bluuebunny/crossref_metadata_2025 huggingface dataset:
The Magic of Music for Improving Psychological Health for Those With Dementia and Their Caregivers
Authors: MacDonald Stuart , Sheets Debra , Smith Andre
Published: December 2020

Arts-based interventions for person’s with dementia and their caregivers represent an inexpensive, non-invasive, and non-pharmacological intervention with the potential to improve psychological function as well as reduce healthcare costs. The paper presents an overview of Voices in Motion (ViM), and the impact of this social-cognitive intervention on changes in psychological function for those with dementia and their caregivers (current n=26 dyads). Choir rehearsals were held on a weekly basis, and included a social discussion component. A range of outcomes (neuropsychological and physiological function, neural activation) were assessed using an intensive repeated measures design that facilitates both between- and within-person analyses, including nuanced evaluation of whether psychological function improves post intervention relative to an individual’s personal average, yielding a conservative within-person test of the benefits of intervention. Discussion focuses on the promise of such interventions for mitigating dementia symptoms and facilitating the psychological health of caregivers.
Tooth Retention and Health Behaviors: Findings From the 4th Chinese National Oral Health Survey
Authors: Ou Xiaoyan , Zeng Liwei , Zeng Yixuan , Pei Yaolin , Wu Bei
Published: December 2020

This study aimed to investigate the association between tooth retention and health behaviors among Chinese older adults. Data was used from the Chinese 4th National Oral Health Survey, a national representative sample. The sample included 9054 older adults age 55-74. The control variables included age, gender, residence, region, education level, occupation, periodontal health, self-reported oral health, and self-reported general health. Logistic regression models shows that older adults who used tooth picks (OR=3.37, 95% CI: 2.94-3.85), dental floss (OR=1.93, 95%CI: 1.05-3.53), and toothpaste (OR=3.89, 95%CI: 3.14-4.83), and never smoked (OR=1.43 95%CI: 1.20-1.70) were more likely to retain more than 20 natural teeth; while having dental visit had the opposite association (OR = 0.45, 95% CI: 0.39-052). Unexpectedly, this study did not find frequency of toothbrushing was associated with tooth retention. This study suggest that improving oral hygiene and preventive dental care are key for good oral health. .
I’m Not Creative in That Way: Older Adults’ Differential Experiences of an Arts-Based Intervention
Authors: Brown Colette , Chirino Andrea , Cortez Cristina , Gearhart Cassandra
Published: December 2020

A recent 12-week intervention study revealed that making conceptual art is linked to improved cognitive health among community-dwelling older adults (Brown et al., 2020). Unknown, however, is whether the intervention experience differed for participants who exhibited more versus less improvement. This pilot study examined 163 excerpts from semi-structured interviews with cognitively normal, older adult participants (N = 11, Mean age = 72.82). Using thematic analysis and data displays on Dedoose, key themes were distilled regarding intervention acceptability. Participants exhibiting less cognitive improvement more often mentioned personally connecting to topics of dementia and aging through art, but more often mentioned scheduling conflicts. Conversely, participants exhibiting greater cognitive improvement more often mentioned experiencing intellectual enrichment, but feeling insecure about their art capabilities. Novel art activities may be personally meaningful and cognitively stimulating for some participants, but emotionally frustrating for others. Future work should explore ways to optimize arts-based interventions for older participants.
The impact of preference-based, person-centered care on regulatory outcomes
Authors: Qiu Xiao , Abbott Katherine , Bowblis John , Van Haitsma Kimberly
Published: December 2020

The Preferences for Everyday Living Inventory (PELI) was mandated as a pay for performance indicator by the Ohio Department of Medicaid in 2015. This study explored the impacts of PELI implementation on regulatory outcomes in 2017.

The level of PELI implementation from n=551 Ohio nursing home providers between 2015 and 2017 were linked with Centers for Medicare and Medicaid Services Nursing Home Compare data. Fixed effects panel regression analyses assessed the effects of time-varying PELI implementation on 2015-2017 regulatory outcomes that could be correlated with quality of life including fines, substantiated complaints, health scores, deficiency counts and deficiency scores.

Results show a significant increase in substantiated complaints among providers that were slow adopters of the PELI. Overall, the extent of PELI implementation was not associated with regulatory outcomes.

The use of the PELI may not impact substantiated complaints suggesting further research is needed to identify person-centered outcomes of interest. Part of a symposium sponsored by the Research in Quality of Care Interest Group.
Gut Microbiome in Older Men: Findings From the Osteoporotic Fractures in Men Study
Authors: Shardell Michelle , Langsetmo Lisa , Demmer Ryan
Published: December 2020

There is great interest in identifying determinants and health consequences of the human gut microbiota, the dynamic population of microorganisms living in the human digestive tract. However, the role of gut microbiota in the health of older adults has received considerably less attention than that among younger or middle-aged adults. Findings among younger age groups are not necessarily generalizable to older adults due to differences in lifestyle, health conditions, and medication usage. Therefore, understanding the role of gut microbial communities in aging-related phenotypes is an emerging gerontology research priority. To fill this significant knowledge gap, the Osteoporotic Fractures in Men (MrOS) Study Microbiome Ancillary Study was conducted in 2014-2016, coinciding with the parent study’s 4th clinic visit. A total of 912 men with mean aged 84.2 (standard deviation=4.0) years provided fecal samples, and 16S ribosomal RNA target gene sequencing was used to characterize the gut microbiota composition. In this symposium, we present findings on the first research projects completed with these data. Dr. Lisa Langsetmo will characterize the association between objectively measured physical activity and the composition of gut microbiota. Dr. James Shikany will present dietary patterns, another lifestyle determinant of gut microbiota. Dr. Deborah Kado will focus on a specific micronutrient, vitamin D, and its metabolites as another factor that may influence the gut microbiota in older men. Lastly, Dr. Michelle Shardell will overview the analytical challenges of microbiome research and illustrate an approach to quantify the potential role of gut microbiota composition and weight in older men.
Multidimensional Benefits of Weight Management in Old Age: The Mobility and Vitality Lifestyle Program
Authors: Albert Steven , Venditti Elizabeth , Nicklas Barbara
Published: December 2020

The high prevalence of overweight or obesity in older adults is a public health concern because obesity is associated with risk of mobility disability. The benefits of brief community-based lifestyle interventions that promote modest weight loss and increased physical activity are unclear. We assessed the impact of a 13-month lifestyle intervention, the Mobility and Vitality Lifestyle Program (MOVE UP), delivered by community health workers (CHW), on a variety of outcomes, including weight loss, performance-based lower extremity function (Short Physical Performance Battery, SPPB), activity, diet, and health-related quality of life (CDC U48 DP005001). The 32-session behavioral weight management intervention enrolled 303 community-dwelling adults (90.4% of those eligible), who were followed for 12 months (2015-19). Participants completed the program at 26 sites led by 22 CHWs. Participants were age (sd) 67.7 (4.1) and were mostly female (87%). 22.7% were racial minorities. The mean (sd) BMI at baseline was 34.7 (4.7). Median weight loss in the sample was 5% of baseline body weight. SPPB total scores improved by +0.31 units (p < .006), gait speed by +0.04 m/sec (p < .0001), and time to complete chair stands by -0.95 sec (p < .0001). Presenters will assess the effect of MOVE UP on activity, diet, fatigue, and health-related quality of life. A final paper examines implementation of MOVE UP and how site and CHW factors affected outcomes. Findings suggest that promoting healthier eating, weight loss, and physical activity in a community setting is an effective strategy for reducing risk of disability in older adults.
Weight Loss Improves HRQOL Physical Function and Vitality More in Blacks Than Whites
Authors: Boudreau Robert , Venditti Elizabeth , Danielson Michelle , Glynn Nancy , Jakicic John , Newman Anne , Albert Steven
Published: December 2020

Participant-reported outcomes are important. Prior MOVE UP reports show ≥5% weight loss was not significantly associated with depressive symptoms but was associated with positive SPPB physical function and the Physical Component Score of the SF-36 HRQOL scale. We examined the SF-36 subscales that showed, a priori, clinically meaningful +5.0-point increases over 13 months, the change in subscales per 5% weight loss, and variability by race. Among all participants (n =240) several subscales show significant pre-post changes [mean (SD)] but only Vitality [+5.6 (15.4)] and Physical Function [+5.0 (16.7)] meet the criterion. Blacks (n = 60) compared to Whites (n = 172) had higher baseline scores on these subscales, were less likely to lose ≥5% (31.7% vs. 59.9%), but mixed regression models indicate that those who did demonstrated a larger change on Vitality (+5.2; p<0.048) than Whites (+3.1; p<0.0003). Studying weight loss and HRQOL associations in larger minority samples is needed.
A Structural Model Approach to Ethnic Disparities in Dementia and Its Assessment
Authors: Royall Donald
Published: December 2020

Ethnicity complicates the assessment of dementia and its biomarkers in the Texas Alzheimer’s Research and Care Consortium (TARCC). Its effect can be mitigated by the construction of latent variables in a structural equation model (SEM) framework. We have developed a dementia-specific phenotype, i.e. “δ” (for “dementia) by that approach. δ provides a continuously distributed dementia severity measure that may be resistant to ethnicity effects. We propose to test the impact of Mexican-American (MA) ethnicity in TARCC data [N = 3502; MA = 1313; Non-Hispanic Whites (NHW) = 2189]. Significant structural associations between observed cognitive performance, δ and δ’s serum protein biomarkers will be tested for ethnicity effects by CHI SQ differences across ethnicity stratified models. Observed clinical variables can be impacted by demographic effects. Those can lead to presumed disparities in clinical outcomes or biomarkers. Latent variables have potential to mitigate demographic effects, refute some perceived disparities and confirm others.
Using REGARDS to Study Family Caregiver Well-Being, Health, and Mortality
Authors: Roth David , Haley William
Published: December 2020

The REGARDS study has provided a unique opportunity to study both disease-specific (stroke) and broader samples of family caregivers, and to examine the effect of transitions to caregiving over time. Using REGARDS has afforded many advantages over conventional caregiving research, including the availability of biomarker and mortality data, a large sample of non-caregiving controls who can be carefully matched to caregivers, and ability to track onset of caregiving over time. Our findings illustrate the complex nature of caregiving-related effects. While caregiving leads to worse psychological well-being, we have found minimal physical health decreases and reduced mortality rates compared to matched non-caregiving samples. These findings have policy implications and have challenged the conventional beliefs about caregiving based on previous studies of convenience samples. Diverse students and junior faculty members from multiple universities have also gained experience and contributed to high impact papers from this work.
Reversing cognitive-decline in older adults in an open-label clinical trial: novel mechanisms and the role of GlyNAC
Authors: Liu Chun , Sekhar Rajagopal , Kumar Premranjan , Minard Charles , Chacko Shaji
Published: December 2020

Age-associated cognitive-decline is an important risk factor for Alzheimer’s disease, but interventions are lacking. We conducted an open-label trial to test our hypotheses on whether: (1) compared to 8 healthy young adults (25y), 8 ‘healthy’ older adults (74y) have cognitive decline, decreased glucose availability for the brain due to mitochondrial dysfunction, elevated insulin-resistance, oxidative-stress and elevated inflammation; (2) supplementing glycine and N-acetylcysteine (GlyNAC) for 24-weeks corrects deficiency of the endogenous-antioxidant Glutathione and improves these defects, and thereby cognition; (3) stopping GlyNAC supplementation for 12-weeks results in a decline in accrued benefits. Outcome measures included cognitive testing (Montreal cognitive assessment; trail-making tests; verbal-fluency tests; digital-symbol substitution-test), mitochondrial fuel-oxidation, RBC-Glutathione concentrations, plasma oxidative-stress, insulin-resistance and inflammation, and tracer-studies to measure glucose metabolism. Results validated our hypotheses and showed that GlyNAC-supplementation corrected these defects and improved cognition. This trial suggests that supplementing GlyNAC may be important for improving/preventing age-associated cognitive-decline in older adults.
How to Successfully Choose a Journal
Authors: Sands Laura
Published: December 2020

Article submissions to The Gerontological Society of America’s high impact scientific journals continue to increase each year which has led to editors becoming more selective about which articles are accepted for publication. The purpose of this session is to describe how to efficiently and successfully navigate the process of determining which journal is the best fit for your manuscript. Objectives of the workshop include guidance in: (1) understanding the differences in scope and features of each journal; (2) determining which journal is most appropriate for the topic and methods of your manuscript; (3) appreciating how to use journals’ Instructions to Authors to your benefit, and (3) conveying the scientific contribution of your article to the journal.
Major Depressive Episode and Generalized Anxiety Disorder Among Sexual Minority Adults in the United States
Authors: Exten Cara , Salomaa Anna
Published: December 2020

Sexual minority (SM) health disparities constitute a serious public health concern, and disparities in mental health are among the most striking. Among a nationally-representative sample (NESARC-III) of US adults (aged 18-66), we used time-varying effects models (TVEM) to estimate the age-varying prevalences of past year major depressive episode (pyMDE) and generalized anxiety disorder (pyGAD) by SM status and biological sex. pyMDE and pyGAD were most common among SM women, followed by SM men, heterosexual women, and heterosexual men. pyMDE was highest among SM women and SM men in early adulthood with a second peak in the mid-50s (women)and around age 40 (men). pyGAD was highest among SM women aged 54-60 and among SM men aged 30-33. Our findings reveal that older adulthood may be a time of increased risk for pyMDE and pyGAD among SM women. Future work should explore factors that contribute to this increased risk.
The Quality of Interactions Between Staff and Residents With Cognitive Impairment in Nursing Homes
Authors: Paudel Anju , Resnick Barbara , Galik Elizabeth
Published: December 2020

Background: Positive and effective staff–resident interactions are imperative to adequately assess and meet the needs of cognitively impaired residents in nursing homes and optimize their quality of life. Purpose: The purpose of this study was to quantify, describe, and analyze the interaction between staff and cognitively impaired residents in nursing homes, using the Quality of Interaction Schedule (QuIS). Specifically, the following aims were addressed— Aim 1: To quantify and describe the quality of interactions between staff and cognitively impaired residents in nursing homes. Aim 2: To analyze whether the quality of staff–resident interactions vary by resident cognitive status (moderate vs severe) and interaction characteristics (interaction location, interaction situation, interpersonal distance, type of staff, and resident level of participation). Method: This descriptive analysis utilized baseline data from the first 2 cohorts in a randomized clinical trial including 341 residents from 35 nursing homes. Results: Five hundred fifty-six staff–resident interactions were evaluated; majority were positive (n = 466, 83.8%) and the remaining were either neutral (n = 60, 10.8%) or negative (n = 30, 5.4%). The quality of interactions varied by interaction location, interpersonal distance, and resident participation. Conclusion: This study provides some current descriptive information about the quality of staff-resident interactions in nursing homes and the interaction characteristics that might impact these interactions. Future research should focus on decreasing the negative/neutral interactions and explore staff characteristics (e.g., gender, level of experience) and facility factors (e.g., size, ownership) that might influence the quality of interactions.
Global Reach of Conceptual Models Used in Ageism and Dementia Studies: A Scoping Review
Authors: Rahman Atiqur , Hyden Lars-Christer
Published: December 2020

Older adults are discriminated against at different social levels- called ageism and the people living with dementia (PlwD) not only face ageism due to being elder but also encounter prejudices, negative attitudes and discrimination because they live with dementia. The purpose of this review is to highlight the different conceptual and methodological approaches used and the groups being investigated as well as the findings from studies in the combined research field of ageism and dementia. Five scientific databases were used within a timeframe between 2009 and 2018. A total number of 98 articles (quantitative, qualitative, and mixed methods) were included and analyzed based on (i) the conceptual frameworks, (ii) methodological approaches, (iii) groups studied, and (iv) findings. The result emerged six themes (i) stereotypes and attitudes in the general population; (ii) stereotypes and attitudes of themselves; (iii) stereotypes and attitudes among staff; (iv) stereotypes and attitudes as part of culture; (v) stereotypes and attitudes of family members; and (vi) miscellaneous. The principal findings identified lower education, lack of knowledge and less information about dementia as the main contributing factors to manifest stereotypes, attitudes, and ageism in society toward PlwD that leads to stigma. Moreover, this review found few studies were based on explicit conceptual frameworks but rather on descriptive understandings of relations between attitudes. There is a domination of the quantitative approach where the target populations were mostly from Western regions. The review suggests that a more conceptually coherent approach would allow for a better cumulative building of knowledge.
Best of Both Worlds: Bridging Research and Practice to Achieve Health Equity
Authors: Lincoln Karen
Published: December 2020

Health inequity is linked to societal and social determinants that constrain health promoting opportunities for older adults. From birth to death, many older adults contend with the prevailing social and health effects of discrimination in employment, education, and housing. As a consequence, middle-aged Black Americans are experiencing accelerated aging, and living with and dying from preventable chronic health conditions typically diagnosed at older ages. Despite these conditions, there is much variation in health outcomes among older Black Americans. Professor Karen Lincoln will share her approach to research that explores heterogeneity within the Black American population to discover factors that promote healthy aging. She will describe her unique outreach and health education program that serves older adults in underserved communities, and her roles as an aging advocate and public scholar. She will discuss how these experiences led to the development and testing of an innovative intervention to reduce Alzheimer’s disease disparities.
Successful Informal Help-Seeking and Resolution of Elder Family Financial Exploitation: A Case Study
Authors: Kilaberia Tina , Stum Marlene
Published: December 2020

Effective interventions are needed to address elder family financial exploitation (EFFE), one of the most prevalent types of elder abuse globally. This poster examines the unique and critical help-seeking role informal family support can play when faced with EFFE. We present a holistic case study that offers an understanding of one family’s successful help-seeking and resolution of the EFFE situation. The family drew on internal family and community supports and did not seek formal elder abuse services. The case stood out as unique relative to 23 family’s help-seeking attempts in a larger study of the meaning and experience of EFFE from the perspective of concerned family members (non-abusing/non-victims). The case summary and analysis are based on an in-depth interview narrative reflecting the subjective experience of a concerned family member who was directly involved in the EFFE situation (in-law relative to both the older victim and the perpetrator). Study findings reveal 5 interwoven themes related to help-seeking processes and outcomes: 1) honoring the victim’s wishes, 2) providing support and accountability for perpetrator, 3) restoring family relationships and functioning, 4) maintaining internal (family-based) control, and 5) engaging in family problem solving processes. The family’s help-seeking demonstrated three distinctive features: a) embracing their informal social support role, b) the interdependence of family members, and c) restorative justice principles. The findings raise questions about broadening the scope and continuum of EFFE intervention research and practices to recognize and support informal social intervention.
Trajectory of Depression among Victims of Elder Mistreatment
Authors: Dong Gabriella , Li Mengting
Published: December 2020

Individuals exposed to elder mistreatment are affected in dissimilar ways. Most existing studies are cross-sectional and fail to capture the change in mental health of older adults with exposure to elder mistreatment. This study aims to examine depression trajectories of elder mistreatment victims and identify protective factors. Data were drawn from the two-wave Population Study of Chinese Elderly in Chicago (PINE) with 725 participants who reported elder mistreatment at the baseline. Depression was measured by Patient Health Questionnaire-9. Self-mastery was assessed by the Pearlin Mastery Scale. Conscientiousness was evaluated by the NEO Five-Factor Inventory. Multinomial logistic regression was used while controlling demographic factors and recurrence of elder mistreatment. We identified four depression trajectories among elder mistreatment victims: chronic (9.61%), delayed (6.27%), recovery resilience (21.17%), and resistance resilience (62.95%). The chronic group was showing severe depression in both waves. The delayed group experienced a delayed reaction with increasing depression over time. The depression level of the recovery resilience group bounced back from elder mistreatment. The resistance resilience group exhibited low depression over time. Elder mistreatment victims with increasing self-mastery were more likely to be in recovery resilience group than in chronic group (RRR=1.05, 95%CI=1.02-1.09). In addition, elder mistreatment victims with increasing conscientiousness were less likely to be in delayed group than in resistance resilience group (RRR=0.96, 95%CI=0.92-1.00). Healthcare providers and social service agents could focus on elder mistreatment victims with chronic and delayed depression trajectories. Interventions could promote mental health of elder mistreatment victims through improving self-mastery and conscientiousness.
CAPABLE Transitions: A Home Health Agency-Based Intervention to Optimize the SNF-to-Home Transition
Authors: Missell Rachel , Szanton Sarah , Caprio Thomas , Nathan Kobi , Simning Adam
Published: December 2020

Community Aging in Place-Advancing Better Living for Elders (CAPABLE) consists of an interprofessional team of a registered nurse (RN), occupational therapist (OT), and handyworker that delivers an in-home client-specific package of interventions to optimize function. CAPABLE aims to reduce functional impairment, home hazards, and acute medical services use and is being widely disseminated. To expand CAPABLE to older adults transitioning from the skilled nursing facility (SNF) to home, we developed CAPABLE Transitions, which makes several important modifications to CAPABLE. First, CAPABLE Transitions will be implemented within a Medicare-certified home health agency (CHHA) and delivered to CHHA clients. Second, it will be delivered to CHHA clients with and without dementia. Adding urgency to CAPABLE Transitions’ development, including persons with dementia has the potential to decrease high utilization of services and meet care transition needs. Third, it includes an initial RN care transition visit. Fourth, its services are more intensely delivered at the beginning of the intervention, shortly after SNF discharge. Beginning in the fall of 2020, CAPABLE Transitions will be tested in a feasibility study of 60 older adults discharged from post-acute SNF care to CHHA services in Rochester, NY. We have designed this 3-year feasibility study to consist of yearly recruitment waves that will enable us to iteratively assess and refine the intervention. Following this study, we hope to test CAPABLE Transitions’ effect on improving home time, quality of life, and the use of acute medical services in order to assist older adults in aging in place.
Race Differences and Depressive Symptoms Among Community-Dwelling Older Americans
Authors: Cheung Ethan Siu Leung , Mui Ada
Published: December 2020

Using data from the Wave 3 National Social Life, Health and Aging Project, this study examines cognition, stress and social support factors associated with depressive symptomatology among older White (n=2356) and Black/African Americans (n=473) living in the community. Bivariate analyses suggest that Whites were slightly older than Blacks [(M(SD) = 73 .24(8.18) and 72.52(8.69); 71)]; and had higher unmarried status (66.58% vs. 43.76%). In terms of cognitive functioning, Whites scored significantly higher than Blacks [Mean (SD) of MoCA Short Form were 10.44(3.06) and 7.75.0(3.33)]. There was race difference in depressive symptoms experienced (CESD Short Form: M(SD) = 20.99(4.01) for Whites; M(SD) = 21.35(4.33) for Blacks). In order to identify predictors of depression, multiple hierarchical regressions were performed. Results showed that race had significant independent effect and multiplicative effect with IADL impairment in explaining depression scores. To identify predicators for each racial group, parallel regression analyses were conducted and two models were significant. Findings show that unmarried status and IADL impairment were common predictors of depressive symptoms for the two groups, and the impact of both variables were stronger for Blacks (for unmarried status; b =-1.42 vs. -.52; for IADL impairment b = .23 vs. .13). For Whites, other unique predictors of depression were male gender, lower income, more ADL impairment, higher stress, less socialization and poor friendship quality. For Blacks, the only unique predictor of depressive symptoms was being younger age. The different correlates of depression for White and Black elders provide new insight into the design of race-sensitive interventions.
Systematic Review of Interventions for LatinX and American Indian Family Dyads Coping With Chronic Illness
Authors: McCarthy Michael , Sanchez Angelica , Garcia Yolanda Evie , Dunn Dorothy , Williamson Heather , Baldwin Julie , Hustead Morgan Lee-Regalado , Bakas Tamilyn
Published: December 2020

The United States is experiencing growth in populations from culturally diverse backgrounds. Studies suggest that Latinx and American Indians experience chronic conditions such as cancer, heart disease, and diabetes in greater numbers than whites. Literature also suggests that Latinx and American Indian families play a significant role as informal caregivers for loved ones with chronic illness. However, little information is available about interventions to assist these patient-family caregiver dyads cope. The purpose of this systematic review is to synthesize published studies about psychosocial interventions developed or adapted for Latinx and American Indian care dyads in order to determine: (1) the benefits of these interventions; (2) their distinguishing features or adaptations, and; (3) recommendations for future intervention development. The protocol for this review was registered in advance with the International Prospective Register of Systematic Reviews (PROSPERO). We searched the databases CINAHL, PsycINFO, MEDLINE, and PubMeb using MeSH-derived keywords developed in consultation with a research librarian. Studies were included/excluded based upon pre-specified criteria. Three-hundred thirty-five records were identified, screened by the research team, and tracked according to PRISMA guidelines. After removing duplicates (n=9), studies that did not pertain to the conditions of interest (n=13), and studies that did not meet inclusion criteria (n=305), eight studies remained. Relevant information was abstracted from the final studies and synthesized by the research team. The majority of interventions for these populations are in cancer. Findings about benefits are largely inconclusive. Adaptations include a focus on cultural contexts, as well as culturally-based strengths, caregiving norms, and values.
Pre-stroke dementia and in-hospital outcomes in the Chinese Stroke Center Alliance
Authors: Liu Chelsea , Gu Hong-Qiu , Yang Xin , Wang Chun-Juan , Yang Kai-Xuan , Li Zi-Xiao , Wang Yong-Jun
Published: December 2020

Little is known about the prevalence of pre-stroke dementia in China and whether this group is at higher risk of adverse in-hospital outcomes. We aimed to understand this association using data from the Chinese Stroke Center Alliance. Multivariable logistic regressions were conducted to assess the association between pre-stroke dementia status and ambulation at day 2, in-hospital mortality, and in-hospital complications. Covariates included age, sex, medical history, history of smoking, history of alcohol use, medication history (antiplatelet drugs, lipid-lowering drugs), stroke severity (measured by the National Institute of Health Stroke Scale), whether IV tPA was administered within 4.5 hours, and whether the patient received deep vein thrombosis prophylaxis as needed. Odds ratios and 95% confidence intervals were presented for the adjusted models. In the final analytic sample of 559,070 ischemic stroke patients with no prior stroke history enrolled across 1476 hospitals, 1511 (0.3%) had pre-stroke dementia, and they were older and more likely to be female. Patients with pre-stroke dementia had lower odds of ambulating at day 2, higher odds of having any complications and higher odds of in-hospital mortality compared to those without pre-stroke dementia, despite little difference in treatment received. Our findings may be explained by communication barriers experienced by patients with pre-stroke dementia that limited their ability to advocate for their own care needs. Further research is needed to determine whether a different care pathway or additional attention from clinicians is necessary for patients with pre-stroke dementia.
A robotic system for high-throughput automated lifespan and phenotyping analysis in C. elegans
Authors: Vayndorf Elena , Pitt Jason , Wu Judy , Chang Emily , Nguyen Richard , Liang Ashley , Ruan Renee , Kaeberlein Matt
Published: December 2020

A goal of gerontology-related research is to develop therapies to improve the healthy period of life by understanding and targeting the molecular hallmarks of biological aging. Much progress has been made toward understanding the genetic and biochemical nature of these hallmarks through studies using simple invertebrate model organisms, such as the nematode Caenorhabditis elegans. Over the past decade, the identification of potential genetic and pharmacological modifiers of lifespan and age-related pathologies in C. elegans and other model organisms has yielded fruitful leads for follow-up investigation. However, such studies are typically time- consuming and labor-intensive. The goal of our work is to automate tasks that require frequent, repeated observations and hours of manual labor to collect and analyze lifespan, motility, and other behavioral data in C. elegans and other nematode models. The advent of affordable high-quality digital cameras, robotics systems, and 3D printers, as well as the decreasing financial and computational costs of image storage and processing, have allowed us to automate data capture and analysis on a large scale. To this end, our group recently developed a tool, we call the WormBot, consisting of an unbiased, high-throughput, automated robotic system and corresponding software, to perform genetic and pharmacological quantification of lifespan and health measures in C. elegans and related nematode species. We will report updates recently made to this system, including significant improvements to hardware, and present screening results from proteasome stimulator drugs known to reduce the accumulation of proteotoxic proteins linked to neurodegenerative diseases and aging.
Racial/ethnic/gender-based Disparities in Health Trajectories among American Older Adults
Authors: Kong Dexia , Lu Peiyi , Davitt Joan , Shelley Mack
Published: December 2020

Numerous studies have examined racial/ethnic- or gender-based disparities in health. However, few examined health outcomes based on a combination of individuals’ race, ethnicity, and gender. Guided by an intersectionality framework, this study explores racial/ethnic/gender-based differences in older adults’ health trajectories over a ten-year period. Longitudinal data from the Health and Retirement Study (2004-2014) were used (n=16,654). Older adults (65+) were stratified into six groups based on their race, ethnicity, and gender, including (1) Non-Hispanic (NH) White Men; (2) NH White Women; (3) NH Black Men; (4) NH Black Women; (5) Hispanic Men; and (6) Hispanic Women. Growth curve models were used to examine the trajectories of three health indicators over time, including cognitive function, physical function (i.e. the sum of activities of daily living and instrumental activities of daily living), and depressive symptoms. The results indicated that NH White men and women outperformed racial/ethnic minority groups in cognition and physical function trajectories. Females in all racial/ethnic groups had more depressive symptoms but better cognition than their male counterparts. Hispanic women reported the most depressive symptoms. Hispanic women and NH Black women had the poorest physical function. NH Black men/women had the lowest cognition. Study findings highlighted the utility of an intersectionality framework in understanding health disparities in later life. Multiple social identities intersect with each other and generate protective and/or risk effects on cognitive, mental, and physical health status. Multilevel intervention strategies are warranted to close the health equity gap among various marginalized population groups.
Metabolomic Signatures of High Red Blood Cell Distribution Width
Authors: Corkum Abigail , Tian Qu , Ferrucci Luigi
Published: December 2020

Red blood cell distribution width (RDW) describes the amount of variation in blood cell volume and size and increases with age. Higher RDW predicts all-cause mortality, metabolic syndrome, diabetes, and markers of glycemic control, such as glycosylated hemoglobin. However, mechanisms that connect high RDW with these health outcomes are unknown. Thus, identification of high risk in these patients cannot be addressed. This study aims to identify metabolites and pathways that are associated with high levels of RDW in community-dwelling older adults. Using data from the Baltimore Longitudinal Study of Aging, we identified 1,004 cognitively normal participants (mean age: 67.1±13, 48% women, 26% black) with concurrent data on RDW and comprehensive targeted plasma metabolites by Biocrates p500. Participants were grouped into RDW quartiles (Q1:14%). Associations of metabolites with quartiles of RDW were examined using multivariable linear regression with Q1 being the reference group. Models were adjusted for age, sex, and race. Compared to Q1, Q4 had higher concentrations of SM(OH)C14:1, PC ae C30:2, and hypoxanthine, and lower concentrations of DHEAS, Cortisol, Tryptophan, and Hex2Cer(d/18:1/24:0) (all p<0.01). These metabolites are critical components of sphingolipid metabolism and steroid hormone biosynthesis pathways. Elevated RDW was associated with metabolites derived from classes of hormones, amino acids, ceramides, sphingomyelins, PCs, and nucleobases. Individuals with elevated RDW (i.e. ≥14%) may have disrupted sphingolipid metabolism and steroid hormone biosynthesis. These pathways can be targeted for prevention.
Minority status and readmissions: a moderated mediation model of caregivers’ health literacy
Authors: Rayan-Gharra Nosaiba , Gur-Yaish Nurit , Shulyaev Ksenya
Published: December 2020

Family caregivers help patients to understand informa¬tion during clinical encounters. Less is known about factors that may affect family caregiver’s Ensuring and Explaining Medical Care (EEMC) during hospitalization and its impact on improved health outcomes. This study examined whether EEMC during hospitalization mediated the association between minority status of patients and 30-day-readmissions, and whether levels of Health Literacy (HL) of caregivers moderated this mediated association. A prospective cohort study of 517 internal medicine patients, Hebrew (general population, coded as 0) and Russian, or Arabic native speakers (minority status, coded as 1), at a tertiary medical center in central Israel, who were accompanied by an informal caregiver. EEMC and HL were patients’ self-reported. 30-day-readmissions were retrieved from the healthcare organization. Logistic regression indicated that minority status was not associated with 30-day readmission when the mediator ICEEMC was not included (B=0.98; p>0.05). However, moderated mediation analysis indicated significant direct (B=-1.08; p=0.003) and indirect effect of minority status on readmission through high ICEEMC during hospitalization among patients who had informal caregivers with high HL level (Mediated effect (ME)=−0.62; CI= -1.07 to -0.29) but not among ones with low HL level (ME= 0.37; CI=-0.24 to 1.06). These findings suggest that caregivers’ high HL may be an essential factor in improving EEMC among minorities. Identifying informal caregivers with high HL level at time of admission to the hospital, and encouraging their involvement during patients’ hospital stay, might be a useful strategy to improve transitions and reducing 30-day readmission, especially among minority patients.
Associations Between Depressive Symptoms, Appetite and Food Intake Among Hospitalized Older Adults
Authors: Rogozinski Amos , Zisberg Anna
Published: December 2020

Inadequate food intake is common among hospitalized older adults and is linked to negative hospitalization outcomes, including functional decline and mortality. Depression is a well-established risk factor in inadequate food intake in the community but its role in food consumption during hospitalization is poorly studied. To examine the associations between depressive symptoms, appetite and the quantity of food consumed by older inpatients, we conducted a secondary data analysis of 724 hospitalized adults aged 69 to 95 using a prospective cohort dataset: Hospitalization Process Effects on Functional Outcomes and Recovery. Depression was evaluated with Tucker’s Short Zung Instrument at time of admission. Food intake and appetite were examined daily for three consecutive days, using self-reports of food consumed at breakfast, lunch and supper, based on the nDay Express Questionnaire. Approximately 40% of respondents reported eating half or less than half of each meal. The risk of depression was prevalent among a third of respondents, 54% of whom were identified at high risk of depression. The association between depression and inadequate food intake was found to be negative [F(2,716)=9.00 ,p=0.000 ,η2=0.025]. Low appetite was significantly linked to reduced food consumption [β=-0.39, t=-12.06, p=0.000] and made a considerable contribution to the explained variance of food consumed [F-change (1,717)=145.41 , p=0.000]. Finally, decreased appetite partially mediated the association between depressive symptoms and food intake during hospitalization (B=-0.001, UCI=-0.001; LCI=-0.002). These findings contribute to the understanding of inadequate food intake during hospitalization and indicate the importance of screening for depression among hospitalized older adults.
Defining the Personal Determinants of Health for Older Adults
Authors: MacLeod Stephanie , Kraemer Sandra , Fellows Annette , Albright Laurie , Ruiz Joann , McGinn Michael , Schaeffer James , Yeh Charlotte
Published: December 2020

Social Determinants of Health (SDOH) are defined as the broad community-scale conditions and factors shaping daily life. Meanwhile, less is known about the personal, individual-level characteristics impacting health outcomes. These have not been defined as a construct, leaving a gap in overall understanding of the resources that shape healthy and successful aging. Our primary purpose is to propose and define a new construct encompassing critical personal resources to be known as the Personal Determinants of Health (PDOH), built on resilience as a key strength later in life and supported by factors that buffer challenges and declining health. A literature search was conducted to streamline the scope of this review, with key terms determined to identify relevant publications; common databases and resources were utilized. Search strategies failed to identify a standard definition for Personal Determinants of Health as a construct, nor does this term exist regarding applied initiatives with older adults. Thus, a clear opportunity exists to establish PDOH as a unique construct. Despite evidence that individual characteristics impact late-life health outcomes, these key personal resources have not been established as a separate construct. Thus, we propose to define PDOH with a foundation of resilience supported by selected personal resources. Establishing this new construct will be critical in designing initiatives to support older adults and improve their health outcomes.
COVID-19 and associations with frailty and multimorbidity: a prospective analysis of UK Biobank participants
Authors: Woolford Stephen , D’Angelo Stefania , Curtis Elizabeth , Parsons Camille , Dennison Elaine , Patel Harnish , Cooper Cyrus , Harvey Nicholas
Published: December 2020

Frailty and multimorbidity, which are more prevalent in older people, have been suggested as risk factors for severe COVID-19 disease. We investigated whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19 in the UK Biobank. 502,640 participants aged 40-69 years at baseline (54-79 years at COVID-19 testing) were recruited across UK 2006-10. A modified assessment of frailty using Fried’s classification was generated from baseline data. COVID-19 test results (England) were available 16/03/2020-01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups. 4,510 participants were tested for COVID-19 (positive=1,326, negative=3,184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR=1.4 [95%CI=1.1, 1.8]), report slow walking speed (OR=1.3 [1.1, 1.6]), report two or more falls in the past year (OR=1.3 [1.0, 1.5]) and be multimorbid (≥4 comorbidity groupings vs 0-1: OR=1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. Furthermore, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants. In conclusion, frailty and multimorbidity do not appear to aid risk stratification, in terms of a positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.
Dementia Care under COVID-19 and Infectious Disease Pandemic Restrictions
Authors: Bradbury Kelly , Moody Elaine , Aubrecht Katie , Sim Meaghan , Rothfus Melissa
Published: December 2020

Emergency measures including social distancing and program restrictions during COVID-19 has reduced supports for people living with dementia and family/friend caregivers in the community. Consequently, these reductions in dementia services and resources have added to existing challenges and (in)equities for this stigmatized population. The objectives of this study were to identify how community-based resources and services for people with dementia and their caregivers are impacted by public health emergency measures enacted during COVID-19 and other infectious pandemics and secondly, use an intersectional health equity perspective to explore how supports for people and families living with dementia are affected by social determinants of health. A scoping review using JBI methodology was conducted. Academic databases searched included Embase, Medline, CINAHL and PAIS. Grey literature was searched using the CADTH tool. English articles published after 2000 in high-income countries were included. Data was extracted by two reviewers using an adaptation of the Health Equity Impact Assessment tool to explore factors related to health equity. Findings included articles discussing the COVID-19 pandemic (N=15). Most alterations to dementia services included switching to telehealth platforms with some advantages/disadvantages of this method discussed. Limited information on how different populations experienced service changes was identified and more research is needed to address issues of (in)equities for people living with dementia and their caregivers during public health emergencies. Information on how health emergency responses affects dementia services and their users will provide important information on resources for current and future efforts to analyze and assess their impacts.