bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the Risk and Protective Factors for the Mental Health of Sexual Minority Asian Americans
Authors: Flatt Jason , Whitmer Rachel , Gilsanz Paola
Published: December 2020

This study characterizes the mental health of Asian American older adults (aged 60+) who identify as sexual minorities (SM or lesbian, gay, bisexual) and compare to their non-Asian American and non-SM counterparts. Data were from the Research Program on Genes, Environment and Health (Aged 60+; N=185,478), a representative sample of healthcare members from Northern California. It includes SM (N=447) and heterosexual/non-SM (N=15,772) older adults who identify as Asian American (Chinese, Japanese, Filipino, and South Asian) and non-Asian American SM (N=3,890). Rates of dementia, anxiety, and PTSD were similar for both SM and non-SM Asian Americans. However, older lesbian and gay Asian Americans were more likely to have a depression diagnosis (30% vs. 18%, p=0.002) compared to non-SM. Overall, mental health outcomes were lower for Asian American SM compared to non-Asian American SM. We discuss need for understanding protective factors for mental health and implications for future interventions.
Adversity, Coping Repertoire, and Psychological Well-Being of Chinese Older Immigrants in the United States
Authors: Guo Man , Wang Yi , Liu Jinyu , Stensland Meredith , Dong XinQi
Published: December 2020

Using data from 2,923 Chinese older immigrants in Chicago, this study aims to identify different patterns of coping repertoires of older immigrants, based on a combination of individual, family and community coping resources, and the optimal coping repertoire that is associated with the best psychological outcomes. The results of Latent Class Analysis revealed four types of coping repertoires: low-resource (43%), spouse-oriented (32%), community-oriented (15%), and multi-source coping repertoire (10%). Overall, immigrants who had multi-source coping repertoire reported the best psychological outcomes. However, the influence of coping repertoires varied based on specific adversities. Having community-oriented coping repertoire was more protective for widowed immigrants, whereas spouse- or community-oriented coping repertoire was more protective for those with poor health. For less-acculturated older immigrants, having community-oriented coping appears most beneficial to their well-being; and for older immigrants who perceived low filial support from their children, having multi-source coping was associated with better psychological well-being.
Affective Vulnerability to Short Sleep Predicts 10-Year Changes in Chronic Health Conditions
Authors: Sin Nancy , Rush Jonathan , Buxton Orfeu , Almeida David
Published: December 2020

We examined daily affective vulnerability to short sleep (i.e., individual differences in the extent that sleeping ≤6h predicts next-day affect) as a risk factor for developing chronic conditions 10 years later. Participants (N=1945, ages 35-85, 57% women) from the National Study of Daily Experiences reported sleep duration and affect in daily diary telephone interviews. Chronic conditions were assessed with a 39-item checklist (e.g., arthritis, hypertension, diabetes). Multilevel structural equation models revealed that individuals with heightened negative affect following short sleep had an increased number of chronic conditions after 10 years (Est.=1.20, SE=.48, p<.01). Positive affective vulnerability (i.e., greater declines in positive affect following shorter sleep vs. longer sleep) was marginally associated with 10-year chronic conditions (Est.=-.72, SE=.40, p=.07). Adding to the well-established connections between sleep duration and well-being across adulthood, these findings suggest that affective vulnerability to short sleep represents a unique risk factor for long-term health as people age.
Dementia Severity Is Associated With Early Potentially Avoidable Readmissions in an Acute Care Hospital
Authors: Mitsutake Seigo , Ishizaki Tatsuro , Tsuchiya-Ito Rumiko , Hatakeyama Akira , Sugiyama Mika , Furuta Ko , Toba Kenji , Ito Hideo
Published: December 2020

Understanding the association of dementia severity with early potentially avoidable readmissions (PAR) could encourage the identification of the target patients for the health care providers to provide transitional care (i.e. follow-up and coordination care) to prevent early readmissions. This study examined whether dementia severity before admission was associated with PAR within 90 days (90-day PAR). This retrospective cohort study was conducted using a Diagnosis Procedure Combination database linked with routinely collected dementia assessment data from a large acute general hospital in Tokyo, Japan. Patients aged 65 or older who were discharged to home or facilities (n=8,910; mean age: 79.8 years, standard deviation: 7.4 years) between July 2016 and September 2018. The dementia severity was classified as normal, slight, moderate, severe dementia based on the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21) from the patient or their family at admission. We conducted a multivariable logistic regression adjusted for covariates (sex, age, insurance copayment rate, diagnosis at admission, Charlson Comorbidity Index, unscheduled admission, ICU utilization, surgical treatment, length of hospital stay, discharge place) to examine the association of severity of dementia with 90-day PAR. Among the patients, 225 (2.5%) experienced 90-day PAR. The adjusted odds of 90-day PAR among patients with moderate dementia were 1.571 times (95% confidence interval [CI]: 1.102-2.240) and patients with severe dementia were 2.386 times (95% CI: 1.294-4.398) higher than the odds among patients without dementia. Patients with moderate and severe dementia before admission would be the target with high priority for providing transitional care.
Narrative Group Interventions to Rediscover Life Wisdom Among Hong Kong Chinese Older Adults: A Waitlist RCT Study
Authors: Chow Esther , Fung Sai-Fu
Published: December 2020

Objectives: To recognize, and rejuvenate the life wisdom of Hong Kong Chinese older adults, a new strength- and meaning-based Narrative Therapy (NT) in practice is developed, with two objectives: to examine its effectiveness in enhancing wisdom; and to test the longer-term effects at 2 and 8 months respectively. Method: A waitlist randomised controlled trial (RCT) design was used. A total of 157 older adults were recruited, 82 of which was randomly assigned to 12 intervention groups to receive four 2-hour NT sessions using the ‘Tree of Life’ metaphor, to assess perceived wisdom at baseline (T1), at the end of treatment (T2), and at two (T3) and 8 months after treatment (T4). Results: Participants in the NT group showed significant improvements in the wisdom outcome measure [F(2.726, p = 0.041)]. As such, the results of latent growth curve models with time-invariant covariates for impact of NT on wisdom scores suggested significant effects two months after treatment (T3) with controlled the effects of age, gender and educational level [TML(11) = 17.306, p = 0.098, RMSEA = 0.079, CFI = 0.960]. Most improvements were sustained at 2- and 8-months post intervention. No adverse reaction was recorded in any of the cases mentioned at all study sites. Conclusion: The findings have significant theoretical contributions for professional social work practice to ground a new theory in understanding wisdom in older adulthood, develop a new clinical practice that appreciate and celebrate life wisdom, and a practice guide to be disseminated among health and social care practitioners.
Exploring the Complexities of Quality Measurement in Assisted Living in Washington State
Authors: Ham Carolyn , McAvoy Cathy , Gantz Roger , Schwartz Lindsay
Published: December 2020

In Assisted Living (AL) choice and quality of life are highly valued by residents. Prior research has found many interrelated components contribute to AL residents’ experiences of quality. There are 543 licensed AL facilities in Washington state, with 33,830 licensed beds; in 2019, resident cost per year ranged from $44,000 to $78,000. In 2018, the Washington Legislature identified a need for consumer access to unbiased information on AL quality and directed the Department of Social and Health Services (DSHS) to form a workgroup on quality measures. The workgroup consists of representatives from state agencies, AL provider associations, advocacy organizations, AL providers and AL residents. To inform the workgroup, DSHS conducted a study of AL quality measures. Five statewide programs were identified and analyzed in 10 categories. The WA workgroup then assessed a series of measures across six domains: community participation and quality of life; consumer satisfaction; equity, diversity and inclusivity; informed choice and decision making; person-centered planning; and, resident safety. The workgroup assessed and chose to adopt CoreQ, a satisfaction measure developed by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) and endorsed by the National Quality Forum (NQF). In evaluating potential measures of quality, workgroup members weighed regulatory, industry, provider, consumer and family perspectives. Outcomes of this process include assessment of AL quality measurement in other states, selected measures for Washington and key insights into relative prioritization of quality domains by different stakeholder types.
Trends in Deficiency Citations in Florida Assisted Living Facilities
Authors: Sharma Hari
Published: December 2020

Despite numerous anecdotal reports of poor quality and residential safety concerns in Assisted Living Facilities (ALFs), there is limited federal oversight of ALFs. Usually, state surveyors conduct inspections of ALFs for compliance with regulations and issue deficiency citations and/or fine non-compliant facilities. Florida is one of the few states that publicly releases inspections data. The aim of this study is to fill the gap in our understanding of ALF quality by examining the trends in deficiency citations in Florida. We obtain data on 1,047 ALFs with 25 or more beds operating in Florida between 2012-2018. We use descriptive methods to examine the trends in citations over time and further stratify by profit status. We also evaluate whether facilities get cited for the same deficiencies repeatedly. Every year, approximately, one third of the facilities were free of any deficiency citations. From 2012 to 2018, fewer facilities were cited for resident care and medication but more facilities were cited for training and staffing. Approximately 45.8% of not-for-profit and 35.1% of for-profit facilities were free of deficiency citations in 2018. A majority of facilities cited for a given deficiency were cited at least once again for that deficiency within the study period. Florida ALFs appear to be improving only in some deficiencies but getting worse in some other deficiencies. Furthermore, repeat citations are common suggesting that facilities fail to improve their care/service patterns to avoid repeat citations. More stringent regulations and stricter enforcements may deter facilities from repeat citations.
Living Arrangements, Electronic Communication Use, and Psychological Functioning
Authors: Shim Hyunju , Ailshire Jennifer , Crimmins Eileen
Published: December 2020

Older people who live alone may benefit more from using electronic communication than those who live with others. Although living alone has been linked to a higher risk of depression and social isolation, few studies examined the effect of using electronic communication separately by living arrangements. The current study examines the effect of electronic communication use by living arrangements for people aged 65 and older. Using the 2011-2018 National Health and Aging Trends Study (NHATS), we examine how the frequency of emails/texts is associated with changes in psychological well-being and depressive symptoms accounting for sociodemographic, health, social network characteristics (N=6,897). Multilevel growth curve models showed that those living alone or with others were more likely to have fewer depressive symptoms at baseline if they used electronic communication, but the use did not affect their trajectory of depression. Those living alone or with others who used electronic communication did not have higher psychological well-being at baseline, nor did it affect their trajectory. The overall findings raise a question on the effectiveness of promoting electronic communication technology as a substitute for in person interaction for older adults living alone in the community.
Coping With the Impact of COVID-19 Safety Recommendations: The Importance of Pets
Authors: Emerson Kerstin , Kim Deborah , Mois George , Beer Jenay
Published: December 2020

The COVID-19 pandemic is disproportionately affecting older adults. Initial research suggests that older adults are experiencing negative emotions and stress during social distancing and self-quarantining. Consistently, literature shows that pet ownership can mitigate some negative emotions, including stress and loneliness. Our goal was to explore the impact of pets on older adults who were restricting their social interactions during the first three to five weeks of the COVID-19 pandemic. The study was based on web-based survey data from 833 persons aged 60 and older in the United States. The sample age of respondents ranged from 60-85, with a majority (80.2%) female and White (95%). About 56% of the sample reported that they owned at least one pet. Respondents with pets did not significantly differ in stress or loneliness measures compared to those without pets. A majority of respondents reported engaging in more distance communication compared to before the pandemic. However, respondents with pets were less likely to report an increase in the following technology-mediated forms of communication: emails, texts, computers, and telephone (all p-values < .05) compared to those without pets. There was no significant difference in other coping mechanisms (e.g. exercise, alcohol intake) by pet ownership. These results suggest that respondents did not rely on pets to reduce stress or loneliness. However, pets may fill other communication/connection needs, and older adults may then rely less on communication with other people. Research on coping with the impact of Covid-19 has implications for interventions, including specific interventions for pet ownership.
How are Informal Caregivers Adapting to COVID19? Preliminary Results of an Online Survey
Authors: Trivedi Ranak , Suresh Madhuvanthi , Risbud Rashmi , Humber Marika , Jacobs Josephine , Thomas Samuel
Published: December 2020

COVID19 may disrupt informal caregivers’ (CG) ability to support their care recipients (CR) but little is known how caregivers adapt. A 10-minute, anonymous, online survey with no geographic restrictions was fielded April-August 2020. Two screening items ensured that the respondents were at least 18y and self-identified as a CG. This English-language survey assessed: sociodemographics; reactions to COVID19; changes in CG responsibilities and abilities; depression (Patient Health Questionnaire, PHQ-2); CG burden (Zarit Burden Inventory, ZBI-4); and anxiety (Generalized Anxiety Disorder, GAD-2). Univariate analyses determined the proportion of those who screened positive on PHQ-2 (cutoff=3), GAD-2 (cutoff=3), and ZBI-4 (cutoff=8). Of the 314 respondents, 74% lived in USA; 73.5% of caregivers and 48.2% CR were women. While 63.4% were married, only 28% cared for their spouse. CG mainly cared for adults (83%), and reported that 75.0% of their CR had 2+ conditions. 49.6% CG provided >20h of care/wk. Since COVID19, 53% reported an increase in CG responsibilities; 28.0% noted a decrease in income. Many CG screened positive on the ZBI-4 (48.4%), GAD-2 (30.9%), and PHQ-2 (26.8%). 74% worried about contracting COVID19 at least some of the time. 35.0% noted limits to performing all caregiving tasks when they (N=34) or their CR (N=57) were asked to self-isolate/quarantine. 163 (51.9%) CG noted spending less time with their CR, of which 46.4% used alternate means (e.g., telephone calls). Preliminary results show that a plurality of CG had changes in their responsibilities and abilities during COVID19. A sizable proportion also reported poor well-being.
Risk Factors for Generalized Anxiety in Older African Americans During the COVID-19 Pandemic
Authors: Bass Dwana , Hanna Sophie , Shair Sarah , DiCerbo Loraine , Giordani Bruno , Kavcic Voyko
Published: December 2020

The COVID-19 pandemic has created worldwide uncertainty and heightened fear and worry, elevating the potential for anxiety. We examined environmental, sociodemographic, and behavioral risk factors predicting generalized anxiety among older African Americans in a large metropolitan area during the COVID-19 outbreak. Sixty African American participants (92% female) age 65 and older were recruited from the Wayne State University Institute of Gerontology Healthier Black Elders Center. In addition to initial demographic questions, the scale (5-point Likert scale from “Not At All” to “A Great Deal”) assessed a range of everyday concerns, such as time spent indoors; family relationships; economic problems; restricted freedom of movement; and access to food, cleaning supplies, medical care, and personal protective equipment during the COVID-19 pandemic. Participants also completed a brief generalized anxiety screener, GAD-7. Of the 60 participants, 5 reported they were COVID-19 infected and their responses were not used for the analyses. Older Black Americans reported that during the pandemic, they were most affected by: Illness in Family (53%), Death in Family (35%) and Isolation (75%). Significant risk factors for anxiety were: Missing Close Ones, Annoyance, Sense of Safety, Media Coverage, and Time Indoors (explaining 58% of variance). The current study highlights everyday risk factors for anxiety in the context of the coronavirus pandemic among city-dwelling African Americans. Identified factors are common concerns that may be ameliorated with reasonable interventions. More research is needed in order to fully understand the scope and correlates of anxiety during these challenging times.
Community Cancer Rates in Massachusetts, New Hampshire, and Rhode Island: Findings From Healthy Aging Data Reports
Authors: Wang Shuangshuang , Lee Chae Man , Kim Bon , Silverstein Nina , Porell Frank , Dugan Beth
Published: December 2020

Cancer is one major health condition that affect people’s later life quality, which could be intervened from the community level. This study compares rates of lung cancer, colon cancer, breast cancer (in women), and prostate cancer (in men) among adults 65+ in 3 New England states (MA, NH, and RI). Data were from the Healthy Aging Data Report (see www.healthyagingdatareports.org), which reported on 150+ health indicators at the local community and state level. Data sources were the Current Medicare Beneficiary Summary File (years) and the American Community Survey (years). Small area estimation techniques were used to calculate age-sex adjusted community rates. Average state rates of cancers (range) are: Lung cancer MA 2.1 (1.0 – 4.4) NH 1.6 (0.9 – 2.9) RI 2.1 (1.3 – 2.9); Colon cancer MA 2.9 (1.8 – 4.1) NH 2.4 (1.8 – 3.7) RI 3.2 (1.6 – 4.5); Breast cancer MA 10.9 (5.3 – 16.4) NH 9.8 (5.4 – 14.8) RI 10.7 (7.2 – 13.9); Prostate cancer MA 13.8 (7.4 – 24.0) NH 11.5 (5.9 – 17.3) RI 13.8 (9.5 – 17.7). NH has the lowest rates on all four types of cancer; MA and NH were similar regarding average rates, but MA communities had the widest disparities for lung, breast and prostate cancer. Findings suggest within and between state variations in cancer rates. Policies and programs may target geographic areas/communities with high rates of cancers, examine environmental effects on cancer rates and develop strategies in reducing cancer rates.
Multilevel Factors for Life Satisfaction Among Residents in Non-Urban Subsidized Senior Housing
Authors: Kim BoRin , Park Sojung , Golomsky Casey , Corvini Marguerite , Wilder Allison , Wilcox John , Winburn Allysha
Published: December 2020

Although a quarter of HUD-assisted properties for older adults are located in rural/non-metropolitan areas, there is limited understanding of the population living in these locations. Advanced age and low income are known risk factors for poor physical and mental health. Older adults in rural subsidized housings may be at increased risk for poor health and social isolation due to their isolated locations and small-scale housing complexes. This presents the additional challenge of service provision for the residents’ needs. This study aims to explore multi-level factors affecting life satisfaction among residents in subsidized senior housing. Data were collected for five subsidized senior housings in New Hampshire: two in Coos county (rural, population=33,055) and three in Strafford county (suburban, population=128,613). Mixed-methods approaches were used: Community/organizational-level data were collected using semi-structured interviews conducted with the directors of senior housings. At the individual level, quantitative survey data were collected from 82 residents of five senior housings. Contrary to expectations, we found that residents in rural senior housings were likely to report better life satisfaction (Coef.=0.597, p<.01) than those in suburban areas despite controlling for individual-level factors such as age, gender, education, marital status, health, social relations, and service use. The most salient terms used in the interviews with directors of rural senior housings include limited resources, tight community, and emotional support. The last two may be protective factors positively influencing life satisfaction among their residents. Our results contribute to development strategies to improve quality of life among residents in rural/non-metropolitan subsidized senior housing.
Quantitative EEG Features of Level of Consciousness in Critically Ill Nonagenarians
Authors: Roberson Shawniqua Williams , Haas Kevin
Published: December 2020

The standard for monitoring sedation levels in critically ill patients is intermittent bedside evaluation, and is prone to anchoring bias. Quantitative electroencephalography (qEEG) allows automated processing of recorded brain electrical activity and could be used to continuously monitor level of consciousness in critically ill patients. The majority of qEEG studies have included persons 80 years of age or less, and the qEEG profiles of nonagenarians have been incompletely characterized. Knowledge of the qEEG patterns of patients 90 years and older is essential for appropriate interpretation of such metrics in this population. This retrospective cohort study characterized qEEG profiles of acutely ill nonagenarians. We investigated whether the relationship between qEEG and level of consciousness differed between patients with and without a history of dementia. We included patients 90-100 years old admitted to Vanderbilt University Medical Center who underwent EEG and as part of their clinical care. We compared qEEG features to nursing-defined level of arousal as measured by the Richmond Agitation-Sedation Scale (RASS) in patients with and without history of dementia. Between January and December 2019, 26 nonagenarians underwent EEG for clinical purposes. One study was excluded due to excessive artifact. Of the remaining, 6 (24%) were male and 18 (72%) were Caucasian. Among all patients, RASS decreased with increases in EEG theta variability (coefficient -7.7, 95%CI -10.6 to -4.8). This relationship was not significantly modified by history of dementia (coefficient of interaction term -0.36, 95%CI -3.7 to 2.9). Dementia does not impact qEEG features of level of consciousness in nonagenarians.
Role of Intramuscular Fat and Lean Muscle in Surface Electromyography Amplitude of the Gluteus Medius in Older Adults
Authors: Lanza Marcel , Gray Vicki , Ryan Alice , Perez Will , Addison Odessa
Published: December 2020

Surface electromyography (sEMG) is frequently used to assess muscle activation in older individuals. Subcutaneous fat is one well-known factor that influences sEMG amplitude. The amount of intramuscular fat (IMAT) may negatively impact the muscles ability to produce force with aging, while high density lean tissue (HDL; fat free muscle) has an opposite effect. However, influence of IMAT or HDL on sEMG amplitude remains unclear. Thus, the aim was to investigate the influence of IMAT and HDL on sEMG amplitude of the gluteus medius (GM) muscle during a maximal voluntary isometric contraction (MVIC) in older adults. Twelve older adults (7 females; age: 71±3 y; BMI= 29±4 Kg/m2; X ± SD) underwent a CT scan to determine IMAT and HDL cross-sectional area in the GM. IMAT and HDL were normalized as a percentage of the total muscle area. Maximal hip abduction MVIC was measured at 30□ hip abduction in standing, while sEMG was recorded from the GM muscle. Spearman correlations showed a positive association between GM HDL and sEMG amplitude (r = 0.692, P = 0.013) and negative between GM IMAT and sEMG amplitude (r = -0.683, P = 0.014). This is the first study to demonstrate the amount of IMAT may limit the ability to activate the hip abductor muscle. Given that muscle activation is a determinant of strength, interventions to lower levels of IMAT and increase levels of lean muscle may be important to slowing decreases in strength with aging.
Baseline Characteristics of Participants in a Randomized Controlled Trial of Metformin for Frailty Prevention
Authors: Cortes Tiffany , Musi Nicolas , Wang Chen-pin , Michalek Joel , Espinoza Sara
Published: December 2020

We are conducting a double-blind, randomized controlled trial of metformin for frailty prevention. Participants are adults aged 65+ years with pre-diabetes assessed by 2-hour oral glucose tolerance test (OGTT). Those who are frail (Fried criteria) are excluded. Participants are randomized to metformin (maximum dose of 2,000 mg/day) vs. placebo and followed for 2 years. The primary outcome is frailty (category and score); secondary outcomes are physical performance and function (short physical performance battery, 6-minute walk, lower extremity strength), systemic and skeletal muscle tissue inflammation, muscle insulin signaling, insulin sensitivity (insulin clamp), glucose tolerance (OGTT), and body composition (dual-energy x-ray absorptiometry). Safety assessments occur every 3 months; frailty, systemic inflammation, and OGTT are assessed at baseline and every 6 months, and insulin clamp with muscle biopsies are assessed at baseline and every 12 months. To date, 85 subjects have been randomized; 120 completers are planned. Mean age is 72.8 ± 5.7 years, 55.3% are male, and 43.5% were Hispanic. Mean BMI is 30.2±5.8 kg/m2, waist circumference is 104.4 ±15.5 cm, fasting glucose is 102.3 ± 10.0 mg/dL, Hemoglobin A1c is 5.8 ±0.3, and glucose at 2 hours during OGTT is 167.3 ± 17.8 mg/dL. Metformin is being examined in this study as a potential therapeutic agent to prevent frailty in older adults with pre-diabetes. Findings from this trial may have future implications for the screening and potential treatment of pre-diabetes in older patients with metformin for the prevention of frailty.
Intranasal Oxytocin Improves Lean Muscle Mass in Older Adults With Sarcopenic Obesity: A Pilot Study
Authors: Lee Jessica , Espinoza Sara , Odejimi Adetutu , Wang Chen-pin , Ganapathy Vinutha , Pascucci Chiara , Musi Nicolas , Volpi Elena
Published: December 2020

Obese older adults often have sarcopenia with increased functional impairments. Unfortunately, conventional weight loss treatments can lead to further muscle mass loss. Increasing evidence from animal studies suggests that the pituitary hormone oxytocin has trophic effects on skeletal muscle cells and can induce weight loss. We piloted a clinical trial testing whether intranasal oxytocin would decrease adiposity without lowering muscle mass in older adults with sarcopenic obesity. Twenty-one older (≥60years), obese (30-43kg/m2), sedentary (<2 strenuous exercises/week) adults with slow gait speed (<1m/sec) were randomized to intra-nasal oxytocin (24IU four times/day) or placebo for 8 weeks. Pre and post body mass index (BMI), 2-hour oral glucose tolerance test (OGTT), hemoglobin A1c (HbA1c), short physical performance battery (SPPB), and whole body lean and fat mass (via dual-energy X-ray absorptiometry) were assessed. Generalized estimation equation method was used to evaluate effects of oxytocin on these continuous measures. At baseline, results were: age 67.5±5.4years, 71% female, BMI 36.0±3.6kg/m2, HbA1c 5.7±0.4%, 2-hr OGTT glucose 140.8±4.1mg/dL, SPPB 9.2±1.9, fat mass 45,429±7,037g, and lean mass was 49,892±10,470g. From baseline to follow-up, total lean mass increased significantly (2,250g) in the oxytocin group (pre- vs. post-treatment difference of -690g in placebo and +1,559g in oxytocin, p<0.01). Oxytocin did not lead to significant changes in other measures. This data suggests that oxytocin leads to significant improvement in whole body lean mass. Future studies in a larger study population will help determine whether older adults with sarcopenic obesity may benefit from intranasal oxytocin to improve lean muscle mass and physical function.
Perceptions of Care Among Older Adults Identified as Fall Risk During a Hospital Stay
Authors: King Barbara
Published: December 2020

In-hospital falls are a significant clinical, legal and regulatory problem. The Centers for Medicare and Medicaid no longer reimburse hospitals for falls that result in injury, adding increase pressure on acute care settings to prevent falls. Additionally, evidence-based practice recommendations for fall prevention in hospitals do not exist, thus leaving administrators to create their own programs. One common strategy used by hospital providers to prevent falls is to restrict patient mobility. Little information on how older adult patients experience fall prevention during a hospital stay has been published. The purpose of this study was to understand perceptions of care among older adults identified as fall risk during a hospital stay. This qualitative study utilized inductive content analysis. Older adults (N=20) from a large academic medical center in the Midwest were recruited to participate in one-to one in-depth interviews. Open coding, categorization and abstraction was used to analyze the data. Three main categories were identified that summarized the older adult patient perception of hospitalization: Act of Caring, something they received from staff, provide to staff or provided to self; Being Restricted in movement resulting in either accepting or rejecting the restriction and Being Freed at discharge, often being told “just be careful”. Older adult identified as fall risk described being restricted in movement during a hospital stay. Many passively accepted this restriction even though they felt a lack of movement would be harmful to them. Additional research on the patient experience with fall prevention is needed.
The Role of Comorbid Diseases in Geographic Disparities of Mortality From Septicemia Among Older Adults Across the United States
Authors: Kravchenko Julia , Akushevich Igor
Published: December 2020

Sepsis is a prominent cause of death in the US. However, few studies examined its regional variations. Using the Multiple-Cause-of-Death and 5%-Medicare data, we analyzed mortality among the US patients aged 65+ who had septicemia and various comorbid diseases in the states with the highest (HI,FL,AZ,CT,CO, and MN––a.k.a. leading states) and lowest (AR,TN, LA,OK,KY,AL,MS, and WV–a.k.a. lagging states) life expectancy. In 2010-2018, age-adjusted mortality from septicemia was almost twice as high in lagging (85.2±0.5/100,000) comparing to leading (45.2±0.3/100,000) states. Between-the-states difference was the most pronounced at age 65-74 (44.7±0.4 vs. 20.8±0.2) and gradually reduced in older age groups. Higher mortality from septicemia in the lagging US states could be, at least in part, because of poorer health of the beneficiaries who enter Medicare at age 65. Mortality rates were the highest among septicemia patients who had comorbid cancer, ischemic heart disease, influenza/pneumonia, or kidney failure. Mortality rates of patients with co-existing Alzheimer’s disease or arterial hypertension were lower, but these comorbidities contributed most to geographic disparities. The role of complications due to surgical and other medical procedures in disparities across the states was minimal. Substantial contributions to geographic disparities in septicemia mortality were detected not only for well-known and highly-lethal comorbidities such as diabetes, heart failure, and kidney diseases, but also for less frequently discussed conditions with lower per se mortality such as disease of intestine, skin/subcutaneous tissue, and cystitis, urethritis, or unspecified infections of urinary tract.
Pilot Study of a Surgical-Oncology Geriatric Co-Management Program
Authors: Patel Megha , Chow Stephanie , Munoz Lizette
Published: December 2020

Purpose: This study aims to evaluate clinical outcomes of a pilot co-management model for patients 65 years and older that were referred by their surgical oncologist for a comprehensive geriatric assessment prior to surgery. Methods: A retrospective chart review was conducted for 9 patients. Patients’ pre-operative Charlson Comorbidity Index (CCI) and frailty index were measured. Additional measures included advanced care planning (ACP) documentation and whether patients transferred primary care. Post-operative courses and complications were followed, including length of stay (LOS) and discharge outcomes. Results: A total of 9 patient charts were reviewed. The average age was 79 years. The average CCI and frailty indices were 9 and 4, respectively. Every patient had ACP during the initial assessment. Five patients had multiple outpatient geriatrician visits. Of the 9 referrals, 7 proceeded with surgery. LOS ranged from 6 – 22 days, with a median and average of 8 and 11 days, respectively. Of those undergoing surgery, 4 had an inpatient geriatrics consult. Complications included 1 mortality, 2 aborted cases and 4 with other complications. Four patients were discharged to previous living situations and 2 to SAR. Two patients had one ED/UC visit and 2 had multiple readmissions. No patients transferred their primary care. Conclusion: This is a small pilot showing a promising collaboration between geriatrics and surgical oncology. It outlines a supportive framework for initial and peri-operative geriatric assessments with favorable experiences for both providers. More studies are necessary to make clinical associations with this co-management model.
Reliability of the Capacity to Consent to Treatment Instrument in Metastatic Cancer
Authors: Fowler Mackenzie , Marotta Dario , Kennedy Richard , Triebel Kristen
Published: December 2020

Metastatic cancer patients undergo numerous treatment strategies with known cognitive side effects. It is unclear how medical decision-making capacity (MDC) is impacted by cognitive deficits in metastatic cancer. This study examines reliability of an objective measure of MDC compared with self-report. Participants with newly diagnosed metastasis to the brain and other sites were enrolled at the University of Alabama at Birmingham over seven years. At the study visit, participants completed a comprehensive neuropsychological battery including memory and executive functioning, and the Capacity to Consent to Treatment Instrument (CCTI) assessing medico-legal domains of MDC. The CCTI is a reliable and valid instrument containing two vignettes of hypothetical medical situations assessing four standards of consent. We examined reliability between the CCTI and self-reported MDC using Gwet’s AC1 statistic. Participants with brain metastasis with impairment on the CCTI demonstrated significantly lower executive functioning and memory skills than those without impairment (Trails B Raw: 158.20±86.82 vs. 118.90±77.98 p: 0.0248; Digit-Span Raw Forward: 9.13±2.30 vs. 10.12±2.03 p: 0.0254). There were no significant differences between intact and impaired participants with other metastases. Low reliability was observed between self-report and all medico-legal standards on the CCTI across both metastatic groups [Gwet’s AC1 Appreciation: 0.70 (0.58, 0.81); Reasoning: 0.34 (0.16, 0.52); Understanding: 0.44, (0.27, 0.60)]. Self-rating of MDC is unreliable in metastatic cancer patients. Patients with metastases (particularly brain metastases) may lack awareness of deficits in their MDC, so providers must affirm proper autonomy in their decisions.
Alcohol Consumption and Cognitive Function in an Older Population in China
Authors: Bai Anying , Hou Bo , Chen Junsong , Fu Boming
Published: December 2020

The relationship between alcohol consumption and cognitive function has only been studied to a limited extent in China. This paper examines this relationship using the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative dataset of the Chinese population aged over 45. Alcohol consumption was measured by drinking status (never, former, moderate, excessive drinkers) based on number of standard drinks per week. Mental status and episodic memory function were used as measures of cognitive function. Lagged dependent variable models were used to examine independent associations between alcohol consumption and cognitive function. Our models controlled for demographic factors, socioeconomic factors, baseline cognitive functioning and an indicator for lifestyle. We also tested for an inverted J shaped relationship between alcohol consumption and cognitive functioning. A total of 10404 nondrinkers (60.09%), 2450 former drinkers (14.15%), 1599 moderate drinkers (9.24%) and 1525 excessive drinkers (8.81%) were included. Compared to never drinkers, there were no statistically significant difference between this group and moderate drinking group. While, excessive drinkers were consistently associated with on average 0.13-point decrease in episodic memory scores (p =0.031). For mental intactness, there were no statistically significant differences between never drinkers and other groups. Furthermore, we did not find evidence to support an inverted J-shaped association between standard drinks per week and measures of cognitive functioning. Excessively drinking was associated with greater decline in episodic memory function, but not in mental intactness in elder Chinese population. There is no significant association between moderate drinking and cognitive functioning measures.
Reciprocal Association Between Cognitive Function and Oral Health: A Systematic Review and Meta-Analysis
Authors: Qi Xiang , Zhu Zheng , Wu Bei
Published: December 2020

Increasing evidence suggests that there is a linkage between cognitive function and oral health. However, there are few systematic reviews with meta-analysis have been conducted to evaluate the strength of this association. Moreover, existing studies usually focused on unidirectional associations between cognitive function and oral health; no research has demonstrated this inter-relationship in a longitudinal study. This study aims to systematically assess the magnitude of the bidirectional association between oral health and cognitive decline for studies using longitudinal data. Six international databases were searched up until December 31, 2019. Random-effects pooled Risk Ratios (RRs) with 95% confidence intervals (CIs) were calculated. The grading of recommendations assessment, development, and evaluation (GRADE) system was used to assess the quality of evidence. From 13,251 potentially eligible articles, 54 longitudinal studies were included in the systematic review and 18 were in meta-analysis. Meta-analysis was performed for tooth loss and periodontitis disease. Random effects analysis showed, with statistically low heterogeneity, Risks of cognitive decline included suboptimal dentition (<20 teeth) (RR 1.44, 95% CI 1.03-3.65) and periodontitis diseases (RR 1.48, 95% CI 1.22-1.81). Cognitive decline was a risk factor for tooth loss (RR 1.54, 95% CI 1.23-9.69). The overall quality of evidence, however, was rated as very low. The result of this review highlights that cognitive decline is a risk factor for poor oral health, and older adults with suboptimal oral health appear to have an increased risk of cognitive impairment. More studies with rigorous designs are needed to further examine this association.
The Relationship Between Daily Rapid-Eye Movement Sleep and Cognitive Functioning in Older Adults
Authors: Broen Tiana , Yoneda Tomiko , Rush Jonathan , Knight Jamie , Lewis Nathan , Vendittelli Rebecca , Hofer Scott , Piccinin Andrea
Published: December 2020

Previous cross-sectional research suggests that age-related decreases in Rapid-Eye Movement (REM) sleep may contribute to poorer cognitive functioning (CF); however, few studies have examined the relationship at the intraindividual level by measuring habitual sleep over multiple days. Applying a 14-day daily diary design, the current study examines the dynamic relationship between REM sleep and CF in 69 healthy older adults (M age=70.8 years, SD=3.37; 73.9% female; 66.6% completed at least an undergraduate degree). A Fitbit device provided actigraphy indices of REM sleep (minutes and percentage of total sleep time), while CF was measured four times daily on a smartphone via ambulatory cognitive tests that captured processing speed and working memory. This research addressed the following questions: At the within-person level, are fluctuations in quantity of REM sleep associated with fluctuations in next day cognitive measures across days? Do individuals who spend more time in REM sleep on average, perform better on cognitive tests than adults who spend less time in REM sleep? A series of multilevel models were fit to examine the extent to which each index of sleep accounted for daily fluctuations in performance on next day cognitive tests. Results indicated that during nights when individuals had more REM sleep minutes than was typical, they performed better on the working memory task the next morning (estimate = -.003, SE = .002, p = .02). These results highlight the impact of REM sleep on CF, and further research may allow for targeted interventions for earlier treatment of sleep-related cognitive impairment.
Future Confidence and Self-Reported Health Among the Bereaved Elderly in China
Authors: Pan Haimin , Liu Qian
Published: December 2020

Time perspective serves as an important determinant for the elderly’s health-related outcomes, including those in bereavement. Confidence in the future (CF) seems a reflecting viewpoint a in this line, however, it is hardly investigated as a predictor for health among the elderly. This study centered on the casual relationship between CF and self-reported health (SRH) among the bereaved older Chinese adults. Data from a sample of 376 elders in bereavement were finally used for analysis. The sample was extracted from a national representative data, namely, China Family Panel Studies (CFPS), and contained 2012, 2014, 2016, and 2018 waves of information. A across-lagged model with four time points was used to explore the longitudinal relationship between CF and SRH among the bereaved elderly in China. This model achieved acceptable indices of goodness of fit, and the results revealed that SRH positively predicted future confidence in general among the senior participants, while CF failed to predict SRH at any point of time. The cross-sectional associations between CF and SRH were generally positively significant. The results implied the casual effect of SRH on CF, which was different from the cross-sectional relationship between CF and SRH. It seemed that enhancing the oral health of the bereaved elderly could be beneficial for increase in their CF. Tailored services are recommended for improving the perception of the bereaved elderly on their general health, and thus strengthening their positive perspectives for future.
The Influence of Race and Gender on Staff-Resident Interactions in Nursing Homes
Authors: McPherson Rachel , Resnick Barbara , Galik Elizabeth
Published: December 2020

Communication and interactions are an integral part of care in long-term care settings. Resident variables, such as race and gender, shape communication and interaction between staff and residents. The Quality of Interactions Schedule (QuIS) was developed to measure the quality of verbal and nonverbal interactions among nursing staff and older adults initially for those in acute care and later used as well in a variety of long term care settings. A quantified measurement of the quality of interactions between residents and staff was created to quantify the QuIS. The purpose of this study was to describe the gender and racial differences in scored quality of interactions. Data for the present study was based on baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) implementation study. A total of 535 residents from 55 settings were included in the analyses. An analysis of covariance was conducted to determine a difference in QuIS scores between males and females while controlling for age. The second model tested for differences in QuIS scores between blacks and whites while controlling for age and gender. There was not a statistically significant difference in QuIS scores between male and female residents. There was a significant difference in QuIS scores between those who were black versus white, such that those who were black received more positive interactions from staff than those who were white. Future work should focus on a deeper examination of resident factors and staff factors that may influence these interactions.
Influence of Physical Activity Energy Expenditure on Functional Fitness Among Older Adults
Authors: Paulson Sally , Gray Michelle
Published: December 2020

Remaining physically active as one ages plays a critical role in maintaining health and improving functional capacity. Further, older adults can see additional health-related benefits by increasing intensity, duration, frequency, and/or levels of physical activity. However, there is limited research examining physical activity energy expenditure (PAEE) and measures of functional fitness. Therefore, the purpose was to examine differences between older adults with varying levels of PAEE on selected measures of functional fitness. A sample of 25 adults (age: 74.0±7.1 years) were recruited from an urban area and divided into two groups. PAEE was calculated using the total caloric expenditure per week for all exercise-related activities from a self-reported PA questionnaire. Group one expended less than 3,000 calories per week and group two spent more than 3,000 calories per week performing PA. The selected measures of functional fitness were a 4-m gait speed (GS), 30-s chair stand test (CS-30), 2-min step test (ST), and the 8-foot up and go test (GUG). Data were analyzed using a one-way ANOVA. There was a statistically significant difference between the groups on GS (F1, 24 = 9.29, p < .01) and CS-30 (F1, 24 = 4.37, p = .05). The results yielded a trend for the GUG (p =.06). However, there was not a difference between the groups on the ST (p = .11). These results suggest older adults expending more than 3,000 calories per week performing PA walk faster and have greater lower-body strength.