Scholarly Works, Center for Gerontology

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Extended Family Caregivers for Persons Living With Dementia
Roberto, Karen A.; Savla, Jyoti S. (SAGE, 2022-11-01)
Despite changes in the structure of contemporary families, little is known about extended family members—siblings, grandchildren, nieces/nephews, stepkin—who are primary caregivers for a relative living with dementia. Information about these caregivers is needed to help ensure their needs are understood by providers in health care and social service settings. The focus of this research was on the care situations of extended family caregivers and the impact of caregiving on their health and well-being. In Study 1, data from the National Study of Caregiving were used to describe the experiences of 107 extended family caregivers. In Study 2, case study techniques elicited additional information about the experiences of 10 extended family caregivers. Collectively, these caregivers provide care with little or no formal support and occasional help from a small informal network. Caregiving affected their physical and emotional health, depending on the strength of the relationship between the caregiver and the person living with dementia and the type of care provided. Findings contribute new knowledge about extended family caregivers and highlight the important role extended family dementia caregivers play and the challenges they face.
Subjective Memory Decline Predicts Incident Cognitive Impairment among White -- but Not Black or Hispanic -- Older Adults
Ferraro, Kenneth F.; Sauerteig-Rolston, Madison R.; Barnes, Lisa L.; Friedman, Elliot; Sands, Laura P.; Thomas, Patricia A. (Oxford University Press, 2022-06-18)
Background and objectives: This study investigates whether subjective memory decline in a racially diverse sample of older adults without cognitive impairment at baseline is associated with incident cognitive impairment during a 12-year follow-up period. Research design and methods: With panel data from a national sample (N=9,244) of cognitively-intact Black, White, and Hispanic Americans 65 years or older in 2004, we examine if subjective memory decline is associated with the loss of normal cognition by 2016. Cognitive status was assessed every two years with a modified version of the Telephone Interview for Cognitive Status to identify the transition from normal cognition to cognitive impairment. Results: Estimates from Weibull accelerated failure-time models reveal that subjective memory decline is associated with earlier incident cognitive impairment (time ratio = 0.96, p<.05). In subsequent models stratified by race-ethnicity, this association was evident among White respondents (time ratio = 0.95, p<.01) but not among Black, US-born Hispanic, or foreign-born Hispanic respondents. Discussion and implications: Given that the prognostic validity of subjective memory decline differs by race and ethnicity, caution is warranted when using it as a screening or clinical tool in diverse populations.
Family Caregivers in Rural Appalachia Caring for Older Relatives With Dementia: Predictors of Service Use
Savla, Jyoti S.; Roberto, Karen A.; Blieszner, Rosemary; Knight, Aubrey L. (Oxford University Press, 2022-01-01)
Background and Objectives Residents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the United States. Although family is the first line of support for older adults needing care, it is unclear whether dementia caregivers in Appalachia assume these care responsibilities because of strong informal networks that support them in their caregiving role, underresourced formal services for persons with dementia, or culture-based reluctance to accept help from outsiders. This research examines how rural residents of Appalachia manage the care of relatives with dementia. Research Design and Methods The study was grounded in the Andersen Behavioral Model, supplemented with culturally relevant variables. Family caregivers from rural Appalachian counties in Virginia caring for community-dwelling relatives with dementia participated in a structured phone interview (N = 163). Generalized structural equation models were estimated, with predisposing, need, and enabling variables as predictors. Use of support services (e.g., meal delivery) and personal services (e.g., home health nurse) by family caregivers to care for the person with dementia were the dependent variables, and caregiver's rural community identity and attitude toward services were moderators. Results Approximately half the sample utilized at least one support service and one personal service. Predisposing and need factors predicted the use of support services, whereas predisposing, need, and enabling factors predicted personal services. Caregivers who strongly identified with their cultural roots were less likely to use personal services unless they held a generally positive view of formal services. Discussion and Implications Although the extent of needs and the caregiver's economic situation were essential influences on formal service utilization, the main drivers were the caregiver's identification with rural Appalachian culture and attitude toward services. Findings point to within-group heterogeneity that requires differential approaches to delivery of community-based services accounting for varying attitudes, preferences, and family resources.
Dual Caregivers of Persons Living with Dementia: The Added Stress of COVID-19 Pandemic
Atkinson, Emily; Savla, Jyoti S.; Roberto, Karen A.; Blieszner, Rosemary; McCann, Brandy R.; Knight, Aubrey L. (SAGE, 2022-02-17)
Serving in dual caregiving roles presents challenges and has consequences for caregivers’ physical and mental health. Forty-six dual caregivers in rural southwest Virginia participated in one semi-structured telephone interview pre-pandemic. Of these caregivers, nine dual caregivers of multiple older adults (MOA) and six caregivers of multiple generations (MG) participated in two telephone interviews during the COVID-19 pandemic. Pre-pandemic health, stress, and support data were used to compare dual caregivers of MOA and MG; differences were minimal. Responses to interviews conducted during the pandemic highlighted the effects of social restrictions on MOA and MG caregivers, revealing five themes (1) Increased isolation, (2) Increased need for vigilance, (3) Negative impact on mental health, (4) Tendency to “do it all,” and (5) Increased informal help. MOA and MG caregivers differed on managing care responsibilities and ensuring the health of care recipients. In general, dual caregivers experienced decreased mental health, increased social isolation, and increased caregiving responsibilities. Antecedents of the pandemic experiences differentiated MOA and MG caregiver. Findings suggest that programs and services should target dual caregivers’ unique needs.
Prediction of fall risk among community-dwelling older adults using a wearable system
Lockhart, Thurmon E.; Soangra, Rahul; Yoon, Hyunsoo; Wu, Teresa; Frames, Christopher W.; Weaver, Raven; Roberto, Karen A. (2021-10-25)
Falls are among the most common cause of decreased mobility and independence in older adults and rank as one of the most severe public health problems with frequent fatal consequences. In the present study, gait characteristics from 171 community-dwelling older adults were evaluated to determine their predictive ability for future falls using a wearable system. Participants wore a wearable sensor (inertial measurement unit, IMU) affixed to the sternum and performed a 10-m walking test. Measures of gait variability, complexity, and smoothness were extracted from each participant, and prospective fall incidence was evaluated over the following 6-months. Gait parameters were refined to better represent features for a random forest classifier for the fall-risk classification utilizing three experiments. The results show that the best-trained model for faller classification used both linear and nonlinear gait parameters and achieved an overall 81.6 +/- 0.7% accuracy, 86.7 +/- 0.5% sensitivity, 80.3 +/- 0.2% specificity in the blind test. These findings augment the wearable sensor's potential as an ambulatory fall risk identification tool in community-dwelling settings. Furthermore, they highlight the importance of gait features that rely less on event detection methods, and more on time series analysis techniques. Fall prevention is a critical component in older individuals' healthcare, and simple models based on gait-related tasks and a wearable IMU sensor can determine the risk of future falls.
Peritraumatic Stress From a Disaster Increases Risk for Onset of Chronic Diseases Among Older Adults
Sands, Laura P.; Do, Quyen; Du, Pang; Pruchno, Rachel (Oxford University Press, 2022-01-01)
Background and objectives: Our understanding of the impact of disaster exposure on the physical health of older adults is largely based on hospital admissions for acute illnesses in the weeks following a disaster. Studies of longer-term outcomes have centered primarily on mental health. Missing have been studies examining whether exposure to disaster increases the risk for the onset of chronic diseases. We examined the extent to which 2 indicators of disaster exposure (geographic exposure and peritraumatic stress) were associated with new onset of cardiovascular disease, diabetes, arthritis, and lung disease to improve our understanding of the long-term physical health consequences of disaster exposure. Research design and methods: We linked self-reported data collected prior to and following Hurricane Sandy from a longitudinal panel study with Medicare data to assess time to new onset of chronic diseases in the 4 years after the hurricane. Results: We found that older adults who reported high levels of peritraumatic stress from Hurricane Sandy had more than twice the risk of experiencing a new diagnosis of lung disease, diabetes, and arthritis in the 4 years after the hurricane compared to older adults who did not experience high levels of peritraumatic stress. Geographic proximity to the hurricane was not associated with these outcomes. Analyses controlled for known risk factors for the onset of chronic diseases, including demographic, psychosocial, and health risks. Discussion and implications: Findings reveal that physical health effects of disaster-related peritraumatic stress extend beyond the weeks and months after a disaster and include new onset of chronic diseases that are associated with loss of functioning and early mortality.
Extended parallel process model (EPPM) in evaluating lung Cancer risk perception among older smokers
Zarghami, Fatemeh; Allahverdipour, Hamid; Jafarabadi, Mohammad Asghari (2021-10-17)
Background There is a lack of scientific literature on the application of fear appeals theories to evaluate lung cancer risk perception among smokers. The aim of the present study is to apply the Extended Parallel Process Model (EPPM) to discover the perception of the smokers about their lifetime risk of developing lung cancer (perceived susceptibility), their perception of lung cancer survival (perceived severity), response efficacy, self-efficacy, and readiness to quit. Methods In this cross-sectional study, 215 eligible smokers (aged 45 years and over who have smoked at least 1 pack per day in the last 5 years) were recruited. The data collection tool was designed using validate self-report questionnaires and it was contained items on the perceived risk of a smoker contracting lung cancer and perceived lung cancer survival rate. It also had questions to measure the main constructs of the EPPM and Readiness to quit (“Low_Readiness”, and “High_Readiness”). To test how the data support conceptual EPPM to data, Generalized Structural Equation Modeling (GSEM) was used. Results Findings showed a significant relationship between Perceived_Susceptibility and Perceived_Response Efficacy; (B = 1.16, P < 0.001); between Perceived_Susceptibility and Perceived_Self Efficacy, (B = -0.93, P < 0.001), Perceived_Severity, and Perceived_Response Efficacy (B = 1.07, P < 0.001). There was also a significant relationship between Perceived_Threat and Perceived_Response Efficacy; between Perceived_Threat and Perceived_Self Efficacy. The relationship between High_Readiness and Perceived_Self Efficacy, and between High_Readiness and Perceived_Severity also were significant. However, the relationships between High_Readiness and Perceived_Threat were not significant (P > 0.05). Conclusion Perceived_threat and Perceived_efficacy were important for smokers with low readiness to quit, while Perceived_efficacy was most important for smokers with high readiness to quit. These findings could be used in promoting lung cancer awareness and designing smoking cessation programs based on smokers’ stages of change.
Friendship in Later Life: A Research Agenda
Blieszner, Rosemary; Ogletree, Aaron M.; Adams, Rebecca G. (Oxford University Press, 2019-01-01)
Friendship is a relationship that can endure across the entire lifespan, serving a vital role for sustaining social connectedness in late life when other relationships may become unavailable. This article begins with a description of the importance of studying friendship in late life and the benefits of friendship for older adults, pointing to the value of additional research for enhancing knowledge about this crucial bond. Next is discussion of theoretical approaches for conceptualizing friendship research, followed by identification of emerging areas of late-life friendship research and novel questions that investigators could explore fruitfully. We include a presentation of innovative research methods and existing national and international data sets that can advance late-life friendship research using large samples and cross-national comparisons. The final section advocates for development and assessment of interventions aimed at improving friendship and reducing social isolation among older adults.
Understanding and Addressing Older Adults’ Needs During COVID-19
Sands, Laura P.; Albert, Steven M.; Suitor, Jill J. (Oxford University Press, 2020-06-02)
Four months have passed since the World Health Organization (WHO) identified coronavirus disease 2019 (COVID-19) as a public health emergency, and 3 months since it declared the outbreak of COVID-19 a pandemic. WHO posted guidelines to reduce the spread of COVID- 19, including isolating those with the virus, quarantining those exposed to the virus, and social distancing. These guidelines have been adopted across the globe, and there is evidence that following these guidelines slows transmission of the disease. Some have suggested that cases have reached a plateau, yet these conclusions are based on data drawn from reports of identified cases, which are not necessarily representative of all cases of COVID-19. This is problematic for designing guidelines and policies that are intended to protect the health of the entire population and the health of those who may be particularly vulnerable to COVID-19, including older adults. The pandemic has created difficulties for all, so we must be thoughtful about our pathway for returning to a life that is not threatened by COVID-19. Guidelines and policies for charting that pathway should be based on high-quality data, scientific knowledge, and ethical decision making.
The Impacts of the Neighborhood Built Environment on Social Capital for Middle-Aged and Elderly Koreans
Hwang, Eunju; Brossoie, Nancy; Jeong, Jin Wook; Song, Kimin (MDPI, 2021-01-14)
The purpose of this study was to investigate the relationship between the neighborhood built environment (NBE) aspects of age-friendly cities and communities (AFCCs) and social capital in the Korean context. We described and compared age differences when analyzing misfits of AFCC NBE and impacts on social capital. We collected the data (N = 1246) from two Korean communities; our multiple and binary logistic regression outcomes show that AFCC NBE aspects such as outdoor spaces, transportation, and housing are significant predictors of different subcategories of social capital. For the older group, the outdoor spaces misfit was significant for all three subcategories of social capital, but transportation and housing misfits were significant for the social trust and reciprocity index scores. For the middle-aged group, the outdoor spaces misfit was significant for social networking and participation, and a transportation misfit was significant for participation and social trust and reciprocity. Fewer misfits or better fits of outdoor spaces and transportation encouraged more networking, participation, social trust, and reciprocity. Dwelling type was important to predict social capital, especially for the older group. The present study confirmed the importance of AFCC NBE in predicting social capital and unique factors in the Korean context.
A Long and Winding Road: Dementia Caregiving With Grit and Grace
Roberto, Karen A.; McCann, Brandy R.; Blieszner, Rosemary; Savla, Jyoti S. (Oxford University Press, 2019)
Background and Objectives: Many dementia caregivers provide care for numerous years. Exhibiting grit, or commitment and persistence in the face of adversity, may bolster their ability to manage caregiving challenges. We explored grit in relationship to memory and behavior problems and response to stressors among women engaged in long-term dementia care. Research Design and Methods: Informed by a life course perspective, and guided by stress-process theory, we interviewed 10 women with a spouse or parent initially diagnosed with mild cognitive impairment 4 times over 10 years. Using Charmaz’s analysis methods and grit as a sensitizing concept, we employed an unfolding analytic strategy involving (a) thematic analysis to identify expressions of grit in response to caregiving stressors across interviews and (b) case-by-case comparisons to assess associations of grit with the use of care strategies across caregivers over time. Results: Dementia caregivers experienced unrelenting and changing psychosocial and physical challenges. Over time, most women exhibited a sustained commitment to the relationship through the ways in which they protected the identity of the person with dementia, modified their expectations for emotional intimacy, and managed their financial affairs. They persevered as their roles and relationships fluctuated, often finding purpose and relief through employment and leisure pursuits. As care intensified, women who took charge and consciously made decisions in the best interest of the care recipient and themselves minimized stress. Discussion and Implications: While some caregivers exhibited grit from the outset, all showed enhanced perseverance and commitment to the ways they managed memory-related changes over time. Developing confidence in their ability to manage and provide care helped the caregivers respond to stressors with purpose and sustain their roles and responsibilities. Enhancing grit in long-term dementia caregivers may result in better individual and relational outcomes.
Perturbation-based balance training targeting both slip- and trip-induced falls among older adults: a randomized controlled trial
Allin, Leigh J.; Brolinson, Per Gunnar; Beach, Briana M.; Kim, Sunwook; Nussbaum, Maury A.; Roberto, Karen A.; Madigan, Michael L. (2020-06-12)
Background Falls are the leading cause of injuries among older adults. Perturbation-based balance training (PBT) is an innovative approach to fall prevention that aims to improve the reactive balance response following perturbations such as slipping and tripping. Many of these PBT studies have targeted reactive balance after slipping or tripping, despite both contributing to a large proportion of older adult falls. The goal of this randomized controlled trial was to evaluate the effects of PBT targeting slipping and tripping on laboratory-induced slips and trips. To build upon prior work, the present study included: 1) a control group; 2) separate training and assessment sessions; 3) PBT methods potentially more amenable for use outside the lab compared to methods employed elsewhere, and 4) individualized training for older adult participants. Methods Thirty-four community-dwelling, healthy older adults (61–75 years) were assigned to PBT or a control intervention using minimization. Using a parallel design, reactive balance (primary outcome) and fall incidence were assessed before and after four sessions of BRT or a control intervention involving general balance exercises. Assessments involved exposing participants to an unexpected laboratory-induced slip or trip. Reactive balance and fall incidence were compared between three mutually-exclusive groups: 1) baseline participants who experienced a slip (or trip) before either intervention, 2) post-control participants who experienced a slip (or trip) after the control intervention, and 3) post-PBT participants who experienced a slip (or trip) after PBT. Neither the participants nor investigators were blinded to group assignment. Results All 34 participants completed all four sessions of their assigned intervention, and all 34 participants were analyzed. Regarding slips, several measures of reactive balance were improved among post-PBT participants when compared to baseline participants or post-control participants, and fall incidence among post-PBT participants (18%) was lower than among baseline participants (80%). Regarding trips, neither reactive balance nor fall incidence differed between groups Conclusions PBT targeting slipping and tripping improved reactive balance and fall incidence after laboratory-induced slips. Improvements were not observed after laboratory-induced trips. The disparity in efficacy between slips and trip may have resulted from differences in dosage and specificity between slip and trip training. Trial registration Name of Clinical Trial Registry: clinicaltrials.gov Trial Registration number: NCT04308239. Date of Registration: March 13, 2020 (retrospectively registered).
An Exploration of Older Men’s Acceptance of Age Inequality
King, Neal M.; Pietilä, Ilkka; Calasanti, Toni M.; Ojala, Hanna (Virginia Tech, 2014)
Age relations treat old people as marginal to occupational and dating networks, stigmatizing them as unattractive and unfit to do valuable work (Calasanti 2003; King 2006). Those systems intersect with gender, in which men gain privilege by associating themselves with skilled, valuable work and athletic performance, and women with sexual receptivity and artificial display (Calasanti and King 2007). In the intersection of age and gender, men lose much of their privileges as they grow old and leave the workplace, dismissed as no longer able to perform on valued jobs (King and Calasanti 2013). A large anti-aging industry markets to men products that promise to restore sexual potency and workplace assertiveness, as ways to counter the emasculating effects of old age (Calasanti 2007). Among studies of inequality, that of age relations provides a unique opportunity to test the extent to which a group can reify its own eventual subordination. This is due to the temporal nature of age relations (Calasanti 2007; Spector-Mersel 2006). We test for the hegemonic effect of masculinity.
Neighborhood Walkability Assessment for Seniors: Using Geographic Information Systems
Gao, Na; Wei, Rongrong; Hwang, Eunju (Virginia Tech, 2014-11-05)
Purpose: To examine walkability for seniors living in a low-income neighborhood (Ward 8). The neighborhood walkability in the DC area was assessed via geographic information systems (GIS) using ArcGIS 10.1 data using the North American Datum (NAD) 1983 state plane coordinate system.
Intergenerational Exchange and Mediators Impact Ambivalence about Future Older Selves
Jarrott, Shannon E.; Savla, Jyoti S. (Virginia Tech, 2014-11-08)
We hypothesized that anxiety, knowledge, and empathy would mediate the relationship between intergenerational contact and internal ambivalence about aging.
Visions for Tomorrow: Designing Intentional Communities for Rural Southwest Virginia
Brossoie, Nancy (Virginia Tech, 2014)
Housing in rural southwest Virginia is aging just like its population. Approximately 70% of homes in the region are more than 30 years old, energy inefficient, and in need of repair. Like many older persons, area residents want to age in place and are looking for ways to achieve that goal. In conjunction with a local livability initiative, local architects, building contractors, aging service providers, community planners, housing professionals, academics, and community members participated in a half day workshop to discuss the meaning of aging in place and to design new intentional communities with new housing options for the regions’ rural, suburban, and urban areas. The three intentional community designs highlighted in this presentation feature new single and multi-family homes built within the scope of current community infrastructure and resources and with accessibility features inside and outside the homes.
Geriatric Chronic Pain: Issues and Challenges from the Research Literature
Gold, Deborah T.; Roberto, Karen A. (Virginia Tech, 2001-11)
Researchers interested in chronic pain in older adults come from multiple disciplines; thus existing information about geriatric pain is widely scattered. To establish a foundation from which to construct future research and interventions for older women and men, we developed a comprehensive, multidisciplinary database of the chronic pain and aging literature published between 1990 and 1998. In this paper, we examined the focus of studies of chronic pain in later life, how chronic pain was assessed and treated, and the influence of chronic pain on older adults’ quality of life. A search of ten electronic databases that index scientific journals yielded 302 articles that focused on chronic pain in later life. Given the disproportionate number of women in many of the study samples, gender comparisons were not always statistically feasible. Because a limited number of studies report gender comparisons in older adults, it is difficult to determine whether older women's experiences with chronic pain are unique and require special attention from health care providers or whether the causes, treatments, and consequences of chronic pain should be considered universal to the older population as a whole.
Understanding Falls in Late Life: A Review of the Empirical Literature
Weaver, Raven H.; Roberto, Karen A.; Brossoie, Nancy (Virginia Tech, 2013-04)
One in three Americans aged 65+ experience unanticipated falls requiring medical care annually. Falls are associated with physical and psychological morbidities, decreased quality of life, and high health care costs. From a review of the falls literature published from 2002-2012, three distinct interrelated dimensions of falls emerged: (1)Prevention; (2)Risk Factors; and (3)Intervention strategies. Studies on falls among older community-dwelling adults dominated the literature, although residents of care facilities generally have greater risks of falling. Findings suggest the need for interdisciplinary approaches for fall prevention and intervention that focuses on common risk factors as well as individual circumstances.
Spending Behaviors of Older Women Living in an Assisted Living Facility
McClung, Mary E. (Virginia Tech, 2002-03-02)
A major demographic trend in the United States is the increasing older adult population. According to the US Census, the number of persons, ages sixty-five and older has increased approximately 4 million in 2000 and will continue to grow. As the baby boom generation reaches retirement, one issue facing older adults is how to assess and manage their housing and living expenses. An option for older adults that need some support, but are not totally dependent on others for their care is assisted living facilities. There is little public awareness about the cost associated with this housing option. The purpose of this study is to examine the monthly expenditures of older adult women living in an assisted living facility located in rural southwest Virginia. Interviews with the women identified spending patterns and the actual living expenses beyond the base rate residents pay each month. The findings highlight the array of expenses for older adult women living in an assisted living facility.
Evidence that Community-Based Long-Term Care is Preventive Care
Sands, Laura P. (Virginia Tech, 2014)
This presentation outlines the benefits of community-based long-term care, including reduced hospitalization rates.

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