bluuebunny/crossref_metadata_2025 huggingface dataset:
PRELIMINARY SOMMA DATA: COGNITIVE AND PHYSICAL FUNCTION RELATIONSHIPS IN OLDER ADULTS
Authors: Kritchevsky Stephen , Newman Anne , Cawthon Peggy , Mau Theresa , Hepple Russell T , Coen Paul , Goodpaster Bret , Cummings Steven
Published: December 2022

We used canonical correlation (n=424) to examine the relationships between a set of physical function measures (400m usual pace, chair stands/sec, 4m walk pace, standing balance times, VO2 peak, muscle power, four-square step test (FSST) time, stair climb time and stair climb power) and a set of cognitive measures (Trail Making Test B (sec), Digit Symbol Substitution Test (DSST), the Montreal Cognitive Assessment, and California Verbal Learning Test). Canonical correlation derives synthetic variables comprised of linear combinations within each set of variables (physical and cognitive) that maximize the correlations between synthetic variables. The FSST was most strongly correlated with the cognitive synthetic variable (- 0.42). The DSST score was the cognitive measure most strongly correlated with the physical synthetic variable (0.48). It is notable that only the timed cognitive and physical tests are inter-associated
HOW CAN PATIENT PORTALS SUPPORT CAREGIVERS PROVIDING END-OF-LIFE CARE?: A MIXED-METHODS STUDY
Authors: Portz Jennifer Dickman , Powers John David , Baldwin Megan , Gleason Kathy , Boxer Rebecca , Palen Ted , Bayliss Elizabeth
Published: December 2022

Patient portal design is rarely centered around patient caregivers—family members, friends and other designated persons who may access these digital tools for the patient’s health needs. This study examines: (a) portal features used by caregivers during their loved-one’s end-of-life; and (b) caregiver perceptions regarding the use of patient portals for caregiving near the end-of-life.Using sequential mixed-methods, we conducted a retrospective cohort analysis of caregiver proxy (N=137) use from 2016-2019 during their loved-ones’ (N=5,284) last 12 months of life and interviews with (N=31) 16-former and 15-current caregiver proxies. Caregiver proxy portal use in this population was lower than expected; however, caregivers who used the portal as proxies found value in tools for caregiving near the end-of-life. To leverage the patient portal to better support caregivers, future strategies should target caregiver portal adoption, awareness of beneficial portal tools, and the addition of caregiver specific resources and education.
EPIGENETIC AGING IN OLDER BREAST CANCER SURVIVORS: THE THINKING AND LIVING WITH CANCER (TLC) STUDY
Authors: Rentscher Kelly , Bethea Traci , Zhai Wanting , Cohen Harvey , Small Brent , Ahles Tim , Mandelblatt Jeanne , Carroll Judith
Published: December 2022

Cancer and its treatments increase risk for age-related disease, and biological aging may be a key mechanism; however, no research to date has examined epigenetic markers of aging in long-term breast cancer survivors. We used data from a national, prospective cohort to test whether older breast cancer survivors had accelerated epigenetic aging compared to non-cancer controls. Non-metastatic breast cancer survivors ages 62–84 years who received chemotherapy with or without hormonal treatment (n=29) or hormonal treatment alone (n=51), and controls frequency-matched on age, race, education, and time between blood draws (n=101), provided two blood samples between 24- and 60-months post-diagnosis (time between samples average=1.8 years). DNA methylation profiling (Illumina Infinium EPIC array) derived epigenetic aging measures: extrinsic, intrinsic, phenotypic, Grim, and Dunedin Pace of Aging (PoAm). Mixed-effects models tested effects of treatment group and change over time on epigenetic aging, adjusting for chronologic age and comorbidities. Survivors who received chemotherapy +/- hormonal treatment had a biological age 1.9–2.6 years older than controls based on extrinsic, intrinsic, and Grim estimates (p=.045, .045, and .001, respectively). Survivors who received hormonal treatment alone had an extrinsic biological age 1.6 years older than controls (p=.032) and a faster Dunedin PoAm (p=.040). Survivors who received chemotherapy +/- hormonal treatment had a trend for accelerated extrinsic aging over time compared to controls (p=.087). Older breast cancer survivors, especially those receiving chemotherapy, showed an accelerated epigenetic aging profile compared to matched women without cancer. Future research is needed to examine associations with age-related survivorship outcomes.
PLASMA PROTEOMIC SIGNATURE OF DECLINE IN GAIT SPEED AND GRIP STRENGTH
Authors: Liu Xiaojuan , Pan Stephanie , Xanthakis Vanessa , Ramachandran Vasan , Newman Anne , Sanders Jason , Austin Thomas , Odden Michelle
Published: December 2022

Physical function predicts health-related quality of life. The biological mechanisms underlying declines in physical function with age remain unclear. We examined the plasma proteomic profile associated with longitudinal changes of physical functions measured by gait speed and grip strength in community-dwelling adults. We applied aptamer-based platform to assay 1,161 plasma proteins on 2,871 participants (60% women, aged 76 years) in Cardiovascular Health Study (CHS) in 1992/1993 and 1,550 participants (55% women, aged 54 years) in Framingham Offspring Study (FOS) in 1991-1995. Gait speed and grip strength were measured annually for 6 years in CHS and at cycles 7 (1998-2001) and 8 (2005-2008) in FOS. The associations of individual protein levels (log-transformed and standardized) with longitudinal changes of gait speed and grip strength in two populations were examined separately by linear mixed effect models. Meta-analyses were implemented using random effect models with a Bonferroni correction for multiple testing. We found that plasma levels of 18 and 12 proteins were associated with changes in gait speed and grip strength, respectively (Bonferroni-corrected p < .05). The proteins most strongly associated with gait speed decline were growth/differentiation factor 15 (GDF-15) (uncorrected Meta-analytic p = 1.60E-15), pleiotrophin (PTN) (1.29E-08), and metalloproteinase inhibitor 1 (TIMP-1) (2.02E-08). For grip strength decline, the strongest associations were for GDF-15 (1.39E-07), carbonic anhydrase III (6.60E-07), and TIMP-1 (3.21E-06). Several statistically significant proteins are involved in the alternative complement pathway, extracellular matrix remodeling or immune function. These novel proteomic biomarkers may inform our understanding of the pathophysiology of functional decline.
ENSURING COMPETENCE: ADDRESSING THE NEED FOR LGBTQ+ AGING EDUCATION
Authors: Guest Aaron
Published: December 2022

The continued demographic shifts in population aging are coupled with an increase in self-identified, LGBTQ+ individuals entering older age. While they share some common age-related experiences with non-LGBTQ+ individuals, they also face unique challenges as they age, including additional intersectional pressures beyond their sexual or gender identity. These challenges are exacerbated by pre-existing health inequities and heteronormative social support systems. Of particular concern is the ability to locate affirming and accessible social and health services. Gerontologists have a critical role in assisting older LGBTQ+ individuals in navigating complex social systems. To do so requires they have the appropriate education to develop the cultural humility needed to understand and assist these individuals. It necessitates the engagement of gerontology and geriatric education programs in educating future gerontologist professionals about LGBTQ+ older individuals. Critically, it requires the identification of appropriate instructors who are equipped to educate on LGBTQ+ aging topics.
IF THEY BUILD IT, THEY WILL COME: ENGAGING OLDER AFRICAN AMERICANS IN EDUCATION AND RESEARCH
Authors: Lincoln Karen
Published: December 2022

Engaging African Americans in health education and research is a mechanism for addressing health disparities and achieving health equity. The science of engagement and retention requires strong community partnerships, authentic leadership, and educational opportunities for students and the broader community. In this presentation, Karen Lincoln will discuss how findings from her research on health and mental health disparities laid the foundation for her community-based health education program and public scholarship. She will highlight Advocates for African American Elders (AAAE), the health education program that she founded and directs. AAAE provides culturally competent health education for older African Americans throughout Los Angeles County and has become a hub for her research, training and mentoring.
METALS EXPOSURE AND COGNITIVE DECLINE IN LATINO ELDERS: RESULTS FROM THE SACRAMENTO AREA LATINO STUDY ON AGING
Authors: Meier Helen , Bakulski Kelly , Aiello Allison
Published: December 2022

Latinos have a higher risk of Alzheimer’s disease and related dementias (ADRD) and clinical presentation could take place 7 years earlier, on average, than non-Hispanic whites. This health disparity will likely intensify as the US Latino population over 65 years is predicted to grow from 4 million in 2016 to 19.9 million in 2060. Environmental exposures, such as metals, are of interest as contextual factors contributing to ADRD due to their known neurotoxic effects, particularly in early life. Using data from the Sacramento Area Latino Study on Aging, we examined the association between blood concentrations of five metals and cognitive outcomes. We hypothesized that Latino elders with higher concentrations of non-essential metals will have greater cognitive decline than those with lower concentrations of non-essential metals. Initial results suggest non-essential blood metal levels are not sociodemographically patterned in SALSA participants. Higher lead and mercury concentrations was associated with cognitive decline.
THE END OF PACE: OPPORTUNITY FOR ADVOCACY AND EDUCATION
Authors: O'Barr Gregory , Bonazinga Lindsay , Carey Rebecca , Brosius Tracy , Alexander Anne , Dabrowski Barbara
Published: December 2022

The Program for All-Inclusive Care for the Elderly (PACE) is a Medicare/Medicaid Managed Care benefit for frail older adults age 55 years or older who, although certified by the state as long-term care (LTC) eligible, choose to live independently in the community. PACE features comprehensive medical and social services coordinated by an interdisciplinary team whose goal is to promote independence. Cheyenne Regional Medical Center has served as Wyoming’s only PACE site since 2007. However, an effort to reduce Medicaid expenditures resulted in elimination of funding and closure of the program by the state. The purpose of this study was to examine the impacts of PACE closure on transition to LTC, concomitant Medicaid expenditures, as well as impacts on participant well-being. Results showed, as expected, that nursing home placement exceeded that projected, thereby increasing Medicaid expenditures in Wyoming. Additional impacts on participant well-being and advocacy benefits of GWEP partnership are discussed.
THE ROLE OF SOCIABILITY IN OLDER ADULTS' ADAPTATION TO COVID-19
Authors: Fiori Katherine , Rauer Amy , Marini Christina , So Christine , Khan Amna
Published: December 2022

Some older adults may be particularly sensitive to the negative effects of social disruptions due to COVID-19 (Tyrrell & Williams, 2020). For example, the unique circumstances of the pandemic may have made greater sociability a liability (Wijngaards et al., 2020). The current study used a community sample of 136 older adults (M age = 67.77, range 50-91; 69.3% females; 93% White) to explore whether sociability moderated links between disruptions to contact with friends and family and indicators of mental health. Using a series of hierarchical linear regressions, we found that sociability moderated the association between disruptions in family interactions and depressive symptoms. For more sociable individuals, disruptions in family interactions were more strongly positively associated with depressive symptoms. Given the potential for future social disruptions due to COVID-19, our findings point to the importance of considering the role of sociability in developing interventions targeting older adults.
“IT'S GOING TO BE A NEW NORMAL”: OLDER ADULTS' FUTURE PERCEPTIONS DURING COVID-19
Authors: Van Vleet Bryce , Fuller Heather , Hofmann Brittany , Huseth-Zosel Andrea
Published: December 2022

This study explores older adults’ perceptions of the future related to COVID-19. Participants (N=76) of a larger study aged 70-97 were asked four times throughout the first year of the pandemic when they thought life would return to normal. Their open-ended responses were coded, and themes were identified at each timepoint. A resilient future perspective was identified at each timepoint; themes of a negative or unstable view of the future emerged over time. Additionally, responses were quantified into a 5-point scale for perceived timescale of a return to normal (5 = very long time) and attitude towards the future (5 = very positive). Repeated measures ANOVA revealed that perceived time to normal increased between the beginning and six months into the pandemic, then decreased by 12 months. Attitudes towards the future became more positive over time. These findings indicated that older adults were largely resilient, if uncertain, about the future.
“COUNT YOUR AGE BY FRIENDS, NOT BY YEARS”: AN INTERPERSONAL PERSPECTIVE ON SUBJECTIVE VIEWS OF AGING
Authors: Shrira Amit , Bergman Yoav , Kornadt Anna
Published: December 2022

Humans are social beings, and as we age, meaningful and close relationships become increasingly important. However, the literature on older adults’ subjective views of aging (VoA) tends to focus on the link between such views and health outcomes, overlooking important interpersonal correlates. This symposium consists of four presentations that focus on various concepts, study designs, and populations, and offers novel insights regarding how VoA operate in the social domain. The first presentation (Bergman et al.) establishes, using a diary study, the mediating role of understanding others’ emotional states (i.e., Theory of Mind) in the connection between VoA and positive social relationships. The second presentation (Mejía & Hooker) examines, through daily assessment, how VoA differentiate the processes by which older adults construct interactions with their closest social partners to progress toward health goals in daily life. The third presentation (Neupert & Can) employs a diary study and demonstrates that daily fluctuations in both subjective age and ageist attitudes are important determinants for older adults’ well-being. The fourth presentation (Shrira), a clinical study, focuses on how orthopedic patients’ rehabilitation is affected by their own and their healthcare professionals’ VoA. Together, the findings highlight the relevance of VoA to interpersonal functioning and health, and offer valuable information for both researchers and clinicians regarding the importance of this direction in future explorations of older adults’ VoA and physical/psychological well-being.
DAILY EMOTIONAL AND PHYSICAL WELL-BEING PREDICTED BY PERSONAL AND OTHER VIEWS OF AGING
Authors: Neupert Shevaun , Can Reyyan
Published: December 2022

Individual differences in personal views of aging and how older adults perceive others contribute to health. We examined these relationships as they unfold within persons over time. A 14-day daily diary study of 428 participants aged 50-85 (M = 63.51) assessed subjective age (how old one feels), ageism, negative affect, and physical health each day. Increases in daily subjective age corresponded to increases in negative affect, but there was no effect of daily ageism. In contrast, increases in daily subjective age and daily ageism were each uniquely associated with increases in daily physical health problems. Further, these views of aging interacted; daily increases in ageism were especially detrimental to physical health when accompanied by increases in subjective age. These results suggest that daily fluctuations in personal views of aging are important for emotional and physical well-being, whereas personal views as well as perceptions of others work together for physical well-being.
HEALTHY AGING DURING THE PANDEMIC AND BEYOND: LESSONS FROM FIVE YEARS OF THE NATIONAL POLL ON HEALTHY AGING AND AARP
Authors: Solway Erica , Keenan Teresa , Lindberg Brian
Published: December 2022

The past five years have brought enormous changes in the lives of older adults and their families. During this time the University of Michigan National Poll on Healthy Aging (NPHA), co-sponsored by AARP and Michigan Medicine, has gathered the experiences and perspectives from nationally representative samples of US adults age 50-80 on a range of topics related to healthy aging. These polls have been used to elevate the voices of the older adults in the development of policies and practices to improve the health of people as they age. During the past two years, poll reports have captured how changes in lifestyle and behaviors during the COVID-19 pandemic have impacted the health and well-being of older adults. Members of the NPHA team from the University of Michigan and AARP will begin with an overview of the poll including its goals and methods. The session will then highlight key findings from the first five years of the NPHA that have important implications during and beyond the COVID-19 pandemic, with special attention to poll findings related to joys and stresses and aging in place. The presenters will also discuss how to access publicly available NPHA data. The session will wrap up with a discussion of how the perspectives and experiences of older adults gathered through the NPHA and AARP polling can be used to inform policy and advocacy to support healthy aging.
COMPETENCY DEVELOPMENT FOR A PROGRAM TO SUPPORT CAREGIVERS OF OLDER ADULTS WITH DEMENTIA: A MODIFIED E-DELPHI METHOD
Authors: Huggins Madison , Puurveen Gloria , Pesut Barb
Published: December 2022

Nav-CARE is a program that utilizes volunteer navigators to support older adults with life-limiting illnesses who are living in the community. Currently, Nav-CARE is being adapted and expanded to support family and/or friend caregivers of older adults with dementia. In order to begin the process of adapting this program a modified e-Delphi method was utilized. This method consisted of presenting three sequential questionnaires to an expert panel (n=50) of individuals with knowledge of and/or experience in caregiving, dementia, volunteerism and/or navigation. Consensus was established regarding the importance of various caregivers’ needs and the competencies volunteer navigators require in order to meet these needs. This process resulted in a final list of 46 caregivers' needs and 41 volunteer navigator competencies. Two key findings suggest that there is a crucial need for increased access to respite, which influences the caregivers' ability to benefit from additional supports, and that dementia stigma is prominent, which negatively impacts the caregiving experience. Additional findings highlight the need for increased knowledge of dementia among providers, caregivers, and community members, the importance of establishing strong volunteer navigator-caregiver relationships, and the need to balance the agency of older adults living with dementia and their caregivers. Findings from this study informed the development of training curriculum for volunteer navigators, and will be used to guide the ongoing development of the adapted Nav-CARE program.
RESILIENCE IN FAMILY CAREGIVERS OF ASIAN OLDER ADULTS WITH DEMENTIA: AN INTEGRATIVE REVIEW
Authors: Duangjina Thitinan , Gruss Valerie
Published: December 2022

Resilience is the ability to rebound from adversity and the amount of resilience varies depending on the sociocultural contexts. Little is known about resilience in Asian family caregivers of older adults with dementia, although Asian countries show the fastest growth of dementia. An integrative review focused on resilience in Asian family caregivers was guided by Whittemore and Knafl (2005). A systematic search of five databases (CINAHL, EMBASE, PsycINFO, MEDLINE, PubMed) was conducted and limited to English-language empirical studies published between 2016 and 2021. A constant comparison approach was used for the data analysis. A total of 15 studies conducted in nine Asian countries were selected for review. Results revealed Asian family caregivers were most commonly adult children, female, and providing home care. Resilience was impacted by multiple interrelated factors. Two influences emerged from this review including risk factors (burden, stigma, family stress, social stress) and protective factors (positive aspect of caregiving [PAC], religiosity/spirituality, social support). Filial piety, derived from religiosity/spirituality, played a role in both risk and protective factors. Asian caregivers with a deep-rooted belief in filial piety exhibited more depression than US caregivers (d=.21, p <.05), as Asian caregivers restricted their other activities and dedicated themselves to caregiving. Other Asian caregivers who balanced a belief of filial piety experienced a PAC and were resilient. Future interventional research should focus on minimizing risk factors (burden) and maximizing protective factors (PAC and religiosity/spirituality) to promote resilience among Asian family caregivers. A culturally aligned family-centered approach to care should be considered.
TYPOLOGIES OF PARENT-CHILD RELATIONSHIPS AND ASSOCIATED HEALTH OUTCOMES: A CROSS-CULTURAL COMPARISON
Authors: Kong Dexia , Lu Peiyi , Silverstein Merril
Published: December 2022

Background

This study investigates types of parent-child relationships and associated health outcomes among older adults of U.S. and China. Method: Cross-sectional data from Health and Retirement Study in the U.S. and Health and Retirement Longitudinal Study in China were used (N_(U.S.)=3918, N_China=4058). Relationship indicators included co-residence, living nearby, having weekly contacts, receiving assistance with daily activities, providing grandchild care, and having financial transfer from/to children. Latent class and regression analyses were conducted.

Results

Four classes were identified for older Americans, including (1) distant and uninvolved (6.58%); (2) geographically proximate with frequent contacts and downward support (47.04%); (3) co-resident with frequent contacts and upward support (13.1%); and (4) geographically proximate with frequent contacts (33.28%). By contrast, three classes were identified among older Chinese, including (1) co-resident with frequent contacts and upward support (37.46%); (2) coresident/interdependent (25.65%); (3) geographically proximate with frequent contacts and upward financial support (36.89%). For both countries, providing downward support was associated with fewer functional limitations and better cognitive function. Receiving instrumental support from children was associated with more depressive symptoms and functional limitations, and poorer cognitive function among Chinese older adults only.

Conclusions

Cultural contrasts were evident in parent-adult child relationship types and their associations with health outcomes. Overall, child-parent relationships in China tend to be more tight-knit than that of the U.S. Receiving financial support from children and co-residence are unique features of child-parent relationships in China. Cultural differences in child-parent relationships call for culturally-relevant strategies to address needs of older adults from various cultures.
NURSING HOME STAFF RISK PERCEPTIONS DURING THE COVID-19 PANDEMIC
Authors: Carpenter Joan , Kooiman Nia , Kowalchik Kalei , Mogle Jacqueline , Newman Jasmine , Behrens Liza
Published: December 2022

Nursing home (NH) staffs’ risk perceptions related to NH residents’ health and safety are a barrier to honoring residents’ preferences for care and activities; this was exacerbated during the COVID-19 pandemic. This study intended to describe NH staffs’ self-perceived risk perceptions during the COVID-19 crisis as measured by the validated Risk Propensity Scale. Participants (N=27) included licensed and unlicensed nursing staff (e.g., RN, LPN, CNA), social workers, and activities directors, were mostly female (85%), White (74%), non-Hispanic (93%), and had more than three years of experience working in NHs (78%). Survey results indicated that males considered themselves risk seekers (M=7.5 out of 9) and females risk avoiders (M=4.0). Despite identifying as a risk seeker or risk avoider, the majority of participants agreed with “safety first”, preferred to avoid risk, and viewed risks as “a challenge.” Findings will be discussed considering implications for person-centered risk management during a public health crisis.
PILOT PROGRAM EVALUATION RESULTS OF DEMENTIA FRIENDS FOR INCARCERATED SETTINGS
Authors: Bibbo Jessica , Nicolay Sarah
Published: December 2022

This presentation will present the findings from the pilot sessions. 266 people completed both pre- and post-session surveys (Mage=46.10, SDage=11.47; Female=62.03%; Full time=97.36%). Sixty-five percent knew a person living with dementia (PWD) and 28.57% said they worked with PWD. Four out of the five attitude items (e.g., I am confident interacting with PWD; I am able to recognize behaviors that may be due to dementia) significantly improved (ps<0.001). There was no change in knowledge items (ps≥0.18); Ninety-five percent agreed they would use the information in their work and 95.82% would recommend the session to the people they worked with. Topics participants wanted to learn more about focused on communication with and activities for PWD in an incarcerated setting, learning more about dementia, adjusting the physical environment for PWD, and ensuring proper diet. Further, participants felt the session should be required for all ODRC staff.
DYING WELL WITH DEMENTIA: SUPPORT NEEDS AND DIVERSITY ACROSS CULTURES AND SETTINGS
Authors: van der Steen Jenny
Published: December 2022

Dementia is increasingly recognized as a terminal illness but the end of life may comprise an extended period with death difficult to predict. Progressive cognitive impairment negatively affects autonomy. Family caregivers of people with dementia often fulfil important roles as spokespersons, informants, partners in care and proxy decision-makers. However, across cultures and individuals, values around autonomy, being in control, and family involvement are diverse. Therefore, perspectives on end of life with dementia and what is good care during the last phase of life may vary as well. Understanding and measuring good end-of-life care in dementia can help improve person and family centered caregiving at the end of life. This symposium will give insights into what is good end-of-life care in dementia and will show cultural and contextual differences drawing on studies in various countries. The contributions are based on diverse innovative and classical qualitative and quantitative methods including those engaging patient and public. Further work addresses how to support good end-of-life care during the COVID-19 pandemic, given the limitations of family restrictions and the need to provide care virtually. We present research on decision aids, care planning tools and care programs with a focus on ensuring that the perspectives of the person with dementia and family are at the forefront, and address individual differences in perceptions of a good end of life with dementia.
PREVALENCE OF SENSORY IMPAIRMENTS VARY BY RACE IN OLDER US ADULTS
Authors: Arshad Faaizah , Pinto Jayant , Yaffe Kristine , Brenowitz Willa
Published: December 2022

Few studies have examined racial/ethnic disparities in sensory function. We studied 3,005 US adults (aged 57-85, mean 69.3 years); 10% Hispanic, 17% Black, 71% White; National Social Life, Health, and Aging Project). Impairment was defined by established criteria for objectively measured vision, smell, taste, touch and interviewer-rated hearing. Vision (22%), hearing (19%), smell (23%), taste (15%), and touch (19%) loss were common. Hispanic and Blacks showed the highest prevalence of vision, smell, and touch dysfunction. Findings persisted after adjustment for age, sex, education, and cardiometabolic conditions. Blacks had higher odds of impaired vision (adjusted Odds Ratio [aOR]:1.61; 95%CI:1.12, 2.32), smell (aOR:2.64; 95%CI:1.81, 3.84)) and touch (aOR:1.81; 95%CI:1.23, 2.64)) compared to Whites. Hispanics had higher odds of impaired smell than Whites (aOR:2.33; 95%CI:1.47, 3.67). Racial/ethnic minorities face marked disparities in function of the classical senses. Understanding how these differences arise, including potential systemic/social mechanisms, may catalyze interventions that promote health equity.
ADVANCING HEARING HEALTH EQUITY FOR OLDER ADULTS: FINDINGS FROM THE HEARS RCT
Authors: Nieman Carrie , Betz Joshua , Morales Emmanuel Garcia , Suen Jonathan , Marrone Nicole , Han Hae-Ra , Szanton Sarah , Lin Frank
Published: December 2022

Hearing loss is highly prevalent but disparities exist in hearing care. Delivering care in partnership with community health workers (CHWs) is an established approach to addressing disparities but has not been robustly studied in hearing care. We recruited older adults with hearing loss from community sites in Baltimore, MD. The 2-hour intervention consists of fitting a low-cost amplification device and counseling.151 participants were randomized. The primary outcome was change in communication function (Hearing Handicap Inventory for the Elderly-Screening [HHIE-S]; range 0-40; higher scores indicate poorer function). Communication function significantly improved in the intervention group, with an intention to treat estimated average treatment effect of a -12.98 point change (95% CI: -15.52, -10.42). In the first randomized control trial of a CHW-delivered hearing care intervention for older adults using low-cost amplification devices, participants receiving the intervention demonstrated a treatment effect comparable to prior studies of conventional hearing aids fit by audiologists.
LINKS BETWEEN SOCIAL CONNECTEDNESS AND COGNITIVE HEALTH OPERATE THROUGH SOCIAL STIMULATION AND COGNITIVE RESERVE
Authors: Peng Siyun , Singh Anmoldeep , Manchella Mohit , Perry Brea
Published: December 2022

The link between social connectedness and dementia risk and resilience has been examined using a diverse set of measures. Though different measures of connectedness reflect distinct social processes and underlying mechanisms (e.g., stress buffering, cognitive stimulation), few studies have compared them. Using data from two social network studies of older adults (N=283), we compare associations between 29 measures of social connectedness and general cognitive function (MoCA), and non-verbal (Rey) and episodic memory (Craft). Measures of social participation (e.g., volunteering, working, attending church) and social support were unassociated with cognitive outcomes, net of controls. Quality of friendships (p<.05), family relationships (p<.01), and marriage (p<.05) were sporadically associated. Measures indicating large, diverse, and expansive networks were strongly and consistently related to all cognitive outcomes (e.g., number of phone contacts [p<.001], network size [p<.001], density [p<.001], racial homophily [p<.05], age heterogeneity [p<0.01], and diversity [p<.001]). We discuss implications for theories of cognitive reserve.
SOCIAL COGNITIVE DEFICITS RELATE TO KEY ASPECTS OF OLDER ADULTS' SOCIAL NETWORKS
Authors: Krendl Anne , Perry Brea
Published: December 2022

Social connectedness confers benefits to older adults’ cognition, including slowing the progression of Alzheimer’s disease (AD). Social connectedness is facilitated by social cognitive function – how people understand, store, and apply information about others – which declines over the lifespan. We examined whether two core social cognitive skills – face memory and theory of mind (the ability to infer others’ mental states) – predicted older adults’ social network structure and composition. Cognitively normal older adults (OA; N=119) and OA with mild cognitive impairment (MCI) or AD (N=96) completed a social network interview, a face memory task, and a theory of mind measure. Social cognitive deficits were highest among OA with MCI and AD. Face memory predicted network size, whereas theory of mind predicted network composition. Neuroimaging results describing OA’s social cognitive deficits are also discussed. Social cognitive function may be an important intervention target for preserving older adults’ social connectedness.
NARRATIVE AS A BOUNDARY CONCEPT IN GERONTOLOGY: THE STORY BEHIND THE STORIES
Authors: de Medeiros Kate , O'Neill Desmond
Published: December 2022

Ever since the “narrative turn” was taken up by the humanities and social sciences in the 1980s and early 1990s, there has been an increased interest in narrative as a medium for gaining knowledge in gerontology. Narrative gerontology in particular assumes that the "life lived is inseparable from the life told" (Bruner 1987). Central to this notion is the metaphor of life as story or, as Kenyon and Randall put it, "[W]e not only have stories, we are stories" (1999). As a boundary concept, “narrative” inhabits several disciplinary worlds. Its analysis can focus on individual identification strategies, on the storytelling process and its context, or on aesthetic dimensions, for instance when analyzing cultural representations including film and fiction. Often loosely defined yet broadly applied, narrative work can range from personal life stories to master narratives that convey cultural and/or political values. The purpose of the Humanities and Arts symposium is to take a critical look at "narrative" within gerontology to include mapping the uses of narrative as actions, objects, ways of knowing and acts of resistance. The first paper presents a conceptual structure of narrative based on findings from a guided review of narrative definitions and approaches in gerontology. The second argues for the normative importance in studying cultural narratives of dementia. The third paper examines narrative in the context of the medical humanities and narrative medicine, pointing to ways in which narrative competence translates into medical practice. The final paper considers the narrative of aging through music.
THE NEW AGING: HOW DIFFERENT ASPECTS OF AGING HAVE CHANGED OVER HALF A CENTURY. THE H70 STUDIES WITHIN NEAR
Authors: Skoog Ingmar , Sterner Therese Rydberg
Published: December 2022

The number and proportions of older people are increasing world-wide. The Gothenburg H70 Birth Cohort Studies started in 1971 and are still on-going. The studies include representative birth cohorts born 1901-02, 1906-07, 1911-12, 1922, 1923-24, 1930, and 1944 followed longitudinally from age 70 until death. The studies include psychiatric, somatic, audiological, opthalmological, psychological, social, genetic, dietary, functional, and psychometric examinations, personality, collection of blood, plasma, serum, and cerebrospinal fluid, and examinations with MRI. During the study period, cognitive and physical functions, and hearing, has improved considerably, the prevalence and incidence of dementia has decreased, the prevalence of depression and psychotic disorders has decreased, and sexual activity and alcohol consumption has increased considerably. Even personality has changed. Present older people are less neurotic and more extrovert. Our study shows that aging is a changing concept, and that previous knowledge needs to be continuously updated, as new generations reach old age.
NOVEL INTERVENTIONS AND TARGETS FOR THE PREVENTION OF DEMENTIA AND FRAILTY: 2021 EDITOR’S CHOICE ARTICLES FROM JGMS
Authors: Lipsitz Lewis , Windham Beverly Gwen
Published: December 2022

This symposium will present four 2021 “Editor’s Choice” articles from the Journal of Gerontology Medical Sciences that focus on novel interventions and targets for the prevention of dementia and frailty. Jeffrey Scherrer and colleagues, in their article “Lower Risk for Dementia Following Adult Tetanus, Diphtheria, and Pertussis (Tdap) Vaccination,” examine the links between adult vaccinations and decreased dementia risk. Katharine Brewster, Justin Golub (presenter), and colleagues, in “Age-Related Hearing Loss, Late-Life Depression, and Risk for Incident Dementia in Older Adults,” investigate hearing loss and depression as independent risk factors for eventual conversion to dementia. By understanding these potentially reversible mechanisms for dementia, targets for early interventions could be identified. “Association Between Long-Term Aspirin Use and Frailty in Men: The Physicians’ Health Study,” written by Ariela Orkaby and colleagues, examines the association between long-term aspirin use and frailty, furthering our understanding of the benefits of anti-inflammatory medications even in older adults. Kristen George and coauthors, in their article, “Impact of Cardiovascular Risk Factors in Adolescence, Young Adulthood, and Midlife on Late-Life Cognition: Study of Healthy Aging in African Americans,” examine how cardiovascular risk factors early in life may affect late life cognition in Black Americans. Beverly Gwen Windham, the discussant, will highlight commonalities and lessons learned from these studies.
ASSOCIATION BETWEEN LONG-TERM ASPIRIN USE AND FRAILTY IN MEN: THE PHYSICIANS' HEALTH STUDY
Authors: Orkaby Ariela , Yang Laiji , Dufour Alyssa , Travison Thomas , Sesso Howard , Driver Jane , Djousse Luc , Gaziano J
Published: December 2022

The role of anti-inflammatory medications such as aspirin to prevent frailty is unknown. We studied 12,101 men ≥60 years who participated in the Physicians' Health Study I, a completed aspirin trial. Annual questionnaires collected data on aspirin use, lifestyle, and clinical variables. Average aspirin use was dichotomized: ≤60 vs >60 days/year. Frailty was assessed using a 33-item index. Propensity score methods addressed confounding by indication. Logistic regression models estimated odds of frailty as a function of categories of average aspirin use. Mean age was 71 years. Following an average of 11 years of follow-up, 15% reported aspirin use ≤60 days/year; 20% were frail. The OR (95%CI) for frailty was 0.85 (0.76-0.96) for average aspirin use >60 days/year vs ≤60 days/year. Results were similar using an alternate definition of frailty. Long-term regular aspirin use is inversely associated with frailty among older men, even after consideration of multi-morbidity and health behaviors.
OPPORTUNITIES AND CHALLENGES OF INNOVATIVE QUALITATIVE RESEARCH METHODS
Authors: Heinz Melinda , Kleszynski Keith
Published: December 2022

Using new qualitative methods can be exciting and add value to the field. However, Institutional Review Boards (IRB) approval can be a challenge if the methods are relatively new. This symposium provides an overview of 1) how several new methodologies have been used 2) IRB approval challenges and resolutions and 3) how varied disciplines can work together to understand phenomena. The first presentation explains how older adults used photographs to document meaning/purpose in their lives. IRB expressed concerns over identifying information in photographs. Discussion of how interdisciplinary collaborations create opportunities for diverse data dissemination will be included. The second presentation focuses on intersectionality and the benefits/challenges to understanding socially constructed identities. Discussion explains how to implement this methodology, including how category complexity creates additional possibilities for data analysis but also difficulties with narrowing down approaches. In the third presentation, examples of how to conduct co-research, such as photovoice with older adults will be reviewed, including best practices. Smartphones offer extensive possibilities for co-research; but developing IRB protocols to address concerns are needed. The fourth presentation outlines digital storytelling between older adults and university students. An explanation of how digital storytelling is connected to the narrative method and critical gerontology framework will be addressed. Advantages and pitfalls of digital storytelling with also be discussed. The last presentation focuses on using reminiscence with older migrant workers who have dementia, using a decolonial framework. The project seeks to improve participatory action research, with increased focus on “hearing” participants.
PLACE AND MEANING OF HOME: RESEARCH IN A VIRTUAL, PHOTOVOICE LENS
Authors: Weil Joyce
Published: December 2022

Photovoice is built upon the principle of empowerment. With the increased use of Smartphones, photovoice provides a more readily available qualitative option for co-research with older adults. This presentation provides examples from the current study illustrating the process of creating a project that uses photovoice to see how older adults construct the meaning of home and place. While the benefits of this design are many, some issues do arise during implementation, such as: creating study protocols to address Institutional Review Board (IRB) concerns; working with organizations to ensure that the design is truly co-created; and navigating and conducting photovoice in a completely virtual arena. Examples will also be drawn from technical training received as part of LeadingAge LTSS Center @UMass Boston and Collective Insight’s Aging Centered Outcomes Research Learning Collaborative, as well as the Healthier Black Elders Center, which is affiliated with the University of Michigan and Wayne State University.
ACCEPTABILITY OF A VIDEOCONFERENCE-BASED MULTICOMPONENT EXERCISE PROGRAM (VIVIFRAIL) FOR THE OLDEST-OLD
Authors: Tiecker Ana , Bos Angelo Jose
Published: December 2022

Introduction

Previous studies have shown the effectiveness of supervised multicomponent exercise programs on counteract age-related changes in functional capacity and quality of life in the oldest-old. During the quarantine imposed by COVID-19 pandemic, social isolation has been a barrier to implement face-to face exercise programs. Objective: To study the acceptance and adequacy of an exercise protocol in oldest-old. Methodology: Quasi-experimental study with initial, intermediate and post-intervention evaluation. The functional capacity assessment was carried out by the Vivifrail test (Short Physical Performance Battery and 4 falls risk assessment tests), by videoconference at the three moments of the project. For twelve weeks, the older adults performed multicomponent ViviFrail exercises with monitoring and acceptance assessment (with a maximum score of 24 points) by weekly contact by videoconference.

Results

This study concluded 14 oldest-old (89.07 ± 6.30 years). In the 12 weeks, the participants showed an average increase of 4.2 points in acceptance, with a significant correlation (p < 0.001). It was possible to observe an improvement in the functional capacity of the oldest old, although not significant, with a decrease in the time to perform the Time Up and Go tests, sit and stand, and in walking time, which is the most evident change.

Conclusions

This study demonstrated that a home training program with weekly monitoring by videoconference was well accepted and suitable for oldest-old people in a period of social isolation imposed by COVID-19. In addition, it proved to be an effective intervention for maintaining and improving the functional capacity of oldest-old people.
POLICY ATTENTION NEEDED TO IMPROVE DIRECT CARE WORKER WAGES AND OTHER CHALLENGES
Authors: Tyler Denise , Stone Robyn
Published: December 2022

Direct care workers (DCWs), including nursing assistants, home health aides, and personal care assistants, play an essential role in the health and well-being of over 20 million Americans who receive long-term services and supports (LTSS) at home, in nursing facilities, and other settings. In 2020, nearly 4 million DCWs supported older adults and people with disabilities in completing self-care and other daily tasks. Their efforts require considerable technical and interpersonal skills, but these essential workers receive low pay and rarely receive benefits. The COVID-19 pandemic has increased the attention paid to DCWs in the media and among policymakers. This symposium presents the results of three studies conducted by RTI International and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) focused on DCWs. First, we present the results of a study examining how the wages of DCWs compare to the wages of other entry-level workers across all 50 states and report the effect of state policies aimed at improving DCW wages. Second, we report findings from a study exploring the experiences of home care aides during the pandemic as well as the federal and state policies implemented to assist these DCWs during the pandemic. Finally, we present the results of a study that assessed the effect of the COVID-19 pandemic on DCW staffing in nursing facilities. Together these studies suggest that more policy attention is needed to improve direct care work and attract the millions of additional DCWs that are expected to be needed in coming years.
CONTENDING WITH UNCERTAINTY: IMPLEMENTING THE CMS ACUTE HOSPITAL CARE AT HOME WAIVER PROGRAM IN THE UNITED STATES
Authors: Gorbenko Ksenia , Franzosa Emily , Baim-Lance Abigail , Schiller Gabrielle , Wurtz Heather , Masse Sybil , Levine David , Siu Albert
Published: December 2022

As Congress considers renewing the Acute Hospital Care At Home (AHCaH) waiver, which provides a full hospital payment for Hospital at Home (HaH) care, evaluating uncertainty around the future of HaH payment is critical. Our qualitative study explored HaH leaders’ experiences with implementing HaH (N=18, clinical/medical directors, operational and program managers) from 14 new and pre-existing programs across the U.S. We conducted semi-structured interviews with HaH programs diverse by size, urbanicity, and geography. We analyzed transcripts using a thematic approach. Participants across settings and regions wanted greater clarity about the waiver’s future. Lack of clarity affected staffing (nurses reluctant to take temporary jobs) and investment in establishing programs (building EMR components, changing workflows, creating inpatient processes in an outpatient setting). Programs adapted to uncertainty in multiple ways: 1) operating parallel waiver and non-waiver programs; 2) seeking to determine/ calculate the HaH value for their institution; 3) determining which patients would benefit most from HaH; and 4) seeking additional health system financing options beyond the CMS reimbursement (new programs) or relying on existing contracts with payers (existing programs). Implementing HaH is a complex and resource intensive process. Greater clarity from CMS regarding the waiver’s future state will encourage programs to invest the resources that they need to establish their programs long-term. Waiver extension/ permanence would also enable programs to develop and test measures of value, making rigorous evaluations possible to optimize different HaH components.