bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of Perceived Mental Fatigability Using the Chinese Version of the Pittsburgh Fatigability Scale
Authors: Hu Yixin , Zhang Hangming , Xu Weihao , wang siyue , Bair Woei-Nan , Fan Li , Qiao Yujia (Susanna) , Glynn Nancy W
Published: December 2021

Background: Recently we validated the simplified-Chinese version of the Pittsburgh Fatigability Scale (PFS) Physical subscale. Next step is to validate the PFS Mental subscale in order to introduce a reliable measure of perceived mental fatigability among Chinese community-dwelling older adults. Methods: This cross-sectional study was conducted in an urban community in Beijing. Internal consistency of the PFS Mental subscale was evaluated by Cronbach’s alpha. The participants were divided in half to evaluate the factor structure validity by exploratory factor analyses and confirmatory factor analysis. Convergent validity and discriminant validity were evaluated against cognitive function (assessed by MOCA) and global fatigue from FRAIL Scale. Results: Our study included 370 participants (mean=83.8 years). The simplified-Chinese version of PFS Mental subscale showed strong internal consistency (total Cronbach’s alpha=0.82, each items Cronbach’s alpha ranged from 0.78 – 0.83). The results of exploratory factor analysis showed all 10 items loaded on two factors: moderate to high and low intensity activities, which explained 60.8% of the total variance. Confirmatory factor analysis showed fit indices: SRMSR = 0.090, RMSEA = 0.120, CFI = 0.89. PFS Mental scores demonstrated moderate concurrent and construct validity against cognitive function (r = －0.24, P<.001). Additionally, the PFS Mental subscale had strong convergent validity, discriminating according to established cognitive impairment or FRAIL Scale fatigue testing cut points, with differences in PFS Mental scores ranging from 3.2 to 8.4 points. Conclusions: The PFS Mental subscale simplified-Chinese version is a valid tool to assess perceived mental fatigability in Chinese-speaking older adults.
Home-Based Care in the Context of COVID-19: Disruptions, Innovations, and Lessons for the Future
Authors: Franzosa Emily , Ornstein Katherine
Published: December 2021

During the initial surge of the COVID-19 pandemic, home-based primary and palliative care (HBPC) practices played a valuable role in maintaining access to health-related services and keeping older, medically complex patients out of hospitals and congregate settings that could heighten their risk for COVID-19. At the same time, these practices faced unique challenges in adapting a traditionally hands-on model of care to accommodate restrictions on in-person contact. In this symposium, we present innovative research highlighting the challenges faced by HBPC practices and patients during spring 2020, as well as their rapid innovations and adaptations. First, Ritchie et al. provide national context with findings from a survey of U.S. home-based primary care practices that highlights the field’s most pressing challenges and successful strategies. Shifting to the initial epicenter of the pandemic in New York City, Reckrey et al. present a qualitative study of the perspectives of paid and unpaid caregivers of dementia patients served by an HBPC practice, while Franzosa et al. describe care disruptions among individuals with dementia who died during the initial surge, using a novel chart-based abstraction technique. Finally, two studies (Gorbenko et al. and Kalicki et al.) explore HBPC practices’ experience of rapidly transitioning to telehealth through qualitative interviews with NYC-based practices and a provider survey exploring telehealth adoption and readiness in the homebound population. Together, these studies yield important insights into the challenges of providing community-based care for at-risk populations during a pandemic, and practical strategies for home-based models of care moving forward.
Listening to Clinical Teams: Developing Strategies to Support Sustained STAR-VA Implementation
Authors: Curyto Kim , Page Kyle , Benson Karen , Wray Laura , Karel Michele
Published: December 2021

Feedback obtained from program evaluations and interviews with CLC team members who participated in STAR-VA helped to inform the development of sustained implementation strategies guided by the CFIR-ERIC Mapping Tool. A CLC readiness assessment was developed to guide selection of new champions and assess for local team readiness to implement STAR-VA. Virtual training materials were developed along with a champion training checklist to prepare additional champions and support team training. We identified key implementation steps and optional strategies to support sustained implementation, developed a sustained implementation guide, associated sustained implementation checklist, and sustainability toolkit. We are piloting a regional community of practice model, encouraging development of and building on relationship networks to promote use of program tools, collaborative problem-solving, feedback, and a shared vision for implementation. We will discuss the importance of tailored strategies for integrating new practices into usual care.
Developing Multimodal IoMT Monitoring System of Geriatric Depression: A Feasibility Study
Authors: Kim Heejung , Cho Youngshin , Lim Kyuhee , Lee Sunghee , Kim Yuntae , Kim Mijung
Published: December 2021

The Internet of Medical Things (IoMT) is a promising tool to monitor depression and relevant symptoms. However, the multimodal IoMT monitoring system has been rarely developed considering the characteristics of older adults, particularly living in the community. Therefore, it is necessary to know how to develop multimodal IoMT monitoring systems tailored for older adults and evaluate the feasibility for research and practice. We developed a multimodal IoMT monitoring system that included a smartphone for facial and verbal expressions, smartwatch for activity and heart rates, and ecological momentary assessment (EMA) application. A convenience sample of 21 older Korean adults aged over 65 years was recruited from a community center, and 19 participants completed it. The data were collected in four weeks using self-report questionnaires, IoMT devices, and semi-structured interviews between July and December 2020 and were analyzed in mixed methods. Based on the Geriatric Depression Scale-Short Form scores, eight participants were classified in the depressive group (38.1%) and 13 in the non-depressive group (61.9%). A total of 1,505 (70.72%) EMA data were collected, and 1,277 (60.00%) were analyzed. Furthermore, 1,421 (66.78%) facial expression data were collected and labeled, including anger, happiness, neutral, sadness, surprise, and exception. Voice dialogues were transformed into 5,264 scripts. The depressive group showed lower user acceptance relative to the non-depressive group. However, both groups experienced positive emotions, had regular life patterns, and increased their self-interest. Thus, our multimodal IoMT monitoring system is a feasible and useful measure for acquiring mental health information in older adults’ depression.
The Sex Difference in Physical Functioning: How Do Risk Factors Contribute?
Authors: Sialino Lena , Picavet Susan , Wijnhoven Hanneke , Loyen Anne , Verschuren Monique , Visser Marjolein , Schaap Laura , van Oostrom Sandra
Published: December 2021

This study explores whether sex differences in the sensitivity to risk factors (strength of the association) and/or in the exposure to risk factors (prevalence) contributes to the sex difference in physical functioning, with women reporting more limitations. Data of the Doetinchem Cohort Study was used (n=5971, initial ages 26-70 years), with follow-up measurements every 5 years (up to 20). Physical functioning (subscale SF-36, range:0-100) and a number of socio-demographic, lifestyle and health-related risk factors were assessed. Mixed-model multivariable analysis was used to investigate sex differences in sensitivity (interaction term with sex) and in exposure (change of the sex difference when adjusting) to risk factors. The physical functioning score among women was 6.75 (95%CL:5.65,7.85,age-adjusted) points lower than among men. In general, men and women had similar risk factors, but pain was more strongly associated with physical functioning (higher sensitivity), and also more prevalent among women (higher exposure). The higher exposure to low educational level and not having a paid job also contributed to the lower physical functioning score among women. In contrast, smoking, mental health problems and a low educational level were more strongly associated with a lower physical functioning score among men and lower physical activity and higher BMI were more prevalent. So, few risk factors seem to contribute the more reported limitations in physical functioning among women aged 26 to 90 years. Our findings provide no indications for reducing this sex difference by promoting a healthy lifestyle but stress the importance of sex differences in pain, work and education.
Stakeholder-Driven Methods Can Enhance Care Delivery for Nursing Home Residents With Dementia
Authors: Leland Natalie , Chew Felicia , Martínez Jenny
Published: December 2021

The ongoing COVID-19 pandemic has underscored the need to optimize care for one of the most affected sectors: older adults in nursing homes and more specifically highly vulnerable populations such as residents with dementia. Research developed in collaboration with stakeholders can optimize impact, relevance, and trustworthiness of study findings thereby informing advances in care. Yet, evidence on stakeholder driven research for enhancing dementia care is limited. This symposium will provide examples of stakeholder-driven research questions that were addressed with stakeholder engagement. First, we will present current evidence about the perspectives of caregivers, including those from communities of color. The second presentation will discuss the perspective of clinical training stakeholders responsible for supporting system-wide clinical program implementation and their experiences with early and later adopter nursing homes within the context of a clinical trial. The third presentation will address the perspective of policy makers and payers via the effect of state-mandated dementia training on resident outcomes. The fourth and final present the findings from a study that examined how nursing home stakeholders responded to a payor requirements for pharmacy services and the relationship between that response and patient outcomes. We will conclude the session with a discussion of stakeholder-engagement methods and recommendations for future nursing home research, which champions stakeholder collaboration.
Exploring Informal Caregivers’ Priorities of Nursing Home Dementia Care From Communities of Color
Authors: Rouch Stephanie , Moscirella Marybeth , Harper Alexandra , Lekovitch Cara , Turner Rose , Piersol Catherine , Leland Natalie
Published: December 2021

Informal caregivers are critical stakeholders in nursing home (NH) care for individuals with dementia. Given racial and ethnic disparities in United States NHs, there is a need to understand informal caregivers’ perspectives, particularly among those that identify as members of a community of color. We conducted a scoping review of informal caregiver priorities of nursing home dementia care. Included studies exclusively examined priorities of informal caregivers identifying as Black, Indigenous, or people of color. The final sample (n=12) included two United States studies representing African American and Korean informal caregivers. The remaining studies were conducted in other countries. Informal caregivers expressed a desire for professional support during the nursing home transition, increased staff knowledge of dementia, and improved resident engagement. These findings highlight the paucity of informal caregivers identifying as Black, Indigenous, or people of color represented in US nursing home dementia research. Future efforts must include communities of color.
The Development of a Smart Reminder System to Promote Adherence to Technology-Based Intervention and Assessment
Authors: Boot Walter , Charness Neil
Published: December 2021

The overarching aim of the National Institute on Aging funded Adherence Promotion with Person-centered Technology (APPT) Project is to promote adherence to technology-based solutions designed to enhance the early detection and treatment of cognitive decline. The goal is to build and evaluate adaptive, tailored, and integrated technology-based adherence support systems for mobile software platforms that assess and train cognitive skill. The symposium describes the various steps of the development process of the APPT smart adherence support system. N. Charness will present an overview of the APPT project, its aims, and the clinical trials designed to assess the effectiveness of the APPT smart reminder system compared to typical reminder systems. S. Chakraborty will present detailed analyses of past cognitive intervention data to inform understanding of who is likely at risk for poor adherence and how adherence lapses might be predicted in advance to provide just-in-time adherence support. D. Carr will present an exploration of motivating factors for participants to engage in research, and these motivations will be tapped to help develop motivational messages for the APPT adherence support system to be used in the two planned clinical trials. M. Dieciuc will provide additional insights into motivations for engaging in home-based cognitive assessment and training derived from a focus group study. Finally, S. Zhang will describe the results of an initial pilot study examining the effectiveness of motivational reminder messages that match vs. mismatch participants’ own motivations. All results inform the design of the APPT system to maximize adherence.
The Influence of MOQI APRNs on the COVID-19 Response in Nursing Homes
Authors: Popejoy Lori , Hiltz Megan , Rantz Marilyn , Vogelsmeier Amy
Published: December 2021

During the COVID-19 pandemic Missouri Quality Initiative APRNs worked in 16 nursing homes (NHs) providing clinical expertise and support. To understand their influence on the NH COVID-19 response, we conducted four group interviews with APRNs from 13 of the 16 NHs. Using thematic analysis, we identified similarities and differences between NH groups and then compared groups by COVID-19 infection rates. Leaders from NHs with high COVID-19 rates were unwilling to report infections and were resistant to resident/staff testing. In contrast, leaders from NHs with low COVID-19 rates were strategic about acquiring supplies, held daily huddles, and initiated CDC recommendations almost immediately. All reported residents lost weight, and experienced mood and physical decline resulting from quarantine/isolation. APRNs worked with providers to identify potentially ill residents/staff, improve isolation/quarantine procedures, manage ill residents, and supported efforts to mitigate viral spread. We will discuss implications for broader infection prevention in NHs.
Age, Attitudes to Aging, and Identity in Older Canadian Women
Authors: Newton Nicky
Published: December 2021

The life course perspective emphasizes social structure, personal agency, and their interdependencies (Settersten et al., 2020), serving as the theoretical framework for this study. Given stereotypical societal views of gender and aging (e.g., Sontag, 1979), physical aging is often the focus when examining women’s aging attitudes and concomitant changes in a sense of personal identity. Additionally, studies of midlife women have found relationships between age and identity (e.g., Stewart et al., 2001). Using quantitative and qualitative data, the present study examines associations between age, personal identity, and attitudes to physical, psychological and social aging in older Canadian women (N = 190, Mage = 70.38). Results show that while attitudes to physical aging contribute to identity maintenance, attitudes to social and psychological aging are also important for older women’s identity maintenance. Interactions between age and attitudes to aging associated with personal identity are discussed with reference to the life course perspective.
Standards and Guidelines for a New Decade
Authors: Shovali Tamar
Published: December 2021

As the field evolved, so too, has the Gerontology and Geriatrics Curricular Standards and Guidelines in Higher Education. The 7th edition is focused on the integration of the highly vetted AGHE Gerontology Competencies for Undergraduate and Graduate Education. Through this work we establish a set of standards and guidelines that provides the foundation for excellence in gerontology and health professions education at various levels and across a range of programs in the US and globally. The document provide a model for institutions of higher education in the development of new programs, a basis for program assessment and evaluation, guidance for academic or institutional reviews in existing programs, and a platform for what constitutes a program of study in gerontology/geriatrics or health professions programs for students, the public, and employers. An overview of the development of the 7th edition and suggestions for its use will be provided.
Associations Between Stress Exposure and Emotional Health: The Moderating Role of Discrimination
Authors: Zavala Daisy , Muñoz Elizabeth , Sliwinski Martin , Scott Stacey
Published: December 2021

The Weathering Hypothesis states BIPOC face more stressors, by which over a lifetime they are subjected to the negative consequences of stress (e.g., poorer emotional health). Using ecological momentary assessments, we examined whether subtle discrimination moderated the within-person stressor slope on positive and negative affect. We predicted emotional wellbeing would be worse at stressor moments, and those with greater discrimination experience would be more impacted by stressors. Participants were 334 diverse adults (25-65 years, Mage = 47, 63% Female) from Bronx, New York. Positive affect decreased and negative affect increased significantly at stressor moments (p<.0001). Unexpectedly, subtle discrimination was not a significant moderator for the within-person stressor slope on positive affect and negative affect. Unlike the predictions of the Weathering Hypothesis, these results show that prior discrimination experiences may not exacerbate responses to stressors and entail additional risk in daily life.
Ribosomal Protein 6 Phosphorylation Regulates Translational Responses to Dietary Restriction
Authors: Rollins Jarod
Published: December 2021

Forms of dietary restriction like intermittent fasting (IF) and caloric restriction (CR) promote health and longevity through changes in gene expression. While the transcriptional changes that occur in response to DR have been well described across several species, the role of translational regulation has lagged. Using polysome profiling and mRNA-seq, we quantified changes in actively translated mRNAs that occur in C. elegans under CR compared to well-fed conditions. The analysis revealed hundreds of transcripts regulated on the translational level that would have been missed using conventual transcriptomics. Among the translationally down-regulated genes that where pro-longevity when knocked down were regulators of the cell-cycle: fbxb-24, sdz-33, kbp-1, and cdk-2. In search of the mechanisms regulating selective translation under CR we investigated a role for ribosomal protein 6 (RPS-6) as its phosphorylation status is thought to regulate cell cycle and selective translation of mRNA transcripts. Using RPS-6 phospho-null and phospho-mimetic mutants, we show that phosphorylation and de-phosphorylation of RPS-6 is necessary for the pro-longevity effects of CR and IF. Furthermore, we show that IF is more beneficial for retaining locomotion with age than CR and that endogenously tagged RPS-6 ::mCherry accumulates in body wall muscle under fasting. However, the benefit of IF on locomotion is lost in RPS-6 phospho-mimetic mutants. Together, results suggest that protein translation is enhanced in the muscle under IF to prevent sarcopenia in a way dependent on RPS-6. Translatome analysis of the phospho-mutant suggested a role for RPS-6 in selective translation of p38 mitogen-activated protein kinases.
Big Five Development From Young Adulthood to Midlife: Findings From a Longitudinal Study of Mexican-Origin Adults
Authors: Atherton Olivia , Sutin Angelina , Terracciano Antonio , Robins Richard
Published: December 2021

A large body of research has documented how personality develops across adulthood, yet very little longitudinal work has examined whether these findings generalize beyond predominantly middle-class, highly-educated White American or Western European individuals. This pre-registered study uses longitudinal data from 1,110 Mexican-origin adults who completed a well-validated personality measure, the Big Five Inventory, up to 6 times across 12 years (median age at Wave 1 = 37.7; range = 26 to 65). Individuals generally maintained their rank ordering on the Big Five over time (rs=.66-.80), and all of the Big Five traits showed small, mean-level decreases across adulthood. These trajectories had few associations with sociodemographic factors (sex, education level, IQ) and cultural factors (generational status, age at immigration, Spanish/English language preference, Mexican cultural values, American cultural values, ethnic discrimination). Divergences between the present findings and previous research highlight the need to study personality development across diverse aging samples.
Methods and Rationale for Using GPS-Derived Objective Technologies to Examine Community Mobility in Older Adults
Authors: Crane Breanna , Moored Kyle , Rosso Andrea , Carlson Michelle
Published: December 2021

Objective measures of community mobility are advantageous for capturing life-space activity. In contrast to subjective, self-reported approaches, GPS-derived objective measures leverage passive, real-time data collection techniques to mitigate recall bias and minimize participant burden. We present methods to quantify community mobility among a sample of 164 community-dwelling older adults (Mean age=77.3±6.5) from a physical therapy intervention aimed at improving walking ability. We characterized community mobility using activity space metrics (e.g., standard deviation ellipse (SDE) area), timing (e.g., time outside home), and shape (e.g., SDE compactness). We will discuss challenges and solutions to generating these metrics as well as their associations with physical and cognitive performance. Time outside of home and SDE area, but not SDE compactness, were correlated with better performance on the 6-Minute Walking Test and Trail-Making Test (Part B) (ρ=.20-.23, p’s<.05). These findings will aid in understanding which community mobility measures are associated with functional capacity.
Aging and Masculinity in Bibliotherapy and Poetry Groups for Men in Late Life
Authors: Harel Dovrat
Published: December 2021

The transition to residential care facility may symbolize the joining into the 'community of older people'. This may influence the ways men in late life construct their identities and the intersection of aging and masculinity. Due to some barriers, this experience may be difficult to express explicitly. Bibliotherapy aims to bridge this gap by using literature to address diverse issues in the form of reading and writing activities. In this presentation we will present "The Literary Parliament" project, in which bibliotherapy and poetry groups of men in late life were conducted in residential care facilities in Israel. We will present findings of a qualitative research which explored poems written by group participants, and the way these helped participants to express their perceptions and feelings of ageing and masculinity in the context of residential care. The use of bibliotherapy to encourage psychological discourse among men in late life will be discussed.
Telehealth Delivery of Group Format Cognitive Rehabilitation to Older Veterans With TBI
Authors: Kornblith Erica , Schweizer Sara , Yaffe Kristine , Novakovic-Agopain Tatjana
Published: December 2021

Traumatic brain injury (TBI) is common among older adults, with significant public health costs, and advanced age is a risk factor for poor outcomes after TBI. Older Veterans with TBI-related cognitive and emotional dysfunction without dementia may benefit from cognitive rehabilitation, particularly executive function training, and technology may promote optimal functioning for these patients by increasing access to such treatments. Dr. Kornblith will present pilot data on one such promising group intervention, Goal-Oriented Attentional Self-Regulation (GOALS), administered via in-home video telehealth. Themes gleaned from qualitative feedback collected throughout the intervention and post-treatment feedback questionnaires include the importance of communication and a smooth process with clear instructions for joining study sessions. Preliminary data suggest that only minor adaptions to the existing GOALS protocol are required for telehealth delivery and that delivering group-based executive function training to older TBI-exposed older Veterans with cognitive complaints via telehealth is feasible and acceptable.
Bereavement Support Services in a National Sample of Hospices: A Content Analysis
Authors: Becker Todd , Cagle John
Published: December 2021

Although the Medicare Hospice Benefit mandates that hospices provide bereavement services to families for 1 year following death, it does not stipulate what services should be offered or how. Thus, this study aimed to explore the range of hospice bereavement services. This study stems from Cagle et al.’s (2020) prior study surveying 600 randomly selected agencies, stratified by state and profit status. Most participants (N = 76) worked as clinical supervisors or directors of patient services (41.6%) for medium-sized (53.2%), for-profit hospices (50.6%). Responses to “What types of bereavement support does your hospice provide to families?” were content analyzed. Analyst triangulation and peer debriefing enhanced trustworthiness. Four domains emerged: timing of support, providers of support, targets of support, and formats of support. Each domain reflected substantial variability. All hospices offered postdeath bereavement support. A minority described offering predeath support, often through bereavement risk assessment and supportive services targeting those at risk. Providers frequently included trained bereavement counselors, social workers, and chaplains. Less often, hospices leveraged familiar members of the decedents’ care team to encourage family participation. Although bereavement services predominantly targeted surviving adult family members of deceased hospice patients, services tailored to children and hospice-unaffiliated community members also emerged. The format of bereavement services demonstrated the widest variability. Commonly reported formats included written materials, support groups, and phone calls. Most hospices employed multiple formats. Although findings are consistent with prior research, the variability in each domain complicates rigorous investigation of which aspects offer the greatest benefit to bereaved family members.
Strengths-Based Interprofessional Practice and Education: Transforming Care Through Disruption
Authors: Kennedy Teri
Published: December 2021

This is a conceptual paper proposing a new model of Strengths-Based Interprofessional Practice and Education (SB-IPE), incorporating appreciative inquiry and narrative, and its application to improve health and social care practice and policy for older adults. Within people, families, communities, and teams are people who understand their assets and culture, hold a collective wisdom derived from their individual biographies and shared history, and are deeply invested in their success. This wisdom and experience can be mined for strengths and best practices to improve health and social care for older adults and their families. The conceptual framework of the model and relationship between concepts are explained, reviewing and synthesizing relevant literature on the strengths perspective, interprofessional practice and education, evolution of the patient voice, appreciative inquiry, and narrative to leverage the voices and experiences of older adults, their families, and interprofessional teams. Providing person-, family-, and community-centered health and social care through SB-IPE involves eliciting, listening to, and processing stories and narratives, then coalescing and co-creating person/family/team narratives throughout the trajectory of care. Appreciate inquiry and narrative can be harnessed to imagine an improved experience of care for older adults and their families. Incorporating the potential disruption of the voices and perspectives of older adults and their families offers value for health and social care delivery and policy innovation. Application of the SB-IPE model holds promise for harnessing these voices and collective experiences leading from disruption to transformation of health and social care practice, health professions education, policy, and research.
Social Isolation in Long-Term Care Facilities Related to COVID-19: Effect on Resident Anxiety and Care
Authors: Peterson Lindsay , Sakib Nazmus , June Joseph
Published: December 2021

Loneliness is a common problem in long-term care. It has been associated with a higher risk of depression, aggressive behaviors, and anxiety and may be a risk factor for cognitive decline. Loneliness can exacerbate social isolation. The COVID-19 emergency brought on measures in Florida, beginning in March 2020, to separate nursing home (NH) and assisted living community (ALC) residents from each other and family members to limit virus spread. This study examines results of a survey with Florida NH (N=59) and ALC (N=117) administrators concerning effects of these measures. Scaled (1-5, lowest to highest) data indicate that resident anxiety was higher in NHs (M=3.40) than ALCs (M=3.17). Care disruptions related to limited resident-to-resident contact also were worse in NHs (M=3.74) than in ALCs (M=3.21), while care disruptions related to loss of family support were higher among ALCs (M=3.19) than in NHs (M=2.86). Implications of these findings will be discussed.
Depressive Symptoms, Leisure Activity Engagement, and Global Cognition in Non-Hispanic White and Black Older Adults
Authors: Sharifian Neika , Kraal A Zarina , Zahodne Laura
Published: December 2021

Prior research has linked more depressive symptoms to worse global cognition in older adulthood through lower leisure activity engagement. Less is known regarding which types of activities drive these associations. Additionally, depressive symptoms disproportionately affect cognition in Non-Hispanic Blacks (NHB) versus Non-Hispanic Whites (NHW). This cross-sectional study used data from the Michigan Cognitive Aging Project (n=453, 52% NHB, Mage=63.60 years) to examine whether distinct leisure activities (solitary-cognitive, solitary-creative, community-social, physical, intergenerational-social, cognitive-games) mediated the association between depressive symptoms and global cognition and whether race moderated these associations. Lower engagement in solitary-cognitive activities partially mediated the negative association between depressive symptoms and global cognition. In multi-group models, this indirect effect was only evident in NHBs, who showed a stronger negative association between depressive symptoms and activity engagement than NHWs. While cross-sectional, findings indicate that depressive symptoms may negatively impact cognition by reducing engagement in activities that promote cognitive reserve.
LGBTQ Older Adult Recruitment in the Midst of a COVID-19 Lockdown: Reminiscences of a Post-Doctoral Fellow
Authors: Beringer Robert
Published: December 2021

Within days of obtaining ethics approval for a qualitative study “Optimizing LGBTQ Engagement with Hospice and Palliative Care in the Island Health Region” our local Covid-19 lockdown began. It took several months to have new Covid-19 research protocols (Zoom Town Hall meetings/Zoom or telephone interviews) approved. Being impatient, I teamed with another group of researchers to launch “Covid-19: Your Current Experiences and Planning for the Future,” an online survey with a large qualitative component where we planned to oversample LGBTQ respondents. In time both projects were approved, and here I reflect on recruitment lessons learned. These include my perceptions how Zoom Town Hall meetings and interviews differ from those I’ve conducted in-person, reflections on how to use social media (including targeted Facebook advertising) to recruit participants, and sadly, how to manage anti-LGBTQ sentiment that resulted from even the most targeted advertising.
Challenges in Resource Utilization for Caregivers of Persons With Dementia: A qualitative Study
Authors: Turner Robert , Weaver Jen , Owens Eric , Boe Meredith , Bride Jessica , Dowling Maritza , Prather Christina , Power Melinda
Published: December 2021

This study highlights primary caregivers’ experiences with health department policies designed to support people with cognitive impairment/Alzheimer’s Disease and Related Dementias (ADRD). Caregivers were defined as individuals aged 45-85 that provide at least 10 hours of unpaid care. Five, 90-minute focus groups were conducted virtually with 24 caregivers of individuals with cognitive impairment/ADRD. Transcripts were analyzed thematically. Caregivers were primarily Black females (75%) with at least a high school education (42%). Care recipients were likely to be community-dwelling parents (71%), with moderate or advanced (79%) dementia. Caregivers described challenges with accessing resources intended for care recipients, especially as cognitive impairment worsened. Caregivers reported providing care 24/7 as traumatizing. Home-based personal aides and companionship services did not reduce this burden. COVID-19 impacted caregivers and care recipient’s access to resources increasing burden. Policies need to be flexible for ever-changing needs of individuals with ADRD and support the overall well-being of the caregivers.
Individuals’ Decision to Disclose a Diagnosis of Dementia and the Development of an Online Empowerment Intervention
Authors: Kohl Gianna , Ulate Mauricio Molinari , Bhatt Jem , Lynch Jennifer , Scior Katrina , Charlesworth Georgina
Published: December 2021

Learning to live with a diagnosis of dementia is a complex process. Many people affected by dementia choose not to disclose the diagnosis to others and avoid social activities due to fear of others’ adverse reactions. This in turn can limit their social participation and negatively affect their psychosocial health. A systematic review explored factors influencing the decision to disclose or conceal a dementia diagnosis to one’s social network, including individuals’ attitudes and experiences regarding this decision. The sixteen studies included reveal the complexity of this decision. Findings highlight the role of stigma and individuals’ wishes to remain ‘normal’, but also the need of explaining what has changed. Results were further discussed with people with dementia and informal caregivers as part of patient and public involvement. End users expressed their attitudes, needs, and wishes towards the design of an online empowerment intervention supporting disclosure decision-making in people affected by dementia.
Causes of the Racial Disparities in the Risk of Alzheimer’s Disease
Authors: Nikitin Stanislav Kolpakov , Yashkin Arseniy , Kravchenko Julia , Akushevich Igor
Published: December 2021

The risk of Alzheimer’s disease (AD) is not uniform across race-specific subpopulations: Blacks face approximately 50% higher risk of AD onset compared to Whites(Hazard Ratio=1.50; 95%CI:1.46-1.54). We used Blinder-Oaxaca decomposition, modified for censored data, to explain the disparities in the risk of AD between these races in Medicare beneficiaries aged 65+. This approach measures the contributions to the total difference in AD risks from the differences in the prevalence and the difference in magnitude of the effects of each potential explanatory variable. We used hypertension, diabetes mellitus, depression, cerebrovascular and renal diseases as the potential causes of the racial disparities in AD risk. We found that the greatest contribution was due to the impact of arterial hypertension, of which 24% of the effect was due to differences in prevalence and 76% due to the differences in effect magnitude. Unexpectedly, the contributions of other studied diseases explained only a small part of the racial disparity in AD risk. The remaining incidence rates, which could not be explained by the contributions of hypertension and other included diseases in the age-specific analysis, were lower for the Black population, although initially, the total age-specific incidence rates of AD were higher for the Blacks when compared to the Whites. Therefore, our results suggest that targeted interventions in the Black subpopulation are urgently needed to mitigate the adverse health effects of hypertension, independent of the possible causes, such as access to hypertension care, or race-related differences in adherence to antihypertensive treatment.
Health and Aging Disparities Among Latin American Older Adults: Findings From Studies in Brazil, Colombia, and Mexico
Authors: Osuna Margarita
Published: December 2021

Aging in Latin America is occurring rapidly, in a context of high levels of poverty and inequality. This symposium is focused on population health and the heath-disparities found in some of Latin America’s largest middle-income countries, Mexico, Brazil, and Colombia. This symposium contains presentations on different health-related issues affecting older adults, which can have further implications for wellbeing, health, and disease risk. The papers in this symposium examine a variety of health-related dimensions and disparities among older Latinos that include physiological functioning, cognition, and oral health. Using the Mexican Health and Aging Study (MHAS), Sheehan investigates the associations between personal and familial educational attainment on sleep quality. Also using MHAS, Milani. Using data from the Brazilian Longitudinal Study of Aging, Farina examines the relationship between race and cognition. Garcia uses data from the Colombian Survey of Health, Well-Being, and Aging to study the relationship between Motor Cognitive Risk Syndrome (MCRS) and cognition and frailty. Using the same dataset, Osuna examines variation in oral health in Colombian older adults and the impact this has on their wellbeing. Results indicate which population subgroups in Latin American have increased risk for poorer health and which dimensions of health have gender, race and socioeconomic disparities. The findings highlight the importance of understanding the conditions under which Latin American older adults are aging and the implications this can have in the future.
National Norms for the Elixhauser and Charlson Comorbidity Indexes Among Hospitalized Adults
Authors: Loyd Christine , Boogaerts Garner , Zhang Yue , Kennedy Richard , Brown Cynthia
Published: December 2021

Multimorbidity has become the defining focus of in-patient geriatric clinical practice and research. Comorbidity assessment burden is often completed using the Elixhauser (ECI) and Charlson comorbidity indexes (CCI), which can predict mortality risk, hospital length of stay and readmission, and healthcare utilization. Yet, the national norms for ECI and CCI have not been reported. Therefore, this study aimed to report comorbidity score national norms of hospitalized patients based on age, race, and sex. Using the 2017 US National Inpatient Sample, ICD-10 coding data from 7,159,694 adult patient’s (≥18years) was abstracted to calculate ECI and CCI scores. Scores were stratified into 5-year age increments from age 45-89. Adults aged<45 and >89 were included in the analysis, however not age-stratified. Overall mean comorbidity score for the population using the ECI was 2.76 (95%CI 2.76, 2.76) and CCI was 1.22 (95% CI 1.22, 1.22). Mean scores for both indexes increased with age until age 90, and this increase was independent of race and sex (all p-values<0.001). Some individual comorbidities increased with age including congestive heart failure and dementia, while others including diabetes and chronic obstructive pulmonary disease increased with age but peaked between 60-74 years and declined in older age. Importantly, a report of US national norms for comorbidity burden among hospitalized adults can provide a reference for determining if clinical and research populations have greater or lesser comorbidity than typical hospitalized adults for their age, race, and sex.
Identity, Integrity, and Religious Doubt in Later Life
Authors: Clark Phoebe , Iwasaki Michiko , Thompson Edward , Futterman Andrew
Published: December 2021

Erik Erikson argued that for religiously involved individuals, the resolution of two stages – Identity vs. Role Diffusion and Integrity vs. Despair – are of critical importance in adult development. Adults typically confront their parents’ religious affiliation in adolescence and young adulthood as they establish themselves as independent actors in the world, and in later life, older adults confront their own lived lives, and evaluate in light of their religious commitments whether they have lived meaningfully and with integrity. To examine Erikson’s views of religious development, we completed open-ended interviews of 278 community-dwelling older adults (55-101 years). In these interviews, participants describe the development of their religious faith, the nature and development of their religious questioning and doubt, and the relationship between their faith and doubt over their life span. Participants were from Northeast U.S., and were denominationally, racially, and ethnically diverse. More extensive religious doubts were reported during young adulthood regarding the meaningfulness of religion in their family of origin. By contrast, religious doubts are reported less during later life, and more emphasis is placed on the value of religious involvement for themselves and their families. This pattern varies between young-old (under 75 years) and old-old (over 76 years): whereas the young-old seem to be working through their religious doubts, the old-old are more focused on the value of their religious faith. These findings are discussed in terms of Erikson’s developmental theory and with respect to cohort differences in religious belief and practice.
Age and Ageism in the COVID-19 Pandemic: What Does the Data Show?
Authors: Dhakal Usha , Kunkel Suzanne
Published: December 2021

Gerontologists were quick to call out the resurgence of ageism that was reflected in the paternalistic, overgeneralized, and deficit views of aging that dominated discussions about age-associated risks of the disease and its consequences. One manifestation of the blunt and potentially ageism-promoting use of age in data about the virus is the failure to routinely distinguish the independent role of age alone, separate from its association with comorbidities. A related problem is the use of broad age categories, which can also mask the role of specific comorbidities. To address that gap, this study uses data from Centers for Disease Control and Prevention, as of Feb 21, 2021 to calculate age-specific COVID-19 death rates (ASDR) and compare the extent to which comorbid conditions potentially associated with COVID-19 deaths were listed on death certificates. Findings showed that the ASDR was significantly higher for those 85 years and over (2249.96 per 100,000); the rate was 802.66 for 75-84 and 312.78 per 100,000 for 65-74. Death certificate information revealed that influenza and pneumonia was the major contributing comorbidity to COVID-19 deaths across all three age groups; (listed on 49% of the death certificates for those 65-74 who died with COVID-19, 46% of those 75-84, and 38% of those 85 and over). Future studies should be more precise about the use of age/age groups, about the rationale for those designations, and about the impact of age separate from comorbidities. Broad use of an arbitrary age as a proxy for frailty and illness contributes to ageism.
Ageism and Undergraduate Attitudes towards Older Adults during COVID-19
Authors: Shea Adam , Yu Aiping , Strong Jessica
Published: December 2021

The COVID-19 pandemic has shed light on the far reaches of ageism in our society. The current study sought to better understand ageist beliefs in Canadian undergraduate students during the pandemic. As part of a larger survey on ageism, we conducted a thematic analysis on open-ended responses to the following questions: 1) “Has your relationship with older adults in your life changed as a result of the COVID-19 pandemic?” and 2) “Have you noticed that attitudes or opinions towards older adults in your community have changed as a result of the COVID-19 pandemic?” Students felt that older adults should be treated differently during the pandemic because they are seen as “high risk” or “vulnerable.” Furthermore, students felt that they needed to be more cautious around older adults because older adults need to be taken care of. Students expressed fear about transmitting the virus to older adults in their lives so chose to isolate from grandparents or avoid older adults in the community in an effort to keep them safe. Finally, examples of negative and positive ageism were present in responses. Negative ageism was seen in comments about how older adults were going to die anyway, the assumption that older adults need more help, and the belief that older adults should be staying home during the pandemic. Positive ageism was present where students realized the importance of their relationships with the older adults in their lives. Results are discussed using the framework of implicit and explicit ageism.
Allophilia and Experience: Predictors of Fear in Developing Dementia
Authors: Rusch Amber , Clark Michaela , Jacobs Moyosoreoluwa , Thomassy Carmen , Patrick Julie Hicks
Published: December 2021

Fear of developing dementia is common and has been linked to delays in seeking medical attention (Arlt et al., 2008). We used data from 320 adults (M age = 39.7, SD = 12.3, range 20 – 70) to examine the ways in which objective knowledge and subjective experience with dementia influence positive attitudes toward persons with dementia. We further examined how these constructs related to fear of developing dementia. A path analysis showed the model fit the data well, X2 (DF = 1) = 0.74, p = .39; RMSEA < .001. Objective knowledge and subjective experience were significantly associated with higher allophilia. Allophilia and subjective experiences were associated with personal fear. However, allophilia decreased fear, whereas subjective experiences were associated with increased fear of developing dementia. To clarify these findings, we conducted a moderated regression in which age was examined as a moderator of the relation between allophilia and fear as well as the relation between subjective experience and fear. Significant results were obtained [F (5, 294) = 10.41, p < .001; R2 = .15]. Age moderated the effect of personal experience on fear. Stronger effects emerged for adults in their 20s compared to those in their 40s; similarly, age exerted a stronger effect for those in their 40s than for those in their 50s. Regarding age effects on the relation between allophilia and fear of dementia, for adults in their 20s and 40s, allophilia reduced fear of dementia. For adults in their 50s, allophilia was associated with higher fear.