bluuebunny/crossref_metadata_2025 huggingface dataset:
A PROFILE OF POST-ACUTE CAREGIVING
Authors: Ankuda Claire , Kelley Amy , Rajagopalan Subashini
Published: December 2022

Post-acute care is increasingly shifting from institutional settings into the home, but the impact on family caregivers is unknown. Using NHATS, we identified a cohort of 2,124 older adults enrolled in fee-for-service Medicare with a survey interview conducted within 90 days of discharge from discharge. We first examined the hospitalization characteristics associated with both receipt of family and friend assistance in the 90 days post-discharge and average hours of assistance per week. We then used linked NSOC data to a subgroup of 365 individuals to compare the caregiver reports for caregivers of older adults in the post-acute period vs. not. We found that both the receipt of post-acute family/friend assistance and hours of assistance varied by hospitalization length of stay and discharge services. We also found that post-acute caregivers differed from non-post-acute caregivers in their caregiving tasks and difficulties related to providing care.
UNDERSTANDING THE ROLE OF SOCIAL INFRASTRUCTURE FOR OLDER ADULT ENGAGEMENT ACROSS GEOGRAPHIC CONTEXTS
Authors: Latham-Mintus Kenzie , Montgomery Lucas , Wilson Jeffrey
Published: December 2022

Using semi-structured interviews of older adults, living alone or with a partner in the community, this research explores themes related to aging in place, social infrastructure, and community engagement across geographic contexts in Indiana. In particular, we are interested in understanding how older adults experience and use the existing social infrastructure in their communities and how these experiences vary across the rural-suburban-urban continuum. Additionally, we examine how social interactions supported by social infrastructure influence the maintenance of social relationships including weak social ties. Because COVID-19 has significantly changed patterns of community engagement among older adults, respondents were asked to discuss their behavior pre- and post-COVID-19. Applying a thematic analysis approach to the data, we explore the interconnections among social infrastructure, community engagement, social relationships, and geographic settings with an emphasis on older adults’ experiences and perceptions.
RESEARCH AT THE INTERSECTION OF TECHNOLOGY AND AGING
Authors: McDaniel Jodi
Published: December 2022

New and emerging technologies offer opportunities for the delivery of wide-ranging, adaptable interventions to improve quality of life of older adults. Novel technologies can also improve the quality of measurement methods used in aging research. In this symposium five presentations will describe advanced technologies to promote health and function in older adults. The first will discuss the Urban Aging Residents Coalition (UARC), an organization founded in partnership with an African American older adult community leader to address engaging urban older adults with technology. A primary goal of UARC is to prevent social isolation and promote mental wellness through education and computer literacy. The second presentation will describe a project testing socially assistive robots (SARs) to complement personnel resources in older adults with cognitive impairment in long term care facilities. Study participants were successfully engaged in a participatory design involving repeated sessions with SARs that resulted in prototype refinement. The third presentation will describe current applications of patient communication technologies in acute-critical care settings with a focus on the user experience among older adult patients. The fourth will report on the implementation of an ongoing, in-home Smarthealth technology intervention for two older adult family caregivers of persons with dementia. Study findings showed the intervention improved self-awareness of emotional care and reactions to care recipients. The final presentation will explain an advanced wound measurement system using artificial intelligence to track healing progress in clinical research. The presentations will highlight technologies to support healthy aging and discuss implication for practice, policy, and research.
PROTEOSTASIS: NOVEL INSIGHTS AND TECHNOLOGIES
Authors: Cortes Constanza
Published: December 2022

Skeletal muscle has recently arisen as a novel regulators of Central Nervous System (CNS) function and aging, secreting bioactive molecules known as myokines with proteostasis and metabolism-modifying functions in targeted tissues, including the CNS. Myokine secretion is heavily modified by exercise, suggesting that myokine signaling in the periphery may underlie the well document geroprotective benefits of exercise on the brain. The following studies address muscle proteostasis, a pathway highly activated during exercise, as a potential new regulator of the neurocognitive benefits of exercise. We have recently generated a novel transgenic mouse with enhanced muscle proteostasis via moderate overexpression of Transcription Factor E-B (TFEB), a powerful master regulator of cellular clearance and proteostasis. We have discovered that the resulting enhanced skeletal muscle proteostasis function can significantly ameliorate proteotoxicity and reduce neuroinflammation in the aging CNS. We derived cTFEB;HSA-Cre transgenic mice in the P301S MAPT background and we detected a significant reduction in hyperphosphorylated tau[AT8 phospho-tau antibody] in whole hippocampal lysates and in the dentate gyrus of cTFEB;HSACre;P301S mice compared to their single transgenic P301S littermate controls. Nanostring nCounter®AD panel analysis reveals displayed reductions in microglia activation modules in P301S MAPT/cTFEB:HSACre hippocampi, suggesting reduced neuroinflammation. We also determined that these CNS benefit sin P301S MAPT/cTFEB:HSACre mice were accompanied by activation of exercise-associated neurotrophic signaling and reduced markers of advancing tau-associated pathologies in the hippocampus. These provocative results suggest that enhanced skeletal muscle proteostasis modifies the accumulation of pathogenic tau isoforms and reduces neuroinflammation in the CNS of P301S MAPT mice via activation of exercise-associated signaling in the CNS.
PHOSPHORYLATION OF ULK1 AT S555 IS REQUIRED FOR METABOLIC ADAPTATIONS TO CALORIC RESTRICTION
Authors: Drake Joshua , Nichenko Anna , Wiloughby Orion , Brisendine Matt , Hays Garrett , DiGirolamo Grace , Weingrad Zach , McMillan Ryan
Published: December 2022

Unc-51 Like Autophagy Activating Kinase 1 (Ulk1) is responsible for initiating selective degradation of damaged/dysfunctional mitochondria (mitophagy) once phosphorylated at S555 in response to energetic stress. Mitophagy is integral for mitochondrial health and Ulk1 has been implicated to be important for metabolic adaptation to exercise. Caloric restriction (CR), which extends lifespan and healthspan, has profound metabolic benefits, including improved mitochondrial health. However, the contribution of Ulk1 in adaptation to CR is unknown. To decipher a functional role of Ulk1(S555) in adaptations to CR we used CRISPR-Cas9 generated, loss-of-function Ulk1(S555A) mice, in which Ulk1 cannot be phosphorylated at S555. 6-month-old, male and female homozygous Ulk1(S555A) mice and C57BL6/J (wild type, WT) mice were placed on a 40% CR diet for 8 weeks. Body mass in both male and female Ulk1(S555A) and WT mice was reduced with CR (p < 0.001), however female Ulk1(S555A) were heavier than their WT counterparts (p=0.02). Via nuclear magnetic resonance (NMR), male and female Ulk1(S555A) mice did not lose fat mass during CR. In addition, periovarian (female) and epididymal (male) fat mass was greater in Ulk1(S555A) compared to WT mice post-CR (p < 0.001). Furthermore, fasting blood glucose increased in male and female Ulk1(S555A) post-CR (p < 0.0001), suggesting altered substrate metabolism. In support of this notion, glucose oxidation in both quadriceps muscle and liver of male mice increased in WT following CR but not in Ulk1(S555A) mice (interaction effect p< 0.002). In sum, these data suggest that phosphorylation of Ulk1 at S555 is required for metabolic adaptations to CR.
ELDER MISTREATMENT, MORTALITY, AND HOSPITAL READMISSION AMONG MEDICARE BENEFICIARIES, 2015–2018
Authors: Pappadis Monique , Wood Leila , Haas Allen , Kuo Yong-Fang , Mouton Charles
Published: December 2022

Elder mistreatment (EM) is a growing public health and safety crisis, with long-term consequences for individuals, families, and communities. We explored whether older adults hospitalized with a primary diagnosis of EM was associated with an increased risk of mortality and unplanned hospital readmission compared to those with a secondary EM diagnosis. We further examined whether EM type and hospital setting was associated with risk of mortality and unplanned hospital readmission. Using 100% of 2015-2018 Medicare files of hospitalized Medicare Fee-for-Service beneficiaries aged 66 and over, we used Kaplan-Meier and Cox proportional hazard models to estimate mortality and unplanned readmission rates by primary versus secondary EM diagnosis, EM type, and facility type. 11,023 patients were hospitalized with an EM diagnosis. The majority were female (64.1%) and Non-Hispanic/Latinx White (74.3%). Neglect was the most common EM type. The three-year mortality rate was 56.7% and one-year readmission rate was 53.8%. Compared to other EM types, patients diagnosed with neglect had a 2.20 (95% Confidence Interval [CI]=1.88-2.56) and 3.21 (95% CI=2.32-4.43) times greater risk for mortality within and after 50-days from discharge, respectively. Patients discharged from a skilled nursing facility (SNF) were at an increased risk of mortality and unplanned readmission compared to those discharged from an acute hospital. Hospitalized patients with a primary EM diagnosis were associated with an increased risk of mortality and readmission compared to those with a secondary diagnosis. Future work should explore care patterns before and after EM diagnosis to identify potential time points for medical and social intervention.
THE ROLE OF PEER HEALTH WORKS IN ENGAGING INCARCERATED PATIENTS IN RESEARCH
Authors: Murillo Fernando
Published: December 2022

Incarcerated peers play a critical role in the provision of care for incarcerated older adults. Peer counsel is part of the culture in carceral settings and official and unofficial caregiving is a necessity for visually, mobility, and cognitively impaired residents of these institutions. Due to their experiences of exploitation by the prison system and research institutions, most older incarcerated people are reluctant to trust community partners or correctional staff members who conduct research in correctional settings. Many older residents who are offered participation in research do not believe any real systemic changes will occur with the publication of findings. This presentation will draw on autoethnographic experiences of a peer health worker in the palliative care setting. We will describe the role that peer health workers play in guiding patients in decision-making around research and interrogate a model of partnering with peer health workers to engage incarcerated older adults in research.
ASSESSING PHYSICAL FUNCTION AND MENTAL HEALTH AMONG OLDER PERSONS IN PRISON
Authors: Barry Lisa
Published: December 2022

As the number of older incarcerated persons grows, evaluating changes in their physical and mental health over time may be important for appropriate planning and needs assessment. Based on findings from the Aging Inmates’ Suicidal Ideation and Depression Study (Aging INSIDE), we will provide recommendations for assessing both objective and subjective physical function in older incarcerated persons. We will also discuss our experiences with assessing depression and suicidal ideation in this population and describe how the processes for collecting data needed to be modified during the COVID-19 pandemic. Those attending this session will learn about the pros and cons of using face-to-face assessments and mailed surveys to assess physical function and mental health among older persons in the prison setting and will learn how these outcomes may differ between those who have a life sentence versus those expecting to be released from incarceration in late life.
COVID-19 ERA EFFECTS ON OLDER ADULTS’ COGNITIVE COMPLAINTS, DEPRESSIVE SYMPTOMS, AND STRESSFUL EVENTS
Authors: Segerstrom Suzanne , Crosby Paris , Witzel Dakota , Kurth Maria , Choun Soyoung , Aldwin Carolyn
Published: December 2022

Older adults have adjusted better to the COVID-19 pandemic in terms of their psychological well-being than younger adults. We investigated individual differences in vulnerability within older adulthood as pandemic severity changed, providing a more refined prediction of older adults’ adjustment to COVID-19. Participants from this longitudinal study were included if they had at least one semiannual assessment before and one during the COVID-19 era (N = 111, 65% women, age range = 62-96 at onset of COVID-19 era in the US). There were 1,098 pre-COVID-19 assessments (M=9.9, 1/5/2018-1/22/2020) and 265 post-COVID-19 (M=2.4, 1/23/2020-10/31/2021). At each assessment, participants reported on six cognitive complaints (MOS), five depressive symptoms (Geriatric Depression Scale), and six domains of undesirability-weighted stressful life events (Louisville Older Persons Event Scale). Daily national, state, and regional COVID-19 case and death rates were obtained from the Centers for Disease Control and summed for the week preceding each assessment. In multilevel ZIP models, the COVID-19 era significantly increased depressive symptoms (0.68 to 1.18, p < .0001) and stressful events (30.9 to 48.5, p < .0001), but did not significantly affect severity of cognitive complaints. Older age was associated with greater impact of COVID-19 on depressive symptoms and stressful events; women reported more stressful events when pandemic severity was high, but men reported more stressful events when pandemic severity was low. Although older adults in general have adjusted better to the pandemic than younger adults, the old-old had greater vulnerability to this unavoidable event than the young-old.
SOCIAL ISOLATION AND LONELINESS AMONG OLDER ADULTS IN SUBSIDIZED SENIOR HOUSING: DOES IMMIGRATION STATUS MATTER?
Authors: Jeong Chung Hyeon , Baek Jihye , Ryu ByeongJu , Park Jina , Kim BoRin , Park Sojung
Published: December 2022

Older immigrants are at increased risk for social isolation and loneliness due to cultural and linguistic barrier to forming social networks. The vulnerability to social isolation could be exacerbated by the gaps between older immigrants’ cultural expectations on social relations and actual social connectivity. Guided by the cognitive discrepancy model of loneliness, this study examined how social isolation influences loneliness among low-income older residents living in subsidized senior housing and if the relation varies by immigration status. Survey data were collected in 2019 and 2020 from 231 residents in subsidized senior housing communities located in St. Louis and Chicago. Social isolation was measured by frequency of social contacts, accounting for the types of relationships (family vs. friends) and the modes of contacts (in-person vs. remote). Loneliness was measured by the Revised University of California Los Angeles loneliness scale. Perceived quality of friendship was also included in the analytic models. The results of multiple linear regression showed that having positive friendship (b=-1.00, p<.001) and more frequent in-person contacts with friends (b=-1.29, p<.001) were negatively associated with loneliness, respectively. A significant moderating effect was found that older immigrants felt less lonely than non-immigrant counterparts when they had more in-person family contacts (b=-1.09, p<.05). The results suggest that the impacts of social isolation on loneliness among senior housing residents could differ depending on immigration status. The findings of this study could contribute to developing culturally sensitive interventions to enhance social connectedness and reduce loneliness among older immigrants in subsidized senior housing.
MISSION AND VISION OF THE MULTISITE VA ELIZABETH DOLE CENTER OF EXCELLENCE (EDCOE) FOR VETERAN AND CAREGIVER RESEARCH
Authors: Trivedi Ranak
Published: December 2022

Enabling Veterans to remain safely in their homes is a Department of Veterans Affairs (VA) priority. Informal caregivers play a critical role in supporting Veterans with functional impairments through their own efforts and the use of home and community-based services (HCBS). The Elizabeth Dole Center of Excellence (EDCoE) for Veteran and Caregiver Research was created in 2018 as part of the VA Choose Home Initiative to expand VA capacity to deliver integrated, Veteran- and caregiver-partnered, data-driven approaches to care through a set of complimentary projects. The EDCoE is a virtual center, with its multi-disciplinary team spread across the country at 5 different VA Medical Centers. The team also collaborates with other VA caregiver researchers. Finally, the EDCoE is closely networked with national, regional, and local operational partners, allowing for rapid dissemination of findings. In this symposium, we will first discuss the mission and vision of the EDCoE. We will then discuss multiple projects that are led through the EDCoE. Paper 1 (San Antonio) will identify measurement gaps to guide monitoring and improving HCBS. Paper 2 (Miami/Canandaigua) will describe a national survey of 8000+ Veterans and 3500+ caregivers. Paper 3 (Palo Alto) will describe caregivers’ barriers to accessing VA and non-VA HCBS. Paper 4 (Salt Lake City/Canandaigua) will describe the results of latent trajectory analyses of administrative data to identify groups of Veterans who use different combinations of HCBS and institutional services. Our results are used by VA operational partners and policymakers to improve services for Veterans and informal caregivers.
TELE-SAVVY: CHALLENGES AND OPPORTUNITIES OF A SYNCHRONOUS/ASYNCHRONOUS PROGRAM
Authors: Kovaleva Mariya
Published: December 2022

This presentation will trace the development of the Savvy Caregiver program from its beginnings as the Center for Nursing Research-supported Minnesota Family Workshop (1993; PI: Sharon Ostwald) through a further test as the Partners in Caregiving Program (1997; PIs: Hepburn 1RO1NR04517-01) to the Alzheimer’s Association-supported Savvy program (1997; PIs Hepburn & Lewis). Three main developments occurred over this period: the program solidified its identity as a caregiver training program and its mechanism of action as that of self-efficacy development through an active learning approach; it sharpened its focus by concentrating on the principal family caregiver (moving away from a broader family approach and eliminating concurrent care recipient programming); and it developed interventionist training materials and programs to enable broader reach. Since 2002, Savvy has enjoyed wide dissemination as an evidence-based in-person psychoeducation program, fostered by support to sponsoring organizations by the Administration on Community Living.
TELE-SAVVY@HOME: CONVERTING TO A COMPLETELY ASYNCHRONOUS DELIVERY APPROACH
Authors: Epps Fayron
Published: December 2022

It is well established that family caregiving is taxing and stressful. Group-based psychoeducational programs such as the Tele-Savvy program demonstrated that the acquisition of skills, knowledge, and caregiving mastery can ameliorate caregiving stress – and enhance PLWD quality of life. Many factors, however, preclude caregivers’ attendance in the synchronous portions of Tele-Savvy limiting the program’s scalability. To make Tele-Savvy more accessible and available to a growing number of dementia family caregivers, we designed a fully asynchronous version of the Tele-Savvy program, Tele-Savvy@Home. To accomplish this, we consulted facilitators and caregivers who participated in Tele-Savvy. We also reviewed the existing curriculum, re-wrote portions, reordered modules, and created new videos to cover synchronous content. In addition, we partnered with education design specialists to create interactive and reflection exercises to maintain a psychoeducation orientation and strengthen caregivers’ self-efficacy. This strategy may help investigators in their augmentation of the delivery strategies of established interventions.
LET’S PLAY TOGETHER: INTERGENERATIONAL EDUCATION BY CO-DESIGN ESCAPE GAME WITH OLDER ADULTS
Authors: Liu Li-Chuan
Published: December 2022

People always think that the older adults are only suitable for participating in activities and games suitable for older adults, and cannot complete games with young people, such as escape game. However, if we can understand the characteristics and needs of the elderly, we find that the older adults still have mobility and vitality to participate in games with young people. Through the intergenerational learning of university’s students and the older adults, we use design thinking and PDCA as class frameworks, and let two groups can jointly together to design escape game for the older adults. During the planning stage, the survey and interview of older adults, game design training; the practical operation in the implementation stage; the team discussion and correction in the reflection stage; and the sharing with older adults in the re-action stage (celebration). As a result, these processes allow students and older adults to communicate and share life experiences and wisdom. In one hand, students have a better understanding and concerns about older adults, and they find that the older adults also have vitality and enthusiasm; on the other hand, older adults also more understand the life of students, and feel the creativity and investment of students. In other words, both groups have changed their cognition to each other, and discovered the possibility of mutual cooperation and communication.
IMPROVING MEDICAL STUDENT RECOGNITION AND UNDERSTANDING OF MORAL INJURY IN MILITARY VETERANS
Authors: Rodriguez-Gonzalez Maribel , Silverman Michael Alan , Miller Maura , DiScala Sandra , Bharadwaj Mythili , Beazley Anthony
Published: December 2022

Developing a curriculum for medical students is essential in teaching specific skill sets to better care for patients. There are 18,000,000 living military Veterans in America with unique needs not usually included in medical school curriculum. Military personnel are trained to kill or neutralize the enemy, a doctrine that goes against the moral, religious, and societal principle of thou shalt not kill. Combat Veterans are frequently placed in circumstances where they are forced to commit or participate in acts that go against their moral beliefs leading to a dimensional problem called Moral Injury (an affliction of the soul) with accompanying psychological, behavioral, social, and symptoms such as lack of trust, spiritual distress, fatalism, regret, depression, self-loathing, and apathy, etc. and can be a significant problem encountered in older Veterans precipitated by the normative changes of aging. Discussion with more than one hundred second- and third-year medical students over a 3-year period showed that the students were unfamiliar with Moral Injury. The Geriatrics Department at the West Palm Beach VA Medical Center has created an educational module for medical students that focuses on 1) recognizing the symptoms of Mora Injury, 2) how to approach and converse with Veterans including specific questions to ask and what not to say, 3) the importance of a team approach including a chaplain, 4) interventions such as providing forgiveness and life review, and 5) being cognizant of the trust issues of older LGBTQ Veterans. The response of the medical students has been both positive and enthusiastic.
USING CONNECTED LEARNING THEORY GUIDED ADOPTION IN SUCCESSFUL IMPLEMENTATION OF 4MS AGE-FRIENDLY CARE
Authors: Tobey Leah , Scherer Danette , McAtee Robin
Published: December 2022

As one of the HRSA funded Geriatric Workforce Enhancement recipients, the Arkansas Geriatric Education Collaborative worked with the Reynolds Institute on Aging Thomas and Lyons Longevity Clinic to implement Age Friendly care. An adult learning theory was used to develop trainings on the 4M’s of Age-Friendly Healthcare and to pursue Age-Friendly Certification from The Institute for Healthcare Improvement. The Connected Learning Theory is a proven method to reliably help a trainee’s adoption of new principles and ideas by connecting familiar relationships which are easily recognized. This theory supports various learner pathways and proposes that students learn best when they form familiar connections to the materials. In an effort to provide enhanced training to healthcare professionals who were already familiar with much of the content, associations were made between M&M’s candy with each of the 4Ms, What Matters, Mobility, Mind and Medications of Age-Friendly Care. Baseline and 6-months post training data on two Merit-Based Incentive Payment Systems (MIPS) measures, depression and falls risk screening, were used to evaluate outcomes. Staff were satisfied with the 4Ms Age-Friendly Framework and found it easily applicable to their older adult patient workflow. MIPS evaluation of data showed significant changes in depression screens with a 23% improvement and a 3% improvement in screenings for future fall risk 6 months after training. This clinic achieved Level I Age-Friendly Certification in June 2021. Although the staff were already specialists in geriatrics, the training increased application of the 4 M’s, improved staff acceptance, and improved knowledge via M&M connections.
MOVING FROM ENDORSEMENT TO ACTION: ALIGNING AFU EFFORTS WITH UNIVERSITY STRATEGIC PLANS AND GOALS
Authors: Walsh Sarah , Zakrajsek Andrea , Barragan Cassandra , Wladkowski Stephanie P
Published: December 2022

The Age-Friendly University global initiative has the opportunity to unite nations around the world towards making higher education spaces inclusive of older adults. Once a university joins the AFU Global Network and endorses the 10 guiding principles, the real work of living up to the principles begins. Each institution has unique geographical, political, social, and financial characteristics that require tailored approaches to this work. At our regional comprehensive university, we completed three separate analyses (external, internal, future directions) as part of our Environmental Scan. The goal of the Environmental Scan was to understand the initial strengths, weaknesses, and opportunities to age-friendliness and inclusiveness for older learners within our campus community. We utilized a multi-pronged data collection approach, including individual stakeholder interviews, online surveys of older leaners, policy analysis, and internal and external audits. Many aspects of data collection for the environmental scan occurred concurrently with data analysis. Data from each of the eight data collection methods were used to generate key findings and recommendations and will be presented. Furthermore, we found that aligning our recommendations with the University’s marketing and enrollment efforts as well as the University’s goals relating to diversity, equity and inclusion allowed for greater administrative support for strategies to increase age-friendliness on campus. with implications for similar work at other institutions. The Age-Friendly University global initiative has the opportunity to better support the inclusion of older adults in higher education. Our Environmental Scan of age-friendliness, from inception to completion will apply to institutions across the globe.
MEASURING UNMET NEEDS OF HIGH-NEED, HIGH-RISK AMERICAN VETERANS AND THEIR CAREGIVERS USING A PROSPECTIVE SURVEY
Authors: Dang Stuti , Garcia Sandra , Munoz Richard , Noel Polly Hitchcock , Desir Marianne , Hansen Jared , Brintz Benjamin , Intrator Orna
Published: December 2022

Success in delaying long term institutionalization (LTI) depends on creating means to adequately support each Veteran’s needs. To better understand the unmet needs of Veterans, we identified a random sample of 20,000 Veterans from five VA sites. Veterans were stratified into low-, moderate- or high-risk tiers using a measure of predicted 2-year probability of LTI. Veterans and their caregivers were asked to complete separate surveys to assess demographic, physical, psychological, and social domains, unmet needs, and experience with HCBS and caregiver support programs. Responses were received between July-Dec 2021 from 8056 Veterans (80.3+/-9.8y; 94.0% men; 82.6% White; 8.9% Hispanic) and 3579 caregivers (71.1+/-13.1y; 75.1% women; 80.5% White; 15.1% Hispanic; 57.1% spousal) responded by mail (96%) or online (4%). Both Veterans and caregivers endorse complex Veteran unmet needs spanning medical, psychological, and social domains. Survey results will be used to inform HCBS policy to support aging Veterans and their caregivers.
SPERMIDINE TOXICITY IN MITOCHONDRIAL DNA-DEFICIENT SACCHAROMYCES CEREVISIAE
Authors: Su Wei-Hsuan , Ocegueda Omar , Choi Catherine , Smith Jessica , Lee Kelsey , Wan Yihan , Yao Jacqueline , Schriner Sam
Published: December 2022

Mitochondrial dysfunction is thought to play a significant role in aging and in manyhuman diseases. Over the last 20 years or so, a number of drugs have been found toextend lifespan in model organisms. Using ethidium bromide to deplete the yeastSaccharomyces cerevisiae of its mitochondrial DNA (mtDNA), we evaluated thedependence on functional mitochondrial in the action of five of these lifespan-extending compounds; dinitrophenol, metformin, rapamycin, resveratrol, andspermidine. None of them extended lifespan in mtDNA-deficient cells, demonstratinga requirement for functional mitochondria in their action. However, we found thatspermidine significantly shortened lifespan in these cells, decreasing the medianlifespan from 6 days to 4 days. Despite this, spermidine, nor any of the othercompounds tested, had any effect of growth rates in mtDNA-deficient cells.Spermidine is thought to extend lifespan through the induction of autophagy. Wepredict that spermidine shortened lifespan in mtDNA-deficient cells through anincreased need for ATP, for which these cells were not able to provide. Given thatmitochondrial dysfunction might be a common feature of aging and disease, ourresults suggest that if spermidine were used as an anti-aging treatment in humans, itmay be harmful.
GOOD ALZHEIMER'S CARE DEFINED BY FAMILY CAREGIVERS AND FORMAL CAREGIVERS IN KOREA
Authors: Chung Gawon
Published: December 2022

The purpose of this study is to explore the meaning of good Alzheimer’s care and the policy needs from the perspective of family caregivers and formal caregivers(in long-term care settings) in Korea and to provide policy suggestions to mainstream "care" and "caregivers" into the Korean National Dementia Plan. By using mixed methods, the Korean Government's policy efforts under the National Dementia Plan to respond to the issue based on Alzheimer’s patients' individual needs and care environments and to alleviate family’s caregiving burden are analyzed. Also, the formal caregivers’ working conditions, difficulties, and the level of knowledge/expertise are examined to find out whether they are well prepared for providing good Alzheimer’s care. The findings reveal that both family caregivers and formal caregivers desire Alzheimer’s care experts’ consulting and honest communication among the care triads. Family caregivers want formal caregivers not to infantilize the patients, to provide more cognitive services based on their individual history and characteristics. Also, the vulnerabilities of patients' spouses are identified that in many cases there is no one other than the spouse who can provide care for the patient, their self-rated health status is poorer, and their tendency to seek professional help is relatively lower. Formal caregivers want the Alzheimer’s patient-formal caregiver ratios to be lowered for better care and their Alzheimer’s care expertise to be acknowledged and properly compensated. Thus, it is crucial to reflect the experiences of the care triads(patients, family caregivers, and formal caregivers) in the Korean National Dementia Plan more rigorously.
LEVERAGING NATURAL LANGUAGE PROCESSING TO IDENTIFY CAREGIVER AVAILABILITY FOR PATIENTS WITH ALZHEIMER'S DISEASE
Authors: Mahmoudi Elham , Wu Wenbo , Najarian Cyrus , Aikens James , Bynum Julie , Vydiswaran Vinod
Published: December 2022

Identifying caregiver availability for patients with Alzheimer’s disease and related dementia (ADRD) can inform healthcare systems and hospital administrations on appropriate discharge planning. However, caregiver availability data is not systematically collected in the healthcare system. Our objective was to use medical notes (from physicians, nurses, or social workers) to assess caregiver availability and types of caregivers for hospitalized patients with ADRD. We used 2016-2019 telephone-encounter notes from a single institution. Rule-based natural language processing (NLP) was used to develop an algorithm to identify whether the patient (1) resides at home; (2) resides at an institution; (3) has a formal caregiver; and (4) has an informal caregiver. We evaluated the data at the note level and used chart abstraction as the “gold standard.” We examined the validity of the algorithm for both training (n=749) and test sets (n=227). Our results indicated a high level of accuracy and reliability for identifying an informal caregiver (F1=0.942; accuracy=0.947, sensitivity=0.970, and specificity=0.928). Identifying whether the patient lived at an institution was the least reliable measure (F1=0.638, accuracy=0.899, sensitivity=0.512, specificity=0.978). The most common causes of misclassifications were: (1) incomplete or misspelled names of the facilities; (2) past/uncertain/undecided situations; (3) lack of specificity; (4) use of uncommon abbreviations; and (5) irregular use of templates. Our NLP algorithm was able to identify whether the patient lived at home vs. an institution and whether the patient had a formal or informal caregiver. There is merit in continuing the NLP approach to identify more granular, caregiver-related information (e.g., hours available).
THE SENIOR COMPANION PROGRAM PLUS: A PROMISING LAY PROVIDER MODEL FOR ADRD FAMILY CAREGIVING
Authors: Xu Ling , Fields Noelle , Williams Ishan , Gaugler Joseph , Cipher Daisha
Published: December 2022

Considerable disparities exist in the prevalence of Alzheimer’s Disease and related dementia (ADRD) in older African American (AA) populations compared to older white populations. Given the need for caregiver interventions for family caregivers from racial and ethnic minority groups that hold potential for translation, implementation, and sustainability in their communities, peer-led, lay provider models may offer promise. We developed the Senior Companion Program Plus (SCP Plus), a peer-led psychoeducational program for AA family caregivers (CGs) provided by Senior Companions (SCs). Guided by sociocultural stress and coping model, the study was a randomized controlled trial that assessed the effects of SCP Plus on AA ADRD family caregivers’ stress and burden, coping skills, and social support. Although COVID-19 ended the trial early, study participants included Senior Companion-Caregiver dyads (N=20). Friedman tests for non-normally distributed variables, one-way repeated measures ANOVA for normally distributed variables, and post hoc between group significance tests were conducted. CGs in SCP Plus group reported significantly decreased caregiving burden (F(2,6) = 17.65, p = 0.003) especially between pre- and follow up-tests, as well as increased coping skills, especially at post-test (F(2,6) = 4.93, p = 0.05), satisfaction with social support (χ2(2) = 6.53, p = 0.04), and positive aspect of caregiving (χ2(2) = 6.53, p = 0.04) (especially between pre- and post-tests as well as between pre- and follow up-tests). Implications for future research are offered as well as lessons learned for culturally congruent, lay provider interventions for ADRD family caregivers.
EFFICACY OF A BRAIN HEALTH PROGRAM FOR OLDER MICHIGANDERS: SINGLE-GROUP DESIGN FINDINGS
Authors: Kim Ha-Neul , Sun Fei , Freddolino Paul
Published: December 2022

This study aims to examine the effectiveness of a brain health education intervention addressing four areas: dementia false beliefs, Alzheimer’s disease knowledge, confidence in managing cognitive changes, and dementia worries among older adults. A quasi-experimental design was used with 6 groups of participants of older adults in Michigan who received the intervention over an 8-week period via Zoom. Participants (n=39) included male = 8, female = 31; Caucasian = 19, African American = 20 that were 60 or older (M = 71.74, SD = 6.80). Participants’ MoCA score ranged from 18 to 30 (M = 26.36, SD = 2.43). Paired t-tests were used to compare pre-post differences on four main areas. At post-test, participants reported decreased false beliefs to dementia (p<.001); increased Alzheimer’s disease knowledge (p=.003); and improved confidence in managing cognitive changes (p=.018) compared to their baseline scores. However, although the mean score of ‘dementia worries’ decreased on post-test (pre-test: 15.67, post-test: 14.53), it did not show statistical significance (p=.33). The 8-week brain health intervention showed a positive impact on lessening participants’ false beliefs on dementia, and enhancing knowledge of Alzheimer’s disease and confidence in managing their cognitive changes. The findings of this study laid the groundwork for future studies that use a larger sample size and randomized control trial design to test brain health education programs among older adults.
CHRONIC CONDITIONS AND MORTALITY: MODERATION BY SELF-RATED HEALTH
Authors: Voss Lauren , Teas Elizabeth , Friedman Elliot
Published: December 2022

Chronic conditions become more common with age and greater numbers and severity of chronic conditions, in turn, increase the risk of mortality. However, individuals with similar disease burden often have different mortality rates. The purpose of the present study is to examine potential explanations for divergent mortality outcomes. Self-rated health (SRH), or perceptions of one’s own health, consistently predicts mortality. Thus, we hypothesized that participants’ SRH would modify the association between chronic conditions and mortality. Data were from the second wave of the Midlife in the US (MIDUS study, N=5,524). Mortality data were collected through 2018. Chronic conditions were measured in two different ways. To assess disease severity, each chronic condition was weighted by its propensity to cause disability; these were then summed. The second was a count of chronic conditions, a common measure in many studies. SRH was measured on a scale of 1-5 (1 = poor, 5 = excellent). Results from logistic regression models showed probability of mortality increased significantly with greater disease burden (measured both as counts and severity of conditions) and decreased with higher ratings of SRH. Importantly, compared to lower ratings, higher ratings on SRH were associated with lower probability of mortality at the same levels of disease severity. In fact, participants who rated their health as excellent showed no increase in probability of mortality with increasing number or severity of conditions. Overall, this study suggests that even in the context of chronic diseases, positive perceptions of health predict greater longevity.
POST-COVID-19 ASSESSMENT: HEALTH LITERACY AND PREVENTION PRACTICES IN LTC FACILITIES IN INDIA: PROVIDER PERSPECTIVE
Authors: Balaswamy Shantha , Samuel Raja , Singh Rufus
Published: December 2022

There were no governmental issued guidelines directed specifically towards Long-Term Care residential facilities (LTCF) for older adults in India during COVID-19 pandemic (Rajagopalan 2020) and no data has been collected on care for resident in NGO’s and private facilities (WHO, 2021). Further, studies of level of knowledge of providers on health indicators of residents, health literacy and risks factors of contracting the virus is absent. In India, older adults who live in LTCF have higher rates of chronic diseases (hypertension, diabetes, respiratory, heart problems), live in crowded communal space, less access to medical care for underlying health conditions, and have untrained, multiple caregivers, thereby putting them at increased risk for exposure and contracting the COVID-19 virus, and significant risk of infection, illness and mortality. LTCF includes NGO’s, government funded old age homes and private paid retirement homes and is considered a multi-residence housing facility. This exploratory study, using online survey of providers of approximately 125 LTC facilities, examines the providers general health literacy level, prevention practices at their facility interventions, demands and rewards of caring for residents during COVID. Preliminary results less than 20% of providers tracked prevalence of illness, health symptoms, infection rate, hospitalization, mortality rate, or post-recovery. Majority reported difficulty in accessing vaccination, getting residents vaccinated, and accessing resources ( food/ medicine/sanitizers) and problem coordinating care due to staffing shortage. Only a small percent use and track health and psychological assessments of residents. Findings have implications for advocating for standardization care and support National and State LTCF policy.
NURSING HOME ADMINISTRATOR EXPERIENCES DURING COVID-19: AN EXPLORATORY STUDY
Authors: Beltran Susanny , Wagner Jennifer , Miller Vivian
Published: December 2022

Nursing homes have been the epicenter for the COVID-19 pandemic; 149,107 residents and over 2,200 staff have died of COVID-19. In addition to the loss of lives, 99% of nursing homes report staffing shortages. Various exploratory studies have emerged gathering the experiences of frontline nursing home staff during COVID-19, however less is known about the experiences of Nursing Home Administrators (NHA) responsible for overseeing personnel and operating a facility in line with shifting state and federal mandates. Thus, this study explores the experiences of NHA during the pandemic. A cross-sectional online survey was conducted. In addition to demographic and facility-level questions, open-ended questions explored prior training on infection prevention, day-to-day operational challenges, needs, and considerations of leaving their role as administrator. The total sample (N=60) included 47 NHA of record and 13 assistant administrators/other; 53% worked in corporate NHs and 23% were part of continuing care retirement communities. Respondents report prior infection prevention training, but indicate it was not adequate preparation for COVID-19. Moreover, administrators describe challenges in recruiting and retaining staff, and in supporting staff mental health needs (e.g., burnout, PTSD). The majority of NHAs endorse a desire to step away from their role, but indicate a commitment to residents keeps them from resigning. Findings indicate that NHAs, like other members of the NH team, have experienced the effects of COVID-19, and point to specific training and support needs to equip NHAs for work in the context of this pandemic and future emergencies.
A DATA-BASED PROPOSITION FOR THE CREATION OF NEW ICD-10 DIAGNOSIS CODES FOR POST-ACUTE SEPSIS SURVIVORS
Authors: Oh Sungho , O’Connor Melissa , Stawnychy Michael , Barrón Yolanda , Garren Patrik , Sang Elaine , Bowles Kathryn
Published: December 2022

Sepsis survivors have the second highest readmission rate among Medicare beneficiaries, next to heart failure. I-TRANSFER is an implementation science study to improve transitions and reduce readmissions among sepsis survivors transitioning from acute to home health care (HHC). A total of 63 semi-structured interviews were conducted with stakeholders among 12 hospitals and 5 affiliated home health agencies (HHAs). The purpose of this secondary analysis was to: 1) examine how the sepsis diagnosis is reflected in HHC documentation, 2) identify barriers in sepsis information transfer to HHC, 3) recommend a documentation strategy to enhance information transfer and HHC documentation. We analyzed the diagnosis coding within a national OASIS dataset and eight I-TRANSFER interviews with hospitalists, documentation specialists, and HHC coders. Findings include: a) sepsis diagnoses were nearly invisible in HHC records being documented for only 10% of 165,000 sepsis survivors transitioned to HHC, b) sepsis information in referral documentation can be unclear to HHC coders, c) the lack of sepsis diagnosis documentation might make HHC clinicians unaware of the patient’s risk for readmission, d) HHC coders recommended improved language in the acute care discharge summary to link the need for HHC to sepsis, thereby supporting the use of ICD-10 sepsis ‘A’ codes in HHC. The use of terms, such as “History of Sepsis” or “Sepsis Resolved,” leads to HHC using non-specific codes, thus is not recommended. We highlight the need for new ICD-10 codes for “Sepsis Aftercare” and “Post-Sepsis Syndrome” to clearly communicate and document the needs of sepsis survivors.
FEASIBILITY OF ECOLOGICAL MOMENTARY ASSESSMENT OF SURROGATES FOR COGNITIVELY IMPAIRED ICU PATIENTS: A PILOT STUDY
Authors: Taylor Tracy , Burke Emily , Slaven James , Pfeffer Bruce , Perez Shelley Varner , Banks Sarah , Torke Alexia
Published: December 2022

We explore the feasibility of ecological momentary assessment (EMA) with surrogate decision makers (SDMs) of critically ill hospitalized adults, to obtain in-the-moment participant-reported data. In this small pilot, 23 SDMs were approached. 82.6% were white, 53.9% were female, and 53.9% were 55 years and older. 25% were spouse or partner, 25% were adult children, 30% were parents, and 20% were other relations. Average ICU length of stay was 13.46 days (range 1.73-77.79). 13 SDMs enrolled (56.52%). Using Twilio, an automated text was sent to SDMs containing a secure link to the surveys. Up to five questions about anxiety, depression, distress, communication, and spiritual well-being were sent up to twice per day. Most participants (84.62%) completed EMA surveys for 5 or more days. Most SDMs stated that the surveys were not burdensome. Of those who declined participation (n= 10), accessibility to a smartphone, stress, and availability to complete texted surveys were noted as barriers to participation. The data suggest that EMA is a valuable tool to inform clinical interventionists and care providers interacting with SDMs. Future research will assess EMA with a larger group of SDMs, utilizing questions that help identify gaps in communication and opportunities to provide support to SDMs. Although surrogates are often under high stress in the ICU setting, they are willing to provide real-time EMA feedback on their experiences. EMA can provide a “just in time” option for research and clinical intervention that focuses on bridging gaps that may contribute to better outcomes for SDMs.