bluuebunny/crossref_metadata_2025_split huggingface dataset:
Declining Trend in Use of Sleep Medications Among Older Adults in the United States
Authors: Kaufmann Christopher , Spira Adam , Wickwire Emerson , Mojtabai Ramin , Ancoli-Israel Sonia , Fung Constance , Malhotra Atul 
Published: December 2021

Abstract
Recent initiatives to discourage over-prescription of sleep medications have increased awareness of their potential adverse effects in older adults; however, it is unknown whether these efforts translated into a decline in use of these medications in the United States. We assessed recent national trends in the use of medications for sleep disorders. Data came from the 2013-2018 National Health and Nutrition Examination Survey. At each of three waves of in-person assessments, participants presented prescription bottles for all medications used in the prior month. Interviewers recorded each medication and participants self-reported duration and indications for use. We identified all medications used for a sleep disorder and categorized medications into two groups: FDA-approved sleep medications, and medications used off-label (i.e., any other medication reported to be used for sleep disorders). We examined changes in the prevalence in use of these medications across the study period. The odds of using medications for sleep disorders decreased 31% between 2013 and 2018 (odds ratio [OR]=0.69, 95% confidence interval [CI]=0.51-0.92). This trend was driven by declines in use of FDA-approved sleep medications (OR=0.45, 95% CI=0.34, 0.59). Of note, among those age 80+ years, we observed an 86% decline (OR=0.14, 95% CI=0.05-0.36) in the odds of using FDA-approved sleep medications over the study period. Results suggest a possible effect of efforts to curb over-prescription and encourage judicious use of these agents. Future research needs to examine whether these changes have coincided with improved sleep health in the growing population of older adults.
Feasibility of Using a Commercial Board Game to Assess Upper Extremity Function in Older Adults
Authors: Niemiec Allison , Hernandez Yareli Lopez , Mulayh Ejlal Bin , Logue Rachel , Brown Susan 
Published: December 2021

Abstract
Upper extremity function, particularly the hand, declines with aging and is predictive of executive ability and independence. Standard assessments typically focus on strength partly due to a lack of easily administered functional tasks requiring multi-joint coordination and precision grasp. This study aimed to determine the feasibility of using an inexpensive board game to assess upper extremity function in older adults. Six healthy older adults (77 +/- 5.1 years) completed reaching tasks using the Connect4® game that requires grasping and placing small discs into a vertical board. Tasks included different hand configurations (unilateral, bilateral), and two dual-task conditions (serial subtraction by 7s and placing colored discs to match specific color patterns). The time to complete each task was recorded. For comparison purposes, participants completed a standardized pegboard test (Purdue Pegboard) using one or both hands. Connect4 results were similar to age-normative findings reported for the Purdue Pegboard. Dominant versus non-dominant hand performance did not differ while bilateral coordination tasks were slower than unilateral tasks for both the Purdue Pegboard (p&lt;0.05) and Connect4 (p&lt;0.01). Pegboard and Connect4 times were moderately to strongly correlated for all hand configurations. Dual-task conditions using Connect4 led to longer completion times (p&lt;0.05). Preliminary results support the use of Connect4 as a functional upper extremity assessment tool for older adults. It is inexpensive, engaging, easy to use, and allows for cognitive-motor assessment using dual-task protocols, a critical factor in maintaining functional independence in older individuals. Further research will include a formal validation study across a wider age range.
Heterogeneous patterns of old-age vulnerability and loneliness from the cross-national comparative perspective
Authors: Shin Oejin , park sojung , Kang Ji young , Kwak Minyoung , Baek Jihye 
Published: December 2021

Abstract
Loneliness has been extensively examined as a major risk factor for mortality and morbidity among older adults. In this research, we identified multi-dimensional patterns of old-age vulnerability in five countries (U.S., Korea, Sweden, Germany, Italy) guided by the welfare regime framework and examined how the patterns of vulnerability are associated with loneliness in old age in each country. Data were drawn from comparative national aging data: HRS for the U.S. (n=4331), KLOSA for Korea (n=3721), SHARE for Sweden (n=2746), Germany (n=2271), and Italy (n=2988). We used three vulnerability constructs: 1) material vulnerability (poverty, high out-of-pocket expenses for health care, unaffordability for housing), 2) health vulnerability (multiple chronic condition, depression), and 3) social vulnerability (living alone, contact with children and friend, social participation). Latent Class Analysis and regression analyses were used for data analysis. The relative proportion of the least vulnerable group varies substantially (from 11.88% in Italy to 59.33% in the U.S). In Sweden and Germany, around 7% of the sample belongs to the most vulnerable group, while in other countries the most vulnerable group was not found. Notably, in Italy, older people in the social vulnerable group were more likely to feel lonely when compared to least vulnerable, suggesting the country-specific significance of social supportive environment. This study is the first research to examine the empirical structure of the concept and how it may vary across countries related to their loneliness. A full discussion of country-specific discussion and policy implication will be presented.
Loneliness, Social Support, and Psychological Wellbeing Among Older Adults
Authors: Dahal Poshan , Kahana Eva , Bhatta Tirth , Ermoshkina Polina 
Published: December 2021

Abstract
Social support in old age has been linked to psychological wellbeing outcomes, such as depressive symptoms. However, insufficient attention has been paid to implications of social support for different domains of psychological wellbeing. In this study, we explored these associations among 797 older adults (mean age = 78.61 years) living in a retirement community in Florida from the ECRC study. Our findings show that measures of social support and connectedness have varying influences on psychological wellbeing. Loneliness was associated with lower life satisfaction (b=- -1.12, p&lt;0.001) and higher depressive symptoms (b=3.52, p&lt;0.001). Higher self-rated social support was associated with higher life satisfaction (b= 1.66, p&lt;0.001) but did not predict depressive symptoms. Depressive symptoms, however, were significantly higher (b=-1.45) among individuals who reported that they don’t have anyone who they can turn to if they feel lonely and want to talk. Feeling lonely also predicted lower positive affects among these older adults (b=-0.65, p&lt;0.001). Similarly, loneliness also predicted higher negative affects (b=1.28, p&lt;0.001). Negative affects were also significantly higher among women (b=-1.15, p&lt;0.001) but lower among those who were living alone (b=-1.06, p&lt;0.001). Overall, our findings underscore the importance of social support and connectedness for psychological wellbeing in later life. This finding is consistent with prior research demonstrating significance of social support in later life for the overall psychological wellbeing of the older adults.
Older Black Americans and Depressive Symptoms During the COVID-19 Pandemic
Authors: Chae David , Martz Connor , Chung Kara , Thorpe Roland , Lincoln Karen 
Published: December 2021

Abstract
Black Americans have experienced multiple health threats during the COVID-19 pandemic, including greater risk of infection compared to Whites. In addition, older adults are more susceptible to worse disease consequences including hospitalization and mortality compared to those who are younger. Racism and economic costs are additional public health crises during this time that have disproportionately impacted Black Americans. Using data from the Uncovering COVID-19 Experiences and Realities (UnCOVER) Study, we examined depressive symptoms in relation to: (1) worry/fear of COVID-19; (2) work loss among household members (being laid off, reduced work hours); and (3) vicarious racism, a particularly salient source of psychosocial stress during the COVID-19 pandemic, including hearing about or seeing acts of racism committed against other race group members. Participants were Black Americans aged 50 years or older (n=300) from five cities (Atlanta, Chicago, Los Angeles, New Orleans, and New York) from May-July 2020. Depression was assessed using the Patient-Reported Outcomes Measurement Information System Short Form. In multivariable linear regression models, all three public health threats were significantly associated with depressive symptoms. When in the model simultaneously, worry/fear of COVID-19 (b=0.30, SE=0.12, p&lt;0.01) and vicarious racism (b=0.62, SE=0.15, p&lt;0.001) showed positive associations; work loss was no longer statistically significant (b=0.62, SE=0.43, p=0.15). When added, the corresponding three-way interaction term was significant (b=0.12, SE=0.04, p&lt;0.01). Synergistic epidemics (“syndemics”) among older Black Americans amplify mental health tolls. Multi-pronged public health strategies are required to address depression in this population.
Perceived Neighborhood Disorder, Social Cohesion, and Depressive Symptoms among Spousal Caregivers
Authors: Choi Yeon Jin , Ailshire Jennifer 
Published: December 2021

Abstract
Most prior research on caregivers’ mental health focused on individual or household factors, we know much less about the influence of neighborhood factors on mental health of spousal caregivers. The current study fills the gap in our knowledge by examining the association of neighborhood characteristics (i.e., perceived neighborhood disorder and neighborhood social cohesion) and depressive symptoms among spousal caregivers. We used data from 2006 to 2016 waves of the Health and Retirement Study, which includes 2,362 spousal caregivers. Negative binomial regression models were estimated to examine the association of perceived neighborhood disorder and neighborhood social cohesion with depressive symptoms. A greater perceived neighborhood disorder was associated with higher CES-D scores, which indicates more depressive symptoms. On the other hand, a higher level of neighborhood social cohesion was associated with lower CES-D scores. When they were included in the same model, the association between neighborhood disorder and depression disappeared, while respondents who reported higher levels of neighborhood social cohesion continue to exhibit lower CES-D scores than those lived in less cohesive neighborhoods. This study highlights the importance of neighborhood contexts in understanding caregivers’ well-being. Findings of this study suggest that neighborhood social cohesion may attenuate the negative effects of neighborhood disorder. Therefore, enhancing positive characteristics of the neighborhood may promote well-being of spousal caregivers.
Reality or a Dream: Barriers and Facilitators for Nursing Assistants Pursuing a Nursing Career
Authors: Trotter Stephanie , Richardson Leah 
Published: December 2021

Abstract
Certified nursing assistants (CNAs) serve a critical role in the care of older adults. However, CNAs often experience significant professional and personal burdens related to caregiving work. Professionally, CNAs experience exorbitant workplace stress (e.g., physical injury, burnout, emotional exhaustion, staffing shortages, turnover). Personally, CNAs may have only a high school education, are subjected to low-paying jobs, and little opportunity for career advancement. Further, CNAs are disproportionately of minority race. Clearly, CNAs are negatively impacted by many social determinants of health. Ultimately, these burdens negatively impact older adults’ care provision and quality of life. Transitioning to a nursing career may alleviate some of these complex problems, but this has scantly been explored. A qualitative descriptive study was designed to 1) identify interest in a nursing career, and 2) explore perceived barriers and facilitators of transitioning into a nursing profession. CNAs from nursing facilities participated in private, semi-structured interviews. Recorded interviews (n = 6) were transcribed verbatim. Preliminary thematic analyses yielded two overarching themes: The Dream and The Reality. Rich subthemes began emerging from both overarching themes. Example subthemes from The Dream were: family legacy in healthcare, and finding purpose. Example subthemes from The Reality were: versus (CNAs vs. nurses; nurses vs. nursing care), and work-life balance. These preliminary findings suggest that CNAs express desire in becoming a nurse, although a range of personal and professional barriers and facilitators exist. Making the nursing dream become reality may improve CNAs’ social determinants, workplace outcomes, and resident outcomes, but further exploration is warranted.
Relationship Between Severity of Comorbidities and Self-Perceptions of Aging
Authors: Chang DaJung 
Published: December 2021

Abstract
An older adult with negative self-perceptions of aging (SPA) can lead to lower self-rated health and a higher risk of mortality. To stay a positive SPA, keep a healthier status is very important. However, evidence also proved that health conditions, like a physical limitation, could predict the level of SPA. Older adults usually have a higher prevalence rate of chronic diseases than the younger population, which can adversely impact them. The purpose of this study is to determine the relationship between the severity of comorbidities and the change of SPA during a time. I examined data in 7,034 people from the 2012 wave Health and Retirement Study (HRS) and followed the respondents who have answer the SPA scale in the leave-behind questionnaire in 2016. The generalized estimating equation was used to analyze the relationship between the severity of comorbidities and SPA in different waves. To measure the severity of comorbidities, a reduced index of the comorbidities severity scale (CmSS) was created to collect the health condition from HRS. Results statistical model shows that an individual with more severity of comorbidities may have a more negative SPA. However, the relationship does not follow through with the times. These findings enhance the previous study that there are relationships between severity of comorbidities and SPA. The benefit of this study is to use a different measurement to identify the severity of comorbidities and extend to more in-depth research.
ESPO and Health Sciences Section Symposium: Conducting Clinical Trial Research During the COVID-19 Pandemic: Transforming Research Practice for the Future
Authors: Morgan Brianna , Nguyen An , Nguyen An 
Published: December 2021

Abstract
The COVID-19 pandemic caused significant disruptions for people and institutions across healthcare settings. Clinical trials are an important research tool to test interventions in real-world healthcare settings and provide high quality evidence that supports older adults’ longevity and wellness. Clinical trialists must consider how to account for unpredictable and ever-changing environmental contexts. The COVID-19 pandemic is a specific example of a changing context that impacted all stages of the clinical trials process from planning, to administration, and outcomes. Reflecting on ways clinical trialists navigated their studies during the COVID-19 pandemic may unlock opportunities to design flexible clinical trials that meet the needs of older adults in real-world environments. This symposium highlights five clinical trials for older adults that occurred during the COVID-19 pandemic. Dr. Carpenter will discuss lessons learned in implementing a palliative care intervention in nursing homes. Brianna Morgan will describe the pivots needed to complete a clinical trial testing an advance care planning website for nursing home residents with dementia. Dr. Nuckols will describe obstacles and opportunities to implementing a randomized controlled trial on hospital nursing units, including implications for medication safety. Dr. Pevnick will highlight barriers and facilitators to implementing a pharmacist-led intervention to reduce hospital readmissions. Dr. Stark will share novel procedures for conducting clinical trials in the community that reduce burden for older adult participants while maintaining fidelity. Presenters will address practice transformations that researchers can bring forward to design flexible clinical trials that meet the needs of older adults in different healthcare contexts.
Daughters-in-Law in Negotiating the Intergenerational Contract in Rural China: A Qualitative Case Study
Authors: Li Yong-Zhen , Kwan Crystal 
Published: December 2021

Abstract
Daughters-in-law play a key role in intergenerational relationships, especially in Rural China. Albeit, their voices are less heard and examined. This study explores how daughters-in-law in Rural China view and negotiate intergenerational contracts with their older adult parents-in-law. A qualitative case study design was used, and multiple data collection methods (including semi-structured interviews, observation and document review) with thematic analysis were employed. Findings highlight that daughters-in-law play a key role in shaping the intergenerational contracts between their spouse and their spouse’s parents. In particular, the daughters-in-law provided instrumental support to their parents-in-law who were without self-care abilities or at risk when their adult child (the daughter-in-law’s spouse) went to the city/county for work. There were also unique findings highlighting diverse negotiations of the intergenerational contract between daughters-in-law and their older adult parents-in-law. In the context of growing austerity and the current pandemic, whereby informal social supports and networks become key to older adults’ wellbeing, identifying strengths and barriers of intergenerational support from daughters-in-law, is significant to support both the individual members and family wellbeing.
Does Money Matter? Characteristics Associated With Joint Pain Medication Access Among Older Adults
Authors: Tur-Sinai Aviad , Bentur Netta , Shuldiner Jennifer 
Published: December 2021

Abstract
The experience of pain is a widespread phenomenon among adults, especially older adults, and entails high costs to both individuals and society. The objective of the current research is to determine if the ability to pay and supplementary insurance are factors associated with pain medication among individuals over 50. Data came from Survey of Health, Aging and Retirement in Europe (SHARE). The sample included 64,281 individuals 50+ from nineteen European countries and Israel. Joint pain was common with one out of three reporting joint pain. Prevalence of pain was similar among different age groups, and more women reported joint pain. Among those in pain, about 21.5% of the individuals reported mild pain, 52.9% moderate and 26% severe pain. In the multivariate logistic regression, we found that men and those older than 60 suffered more from joint pain, while controlling for education and subjective assessment of the ability to cope economically (Able to make ends meet). A large percentage of those with pain were not taking medication to manage their pain, and there were significant demographic differences between those that did and did not take medication. Those that took medication were younger, male, had more education, were able to cope economically and had supplementary insurance. Our study showed that about half of the individuals with pain were not taking medication to manage their pain. Our results demonstrate that among individuals over 50 in Europe income is strongly associated with taking pain medication and that there is economic inequity in medication access.
Modifiable Factors of Health-Related Quality of Life Among LGBTQ Older Adults Living With Cognitive Impairment
Authors: Kim Hyun-Jun , Goldsen Karen Fredriksen 
Published: December 2021

Abstract
Cognitive impairment can lead to significant decline in health-related quality of life (HRQOL) in later life especially among those who are socially marginalized. While Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are documented to be at heightened risks of cognitive impairment, they may face unique challenges due to discrimination, social isolation, and other LGBTQ-related risks. This study examined factors associated with psychological and physical HRQOL among LGBTQ adults aged 50 and older analyzing a sub-set of longitudinal data (N = 646) from National Health, Aging, and Sexuality/Gender Study: Aging with Pride. Lifetime LGBTQ discrimination and victimization and insufficient food intake were negatively, and physical and leisure activities were positively associated with both HRQOL dimensions. Community engagement, social support, and social activities were positively associated with psychological HRQOL. Culturally responsive interventions addressing these modifiable factors are needed to improve HRQOL of this socially marginalized but resilient population.
Nursing Home Social Work With Residents With Severe Mental Illness, Thoughts of Suicide, or Dementia
Authors: Bern-Klug Mercedes , Roberts Amy Restorick 
Published: December 2021

Abstract
Many of the close to 3 million persons who receive care in a U.S. nursing home in any given year face mental-health-related challenges that range from minor to severe. One of the core professionals involved with care planning for the psychosocial needs of nursing home residents with mental health concerns is the social worker. Reporting data from a 2019 nationally representative survey of nursing home social services directors, this session provides information about the training needs of nursing home social workers in terms of their work with residents diagnosed with a severe mental illness such as schizophrenia or severe depression, residents who are suicidal, and residents with dementia.
Disability Trends Among Community-Dwelling Older Adults and Related Determinants of Disability
Authors: Li Qiwei , Szanton Sarah 
Published: December 2021

Abstract
The growing aging population with disabilities poses challenges to caregiving and health care services but there is little recent data on disability trends. Some studies have shown that disability is decreasing while others have shown it increasing. Understanding these trends among community-dwelling older adults is critical for communities to allocate resources and develop policies. This study updates disability trend data among community-dwelling older adults using nationally representative National Health & Aging Trends Study data. Results revealed that about 30% of Medicare beneficiaries had at least one limitation of the activity of daily living (ADL) from 2011 to 2019. Age 75-79 (IRR=1.55), 80-84 (IRR= to 4.60), 85-89 (IRR=2.99), 90+ (IRR=4.60), female, (IRR=1.18), not a house owner (IRR=1.51), financial strain (IRR=1.71), and receiving Medicaid (IRR=1.84) are associated with a higher likelihood of becoming ADL limited or having more ADL limitations. We will discuss potential policy, intervention, and research implications.