bluuebunny/crossref_metadata_2025 huggingface dataset:
EXPLORATION OF FALL RISK OF PARTICIPANTS ACROSS EVIDENCE-BASED FALL PREVENTION PROGRAMS
Authors: Wong Rita , Elrod Cathy , Pappa Sara , Kelekar Uma , Heyn Patricia
Published: December 2023

The National Council on Aging houses the Administration for Community Living’s (ACL) national database on evidence-based, community-delivered fall prevention programs (EBFPP). Each year, cooperative agreement grants are awarded competitively to groups demonstrating readiness to deliver EBFPP in their communities. Participants in these programs completed a standardized pre-participation survey documenting demographic and self-reported fall risk factors that were entered into the national EBFPP database. Marymount University received permission to analyze the survey data entered into the ACL’s National Falls Prevention Database between July 2016 and June 2022. An exploratory analysis was conducted of 105,323 older adults who participated in one of eight ACL-approved EBFPP programs. EBFPPs vary in their targeted fall risk level, tailoring intervention components (health education, self-management training, physical exercise) and adjusting intensity and focus to match the risk level. It is unknown if people join the program that best fits their risk level. This study evaluates and compares participant demographic characteristics and fall risk across EBFPPs. We created an index to categorize risk levels, anchored in the CDC’s STEADI toolkit for fall risk, finding that 29% were high risk, 51% moderate risk, and 19% low risk. The factors used to establish risk level included 1) falling in the last 3 months, 2) referral from a healthcare professional, 3) fear of falling, 4) self-reported health (not excellent or very good), 5) depression, and 6) age 85 or older. Exploring participant characteristics by risk level and choice of EBFPP adds unique information to guide future EBFPP recruitment strategies.
FACING TRUSTWORTHINESS: AGE-GROUP DIFFERENCES IN TRUST-RELATED DECISION-MAKING AND LEARNING
Authors: Horta Marilyn , Shoenfelt Alayna , Lighthall Nichole , Perez Eliany , Frazier Ian , Lin Tian , Heemskerk Amber , Ebner Natalie
Published: December 2023

Facial impressions contribute to evaluations of trustworthiness. Older adults are especially vulnerable to trust violations, incurring risks for deception and exploitation. Using the newly developed Social Iowa Gambling Task (S-IGT), we examined age-group differences in the impact of facial trustworthiness on decision-making. Advantageous decks were represented by trustworthy (congruent condition, CS-IGT) or untrustworthy (incongruent condition, IS-IGT) faces and disadvantageous decks were represented by untrustworthy faces in the CS-IGT and by trustworthy faces in the IS-IGT. Younger (n = 143) and older (n = 129) participants completed either the standard IGT, CS-IGT, or IS-IGT. Both age groups preferred trustworthy faces in their initial choices. Older adults performed worse than younger adults across all tasks over time. Further, compared to younger adults, older adults performed worse on the IS-IGT, suggesting that incongruent facial cues interfered with older adults’ performance, which aligns with reduced sensitivity to negative social reputations in aging. Exploratory multilevel modeling indicated that age-group differences were most pronounced in the last 40 trials across all tasks. Together these findings indicate that differences between younger and older adults in experience-dependent decision-making are magnified in social contexts that involve a “wolf in sheep’s clothing,” which may reflect age-related difficulties in information integration.
FACTORS ASSOCIATED WITH OLDER ADULTS’ READINESS FOR DISCHARGE FROM POST ACUTE CARE TO HOME
Authors: Barnason Susan
Published: December 2023

Following acute hospitalization, older adults are often transferred to post-acute care (PAC) for rehabilitation and nursing care. Most PAC admissions are comprised of adults with multimorbidity (>2 chronic diseases). After PAC discharge many patients are rehospitalized within 30 days. The goal of this study was to evaluate factors associated with older adult’s readiness for PAC discharge to home. A prospective one-arm descriptive correlation study was conducted. Older adults (N=19) discharged from PAC to home participated. Subjects were recruited over a 3-month period from a large midwestern facility. Participants completed the Patient Readiness for Hospital Discharge -Short Form (PR RHDS-SF) and Patient Activation Measure (PAM). Medication burden, measured by the medication regimen complexity index (MRCI) calculated from discharge medication record. Participants included 12 females and 5 males, mean age of 73 (SD 8.2)) years. The PT RHDS -SF mean score was 49.3 (SD 16.8). The PAM mean score was 54.7 (SD 7.4). Medication burden was high, mean MRCI was 31.5 (SD 11.6). There was a significant correlation [r (17) .48, p=.04] between total PT RHDS-SF score and patient activation levels. Preparing PAC patients to self-manage their multimorbid conditions may enhance their self-confidence with transition from PAC to home. Evaluating self-management preparedness of older adults prior to PAC discharge is vastly understood. Research is needed to prepare multimorbid older adult patients transitioning from PAC to home focused on perceived readiness and self-management confidence.
FAMILY CAREGIVER COMFORT WITH TELEHEALTH TECHNOLOGIES: DIFFERENCES BY RACE/ETHNICITY IN A CROSS SECTIONAL SURVEY
Authors: Bratches Reed , Onsando Wambui , Puga Frank , Odom J Nicholas , Barr Paul
Published: December 2023

Telehealth has seen widespread use since the onset of the COVID-19 pandemic, and 82% patients required assistance in accessing their telehealth appointments. This assistance commonly comes from a family caregiver who may or may not be comfortable using the technologies associated with telehealth. The objective of our study was to analyze a demographically representative survey of US family caregivers to understand the level of comfort using telehealth technologies among family caregivers through a secondary analysis of survey data collected during the COVID-19 pandemic in 2020. Level of caregiver comfort using computers, smartphones, and tablets was determined through three Likert-style questions. Proportional odds logistic regression was used to understand the associations between demographic variables and level of caregiver comfort using each technology, when adjusting for covariates. A total of 340 caregivers were included in the analysis. Compared to Non-Hispanic White caregivers, Asian caregivers had a higher odds (OR 3.14; 95%CI 1.36, 8.02; p=0.01) of expressing comfort using computers; Black caregivers (OR 0.46; 95%CI 0.21, 0.98; p=0.04) and Hispanic caregivers (OR 0.36; 95%CI 0.17, 0.79 p=0.01) expressed lower odds of comfort using smartphones; and Asian caregivers had a higher odds (OR 4.64; 95%CI 2.05, 11.69; p=0.001) of expressing comfort using tablets. : There are identified disparities in level of technological comfort using computers, smartphones, and tablets by different racial and ethnic groups. Health systems should consider early stakeholder involvement in the design of telehealth technologies and culturally responsive training materials on telehealth technology use to reduce disparities in comfort using telehealth technologies.
FEAR OF FALLING PREDICTS NEGATIVE PERCEPTIONS OF AGING AMONG LOW-INCOME COMMUNITY-DWELLING OLDER ADULTS
Authors: Trahan Evette , Komalasari Renata , Blount Amber , Lighthall Nichole , Thiamwong Ladda
Published: December 2023

Negative self-perceptions of aging (NSPA) are associated with various health-related outcomes, including fear of falling (FOF). Despite the leading cause of injury, disability, and hospitalization among racially diverse low-income older adults, FOF’s predictive potential effect on NSPA is less studied. This was a cross-sectional study with a sampling of 54 independent and cognitively healthy older adults (4 males, 47 females, mean age 73.91, SD: 6.4; 61-87 years old) in a low-income community. A five-item NSPA Likert scale, part of the Brief Ageing Perceptions Questionnaire (B-APQ), was used to assess the negative self-perceptions of aging, with higher scores indicating fewer negative views. The Short Fall Efficacy Scale International questionnaire was used to evaluate the level of concern about falls for a range of activities of daily living. More than half of the participants were African Americans (27 or 50%), completed high school (29 or 53.7%), lived alone (37 or 68.5%), and earned just enough financially (29 or 53.7%). The simple regression results indicated that the model explained 14.9% of the variance (R2=.149, F(1,52) = 9.13, p =.004). Fear of falling (FOF) (β = -.406, p =.004) was negatively associated with NSPA. As FOF scores increased, NSPA scores decreased, signifying higher FOF, accentuating worse perceived aging. Future longitudinal research should focus on the relationship between FOF and NSPA in increasing fall risk and injurious falls, especially in ethnically diverse low-income older adults, to further clarify this relationship and its consequences. Additionally, assessing FOF and providing interventions may enhance positive perceptions of aging.
FEASIBILITY AND ACCEPTABILITY OF A LOVING-KINDNESS MEDITATION AMONG SOCIO-ECONOMICALLY DIVERSE OLDER ADULTS
Authors: Lekhak Nirmala , Bhatta Tirth , Streb Carolyn , Tran Karenna , Snyder Joel
Published: December 2023

It has been established that contemplative practices such as meditation can aid in stress management and the prevention of mental health issues. However, whether one of these techniques, such as loving-kindness meditation (LKM), is feasible for promoting later-life self-compassion, reducing loneliness, and maintaining mental health is unclear. This study examined the feasibility and acceptability of a LKM intervention among socioeconomically diverse older adults. We employed a waiting list control design and mixed methods approach to randomize the participants (n = 59) into two groups. The same intervention was administered to the second group at a later time. We oriented and instructed the older adults on how to meditate and perform the LKM intervention. It contained phrases for the self, immediate family, others, and humanity. We gathered outcome data at baseline, post-intervention, four weeks following journaling, and four weeks without journaling. The intervention was feasible and acceptable (n = 54). One hundred percent of participants rated this meditation practice as either good or better. The range for acceptability was between 4 and 20, while the range for feasibility was between 3 and 15. The participants reported that they accepted (M = 16.8, SD = 2.9) and found this meditative practice feasible (M = 12.9, SD = 1.8). Participants who engaged in this intervention daily reported that this meditative practice helped them reduce anxiety and enhance self-awareness. Our findings highlight the need for large-scale contemplative interventions (including more music and silence) that can promote self-compassion and reduce loneliness in older adults.
FEASIBILITY AND ACCEPTABILITY OF INSPIRATORY MUSCLE STRENGTH TRAINING AMONG OLDER ADULTS IN MYSORE, INDIA
Authors: karnam Raghavi , Ningaiah Nagalambika , Nanjaiah Shivamma Nanjaiah , Bhyra Nagaveni , Muralidhar Kiranmayee , Madhivanan Purnima , Krupp Karl
Published: December 2023

Hypertension, a major risk for cardiovascular and cerebrovascular diseases, affects 1.3 billion globally and 229 million in India. While exercise has shown to lower blood pressure, 40% of older Indians report inadequate physical activity. Inspiratory Muscle Strength Training (IMST), a novel breathing exercise, shows promise for controlling hypertension, but little is known about its acceptability among older Indian adults. This study examined feasibility and acceptability of IMST in older adults with hypertension in Mysore, India. Between November-2022 and January-2023, 31 non-smoking adults aged 65 - 80 years, with a blood pressure □140/90 mm Hg were enrolled in a 6-week interventional study after informed-consent. Participants used a Power-breathe Plus breath trainer for 30 breaths a day, 5 days a week, for 6-weeks, weekly increasing resistance to a maximum of 30% of their Maximum Inspiratory Pressure. Participants underwent medical assessment, interviewer-administered survey to collect data on demographics, depression, cognition, physical performance, pulmonary function and acceptability, at baseline and post-intervention. Univariate analysis was conducted. Of 31 participants, 20% were male and 55% were on antihypertensive. Four participants discontinued by week two. Post-intervention, 22% had □10 mm Hg decrease in systolic- pressure and 37% □10 mm Hg decrease in diastolic- pressure. About 59% showed improvement in depression screening scores, 40% had improved cognitive scores and 48% reported improved physical-performance scores; 80% reported IMST was useful and 90% reported device was user-friendly; 45% reported improvements in breathlessness and exercise-tolerance. IMST was acceptable, feasible and safe as a hypertension intervention for older adults in Mysore, India.
FINDABILITY OF HEALTH EQUITY DEFINITIONS ON REPUTABLE AGING AND PUBLIC HEALTH WEBSITES
Authors: Dagne Mahederemariam , Terhune Elizabeth , Heyn Patricia
Published: December 2023

In the current era of electronic health information, ensuring proper access to consistent and accurate information supporting health equity is crucial for older adults. It is imperative that older adults comprehend health terminologies and definitions on websites, enabling them to understand the necessary information effectively. To evaluate how public health websites define, communicate, and display health equity terms and definitions, we developed a tool to review how easy it is to find and understand information on websites that play an integral role in guiding the health of older adults. Thus, we reviewed over 60 credible websites widely used for health information. Many of them included dedicated aging content. Our evaluation revealed that health equity definitions were inconsistent across websites and were often challenging to locate, requiring substantial time and effort to retrieve the information. Additionally, 50% of them lacked definitions. Furthermore, most websites failed to include citations that could substantiate the provided definitions. This study underscores the absence of a systematic, standardized, and regulated approach to how public health websites inform the public, particularly by using consistent terms to define health equity. This study highlights the lack of a universally shared and standardized health equity definition for websites. We recommend that websites structure their content to be easily findable and propose adopting universal standards for displaying health information on websites, especially when communicating with the public. This can mitigate confusion, enhance the understanding of health equity, and ensure important health information findability for older adults.
FRAILTY AND COGNITIVE IMPAIRMENT: RESULTS FROM A DIVERSE SAMPLE OF OLDER PERSONS RECEIVING HEMODIALYSIS
Authors: Alfaro Ana , Bryan Rachel , Balantrapu Swathi , Liu Christine
Published: December 2023

Persons who are receiving hemodialysis are at high risk for frailty and cognitive impairment. However, little is known about the overlap of these conditions in a diverse older hemodialysis population. Our goal is to examine frailty and cognition in a diverse sample of older adults receiving hemodialysis. Data was collected as part of a cross-sectional observational study examining mentation, mood, and mobility. Frailty was identified using the Study of Osteoporotic Fractures Index and cognition was assessed with the Montreal Cognitive Assessment (MoCA) (cut off score ≤ 26). Blind MoCAs were administered (cut off score ≤ 22) when appropriate. 35 participants (mean age = 73.9 ± 10.7) enrolled. 60% were males and 20% were Spanish-speaking. 20% identified as Asian, 23% as Black, and 23% as Hispanic/ Latino. Of note, four blind MoCAs in Spanish were administered. 83% had abnormal MoCA scores. 86% were frail or pre-frail. The majority of the sample (69%) had concurrent cognitive impairment and frailty or pre-frailty. In this diverse sample of older adults receiving hemodialysis, we found that both frailty and cognitive impairment are extremely common, with a large portion of the sample exhibiting both. This suggests that interventions targeting cognitive impairment or frailty should account for the frequent overlap of both conditions, particularly among historically underserved populations.
GDF15 AND REDUCED PHYSICAL FUNCTION FOLLOWING TOTAL KNEE REPLACEMENT: A STUDY OF PHYSICAL RESILIENCE AND AGING
Authors: Fountain William , Milcik Nicholas , Schmedding Nicholas , Sieber Frederick , Oni Julius , Varadhan Ravi , Bandeen-Roche Karen , Walston Jeremy
Published: December 2023

The metabolic and inflammatory cytokine growth-differentiation factor 15 (GDF15) increases with age and negatively associates with physical and cognitive function in older adults. We hypothesized GDF15 also negatively associates with resilient outcomes after surgery. This hypothesis was tested in the SPRING study of physical resiliency after total knee replacement by assessing relationships between pre-operative plasma GDF15 levels and postoperative resilience measures including short physical performance battery (SPPB) scores, fatigability, and grip strength. GDF15 analyses and physical resilience were assessed in 127 SPRING participants (age 70±6 yrs, n=83 women). Baseline GDF15 levels correlated with age (r=0.263, P< 0.05); age-adjusted analyses were applied. In total, pre-operative GDF15 levels did not significantly correlate with functional measures at any timepoint. However, in men (n=44), GDF15 levels correlated with age (r=0.408, P< 0.05) and significant age-adjusted correlations were observed in fatigue (r=0.368, P< 0.05), gait speed (r=-0.428, P< 0.05), and SPPB score (r=-0.329, P< 0.05). Additionally, GDF15 levels correlated with chair stands at six months (r=-0.398, P< 0.05), SPPB score at six months (r=-0.384, P< 0.05), and gait speed after one year (r=-0.487, P< 0.05). GDF15 did not significantly correlate with changes in SPPB score (P>0.05). There were no significant correlations between GDF15 and any of these functional measures in women (r-value range: -0.259 to 0.107; p-value range: 0.112 to 0.969). Elevated pre-operative GDF15 appears to correlate with worsening physical function following knee replacement in men, but not women. Further investigation is necessary to understand the relationship between GDF15 and the biology of physical resiliency.
GROUP RESIDENTIAL TRAINING OF BLIND OLDER ADULTS OFFERED BY VISUALLY IMPAIRED AND SIGHTED PROFESSIONAL TRAINERS
Authors: Miller Nancy , Marcille Frankie Ann , Storm Sierra , McGuire Cathleen
Published: December 2023

VISIONS/Services for the Blind and Visually Impaired piloted a 6-day residential group training for 6 legally blind older adults ages 57-80, self identified as Caucasian or African-American. Assessments occurred in five core areas: personal, home, financial and meal management and communication skills. Mobility and family care skills were also assessed. One legally blind and one sighted professional instructor offered the training along with adaptive equipment and training on how to use it. Each participant received follow up visits in their home to measure how well they retained the skills taught and how well they were safely using them. Referrals were made to VISIONS occupational therapists to address other chronic health conditions, social workers for adjustment to blindness counseling or low vision optometrists for additional follow up. Offering intensive residential group training with peers resulted in documented improvement in ADL/IADL skills and increased social connections. Group training, even when participants had varied skill levels, education, age of onset of vision loss, and eye diseases, proved successful. One participant framed his completion certificate and hung it in his living room. The value of learning new skills with a peer group was confirmed as well as the willingness for older adults with legal blindness to attend a 6-day residential program. Providing group training helps to address the long waitlist for services with a national personnel shortage of nationally certified vision rehabilitation therapists to serve the growing older blind. population. Group training also effectively utilizes the limited government funding for training older blind adults.
HEALTH PROMOTION AS CATALYST: CHALLENGES AND COMPLEXITIES OF HEALTHCARE AMONG OLDER ASIAN IMMIGRANTS
Authors: Shrestha Sabita , Kim Jae , Hogue Mary
Published: December 2023

Older adults are the most disadvantaged, vulnerable, and marginalized groups in the world. They often experience various challenges and complexities in navigating healthcare and other social care. Needless to say, these complexities are profound, especially, among older Asian immigrants in navigating healthcare and social care compared to other populations in the US. They often face various sociocultural challenges including structural barriers in search of proper healthcare and accessibility to care. The studies have shown older Asian immigrants are reluctant to seek or access needed care due to structural barriers poised against them. In addition, lack of cultural awareness and understanding by healthcare professionals further impedes accessing timely healthcare. Despite the complexities of healthcare navigation, health education and promotion play an important role as catalysts in disseminating health information relevant to healthcare and structural barriers to older Asian immigrants. Based on ecological framework, this presentation will showcase a holistic approach to health education intervention and promotion aimed to minimize complexities of healthcare navigation and structural barriers towards older Asian immigrants in the US.
HOME TRIAD: A NEW WAY TO UNDERSTAND THE MEANING OF HOME FOR PEOPLE LIVING WITH DEMENTIA
Authors: Wang Wenjin , Huang Hao
Published: December 2023

Highlighted by the frequent stating “I want to go home,” understanding the meaning of home for people living with dementia (PLWD) is crucial to provide them better care and environment. Our novel theoretical framework, termed ’home triad’, abstracts “home” into three interconnected pillars: conceived, perceived, and lived home. We conducted in-depth interviews with five PLWD, who were over 65 years old with MMSE scores between 11-24, received home care, and could understand and consent to the study. Their caregivers were also consulted for member-checking. The findings showed that the early memories of home were more vivid. The lived home experience held paramount significance; while stable housing was vital, family was of utmost importance to PLWD. Additionally, a gender-based distinction in lived home was evident. It was also found that PLWD’s perceived daily activities and lived memories expanded their home beyond their immediate residence, encompassing neighborhoods, villages, and cities. Within home triad, we noticed that the conceived home, focusing on the discourses of power and knowledge, could easily be overlooked. Yet, focusing on this pillar revealed the pivotal roles of design and caregivers in shaping PLWD’s home, which in turn influenced perceived and lived experiences. Through home triad, we can better appreciate profound home memories for PLWD. This could bolster reminiscence therapy and enable more effective home modifications, or even improve institutional homelike environments. Our future direction aims to refine and apply home triad with more home stories, thereby informing research and practice to enhance dementia-friendly environment and PLWD’s well-being.
HOME-BASED END-OF-LIFE CARE COOPERATION BETWEEN VISITING NURSES AND CARE MANAGERS IN JAPAN
Authors: Ono Keiko
Published: December 2023

End-of-life care patients use home-visit nursing services under Japanese long-term care insurance; however, they require a care manager to implement the care plan. However, the cooperation procedure of home-based medical care between visiting nurses and care managers has not been adequately researched. Thus, this study aimed to clarify the presence of support between visiting nurses and care managers to be adapted to this situation. This study was conducted in March and April 2023 at home-visit nursing stations located in a prefecture in Japan. Self-administered questionnaires were mailed to 192 visiting nurses in Japan, and 136 response forms (70.8%) were received through postal mails. A total of 130 questionnaires (67.7%) were determined to be valid responses, which also included the participants’ written consent for research. The presence or absence of work experience and the importance of collaboration in the preparatory, introductory, stable, and near-death stages of end-of-life care were answered. The presence of work experience at each stage was over 53.1%. The importance of collaboration at each stage was over 76.9%. Query regarding collaborating well with care managers was answered on a scale from 0 to 100 %. Good collaboration with care managers had an average score of 75.4%. The presence or absence of experience and the importance of collaboration items were clarified at each stage. The research findings could contribute to the development of education and training. This work was supported by JSPS KAKENHI Grant Number JP21K02802.
IDENTIFYING CARE TRANSITIONS NEEDS EXPERIENCED BY OLDER ADULTS AND CAREGIVERS HOSPITAL TO HOME
Authors: Regan Claire , Hirschman Karen , McHugh Molly , Osokpo Onome , Mccauley Kathleen , Shaid Elizabeth , Naylor Mary
Published: December 2023

Transitions from hospital to home are a fragile period for older adults, associated with increased risks for hospital readmission and mortality. The Transitional Care Model (TCM), a multi-component, advanced practice registered nurse (APRN) led, team-based care intervention designed to support older adults and their family caregivers during this transition, has consistently demonstrated improvements in both patients’ health outcomes while lowering care costs. This secondary analysis of data generated during a large-scale replication trial of the TCM conducted in three U.S. healthcare systems (ClinicalTrials.gov: NCT04494295) was designed to identify the key challenges experienced by APRNs in implementing TCM’s intervention protocol as designed. Data from multiple sources (i.e., case studies, case presentations, APRN documentation related to 184 intervention group patients) collected from September 2020 through August 2022 were analyzed using qualitative content analysis. Across sites, the top challenges in implementing the TCM and percentage reporting these issues were: social determinants of health (SDoH, 23%); complexity of care (15%); patient engagement (14%); and communication with patients/families (12%) and with providers (10%). Non-Veteran Affairs (VA) hospitals faced a higher number of SDoH challenges such as delays in accessing care and supporting non-English speaking patients, while VA hospitals had a higher number of patients with housing safety concerns. The VA sites also had a slightly higher percent of complexity of care (15%) challenges compared to non-VA sites (12%). Findings offer insight into enhancing the design of transitional care interventions by targeted challenges associated with SDoH, complexity of care, engagement, and communication.
IDENTIFYING NEW ADRD DIAGNOSES IN HOME HEALTH CARE PATIENTS USING NATURAL LANGUAGE PROCESSING OF NURSES’ NOTES
Authors: Barrón Yolanda , Ryvicker Miriam , Song Jiyoun , Zolnoori Maryam , Topaz Maxim
Published: December 2023

Patients at risk of developing Alzheimer’s Disease and Related Dementias (ADRD) admitted to home health care (HHC) may show signs of the disease before receiving a formal diagnosis. HHC nurses are uniquely positioned to observe signs of patients’ cognitive symptoms and may record them in free-text notes in the electronic health record (EHR). We applied natural language processing (NLP) to approximately 1.8 million nurses’ notes to identify signs and symptoms of ADRD in a retrospective cohort of 56,652 patients receiving care from a large HHC agency. In a subset of 38,032 patients starting HHC without an ADRD diagnosis, we used survival analysis competing risks models to examine associations between NLP-derived indicators of ADRD constructs during the HHC episode and new ADRD diagnoses during a four-year follow-up period, adjusting for patient demographics, clinical characteristics, and functional status derived from structured standard assessment tools. By the end of follow-up, 23% of the patients were newly diagnosed with ADRD, while 35% died without a diagnosis. We observed higher 4-year cumulative incidence rates of ADRD when more ADRD-related symptoms were present in the nurses’ notes (e.g., confusion only, 0.35, 95% CI: 0.32; 0.38, memory loss only, 0.38, 95% CI: 0.36, 0.39; both, 0.52, 95% CI: 0.48, 0.56; none, 0.10, 95% CI 0.097, 0.103). These findings indicate that data from free-text notes taken during HHC serve as significant predictors for potential ADRD diagnoses. Such information can facilitate prompt specialist referrals, allowing for early diagnosis and potentially more effective treatments during the disease’s initial stages.
IDENTIFYING PATTERNS OF CHANGE IN SPIRITUAL WELL-BEING OVER TIME AMONG NEURO-ONCOLOGY CAREGIVERS
Authors: Zhu Jiayi , Sherwood Paula , Sereika Susan , Donovan Heidi
Published: December 2023

Spiritual well-being/spirituality has been recognized as a protective factor against caregiver burden, depression, anxiety, and poor quality of life in family caregivers (CG) of patients diagnosed with serious illnesses, such as cancer. However, inconsistent previous findings may be attributed to the limited understanding of spirituality as a dynamic, multidimensional concept. To address this gap, we conducted a secondary analysis using longitudinal data from two independent studies of CGs of patients with primary malignant brain tumors (pooled N=261) to identify trajectories in overall spirituality (FACIT-SP) and its 3 sub-dimensions (faith, meaning, peace) from diagnosis to 10-12 months post-diagnosis, as well as predictors and outcomes associated with trajectory group membership. For overall spirituality, 3 unique trajectories were identified: low-increasing, medium-stable, and high-stable. The faith and meaning sub-dimensions had 3 and 2 stable trajectories, respectively, while the peace sub-dimension showed low-increasing, medium-stable, and high-increasing trajectories. Older age and higher levels of perceived social support at baseline were associated with increased odds (up to 1.06 and 1.20, respectively) of being in the high-stable/high-increasing trajectories for overall spirituality and the sub-dimensions. The trajectories of overall spirituality and sub-dimensions were positively associated with CG’s mental well-being (η2=.030-.069) and self-esteem (η2=.072-.162), and negatively associated with CG’s depression (η2=.053-.319), anxiety (η2=.055-.271), and feeling of abandonment (η2=.032-.160) at 10-12 months. This study supports recognizing spirituality in CGs as a dynamic, multidimensional concept. Future interventions focusing on early screening in younger adults and supportive measures for low spiritual well-being through improving social support might improve important CG outcomes.
IMPACT OF A 4-MINUTE STRENGTH TRAINING PROGRAM ON LOWER BODY FUNCTION IN OLDER ADULTS WITH MOBILITY DISABILITY
Authors: Kurth Jordan , Sciamanna Christopher , Stine Jonathan , Ladwig Matthew , Conroy David , Schmitz Kathryn , Herrell Cheyenne
Published: December 2023

One in four older adults experience mobility disability, often resulting in financial strain and declines in quality of life. Though resistance training (RT) can improve physical function, too few older adults do RT. This study specifically reports on the impact of a short, daily RT program called Functional Activity Strength Training (FAST) on lower extremity function. FAST entailed one 30-second bout each of four exercises (push-ups, chair stands, two-arm resistance band rows, stair-stepping) followed by 30 seconds of rest daily for 12 weeks. Ninety-seven participants were randomly assigned to either intervention (n = 44) or delayed treatment control (n = 53) group. Research staff remotely provided one-on-one coaching relating to modifications and progress every 2 weeks until week 8. Participants received a daily email reminder to complete the exercises and report repetitions completed for each exercise. Outcome measures (5-time sit-to-stand, maximum 30 second chair stand performance, and single-leg stance duration) were evaluated at baseline and week 12. Participants completed exercises on 80% of possible days. Over the 12 weeks, the intervention group improved over and above the control group by +4.2 chair stands (d = 1.21), -2.3 seconds (d = -0.43) on the 5-times sit-to-stand, and +3.58 seconds (d = 0.46) on the single-leg stance. In sum, a four-minute daily, 12-week functional RT program led to improvements in chair stand, 5-times sit-to-stand, and single-leg stance performance. Efficacy trials, using gold-standard assessments should examine whether similar improvements are observed and adherence is maintained over a longer period of time.
IMPACT OF GRANDPARENTS’ CHRONIC STRESS ON GRANDPARENT-PARENT RELATIONSHIP AND LIFE SATISFACTION BY GENDER AND RACE
Authors: Mozid Nusrat E , Guastaferro Kate
Published: December 2023

Grandparents raising grandchildren are a rapidly growing population in the United States—an estimated 7.1 million children under 18 live with a grandparent in 2023. Family system theory suggests raising a grandchild impacts grandparents’ immediate and extended family relationships and amplifies stressors in the relationship with the parent of the grandchild. The quality of relationships with the parents negatively impacts grandparents’ psychosocial well-being but may also have lasting adverse effects on the grandchild. Using the most recent wave (2020) of the nationally representative Health and Retirement Study, we conducted linear regression analyses to understand the association between grandparents raising grandchildren’s (N=4,238) chronic stress (e.g., health, finances, housing) and anxiety symptoms by gender and race. Then, we examined the grandparents’ relationship with the parent and satisfaction with life as potential mediators in these associations. Results suggest grandparents’ stressors were significantly associated with anxiety symptoms (β=0.349; p< 0.01); however, there were no significant differences in total chronic stress by either gender or race. Path analysis showed both the grandparent-parent relationship and grandparents’ satisfaction with life partially mediated the association between grandparents’ chronic stress and anxiety symptoms (p< 0.001). Cultivating a consistent and quality relationship between grandparent and parent as well as focusing on grandparents’ perspectives of life suggests innovative intervention targets to improve the health and well-being of both grandparents and grandchildren.
IMPROVING HEALTHCARE REGULATIONS FOR RESIDENTS WITH DEMENTIA: PERSPECTIVES OF REGISTERED DIETITIANS
Authors: Thaitrong Phatt , Douglas Joy , Knol Linda L , Ellis Amy , Noh Hyunjin , Sanchez Shena
Published: December 2023

In order to admit residents on Medicare or Medicaid, long-term care (LTC) facilities in the United States are required to comply with federal regulations provided by the Centers for Medicare and Medicaid Services (CMS). However, limited research exists regarding the first-hand experiences of Registered Dietitians (RDs) working in LTCs and their perceptions on the extent to which the current healthcare regulations adequately address the nutritional needs of residents with dementia. Exploring the perspectives of RDs is crucial since residents with dementia may face difficulties expressing their nutritional needs. Our study explored RDs’ perspectives and identified how menu planning (F803) and mealtime environment (F558) regulations could be improved to better meet the needs of LTC residents with dementia. RDs who work with residents with dementia in the U.S. (n = 18) participated in one of five focus groups. Focus groups were led by a trained moderator using a semi-structured interview guide, transcribed verbatim, and audited by the research team for accuracy. Transcripts underwent descriptive content analyses using NVivo© software. Analyses revealed the RDs’ suggestions that F803 and F558 regulations need to 1) be more clear, 2) specify objective criteria to measure adherence, 3) work toward patient-centered care, and 4) give priority to residents with dementia. To meet the needs of LTC residents with dementia, mealtime-related healthcare regulations need to incorporate clear verbiage with measurable criteria. This will allow for easier understanding of the regulations and assessment of compliance with the regulations in LTCs.
INCREASING DEPRESSION PREVALENCE AMONG OLD ADULTS DURING THE COVID-19 PANDEMIC
Authors: Zhu Jiangyuan , Li Guohua , Lang Barbara , Chihuri Stanford
Published: December 2023

Previous research has reported worsening mental health outcomes in children and young adults amid the COVID-19 pandemic. The purpose of this study was to assess the impact of the COVID-19 pandemic on the prevalence of depression in older adults. The Longitudinal Research on Aging Drivers (LongRoad) study involved prospectively following (between July 2015 and September 2022) 2990 drivers aged 65-79 years recruited from five sites across the contiguous United States. Study participants were assessed at baseline and annually during the follow-up period using the Patient-Reported Outcomes Measurement Information System (PROMIS). The overall response rate was 69.1%. The prevalence of depression increased from 7.12% during 2015-2019 to 9.89% during 2020-2022 (p < 0.001). After adjusting for age, gender, race and ethnicity, marital status, and annual household income, the risk of depression increased by 42% [adjusted odd ratio (aOR) 1.422, 95% confidence interval 1.237-1.635] during the COVID-19 pandemic. The results of this study indicate that the prevalence of depression among older adults increased significantly during the COVID-19 pandemic.
INVESTIGATING DREAMING IN COGNITIVELY DIVERSE OLDER ADULTS
Authors: Britton Warren , Strong Jessica
Published: December 2023

Dreaming changes across the lifespan. While our understanding of how dreaming relates to aging and well-being has developed with respect to early and middle phases of the lifespan, the dreams of older adults remain under-studied. Reviews of the literature suggest decreases in dream recall and the emotionality of dream content that often precede age-related changes in sleep architecture, with few changes in dreaming occurring between ages 45-75, after which dream recall declines steeply. However, these findings are based on relatively few studies. This point is underscored when considering the effects of secondary aging on dreaming, where virtually no literature exists on the dreams of older adults experiencing mild cognitive impairment. Studying the dreams of older adults experiencing cognitive impairment may seem trivial when compared to other processes implicated in secondary aging, but recent studies examining the relationship between frequency of negative dream content and the increased risk of onset and acceleration of cognitive decline beg a closer examination of how dreaming contributes to a broader understanding of health and functioning across the lifespan. The scoping review of sleep, dreams, well-being and cognition across the lifespan, and the subsequent proposed study design seeks to employ the Hall and Van de Castle Coding System of content analysis to contribute to the literature on the dream frequency and content of cognitively typical older adults while also exploring the feasibility and methodological considerations of studying the dream content of older adults with mild cognitive impairment.
LONGITUDINAL CHANGE IN PERFORMANCE ON THE MONTREAL COGNITIVE ASSESSMENT IN THE PEOPLE WITH DEMENTIA
Authors: Wu Kuan-Ching , Jin Jessica , Chien Shao-Yun , Zaslavsky Oleg
Published: December 2023

The Montreal Cognitive Assessment (MoCA), a widely employed cognitive screening tool, is designed to identify mild cognitive impairment and diverse forms of dementia. Through its multidimensional evaluation of cognitive domains, MoCA supports clinicians in precise assessment and intervention planning for individuals manifesting cognitive deficits. Despite MoCA’s prevalence, limited research has explored its temporal dynamics in individuals experiencing memory loss, particularly across different stages of dementia. This study examined the MoCA changes of a longitudinal study analyzing the conversational speech in 8 older adults (5 males 3 females) with mild- to moderate-stage of dementia. Repeated biweekly measures at 12 intervals over six months were employed to gauge changes in total MoCA scores and its sub-tasks. Our findings reveal: 1) a significant negative correlation (r=-0.22, p=0.03) between the total MoCA score and the total time spent in tests; 2) most participants present a positive correlation (r=0.03 to 0.6) in their first memory trial session and a negative correlation (r=-0.1 to -0.8)in the second trial between words recalled and the time spent; 3) over 60% of participants demonstrating a declining trend in naming sessions, while orientation sessions exhibit no clear trend. These outcomes imply MoCA’s susceptibility to a “learning effect” with repeated measurements in people with dementia. Future longitudinal studies should consider alternate MoCA versions or extended assessment intervals to mitigate this effect.
LONG-TERM NMN TREATMENT INCREASES LIFESPAN AND HEALTHSPAN IN MICE IN A SEX DEPENDENT MANNER
Authors: Kane Alice , Chellappa Karthikeya , Schultz Michael , Diener Christian , Gibbons Sean , Baur Joseph , Rajman Luis , Sinclair David
Published: December 2023

Levels of nicotinamide adenine dinucleotide (NAD+) decline by up to 50% in aging. NAD+ is an essential co-factor for many metabolic processes, including the deacetylase activity of sirtuins, and previous studies have demonstrated that supplementing NAD+ levels has a range of health benefits in both mice and humans. Here we investigate the effect of long-term (from 13 months of age) administration of the NAD+ precursor nicotinamide mononucleotide (NMN) on frailty and lifespan in male and female mice. NMN treatment delayed the onset of frailty in both sexes, improved metabolic health in male mice, and increased median lifespan by 8.5% in female mice. Exploration of the potential mechanisms of this protection showed that NMN treatment prevented age-related gene expression changes in skeletal muscle and led to a large increase in levels of Anaerotruncus colihominis, a microbe associated with reduced inflammation, in the gut. A thorough characterization of NMN metabolism across age, sex and tissues shows context-specific sex differences in metabolic pathways, including greater Preiss-Handler pathway metabolism in females than males, which may contribute to observed sex differences in health and lifespan. Overall, this data provides preclinical evidence that chronic NMN treatment increases lifespan and improves frailty and metabolic health in aging, and highlights the importance of using both sexes for interventional lifespan studies.
MIDLIFE MEDIATORS OF EDUCATIONAL DIFFERENCES IN DEMENTIA RISK IN LATER LIFE:PRELIMINARY RESULTS FROM THE HUNT STUDY
Authors: Mekonnen Teferi , Skirbekk Vegard , Kohler Hans-Peter , Stern Yaakov , Håberg Asta , Engdahl Bo , Zotcheva Ekaterina , Strand Bjorn Heine
Published: December 2023

There is a well-known association between education and dementia risk. However, there is limited knowledge of the mediating mechanisms. Using data from the HUNT study linked with registries (n=9745), we examined the mediating role of occupation complexity, smoking, physical inactivity, systolic blood pressure, body mass index(BMI), cardiovascular diseases, hearing impairment, diabetes, and depression score (only in HUNT2) assessed during HUNT1(age 45years) and HUNT2(age 56years) for the association between education and dementia among 70+ years using causal mediation analysis. Among eligible participants, 15.7% had dementia at age 70+ years, completed compulsory education (25.7%), lower-secondary (41.7%), upper-secondary(12%), undergraduate(16.5%), and postgraduate education(4%). For every one-unit increase in educational level from compulsory education to the following levels, a decrease in the odds of having dementia among 70+ years was found (OR=0.74). Midlife mediators assessed at 45 and 56 years jointly explained 17.3% and 26.8% of the effect of education on dementia among 70+ years, respectively. Smoking and systolic blood pressure (each explained 3.7%) followed by BMI(explained 2.3%) showed a significant independent mediating role for the educational differences in dementia among 70+ years. Whereas, among the mediators assessed at the age of 56 years, systolic blood pressure(explained 6.1%), hearing impairment (explained 4.4%), smoking(explained 3.1%) and depression score(explained 2.7%) showed significant independent mediating effects. Midlife risk factors of dementia considered in this study explained nearly one-fourth of the effect of education on dementia in particular, systolic blood pressure, hearing impairment, smoking, depression score and BMI. If truly causal, these factors could indicate potential targets for interventions.
MINDFULNESS AND DEPRESSION ASSOCIATED WITH FALL RISK IN LOW-INCOME COMMUNITY-DWELLING OLDER ADULTS
Authors: Uddeen Aleeyah , Komalasari Renata , Thiamwong Ladda
Published: December 2023

Mindfulness is the state of being aware and present using mind-body exercises. Practicing mindfulness and reducing depression can improve balance and reduce fall risk among older adults. The purpose of the study was to examine the correlation between mindfulness and depression with fall risk among community-dwelling older adults in low-income settings. A descriptive cross-sectional survey design was used to assess 103 older adults (males=16, females=87, mean age=75.70, 95% CI±7.19) using questionnaires to measure mindfulness, depression, and fall risk. Mindfulness was measured using the Day-to-Day Experiences, which is a fifteen-item scale with lower scores indicating less awareness. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Fall risk was assessed using the CDC’s Stay Independent checklist. Data analysis was run using SPSS version 28. Spearman rank analysis showed that mindfulness was negatively correlated with fall risk (r=-.437, p<.001), whilst depression was positively correlated with fall risk (r=.486, p<.001). Using regression analysis, we examined if mindfulness and depression predicted fall risk. The results of the multiple regression indicated that the model explained 23% of the variance (R²=.230, F (2,100)=14.97, p<.001). Mindfulness (β=-.060, p=.010) and depression (β=.341, p=.002), respectively, were significantly associated with fall risk. It can be concluded that mindfulness and depression are predictors of fall risk in this study. Older adults, particularly in low-income settings, could potentially benefit from improving mindfulness through mind-body exercises that enhance awareness and mindful movement, as well as from improving mental health, thereby reducing fall risk.