bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Hearing Aid Use Among Older Adults in the United States, 2011-2018
Authors: Reed Nicholas , Morales Emmanuel Garcia , Willink Amber 
Published: December 2020

Abstract
Hearing loss among older adults is prevalent and associated with dementia and health care utilization. However, cross-sectional data suggest less than 20% of adults with hearing loss use hearing aids. There is a paucity of studies examining trends in hearing aid ownership over time. This study analyzed data from the 2011, 2015, and 2018 cycles of the National Health Aging and Trends Study (NHATS), a nationally-representative longitudinal study of Medicare Beneficiaries. Participants were asked “in the last month, [have you/has [he/she]] use a hearing aid or other hearing device?” (“yes” or “no”). Among a weighted sample of Medicare Beneficiaries 70 years and older (26.47 million in 2011; 29.70 million in 2015; and 33.28 in 2018), the overall proportion who own and use hearing aids rose from 14.96% in 2011 to 16.90% in 2015 to 18.45% in 2018. As age increased so did the proportion of older adults who used hearing aids. A smaller proportion of Black Americans used hearing aids across time and experienced a smaller overall increase in the proportion in hearing aid ownership over the 8-year period compared to White Americans (+0.78% vs. +4.30%). Black women had the lowest rates of hearing aids use across the 8-year period. Notably, older adults at less than 100% of the federal poverty level experienced an overall decrease in proportion of hearing aid ownership and use. This study lays the groundwork to examine the impact of the Over-the-Counter Hearing Aid Act of 2017 across subpopulations when it takes effect in 2021.
Obesity Intervention Improves Outcomes in Socially Isolated Older Adults: Progress Despite a Pandemic
Authors: Starr Kathryn Porter , Borack Michael , Miller Marshall , Fruik Angela , Rincker Jamie , Wallis Jessica , Hakim Amir , Bales Connie 
Published: December 2020

Abstract
The extended social isolation necessitated by the COVID-19 pandemic will likely have a prolonged negative impact on the health of community-dwelling older adults. We studied the potential to counteract these negative effects, examining the before and after measurements of participants in two obesity intervention studies that were converted from in-person to remote delivery, due to COVID-19. The Veterans Achieving Weight Loss and Optimizing Resilience-Using Protein study (VALOR-UP; n=9) and the Egg-Supplemented Pre-Diabetes Intervention Trial (EGGSPDITE; n=6) enrolled obese (BMI = 34.2±3.8 kg/m2) older adults (age = 71.5±4.5 yrs; 80% male; 47% black) with prediabetes (fasting blood glucose 100-125 mg/dL and/or HbA1c of 5.7-6.4%). Participants followed a hypocaloric diet, attended weekly support groups, and weighed themselves weekly; VALOR-UP participants also attended a weekly exercise class delivered remotely. Outcomes were assessed at baseline (pre-COVID) and the end of a 4-month period coinciding with stay-at-home orders. Between baseline and 4 months, calorie intakes (3-day diet record) decreased by 402.1±529.3 kcal/day (p&lt;0.05) and body weight by 6% (6.1±3.4 kg; p&lt;0.0001). Physical function (Short Physical Performance Battery) improved by 1.1±1.4 units (p&lt;0.01) and Short Form Health Survey (SF-36) physical and mental composite quality of life remained stable (p=0.63 and p=0.48, respectively). Thus, despite COVID-19 circumstances, most participants were able to benefit from an intervention to improve function and reduce obesity. The somewhat surprising findings for this small cohort offer promise not only for future lifestyle interventions during COVID-19 isolation but also for other isolated populations, including home-bound older adults.
Access to Information on Needed Services Mediates the Association Between Income and Self-Rated Health
Authors: Moss Sara , White Katie , Dabelko-Schoeny Holly 
Published: December 2020

Abstract
Prior research has documented that individuals with fewer financial resources report lower self-rated health. The relationship between financial status and health is important to understand among older adults, for whom income is often fixed, and who face unique health stressors. In this study, we examined whether physical activity, connection to community, and access to information, variables which have demonstrated associations with financial resources and health in previous studies, accounted for unique variance in the association between income and self-rated health. We conducted a secondary data analysis of a community sample of 184 adults over the age of 50 in a large, Mid-western city. We tested a mediation model, entering income as a predictor of self-rated health with frequency of physical activity, feelings of being disconnectedness, and ability to find information about needed services as hypothesized mediators, controlling for the effects of race, education, and gender. Access to information about needed services, ab = .08, 95% CI [03, .15] accounted for unique variance in self-rated health scores beyond the direct effect of income, c’ = .38, p &lt; .0001, 95% CI [.22, .53]. These findings suggest that higher perceived access to information about needed services may partially explain the association between income and self-rated health. Future researchers should track these variables across time to establish causal associations between access to information and health. Additionally, further study of perceived access to information and objective measures of access to information is warranted, as the role of health literacy in this study is unclear.
Social Participation, Social Support, and Social Policy Among Older Adults
Authors: Waite Linda 
Published: December 2020

Abstract
The social world is closely linked to other dimensions of health, including physical health and illness, physical functioning, cognition and emotional well-being, and these links may change across generations and may depend on social and policy context. The papers in this symposium focus on these links. Carr examines the associations between productive engagement in later life and perceptions of social support and interactions with friends and family. She finds that volunteer engagement is associated with greater perceived social support and interaction with friends and family but not with support from spouse. Waite, Duvoisin and Kotwal measure changes in social participation between the Silent Generation cohort, born between1938 and1947, and the Baby Boom cohort, born from1948-1958. They find find that the gender differences shown in the Silent Generation cohort are reduced among those born during the Baby Boom. Azar examines the moderating role of social policy, particularly defamilization, on the link between loneliness and health, using data from30 European countries and the U.S. Choi compares marital and partnership status, social support and strain in Silent Generation vs. Baby Boom cohorts. Her results suggest that those born during the Baby Boom are embedded in looser social relationships compared to their older counterparts. Together, these papers point to the importance of considering various dimensions of social life, gender, and context, including historical time and the life cycle, in understanding how the social world acts to affect well-being.
Time-Restricted Feeding and Caloric Restriction Impact on Spontaneous Neoplasms in Female Mice
Authors: Rudderow Annamaria , Duregon Eleonora , Bernier Michel , de Cabo Rafael 
Published: December 2020

Abstract
In older humans, multiple chronic diseases and increased life expectancy impose a disproportionate socioeconomic burden. Dietary interventions are valuable strategies for promoting healthy aging. Caloric restriction (CR) without malnutrition is a robust intervention able to delay disease onset and increase survival in model organisms. However, the impracticability of chronic CR outweighs the potential long-term benefits in humans. Time-restricted feeding (TRF), i.e. the limitation in the timing of food intake without necessarily reducing caloric intake, can protect against metabolic disorders through the synchronization of the circadian rhythm. This study compares whether limiting access to ad libitum (AL) food for a few hours per day mimics the beneficial effects of a CR diet. A large cohort of C57BL/6J female mice (n=250) was distributed into five feeding paradigms at midlife: AL, TRF for 8 hours, TRF for 4 hours, 20% CR and 20% CR fed twice a day (CRx2). Pathological analyses at death reveal a shift in fatal neoplasms toward an older age in TRF8 mice. AL mice had the highest prevalence of tumors (93%) and TRF4 had the lowest (77%). The highest tumor burden was observed in AL mice while CRx2 animals had the lowest number of neoplasms. Histiocytic sarcoma and lymphoma were the most represented malignancies, with CR mice exhibiting the highest rate of histiocytic sarcoma (75%) and the lowest rate of lymphoma (10%). These results indicate that time- and calorie-restricted feeding regimens can slow down malignant neoplasm progression and extend health span in female mice, even when started in adulthood.
Vaccination Improves CD4 T Helper Subset Balance in Aged Mice by Overcoming the Effects of the Senescent Environment
Authors: Torrance Blake , Lorenzo Erica , Keilich Spencer , Harrison Andrew , Al-Naggar Iman , Haynes Laura 
Published: December 2020

Abstract
Influenza (flu) infection is a leading cause of morbidity and mortality in older adults. Although vaccination is the best strategy to combat the effects of flu infection, there is a marked decline in vaccine efficacy in older adults. We hypothesized that an increased level of basal inflammation, a hallmark of the aging, plays a role in this decreased vaccine efficacy and that a vaccination strategy designed to augment the aged response to flu would be beneficial. Adjuvanted vaccination with a conserved influenza protein enhanced viral clearance, antibody production, and protected against weight loss in both young and aged mice. Vaccination also decreased levels of inflammation brought about by leukocyte infiltration and induced a strong type 2 cytokine environment in the lung. Additionally, vaccination reduced the proportion of flu-specific FoxP3+ T regulatory cells (Tregs) and decreased levels of TGF-β in aged lungs following infection. Accumulation of senescent cells, another hallmark of aging, can contribute to the inflammatory environment via their senescent associated secretory phenotype (SASP). Supporting a role for senescent cells in exacerbating age-related deficits in the response to vaccination, treatment of aged mice with the senolytic drugs Dasatinib and Quercetin also decreased levels of Tregs and TGF-β in the lungs following flu infection. These findings give insight to how vaccination responses can be ameliorated in older adults by targeting both inflammatory and regulatory signals and how accumulation of senescent cells could influence the dysregulation of the immune response with age.
Association of Sleep Quality and Nutritional Status in Middle-Aged and Older Adults: Findings From the WCHAT Study
Authors: Zhao Wanyu , Zhang Yan , Dong Birong 
Published: December 2020

Abstract
Poor sleep quality and malnutrition are two common symptoms which are closely related to the health of middle-aged and older people, but few studies focus on the association between them. In this study, we aimed to identify associations between sleep quality and nutritional status in middle-aged and older adults. A total of 6792 community-dwelling adults aged 50 and older from the baseline of the West China Health and Aging Trend (WCHAT) study were analyzed in the present study. Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI). Scores &lt;=5, 6-10,11-15 and &gt;=16 were categorized as good/mild impaired/moderate impaired/severe impaired sleep quality, respectively. Mini Nutritional Assessment Short Form (MNA-SF) was used to assess the nutritional status and a score&lt;12 was identified as at risk of malnutrition. Logistic regression models were conducted to explore the associations. Of 6792 participants (mean age 62.41 ± 8.26 years, 62.49% women), 1831 (26.96%) had risk of malnutrition. The prevalence of participants with good/mild impaired/moderate impaired/severe impaired sleep quality were 53.72%, 35.54%, 9.61%, and 1.12%, respectively. In the logistic regression model, there were significant association between mild/moderate/severe impaired sleep quality and the presence of risk of malnutrition (OR=1.49, 95% CI=1.32, 1.68; OR=2.15, 95% CI=1.79, 2.59; OR=2.52, 95% CI=1.56, 4.06; all p&lt;0.05) after adjusting for potential confounders. Sleep quality was significantly associated with malnutrition risk with a dosage effect among middle-aged and older adults. Our results highlight the importance of maintaining good sleep quality and nutritional status in middle-aged and older adults.
Nurse-Driven Transitions Program Provides High Value End-of-Life Care to Veterans With Serious Illness
Authors: Driver Jane , Hayes Barbara , Chen Li , Gosian Jeffrey , Skarf Lara , Paik Julie , Kind Amy 
Published: December 2020

Abstract
We developed the Supportive Coordinated Transitions of Care (SC-TraC) pathway at VA Boston to improve the quality of end-of-life (EOL) care. A nurse case manager (NCM) with training and experience in geriatrics and palliative care enrolled hospitalized patients with advanced illness (life expectancy &lt; 2 years) who were not enrolled in hospice, and provided phone-based care coordination after discharge for up to 1 year. Our prior work found that SC-TraC patients were more likely to receive goal-concordant care, 60% more likely to enroll in hospice, twice as likely to die at home with hospice, and half as likely to die in an ICU, with no difference in survival. We worked with VA Geriatrics and Extended Care Data Analytics Center to calculate VA and Medicare/Medicaid cost data for a cohort of 104 SC-TraC cases and 104 carefully matched controls enrolled January 2017-June 2018, with follow-up through December 2019. Total cost data (VA + non-VA) was available for all patients up to 6 months following initial discharge. Difference in total cost per-patient was higher in SC-TraC patients at 30 days post-discharge (+ $3,258), but lower at 90 days (-$1,686) and 6 months (-$1,267). SC-TraC cost was substantially less in the last 30 days of life (-$-4,057). Cost differences were due to more home-based and less inpatient/institutional care in the SC-TraC cohort. This data suggests that the SC-TraC program promotes high value EOL care and is a financially sustainable model.
Palliative Care Consult for Clinician Distress Through the Philosophical Lenses of Gender Norms and Phenomenology
Authors: Foxwell Anessa , Meghani Salimah , Ulrich Connie 
Published: December 2020

Abstract
The National Academy of Medicine has raised significant concerns on clinician health and well-being as many experiencing burnout, post-traumatic stress, and depression. Indeed, clinicians experience a range of human emotions when caring for older adults with severe, life-limiting illnesses. These emotions may manifest in multiple ways and from various sources. Uncertain of how to attend to such distress, clinicians may consult a trusted resource, including the palliative care team. Palliative care specialists are trained to support the complexities and needs of patients and families; increasingly, however, palliative care consults are rooted in clinician distress. This session uses clinical case examples to explore the palliative care consult for distressed clinicians from two different philosophical perspectives: (1) phenomenology and (2) the social construct of gender norms. A phenomenological lens respects the unique, subjective lived experience of each individual in their day-to-day interactions with patients, families, and health care systems. Therefore, when caring for seriously ill older adults, clinicians may bring their own subjective experiences to the patient encounter and react differently to ethical dilemmas and conflicts that arise. The social construct of gender norms asks us to examine clinician distress from a different perspective. Here, the postmodern rejection of gender binarism allows clinicians to experience a spectrum of emotions and distress regardless of gender. Exploration through clinical cases will highlight the unique, varied experience of clinician distress and offer opportunities for future research into the role of palliative care teams in supporting distressed clinicians who care for seriously ill older adults.
Multimorbidity and Depression Incidence Among Middle-Aged and Older Adults in China
Authors: Tang Fei , Vasquez Elizabeth 
Published: December 2020

Abstract
Previous studies suggested that multimorbidity (co-occurrence of two or more chronic conditions) is associated with increased risk of depression. However, limited studies have examined the relationships between multimorbidity and depression among Chinese middle-aged and older adults. The current study aimed to evaluate the associations between multimorbidity and incidence of depression and the potential mediation effect of functional limitation among Chinese middle–aged and older adults. Data of 8,093 individuals who participated in both wave 1 (2011) and wave 4 (2015) of China Health and Retirement Longitudinal Study (CHARLS) and were free of depression in wave 1 were included in the study. Multiple log-binomial regression models were used to evaluate the associations between multimorbidity and incident depression. Mediation analysis was conducted to examine the effect of functional limitation. A third of participants in our study were identified as having multimorbidity in wave 1 (N=2,479) and 23% participants were free of depression in wave 1 but had depression in wave 4 (N=1,827). After adjusting for potential confounders, multimorbidity was observed to be associated with depression incidence (RR: 1.31; 95% CI: 1.21 – 1.42). In addition, functional limitation mediated the relationship between multimorbidity and depression incidence. Our findings add to the literature on the potential associations between multimorbidity and depression incidence among Chinese middle-aged and older adults. Furthermore, the relationship between multimorbidity and depression incidence was observed to be mediated by functional limitation. Interventions that improve functional ability among Chinese middle-aged and older adults could potentially attenuate the effect of multimorbidity on depression incidence.
Body Measurement and Health Risk Education Effects on Older Adults’ Health Beliefs and Behaviors
Authors: Gaynor Beatrice 
Published: December 2020

Abstract
Waist circumference (WC) measurement is an indicator of central obesity related disease risk that is rarely used in primary care (PC). The current PC practice of body mass index (BMI) calculation to screen for disease risk lacks specificity to the older adult habitus. Guided by the Health Belief Model, this study utilized a one-way analysis of covariance to examine the effect of experimental cues, WC measurement and central obesity disease risk education, compared to control cues, BMI and obesity classification, on older adults’ health beliefs (perceived susceptibility and health benefits) and behaviors (diet and exercise) 6 weeks post cues/intervention. Of the 99 participants (control group [N=49]; experimental group [N=50]) 92% reported ‘never’ having WC measurement and 76% reported ‘never’ having BMI calculation in PC. Both groups reported high levels of perceived susceptibility and exercise at baseline. Changes in perceived susceptibility, diet, and exercise were non-significant in either group. There was a significant increase in perceived health benefits of WC measurement (p=0.01) and BMI calculation (p=0.01) in the experimental group compared to the control group. Willingness to exercise (p=0.007) significantly increased in the experimental group compared to the control group. The lack of BMI experience in both groups may have caused control cues to function as experimental cues in both groups. Thus, this study provides evidence that combined use of WC measurement, central obesity health risk education, BMI calculation, and obesity classification increase perceived benefits of body measurements and motivate physical activity in older adults over BMI and obesity classification alone.
Association of Affect and Gait Performance in Dual-Task Walking in Non-Demented Older Adults
Authors: Guharajan Deepan , Holtzer Roee 
Published: December 2020

Abstract
Aging populations are at increased risk to experience mobility disability, which is associated with falls, frailty, and mortality. Previous studies have not examined the concurrent associations of both positive and negative affect with gait velocity. We examined whether individual differences in positive and negative affect predicted dual-task performance decrements in velocity in a dual-task (DT) paradigm in non-demented older adults. We hypothesize that positive affect would be associated with lower DT costs, and negative affect would be associated with higher DT costs. Participants (N = 403; mean age, = 76.22 (6.55); females = 56%) completed the Positive and Negative Affect Schedule (PANAS) and a DT paradigm that involved three task conditions: Single-Task-Walk (STW), Alpha (cognitive interference requiring participants to recite alternate letters of the alphabet), and Dual-Task-Walk (DTW) requiring participant to perform the two single tasks concurrently. Gait velocity was assessed via an instrumented walkway. As expected, results of a linear mixed effects model (LME) showed a significant decline in gait velocity (cm/s) from STW to DTW (estimate = -11.79; 95%CI = -12.82 to -10.77). LME results further revealed that negative affect was associated with greater decline in gait velocity from STW to DTW (ie., worse DT cost) (estimate = -0.38; 95%CI = -0.73 to -0.03). Positive affect did not, however, predict DT costs in gait velocity (estimate = -0.09; 95%CI = -0.23 to 0.05). These findings suggest that increased negative affect interferes with the allocation of attentional resources to competing task demands inherent in the DT paradigm.
The Impact of Bilingualism on Cognitive Functioning in Older Adults
Authors: Rouse Hillary , Small Brent , Schinka John 
Published: December 2020

Abstract
Research on bilingualism has found inconsistent results regarding its potential benefit on the cognitive abilities of older adults. The goal of the current study was to evaluate differences in cognition on a wide array of neuropsychological assessments between monolingual and bilingual cognitively healthy older adults who specifically speak only English and/or Spanish. The sample included cognitively intact older adults who were either monolingual (n=247) English speakers or bilingual (n=42) in English and Spanish. Performance was compared between groups from a battery of neuropsychological assessments that measured executive function, attention, short-term memory, and episodic memory. Compared to English and Spanish bilinguals, monolingual English speakers performed significantly better on a variety of tasks within the domains of executive function, attention, and short-term memory. No significant differences were found in favor of the bilinguals on any domain of cognitive performance. In the present study, we failed to observe a significant advantage for English and Spanish bilingual speakers on the cognitive performance of older adults when compared to monolingual English speakers. This study suggests that the bilingual advantage may not be as robust as originally reported, and the effects of bilingualism on cognition could be significantly impacted by the languages included in the study.