bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intergenerational Communication as Intervention: Social Isolation in Older Adults During COVID-19
Authors: Kirk Laura , Kessler Penny , Gingerich Stephanie , McGill Sharon , Pryor Hanna 
Published: December 2021

Abstract
Social isolation and loneliness are prevalent and impactful in the lives of older adult across care settings, and the emergence of a deadly global pandemic requiring social distancing and quarantining exacerbated these experiences significantly in 2020. A semester-long communication-focused clinical project was developed and piloted for sophomore bachelor of nursing science (BSN) students during fall 2020. Affording preclinical nursing students the opportunity to develop communication skills early in their program of study holds potential, and learning the story of older adults appears to be mutually beneficial; older adults serve as mentors and share their story, and preclinical nursing students have an opportunity to learn about their mentor’s life, challenging some prevalent stereotypes about aging. A pre- post-clinical survey of student attitudes toward older adults suggests a dramatic positive shift in perspective, and unsolicited, anecdotal comments in student reflections support this finding: “...it helped me feel much more open to working with older adults in the future”; “This conversation taught me that my assumptions about the older generation are not always correct”. Of older adult participants, 96% reported the experience enriched and enhanced their social connectedness, with 88% requesting to participate in the program again. Narrative comments from residents indicated that their involvement enabled them to feel engaged and purposeful: “I was a mentor”; “Conversations were so alive. Connections with curious young people fill my heart and soul.” Intergenerational sharing of life stories has the potential for both healing and growth and may provide an antidote to ageism.
Hope, active coping and well-being in stroke-survivors and caregivers: An actor–partner model analysis
Authors: Chow Esther , Fung Sai-fu 
Published: December 2021

Abstract
Purpose: Stroke is a medical condition cause of suffering for both patients and their caregivers within the family. This paper aimed to assess the influence of the psychological construct of hope and active coping on hedonic wellbeing in patient with stroke and caregiver dyads by determining the dyadic patterns. Methods: A baseline study including 200 stroke-survivor (Age 73.63; SD=7.22) and caregiver (62.49; SD=14.44) dyads with actor–partner interdependence model (APIM) estimated by structural equation modelling with maximum likelihood estimation. Herth Hope Index (HHI), Proactive Coping Inventory (PCI) and Personal Wellbeing Index (PWI) were used to measure hope, proactive coping and wellbeing, respectively. Results: The APIM analysis revealed that both stroke patients and caregivers demonstrated double actor-only pattern. As such, stroke-survivors’ hope and active coping excreted an actor effect on their own wellbeing with beta = 0.48 (p &lt; 0.01) and 0.16 (p &lt; 0.01), respectively. Similarly, the caregiver also reported an actor effect between hope and wellbeing (beta = 0.84, p &lt; 0.01) as well as active coping with wellbeing (beta = 0.37, p &lt; 0.01). The overall SEM model also fulfilled the criteria for good model fit (χ2 (5.87), p = &gt; 0.05, CFI = 0.98, TLI = 0.96 and RMSEA = 0.07). Conclusions: The results suggest that both stroke patients and caregivers’ hedonic wellbeing are holding actor-oriented pattern with the hope and active coping. The implications for clinical practitioners, research and theoretical development are discussed.
Psychosocial Interventions for People With Dementia and Their Caregivers in Primary Care
Authors: Frankenstein Lou , Jahn Georg 
Published: December 2021

Abstract
Psychosocial interventions, such as occupational and behavioral therapy are effective opportunities to support people with dementia and their caregivers in adapting to the cognitive and behavioral changes and the resulting challenges in everyday life they are facing. However, psychosocial interventions do not seem to have found their way into routine care yet. We wanted to get an insight into the knowledge and attitudes general practitioners have about occupational and behavioral therapy. In an online survey we asked medical students about the relevance of dementia, occupational therapy, and behavioral therapy during their studies. In another online survey we asked practitioners what they had learned about these topics and to what extent they are making use of psychosocial interventions. Then semi-structured interviews were carried out with general practitioners all over Germany, exploring their experiences with dementia and psychosocial interventions in primary care as well as their expectations regarding interdisciplinary cooperation. It became obvious that psychosocial interventions are not conveyed sufficiently within medical school. A lack of occupational therapy prescriptions for people with dementia seemed to result from uncertainties regarding the content of the approach and the budgeting of the prescriptions. Barriers for prescriptions of behavioral treatment were a lack of therapy places and the perceived inadequacy of the approach for this target group. General retentions to invest in people with dementia were expressed. These obstacles need to be overcome in order to provide optimal care for people with dementia and their family caregivers.
Qualitative Study of an mHealth Mindfulness intervention with Caregivers of Older Adults with MCI or Dementia
Authors: Llaneza Danielle , Dong XinQi , Duberstein Paul , Kozlov Elissa 
Published: December 2021

Abstract
Caregivers of patients with dementia experience high levels of emotional distress. mHealth interventions have the potential to feasibly address some needs of caregivers and reduce stress. This qualitative research study of (n = 15) caregivers of patients with dementia explored caregivers’ experience using a mindfulness meditation mobile application. The qualitative interviews were guided and structured to allow participants to share their perceived benefits, drawbacks, likes, and dislikes of using mHealth strategies to manage stress and anxiety. We asked about the caregivers' experience with mindfulness before the study, use of the app, their positive/helpful and negative/unhelpful app experiences, the perceived value of the app, and potential enhancements of the app. Caregivers reported that the app was easy to use, engaging and that there were many perceived benefits. They also noted multiple barriers to using the app including time constraints and implementation of mindfulness techniques outside of direct app use. Most of the caregivers recommended using the app to increase knowledge of mindfulness and to reduce stress. Our findings support the growing body of literature on the practical use of mHealth strategies for caregivers. Future work should address the perceived barriers caregivers encounter when using mHealth strategies.
Association of Frailty Index with Clinical BPH Progression and Serious Adverse Events: the MTOPS Trial
Authors: Bauer Scott , Ensrud Kristine , Walter Louise C , Suskind Anne M , Ricke William A , Liu Teresa T , McVary Kevin T , Covinsky Kenneth 
Published: December 2021

Abstract
Lower urinary tract symptoms due to suspected benign prostatic hyperplasia (BPH) are increasingly treated with medications targeting obstruction among older men, but frailty may represent a novel risk factor for this condition. Our objective was to assess the associations between frailty and clinical BPH progression or serious adverse events (SAE) among 3047 men, age 50-89 years, enrolled in the Medical Therapy of Prostatic Symptoms Study, a placebo-controlled RCT of doxazosin, finasteride, or combination therapy on clinical BPH progression. We created a frailty index using 69 items collected at baseline and categorized men as fit (0-0.1), less fit (0.1-&lt;0.25), or frail (0.25-1.0). The primary outcomes were time to 1) first composite event of clinical BPH progression, and 2) SAE requiring hospitalization. Cox proportional hazards models were adjusted for demographics, intervention, BPH surrogates, and comorbidities. At baseline, 28% men were fit, 58% were less fit, and 14% were frail. During follow-up (mean 4.5 years), the incidence rate of clinical BPH progression was 2.2/100p-y among fit, 3.0/100p-y among less fit (HR =1.28, 95% CI 0.98, 1.67), and 4.1/100p-y among frail men (HR=1.60, 95% CI 1.13, 2.26). Among men randomized to combination therapy, the SAE incidence rate was 3.4/100p-y for fit men versus 12.7/100p-y for frail men (HR=5.98, 95% CI 3.76, 9.52). In conclusion, frailty is independently associated with greater risk of both clinical BPH progression and SAE. The decision to initiate medical therapy for BPH among frail men should therefore include a discussion of both benefits and risks via shared decision making.
Body Mass Index and Frailty Among Older Mexican Americans: Findings From an 18-year of Follow-up
Authors: Rutherford Megan , Downer Brian , Li Chih-Ying , Snih Soham Al 
Published: December 2021

Abstract
The objective of this study was to examine body mass index (BMI) as predictor of frailty among non-frail Mexican American older adults at baseline. Data are from an 18-year prospective cohort of 1,647 non-institutionalized Mexican American aged ≥ 67 years from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1995/1996-2012/13). BMI (Kg/m2) was grouped according to the National Institutes of Health obesity standards (&lt;18.5=underweight, 18.5–24.9=normal weight, 25.0–29.9=overweight, 30.0–34.9=obesity category I and ≥ 35=obesity category II and extreme obesity). Frailty was defined as meeting three or more of the following: unintentional weight loss of &gt;10 pounds, weakness, self-reported exhaustion, low physical activity, and slow walking speed. Covariates included socio-demographics, comorbidities, cognitive function, depressive symptoms, and limitations in activities of daily living (ADL). General Estimating Equations were performed to estimate the odds ratio (OR) and 95% confidence interval (CI) of frailty as a function of BMI categories. All variables were analyzed as time varying except for gender and education. Participants in the underweight or obesity type II / morbidity obesity category had increased OR of frailty over time than those in the normal weight category (2.68, 95% CI=1.46-4.9 vs.1.55, 95% CI=1.02-2.35, respectively) after controlling for all covariates. Those who reported arthritis, hip fracture, depressive symptoms, or ADL disability had increased odds of frailty over time. This study showed a U-shaped relationship between BMI and frailty over an 18-year period of follow-up which has implications for maintaining a healthy weight to prevent frailty in this population.
Malnutrition-Sarcopenia Syndrome and its Associated Factors Among Older Adults
Authors: Taani Murad 
Published: December 2021

Abstract
Malnutrition and sarcopenia are present in parallel in older adults and characterized by a combination of inadequate nutrient intake and decreased muscle mass, strength, and/or function. The presence of both conditions has been termed Malnutrition-Sarcopenia Syndrome (MSS) and is associated with negative health outcomes. The objective of this correlational study was to identify the prevalence and factors associated with the malnutrition-sarcopenia syndrome among older adults living in continuing care retirement communities. A convenience sample of 104 older adults living in CCRCs participated in this study. Muscle mass, strength, and function were measured using bioimpedance analysis, Jamar digital hand dynamometer, and the Short Physical Performance Battery test, respectively. Physical activity, sedentary time, and nutritional status were measured using ActiGraph GT3X and Mini Nutritional Assessment, respectively. Questionnaires were used to measure self-efficacy for exercise and goal congruence for physical activity and protein intake. Of the 104 participants, 37 (35.2%) had sarcopenia, 19 (18.1%) had malnutrition, and 14 (13.5 %) had MSS. Compared with those without MSS, older adults with MSS were more than two times more likely to have a sedentary lifestyle (Odd ratio, 2.028; 95% confidence interval, 2.012–2.044). Findings showed that sarcopenia, malnutrition, and MSS are prevalent in older adults living in continuing care retirement communities. Older adults should be screened and assessed for both malnutrition and sarcopenia. The results also suggest that decreasing the sedentary time could help in preventing MSS among older adults living in continuing care retirement communities.
Risk factors associated with cognitive frailty among community-dwelling older adults: A scoping review
Authors: Lee Sumi , Lee JuHee 
Published: December 2021

Abstract
Objectives: This study aimed to explore the risk factors associated with cognitive frailty(CF) among community-dwelling older adults, and to provide the impact of CF on health-related outcomes. Methods: PubMed, EMBASE, Cochrane, PsycINFO, CINAHL, RISS, DBpia, NDSL, and KoreaMed databases were searched to retrieve studies. Two reviewers independently screened titles, abstracts and articles. The inclusion criteria are peer-reviewed articles written in English or Korean for community-dwelling older adults with both physical frailty and cognitive impairment present at the same time. Results: A total of 3,513 were searched, and the final 33 were extracted according to the inclusion criteria. Physical factors affecting CF were the number of chronic disease, cardiovascular disease, activity of daily living(ADL), making telephone calls and shopping during instrumental ADL, and a Mini Nutrition Assessment–Short Form score. Psychological factor was depressive symptoms. Significant behavioral factors included self-reported physical activity, low vitamin D, smoking, frequent insomnia, and sedentary lifestyle. In social factors, social participation such as volunteering was identified as a protective factor. Mortality, followed by dementia was health related outcomes on CF, including ADL dependence, poor quality of life, and hospitalization. However, the CF-related fall was inconsistent. Conclusion: A wide variety of factors have been presented in studies related to CF. In order to understand CF and improve health-related outcomes, older adults in CF should be screened as high-risk group. When the risk factors and protective factors of CF managed, better health-related outcomes will lead to successful aging of community-dwelling older adults.
The Effect of Low-Dose Aspirin on Frailty in Older Adults in the Aspirin in Reducing Events in the Elderly Study
Authors: Espinoza Sara , Ekram A R M Saifuddin , Woods Robyn , Ernst Michael , Polekhina Galina , McNeil John , Murray Anne , Ryan Joanne 
Published: December 2021

Abstract
There are no widely accepted pharmacologic treatments for frailty prevention. Since frailty is associated with inflammation, aspirin has the potential to reduce frailty. We investigated whether low-dose aspirin reduces incident frailty in participants of the ASPirin in Reducing Events in the Elderly (ASPREE) trial. In the U.S and Australia, 19,114 healthy community-dwelling individuals aged ≥70 years (U.S. minorities ≥65 years) were enrolled in ASPREE, a double-blind, placebo-controlled trial of 100mg daily low-dose aspirin vs. placebo. Frailty was defined according to a modified Fried frailty definition, and a frailty index which used a deficit accumulation model. Competing risk Cox proportional hazards models were used to compare time to incident frailty for aspirin vs. placebo. At baseline, 2.2% and 8.1% met criteria for frailty by Fried and frailty index criteria, respectively. Over a median of 4.7 years of follow-up, 2252 participants developed incident frailty according to Fried classification, and 4376 according to the frailty deficit accumulation index. There was no difference in the risk of incident frailty between individuals randomized to aspirin versus placebo according to either criteria (Fried frailty HR: 1.03, 95% CI 0.97-1.09, p=0.41; frailty index HR: 1.03, 95% CI 0.97-1.10, p=0.29). Change in frailty over time was not different between the aspirin and placebo treatment arms. The results were consistent across a series of sub-groups, including baseline frailty status. Based on these results, aspirin use in healthy older adults does not reduce incident frailty.
Pre-Operative Physical Function Predicts Post-Operative Skeletal Muscle Gene Expression in Old Mice
Authors: Asche-Godin Samantha , Harlow Lauren , Graham Zachary , Huang Weihua , Mobbs Charles , Cardozo Christopher , Ko Fred 
Published: December 2021

Abstract
In older adults, pre-operative physical function predicts post-operative outcomes. The biological mechanisms underlying vulnerability to physical decline remain poorly understood. Using a mouse model of laparotomy, we sought to identify biological correlates of post-operative function. 24-month-old male C57BL/6N mice were categorized as high functioning (HF) or low functioning (LF) based on pre-operative performance on the accelerating rotarod. On post-operative days (POD) 2 and 4, LF mice had lower rotarod latency to fall times than HF mice did. Forelimb grip strength was reduced after laparotomy in both HF and LF groups on POD 1 and 3 and did not differ significantly between these groups. Whole transcriptome sequencing analysis (RNAseq) of soleus muscles collected on POD 5 showed 224 and 228 differentially expressed genes (DEGs) for HF and LF, respectively, compared to their respective controls. Only 21 DEGs were observed in both groups, including Pparα, Fst and Pla2g15. Such changes may be hallmarks of the post-surgical response in aging. Pathway analysis of DEGs using Ingenuity Pathway Analysis software (Qiagen) revealed one pathway common to HF and LF (osteoarthritis) whereas activation of GP6 signaling and apoptosis signaling was observed in HF and inhibition of PPARα/RXR activation and PPARα signaling was noted in LF. We conclude that pre-operative performance on the accelerating rotarod correlates with differences in skeletal muscle gene expression, which may contribute to the differences in functional outcomes post-operatively in HF and LF mice. Further studies are needed to delineate the roles of these signaling pathways in physical resilience to surgery.
The Role of Obesity in Frailty Incidence: The San Antonio Longitudinal Study of Aging
Authors: Cortes Tiffany , Wang Chen-pin , Hazuda Helen , Espinoza Sara 
Published: December 2021

Abstract
Background: Although initially conceptualized as a wasting syndrome, obesity has been associated with frailty in prior studies. The goal of this study was to examine the associations of obesity and waist circumference with frailty and determine whether they predict incident frailty in an ethnically diverse population of older Mexican Americans (MAs) and European Americans (EAs). Methods: 749 MA and EA community-dwelling older adults (65+) participated in the baseline examination of the San Antonio Longitudinal Study of Aging (SALSA), and 474 participants completed the first follow up approximately 6 years later. Frailty was classified using Fried criteria. Baseline characteristics, including body mass index (BMI) and waist circumference (WC) were summarized by frailty category (non-frail, pre-frail, frail) using ANOVA. The odds of becoming frail at follow-up by baseline BMI and WC were estimated using separate logistic regression models, adjusting for age, sex, ethnicity, diabetes, comorbidity (presence of ≥2 chronic diseases not including diabetes), baseline frailty score, and follow-up time. Results: At baseline, participants were 69 ±3 years old, 61% female, and 50% MA. BMI and WC increased with increasing frailty category (p &lt;0.01 for both). BMI was a significant predictor of incident frailty (OR=1.08, 95% confidence interval [CI]: 1.02-1.14, p=0.011). WC also predicted frailty (OR=1.03, 95% CI: 1.01-1.05, p =0.017). Conclusion: These results demonstrate that BMI and WC are significant predictors of frailty. Interventions which target obesity may reduce the incidence of frailty; however, more research in this area is needed.
Comparison of Catastrophic Out-of-Pocket Medical Expenditures in the US and South Korea
Authors: Kim Narae , Jacobson Mireille 
Published: December 2021

Abstract
To date, relatively few studies have examined catastrophic out-of-pocket medical spending in the United States, especially in comparison to other high-income countries. We compared catastrophic out-of-pocket medical spending among adults age 65 and older in the United States versus South Korea, a high-income country with national health insurance that is often overlooked in cross-country comparisons. We defined catastrophic medical spending as health care expenditure for the past two years that exceeds 50% of one’s annual household income. Using data from the 2016 Health and Retirement Study (HRS) and Korean Longitudinal Study of Aging (KLoSA), we performed a logistic regression to examine the factors affecting catastrophic out-of-pocket medical spending for older adults in both countries. We also performed a Blinder-Oaxaca decomposition to compare the contribution of demographics factors versus health system-level factors to catastrophic out-of-pocket medical spending. The proportion of respondents with catastrophic out-of-pocket medical expenditure was higher in the US; the proportion was 5.8% and 3.0% in the US and South Korea, respectively. Both in the US and South Korea, respondents who were in the lower-income quartiles, who had experienced a stroke or had diabetes, and who rated their health as poor had higher odds of catastrophic out-of-pocket medical expenditure. The Blinder-Oaxaca non-linear decomposition showed that the significant difference in the rate of catastrophic out-of-pocket medical spending between the two countries was attributable to unobservable system-level factors, not observed differences in the sociodemographic characteristics between the two countries.
Non-Response to Population Aging in Sub-Saharan Africa: A Survey of Gerontology Scholars
Authors: Adamek Margaret , Kotecho Messay , Chane Samson , Gebeyaw Getachew 
Published: December 2021

Abstract
Life expectancy is increasing globally, with the biggest gains expected in sub-Saharan Africa. In fact, most of the population growth globally in the next few decades will occur in sub-Saharan Africa. Using an online survey we investigated the perspectives of gerontology scholars on the challenges of aging in sub-Saharan Africa as well as the assets of elders. Respondents (n=72) from 17 countries, primarily in Africa, and representing 16 disciplines, identified the top issues facing African elders as: poverty, lack of trained professionals, food insecurity, disability/health issues, and long-term care. Older adults’ unique strengths were noted as indigenous knowledge systems, being holders of cultural heritage, and their contributions to development. Respondents’ biggest concerns about older adults in sub-Saharan Africa were the lack of government attention to aging issues (63%) and a lack of social services targeted to elders’ needs (57%). Government funding (77.8%) and international partnerships (38.9%) were noted as resources needed to support aging research in sub-Saharan Africa. The response or non-response of governments in sub-Saharan Africa will determine whether the growing number of older adults will increasingly experience unmet needs and whether their assets will be considered in development efforts. Establishing professional networks of gerontology scholars in the region will help to document the challenges faced by elders, to plan for the coming demographic shift, and to empower elders to thrive as valued community members.