bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimating Risk of Elder Abuse: Intergenerational Communication/Empathy, Census-Based Assessment
Authors: Wu Heng , Holley Lyn
Published: December 2020

COVID highlights the importance of accurate estimates of the risk of elder abuse to guide prevention. Reliability of data is problematic; reports have issues with consistency of definitions, time periods, and stigma. This paper demonstrates the use of US Census data to estimate risk of elder abuse by mapping generational incongruities between care-givers and care-receivers that invite dissonance (Cohen, 2011). Using the 2014-2018 Nebraska Public Use Microdata and 5-year American Community Survey, this research identifies and profiles personal care aides/nursing aides for institutionalized persons (65+). Data reveal generation gaps in age, education, and race between care-receivers and care-givers that are geographically comparable in the three most populous counties (the Big-3), but different for the 90 rural counties. In Nebraska’s Big-3 Counties the difference in education between care-givers (ages 25+) and care-receivers (65+) is considerable; 42.9% of Big-3 care-givers have some college, while 43.6% of care-receivers have only high school. Intergenerational differences in education are greater in Nebraska’s 90 rural counties than in the Big-3; 41.2% of rural care-givers have some college; 46.1% of rural care-receivers have only high school. Racial intergenerational differences are greater in Big-3 than in rural counties; 90.3% of care-receivers and only 62.3% of care-givers are non-Hispanic White. For rural Nebraskans, intergenerational differences in race are smaller, 97.2% of care-receivers and 79.4% of care-givers are non-Hispanic White. This type of analysis can be used to identify geographic settings where elder abuse is most likely to happen and guide the development of preventive measures that mitigate elder abuse.
Perceived Social Support and Help-seeking among U.S. Chinese Older Adults with Elder Mistreatment
Authors: Chao Ying-Yu , Kong Dexia , Dong XinQi
Published: December 2020

Background/Purpose: Older immigrants are at risk of experiencing marginalization and social exclusion. Traditional Chinese culture values could deeply influence the older Chinese immigrants’ perceptions regarding mistreatment and motivating them to seek help. This study aimed to examine the associations between perceived social support and informal/formal help-seeking intentions and behaviors among U.S. Chinese older adults experiencing elder mistreatment. Methods: Data derived from the Population Study of Chinese Elderly in Chicago (PINE). Independent variables were positive and negative perceived social support. Dependent variables were informal/formal help-seeking intentions and behaviors. Descriptive statistics and logistic regression analyses were performed. Results: A total of 423 participants experienced elder mistreatment (mean age: 72.4 ±7.88 years old). The most common informal help-seeking sources were adult children, followed by partner, and friends/neighbors/colleagues. The most common sources of formal help-seeking were community social services organizations and the legal criminal justice system. After controlling for covariates, positive perceived social support was associated with informal help-seeking intentions (OR=1.14, 95% CI: 1.05-1.24, p < .01) and behaviors (OR=1.12, 95% CI: 1.04-1.22, p < .01). However, the associations between perceived social support and formal help-seeking intentions and behaviors were not significant. Conclusions & Implications: Further research is needed to examine the mediating effects of cultural values on the relationship between perceived social support and help-seeking among mistreated older Chinese immigrants. In addition, additional studies are needed to identify impede or facilitate factors of informal/formal elder mistreatment help-seeking. Prevention and intervention programs should incorporate valuable cultural insight to improve help-seeking among this population.
Asking Young Adults about Their Attitudes toward and Knowledge of Sex in Later Life
Authors: Fratila Iulia , Berdychevsky Liza
Published: December 2020

Sexual expression is a lifelong need related to health and wellbeing. However, older adults’ sexuality is often neglected and stigmatized due to societal ageist stereotypes portraying them as asexual. Although baby boomers’ generation resists such portrayals, societal acceptance of sexuality in later life is slow to materialize. The purpose of this study was to explore this acceptance among young adults while focusing on three research questions: (1) How much do young adults know about older adults’ sexuality and how do they feel about it? (2) Do young adults’ knowledge and views of later-life sexuality vary by gender? (3) Do young adults’ views of later-life sexuality vary based on their general attitudes toward sexuality? Data collection included online and intercept survey methods. The sample (N=270) was young (M=21.58 years, SD=4.32) and included 149 women and 113 men. Results revealed that young adults had medium levels of knowledge, yet rather permissive/open-minded attitudes regarding later-life sexuality. Higher levels of knowledge were unrelated to more permissive attitudes. Independent samples t-test revealed no differences by gender in young adults’ knowledge and attitudes. However, multiple regression results indicated that general liberal attitudes toward sexuality (β=.772, t=17.867, p=.000) and viewing sex as leisure activity (β=.147, t=3.338, p=.001) are significant predictors of having more permissive/open-minded attitudes toward older adults’ sexuality (R2=.557, F(3,266)=111.390, p=.000). These findings suggest that socio-psychological (rather than cognitive and demographic) factors drive the acceptance of later-life sexuality among young adults. This study offers valuable insights for knowledge, practice, and advocacy concerning older adults’ sexuality.
Perceived Everyday Age Discrimination and Depressive Symptoms:The Moderating Effect of Social Environment
Authors: Park Min Kyoung , Mair Christine
Published: December 2020

Approximately 30% of men and women in the United States have experienced age discrimination (Rippon, Zaninotto, & Steptoe, 2015). Experiencing age discrimination may lead to increased risk of depressive symptoms among older adults. Although positive social environments are known to buffer depressive symptoms, it is unknown to what extent a positive social environment may buffer the association between age discrimination and depressive symptoms for older adults in the US. The purpose of this study is to examine the association between perceived age discrimination and depressive symptoms among older adults, and to explore whether this association varies by two aspects of the social environment: social support and neighborhood environment. We explore this topic with data on 5,439 adults aged 50 and older in a sample drawn from the Psychosocial Module of the Health and Retirement Study (HRS, 2016 wave). Our results show a clear association between age discrimination and increased risk of depressive symptoms, net of a range of covariates. Older adults who receive more positive social support and rate their neighborhood environment more positively also report lower depressive symptoms. Finally, we find statistically significant interactions between age discrimination and both measures of the social environment, which suggest that social support and a positive neighborhood environment may buffer the negative impact of age discrimination on depressive symptoms. We discuss these findings in light of the prevalence of age discrimination in the US and cross-nationally, and consider potential mechanisms for improving the social environment of older adults, particularly in the post-COVID era.
How Does Adult Children Migration Effects Older Adults Aging in Place? Community and Individual Level Interventions
Authors: Balaswamy Shantha , Singh Rufus
Published: December 2020

In India, the increasing emigration by adult children for job opportunity and socio-economic betterment has left vulnerable older adults (OA) to age in place. Almost ‘one of out of ten households in Tamil Nadu state has one or more (e) migrants’ (TN Migration Survey 2015), leaving behind OA who traditionally depend on family as a major source of support. There are few studies on impact of immigration of male adult on wife and children who are left behind, but hardly any research on OA who stay behind. This study aims to understand the social, emotional, economic, and health experiences of OA in one of the districts that has the highest rates of out migration. Data was collected using in-person interviews with 304 randomly selected OA whose adult child had migrated to another country. Nearly half of OA live alone (49.7%), have one or more chronic diseases (60%), require support for meeting their ADLs (90%), and half receive no financial support from adult child (50%) contrary to expectations of providing care for OA in this culture. Findings also reveal that persons over the age of 70 exhibit greater coping skills despite lower functional health, smaller social network, and less financial resources. A significant relationship exists between frequency of visits by adult child and reported levels of anxiety and depression. Implication discussions explore solutions at individual, community and policy levels to address vulnerabilities of the older population who are left behind in villages and towns of India due the globalization related mobility.
Not All Home Care is Created Equal: The Relationship Between Sources of Care and Recipients’ Perceived Control
Authors: Wylie Molly
Published: December 2020

Perceived control is an important psychological resource for middle-aged and older adults. Aging in place may help foster feelings of control and autonomy, yet many community-dwelling older adults must rely on others for physical assistance. Little is known about psychological reactions to receiving this support. This study investigated how receiving home care from different sources was associated with two facets of perceived control (mastery and perceived constraints) among adults with varying levels of physical disability. Data was drawn from the 2012 and 2014 waves of the Health and Retirement Study. Community-dwelling adults aged 50 years and older receiving help for at least one activity of daily living (ADL) impairment (N = 884) reported their relationship to each respective caregiver (formal professional and/or informal family or friend), level of ADL impairment, and ratings of perceived control. Ordinary least squares (OLS) regression was used to examine the association between type of support and perceived control and the moderating effect of physical disability on that relationship. Receiving formal or a combination of formal and informal support was related to perceptions of greater control over one’s life, but only in terms of mastery. The level of one’s ADL impairment did not have a moderating effect on the relationship between support type and perceived control. Findings suggested that the type of instrumental support adults receive in their home has implications for specific facets of perceived control. Those receiving formal or mixed support had perceptions of greater mastery than those only receiving informal support.
Racial and Ethnic Differences in Preventive Services Use After the Affordable Care Act’s Enhancement of Medicare Benefits
Authors: Toseef Mohammad Usama , Tarraf Wassim
Published: December 2020

As a consequence of the Affordable Care Act’s enhancements of Medicare benefits, certain recommended clinical preventive services became available to Medicare beneficiaries without cost-sharing. We study the impact of these mandates on racial/ethnic disparities in the use of preventive services among traditional Medicare beneficiaries. We analyze nationally representative data on non-institutionalized Medicare seniors from the 2006-2016 Medical Expenditure Panel Survey (N=27,124). Our preventive services of interest include yearly receipt of cholesterol check, blood pressure test, flu shot, endoscopy, blood stool test, clinical breast examination, mammography and prostate exam. We estimate propensity score weighted difference-in-difference (DID) models to test for differences in preventive services utilization by race/ethnicity. Among traditional Medicare beneficiaries, we do not observe significant change in the use of most preventive services for Blacks and Hispanics compared to their White counterparts. However, Hispanics have significantly increased their use of blood stool tests relative to whites. Overall, we do not find major evidence to support a differential effect of reforms on race/ethnic minorities’ uptake of preventive services following the mandates. Our results suggest that despite an overall benefit trough services expansion and cost-sharing elimination race/ethnic group differences persist. As such, disparities might continue and would require additional interventions. Reduction in disparities is a stated goal of US policy for many decades and achieving equity might require additional work and more varied and targeted interventions.
Demystifying Grief in the Dementia Divide: A Case for Grief Therapy in Dementia Care
Authors: Ione Adrienne
Published: December 2020

The results of emotional and psychological losses overlap with behavioral and psychological symptoms of dementia (BPSD) in the neuronal and structural changes in the brain. The aim of this current study was to explore the magnifying effects of COVID-19 on exacerbating residual losses, illuminating a case for using grief therapy to moderate BPSD. A case control study was conducted with people ages 65 and greater, with an established diagnosis of dementia prior to March 2020. Compared with an active control group - participants without a current dementia diagnosis who self-reported mild cognitive shifts and who also received active grief-informed therapies – offer supporting evidence of a strong factor of efficacy for including grief therapy in services offered to people living with dementia. Evidence of a continued point improvement on both the brief grief questionnaire and inventory of complicated grief, as well as decreased severity of items on NPI-Q corroborate this therapeutic recommendation. Now more than ever – as people across the globe who are diagnosed with dementia face uncertain ramifications of previous grief episodes, ones that have potentially been reignited by the flames of COVID-19 – therapists must foster safe spaces informed by novel therapeutic grief approaches. In any just society, emphasis on therapeutic techniques that allow participants to ventilate their feelings and fears, as well as promote movement along a continuum from isolation to intimacy, must prevail. People exhibiting BPSD should not be excluded from such treatments.
Lifestyle Interventions for Persons with Dementia: Singing your Way Toward Wellness
Authors: McDowell Cynthia , Santana Sebastian , Smith André , Sheets Debra , MacDonald Stuart
Published: December 2020

Arts-based interventions represent an inexpensive, non-pharmacological, and non-invasive approach to help mitigate negative symptoms and improve quality of life for persons with dementia (PwD). The present study examined whether a social singing intervention can modulate patterns of cognitive change and whether select biopsychosocial indicators exhibit concomitant within-person time-varying covariation. Participants with dementia (n=32, mean age=79.6 years; 53% female) engaged weekly in the Voices in Motion project, an intergenerational, social-cognitive choral intervention spanning up to 18 months and 9 individual assessments. The Mini Mental State Examination (MMSE), gait velocity, and positive and negative affect were assessed using an intensive repeated-measures design, with multilevel models of change employed to disaggregate both between- and within-person effects. Across months of the social intervention, several significant within-person time-varying associations were observed; on occasions when a given individual performed one unit faster on gait velocity (p<.05) or one unit lower on negative affect (p<.01), relative to their personal average, there were corresponding improvements in cognitive function. Notably, in contrast, MMSE change remained relatively stable over the course of the 18-month intervention (-0.105, p=0.12), with little between-subject variability in rates of change. These findings imply that, within-persons, reducing comorbidities associated with dementia (e.g., elevated negative affect and its corresponding impact on cognitive resource competition) through participation in a lifestyle intervention may facilitate increases in cognitive, physiological, and psychological function. Implications are discussed with regard to the merits of invoking virtual lifestyle interventions for socially isolated individuals (e.g., PwD and those in residential care).
Age Differences in Executive Control Assessed with a Robotic Object Hit and Avoid Test of Rapid Motor Decision Making
Authors: Watral Alexandra , Trewartha Kevin
Published: December 2020

Motor decision-making processes are required for many standard neuropsychological tasks, including the Trail Making Test (TMT), that aim to assess cognitive functioning in older adults. However, in their standard formats, it is difficult to isolate the relative contributions of sensorimotor and cognitive processes to performance on these neuropsychological tasks. Recently developed clinical tasks use a robotic manipulandum to assess both motor and cognitive aspects of rapid motor decision making in an object hit (OH) and object hit and avoid (OHA) task. We administered the OH and OHA tasks to 77 healthy younger adults and 59 healthy older adults to assess age differences in the motor and cognitive measures of performance. We administered the TMT parts A and B to assess the extent to which OHA performance is associated with executive functioning in particular. The results indicate that after controlling for hand speed, older adults performed worse on the OH and OHA tasks than younger adults, performance declines were far greater in the OHA task, and the global performance measures, which have been associated with cognitive status, were more sensitive to age differences than motor measures of performance. Those global measures of performance were also associated with measures of executive functioning on the TMT task. These findings provide evidence that rapid motor decision making tasks are sensitive to declines in executive control in aging. They also provide a way to isolate cognitive declines from declines in sensorimotor processes that are likely a contributing factor to age differences in neuropsychological test performance.
Age, Sex and Cerebral Microbleed Effects On White Matter Degradation After Traumatic Brain Injury
Authors: Irimia Andrei , Dharani Ammar , Ngo Van , Robles David , Rostowsky Kenneth
Published: December 2020

Mild traumatic brain injury (mTBI) affects white matter (WM) integrity and accelerates neurodegeneration. This study assesses the effects of age, sex, and cerebral microbleed (CMB) load as predictors of WM integrity in 70 subjects aged 18-77 imaged acutely and ~6 months after mTBI using diffusion tensor imaging (DTI). Two-tensor unscented Kalman tractography was used to segment and cluster 73 WM structures and to map changes in their mean fractional anisotropy (FA), a surrogate measure of WM integrity. Dimensionality reduction of mean FA feature vectors was implemented using principal component (PC) analysis, and two prominent PCs were used as responses in a multivariate analysis of covariance. Acutely and chronically, older age was significantly associated with lower FA (F2,65 = 8.7, p < .001, η2 = 0.2; F2,65 = 12.3, p < .001, η2 = 0.3, respectively), notably in the corpus callosum and in dorsolateral temporal structures, confirming older adults’ WM vulnerability to mTBI. Chronically, sex was associated with mean FA (F2,65 = 5.0, p = 0.01, η2 = 0.1), indicating males’ greater susceptibility to WM degradation. Acutely, a significant association was observed between CMB load and mean FA (F2,65 = 5.1, p = 0.009, η2 = 0.1), suggesting that CMBs reflect the acute severity of diffuse axonal injury. Together, these findings indicate that older age, male sex, and CMB load are risk factors for WM degeneration. Future research should examine how sex- and age-mediated WM degradation lead to cognitive decline and connectome degeneration after mTBI.
Neuropsychiatric Symptoms by Cognitive Status for Mexican-Americans Aged 85 and Older
Authors: Vu Lan
Published: December 2020

Older adults with dementia and cognitive impairment often experience neuropsychiatric symptoms (NPS). Few studies have investigated the presence of NPS among older Mexican-American adults. Our objective was to describe the NPS of Mexican-Americans 85 years and older according to cognitive status. Data came from wave 9 (conducted in 2016) of the Hispanic Established Populations for the Epidemiological Study of the Elderly. The final sample consisted of 381 care recipients aged 85 years and older, along with their caregivers. The 12-item Neuropsychiatric Inventory (NPI-12) was administered to measure behavioral and psychiatric symptoms among the care recipients. Cognitive impairment was defined as a score of 18 or less on the Mini Mental Status Exam (MMSE). Care recipients with a diagnosis of dementia as reported by the caregiver were also classified as cognitively impaired. Overall, 259 (68.0%) participants had one or more NPS. Logistic regression models were used to estimate the average marginal effect (range = -1 to 1) of cognitive impairment on NPS, controlling for care-recipient characteristics. Approximately 87% of care recipients with cognitive impairment had at least one NPS compared to 55.8% of those without cognitive impairment (p<0.01). The predicted probability of having one or more NPI symptoms was 0.25 percentage points (95% CI=0.14-0.35) higher for participants with cognitive impairment than those without. NPS are present in the majority of older Mexican American adults, particularly in those with cognitive impairment. Future research could also investigate sociodemographic correlates of NPS.
Older and Younger Adults Reappraise Negative Life Events in Different Ways
Authors: Hamilton Lucas , Allard Eric
Published: December 2020

Past reappraisal studies have been equivocal regarding age and reappraisal efficacy potentially due to the use of laboratory-generated stimuli. We examined reappraisal in a more self-relevant context: negative autobiographical events. 49 younger adults (YA) and 47 older adults (OA) generated 50 negative memories and provided negativity, positivity, and vividness ratings. One to two weeks later, participants underwent the reappraisal task during which physiological data were collected. Participants implemented one of three instructions for 30 seconds: remember naturally, increase negative reactions, or decrease negative reactions via a “positivizing” tactic. Each instruction was provided for 10 unique memories with negativity, positivity, and vividness ratings collected after each trial. 2 (Age; YA, OA) × 3 (Instruction; Remember, Increase, Decrease) mixed ANOVAs uncovered no differences in negativity or vividness ratings before reappraisal. However, OAs rated all memories more positively than YAs. This age difference persisted after reappraisal; however, OAs rated all memories more negatively and vividly than YAs, although both decreased compared to pre-reappraisal levels. Cardiorespiratory data were tested via 2 × 3 mixed ANOVAs, uncovering only a main effect of age on average heart rate. A multilevel model revealed significant variability in the time-course of pupillary responses. 2 × 3 mixed ANOVAs illustrated that reappraisal brought about faster and more frequent spikes in pupil diameter, particularly for OAs. We conclude that OAs and YAs may achieve reappraisal in different ways. Contrary to strict hedonic orientations, OAs simultaneously maintain higher negativity and positivity than YAs challenging existing propositions regarding age-related prioritization of hedonic goals.
Clinical Interventions for HIV-Associated Neurocognitive Disorder (HAND): A Systematic Review
Authors: Mitchell Hannah , Robinson Erin , Donehower Allison
Published: December 2020

Despite the widespread use of antiretroviral therapy, HIV-associated neurocognitive disorder (HAND) continues to be one of the most common central nervous system complications of human immunodeficiency virus type 1 (HIV-1). The severity and prevalence of HAND underscores the need for safe, effective therapies to mitigate or eliminate the impacts of the disorder to improve the quality of life of individuals living with HAND. The current study conducted a systematic review of the literature regarding experimental studies of clinical therapeutic interventions for HAND. An electronic search of four databases (PsycINFO, SCOPUS, Ovid MEDLINE, and CINAHL) initially returned 4,280 articles, 31 of which met the inclusion criteria for this study. Articles were selected for inclusion based on several criteria, including the use of a clinical experimental study design and measurement of neuropsychological performance. A large number of studies were excluded due to utilizing observational or cross-sectional designs, relevance, or for otherwise not meeting inclusion criteria. The results of this review revealed 31 articles that investigated both pharmaceutical and cognitive therapies for HAND. Pharmaceutical interventions range from common antiretroviral therapies to novel drug classes with various mechanisms of action. Importantly, this review revealed a number of limitations present in the greater body of HAND research including inconsistencies among methods of diagnosis of HAND and study design, which ultimately make comparisons across studies difficult. This review presents the current evidence that exists regarding therapies for HAND and broadly discusses trends, limitations, and gaps in the literature.
The BAND Test: Improving Reliability and Balance Testing for People with Neurocognitive Impairments: A Pilot Study
Authors: Hahn Evelyn , Moore Melissa , Neirman Lindsay , Arcadia Stephanie , Krasa Stacy-Jo , Majid Tabassum
Published: December 2020

People with neurocognitive impairments have a higher risk of falls compared to other older adults and require specific cues for evaluation. Additional options for balance testing is necessary to improve reliability and assessment of fall risk. This study established the efficacy of the novel Balance Assessment for Neurocognitive Deficits (BAND) in order to improve measurement of fall risk for people with neurocognitive impairments. The BAND was analyzed for construct validity and reliability through comparison with the Berg Balance Scale (BBS). Older adults with neurocognitive impairments (n=15) in subacute and long-term settings performed BAND and BBS assessments during therapy. Clinicians determined ambulation assistance, fall risk, and time. Calculation of intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC95) values was completed. Corresponding ICC values were 0.985 (95% confidence interval (95% CI), 0.956-0.995) for test-retest reliability and 0.995 (95% CI, 0.985-0.998) for inter-rater reliability. Other values included SEM=0.79 and MDC95=2.18. A linear-regression graph including Pearson’s coefficient (r) demonstrated validity through comparing BAND and BBS and showed a strong correlation (r=0.94, 95% CI, 0.825-0.98). A Bland-Altman plot was created to assess agreement between clinicians, and the mean difference was 0.2667 with 95% limits of agreement (-0.897 to 1.430). The BAND demonstrated excellent reliability and agreement for clinicians providing the test. Further research is necessary to compare the BAND with additional assessments and to demonstrate the utility in expanded populations including the community.
An Assessment of Attendee Experiences With a Workshop to Reframe Aging-Related Communications
Authors: Chesser Stephanie , Porter Michelle
Published: December 2020

In 2018, the Centre on Aging at the University of Manitoba adapted the FrameWorks Institute’s Gaining Momentum toolkit into an interactive workshop that was delivered to aging-related stakeholders (e.g., health professionals, educators, researchers, advocates, older persons) across the province of Manitoba, Canada. The purpose of this study was to complete a qualitative assessment of attendee experiences with the workshop and its impact, if any, on their aging-related communication behaviours. Study participants completed two telephone interviews—one approximately two weeks and one approximately three months post-workshop—about their workshop experiences, motivations for attending, and short and long-term communication goal setting. Through the interviews, most participants expressed positive experiences with the workshop content, as well as an enjoyment of its interactive elements (e.g., self-introduction activity, reframing short and long form aging-related communications, group feedback). Several also shared specific examples of how workshop content was influencing their short/long-term aging communication strategies. Some participants, however, also identified ways that local culture could impact the interpretation of and, thus, potential success of workshop language and/or framing recommendations in specific communities. Overall, the findings from this study suggest that the Gaining Momentum workshop was a valuable experience for attendees that inspired critical assessment of, and changes to, the ways they communicated about aging in their professional and personal lives. Future research is warranted to explore the ways its content could be adapted to better meet the unique communication considerations within the province of Manitoba (e.g., cultural, geographic, and language-related implications).
Virtual Reality Therapy Takes Greenspace to Older Nursing Home Residents: A Pilot Study
Authors: Blankenship Jody
Published: December 2020

Nature-based virtual reality (VR) interventions can offer a safe adjunct approach for managing depression and anxiety, but applications of this innovative technology have not been studied in the nursing home (NH) setting. Pleasant events like those generated with VR may provide a psychological time-out from the ongoing stress associated with living in an NH, and thereby, may facilitate adaptive coping. This study, conducted between January and February of 2020, aimed to pilot test the effects of ViRT-Ta-GO: Virtual Reality Therapy Takes Greenspace to Older NH residents on the severity of depressive and anxiety symptoms among NH residents aged 60 years and older and obtain estimates of effect sizes on outcome measures. Using a quasi-experimental, one-group, pretest-posttest design, nine cognitively intact NH residents (Mage = 81, SD = 10.23) were recruited from two Pennsylvania NHs. The outcome measures included the Patient Health Questionnaire-9, Geriatric Anxiety Inventory, and 10 open-ended questions. Residents participated individually in three 10-minute VR sessions per week for four weeks. There were no adverse effects. Participant attrition and self-report indicated that ViRT-Ta-GO was feasible and acceptable. At posttest, a Wilcoxon signed rank test showed a significant decrease in anxiety symptoms (z = -2.02, p = .04) with a large effect size (r = -.48). Nonsignificant trend improvements in depression were observed (p = .08), pretest to posttest. The 4-week VR intervention was effective in reducing symptoms of anxiety. Preliminary findings demonstrate utility within an NH population, suggesting it will be advantageous to evaluate ViRT-Ta-GO through controlled clinical trials.
Exploration of Barriers and Facilitators for Deprescribing Opioids and Benzodiazepines to Reduce Older Adult Falls
Authors: Roberts Ellen , Henage Cristine , Armistead Lori , Hughes Tamera , Niznik Joshua , Schlusser Courtney , Busby-Whitehead Jan , Ferreri Stefanie
Published: December 2020

As part of a randomized control trial for deprescribing opioids and benzodiazepines (BZD) to reduce falls (funded by Centers for Disease Control), we conducted a virtual focus group and surveys to evaluate opioid and BZD prescribing practices among healthcare providers in four primary care clinics in North Carolina. Survey and focus group questions measured providers’ confidence in their abilities to weigh benefits and harms of opioids and/or BZDs in older adults; determine alternative interventions; create a safe dosing plan; and incorporate patient preferences. A validated pre-intervention survey, adapted from a survey by the Canadian Deprescribing Network, was administered to providers in control and intervention clinics (n=29). Providers expressed high confidence in their abilities to weigh risks and benefits of deprescribing opioids and BZDs, but low confidence in deprescribing under impeding circumstances (e.g. when not the original prescriber or when there is no evidence to inform them). Results were similar across opioids and BZDs. A focus group was conducted among seven providers from the two intervention clinics. Barriers to deprescribing identified included patient resistance, lack of knowledge of deprescribing best practices, and lack of time to discuss deprescribing during regular clinic visits. Providers also expressed concerns about deprescribing medications initiated by or managed by other prescribers. Key facilitators of deprescribing included patient trust in physician, patients being agreeable to reduce medications, and use of gradual tapering rather than abrupt discontinuation. Barriers and facilitators were subsequently used to optimize training and provider resources for the deprescribing intervention, which is currently being implemented.
Investigating Falls and Rehabilitation Use in Older Wheelchair Users from the National Health and Aging Trends Study
Authors: Nie Qiong , Rice Laura , Sosnoff Jacob , Rogers Wendy
Published: December 2020

Falling is a serious health concern among older wheelchair users as falling may result in functional impairment, morbidity, and mortality. Researchers have examined prevention strategies of falls. However, little is known about the prevalence of falls and rehabilitation service use among wheelchair users over age 65. We analyzed a population-based data set – the National Health and Aging Trends Study– to describe trends over time of wheelchair use among older adults who completed a sample interview in this study; we further identified 417 community-dwelling older wheelchair users in wave 5, described prevalence of falls and rehabilitation service use among them and investigated indicators of fall-related rehabilitation service utilization using multinomial logistic regression. The results indicated that there was an increasing trend of wheelchair use from 2011 (7.2%) to 2019 (10.6%). Falling was a common problem (56.1%); however, only 12.1% received rehabilitation service addressing the problem of falls. Around half of rehabilitation service users reported that their functioning improved, but the effect was not lasting. Age (74-79 years old: odds ratio [OR] =2.72, 95% confidence interval [CI], 1.01-7.33; 80-84 years old: OR= 2.93, 95% CI, 1.19-7.25) and balance or coordination problem (OR= 4.70, 95% CI, 1.84-12.06) were associated with receiving fall-related rehabilitation. These data suggest that we need to understand more about the underuse of the rehabilitation services, ensure that older wheelchair users are equally utilizing the services to prevent falling and improve the long-lasting effect of the services.
Dementia Caregivers Perspectives of Caregiving, Burden, Emergencies, and Emergency Preparedness
Authors: Crawford Nicole , Levin Bruce , Amber Gum , Martinez-Tyson Dinorah , Huntington-Symons Makeba , Masys Anthony
Published: December 2020

Limited research has been conducted regarding the perspectives of caregivers of persons with dementia (PWD) regarding preparing for emergencies. The purpose of this study was to understand dementia caregivers’ perceptions of burden, emergencies, and emergency preparedness through the caregiving lens. Fourteen semi-structured interviews were conducted with a purposive sample of dementia caregivers who reside in Hillsborough County, Florida, to gain participants’ perspectives. Data were analyzed using the thematic analysis method. Caregivers discussed emergencies in terms of medical issues, mostly related to the PWD’s health, as well as natural disasters such as hurricanes. Caregivers discussed their perspectives of caregiving and burden as centered around their roles and experiences with the PWD, including ways in which they would deal with emergencies such as natural disasters. Caregivers reported that they were physically prepared for emergencies (i.e., hurricanes) but not mentally prepared for coping with or helping their loved ones cope with the stress of an emergency related event. The interviews presented opportunities to raise awareness of emergency preparedness resources and provide information specific to each caregivers’ situation. The results suggest the caregiver role may be essential to mitigating the adverse effects of emergencies on PWDs. Recommendations for practice include providing person-centered care, individualized emergency planning, and interprofessional collaboration.
Frailty & Depression: Mediators of Fear of Falling and Quality of Life in Older Adults
Authors: McKay Michelle , Whitehouse Christina , Mensinger Janell
Published: December 2020

Fear of falling is a known predictor for decreased health-related quality of life (QoL) in older adults, including among high risk frail community-dwelling older adults with multiple comorbidities including depression. The study aimed to examine the sequential explanatory roles of frailty and depressive symptoms in the relationship between fear of falling (FoF) and QoL in a program for all-inclusive care for the elderly (PACE). This was a retrospective single cohort study that included 84 older adults in a PACE program located in the Northeastern United States. Participants were cognitively intact older adults ≥55 years (M=70.33; SD=6.46). FoF was assessed with the Falls Efficacy Scale-International; frailty was measured with the Edmonton Frail Scale; QoL was measured with the Short Form 12v2 which includes both physical and mental domains. Using the Process Macro (model 6) in SPSS, path models were constructed hypothesizing frailty and depressive symptoms as serial mediators of the relationship between FoF and QoL while controlling for race, gender, age and comorbidities. Frailty and depressive symptoms serially mediated the FoF and mental QoL relationship (Indirect Effect = -0.10; 95% CI= -0.19, -0.03). Serial mediation effects of frailty and depressive symptoms were not replicated for the association between FoF and physical QoL (Indirect Effect = 0.00; 95% CI= -0.04, 0.05). Understanding the roles of frailty and depressive symptoms in explaining the association between FoF and mental health-related QoL can delineate targeted areas for intervention development not typically considered when attempting to reduce the influence of FoF on QoL in older adults.
A Geriatrics Telehealth Curriculum: A Workshop for Medical Students on “Tele-skills” using Standardized Patients
Authors: Wilson Lindsay , Powell Ross , Foster Megan , Vogel Kathleen , Kelley Casey , Henage Cristine , Roberts Ellen , Busby-Whitehead Jan
Published: December 2020

Background: Telemedicine allows for interprofessional care of geriatric patients and allows older adults to access healthcare from their homes. The coronavirus pandemic has prompted a rapid shift to telemedicine. In 2016-2017, only 58% of medical schools in the US offered telemedicine curricula. Thus, a large gap in medical education has emerged. There are specific skills needed to ensure students’ “webside” manner is comparable to their bedside manner.This curriculum was created to train medical students in geriatric-sensitive telemedicine using standardized patients (SP). Methods: A didactic detailing geriatric interviewing preceded the SP encounter. Students were assigned roles for the SP encounter as follows: A) Set agenda, elicit questions, triage problems, perform a history, ensure appropriate lighting and audio B) Perform a geriatric review of systems and reconcile medications C) Present an assessment and plan to the preceptor D) Relay the plan to the SP E) Provide feedback. Students were given pre- and post-surveys to assess their comfort using telemedicine and caring for SP’s >65 years old. Results: Seventeen participants were surveyed (pre-survey=17, post-survey=10). Fifty-nine percent of participants reported no prior experience with telemedicine. Participants reported statistically significant increases in comfort using telemedicine (p=0.022), using telemedicine for patients >65 years old (p<0.001), interviewing patients >65 years old over telemedicine (p=0.007), managing patients over telemedicine (p=0.040), and managing patients >65 years old over telemedicine (p=0.001) after completing the curriculum. Discussion: This virtual curriculum improved medical student comfort with geriatric care and telemedicine and highlights the need for telemedicine curricula in medical schools.
Is Health Information Exchange Use by Hospitals and Home Health Agencies Associated with Lower Readmission Rates?
Authors: Jones Christine , Thomas Jacob , Roczen Marisa , Ytell Kate , Gritz Mark
Published: December 2020

For older adults transitioning from the hospital to home health agencies (HHAs), clinical information exchange is key for optimal transitional care. Hospital and HHA participation in regional health information exchanges (HIEs) could address fragmented communication and improve patient outcomes. We examined differences in characteristics and outcomes for patients with either Medicare or Medicare Advantage (MA) insurance who transitioned from hospitals to HHAs based on HIE participation with 2014-2018 data from the Colorado All Payer Claims Database. We performed analyses including chi square and t tests to compare patient characteristics and 30-day readmission rates for high versus lower HIE use, determined by HIE participation (+) and non-participation (-) among HHAs and hospitals: High HIE use dyads (Hospital+/HHA+) were compared to lower HIE use dyads (Hospital+/HHA-, Hospital-/HHA+, Hospital-/HHA-). We identified 57,998 care transitions from 123 acute care hospitals to 71 HHAs. On average, patients were 75 years old, had a three day hospital length of stay, over half were female (58%), 82% had Medicare and 18% had MA insurance. Although most characteristics were similar between high versus lower HIE use dyads, high HIE use dyads had a higher proportion of Medicare patients compared to the lower HIE use dyads (85% vs 79%, p <0.001). Thirty-day readmissions were 12.4% for care transitions that occurred among high HIE use dyads (n=27,784) compared to 12.8% among lower HIE use dyads (n=32,929, p=0.102). For adults transitioning from hospitals to HHAs among high HIE use dyads, a trend toward lower 30-day readmission rates was identified.
Mindfulness Intervention Benefits Older Adults Receiving Rehabilitation Services in Long Term Care
Authors: Felsted Katarina , Supiano Katherine , Mai Trinh , Muradas Anthony
Published: December 2020

Research literature includes preliminary examination of mindfulness in rehabilitation settings; however, further investigation is warranted. Some of the strongest findings to date are adaptation improvements such as self-efficacy, increased quality of life, and decreased stress. The purpose and aims of this pilot feasibility and acceptability study were to develop, administer, and evaluate a modified mindfulness program for older adults in rehabilitation in long term care, and to measure self-efficacy, quality of life, and perceived stress. Nine residents 65+ were recruited. Inclusion criteria for participants included residents receiving any type of therapy (e.g., physical, occupational, speech), an anticipated length of stay inclusive of the intervention treatment period, and cognitive capacity to participate. A mindfulness intervention was developed by the research team and administered by a CITI trained, qualified mindfulness instructor. As this is a pilot study, no control group was used. This study proved both feasible and acceptable. All eligible participants consented; both attendance and retention percentages were above the 75% standard (78% and 89%, respectively), and the Meaningful Activities Scale rating=82.4, indicating strong acceptability. Statistical results values for the Health-Related Quality of Life (V=153, p< 0.001), Bandura’s Self Efficacy Questionnaire (V=153, p< 0.001), and Cohen’s Perceived Stress Scale (V=152, p< 0.001) were all statistically significant. These preliminary research findings will inform a larger pragmatic trial testing preliminary effectiveness of the intervention in this population in quality of life, self-efficacy and stress reduction. While this study began prior to the COVID-19 pandemic, its findings are now even more relevant to gerontology.
Explorations of Alaska Native Urban Eldership
Authors: Kim Steffi
Published: December 2020

Successful aging in Alaska Native people or “Eldership” is a state that is embedded within a cultural, relational, and generational context (Boyd, 2018; Lewis, 2011; Wexler, 2014). Eldership has been described as a developing and nuanced personal quality shaped by individual, relational, and contextual influences (Kim, 2020). Within the cultural and traditional understanding of Alaska Native people, the concept of Eldership is analogous to the Western concept of successful aging. With increasing numbers of outmigration from rural community members (Driscoll et al., 2010), this study investigated the impact of relocation from a rural traditional community to an urban Western community and its effect on the Elder’s perception of “Eldership.” This study considered the broader impact of the multi-systemic and socio-ecological context of minority and majority culture, dominant culture, and its implications for successful aging and identity (Grandbois & Sanders, 2009; Kirmayer et al., 2011). Gee’s discourse analysis was used for the systematic interpretative study of 25 Elder interviews regarding their use of language describing their lived experiences, including three identified discursive patterns: cultural discourse, psychological discourse, and Elder identity discourse. Based on the study findings, Elders’ experiences are impacted by socio-economical and cultural differences encountered during relocation shifting the cultural frame of Alaska Native “Eldership” according to rural or urban contexts.