bluuebunny/crossref_metadata_2025 huggingface dataset:
GETTING TO KNOW YOU: USING VIRTUAL REALITY IN VOLUNTEER RESPITE PROGRAM FOR PERSONS WITH MEMORY LOSS
Authors: Bakk Louanne , Agyemang Lillian , Milnamow Mary , Dauenhauer Jason , Allen Katy
Published: December 2023

Virtual reality (VR) can provide an immersive experience that simulates real or imagined environments and provides an innovative solution to promote engagement and socialization. Interventions to date have not explored the use of trained volunteers to use VR to promote socialization and provide active experiences with community-dwelling persons with memory loss. This presentation will provide an overview of a volunteer-led drop-in respite caregiving program. The program uses Rendever’s VR platform, which includes a series of pre-programmed and on-demand immersive experiences delivered to persons with memory loss through a VR headset via a volunteered-controlled tablet. Volunteers conduct tailored individual and group VR sessions as a scheduled activity with persons with memory loss. This study aimed to understand the experiences of volunteers administering VR programming within the drop-in respite center. A total of eight volunteers participated in a focus group. A semi-structured interview guide explored volunteers’ motivation for becoming trained to use VR, observations of using VR with persons with memory loss, how they are implementing VR, challenges they experienced using VR, and ideas for improving/expanding implementation. Volunteers reported increased socialization when using VR with persons with memory loss, a desire for continued and ongoing VR training, and suggested larger group VR sessions delivering the same content to foster greater interaction among respite participants. Results suggest that VR programming can be an effective format for increasing socialization and involvement among persons living with memory loss.
GRAY MATTER CORRELATES OF ANXIETY, DEPRESSION, AND GAIT SPEED IN OLDER ADULTS WITH CHRONIC PAIN
Authors: Lipat Ania , Clark David , Cruz-Almeida Yenisel
Published: December 2023

Chronic pain and its comorbidities, (e.g., anxiety, depression, slow gait speeds) are a widespread, disabling condition prevalent among older adults. Worse anxiety and depression have been associated with slower gait speeds in individuals with chronic pain, and each comorbidity has been associated with structural gray matter changes; however, results are inconclusive or limited. Further investigation into these relationships may provide insight into neural mechanisms through which anxiety and depression contribute to slow gait speeds in this population. Therefore, the aim of this study was to identify gray matter measures associated with anxiety, depression, and gait speed in older adults with chronic pain. Participants (n = 31) walked across a GAITRite mat to obtain gait speed, and completed the State-Trait Anxiety Inventory (STAI), Center for Epidemiologic Studies Depression Scale (CES-D), and a T1-weighted anatomical scan. STAI score (mean = 7, β = - 0.015, p = 0.010) and CES-D score (mean = 30, β = - 0.014, p = 0.016) were significantly associated with gait speed. CES-D score was associated with left cuneus gyrus (β = 0.017, p = 0.0002) and frontal inferior sulcus surface area (β = 0.019, p = 0.002). Gait speed was associated with right inferior temporal gyrus surface area (β = 0.436, p = 0.019). STAI score was not associated with any measure. In conclusion, anxiety and depression symptoms contribute to gait slowing in older adults with chronic pain but without clinical depression or anxiety. This relationship, however, is not reflected in each comorbidity’s structural neural correlates.
GREATER PHYSICAL ACTIVITY AND SOCIAL ENGAGEMENT OFFER PROTECTION AGAINST COGNITIVE DECLINE OVER TIME
Authors: Dhakal Usha , McLaughlin Sara , Kim Seonjin , Roberts Amy , Vivoda Jonathon , Brown J Scott
Published: December 2023

Evidence suggests that physical activity and social engagement in later life are associated with a less pronounced and reduced risk of cognitive decline over time; however, findings are mixed and knowledge concerning the effect of these factors on cognitive functioning in older adults with mild cognitive impairment (MCI) is underdeveloped. To enhance understanding, we extracted data from eight waves (2004-2018) of the Health and Retirement Study and used hierarchical linear mixed models to investigate the impact of physical activity and social engagement on cognitive functioning in Americans aged 60 years and older with MCI (n=1462). The average cognitive score (sum of immediate and delayed word recall, serial seven subtraction test, counting backwards, range: 0 to 27) at baseline was 9.6, which decreased by 0.14 points each year. Each unit increase in physical activity (weighted sum of light, moderate, vigorous activity; range: 9 to 45) and social engagement (measure capturing social visits, volunteerism, religious participation; range: 0 to 3) reduced the effect of time on cognitive functioning by 0.01 (β=0.007, p<.0001) and 0.04 (β=0.040, p<.0001) points, respectively, while simultaneously controlling for APOE genotype and other covariates. This means, for example, that the cognitive score of someone with a physical activity score of 40 was, on average, 3.1 points higher than someone with a physical activity score of 10 after 16 years of follow-up. Findings suggest that greater physical activity and social engagement offer protection against cognitive decline and could minimize MCI progression among older adults experiencing MCI.
HAPPY LIFE EXPECTANCY AND REGIONAL AND GROUP HETEROGENEITY AMONG CHINESE OLDER ADULTS
Authors: Guo Chao , Yang Peisen
Published: December 2023

A long, healthy and happy life is the aspiration of most people and an essential part of human well-being. However, longer life expectancy does not mean a higher quality of life. The measure of quality of life includes both objective and subjective indicators. Similar to healthy life expectancy, happy life expectancy is a measure that combines life expectancy with happiness indicators and can reflect both life length and quality of life. But at present, there is relatively little research on happy life expectancy. In China, there have been no studies using panel data to calculate happy life expectancy. We obtained longitudinal data from the Chinese Longitudinal Health Longevity Survey (CLHLS). We used the multistate life table approach to calculate the happy life expectancy of Chinese older adults, and analyzed the regional and group heterogeneity. A total of 13,807 participants aged 65 and older were included in this study. We found that the proportion of happy life expectancy to remaining life of Chinese older adults increased with age, which confirmed the “compression of unhappiness” hypothesis. In addition, older adults with more education had a higher proportion of happy life expectancy than those with less education. Finally, in terms of region, older adults in the more economically developed areas of eastern China have a higher proportion of happy life expectancy. Our findings provide a more comprehensive understanding of the quality of life of Chinese older adults and highlight the importance of education for the happiness of older adults in later life.
HAPPY TO CHAT – PROMOTING TALKING TO STRANGERS IN PUBLIC PLACES IN THE UK
Authors: Victor Christina , Yen Dorothy
Published: December 2023

After the Covid-19 pandemic, many countries are trying to reboot social connections in communities and societies, especially for older people who suffered mental wellbeing due to lockdowns and social distancing. Existing studies show talking to strangers can improve individuals’ well-being and reduce social isolations, although only with data from younger participants. This research aims to understand older people’s experience of talking to strangers, specifically in discussing how, why and where they feel most comfortable in talking to strangers. Using semi-structured interviews with 23 people (from 51 to 88 years old) based on their participation in a community-based Happy to Chat intervention (Happytochat.uk) from January to April 2023, we discuss how talking to strangers are consumed and practised by older adults. Applying agency and self-efficacy theory, findings show that their experience vary by age, gender and two types of self-efficacy: a) confidence in enjoying conversations with strangers; b) capability in navigating the risk involved in talking to strangers. The findings show that compared to the younger group (51-64 years old), the older participants (65+) are more willing and spend more time talking to strangers. Also, male participants tend to be more confident than females in navigating the risk associated with talking to strangers. Our research findings have practical and policy implications. Insights derived from the research findings are useful in developing training materials or conversation aids to improve current chatty schemes and increase older people’s self-efficacy in having conversations with strangers, thus benefiting from better social connections.
HEALTH AND SOCIAL CARE TRAINEES’ ATTITUDES ABOUT AGING AND OLDER ADULTS
Authors: Park Min-Kyoung , Martin Diane
Published: December 2023

Ageism is pervasive in healthcare. It costs billions of healthcare dollars and results in earlier patient mortality and decreased quality of life. Existing research highlights the prevalence of ageist attitudes among health and social care practitioners, but there is a dearth of research regarding attitudes of trainees toward older adults. The present study utilized the Fraboni Scale of Ageism to examine attitudes of health and social care trainees participating in geriatric interprofessional training programs. Participants completed an electronic survey prior to the didactic portion of the program. Seventy-seven surveys were completed between November 2022 and June 2023. Results revealed a nuanced understanding of older adults’ contributions, particularly regarding creativity, social and political engagement, and the richness of their accumulated life experiences. Positive sentiments were evident regarding interactions and participants acknowledged the self-management capacities of older adults, encompassing personal hygiene and other aspects of independent living. Notably, findings underscore substantial support for creation of inclusive spaces. Overall, a person-centric understanding of older adulthood was evident in the results; less than 20% of trainees expressed a negative perception of older adults/later life to any given question. Recognizing the significance of bridging intergenerational perception disparities to counter ageism, this research contributes to a foundational understanding of younger generations’ awareness of aging. Given the contrast to existing research regarding attitudes of practitioners toward older adults, these results emphasize the importance of fostering opportunities for intergenerational dialogue and activities to maintain an attitude of inclusivity and empathy that underscores a person-centered approach to healthcare.
HEALTH SYSTEM LEADERSHIP PERSPECTIVES AND PRIORITIES ON CARE FOR OLDER ADULTS
Authors: Franzosa Emily , Kelley Lynette , Dryden Eileen , Moo Lauren , Hung William
Published: December 2023

Innovative care models for older adults such as non-institutional and home-based care have the potential to improve quality and efficiency of healthcare, but adoption of these models requires resources from health systems. Health systems leaders can influence the relative priority of geriatric care and associated resource allocation. This influence is especially important for areas with limited resources such as in rural areas. We interviewed recently retired health system leaders about their experience and how priorities in health systems can be aligned to improve the quality and reach of geriatric care. We conducted qualitative interviews with 10 participants (40% female) using a snowball sampling strategy of geographically diverse, retired hospital, regional, and national leaders in the Veteran Healthcare system, the largest single-payer system in the US. Participants described how they managed myriad competing health system priorities by weighing and devoting attention and time to tackle the crises of the day, the numerous national mandates and directives, and the goals for the local hospital or system, as seen from their own perspectives. Alignment with performance metrics provides strong impetus for some health system leaders to determine their priorities. Incentives to encourage health systems leaders to prioritize and allocate resources aimed at long-term improvements in care could be important. Additionally, building relationships and maintaining trust amongst partners across facilities and offices is critical to initiating and growing geriatrics programs. This work highlights that influence must work on multiple levels to effect change in prioritization of care for older adults.
HEALTHCARE SERVICES UTILIZATION IN ELDERLY RESIDENTS OF A PERUVIAN HIGHLAND COMMUNITIES: AUNQUI-ANDES STUDY
Authors: Cahuapaza-Gutierrez Nelson Luis , Olazo-Cárdenas Kamyla M , Urrunaga-Pastor Diego , Runzer-Colmenares Fernando M
Published: December 2023

It is estimated that approximately one out of every three Peruvians does not utilize healthcare services when facing an ailment. Nevertheless, this frequency could be higher in highland regions, given the limited availability of healthcare services. The aim was to estimate the prevalence of non-utilization of healthcare services among elderly residents of a Peruvian highland community during 2022. We conducted an analytical cross-sectional study in the district of Totos (average altitude of 3286 meters above sea level) in the Ayacucho region of Peru during 2022. A census sampling method was employed, including residents aged 60 and older in Totos. Non-utilization of healthcare services was defined as a participant not seeking healthcare services when facing a health issue. The current study was approved by the Institutional Research Ethics Committee of Universidad Científica del Sur. We evaluated 272 elderly adults with an average age of 74 years, of which 60.3% were female, 62.5% were cohabiting or married, 82.3% had not completed primary education, and 65.4% reported being beneficiaries of a social program for economic support. We found that 28.3% did not use healthcare services, while 44.9% reported using traditional medicine, and 13.2% practiced self-medication. Participants reported that the nearest health center to their residence was, on average, 55 minutes away. We found that approximately one out of every five elderly adults did not use healthcare services. It is necessary to reduce cultural barriers to increase healthcare service utilization, as well as to enhance their availability for elderly individuals living at high altitudes.
HEALTHY AGING AND OLDER ADULTS WITH AUTISM: A SCOPING REVIEW
Authors: Stringfellow Mary , Fields Noelle , Lee Kathy , Anderson Keith
Published: December 2023

Autism Spectrum Disorder (ASD) is a lifelong diagnosis. While several studies have examined the effects of this disorder throughout childhood, few have considered older adulthood and the differences between allistic (i.e., persons who are not affected by autism) and autistic older adults. Moreover, an examination of the intersections of healthy aging in older adulthood and autism are largely absent from extant research. The purpose of this scoping review was to examine the state of literature regarding autistic older adults and the domains of healthy aging, utilizing the framework developed by Arksey and O’Malley (2005). After developing the research question, the researchers followed following the PRISM-ScR guidelines. The specific domains of healthy aging considered included physical health, mobility, mental health, cognition and memory, and social connectedness. A total of 35 articles were selected for final review. There was no definitive age group for autistic older adulthood, therefore the studies’ selection of ages for the older adult population were not homogenous. Fifty-seven percent of these studies considered only one domain of healthy aging, 23% studied two domains, while 14% measured three domains and 6% assessed four domains. No study considered all five domains. Of the five domains considered for this scoping review, mental health and cognition and memory were the most represented domains in the studies. Overall, healthy aging among autistic older adults is largely understudied. More research is needed to better identify and tailor interventions and services for autistic older adults and their families to support healthy aging.
HEARING LOSS AND HOSPITALIZATION IN OLDER ADULTS: EVIDENCE FROM THE ATHEROSCLEROSIS RISK IN COMMUNITIES STUDY
Authors: Zhang Wuyang , Morales Emmanuel Garcia , Reed Nicholas
Published: December 2023

Hearing loss is highly prevalent among older adults and is associated with increased healthcare utilization. However, the majority of evidence relies upon self-report measures of hearing and hospitalization which are subjective to validity concerns. Using cross-sectional data from the Atherosclerosis Risk in Communities Study and linked Centers for Medicare and Medicaid Services (CMS) records (2016), we aim to investigate the association between objectively measured hearing loss and record-based hospitalization in a population-based sample. Among 1,330 older adults (Mean age: 79.3 years; Female: 57.8%; Black: 17.4%), hearing loss was measured using pure-tone audiometry and hospitalization outcomes, including occurrence of any hospital stays (yes/no); number of hospital stays; and duration of hospital stays, were ascertained from CMS records. In models adjusted for demographic, socioeconomic, and health characteristics, those with mild and moderate/greater hearing loss had 1.71 (95% CI: 1.13-2.58) and 1.87 (95% CI: 1.18-2.98) times higher prevalence of any hospital stay over 12 months; 2.23 (95% CI: 1.47-3.37) and 1.68 (95% CI: 1.04-2.71) times higher Incident Rate of multiple hospital stays, relative to those without hearing loss. Moreover, both groups had significantly longer durations of hospital stay (mild: Incident Rate Ratio [IRR]=2.41; 95% CI: 1.46-3.98; moderate/greater: IRR=2.32; 95% CI: 1.32-4.07). Using criterion exposure and outcome measures, these findings confirm previous work and provide the first insight into the association of hearing loss with increased inpatient service use. Future work should focus on accommodations for hearing to reduce healthcare utilization and design equitable healthcare systems that meet the needs of all older adults.
HOLISTIC ASSESSMENT OF NURSING HOME RESIDENTS PREDICTS QUALITY OF LIFE AND PERCEPTION OF CARE
Authors: Ertle Emilee , Simon Darby , Mast Benjamin , Meeks Suzanne
Published: December 2023

The traditional medical model employs a problem-focused approach to assessment and care, but recent research emphasizes holistic assessment to facilitate person-centered care. The current study examines whether holistic assessment of problems and strengths can predict quality of life (QoL) and perception of care (PoC) of long-term nursing home residents. Sixty-six long-term nursing home residents were tested at time of admission, and at three and six month follow-up. Problem-focused measures were cognition, illness severity, depression, frailty, and anxiety. Strength-focused measures were hope, optimism, and social support. QoL at three months was correlated with anxiety (r=-.47, p=.001) and social support (r=.33, p=.047). At six months, QoL was correlated with anxiety (r=-.53, p<.001) and illness severity (r=-.30, p=.042). PoC at three months was not correlated with any problem-focused measures; it was correlated with optimism (r=-.38, p=.014), hope (r=.416, p=.008), and social support (r=.37, p=.036). PoC at six months was correlated with hope (r=.41, p=.009). Variables with significant correlations were selected for regression analysis; hope and optimism were combined into a single positive outlook variable. Anxiety was the only significant predictor in the regression model for QoL at three months. Anxiety and positive outlook were significant predictors of QoL at six months and PoC at three months. Positive outlook was the only significant predictor in the model for PoC at six months. Traditional problem-focused measures alone may provide insufficient information to predict well-being. Older adults’ strengths, particularly hope and optimism, may predict QoL and PoC in the months following nursing home admission.
HOSPITALIZED AFTER A FALL: EXAMINING THE IMPACT OF INPATIENT GERIATRIC POLYPHARMACY REVIEW AND DEPRESCRIBING
Authors: Gangupantula Pratima , Cooney Alissa
Published: December 2023

Falls are reported in 1 out of 3 older adults (≥65 years old) annually. While there are many modifiable factors contributing to falls in OA, polypharmacy increases risk of falling as well as recurrent falls by 1.5-2x. In an acute inpatient setting, geriatricians can evaluate an OA’s medications to ensure these medications are indicated and potential benefits outweigh potential risks. Little is known regarding the impacts of deprescribing (including discontinuing, holding, or tapering medications) in the inpatient setting for OA admitted for falls. A retrospective chart review was conducted at a single academic institution from January 1st to June 30th 2023 to examine associated polypharmacy and deprescribing in OA hospitalized after a fall. The OA’s complete home medication list was obtained, geriatric consultation notes were reviewed to determine if deprescribing was recommended, and commonly deprescribed drugs were noted. Of the 283 OA meeting inclusion criteria, 238 (84.45%) OA experienced polypharmacy. Deprescribing recommendations were given to 203 (84.94%) of OA experiencing polypharmacy. 54.39% of OA had ≥1 medications discontinued, 71.13% of OA had ≥1 medications held, and 23.85% of OA had ≥1 medications tapered. Commonly deprescribed drug classes included antihypertensives, non-steroidal anti-inflammatory drugs, proton pump inhibitors, and opioids. Pantoprazole, aspirin, omeprazole, and zolpidem were the most commonly deprescribed Beers criteria medications. Polypharmacy is associated with deprescribing in older adults admitted for falls. Future studies should examine whether deprescribing recommendations were followed by healthcare providers when given in an inpatient setting and whether deprescribing contributes to decreased fall risk over time.
HOW DOES EXECUTIVE FUNCTION IMPACT ADHERENCE AND COMPLIANCE TO NOVEL PHYSICAL THERAPY INTERVENTION AMONG VETERANS?
Authors: Ogawa Elisa , Harris Rebekah , Ward Rachel , Palleschi Mary-Kate , Milberg William , Gagnon David , Halasz Ildiko , Bean Jonathan
Published: December 2023

Executive function problems may make it difficult for a person to adhere to and comply with Physical Therapy (PT) treatment. This study examined adherence and compliance to a novel PT intervention among Veterans with and without executive function deficits (EFD+/EFD-). This study was a preplanned secondary analysis of an ongoing Randomized Controlled Trial among middle to older Veterans (≥50yrs) with slow walking speed. Participants’ adherence (dropouts) and compliance (attendance, post-treatment exercise) to 8-week PT treatment were evaluated based on their baseline EFD status. Seventy-two participants were included in this study (mean age 72) and 22% (n=16) were EFD+. Veterans with EFD+ at baseline had worse mobility both objectively (Short Physical Performance Battery, 7.7 ± 1.9 vs. 9.5 ± 2.2, p< 0.01) and subjectively (Activity Measure for Post-Acute Care (AM-PAC), 57.6 ± 4.7 vs. 62.2 ± 5.7, p< 0.01). Dropout rates for EFD+ and EFD- were 44% and 25%, respectively. In the multivariable logistic regression, dropouts were associated with pain interference, depressive symptoms, mobility, and living alone. There were no differences in treatment attendance or post-treatment exercise compliance based on EFD status measured by number of attended sessions or number of post-treatment exercise days. In conclusion, EFD+ was associated with poor mobility and higher rates of dropping out. Screening for EFD is critical and may assist in predicting individuals who will need more support to enhance mobility.
HOW REAL IS THIS DEAL? EVALUATING AI ACCURACY IN PROVIDING SUPPORT TO DEMENTIA CAREGIVERS
Authors: Ross Jeanette , Reilly Elizabeth , Sanchez-Reilly Sandra , Arevalo-Flechas Lyda , Dentchev Alexander
Published: December 2023

Background

Dementia, a devastating and incurable disease, affects millions of older Americans, placing astronomical levels of burden on caregivers, who usually lack resources to learn to provide their loved ones with high-quality care. Artificial Intelligence (AI), a programmed pioneering resource to generate immediate automated responses, is universally available when one looks for potentially accurate answers. Objective: To evaluate accuracy of AI sites pertaining to questions related to dementia caregiving

Methods

AI sites (ChatGPT and Textero.ai) were asked questions about dementia caregiving aspects such as self-care, patient symptoms/complications, stress control and managing expectations. Dementia caregiving experts reviewed and classified responses using the validated Zarit Caregiver Burden Scale (ZCBS) as framework. Inter-reliability scores were calculated among reviewers’ responses.

Results

AI sites responded in paragraph and list formats. Common themes identified by reviewers from both AI sites included self-care suggestions and seeking/accepting help. Several ZCBS aspects were not addressed by both sites such as guilt, exhaustion, negative emotions, and patient’s dependence. Textero.ai obtained lower scores addressing ZCBS, specifically not addressing potential caregiver’s unreasonable expectations. Inter-reliability score (reviewers) was 0.91 (highly significant).

Conclusions

In evaluating varied aspects of caregiving, results showed that AI sites, as it pertains to dementia caregiving are promising resources for accurately emphasizing caregiver’s self-help encouraging positive thoughts. However, validation and exploration of negative feelings and emotions within AI sites might not be properly addressed for dementia caregivers. Further studies need to further explore the use of AI in combination with hands-on dementia interventions to validate all aspects of caregiving.
HYPERTENSION SELF-CARE AMONG MEDICARE BENEFICIARIES WITH SELF-REPORTED HEARING TROUBLE
Authors: Wallace Laura , Reed Nicholas
Published: December 2023

Hearing loss is common in older adults and frequently comorbid with chronic illnesses like hypertension, which requires self-care practices learned through patient-provider health communication. However, hearing loss is a barrier to communication. This cross-sectional analysis used the 2020 Medicare Current Beneficiary Survey of (N=11,587; weighted estimate, 51.8 million) to characterize hypertension self-care outcomes (measuring blood pressure, taking blood pressure medications, reducing alcohol, and confidence in blood pressure control) by hearing status among Medicare beneficiaries ages >65. In the sample, 39% reported a little and 6% reported a lot of trouble hearing while 66% reported having received a hypertension diagnosis. In models adjusted for sociodemographic and health variables, Medicare beneficiaries with a little trouble hearing (OR=0.84 95% CI=0.72-0.97; P=0.02) and a lot of trouble hearing (OR=0.74; CI 0.57-0.95; P=0.02) had 16% and 26% reduced odds of reporting confidence in hypertension control compared to beneficiaries with no hearing trouble. Similar results were found when excluding hearing aid users (a little trouble hearing OR=0.85; CI=0.72-1.01; P=0.06; a lot of trouble hearing OR=0.69; 95% CI=0.52-0.91; P=0.01). No significant difference was found for other self-care outcomes. To the authors’ knowledge, this is the first characterization of hearing difficulty and hypertension self-care and findings align with previous work suggesting hearing loss may be a barrier to vital health communication. Future work should focus on examining self-care activities across chronic illnesses, temporal relationships, and designing population-appropriate interventions to improve self-care understanding among adults with hearing loss.
IDENTIFYING THE RELATIONSHIP BETWEEN ALZHEIMER’S DISEASE PREVALENCE AND CURRENT SERVICE USE IN OHIO’S 88 COUNTIES
Authors: Nelson Matt , Menne Dr Heather
Published: December 2023

Recently released data reveals that over 235,000 people over the age of 65 have Alzheimer’s disease and related dementia (ADRD) in Ohio. Using 2020 data from the National Center for Health Statistics, county-level specific ADRD prevalence estimates for Ohio’s 88 counties were also prepared (Range: 9.4-13.4 per 1000 individuals 65+). Researchers, practitioners, and policy-makers can use these estimates to better understand the reach and impact of ADRD in local communities. Nationally and in Ohio, care and support for older adults and specifically older adults with ADRD typically falls to family caregivers, home- and community-based service (HCBS) providers, and residential care providers such as nursing homes. This study pairs the county-level ADRD prevalence data with county-level data on available services (e.g., Memory Care Units, nursing home beds) and service users (e.g., HCBS users). The 10 counties in Ohio with the highest prevalence rates are home to nearly 60% of the 65+ population statewide. Additionally, these counties had a significantly higher proportion of older Black/Hispanic individuals than the other counties (10.8 versus 2.9). When looking at capacity, the top 10 counties contained just 12% of all nursing home beds, but 54% of nursing homes memory care units for the entire state. When considering service use, these 10 counties served a smaller percentage of the state’s HCBS users (13%). For Ohio and other states, it is important to explore available services and current service usage when faced with the increasing estimates of people living with ADRD.
IMPACT OF HEALTHY LIFESTYLE FACTORS ON LIFE EXPECTANCY AND LIFETIME HEALTHCARE COST: A NATIONWIDE COHORT STUDY
Authors: Lo Wei-Cheng , Hu Tsuey-Hwa , Shih Cheng-Yu , Lin Hsien-Ho , Hwang Jing-Shiang
Published: December 2023

In an aging society with increasing life expectancy, the significance of healthy behaviors has garnered considerable attention. Research indicates that adopting healthy behaviors not only contributes to a longer life expectancy but also leads to reduced healthcare expenditure. Our study aims to investigate the impact of individual and combined healthy lifestyle factors on life expectancy and lifetime healthcare expenditure in Taiwan. Analyzing data from the National Health Interview Survey cohort, we examined five healthy lifestyle behaviors: nonsmoking, avoiding excessive alcohol consumption, regular physical activity, sufficient fruit and vegetable intake, and maintaining a normal weight. By employing a rolling extrapolation algorithm, we estimated the lifetime survival function of the study cohorts and calculated the life expectancy and lifetime healthcare expenditure of populations with and without healthy lifestyle factors. Our analysis of 19,893 participants aged 30 and above revealed that adopting a healthy lifestyle is associated with longer life expectancy and reduced healthcare expenditure in Taiwanese adults. Participants adhering to all five behaviors gained 11.93 years in life expectancy compared to those with none, with an annual average healthcare expenditure reduction of $7,308. Smoking and diet were the most significant risk factors for shorter life expectancy, with current and former smokers experiencing a 4.02-year reduction and individuals with sufficient fruit and vegetable intake gaining 3.69 years compared to those with insufficient intake. These findings offer a comprehensive understanding of the impact of healthy lifestyle factors on overall health and economic burden, providing evidence-based guidance for policymakers and stakeholders in promoting healthy aging.
IMPACT OF THE TEACHING NURSING HOME ON STAFF SATISFACTION AND BURNOUT
Authors: Degenholtz Howard , Dunbar-Jacob Jacqueline , Ratliff Kim , Fick Donna , Dickson Chelsea , Campbell Kenna , Kitt-Lewis Erin , Franke Emily
Published: December 2023

The Teaching Nursing Home (TNH) is designed to improve the long-term care workforce and improve quality of care in nursing homes (NHs). The initiative is guided by an academic-practice partnership with mutual respect and shared learning and has multiple components: enhanced clinical rotations for nursing students with partner schools of nursing, implementation of the Institute for Healthcare Improvement Age-Friendly Health System “4M” quality improvement model, and an online learning network. Following the principles of participatory research, NH staff were engaged in the selection of outcomes and in decisions regarding data collection. The University of Pittsburgh collected staff satisfaction at two nursing homes, and burnout at three NHs. Baseline surveys were conducted in the winter of 2022 using a combination of web-based and in-person paper administration, and follow-up surveys were collected in 2023, one year after implementation. Response rates ranged from 14% to 54%. A total of 190 surveys were available at baseline, and 183 at follow-up. All surveys were anonymous; cross-sectional analyses were conducted to identify trends. Baseline burnout scores varied considerably across the three participating NHs and improved at two of the three NHs (p = .0000). By contrast, job satisfaction was unchanged in one NH and declined in one NH across two dimensions (p= .0058; p = .01216). After the first year of implementation, the TNH program is showing some benefit in terms of reducing burnout, a factor associated with turnover. As the Age-Friendly NH program is disseminated, it is important to track the impact on the workforce.
IMPORTANT IMPROVEMENTS TOWARD EQUITY IN PROSTATE CANCER SURVIVAL BETWEEN WHITE AND BLACK MEN
Authors: Merrill Ray , Gibbons Ian
Published: December 2023

Prostate cancer survival is significantly influenced by tumor stage, age, and marital status at diagnosis. There is also evidence that cases diagnosed prior to age 40 and after age 80 years have a poorer prognosis. While Blacks have historically had lower prostate cancer survival than whites, it is not clear whether this difference still exists and if it varies across the levels of tumor stage, age, or marital status at diagnosis. These issues are addressed in this study. Analyses are based on Surveillance, Epidemiology, and End Results (SEER) data to obtain 5-year relative survival (5-YRS) estimates. Cases reflect 2000-2015 and follow-up extends through 2020. Over the study period 5-YRS decreased for Whites and increased for blacks, such that by 2015 the 5-YRS was about the same between races. Multiple regression models with race, age, and marital status simultaneously estimated showed that 5-YRS in Whites versus Blacks was not significantly different for local/regional stage or distant stage. 5-YRS in married (or living with a partner) was 3.02 higher for local/regional stage but not significant for distant stage. 5-YRS was significantly lower in the age groups < 40 and ≥80 for local/regional stage but were highest in the age group < 40 and significantly fell with older age for distant stage. Race did not modify the relationship between 5-YRS and tumor stage, age, or marital status at diagnosis. Thus, while tumor stage, age, and marital status at diagnosis are important predictors of 5-YRS for prostate cancer, White and Black inequality no longer exists.
INCIDENCE AND DYNAMICS OF MOBILITY DEVICE USE AMONG COMMUNITY-DWELLING OLDER ADULTS IN THE UNITED STATES
Authors: Liu Xinran , Baumann Sara , Rosso Andrea , Venditti Elizabeth M , Yao Yao , Albert Steven
Published: December 2023

Mobility devices significantly enhance the activities and participation for individuals with mobility disability, particularly in the rapidly expanding population of older adults globally. This research reports patterns of mobility device use among community-dwelling older adults in the United States. Using the National Health and Aging Trends Study (NHATS) waves 1-9, data on basic demographics and mobility device use were collected in a nationally representative group of community-dwelling older adults (65+ years old). Mobility device use included canes, walkers, wheelchairs, and scooters. In a total of 47,722 person-years observed in community settings, 2,943 incident mobility device uses over an average of 3.8±3.0 years were identified among 2,591 participants, with an incidence rate of 61.7/1,000 person-year. Participants had an average age of 80.3±7.2 years, with 57.7% female, 70.2% White, 20.1% Black, and 5.7% Hispanic, and 34.6% living alone. The majority (51.3%) of incident mobility device use lasted no longer than one year, and only 18.6% continued for four or more years. The most popular combinations of mobility device types were cane only (44.3%), cane+walker (15.7%), walker only (15.1%), and walker+wheelchair (8.3%). 30.5% of community-dwelling older adults changed their patterns of mobility device use at least once, with the most common changes including cane only to cane+walker (16.4%), cane+walker to cane only (7.97%), walker only to walker+wheelchair (5.2%), and cane+walker to walker only (5.1%). Mobility device use among community-dwelling older adults is dynamic: use of mobility devices involves mostly short bouts and changes frequently, with a preference for a combination of mobility devices.
INHIBITION OF AUTOPHAGY RESTORES IMMUNOMODULATORY CAPACITY OF SENESCENT MSCS VIA COX-2/PGE2 PATHWAY
Authors: Ma Yang
Published: December 2023

Mesenchymal stem cells (MSCs) have been increasingly utilized in many therapeutic applications including autoimmune diseases and tissue repair due to their regenerative and immunomodulatory capacity. In vitro expansion will cause cell senescence and compromise their therapeutic effect. Therefore, underlying mechanisms of MSCs senescence during in vitro culture and methods of enhancing their therapeutic capacity need to be explored. Autophagy is a key regulator of biological properties of MSCs and is highly related to aging process. Whether manipulation of autophagy could restore immunomodulatory capacity of senescent MSCs after in vitro culture is still unclear. We demonstrated here that autophagy was significantly increased in aged MSCs compared with young MSCs. Inhibition of autophagy by BafA and CQ enhanced their immunomodulatory capacity of eliciting M2 polarization of macrophages. COX-2/PGE2 pathway was activated by inhibition of autophagy in this process. Inhibition of COX-2/PGE2 pathway of aged MSCs by SC-236 abandoned the enhanced immunomodulatory capacity of aged MSCs. Inhibition of autophagy by CQ of aged MSCs also increased their therapeutic capacity in cutaneous wound models of rats by increasing their capacity of eliciting M2 polarization of macrophages. Taken together, this work indicates that inhibition of autophagy of MSCs after in vitro expansion could ameliorate senescence-related changes in MSCs and enhance their immunomodulatory capacity. This may represent a potential therapeutic avenue to clinical application of MSCs.
INTEGRATING HOME HEALTH IN AN INTEGRATED CARE SYSTEM: VETERAN EXPERIENCES WITH A VA PILOT PROGRAM
Authors: Davila Heather , Good Mary , Seaman Aaron , Walkner Tammy , Roman Irene San , Benzel Heather , solimeo Samantha
Published: December 2023

The Veterans Health Administration (VA) serves nearly 3 million Veterans aged 65 and over, 350,000 of whom use skilled home health (e.g., nursing, rehabilitation therapy) or homemaker/home health aide services annually. Despite being the nation’s largest integrated healthcare system, VA has traditionally purchased home health services from contract agencies. Coordinating care between VA and contract agencies is an ongoing challenge, and accessing home health has become increasingly difficult, especially in rural areas. To address these challenges, the Iowa City VA launched VA’s first “VA Home Health” (VAHH) program in 2021. In 2022, the VA Midwest Health Care Network (VISN 23) expanded VAHH to three additional sites, with over 700 Veterans served to date. We interviewed Veterans receiving VAHH who had previously used contract services (n=30) to learn about their care experiences. Veterans described multiple benefits of VAHH over contract services: staff’s access to VA electronic health records, mechanisms for quickly sharing information with other care providers, understanding of Veterans’ unique care needs (e.g., PTSD), and knowledge of the breadth of services VA offers. Most Veterans said they were highly satisfied with VAHH, with many expressing a desire for VAHH to expand and serve more Veterans. Our preliminary findings suggest VAHH may improve Veterans’ experiences with care and overall quality of care. Given VA’s focus on expanding Veterans’ access to home-based services, these preliminary findings could inform national VA decisions surrounding home health delivery. Our findings are also relevant to other healthcare systems as they address similar coordination and access challenges.
KINLESSNESS, RACE, AND QUALITY OF CARE AT THE END OF LIFE: FINDINGS FROM NATIONAL HEALTH AND AGING TRENDS STUDY
Authors: Pei Yaolin , Qi Xiang , Zhu Zheng , Wu Bei
Published: December 2023

Close family members provided the majority of end-of-life (EOL) caregiving. The number of older adults who are kinless (without close family/partnerships) are increasing. We therefore examined the association between kinlessness and quality of EOL care among older adults, and the moderating role of race in this association. Data were derived from the combined Round 2 to Round 11 of the National Health and Aging Trends Study. 3066 older adults who aged 65 and above and were living in the community or residential care at last interview were included in the working sample. Kinlessness was defined as lacking children and a spouse/partner. The primary outcome was quality of care at the end of life. Logistic regression models ware used to examine the association between kinlessness, race, and quality of care at the end of life. A total of 8.0% of decedents were kinless at the end of life. Kinless older adults were less likely to receive excellent EOL care than those with kin. Having at least one child or spouse/partner weakened race disparities in EOL care quality among older adults. These results point to a significant disadvantage for the minority kinless older adults, who had worse EOL care quality. Practice interventions may include a culture match between older adults and providers. Form a policy standpoint, guardianship is needed to enable kinless older adults to receive high-quality EOL care.
LEVERAGING CONSUMER HEALTH TECHNOLOGIES TO ENGAGE CARE PARTNERS OF OLDER ADULTS WITH DEMENTIA
Authors: Smith Jamie , Cassidy Jessica , Riffin Catherine , Wolff Jennifer , Lum Hillary
Published: December 2023

Care partners are critical in supporting the complex health needs of older adults with dementia; the importance of their role increases with disease progression. Despite their extensive involvement in dementia care, care partners are not systematically identified or supported in healthcare settings. Consumer health information technology (CHIT) affords a largely untapped opportunity to formalize dementia care partner identification and engagement in healthcare delivery. One example is OurNotes, a portal-based agenda-setting questionnaire that allows patients to submit concerns for discussion ahead of medical visits. In a proof-of-concept study, OurNotes was first adapted to elicit the identity of the person completing the form and clarify their relationship to the patient, and subsequently piloted at an academic geriatric practice. Semi-structured interviews were conducted with 15 care partners to elicit their perceptions of the adapted OurNotes (utility, benefits, challenges) and suggestions for refinement. Transcripts were analyzed using deductive, thematic analysis. Care partners’ perceptions of the tool were overwhelmingly positive. Major benefits included enhancing their feelings of preparedness for the visit, having a voice to express concerns, and streamlining visit communication. The most commonly endorsed challenge was the time required to complete the adapted OurNotes in addition to routine check-in items. A primary suggestion was to enable the submitted OurNotes responses to be edited/updated. Findings suggest that the adapted OurNotes is an acceptable approach to identifying care partners in the dementia context. Refinements may further facilitate visit efficacy through preparedness. Future research will examine CHIT engagement on patient and care partner outcomes.
LGBTQ+ INCLUSIVITY TRAINING AND EDUCATION FOR SKILLED NURSING FACILITIES
Authors: May Jennifer , Domeracki Alexis , Ashar Perisa , Hart Foxx , Wheeler Jason , Salgado Glaucia , Wang Melanie
Published: December 2023

The population of older adults is growing in the United States, leading to greater need for specialized care offered by skilled nursing and long-term care facilities. Among older adults that require specialized health care, lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) older adults are more likely to experience health disparities and health care barriers due to lifelong discrimination and exclusion. Healthcare workers within skilled nursing facilities (SNF) have expressed they do not feel prepared to care for LGBTQ+ older adults. The aim of this research was to develop the LGBTQ+ Inclusivity Training and Education (LITE) toolkit to provide information to healthcare workers, staff, residents, and their families in the SNF environment. Phase 1 used a community engaged approach to develop the LITE toolkit through engagement with an LGBTQ+ Community Advisory Board. Phase 2 was the implementation and evaluation of the LITE toolkit with 25 SNFs throughout North Carolina. The majority of SNF healthcare workers and staff (N=20) who responded to the survey indicated that the LITE toolkit was “easy to use,” they were satisfied with the contents, and that it would improve the way they care for patients. Providing LGBTQ+ focused education for members of the SNF community addresses the need for healthcare worker and staff training, thereby contributing to equitable care and inclusive environments for the LGBTQ+ older adult community. Additional work focused on understanding the facilitators and barriers to using the LITE toolkit in the SNF setting is needed.