bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECTIVENESS OF A COLLABORATIVE STEPPED-CARE MODEL FOR OLDER ADULTS WITH DEPRESSION
Authors: Lum Terry , Wong Gloria , Liu Tianyin , Lu Shiyu , Leung Dara , Sze Lesley , Sing Joyce , Kwok Weiwei
Published: November 2019

Background: Depression is common among older adults and creates a substantial burden on individuals, caregivers, and healthcare system. This paper presents an innovative collaborative stepped care intervention that promotes the coordination between elderly center and community mental health center to provide nonpharmacological intervention to elders with mild to moderate level of depression. Methods: The stepped care model were implemented in four districts in Hong Kong between September 2017 and February 2019. In each district, one community mental health center and one elderly center worked together to implement this stepped care model. A quasi-experimental design was used to study the effectiveness of this intervention. Findings: A total of 853 older adults completed the intervention and additional 500 elders were recruited as control. The average age of intervention participants was 76.3 years. Their levels of depression and anxiety were measured by Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) respectively. The average intervention lasted for 10 months. Their average PhQ9 score reduced from 7.2 before intervention to 2.7 after intervention (t= 34.7, p < .001). Their level of anxiety was lowered from 4.9 to 2.0 (t=16.9, p < .001). The different between the intervention and control groups were statistically significant. Conclusion: The stepped care model was effective in reducing the levels of depression and anxiety among Chinese older people. This paper will give detailed information about the stepped care model and its implementation.
REDUCING DYSFUNCTIONAL BELIEFS ABOUT SLEEP PROVIDES LONG-TERM BENEFIT IN OLDER ADULTS WITH INSOMNIA
Authors: Song Yeonsu , Fung Constance , Dzierzewski Joseph , Mitchell Michael , Josephson Karen , Fiorentino Lavinia , Martin Jennifer , Alessi Cathy
Published: November 2019

Cognitive behavioral therapy for insomnia (CBTI) is recommended as first-line treatment in older adults. Changing dysfunctional beliefs and attitudes about sleep is an important component of CBTI, but the long-term impact of these changes are unknown, particularly in older adults. Methods involved secondary analyses of data from a large randomized controlled trial comparing CBTI (provided in 5 weekly sessions) to sleep education control, among older veterans with insomnia (N=159, mean age 72.2 years, 97% male, 79% non-Hispanic white). The purpose was to examine whether changes in a validated scale of Dysfunctional Beliefs and Attitudes about Sleep (DBAS) with CBTI treatment (baseline to post-treatment) was associated with later changes in self-reported sleep (post-treatment to 6 months follow-up). Sleep measures included Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and 7-day sleep diary measures. Analyses compared the slope of change in DBAS (baseline to post-treatment) between CBTI and control with respect to the slope of change in sleep outcomes (post-treatment to 6-months). Compared to controls, the CBTI group had stronger associations between DBAS improvement (baseline to post-treatment) and subsequent PSQI improvement (post-treatment to 6-months) (difference in slopes=1.3, 95% CI=[.52,2.1], p=0.001). This pattern of significant results was also found for ISI (difference in slopes=1.8, 95% CI=[.58,3.0], p=0.004) and ESS (difference in slopes=1.0, 95% CI=[.25,1.7], p=0.009). Slopes were not different for sleep diary measures. These findings suggest that changing dysfunctional beliefs and attitudes may continue to confer sleep benefits well after completion of CBT-I in older adults.
RELIGIOUS ATTENDANCE AND SLEEP DISTURBANCE IN OLDER MEXICAN AMERICANS
Authors: Hill Terrence D , Ellison Christopher , Hale Lauren
Published: November 2019

Although numerous studies have shown that religious involvement is associated with better health across the life course, researchers have virtually ignored possible links between religious involvement and sleep-related outcomes. Building on previous work, we tested whether religious attendance was inversely associated with sleep disturbance among older Mexican Americans. We also assessed whether depressive symptoms could mediate or explain any of the inverse association between religious attendance and sleep disturbance. Relevant hypotheses were tested using ordinary least squares regression and conditional process mediation analysis of cross-sectional data collected from the original cohort of the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE). The baseline H-EPESE (1993-1994) included a probability sample of 3,050 Mexican Americans ages 65 and older. Due to missing data on our focal variables, our final analytic sample included 2,323 respondents. Regression models show that religious attendance is inversely associated with depressive symptoms and sleep disturbance, even with adjustments for smoking, drinking, body mass, chronic disease, mobility, marital status, living arrangements, family engagement, secular group participation, social support, age, gender, immigrant status, language proficiency, education, household income, and religious affiliation. Mediation analyses also indicate that depressive symptoms fully mediate the association between religious attendance and sleep disturbance. These findings contribute to previous work by showing that regular religious attendance may protect against sleep disturbance by promoting mental health in an understudied population of older Mexican Americans. The importance of religious involvement is supported by the fact that secular group participation was unrelated to sleep disturbance.
PARTNERING WITH NURSING HOME PROVIDERS FOR PERSON-CENTERED QUALITY IMPROVEMENT
Authors: Hermesch Abigail , Chang Da Jung , Goldstein Chelsea , Van Haitsma Kimberly , Abbott Katherine
Published: November 2019

The purpose of this study was to assist Ohio NH providers in implementing PAL Cards. Providers were recruited to utilize the recreation and leisure items from the PELI to assess resident important preferences and create PAL cards for 15-20 residents. A total of n=43 providers registered and n=26 (60%) providers completed the project, which involved monthly coaching calls and an end of project telephone interview. Participating providers were not for profit 46% (n=12), for-profit 46% (n=12), and government-owned 8% (n=2). Their average bed size was 87 and 50% (n=13) of providers had five-star ratings with a range from 1-5. Participants attempted n=439 PAL card interviews with residents and completed n=414 (94.31%) PAL Cards. Providers received over 1,428 minutes of coaching support from the Project Manager over the phone. The majority of providers were successful in implementing PAL Cards for residents with substantial support from the project manager.
COHORT DIFFERENCES IN SLEEP ENVIRONMENT, BEHAVIORS, AND CONCERNS: DESCRIPTIVE ANALYSES USING MY SLEEP SCRIPT APP
Authors: Parker Christina Pierpaoli , Salas Rachel , Gamaldo Charlene , Gamaldo Alyssa , Dziedzic Peter
Published: November 2019

Behavioral and environmental factors influence sleep outcomes. However, we understand little about how enviro-behavioral sleep hygiene practices and related sleep concerns vary across age cohorts. Using data from My Sleep Script, an app-based diagnostic checklist for identifying at risk patients, we described cohort differences in sleep hygiene and new sleep disturbances. 323 adults (46.6% female, 63.9% Caucasian) reported basic demographic, health, sleep, as well as enviro-behavioral data using the Epworth Sleepiness Scale (ESS), Pittsburg Sleep Quality Index (PSQI), and the Johns Hopkins Sleep Environment Instrument. We partitioned participants into four cohorts corresponding to birth year: The Silent Generation (N = 48, 14.9%), Baby Boomers (N = 124, 38.4%), Generation Xers (n = 109, 33.7%), and Millennials (N = 42, 13.0%). Spearman correlations described linkages among environment, behaviors, and sleep outcomes; a chi-square analysis, cohort differences in new sleep concerns. Having weapons, music players, lights, pets, and a disruptive sleep surface in the environment correlated with worse sleep quality. Eating, exercising, working, and sexual activity one hour before bed also correlated with worse sleep quality. Sleeping with pets, electronics, and on a disruptive surface correlated with lower sleep duration. Regarding cohort, we observed significant generational differences in new snoring and sleepiness complaints. Results confirm associations of suboptimal sleep hygiene with poor sleep outcomes and provide insights into their generational differences, warranting additional investigation.
LONELINESS PREDICTS REDUCTIONS IN SLEEP QUALITY IN OLDER AMERICANS
Authors: Griffin Sarah , Williams Baylor , Ravyts Scott , Dzierzewski Joseph , Rybarczyk Bruce
Published: November 2019

Research documenting loneliness as a factor predicting health decline accumulates, yet the mechanisms underlying this relationship remain obscure. A potential mechanism is sleep disturbance, which is associated with loneliness. However, it remains unclear whether loneliness is a risk factor for subsequent sleep disturbance. The present study aimed to examine loneliness (measured via the Hughes Loneliness Scale) as a risk factor for sleep disturbance in a nationally representative sample of older (>65) Americans. Weighted linear regressions (accounting for complex sampling) were conducted on data from the Health and Retirement Study (n=3,042; 2006 & 2012 waves). Higher levels of loneliness in 2006 predicted sleep disturbance in 2014 when controlling for baseline sleep (B=.08, 95% confidence interval [CI]=[.04, .13]). This association remained after controlling for age, gender, race, ethnicity, education, net worth, and depressive symptoms (B=.07, 95% CI=[.04, .11]). These results identify loneliness as a risk factor for sleep disturbance over an eight-year span in older Americans. Further research is necessary to tease apart this relationship: specifically, to assess reciprocal effects over multiple timepoints, investigate the role of depression in loneliness and sleep disturbance, and employ experimental methods to address causality.
THE FEASIBILITY, ACCEPTABILITY, AND APPROPRIATENESS OF A PERSON-CENTERED COMMUNICATION TOOL
Authors: Shakya Shamatree , Yu Heshuo , Mueller Emily , Van Haitsma Kimberly , Abbott Katherine
Published: November 2019

The purpose of this study was to assess the acceptability, feasibility, and appropriateness of the PAL Card intervention. The data for this study came from monthly logs and final calls completed by n=26 NH providers. Staff from multiple departments contributed to the PAL card implementation. Common places for placing PAL cards were wheelchairs, walkers, doors, and in closets. Over 90 % of residents approved of the accuracy of information presented in PAL cards. From the providers’ perspective, PAL cards’ acceptability ranged from 96 to 100%, appropriateness ranged from 93.10 to 100 % and feasibility ranged from 90 to 100%. The total staff time estimated costs for PAL card implementation ranged from $180 to $3,236 depending on the individuals involved. The PAL card intervention was deemed acceptable, feasible, and appropriate by providers and accurate by residents. A discussion of the opportunity costs associated with implementing this intervention will be discussed.
LONELINESS SHAPES THE RELATIONSHIP BETWEEN ICT USE AND PSYCHOLOGICAL ADJUSTMENT AMONG OLDER ADULTS
Authors: Fang Yang , Chau Anson , Fung Helene H , Woo Jean
Published: November 2019

Background: Given findings that generally support the benefits of information and communication technology (ICT) for older adults’ psychosocial adjustment, one might surmise that lonely older adults, who have a stronger need for psychological support, would reap more psychosocial benefits from ICT use. However, scant research has examined this view, much less the likelihood that ICT use might worsen the psychological well-being of lonely older adults, as has been shown to be the case in younger adults. Objective: To examine whether the association between ICT use and psychological adjustment (i.e., psychological distress and sense of community [SOC]) among older adults depends on their loneliness levels. Methods: A representative sample of 738 Hong Kong SAR Chinese older adults aged 60 years or older (56% female) was interviewed in 2017 on loneliness, frequency of ICT use (i.e., Internet and smart devices), psychological distress (6-item Kessler scale; K6), and SOC. Results: Regression analyses showed that loneliness significantly moderated the relationship between ICT use frequency and psychological adjustment (psychological distress and SOC); more frequent ICT use was associated with more psychological distress and less SOC, with higher levels of loneliness. Conclusion: These findings suggest that ICT use may be a mixed blessing for older adults, i.e., using more ICT might predict worse psychological adjustment among lonelier older adults. Efforts that promote ICT use among older adults should take their loneliness levels into account.
AN ECOLOGICAL MOMENTARY OUTLOOK ON SUBJECTIVE AGING
Authors: Segel-Karpas Dikla , Shrira Amit , Lachman Margie E
Published: November 2019

Cross-sectional and longitudinal studies showed that subjective age – individuals’ perceptions of their own age as older or younger in relation to their actual age, is an important predictor of physical, cognitive, and mental health. Despite some initial findings suggesting that subjective aging responses to variations in the daily experiences, less is known about how daily and momentary experiences shape how old people feel, and how their perceived age affects their daily experiences. In this symposium, five studies using daily diaries and experience sampling methods will be presented and discussed to explore how subjective aging affects, and is affected by, daily changes. In the first presentation, Neupert will discuss her findings regarding the covariation of anticipatory next-day health-related stressors and coping with felt-age, suggesting that forecasting and coping with future stressors play a role in subjective aging. Presenting findings from his experience-moment-sampling study, Hughes will discuss the momentary association between subjective age and mind wandering. Zhang and Segel-Karpas will present findings from studies focusing on attitudes towards aging. Zhang will focus on state vs. trait subjective aging, exploring their association with daily variability in control and competence, while Segel-Karpas will focus on the moderating role of attitudes in the daily associations between subjective age and mental health. Finally, Shrira will present a study of rehabilitation patients, finding that subjective aging is related to physical and mental health, especially for patients with high age-awareness. Professor Lachman will lead a discussion.
IMPACT OF MULTIPLE CHRONIC CONDITIONS ON CHANGE IN PHYSICAL FUNCTION FROM MID- TO EARLY LATE LIFE
Authors: Maia Brittney S Lange , Karavolos Kelly , Strotmeyer Elsa , Karvonen-Gutierrez Carrie , Avery Elizabeth , Janssen Imke , Dugan Sheila , Kravitz Howard
Published: November 2019

Chronic conditions emerging in midlife may be modifiable to prevent progression ultimately preserve physical function (PF) in late life. We quantified change in perceived PF in relation to several common chronic conditions known to impact PF in late life (osteoarthritis, diabetes, stroke, hypertension, heart disease, cancer, osteoporosis, and depression). Physical function (PF) was assessed using the Physical Functioning Scale of the SF-36 among 2,283 women in SWAN from an average age of 50.0±2.7 to 64.0±3.7 years. In covariate-adjusted Poisson models, each additional condition was associated with 3% worse PF (p<0.001), and an additional 0.4% annual worsening (p<0.001). Thus, holding demographic, lifestyle, socioeconomic, and other health factors constant, a woman a decade later entering old age with no chronic conditions would have 8.1%, 15.5%, and 17.0% better PF vs. having one, two, or three conditions, respectively. Preventing or delaying chronic disease progression in midlife may improve PF trajectories into late life.
DEVELOPMENT AND REVISION OF THE FAMILY EMERGENCY PREPARATION PLAN AMONG OLDER ADULTS
Authors: Cong Zhen , Cong Zhen , Keaton James Craig , Liang Daan
Published: November 2019

This study examines factors related to holding, revising, and developing an individual emergency preparation plan among older adults who experienced violent tornadoes. A telephone survey was conducted with 543 respondents approximately one year after two violent tornadoes in 2013 with 276 respondents aged 65 or above. Logistic and multinomial logistic regression showed that education was positively associated with a higher likelihood of having a plan among younger but not older adults. Among those who had a plan before the tornado, older, but not younger, adults who experienced more stress were more likely to report the plan as helpful. More stress and having someone in the household with disability increased the likelihood of revising plans afterward among older adults but not among younger adults. Older adults were less likely to develop a new plan and older, but not younger, adults who reported more stress were more likely to develop a plan.
EXPLORING SEX DIFFERENCES IN COGNITION IN OLDER BLACKS
Authors: Byrd DeAnnah R , Thorpe Roland J , Whitfield Keith E
Published: November 2019

Previous literature suggest that women experience more dementia than men. However, it is unclear what accounts for these differences and whether sex differences exist among Blacks over time. We hypothesize that Black women will have worse cognitive outcomes than men and smoking may potentially explain these differences. Longitudinal data from the Baltimore Study of Black Aging-Patterns of Cognitive Aging was used to assess cognitive change over 33 months in five domains. The sample consisted of 602 community-dwelling Blacks, aged 48-92 years at baseline and 450 at follow-up. Findings indicated that Black women reported better vocabulary, working and verbal memory than Black men, controlling for age, education, smoking, and health status. These findings suggest that Black women may have some cognitive advantages in mid to later life compared to Black men. Future research should continue exploring longitudinal sex differences in cognitive domains among Blacks and the underlying drivers of these differences.
HEARING IMPAIRMENT, COGNITIVE PERFORMANCE, AND BETA-AMYLOID DEPOSITION IN THE ARIC-PET AMYLOID IMAGING STUDY
Authors: Deal Jennifer A , Rawlings Andreea , Sharrett A Richey , Reed Nicholas , Betz Joshua , Mosley Thomas , Lin Frank , Gottesman Rebecca
Published: November 2019

Hearing impairment is a risk factor for dementia but the mechanism underlying this association is unknown. We investigated the relationship between hearing and cognitive performance and brain β-amyloid deposition in 252 adults aged 67-88 years (37% black race) without dementia from three U.S. communities. Global cortical standardized uptake value ratios (SUVRs) were calculated from florbetapir-positron emission tomography scans, with elevated SUVR defined as >1.2 (the median value). Air conduction hearing threshold levels for the frequencies of 0.5, 1, 2 and 4 kHz were obtained by pure tone audiometry and averaged for the better-hearing ear to yield a pure tone average (PTA) in decibels hearing level (dB). A composite cognitive score was created from ten neuropsychological tests summarized using latent variable methods. Multivariable-adjusted linear and Poisson regression with robust standard errors were used to estimate the average difference in cognitive scores and prevalence of elevated SUVR, respectively, by hearing impairment status. In analyses adjusted for age, sex, education and APOE ε4 status, hearing was not associated with elevated SUVR [prevalence ratio per 10 db increase (worse hearing) = 0.94 (95% CI: 0.84, 1.04)]. Results did not differ by race. In contrast, each 10 db increase in hearing impairment was associated with 0.08 standard deviation (95% CI: 0.02, 0.15) lower cognitive score, after adjustment for demographic and cardiovascular factors. Poorer hearing is associated with poorer cognitive performance but not with amyloid deposition, suggesting that the mechanism underlying the relationship between hearing and cognition may be independent of Alzheimer’s-related pathologic brain changes.
SUBCLINICAL AGE-RELATED HEARING LOSS IS INVERSELY ASSOCIATED WITH DEPRESSIVE SYMPTOMS
Authors: Golub Justin S , Brewster Katharine K , Brickman Adam , Ciarleglio Adam , Luchsinger José , Rutherford Bret
Published: November 2019

Age-related hearing loss (HL), defined by a pure-tone average (PTA) >25 decibels (dB) has been associated with depressive symptoms. We aimed to assess whether this association is present when hearing is better than the arbitrary, but widely-used, 25 dB threshold. The sampled population was the multicentered Hispanic Community Health Study (n=5,165). Cross-sectional data from 2008-2011 were available. Hearing was measured with pure tone audiometry. Clinically-significant depressive symptoms (CSDS) were defined by a score ≥10 on the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Participants’ mean age was 58.3 years (SD=6.2, range=50-76). Among those with classically-defined normal hearing (PTA ≤25 dB), a 10 dB increase in HL was associated with 1.26 times the odds (95% CI=1.11, 1.42) of CSDS, adjusting for age, gender, education, vascular disease, and hearing aid use (p25 dB; p<0.001). Results held even for a stricter HL cutpoint of 15 dB. Among subjects with strictly normal hearing (PTA ≤15 dB), a 10 dB increase in HL was associated with 1.47 (1.14, 1.90) times the odds of CSDS, adjusting for confounders (p<0.01). Results also held when defining CSDS by an alternative CESD-10 score ≥16. In conclusion, increasing hearing thresholds were independently associated with CSDS among adults with subclinical HL (PTA ≤25 dB). Studies investigating whether treating HL can prevent late life depression should consider a lower threshold for defining HL.
CASES OF OPTIMALLY LOCAL SOLUTIONS TO UNMET NEEDS OF RURAL-DWELLING OLDER ADULTS: ROLES OF NESTED NETWORKS
Authors: Holley Lyn , Kohel Kara l , Hatton-Bowers Holly , Harris-Broomfield Susan
Published: November 2019

Solutions developed top-down frequently make suboptimal use of resources. Programs (e.g., caregiver respite) are studied extensively; study focused on the roles of nested networks (family/locality/state/nation) that intersect in care is lacking. To identify and assess potential for improving solutions, this study examines cases acknowledged to provide optimal support. It identifies and describes network roles and intersections critical to success, with particular attention to timing and intentionality of family and community interfaces. Findings may suggest improved design and operation of programs through targeted empowerment of networks Cases were identified in cooperation with the Nebraska Extension service, and analyzed by a multidisciplinary team that included Family Science and Gerontology. Rural-dwelling older adults who benefited from the solution, expert practitioners, officials and local champions were interviewed. Analysis included private and public actors, and explains outcomes within a cultural (e.g., individualist, independent) and opportunity (e.g. information, financial and human resources) framework (Gelfand, 2003).
THE USE OF QUALITATIVE METHODS IN UNDERSTANDING FEARS FOR THE FUTURE AMONG AGING CAREGIVERS OF ADULTS WITH ASD
Authors: Marsack-Topolewski Christina N , Topolewski Christina , Graves Jillian
Published: November 2019

Understanding the realities of enduring caregivers as they age is essential to providing adequate supports and services to support the both caregiver and care recipient. An analysis of 51 one-on-one interviews was used to examine the lived experiences of aging caregivers, specifically regarding future care plans and barriers for their adult children diagnosed with autism spectrum disorders (ASD). Using a phenomenological research design, our qualitative analysis included line-by-line analysis, followed by PI and co-investigator collaboration to discuss findings. As a collaborative process, the codes and themes were refined by collapsing and consolidating codes. Intensive interviewing, coupled with systematic qualitative analysis, yielded substantive responses around aging caregivers’ experiences. Results highlighted four main themes that emerged from the interview responses, including (1) difficulty identifying caregiving support for the future, (2) barriers to making plans/decisions, (3) fear of the unknown, and (4) feeling the need to make plans and decisions now.
THE SYNERGY OF QUALITATIVE AND MIXED METHODS TO EXPLORE THE RELATIONSHIP BETWEEN OLDER ADULTS AND THEIR SENSE OF PLACE
Authors: Weil Joyce
Published: November 2019

Understanding person-environment fit, or how well older adults’ environment suits their needs, is complex. While all methodological approaches to gain deeper knowledge about fit have great value, the combination of methodologies provides a layered account of the experience of aging in a place, including the people older adults find important. This research found a clear benefit of combining results of 2 focus groups, 85 in-depth qualitative interviews, and 100 web-based surveys to assess how older adults discuss who and what is meaningful to them. Results show the combined benefit of using a qualitative and mixed-method process during the psychometric testing of the Person-Place Fit Measure for Older Adults. Qualitative focus groups and interviews offered additional domains and exact language older adults used to discuss place. Early qualitative phases improved later stages of this research, namely, online testing, reduction of survey items, and psychometric testing of the final quantitative instrument.
BIOMARKERS OF SENESCENT CELL BURDEN
Authors: LeBrasseur Nathan
Published: November 2019

Senescent cells drive aging. Preclinical studies suggest that targeted elimination of senescent cells offers a unique therapeutic approach to counter numerous chronic diseases and geriatric syndromes. To foster the translation of basic science discoveries to clinical application, we have sought to identify circulating biomarkers that reflect systemic senescent cell burden. We first analyzed the secretome of multiple senescent human cell-types and developed a candidate panel of proteins that could be reliably measured in human blood. Multiple proteins demonstrated significant associations with chronological age in a community-based cohort of adults aged 20-to-90 years. Impressively, in two distinct surgical cohorts (severe aortic stenosis and ovarian cancer), candidate protein concentrations were associated with biological age indices, including frailty and adverse outcomes. Our data suggest senescence biomarkers may have utility for clinical practice as indicators of risk, and for clinical research as surrogate endpoints in trials of interventions targeting senescent cells.
ROLE OF SOCIAL DETERMINANTS IN ENROLLMENT AND DISENROLLMENT IN MEDICARE INSURANCE PLANS IN OLDER MEXICAN AMERICANS
Authors: Kumar Amit , Rivera-Hernandez Maricruz , Chou Lin-Na , Karmarkar Amol , Kuo Yong-Fang , Ottenbacher Kenneth J
Published: November 2019

Objective: The objective of this study is to examine the association between social-medical risk factor with disenrollment from Medicare Fee-for-Service (FFS) and enrollment in a Medicare Advantage (MA) plan in Older Mexican Americans. Methods: The sample included older adults participating in the Hispanic Established Populations for the Epidemiologic Study of the Elderly linked with Medicare data. We used logistic regression to estimate odds ratios (OR) for the association of each sociodemographic and clinical factor with insurance plan switching. Results: FFS enrollees were more likely to speak Spanish, less educated, lower income, disability, and be dual eligible compared to MA enrollees. At 2-year follow up, older adults with social support had higher odds of switching from FFS to MA after controlling for all covariates (OR; 1.73, 95% CI: 1.11-2.69). Conclusion: Having social support from family and the community was strongly associated with disenrollment from FFS and transition to an MA plan.
COMMON UNDERLYING FACTORS FOR KNOWN MODIFIABLE FALL RISKS
Authors: Bergen Gwen , Kakara Ramakrishna , Burns Elizabeth , Stevens Mark R
Published: November 2019

Certain demographics, health conditions, and functional limitations are associated with increased older adult falls. Health conditions and functional limitations are potentially modifiable and may have underlying factors in common. This study’s objective is to understand whether health conditions and functional limitations related to increased fall risk have common underlying factors that could be useful in designing interventions. Factor analysis and multivariate logistic regression were used to analyze 2016 Behavioral Risk Factor Surveillance Survey data for adults aged 65+ years. About half of those who reported difficulty dressing (58%), difficulty running errands alone (53%), difficulty remembering (51%) and depression (48%) reported falling compared to 30% of the general older adult population. Two common factors of cognitive and physical limitations were identified and scales created for each. When controlling for demographic characteristics, both cognitive and physical limitations scales were significantly related to a higher odds of falling (Odds ratios=1.5, 1.4 respectively).
USING MODELING TO COMPARE THE ABILITY OF FALLS SCREENING TOOLS TO PREDICT FUTURE FALLS
Authors: Burns Elizabeth R , Pineau Vicki J , Koff Rosalind , Hodge Sarah , Welch Bess
Published: November 2019

The STEADI initiative recommends screening older adults for falls annually using either the 12-item “Stay Independent” or the “three-key questions” screening tools. Both tools ask about falling in the preceding year. However, the comparative predictability of each tool has not been assessed. In response, CDC and NORC, assessed both tools’ ability to predict falls at six and twelve months. Adults 65+ (n=1900), were recruited from a nationally representative panel and were screened for fall risk at baseline using both tools and then followed for a year to determine if they fell. At baseline, 38% of older adults were categorized at-risk of falling based on the 12-item “Stay Independent” and 56% were considered at-risk based on the three-key questions. The history of falling question was excluded for the six month analyses. The “Stay Independent” identified 60% of fallers and the remaining two questions of the three-key questions identified 57% of fallers.
UNDERSTANDING FACILITATORS AND BARRIERS TO PARTICIPATION IN EVIDENCE-BASED FALL-PREVENTION INTERVENTIONS
Authors: Mark Janice , Bergen Gwen , Moreland Briana
Published: November 2019

Prescribing evidence-based interventions based on older adults’ modifiable risk factors is recommended to prevent falls. Older adults need to adhere to the prescribed intervention to successfully reduce risk. This study reports on a structured systematic review to understand patient attitudes to adherence to fall prevention interventions. A systematic search for publications from 2008-2018 identified 72 articles on patient attitudes toward exercise, physical therapy, medication management, podiatry, and vision care for fall prevention. Three reviewers coded facilitators and barriers based on a socio-ecological model of interpersonal, intrapersonal, community, and policy factors. Perceived susceptibility to falling and perceived effectiveness of the intervention were important factors across all fall prevention interventions. Physician prescribing and discussion facilitated exercise, medication changes, and physical therapy. For attitudes related to community and policy, the most reported barriers were transportation and cost. Information from this review can be used to improve the implementation of fall prevention interventions.
INTEREST GROUP SESSION—INTERGENERATIONAL LEARNING, RESEARCH, AND COMMUNITY ENGAGEMENT: USING INNOVATIVE INTERGENERATIONAL STRATEGIES TO BOOST CAREERS IN AGING
Authors: Montepare Joann M , Donorfio Laura K
Published: November 2019

Populations are aging dramatically, and call for higher education to be more age-friendly and pave the way for career paths in aging. The Careers in Aging Week (CIAW) program sponsored annually by the Academy for Gerontology in Higher Education (AGHE) of GSA has been a core stimulus for building career interest – however, more could be done to strengthen and invigorate this effort. This symposium will show how intergenerational exchange can be used to mount interest in careers in aging and create new pipelines to gerontology programs in higher education. Examples of innovative approaches will demonstrate how career information can be communicated to students in more creative and compelling ways. The first paper will set the stage with an evidence-based overview of emerging areas for career development, and a presentation of career planning models to aid student understanding as to how to make aging career decisions. Two presentations will then focus on different aging-workforce initiatives aimed at building educational pipelines that connect high-school students with college students studying gerontology. In addition to highlighting the oft-overlooked population of high school students, attention will be given to the importance of including minority student populations in career development efforts. The final paper will describe the utility of broader intergenerational strategies that build bridges across students, educators, aging professionals, and community collaborators via campus career events. The discussant will bring these efforts together with an intergenerational programming lens that higher education can use to amplify awareness about the wide-range of career opportunities aging offers.
THE IMPORTANCE OF LOW SOCIAL LONELINESS FOR MAINTAINING GOOD WELL-BEING
Authors: Switsers Lise , De Donder Liesbeth , Dierckx Eva , Dury Sarah
Published: November 2019

Older people are often confronted with dependence, death of spouse and other loss experience. Nevertheless, older adults generally experience a good well-being. This lack of age-related decline of subjective well-being has been named the ‘paradox of ageing’. One possible explanation for this paradox can be found in the socio-emotional selectivity theory of Carstensen. Thus, we hypothesize that low emotional and/or low social loneliness can act as a buffer for the negative relationship between negative life events and well-being. We use data of the D-SCOPE project that includes 869 older community-dwelling adults at risk of frailty residing in Flanders. By means of regression moderating analyses the research gains insights into the relationships between older people and well-being where the absence of social loneliness is detected as a possible buffer against negative outcomes. The discussion develops the argument that the absence of loneliness is a crucial facet for maintaining a good well-being.
SYSTEMS-LEVEL MODELING OF BIOLOGICAL AND MOLECULAR AGING CHANGES OVER TIME
Authors: Levine Morgan E , Kuo Perry , Schrack Jennifer , Simonsick Eleanor M , Resnick Susan , Shardell Michelle , Ferrucci Luigi
Published: November 2019

Aging is associated with numerous changes at all levels of biological organization. Harnessing this information to develop measures that accurately and reliably quantify the biological aging process will require longitudinal modeling and incorporation of systems level approaches. We will describe applications of network modeling for longitudinal multi-system biomarker data. Using data from the Baltimore Longitudinal Study of Aging (BLSA) we are able to generate systems level models of biological and physiological function, and then demonstrate how these networks change with age. We will also link systems-level aging changes to hallmarks of aging, including epigenetic alterations, senescence, mitochondrial dysfunction, and proteostasis. Given the complexity of the biological aging process, modeling of systems dynamics over time will both lead to the development of better biomarkers of aging, and also inform our conceptualization of how alterations at the molecular level propagate up levels of organization to eventually influence morbidity and mortality risk.
AGENCY AS IDEOLOGY: PRECARITY AND DISEMBEDDEDNESS IN THE 21ST CENTURY LIFE COURSE
Authors: huang wenxuan
Published: November 2019

The “individualization” thesis has gradually merged into the discussion of increasing heterogeneity of the life course as well as growing inequality over historical time. As individuals are “disembedded” from both cultural traditions and more recently social institutions, individual agency has drawn revived interest in outlining “choice biography” that is seen as paramount to personal outcomes and even containing overcoming force against structure. This practice mutes the consideration of the ongoing forces of social structure that by their very nature continue to constitute individual selves and possibilities. The uncritical treatment of individual agency makes it problematic for the study of precarity, mystifying and obscuring the analysis of inequality-generating mechanisms, reducing them to the individual-level. We analyze current uses of the concept of agency in the life course research, and particularly in the areas of transition research, e.g., transition to adulthood/retirement, where individual agency is assumed to be most active.
FRAILTY AND PRECARITY: UNTANGLING THE CONCEPTUAL PATHWAYS OF NEED AND DISADVANTAGE IN LATE LIFE
Authors: Grenier Amanda M
Published: November 2019

The concepts of frailty and precarity circulate in social gerontology and studies of aging, with the former a dominant construct, and the latter emerging as a way of linking experiences, insecurities and risks. Although these concepts are used inter-changeably by some authors, their roots, key areas of focus and meanings differ. This paper considers the state of knowledge on frailty, and sets this against the uses of precarity. A After outlining a recent scoping review on precarity that revealed a high number of articles cross-referencing concepts of frailty and vulnerability. the paper distinguishes key aspects of frailty, vulnerability, and precarity. Situating qualitative experiences of each serves as a means to further explore similarities and differences. The paper concludes with reflections on what (if anything) each of these allied concepts may offer understandings of late life, and in particular, the study of disadvantage across the life course and into late life.
NEIGHBORHOOD SOCIAL COHESION, RESILIENCE, AND WELL-BEING AMONG CHINESE OLDER ADULTS IN HONOLULU, HAWAII
Authors: Zhang Wei , Liu Sizhe , Zhang Keqing , Wu Bei
Published: November 2019

Few studies have examined the association of social environment and well-being among Chinese older adults, the fastest growing aging population across all racial/ethnic groups in the U.S. To address this gap, the current study aims to examine the associations of neighborhood social cohesion with psychological distress and life satisfaction as well as the mediating role of resilience and the moderating roles of gender and place of birth using data collected among 430 Chinese older adults in Honolulu. Results show that neighborhood cohesion was significantly associated with both distress and life satisfaction, with resilience being a significant mediator. The association between neighborhood cohesion and distress was moderated by birth place such that the protecting effects of neighborhood cohesion on distress were only salient for the U.S.-born. Our findings indicate the importance of a cohesive social environment in shaping well-being of U.S. Chinese older adults, the U.S.-born in particular, living in Hawai’i.
THE INTERSECT OF SOCIAL DETERMINANTS, MOTIVATION, AND BLACK WOMEN TRIATHLETES
Authors: Brown Candace
Published: November 2019

Social determinants of health are often adjacent to negative impacts on physical health due to the association of a sedentary lifestyle. Yet, knowledge is limited regarding how motivation to exercise, through sport, may relate to social determinants. This study aimed to understand the intersect of social determinants of Black women who exercise, by participating in triathlons, using the novel Motivations for Triathletes Interview Guide (MOTIG). The Organismic Integration Theory guided an assessment of social determinants among (N = 12) Black women from nine scales within the MOTIG. The subtheme ‘physical awareness’ supported Health Orientation while ‘social support’, ‘camaraderie’ and ‘family’, all supported the Affiliation scale. Results indicate that Black women who exercise through triathlon are motivated because certain social determinants are positively addressed. Future interventions directed toward sedentary women should consider how to positively reinforce individual and social determinants to increase motivation to exercise.
RECRUITMENT OF FAMILY CAREGIVERS OF AFRICAN AMERICAN OLDER ADULTS WITH DEMENTIA
Authors: Moss Karen O , Wright Kathy , Brewster Glenna , Rose Karen , Wills Celia E , Monroe Todd
Published: November 2019

Multiple factors influence decision-making of family caregivers of African American older adults with dementia about participation in end-of-life care research. Existing literature on best practices for research recruitment includes little on recruitment strategies for this specific population. The purpose of this presentation is to analyze successful recruitment strategies used with family caregivers of African American older adults with dementia. Sixty-five caregivers of African American older adults with dementia were recruited over 11 months throughout a southeastern state from local communities and Program of All-Inclusive Care for the Elderly. Community partnership strategies such as community-based networking, purposively-targeted presentations, and leveraging of existing social networks provided a strong basis for successful recruitment. These strategies were credible to the participant population and effective in engaging both research participants and community partner stakeholders in working on shared goals of improving older adult and caregiver outcomes near the end of life.
KENT AND KLEEMEIER AWARD LECTURES
Authors: Bartke Andrzej
Published: November 2019

The Donald P. Kent Award is given annually to a member of the The Gerontological Society of America who best exemplifies the highest standards of professional leadership in gerontology through teaching, service, and interpretation of gerontology to the larger society. The Kent lecture will feature an address by the 2018 recipient, Lewis Lipsitz, MD, Hebrew Senior Life. The Robert W. Kleemeier Award is given annually to a member of The Gerontological Society of America in recognition for outstanding research in the field of gerontology. The Kleemeier lecture will feature an address by the 2018 recipient, Keith Whitfield, PhD, Wayne State University.
DEVELOPMENT AND PSYCHOMETRIC TESTING OF THE PERSON-PLACE FIT MEASURE FOR OLDER ADULTS
Authors: Weil Joyce
Published: November 2019

Person-environment fit models are at the core of gerontological theory and practice. The Person-Place Fit Measure for Older Adults (PPFM-OA) was developed to capture key place domains arising from the expansion of aging in place and age-friendly concepts across the continuum of care, increasingly diverse older populations, and the changing meaning of place. The goal of this study was to create a validated measure to assess “fit”. Data from in-depth interviews, focus groups, review of literature and existing comparable measures, and cognitive interviewing created an initial instrument of 90 items. Through the use of a Delphi panel of experts, 60 items were selected and tested in the final measure on Mechanical Turk (MTurk). Results from a sample of persons 60 and older are discussed. Findings from psychometric testing of the PPFM-OA measure are reported. These findings show the final, further-reduced-item version of the Person-Place Fit Measure for Older Adults has good internal consistency and validity. Both this measure and its development process can advance understanding and measurement of place models.
A COMPARATIVE ANALYSIS ON HEALTHY LONGEVITY PHENOTYPES BETWEEN CHINESE AND ITALIAN CENTENARIANS
Authors: Chen Huashuai , Zeng Yi , Chen Huashuai , Yao Yao
Published: November 2019

This paper reviews and compares demographic, socioeconomic, behavioral (including diet) characteristics and heath phenotypes of centenarians in China and Italy. The results revealed that the interactions between familial longevity and any one of the three environmental factors (receipt of adequate medical care when ill as a child, number of living children, and household economic conditions) were significantly associated with the three health outcome indicators (IADL, self-rated life satisfaction, and anxiety-loneness) at old ages. We discovered that the effects of these environmental factors on the health outcome indicators were substantially stronger among elders who had no family history of longevity compared to centenarians’ children who likely carry genes and/or inherited healthy behavior and better lifestyle from long-lived parents.
BEREAVEMENT IN A FAMILY CONTEXT
Authors: Stokes Jeffrey E , Kim Kyungmin , Carr Deborah
Published: November 2019

Bereavement is an impactful, often difficult experience for individuals throughout the life course. Moreover, bereavement experiences inherently involve wider family networks: The death of a spouse is often also the death of a parent, grandparent, or sibling, as well. The present symposium investigates a variety of different family loss experiences that individuals are exposed to in adulthood and older age, and situates such bereavement in a larger family context. Stahl explores how daily routines and sleep patterns can be altered by spousal bereavement, and assesses an intervention designed to improve widowed older adults’ behaviors and, in turn, reduce their depressive symptomology. Kim and colleagues analyze the death of a parent in adulthood, examining the extent to which pre-loss relationship quality and relationship importance may predict post-loss symptoms of grief. Stokes and colleagues extend this intergenerational perspective, examining the death of a grandparent in adulthood, and whether adult grandchildren’s relationships with their middle-generation parents – bereaved adult children themselves – impact their experiences of grief after loss. Focus is also paid to the influence of gender across all three generations. Lastly, Donnelly explores the cumulative consequences of experiencing multiple family deaths throughout the life course for adults’ health trajectories. Together, these papers expand the scope of bereavement research to incorporate spousal, multigenerational, and cumulative loss experiences and their repercussions for midlife and older adults. As discussant, Carr will assess the contributions of these papers to theory and the literature, and highlight potential directions for future research concerning aging, families, and bereavement.