bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Affecting the Sustainment, Sustainability, and Spread of Practice Changes in Canadian Long-Term Care Homes
Authors: MacEachern Lauren , Song Yuting , Ginsburg Liane , Doupe Malcolm , Wagg Adrian , Spiers Jude , Berta Whitney
Published: December 2021

Our understanding of the post-implementation sustainment, sustainability, and spread (SSS) of complex quality improvement interventions is limited. We explored factors that influenced the SSS of a care aide-led quality improvement initiative (Safer Care for Older Persons (in residential) Environments [SCOPE]) implemented in 6 Manitoba long-term care homes two years after the conclusion of SCOPE in 2017. We analyzed small group interview data collected from all unit- and facility-level managers who participated in SCOPE and were still working in these facilities. We asked about SCOPE implementation, post-SCOPE quality improvement activities, factors that influenced them, and about inter-unit spread of SCOPE following the project’s conclusion. The interviews were audio-recorded, transcribed verbatim, de-identified, and analyzed using thematic analysis. Five of the 6 facilities reported sustained SCOPE quality improvement activities, tools, and facilitative structures. In the same 5 facilities, SCOPE benefits (e.g., increases in care aide empowerment and self-efficacy, manager belief in care aide capacity) continued post-implementation. Spread beyond the original SCOPE units had occurred in 3 facilities. Factors that influenced the SSS of SCOPE were related to the team (e.g., care aides' quality improvement capacity), to the unit and facility (e.g., culture of innovation and change), and to the long-term care system (e.g., competing imperatives). Some factors influencing SSS differ from factors known to influence implementation. The identified factors affecting SSS highlight the influence of social dynamics (i.e., interactions, communication, relationships) among staff on SSS. Further research is warranted to explore interactions among these influencing factors and how they lead to SSS.
Does Bridge Employment Mitigate or Exacerbate Inequalities Later in Life?
Authors: Cahill Kevin , Giandrea Michael , Quinn Joseph , Sacco Lawrence , Platts Loretta
Published: December 2021

This paper explores how gradual retirement impacts inequality later in life, with a focus on transitions from career to bridge employment. We use 26 years of longitudinal data from the Health and Retirement Study to document the various pathways that older Americans take when exiting the labor force, and examine how bridge employment impacts non-housing wealth and total wealth, including the present discounted value of Social Security benefits. We find that gradual retirement in the form of bridge employment neither exacerbates nor mitigates wealth inequalities among Americans who held career jobs later in life. We do find evidence that wealth inequalities grow among the subset of older career workers who transition from career employment to bridge employer at older ages. These findings provide quantitative evidence that bridge employment at older ages is taken by those who need to continue working financially and those who continue working for nonpecuniary reasons.
Presidential Symposium: Stories of Struggle and Resilience: Expert Interdisciplinary Reflections of the Past Year
Authors: Waldron Danielle , Johnson Kalisha Bonds
Published: December 2021

Are you an ESPO member curious about what the “new normal” means for your future career in the field of aging? Or are you a GSA member interested in hearing from your colleagues about their experiences over the past year? Welcome to the ESPO Presidential Symposium! During this session, speakers will share honest and candid insights about their careers in the field of aging amidst the pandemic, racial discrimination/social unrest, and economic insecurity. Speakers in the ESPO Presidential symposium include: Dr. Thomas K.M Cudjoe, Dr. Candace S. Brown, and Dr. Marnin J. Heisel. Dr. Cudjoe, a physician, will discuss his clinical experience treating older adults with COVID-19, the shift to tele-health, and his research on the impact of social isolation on older adults. Dr. Brown, an academician, will discuss how the new attention to the longstanding issues of social injustice in the U.S. shaped her teaching pedagogy, research, student mentorship, and provide critical context regarding the impact of COVID-19 on Black and Indigenous People of Color (BIPOC) professors. Dr. Heisel, a clinical psychologist, will share how his intervention research on resiliency and well-being in older adulthood shifted amidst the “new normal,” as well as how older adults in his clinical practice encountered and coped with difficulties over this past year. As our society confronts social injustice, tackles health implications of COVID-19, and adjusts to a new way of life, we must consider how these factors, together, inform the interdisciplinary stories of struggle and resilience in the field of aging.
Peer Mentoring to Foster Resilient Age-Friendly Rural Communities in Maine
Authors: Oh Patricia , Crittenden Jennifer , Lee Laura
Published: December 2021

Maine has a growing number of age-friendly community initiatives (AFCIs); 116 communities are actively working to adapt the social, service, and built environments for aging and 71 have formally joined the AARP Network of Age-Friendly States and Communities. During COVID, rural municipalities were faced with dynamic changes that limited older resident’s access to services and social engagement. To overcome these limitations, it is critical for emergent AFCIs to have tools and strategies to maintain and further enhance healthy environments and resilient communities. This study uses group interviews with 6 leaders of established AFCIs and 6 leaders of emergent AFCIs to explore how the Lifelong Fellows Program, a peer mentoring model that matches experienced leaders with newly formed initiatives, was able to spur development of new strategies to build community resilience. Prominent themes were (1) engaging new local and regional partners; (2) intergenerational volunteerism; (3) fun and flexibility; and (4) relationship-building.
When Does Support to Adult Children Negatively Affect the Subjective Well-Being of Older Japanese?
Authors: Kobayashi Erika
Published: December 2021

Providing time and money to adult children may enhance perceived usefulness and consequently the subjective well-being (SWB) of older parents. However, non-reciprocal relationships with children and conflicts with leisure activities could negatively affect parents’ SWB. It was hypothesized that a substantial amount of support to children would be associated with lower SWB when older parents (a) had a low expectation of receiving long-term care from the children, and (b) were engaged in hobbies/learning activities. Life satisfaction and depressive symptoms measured as SWB were predicted based on the Generalized Estimating Equations, using panel data (2012-2017) with a nationwide representative sample of Japanese adults aged 60 years and older (1,212 parents). Providing child-rearing support (i.e., grandchild care) of 30 hours or more per month was positively associated with SWB regardless of conditions (a) and (b). Hypothesis (b) was partially supported: providing financial support enhanced depressive symptoms among older adults with hobbies/learning.
Who Should Make Care Arrangement for Older Adults? Heteronormative Family Responsibility in Japan
Authors: Hirayama Ryo
Published: December 2021

In Japan, despite the greater availability of public care services upon implementation of national long-term care insurance, families are still considered as primarily responsible to make care arrangement for older adults. My aim in this study was to explore (hetero)normative ideas about families that underlie Japan’s institutionalized practices of elder care. In doing so, I focused on care managers, who are certified care practitioners helping families to make care arrangement, and whether they would count older adults’ same-sex partners as legitimate family members to participate in such arrangement. Data were collected from 1,580 care managers working for officially designated in-home care providers across the nation. Preliminary analysis revealed that although most care managers believed the voices of same-sex partners should be preferably reflected in the process of care arrangement, they also thought that these partners could not participate in such process without permission from older adult’s “blood relatives” (e.g., siblings).
Technology is the New Normal for Individuals Aging-In-Place With Disabilities
Authors: Kadylak Travis , Stark Susy
Published: December 2021

Technology designers often exclude individuals aging with diverse needs, capabilities, and disabilities from engaging in the design process, which can hinder the usability and usefulness of emerging technologies. In this symposium, investigators report on research and development efforts aimed at understanding the needs of, and developing supportive technologies for, people aging with long-term disabilities. This symposium features projects from the Rehabilitation Engineering Research Center on Technologies to Support Aging-in-Place for People with Long-Term Disabilities (RERC TechSAge), which is an interdisciplinary collaboration between Georgia Tech and the University of Illinois at Urbana-Champaign. First, Bayles et al. will discuss findings from the Aging Concerns, Challenges, and Everyday Solution Strategies II study, focused on Deaf older adults’ use of technologies as solution strategies for common everyday challenges. Next, Mitzner et al. will highlight the development of an evidence-based group exercise intervention (Tellewellness Tai Chi for Arthritis) aimed at promoting both physical exercise and social interaction for older adults with long-term mobility disabilities. Kadylak et al. will describe how voice-activated digital assistants can support older adults aging with mobility disabilities by reporting on findings from a longitudinal demonstration project with older adults in assisted and independent living communities. Exploring the potential for smartbathroom technology to promote aging in place, Sanford et al. will discuss how smartbathroom sensor data can be analyzed and vizualized to identify ways to communicate insight from sensor data to improve training of occupational therapy practitioners. Susy Stark from Washington University will serve as the discussant for the symposium.
Access and Barriers to Use of Long Term Services: Contextual Issues
Authors: Glicksman Allen , Ring Lauren , Keating Norah
Published: December 2021

The challenges that some older adults face in accessing both health and social services is a topic of continuing concern. This panel will focus on contextual issues that often shape specific challenges. These contextual issues usually emerge either from issues of diversity among the older persons themselves (for example, minority status or foreign born) and diversity between the ways in which services are offered (usually established at the national or in the case of the United States, at the state level). The intersection of these two forms of diversity often define the specific challenges faced by older persons in accessing health and social services. Further, unexpected events, such as the COVID pandemic, can affect both types of diversity (greater challenges for persons who do not speak the dominant language; inability of services to quickly adapt to radically changed environment). Our panel will address these issues through four presentations, each taking a different look at the ways in which diversity affects access. Our first paper, by Torres, will place this discussion in wider context by presenting results from a scoping review. Our second paper, by Diederich looks at access to services by immigrant generation (that being another source of diversity) in Germany. The third paper, by Thiamwong looks at how the COVID crisis affected older Hispanic women. Finally, Ring will examine how a national policy, here the definition of poverty, affects outcome and access for older person in the United States.
Reframing Aging: A Generation's Work
Authors: D'Antonio Patricia
Published: December 2021

Changing American culture is challenging and changing attitudes and behaviors around the universal experience of aging especially so. Unless the field of advocates who care about aging issues cultivates a more visible, more informed conversation on older people, it will remain difficult to advance the systemic changes needed to adjust to a society with increased and increasing longevity. Advocates will need to be vigilant to avoid cueing negative attitudes towards aging and aging policies. The Reframing Aging Initiative is a long-term, social change endeavor designed to improve the public's understanding of what aging means and the many contributions older people bring to society. Using evidence-based research, the initiative seeks to teach how to tell an effective story about aging that will promote positive perceptions of aging and reduce ageism.
Age Equity: A Framework for Addressing Ageism, Stigma, and Bias
Authors: Goldsen Karen Fredriksen , Emlet Charles
Published: December 2021

In the Covid-19 context, researchers and policy makers have turned their attention to long-standing disparities in health equity, including by race, ethnicity, poverty, sexuality, and gender. Yet, scholarship to date does not conceptualize age as a critical aspect of difference requiring an equity lens. In this presentation, we utilize an Age Equity Framework to investigate ageism based on research findings from the 2018 National Health, Aging and Sexuality/Gender Study (NHAS): Aging with Pride. Investigating ageism, stigma, and bias, we found nearly half of LGBTQ older adults feel invisible and disrespected. After adjusting for background characteristics, experiences of ageism were associated with higher rates of stigma, lifetime victimization, discrimination, lower support and community engagement, and adverse outcomes (lower mental and physical health and quality of life). The rapidly growing older adult population highlights the pressing need to consider age inequities and the importance of achieving age equity across the life course.
Smartwatch Technology for Physical Activity in Older Adults: A Qualitative Study
Authors: Li Mengchi , McPhillips Miranda , Szanton Sarah , Wenzel Jennifer , Li Junxin
Published: December 2021

Older adults’ experiences using smartwatch technology for physical activity (PA) have not been well studied. We studied older adults’ acceptance, capacity, and experience using smartwatches for self-monitoring and promoting PA. We conducted individual interviews using semi-structured interview guides with 15 older adults who participated in two studies. The two studies employed smartwatches in combination with personalized exercise training to promote PA and the interventions were 4 and 24 weeks in length. Interviews were transcribed verbatim. Two researchers conducted inductive content analysis using NVivo V.12 to identify and categorize codes into major themes. Participants reported high overall acceptance, ease of use (i.e., charging, checking steps, reading the screen), and attractive design of smartwatches. Participants’ positive descriptions of their smartwatch experience included: increased activity awareness (step counts and heart rate), improved exercise accountability, and enhanced motivation (response to prompts). Most participants expressed interest in long-term smartwatch use. While participants expressed enjoyment of smartwatch technology for self-monitoring and PA promotion, some reported decreased motivation over time. Participants’ concerns of smartwatch functionalities included short battery life, inaccurate step-recordings, and touchscreen insensitivity. Some also reported failure to troubleshoot smartwatch syncing/pairing problems with smartphones and daily smartwatch charging issues. Smartwatch Bluetooth connectivity and battery life can be improved to increase usability and acceptability among older adults. Future research should explore the role of smartwatches for older adults’ PA with emphasis on behavior change over time.
The AgingPLUS Trial: Intervening to Promote Physical Activity in Middle-Aged and Older Adults
Authors: Rebok George , Roth David , Chung Shang-En (Michelle) , Li Kaigang , Nehrkorn-Bailey Abigail , Thompson Katherine , Diehl Manfred
Published: December 2021

This paper investigated whether the AgingPLUS program promotes physical activity in middle-aged and older adults by examining outcomes at weeks 4 and 8 with baseline scores included as covariates. The analyses assessed intervention effects on negative views of aging (NVOA), physical activity (CHAMPS), physical function (SPPB, VO2max), and accelerometry measures (e.g., minutes sedentary). We found significant intervention effects on NVOA (p < .001) and frequency of moderate intensity exercise (p = 0.048), but no significant effects on physical function, VO2max, or the accelerometry measures. Standardized effect sizes for the significant effects ranged from 0.31 to 1.03 standard deviation units. These findings suggest that AgingPLUS improved motivational factors for engaging in physical activity but did not lead to objective changes in physical activity in the short term. Further research will investigate the mediational role of these motivational factors in enhancing physical activity over the longer term (6 months).
AgingPLUS: Examining the Malleability of Implicit Views of Aging
Authors: Tseng Heidi , Forsyth Garrett , Nehrkorn-Bailey Abigail , Rodriguez Diana , Thompson Kat , Diehl Manfred
Published: December 2021

AgingPLUS also examines whether the intervention can change participants’ implicit VOA. To that end, participants completed a lexical decision-making task (LDMT) and the Brief Implicit Association Test (BIAT) at baseline and post-intervention. One-way ANCOVAs with baseline scores as covariate were used for these analyses. For LDMT, there was no significant difference between the groups regarding their post-intervention latencies for old-positive words, F(1,181) = 0.01, p = .60, old-negative words, F(1,181) = 0.43, p = .51, young-positive words, F(1,181) = 0.19, p = .67, and young-negative words, F(1,181) = 1.16, p = .28. For BIAT, both groups showed a slight preference for the young at baseline (mean d = 0.39), and post-intervention (mean d = 0.38). There was no significant difference between the groups regarding post-intervention d scores, F(1,181) = 0.002, p = .97. These preliminary findings suggest that in the current subsample, AgingPLUS did not significantly change participants’ implicit VOA.
Cognitive Frailty and Its Long-Term Effect on Depression in an Older Population in Korea
Authors: Ji Yoonjung , Lee TaeWha , Kim Eunkyung
Published: December 2021

Cognitive frailty is a condition where physical frailty and mild cognitive impairment (MCI) co-exist without dementia. It occurs in 1.8%-8.9% of the general older population, and older people with depression have a higher risk of frailty. However, the relationship between cognitive frailty and depression is still unclear. This study aimed to determine the relationship between cognitive frailty and depression of older adults by time using comparative group analysis. A secondary analysis was conducted using the Korean Longitudinal Study of Aging (KLoSA) dataset from 2010 to 2018. A sample was 981 older adults who were 65 years old and without dementia over residing in the community. Cognitive frailty was defined as having a mini-mental state examination score of 18-23 and 3 or more of the Fried frailty indexes. Generalized Estimating Equation model and chi-square test were employed. Of the 981 subjects, the cognitive frailty(CF) was 28.5%, followed by robust (37.7%), physical frailty (PF, 29.4%), mild cognitive impairment (MCI, 4.4%) at baseline. The group differences on depression measured by the Center for Epidemiological Studies Depression (CESD) were statistically significant in the PF (F=4.70, p<.001) and the CF (F=4.95, p<.001) group compared to the robust group. The time difference effect (F=.09, p=.05) and a group-by-time interaction effect were observed (p<.001). This study confirmed that cognitive frailty is strongly associated with depression. Effective approaches to managing psychological wellbeing, including dementia, are essential for older adults with cognitive frailty.
Hip Accelerometry Activity Patterns Improve Machine Learning Prediction of 1-Year MoCA Score Change
Authors: Shi Chengjian , Urbanek Jacek , Babiker Niser , Gonzolez Alan , Soto Jovany , Rzhestsky Andrey , Huisingh-Scheetz Megan
Published: December 2021

We tested whether free-living hip accelerometry measures improved prediction of 1-year change in Montreal Cognitive Assessment (MoCA) scores beyond clinically available information. We analyzed data (n=126) from predominantly African American (78.2%) older adults without moderate-severe dementia residing near our geriatrics clinic. Age (73.6 ±6.1 years), gender, education, comorbidities, income, and MoCA performance were collected at baseline; participants then wore a right hip, triaxial Actigraph accelerometer (30Hz) continuously for 7 days. A MoCA was repeated at 1 year. Six measures were calculated from the daytime (7am-5pm) data: mean/variance of hourly counts per minute, mean/variance of daily percent of time spent in the lowest activity quartile, and mean/variance of daily percent of time spent in the highest activity quartile. In a random forest model containing baseline MoCA, demographics and comorbidities, the accelerometry measures improved prediction of 1-year MoCA performance by ~17.8%. Accelerometry data may be clinically useful for predicting early cognitive decline.
Mean Arterial Pressure and Risk of Falls Resulting in Hospital Presentation in Older Adults
Authors: Hussain Sultana Monira , Ernst Michael , Reid Christopher , Tonkin Andrew M , Neumann Johannes , Le Thao Thi Phuong , Barker Anna , McNeil John
Published: December 2021

Utilising data from the ASPirin in Reducing Events in the Elderly trial participants aged 70-years, we estimated MAP and variation in MAP defined as within-individual SD of MAP from baseline and first 2 annual visits. Falls were confined to those involving presentation to a hospital. Cox proportional hazards regression was used to calculate hazard ratio (HR) and 95% confidence interval (CI) for associations with falls. Amongst 16,703 participants (1,540 falls), MAP was not associated with falls irrespective of antihypertensive medication status (all: HR 1.00, 95% CI 0.99-1.01, not on antihypertensive: HR 1.01, 95% CI 0.99, 1.02, on antihypertensive: HR 1.01, 95% CI 0.99-1.02). Amongst 14,818 participants who remained in the study up to year 2 without falls, 1 unit escalation in MAP variability increased the risk (HR 1.01, 95% CI 1.00-1.03). Compared with those in the lowest tercile of variability, those in the middle or highest tercile of variability experienced an increased risk of falling (middle: HR 1.32, 95% CI 1.06-1.65; highest: HR 1.25, 95% CI 1.01-1.55). When stratified for antihypertensive medication status, those receiving diuretics (HR 1.18, 95% CI 1.00-1.39) or beta-blockers (HR 1.37, 95% CI 1.08-1.73) were at increased risk compared to those receiving renin-angiotensin-system acting agents. All results persisted after adjustment for multiple covariates. The association of diuretics and beta-blockers with falls remained significant even after excluding those with history of heart failure. Older community-dwelling adults with high variability in MAP are at increases risk of falls, particularly amongst those receiving beta-blockers or diuretics.
Measurement Disparities in Frailty Among Kidney Transplant Patients: Impact of Differential Item Functioning
Authors: Chu Nadia , Gross Alden , Chen Xiaomeng , Xue Qian-Li , Bandeen-Roche Karen , Segev Dorry , McAdams-DeMarco Mara
Published: December 2021

Frailty is commonly measured for clinical risk stratification during transplant evaluation and is more prevalent among older, non-White kidney transplant (KT) patients. However, group differences may be partially attributable to misclassification resulting from measurement bias (differential item functioning/DIF). We examined the extent that DIF affects estimates of age, sex, and race differences in frailty (physical frailty phenotype/PFP) prevalence among 4,300 candidates and 1,396 recipients. We used Multiple Indicators Multiple Causes with dichotomous indicators to assess uniform DIF in PFP criteria attributable to age (≥65vs.18-64 years), sex, and race (Black vs.White). Among candidates (mean age=55 years), 41% were female, 46% were Black, and 19% were frail. After controlling for mean frailty level, females were more likely to endorse exhaustion (OR=1.20,p=0.003), but less likely to endorse low activity (OR=0.83,p=0.01). Younger candidates were more likely to endorse weight loss (OR=1.30,p=0.005), exhaustion (OR=1.60,p<0.001), and low activity (OR=1.80,p<0.001). Black candidates were more likely to endorse exhaustion (OR=1.25,p<0.001), but less likely to endorse weakness (OR=0.79,p<0.001). Among recipients (mean age=54 years), 40% were female, 39% were Black, and 15% were frail. Younger recipients were more likely to endorse weight loss (OR=1.55,p=0.005) and low activity (OR=1.61,p=0.02); however, no DIF was detected by sex or race. Results highlight the impact of DIF for specific PFP measures by age, sex, and race among candidates, but only by age for recipients. Further research is needed to ascertain whether candidate- and/or recipient-specific thresholds to correct for DIF could improve risk prediction and equitable access to KT for older, female, and Black candidates.
Family Caregiving for Persons With Emotional, Developmental, and Behavioral Disorders During COVID-19
Authors: Beach Scott , Schulz Richard , Donovan Heidi , Rosland Ann-Marie , Klinedinst Tara , Kim Hansol
Published: December 2021

COVID-19 has the potential to exacerbate stresses of family caregiving. While studies during COVID-19 have focused on caregivers of those with memory / cognitive issues like Alzheimer’s Disease, less attention has been paid to those caring for persons with emotional / developmental / behavioral disorders. This paper compares family caregivers of persons with emotional / developmental / behavioral disorders (EDB); physical conditions (PH); and memory / cognitive problems (MC) during the early phase of the pandemic. We focus on demographics, caregiving context, COVID-related caregiver stressors, and validated physical, psychosocial, and financial well-being outcomes. We conducted a cross-sectional national online survey during April-May, 2020 (n = 556). The sample included 274 PH (50%), 141 MC (25%), and 141 EDB (25%) caregivers. EDB caregivers were younger, with younger care recipients who were more likely to be their child. EDB caregivers reported more COVID-related caregiver stressors than MC or PH caregivers, including increased caregiving duties (p<.01); more family disagreements about care provision (p=.05); and worsened mental health of the care recipient (p<.01). In multivariate regression models, EDB caregivers had significantly higher anxiety; depression; and fatigue (all p<.01); more sleep disturbance (p=.05); less social participation (p<.05); and poorer overall financial well-being (p<.05). MC caregivers also reported more negative outcomes, but effects were consistently strongest for EDB caregivers. This study shows that EDB caregivers are at significantly elevated risk for negative impacts due to COVID-19 and should receive increased support and attention during this public health crisis.
Ohio's Large Scale Experiment on Integrated Care: Results and Implications for Long-Term Services Reform
Authors: Applebaum Robert , Nelson Matt , Bowblis John
Published: December 2021

Implemented through five health plans, Ohio’s MyCare demonstration began in 2014 and was designed to coordinate primary, acute care, behavioral health and long-term services in the major urban areas of the state. Individuals who are dually eligible for both Medicaid and Medicare and who reside in specified geographic regions must enroll into a managed MyCare plan. MyCare beneficiaries are assigned to two primary categories: community well and those needing long-term services and supports (LTSS). Individuals receiving the integrated MyCare intervention were expected to have lower acute care hospitalizations, lower long-term nursing home use, better longevity and lower overall health and long-term care costs. Using a propensity score matching design, the evaluation compared MyCare enrollees to comparison group members in non-MyCare counties of the state, using Medicaid and Medicare claims data. The 120,000 MyCare program participants represented about half of the dual eligible individuals in the state.
The Impact of Low Back Pain and Physical Activity on Mental and Physical Health Outcomes in Older Adults With Arthritis
Authors: Taylor Janiece , Regier Natalie , Liu Minhui , Szanton Sarah , Skolasky Richard
Published: December 2021

Nearly 50% of Americans aged 65 and above have been diagnosed with arthritis at any point in time, and an estimated 80% of adults experience low back pain (LBP) at some point in their lives. However, little is known about the experience of LBP in older adults with arthritis and whether or not it is related to adverse mental and physical health outcomes over and above those linked to arthritis. This study examined the relationship between LBP and four associated physical and mental health conditions (depression, insomnia, mobility limitations, and self-rated health) in older adults with arthritis. We also examined whether physical activity mediated the relationships between LBP and these four conditions. A cross-sectional analysis was conducted using data from the National Health and Aging Trends Study. Descriptive analyses and chi-square tests assessed whether there were demographic differences between persons with and without LBP. Binary logistic regressions found that participants with LBP were 30% more likely to endorse insomnia (95% confidence interval (CI) =1.1 to 1.5, p<.001), had 40% higher odds of depression (95% CI=1.1 to 1.6, p<.001), and 70% higher odds of poor self-rated health (95% CI=1.5 to 1.9, p<.001) than those without LBP. Activity mediated the relationship between LBP and the four health outcomes in unadjusted models. Findings indicate that LBP may be associated with adverse mental and physical health in older adults with arthritis, and treatment for older adults with arthritis and comorbid LBP should include interventions targeting LBP and routine assessment of mental and physical health.
Do Social Connections Buffer Loneliness Associated With Living Alone?
Authors: Schafer Markus , Sun Haosen , Lee Jin
Published: December 2021

The growth of solo living has important implications for the rising “loneliness epidemic” among older adults. This study considers whether two forms of social connectedness—extra-household core discussion networks and formal social participation—buffer the loneliness associated with living alone. Our study uses data from two surveys (National Social Life, Health, and Aging Project; Survey of Health, Ageing and Retirement in Europe) encompassing 20 developed Western countries in 2009/2010 and 2015/2016 (n = 110,817). Harmonizing measures across data sets, we estimate survey-specific and pooled linear regression models with interaction terms. Results indicated that high levels of social connectedness only moderately buffer the loneliness associated with living alone in later life. Findings were largely consistent across regions of Europe and the United States, though the buffering patterns were most robustly identified for widowed solo dwellers. Taken together, the results suggest that extra-household connections are partial compensators, but do not seem to fully replace the ready companionship afforded by residential co-presence in later life. Future research is needed to understand whether the efficacy of compensatory connections differs by gender, race/ethnicity, and across more diverse global regions.
Speaking of Dementia: How to Refer to Dementia in Racial-Ethnic Minority Community-Facing Communications
Authors: Baker Zachary , Shippee Tetyana , Gaugler Joseph
Published: December 2021

What do you call “dementia”? In academic writing, researchers often chose the inclusive, “Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD)”. When referring to the people experiencing dementia, the person-centered language: “persons living with dementia (PLWD)” is preferred. This is a welcome departure from the antiquated disease-centered language of “dementia patients” or “the demented”. Still, AD/ADRD and PLWD may be less fitting in community-facing education or participant recruitment. For instance, community-facing materials may benefit from choosing terms like “memory loss”, “issues related to memory or aging”, or “changes in ability, behavior, or judgment”. In this symposium we present a range of viewpoints focused on how to refer to “dementia” in community-facing materials/conversations. These viewpoints include those of several racial and ethnic groups (i.e., African Americans, African Immigrants, American Indians, Asians, Hispanics/Latinos/as/x/e, and Whites). We also include viewpoints from people interfacing with many different diseases that cause dementia (i.e., Alzheimer’s disease, dementia with Lewy bodies, Early-onset Alzheimer’s disease, and Parkinson’s disease dementia) because of the different manifestations of dementia that can arise from those diseases. Viewpoints were gathered through 1) a nation-wide community advisory board, 2) community conversations with African Immigrants, 3) a national effort to increase the representation of Hispanics/Latinos/as/x/e PLWD in AD/ADRD research, and 4) eight community projects exploring the African American AD/ADRD experience. These talks will present possible terms to use within groups, considerations to increase inclusiveness, issues with translation into native languages, considerations surrounding symptoms that may be most recognizable to community members, and stigmatized terminology.
Holy and Helping: The Role of Sanctification in the Communal Coping of Older African American Couples
Authors: Skipper Antonius , Rose Andrew , Joiner Jhazzmyn , Jones Ethan , Reeves Alex
Published: December 2021

Disproportionately affected by numerous relational stressors (e.g., financial strain, morbidity), older African American couples frequently find solace in religion and each other. Research notes that both married and cohabiting couples effectively respond to difficult situations by sharing the ownership of a stressor and organizing a collaborative, collective response. However, little is known about the influence of religion on shared coping experiences, particularly among older African American couples. This study examined dyadic data from the Strong African American Couples Project to capture the influence of relational sanctification on the communal coping practices of married and cohabiting older African American couples. The sample included 194 African American couples (146 married and 48 cohabiting) between the ages of 50 and 86 years. With the use of Actor Partner Independence Models, this study found that men’s sanctification predicted both their own communal coping and their partner’s communal coping. However, there were no significant effects when women’s sanctification was used as a predictor of communal coping among older African American couples. These findings are both important and novel, because these relationships had never before been examined within the United States, much less among older African American couples. Similar to existing research among majority White couples, this research finds that men’s religiosity may be a more influential predictor of relational outcomes than women’s religiosity. Such findings offer a valuable foundation for future studies seeking to consider how relational sanctification and communal coping may impact other outcomes associated with the romantic relationships of older African Americans.
Sustainability of the Aging Network's COVID-19 Responses: Isolated Impact or Transformative Change?
Authors: Kunkel Suzanne , Kunkel Suzanne
Published: December 2021

The COVID-19 pandemic mobilized individuals, organizations, and communities. Area Agencies and Aging (AAAs) and Title VI Native American Programs, core organizations of the network of community-based organizations (CBOs) that serve older adults and their families, pivoted their service delivery methods to provide life-sustaining services. Their long-standing expertise in community needs assessment, pre-existing cross-sectoral partnerships, and an infusion of emergency federal funding, enabled this rapid response. Recently concluded studies using key-informant interviews and national surveys of AAAs and Title VI programs highlight these service adaptations, from expansion of home-delivered meal programs to new partnerships in telehealth. These organizations also reported expansion of services offered and people served, and the emergence or strengthening of partnerships with other CBOs, businesses, and governmental organizations such as public health entities. For example, 78% of the respondents to the recent survey of AAAs reported that they have a role in vaccination outreach, scheduling support, or delivery. The papers in this symposium will use these new studies to describe the nature, origins, and potential sustainability of new and expanded services and partnerships. The Collective Impact Model for community change (introduced in the Stanford Social Innovation Review) will provide a framework for the discussion. Built on the importance of cross-sector coordination, the five pillars of success for collective rather than isolated impact are: a common agenda, mutually reinforcing activities, continuous communication, shared measurement, and a backbone organization. Each of these five pillars is relevant to the heightened community response during the pandemic, and to the likelihood of sustainability.
Day-to-Day Mobility, Affect, and Stress Couplings in Swiss Older Adults
Authors: Roecke Christina , Kim Eun-Kyeong , Griffel Pascal , Moulder Robert , Fu Cheng , Luo Minxia , Martin Mike , Weibel Robert
Published: December 2021

The Mobility, Activity, and Social Interactions Study (MOASIS) is part of a global effort to more closely examine indicators of functional ability in relation to person characteristics and life contexts as proposed by the WHO’s healthy aging definition. In MOASIS, sensor-based and self-reported mobility and activity indicators were used to capture functional ability in 153 community-dwelling older adults aged 65-91 over 30 days. The present study examines daily time out-of-home and place diversity and its within-person associations with positive and negative affect and stress. Initial between-person analyses indicate that mobility is only weakly related to indicators of physical and mental health. We propose that the health- and well-being implications of mobility more strongly play out in daily life and at the within-person level, and will examine general health, cognitive ability, and marital status as intrinsic capacity moderators accounting for some of the expected interindividual heterogeneity.
The Many Faces of Elevated TSH: When to Avoid Thyroid Hormone Therapy in Older Adults
Authors: Mammen Jennifer , Abbey Enoch , McGready John , Ferrucci Luigi , Simonsick Eleanor
Published: December 2021

We have previously demonstrated that hypothalamic-pituitary-thyroid axis aging is characterized by several distinct patterns. An elevated thyrotropin (TSH) level (mean 5.6mIU/L) with normal free thyroxine (FT4) was present in 75 BLSA participants with at least 3 visits. Twenty-one percent had an historical pattern consistent with primary gland failure, while 13% had a pattern consistent with an HPT response to stressors (aging-adaptation). The remainder had intermediate patterns of change. FT4 >0.92pg/ml identified those in whom TSH elevations occurred with aging-adaptation with a 90.0% sensitivity and 93.8% specificity, indicating no need for therapy. In addition, among 597 participants with stable TSH levels in the reference range, being on thyroid hormone therapy increased mortality risk (IRR=1.8; 95% CI 0.9-2.1). Thus, including FT4 in the diagnostic criteria for hypothyroidism in older adults could target therapy to avoid the potential harm of reversing the aging adaptations in those who do not have true early hypothyroidism.
Well-Being and All-Cause Mortality in Aging Women in the Women's Health Initiative (WHI)
Authors: Rillamas-Sun Eileen , Pike Kenneth , Cochrane Barbara , Woods Nancy
Published: December 2021

To study the relationship between well-being and all-cause mortality, we estimated mortality among women in four classes of well-being using the well-being profile from the Women’s Health Initiative Study (WHI). Demographic characteristics were self-reported at enrollment (1993-98). All-cause mortality included death from any cause between 2012-2020. We used logistic regression to examine all-cause mortality risk across the classes, using Class 4 (highest hedonic and eudaemonic well-being scores) as the referent, adjusting for age and race. Compared to Class 4, all other classes had higher age- and race-adjusted odds of death. Highest risks were in Class 1 women (OR=2.61; 95% CI: 2.46-2.76) and Class 3 women (OR=1.62; 95% CI: 1.55-1.68). Women in Class 4 had the lowest risk of all-cause mortality over an 18-year follow-up. These results confirm the utility of a profile of well-being for predicting all-cause mortality while preserving ability to identify the differences among well-being indicators across classes.
Bridging Digital Divides: GWEP Pivots to Support Telehealth for Clinical Care and Education
Authors: Lee Jung-Ah , Gibbs Lisa , Rousseau Julie , Sehgal Sonia , Saville Neika
Published: December 2021

Early in the pandemic, the University of California, Irvine (UCI), GWEP pivoted to focus on building telehealth and remote patient monitoring, while supporting team-based interdisciplinary learners. Our Health Assessment Program for Seniors (HAPS) adapted to provide hybrid remote/in-person evaluations with our Geriatric Fellows and Doctor of Nurse Practitioner (DNP) students working alongside our multi-disciplinary team. Learner teams innovatively bridged the digital divide through weekly DNP support phone calls, and the Fellows delivered family conferences through Zoom. In ASSIST, medical students and nursing students gained digital competencies through a phone support system for isolated older adults with friendly weekly check-ins providing referrals to community resources. Another IRB-approved pilot, Healing at Home, diverted patients from the Emergency Room and In-Patient care with a team of ED, Hospitalists, Geriatricians teaching DNP and Fellows telehealth management. GWEP successfully piloted symbiotic learning for both older adults and health profession students through new virtual formats.
Greater Adolescent Cognitive Ability Is Linked to Lower Risk of Cognitive Impairment in Later Life
Authors: Gruenewald Tara , Zavala Catalina , Grossman Molli , Arpawong Thalida , Manly Jennifer , Lapham Susan , Gatz Margaret , Prescott Carol
Published: December 2021

There have been few investigations of the role that adolescent cognitive ability plays in predicting later-life cognitive impairment, and the mechanisms, such greater life course educational exposure, that might underlie these connections. This knowledge gap is due, in part, to a lack of cohorts with early-life cognitive assessment who are followed to later adulthood. We capitalized on data from the 1960 Project Talent (PT) high school cohort (n>360,000) and two recent follow-ups, the Project Talent Twin & Sibling (PTTS; n=2,491 in 2014) Study and the Project Talent Aging Study (PTAS; n=6,421 in 2018), to examine these potential links. In 1960, ability was assessed in multiple cognitive domains (e.g., general aptitude, quantitative, reasoning). Participants/proxies reporting 2 or more symptoms of cognitive impairment in 2018 on the AD8 Dementia Screener were classified as having a positive screen. Binary logistic generalized estimating equations with race, sex, and adolescent family SES covariates, indicated that in multiple cognitive domains, higher ability in adolescence predicted lower odds of a positive AD8 screen in later life (ORs of 0.80 - 0.85). The effects were only slightly attenuated with inclusion of life course educational attainment. Sibling models found a similar pattern of associations and effect sizes, indicating that the association is not attributable to shared family and genetic background. These findings indicate that higher cognitive ability as indicated by better performance in multiple cognitive domains in adolescence may be protective against cognitive impairment five decades later and life course educational attainment only partially mediates this association.
Early Adversity and Later Health: The Pathway of Social Relationships in Adulthood in HRS and ELSA
Authors: Liu Yin , Steptoe Andrew , Chopik William , Leggett Amanda , Kong Jooyoung , Polenick Courtney
Published: December 2021

Early adversity is associated with compromised health and well-being in later life, but whether social functioning mediate the association is unclear. We examined 2 longitudinal samples of older adults (>= 50 years) whose baseline surveys were between 2006 and 2008 with follow-up until 2016 in the Health and Retirement Study (HRS, n = 15,946) and its sister study in England (ELSA, n = 9,692). Health outcomes included depressive symptoms, chronic health conditions, and subjective memory complaints. Social relationships were measured by contacts, relationship strains, and feelings of loneliness. Early adversity was measured by parental physical abuse and alcohol and drug problems in the family before the age of 16. Patterns of association were similar in these 2 samples, where social contacts decreased over time, while relationship strains and loneliness increased especially for older adults with early trauma, which in turn mediated the associations between early adversity and poorer later health.
Socioeconomic Status and Later-Life Health: Longitudinal Evidence From Europe and China
Authors: Cheng Mengling , Sommet Nicolas , Jopp Daniela , Spini Dario
Published: December 2021

Scholars are divided as to how the protective effect of SES on health (the SES-health gradient) varies over the later-life course: The age-as-leveler perspective suggests that the SES-health gradient weakens with age, whereas the cumulative (dis)advantages perspective suggests that it strengthens with age. To clarify this, we used SHARE 2004-2017 (73,407 respondents from 19 European countries) and CHARLS 2011-2018 (8,370 Chinese respondents). Congruent with the age-as-leveler perspective, growth curve models revealed that the overall protective effect of SES on multimorbidity was weaker for older than younger adults (the country-specific effects were significant in two thirds of the case). We interpret this as a selection effect. However, the within-participant protective effect of SES on multimorbidity did not vary over the later-life course (the country-specific effects were nonsignificant in the majority of the case). Findings suggest that extant cross-sectional studies should be interpreted with caution and that longitudinal, cross-national studies are needed.