bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact Of A Whole Health Model Of Care On Patient Outcomes
Authors: Faul Anna , Yankeelov Pamela , D'Ambrosio Joseph , Cotton Sam , Gordon Barbara , Hall-Faul Maria
Published: December 2021

The FlourishCare Model (FCM) transforms primary care sites by addressing all determinants of health and focusing on helping patients to flourish. The FlourishCare Index (FCI) is a clinical measure to assess the effectiveness of the FCM to address all determinants of health. We will present data on the effectiveness of the FCM serving 159 older adults with MCCs. The sample was mostly female (77%), White (64%), retired (54%), married (30%) or widowed (20%) and living in urban areas (64%). The mean age was 69 (SD=15), with 13 years education (SD=3). Patients changed significantly over time on total FCI scores (57%-72%;□=3.80,SE=0.63). Results show significant growth over time for individual health behaviors (58%-67%;□=2.14,SE=0.84), health care access (71%-89%;□=4.43,SE=1.00) and social determinants (62%-85%;□=5.54,SE=1.02) with psychological determinants (54%-61%;□=1.74,SE=0.95) and environmental determinants (70%-81%;□=2.81,SE=1.62) showing a trend to significance. Interaction effects with time show that the FCM supported patients with lower education attainment to improve at a higher rate than those with higher education attainment, for the total FCI score (□=-0.59,SE=0.24) and health care access (□=-0.94,SE=0.38). Receiving mental health counseling resulted in more improvement in psychological determinants than those who did not receive counseling (□=3.43,SE=2.04). The FCM was able to support rural patients at a higher rate than urban patients to gain access to health care (□=4.13,SE=2.02). The FCM supported Hispanic patients the most in improving social determinants of health (□=8.40,SE=3.93). This study showed the importance of a systems approach to care using measures that focus on what matters most to older adults who value quality-of-life outcomes.
Talking about Complimentary and Alternative Medicine: A Conversation Analysis Study
Authors: Halpin Sean , Len Kathleen , Konomos Michael
Published: December 2021

Multiple Myeloma (MM) is a clonal plasma cell malignancy characterized by low blood counts and increased risk of infection, and primarily afflicts older adults. Although MM is incurable, advances in treatment, including autologous stem cell transplant (ASCT) has improved the lifespan of patients. MM patients commonly use over-the-counter complementary and alternative medicines (CAM) alongside conventional cancer therapies which, often without recognition by health care practitioners, may impact their treatment. Using data from an 18-month ethnographic study, we applied conversation analysis to examine 1180 minutes of audio-recordings to describe how patients and nurses interacted about CAM during ASCT education visits. Patients (n=12) had a median age of 62 years (IQR= 54-73), were mostly white (n=12, 75%), male (n=9, 56%), and had a moderate score on the FACT-G7 of 15 (IQR= 10-20). All patients had a caregiver present during their visit. Nurses (n=3) were aged 39 (IQR= 29-49) all with at least five years providing care to patients with blood cancers. Results suggested that nurses rarely provided direct feedback about CAM modalities, instead providing brief responses, and moving on to other topics. Excerpts were categorized into three groups, (1) demonstration of implicit epistemic authority, (2) demonstration of deferred epistemic authority in patient-initiated conversations, and (3) demonstration of deferred epistemic authority in nurse-initiated conversations. Understanding how conversations surrounding CAM are navigated can provide insights into patient-communication in general, and methods for improving ASCT education.
Development Of Diet Score For Reflecting Diet Patterns and Dietary Guidelines: A Case Of Singapore
Authors: Liu Yuezhong , Verma Rakhi , Ho Ringo , Theng Yin-Leng
Published: December 2021

Foods and dietary patterns substantially affect health outcomes. The overall dietary assessment score associated with dietary guidelines in Singapore has not been assessed previously. This study aimed to develop and evaluate diet score for identifying the relationship between dietary patterns and dietary guidelines in Singapore. Using a localised diet score survey collaborated with the Commonwealth Scientific and Industrial Research Organisation (CSIRO), we conducted a cross-sectional study of 600 Singapore persons in two-generational cohorts (40-64: 300 and > 65 years: 300). The proposed local diet score was calculated to reflect their overall compliance with the Dietary Guidelines in Singapore. ANOVA analysis was used to identify the significant difference among socio-demographic variables associated with diet score and comparison analysis was performed to compare the diet patterns and diet score. There are significant differences among age, education, housing, residency associated with diet score. Diet score of older cohort (M= 67.71, SD= 13.38) is significantly higher than young cohort (M= 60.73, SD= 14.71). The highest education level (University or tertiary) obtain the lowest diet score (M= 58.58, SD= 14.41). The participants who live in the landed property (M= 69.45, SD= 14.43) are higher than those who live in Condominium and Public House. And the participants who live alone (M= 67.26, SD= 14.66) have a higher average diet score. Two-generational cohorts are not compliant with recommendations about dietary guideline well in Singapore. The present findings suggest that dietary patterns need improvement in aspects such as vegetables and extra food components.
Exploring Factors that Shape Adherence to Technology-Based Cognitive Interventions
Authors: Harrell Erin , Roque Nelson , Boot Walter , Charness Neil
Published: December 2021

A cognitive intervention study was conducted to explore methods to improve adherence to a technology-based cognitive intervention and uncover individual differences that predict adherence (N = 120). The study was divided into two phases: (1) in which participants were asked to follow a prescribed schedule of training that involved gamified neuropsychological tasks administered via a tablet, and (2), in which participants were asked to play as frequently as they wished. Positively and negatively framed messages about cognitive health were delivered via the software program, and measures of cognition, technology proficiency, self-efficacy, technology attitudes, and belief in the benefits of cognitive training were collected. We computed an aggregate measure of adherence during each of the two phases, as well as a measure of daily engagement. Across data modeling approaches, the finding was consistent: only during Phase 2, was there evidence that positively-framed messages encouraged greater adherence over negatively-framed messages. Measures of memory and self-efficacy demonstrated some, but limited, ability to predict individual differences in adherence.
Discrepancies in Objective and Subjective Fine Motor Abilities in Octogenarians
Authors: Fauth Elizabeth Braungart , Hooyman Andrew , Schaefer Sydney , Hall Anna , Ernsth-Bravell Marie
Published: December 2021

Older individuals may have discrepancies between self-reported and performance-based abilities on activities of daily living (ADL). We examined objective and self-reported fine motor abilities (FMA). FMA are required for many ADLs, but are examined less frequently than gross-motor tasks in this population. We used two waves of the population-based OCTO-Twin study including mono-/dizygotic Swedish twins, aged 80+. One twin was randomly selected for analyses (baseline N=262; wave 2 N=198; Meanage =83.27; SDage=2.90; 66.4% female). Participants self-reported their ability to manipulate things with hands (cannot do, some problem, no problem) and completed a timed FMA assessment including five everyday tasks (e.g. inserting a key in a lock). Slow performance was coded as 1+ SD from the mean (=80+ seconds). At baseline, 65.8% of slow performers reported ‘no problems’ with hand manipulation. Over two waves (two years), a two-factor ANOVA (including slowness-by-perception interaction) supported a significant difference in total motor task performance between slow performers reporting ‘no problems’ and fast performers reporting ‘no problems’, for both rate of change (diff = -26 seconds, p<.0001) and wave 2 level (diff = 50 seconds, p < .0001). 82% of slow performers at wave 2 reported ‘no problems’, which is surprising given that they had become even slower over the past two years. Findings suggest that objective FMA measures are needed, as self-report is inaccurate and not prognostic. Future work will examine if discrepancies in performance/perceived FMA predict poorer outcomes, and/or if reporting ‘no problems’ despite slower performance is protective against cognitive adaptation to slowing.
Trajectories of Functional Health Following Stroke: The Role of Social Resources
Authors: Nakagawa Takeshi , Noguchi Taiji , Komatsu Ayane , Ishihara Masumi , Saito Tami
Published: December 2021

Stroke is one of the major causes of disability in old age. Predictors for the functional prognosis have been studied, but the role of social resources in recovery has not studied as much. We examined whether social resources available before and after stroke onset improved functional prognoses. Data was derived from longitudinal data collected between 1987 and 2006 from Japanese adults aged 60 years and older. We identified 396 people who had experienced their self- or proxy-reported first stroke during follow-up (age at stroke onset: M = 76.0, SD = 6.9; 74.2% women). Functional health was measured by self- or proxy-reported activities of daily living. Social resources were indexed as residential status, contact with non-coresident children, social participation, and perceived support. Analyses were adjusted for age at stroke onset, gender, and education. A multiphase growth model showed that functional health typically deteriorated surrounding stroke and gradually declined thereafter. There were also individual differences in the trajectories of functional health. Individuals who more frequently participated in social groups prior to stroke and those who came to participate more frequently thereafter exhibited less functional decline immediately following stroke. Our findings indicate that social participation plays a protective role against adverse prognoses following stroke regardless of when individuals start participating. Inclusive communities would enable older adults to remain independent. Our study was limited in that crucial information about stroke, such as objective measures of initial severity, was not available and that individuals with more severe stroke may have dropped out after the onset.
Preventable? Long-Term Care Policy Successes and Failures During COVID-19 Pandemic: A Scoping Literature Review
Authors: Wu Chaoran , Zecevic Aleksandra , Smith Maxwell , Sibbald Shannon
Published: December 2021

The number of older adults who live in long-term care (LTC) is expected to increase worldwide. The COVID-19 pandemic has caused serious consequences in Canadian LTC homes, while homes in China and Japan reported minimal infection and death rates in residents. The differences in LTC policies may be one of the contributors. The purpose of this literature review was to identify elements of the LTC policies that might have impacted COVID-19 outcomes in LTC homes in Canada, China, and Japan. A scoping review was conducted following the framework proposed by Arksey and O’Malley. Scholarly articles and grey literature published between January 2015 and June 2020 were identified in six databases, four in English (CINAHL, Scopus, ProQuest, and PubMed), one in Chinese (CNKI), and one in Japanese (CiNii), using MeSH terms for LTC and health policy. Grey literature was identified using Google. Data were extracted, summarized and common themes identified through content analysis. A total of 52 articles and 26 grey sources were included in the review based on determined inclusion criteria. They were research articles, reviews, government or association reports, policy briefs, policy documents, and guides. Four common themes of challenges emerged: caregiver workforce, service provision, funding, and physical environments. Three sub-themes were identified for caregiver workforce and service provision. Differences in COVID-19 consequences in LTC homes in the three countries seem to be related mainly to the challenges with the caregiver workforce and the lack of funding. The result suggests Improvements of LTC policies are required, especially in Canada.
Scoping Review: Home and Community-Based Service Waiver Programs and Person-Reported Outcomes
Authors: Bucy Taylor , Mulcahy John , Jutkowitz Eric , Shippee Tetyana
Published: December 2021

State Medicaid programs are rebalancing their long-term care spending from nursing home to home and community-based services (HCBS). Emphasis on person-centered and person-directed care warrants investigation into models of HCBS delivery that promote quality of life. We performed a scoping review of the literature to catalogue the breadth of the studies describing HCBS waiver programs targeting adults (18+). We identified 757 articles, and after duplicate removal and reconciliation, we excluded articles on children or adolescents, non-peer reviewed reports, international studies, and articles that did not describe HCBS waiver programs. After abstract and title review, 292 articles met our inclusion criteria. Most included articles (22.3%) were single state descriptive evaluations or evaluations of service use patterns among participants. 17.8% of included articles examined multi-state or national variation in program trends, while 17.1% made national program conclusions without a major focus on interstate comparison. Less common were studies examining integrated care or dual-eligibles (7.5%), PACE (3.4%), medication management (3.1%), quality and satisfaction of both consumer and caretaker perspectives (3.8%) and consumer-only perspectives (5.1%). The remaining articles focused on HIV (4.1%), TBI (1.4%) or ID/DD (14.4%) waiver programs. The 8.9% of articles addressing quality and satisfaction consisted mostly of interviews, either with state Medicaid administrators or with care recipients and/or caregivers. Consumer reported satisfaction and unmet care needs were the primary outcomes examined. Given the heightened focus on long-term care as a result of the ongoing coronavirus pandemic, this review justifies further exploration into the delivery and outcomes of state-directed HCBS waiver programs.
Do Personality and Belief Influence the Ownership of Private Long-term Care Insurance?
Authors: Yeh Shu-Chuan Jennifer , Chou Hsueh-Chih , Chen Shih-Hua Sarah
Published: December 2021

Long-term care is the largest out-of-pocket expenditure risk for the elderly. Private long-term care insurance is one crucial source to cover the gap. The study aims to investigate (1) whether wealthy people are more likely to purchase private long-term care insurance (LTCI); (2) whether personality traits are associated with ownership of LTCI; and (3) whether individual experience influences the ownership of private LTCI. We surveyed 375 participants for three groups, including nurses, executive MBA, and MBA students. EMBA group had highest percentage of personal discretionary income (defined as greater than 1,780 US dollar per month)(77.6%), followed by MBA group (17.6%) and nurse group (8.8%). The nurse group had highest in long-term caring experience for sick family members (46.4%), self-experience catastrophic diseases (11.2%), and number of family/relatives/friends share responsibilities of caregivers (2.33 persons). The nurse group had lowest risk propensity score as well as openness to experience traits. The percentage of ownership in private LTCI was 48%, 45.6%, and 28.8% for nurse, EMBA, and MBA groups, respectively. After controlling for age and tenure, results from logistic regression indicated that MBA group was less likely to own LTCI compared with nursing group. Compared with less than 30,000, only personal discretionary income 30,001~ 50,000 had higher odds ratio to own LTCI. Wealthy is inconclusive in determining ownership of private LTCI. Nurses who were lowest risk propensity and openness traits and have more sickness experience were more likely to purchase private LTCI. Believe needing LTCI is the strongest predictor in ownership of LTCI.
Self-Reported Health, Well-Being, and COVID-19 Vaccination Willingness Across the Generations
Authors: Patskanick Taylor
Published: December 2021

The COVID-19 pandemic has impacted the generations’ health and wellbeing across a range of dimensions. In the first survey, the 50+ adopted the smallest number of health behaviors (e.g., handwashing, mask-wearing, etc.) in response to the pandemic compared to younger age groups. In the first and second surveys, the Baby Boomer generation reported less intense worry than other generations, especially regarding their socioemotional health and family members’ health. For younger generations, worries tended to increase from March to June—especially those related to socio-emotional health and COVID-19 in general. In the third survey wave, older generations self-reported better psychological wellbeing, less personal burnout, and better cognitive health compared to younger generations. Willingness to get the COVID-19 vaccine did not vary by generation in this sample; however, implications of this (including additional factors that may be influential such as psychological wellbeing) will be discussed.
Is Higher Nurse Aide Retention Associated with Fewer Nursing Home Allegations and Complaints?
Authors: Kennedy Katherine
Published: December 2021

Consumer voices are often left out from assessments of nursing home (NH) quality. For this reason, consumer allegations and complaints against nursing homes were studied in relation to facility rates of nurse aide retention. Analyses involved means and frequencies, correlations, ANOVAs with Tukey correction to examine the independent and dependent variables (N=690). Four quartiles of retention were created. In the final models, medium, high, and extremely high retention facilities are compared to the low retention facilities. Negative binomial regressions were estimated on total, substantiated, and unsubstantiated counts of allegations and complaints. All regressions controlled for the same characteristics, including nurse aide empowerment, consistent assignment, administrator turnover, director of nursing turnover, average age of residents, and percent female. The correlation between retention and the dependent variables was negative and statistically significant (r=-0.11, p<.01). The ANOVAs showed that high retention NHs (61-72%) received significantly fewer allegations than low (0-48%) and medium (49-60%) retention NHs; they also received fewer unsubstantiated allegations, and fewer complaints, both substantiated and unsubstantiated. After controlling for other variables, each retention group was significantly related to having fewer allegations and complaints compared to the low retention NHs. Notably, high retention NHs received between 29 and 35% fewer allegations and complaints of all types. Unexpectedly, extremely high retention NHs had more allegations, complaints, and unsubstantiated allegations than high retention NHs. Policy and practice have a role to promote nurse aide retention, improve job quality, and ensure adequate support for this critical, in-demand workforce.
Care Aides’ Perceptions of Caring for Nursing Home Residents With Past Psychological Trauma
Authors: Thorne Trina , Titley Heather , Norton Peter , Lanius Ruth , Estabrooks Carole
Published: December 2021

The dynamic interplay between dementia and psychological trauma can exert powerful effects on nursing home residents’ behavioral symptoms and quality of life. Our objectives in this exploratory study were to assess care aides’ perceptions of how often they worked with residents with past psychological trauma, the types of trauma encountered, and reasons for these beliefs. We conducted semi-structured cognitive interviews (n = 10) with care aides in June 2019 to inform the development of a trauma needs assessment (4 questions) that we included in a large survey of nursing staff (2019 - 2020). Care aides (n = 3761) were sampled from 91 randomly selected urban nursing homes stratified by health region, owner operator model, and size. We completed basic statistics and content analyses. Care aides identified residents they believed to have psychological trauma histories and provided reasons for their beliefs. Approximately 12% of the reported traumatic events were disclosed to staff. The most common, broad categories of trauma to emerge during analysis were abuse (40%) and war exposure (30%). Each had sub-categories. The most common categories of signs of trauma were re-experiencing symptoms such as flashbacks and nightmares (28%), and avoidance of specific triggers, such as water or intimate care (24%). The majority of the reported signs of trauma were persistent and distressing for staff and residents. Some behaviours assumed to be responsive behaviours of dementia may relate to traumatic stress symptomatology. Implementing trauma-informed supports for residents and care aides is essential to person-centred care and optimal quality of life.
Distress Behavior Conversations: Supporting Whole Person Whole Team Responses in VA Community Living Centers
Authors: Loup Julia , Smith Kate , Wehry Susan , Sloup Sharon , Keleher Jennie , Nash Princess , Hartmann Christine , Snow Andrea
Published: December 2021

Resident distress behavior, a prevalent challenge in long-term care, contributes to resident morbidity, staff burden, and turnover. We describe an education model developed in the Veterans Administration (VA) Community Living Centers (CLC) through a CONCERT (VA CLCs’ Ongoing Center for Enhancing Resources & Training) quality improvement series. The Distress Behavior Conversation (DBC) uses a team meeting structure and process. Informed by unmet need and relational coordination theories, it guides the whole team, inclusive of interdisciplinary team members and front-line staff with resident contact, through a collaborative problem-solving action-planning discussion. DBC uses facilitated round-robins to identify potential resident behavior causes and individualized solutions. DBC supports the team in maintaining whole person and whole team mindsets, thus challenging the narrower medical model of discipline-specific clinical mindsets and staff level hierarchies. Over two years we have co-created and refined DBC through trainings and team debriefings with over 80 CLCs. Care teams reported “aha” moments during DBCs their thinking shifted (“we are now looking at the REAL why”; “we went from asking, how did he fall? to, why did he fall?; “tended to try to treat falls in a standardized way, [but] when you focus on a specific person you get to focus on HIS needs”; “personal information about the Veteran is the 5th vital sign!”). Teams additionally reported reduced strain and improved collaborative thinking (“I feel better about what I’m doing...more motivated to keep going!; “Now I see it is a team approach – don’t have to do it by myself.”).
Resilience and Mental Health Among Male Older Adults in Extreme Poverty in Long-term Care Facilities in Rural China
Authors: Ma Ying , Leung Patrick
Published: December 2021

Older adults in extreme poverty refer to “three-noes people”: no working ability, no income source, and no children or legal supporters. They are eligible for a government-funded welfare system called “Five Guarantee system”. The majority of residents in rural welfare institutes are male older adults in extreme poverty. Research demonstrates that resilience is a critical factor in shaping health. This study aims to examine the association between resilience and mental health for male older adults in extreme poverty, and its differences in young-old (60-69 years), old-old (70-79 years), and oldest-old groups (≥80 years). A cross-sectional study was conducted with 1,427 eligible subjects in rural long-term care facilities from Anhui province in China during 2019, with a response rate of 77.4%. Resilience was measured by the Chinese version of Connor-Davidson Resilience Scale, including three subscales of optimism, strength and tenacity. Mental health was assessed using General Health Questionnaire-12. A MANOVA test revealed a significant difference among age groups on three subscales of resilience [Pillai’s Trace=.023, F (6,1486) =2.709, p=.013, ηp2=.012]. Tukey Post hoc indicated the oldest reported significantly lower levels of strength, optimism, and tenacity compared to the other two groups. A multiple logistic regression identified a significant negative association between resilience and mental disorder for the old-old (OR=0.95, 95%CI:0.93-0.97) and oldest-old (OR=0.93, 95%CI: 0.88-0.99) groups. Our findings identified th differences in the link between resilience and mental health within the three different age groups. Resilience-training programs to improve mental health would require targeting specific subscales of resilience for each group.
Robotic-assisted virtual care
Authors: Hung Lillian
Published: December 2021

Heightened isolation during the pandemic has exacerbated the stress, anxiety, and adverse consequences through the loss of family connections older people experience in LTC. Heavy workload and staffing shortage limit staff’s capacity to assist residents in accessing regular virtual visits. Using a Collaborative Action Research (CAR) approach, this project aims to assess the implementation of a telepresence robot, Double 3 to help residents connect with their families. CAR allows careful planning of implementation with stakeholders (patient and family partners, staff, and decision-makers), tailoring adaption to the complex LTC environment. We will program path planning to allow efficient movement between target destinations (residents' rooms) and the charging dock. For example, the robot will go to a resident’s room every morning or evening to help the resident to make a virtual call with family. The project involves three phases (a) Observe and Reflect, (b) Act and Adapt, (c) Evaluate. We work with two Canadian LTC homes in British Columbia to investigate feasibility and acceptability. CAR emphasizes research with, rather than research on people. Meaningful engagement with patient and family partners, frontline staff, and decision-makers at each site throughout the whole project will ensure the project will meet the local needs. Anticipated resident outcomes include improved quality of life, mood, perceived loneliness, perceived social support, and acceptance. Anticipated staff outcomes include perceived ease of use, and acceptability.
Empirically Evaluated Suicide Prevention Program Approaches for Older Adults: A Systematic Review
Authors: Miller Vivian , Fields Noelle , Xu Ling , Mercado-Sierra Marta , Wallace Marissa
Published: December 2021

Suicide is a serious public health concern, particularly for individuals in later life. Studies suggest that greater attention to suicide prevention programs for older adults is needed as well as continued research related to interventions with older adults at risk of attempting suicide. A systematic review of the literature on suicide prevention treatment and effectiveness is fundamental to assessing existing services and developing new programs and practice standards. This systematic review of the literature extends an earlier and well-cited systematic review (1966-2009) by examining articles published between 2009 and 2021 with a focus on what types of empirically evaluated suicide prevention programs effectively prevent and reduce suicidality in older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to gather the appropriate extant research and improve reporting accuracy. A three-stage review guided the selection of the articles. At stage one, titles were screened, which excluded 284 articles based on the inclusion criteria. Second, after a full review of each abstract, a final 14 articles remained for full-text review. Lastly, three independent researchers reviewed each of the full-text articles, and six articles were excluded. The final sample includes eight articles (N=8). The articles were categorized into three types of programs: 1) primary and home health care, 2) community-based outreach, and 3) counseling. Following a description of the articles, the authors assessed each study using the GRADE rating system. Findings underscore the critical need for evidence-based suicide prevention programs for older adults. Implications for future research are offered.
Examining Measurement Invariance of Depression among Male and Female in Chinese Older Adults
Authors: Melipillán Roberto , Hu Mengyao
Published: December 2021

Depression of older adults is an important public health concern. With the increasing popularity of cross-cultural research and comparison studies, researchers are facing a difficult problem: responses to the depression scales obtained from different population groups may not always be comparable. This study examines the measurement invariance of the 10-item version of the Center for Epidemiological Studies Depression (CES-D) Scale across male and female in Chinese older adults. Data are drawn from the baseline wave of the China Health and Retirement Survey (CHARLS), a national survey conducted biennially with a sample of the Chinese population who are 45 years of age or older. The final sample size includes 15,977 respondents; 53.2% of whom are female. The mean age for the sample is 58.3 (SD = 10.2). Measurement invariance (MI) tests based on Multiple Group Categorical Confirmatory Factor Analyses (MGCCFA) was performed. Results show that full scalar model was not supported, and question items invariant across groups were identified. These results indicate that any mean comparisons of CES-D across Chinese male and female older adults not accounting for the noninvariance in the items could be biased, highlighting the importance of performing MI tests before conducting mean comparisons across groups.
How do Alcohol Use and Depression Predict Grip Strength among Middle-Aged and Older Adults?
Authors: Ge Song , Dune Linda , Frantz Desiree' , Laviolette Laurel , Njuguna Mary , tang xianping , Li Changwei
Published: December 2021

Background: Physical performance is an important indicator that reflects current and predicts future health. In this study, we examined the association of alcohol use and depression with grip strength a national sample of middle aged and older Chinese adults. Methods: We used the baseline data from the China Health and Retirement Longitudinal Study (CHARLS) and constructed a multivariate linear regression using SAS 9.4 to examine the independent association of alcohol use (never, former, moderate, and at-risk drinkers) and depression with grip strength controlling for socio-economic factors and domestic partner status. Results: The study population consisted of 12,488 Chinese adults（mean age 59）. The prevalence of ever drinking during lifetime and current at-risk drinking (>14 standard drinks [one standard drink contains 14 grams of pure alcohol] per week) in this population was 25.7% and 15.2% respectively. 28.4% of the study population had depression. Compared with never drinkers, moderate and at-risk alcohol use were independently associated with better grip strength (P<0.0001). Depression was independently negatively associated with grip strength (P<0.0001). Conclusions: We found that current alcohol use might be protective of grip strength while depression might be detrimental to grip strength among middle-aged adults. However, the underlying mechanism is unclear. Given the negative impact of alcohol and depression on adults’ overall health, clinicians should assess alcohol use and depression in middle-aged and older patients using validated tools and provide resources. Clinicians should counsel patients that if depression is not managed, patients may suffer from depression associated health consequences such as declined grip strength.
The Effect of Computerized Cognitive Training for Adults Over 40 with Dementia-Related Anxiety
Authors: Roberts Jennifer , Maxfield Molly
Published: December 2021

Dementia-related anxiety (DRA) may occur when cognitive lapses are appraised as threatening. Individuals with DRA may seek activities to improve cognitive function, including popular computerized cognitive training programs like Lumosity©. We evaluated if DRA changed after eight weeks of Lumosity© use and whether changes were maintained over time. Participants aged 40 and older with pre-existing DRA participated via Amazon’s Mechanical Turk (T1 N = 395; age M = 52.49, SD = 8.71) and were randomly assigned to the experimental (Lumosity© software), active control (Lumosity© crossword puzzles), or no treatment group. Participants completed measures of DRA at T1 and at four follow-up points (T2 = 8 weeks; T3 = 12 weeks; T4 = 16 weeks; T5 = 20 weeks). Repeated measures ANOVAs were used to evaluate the change in DRA. A significant T1-T2 reduction in DRA occurred for the Lumosity© group only (p = .01, partial-eta2 = .03). Longitudinal changes were observed for the Lumosity© group only: DRA scores at T1 were significantly greater than at T2, T4, and T5 (ps < .05). A step-up test procedure was conducted to determine minimum treatment dose effects. A greater reduction in DRA occurred between the Lumosity© and crossword puzzle groups between 25.00 and 29.99 hours of software use (p = .05, partial-eta2 = .19). Lumosity© software outperformed crossword puzzles in DRA reduction from T1 to T2, which was maintained for 12 weeks post-software use. Independent of Lumosity’s intended purpose of supporting cognitive functioning, participants subjectively believe it helps and experience associated benefits.
Dental Issues And Depressive Symptoms In Institutionalized Older Adults
Authors: Bulgarelli Alexandre , Lopes Luiza Guilhermina , Frichembruder Karla , Santos Camila
Published: December 2021

Objective: To map and discuss scientific knowledge involving the research object "Oral health conditions and depression in institutionalized elderly people". Method: Systematic scoping review. The mapping of the selected data was carried out using Summative Content Analysis from Manifest Themes' perspective in the texts. After the exclusions, 27 articles were selected. Results: With the analysis of the articles, it was possible to divide them into two themes named: ‘Oral health condition: Long-term institution, depressive disorders and pluralities’ and ‘Depression in institutionalized older adults: medicalization, oral health conditions and subjectivities’. Heterogeneity was found in the sub-themes of the articles accessed and in the characteristics of the published studies as well. All continents have publications on the topic. Many studies with deductive methods have been carried out when dealing with its methodology, and less research has been carried out with inductive methods. Conclusion: The present study identified that there is an association between some oral health conditions (dry mouth and tooth loss) and prevalence of depressive disorders in institutionalized polder people. The knowledge produced about oral health and mental health in long-term care facilities for the elderly is relatively recent, reflecting the contemporary nature of the theme. Besides, the construction of this knowledge is associated with the diversity of epidemiological and qualitative studies seeking to answer questions that involve technical and subjective plurality involving mental health and oral health of institutionalized older adults.
Connecting Older Adults With Mental Health Apps: A Survey of Provider App and Education Material Use
Authors: Mehta Priyanka , Carlson Chalise , Anderson Jason , Alfaro Ana , Sakai Erin , Gould Christine
Published: December 2021

Many older veterans have access to mobile devices and are interested in using apps for mental health self-management, but few have ever downloaded health apps. To address the need for awareness of and access to VA mental health apps, we developed patient educational materials aimed towards older (or novice) users of mobile devices. The present study explored health care providers’ and staff’s perceptions about use of mental health mobile applications (apps) with older veterans and examined potential utility of these patient educational materials. Requestors of mobile device education materials (N = 90) were surveyed when ordering materials and again 4 months later. Baseline and follow-up surveys assessed frequency of app recommendation, and comfort recommending apps. Baseline surveys examined perceived advantages of apps; follow-up surveys examined perceived utility of the educational materials. Descriptive statistics and qualitative analysis were conducted. Most requesters (68.5%) initially were not comfortable using apps, yet perceived many advantages to using apps and hoped materials could facilitate app use. At follow-up, requestors felt more comfortable recommending apps alongside our materials. Qualitative analysis revealed perceived advantages to using the education materials. The benefits of developing and disseminating educational materials for providers to share with older veterans helped support older veterans’ app use, and potentially increased providers’ comfort with and frequency of recommending apps to their older patients. Access to educational materials can mitigate discomfort among providers in recommending apps to older users and may bring about valuable discussions about apps which support mental health.
eMental Health Literacy and Psychological Distress as Predictors of Barriers to Mental Health Services
Authors: Root Eve , Caskie Grace
Published: December 2021

Since the COVID-19 pandemic, psychologists have begun to rely heavily on technology to provide mental health information and services (APA, 2020). As the older adult population increases, the number of older adults in need of mental health services also increases; however, little is known about the way older adults might utilize technology to inform mental health-related decisions. This study expands on the construct of eHealth Literacy by examining eMental Health Literacy, which is defined as the degree to which individuals seek, find, understand, and appraise basic mental health information and services online that are needed to inform mental health-related decisions. A sample of 244 older adults (M=68.34, range=65-82 years) were recruited online through Amazon Mechanical Turk. A structural equation model was estimated specifying eMental Health Literacy and psychological distress as predictors of extrinsic and intrinsic barriers to mental health services. After adding three correlated errors, the model achieved good fit (χ2(110)=329.20, p<.001, SRMR=.08, CFI=.93, TLI=.91, GFI=.86, RMSEA=.09). All indicators were significantly related to their latent construct (p<.001). The results indicated that, controlling for psychological distress, higher eMental health literacy was significantly related to fewer reported intrinsic (b=-.386, p<.001) and extrinsic barriers (b=-.315, p<.001) to mental health services. Higher distress was also significantly related to more intrinsic (b=.537, p<.001) and extrinsic barriers (b=.645, p<.001) to mental health services. These findings suggest that, as we move towards a more digital world, eMental health literacy could play a significant role in the way older adults navigate through the mental healthcare system.
Piloting an Augmented Reality Life Review Experience to Promote Mental Health Outcomes in Aging Asian American Women
Authors: Hwang Sarah , Armendariz Jazlyn , Argueta Jeremy , Fruiht Veronica , Chan Thomas
Published: December 2021

Asian-American older women report the highest prevalence of suicidal ideations and rates of completed suicide compared to other racial groups. Ironically, Asian-American communities report disproportionately low rates of formal mental health utilization—this may be attributed to the lack of culturally-relevant services and negatively ingrained perceptions of mental health aid. One potential solution that has not been widely investigated is the use of technology to help older Asian-American women engage in mental health interventions. This study leverages innovations in augmented reality (AR) technology (i.e., overlaying of digital holograms onto the real world) to create a life review intervention aimed at promoting mental health well-being. The application, Tell-Being, is a personalized holographic life review experience that facilitates older adults to foster a sense of coherence and wholeness within their lives. Pilot data collection was amassed from four aging Asian-American female participants averaging 51.3 (SD=8.61) years of age. Initial pre/post analyses showcased mean differences that trend towards a higher presence of emotion regulation from pre-test (M=4.88, SD=1.08) to post-test (M=5.21, SD=1.17). Although data collection was prematurely halted due to COVID-19, results trended in promising directions. The technological innovations and findings from this study may lead to promising novel avenues to address barriers for older Asian-American women in seeking mental health assessment and treatment in a “new normal” world.
Cultural Safety within the Indigenous Health Context: Findings from a Review of Reviews
Authors: Bacsu Juanita-Dawne , Chakanyuka Christina , DesRoches Andrea , Walker Jennifer , Dame Jessy , O'Connell Megan , Symenuk Paisly , Bearskin Lisa Bourque
Published: December 2021

First Nations, Inuit, and Métis older adults often face systemic barriers to accessing culturally safe and equitable healthcare, including racism, structural injustice, and a historical legacy of colonialism. However, there is a paucity of knowledge on cultural safety interventions and implementation strategies in care for older adults. This presentation aims to: 1) explore persistent barriers to achieving health equity and advancing cultural safety in healthcare; and 2) identify cultural safety interventions to improve healthcare for Indigenous older adults. Guided by Arksey and O’Malley’s scoping review framework, we conducted a review of reviews published between January 2010 to December 2020 on Indigenous cultural safety in healthcare. We searched five databases (CINAHL, PubMed, Scopus, Web of Science, and Google Scholar) and hand-searched reference lists of relevant articles. We conducted a thematic analysis to identify patterns and themes in the literature. Key barriers to achieving health equity and advancing cultural safety in healthcare included care providers lacking knowledge of Indigenous culture, power imbalances, racism, and discrimination. A range of cultural safety interventions were identified, from education and training initiatives for healthcare providers (emergency physicians and occupational therapists) to collaborative partnerships with First Nations, Inuit, and Métis communities. As First Nations, Inuit, and Métis populations age, there is a growing need for safe healthcare services for Indigenous older adults, and these findings suggest focusing on healthcare providers knowledge and attitudes is key. Research is necessary to develop, implement, and evaluate cultural safety interventions aimed at healthcare providers to improve healthcare for Indigenous older adults.
I Know I'm Healthy Because: Qualitative Definitions of Health in Older Rural African-Americans
Authors: Adams-Price Carolyn , Riaz Muhammed
Published: December 2021

In recent years, there has been attention to health disparities between racial groups in the US, and between urban and residents. Older rural African Americans are at high risk, but have historical reasons tor distrust the health care system. This study examined qualitative definitions of health in older rural African Americans. Our sample included 47 African Americans aged 52-79 (20 male, 27 female, median age = 66 ) from non metropolitan counties in northeast Mississippi, at least 10 miles from the nearest town of more than 1000. Participants rated their health on a 5-point scale; only 1 person rated their health as a 5 for excellent. On average, they rated their health as fair. Most reported significant health problems, (mean=2) including 17 (36%) who reported having been diagnosed with diabetes. Participants were asked by interviewers “how they knew they were healthy.” Their responses were transcribed. Using phenomenological methods, participants’ responses were sorted into naturally-occurring categories, which were retested against the data. The categories that emerged were Performing Basic Tasks is Enough/I’m OK (12), Good Health Due to Healthy Behaviors (8), Healthy Due to Social Support or God (11), Healthy Despite One Problem (6), and I’m Not OK (7). Given that our sample is somewhat younger than most gerontological samples, participants seemed to have relatively low expectations about their health, which might not be surprising considering the health problems in the sample. Interventions to improve the health of this group should concentrate on increasing health self-efficacy and expectations.
Race/Ethnicity, Vascular Aging, and Mortality Risk: Evidence from the Health and Retirement Study
Authors: Heffernan Kevin , Wilmoth Janet , London Andrew
Published: December 2021

Vascular aging, which is associated with cardiovascular disease risk and mortality, is characterized by increasing arterial stiffness. The gold standard method for the assessment of arterial stiffness is carotid-femoral Pulse Wave Velocity (cfPWV). An emerging body of research suggests that cfPWV can be reasonably estimated from two commonly measured clinical variables—age and blood pressure. Thus, estimated Pulse Wave Velocity (ePWV) holds promise as a novel and easily obtained measure of arterial stiffness that can be used to study vascular aging, particularly with nationally representative datasets that collect biomarker data on sufficiently large sample sizes to examine race/ethnic differences. This analysis uses data from the 2006-2016 Health and Retirement Study to examine race/ethnic variation in the relationship between ePWV and mortality risk. We estimate logistic regression models predicting mortality over an eight-year period for four racial/ethnic groups: White, Black, Other, and Hispanic. Controls are included for sociodemographic characteristics, health status and behaviors, and blood biomarkers such as C-reactive protein, cystatin-C, hemoglobin A1c, total cholesterol and high-density lipoprotein (HDL) cholesterol. The results indicate ePWV increases the risk of mortality in the total sample and among each race/ethnic group, net the effect of age, systolic blood pressure, and diastolic blood pressure. Mechanisms that mediate this relationship are explored. The findings provide insight into vascular aging processes that influence mortality risk among race/ethnic groups.
The Effects Of Latent Classes Of Stress On Health Outcomes In Korean Middle-aged Adults: A Focus On Gender Differences
Authors: Cho Kyuyoung
Published: December 2021

This study indicated the effect of the latent classes of stress on the physical and psychological health outcomes in Korea. Using the 2010 Korea Health Panel Study, 1,689 middle-aged adults (women: n=793, men: n=896) were analyzed to identify the latent classes of stress by gender using Latent Profile Analysis (LPA). After the determination of the number of latent classes, health outcomes (anxiety/depression and health status) were also regressed on the latent classes including covariates (age, marital status, and education level). The perceived stresses (financial diversity, disease of self or family, children's education, and family conflicts) are classified as the 2-class model for women and the 3-class model for men. The classes of women are named 'high stress and 'low stress; however, the classes of men are named 'family-related stress', 'disease stress', and 'low stress.' The different combinations of stress are associated with anxiety/depression and health status respectively. This study will discuss the difference of latent stress classes by gender and extend the understanding of stress groups and health outcomes.