bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Determinants of Unmet Healthcare Needs: Comparison Between Middle-Aged and Older People
Authors: Hong Sungjae
Published: December 2020

This study aims to 1) examine unmet healthcare needs by age groups and 2) compare the social determinants of unmet healthcare needs between older and middle-aged people in Korea. This study employed a nationally representative dataset of the 2017 Healthcare Service Experience Survey in Korea. Unmet healthcare needs consisted of three categories by healthcare type: 1) clinic visitation, 2) treatment, and 3) medication. Independent variables include demographic, socioeconomic, and health status. Logistic regression models were estimated to reveal the social determinants of unmet healthcare needs of older (age≥65; N=2,178) and middle-aged (age 40~64; N=5,062) people. There was a positive gradient of unmet healthcare needs prevalence by age group, having the highest prevalence among older people (10.8%). While older people living alone were 1.70 times more likely to report any of unmet healthcare needs, there was no significant relationship between the two among middle-aged people. In addition, the effect of chronic disease morbidity on the probability of unmet healthcare needs was stronger among older people than it is among middle-aged people (OR=3.50 and 2.90, respectively). In contrast, the effect of household income was weaker than it is among middle-aged people (OR=1.73 and 2.95, respectively). The gradient of unmet healthcare needs by age group asks gerontologists and public healthcare scholars to focus on older people regarding unmet healthcare needs. Also, the difference between middle-aged and older people on social determinants of unmet healthcare needs implies different psychosocial pathways of unmet healthcare needs between the two age groups.
The Association Between Obesity and Long-Term Cognitive Performance in Middle-Aged and Older Adults
Authors: Fiscella Andrew , Andel Ross
Published: December 2020

Obesity is a growing epidemic in the United States and has been associated with negative health outcomes such as cardiovascular disease and diabetes. However, an obesity paradox has emerged which suggests that the effects of obesity may vary by age, with older adults potentially seeing a protective effect of obesity. This study examined the effects of overweight and obese status on cognitive performance at baseline and follow-up. It was hypothesized that obese middle-aged adults would perform worse than normal weight peers, but that reverse would be observed in older adults. Data from 701 participants in the Midlife in the United States study were included. Body mass index (BMI) and waist circumference were employed as measures of obesity. Z-scores for executive function, memory, and global cognition were used to quantify cognitive performance. While obese participants tended to perform worse on average than normal weight individuals there were no significant differences in performance between obese and normal weight participants in global cognition (p=.134), executive function (p=.164), or episodic memory (p=.708). Additionally, age did not moderate this relationship. However, there was a significant effect of education on all three domains. When stratified by education, participants with some college or higher, had a significant time*obesity*age interaction (F[3,328]=3.016, p<.05). For the oldest-old participants, executive function scores were higher for obese participants at follow-up compared to normal weight participants, but not at baseline. These findings suggest that level of education may serve as a form of cognitive reserve which compensates for deficits due to obesity.
Narcissism, Social Encounters, and Mood in Late Life
Authors: Zhang Shiyang , Ng Yee To , Fingerman Karen
Published: December 2020

Social contacts have a strong impact on older adult’s well-being. However, narcissism (i.e., feelings of self-importance) may undermine interpersonal connections. Research with young adults has found that being narcissistic may generate feelings of boredom, irritation, and pride because narcissistic young adults oftentimes have difficulty maintaining attention, have greater sensitivity to negative social events (e.g. social rejections), and have an exaggerated sense of self-worth. Yet, we know little about narcissism in late life, particularly in a daily context. This study examined the associations between narcissism, social encounters, and mood (i.e., bored, irritated, lonely, proud) throughout the day. Older adults aged 65 + (N = 307) from the Daily Experiences and Well-being Study completed a measure of narcissism in a baseline interview. Then, in ecological momentary assessments (EMA), they reported social encounters and mood every 3 hours for 5 to 6 days. We found no significant associations between narcissism and number of social encounters throughout the day. Multilevel models revealed that older adults who scored higher on narcissism felt more bored and prouder throughout the day. Interaction terms involving narcissism and social encounters showed that during assessment periods when they had social encounters, participants who scored higher on narcissism reported a similar level of loneliness as when they were alone, whereas their peers who scored lower on narcissism experienced decreases in loneliness. Findings suggest that narcissism does not predict social encounters. However, older adults who are higher in narcissism may be less likely to be influenced by their social encounters.
Self-Reported Memory Problems Are Related to Depressive Symptoms in Older Adults With Certain Personality Traits
Authors: Bhargava Sakshi , Hill Nikki , Mogle Jacqueline
Published: December 2020

Self-reported memory problems and depressive symptoms tend to co-occur in older adults; however, this relationship may depend on personality traits and the type of self-reported memory assessed. Using a coordinated analytic framework, this study examined whether neuroticism, extraversion, and conscientiousness moderated the associations of older adults’ self-reported memory with depressive symptoms at between- and within-person levels across three large, longitudinal datasets (range=8-12 years of follow-up) of community-dwelling older adults with no evidence of cognitive impairment (n=427-6,960; Mage: 69.47- 75.94; 72-84% White; 60-64% Female). Assessments of depressive symptoms (GDS-15 or CES-D) and self-reported memory (perceived memory decline, frequency of forgetting, and current memory rating) were taken annually or biennially; personality was assessed via the IPIP or NEO Five-Factor Inventory. Results were largely consistent across datasets. Specifically, between persons, self-reported memory problems (including perceived memory decline, higher frequency of forgetting, and lower current memory rating) were related to higher depressive symptoms only among older adults higher in neuroticism. In one dataset, results supported a protective effect of conscientiousness such that higher frequency of forgetting was related to lower depressive symptoms among older adults higher in this trait. Within persons and across datasets, at times when perceived memory decline was reported, or current memory rating was lower, depressive symptoms tended to be higher only in older adults higher in neuroticism. Results demonstrate the importance of considering personality traits and the type of self-reported memory when examining associations among reports of memory problems and depressive symptoms in cognitively intact older adults.
The Association Between Personality Traits and Depressive Symptoms in U.S. Chinese Older Adults
Authors: Li Maggie , Dong XinQi , Kong Dexia
Published: December 2020

Depressive symptoms are prevalent in the aging population and can negatively impact the health and well-being of older adults. Personality traits may interact with depressive symptoms, but there is currently limited knowledge regarding this relationship in minority aging research. This study aims to explore the associations between two personality traits, neuroticism and conscientiousness, and depressive symptoms in 3,157 U.S. Chinese older adults. Data were obtained from the Population Study of Chinese Elderly in Chicago (PINE) collected between 2011 and 2013. Neuroticism and conscientiousness were measured by the NEO Five-factor Inventory. Depressive symptoms were measured by the nine-item Patient Health Questionnaire (PHQ-9). 45.3% of the participants reported at least one depressive symptom. Controlling for potential confounders, logistic regression analyses showed that both traits were significantly associated with depressive symptoms. One unit increase in neuroticism was associated with 19% increased odds of having any depressive symptoms (odds ratio [OR]=1.19, 95% confidence interval [CI]=1.17-1.22). One unit increase in conscientiousness was associated with 5% decreased odds of having any depressive symptoms (OR=0.95, 95% [CI]=0.94-0.96). Results validate the significant association between both traits and depressive symptoms among U.S. Chinese older adults, adding to the psychological and cultural profiles of those who have experienced mental distress. More in-depth examination using culturally-tailored measurements for personality traits is encouraged in minority aging studies. The NEO inventory was developed from Western populations and hence might not adequately represent personality traits valued by non-Western cultures.
Longitudinal Association Between Education and Disability in Older Adults Living in Iceland
Authors: Chang Milan , Geirsdottir Olof , Launer Lenore , Gudnasson Vilmundur , Jonsson Palmi , Ramel Alfons , Gudjonsson Milan Chang
Published: December 2020

BACKGROUND: Disabilities among older adults are associated with cumulative adversities such as low socioeconomic status (SES), poor nutrition, and lack of access to medical care and education. However, there is little evidence on the long-term association between education and disability status among older adults in Iceland. The aim of the study was to examine the association between mid-life education and prevalence of disability in activities of daily living (ADL) and mobility disability in late-life using 25 years of longitudinal data. METHODS: A large community-based population residing in Reykjavik, Iceland participated in a longitudinal study with an average of 25 years of follow-up (N=5764, mean age 77±6 yrs, 57.7% of women) Mid-life education was categorized into 2 groups (primary and secondary versus college and university). Disability status in late life was defined with ADL and mobility disability with a binary outcome (no difficulty versus any difficulty). Logistic regression analysis was used to examine the association. RESULTS: After controlling for age and gender, and midlife health risk factors, those who had high education at mid-life were less likely to have ADL disability (Odds Ratio (OR) = 0.75, 95% Confidence Interval (CI): 0.64 ~ 0.88, P ≤ 0.001) and mobility disability (OR = 0.72, 95% CI: 0.61 ~ 0.86, P < 0.001) compared with those who had low education in mid-life. CONCLUSION: People with high mid-life education were less likely to have ADL and mobility disability after 25 years later.
A Time-, Gender-, and Disease-State Invariant Model of Fitness Across the Adult Lifespan
Authors: Maitland Scott , Brauer Paula , Mutch David , Royall Dawna , Klein Doug , Tremblay Angelo , Rhéaume Caroline , Jeejeebhoy Khursheed
Published: December 2020

In studies of community-based health behavior interventions (diet and physical activity) one goal in analysis is to show expected relationships between measures of intervention and clinically relevant outcomes. Many programs fail to show such clear links for many reasons beyond lack of intervention effectiveness. These secondary analyses were undertaken to assess if the measurement properties (stability and responsiveness) of intervention measures could have contributed to study findings. A feasibility study of lifestyle treatment of metabolic syndrome (n=293; mean age = 59yrs) had achieved 19% reversal over one year, yet neither diet quality nor fitness were associated with cardiovascular disease risk. Confirmatory factor analysis was used to examine fit of measurement models and factorial invariance was tested across three time points (baseline, 3-month, 12-month), gender (male/female), and disease status (diabetes) for the Healthy Eating Index (HEI) (Canada 2005) and several fitness measures (VO2max, flexibility, curl-ups, push-ups). The model fit for HEI was poor and could account for the lack of association seen in the original study. More development of diet quality measures is needed. The model for fitness, however, demonstrated excellent fit and displayed measurement equivalence across time, gender, and disease state. A higher degree of confidence exists when measurement equivalence/invariance is demonstrated, allowing for reliable tests of differences in comparison groups. The use of a multiple measure of fitness, including cardiorespiratory fitness, flexibility, and strength, helps eliminate limitations of using measures from a single domain or self-reported data is promising and should be considered in future work.
Growth Curve of Disability of Older Adults Over a 12-Year Period: Can It Be Modified by Age or Engaging in Activities?
Authors: Sun Rongjun
Published: December 2020

Adopting a growth curve model, this study aims to fit a growth trajectory of disability of older adults over a 12-year period, and to investigate whether such a trajectory is modified by initial age and level of engagement in activities. The data are from the Chinese Longitudinal Healthy Longevity Survey, which includes 16,064 individuals aged 60 or above in the first wave in 2002 who were followed-up in four more waves until 2014. Disability in this study is measured by having any difficulty in performing six activities of daily living. Activities include physical exercise and eight leisure activities. To rigorously test the causal effect of engaging in activities on disability, we adopted a time-lagged growth curve model. In addition, disability status in the initial wave was controlled at baseline and an array of health status measures, such as physical functioning and cognitive performance, were included as time-varying covariates. We introduced a random effect to control for unobserved heterogeneity between individuals. The results show a quadratic curve of disability over time with an accelerating pace in later waves. While initial age shows a moderate modifying effect, engaging in leisure activities substantially modified the trajectory: The probability of being disabled increased from 6.7% to 45.8% between the first and fourth follow-up for those inactive individuals. For those active older adults, it only increased from 3.1% to 18.0%. This study demonstrates that engaging in leisure activities can significantly reshape the trajectory of developing disability among older adults.
Improving Healthy Behavior and Adopting Healthy Habits by Bodywise Program for Older Adult DC Residents
Authors: Monroe-Lord Lillie , Ardekani Azam , Lee James , Harrison Elgloria
Published: December 2020

An increase in physical activity (PA) level is associated with reduction in chronic diseases. However, the number of older adults who meet the PA guideline is low and decreases with age. Bodywise is a free program that aims to promote healthy behavior and to encourage older adults who live in Washington, DC to adopt a healthy habit by increasing their PA. The Bodywise program offers water aerobics, yoga, low-impact aerobics, and chair exercise classes, conducted by trained instructors at the University of the District of Columbia. This study reports an evaluation of the implementation of this program based on the surveys completed by participants after finishing the classes. Participants were DC residents aged 60 or older. According to the surveys, 68% of participants have adopted one or more healthy habits since joining the Bodywise program. In addition, more than 62% of participants have an increase in awareness of healthy behavior through this program. Overall satisfaction with the Bodywise program is 93%, satisfaction with the variety of classes offered is 72% and satisfaction with offered skill levels is 75%. Furthermore, 81% of participants reported overall satisfaction with their instructor, specifically 100% satisfaction related to their knowledge and skill level, and appropriateness of selected music, moves, and exercises. In conclusion, the Bodywise program leads to an overall change in both awareness of healthy behavior and development of healthy habits in participants. Further research can investigate the correlation of health awareness and healthy habits with overall satisfaction with the program and the instructor.
Social Participation Across Midlife and Later Life: Evidence From the Silent Generation
Authors: Vogelsang Eric
Published: December 2020

Despite the well-established benefits of social participation for individuals and communities, little is known about how it varies throughout the life course. Drawing upon data collected between 1957 and 2011 by the Wisconsin Longitudinal Study (22,023 observations from a cohort of 6,627), this study provides four valuable results. One, I find evidence of five distinct social participation trajectories between the ages of 35 and 71; the majority of which demonstrate social disengagement over time. Two, these participation declines are primarily attributable to changes in meeting friends and group exercise activity. Three, the most pronounced activity differences separating those in more favorable and unfavorable participation trajectories are cultural event attendance and voluntary group membership. Lastly, I identify particular high school activities that are associated with social participation decades later. In total, these results highlight heterogeneity among different types of social activities, and underscore the possible consequences of membership decisions made in early adulthood.
Feasibility and Acceptability of App-Based Mindfulness-Meditation Training for Older Adults
Authors: Mahlo Leeann , Windsor Tim
Published: December 2020

Few studies have focused on the utility of mindfulness-meditation for well-being in older adults. This study aimed to investigate the feasibility and acceptability of an app-based mindfulness-meditation program for community-based older adults. A convenience sample of 46 participants aged between 63 and 81 (M = 70.85, SD = 4.70) was recruited from the community. Participants were invited to engage with a 30-day app-based mindfulness-meditation program for 10-minutes daily on their smartphones. Each meditation session comprised focusing on the breath, mentally scanning the body, monitoring the mind’s activity, and cultivating a nonjudgmental attitude toward experience. Participants completed psychosocial questionnaires at baseline, day 10, and day 30. On average, participants completed 25 sessions and almost 4 hours of application use across the 30-days. Results of linear mixed effects models showed significant improvements in positive affect, negative affect, and life satisfaction across the study interval, but no meaningful change in total or facet-level mindfulness or perceived stress. Furthermore, relative to high levels of smartphone efficacy, low smartphone efficacy was associated with higher perceived stress and negative affect, and less life satisfaction at baseline; and steeper improvements on these outcomes across the study interval. Results indicated that, on average, older adults found app-based mindfulness-meditation training interesting, enjoyable, valuable, and useful. The findings provide preliminary support for the feasibility and acceptability of an app-based mindfulness-meditation program with community-based older adults and demonstrate potential benefits for well-being. Furthermore, older adults’ perceptions of smartphone competency may play an important role in the outcomes of app-based programs.
Recruitment of Hard-to-Reach Older Adults in Technology-Based Mental Health Services Studies: Lessons Learned
Authors: Lai Patrick Ho Lam , Xiang Xiaoling , Sun Yihang , Himle Joseph
Published: December 2020

Homebound older adults are a hard-to-reach population with a high burden of depression and face substantial access barriers to mental health treatments. Internet-based psychotherapy is a promising strategy to address this persistent treatment gap, but older adults are severely underrepresented in internet-based psychotherapy trials. One challenge to advance this area of research and practice is the recruitment and retention of homebound older adults in clinical trials. Previous research has discussed the challenges of recruiting older adults in behavioral interventions and offered useful recommendations. However, recruiting homebound older adults, who face substantial mobility barriers, poses additional challenges not fully addressed in the literature. The expectation of using technology adds another layer of difficulty. In this presentation, we will discuss our group’s experiences working with community partners to recruit and retain homebound older adults for a study on technology-based mental health treatment. We partnered with home care agencies, senior apartment buildings, and Meals-on-Wheels and experimented with a few different ways to recruit study participants. Issues related to accessibility, trust, and stigma emerged as important considerations when designing recruitment strategies and materials. The discussion will be an integration of our experiences and a review of previous literature on the challenges and recommendations for recruiting older adults in mental health services research.
Relationship Status, Social Interactions, and Conversations in Late Life
Authors: Ng Yee To , Huo Meng , Zhang Shiyang , Fingerman Karen
Published: December 2020

Studies suggest spending more time interacting with and talking to others is associated with better well-being. Older adults with partners (e.g., married, cohabitated) may spend more time with their romantic partners and rely on them for support, whereas older adults without partners (e.g., widowed, divorced, never married) may have a greater reliance on other family members (e.g., grown children, siblings) and non-kin (e.g., friends). Yet, we know little about how older adults’ relationship status affects their time spending alone or with other social partners, and the frequency of conversation throughout the day. Adults aged 65+ (N = 313) completed an interview about their relationship status and social partners. They then reported social encounters in ecological momentary assessments every 3 hours for 5 to 6 days. Participants also wore Electronically Activated Recorders which captured snippets of their conversation throughout the day. Older adults with partners reported 85% of time was with their romantic partners. Multilevel models revealed that compared to older adults with partners, older adults without partners were more likely to spend time alone and have encounters with friends throughout the day. Older adults without partners also engaged in fewer conversations throughout the day. Further, older adults without partners talked significantly more when they encountered friends than did older adults with partners. Findings suggest that friends are important in older adults’ social networks particularly for those who do not have romantic partners. Daily contact with social partners facilitates conversations and that could have implications for emotional or cognitive health.
Volunteering and Friendship in Later Life: Does Gender Moderate the Relationship?
Authors: Lim Emily , Peng Changmin , Burr Jeffrey
Published: December 2020

Friendship, which is an essential part of social life and beneficial to individuals’ well-being, plays a crucial role in maintaining social connectedness in late life. Volunteering is an avenue for older adults to stay socially engaged, and also provides older adults the opportunity to meet and make new friends. A limited literature suggests that volunteering may be associated with friendship, but many studies are limited by reliance on small, non-probability samples and overly simplistic analytic approaches. The literature is also unclear with respect to how volunteering behaviors relate to specific characteristics of friendships and whether there are gender differences underlying these relationships. Using the 2014 wave of the Health and Retirement Study (N=5,306), this study investigates the association between volunteering characteristics (i.e., volunteer status and hours) and friendship characteristics (i.e., the number of close friends, friendship quality, and contact frequency) among community-dwelling older adults. We also examine whether gender moderated these relationships. Results from linear regression analyses indicate that volunteer status and the number of volunteer hours were positively associated with each dimension of friendship. Also, the positive association between volunteering at 1–99 hours, 100–199 hours, and 200 hours or more and number of close friends, friendship quality, and contact frequency were stronger for older women than for older men. Findings demonstrated that volunteering is integral in shaping late-life friendships. The differential benefits of volunteering between older men and women also suggest that volunteering might be more critical for older women’s friendships.
Home Hospice Versus Other Places of Death and Caregiver Stresses
Authors: Luth Elizabeth , Prigerson Holly
Published: December 2020

As of 2017, more individuals in the U.S. die at home than in any other location. Hospice care was designed to provide support for people who are dying and their families. However, dying persons may have rapidly emerging needs that home hospice does not immediately meet, thereby, exposing family members to be “first responders.” Thus, home death may result in distress and burden for dying individuals’ family members, even when hospice is involved. This study uses multivariable regression analysis to explore the relationship between place of death and stressful end-of-life experiences in a sample of 185 patients with advanced cancer. We also analyze which end-of-life experiences are associated with death location. Compared to home hospice death, we found dying in a hospital was associated with fewer caregiver exposures to, and reports of fearfulness and helplessness in response to, stressful end-of-life events. Compared to home hospice death, hospital death was associated with decreased frequency of choking, falls, confusion/delirium, and feeling the patient has had enough. It was also associated with less fearfulness about choking and falls and less hopelessness about falls, the patient having enough, and thinking the patient was dead. Our results suggest home death with hospice care, often involves undesirable experiences that result in more caregiver fear and helplessness than dying in a hospital without hospice care. Research is needed to understand how to best support family members through stressful end-of-life experiences even when supported by home hospice services.
Religiosity, Cognition, and Engagement in Advance Care Planning Among Older Adults
Authors: Chunga Richard , Stokes Jeffrey , Dugan Beth
Published: December 2020

Advance care planning (ACP) is an important process of discussion and documentation that may help older adults receive the end-of-life care they prefer. Although existing literature predominantly finds greater self-reported religiosity to decrease the rates of ACP, a clear consensus is not yet evident. Data from 3,182 adults aged 55 and older participating in the 2012 wave of the Health and Retirement Study were used to investigate this association and examine the moderating role of cognition. Participants reporting at least one of two ACP behaviors (written instructions and assigning a health care proxy) were categorized as formal planning only, engaging in only informal discussions was categorized as informal planning, and those who completed both or none were categorized accordingly. Cognition was measured using self-reported memory change over the last two years and with objective cognitive testing scores. Using multinomial logistic regression, three forms of ACP behaviors were regressed on a religiosity/spirituality scale, the two cognition measures, and demographic and psychosocial covariates. Greater religiosity was associated with a lower likelihood of engaging in both plans compared to none (OR=0.91, 95%CI=0.84-0.97), however this effect was no longer significant with the inclusion of race. Higher cognitive scores were associated with greater odds of engaging in informal-only (OR=1.07, 95%CI=1.04-1.10) and both plans (OR=1.04, 95%CI=1.01-1.06); subjective memory change was not associated with ACP. Neither cognitive measure significantly moderated the negative association of religiosity on ACP, suggesting that the awareness of worsening memory does not undermine the tendency to avoid planning among the highly religious.
Systematic Review of Grief Interventions
Authors: Ricken Nicole , Kim Alice , Khaled Mona , Corner Geoff , Beam Christopher
Published: December 2020

Grief interventions address pain and suffering in response to the death of a significant other. Evidence-based grief psychotherapies treat normative grief to symptoms of persistent complex bereavement disorder, the latter of which is characterized by difficulty accepting the loss and persistent yearning for the decedent. We reviewed published randomized controlled trials (RCT) of grief-focused psychotherapies to test two hypotheses. First, participants receiving grief-focused psychotherapies should demonstrate decline of grief symptoms from pre- to post-intervention. Second, participants receiving grief-focused psychotherapies should demonstrate lower grief symptoms post-intervention than participants receiving control treatments. Published studies were identified using academic search engines (Web of Science, PsycInfo, and Google Scholar) and by reviewing reference sections of published RCTs. Twelve published RCTs were identified. Effect sizes (Hodges’ g) and confidence intervals were calculated. Results support our first hypothesis and partially support our second hypothesis. Grief-related symptoms declined from pre- to post-intervention (g ranged from -0.39 to -2.51), with all studies reporting statistically significant effects. When comparing post-intervention differences in grief-focused psychotherapies versus control groups, effects were more variable (g ranged from -2.40 to 3.02), with seven studies demonstrating greater improvement among grief intervention recipients than control treatment recipients. Grief interventions appear to be effective for reducing grief-related symptoms pre- to post-intervention. However, they were only more effective than control treatments in just over half of published RCTs. While grief interventions were more effective, point estimate ranges are wide, suggesting that treatment effectiveness probably depends on factors other than the treatments themselves.
Concept Analysis of Aging With Disability in Adults
Authors: Park Seeun
Published: December 2020

People with long-standing physical disabilities are living longer than at any time in history, owing to advancements in medical science, rehabilitation, and social systems. Approximately 12–15 million people in the U.S. are aging with long-standing disabilities that were acquired before age 40 years. This population is forecast to grow, resulting in a subset within the aging community. More research is needed to increase understanding of successful aging with disabilities, the pathways of aging with disability, and unique characteristics of the aging process. The purpose was to define and clarify the conceptual meaning of aging with disability, identify its attributes, antecedents, and consequences, and explore the significance and implications of the concept in nursing. Rodgers’ evolutionary method of concept analysis was used. Three databases, CINAHL, PubMed, and PsycINFO were used to retrieve literature. Inclusion criteria were publication year from 2001 to 2019, peer-reviewed academic journals, and English-language. Exclusion criteria included other than physical disability such as developmental, learning, or intellectual disability, focus on the aging process of people without disability, the main topic on the perspectives of caregivers or health care providers. Thirty-five articles met inclusion criteria. The analysis identified three antecedents (e.g., contributing barriers), three attributes (e.g., premature aging), and three consequences (e.g., accommodation needs). An understanding of the antecedents, attributes, and consequences of aging with disabilities will enhance quality of care including effective prevention and communication. Findings will guide researchers in developing a framework or theory to increase understanding of aging in individuals who acquired disability early in life.
Factors Associated With Perceived Stress Among Dementia Caregivers With Poor Sleep
Authors: Song Yeonsu , Papazyan Anna , Kelly Monica , Choi Sarah , Fung Constance , McCurry Susan , Alessi Cathy , Martin Jennifer
Published: December 2020

Poor sleep among family caregivers of individuals with dementia is associated with higher levels of caregiver stress. Modifiable factors that increase risk of stress among caregivers with poor sleep are targets for intervention. This analysis aimed to identify factors associated with greater caregiver stress among caregivers with poor sleep. Baseline data from an ongoing trial of a dyadic sleep intervention program for individuals with dementia and their caregivers with poor sleep quality (defined by Pittsburgh Sleep Quality Index total score > 5; N=21 dyads; mean age 70.8± 11.1 for caregivers, 80.5± 8.3 for care-recipients) were analyzed. Caregiving factors included Zarit Burden Index (ZBI) and SF-12 Short Form Health Survey (SF-12v2). Care-recipient factors included Mini-Mental State Examination (MMSE) and Revised Memory and Behavior Problems Checklist (RMBPC). Stress was measured with the Perceived Stress Scale (PSS). Analyses included Pearson correlations and t-tests. Caring for multiple care-recipients (n=5: 24.8±2.7) was associated with higher (worse) PSS scores than caring for one care-recipient only (n=16: 19.6±3.7, p=0.011). Caregivers with higher PSS also had a significantly higher ZBI score (r=0.53, p=0.015), higher distress related to care-recipient behaviors on the RMBPC (r=0.57, p=0.009) and worse mental health on the SF-12v2 (r= -0.47, p=0.037). PSS was not associated with care-recipient MMSE. These findings suggest that caregivers with poor sleep who care for multiple care-recipients may be at higher risk of stress. This work also identified potential targets (e.g., caregiver burden, mental health, distress related to care-recipient behavior) for reducing stress in this population.
Personality and Sleep Health: Do Lifestyle Habits Play a Role?
Authors: Deason Karley , Mu Christina , Lee Soomi
Published: December 2020

The health behavior model proposes that healthy/unhealthy behaviors may play a role in the relationship between personality and health. Previous research shows that personality traits are linked to sleep, however, few studies have considered the moderating role of unhealthy behaviors in the personality—sleep relationship. The current study investigated the associations between specific personality traits and sleep and whether the associations were moderated by unhealthy behaviors. Participants were 61 oncology nurses (Mage=35.39, SDage=11.73). They responded to a background survey that assessed the big five personality traits and engagement in unhealthy behaviors (i.e., exercise, smoking, fast food and alcohol consumption). For two weeks, ecological momentary assessments captured daily variability in sleep (i.e., quality, sufficiency, onset latency, insomnia, duration). A series of multilevel models was used. After controlling for sociodemographics and work shift, higher conscientiousness was associated with greater sleep sufficiency (B=0.31, p<.05) and lower odds of having insomnia symptoms (OR=0.24, p<.05). Moreover, higher agreeableness was associated with longer sleep duration (B= 0.51, p<.05) and lower odds of insomnia symptoms (OR=0.29, p<.05). Other personality domains were not associated with sleep, however, extraversion interacted with unhealthy behaviors to be associated with sleep. Those who were more extraverted reported lower odds of insomnia and better sleep sufficiency; these associations were significant only for those with less unhealthy behaviors. Findings suggest that conscientiousness and agreeableness were associated with sleep health. The interaction between extraversion and unhealthy behaviors suggests that reducing unhealthy behaviors may be beneficial to improving sleep in individuals with certain personality traits.
Rural-Urban Differences in Survival and Nursing Home Use Among Medicare Beneficiaries Diagnosed With Dementia
Authors: Rahman Momotazur , White Elizabeth , Thomas Kali , Jutkowitz Eric
Published: December 2020

There is poor understanding as to how survival and healthcare utilization vary among older adults living with Alzheimer’s disease and related dementias (ADRD) in rural versus urban areas of the United States. This prospective cohort study used 2008-2015 Medicare claims linked with nursing home and home health assessment data to describe differences in survival and healthcare utilization in the six years following a new ADRD diagnosis between rural and urban populations. The sample consisted of 1,203,897 Medicare fee-for-service beneficiaries who were diagnosed with ADRD in 2008 or 2009. 77% (n=921,853) resided in metropolitan counties, 14% (n=162,857) in micropolitan counties, and 10% (n=119,187) in rural counties. Rural residents were on average about six months younger than metropolitan residents at diagnosis. Metropolitan residents survived a mean of 1211 days after diagnosis. Adjusting for individual characteristics, beneficiaries in rural and micropolitan counties survived 29.2 fewer days (95% CI -34.0,-24.4) and 31.9 fewer days (95% CI -36.1,-27.7) than metropolitan residents, respectively. Compared to metropolitan residents, rural residents spent 59.8 more days (95% CI 56.7, 63.0) in nursing homes. We found similar patterns in nursing home use for micropolitan vs. metropolitan residents, though the magnitude of the differences was smaller. Differences between groups became more pronounced the greater the time from diagnosis. These findings demonstrate that urban-dwelling older adults with ADRD are significantly more likely to remain in the community and less likely to use nursing homes than individuals in rural and micropolitan counties, particularly in later disease stages.
Creative Cities Creating Connections: Fostering Cross-Age Interaction Through Leisure
Authors: Douglas Rachel , Barrett Anne
Published: December 2020

Older and younger people interact infrequently in most social realms – a pattern stemming from institutional, cultural, and spatial age segregation. Increasing cross-age interaction offers promise as a strategy for not only enhancing social connections but also reducing ageist attitudes. We argue that a social realm with untapped potential for creating these connections is leisure, particularly within creative cities. To explore this possibility, our study examines cross-age interactions in Key West, Florida – a leisure-oriented city that promotes creativity through its social and built environment. Using participant-observation and interview data (n=126) from 2017 to 2019, we examined leisure experiences of tourists and residents, aged 23 to 83. Findings indicate that creative cultural contexts can counter ageist attitudes by promoting cross-age interaction. Data analysis revealed three processes encouraging these shifts – promoting diversity and acceptance, enhancing older adults’ participation, and nurturing intergenerational bonds. Ongoing cross-age interactions were fostered through the island’s welcoming philosophy and encouragement of out-group acceptance and diversity. They were further fostered by the island’s wide array of leisure activities and proximity of shared spaces that enabled older adults to readily pursue leisure with younger people. Cross-age ties also were promoted by the island’s focus on family-friendly leisure experiences. Our research highlights the potential of creative cities to promote age integration, and reduce ageism, through its cultural practices within leisure spaces.
What Is the Purpose in Retiring?
Authors: Best Rachel , Hill Patrick
Published: December 2020

Sense of purpose is related to many positive physical and mental health outcomes (Boyle, Barnes, Buchman & Bennett, 2009). Unfortunately, sense of purpose declines as adults age and particularly with retirement (Pinquart, 2002). Retirement is often measured dichotomously, however, many people are retiring gradually and do not fit clearly as retired or not retired. Moreover, people retire for different reasons ranging from seemingly non-negative reasons (financial incentives or wanting to spend more time on non-work activities) to more negative reasons (physical health problems, mental health problems, cognitive decline, pressure to retire, or getting fired). The current study (N = 558; mean age = 60.17) used data from a Hawaiian sample in which participants completed self-report surveys on retirement status and activity engagement, as well as a measure of purpose (Scheier et al., 2006). We examined whether the role of retirement on sense of purpose differed by form of or motive for retirement. Results indicated the fully retired population reported significantly lower sense of purpose than both the still working and the partially retired populations, but these two groups did not differ. Participants who retired for negative reasons reported significantly lower sense of purpose than those who retired for non-negative reasons. Greater activity engagement was significantly related to sense of purpose for all retirement statuses. However, this relationship was stronger for the partially retired population. Future research should examine further the role of partial retirement for maintaining sense of purpose in older adulthood.
Longitudinal Impact of an Interdisciplinary Course on Aging for First-Year Students
Authors: Picchiello Matthew , Morrow-Howell Nancy , Stark Susan , Carpenter Brian
Published: December 2020

Undergraduate courses on aging have the potential to counteract negative stereotypes about older adults and to shift students’ academic plans as they learn about aging-related opportunities. For six years we have taught an interdisciplinary course on aging for first-year undergraduate students. We present longitudinal data on students’ attitudes and academic trajectories after taking the course. Students who took the course (n = 314) and comparable students who were not in the course (n = 353) were surveyed prior to and at the end of their first semester and at the end of each subsequent academic year. At each time point students rated the degree to which aging issues are relevant to their personal and professional lives. Students also reported aging-related curricular and extracurricular activities they pursued. Multivariate repeated-measures analyses revealed a significant interaction such that personal and professional relevance of aging issues were lower and remained stable for students not in the class, and were higher and increased for students in the class, F(2,226) = 13.18, F(2,226) = 14.94, p’s < .01. However, for course students, relevance returned to baseline levels by the end of their first year and remained constant in subsequent years. Results from chi-square analyses revealed that students in the class reported more engagement in aging-related courses, χ2(1) = 8.3, research projects, χ2(1) = 90.1, and extracurriculars, χ2(2) = 20.6, p’s < .01. Results suggest that exposing students to information about aging early has the potential to alter academic trajectories, highlighting the importance of early education.
The Efficacy of Palliative Care Education and Training in Primary Care Settings: A Scoping Review of the Literature
Authors: Hsieh Jessica , Mirza Raza , McDonald Lynn , Klinger Christopher
Published: December 2020

Primary care providers play an important role in palliative care service provision. A scoping review of the literature was undertaken in an attempt to gain insight into and awareness of palliative education and training needs in primary care settings. Four scientific databases covering the medical and social science fields were searched, alongside Grey literature. A total of 5,109 hits were generated, leading to 2,875 titles for individual review. Of these, 33 articles were included in the final review. Five major themes were identified: (1) communication skills; (2) knowledge of spiritual/psychosocial needs; (3) pain and symptom management; (4) cultural proficiency; and (5) experience working within interdisciplinary teams. Many primary care practitioners felt inadequately trained in palliative care and felt unprepared to provide the necessary care. Specifically, poor communication between healthcare professionals and patients were found to adversely affect the level of palliative care that is provided. Additionally, practical experience in palliative/end-of-life care was cited as one of the most beneficial methods in helping to improve knowledge about and ability to practice in the field. The majority of articles emphasized the need for education and training programs to enhance the quality of palliative/end-of-life care service provision. Palliative care education appeared to have numerous benefits, including enhancing providers’ knowledge of and attitudes towards this subject, ability to provide palliative/end-of-life care, and self-perception of preparedness. As the landscape of education needs are constantly changing, this review serves as one of the steps in an ongoing evaluation of palliative care providers’ training needs.
The Impact of Educational Training for Supporting Chinese American Family Caregivers
Authors: Lun Man Wai
Published: December 2020

A pilot self-care educational training, focusing on common caregiving stress, self-care, conflicts, and communication within families for supporting caregiving for family members of old age, was offered to the Chinese American community. After the series of training, 16 participants were asked to evaluate their knowledge of family caregiving as well as the training. Results of the preliminary study revealed that most participants found the training informative but were not sure if they would continue to apply over time. Overall participants reported to be satisfied with the training and receptive to additional training in the future. Results encourage further implementing the training, and investigation of the longitudinal effect of the training to help with family caregiving issues.