assessment were classified as having a decline in LSM. Logistic regression was used to estimate the odds for a decline in LSM according to poor hearing and vision, controlling for baseline demographic and health characteristics. Results: Poor vision was associated with 2.70 (95% CI=1.37-5.62) greater odds for a decline in LSM. This association varied according to depressive symptoms. Poor vision was significantly associated with a decline in LSM for participants without high depressive symptoms (OR=5.04, 95% CI=2.00-15.5), but not for participants with depression (OR=0.63, 95% CI=0.12-3.13). The association between poor hearing and decline in LSM was not significant (OR=0.68, 95% CI=0.36-1.27). Conclusions: Poor vision is a risk factor for decline in LSM, especially for older Mexican-Americans who do not have high depressive symptoms. Poor hearing does not appear to be a risk factor for a decline in LSM for older Mexican-Americans.
FACTORS RELATED TO QUALITY OF LIFE OF OLDER PEOPLE IN TEHRAN IN 2019
Authors: Kakhki Ali Darvishpoor , Abedsaeedi Zhila , Davidson Patricia
Published: November 2019

Aging is accompanied by a variety of challenges and tensions that have consequences for quality of life in older people. Optimizing quality of life is a key goal for active aging. This study was conducted to describe factors and quality of life of older people in the city of Tehran. This descriptive, correlational study was conducted on a sample of 290 older people above age 60 recruited in 10 public parks in five regions of Tehran in 2019. A socio-demographic questionnaire and instrument on Quality Of Life of Older People (QOL-OP) were used for data collection. Content validity and Cronbach’s alpha were used for evaluation of the validity and reliability of questionnaires. Data were analyzed with SPSS software. Fifty-one percent of older people were male and 49% male with a mean age of 69.52(± 7.11) years. The mean scores for quality of life domains ranged from 57.61(±7.11) for family integrity, to 64.73(±7.50) for spiritual well-being on a 100-point scale. The scores on health-related quality of life domains were influenced significantly by characteristics of age, gender, marital status, housing status, income source, treatment insurance, supplementary treatment insurance, education level, living persons, number of offspring, and annual physician referral rates. The findings of this study showed that quality of life of older people was lower than expected and related to a number of factors. Monitoring modifiable factors such as treatment insurance and non-modifiable factors will help us to preserve or improve quality of life of older people.
SOCIAL FRAILTY IN RECENTLY RELOCATED SEMI-INDEPENDENT OLDER ADULTS
Authors: Dupuis-Blanchard Suzanne , Bigonnesse Catherine , Maillet Danica , Gould Odette , Andrews Melissa , Légaré France
Published: November 2019

Although most older adults live outside of care institutions, not all seniors choose to live in traditional family homes. Among those who relocate, some relocate too early while others are pre-frail or frail when they relocate. Social frailty – the interaction between social vulnerability and frailty – could contribute to these untimely relocations. The goal of this study was to inform the concept of social frailty by examining a population of semi-independent older adults who recently relocated to a continuum of care community. The objectives of this study were to: 1) understand the influence of the social determinants of health on the relocation process; 2) explore whether relocation increases or reduces social frailty; and 3) measure the level of post-relocation frailty in study participants. This mixed method study combined semi-structured interviews on the relocation process, the frailty identification tool PRISMA-7, and socio-demographic surveys. Twenty-nine recently relocated seniors were recruited with the assistance of a Citizens' Advisory Committee along with advertisements, presentations, information booths, and word of mouth. Qualitative descriptive thematic analysis and descriptive statistical analyses were used to examine the relationship between frailty, socio-demographic variables and relocation. Findings indicated that several social determinants contributed to frailty and that relocation into a continuum of care community could mitigate some aspects of social frailty. A conceptual framework on the influence of social frailty on relocation is discussed. More research is needed to inform the concept of social frailty and to better understand the impact of social factors on frailty.
THE EFFECT OF ACTIVITIES OF DAILY LIVING ON FAMILY CAREGIVER SOCIAL ISOLATION
Authors: Gallanis Tony
Published: November 2019

Social isolation has been shown to associate with negative health outcomes including depression and stress. For family caregivers of older adults, the demands on the caregiver often are associated with increasing feelings of loneliness and decreased social contact. The degree to which the caregiver’s social isolation is related to the complexity of the caregiving situation remains unknown. Through a cross-sectional analysis of 526 family caregivers from the Family Caregiver Alliance client record database, an association has been established between care recipient functional decline and caregiver social isolation. Social isolation was measured through the Lubben Social Network Scale and functional decline was measured through ADL/IADL reporting. Covariates controlled for in the analysis included caregiver ethnicity, duration of caregiving, adult child status, caregiver education, care recipient income, and hours per week caregiving. Family caregivers of care recipients with higher functional decline experienced elevated odds of social isolation as compared to family caregivers of care recipients with little to no functional decline. The results from this study highlight the need for medical personnel and non-profit actors to anticipate social isolation as a risk factor for family caregivers of older adults given the care recipient is experiencing functional decline.
WHAT CONSUMERS SAY ABOUT HOSPICES IN ONLINE REVIEWS
Authors: Cardenas Valeria , Rahman Anna N , Singleton Mekiayla , Zhu YuJun , Enguidanos Susan
Published: November 2019

Until recently, consumers have had limited resources to assess quality of hospices agencies, contributing to growing numbers of consumers turning to online review sites, such as Yelp. Yet little is known about the content of hospice Yelp reviews and how these relate to recently available Center for Medicare and Medicaid Services’ Hospice Compare site data. No study has examined Yelp hospice reviews and compared the themes identified in Yelp reviews to the topics addressed by CMS’s HC measures. To better understand how consumers perceive hospice care, we drew a purposeful sample of 67 hospices in California. Researchers used grounded theory to identify themes and categories within the hospice reviews. Each of two teams of two researchers independently coded the reviews and then met to compare coding and reconcile discrepancies until 100% consensus was reached. We coded a total of 692 consumer Yelp reviews, identifying 15 themes and grouping them under five overarching thematic categories: patient/caregiver-provider relationship; clinical care; agency competency; staff professionalism; and medical equipment and supplies. We found that overall Yelp comments were positive. The most frequently mentioned Yelp themes in hospice reviews were compassionate, caring staff; patient/family gratitude; and staff responsiveness. There was considerable overlap between the themes captured in HC caregivers survey items and Yelp. However, Yelp reviews cover a greater number and more diverse themes than those measures reported on the CMS Hospice Compare site. We recommend that consumers consider both HC and online review sites such as Yelp when evaluating a hospice.
PHYSICAL ACTIVITY IN EARLY AND MIDDLE ADULTHOOD PREDICTS LATER-LIFE MEMORY TRAJECTORIES VIA HEALTH PATHWAYS
Authors: Kraal Zarina , Zahodne Laura B
Published: November 2019

Physical inactivity measured during late-life is a modifiable risk factor for dementia, but many studies use concurrent assessments with limited longitudinal follow-up. Less is known regarding life course exposure to physical inactivity. Physical activity patterns at different ages may make independent contributions to dementia risk, which would point to multiple critical periods for intervention. Using Health and Retirement Study Life History Mail Survey data (N=4,396), latent growth curves tested whether retrospectively-reported activity in early (18-29 years) and middle (40-49 years) adulthood predicted later-life memory trajectories over 18 years (mean age at study entry = 60.56 ± 5.44; mean follow-up = 13.27 ± 4.03 years). Total metabolic equivalents were computed from reports of moderate and vigorous physical activity. Biennial memory performance was modeled from study entry (between 1996 and 2014) to 2014. Self-reported physical and mental health at study entry were modeled as independent mediators. Models were adjusted for age at study entry, sex, education, race, ethnicity, childhood socio-economic status, year of study entry, and year of mail survey enrollment. More physical activity at ages 18-29 and 40-49 were independently associated with better initial memory, but not subsequent memory change. The association between physical activity at ages 40-49 and initial memory was partially mediated by better mental and physical health. These observational results support the possibility that physical activity interventions during multiple stages of the adult life course might be effective at lowering dementia risk. In particular, mid-life physical activity may have broad effects on later mental, physical, and cognitive health.
RETIREMENT TIMING AND POST-RETIREMENT HEALTH: QUASI-EXPERIMENTAL EVIDENCE FROM DENMARK
Authors: Qvist Jeevitha Y
Published: November 2019

A growing concern among policy makers in the European welfare states is that the proportion of the population in the working age has decreased over the last decades. In response to these demographic trends, many European countries have introduced reforms that roll back welfare policies that enables early retirement in order to sustain the current standards of living. However, scholars have voiced the concern that reforms which prevent early retirement could cause a rise in health inequality in old age because some people are not able to extend their working life. There are two contradictory views on post-retirement health. Retirement can either be seen as a kind of identity crisis, leading to less motivation to maintain health or retirement can be seen as a health preserving transition, enabling individuals to relieve stress and be more aware of their health. So far, empirical evidence on the effect of retirement timing on post-retirement health is inconclusive about the causal nature of this relationship. To estimate the causal effect of retirement timing on post-retirement health, this paper uses month of birth variation in incentives to postpone early retirement in the cohort born in 1939 that was created by a reform of the Danish retirement legislation, which the government introduced in 1999. The results suggest that people who retire at the age of 60 have more adverse health outcomes in old age than people who retire later, but this difference does not appear to be caused by differences in retirement timing.
VALIDATING SILICONE WRISTBANDS TO MEASURE PESTICIDE EXPOSURES AMONG OLDER ADULTS -- PROOF-OF-CONCEPT STUDY
Authors: Chanti-Ketterl Marianne , Plassman Brenda L , Parks Christine , Herkert Nicholas , Fleenor Julie , Zhang Sharon , Stapleton Heather
Published: November 2019

Silicone wristbands have been used to measure exposure to pesticides and other chemicals among children and younger farm workers, but not in older adults. Thus, we aimed to examine exposure to pesticides using silicone wristbands in a small cohort of older adults living on agricultural land, with variable contact with fields and pesticides. We also investigated correlations between pesticide levels on wristbands and urinary pesticide metabolites. Organophosphate (OPH) pesticides and several organochlorines were measured in wristbands worn by 15 males age 70+ (10 farmers using pesticides and 5 non-farmers with no recent pesticide use). Wristbands were worn continuously for 5-days. End-of-day urine samples were collected on days 1-3-5. Spearman correlations and Wilcoxon Scores were calculated. Five pesticides were quantified in the wristbands and detection frequencies ranged from 40-90%. In urine,12 OPH metabolites were quantified, but only 5 were detected in >50% of the samples. None of 5 urinary herbicides were detected. Imputation was performed by dividing minimum-detect by square-root-2. Malathion was only detected in farmers compared to non-farmers. Correlations between OPH urinary metabolites and wristband were examined but only two were significant and were negative in direction. Notably, organochlorine DDE on the wristbands was significantly correlated with 3 OPH metabolites. These unexpected relationships, based on small numbers, suggest a need to replicate this work in a larger study sample to explore potential for confounding or mixtures in future studies of pesticides and health in older farmers.
UNDERSTANDING DEMENTIA PREVALENCE AND HEALTH CARE USE PATTERNS IN RURAL NORTH CAROLINA
Authors: Grant Amanda N , Liu Tsai-Ling , Rozario Nigel L , Mangieri Deanna A , Woodward Jennifer M , Taylor Yhenneko J
Published: November 2019

Rural and remote communities have limited access to high quality dementia care, prompting a need for innovative solutions to meet the health care needs of affected older adults. As part of a study aimed at implementing a telehealth intervention for primary care patients with dementia in two rural North Carolina counties, we examined baseline dementia prevalence and compared health care use between patients with and without dementia. Electronic health records from January 2018 to December 2018 were examined for 2,288 patients aged 65 or older. A zero-inflated Poisson regression model was used to compare healthcare use between patients with and without dementia adjusting for patients’ demographic and clinical characteristics. Dementia prevalence was 8.7% based on diagnosis codes. Most patients with dementia were women (70%), not married (55%), Medicare-insured (78%), and had more comorbidities (mean: 2±2) than non-dementia patients. Dementia patients had a significantly higher number of primary care visits, emergency department visits, inpatient visits, and preventable hospitalizations than patients without dementia (risk ratio = 1.1, 1.8, 2.18, and 1.3, respectively; all P< 0.05). Dementia burden was higher among women and use of acute care services by patients with dementia in this rural setting was higher than patients without the disease, similar to urban settings. These findings suggest opportunities to improve care coordination and access to resources to help reduce the need for acute care services among patients with dementia and can help tailor interventions to address the health care needs of this group.
CHALLENGES FOR BLIND AND VISION IMPAIRED USERS OF A VISUAL QUESTION ANSWERING TOOL: IMPLICATIONS FOR AGING ADULTS
Authors: Davis Nathan , Xie Bo , Gurari Danna
Published: November 2019

Recent technological developments provide individuals with vision impairment the transformative ability to upload pictures they take and promptly receive descriptions from remote workers. This study aimed to: identify challenges for visually impaired individuals to use such technology to obtain health-related information and provide recommendations for crowd-workers and the future development of assistive artificial intelligence (AI) design. In spring and summer of 2019, we analyzed 265 images of medication packages submitted by users of a visual question answering (VQA) application called VizWiz -- a smartphone application that provides near realtime assistance to visually impaired users by employing crowd-workers. We developed a 4-category coding scheme to analyze image quality, with two independent coders achieving excellent intercoder reliability (85%-95%). Of the 265 images, we found less than half were legible (46%), contained clear indicators for information sought (40%), or had minimum background noise (40%); while only a small percentage contained complete information (6%). Through thematic analysis of the data, we also highlight seven challenges with queries submitted by vision impaired users . Based on our findings, we make recommendations for the future design of VQA technologies, such as VizWiz, for visually impaired users. We also suggest that there is both great need and potential for user-centered design research to significantly enhance such assistive technologies. While this study did not focus exclusively on data submitted by aging adults, many VizWiz users are, in fact, aging adults, and such assistive technologies have strong implications for the design of assistive technology for this age group.
THE EFFECT OF SOCIAL SUPPORT ON QUALITY OF LIFE OF PERSONS WITH COGNITIVE IMPAIRMENT
Authors: Afunugo Wilma E , Samper-Ternent Rafael
Published: November 2019

According to the Alzheimer’s Association, 5.6 million Americans age 65 and older are living with Alzheimer’s Disease. Since pharmacological treatments have yet to be developed, we want to determine whether the amount and quality of social support influence the quality of life (QoL) of persons with dementia so they can lead active and purposeful lives. We analyzed data from 22,030 individuals aged 50+ from the 2010 Health and Retirement Study cohort. The dependent variable, QoL, was measured as self-rated health. The main independent variable, cognitive status, was obtained through direct and proxy interview measurements of cognition. For social support, a composite score including the number of social contacts/close relationships and perceived social support/strain was created. Lastly, several covariates were included. Longitudinally, we examined how QoL changed between 2010 and 2012 using 3 stepwise regression models. Model 1 found those with normal cognition have lower odds of poor QoL vs. those with cognitive impairment (OR = 0.38, p <.0001), number of relationships and perceived social support decreases the odds of poor QoL (p = 0.003, p <.0001), while social strain increases the odds of poor QoL (p <.0001). Model 3 revealed similar findings but also, persons with comorbidities have increased odds of poor QoL (p <.0001), while persons with better function have decreased odds of poor QoL (p <.0001). In conclusion, these results can be used to design interventions to improve social support and reduce social strain, which can also improve QoL for dementia caregivers.
PENSION AND SUBJECTIVE WELL-BEING AMONG OLDER ADULTS IN URBAN CHINA: THE ROLE OF SOCIAL PARTICIPATION
Authors: jiang haojun , Chi Iris
Published: November 2019

This study highlighted the relationship and interaction mechanism among pension, social participation and subjective well-being of older adults in urban China, which provided cross-cultural evidence for theories, and had significant implications for social security policy. It examined the relationship between pension and subjective well-being (i.e., life satisfaction, depression) among older adults in urban China. It also assessed the mediating and moderating effects of social participation (i.e., three types of activity participations including labor activity participation, political activity participation, voluntary activity participation; and the variation of activity participation) in the linkage between pension and subjective well-being. The data came from the 2014 China Longitudinal Aging Social Survey (CLASS), a national, large-scale survey of a representative community aging sample (60 years and older) in urban China (N=6907). The study used hierarchical regression analysis and structural equation modeling methods. The results showed that pension could improve the subjective well-being of the older adults, specifically, pension enhances life satisfaction and reduces the depression of older adults. Both of three types of activity participation and the variation of activity participation were a significant moderator in the relationship between pension and subjective well-being. Besides, both labor activity participation and variation of activity participation were also a partial mediator in the relationship between pension and subjective well-being.
DEVELOPMENT AND VALIDATION OF THE ANTIPSYCHOTIC MEDICATION RISK SCORE FOR NURSING HOME RESIDENTS
Authors: Phillips Lorraine J , Petroski Greg , Birtley Nancy
Published: November 2019

Prevalence rates of antipsychotic medication (APM) use in U.S. long-stay nursing home (NH) residents, excluding those with approved diagnoses, range from 7.2% to 20.7%; Missouri’s rate is 18.6%. This study developed an APM risk score for NH residents using variables from the Minimum Data Set 3.0 (MDS 3.0) assessment. Data from the most recent Missouri MDS 3.0 assessment, excluding admission and discharge, for each long-stay NH resident from November 2017–December 2018 were used to create development (n= 30,893) and validation (n= 7,651) data sets. Potential predictors of APM use were entered in a logistic regression model with variable selection via the least absolute shrinkage and selection operator (LASSO). In a final step, only variables with odds ratios > 1.2 were retained. A weighted score was created by assigning points relative to the maximum coefficient [10*βi /max (β)] and rounded to integer values. APM rates were 17.29% and 17.70% in the development and validation data, respectively. The final model included 14 demographic and clinical indicators; assigned points (1-10) summed for total score (0-50). Areas under receiver operator characteristic curves were 0.801 and 0.798 for the development and validation models, respectively. Youden's index cut-point = 8, with sensitivity of .70 and specificity of .75. Our findings demonstrate it is possible to predict with good accuracy a NH resident’s risk of APM use. Identifying residents at increased risk of receiving an APM, perhaps inappropriately, could position NH staff to proactively design and deliver nonpharmacological interventions individualized to each resident’s needs and preferences.
THE IMPACT OF AN EDUCATION INTERVENTION: IMPROVING COMMUNICATION BETWEEN OLDER ADULTS AND HEALTH CARE PROVIDERS
Authors: Heyman Janna , White-Ryan Linda , Kelly Peggy
Published: November 2019

As people age, ensuing physical and psychological problems can increase, which makes it paramount to be comfortable discussing medical needs with health care professionals, particularly in light of the danger associated with misunderstanding medication use and combining alcohol with prescriptions and/or over the counter medications (National Institute on Aging, 2018). National studies found that about 40 percent of adults ages 65 and older drink alcohol and often do not understand the dangers of combining alcohol with medications (National Institute for Alcohol and Alcohol Abuse, 2008). An educational intervention was developed with a team of expert physicians, nurses, pharmacists and social workers who work in gerontology to focus on improving communication and addressing alcohol and medication use for older adults. A randomized controlled trial was conducted to assess whether the educational intervention improved older adults’ comfort in communicating with their health care providers, as well as their knowledge of the concomitant use of alcohol and prescription and over-the-counter (OTC) medications. Results of a MANCOVA showed that those in the intervention group showed larger increases in scores on communication with their health providers and knowledge about the implications of combining alcohol with prescription drugs than those in the control group (Wilks’ Lamda=.808, F(3,76)=6.039, p=.001<.05). In addition, linear regression models showed that the intervention was significantly associated with participants’ knowledge of the implications of combining alcohol with prescription drugs. The coefficient across models was approximately 1.00, which represented a substantial increase given the average score of 6.5.
PROTEIN SUPPLEMENTATION DOES NOT RESCUE MUSCLE MASS AND FUNCTION–HEAVY RESISTANCE TRAINING IS REQUIRED
Authors: Holm Lars , Bechshoeft Rasmus , Reitelseder Soren , Mertz Kenneth , Bulow Jacob , Hojfeldt Grith
Published: November 2019

The requirement of an enhanced dietary protein intake to counteract the age-related loss of muscle mass is still debated. Further, the dinner meal generally contains the majority of protein and energy and since, the muscle of older adults responds less to protein intake than that of younger adults it is hypothesized that older adults would benefit from taking more protein in at other meals. The aim of this study was to investigate whether the provision of protein supplements for breakfast and lunch meals over the course of a year would make healthy, older, home-dwelling adults (N=136) take in more protein and whether that then would affect their muscle mass (primary outcome) and a number of metabolic health parameters, muscle strength parameters and functional capabilities. More than 77% ingested more than 75% of the provided supplements, irrespective of supplementation type (isocaloric carbohydrate; collagen hydrolysate low quality protein: whey hydrolysate high quality protein). Providing supplementation for a year among older adults makes them comply very well. However, provision of extra protein has no impact on the muscle mass or strength or on the functional parameters. Further, we studied the impact of adding resistance training on top of WHEY protein supplementation and found that heavy more than light-load resistance training affects fat-free mass and maximal-voluntary contraction. Daily protein intake can be enhanced by supplementation but do not impact muscle mass and function over the course of a year, where heavy resistance training on top benefits, but to a lesser than expected degree.
CIRCADIAN PATTERNS OF FREE-WHEEL RUNNING IN YOUNG AND OLD MICE
Authors: Hibbs Carly , Yusifova Musharraf , McNair Benjamin , Bruns Danielle , Schmitt Emily
Published: November 2019

The mammalian circadian clock operates on a 24-hour cycle and regulates physiological, endocrine, and metabolic responses to changes in the environment. Aging disrupts this circadian process, increasing risk for development of age-associated diseases. Free-wheel running is not only an indicator of circadian rhythm, but also a strong predictor of survival from age-related diseases (i.e. cardiovascular disease). Thus, understanding the impact of age on free-wheel running can lead to a better understanding of disease progression. We analyzed free wheel running in both male and female C57BL/6J mice at young (3-6 months) and old (18-21 months) ages exposed to standard 12h light/dark cycle. Running wheel data was recorded hourly for 10 days. As expected, young female mice ran more than male mice, and old mice ran less than young mice. Regulation of wheel running demonstrated that older mice of both sexes had a delayed start time in activity patterns. Young mice began running immediately at lights off (signaling the start of their active period) and ran consistently throughout the dark phase with peak activity in the first 2 hours. In contrast, older mice had a delayed response to light with peak activity not occurring until hours 4-6 of the dark cycle and nightly activity ending 2 hours before lights on. Ongoing work will assess the central (brain) and peripheral (muscle, cardiac) regulation of free-wheel running in aging. Together, we demonstrate the importance of studying molecular mechanisms underlying circadian misalignment in older individuals to identify ways to combat age-associated disease with circadian misalignment.
“THEY DON’T TELL YOU ANYTHING”: ETHICS OF PRIVACY AND SOCIAL RELATIONSHIPS IN ASSISTED LIVING
Authors: Cooke Emma , Perkins Molly M , Doyle Patrick , Kinlaw Kathy , Wack Kevin , Vandenberg Ann E
Published: November 2019

The Health Insurance Portability and Accountability Act was developed to ensure patient privacy. Yet in assisted living (AL), social connectedness—which is associated with positive sense of self and well-being—may conflict with privacy regulations restricting information sharing. These regulations, while intended to protect, rely on a traditional conception of autonomy that foregrounds self-determination, freedom of choice, and freedom from outside interference, rather than a relational definition that acknowledges dependency, interdependence, and care relationships. We sought to identify health information sharing practices in AL that help or hinder residents’ ability to maintain a positive sense of self. We conducted a thematic analysis with secondary data (61 interviews with residents and their informal and formal caregivers, 916 hours of ethnographic observation) from one large (125 beds) AL community in Atlanta enrolled in a 5-year NIA-funded end-of-life study (5R01AG047408). We examined these data to determine how health information is shared in AL, and the valence of different sharing practices. Findings showed that exchanging information about shared life stage and health circumstances built community within AL. Conversely, receiving partial or inadequate health information frustrated residents. Medical information could be inferred from environmental cues, but many residents felt these cues harmfully “medicalized” social space. Negotiating privacy boundaries required staff and resident compromise. These results indicate divergence between AL policies intended to preserve privacy, and resident values emphasizing social relationships and bonding. A relational perspective may be valuable in developing alternatives for residents wishing to share health information with peers.