bluuebunny/crossref_metadata_2025 huggingface dataset:
SUPPORTING FAMILY CAREGIVING FOR PERSONS WITH DEMENTIA FROM CULTURAL AND LIFE-COURSE PERSPECTIVES
Authors: Wang Jing , Wu Bei
Published: December 2022

Providing person-centered and culturally sensitive support for persons with dementia and their family caregivers is critically important. This symposium focuses on understanding and supporting decision-making and family caregiving through a lens of a life course perspective. The first study explored Black and White family caregivers’ experience of adjusting to their new role as caregivers of persons with dementia during the COVID-19 pandemic. The pandemic added to the complexity of their challenges and demonstrated the need for person-centered support. The second study provided insights into Chinese American family caregivers’ attitudes toward and the preference of shared family decision-making on tube feeding for their family members with dementia. Almost all the participants considered pain and discomfort relief as a priority in decision making. The third study synthesized the literature on decision aid interventions for family caregivers of older adults with advanced dementia regarding tube feeding. The study found that culturally sensitive and family-centered decision aid interventions are needed to support the decision-making of tube feeding. The fourth study used data from two national databases and identified positive aspects of caregiving. It highlighted the significance of tailoring support for family caregivers based on their caregiving responsibilities and care recipients’ cognitive status to enhance the positive aspects of caregiving. The last scoping review identified and synthesized existing technology-based interventions to address social isolation and loneliness among informal dementia caregivers. The results suggested that technology-based interventions could reduce feelings of loneliness and improve caregiver well-being.
I HAVE TO COPE WITH IT: THE VOICES OF OLDER AFRICAN IMMIGRANTS EXPERIENCING SOCIAL ISOLATION AND LONELINESS IN THE US
Authors: Adeniji Dolapo , Ashirifi Gifty
Published: December 2022

Social isolation and loneliness have been recognized as significant challenges in the world of older adults. For older African immigrants living with their families in the US, researchers have captured factors such as language barriers, cultural differences, and limited access to transportation to contribute their feelings of social isolation and loneliness. However, little is known about how they cope with these challenges. As the population of older African immigrants continues to increase in the US, it is pertinent to expand knowledge about their experiences for the purposes of social work practice and policy development. Using a qualitative approach, this study recruited and conducted in-depth interviews with 11 participants aged 63 -79. Four themes emerged from the data through a thematic analysis approach which includes a) Positive Self-talk: “I have to cope with it”, b) Technology/Social media: "if I cannot interact physically outside, then, I go through the social media”/Watch TV”, c) Intergenerational social engagement beyond caregiving: "They [grandchildren] are my immediate constituency”, and d) Digging deep through faith. Although the result of this study shows that older Africans immigrants are finding strategies to cope with social isolation and loneliness further support is needed specially to strengthen their coping skills and enhance their social network with people outside of their families.
COMMUNITY OUTCOMES FROM A PSYCHOSOCIAL INTERVENTION FOR LONELINESS AND SOCIAL ISOLATION IN OLDER ADULTS
Authors: Amick Matthew , Gartlan Olivia , Zubatsky Max , Berg-Weger Marla
Published: December 2022

Social isolation and loneliness are quickly becoming global health epidemics, where older adults are experiencing greater chronic health conditions and other complications as a result of this trend. This prevalence is likely underreported, given that stigma and health disparities associated with social isolation and loneliness often prevent older adults from reporting this to family members and professionals. This study's aim is to determine the rates of older adult social isolation and social connections from a psychosocial group model called Circle of Friends (CoF). Circle of Friends is built on a model of group rehabilitation model, with the aim to alleviate and prevent loneliness in older adults. The group protocol consists of 6-8 older adults who self-identify as lonely or socially isolated, who meet 12 times over three months. A midwestern university conducted virtual CoF groups between 2020-2022 to underserved areas of a metropolitan city. Researchers used the UCLA Loneliness Scale and Lubben Social Support Scale to determine differences in rates of loneliness and social supports. 15 members participated in three virtual CoF groups, with over 50% of the sample reporting low socioeconomic living conditions. Preliminary findings show that group members reported a 3-point decrease in overall loneliness (p<.05), but no differences in frequency of social supports through friends or family. While our research group continues to collect more data on outcomes of our CoF groups, these initial results highlight the need for more community interventions and social connection resources for older adults lacking financial means for healthcare options.
EXAMINING THE CUMULATIVE EFFECTS OF SOCIAL ISOLATION AND LONELINESS IN OLDER ADULTS WITH HIV
Authors: Yoo-Jeong Moka
Published: December 2022

Social isolation exists when one has limited or lacks social contact with others and is distinct from loneliness, an affective state on the perception of isolation. Social isolation and loneliness are recognized as risks to well-being among older adults. Less in known about the cumulative effects of social isolation and loneliness in older persons with HIV (OPWH). Using cross-sectional data on OPWH (age ≥50) recruited from an outpatient HIV clinic in Atlanta, GA (N=146), we aimed to 1) describe the overlap between social isolation and loneliness and 2) examine the combined effects of social isolation and loneliness on quality-of-life (QoL), HIV-related stigma, depressive symptoms, and comorbidity burden. Loneliness and social isolation were assessed using the PROMIS-Social Isolation Scale and Social Network Index, respectively. Participants were grouped into four categories into ‘lonely only,’ ‘isolated only,’ ‘both lonely and isolated,’ or ‘neither.’ Bivariate and adjusted associations were conducted. Among participants (mean age=56.53), 26.7% (n=39) were considered ‘lonely’ only, 12.3% (n=18) ‘isolated’ only, 15.1% (n=22) ‘both lonely and isolated,’ and 45.9% (n=67) ‘neither.’ In bivariate analyses, individuals categorized as ‘both lonely and isolated’ were likely to have past homelessness and higher depressive symptoms, stigma, and comorbidity burden, and lower QoL. In adjusted models, ‘both isolated and lonely’ significantly predicted QoL, stigma, and depressive symptoms. Findings highlight the critical emphasis on targeting OPWH who are both isolated and lonely.
MULTIMORBIDITY AND QUALITY OF LIFE: EXAMINING THE PATHWAYS THROUGH LONELINESS, ADL, IADL, AND DEPRESSIVE SYMPTOMS
Authors: Sieber Stefan , Roquet Angélique , Lampraki Charikleia , Jopp Daniela
Published: December 2022

Background. Multimorbidity, defined as two or more chronic conditions, negatively affects quality of life. However, little is known about the underlying pathways leading from multimorbidity to lower quality of life (QoL). Objective. The objective of this paper was to examine multiple potential mediating factors (loneliness, Activities of Daily Living [ADL], Instrumental Activities of Daily Living [IADL], depressive symptoms) in the relationship between multimorbidity and quality of life. Furthermore, we explored moderated mediation patterns by age, gender, and education. Methods. Longitudinal data were drawn from five waves (from 2011 to 2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE). We included 37,082 individuals aged 50 years and older in the analyses. The predictor (multimorbidity) and covariates were measured four and the mediators two years before the QoL outcome (CASP-12). Confounder-adjusted mediator and outcome models were fitted using mixed-effects models. The total association was decomposed into direct and indirect pathways applying causal mediation analyses with Monte-Carlo simulations. Results. Multimorbidity was associated with lower QoL four years later; 2.12%, 6.17%, and 19.90% of the association was mediated by ADL, IADL, and depressive symptoms, respectively. Mediation by loneliness was not significant. Generally, the mediation patterns were more pronounced in women and individuals with tertiary education as compared to primary and secondary. Differential mediation by age quartiles did not reveal a clear pattern. Conclusions. The results showed that depressive symptoms were the most important mediator between multimorbidity and QoL, with ADL and IADL also playing an important role.
CHARACTERISTICS OF NORWEGIAN OLDER ADULTS LIVING ALONE OVER THREE DECADES (1995–2019)
Authors: Gudjonsson Milan Chang , Michelet Mona , Strand Bjørn Heine
Published: December 2022

Introduction

Among older adults who are living alone, social isolation, and physical and cognitive impairment are more common than among those who do not live alone. The proportion of older adults who live alone is expected to increase further. The current study investigated the disability and formal care service use among older adults living alone between 1995-2016 in Norway.

Methods

A total of 31,263 people aged 70+ participated in the Trøndelag Health Study (HUNT) survey 2 (1995/97), 3 (2006/08), and 4 (2017/19). The study assessed the use of formal care including practical help (PH) and home nursing (HN), and disability in personal and instrumental activities of daily living (PADL:7 items and IADL: 6 items).

Results

More than 70% of older adults living alone were women (74% in HUNT2, 77% in HUNT3, 71% in HUNT4). The use of PH service among those who were living alone decreased from 33.7% to 18.6%, while HN service use increased from 10.4% to 16.4%. The percentage of PADL disability among those who lived alone was similar (10.3% to 9.1%) between 1995-2019. However, the percentage of IADL disability has decreased from 37.6% (1995-97) to 27% (2017-19) while in all cohorts IADL disability rates were significantly higher among those who were living alone than those who were living with others.

Conclusions

Although the use of HN service among older adults who were living alone decreased during 1995-2016, those who were living alone in all cohorts had higher IADL disability rates compared to those who lived with others.
LONELINESS AND PSYCHOLOGICAL WELL-BEING OF THE INSTITUTIONAL OLDER ADULTS DURING THE COVID-19 PANDEMIC
Authors: Chao Shiau-Fang , Hsu Hui-chuan , Su Yun-Pei
Published: December 2022

Purpose

Institutional residents experienced more restrictions in the lockdown of covid-19. The purpose of this study was to examine the association of loneliness and lonely literacy with mental health wellbeing during covid-19 for older institutional residents.

Methods

The participants living in the 13 long-term care institutions who were aged 65 and more and able to communicate with were invited in the survey (n=143). Mental well-being was measured by depressive symptoms and life satisfaction. Loneliness was measured by the 6-item UCLA loneliness scale. In addition, demographics, health status, active and passive coping strategies, social support from family and friends, social interaction changes after covid-19, loneliness change after covid-19, and worries about covid-19 were investigated. Linear regression and logistic regression models were conducted.

Results

The mean of the loneliness score (6~24) was 9.71 (SD=4.02). Factors related to loneliness increased during covid-19 for the institutionalized residents included having more physical function difficulties (OR=1.179), feeling more lonely (OR=1.146), and having more worries for covid-19 (OR=2.317). The residents having depressive symptoms was related to have more loneliness (OR=1.269), worse self-rate health (OR=0.320), and increased more loneliness during covid-19 (OR=3.233); while having high life satisfaction was related to less loneliness (OR=0.859), less physical difficulties (OR=0.834), higher satisfaction of family support (OR=2.835), and not increasing loneliness during covid-19 (OR=0.255).

Conclusion

Loneliness during covid-19 is related to more depressive symptoms and lower life satisfaction, especially during covid-19. Learning active coping strategy and providing proactive and helpful environment for the long-term care residents is suggested during the pandemics.
THE RELATIONSHIP BETWEEN SOCIAL NETWORK AND PURPOSE IN LIFE: APPLICATION OF A RANDOM INTERCEPT CROSS-LAGGED MODEL
Authors: Lee Gina
Published: December 2022

The purpose of this study is to examine if there are reciprocal effects between social network size and purpose in life among older adults using data from the National Health and Aging Trends Study. A second aim is to assess whether there are moderated effect of gender on this relationship. The sample included 1,485 male and 2,058 female adults 65 years and older. In order to examine the reciprocal effects between social network size and purpose in life over four time points (2017, 2018, 2019, and 2020), a random intercept cross-lagged model (Model 1) was computed. Then, two multiple group RI-CLPM analyses (Model 2 and 3) were computed in order to test moderation of gender on the relationship. Model 2 estimates the cross-lagged parameters freed and model 3 estimates the cross-lagged parameters constrained. The results indicated that Model 1 fit the data well, χ2(9) = 26.06, p = .002. The carry-over effects of social network and purpose in life were significant. The spill-over effect from wave 3 purpose in life on wave 4 social network was significant. The variance of the random intercepts were significant, indicating that there are stable, trait-like differences between social network and purpose in life. The results of the multiple group model revealed that there were no significant differences between the freed and constrained models, indicating that lagged effect for male and female appear to be same. Future research should explore if other factors like race or education show moderated effects.
THE EFFECT OF SUBJECTIVE AND OBJECTIVE RELATIONSHIPS ON THE LIFE SATISFACTION AND HEALTH OF OLDER ADULTS
Authors: Kim Meeryoung
Published: December 2022

This study examines the effects of subjective and objective relationships among older adults on life satisfaction. Human beings are social animals and must live in relationships with people. In particular, in a situation where social networks decrease in old age, objective or subjective social relationships that can receive help when needed, and satisfaction with such relationships can improve the quality of life in old age. This study used the sixth additional wave (2016) and the seventh wave (2017) of the Korean Retirement Income Study. The subjects of this study were older adults who are aged 65 and older, and the sample size was 3,423. The number of objective relationships, subjective social support, relational satisfaction, and having a spouse and children were used as independent variables. Life satisfaction and health were used as dependent variables. Demographic variables were controlled. Multiple regression was used for data analysis. The more objective relationships there were, the higher the life satisfaction and health. Subjective social support also significantly increased life satisfaction and health. Satisfaction with interpersonal relationships also significantly increased both life satisfaction and health. Having a spouse made a significant difference in affecting life satisfaction and health. The results showed that both subjective and objective relationships in old age improved the quality of life of older adults, but the presence or absence of children made no significant difference in affecting life satisfaction or health. This implies that as you get older, you may find that having a spouse becomes very important.
PSYCHOLOGICAL WELL-BEING IN OLDER ADULTS AFTER MULTIPLE SEVERE WEATHER EVENTS
Authors: Cherry Katie , Calamia Matthew , Elliott Emily , Miller Luke , Sampson Laura , Galea Sandro
Published: December 2022

Catastrophic hurricanes and flooding threaten health and well-being, although the long-term consequences of these events for survivors are poorly understood. In 2005, Hurricane Katrina devastated the US Gulf Coast. Many lost homes in these storms and relocated permanently inland. In August of 2016, historic flooding in Baton Rouge, Louisiana devastated a 22-parish (county) region, resulting in widespread destruction and a second round of disaster-related losses for those who relocated to Baton Rouge after Katrina. The present research is part of a larger longitudinal study on health and well-being after multiple disasters. Cherry et al. (2021) reported that greater flood damage was associated with more symptoms of depression and post-traumatic stress during the Wave 1 immediate impact phase. Here we examined symptoms of depression, anxiety and post-traumatic stress at Wave 2, a follow-up assessment that occurred 9 (+/- 3) months after Wave 1 testing. Three flood exposure groups were compared: non-flooded (controls), single disaster (flooded in 2016) and double disaster (flooded in 2005 and again in 2016). Results indicated that symptoms of depression and post-traumatic stress, which were elevated at Wave 1 for the single and double disaster groups relative to the non-flooded controls, were reduced at Wave 2 and did not differ from the controls. Correlation analyses revealed that age was negatively associated with symptoms of post-traumatic stress, depression, and anxiety, consistent with the inoculation view of post disaster psychological reactions. Implications of these data for understanding older adults’ psychological health after multiple disaster exposures are discussed.
UROLITHIN A: GUT-BRAIN DIETARY INTERVENTION IN PARKINSON'S DISEASE
Authors: Ng Jenny Hong Yu , Andersen Julie
Published: December 2022

Gastrointestinal dysfunction is amongst the most common prodromal symptoms of Parkinson’s disease (PD). Pathological alpha-synuclein has been detected in the intestines prior to disease onset, and a leaky gut is also implicated in its etiology. Thus, we hypothesized that modulation of the gut microbiome and intestinal immune milieu via early dietary intervention may act to mitigate PD pathogenesis. Urolithin A (UA) is a gut metabolite shown to ameliorate geriatric diseases by increasing mitophagy and dampening inflammation. The aim of our study is to elucidate its mechanism of action and therapeutic efficacy in PD, which to date is unclear. Preliminary flow cytometric data demonstrates that administration of a UA-diet significantly increased the proportion of colonic gamma-delta (γδ) T cells in nine-month-old Thy-1 α-syn mice, which are downregulated relative to non-transgenics on a non-UA control diet. PD patients have been reported to have higher levels of γδ T cells in their cerebrospinal fluid and, while little is known about colonic γδ Ts in the context of PD, these cells are anti-inflammatory and responsible for intestinal repair in several colitis models. Our data suggests a retention of lymphocytes involved in the targeted migration from the gut to the brain, which may contribute to gut epithelial integrity. Proportion of induced regulatory T cells in peripheral blood, which are critical for immune tolerance, also increased significantly with a UA-diet. In addition, UA-fed mice showed a slight improvement in novel object recognition. Additional analyses are underway to comprehensively evaluate the impact of UA on PD pathology.
COMBINING SCLEROSTIN AND DKK1 INHIBITORS TO IMPROVE BONE PROPERTIES IN THE AGED SKELETON
Authors: Choi Roy , Robling Alexander
Published: December 2022

Targeting the secreted Wnt inhibitor sclerostin has been an attractive strategy to improve skeletal health. Sclerostin antibody (romosozumab-aqqg; Evenity) was recently approved by the FDA to treat patients at increased risk of fracture. However, an increased risk of cardiovascular events was reported, resulting in issue a ‘black box warning’ requirement for romosozumab. One potential solution to lower the risk of adverse events is to reduce the medication dose. Previously, we found that dual inhibition of sclerostin and Dkk1 produced extremely potent synergistic bone anabolic effects, in both genetic and pharmacological models. While Dkk1 inhibition alone has no consistent bone-building effects, combining antibodies that target sclerostin (Scl-mAb) and Dkk1 (Dkk1-mAb) at 3:1 ratio resulted in 2-3X more bone gain as Scl-mAb alone. Further, much lower total doses of dual antibody treatment, given at optimized proportions, generated equivalent bone anabolic effects as Scl-mAb alone (at much higher doses), suggesting that a combinational strategy has obvious translational benefits. Finally, we tested whether low-dose combination therapy can maintain the same osteogenic effect as Scl-mAb in adult (6 month) and aged (20 month) mice. Outcome measures derived from radiographic, biomechanical, and histomorphometric assays revealed that a 3:1 ratio of Scl-mAb:Dkk1-mAb at 12.5mg/kg was as efficacious as 25mg/kg of Scl-mAb alone, in both age groups. Moreover, cortical porosity—a significant factor contributing to skeletal fragility in the aged skeleton—was significantly reduced by both Scl-mAb and low-dose combination treatment. In conclusion, our findings suggest that optimized low-dose combinational therapy is viable strategy for improving skeletal fragility.
THE ROLE OF THE ENDOPLASMIC RETICULUM UNFOLDED PROTEIN STRESS RESPONSES IN A C. ELEGANS MODEL OF QUIESCENCE
Authors: Pankey Arianna
Published: December 2022

Cells devote extraordinary energy to translate and fold approximately 20,000 proteins encoded by the human genome. About one third of these proteins are transmembrane proteins—correctly folded in the endoplasmic reticulum (ER). The ER Unfolded Protein Response (UPRER) is a response to disturbances at the ER. As an organism ages, cells lose the ability to activate the UPRER. Our lab uses C. elegans—a microscopic roundworm—as a model organism to determine how loss of ER function can contribute to aging. The UPRER plays a key role in maintenance of functional quiescence. Quiescent cells exist in a reversible state of dormancy and can receive specific environmental cues to proliferate. The developmental state known as L1 arrest resembles the same features as quiescent cells. IRE-1 is required for worms to exit their quiescent state after starvation. Understanding the genetic pathways that are best at suppressing ire-1 terminal L1 arrest could indicate ways to improve functional quiescence. We forced the worms into an L1 arrest state; The unfolded protein response in the endoplasmic reticulum maintains functional quiescence within the cell. The worm’s ability to develop once they exit this quiescent stage effectively, indicated the ability of the worm to maintain protein homeostasis despite non-ideal conditions. It was found that all tested mutations were unable to demonstrate improvement in ability to maintain development when arrested long-term. Our data indicates that our worms were counted prematurely. In the future, we will allow for a longer growth period as well as larger quantities of food.
COGNITION AND HEALTH: PRELIMINARY RESULTS OF A MUSIC CREATIVITY INTERVENTION FOR ADULTS AT RISK OF MCI
Authors: Wu-Chung E Lim Lydia , Brandt Anthony , Bonomo Melia , Denny Bryan , Karmonik Christof , Frazier Jefferson , Blench Karl , Fagundes Christopher
Published: December 2022

As the number of people with dementia is projected to rise to 13.8 million by 2050, there is a growing need to develop interventions that prevent or slow down disease progression in at-risk individuals. Older adults are particularly vulnerable, given that increasing age is the strongest predictor of dementia. Music interventions are promising, non-pharmaceutical treatment options for slowing down cognitive decline and enhancing psychological health. However, more music-related clinical trials are needed to evaluate treatment efficacy and to identify biobehavioral mechanisms of change. Project Chroma is a Stage 1 semi-randomized clinical trial, developed to assess the effects of a novel, music creativity curriculum on cognitive, socio-emotional, neurobiological, and immunological outcomes. In this study of 58 older adults with or without MCI, we demonstrate that Project Chroma has good feasibility and acceptability: participation, retention and satisfaction rates were comparable to other similarly designed clinical trials. Preliminary analyses revealed that participants in the music condition, relative to those in the control condition, showed marked improvements in cognitive functioning. Slight changes in socioemotional well-being were observed, which may be attributed to a minimally distressed sample. This study contributes to a growing literature substantiating music interventions as effective options for curtailing cognitive decline. Forthcoming work will examine the effects of music creativity on neural and immune outcomes.
CHARACTERISTICS OF HOSPITALS AND PROVIDER MARKETS ASSOCIATED WITH INCREASES IN HOME HEALTH CARE USE
Authors: Watts Elizabeth , Bucy Taylor , McHugh John , Cross Dori
Published: December 2022

Many older adults require post-acute care from a nursing home or home health agency following hospitalization. Recent trends show providers are increasingly relying on home health agencies rather than institutionalized settings, with home health volume surpassing skilled nursing facility (SNF) volume since 2017. Using MedPAR patient encounter data from 2016–2019 and provider data from CMS, we analyze changes in the profile of patients receiving home health over time, showing that individuals discharged to home health are increasing in complexity based on hospital length of stay, comorbidities, and use of critical care services. Mixed effects models additionally suggest that grouping patients at the hospital and market level helps to account for unexplained variation in whether a patient is likely to receive home health versus SNF services. Examining the characteristics of hospitals and provider markets with increasing rates of home health referrals over time, we found that hospitals with increasing rates of discharge to home health were more likely to be for-profit facilities in urban areas with higher operating margins. However, this increase was not consistently tied to a corresponding decrease in rates of discharge to SNF, suggesting that hospitals are experiencing a combination of both patient-shifting across post-acute settings as well as an overall increase in baseline complexity of hospitalized patients over this time period. These results have implications for understanding the how policies currently being considered to improve value in the post-acute sector filter through heterogeneous market structures and complex organizational environments to impact patient care decisions.
EXPLORING INTERSECTIONS OF NURSING HOME CULTURE, IMPROVEMENT, AND DOCUMENTATION-RELATED ATTITUDES
Authors: Baker Hannah
Published: December 2022

Documentation of patient care and characteristics is an important part of nursing home (NH) operations, affecting financial aspects, quality improvement (QI) efforts, inter-provider communication, and potential for medical errors. However, relationships among NH culture, QI, and documentation-related attitudes are unclear. This study explored Wisconsin NH staff and administrator perspectives on these variables (n = 10 in 8 NHs), using interviews structured on a composite of Schein’s organizational culture typology and Shortell’s Quality Improvement Implementation Survey concepts. Interview questions related to perspectives and emotions about NHs’ documentation quality, OC, QI efforts, and nursing staff turnover. Verbatim transcription, member checks, and team-based transcript coding and analysis ensured good data quality. Thematic analysis was used to construct a “storyline” and refine the original theoretical model. Sample data fit the model well, supporting the perception of pairwise relationships between NH OC, QI, and documentation. One of Schein’s culture types was not represented in the sample. Attitudes and perceived influences on documentation-related quality were mostly negative. This research contributes to knowledge on long-term care and could point future research toward (1) similar work in dissimilar NHs to replicate results, (2) closer examination of staffing variability, (3) quantitative work on effects of education and auditing on documentation-related attitudes, and (4) strategies to improve attitudes without increasing staff stress levels.
FEASIBILITY OF REMOTELY SUPERVISED ONLINE CHAIR YOGA INTERVENTION FOR OLDER ADULTS WITH DEMENTIA
Authors: Park JuYoung , Sullivan Marlysa , Heilman Keri , Surage Jayshree , Levine Hannah , Hung Lillian , Ortega María
Published: December 2022

This study assessed the feasibility of a remotely supervised online chair yoga (CY) intervention for older adults with dementia, exploring preliminary effects of CY on chronic pain, mobility, risk of falling, sleep disturbance, autonomic reactivity, cardiac rhythms (using IOM2 biofeedback device), and loneliness in this population. Using a one-group pretest/posttest design, a home-based CY intervention was delivered remotely to a group of 10 older adults with dementia who were socially isolated due to COVID-19. The online intervention was conducted twice weekly in 60-minute sessions for 8 weeks; data were collected virtually at baseline, mid-intervention, and post-intervention. Results indicated that online CY is a feasible approach for managing physical and psychological symptoms in older adults with dementia, based on retention (70%) and adherence (87.5%) with no injuries or other adverse events during the intervention. Senior-friendly videoconferencing should be available so that more older adults can gain access to the online intervention
TECHNOLOGY TO PROTECT HIPS IN SERIOUS FALLS - PRELIMINARY EVIDENCE
Authors: Tarbert Rebecca , Stefanacci Richard
Published: December 2022

Major injuries from falling in the older adult population is a tragic outcome that is growing in number. There is limited evidence of methodology to avoid major injuries from falls for those most at risk. Hip fractures are a catastrophic outcome from falls that incur cost to the individual, family and healthcare system. A study is currently underway in older adult living settings designed to demonstrate the efficacy and safety of a wearable smartbelt that deploys a protective airbag around the hips prior to landing on the ground as a mitigation for fall-related major hip injuries. The smartbelt technology includes embedded sensors and WiFi connection for data sharing. The primary endpoint of the study is to examine the efficacy and safety of the smartbelt in a population of older adults with high-risk profile of falls and major hip injuries. The study will be a comparative analysis of rate of major hip injuries from falls between a retrospective control group and a selected intervention group wearing the smartbelt for 6 months with all subjects continuing to receive standard of care for fall injury mitigation. Implementation methodology of clinical study performance in the care settings and integration into plan of care will be outlined. Outcomes from the enrolled subjects to date in the study will be shared including fall risk factors, fall events and injuries from falls reported.
AI AND AGING: IDENTIFYING IMPORTANT LIVING ACTIVITIES FOR HEALTHY AGING IN SINGAPORE LONGITUDINAL AGING COHORT
Authors: Zhong Xin , Yang Feng , Hu Wangyang , Gwee Xinyi , Chua Denise , Ling Qian , Ng Tze Pin
Published: December 2022

Population aging in Singapore has encouraged the development of ambient smart communities to support healthy aging. Poor understanding of the living activities that address both clinical and biological concerns may plague efficient aging service designs and community health programs. We have designed a new computational workflow to identify important living activities for older adults in Singapore. We investigated innovatively three pillars of human life aspects: activities, clinical health, and biological health to identify living activities that are significantly associated with both clinical health and biological health. Cross-sectional data analyses were performed on 1356 community-living Chinese older adults of 65–80 years old in the Singapore Longitudinal Aging Study II (SLASII) cohort. 7 out of 29 living activities were found significantly associated with clinically healthy aging and showed improved prediction accuracy towards health status in machining learning schemes. Furthermore, biological age has been computed by screening and modeling 66 biomarkers. 15 out of the 29 living activities were found significantly associated with biologically healthy aging. Checking the overlapping living activities, we have found that physical exercise and cognitive-simulating activities are the most important activities for healthy aging: such as jogging regularly and reading, writing, and doing puzzles often. We regroup participants into active and non-active groups according to these two activities. The Keplan-Meier survival analysis showed statistically significant differences in survival time between the active and non-active groups (p < 0.001) in an 8-year longitudinal study. The workflow, results and biomarkers may provide references for future health program design improvement.
NEEDS FOR SUPPORTING PEOPLE AGING WITH HIV: RESULTS FROM A CBPR COMMUNITY-NEEDS ASSESSMENT
Authors: Rapoport Andy , Guasco Rick , Musolino Teresa , Reese Melanie , Teasley Kenneth , Danilovich Margaret
Published: December 2022

Nearly half of people living with HIV in the U.S. are over age 50 and are navigating age-related changes while managing the complexities and challenges of HIV. People aging with HIV are an emerging community—it is imperative to understand the key issues faced by this community so to improve health outcomes and eliminate health disparities. This paper presents a CBPR approach by the SHARE board (a community advisory group comprised of older people living with HIV) and academic researchers. SHARE members conducted a mixed-methods needs assessment using a semi-structured interview guide they had developed, as well as a survey to determine community priorities for research, healthcare, and social services for people aging with HIV. SHARE members conducted 32 semi-structured interviews with individuals from across the country. From the 216 survey responses (mean age 55 years), 35% were Black, 30% were Hispanic, 50% were male, and 43% had been living with HIV for 11–15 years. 44% were fearful that long-term HIV medications will adversely affect them with aging. Triangulating interviews and surveys, financial strains and caregiving were primary age-related concerns. Affording medication and transportation were primary barriers to accessing healthcare. Most respondents had experienced stigma due to both age and HIV status. Respondents felt the most important areas for future research were optimizing management of multiple co-morbidities including HIV, and cognitive changes with HIV. Results from this community-led needs assessment identified key areas for interventions and research to address conditions disproportionately affecting the health of those aging with HIV.
OVERCOMING OLDER ADULT RESISTANCE TO TECHNOLOGY TO SUPPORT DIGITAL HEALTH LITERACY: A CBPR APPROACH
Authors: Freddolino Paul , Sun Fei , Kim Ha-Neul , Wishart Dona , Godek Eileen , Bentley Megan
Published: December 2022

Overall low digital use by older adults creates a barrier to tools that enable them access to basic and specialty healthcare through telehealth and address their isolation and loneliness. In particular, older adults with low-income, like low-income isolated Home Delivered Meal (HDM) program recipients, can be most vulnerable to this barrier. A university team and a local Commission on Aging jointly secured funding to pilot the Virtual Table (VT) model which builds on relationships between HDM drivers and meal recipients to overcome lack of interest and skepticism of technology like the internet and video chatting. For the pilot, 25 recipients were recruited to learn basic technology skills (e.g., email, video chat) from trusted peer tutors through weekly one-to-one sessions, in-person or by video, leading to knowledge and skills to support telehealth utilization. Twenty recipients (80%) are completing the pilot. Results to date show increased technology use and comfort, together with confidence to use telehealth. Participants valued the interactions with tutors as well as what they learned. Feedback from tutors, agency staff, and participants has been used to refine the pilot during implementation. Building on the lessons learned and feedback, the goal for the next stage of collaboration is developing a set of effective tools to implement VT in several diverse communities. Four VT ‘graduates’ will be actively involved as co-producers of these revised tools. In addition, older adult home-delivered-meal (HDM) recipients, agency staff, tutors, and other older adult volunteers will directly participate in ongoing evaluation of the new resources.
INTERPROFESSIONAL COLLABORATIVE RESEARCH ASSESSING OLDER ADULT TECHNOLOGY USE (OR NONUSE)
Authors: Case Donna , Groden Sheryl , Sahli Michelle , Tremaine Wendy
Published: December 2022

This interprofessional study conducted by faculty in Occupational Therapy, Social Work and Public Health explored older adult technology use (or nonuse) by 216 Genesee County Michigan residents. Three professional lenses informed survey development, implementation and data analysis. Occupational therapy emphasized accessibility, how physical or cognitive impairments hinder technology use, and role of technology to complete daily living activities. Social work focused on technology use to facilitate social connectivity, decrease risks for mental health problems, and resource access. Public health explored if technology use or nonuse impacts health. Results indicated that 14% of participants want to learn to obtain transportation (social, health) via the internet, 13% stated they wanted to learn how to use technology to access medical records, 12.5% to attend on-line appointments, 11% reported they would engage in additional technology-based social activities (e.g. communicating with family/friends), 10% to order/refill medications, and 9% of older adults surveyed had difficulty accessing technology due to a physical, cognitive or sensory impairment. Researchers found the questions provided an integrated view of factors influencing older adult use or nonuse of technology and provided a guide for designing collaborative interventions to facilitate older adult access and use of technology to result in positive holistic health outcomes.
REMOTELY MEASURED IN-HOME DISTANCE FROM CARE RECIPIENT PREDICTS DEMENTIA CAREGIVERS’ LONELINESS
Authors: Chen Kuan-Hua , Chen Yuxuan , Levan Darius Tran , Yee Claire , Merrilees Jennifer , Scheffer Julian A , Chen Samson , Levenson Robert W
Published: December 2022

Caregivers (CGs) of a family member with dementia often experience increased loneliness, which can result from reduced social interactions and increased physical distancing associated with care recipient’s (CR) disease progression. Through a university-industry collaboration, we developed new technology for measuring physical distance remotely. CGs and CRs wore watches that monitored their location in the home using low-energy Bluetooth technology that enabled long battery life (up to four months). Using measures of proximity of the watches to three plug-in Bluetooth receivers located in the home, we assessed CG-CR physical distance on a second-by-second basis over a six-month period. Participants were 27 CRs diagnosed with dementia or mild cognitive impairment and their co-residing familial CGs. CG loneliness was measured by questionnaire at the beginning and end of the study. Both watches and receivers were remotely installed (by CGs). Results indicated that CG-CR physical distance increased from the first three months to the last three months of the study (t = 20.67, p < 0.001). In addition, greater increases in CG-CR physical distance over the six-month period were associated with greater increases in CG loneliness (r = 0.46, p = 0.03). These results advance our understanding of how increases in physical distancing between CGs and CRs contribute to increased CG loneliness (a well-established risk factor for depression and other mental health symptoms). The study also underscores the value of remote technologies that allow for in-home long-term monitoring for research on interpersonal distance and other social behaviors in CG-CR and other aging dyads.
LONGITUDINAL ASSOCIATIONS BETWEEN FALLS AND DEPRESSIVE SYMPTOMS AMONG CHINESE OLDER ADULTS
Authors: Zuoting Nie , Tracy Eunjin Lee , Du Yan , Li Sha , Yang Rumei
Published: December 2022

Falls and depressive symptoms are prevalent and costly to Chinese older adults. Although falls and depressive symptoms are frequently interrelated, previous studies were mainly based on cross-sectional data, and the nature of interrelationships between them were not well understood. In this study, we aimed to examine the longitudinal bidirectional relationship between falls and depressive symptoms among Chinese older adults, and whether this bidirectional relationship is different for males and females, given that females are found to suffer from falls and depressive symptoms significantly more than males. Older adults aged 60 years+ who completed all three waves of data from the China Health and Retirement Longitudinal Study on falls and depressive symptoms between 2011 (wave 1), 2013 (wave 2), and 2015 (wave 3) were included in the current analysis (Nf2,203). Data were analyzed using random intercept multilevel models that adjusted for demographic information (e.g., age, education, and marital status). Overall, there is a relatively stable rates of comorbid falls and depression (about 10%) over time among Chinese older adults. Significant bidirectional associations at between-person and within-person levels were observed between depressive symptoms and falls over time, with greater depressive symptoms associated with higher risk for falls and vice versa. However, such associations were not different between males and females. Taken together, these findings indicate the importance of addressing both depression and falls at the same time to prevent falls in the clinical practice for both males and females.
EFFECT OF CHANGE IN BODY SIZE ON MORTALITY IN THE INITIALLY HEALTHY COMMUNITY-DWELLING OLDER ADULTS
Authors: Hussain Sultana Monira , Newman Anne , Beilin Lawrence , Tonkin Andrew , Woods Robyn , Neumann Johannes , Nelson Mark , McNeil John
Published: December 2022

Utilising data from the ASPirin in Reducing Events in the Elderly trial participants [aged >70-years (Australians), >65-years (US)], we estimated percent change in body size (BMI: body mass index, WC: waist circumference) from baseline and the second annual visits. Both BMI and WC changes were categorised as 1) change within 5% (stable), 2) decrease by 5–10%, 3) decrease by >10%, 4) increase by 5–10%, and 5) increase by >10%. Mortality events were classified according to the underlying cause by adjudicators. Hazard ratios were calculated to compare mortality between body size change categories. Amongst 16,773 participants, 1,269 mortality were observed over an average 4.4±1.7 years. In men compared to stable BMI, a 5–10% decrease in BMI had a 35% higher (HR 1.35, 95% CI 1.08–1.67), and a >10% decrease in BMI had a 3.84-fold higher (HR 2.99, 95% CI 2.44–3.68) risk in all-cause mortality. A decrease in BMI was associated with a higher cause-specific (cancer, cardiovascular disease [CVD], and non-cancer non-CVD) mortality. A decrease in BMI was associated with higher mortality risk in women, however, the magnitude of association was weaker than men. A decrease in WC was predictive of mortality but with a much weaker relationship than a decrease in BMI. Weight gain was not predictive of mortality except for non-cancer non-CVD mortality in women. Physicians should be aware of the ominous consequence of weight loss, especially amongst older men. The risk extends beyond an increased risk of cancer, extending to CVD and a range of other life-limiting conditions.
AN OLDER ADULT FRACTURE PROGRAM EMPLOYING AGE-FRIENDLY CARE CAN BE IMPLEMENTED AT YOUR HOSPITAL AND IMPROVE OUTCOMES
Authors: Breda Kathleen , Keller Michelle , Gotanda Hiroshi , McKelvey Karma , Lin Carol , Rosen Sonja
Published: December 2022

Older adult fractures are expected to increase dramatically over the next several decades, with hip fractures reaching an estimated 6.26 million worldwide by 2050. A combined approach to the care of older adult fracture patients was first reported in the early 1990s, emphasizing geriatric and orthopedic co-management. Early studies showed significant improvements in complications, function, and discharge rates to nursing homes. Subsequent studies demonstrated shorter time-to-surgery, lengths of stay (LOS), lower readmission rates, reduced in-hospital mortality, and lower cost of care. The studies are from large academic centers whose physicians are employed faculty or have dedicated geriatric units. Less studied is whether similar models could be implemented in community health systems/mixed practice settings like Cedars-Sinai. Cedars-Sinai’s older adult fracture program integrates inpatient and outpatient care and uses best practices of the 4Ms Framework of an Age-Friendly Health System, including What Matters Most, Mentation, Medications, and Mobility. The program was designed through the consensus of interprofessional champions and empirical evidence. Results showed enrolled patients with all fracture types had significantly lower LOS (marginal effect [ME]: -2.12, 95%CI: -2.61, -1.63), LOS index (ME: -0.33, 95%CI: -0.42, -0.25), and total direct costs (ME: -$5316.4, 95%CI: -6806.31, -3826.5). There was no significant difference in time-to-surgery. Of the 746 enrolled patients, 170 (23%) had a post-discharge visit with a participating geriatrician within 6 months. Findings indicate a systematic approach to improving care for older adults with fractures improves inpatient outcomes in a mixed practice setting. Future studies will examine the effectiveness of Cedar-Sinai’s outpatient program.