bluuebunny/crossref_metadata_2025 huggingface dataset:
Music Therapy Clinical Trials in Cross-Cultural Settings
Authors: Rose Tara
Published: December 2020

Music therapy in clinical trials has shown efficacy as a nonpharmacological intervention for multiple medical conditions and procedures. Every culture has music and virtually everyone on this globe enjoys music suggesting the universality of music therapy. However, in the US, most music therapy clinical trials participants are English-speaking Caucasians. That narrow pool limits our understanding of the benefits of music in an ethnically and culturally heterogeneous nation. This study looks to the international clinical trials for lessons and information that can advance U.S. studies by expanding the methodology and clinical reach to benefit a more extensive population of patients. A review of 449 studies in 48 countries from clinical trials registries supports an effort to expand music therapy studies and interventions by incorporating a cross-cultural perspective. Researchers and clinicians using international resources can increase their understanding and capacity. Globally, many standardized measures have been translated, including self-report measures of behavioral and mental health, pain, sleep, medical conditions, and symptom severity used for outcome measures, as well as music therapy measures and intervention checklists. Scientifically accepted physiological outcome measures have shown the benefits of music interventions for older adults regardless of cultural or ethnic differences. For example, neuroimaging research supports the clinically derived notion that music can address needs of people with dementia. The future will require new standards for multi-cultural research. To expand studies and methodologies, we need to include more diverse populations. This paper proposes that to do that, we must look to the global scientific community.
Challenges, Barriers, Strategies Implementing an Oral Hygiene Program in Assisted Living Facilities Post COVID-19
Authors: Attanasi Kim , Raveis Victoria
Published: December 2020

[Objective] Almost 8% of the U.S. population, 65 and older, reside in long term care facilities with limited delivery of essential dental care to prevent and manage oral health disease. By 2050, this population is expected to increase by 1.6 billion. Multiple bi-directional connections exist between oral disease and overall health. [Methods] Faculty from the Dental Hygiene Department, New York University College of Dentistry conducted an extensive outreach effort and randomly selected assisted living facilities. Facilities were offered the opportunity to receive at no-cost, a dental hygiene-led, educational, preventive oral health program delivered virtually to their residents as a community service. Incentives discussed. [Results] Twenty-one facilities were contacted, 17 (94.4%) had no oral healthcare program; one had an oral health component. In 13 (72%), the concierge functioned as gatekeeper, unwilling to transfer calls or deliver messages. In five (28%), calls were directed to the activity coordinator. Feasibility concerns and uncertainty about oral health service necessity and resident safety were voiced. Two facilities mentioned familiarity with dental hygiene professionals. Strategic changes in outreach resulted in successfully engaging with facility administrators. Strategies included identifying directors with familiarity or experience with dental hygiene profession, establishing a portfolio and utilizing technology that facilitate incorporating COVID-19 protocols. [Conclusions] Efforts to initiate a dental hygiene-led virtual oral health program encountered gatekeeper challenges. Although facility activity coordinators acknowledged benefits for their population, they were not final decision-makers. It was necessary to implement strategies that facilitated discussing the virtual oral hygiene program directly with the facility’s executive leadership.
COVID-19 Bereavement: Considerations for Families, Psychologists, and Student Trainees
Authors: Hogan Jacqueline , Richards Lisa
Published: December 2020

During the peak of COVID-19, inflicted individuals died unexpectedly and in isolation. These circumstances deprived families of opportunities to say goodbye or memorialize the death of their loved one in alignment with their values and cultural heritage (e.g., wakes/vigils, funerals, shiva, washing, shrouding, military honors). Unable to hold hands, have final conversations, or develop treatment plans with providers, bereaved families experienced compounded losses. Concurrent quarantine hindered their engagement in coping strategies. COVID-19 bereavement increases the risk for complicated grief, which escalates the risk of physical and mental health problems, suicide, drug abuse, and family discord (Shear, 2015, 2020). While death, grief, and mourning are normal life experiences, traumatic and sudden death during a global pandemic is a new domain and the voices of those left behind are under-represented in social discourse. Simultaneously, psychologists and trainees quickly became last responders. COVID-19 presented a constellation of clinical challenges. Practitioners provided care during a time of political and racial tension, civil unrest, school closures, health and financial insecurity, and a collective loss of normalcy. Additionally, COVID-19 cast a spotlight on ageist attitudes and critical need for increased representation of older adults in training curricula. These issues echo the call to embrace aging as a valued aspect of diversity, and to strengthen psychology’s workforce in the areas of training, practice, research and advocacy for aging adults (Hoge, et al., 2015). This poster will explore the impact of COVID-19 bereavement on families and practitioners, promote advocacy efforts, and offer tangible training recommendations for psychology programs.
Family Caregivers on the Frontline: Challenges of Providing Care to Post-ICU COVID-19 Patients
Authors: Leggett Amanda , Carmichael Alicia , Leonard Natalie , Robinson-Lane Sheria , Li Sophia , Oxford Grace , Wisniewski Maren , Gonzalez Richard
Published: December 2020

Family caregivers are essential care providers helping to ensure the sometimes complicated recovery of recently hospitalized COVID-19 patients. COVID-19 caregivers face pandemic-specific challenges such as not being at patient bedside throughout the hospital stay and managing social distancing post-discharge. The current study aims to explore the unique experiences of family caregivers of Intensive Care Unit (ICU) COVID-19 patients. In-depth qualitative interviews were conducted by web conference with 13 dyads of adults who were in an ICU for COVID-19 between March and August 2020 and their primary caregiver (n=26). Participants were interviewed about the care recipient’s hospitalization and recovery journey, supports received, challenges experienced, and gaps in the system of care. Thematic qualitative analysis was conducted utilizing Watkins’ (2017) rigorous and accelerated data reduction (RADaR) technique. Caregivers played a critical role in patient admission, discharge, and recovery. Themes of caregiving challenges included self-management of COVID-19 infection, knowledge deficits of available resources and post-discharge care needs, post-infection stigma, separation guilt, deprioritized self-care, financial challenges, and lengthy recoveries with some ongoing health needs. While receipt of emotional support was considered an advantage, some caregivers expressed contact fatigue. Understanding how COVID caregivers experience illness management across the recovery journey can aid our understanding of the COVID caregiving process and identify intervention targets to improve overall health and well-being of the care dyad.
Forward-Focused Coping Predicts Better Mental Health Outcomes in Older Adults During COVID-19 Pandemic
Authors: Jordan Leslie , Woodard John , Pena Gabriel , Arnold-Nedimala Naomi , Won Junyeon , Callow Daniel , Smith J Carson
Published: December 2020

Psychosocial stressors associated with the COVID-19 pandemic may increase risk of depression and anxiety in the general population. Older adults may be especially vulnerable to these psychosocial stressors and their impact on mental health outcomes. Consequently, there is an urgent need to identify protective factors for older adults. The purpose of the present study is to determine the relative contribution of coping flexibility and two distinct coping strategies, forward-focused and trauma-focused, on negative affect in older adults during the COVID-19 pandemic. Data were collected using an online survey, including questions about demographic information, coping, depression, and anxiety. Participants aged 50 and over were included in our analyses of depression (N = 800) and anxiety (N = 638). Results indicate that both higher coping flexibility and higher forward-focused coping predict lower depression and lower anxiety. In contrast, higher trauma-focused coping predicts slightly higher depressive symptoms but is not a significant predictor of anxiety. Our findings suggest that higher forward-focused coping may serve as a protective factor in older adults during the pandemic and, therefore, may be an effective treatment target for mental health interventions.
Impact of Adult Day Service Center Closures in the Time of COVID-19
Authors: Vora Paayal , Missaelides Lydia , Trinh-Shevrin Chau , Sadarangani Tina
Published: December 2020

Adult Day Service Centers (ADCs) are a form of community-based long-term care that address frail older adults’ health and social needs. Due to their congregate nature and participants’ compromised health, many ADCs have been forced to temporarily shutter during the COVID-19 pandemic. It is unknown how closures have impacted service delivery at ADCs. Guided by the Resiliency Framework, we (1) explore methods employed by ADCs during the pandemic to meet participant/caregiver needs and (2) determine how/whether these methods have mitigated the negative effects of ADC closures on participants and their caregivers. Both virtual focus groups and one-on-one semi-structured qualitative interviews were conducted with ADC staff members (n=20) across the United States. Preliminary results showed precipitous declines in physical, cognitive, and mental health of participants, as well as increased caregiver strain, particularly among dementia caregivers. However, ADCs found creative solutions to care for participants despite restrictions, creating, in their words, “centers without walls.” Staff developed virtual programs (e.g. support groups, music and exercise therapy) and conducted “door-step” visits to support productive engagement and combat loneliness. Telehealth supported care coordination and identification of emergent clinical problems. Results suggest that despite innumerable COVID-19-related challenges, ADCs demonstrated resilience and creativity in managing participants’ needs, fostered a sense of purpose, and provided caregiver respite. Further research on the effectiveness of remote programming and advocacy for sustainable reimbursement by payers is needed to ensure that ADCs can continue to provide older adults and their families with meaningful support as the pandemic wears on.
Learning Together During a Pandemic Lockdown: Connecting Older Mentors with Nursing Students
Authors: Phinney Alison , Affleck Frances
Published: December 2020

Nursing education tends to focus on complex clinical issues affecting older adults who are acutely ill or in long-term care. This creates challenges for educators wanting to expose students to a greater range of experience, including realities of healthy aging. Opportunities to do things differently were presented when an established undergraduate nursing course on complex aging care underwent significant adjustment in the early months of the COVID-19 pandemic. As the course was condensed and moved online and clinical sites closed, invitations were extended to community-dwelling older people who wanted to “help teach nursing students about aging”. The response was overwhelming; over nine days, 118 people (ages 65-94) volunteered to be mentors. Through weekly online/ phone conversations, each person guided their assigned student to learn about diverse experiences of aging. Post-survey results showed the impact of these conversations. Over 90% of mentors felt they had contributed in a meaningful way to student learning and would do it again and recommend it to others. 85% of students felt it was a meaningful experience, offering comments like: “I am more mindful of my assumptions now” and “I learned to approach interactions with older adults as a collaboration; we have so much to give each other”. These results provide a needed counterpoint to the predominant COVID discourse of older people as “isolated, helpless, and needy”. Students came to understand that older people were also “engaged, active, and contributing” and identified how this had changed their view of aging. Implications for nursing education are explored.
Age and Socioeconomic Gradients in Frailty Among Older Adults in India
Authors: Chowdhary Ravindra
Published: December 2020

Although individuals with frailty and lower socioeconomic status (SES) are vulnerable to morbidity and early mortality, few studies have investigated this association. We intend to fill this gap with a study using older adults aged ≥ 50 years from the SAGE WAVE II in India. The Aim of study is to examine the association of frailty with SES and how this association varies across different age groups. A modified Fried phenotype approach with five frailty indicators was used to categorize 6560 older adults as frail, pre-frail or robust who had more than two, one or zero indicators, respectively: grip strength, exhaustion, weight loss, walking speed and physical activity. Multinomial logistic regression estimated the likelihood of being pre-frail and frail for various levels of SES, controlling and not controlling for confounders. This study also shows the overall socioeconomic gradients and age patterns of socioeconomic gradients of frailty indicators using predicted probabilities. Approximately 26%, 55% and 20% participants were robust, pre-frail and frail, respectively. The number of frailty indicators was positively associated with lower income and education levels in the case of controlling and not controlling for confounders. Also, among the higher age groups, individuals with low SES had higher chances of being frail.Overall, the results in this research indicated a negative low SES and frailty association as found in previous studies worldwide. This highlights the need for comprehensive and centered public health interventions for older adults with low SES.
Supporting Older Adults and Caregivers Through Integrative Service Learning During COVID
Authors: Chan Keith , LaFave Sarah , Ratnayake Maggie , Marsack-Topolewski Christina , Graves Jillian , Fenske Diane , Lukas Shay
Published: December 2020

There is a growing population of older adults who are living longer and acquiring chronic illness and disabilities, making it difficult for them to complete everyday activities and age in place. More than 2 million of these older adults are homebound and 5 million need help leaving their homes. They experience social isolation, food insecurity, and lack of connection to community resources which has intensified since the pandemic. Integrative service learning models can provide home-based support to older adults while offering valuable, hands-on learning experiences for students. This study examined findings for a community-based program which trained university students to provide practical home-based support for older adults and their caregivers. Data was collected for 109 older adults who were connected with student trainees. Students provided services with groceries, companionship, and help accessing needed services. Findings from t-test results using the UCLA Loneliness Scale indicated that older adults reported less loneliness after engagement with students (mean difference = 6.15, t = 3.14, df = 82, p < 0.01). Qualitative process data suggested that older adults benefited from services and a connection to their assigned students prior to and during the pandemic. Student trainees reported that the experience enriched their learning and reaffirmed their commitment to working with older adults. Community-based service learning can address home-based needs of older adults and their caregivers and enhance learning opportunities for students. Policies and practice can support a pipeline of geriatric health professionals through innovative service learning models to benefit older adults, caregivers and students.
Voices From the Frontlines in Longterm Care During COVID-19: Narratives of Direct Care Workers
Authors: Wolf Christin , Freidus Andrea , Shenk Dena
Published: December 2020

Our study draws from the narratives of 30 staff caring for residents in congregate care communities in central North Carolina from June-September 2020. It is part of phase 2 of an on-going 3-phase rapid qualitative appraisal of workers providing longterm care to older adults with the purpose of disseminating findings to key stakeholders to inform policy, programming, and funding decisions. The 3-phase project involves semi-structured interviews with 60+ participants that were videorecorded using a web-based platform. We report on the emotional and visceral experiences of these direct care workers providing care during the pandemic. We organize the data into four affect categories: fear/anxiety, sadness/grief, anger/frustration, and trauma/stress. The 30 participants include nurses, activities staff, med techs, CNAs, housekeepers, dining staff, chaplains and administrators at nursing homes, assisted living communities, memory care units and continuing care retirement communities. We amplify the voices of these formal caregivers in order to demonstrate how their sensorial and emotive experiences can speak to the human suffering they bore witness to, the underlying ageism that permeates our culture, and the social hierarchy that devalues their labor and their worth as they serve on the frontlines during this unprecedented global pandemic.
Early Learning from the Healthy End of Life Project (HELP) Ottawa in the Context of COVID-19
Authors: Grassau Pamela , Miloff Hayley , Davison Emily , Stinchcombe Arne , Wright David Kenneth , Thomas Roanne
Published: December 2020

Healthy End of Life Project (HELP) Ottawa is a community-based participatory research initiative which is based in four community sites in Ottawa, Ontario (Canada) (2 community health centers, and 2 faith communities). Focused on the needs of people who are frail, living with advanced illness, and their caregivers, including the needs of people who are bereaved, HELP Ottawa strives to, 1)strengthen informal and community social networks, organizational cultures and linkages across local health and social care services; 2)create a community culture that supports people to build social care networks to be able to ask for and accept help, and, 3)mobilize and prepare community members to be confident and capable of offering and providing help to people in their communities. Unfolding within the context of COVID-19, each HELP Ottawa site has found ways to mobilize, adapt and respond to lockdowns, quarantines, increased isolation and altered needs and services. Drawing on 89 initial consultations, followed by 111 interviews and 16 focus group participants (n=164), qualitative findings speak to the heightened grief and fear experienced within each site during the COVID-19 pandemic, and the multiple costs of severed ‘essential’ links. Critically highlighted is the need to build and sustain social supports and connection through everyday and local means while also integrating technology and online communication. Further apparent are the critical questions that need to be asked about how compassionate communities, and communities at large, can prepare for and respond to current and future waves of COVID-19.
Fatal Crashes Among Drivers Age 60+ in Connecticut, Massachusetts, New Hampshire, and Rhode Island
Authors: Lee Chae Man , Dugan Beth
Published: December 2020

Fatal crashes are related with the spatial components of physical environments (e.g. roadways, land use, and political boundaries). This study compares rates of fatal crashes among drivers age 60+ by counties in 4 states of CT, MA, NH, and RI. The GIS application is used to visualize the location of fatal crashes and to identify whether it is clustered as hotspots. This study pooled data related to fatal crashes in CT, MA, NH, and RI from the Fatal Accident Recording System (2008-2018). Sample (n=2,373) inclusion criteria were subjects (driver age 60+) had to have complete data on variables of interest and be involved in a crash with at least one fatality. More than half (n=1,387, 58.5%) of drivers had a fatal injury. Results showed that the county with the highest incidents of fatal crashes was New Haven, CT (n=183 involved, 53% fatality), Worcester, MA (n=179, 61.5% respectively), Hillsborough, NH (n=75, 65.3% respectively), and Providence, RI (n=94, 59.6% respectively). The GIS spatial analysis showed that crashes were clustered along roads with the highest speed limits (interstate highways or multilane state routes) and found that the hotspots of clustered fatal crashes were located in counties with big cities with high population densities (New Haven CT, Hartford CT, Springfield MA, Worcester MA, Boston MA, Concord NH, and Providence RI). Identification of these crash hotspots will be beneficial for drivers and policy makers. The findings may alert drivers to high risk areas and policy makers can implement countermeasures.
Visitation Access to U.S. Nursing Homes: An Analysis of Facility Locations, Ratings, and Disparities
Authors: Helander Mary
Published: December 2020

Research findings suggest that family visits to nursing home residents are important for countering depression, increasing residents’ well-being and quality of life (Miller, 2019; Durkin et al., 2014), maintaining physical function (Shankar et al., 2017), and improving general health (Parmenter et al., 2012). Presence by family can directly impact a resident’s care quality, since family members may take a role in monitoring their older relative’s status (Miller, 2019). Unfortunately, regular family visits to nursing homes may be difficult, or impossible, due to challenges that include distance, travel time, lack of transportation, and cost (Fields et al., 2019) (Miller, 2019). These same challenges may translate to socio-economic barriers for families, eliminating long-term-care as an option for older relatives (Ferraro et al., 2017), (Angel and Berlinger, 2018). This paper considers the issue of nursing home visitation access and examines related disparities through spatial and demographic analysis of 15,000+ US facilities monitored by the Centers for Medicare the Medicaid Services. Mathematical models are used to analyze facility and population data, using access measures adapted from the geography discipline (Lou and Wang, 2003; Paez et al., 2019). Analysis explores whether higher rated nursing homes are more likely to be closer to affluent populations, and whether socioeconomic status is a significant factor in overall access. Analysis reveals patterns of access disparity with respect to nursing home ratings and geographies. For example, proximity to higher rated facilities increases monotonically with median household income. Specific policy recommendations are discussed.
Fusogenic Liposomes Deliver Resveratrol to Brain Microcirculation and Improve Neurovascular Coupling in Aged Mice
Authors: Toth Adam Nyul , Wiedenhoeft Tabea , Tarantini Stefano , Csipo Tamas , Balasubramanian Priya , Csiszar Anna , Csiszar Agnes , Ungvari Zoltan
Published: December 2020

Adjustment of cerebral blood flow (CBF) to the increased oxygen and nutrient demands of active brain regions via neurovascular coupling (NVC) has an essential role in maintenance of healthy cognitive function. In advanced age, cerebromicrovascular oxidative stress and endothelial dysfunction impair neurovascular coupling, contributing to age-related cognitive decline. Recently we developed a resveratrol (3,4′,5- trihydroxystilbene)-containing fusogenic liposome (FL-RSV)-based molecular delivery system that can effectively target cultured cerebromicrovascular endothelial cells, attenuating age-related oxidative stress. To assess the cerebromicrovascular protective effects of FL-RSV in vivo, aged (24-monthold) C57BL/6 mice were treated with FL-RSV for four days. To demonstrate effective cellular uptake of FL-RSV, accumulation of the lipophilic tracer dyes in cells of the neurovascular unit was confirmed using two-photon imaging (through a chronic cranial window). NVC was assessed by measuring CBF responses (laser speckle contrast imaging) evoked by contralateral whisker stimulation. We found that NVC responses were significantly impaired in aged mice. Treatment with FL-RSV significantly improved NVC responses by increasing NO-mediated vasodilation. These findings are paralleled by the protective effects of FL-RSV on endothelium-dependent relaxation in the aorta. Thus, treatment with FL-RSV rescues endothelial function and NVC responses in aged mice. We propose that resveratrol containing fusogenic liposomes could also be used for combined delivery of various anti-geronic factors, including proteins, small molecules, DNA vectors and mRNAs targeting key pathways involved in microvascular aging and neurovascular dysfunction for the prevention/treatment of age-related cerebromicrovascular pathologies and development of vascular cognitive impairment (VCI) in aging.
Neurofilament Light Chain and Cognitive Performance in Selected Siblings From the CATSLife Study
Authors: Reynolds Chandra , Smolen Andrew , Link Christopher , Wadsworth Sally
Published: December 2020

Markers of neurodegeneration such as neurofilament light chain (NfL) may be elevated with neurological diseases such as multiple sclerosis (MS) as well as Alzheimer’s disease. NfL is a marker of axonal integrity where higher values positively relate to the degree of damage. NfL shows variations in early adulthood among healthy individuals and may relate to executive function performance in otherwise healthy individuals aged 19-32 years. In the ongoing CATSLife (Colorado Adoption/Twin Study of Lifespan behavioral development and cognitive aging) Quanterix Simoa assays of NfL were measured in 34 individuals selected based on self-reported neuroinflammatory conditions (N = 5) or by APOE genotype (N_nonE4 = 18, N_E4 = 16). The distribution of NfL was consistent with other studies of early-mid adulthood (range = 1.3 - 22.3 pg/ml). Based on partial regression weights predicting log-transformed NfL, NfL was higher in cases (exp(b)=1.08 pg/ml), in males (exp(b)=1.25 pg/ml), by age (exp(b)=1.03 pg/ml per year) and in APOE E4 carriers (exp(b)=1.11 p/mg). Moreover, correlations partialed for age, sex, APOE e4 and case status suggest higher NfL may be associated with lower Full Scale IQ and general cognitive ability (r’s = -.18 and -. 28) overall and may be more evident among APOE E4 carriers (r’s = -.42 - .44, partialed for age, sex, case status). In this pilot study, the observed NfL associations with general cognitive ability, particularly among APOE E4 carriers, suggests NfL may be a salient biomarker of cognitive functioning by early- to mid-adulthood.
Sex-Dependent Effects of Quadriceps Fat Content on Single Muscle Fiber Size in Older Adults
Authors: Straight Chad , Gordon Joseph , Foster Aurora , Remillard Nicholas , Damon Bruce , Chipkin Stuart , Kent Jane , Miller Mark
Published: December 2020

Evidence suggests that ectopic fat deposition interferes with skeletal muscle structure and function, but few studies have examined underlying morphological and contractile properties at the single fiber level. Healthy older (65-75 y) men (n=9) and women (n=9) underwent dynamometry for assessment of knee extensor maximal torque, water-fat magnetic resonance imaging to quantify quadriceps muscle cross-sectional area (CSA) and fat fraction (FF), and vastus lateralis biopsies to determine morphology and function of type I and II muscle fibers. Despite similar body mass indices (24.4±1.3 vs. 24.6±0.5 kg∙m2, p=0.93) and daily moderate-to-vigorous physical activity (46±7 vs. 41±9 min∙d-1, p=0.67), women had greater FF (9.0±0.3 [range: 7.6-10.6] vs. 7.9±0.4 [6.0-9.7] %, p=0.04) than men, indicating increased adipose tissue deposition in skeletal muscle. Women also had smaller quadriceps CSA (39.8±1.8 vs. 57.9±1.3 cm2, p=0.01), specific torque (1.5±0.1 vs. 1.9±0.1 Nm∙cm-2, p=0.01) and type II fiber CSA (3,943±312 [2,350-5,140] vs. 5,352±384 [3,560-6,590] µm2, p=0.01) than men. Type I CSA did not differ by sex (4,918±228 [3,740-5,600] vs. 5,630±440 [3,640-7,670] µm2, p=0.19). In older women, FF was inversely associated with single fiber CSA in type I (r= -0.81, p=0.02) and II (r= -0.76, p=0.03) fibers, and tended to be associated with slower myosin-actin cross-bridge kinetics (longer myosin attachment time) in type I fibers (r=0.65, p=0.08). These relationships were not observed in men. Overall, healthy older women have greater intramuscular fat than men, which may contribute to sex-specific effects on knee extensor specific torque through differences in muscle fiber size and cross-bridge kinetics.
Uncovering the Specific Functions of miR-33 in Regulation of Feeding and Cardiometabolic Diseases Linked to Aging
Authors: Price Nathan , Zhang Xinbo , Fernandez-Tussy Pablo , de Cabo Rafael , Fernandez-Hernando Carlos
Published: December 2020

Heart disease and metabolic dysfunction are two of the most important age related health issues, and feeding behavior is a critical factor contributing to these conditions. miR-33 promotes the development of atherosclerosis, by impairing macrophage cholesterol efflux and reverse cholesterol transport. Specific disruption of the interaction between miR-33 and the cholesterol transporter ABCA1 protected mice from atherosclerosis in a manner similar to that observed with loss or inhibition of miR-33. However, miR-33 has also been shown to impact other cellular functions, including targeting numerous mRNAs related to bioenergetics and inflammatory response, that may also contribute to its effects on atherosclerosis. Moreover, characterization of miR-33 deficient animals has revealed a strong predisposition to the development of obesity and metabolic dysfunction. While this phenotype appears to be due to alterations in feeding behavior, it is not clear what organ or organs are primarily driving this effect or what functions of miR-33 may be responsible. To address these questions, we have generated conditional miR-33 knockout mice to selectively remove miR-33 from a number of key metabolic tissues. Using these unique mouse models, we have performed an extensive characterization of how miR-33 impacts the function of different metabolic tissues in both chow and high fat diet fed mice, and assessed what impact this has on regulation of metabolic homeostasis and atherosclerosis. This work will improve our understanding of the mechanisms regulating feeding behavior and provide critical information for the development and evaluation of novel approaches to combat cardiometabolic diseases associated with aging.
A Panel of DNA Methylation and Proteomic Biomarkers for Specific Aging Pathways
Authors: Higgins-Chen Albert , Ferrucci Luigi , Levine Morgan
Published: December 2020

Most aging biomarkers such as DNA methylation and proteomic clocks have focused on measuring overall “biological age,” a single number that predicts age-related morbidity and mortality better than absolute chronological age. While intuitive and interpretable, this single biological age number does not account for the possibility that different individuals may preferentially experience aging in different molecular and cellular pathways, and therefore does not suggest personalized aging interventions. We reasoned that a panel of biomarkers each capturing specific aging pathways, such as mitochondrial dysfunction or cellular senescence, may capture the heterogeneity of aging better than existing composite measures. To address this, we employed weighted gene co-expression network analysis to cluster tissue-specific transcriptomes and the serum proteome into specific modules with distinct biological functions and characterized how these modules change with age. We trained DNA methylation proxies of these functional modules that we then applied to independent validation data to identify associations with age-related morbidity and mortality. Clustering analysis using the DNA methylation biomarkers showed that different individuals show distinct patterns of aging. These pathway-specific biomarkers will elucidate how different aging mechanisms interact with each other to produce the larger phenomenon of aging, and for evaluating novel therapeutics targeting specific hallmarks of aging.
Dementia Nursing Competency Scale at Acute Hospitals Version 2: Development and Psychometric Evaluation
Authors: Greiner Chieko , Urashima Shoko , Ryuno Hirochika , Yamaguchi Yuko , Fukuda Atsuko
Published: December 2020

Under an increasing number of people with dementia worldwide, the number of patients with dementia in acute settings is also growing. For patients with dementia to receive treatment with peace of mind, nurses should have competency in caring for patients with dementia. Thus, the aims of this study were to develop the Dementia Nursing Competency Scale in Acute Hospitals version 2 (DNCS-AH-v2) and to evaluate its psychometric properties. The draft was distributed to a convenience sample of 3000 nurses at 300 acute hospitals. After confirming the ceiling effect and the floor effect, reliability and validity were verified using Cronbach’s alpha, I-T correlation, test-retest reliability, G-P analysis, and exploratory and confirmatory factor analyses. This study was approved by the Institutional Review Board of Kobe University. Of a total of 3000 nurses, 878 (29.3%) responded to the questionnaire and 773 (25.8%) valid responses were analyzed. Mean age and mean working experience of the participants were 37.4 ± 9.3 and 14.0 ± 8.7 years, respectively. The 27-item DNCS-AH-v2 was developed with five factors scored on a six-point Likert scale. Cronbach’s alpha was .925, I-T correlation was between .46 and .68 (p<.01), ICC coefficient (1, 1) was .76 (p<.001), and significant differences were confirmed for G-P analysis (p<.001). For the confirmatory factor analysis, fit indices of CFI =.868, GFI =.868, and RMSEA =.065 were obtained. High reliability and moderate validity were confirmed for the DNCS-AH-v2. The developed DNCS-AH-v2 could be used to evaluate dementia nursing competency in acute hospitals.
Enhancing Our Understanding of Transitional Care Programs
Authors: McGilton Katherine , Vellani Shirin , Krassikova Alexandra , Cumal Alexia , Robertson Sheryl , Irwin Constance , Bethell Jennifer , Sidani Souraya
Published: December 2020

Many hospitalized older adults experience delayed discharge. Transitional care programs (TCPs) provide short-term care to these patients to prepare them for transfer to nursing homes or back to the community. There are knowledge gaps related to the processes and outcomes of TCPs. We conducted a scoping review following Arksey & O’Malley’s framework to identify the: 1) characteristics of older patients served by TCPs, 2) services provided within TCPs, and 3) outcomes used to evaluate TCPs. We searched bibliographic databases and grey literature. We included papers and reports involving community-dwelling older adults aged ≥ 65 years and examined the processes and/or outcomes of TCPs. The search retrieved 4828 references; 38 studies and 2 reports met the inclusion criteria. Most studies were conducted in Europe (n=19) and America (n=13). Patients admitted to TCPs were 59-86 years old, had 2-10 chronic conditions, 26-74% lived alone, the majority were functionally dependent and had mild cognitive impairment. Most TCPs were staffed by nurses, physiotherapists, occupational therapists, social workers and physicians, and support staff. The TCPs provided 5 major types of services: assessment, care planning, treatment, evaluation/care monitoring and discharge planning. The outcomes most frequently assessed were discharge destination, mortality, hospital readmission, length of stay, cost and functional status. TCPs that reported significant improvement in older adults’ functions (which was the main goal of the TCPs) included multiple services delivered by multidisciplinary teams. There is a wide variation in the operationalization of TCPs within and between countries.
The Association of Freezer Storage Time With Vitamin K and Vitamin D Concentrations in Human Brain Tissue
Authors: Shea Kyla , Fu Xueyan , Dolinkowski Gregory , Dawson-Hughes Bess , Holland Thomas , Dhana Klodian , Booth Sarah
Published: December 2020

Vitamins K and D are present in the human brain and have been implicated in Alzheimer’s disease and related dementias (ADRD). Because the use of banked brain tissue in ADRD research is increasing, we evaluated the stability of vitamin K and vitamin D in human brain tissue over long-term freezer storage using samples obtained from the Rush Memory and Aging Project (n=500, mean age=91, 29% male). Specimens were stored at -80□C until analyzed. Vitamin K (menaquinone-4, MK4) and vitamin D (25(OH)D) were measured in four regions (mid-temporal and mid-frontal cortexes, cerebellum, anterior watershed white matter) and averaged across regions. Storage time was categorized into two-year increments. Differences in MK4 and 25(OH)D concentrations according to storage time were evaluated using general linear models. MK4 concentrations did not differ in brains stored ≤8 years (geometric mean±SEM MK4 pmol/g: storage ≤2.0 years=1.2±0.1, 2.1-4.0 years=1.2±0.1, 4.1-6.0 years=1.4±0.1, 6.1-8.0 years=1.4±0.2; p≥0.21). MK4 in brains stored >8.0 years (0.8±0.1 pmol/g) was 33% lower than the concentration in brains stored ≤2.0 years (p=0.005). The 25(OH)D concentrations did not differ in brains stored ≤6 years (geometric mean±SEM 25(OH)D pmol/g: storage ≤2.0 years=1.2±0.1, 2.1-4.0 years=1.1±0.1, 4.1-6.0 years=1.2±0.1; p≥0.37). The 25(OH)D concentration in brains stored >6.0 years was 31-37% lower than that in brains stored ≤2.0 years (6.1-8.0 years=0.8±0.06, >8.0 years=0.7±0.04; p<0.001). MK4 and 25(OH)D appeared to be stable in human brain tissue stored at -80oC for up to 8 and 6 years, respectively. Storage time merits consideration when designing and interpreting studies that relate brain nutrient concentrations to ADRD.
The FoxO3 Longevity Genotype Is Associated With Better Survival After Acute Myocardial Infarction in Older Patients
Authors: Chen Randi , Nakagawa Kazuma , Masaki Kamal , Donlon Tim , Elliott Ayako , Allsopp Richard , Willcox D Craig , Willcox Bradley
Published: December 2020

Background: Although numerous studies have been published on prognostic factors after a first acute myocardial infarction (AMI) among middle-aged men, little is known about the prognostic factors and genetic determinants for post-AMI elderly patients. Methods: The Kuakini Honolulu Heart Program (KHHP) is a prospective population-based study of cardiovascular disease (CVD) (defined as coronary heart disease (CHD) and stroke) among men of Japanese ancestry living in Hawaii. We identified 141 first AMI patients from participants of the KHHP exam 4 (1991-93) by ECG and/or cardiac enzymes (onset age: 73-96 years). Men who survived more than one year after AMI were followed for mortality from onset of AMI to December 2018 (all were deceased by 28 years of follow-up). All had FOXO3 genotype information available. Quantile regression was used to compare the median survival times of FOXO3-G allele carriers (longevity genotype) with FOXO3-TT homozygotes (common genotype). Results: Adjusting for age at AMI onset, baseline body mass index (BMI) and glucose levels (at exam 4), median survival times differed between FOXO3-G allele carriers and FOXO3-TT homozygotes by 2.1 years (95% CI=0.24-3.95, p=0.027). Adding other known CHD risk factors (i.e. hypertension, etc.) to the model reduced the difference to 2.03 years (95% CI=0.17-3.89, p=0.033). Furthermore, chi-square testing showed the mortality rate from CVD among FOXO3-G allele carriers was significantly lower than that among the common FOXO3-TT genotype. Conclusions: The data suggest that the FOXO3 longevity genotype reduces the risk of dying from CVD and extends survival time of elderly patients with acute myocardial infarction.
Exploring Formal Caregiver Burden Within Nursing Homes: An Integrative Review
Authors: Kunkle Rachel , Chaperon Claudia , Berger Ann
Published: December 2020

The purpose of this integrative review was to explore formal caregiver burden in nursing homes among direct care nursing staff. The aim was to gain an understanding of the state of the science of formal caregiver burden, it’s measurement, and its effect on resident care. Based on PRISMA guidelines, a systematic search of CINAHL, PubMed, PsycINFO and Embase databases was conducted using terms from the definition of formal caregiver burden, three conceptual models, and the thesaurus feature of each database for years ranging from 1979-2019. Inclusion criteria consisted of peer-reviewed articles in English that focused on the key terms of formal caregiver burden among direct care nursing staff only in nursing home facilities. Out of 925 citations, 20 articles met criteria; 15 quantitative and 5 qualitative studies. Sample sizes ranged from 11-1283, number of facilities from 1-55, and bed size from 31-203. Psychometric measures used in the studies reported lower validity and reliability, a variety of conceptual definitions interchangeably, and primarily studied nursing assistants (n=19). Five studies included nurses as formal caregivers, and one studied only nurses. Variables used to identify burden were racial disparities (n=2), trauma experience (n=1), depression (n=4), distress (n=3), mental health (n=1), stress (n=2), health complaints (n=1), and alienation (n=1). Two studies evaluated the effect on resident care, one finding significant results of in-service training contributing to positive attitudes of formal caregivers toward confused residents. Current limitations in the understanding of formal caregiver burden limit the advancement of research.
How Healthcare Interactions Contribute to Burden for Care Partners of Older Adults
Authors: Mueller Anne , Fields Beth
Published: December 2020

As the aging population in the U.S. continues to grow, care partners (i.e. family and friends) are assuming increasingly intense and complex caregiving responsibilities. Care partner burden is associated with poorer health outcomes for older adults and more frequent rehospitalizations. This secondary data analysis aims to examine the relationship between different types of health care interactions and care partner burden. A total of 2,588 care partners of Medicare beneficiaries age 65 and older were included. Secondary analyses were conducted using cross-sectional data from the 2017 National Study of Caregiving. Logistic regression analyses were used to determine the relationship between health care interactions and care partner burden while controlling for demographic characteristics. The average care partner was 62 years old (range 18-98), female (68.1%), and white (62.8%). More than half of the care partners (51.3%) reported financial, emotional, and/or physical difficulty as a result of helping the older adult. Logistic regression analyses show that care partners who made medical appointments (AOR=2.04), accessed online medical information (AOR=1.55), and coordinated care between medical providers (AOR=2.15) were significantly more likely to report burden. Care partners are important allies in supporting the health of older adults but may experience excess burden due to health care interactions. Practitioners and researchers may need to evaluate ways to improve the ease, efficiency, and accessibility of different types of health care interactions for care partners of older adults. A better understanding of factors that contribute to care partner burden may inform tailored interventions and future health and aging policies.
Symptom Experience Among Family Caregivers: Symptom Cluster Analysis
Authors: Chang Yu-Ping , Seo Young , Von Visger Tania
Published: December 2020

Family caregivers of older adults experience physical and psychological symptoms such as fatigue, insomnia, depression, or anxiety which may negatively impact their quality of life. Although those symptoms often co-occur, there is no prior research on symptom clusters identification among family caregivers. Symptom cluster analysis in chronic disease populations demonstrates usefulness in clinical management. An in-depth understanding of the pattern of symptom experience can guide intervention development to improve caregiving experience, coping skills, and well-being. This study aimed to identify symptom clusters as experienced by family caregivers in the US. We analyzed responses of 2,652 unpaid caregivers from the National Study of Caregiving (NSOC) III (2017) survey to identify underlying symptom clusters. The NSOC is a nationally representative survey of family caregivers to older adults with limited functions in daily activities. We used 17 binary items measuring the physiological and psychological symptoms of caregivers. We conducted a hierarchical cluster analysis with Ward linkage method to identify the symptom clusters. Three symptom clusters were identified based on the optimum silhouette width as follows: (1) Cluster 1 (lack of cheerfulness, peacefulness, and full of life, breathing problems, and sleep interrupted); Cluster 2 (feeling lonely, down, bored, nervous, worrisome, upset, and having little interest); and (3) Cluster 3 (limited strengths in arms and legs, having low energy, pain, and troubles falling back asleep). Our findings indicate that physical and psychological symptoms are highly preventable in family caregivers. Future research on symptoms management strategies can focus on targeting multiple symptoms based on their co-occurence.
Understanding the Link between Family Caregiver Quality of Life and the Care Provided to Older People With Dementia
Authors: Hazzan Afeez
Published: December 2020

Dementia is one of the most rapidly growing diseases in the United States. In 2018, the direct costs to American society of caring for older people with dementia was approximately $277 billion. Primary informal caregivers are mainly responsible for the care of older people with dementia including Alzheimer’s disease. Caregivers perform a myriad of duties ranging from shopping for their loved ones’ groceries, helping with medications, and managing finances. The caregiving role becomes more demanding as the disease progresses over time, and studies have shown that the quality-of-life (QoL) experienced by caregivers of older adults who have dementia is lower than the QoL of caregivers for older people who do not have dementia. To the best of our knowledge, there has been no research conducted to investigate whether lower caregiver QoL affects the level or quality of care that caregivers provide to persons with dementia. In the current study, we interviewed family caregivers living in Rochester, New York to inquire about their quality of life and the care provided to older people living with dementia. Further, caregivers completed the 36-item Short Form Health Survey (SF-36) as well as a draft questionnaire for measuring the quality of care provided to older people living with dementia. Both quantitative and qualitative findings from this study reveals important relationships between family caregiver QoL and the care provided, including the impact of social support and financial well-being. The study findings could have significant impact, particularly for the provision of much needed support for family caregivers.