bluuebunny/crossref_metadata_2025 huggingface dataset:
ENGAGEMENT OF FAMILY/CARE PARTNERS OF OLDER ADULT LONG-TERM CARE RESIDENTS WITH PHYSIOTHERAPISTS: A SCOPING REVIEW
Authors: Connelly Denise , Stephen Alexander , Guitar Nicole
Published: December 2023

The aim of this scoping review was to summarize and critically evaluate literature describing the relationship between physical therapists and family/care partners of older adults living in long-term care homes. A librarian-informed search strategy was applied to Medline, EMBASE, Proquest, PsychINFO, SCOPUS and CINAHL databases. Papers were included if they addressed rehabilitation, physical therapists, family/care partners, and long-term care (LTC) setting or equivalent. Five papers were retrieved; quality was mid-to high. Challenges included minimal integration of family/care partners into the long-term care home ’team’, inconsistent resident-centred health goals across staff, and lack of awareness about availability of physical therapy services within long-term care homes. Value for family/care partners as members of the health care team included their historical knowledge of their loved one, ability to perceive and manage behaviour change, signs/symptoms of pain by their loved ones with impaired communication (e.g., dementia diagnosis), and the resource of time and availability to engage in rehabilitation-related care activity. There is little information about partnership with family/care partners of older adults living in long-term care homes. The timing is optimal to explore the engagement of family/care partners in providing care and building rehabilitation capacity within the context of increasing nursing workloads, nurses’ experience of burnout, difficulty in attraction and retention of care staff in long-term care homes, and challenges in funding for and standards in provision of optimal rehabilitation for older adult residents of long-term care homes.
EXAMINING VETERANS’ CHOICES OF HIGH-QUALITY MEDICARE SKILLED HOME HEALTH CARE AGENCIES
Authors: Kennedy Katherine , DeVone Frank , Corneau Emily , Cornell Portia , Gozalo Pedro , Magid Kate , Jones Christine , Thomas Kali
Published: December 2023

Medicare-certified skilled home health helps Veterans restore function post-hospitalization. Our objective was to understand the quality of VA contracted home health agencies (HHAs) available to Veterans (i.e., had at least 1 VA-paid episode of care in the 12 months) relative to the local market. For comparison, about one-third (30.4%) of traditional Medicare beneficiaries received care from high-quality HHAs (4- or 5-stars on quality of care) in 2015 (Schwartz et al., 2019). We used the Home Health CAHPS (Consumer Assessment of Healthcare Providers and Systems) 2016-2019 quarterly patient experience of care overall ratings (possible values: 1-5) to define a high-quality agency as those with 4- or 5-star ratings. We matched the quarterly ratings with the discharge date from a VA Medical Center to create HHA choice sets per eligible Veteran discharge. A choice set contains all contracted and non-contracted HHAs that serve a Veteran’s Zip Code. Among HHAs proximal to Veterans’ homes across all years (N= 10,507 unique HHAs), 54.8% were high-quality (n=12,449 HHA-years), 30.1% were 3-star quality (n=6,835 HHA-years), and 15.1% were low-quality (1- or 2- stars) (n=3,444 HHA-years). Among discharges, 53.2% (n=28,081) of the discharges went to high-quality HHAs and 15.7% (n=8,294) went to low-quality HHAs. Veterans tended to live in areas with access to high-quality home health care, and most discharges mapped to high-quality HHAs. However, there is room to improve Veterans’ access to high-quality skilled home health and more to understand about VA contracting practices and the HHA selection process.
TOOLS FOR MEASURING PERSON-CENTERED CARE FOR OLDER ADULTS IN LONG-TERM SERVICES: A SCOPING REVIEW
Authors: Akter Nahida , VanHaitsma Kimberly
Published: December 2023

Person-Centered Care (PCC) involves individuals in their care planning and decision-making. Measuring PCC is crucial in identifying the adequacy of PCC dimensions, which can then be used to promote quality of care and life, yet a comprehensive review of evidence on PCC measurement tools in long-term service and support settings (LTSS) is lacking. Our study aims to identify and evaluate available tools for measuring PCC for older adults in LTSS. This review followed the Arksey and O’Malley (2005) five-stage approach for scoping reviews and search was conducted in PubMed and CINAHL using selected keywords. The inclusion criteria were peer-reviewed journal articles written in English, reporting on PCC measurement tools for older adults (≥ 65 years) living in LTSS. Tools intended for use by family members and gray literature were excluded. Articles (n=23) were chosen from 914 studies after reviewing titles, abstracts, and full texts by two reviewers. They revealed 10 distinct tools for measuring PCC in LTSS, categorized as non-observational (e.g., interview, self-report) and observational (e.g., structured observation). The psychometric properties (reliability and validity) of the tools were reported, and their applicability in different cultural contexts was discussed. Many tools (n=8) demonstrated good reliability and validity, and their applicability was evident in multiple countries (e.g., Spain, Japan, Sweden, China, Italy and Norway). Our study adds to the discussion on PCC measurement tool development as it identifies gaps (e.g., lack of harmony between tools) for future researchers and potential areas for development by policy makers and administrators.
ENGAGING OLDER ADULTS AND CAREGIVERS AS STAKEHOLDERS IN THE ARTIFICIAL INTELLIGENCE AND TECHNOLOGY COLLABORATORY
Authors: Jain Paavani , Schoenborn Nancy , Cudjoe Thomas
Published: December 2023

Artificial Intelligence (AI) holds the unique potential to capture older adult functional and behavioral diversity and improve geriatric care. Yet a gap exists between new technologies and the real-world needs of their target populations. Currently in the United States, three Collaboratories support novel AI projects in Aging Research. As the Stakeholder Engagement Core of the Johns Hopkins AI Collaboratory, in this poster, we share early lessons of forming a ‘Council’ of stakeholders – a group with the charge of informing pilot AI projects longitudinally. The Council was envisioned to include 10-15 persons: older adults, caregivers, and clinicians. We adopted different outreach techniques for clinicians versus non-clinicians; leveraged existing relationships with affiliated Memory and Social Clinics; individually approached community dwelling older adults and caregivers including homebound older adults and older adults with disabilities; and reached out to clinicians and advocates known to be committed to geriatric care. We developed plain language materials and explained the meaning of ’AI’ and ’Stakeholder Engagement’. Five out of 5 outreached clinicians, and 10 out of 20 older adults/caregivers agreed to serve on the Council. Many older adults on our Council had difficulty using their email and computer and required support. Several caregivers declined due to high caregiving demands and many older adults with multiple chronic conditions declined due to high personal needs; all reiterated their interest in the topic area despite declining participation. Future novel-technology projects should ensure inclusion of diverse stakeholders; incorporating a flexible plan of engaging high-needs older adults and caregivers is required.
SOCIOCULTURAL BARRIERS TO EQUITY IN SOCIAL SUPPORT FOR DEMENTIA CAREGIVING IN MINORITY WOMEN
Authors: Kim Heejung , Kim Hyein , Brewster Glenna , Chee Wonshik , Im Eun-Ok
Published: December 2023

Racial and ethnic minority is growing in dementia caregiving population. This study aimed to identify racial/ethnic differences in social support and sociocultural factors related to caregiving among minority midlife women who were family caregivers of persons living with Alzheimer’s disease (MWPLAD). A secondary data analysis was conducted using the data from a cross-sectional online survey of 172 MWPLADs. Self-report questionnaires were used to collect the data on the caregivers’ sociodemographic and caregiving-related characteristics, social support for caregiving, and sociocultural factors for caregiving. Descriptive statistics, one-way analysis of variance, and hierarchical linear regression were adopted for the data analysis. Non-Hispanic Asian caregivers reported lower social support and greater perceived barrier during dementia caregiving than non-Hispanic African-American and Hispanic caregivers (p ≦ .001). Furthermore, non-Hispanic Asian caregivers reported a higher level of discrimination during caregiving, a lower level of cultural justification for reciprocity, and a lower level of cultural justification for duty than non-Hispanic African-American caregivers (p < .001). After controlling for race/ethnicity and sociodemographic factors, those who received more social support were younger, experienced a lower level of discrimination, and had a higher level of cultural justification for caregiving duties (p < .05). Our study findings support that racial/ethnic differences exist in caregivers’ social support. When enhancing social support among racial/ethnic minority caregivers for dementia, it is necessary to develop specific strategies for encouraging each race/ethnicity group in further large-scale studies and clinical practice in the future.
Fall Prevention Model at Local Non-Profit Equipment Exchange Program Utilizing the STEADI: a Compilation of Two Pilot Studies
Authors: Lewis Constance , Probst Karen , Tanilli Rachel , Schoenfeld Alix
Published: December 2023

Individuals picking up gently used durable medical equipment (DME) from a local non-profit equipment exchange program in Erie, Pennsylvania were prompted with the CDC’s Stopping Elderly Accidents, Deaths & Injuries (STEADI) 3-item abbreviated questionnaire and contacted by telephone 6 months later to assess if this survey tool can accurately predict falls. Individuals were also given a STEADI pamphlet upon equipment pickup to educate community members on fall risk. Ninety individuals, who ranged from caregivers to the individual themselves, chose to participate in the follow-up research phone call. Our researchers found that while the abbreviated 3-item STEADI suggested that 80% of community members (in need of DME by way of an equipment exchange program) were predicted to be at risk for a fall, only 22.5% suffered a fall within a six-month follow-up period. This questions the validity of the 3-item abbreviated STEADI, though additional studies are recommended to improve the participant percentage (only 90 out of 255 individuals, or 35%, answered the follow-up call questions) as well as increasing the length of wait time to assess for subsequent fall incident beyond six months. Additionally, only 34% of individuals recalled receiving a pamphlet when picking up equipment, and of those 31 individuals, only 10 of them (32%) remembered what the pamphlet said. This suggests that the simple use of a brochure handout to decrease fall risk amongst community-dwelling adults does not seem to be an effective educational strategy within the Erie, PA community.
RECRUITMENT AND RETENTION AMONG A LONGITUDINAL COHORT OF AGING ADULTS: EXPERIENCES OF THE WOODLAWN STUDY
Authors: Bugbee Brittany , Doherty Elaine , Green Kerry
Published: December 2023

Minimizing participant attrition is critical to the success of longitudinal studies, but locating and retention is challenging when assessments occur decades apart. This poster will describe efforts to locate participants from the Woodlawn Study, a longitudinal cohort of 1,242 Black Americans followed since 1966 who were assessed at ages 6, 16, 32, and 42. In 2021-2023, two decades since the last assessment, we attempted to locate 1038 participants still thought to be alive to complete an Age 62 interview. Key sources for locating were online contact information databases, genealogical records, and public property records. Deceased participants were identified via National Death Index records. Strategies to encourage participation included monetary incentives, flexible scheduling options, and sharing results from previous assessments. To date, 90.8% have been located, 2.5% are unlocatable, and 6.6% have been identified as newly deceased. Although the cohort originated in Chicago, participants were located in more than 25 states. Interviews were completed with 45.7% of located participants. Approximately one-third (37.7%) did not respond to contact attempts, 6.4% were hard refusals, and 10.3% were soft refusals. Mailed letters and phone calls were the most successful contact methods; social media and email were not fruitful. Interview completion rates were highest for participants who participated at Age 42 (51.4%) and lowest among participants not reached since Age 6 (5.3%). Recruitment challenges included non-response to phone calls, suspicion about scams, and unknown accuracy of locating information. Implications for locating and maintaining aging cohort members will be presented.
AGE-FRIENDLY COMMUNITIES IN THE ANDES: CONSIDERATIONS TO IMPROVE UPTAKE
Authors: Guillemot Jonathan , Warner Mildred
Published: December 2023

Despite the demographic aging of the Global South, the uptake of WHO’s age-friendly cities framework remains extremely low. The Andean region of Latin America is currently represented by only four cities, out of more than 1,400 globally. Causes may include the partial inadequacy of the eight WHO domains for communities in the Andean region. We argue for a broader human ecological framework to address the macro, meso and micro levels to better address the context, challenges and opportunities for age-friendly cities in the Andean region. WHO’s age-friendly city domains are focused primarily at the meso (community) scale – on built environment, services and participation. We call for more attention to the macro policy scale, in societies where robust social security systems cannot be assumed. We also call for more attention to the micro scale, to recognize the critical role of family and informal care supports. We question whether the WHO domains are the result of a design bias, with Global North settings in mind for its development. We find the domains of UNICEF’s child-friendly cities initiative, which give more attention to the realities of the Global South, helpful to broaden WHO’s age friendly framework.
BARRIERS TO HEALTH CARE ACCESS AMONG UNDOCUMENTED IMMIGRANTS: PERSPECTIVE OF PALLIATIVE CARE HEALTH CARE PROVIDERS
Authors: Cardenas Valeria , Hulsebus Lindsey , Enguidanos Susan
Published: December 2023

Undocumented immigrants face numerous barriers to obtaining healthcare services, largely due to fear of deportation and limited access to health care. The purpose of this study was to learn about challenges and facilitators palliative care healthcare providers experience in caring for seriously ill undocumented immigrants and the factors affecting access to care in this seriously ill population. From November 2022 to January 2023, we conducted semi-structured, individual telephone interviews with 11 palliative care healthcare providers from two inner city hospitals in California. Our interview protocol elicited providers’ experience caring for undocumented immigrants, including the patients’ stage of illness when providers encounter them, referrals made by the healthcare team, and gaps in care they have witnessed for these undocumented immigrants. Transcripts were analyzed using thematic analysis. Themes related to provider perceived patient care-seeking behaviors and challenges include complications of postponing care, financial burden, fear of deportation, transportation, health literacy, lack of family support, lack of awareness and misperceptions of palliative care. Themes related to provider care challenges include language barriers, longer care process, and cultural barriers. Facilitators and recommendations include awareness of care options and reassurance, importance of social and community resources, expanded palliative care awareness, knowledge, and access, and improved cultural competence. Our findings underscore the need for intervention studies that focus on alleviating identified barriers for undocumented immigrants. Future studies are needed to elicit the perspectives of seriously ill undocumented patients.
UNDERUTILIZATION OF HOSPICE CARE IN OLDER BLACK ADULTS
Authors: Tate Channing
Published: December 2023

Hospice is underutilized in Black Americans despite evidence that Black Americans benefit from hospice services. There are several potential reasons hospice is underutilized in Black Americans including lack of knowledge of hospice, poor opinions of hospice, and low self-efficacy in end-of-life decision-making. Patient decision aids are one technique used to improve patient knowledge and agency in making medical decisions. This research project endeavored to addresses potential barriers to hospice enrollment in Black adults and evaluates if a hospice specific patient decision aid could improve hospice knowledge, opinions of hospice, and decision-making self-efficacy. The study was a pilot randomized controlled trial that enrolled Black adults aged ≥ 65 years. The three primary outcomes for the study included hospice knowledge measured by the Hospice Knowledge Scale, opinions of hospice measured by the Hospice Beliefs and Attitudes Scale, and confidence in making decisions measured by the Decision Self-Efficacy Scale. Additionally acceptability and usability outcomes of the decision aid were collected. All participants completed the three baseline surveys prior to randomization. Those randomized to the intervention were provided with the hospice patient decision aid while those in the control did not receive the decision aid. Hospice knowledge, opinions of hospice, and decision self-efficacy improved from baseline to one-month follow-up in the intervention group, but between group (intervention vs control) differences were not statistically significant. Overall acceptability outcomes were favorable, and participants stated the patient decision aid would be beneficial in facilitating hospice decision making.
THE DIRECT EFFECT OF COMMUNITY-LEVEL RISK FACTORS ON LUNG CANCER INCIDENCE IN FOUR NEW ENGLAND STATES
Authors: Jansen Taylor , Song Qian , Long-Foley Kristie , Dugan Elizabeth
Published: December 2023

Lung cancer is the most common cancer globally and 70% of diagnoses are among the 65+ population. This study identifies what town-level risk factors are contributing to geographic disparities in 65+ lung cancer in N=796 towns in Connecticut, Massachusetts, New Hampshire, and Rhode Island. Multiple spatial-based analyses (e.g., Moran’s I, Getis-Ord Gi*, mapping) were conducted before running a series of spatial regression models to determine the association between town-level risk factors (i.e., environmental exposures, respiratory conditions prevalence, education rates, smoke free legislation) and lung cancer incidence. Mapping and Moran’s I test suggested the 65+ rates of lung cancer in our sample were non-randomly distributed and clusters of high and low rates were present. A hot spot analysis was conducted in ArcMap 10.8 which identified several significant clusters of 65+ lung cancer. Spatial regression models showed that community rates of comorbid respiratory conditions (65+ asthma, COPD, and tobacco use disorder (TUD)) increased lung cancer incidence by 7%, while increasing ozone emissions were directly associated with a 10% increase in incidence. Comprehensive smoke free legislation coverage was significantly associated with lung cancer incidence, but no increasing or decreasing relationship was found. No effects were found for the percentage of 65+ with low education, or 60+ who were current or former smokers. Spatial regression models allow for results which are specific to the geographic sample used and this study suggests that comorbid respiratory conditions and ozone emissions are directly associated with increased rates of 65+ lung cancer incidence in our sample.
SOCIAL INTEGRATION, COGNITION, AND FUNCTIONAL OUTCOME IN OLDER ADULTS FOLLOWING TRAUMATIC BRAIN INJURY
Authors: Jung Wonkyung , Hoffman Jeanne , Byun Eeeseung , Thompson Hilaire
Published: December 2023

Persons aged 65 and older have the highest rates of traumatic brain injury (TBI), and this injury is known to be related to significant, persistent functional changes. What is not known is what factors may mediate these changes. The current study aimed 1) to examine interrelationships among social integration, functional outcome, and cognition in older adults at years 1, 2, and 5 post-traumatic brain injury (TBI) and 2) to examine if functional outcome mediates the concurrent and longitudinal relationships between social integration and cognitive function post-TBI in older adults. This is a secondary analysis of data obtained from Traumatic Brain Injury Model System National Database (TBIMS-NDB). Included subjects from the database were persons aged 65 years and older at the time of injury (N=1469). We used longitudinal mediation analysis to address study aims. We found that social integration had a direct effect on functional outcome and cognition at 1, 2, and 5-years post-TBI. Functional outcome had a positive direct effect on concurrent cognitive function. Regarding mediation, social integration and cognition were mediated by concurrent functional outcome. However, there were no significant mediating effects of concurrent functional outcome on concurrent social integration or subsequent cognitive function. Our findings suggest there are positive relationships between social integration, functional outcome, and cognition over time. With a better understanding of these interrelationships, tailored interventions that target social integration, such as activities fostering a sense of belonging in the community and cultural diversity programs may promote improved functional and cognitive outcomes.
SOCIAL ISOLATION OF OLDER ADULTS WITH AND WITHOUT PHYSICAL HEALTH CONDITIONS DURING COVID-19
Authors: Kilaberia Tina , Hu Yuanyuan , Ratner Edward , Bell Janice
Published: December 2023

Older adults have been disproportionately affected by COVID-19. This study examined health care utilization and social isolation during the pandemic among older adults using written surveys and zoom and phone interviews. We compared two subgroups, those reporting physical health problems (N=12) and those reporting no health problems (N=6). Half of those with physical health problems reported postponing routine or elected healthcare as compared to four (66%) in the subgroup without physical health problems. Seven of 12 (58%) older adults with physical health problems reported isolation specifically from decreased participation in church even though as many lived either in a retirement community or with family, suggesting greater environmental or social supports. This compares to two (33%) in the subgroup without physical health problems reporting isolation from decreased participation in church with only one older adult living in a retirement community. Interviews identified three themes that complement these data: avoiding danger, compound stress (reported only among those with health problems (N=4)), and church as the largest event. These findings suggest that those with physical health problems were less able to delay seeking healthcare, were more likely to feel isolated when unable to attend church services, and suffered from compound stress due to the combination of public health directives and social unrest, such as the George Floyd protests. Religious, faith, or spiritual supports may be important buffers against social isolation during public health emergency, especially for older adults with physical health conditions and when there is concurrent social unrest.
THE COGNITIVE DECLINE–MORTALITY ASSOCIATION IS MODIFIED BY LIVING ALONE AND SOCIAL NETWORK: A PARADOX OF ISOLATION
Authors: Murayama Hiroshi , Sugiyama Mika , Inagaki Hiroki , Ura Chiaki , Miyamae Fumiko , Edahiro Ayako , Okamura Tsuyoshi , Awata Shuichi
Published: December 2023

Cognitive decline (CD) is a well-known mortality risk. To date, modifiers of this relationship have been insufficiently investigated. This study explored the factors modifying the association between CD and all-cause mortality among older Japanese people. A baseline questionnaire was completed with all 132,005 residents, aged ≥65 years, without long-term care insurance certification in Adachi Ward of the Tokyo Metropolitan area in July 2015 (valid response: 75,358). The final analytic sample was 74,872, excluding 486 who reported a history of dementia (mean age = 73.7 ± 6.0 years; 44.9% males). We assessed CD using a self-administered dementia checklist that was validated via the Clinical Dementia Rating Scale. The survival analysis (average follow-up of 1,657 days) showed that CD was associated with a higher mortality risk (hazard ratio [95% confidence interval] = 1.40 [1.28–1.53]). We examined the interaction between socio-demographics, health behaviors/conditions, and CD on mortality. Only household composition and social network (SN; frequency of contact with others) demonstrated significant associations with CD. The stratified analyses showed that the CD-mortality association was stronger among those with a small SN (1.62 [1.40–1.87]) than a large SN (1.26 [1.12–1.41]). Conversely, the association was weaker in living-alone individuals (1.11 [0.90–1.38]) than in cohabiting individuals (1.46 [1.33–1.61]). Although living alone and having a small SN represented “isolated” status, their modifying effects on the CD-mortality relationship were the exact opposite. Our findings highlight that the isolation type needs to be considered when implementing dementia prevention and support for older people with CD/dementia.
JOB AVAILABILITY FOR OLDER WORKERS IN A COMMUNITY: ANALYSIS ON JOB POSTINGS
Authors: Yeo Hyesu
Published: December 2023

Objectives

This study examined the current job availability in a local job market for older workers and investigated the required skills the older workers to be competitive.

Background

Most studies approached older workers’ employment transition from the supply side of the labor market, examining individual-level factors for a successful employment transition. However, there is a lack of knowledge on the demand side, such as job opportunities, regarding older workers’ employment transition.

Methods

The study uses combined data with job postings collected in the 4th quarter of 2021 from three engines and the O*NET database with occupational information to identify job opportunities and required skills. Additionally, the 2020 and 2021 American Community Survey were used to explore the characteristics of the older workforce in the community.

Results

A total of 5,160 job postings divided into 468 occupations were found in the community. The most frequently available jobs were healthcare (14%), transportation and material moving (13 %), and sales (13%) occupations, which required some work experience needed. The older labor force mostly had a college or associate degree (45.8%) and was in educational (16%), office (11%), and sales (11%) occupations. All occupations require technological skills.

Conclusion

The study found a mismatch between the available jobs and the actual older labor force, and those who are in employment transition, even downward movement, would be required some related experience. These suggest that a pre-employment transition program providing job training and age-friendly employment support services would be helpful for older workers in all occupational classes.
CO-PRODUCTION TO TAILOR A DIGITAL TOOL FOR MONITORING SYMPTOMS OF DEMENTIA IN NURSING HOME CARE IN SWEDEN
Authors: Malm Johannes , Bielsten Therése , Odzakovic Elzana , Finkel Deborah , Nilsen Charlotta , Kåreholt Ingemar
Published: December 2023

Symptoms of dementia change over time, resulting in complex situations that can negatively impact the person with dementia, as well as their relatives, and create challenges for staff members. Behavioral and Psychological Symptoms of Dementia (BPSD), such as delusions, hallucinations, agitation, depression, anxiety, apathy, irritability, aberrant motor behavior, and sleep disturbances, occur in approximately 90% of older people with dementia. The purpose of the study was to identify potential barriers and facilitators prior to introducing a web-based digital tool, the Daily-BPSD. Daily-BPSD is going to be used by staff members for daily registrations of severity levels of BPSD for persons with dementia in nursing home care in Sweden. Qualitative data collection was conducted in co-production with previous users of a similar digital tool in disability care (n = 11) and future users in dementia care (n = 32). The participants were assistant nurses, care managers, nurses, occupational therapists, and relatives. The responses highlight the importance of an accessible and time-effective registration procedure, a manageable number of variables and registrations occasions per day, and ensuring that the same information does not need to be documented in different systems. The findings will be used to tailor Daily-BPSD and adequately prepare staff members for large-scale data collection in the next step of the research project. Daily-BPSD could provide an extended foundation of knowledge of the person with BPSD, which could be used to provide more person-centered and appropriate care.
EARLY DETECTION OF DEMENTIA AND MILD COGNITIVE IMPAIRMENT WITH BRAINCHECK
Authors: Huang Bin , Huynh Duong , Ghomi Reza Hosseini
Published: December 2023

Dementia is projected to affect 14 million people in the United States and 152 million people globally in the coming decades. Early detection of dementia, which involves diagnosis of mild cognitive impairment (MCI), a possible prestage of dementia, is critical for intervention and care planning but remains a challenge with current clinical protocols. While brief screening tools are narrow in scope, comprehensive neuropsychological tests are time-consuming and require specialized training and expertise to conduct and interpret results. BrainCheck, a computerized cognitive assessment tool, provides an accessible and promising solution to address these current challenges. The aim of this study was to evaluate BrainCheck for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment. A total of 99 participants clinically diagnosed with dementia (DEM; n=42), MCI (n=22), or normal cognition (NC; n=35) completed the BrainCheck battery. Statistical analyses compared participant performances on BrainCheck based on their diagnostic group. BrainCheck battery performance showed significant differences between the three groups, achieving 88% or higher sensitivity and specificity for separating DEM from NC, and 77% or higher sensitivity and specificity in separating the MCI group from the NC and DEM groups. Three-group classification found true positive rates of 80% or higher for the NC and dementia groups and true positive rates of 64% or higher for the MCI group. These results show that BrainCheck was able to distinguish between diagnoses of DEM, MCI, and NC, providing a potentially reliable tool for early detection of cognitive impairment.
THE MEDIATING ROLE OF PAIN SEVERITY IN THE ASSOCIATION BETWEEN DEPRESSIVE SYMPTOMS AND GAIT SPEED
Authors: Mehta Rhea , Shardell Michelle , Ryan Alice , Dong Yu , Beamer Brock , Hochberg Marc , Rathbun Alan
Published: December 2023

Knee osteoarthritis (OA) and comorbid depression adversely impact gait speed over time. Depression can alter pain tolerance and perception; therefore, self-reported knee pain severity may mediate the relationship between depressive symptoms and gait speed, but this has not been evaluated longitudinally using repeated measures data. Thus, we assessed whether knee pain severity mediates the association between depressive symptoms and gait speed over time. Participants (n=2,222) from the Osteoarthritis Initiative with radiographic knee OA (Kellgren-Lawrence grade ≥ 2) in at least one knee were included. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D; range 0-60) at baseline and first two annual follow-up visits. The twenty-meter gait speed (meters per second) outcome was assessed at the second through fourth annual follow-up visits. Knee pain severity was assessed as a mediator and measured using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain subscale at the first through third annual follow-up visits. Linear regression mediation using a version of the Sobel-Goodman approach was the primary method of analysis. Indirect and direct effects of depressive symptoms on gait speed for each one-unit CES-D score were -0.001 (p < 0.001) and -0.003 (p = 0.020) standard deviations, respectively. Thus, approximately 24% of the association between depressive symptoms and gait speed was mediated by knee pain severity across time. The current results support the need for simultaneous, multidisciplinary interventions for both depressive symptoms and knee OA pain to prevent future decline in physical performance.
USE OF PSYCHIATRIC RISK FACTORS IN PREDICTING 10 YEAR CARDIOVASCULAR RISK FOR CHINESE PATIENTS WITH SCHIZOPHRENIA
Authors: Tang Jennifer Yee-man , Luo Hao , Lau Gary K K , Lee Edwin H M , Wang Pengcheng , Wong Ian C K , Lum Terry , Wong Gloria Hoi-Yan
Published: December 2023

Patients with schizophrenia are known to have excessive cardiovascular morbidity. Traditional Framingham risk prediction models do not consider additional risk attributable to factors related to psychiatric illness and treatment. The Framingham risk scores also tend to over-estimate cardiovascular risk in Chinese cohorts. This study aimed to develop a 10-year cardiovascular risk prediction model using routine clinical data from an electronic health database in Hong Kong. We identified a cohort of 39,449 patients who were diagnosed with schizophrenia between Year 2005 and 2015 and had no history of cardiovascular disease (CVD). Cox proportional hazards regression models were employed to determine psychiatric and clinical risk factors influencing the timing of incident CVD over 10 years. Psychiatric variables of interest included comorbid psychiatric disorders, duration of schizophrenia, use of antidepressant, use of first- or second-generation antipsychotics (FGA & SGA) at baseline and duration of exposure to FGA and SGA. The main analysis showed that comorbid substance use-related disorders (HR = 1.52; 95% CI 1.22 – 1.90; P < 0.001) increased CVD risk and each year of cumulative exposure to FGA increased CVD risk by 2% (HR = 1.02; 95% CI 1.01 – 1.04; P = 0.001). The use of antidepressant predicted a higher CVD risk in female patients (HR 1.19; 95% CI 1.02 – 1.38; P = 0.028). Our risk model predicted that 20.6% of patients had a CVD risk ≥ 20% over 10 years. Our risk models may offer an accessible clinical tool to help monitor cardiovascular risk in patients with schizophrenia.
MEASUREMENTS OF SKIN CAROTENOID STATUS BY VEGGIE METER® IN URBAN ADULTS
Authors: Schweitzer Amy , Brown Ricardo , Monroe-Lord Lillie
Published: December 2023

Recent advances in technology related to objective measures of dietary intake have led to tools such as the Veggie Meter®. The Veggie Meter uses pressure-mediated reflection spectroscopy to determine skin carotenoid status as an objective proxy of fruit and vegetable intake. This project is part of a larger study to determine seasonal changes in skin carotenoids of residents in an urban setting. The purpose of this project is to report baseline measures of skin carotenoids in a subset of older urban adults. Adults frequenting community events (senior center, food pantries, health fairs) consented to triplicate Veggie Meter readings. Adults (n=54) ages >60 years old who provided consent completed a survey and a baseline Veggie Meter reading. Participants were 68% female with a mean ± standard deviation age of 68 ± 7.2 years. Mean BMI was 29.9 ± 7.47 kg/m² . Most were non-smokers (75%). Participants identified as African American (78%), Caucasian (7%), two or more races (7%), or other race (6%). Mean Veggie Meter score was 275.6 ± 98.88. Smokers had a significantly lower Veggie Meter® score (216±73.4) than non-smokers (295 ± 98.7) p=0.006. Conclusion: For this sample of older adults in the DC area, differences in skin carotenoid status was seen by smoking status. Additional data is pending for Winter, Spring and Summer readings to determine whether seasonal variations exist in skin carotenoid status as measured by the Veggie Meter.
SOCIAL DETERMINANTS OF HEALTH AND AGING: DISPARITIES AND BARRIERS TO ORAL HEALTH CARE AMONG OLDER ADULTS IN ALABAMA
Authors: Smith Nathan , Cofield Stacey , Mazer Raquel
Published: December 2023

Limited data exists on the oral health status of the older adult population of Alabama; improved surveillance programs are needed for estimations and planning. Aim: This study compares gender, racial, and economic differences in barriers to oral healthcare among older adults in Alabama. Methods: Self-reported, voluntary surveys including sociodemographics, oral care behaviors, and care utilization were completed along with intraoral screenings at senior centers and senior living communities. Univariate analyses were conducted using Chi-Square or Fisher’s Exact test, p< 0.05 considered meaningful. Results: 357 respondents were assessed: mean age 73.4 (SD 8.4), 70.3% female, 57.1% Black/African American (AA), 42.9% Caucasian (Ca), 88.8% sole source of income Social Security/Disability. Ca were more likely than AA to have dental insurance (65.0 vs 51.5%, p=0.013), and more likely to have had a cleaning/check-up (20.9 vs 12.3%, p=0.029). Those with income <$1500/month who received dental care were more likely to receive care for dentures compared to those with higher income (17.1 vs 8.0%, p=0.030). Those still driving who received dental care were more likely to have had a cleaning/check-up compared to those not still driving (20.9 vs 9.2%, p=0.025). Untreated tooth decay was detected in 25% of those with remaining dentition and was more common among AA than Ca (57.4 vs 44.4%, p=0.035). Conclusions: The preliminary analysis points to the need to further explore access to oral health services for older Alabamians living independently. Further data is needed for planning and policy making. Barriers to care were not explored for those who are homebound.
EPIGENETIC AGE ACCELERATION AND IMMUNE CELL COUNT: A TWIN STUDY
Authors: Penichet Eric , Beam Christopher , Bakulski Kelly , Turkheimer Eric , Higdon Kristin , Ryan Lesa , Sikes Kendra , Davis Deborah
Published: December 2023

Accelerated aging, as measured by epigenetic clocks, is associated with declines in immune system functioning. Investigating the causal basis of this association may provide mechanistic insight into the link between DNA methylation, on which epigenetic clocks are based, and age-related changes in immune cell composition. Using preliminary data from the Louisville Twin Study, this study examined the genetic and environmental sources of covariation between immune cell count (neutrophils, lymphocytes) and GrimAge Acceleration. GrimAge is a composite biomarker derived from 7 DNA methylation-based surrogates associated with mortality and smoking pack years. GrimAge Acceleration is the residual of GrimAge regressed onto chronological age. Participants consisted of 43 monozygotic twin pairs and 30 (18 same-sex) dizygotic twin pairs with a mean age of 54.5 years (sd = 5.27). Phenotypic analyses revealed that GrimAge Acceleration was significantly associated with neutrophil and lymphocyte count (r = 0.45 and -0.49, respectively). To examine the sources of covariation between these variables, biometric regression models were used to decompose the covariance between GrimAge Acceleration and neutrophils (and lymphocytes) into genetic and environmental components. Bivariate analyses revealed moderate, marginally significant genetic correlations between GrimAge Acceleration and immune cell count (rg = 0.32 and -0.38 for neutrophils and lymphocytes, respectively) and large, significant nonshared environmental correlations (re = .58 and -.54 for neutrophils and lymphocytes, respectively). Common genetic factors accounted for 39% of the phenotypic correlation in neutrophils and 43% in lymphocytes, whereas common nonshared environmental factors accounted for 61% and 57% of the correlation in these cell types, respectively.
UNRAVELING NONGENOMIC MECHANISMS BY WHICH 17A-ESTRADIOL EXTENDS HEALTHSPAN AND LONGEVITY
Authors: Zomer Helena , Sirohi Vijay , Medrano Theresa , Cooke Paul
Published: December 2023

Recent work indicates that exogenous 17α-estradiol (17α-E2), a stereoisomer of 17β-E2, produces unprecedented longevity increases (~20%) in male mice, challenging prevailing assumptions that 17α-E2 is a weak estrogen. However, is unclear how 17α-E2 acts. Therefore, this study aimed to obtain mechanistic insights into 17α-E2 actions in the uterus, the most widely used vivo model system for estrogen action. We hypothesized that 17α-E2 signals through membrane (m)ESR1 to affect target tissues and promote longevity. To test this, we treated pre-pubertal (postnatal day 20) female CD-1 mice with 3 daily IP injections of vehicle or 10 mg/kg of 17α-E2 or 17β-E2 (n=4/group). 17α-E2 treatment did not significantly increase uterine weight – a marker of nuclear (n)ESR1 signaling (20.3 ± 2.1 mg vs. vehicle 15.7 ± 2.0 mg, p>0.05), while 17β-E2 strongly increased it to 41.4 ± 1.1 mg (p< 0.05). Accordingly, histological analysis revealed reduced cell proliferation in 17α-E2- vs. 17β-E2-treated uteri. Both 17α-E2 and 17β-E2 robustly stimulated epithelial p-ERK and p-AKT expression, the active phosphorylated forms of these protein kinases, and western blotting showed a strong and comparable stimulation of EZH2, a critical mediator of estrogen’s epigenetic effects, which are linked to mESR1 signaling. In conclusion, our results indicate that despite limited actions through nESR1, 17α-E2 robustly signals through mESR1 to activate uterine protein kinase cascades and produce epigenetic effects. These findings may cause a significant reappraisal of 17α-E2 biological effects and role in normal estrogen physiology and provide critical insights into its unique ability to stimulate longevity.
WORKING TOGETHER TO PROVIDE GERIATRIC CARE: INTERDISCIPLINARY TEAM CREATION AND EVALUATION IN CANADA
Authors: Strong Jessica , Kerzner Rachel
Published: December 2023

Prince Edward Island is Canada’s smallest province (pop. 160,000) and has one of the oldest populations in Canada. While there is a robust and growing geriatrics program through provincial healthcare, it consists exclusively of medical providers (i.e., geriatricians and nurse practitioners). An opportunity for formal interprofessional collaboration presented itself when the University of Prince Edward Island began a Doctor of Psychology (PsyD) program in 2019. Soon thereafter, we established an interdisciplinary team between the PsyD and the provincial geriatrics programs. The goals of the team included: 1) enhancing care for older adults on the island, 2) providing training for PsyD students, and 3) increasing interprofessional collaboration and learning. In an evaluation of the first year of the collaboration, we collected data on the types of referrals and characteristics of the patients referred (e.g., number of medications), and asked all providers on the team (N=4 geriatricians, N=9 nurse practitioners, and N=4 psychology student clinicians) to answer open ended questions on the highlights and challenges of establishing the team, the organization of formal team meetings, and provision of patient care. Of the 74 patients seen by psychology, reasons included cognitive or psychodiagnostic assessment (N=22, 30%), psychotherapy (N=20, 27%), caregiver support (N= 25, 34%), or multiple services (i.e., both assessment and intervention; n=7, 10%). Additional patient characteristics will be shared, as well as themes from provider survey responses. Our program has implications for other areas in rural North America, particularly training opportunities built into our team functioning.
UNDERSTANDING THE MEANING OF CARE: FROM THE PERSPECTIVE OF SPOUSE CAREGIVERS OF PEOPLE WITH PARKINSON’S DISEASE
Authors: Lee JuHee , Yoo Subin , Kim Eunyoung , Park Hyeran , Kim Yun Joong , Chung Seok Jong , Yoo Jee-Hye
Published: December 2023

Parkinson’s disease is a highly prevalent geriatric disease in people aged 60 years and over. Parkinson’s disease can largely affect an individual’s life because it causes diverse motor and non-motor symptoms. As symptoms worsen, people with Parkinson’s disease are likely to become dependent, which can lead to caregiver burden. Therefore, the aim of this study is to understand the meaning of care in spouse caregivers who care for people with Parkinson’s disease. This study is a qualitative study using face-to-face in-depth interviews. A total of 15 spouse caregivers (10 husbands and 5 wives) were recruited from a neurological outpatient clinic at a tertiary hospital in South Korea. Two trained nurses interviewed spousal caregivers, and thematic analysis was used for data analysis. In this study, four themes were identified: (a) symptom management, (b) struggling to care, (c) intimacy with one’s spouse, and (d) uncertainty of the future illness progress. People with Parkinson’s disease experienced at least more than one motor or non-motor symptoms. Physical function and lifestyle modification of people with Parkinson’s disease, caregivers’ positive attitude towards the care role, and intimate relationships were key factors of self-care. For caregivers, the progression of disease was the major concern of care. Given that the number of older households is increasing in Asia, it is important to understand older spouse caregivers’ perspective for care of people with Parkinson’s disease. By understanding their needs and difficulties, healthcare providers can build further plans for them.
YOGA, TAI CHI, AND PILATES AND FAMILY CAREGIVERS’ SUBJECTIVE WELL-BEING: FINDINGS FROM MIDUS
Authors: Bhattacharyya Kallol Kumar , Liu Yin , Fauth Elizabeth
Published: December 2023

Being an informal caregiver has been associated with stress and lower levels of subjective well-being. Exercise/movement therapy techniques of yoga, tai chi, and Pilates are physical activities that also incorporate stress reducing practices. The current study aimed to examine the association of exercise/movement therapy techniques on family caregivers’ subjective well-being assessed by life satisfaction and mindfulness. Participants were part of the Midlife in the United States (MIDUS) study (wave 2, N = 507 aged 35-86 years; Mage = 56±11, 68% women) who provided informal care in the past 12 months. We recoded the aforementioned exercise/movement therapy activities into three categories, based on the distributions in MIDUS, including regular practice (defined as participating in one or more of them “a lot” or “often”), irregular practice (participating “sometimes” and “rarely”), and no practice (“never”). Subjective well-being was measured using the 5-item global life satisfaction scale and the 9-item mindfulness scale. We considered sociodemographic factors and health as covariates. We used multivariate linear regression models to examine associations between practice and caregivers’ subjective well-being. After controlling for covariates, the findings indicated that regular practice was associated with both better mindfulness-related well-being (b = 2.26, p < .05) and better life satisfaction (b = 0.43, p < .05). Future research should examine whether there is a selection effect of caregivers with higher well-being being more likely to choose these activities, and/or if exercise/movement therapies are effective non-pharmacological interventions to improve family caregivers’ overall quality of life.