bluuebunny/crossref_metadata_2025 huggingface dataset:
Protection against APOE4-associated aging phenotypes with a longevity-promoting intervention
Authors: McGill Cassandra , Christensen Amy , Qian Wenjie , Finch Caleb , Benayoun Berenice , Pike Christian
Published: December 2021

Two of the primary risk factors for late onset Alzheimer’s Disease (AD) are aging and APOE genotype. While the causal relationship between aging and AD is not well defined, there are strong leads from shared phenotypes such as decreased metabolic function and increased inflammation. APOE genotype may be linked to AD phenotypes through the regulation of aging processes. The NIA Interventions Testing Program (ITP) recently found that 17α-estradiol (17αE2) treatment increases rodent lifespan. Since 17αE2 acts upon systemic and neural pathways associated with AD pathology, we propose that 17αE2 may be a pleiotropic intervention strategy. Further, because APOE4 is associated with a senescent phenotype, 17αE2 may have APOE genotype-specific effects. Using 10-month-old APOE3 or APOE4 targeted replacement male mice maintained on normal chow with and without 14.4 ppm 17aE2 for 20 weeks, our initial results indicate genotype differences in the efficacy of 17αE2 across multiple outcomes. APOE4 mice exhibited an aged phenotype compared to APOE3, with APOE4 mice having a higher frailty index; however, 17αE2 treatment reduced the frailty index most strongly in APOE4 mice. APOE4 mice were impaired across multiple metabolic measures including body weight, plasma leptin, and hepatic steatosis. 17αE2 significantly attenuated the APOE4 metabolic phenotype. These data confirm and extend prior findings that APOE4 is linked to progeroid effects both peripheral and neural outcomes associated with AD risk. Importantly, 17αE2 significantly improved a range of measures, but showed the strongest effects in the APOE4 genotype. This research was funded by the Cure Alzheimer's Fund.
Role of Nativity in End of Life Care Planning
Authors: Kyaw Kay Thwe , Helzner Elizabeth , Rosenberg Carl , Reinhardt Michael
Published: December 2021

Given the rapidly aging population, optimal end-of-life (EOL) consistent with individual wishes is a public health priority. Advanced Care Planning (ACP) involves Advanced Directives (AD) and establishing a Power of Attorney (POA). AD describe EOL Care preferences including options to limit treatment, withhold treatment, provide comfort care, and prolong treatments. Nativity can provide meaningful guidance in decision-making at the end of life. Data from this study came from the Health and Retirement Study, nationally representative longitudinal study of U.S. residents. The sample included 4,015 older adults, 65 and above years of age who died during study follow-up. Nativity was categorized as U.S born and Foreign born. ACP variables included presence of AD and POA, and EOLC preferences included provide comfort care, limit, withhold, or prolong treatment. Covariates included age, gender, race, marital status, education, and subjective health at baseline. Cox Proportional Hazards (Cox PH) and Weibull Models were used to identify associations between nativity and end of life care. Results: Compared to U.S born, Foreign born participants were less likely to have POA (HR: 0.75; 95% CI:0.64-0.89) in Cox PH and POA (HR: 0.63; 95 % CI:0.53-0.75) Weibull models in unadjusted models, limited treatment (HR: 1.58; 95 % CI: 1.2, 2.1), and prolong treatment (HR: 0.23; 95 % CI:0.06-0.99) and Cox PH and (HR: 0.20; 95 % CI: 0.05-0.83) in Weibull modes. Conclusion: There are differences in Advanced Care Planning by nativity. Country of origin should be considered when helping individuals plan for end-of-life care.
The Mediation Effects of Perceived Healthcare Discrimination on Racial and Ethnic Disparities in End of Life Care
Authors: Han Junghee
Published: December 2021

Numerous studies demonstrate racial and ethnic differences in end-of-life (EOL) care, including place of death and hospice use. Experiencing discrimination in healthcare is often cited in the literature as a potent source explaining the pathways of the racial and ethnic disparities in EOL care. However, none of the studies have tested its mediating effects on racial and ethnic disparities in EOL care. The study examines if the effects of race and ethnicity on place of death and hospice use are mediated by perceived healthcare discrimination. This is a secondary analysis of 2008-2014 data from the nationally representative Health and Retirement Study, including oversampling of Blacks and Hispanics. Samples included 1,446 decedents aged 65 or older who completed an exit interview by proxy. Perceived healthcare discrimination was measured by a self-report of receiving poorer service or treatment than other people from doctors or hospitals. In multivariate analyses, Blacks were more likely to die at hospitals (OR=1.57, p < .05) than Whites. Those who experienced discriminatory healthcare were more likely to die at hospitals than those who never experienced discriminatory healthcare (OR=1.44, p < .05). However, the Karlson-Home-Breen (KHB) method showed no significant mediating effects of perceived healthcare discrimination on racial and ethnic disparities in place of death. Race and ethnicity did not affect hospice use. Although there is no mediating effect of healthcare discrimination on racial and ethnic disparities in EOL care, its direct impact is observed. The research contributes to evidence on the significant role of discrimination in healthcare choices.
A Virtual Companionship Intervention Reduces Loneliness During the COVID-19 Pandemic
Authors: Rudy Ellen , McNamara Kelsey , Patel Rajiv , Sturm Corey
Published: December 2021

Loneliness and social isolation are established risk factors for many clinical conditions yet few scalable interventions exist. Papa Inc. is a national service that pairs older adults with “Papa Pals” (empathetic, laypeople) who provide companionship and assistance with everyday tasks. Participants have free access if their Medicare Advantage plan offers it. During the COVID-19 pandemic, Papa provided virtual companionship visits via telephone or video. This study evaluated the impact of virtual companionship visits on loneliness status (UCLA 3-item Loneliness Scale) during the COVID-19 pandemic. The sample (N=894) included adults ages 65+ who identified as lonely at baseline and who completed at least one virtual visit between March 18, 2020 and December 31, 2020. Virtual visits were classified into four categories based on participants’ total number of visit minutes: Low (124 ave min), Medium Low (ML) (305 ave min), Medium High (MH) (567 ave min), and High (1360 ave min). Lonely and severely lonely participants engaged a mean of 573 and 673 minutes in the program, respectively. Improvement in loneliness status was associated with greater use of minutes for the ML and MH participants compared to Low participants (ML OR: 1.46 95CI: 1.00 - 2.11, MH OR 1.65 95CI: 1.13 - 2.40). These findings indicate that a virtual companionship intervention can be an impactful and scalable tool for older adults who want to age at home and have limited social support, especially during the uncertain COVID landscape. Further research is warranted to understand persistent loneliness.
Can a Data-Driven Measure of Neuroanatomic Dementia Risk be Considered a Measure of Brain Aging?
Authors: Casanova Ramon , Anderson Andrea , Justice Jamie , Windham Gwen , Gottesman Rebecca , Mosley Thomas , Wagenknecht Lynne , Kritchevsky Stephen
Published: December 2021

There is an increasing interest in identifying aging-related factors which may be permissive of Alzheimer’s Disease (AD) emergence. We previously used machine learning to derive an index of neuroanatomic risk of dementia called AD pattern similarity (AD-PS) score using MRIs obtained in the Atherosclerosis Risk in Communities (ARIC) study. Here, we investigate the potential of the AD-PS scores as a brain-focused measure of biologic age. Among 1970 ARIC participants with MRI collected at ARIC Visit 5, we related AD-PS scores to three measures of aging: mortality (n=356) over 8 years of follow-up; an a priori panel of 32 proteins related to aging (N=1647); and a deficit accumulation index (DAI) based on 38 health-related measures. We found lower AD-PS scores associated with significantly lower mortality (HR=0.58, CI-95%, [0.45 - 0.75], p < 0.001) after adjusting for age, race, smoking and hypertension. Among the 32 proteins, nine were significantly associated to AD-PS scores (p < 0.05) with 4 remaining significant adjusting for multiple comparisons (Growth/differentiation factor 15, Tumor necrosis factor receptor superfamily member 1A and 1B and Collagen alpha-1(XVIII) chain). Finally, in a linear regression model after adjusting for age, race, sex, hypertension and smoking, AD-PS scores were associated with the DAI (p < 0.001). The consistent patterns of associations suggest that a data-driven measure of AD neuroanatomic risk may be capturing aspects of biologic age in older adults.
Combating Social Isolation among Older Immigrant Adults: A Qualitative Interpretive Meta-Synthesis
Authors: Miller Vivian , Tonui Betty , Adeniji Dolapo
Published: December 2021

Older immigrants totaled 7.3 million in 2018, representing 13.9 percent of the population of seniors in the U.S. While this population is found to contribute significantly to society, along with new opportunities comes circumstantial challenges. Of these, one of the most salient issues for foreign-born older adults is social isolation. Additionally, this population may be at an increased risk for social isolation with poor mental health because migrating to a new country might results in resettlement challenges. Despite these concerns, less is known about the consequences of social isolation among older immigrant adults. Guided by the Population Interest Context (PICO) framework and the Qualitative Interpretive Meta-Synthesis (QIMS) guidelines, this study seeks to explore consequences of social isolation among older immigrant, as well as interventions to combat isolation. The final sample of six full text articles were published between 2011 and 2021, totaling 180 participants with ages ranging from 61 to 93 years old. Findings from the study indicated that older immigrants are at risk of social isolation and loneliness because they have fewer social connections due to leaving behind their familiar social group in the home country, encounter linguistic challenges that negatively contribute to greater social isolation and poor mental health. Despite these difficulties older immigrants reported various social interventions, i.e., access to senior centers, community programs and services to be of greater importance in building social networks. Authors discuss opportunities for future research, such as exploring evidence-based studies on interventions for social isolation and loneliness of older immigrant populations.
Designing a Genetic Screen to Identify Factors Required for Meiotic Nuclear Rejuvenation
Authors: Jones Chelsey
Published: December 2021

During the natural cycle of life, most eukaryotic organisms grow old, age, and die. A common natural mechanism by which organisms “reset” their lifespan is through sexual reproduction; however, how this rejuvenation takes place remains unknown. My lab has found that meiosis in budding yeast, the developmental program that forms sex cells, eliminates age-induced damage. This involves the formation of a novel nuclear compartment, the Gametogenesis Uninherited Nuclear Compartment (GUNC), which acts as a trash can for accumulated age-induced damage. To understand the molecular details of this process, I worked on designing a screen for genes involved in GUNC formation. My mentor and I fused three different proteins targeted to the GUNC and a protein that is able to bind to a drug-resistance plasmid, in order to couple the inheritance of a selectable DNA marker with the elimination of age-induced damage. Initial testing of these three fusion proteins suggested that they were unable to successfully target the plasmid to the GUNC; as such, testing of additional candidate proteins is necessary. We plan to eventually use this system to identify mutations that disrupt GUNC formation and cause inheritance of the drug-resistance plasmid. By identifying and perturbing proteins involved in GUNC formation, we are hoping to be able to drive the inheritance of specific types of age-induced damage, allowing for the determination of what a symptom versus a cause of aging is.
Factors Associated with Older Peoples′ Perceptions of Dignity and Well-being at Residential Care Facilities.
Authors: Roos Charlotte , Alam Moudud , Swall Anna , Boström Anne-Marie , Hammar Lena
Published: December 2021

Dignity and well-being should be promoted in care of older people living at residential care facilities (RCFs). In addition, care should be person-centred. Dignity and well-being can be interpreted as person-centred outcomes. Older people living at RCFs experience a lack of dignity and well-being. To promote this, it is important to understand the associated factors to target. The aim of this study was to examine the associations between perceived dignity and well-being and factors related to attitudes of staff, the care environment and individual issues (age, gender, self-rated health and dementia) among older people living at RCFs. A national cross-sectional study was conducted retrospectively. All older people 65 years and older (n=71,696) living at RCFs in 2018 were invited to respond to the survey. The survey included the areas: self-rated health, indoor-outdoor-mealtime environment, performance of care, treatment from staff, safety, social activities, availability of staff and care in its entirety. Age, gender and diagnosed dementia were collected from two national databases. Data was analysed using ordinal logistic regression models. The result indicated that respondents who had experienced disrespectful treatment, who did not thrive in the indoor-outdoor-mealtime environment, who rated their health as poor and respondents with dementia had higher odds of being dissatisfied with dignity and well-being. There is a need to improve the prerequisites of staff regarding respectful attitudes and to improve the care environment. The Person-centred Practice framework, targeting the prerequisites of staff and the care environment, can be used as a theoretical framework for designing future improvements.
Tolerability of Lithium: A Naturalistic Discontinuation Study in Older Adults (≥60 Years)
Authors: Flapper Marinke , van Melick Els , van Campen Jos , Schutter Natasja , Kok Rob
Published: December 2021

Lithium is one of the most effective treatment options in both bipolar disorder and treatment-resistant depression. The use of lithium in older adults declined during the last decades, probably resulting in undertreatment of older adults. To investigate how well lithium is tolerated in old age, we aimed to determine the frequency, reasons and possible predictors of discontinuation due to adverse effects in a cohort of hospitalized adults aged 60 years or older who had started with lithium.

We performed a retrospective cohort study based on chart reviews. Participants were in treatment at Parnassia Group at The Hague, the Netherlands. After inclusion (between January 2010 and December 2016), participants were followed until April 2017, when we performed data extraction and analysis.

In our sample of 135 patients (median age 69 years, median follow-up duration 18 months), 49 (36.3%) participants discontinued lithium. Only a minority (11 (8.1%)) of the participants discontinued solely due to adverse effects. The majority discontinued lithium due to psychiatric (18,5%) reasons, (most commonly mentioned within this subgroup: lack of effectiveness and non-compliance) or a combination of reasons (7.4%). None of the factors we studied (age, gender, Charlson Comorbidity Index (CCI), polypharmacy, renal function and neurological history) were significantly associated with discontinuation due to adverse effects.

The frequency of lithium discontinuation in our cohort was in range with frequencies reported in younger patients. Older age itself should not be a reason to withhold lithium treatment.
Formative Examination of a Multi-Focus Educational Exergame Designed for Older Adults
Authors: Ruggiero Laurie , Orsega-Smith Elizabeth , Barmaki Roghayeh
Published: December 2021

Exergames and digital health games have shown promising outcomes in older adults. Most games have had one focus (e.g., physical activity, cognitive functioning). We developed a demonstration version of a multi-focus educational exergame (i.e., healthy eating, physical activity, cognition) that builds on healthy aging theory. Community-engaged and mixed methods (e.g., surveys, focus groups) research approaches were used to examine preliminary game acceptability and usability. The game was demonstrated with 20 senior center members (95% female; 48% African American; 52% White; average age 64 years) and participants were able to play the game. The post-gameplay survey results support acceptability/usability of the game. For example, 87% of participants “agreed” or “strongly agreed” that they felt comfortable playing; the game instructions were clear; the text was readable; and gameplay was enjoyable. The majority also “agreed”/“strongly agreed” that the audio was appealing/helpful in playing the game (86%); sound quality was appropriate (78%); hand tracking was precise (57%), feedback on correct/incorrect responses was motivating (73%); they felt excited to get the correct answers (80%); they would play the game again (87%); and they would recommend it to a friend/family member (80%). When asked how often they would play it, the responses were: 33% five or more times/week; 27% three-four times/week; 20% one-two times/week; and 20% never. Observations and focus groups further clarified acceptability and identified areas for improvement (e.g., game instructions). Preliminary results support acceptability of this multi-component educational exergame with older adults and suggest the potential for future tailoring of this game.
Infection Control in Small Residential Care Settings: Insights From a National Survey and Washington State Data
Authors: Ham Carolyn , Unutzer Anna
Published: December 2021

Infection control is a vital issue in long-term care, and the increasing popularity of small residential care facilities (SRCF) raises questions about the effectiveness of this model for preventing facility-acquired infections. In SRCF, care is provided in a residential home to a small number of residents. The setting lacks common terminology, and states license SRCF under various titles including Adult Family Homes, Adult Foster Homes and Family Care Homes. To better inform infection control efforts in this unique setting type, DOH staff conducted a comprehensive search to locate states that license SRCF. A total of 24 states were identified and approached to participate in a qualitative research study; 21 responded, three declined and nine were unable to participate due to staff time constraints. Between March 12th and April 15th, 2021, ten public health and regulatory staff from nine states completed semi-structured telephonic interviews on infection control in SRCF. Infection control licensing requirements and public health oversight for SRCF varied significantly across participating states. Data from these interviews was analyzed and compared with two Washington State Adult Family Home (AFH) sources: 1) online survey of AFH providers 2) Infection Control Assessment and Response evaluations conducted by public health staff. Four themes were identified in all three data sets: access to personal protective equipment, environmental safety, staffing issues and knowledge deficits. SRCF are valued by states that license them. Despite the challenges of implementing infection control in the home-like environment, extraordinary opportunities exist for improving care and preventing infections in this setting.
A Case for Trauma-Informed Dementia Care: The Emancipatory Power of Psychological Resilience and Trauma From COVID-19
Authors: Ione Adrienne
Published: December 2021

The dominant nonpharmacological therapeutic approach in dementia care is “person-centered.” The racial disparities in disease and diagnosis affliction, represents an urge to incorporate trauma sensitivity. Antipsychotic use rates among this population being substantially higher than two years ago, as well as increasing evidence of ACE scores being a significant risk factor in dementia development, we need to consider the emancipatory power of trauma-informed dementia care. Data were collected from 103 peer-reviewed journal articles. Person-centered care practices were analyzed for adherence to SAMHSA’s principles that guide a trauma-informed approach. Studies were rated on a Likert-scale in six areas: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment and choice; and cultural, historical & gender issues. It was observed that of the 103 search returns, 38 met study criteria. Within these data, it was observed that the majority of studies scored low on incorporation and adherence to SAMSHA’s trauma-informed approach. While a few studies mentioned the magnifying effects of a current traumatic event on preexisting vulnerabilities, no study highlighted the growth or flourishing potential in triggering past trauma and the current traumatic event offering an opportunity of mind-somatic integration. This paper proposes trauma-informed dementia practices consider: 1) intake and assessment to include a screening of ACE score; 2) evaluation of (re)integrating current losses into current developmental and lifespan phase; and 3) offering therapeutic support of current traumatic event (COVID-19) to metabolize past traumatic events in the context of current developmental and lifespan phase.
Interdisciplinary Innovations Utilizing Pet Robots to Meet Research, Education, and Care Needs
Authors: Troutman-Jordan Meredith , Davis Boyd
Published: December 2021

Studies of the impact of robotic companion pets are proliferating, authored by several disciplines, each with different concerns. Roboticists focus on technology design and artificial emotional intelligence as opposed to general preferences for soft, furry, interactive animals. Others worry that as people interact with potentially deceptive technology, they may think the pet is alive. While aware of these serious concerns, gerontologists have focused on how lonely older persons without cognitive impairment respond to social ‘helper’ robots. More recent studies emphasize the possible impact of animatronic pets on persons with dementia (PWD). Therapeutic benefits of these pets are just being established. Our current pilot study is timely in that it now involves semi-structured interviews with formal/ informal caregivers of PWD who have been given a robot pet. We are eliciting perceptions, opinions, and observations of the PWD’s response to robotic pets. We recruited 8 gerontology students as much-needed assistants for a research-driven topics course to afford them field exposure to PWD, caregivers, and direct research experience. Because students seldom have experience either with robotic pets or PWD, they read selected articles and received training/practice in semi-structured interviewing techniques. Students next conducted interviews with caregivers of PWD who have interacted with the pets. All interviews are audio-recorded, transcribed and deposited in the Carolinas Conversations Collection. Content and thematic analysis of transcriptions, student activity logs and bi-weekly reflective discussions will inform next steps in intervention research, testing therapeutic outcomes such as agitation reduction by pet robots for PWD.
Neuron-Specific Mechanisms Control the Mitochondrial Regulator PGC-1a
Authors: McGregor Eric , Souder Dylan , Clark Josef , Rhoads Timothy , Elicieri Kevin , Beasley Mark , Moore Darcie , Anderson Rozalyn
Published: December 2021

Mitochondrial dysfunction has been proposed as a hallmark of the aging process. Specifically, as a function of aging, mitochondria appear to have decreased enzyme activity and respiratory capacity and increase reactive oxygen species production. Brain aging is associated with morphological and homeostatic changes, including alterations in brain size, cognitive impairment, and white and grey matter integrity. However, the causes of these changes remain an open and actively pursued field of study. The ubiquitously expressed transcriptional coactivator peroxisome proliferator-activated receptor gamma-coactivator 1 (PGC-1a) has been described as the master regulator of mitochondrial function. Despite the emerging connections between PGC-1a and disease vulnerability, the regulation of PGC-1a outside of the skeletal muscle, liver, and adipose tissue is not well defined. This is particularly true in the brain, where PGC-1a is enriched in neurons, and alterations in expression levels have been linked to neurodegenerative disorders. Here we report that astrocytes and neurons differ substantially in mitochondrial status and the transcript variants of PGC-1a expressed, including using a neuron-specific promoter. Taking advantage of the ability of the tau-kinase GSK-3b to influence PGC-1a expression, we investigate how transcript variants are differentially regulated in primary neurons and astrocytes. Neuronal PGC-1a responds robustly to GSK3b inhibition by lithium, switching the dominant promoter, leading to changes in isoform distribution and abundance, while astrocytes are refractory to lithium treatment. The data presented here highlight key mechanisms for neuron-specific metabolic regulation that are likely to be relevant to neurodegenerative diseases that have a link to mitochondrial dysfunction.
Older People’s Perceptions of what is Needed to Experience Dignity and Well-being at Residential Care Facilities.
Authors: Roos Charlotte , Swall Anna , Hammar Lena , Boström Anne-Marie , Skytt Bernice
Published: December 2021

Dignity and well-being are central values in care of older people living in residential care facilities. In addition, care of older people living in residential care facilities should be person-centred. Dignity and well-being can according to the person-centred practice framework be interpreted as person-centred outcomes. Despite this older people living in residential care facilities have described that they not fully experience dignity and well-being and improvements are needed. To improve care it is important to know what to target. The aim of this qualitative study was therefore to describe residents’ perceptions and experiences of what is needed to live with dignity and a sense of well-being. Interviews were carried out with older people living at residential care facilities (n=20). Inductive content analysis was used to analyse data and one overarching theme and three categories emerged. The result revealed the importance of, and that staff and the care environment supported, to manage daily life by oneself, to be shown respect and to belong to a social context. For older people to experience the person-centred outcomes dignity and well-being managers at residential care facilities need to develop and support the staff prerequisites related to knowledge, skills and attitudes and to improve the care environment. According to the person-centred practice framework, the staff prerequisites and the care environment must be taken into account to achieve the person-centred outcomes dignity and well-being.
Predictive Ability of Self Compassion in Psychosocial Outcomes of Caregivers of Persons With Dementia
Authors: Grant Claire , Judge Katherine
Published: December 2021

Caregivers of Individuals with Dementia (IWDs) often face increased rates of depression, anxiety, and burden because of their role as caregiver. Self-compassion, a construct centered around self-kindness and understanding has not been well studied within the caregiving population. The present study was aimed at understanding the relationship between self-compassion and the psychosocial outcomes of burden, depression, and anxiety. Strong relationships between self-compassion and these outcomes have been established in other populations, but these relationships have not been studied with the dementia caregiving population. A diverse sample of dementia caregivers providing over 5 hours of care per week were recruited through CloudResearch and MTurk (N = 99). Participants were aged 18 to 69 years (M = 38.61) and 66.7% were female. 67.7% were White, 13.1% were Black, and 8.1% were Asian. 73% were children/in law or grandchildren/in law of the individual with dementia and 12% were a close friend of the individuals with dementia. The individuals with dementia had an average age of 73.88 years. Results of multiple regression models showed that self-compassion was a significant predictor of depression (β = -.25, p = .025), anxiety (β = -.36, p = .001), and burden (β = -.25, p = .023) even while controlling for other constructs including self-esteem, types of coping, and IWD impairment level. Self-compassion will be discussed as a novel contribution to the caregiving literature in furthering our understanding of well-being predictors and how to target self-compassion as a modifiable factor for offsetting the negative impacts of caregiving.
Preventing elder maltreatment: Identification of high risk factors from LTC administrative data
Authors: Chao Shiau-Fang , Hsiang Chen-Wei , Chen Kuan-Ming , Chen Ya-Mei , Hsieh Ji-Lung , Chou Yu-Hsuan , Lin Ming-Jen , Wu Shih-Cyuan
Published: December 2021

Elder maltreatment is a serious problem endangering physical, emotional, and material well-being of older persons, especially those with physical and cognitive impairment. However, detecting the incident of elder maltreatment is difficult and its prevalence has been seriously underestimated. This study explores how LTC use relates to elder maltreatment report, using government LTC service records in Taiwan. A total of 88,633 reported cases in adult protection system in 2019 were merged with 443,952 valid cases in LTC service system. Descriptive statistics were firstly performed to examine the proportion and characteristics of repeated cases in both systems. Linear probability modeling was then used for analyses. 1. In 2019, 3,413 elder maltreatment clients can be identified in LTC service system, accounting for 27.3% of the elder maltreatment cases. 2. Older persons who used LTC service first and being reported as elder maltreatment cases later had a higher prevalence of being discovered by social workers and care attendants. 3. These group of clients also had higher proportion of being reported as neglected by others, abandonment, and self-neglected. 4. Characteristics in LTC service system, such as being older, low severity of disability, high cognitive impairments, low income status, and with a LTC service use record, were related to high probability of being detected with elder maltreatment problems. Characteristics in LTC service system could be effective indicators in discovering potentially abusive situations of disabled older persons. Training and education are essential for LTC service providers to enhance their literacy and ability of assessing elder maltreatment.
Resilience in Relation to Multimorbidity in Older Adults: A Scoping Review
Authors: Seong Hohyun , Lashley Heather , Bowers Katherine , Corazzini Kirsten
Published: December 2021

Multimorbidity is widespread, costly, and associated with a range of deleterious symptoms, affecting 70-80 % of older adults. Resilience in late life has been the focus of considerable research to understand differences in vulnerabilities and recovery from stressors relevant to multimorbidity. Despite this, previous reviews have not focused on resilience in relation to multimorbidity in older adults; therefore, this study synthesized relevant literature. The study design was a scoping review following JBI methodology. Searched electronic databases included PubMed, Embase, CINAHL, and PsycINFO. Data were extracted by two independent reviewers and charted using Garrard’s review matrix method. Gough’s weight of evidence criteria were used to appraise quality. Of 468 retrieved studies, 14 met inclusion criteria, primarily from the US, UK, and Canada. Most resilience in multimorbidity frameworks operationalize resilience as dependent on the socio-environmental context of older adults. Resilience was commonly considered a dynamic process, but only one study was longitudinal. Measures were primarily psychological or psycho-social in nature and did not include biological or physical measures of resilience. Quality of life and quality of care were common outcomes; resilience significantly related to these outcomes. Findings indicate both the important relationships of resilience with outcomes of multimorbidity, as well as multiple gaps in our current understanding of resilience in relation to multimorbidity. Results highlight the need for studies with diverse populations across diverse cultures, studies that incorporate multidimensional measures, with attention to physiological or physical properties of resilience, and longitudinal studies that capture the dynamic process of resilience in multimorbidity.
Socioeconomic status across the life course and smoking trajectories of older adult smokers in the U.S.
Authors: Avila Jaqueline , Lee Sangah , Osuoha Ezinwa , Maglalang Dale Dagar , Sokolovsky Alexander , Ahluwalia Jasjit
Published: December 2021

The objective of this study is to assess how SES over the life course impacts smoking cessation among older adult smokers in the U.S. 6,058 current smokers 50 years and older were identified from the 1998-2018 Waves of the Health and Retirement Study (HRS). The outcome of interest was smoking cessation. The main independent predictor was lifetime SES, categorized as low child and low adult SES (persistent low); low child, high adult SES; high child, low adult SES; and high child, high adult SES (persistent high). Multilevel mixed-effect logistic model was used to examine how lifetime SES predicts smoking cessation at age 65 and over time, adjusted by health and smoking covariates. The majority of older smokers had persistent high lifetime SES (60.3%), followed by high child/low adult SES (18.7%), persistent low SES (15.5%) and low child/high adult SES (5.6%). Compared to those with persistent high SES, those with persistent low SES were more likely to be Hispanic (25.9% vs. 3.0%, p<0.001) or non-Hispanic Black (22.7% vs. 8.7%, p<0.001), respectively. The adjusted results showed that at age 65, compared to those with persistent high SES, those with persistent low SES, low child/high adult SES, and low adult/high child SES were less likely to quit (OR: 0.42, 95%CI:0[.31-0.56]; OR:0.37, [0.24-0.55]; OR:0.53, [0.40-0.70], respectively). Similar results were observed over time for those with persistent low SES and low adult/high child SES. However, there was no significant difference for those with low child/high adult SES.
The Role of Occupational Switching on Retirement of American Midlife Workers
Authors: Oh Yun taek
Published: December 2021

An increasing number of midlife Americans are financially unprepared for retirement. This is a problem because of the increasing life expectancy that prolongs the need for financial resources. One way to resolve this problem is to postpone full retirement by having bridge jobs that provide more time to work and accumulate retirement savings. While having a bridge job means numerous labor market behavior such as working for different employers and reducing work hours and intensity, there is a limited number of studies focused specifically on how switching occupations can contribute to retirement decisions with a longer time frame. This study investigated the association between occupational switching and retirement patterns of American midlife workers aged between 50 to 59 years using the Health and Retirement Study longitudinal data from 2004 to 2016, Occupational Information Network data, and American Community Survey from 2003 to 2016. The changes in occupational demandingness before and after switching occupations were reflected by using mover design event study regression with fixed effects. In general, occupational switching is associated with later retirement until two to three years after switching occupations for both genders, yet this association varies by the directions of the change in occupational demandingness.
It Was Heartbreaking . . . It Was Horrible: The Experiences of Nursing Home Residents’ Children During COVID-19
Authors: Miller Vivian , Kusmaul Nancy , Burns Jacquelyn , Cheon Ji Hyang
Published: December 2021

As a result of COVID-19, the Centers for Medicare and Medicaid Services (CMS) suspended all outside visitors from entering nursing homes on March 13, 2020. For more than six months, care partners were only permitted in compassionate care situations, so adult children of residents were only able to contact their parents via phone calls, video chats, window visits, and in some cases, limited outdoor visits. Experts have written on the adverse, detrimental impact of this lack of connection and isolation has had on residents. However, the lived experiences from the perspectives of residents’ adult children remain largely absent from the literature. To uncover the experiences of these care partners, semi-structured interviews were conducted (N=12) from December 2020 to February 2021. Adult children shared witnessing their parent’ physical and cognitive decline which they attributed to the lack of visitors. Care partners expressed feeling frustrated that they were unable to observe their parent’s health condition, and could not provide support. Also, many rightfully worried they would never see their loved one again. Findings from this study reveal implications for nursing home leaders and policymakers, such as building infrastructure and systems that both ensure safety and allow care partners to regularly see their residents in long-term care to avoid the unintended adverse consequences of these policies. Further, findings from this research indicate the need for future programs to mitigate and lessen the long-term consequences this isolation has had on both residents and their adult children.
Applying Intersectionality Framework to Explore the Development of Frailty in Older Adults
Authors: Shakya Shamatree , Silva Susan , Cary Michael
Published: December 2021

Background: Frailty is a state of compromised homeostasis reserve that makes older adults susceptible to adverse health outcomes. Frailty is highly prevalent among women, racial and ethnic minorities. We aimed to investigate the combined influence of gender, race, and ethnicity on the development of frailty in older adults without frailty at baseline using the intersectionality framework. Methods: The data came from the Health and Retirement Study, a nationally representative US older adults of 65 years and older (2006-2012). Logistic regressions were used to examine the relationships. Results: 18.7% of older adults without frailty at baseline developed frailty after a 4-year follow-up. Females were likely to develop frailty than males (aOR 1.66, 95% CI 1.32-2.09, p < 0.0001). In comparison to Non- Hispanic Whites, Non-Hispanic Blacks (aOR 2.66, 95% CI 1.89, 3.74, p < <.0001) and Hispanics or others (aOR 1.73, 95% 1.16, 2.58, p < .0068) had the greater likelihood of developing frailty, after adjusting for age and clinical morbidities, such as lung disease and cardiometabolic diseases. The intersectionality approach showed that both Non-Hispanic Black females (aOR 1.82, 95% CI 1.12-2.99, p = 0.0185) and males (aOR 3.30, 95% CI 1.85-5.91, p < .0001) had the highest likelihood of developing frailty than Non-Hispanic Whites at 4-year post-baseline, adjusting for age and chronic clinical conditions. Conclusion: Our findings highlight the importance of taking the intersectionality approach to examining the frailty risk in later life, which will help in providing precision-based care.
Mental Health Effects of COVID-19 in Older Adults Are Moderated by Existing Mental Health Needs and Emotional Support
Authors: Liu Tianyin , Lu Shiyu , Lum Terry Y S , Au Walker Siu Hong , Peng Man-Man , Leung Dara K Y , Wong Gloria H Y
Published: December 2021

Mitigating mental health consequences is one of the priorities for the society to advance, and the aim of this study is to investigate the mental health effects of COVID-19 in older adults and to explore risk and protective factors. Social workers recruited 722 older adults living in the community (mean age 73.6±8.4) from January 2020 to February 2021 in Hong Kong, and interviewed them for basic demographics (age, gender, education, and living status), mental health service use in recent three months (proxy for existing needs), number of people to talk to when feeling down (proxy for emotional support network), and assessed their depression using Patient Health Questionnaire-9 (PHQ-9). Impacts of COVID-19 were indicated by local daily effective reproductive number (Rt) and Nth wave since the start of the pandemic. Generalized linear models (GLM) were applied. Basic demographics were not associated with depression, existing mental health needs (β=2.99, p<.001), Rt (β=1.08, p<.05) and Nth wave (β=0.49, p<.05) were positively associated with depression, while emotional support network was negatively associated with depression (β=-2.47, p<.001). There was also a significant interaction between Rt and Nth wave on depression (β=0.69, p<.05), suggesting ongoing COVID-19 took a toll on older adults’ mental health. Three-way interactions between COVID-19 Rt, Nth wave and existing mental health needs (β=0.25, p<.05) and emotional support network (β=-0.12, p=.07) on depression further indicated that older adults with existing mental health needs warrant more attention, and wider emotional support network may buffer the impact of the pandemic on mental health.
Cardiovascular monitoring systems for aging in place: current perspectives and a novel toilet seat-based system
Authors: VandeWeerd Carla , Roberts Mitchell , Collins Lindsey , Sappington Erica , Poon Lydia , Lowenkron Jeff
Published: December 2021

Cardiovascular disease (CVD) is a leading cause of death. Questions remain as to how older adults, providers and researchers can harness remote patient monitoring (RPM) to maintain/improve cardiovascular health--especially in light of COVID-19 and increased reliance on telehealth. The objective of this study was to understand the perceptions of older adults with cardiovascular challenges and providers surrounding a novel RPM device. The Heart Seat (THS) developed by Casana, is a toilet-seat-based cardiac monitoring device. Focus groups, stratified by gender, were conducted in 2021 by the UF Health Precision Health Research Center (UFIRB202100290) with older (55+) adults (n=36) in The Villages, Florida. Adoption, benefits/concerns, usability, utility and gender differences were explored. One-on-one provider interviews (n=6) explored future utility of THS. The primary benefit of THS noted by providers and older adults was ease-of-use and passive data collection, promoting adherence. Providers considered THS ‘easy-to-use’ and a positive alternative to current RPM devices. While genders' sentiments towards cardiac monitoring devices were similar, males reported having more experience with RPM. Despite this, females reported using cardiac monitoring devices more consistently than males. Therefore, passive RPM may be beneficial for increasing adherence in males. Participants' largest concern surrounding RPM was information sharing, including data monitoring, and security. Providers were also concerned about information sharing, specifically who would receive/monitor and interpret data from RPM. RPM devices should focus on enhancing ease-of-use, catering to user and provider information sharing and data monitoring/interpretation preferences and privacy.
Dietary patterns of US Chinese Older Adults
Authors: Dong Alexander , Lanza Lisa , Le Qun , Bergren Stephanie , Dychtwald Dana
Published: December 2021

A westernized diet, characterized by intake of foods high in fat and sugar, has been associated with several chronic conditions. However, the dietary pattern of US Chinese older adults is not well understood. The primary objective of this study was to determine the relationship between years of US residence and other demographic factors and the intake of foods high in fats and sugar. As part of the Population Study of Chinese Elderly, participants were given a 48-item food frequency questionnaire, which were further placed into primary food groups. Each group was then categorized into whether they consumed the food group at least once a week. The total sample was 59% female with an average age of 75, with 49% consuming fatty foods and 85% consuming sweets in the past week. Using logistic regression (N=3053), each additional year of US residence (range of 0-93 years) was associated with a higher dietary intake of fats (OR: 1.01 (95%CI:1.01-1.02)) and sweets (OR: 1.01 (95%CI:1.00-1.02)). Additionally, higher education was associated with lower consumption of fats (OR: 0.98 (95%CI:0.96, 0.99)) and higher income was associated with higher consumption of fats (OR: 1.11 (95%CI: 1.04, 1.18)). For sweets, women compared to men were 54% less likely to consume sweets in the last week (OR: 0.46 (95%CI:0.36, 0.59)), and higher education was associated a greater likelihood of consuming sweets (OR: 1.07 (95%CI: 1.05, 1.10)). Study findings suggest that immigration related factors and demographic factors may influence consumption of a westernized diet high in fats and sugars.
Erectile Function, Sexual Satisfaction, and Cognitive Decline in Men from Midlife to Old Age
Authors: Slayday Riki , Bell Tyler , Lyons Michael , Kremen William , Franz Carol
Published: December 2021

We investigated how changes in erectile function and sexual satisfaction relate to cognitive decline in men from midlife into early old age. This is a major transitional period for increased incidence of erectile function and for cognitive decline. We examined 833 men from the Vietnam Era Twin Study of Aging whose mean ages were 56, 61, and 68 at the time of assessment. Erectile function and sexual satisfaction were measured using scores from the International Index of Erectile Function. Individuals with erectile dysfunction at baseline were excluded. Cognitive performance was measured using factor scores for separate domains of episodic memory, executive function, and processing speed. We tested linear mixed models hierarchically adjusted for demographics, sexual activity, as well as physical and mental health confounders to examine how changes in erectile function and sexual satisfaction related to changes in cognitive function. Declines in erectile function were associated with declines in episodic memory (p=.004, d=.25), while declines in sexual satisfaction were associated with declines in processing speed (p=.006, d=.19). Decreasing erectile function and sexual satisfaction may be indicative of individuals also likely to be facing cognitive decline. Possible mechanisms accounting for these changes may include white matter microvascular disease and/or various lifestyle influences. Discussing and tracking sexual health with middle aged men may be a crucial step in identifying those likely to face cognitive decline.