bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Group B Streptococcus (GBS) Serum Serotype-Specific Anticapsular Immunoglobulin G Concentration and Risk Reduction for Invasive GBS Disease in South African Infants: An Observational Birth-Cohort, Matched Case-Control Study
Authors: Madhi Shabir A , Izu Alane , Kwatra Gaurav , Jones Stephanie , Dangor Ziyaad , Wadula Jeanette , Moultrie Andrew , Adam Yasmin , Pu Wenji , Henry Ouzama , Briner Carmen , Cutland Clare L
Published: December 2020

Background

Licensure of a group B Streptococcus (GBS) polysaccharide-protein conjugate vaccine for protecting infants against invasive GBS disease (IGbsD) will likely need to be based on demonstrating vaccine safety in pregnant women, and benchmarking immunogenicity against a serological threshold associated with risk reduction of IGbsD. We investigated the association between naturally derived GBS serotype Ia and III IgG and risk reduction of IGbsD in infants ≤90 days of age.

Methods

In a matched case-control study, IGbsD cases were identified from a cohort of 38 233 mother-newborn dyads. Mothers colonized vaginally with serotype Ia or III at birth and their healthy infants were eligible as matched controls. GBS serotype-specific anticapsular immunoglobulin G (IgG) was measured on maternal and cord blood/infant sera by multiplex Luminex assay, and the IgG threshold associated with 90% risk reduction of IGbsD was derived by estimating absolute disease risk.

Results

In infants born at ≥34 weeks’ gestational age, cord-blood IgG geometric mean concentrations (GMCs) were lower in cases than controls for serotypes Ia (0.05 vs 0.50 µg/mL; P = .004) and III (0.20 vs 0.38 µg/mL; P = .078). Cord-blood IgG concentrations ≥1.04 and ≥1.53 µg/mL were associated with 90% risk reduction of serotype Ia and III IGbsD, respectively. The maternal sera IgG threshold associated with 90% risk reduction was ≥2.31 µg/mL and ≥3.41 µg/mL for serotypes Ia and III, respectively.

Conclusions

The threshold associated with a reduced risk for serotype Ia and III IGbsD identified on infant sera supports the case for licensure of a GBS polysaccharide-protein conjugate vaccine based on an immunogenicity evaluation benchmarked against the defined thresholds.

Clinical Trials Registration

NCT02215226.
Poor Baseline Health of IBD Patients at Presentation to a Surgeon: Results From a Patient-Reported Outcomes Database
Authors: Sacks Olivia A , Goldwag Jenaya L , Eid Mark A , Shaw Robert D , Williams Trenika J , Ivatury Srinivas J
Published: December 2020

Background

Many patients with inflammatory bowel disease (IBD) are referred to surgeons when medical treatments are ineffective, signifying poor disease control. We aimed to assess the association of IBD diagnosis with physical and mental health upon presentation to a colorectal surgeon.

Methods

We included all new patients presenting to colorectal surgery clinic over 1.5 years. During registration, patients completed the PROMIS Global-10, a validated outcome measure assessing physical and mental health. We grouped patients by diagnosis: IBD, anorectal, benign colorectal, and malignancy. Details on IBD patients were obtained via chart review. We evaluated the interaction between PROMIS scores and diagnosis through ANOVA analysis and post hoc Tukey–Kramer pairwise comparison. We estimated the strength of association of age, sex, and visit diagnosis with poor physical and mental health (PROMIS: −1 SD) through logistic regression.

Results

Eight hundred ninety-seven patients were included. The cohort was as follows: IBD (99) (Crohn = 73; ulcerative colitis = 26), anorectal (378), benign colorectal (224), and malignancy (196). The mean age of patients was 56 (±17) years. Fifty-seven percent were female. The IBD group was youngest (P < 0.001). IBD had significantly lower PROMIS scores on pairwise comparison; anorectal had the highest scores. Controlling for age and sex, the IBD group had 4.1× odds of poor physical health (95% confidence interval 2.46–6.76) and 2.9× odds of poor mental health (95% confidence interval 1.66–5.00).

Conclusions

Patients with IBD, specifically Crohn disease, have worse physical and mental health on presentation to a colorectal surgeon compared to patients presenting with other colorectal diagnoses. These patients considering surgery might benefit from added support during the perioperative period.
248 Association between abnormal blood pressure response to exercise and incident cardiovascular events
Authors: Bellomo Francesca , Campisi Mariapaola , Lantone Giuseppe , Mazzone Paolo , Firetto Giorgio , Ciccarelli Iacopo , Casale Matteo , Di Lorenzo Anna , Sarullo Filippo Maria , Migliorato Alessandro , Giallauria Francesco , De Gregorio Cesare
Published: December 2020

Aims

The aim of this multicentre registry was to verify the association between an exaggerated blood pressure response (EBPR) to exercise stress test (EST) and evidence of previous myocardial and/or brain ischaemic events in the general population.

Methods and results

All subjects who underwent EST for screening of ischaemic heart disease and/or follow-up and re-evaluation of heart disease were included in the registry. Patients who discontinued EST due to early muscle exhaustion, younger individuals (<18 years), patients with potentially dangerous channelopathies or ventricular arrhythmias, as well as those with disabling chronic diseases or experiencing cardiovascular events in the 3 months prior to TE. Everyone performed EST on a treadmill or cycle ergometer using similar protocols in the various centres. Based on some study in the literature, we identified the EBPR to exercise for a systolic BP rise >60 mmHg (men) or > 50 mmHg (women) compared to pre-exercise baseline measurement, but also an absolute value >210 or > 190 mmHg, respectively. Retrospectively, we verified the presence of non-disabling ischaemic cardiac and cerebrovascular events over the past 10 years. Five hundred and three subjects of mean age 61 ± 11 years were included in the registry. EST was performed on a treadmill in 65% of subjects and maximal workload was achieved by 75% of them. Subjects with EBPR were 170 (34%) vs. 333 (66%) who had normal response (controls). EBPR group included most male subjects, often overweight and with a higher prevalence of diabetes (31% vs. 20% in the control group, P < 0.01), and with already diagnosed arterial hypertension in a half of cases. Previous ischaemic myocardial events were found in 35% of EBPR subjects vs. 36% of controls (P = NS), while cerebrovascular disease in 20% vs. 10%, respectively (P < 0.005).

Conclusion

Albeit retrospectively performed, this multicentre registry highlighted an association between EBPR to exercise (present in more than one-third of the subjects examined, especially males) and history of cerebrovascular ischaemic events within 10 years prior to enrolment. In line with previous studies, present data confirmed a clinical impact of EBPR on exercise. However, the precise pathophysiological mechanism(s) need to be clarified yet, also in terms of therapies against such exaggerated functional response and its possible prognostic impact over time.
138 Pulmonary valve preservation and transannular patch techniques in children with repaired tetralogy of Fallot; echocardiographic comparison
Authors: Avesani Martina , Guariento Alvise , Schiena Chiara Anna , Reffo Elena , Castaldi Biagio , Padalino Massimo , Vida Vladimiro , Di Salvo Giovanni
Published: December 2020

Aims

To investigate pulmonary valve (PV) and right ventricular function by echocardiography in paediatric patients with repaired Tetralogy of Fallot (ToF), comparing PV preservation surgical strategies to standard transannular patch (TAP) repair.

Methods and results

All patients undergoing transatrial-transpulmonary repair for ToF at our institution between January 2007 and May 2020 were reviewed retrospectively. Patients were divided into 2 groups, according to the different techniques used (PV preservation strategy vs TAP repair). All patients underwent standard echo-Doppler study including RV areas, fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE); Pulmonary regurgitation (PR) was assessed by Color Doppler, continuous-wave (CW) Doppler, pressure half time (PHT) and PR index. By speckle tracking we measured also, in a subgroup of patients, right atrial strain (RAS), RV and left ventricle (LV) global longitudinal strain (RVGLS, LVGLS) and their time to peak (TTP) values.

Eighty-two patients underwent a PV preservation strategy while 34 underwent a standard TAP repair. Five-year actuarial freedom from moderate/severe PV regurgitation was significantly higher in the PV preservation group compared to the TAP (61.3% [95% CI: 48-73%] vs 25.9% [95% CI: 12-43%], respectively; p = 0.02). After adjusting for age, gender, BSA, and type of PV, the use of a TAP was still significantly associated with an increased risk for PV regurgitation at Follow-up (HR: 1.85, 95% CI: 1.09, 3.15; p = 0.02). At a mean follow-up of 6.9 ± 0.3 years, patients undergoing PV preservation showed an increased right ventricular fractional area change (46.9 ± 0.8% vs 42.5 ± 1.7%, P < 0.001) and (TAPSE) z-score (-3.36 ± 0.3% vs -4.7 ± 0.4%, P = 0.005), while maintaining better PV competence in terms of pulmonary regurgitation index (87.9 ± 1.2% vs 82.7 ± 2.4%, P = 0.02). At speckle tracking subanalysis, patients undergoing PV preservation (n = 23), compared to the TAP group (n = 13) showed also higher values of RAS (37.5 ± 6.0% vs 29.3 ± 8.2%, P < 0.006), shorter right TTP (319 ± 39ms vs 357.5 ± 45.2 ms, P < 0.01) and higher values of LVGLS (-20,6 ± 4,2% vs -17.5 ± 3.0, P < 0.03).

Conclusion

Surgical repair of ToF with PV preservation provides excellent outcomes in terms of PV competence and right ventricular function and should be advocated whenever possible.
Understanding Transitions in IADL and Their Consequences for Cognitive Impairment Among Older Mexican Americans
Authors: Kim Jiwon , Angel Jacqueline , Rote Sunshine
Published: December 2020

Mexican Americans tend to live longer lives than other ethnic groups, but it remains unclear how this trend influences the trajectory of disability and its consequences for cognitive frailty. Building on previous research, we assess transitions in IADL among the oldest old. We use data from three waves of the Hispanic Established Population of the Epidemiologic Study of the Elderly (H-EPESE) to investigate trajectories of IADL disability as individuals’ age into their 80s and 90s, a period of the life course with much higher rates of morbidity and decreasing socioeconomic resources. The H-EPESE is a benchmark longitudinal cohort study based on an original sample of 3,050 Mexican-Americans aged 65 and older in the Southwestern United States. Our modeling approach estimates transitions in patterns of IADL employing the Latent Transition Analysis (LTA). Results revealed three heterogeneous latent classes: high IADLs, difficulty in transportation and mobility, and low IADLs. Those with high IADLs tended to remain in the same class over time. Individuals having difficulty in transportation and mobility tended to stay in the same class or transfer to high IADLs, whereas those with overall low IADLs transferred to either the same class or to difficulty in transportation and mobility. Additional analysis revealed that cognitive impairment was a significant predictor of instrumental disability over time. Furthermore, females were more likely than males to belong to difficulty in transportation or mobility class than to the low IADL class. Our results highlight the long term consequences of cognitive decline on IADL limitations.
Work and Self-Rated Memory Among Native Hawaiian and Other Pacific Islander Older Adults
Authors: Lee Yeonjung (Jane) , Terada Tyran
Published: December 2020

According to the productive aging framework, productive activities can function as protective factors of cognitive health. Productive activities, such as work, have been linked to positive cognitive health outcomes in older adults. Yet, less is known about if the beneficial effects of work on cognition extend to the Native Hawaiian and Other Pacific Islander (NHOPI) older adult population. Thus, the purpose of this research is to investigate how work is associated with self-reported memory/concentration among NHOPI older adults. Moreover, the moderating role of education was explored. Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS), the study explores the associations between work and self-rated levels of difficulty remembering or concentrating. A total of 1,045 older adults ages 50 years and older were included for analyses. Weighted multivariate analyses with multiple imputation techniques were used. The NHPI NHIS is the first federal survey focusing on the NHOPI population in the United States. Those who were engaged in work had lower odds of having severe difficulty memorizing or concentrating while controlling for other sociodemographic and behavioral factors. Interestingly, there was a significant interactive effect of work and education on self-rated memory. Those with lower education levels have lower self-rated memory, but the odds of having memory difficulty decreased when they worked. Findings highlight the importance of productive aging in promoting healthy cognitive aging. Research and practice addressing productive aging and cognition should provide culturally relevant resources to NHOPI older adults.
Gentrification and Chronic Conditions in Older Adults: Service Providers’ Perspectives
Authors: Rooks Ronica
Published: December 2020

Where we live impacts our health, but this is more apt for older adults (aged 55+) aging-in-place in their neighborhoods. Gentrification, i.e. the transformation of neighborhoods from low to high value, can put community-dwelling older adults at risk for residential displacement with limited retirement incomes and financial stressors like increased housing costs and property taxes, residential turnover and changing access to resources. As a place-based stressor, gentrification may exacerbate social vulnerabilities (e.g., lower socioeconomic status and racial/ethnic minority status) related to chronic condition (CC) disparities. But, little gentrification research focuses on these issues. This research examines associations between gentrification and older adults’ CC management related to broader social determinants in Hamilton, Ontario, Canada from health and social service providers’ perspectives. Hamilton, a recovering steel industry city with in-migration from Toronto, is experiencing higher costs of living, income inequality and tension with recent gentrifiers. I conducted key informant interviews with service providers in city government and community-based organizations using thematic analysis. Across providers, food insecurity, social isolation and displacement were the biggest issues associated with gentrification and CC, particularly for older adults with lower incomes and government disability support. Results thus far reveal Hamilton has numerous older adult-focused providers, but older adults often have difficulties accessing services due to a lack of knowledge, not always asking or realizing when they need help and coordinated referral difficulties across providers. To address these challenges, providers consider environmental scans, mapping resources and advertisement in an online community information database from the city’s public library.
Dietary Behavior and Depressive Symptoms in Late-Life Marriage
Authors: Ali Talha , McAvay Gail , Monin Joan
Published: December 2020

Epidemiologic studies have linked dietary patterns to psychological health including depression, anxiety, and stress. However, no research has examined dyadic associations between dietary behavior and depressive symptoms in older married couples. In this study, one hundred and one couples 51 to 90 years of age who were married or in a marriage-like relationship and living together for at least 6 months were recruited. Participants completed questionnaires and self-reported their dietary behavior (i.e., the total number of meals, number of snacks, and number of fast-food meals eaten in a typical day and the number of meals they eat alone and eat sitting down). They also completed the 20-item Center for Epidemiologic Studies Depression Scale. Results of the Actor Partner Interdependence Models controlling for income, education, chronic conditions, and marital satisfaction, showed that for wives only, more meals eaten in a day were associated with lower depressive symptoms (actor effect). Additionally, more snacks eaten by the wife and more meals eaten alone by the wife were associated with higher depressive symptoms for the husband (partner effects). Findings suggest that wives’ dietary behavior is particularly important, not only for their own but also their husbands’ mental health in late-life marriage.
The Relationship Between Lifespan Volunteerism and Personality Among Oldest Old Adults
Authors: Lee Gina , Martin Peter
Published: December 2020

There has been a lack of studies exploring volunteerism from the life span perspective. This study aims to examine the relationship between personality and volunteerism among the oldest old population, using three types of volunteerism: “ever volunteered,” “last volunteered,” and “currently volunteering.” “Ever volunteered” assesses whether individuals ever volunteered in their life. “Last volunteered” examines when an individual last volunteered. “Currently volunteering” explores whether an individual is currently volunteering. By comparing the three volunteerism measures, this study took a life span view of volunteerism. Data of 208 oldest old adults, octogenarians (34.1%) and centenarians (65.9%), from the Georgia Centenarian Study were included in this study. The majority of the sample had volunteered sometime during their lifetime (88.9%), many of them still volunteered when they were in their 80s and 90s (40.4%), and the majority of the sample indicated that they were not currently volunteering (78.8%). Multiple regression analyses indicated that competence (a facet of conscientiousness) significantly predicted “ever volunteered,” and extraversion significantly predicted “last volunteered.” In other words, oldest old adults with high competence levels were more likely to have volunteering experiences in their life. Also, those with high levels of extraversion were likely to have more recent volunteering experiences. None of five personality traits significantly predicted “currently volunteering.” This study sheds light on the importance of different types of volunteerism which enables us to better understand the relationship between volunteerism and personality. We recommend future research to test the link between different types of volunteerism and well-being outcomes.
Chinese Americans’ Priorities and Practices for Designating a Healthcare Proxy
Authors: Liu Mandong , Chi Iris
Published: December 2020

Many Americans need decision-making from someone else due to cognitive impairment. Chinese comprises the largest Asian group in the U.S.; few studies have investigated factors influencing Chinese Americans’ health care proxy (HCP) designation. The aim of this study was to examine factors associated with Chinese Americans’ HCP designation, using Andersen’s Behavioral Model as a lens. Data were from the 2015 Asian American Quality of Life Survey. Hierarchical logistic regression analyses were conducted to test the incremental predictive power of predisposing, enabling, and needs factors. We found that age, marital status, religious affiliation, health insurance, acculturation, and self-rated health were predictors for HCP designation. The odds of having an HCP designation were 1.96 times higher for those aged 65 and above, compared to those aged 18-64 (p=0.045); The odds were 2.40 times higher for those who were married (p=0.006); The odds were 1.79 times higher for Protestants (p=0.042) and 2.25 times higher for Buddhists (p=0.025), compared to those with no religious affiliation; Having a health insurance increased the odds of having an HCP designation by 2.23 (p=0.022); For each additional unit in acculturation score, the odds of having an HCP designation increased by 0.65 (p=0.011); Compared to those who rated their health as excellent/very good/good, those rating health as fair/poor had a 2.97 times higher odds of HCP designation (p=0.001). We concluded that various factors influence Chinese Americans’ HCP designation, and appropriate and innovative practices should be used to assist HCP discussion and designation among Chinese and other ethnic minority populations.
Better Night’s Sleep and Subjective Cognition: The Role of Day and Night Work Shifts
Authors: Veal Britney , Mu Christina , Lee Soomi
Published: December 2020

Previous research indicates poor sleep and cognitive functioning are associated. Studies have yet to consider the role of work shift on this relationship. The current study examined the sleep and subjective cognition relationship in nurses, and if this relationship differed for day- and night- shift nurses. Sixty-one nurses (M=35.39, SD=11.73; 39 day-, 22 night-shift) reported their nightly sleep characteristics and next-day subjective cognition (i.e., processing speed, memory, and mental focus) using ecological momentary assessments for 2 weeks. Multilevel models controlled for sociodemographic characteristics and decomposed the variance attributed by between- and within-person levels. At the within-person level, better sleep the previous night was associated with better subjective cognition the following day. This relationship was more apparent in night-shift nurses than in day-shift nurses, such that (a) longer sleep duration predicted better mental focus (B=1.62, p<.05) and (b) higher sleep quality predicted better memory (B=8.67, p<.001). At the between-person level, better sleep overall was associated with better subjective cognition across days. This association was more apparent in day-shift nurses than in night-shift nurses, such that (a) better sleep quality and sufficiency predicted faster processing speed (B=34.33; B=26.28; p<.001) and (b) better sleep quality and greater sleep sufficiency predicted better memory (B=30.94; B=23.09; p<.001). Findings suggest that sleep characteristics are associated with subjective cognition in nurses day-to-day and on average. Specific sleep characteristics associated with subjective cognition differ between day- and night-shift nurses, presumably due to differences in their sleep issues and perceived cognitive abilities.
Longitudinal Changes in Arthritis Pain Contribute to Subsequent Changes in Body Mass
Authors: Finkel Deborah , Emery Charles , Aslan Anna Dahl
Published: December 2020

Prior studies have documented that body mass index (BMI) is positively associated with bodily pain. However, data on the temporal sequence of BMI and pain suggest mixed results, with some studies indicating a bi-directional relationship, and other research among older adults supporting a uni-directional relationship from BMI to increased pain. Thus, it is critical to further examine temporal dynamics between changes in BMI and changes in bodily pain to help explicate possible mechanisms influencing the relationship. This study evaluated bivariate dynamic models of longitudinal change (McArdle & Hamagami, 2003) in the relationship between BMI and bodily pain with data from older adults participating in the Swedish Adoption/Twin Study of Aging (SATSA). The sample included 858 individuals aged 45-88 at intake, with up to eight waves of follow-up over 26 years. BMI {weight(kg)/[height(m)]2} was evaluated with objective measures of weight and height recorded by a study nurse. Pain symptoms were measured with six self-report pain questions, reflecting two pain factors: (1) pain in neck, back, or shoulder; and (2) hip pain, history of arthritis, or use of arthritis medications. Results indicated that the relationship between BMI and arthritis pain was uni-directional, with changes in pain symptoms contributing to subsequent changes in BMI, but no evidence that changes in BMI contributed to subsequent changes in pain symptoms. Model comparison indicated that the impact of pain on BMI was greatest before age 70, and then reduced somewhat after age 70, when the impact of other factors on BMI (e.g., ill health) likely increases.
Patient Experience of an Osteoporosis Telemedicine Clinic
Authors: Steffen Melissa , Van Tiem Jennifer , Seaman Aaron , Miller Karla , Wardyn Shylo , Solimeo Samantha
Published: December 2020

Rural Veterans at risk of fracture due to osteoporosis remain underdiagnosed and undertreated, in part due to location-related barriers to accessing care. Despite lowered cost and travel barriers to osteoporosis care through implementation of a telehealth model directed at rural at-risk Veterans that took advantage of many strengths of the VA’s healthcare system, only 30% of eligible Veterans accepted care. To understand low acceptance, we conducted 39 semi-structured telephone interviews with Veterans eligible for the clinic, including 19 who accepted screening and treatment, 12 who completed screening but declined treatment, and 8 who declined screening and treatment. Veterans who opted to be screened and/or treated for osteoporosis did so because: it was recommended by the VA; they were interested in learning more about their health; thought they may be at risk of osteoporosis; or believed screening would not cause them harm. Conversely, Veterans refused screening or treatment because of past negative experiences with medications, both bone and non-bone; a wish to not put anything else into their bodies; or the belief that their bone loss is not severe enough to warrant treatment. Outside medical professionals and peers influenced Veterans’ decisions to not take or alter their treatment. Cost and travel distance remained a barrier for Veterans who did not live near a VA facility with the necessary screening and treatment infrastructure. Many barriers to osteoporosis care remain despite efforts to remove them. Delivery systems must account for both instrumental and social access to care to reduce fracture risk.
The Importance of Cancer-Related and Other Health Factors on Cognition Among Older-Adult Long-Term Survivors
Authors: Beck Gabrielle , Deimling Gary , Kahana Boaz , Kahana Eva , Phelps Erin , Ciaralli Spencier
Published: December 2020

Previous research has identified cancer and cancer-treatment related effects on survivors’ mental impairment including memory and concentration. However, research has not systematically examined the relative impact of cancer in the context of age and other age-related health challenges common in later life. This paper compares the effects of cancer-related factors with other health challenges faced by 471 older adult long-term survivors from an NCI-funded study of a randomly selected tumor registry sample from a major comprehensive cancer center. Having had chemotherapy is associated with several cognitive outcomes including memory and concentration. Survivors who reported more cancer-related symptoms during treatment reported a greater number of cognitive symptoms even decades after treatment. Importantly, other comorbid health problems as well as social factors were found to be important in explaining symptoms of cognitive impairment in this older adult sample. These findings suggest that health care and mental health providers consider the range of health challenges, including those related to cancer and its treatment, as they provide patient centered care.
Living Within and Without: Life-Space Mapping to Visualize Need and Resource Access of Rural Dementia Dyads
Authors: Loup Julia , Snow A Lynn , Hilgeman Michelle
Published: December 2020

Rural-dwelling veterans with dementia (PWD) and their family caregivers (CG) have unique needs and resource access limitations. Life-Space assessment models suggest older adults’ needs are reflected in their daily-life mobility and routines (Peel et al., 2005). Yet, medical treatment models seldom incorporate non-health related activities (e.g., transportation, groceries, distance to formal and informal support networks). This mixed-methods study proposes an exploratory life-space modeling visualization that integrates qualitative and quantitative daily-life data from rural dwelling dyads in Alabama. Two case studies are selected from a sample of 30 qualitative interviews to demonstrate this innovative analytic approach. One case depicts a married dyad (PWD and spousal CG) (CGage = 74; PWDage = 80, PWD MoCA score = 21) and the second visualization is of a PWD living alone (PWDage = 82, PWD MoCA Score = 20). Daily-life experiences and routines mentioned during interviews were categorized using a rapid analysis template approach and informed by unmet needs theories (Algase et al., 1996). Next, extracted data were placed into mapping visualization software. The maps include visual cues (colors, transportation routes, and icons) to designate met, unmet, and vulnerable needs and resources, allowing visual interaction with the two cases’ dementia caregiving context and qualitative responses. Life-space maps may be useful tools to visualize resource access and assist integrated health care systems in better understanding daily interactions and intervention gaps for difficult to reach populations. Future developments include ecological momentary assessment and Global Positioning System (GPS) data to develop life-space maps using real-time data collection.
Training Clinicians to Support Aging in Place in a Medicaid Home and Community-Based Waiver Program
Authors: Spoelstra Sandra , Schueller Monica , Sikorskii Alla , Ware Katelyn
Published: December 2020

A randomized trial in 18 home and community-based waiver sites implemented an aging-in-place model for 12,000 disabled older (mean age 78) adults. The trial was underpinned by the Knowledge-to-Action model and utilized 7 implementation strategies, including a 5.5-hour online social worker (SW) and registered nurse (RN) training. Baseline self-efficacy and attitudes of SWs and RNs were measured using validated scales, and knowledge uptake and satisfaction with a tool designed by the team. Characteristics, knowledge uptake, and satisfaction of SWs versus RNs were compared using t-, Wilcoxon, and chi-square tests. Two hundred forty-one RNs and 264 SWs participated. RNs were older (mean age 50; standard deviation [SD] 10.95) than SWs (41.35; SD=11.21) p<.01; and >90% overall were female. RNs had more professional experience, while SWs worked more years in the waiver (p<.01). SWs had greater self-efficacy (t(497)=2.99, p<.04), better attitudes (t(500)=2.59, p<.01), employability (t(500)=2.99, p<.04), and balance (t(491)=2.03, p<.05) than RNs. No differences were found on leadership, organizational culture, motivation, pressure to change, or attitude toward evidence-based practice. Knowledge uptake (range 1-16) was high and did not differ for RNs (Mean=15.2, SD=1.23) versus SWs (Mean=15.26, SD=0.89). Training content, format, role explanation, and information satisfaction (range 0-50) means also did not differ for RNs (Mean=35, SD=10.2) or SWs (Mean=34.9, SD=9.8). While many of the characteristics and outcomes were similar for RNs and SWs, SW’s higher self-efficacy, better attitude, and employability despite less experience in the waiver indicate they may play a positive role in implementation of the intervention that is currently underway.
Are Home Care Aides Interested in Helping Clients Do Physical Activity?
Authors: Muramatsu Naoko , Yin Lijuan , Caceres Maria
Published: December 2020

The current home care paradigm dictates home care aides (HCAs) provide prescribed help with activities of daily living, rather than stimulating older adults’ reserves to maintain independence. Little is known about whether HCAs are interested in expanding their role to promote their clients’ health. This study examined HCAs’ interest in helping clients do physical activity among workers who care for their family members or clients assigned by home care agencies in a Medicaid-funded home care program. Data came from brief surveys completed by HCAs at state-mandated in-service training sessions (N=602; 42% caring for non-family clients only, 38% family clients only, 20% both family and non-family clients). Ordered logit analysis was conducted to examine whether HCAs caring for family clients differ from those caring for non-family clients in levels of interest in helping clients do safe physical activity as part of home care work, controlling for HCAs’ age, gender, language (English/Spanish), and years of home care experience. HCAs’ interest levels were high (62% very, 21% somewhat, 8% slightly, 9% not at all interested). Ordered logit analysis indicated that HCAs caring for family members had significantly higher interest levels than those caring for non-family clients only (83% higher among HCAs caring for both family and non-family clients, 30% higher among HCAs caring for family clients only). To reflect HCAs’ interests and to maintain clients’ independence, home care workforce training should direct its attention to empower HCAs to assume health-promoting roles.
Developing Life Stories for Nursing Home Residents and Examining the Impact on Residents and Staff
Authors: Rose Miriam , Ejaz Farida , Polk Brian
Published: December 2020

A life story program was implemented in 16 nursing homes (NHs) in Ohio with partners including a company specializing in life story work and a gerontological institute. The aim was to evaluate the impact of the life story program on residents and staff. NH sites were selected from an urban/suburban and a rural county using sampling procedures ensuring variation in auspice, quality star ratings and bed size. A longitudinal design was used to conduct in-person interviews with residents at baseline (prior to the life story interview), immediately after the interview, and approximately a month after most life story books were delivered to a NH. Resident eligibility criteria included being age 60 or older, Medicaid-eligible, long-stay and having no to moderate cognitive impairment. Residents’ (n=238) average age was 77 years, 66% were female, and 52% had resided in the NH for 1-5 years. Cognitive scores declined over time, but depressive symptomatology improved significantly. Residents had very high levels of satisfaction with care, enjoyed telling their life stories and would recommend the program; these findings did not change. A pre-post study design was used with staff (n=198), who included nurse aides, nurses, administrators, social workers and activity staff. Their average age was 44 years. Although staff job satisfaction did not change significantly, the vast majority enjoyed learning about residents’ life stories and used them in care planning. The findings demonstrate that life story work may be useful in promoting person-centered care, although further testing is needed with a more generalizable sample.
The Creative Benefits Scale as a Predictor of Attitudes About Aging in Middle-Aged and Older Women
Authors: Israel Sarah , Adams-Price Carolyn
Published: December 2020

Expectations about aging are connected with both positive traits (e.g., wisdom) and negative traits (e.g., physical frailty). Adams-Price et al. (2016) created the Personal Longevity Scale (PLS), which measures positive expectations (Hope) and negative expectations (Dread). The purpose of this study was to examine how psychological benefits gained from participating in creative hobbies may positively impact middle-aged and older women’s attitudes about aging. In addition, we examined if participant age moderated this relationship. A total of 198 women, aged 50 to 82 years old, completed the Personal Longevity Scale (Hope and Dread subscales) and the Creative Benefits Scale (CBS; used to measure psychological benefits that people may experience as a result of long-term participation in a creative hobby). The CBS includes four subscales: gaining a sense of identity (Identity), getting a sense of relaxation (Calming), feeling closer to God or nature (Spirituality), and receiving recognition from others for one’s hobby (Recognition). Single moderation models suggest that higher Identity scores were linked to more positive attitudes about aging but did not significantly predict negative attitudes. Age provided a marginally significant moderation effect to this relationship such that older women who received more of a sense of identity from their hobby reported the most positive attitudes about aging. Spirituality was linked to more positive attitudes about aging but did not significantly predict negative attitudes. Neither Calming nor Recognition were predictive of either positive or negative attitudes about aging. Implications for women’s development will be discussed from an Eriksonian perspective.
Marital Status and Gender Differences in End-of-Life Planning
Authors: Stratton Lauren , Meinertz Naomi , Bartholomae Suzanne
Published: December 2020

Less than half of older adults make formal preparations to control difficult life transitions, yet planning can mitigate negative outcomes that accompany changes. To better understand multiple forms of end-of-life planning behaviors and the effect of demographic characteristics, we use data from the Understanding America Study (N=1812; aged 60+). We explored gender and marital differences in whether respondents created a will, living will, or declared a durable power of attorney for health care (DPOAHC), and who was chosen as DPOAHC (i.e., spouse, child, other relative). T-tests determined no significant gender differences in declaring a DPOAHC, creating a will, or living will. An analysis of variance (F=13.422, df=3, p<0.001) found married respondents more likely to declare a DPOAHC than separated/divorced (p<0.001) and never married respondents (p=0.002). Divorced respondents were less likely to declare a DPOAHC compared to widowed respondents (p<0.001) and widowed respondents were more likely compared to never married respondents (p=0.001). Additional analyses found the same pattern in who created a will or living will. A follow-up analysis of variance found no gender differences within marital status categories (i.e., married men versus married women). Overall, respondents who were never married were less likely to have prepared any forms of end-of-life planning. These results highlight the importance of having close relationships on the level of preparedness for end-of-life planning. Additional implications include increasing awareness about end-of-life planning for more vulnerable audiences. Future analyses will integrate findings regarding financial DPOAHC and examine other socio-demographic characteristics, such as education and race.
The Mediating Effect of Negative Emotion on the Well-Being Consequence of Belongingness Deficit Across Ages
Authors: Tsang Vivian Hiu Ling , Fung Helene
Published: December 2020

Previous studies suggested that the negative influence of belongingness deficit on wellbeing may be driven by an increase in negative emotion, but the age difference of this mediating effect is still uncertain. This study tested the mediating effect of negative emotion in the influence of relationship quality on depressive symptoms across age. Based on the potential biological decline in emotional sensitivity and better management of emotion with age, we hypothesize that negative emotion may be a weaker mediator in driving the consequences of relationship quality among older adults than younger adults. A total of 494 participants (19 – 85 years old, 60% was female) participated in this study at three timepoints with a two-year interval across Hong Kong, USA and Germany. Results suggested a significant partial mediating effect of negative emotion (b = -.0920, 95%LLCI = -.1315 to 95%ULCI = -.0568). In particular, poorer relationship quality at timepoint 1 predicted more negative emotion at timepoint 2 and therefore predicted more depressive symptoms at timepoint 3. More importantly, the mediating effect was moderated by age significantly (b = .0025, 95%LLCI = .0009 to 95%ULCI = .0042). As expected, the mediating effect of negative emotion decreased with age and became not significant among individuals at older age (b = -.0344, BootLLCI = -.0805 to BootULCI = .0075). Future studies can further investigate on age-related mediators in driving the consequences of belonginess deficit.
Caregiver Resilience as a Protective Factor for Elder Abuse
Authors: Yan Elsie
Published: December 2020

This study examines the protective function of caregiving resilience and caregiving self-efficacy for elder abuse. A convenient sample of 600 family caregivers of community dwelling older Chinese in Hong Kong were individually interviewed. Participants were assessed on the caregiving context, care recipient physical functioning and behavioral problems, perceived caregiver stress, neurotic personality, caregiving self-efficacy and resilience. Past year elder abuse was assessed using Revised Conflict Tactic Scale and Older Adult Financial Exploitation. Elder abuse is common in this sample: 7.5, 11.5, 24 per cent reported physical, psychological, and financial abuse respectively. Injuries were reported in 2.3% of the sample. Hierarchical linear regression analysis was conducted. Number of co-residing days and hours of care provided per week were entered into Model One; Care recipient physical functioning, behavioral problems, and caregiver stress were entered into Model Two; Caregiver resilience and caregiving self-efficacy were entered into Model Three. Care recipient behavioral problems and caregiver stress were prominent factors associated with abuse across all models. With the exception of physical abuse, caregiver resilience buffered the effects of care recipient behavioral problems and caregiver stress on all forms of elder abuse. No such effect was observed for caregiving self-efficacy. Intervention efforts aiming at fostering caregiver resilience could potentially prevent elder abuse.
Work and Functional Limitations for Older Workers: Does Measurement Make a Difference?
Authors: Andrasfay Theresa , Pebley Anne , Goldman Noreen
Published: December 2020

Social scientists have become increasingly interested in strenuous jobs as contributors to health inequality over the life course. Physically demanding work at later ages is of particular interest because it can have implications for retirement decisions, physical functioning, and disability, and strenuous jobs are prevalent among lower-income and minority older workers. Many studies have relied on occupational characteristics from the Occupational Information Network (O*NET), but few have assessed how these measures compare to self-reported occupational characteristics in terms of identifying social gradients in exposure and predicting future health outcomes. Using data from 16,683 respondents of the Health and Retirement Study, we obtained self-reported and O*NET measurements of general physical activity, frequency of lifting objects, and frequency of stooping/crouching required in the jobs they held at first interview. Pearson correlation coefficients revealed moderate correlations between the self-reported items and corresponding O*NET items. Though they are measured on different scales, both the self-reported and O*NET measures of physical demands revealed similar racial/ethnic and gender gradients in exposure to physically strenuous work. Lastly, we fit a series of random effects Poisson models to assess how these measures predict accumulation of functional limitations, a health outcome thought to result in part from strenuous working conditions. We found that while models using self-reported working conditions have the best fit with the data, models using the corresponding items in O*NET have comparable goodness-of-fit. These results suggest that, in the absence of self-reported physical occupational characteristics, O*NET characteristics provide a reasonable alternative.
Impact of Doing Good on the Aging Self: Growth and Change Themes in Narratives of Prosocial Behavior
Authors: Graham Laura , Nakamura Jeanne , Ringler Noah
Published: December 2020

Contemporary theories consider development to be lifelong, suggesting a potential for personal growth in older adulthood. Narrative studies have found benefits of having growth themes in older adults’ broad life stories, yet there is limited research focusing on the specific experiences in later life that elicit growth. One potential for personal growth during older age is through prosocial behavior, but studies have overlooked how older adults narrate such experiences and the perceived impact the narratives have on the self. We conducted interviews with a sample of 47 older adults engaged in prosocial commitments to examine the types of perceived self-change as well as patterns in high points and low points of the experience. Narrative analyses revealed the majority of participants reported a change in the self, and half of the sample used growth themes to characterize the self-change. Inductive coding of change narratives revealed an emergent category of virtuous change (e.g., transcendence, wisdom, humanity), as well as a variety of other change categories (e.g., competence, cognitive abilities, negative changes). Those who grew narrated high points and low points with more integration than those who did not, displaying a multifaceted, complex understanding of significant episodes through a blend of both positive and negative elements within one story. These findings suggest that an integrated understanding of prosocial experiences may provide an avenue toward personal growth. Implications for research and practice are discussed.
Determinants of Advance Directive Completion Among Older Chinese Americans
Authors: Wang Kaipeng , Wu Bei , Sun Fei , Kong Dexia , Liu Yanqin
Published: December 2020

Advance Directive (AD) allows older adults to communicate preferred care at the end of life. Numerous studies reported that ethnic minorities were less likely to complete AD then non-Hispanic Whites. However, determinants of AD completion among older Chinese Americans remain unknown. The present study aims to address this knowledge gap. Data came from a survey of 439 Chinese Americans aged from 51 to 103 living in two metropolitan areas in 2018. Participants’ average year was 75 (SD=9.37). About 63% were women and 93% were born outside the US. Approximately 14% of participants completed an AD. Guided by the Andersen’s Service Use Model, we used logistic regression to examine determinants of AD completion. Results show that older age (OR = 1.06, p < 0.01), being employed (OR = 2.63, p < 0.05), acculturation (OR = 2.09, p < 0.001), having US citizenship (OR = 3.57, p < 0.01), and expectation of intergenerational support (OR = 1.84, p < 0.05), were positively associated with AD completion. Physical and mental health needs were not significantly associated with AD completion. This is among the first studies focusing on AD completion among Chinese Americans, one of the fastest growing older minority populations in the US. Findings highlight the influence of socioeconomic and cultural factors on AD completion and illustrates the importance of developing culturally sensitive interventions to promote end-of-life care decision-making among older Chinese Americans.