bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolation in Older Adults in the United States and Japan: An Early Examination of IOT Possibilities
Authors: Bradley Dana , Sceppa Carmen , Sceppa Carmen
Published: December 2021

Isolation in older adults is a growing problem in both the US and Japan. This symposium showcases work funded by NSF and JST (Japan Science Technology Committee) to develop smart technology to create caring, connected communities by integrating gerontology and technology research. The U.S. and Japan are experiencing dramatic population aging and share several similarities: Populous (U.S. 327 million at #3 and Japan 127 million at #11) and economically developed (GDP: the U.S. #1 and Japan #3) and isolation was increasing even before the pandemic. This multi-year project addresses the challenges of isolation by using smart technologies in culturally appropriate ways to support older adults and suggests ways that isolation and loneliness may be managed by older persons, local governments, and NGOs. The first paper examines the experiences of loneliness as characterized by early retirees in both countries. The interdisciplinary research team has used this qualitative set of case studies to identify promising technology support points. Our second paper explores these issues surrounding isolation using data from Study on the Lifestyle and Values of Senior Citizens (Japan). This analysis focuses on longitudinal data from both countries and helps situate our work outside the Covid-19 Pandemic. The third presentation focuses on the intersection between culture and technology and proposes a continued research collaboration model. Our discussion will highlight how community stakeholders in U.S. and Japan have a role in creating evidence-based adaptive environments to detect and mitigate isolation by developing and using gero-centric approaches.
A Quantitative Comparison of Social Interactions of Older Adults Pre-COVID-19 Between the United States and Japan
Authors: Nishikitani Mariko
Published: December 2021

Using the Study on the Lifestyle and Values of Senior Citizens (The Eighth International Study by the Japan Cabinet Office), the social interactions were assessed in the context of health and life satisfaction of the older adults of the U.S and Japan to confirm the relationship between ICT usage and social interactions. The less social interaction was defined as those who answered that they had no "role in the family," "working," or "social activities such as volunteering." The proportion of less-social interaction people and non-use of ICT increased with age, but the proportions of Japanese were higher than that in Americans. The adjusted odds ratio for non-use of ICT to the risk of isolation of the older adults in Japan was 2.43 (95% CI: 1.59-3.73), but no significant relationship was observed in American older adults. Future research will examine the use of ICT by older adults in each country.
Managed Long-Term Care Services: A Playbook Innovation or a Hail Mary?
Authors: Polivka Larry , Applebaum Robert
Published: December 2021

The approach to providing long-term services and supports (LTSS) has changed dramatically over the last three decades in both the financing and delivery arenas. In the U.S., long-term strategies have varied by state in organizational structure, scope of delivery and administrative practices. In the past two decades an additional change has emerged with over half the states adopting some form of managed LTSS. This shift has deepened the divide in state approaches to LTSS system design and delivery. The shift to managed LTSS has been largely fueled by ideological expectations and concerns about growing Medicaid costs: Empirical research findings have played a minimal role. For example, the large CMS evaluation conducted in this area did not include Medicaid data or encounter data from the managed care plans as part of the study efforts. However, the managed LTSS experiment does create an opportunity to compare costs and outcomes of these different models of financing and delivery. This symposium will present preliminary evaluation findings from two states, Ohio and Pennsylvania, which are generating data to assess both the implementation and outcomes of these alternative LTSS models. To set the context an initial paper will discuss the expansion of managed LTSS programs across the nation and examine how these efforts compare to the development occurring in the European LTSS systems. The third presentation will discuss the results of the Community Catalyst dual eligibles’ managed care demonstration program monitoring project.
Rolling Out Behavioral Recovery Outreach (BRO) Teams: Perspectives From an Inaugural Partner Site
Authors: Gaudig Trisha
Published: December 2021

The Sioux Falls VA Community Living Center (CLC) is a partner site for the Behavioral Recovery Outreach (BRO) Team dissemination. This CLC is home to over 55 Veterans requiring a variety of specialty needs such as dementia care, short-term rehabilitation, respite, hospice, and/or psychosocial needs. Many of the Veterans followed by the BRO Team on the CLC experienced frequent rehospitalizations and difficult placement in the community due to behavioral concerns. Local leadership encouraged participation in the BRO Team dissemination due to the growing need in this VA system to open access to dementia and mental health care, successfully discharge Veterans to appropriate community settings, and reduce unnecessary rehospitalizations. This presentation will discuss BRO Team development, including several factors facilitating successful BRO Team implementation (e.g., leadership support, community outreach approaches, staff partner buy-in), and identify barriers impacting successful implementation with a case example to illustrate strategies to overcome such barriers.
Pennsylvania's Transition to Medicaid Managed Long-Term Services and Supports
Authors: Degenholtz Howard
Published: December 2021

Implemented through five health plans, Ohio’s MyCare demonstration began in 2014 and was designed to coordinate primary, acute care, behavioral health and long-term services in the major urban areas of the state. Individuals who are dually eligible for both Medicaid and Medicare and who reside in specified geographic regions must enroll into a managed MyCare plan. MyCare beneficiaries are assigned to two primary categories: community well and those needing long-term services and supports (LTSS). Individuals receiving the integrated MyCare intervention were expected to have lower acute care hospitalizations, lower long-term nursing home use, better longevity and lower overall health and long-term care costs. Using a propensity score matching design, the evaluation compared MyCare enrollees to comparison group members in non-MyCare counties of the state, using Medicaid and Medicare claims data. The 120,000 MyCare program participants represented about half of the dual eligible individuals in the state.
Can Rural Migrant Workers Afford to Retire in China? A Study of Chinese Migrant Worker’s Retirement Savings
Authors: Liu Jing , Zhan Heying , Qiu Fengxian
Published: December 2021

This paper makes connections between social policies of retirement, migrant worker’s migration experience, and migrant workers’ retirement savings. Using insight from the political economy of aging and stress theory, this paper links the macro levels of understanding with the micro levels of work and aging experiences for migrant workers. Using binary logistic regression with a sample of 699 Chinese migrant workers from three emigration provinces (Anhui, Henan, Sichuan), this paper explores four specific aspects of migrant worker’s migration experience in relation to their retirement savings: financial status; length of employment; social support, and levels of hopefulness. Findings reveal that migrant workers with better financial status, social support, and higher level of hopefulness towards future are more likely to have retirement savings as compared to their counterparts. Discussions linking the macro and micro levels of social policies were provided. Policy implications were discussed.
New Aspects in Metabolism of Aging
Authors: Anderson Rozalyn
Published: December 2021

In recent years there has been a renewed emphasis on metabolism as a key contributor to a host of chronic non-communicable conditions: cancer, neurodegeneration, frailty, and functional declines in immune and inflammatory processes. All share a common connection in metabolic dysfunction. Furthermore, aging itself is associated with changes in metabolism, although the underlying drivers for these changes are unknown. Here we introduce speakers working at the cutting edge in metabolism research, and whose studies are of direct relevance to aging. Dr. Chandel will focus on mitochondrial biology, describing recent advances in understanding the mechanisms of the beneficial effects of metformin. Dr. Haigis takes the mitochondrial theme to cancer biology, the area of research that revived metabolic perspectives in biomedical research. Dr. Najt’s talk describes a less well studied organelle, the lipid droplet, and its role in a rapidly expanding area of research on lipid metabolic regulation specifically in the context of aging. Dr. Brown-Borg will present data on nutritional and genetic modulation of metabolism and how pathways converge to influence chromatin and epigenetic regulation of gene expression. Together our speakers explore new concepts in metabolism research that are of particular relevance to aging. This session aligns with the concept of GeroScience, the more we know of aging biology the better we understand diseases and disorders of aging. This session will demonstrate that metabolism, its regulation, and its influence on key processes linked to health and longevity, place it in a central position as we seek to discover targets and interventions to improve human aging.
Methionine Metabolism in Aging Regulation
Authors: Brown-Borg Holly
Published: December 2021

Aging is the major risk factor for many diseases but the mechanisms are poorly understood. The risk of developing hepatic steatosis increases with age and the health impact of this disease is negative and high. When challenged with high fat diets, long living Ames mice withstand the detrimental metabolic effects that occur in normal mice. We examined transcriptomic and epigenomic profiles of Ames and wild type hepatocytes in the presence or absence of fat to demonstrate that the epigenomic profile drives transcription factor and downstream gene expression resulting in susceptibility or resistance to fatty liver disease. We found that markers of steatosis are related to gene expression in wild type and Ames mice, and dwarf mice retain fewer lipid droplets compared to wild type mice. These studies will provide data to guide our understanding of mechanisms leading to hepatic disease and define factors that provide protection from age-related metabolic disorders.
Advancing the Science on Unexpected Episodes of Clarity and Lucidity in People With Dementia
Authors: Griffin Joan , Eldadah Basil
Published: December 2021

People with late-stage Alzheimer’s disease and related dementias (ADRD) have been reported, largely by way of anecdote, to exhibit unexpected episodes of spontaneous, meaningful, and relevant communication or behavior. These episodes of lucidity (EL) are characterized by spontaneous mental clarity in people living with dementia (PLWD) who are assumed to have lost coherent cognitive capacity. Given the transient nature and limited understanding of underlying mechanisms responsible for this phenomenon, these episodes are frequently overlooked and have received little scientific attention. Few studies have documented EL among PLWD with precision; scientific understanding is limited to anecdotes and case studies, which have not operationalized EL. Thus, there is a critical need for an evidence-based understanding and systematic operationalization of EL. Precise and robust operationalizations of EL will allow future research to assess if EL has different effects on ADRD prognosis or alters how family members manage and adapt to ADRD progression in their care recipient. The National Institute on Aging (NIA) has funded six studies to advance the scientific understanding of EL in dementia. These studies use a variety of methodological approaches to capture EL experiences, and together, they will provide evidence-based operational definitions of EL, novel approaches for measurement of this phenomenon, and estimates of its prevalence. This symposium will provide an overview of the funded studies and three different methodological approaches that are being used to better operationalize and understand EL.
Lipid Droplet Signaling in Metabolic Health and Aging
Authors: Najt Charles , Mashek Douglas
Published: December 2021

Lipid droplets (LDs) are neutral lipid rich organelles involved in lipid storage, fatty acid trafficking, and signaling. Emerging evidence from our laboratory and others suggests that the specific LD resident proteins couple/uncouple cells and tissues from inflammation and metabolic dysfunction. However, the mechanism by which LD proteins influences these critical pathways remains unknown. We will present data delving into the role of LD proteins Perilipin (PLIN) 2 and 5 in balancing cellular energy metabolism, mitochondrial function, and inflammation. Data will be presented defining novel mechanisms through which PLIN2 orchestrates eicosanoid production as a means to promote inflammation. We will contrast these findings to PLIN5, which uncouples LD accumulation from metabolic dysfunction and inflammation, in part due to its promotion of SIRT1 signaling. Overall, these studies will highlight a crucial role of LD metabolism and signaling in regulating cellular energy homeostatic processes known to be key players in governing healthspan.
How COVID-19 Impacted Older Adult Walking Group Members in Scotland: A Mixed-Methods Study
Authors: Martin Kathryn , Stelfox Kevin , Khor Wei Lynn , Poobalan Amudha , Powell Daniel , Vieira Rute , D'Arcy Marjory , Murchie Peter
Published: December 2021

Scotland has enacted strict social distancing and stay-at-home policies during the COVID-19 pandemic, at times prohibiting outdoor group-based physical activity. This mixed-method study examined the changing role of older adult walking groups in North East Scotland around the first lockdown and how restrictions impacted members’ well-being. Three consecutive surveys were posted or emailed to members of the Grampian 50+ Network over summer 2020, with questions about social contact, loneliness, well-being, physical activity, public health messages, help-seeking behavior, and socio-demographics. 346 members completed the June survey, with 268 (83%) returning the follow-up survey in July, and 258 (80%) in August. Twenty participants (selection criteria - gender and geographic location) participated in repeated semi-structured interviews. Participants were, on average, 72±7 years old (range: 58-90), retired (94%), and women (80%). Participants reported missing in-person interaction from not regularly meeting with their walking group. Groups adapted to stay-at-home measures by using technology (i.e. videoconferencing/text/email/telephone) to maintain relationships. Easing restrictions required groups to modify format, location and size. Concerns about safe transport, mask-wearing, maintaining social distance (2m/6ft), and potential lack of socialisation emerged as barriers for future engagement. While, participants generally expressed confidence in the Scottish Government’s pandemic response and public health messaging, they expressed dissatisfaction that ‘over-70s’ were grouped together. Findings suggest that these walking group members fared well and were adaptive in response to the pandemic. Promoting group-based opportunities for physical activity and social interaction remain vital for the health and well-being of older adults in the near and long term.
Social Islands: Examining the Intersection of Isolation and Technology Use
Authors: Svec Joseph , Gilligan Megan
Published: December 2021

Life course theory suggests that social relationships are tied to overall well-being. In the extant literature social isolation negatively impacts physical and mental health outcomes in later life. In this study, we focus specifically on the association between social isolation and older adult’s self-rated health status. We also examine whether and the extent to which technology use augments negative health consequences attributed to isolation. Using data on 3,758 older adults (ages 65+) from the 2018 wave of the Health and Retirement Study, we contribute to current scholarly examinations at the intersection of technology and isolation. We conduct a series of ordinal logistic regressions to estimate the odds of respondents’ higher self-rated health (from poor = 1 to excellent = 5) on subjective measures of social isolation (i.e. feel left out, lack of companionship and isolated from others) in addition to whether respondents live with a partner and have an adult child who lives in close geographic proximity. Preliminary results show that individuals who perceived higher levels of social isolation evaluated their own health status as poorer. We also find that the use of computers for virtual communications corresponds with higher self-rated health statuses, regardless of the proximity of children or other family members. However, a negative interaction between computer use and isolation indicates the positive effects of technology are limited for those who are highly isolated. These findings suggest that technology impacts on health are nuanced, where an overreliance on technology as a substitute may not consistently yield positive outcomes.
The Evolving Role of Area Agencies on Aging Through the COVID-19 Pandemic and Beyond
Authors: Wilson Traci , Blair Elizabeth
Published: December 2021

Area Agencies on Aging (AAAs) have played an important and well-documented role in meeting the nutritional and wellness needs of older adults during COVID-19. To better understand the continued impact of COVID-19 pandemic on AAA services, partnerships, and clients, the National Association of Area Agencies on Aging surveyed the nation’s 618 AAAs in February 2021, with a 27% response rate. As a result of COVID-19, most AAAs reported both increased numbers of new clients and needs of existing clients; three-quarters of AAAs developed new external partnerships; and over half are implementing strategies to address equity and inclusion regarding their services and clients. Nearly 80% of AAAs are involved with COVID-19 vaccine outreach and delivery, from scheduling appointments to administering the vaccine to homebound clients. We will describe these and other transformations of services, partnerships, and client needs; discuss challenges and opportunities; and provide examples and video vignettes from AAA directors.
Case Study on the Community Resilience Within Title VI Programs During COVID-19: A Qualitative Analysis
Authors: Bailey Abigail
Published: December 2021

Health inequalities increased for Native Americans during the COVID-19 pandemic due to poor infrastructure, lack of electricity, health disparities, limited transportation, and rural location (Yellow Horse, 2021). Title VI programs-- aging network organizations that serve tribal elders--had to be resourceful to meet increased needs and restrictions on service delivery options. Qualitative data from the national 2020 Title VI Native American Aging Programs Survey illustrated the challenges faced and the resiliency of these organizations and their communities. Two rounds of thematic coding of 479 open-ended responses to the survey revealed that communication across organizations, a sense of shared mission, and sharing of resources allowed these agencies to provide more services in innovative ways. Challenges included limited funding, regulatory barriers, and staff burnout. A video presentation by a Title VI program director will provide context for the results of the survey.
An Interdisciplinary Home-Based Medical Care Program to Reach Homebound Adults Living With Dementia
Authors: Mattos Meghan , Duffy Karen , Ranta Tuula , Mutter Justin
Published: December 2021

The COVID pandemic has impacted access to care, particularly for older, homebound persons living with dementia (PwD). At the beginning of the pandemic, our interdisciplinary team introduced a home-based medical care program (HBMC) to address chronically ill and homebound PwD and caregivers’ needs to promote aging in place. The purpose of this presentation is to describe PwD and caregiver service use and experiences with Virginia at Home (VaH) HBMC during the pandemic. All PwD participating in VaH program are offered home telehealth access with necessary devices. We will discuss telehealth access and use and dyad-care provider communication across up to 20 dyads to facilitate continuity of care. These data are supplemented by qualitative interviews with dyads presenting needs, preferences, and experiences accessing and using services across the first six months of program launch. We will conclude with a discussion of participant-informed program alterations to facilitate optimal overall care and outcomes.
Adaptations to In-Home Health Care Due to COVID-19: The VA’s Home-Based Primary Care Program
Authors: Wyte-Lake Tamar , Haverhals Leah , Manheim Chelsea , Solorzano Nelly , Gillespie Suzanne
Published: December 2021

The COVID-19 pandemic disrupted traditional Home Based Primary Care (HBPC) care processes, including changes to provision of face-to-face care in-home for older adults. Our study describes and explains care delivery changes Department of Veterans Affairs (VA) HBPC programs made in response to the pandemic. We fielded a national survey to all 140 VA HBPC programs, targeting interdisciplinary care teams and HBPC leadership. We structured survey questions using a mixed method approach with both closed and open-ended questions, applying a qualitative content analysis approach to open-ended responses complemented by analysis of descriptive quantitative data. Preliminary findings highlight the value and consideration of different telehealth modalities when caring for an older, homebound population, as well as creative adaptations HBPC teams made to deliver care during the pandemic. Implications include nascent development of decision-making paradigms beyond the pandemic particularly for appropriate use of telehealth modalities for older homebound adults.
Lessons From Lighthouse: Operationalizing Technology to Support Older Adults in Affordable Housing Communities
Authors: Lindeman David
Published: December 2021

Lighthouse for Older Adults, an innovative public-private partnership, was developed in response to COVID-19 as a means of advancing telehealth for low-income older adults living in affordable housing communities. Residents of these communities often don’t have reliable access to devices, sufficient bandwidth for telehealth, or adequate social services, further complicated by the need for multi-lingual and culturally sensitive programs. This presentation will share program implementation strategies and outcomes, including the essential role telehealth services play in the care and wellbeing of older adults during and beyond COVID-19. This session will review evidence-based components of a telehealth intervention, including digital literacy training and technology support. Key drivers for successful implementation (e.g., peer led training, user input into technology selection) as well as barriers to implementation (e.g., broad band installation, internet service availability/cost, tech support) will be reviewed. Lessons learned through program replication and scaling of Lighthouse telehealth services will be discussed.
Telehealth and 30-Day Readmissions Among Heart Failure Patients During the COVID-19 Pandemic
Authors: Xu Hanzhang , Granger Bradi , Peterson Eric , Dupre Matthew
Published: December 2021

This study examined whether outpatient follow-up within 14 days of discharge via telehealth visits are as effective as in-person visits for reducing 30-day readmission in heart failure (HF) patients. Using electronic health records from a large health system, we included HF patients (n=1,722) who were hospitalized during the period of March 15-July 15, 2020. Overall, 28.1% of patients received an early outpatient follow-up visit. Patients who received telehealth visits (n=119) were more likely to be older and live in areas with higher median household incomes than those with in-person visits (n=365). Thirty-day readmission rates were 20.5% during the COVID-19 period. Multivariate models showed that patients who received a telehealth (OR=0.36, 95%CI [0.23-0.56]) or an in-person (OR=0.42, 95%CI [0.31-0.57]) visit were less likely to be readmitted within 30 days compared with patients without an early outpatient follow-up. Telehealth visits were just as effective as in-person visits at reducing 30-day readmissions.
The Pathways to Healthy Ageing: Evidence From Longitudinal Studies and Real-Time Data
Authors: Lum Terry Y S
Published: December 2021

The WHO has replaced its active ageing policy framework developed in 2002 with the new Healthy Ageing framework developed in 2015 and declared the decade between 2020 and 2030 as the Decade of Healthy Ageing. Healthy Ageing framework emphasizes the pivotal role of functional ability (FA) among older adults and conceptualizes that FA can be determined by intrinsic capacity (IC), environments (EN), and their interaction. WHO calls for global research to advance theoretical understanding of Healthy Ageing framework and translate the evidence into policy actions. This symposium provides the latest findings on Healthy Ageing from multi-country studies using real-time data and longitudinal study design. Dr. Röcke explored daily time-out-of-home and place visit diversity with daily emotional and stress processes in Zurich, using sensor-based and self-reported mobility and activity indicators to capture FA. Dr. Lu investigated the EN and 4-year trajectories of IC and their impact on FA trajectories among older adults in Hong Kong. Dr. Liu explored the longitudinal associations between neighborhood physical EN and depressive symptoms of older adults in Hong Kong and the moderating effects of terrain slope and declining daily activity of living. Dr. Guo investigated the relationship between perceived EN (environmental cognition) and mental health and the mediating roles of physical activity and place attachment. Dr. Chan explored neighborhood physical EN and cognition among older people and identified whether this association varies among different older age groups. Based on these findings, this symposium will discuss the future research direction on Healthy Ageing and its policy implication.
Associations Between Neighborhood Environments and Depressive Symptoms of Older Adults
Authors: Liu Yuqi , Lu Shiyu , Guo Yingqi , Ho Hung Chak , Chui Hiu Kwan , Webster Chris , Chiu Lai Har , Lum Terry Y S
Published: December 2021

Little is known about the accumulative impacts of neighbourhood physical environments on depression among older adults. Based on a cohort study of 2,081 older adults in Hong Kong, this study examined longitudinal relationships between neighbourhood physical environments and depressive symptoms among older adults and the moderating effects of the slope of terrain and individual functional ability using latent growth curve modelling. Results indicated that the availability of community centres and passive leisure facilities reduced depressive symptoms over time. The protective effects of residential surrounding greenness on depressive symptoms among older adults differed by the slope of terrain. Longitudinal associations between neighbourhood physical environments and depressive symptoms varied between older adults with and without functional limitations. Identifying environmental barriers and applying targeted residential environment interventions are essential.
Environmental Cognition and Mental Health: Physical Activity and Place Attachment as Pathways
Authors: Guo Yingqi , Lu Shiyu , Liu Yuqi , Chan On Fung , Chui Hiu Kwan , Lum Terry Y S
Published: December 2021

Few studies have explored the underlying pathways between environment cognition (i.e., perception of environment) and mental health in older adults. We tested the mediation effects of physical activity and place attachment in the relationship between environmental cognition and mental health, based on a survey study of 1,553 older adults in Hong Kong using structural equation model. The results showed that significant relationship between negative environmental cognition (i.e., residing in higher accessible area but perceive lower) on access to convenient stores, leisure facilities, clinics, community centers, religious places and lower mental health can be explained by lower daily average physical activity time. Place attachment can significantly mediate the positive effect of positive environmental cognition (i.e., residing in lower accessible area but perceive higher) towards all types of services on mental health. Findings from this study have policy implication for urban planning and age-friendly community design
The Rational Use of Hormone Replacement Therapy in Older Adults
Authors: Mammen Jennifer , Simonsick Eleanor , Simonsick Eleanor
Published: December 2021

Multiple hormone levels are lower in older compared to younger adults, but the clinical implications are controversial. Lower thyroid hormone, testosterone, estrogen and vitamin D are variously associated with metabolic syndrome, sarcopenia, low bone density and cognitive decline, for which treatment has been recommended in the past. However, evidence from the T Trials of testosterone therapy failed to show benefit for endpoints other than sexual function. In the Women’s Health Initiative, a large RCT of estrogen replacement in older women, found evidence of an interaction between estrogen therapy and metabolic risk factors such as diabetes that actually exacerbates risk of cognitive decline. Longitudinal observation of thyroid hormone and thyrotropin patterns in the Baltimore Longitudinal Study of Aging demonstrate heterogeneity that might account for a lack of benefit in studies of treatment for subclinical hypothyroidism in older adults. At the same time, new data suggest the need for a more aggressive threshold for vitamin D in older adults, with a lower threshold associated with a drop in physical function compared to younger adults. Complexity in the regulation of hormonal pathways and the downstream effects on target tissues means multiple individuals with similar hormone levels may have different underlying physiology, with divergent clinical needs. Changes in activity and diet common during aging, and exacerbated by the pandemic, lead to physical and mood changes associated with hormonal dysfunction in popular culture and patient requests for evaluation. The ultimate goal should be personalized treatment decisions based on comprehensive evaluation and pathophysiology.
Prioritizing Community in Research Decision-Making Through Partnership
Authors: Marrone Nicole , Ingram Maia , Wong Aileen , Piper Rosie , Colina Sonia , Carvajal Scott , Coco Laura
Published: December 2021

In behavioral intervention research, taking a community-based participatory research approach enhances recruitment and retention while facilitating the transfer of research findings into social change. Successes with recruitment and retention are secondary to enacting fundamental principles of trust, reciprocity, cultural humility, empowerment, and respect. This presentation will describe a longitudinal clinical trial in a Southwest borderlands community, Oyendo Bien. The study was co-developed and implemented with community partnership throughout the research process. Dyads were recruited to participate in a community-delivered group education and support program addressing hearing loss for Spanish-speakers age 50+ years (n=132 participants randomized). We highlight the critical role that community health workers (promotoras) held as members of the research team. Furthermore, we describe an innovative approach for language mediation that integrates and empowers community participation. This presentation will include examples of lessons learned from the community in collaborating to conduct research in a way that truly serves.
Kent and Kleemeier Award Lecture and Presentations
Authors: Harvath Theresa
Published: December 2021

The Donald P. Kent Award lecture will feature an address by the 2020 Kent Award recipient, David Ekerdt, PhD, FGSA, of the University of Kansas. The Kent Award is given annually to a member of The Gerontological Society of America who best exemplifies the highest standards of professional leadership in gerontology through teaching, service, and interpretation of gerontology to the larger society. The Robert W. Kleemeier Award lecture will feature an address by the 2020 Kleemeier Award recipient, Matt Kaeberlein, PhD, FGSA, of the University of Washington. The Kleemeier Award is given annually to a member of The Gerontological Society of America in recognition for outstanding research in the field of gerontology.
Neighborhood Environment and Cardiometabolic Disease in Individuals Aging With Physical Disability
Authors: Khan Anam , Lin Paul , Kamdar Neil , Mahmoudi Elham , Clarke Philippa
Published: December 2021

The environment may be particularly important for facilitating participation and health for individuals aging with physical disability. However, little is known about which features of the neighborhood are particularly pertinent for this population. This study aims to address this gap by examining the type(s) of neighborhood environments associated with cardiometabolic disease. We identified ~26,000 individuals with a diagnosis of physical disability using a national private health insurance claims database in the U.S. Geocoded information for individuals was used to assign them to features of their neighborhood from the National Neighborhood Data Archive. An adapted typology was used to classify neighborhoods into the following based on density of health-promoting and harming features: 1) High health-promoting/harming (service-dense), 2) High health-promoting/low harming, 3) Low health-promoting/high harming, 4) Low health-promoting/harming, and 5) Average. We used time-varying Cox models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for time-to incident cardiometabolic conditions. High neighborhood-level affluence, and low disadvantage scores characterized service-dense neighborhoods. They had more than 2x higher density of health-promoting resources (e.g., transit) compared to other neighborhood types. Individuals residing in service-dense neighborhoods had an 8% lower risk of any cardiometabolic disease (HR 0.92, 95% CI: 0.85-0.99) compared to those in average neighborhoods. Similar effects were observed for Hypertension and Type 2 Diabetes, with effects most pronounced for the latter (HR 0.82, 95% CI: 0.71-0.94). For individuals aging with physical disabilities, service-dense neighborhoods may be protective against cardiometabolic morbidity. Findings can inform community design that support cardiometabolic health in this population.
Care in Context: Dementia Support in Mexico and the United States
Authors: Rote Sunshine , Angel Jacqueline , Vega William
Published: December 2021

Due to rapid demographic transitions, the number of people with dementia is rising in the Americas, and is expected to double in the coming decades, increasing from14.8 million in 2030 to over 27 million by 2050. The burden of dementia is especially pronounced for the Mexican-origin population in Mexico and the U.S. For Mexico, financial support for older low-income citizens and medical care are universal rights, but limited fiscal resources and the needs of a large low-income population create inevitable competition for limited resources among the old and the young. Although the United States has a more developed economy and well-developed Social Security and health care financing systems for older adults, Mexican-origin individuals in the U.S. do not necessarily benefit fully from these programs. The institutional and financial problems are compounded in both countries by longer life spans, smaller families, as well as changing gender roles and cultural norms. Such changes affect the Mexican-origin population in particular because of a higher prevalence rates of cognitive impairment than other racial and ethnic groups, and the lower access to resources to provide care. In this GSA Symposium, the authors of four papers deal with the following topics as they relate to dementia care in Mexico and the United States: (1) living alone in late life; (2) living arrangements and dementia care; (3) the role of non-governmental organizations in care; (4) next steps to address dementia care needs in the U.S. and Mexico.
Living Beyond 80: A Longitudinal Study of Cognitive and IADL Disablement Among the Oldest Mexican Americans
Authors: Kim Jiwon , Angel Jacqueline , Rote Sunshine
Published: December 2021

Mexican Americans live longer on average than other ethnic groups, but often with protracted cognitive and physical disability. Little is known, however, about the role of cognitive decline for transitions in IADL disability and tertiary outcomes of the IADL disablement for the oldest old. We employ the Hispanic Established Populations for the Epidemiologic Study of the Elderly (2010-2011, 2012-2013, 2016, N=1,078) to investigate the longitudinal patterns of IADL decline using Latent Transition Analysis. Three IADL groups were identified: independent (developing mobility limitations), emerging dependence (limited mobility and community activities), and dependent (limited mobility and household and community activities). Declines in cognitive function were a consistent predictor of greater IADL disablement, and loneliness was a particularly salient distal outcome for emerging dependence. These results highlight the social consequences of cognitive decline and dependency as well as underscore important areas of intervention at each stage of the disablement process.
Bilingualism and Healthy Aging: Onset Age of Bilingualism as a Predictor of Older Adult Theory of Mind
Authors: Yow W Quin , Li Xiaoqian , Lee Jia Wen
Published: December 2021

The ability to understand and speak more than one language (i.e., bilingualism) may protect against age-related cognitive deterioration (Abutalebi et al., 2015). While there is mounting evidence suggesting that bilingualism confers advantages in domain-general cognitive abilities in late adulthood (see Bialystok, 2017, for a review), few studies have investigated the influences of bilingualism on socio-cognitive abilities such as theory of mind (ToM) in the normal aging process. Thus, in this study, we examine how bilingualism factors (i.e., onset age of bilingualism, language balance, and diversity in language use) are associated with individual differences in ToM in healthy older adult bilinguals aged 58-79 (N=44). ToM abilities were assessed using the Theory-of-Mind Task Battery (Hutchins et al., 2008), where participants viewed vignettes and answered questions about the protagonists’ cognitive and affective mental states. All participants completed a self-report language background questionnaire and the Montreal Cognitive Assessment (MoCA) test as a measure of general cognitive ability. Results revealed that better ToM was negatively correlated with participants’ chronological age (r=-.43, p=.004) and the onset age of second-language acquisition (r=-.41, p=.006), but not language balance and diversity (ps>.40). Partial regression analyses showed that earlier onset age of bilingualism predicted better ToM performance (β=-.40, p=.009), even after controlling for age, education, and general cognitive ability. These findings suggest that bilingual language experience, particularly earlier exposure to a second language, may provide benefits to older adults in preserving their ability to understand others’ mental states, acting as a cognitive reserve against age-related declines in socio-cognitive functions.
Verbal Communication in Dementia Family Caregiving: Using the VNVIS-CG Scale for In-Home Video Observations.
Authors: Williams Kristine , Coleman Carissa , Aly Iman , Wilson Paige
Published: December 2021

Communication is fundamental for dementia care and identifying communication behaviors is key to identifying strategies that facilitate or impede communication. To measure caregiver verbal communication, we adapted the Verbal and Nonverbal Interaction Scale for Caregivers (VNVIS-CG) for second-by-second behavioral coding of video observations. The VNVIS-CG was adapted for computer-assisted Noldus Observer coding of video interactions captured at home by family caregivers from the FamTechCare clinical trial. Operational definitions for verbal communication behaviors were developed and inter-rater reliability was excellent (Kappa = .86) using two independent coders. Videos (N=232) were coded featuring 51 dyads; caregivers were primarily female (80%) spouses (69%) of men (55%) diagnosed with moderate to severe dementia (64.7%). Mean caregiver age was 65 years. Silence occurred most frequently (44.9% of the time), followed by caregiver direction or instruction (22.6%), and the person with dementia (PWD) verbalizing (22.8%). Caregiver communication also included asking questions (14.2%), verbalizing understanding (7.9%), repeating information (2.1%), affirmations (1.0%), acknowledging emotions (0.3%), and ignoring (0.0%). Questions most commonly requested clarification, showed interest, or repetitive quizzing; few questions sought to engage PWD input (ex. offers choices, encourages emotional expression, or ask permission). Tone was overwhelmingly neutral rather than humorous, aggressive, or patronizing. The adapted behavioral coding scheme provides a reliable measure that characterizes dementia caregiver verbal communication behaviors for analysis of video observations. Ongoing research will identify strategies that facilitate communication as well as determine how strategies vary by dementia stage, diagnosis, and dyad characteristics.
Intensity of Walking Training Impacts Cognition Among Assisted Living Residents With Frailty
Authors: Danilovich Margaret , Norrick Christie
Published: December 2021

Exercise has many proven cognitive benefits but the precise intensity to modify cognition is unclear. This pilot study investigated the role of exercise intensity on cognitive outcomes among assisted living residents. We enrolled n=33 frail or pre-frail residents who completed an 8 week, twice-weekly walking intervention. Participants were 66% female, and on average were 88 years old with a MMSE score=25.6, and low cognitive scores (Category Fluency Animals=10.45, Category Fluency Vegetables=7.67, Trail Making Test A=60.82 seconds, Trail Making Test B=155.18 seconds). Walking sessions used 5-minute intervals focused on maximizing steps, fast speeds, and multi-directions for 45 minutes per session. Participants in the high intensity group walked at >70% heart rate maximum or RPE 15-17 and those randomized to the casual intensity group walked at <60% heart rate maximum or RPE <13. Results showed the casual-intensity group improved more on Category Fluency tests (increase of 0.88 animals and 1.06 vegetables) compared to the high-intensity group (increase of 0.12 animals and increase of 0.35 vegetables). On Trail Making Test A, high-intensity participants had a 7.47 second decrease in time to complete compared to the casual-intensity group (2.00 seconds increase). On Trail Making Test B, high-intensity participants decreased time to complete by 27.13 seconds compared to a 26.19 decrease in the casual-intensity group. Results show promising trends in the role of exercise intensity in impacting different elements of cognition among assisted living residents.
Worsening Mental Health and Self-Rated Health in Older Incarcerated Persons During the COVID-19 Pandemic
Authors: Barry Lisa , Noujaim Deborah , DePalma Alexandra , Coman Emil , Wakefield Dorothy
Published: December 2021

Incarcerated persons age 50 and older comprise one of society’s most vulnerable groups given high rates of chronic illness, estrangement from family/friends, and suicide. Consequently, the mental health impact of COVID-19 on this population may be especially salient. Using data from the ongoing Aging Inmates’ Suicidal Ideation and Depression study (Aging INSIDE), we determined change in older incarcerated persons’ mental health (anxiety and depression symptoms) and change in self-rated health (SRH) from before to during the COVID-19 pandemic, and evaluated how these variables were related. Of the 202 still-incarcerated Aging INSIDE participants, 157 (77%) completed Check-In Surveys between August-September 2020. Participants were 96% male, racially diverse (41% White, 41% Black, 18% Hispanic/Other) and average age was 56.0(±5.8) years. From before to during the COVID-19 pandemic, average anxiety symptom scores, assessed by the GAD-7, increased (worsened) (from 6.4±5.7 to 7.8±6.6; p<0.001), average depressive symptoms scores, measured by the PHQ-8, increased (worsened) (from 5.5±6.0 to 8.1±6.5; p<0.001), and average SRH decreased (worsened) (from 3.0±0.2 to 2.6±0.2; p<0.001). Worsening anxiety led to worsening depressive symptoms (direct effect = 0.339; p<0.05). A mediation model controlling for age, race, chronic conditions, years until release, and change in social support score found a total effect of change in anxiety on SRH change of -0.04 (p<0.001), of which 34.2% flows indirectly through change in depression (p<0.001). Older incarcerated persons experienced worsening mental health and SRH during the COVID-19 pandemic. Future research will determine if mental health and SRH improve following vaccination and return to “normal” procedures.
Co-Calibration of Cognitive Domains Across Different Countries Without Common Linking Items
Authors: Nichols Emma , Jones Richard , Gross Alden
Published: December 2021

Modern psychometric methods allow for cocalibration of cognition across cross-national surveys, given the presence of common tests across studies. For narrow cognitive domains, there may not be common tests due to cultural and linguistic differences in testing. We developed a novel method to facilitate cocalibration that entails (1) identifying a common score across studies highly correlated with the focal domain; (2) deriving scores separately in each study for the domain of interest; and (3) applying stratified equipercentile equating to equate domain scores in (2) to the distribution of the common metric in (1). We tested this method by equating executive functioning in the Harmonized Cognitive Assessment Protocols (HCAP) in the US (N=3496), India (N=4096), and England (N=1273). The method preserves the rank order of executive functioning derived separately (r>0.99 in England; r>0.99 in India), while preserving between-study differences observed in general cognitive functioning. We discuss limitations and future directions.