bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retirement Financial Insecurity for Men and Women in Canada: The Impact of Life Course Work and Income Instability
Authors: Taylor Miles , Carr Dawn , Quesnel-Vallee Amelie 
Published: December 2020

Abstract
Financial security is critical to overall well-being in retirement. Life course disruptions in work due to unemployment or disability may have lasting impacts on financial security in later life, and these effects may or may not be ameliorated by old age security programs and retirement benefits. Women are known to be particularly vulnerable for financial hardship in later life, making their life course experiences especially important in understanding financial well-being in retirement. We examine the Canadian Longitudinal and International Study of Adults (LISA) to assess later life financial insecurity in retirement, including 20 years of data on labor force experiences across adulthood drawn from linked tax records (N=2,353; N=1,079 men and N=1,274 women). The Canadian context is a useful complement to studies in the US due to its diverse and relatively generous public support programs, in addition to personal savings options for retirement. We find that among men, financial insecurity is tied to years reporting unemployment, where for women this outcome is more strongly linked to reports of disability and income assistance across adulthood. Although public and private retirement benefits do not offset these associations for either gender, receipt of income supplements reduce subjective financial insecurity among women. Among men, personal savings have the most robust effect in reducing financial insecurity. Our results suggest that in Canada, with its relatively generous provision of retirement support, life course work and health instability have lasting but differential effects for men and women in retirement.
Higher Rates of Untreated Distress in Older Versus Younger Adults With Indolent Lymphoma
Authors: Trevino Kelly , Martin Peter , Leonard John 
Published: December 2020

Abstract
Indolent lymphomas are incurable but slow-growing cancers, resulting in a large number of older adults living with these diseases. Patients typically live with their illness for years with the knowledge that disease progression is likely. Yet, little is known about psychological distress in this population. This study examined rates of and the relationship between distress and mental health service use in older and younger adults with indolent lymphomas. Adult patients diagnosed with an indolent lymphoma (e.g., follicular lymphoma, marginal zone lymphoma) within the past six months completed self-report surveys of distress (Hospital Anxiety and Depression Scale; HADS) and mental health service use since the cancer diagnosis (yes/no). Descriptive statistics, t-tests, and chi-square analyses were used to examine study questions. The sample (n=84) included 35 patients 65 years or older. Across the entire sample, 21.4% screened positive for distress on the HADS; 58.8% of these patients did not receive mental health services. Older adults reported lower distress levels than younger adults (17.1% v. 24.5%; p=.038). Among younger adults, 50% of distressed patients received mental health services; only 20% of distressed older adults received mental health services. Distress was associated with mental health service use in younger adults (p=.004) but not in older adults (p=.17). Older adults with indolent lymphomas have higher levels of untreated distress than younger adults. Research on the mechanisms underlying these age differences (e.g., stigma toward mental health services, ageism) would inform interventions to increase rates of mental health service use and reduce care disparities due to age.
Technology Use Among Caregivers for Persons With and Without Cognitive Impairment
Authors: Lee Shinduk , Smith Matthew , Dahlke Deborah Vollmer , Shubert Tiffany , Popovich Steve , Ory Marcia 
Published: December 2020

Abstract
This study aims at describing technology use among caregivers for middle-aged or older adults with and without cognitive impairment (CI) and examining whether the associations between technology use, caregiver strain, and social support differ by care-recipient CI status. Online data from caregivers (n=561) for adults at aged 50 years and older were analyzed from a national caregiver and technology survey. Multiple binary items were used to indicate caregivers’ use of various devices (smartphone, computer, e-reader, and wearable activity tracker) and applications (communication, online banking, navigation, online entertainment, medication alert/tracker, and physical activity tracker). Predictors were care-recipient CI status (having been diagnosed with cognitive problems versus no cognitive problems), caregiver strain, and social support. Multivariable logistic regression models were fitted for each technology and for testing effect modification by care- recipient CI status. All models were adjusted for total caregiving hours and caregiver age, sex, race/ethnicity, financial status, and residence. Almost half (47%) reported their care-recipient was diagnosed with CI. Caregivers for those with CI were more likely to use e-readers (adjusted odds ratio (AOR) = 1.55, p=.040), wearable activity trackers (AOR=1.77, p=.013), and medication alerts/trackers (AOR=2.59, p&lt;.001). Generally, greater caregiving strain and social support were positively associated with use of multiple technologies (p&lt;.05). No effect modification of caregiving strain and social support by CI status was observed (p&gt;.05). Technology use differences among caregivers of persons with CI may be driven by care recipients’ unique situations and demands. Future research should identify technology use benefits on caregiver health-related quality of life.
The Impact of Sleep Disturbance on Regional Brain Volumes
Authors: Burke Shanna , Li Tan , Grudzien Adrienne , Barnes Christopher , Hanson Kevin , DeKosky Steven 
Published: December 2020

Abstract
Sleep disruption has been associated with increased beta-amyloid deposition and greater risk for later development of Alzheimer’s disease. Studies indicate that sleep disturbance correlates with regional brain volumes, but data are limited. We sought to determine the effect of sleep disturbance on regional brain volumes by cognitive and apolipoprotein e (APOE) e4 status. We conducted a secondary analysis of the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set using complete structural imaging data from 1,371 participants (mean age: 70.5; SD: 11.7). Multiple linear regression was used to estimate the adjusted effect of sleep disturbance (via Neuropsychiatric Inventory Questionnaire) on regional brain volumes through measurement of 30 structural MRI biomarkers. Sleep disruption was associated with greater volumes in the right and left lateral ventricles and greater volume of total white matter hyperintensities (p&lt;.05). Lower mean volumes in total brain, total gray matter, and total cerebrum grey matter volumes, and in 12 hippocampal, frontal, parietal, and temporal lobe volumes were observed among participants who reported sleep disturbance. Males, Hispanic participants, and those with less education were more likely to report sleep disruption. Cognitive status moderated the relationship between sleep disturbance and lateral ventricular volumes, while APOE e4 moderated the effect between sleep disturbance and parietal lobe volumes. These findings suggest that disrupted sleep is associated with atrophy across multiple brain regions and ventricular hydrocephalus ex vacuo, after controlling for intracranial volume and demographic covariates. The influence of cognition and APOE e4 status indicates that this relationship is affected by co-occurring physiological processes.
Wellness for Older Adults Living With Serious Mental Illness: A Proposed Practical Framework
Authors: Zechner Michelle , Fullen Matthew , Barrett Nora , Swarbrick Margaret , Pratt Carlos , Santos Stephanie 
Published: December 2020

Abstract
Multi-dimensional wellness is a holistic, person-centered clinical approach, that offers promise as a framework for improving the health and well-being of older adults. This approach can be especially helpful for older adults who are experiencing mental health conditions as it focuses on strengths, resilience and recovery comprehensively. Few clinical interventions have addressed wellness in older adults with mental health conditions (Zechner et al., 2019).The authors reviewed two existing wellness frameworks: 1) grounded in extensive practical interventions for people living with mental health conditions (Swarbrick, 1997; 2006; 2012; 2017), and 2) a theoretical framework informed by a systematic literature review (Fullen, 2019). The two frameworks were compared for usefulness in older adults living with mental health conditions using the concept analysis strategies of analyzing the overlap and contrasting characteristics of concepts with related ideas, and then proposing a merged operationalized definition and practical implementation suggestions based on the characteristics of the original dimension (Mackeroff et al., 2016). The two wellness models described similar dimensions, but also represented distinct areas. We propose a synthesized framework combining the models to best serve older persons living with mental health conditions. The framework holds eight distinct areas 1) Developmental 2) Cognitive/ Intellectual, 3) Physical 4) Emotional 5) Social/Relational, 6) Occupational/Vocational 7) Spiritual and 8) Contextual/Environmental/Financial. Inter-professional practical clinical strategies and policy suggestions will be presented for consideration. More work is underway to understand the salience of the proposed model for stakeholders and to empirically test how the proposed framework impacts outcomes.
Unraveling the Effects of Social Class and Systemic Racism on Advance Care Planning
Authors: McDonnell Jenny 
Published: December 2020

Abstract
While advance care planning (ACP) is recognized as a key facilitator of high-quality, goal-concordant end-of-life care, black Americans are less likely to participate in ACP than non-Hispanic whites (Carr 2011; Detering et al. 2010). There are divided explanations for why these disparities persist. Some scholars attribute racial disparities in end-of-life care to socioeconomic (SES) differences between black and white Americans citing blacks’ and whites’ differentiated access to, control over, and use of material resources (Wilson 1978; Yearby 2011). Others assert that health care preferences do not solely reflect lack of resources or health literacy, but that the larger social context frames care preferences differently across racial and ethnic groups in American society (Alegria et al. 2011; Sewell and Pingel forthcoming). By turning the analytical lens to class-privileged black Americans, I investigate whether racism overflows the margins of class disadvantage. Using data from the Health and Retirement Study, I ran logistic regression and moderation models. I found that class-privileged blacks are less likely to engage in ACP than both high-SES and low-SES whites. The interaction of race and SES was negatively and significantly associated with ACP (OR=0.91; P&lt;0.05), indicating that SES has a stronger effect on the probability of ACP among whites than among blacks. Predicted probabilities show that 51% of low-SES whites are likely to engage in ACP compared to 32% of high-SES blacks. These findings indicate that racialized disparities in ACP exist independent of SES, and that the effects of SES and race are intersectional rather than simply additive.
Does Spouse’s Dementia Diagnosis Make Individuals Skimp on Health Care?
Authors: Chen Yi 
Published: December 2020

Abstract
Dementia is a costly disease that places great burden on individuals, families, and health care systems. The substantial time and financial resources taken away by living with persons with dementia (PWDs) may make their spouses forgo needed health care, thus deteriorating long-term health. To quantify the effect of dementia on spouses’ health investment, I employed a difference-in-difference approach, comparing use of preventive services and doctor visits before and after spouses’ dementia onset. Using Health and Retirement Study (HRS) with linkage to Medicare claims, I identified 650 older adults whose spouses had incident dementia during 1993 to 2007, and matched them to 1,816 controls whose spouses were dementia-free. Primary analysis reveals that individuals whose spouse had dementia did not change their use of most health services, relative to dementia-free controls. In stratified analysis, middle-class individuals skimped on flu shot and diabetes screening. Providing help for activities of daily living (ADLs) was associated with 1.9 less doctor visits, the effect of which was stronger among females (2.5 less visits). Help with instrumental activities of daily living (IADLs) was not a predictor of any utilization outcome. In conclusion, externalities of dementia imposed on family members are more profound and complex than deprivation of time. Certain subgroups were worse off in health investment when facing the trade-off between caring for spouses with dementia and caring for themselves. When understanding dementia burden, the externality imposed on spouses and its heterogeneity should be considered.
Characteristics of Older Veterans Enrolled in the Illinois Medical Cannabis Patient Program
Authors: Bobitt Julie , Kang Hyojung 
Published: December 2020

Abstract
Veterans often struggle with disabling conditions such as chronic pain and post-traumatic stress disorder (PTSD) that tend to worsen as they age. Common treatments for these conditions include the use of opioids and benzodiazepines, yet these medications tend to have unwanted side effects and can even result in addiction. While cannabis use in the US has increased significantly over the past decade, research regarding the risks and benefits is mixed and a growing number of research studies have highlighted the benefits of taking cannabis for medical purposes. While previous studies have looked at cannabis use in older adults and in Veterans over 18, no research has looked at cannabis use specifically in older Veterans. We surveyed adults age 60 and over who were enrolled in the Illinois Medical Cannabis Patient Program as of September 2019. We collected demographics, reason for enrolling in the medical cannabis program, history of cannabis, opioids, and/or benzodiazepines use, and health outcomes. Of 3,768 responses, 593 were Veterans. Older Veterans in our study were predominately male (92.1%), reported using cannabis primarily for pain (80.1%), PTSD or emotional health problems (50.1%) (i.e. anxiety and depression), and reported that cannabis use has positively impacted their quality of life (89.4%), health outcomes (81.9%), pain (86%), and sleep quality (77.1%). Understanding why older Veterans use cannabis and the outcomes they experience from cannabis use can inform state and federal policy makers and enhance clinical care practices.
Health Differences Among People With Varying Profiles of Awareness of Positive and Negative Age-Related Changes
Authors: Sabatini Serena , Ukoumunne Obioha , Ballard Clive , Diehl Manfred , Wahl Hans-Werner , Brothers Allyson , Clare Linda 
Published: December 2020

Abstract
Higher awareness of negative age-related changes (AARC-losses) is related to poorer mental and physical health whereas higher awareness of positive age-related changes (AARC-gains) is related to better mental health. Associations of health with AARC-gains and losses have been explored separately, but often people experience gains and losses concurrently. Using latent profile analysis, we identified at the cross-sectional level patterns of AARC-gains and losses and explored whether groups with distinct profiles of AARC-gains and losses differed in physical, mental, and cognitive health, and demographic characteristics. Analyses were based on the large-scale PROTECT study conducted in the UK (N= 6,192; mean age= 66.10(SD= 7.04); 76% women). A four-group solution revealed the best model fit (Akaike’s information criterion= 156,061.93; Bayesian information criterion= 156,418.67); 45% of participants perceived many AARC-gains and few losses (Group 1); 24% of participants perceived moderate AARC-gains and few losses (Group 2); 24% of participants perceived many AARC-gains and moderate losses (Group 3); and 7% of participants perceived many AARC-gains and many losses (Group 4). The four groups differed meaningfully in health; Group 1 was the most healthy, followed by Groups 2, 3 and 4. Participants in Group 1 were most likely to perceive their health as excellent, reported the lowest levels of depression and anxiety, and showed the best cognitive performance. On average participants in Group 1 were younger, and more likely to be female, employed, and married, compared to other groups. Considering the co-existence of gains and losses is important when relating awareness of age-related changes to health.
Moderating Effect of Psychological Resilience on Functional Impairment in Relation to Subsequent Depression
Authors: Choi Shinae , Namkung Eun Ha 
Published: December 2020

Abstract
The growing prevalence of functional impairment is a serious concern due to its relation to decreased quality of life in later life. Guided by the social convoy model and the stress process model, the present study investigated whether psychological resilience, particularly optimism and mastery moderated an association between functional impairment and subsequent depressive symptoms in later life. This study used data derived from two population-based national studies in the United States: 2012 and 2016 waves of the Health and Retirement Study (N = 5,035) and 2004 and 2013 waves of the Midlife in the United States (N = 2,476). Ordinary least squares regression was used to estimate the impact of optimism and mastery, respectively, on the associations between functional impairment (baseline measure at wave(t-1), changes over the study period from wave(t-1) to wave(t)) on subsequent changes in depressive symptoms. Across both studies, we found that having and developing functional impairment are related to increased number of depressive symptoms. Optimism independently predicted decreased depressive symptoms over the study periods and buffered the negative effects of functional impairment on depressive symptoms across the two studies. Specifically, the mitigating effects of optimism on depressive symptoms were greater for those with more numbers of functional limitations. The findings suggest that psychological resilience plays a key role in decreasing depressive symptoms, especially for midlife and older adults with functional impairment. The results also demonstrate the importance of examining both optimism and mastery when investigating psychological resilience and emotional well-being in older adults.
Stepping Out: A Novel Pilot Falls Prevention Program for Individuals With Mild Cognitive Impairment
Authors: Fischer Barbara , Midden Allison , Hoffmann Aundrea , DeWitt Lynn , Kohlman Kathryne , Clemson Lindy , Sherman Katherine , Mahoney Jane 
Published: December 2020

Abstract
Objectives: Falls are the leading source of accidental injury and hospitalization among adults over the age of 65. Relative to people with intact cognition, individuals with cognitive impairment are at increased risk for falls; however, few falls prevention programs exist to specifically reduce and prevent falls in this population. To address this issue, we developed a novel, multifactorial, cognitively-based falls prevention program, Stepping Out. Based on the popular and effective evidenced-based program, Stepping On, Stepping Out was modified and tailored to the learning needs of individuals with Mild Cognitive Impairment (MCI). We hypothesized that older adults with MCI would find the program understandable, and that program participants would demonstrate reduced falls. Methods: Sixteen veterans, mean age of 77.5, diagnosed with MCI and at increased risk for falls participated in Stepping Out. Falls were collected for the six months prior to intervention and the six months during and after program participation. All participants completed post-program evaluations. Falls incidence was compared using a Wilcoxon paired signed rank test. Results: Stepping Out was found to be feasible and comprehensible by all participants. Program participants exhibited significantly reduced falls, with median reduction of two falls (p = 0.0020), and a range of zero to 12 falls. Discussion: With appropriate modifications, individuals with MCI were able to benefit from a cognitively-based falls prevention program and to reduce accidental falls incidence. Falls are an important and feasible target to address among individuals with cognitive impairment.
Family Caregiver Role in the Long-Term Services and Supports of Individuals With Dementia Over Time
Authors: Reckrey Jennifer , Bollens-Lund Evan , Husain Mohammed , Ornstein Katherine , Kelley Amy 
Published: December 2020

Abstract
Family caregivers of persons living with dementia (PLWD) provide disproportionately high levels of care over a long and variable disease course, yet an understanding of the trajectory of care hours provided over time and the contributions of individual family members to overall care is lacking. This study used longitudinal data from the nationally representative Health and Retirement Study in order to compare the hours of care that spouses, children, and other family caregivers provide to those with and without dementia. During the last 10 years of life, family caregivers of PLWD provided nearly three times as many total care hours as compared to others (7,447 vs. 2,653 total hours). While care hours provided to PLWD increased steadily in each of the last 10 years of life (going from 4 hours/week 10 years before death to 33 hours/week the year before death, average annual increase 27%), care hours provided to others remained low and then nearly tripled in the last year of life to 22 hours/week on average. Adult children of PLWD provided 50% of total care hours, while adult children of others provided 41% of care hours. This study provides important insight into the high levels of year-over-year caregiving provided to PLWD by their family caregivers in general and by adult children in particular. Policies to support these caregivers must shift from short-term, episodic support to sustained assistance in acknowledgment of the key role family caregivers play in the long-term services and supports of PLWD.