Asian Cohort for Alzheimer's Disease (ACAD) pilot study on genetic and non-genetic risk factors for Alzheimer's disease among Asian Americans and Canadians

INTRODUCTION

Clinical research in Alzheimer's disease (AD) lacks cohort diversity despite being a global health crisis. The Asian Cohort for Alzheimer's Disease (ACAD) was formed to address underrepresentation of Asians in research, and limited understanding of how genetics and non-genetic/lifestyle factors impact this multi-ethnic population.

METHODS

The ACAD started fully recruiting in October 2021 with one central coordination site, eight recruitment sites, and two analysis sites. We developed a comprehensive study protocol for outreach and recruitment, an extensive data collection packet, and a centralized data management system, in English, Chinese, Korean, and Vietnamese.

RESULTS

ACAD has recruited 606 participants with an additional 900 expressing interest in enrollment since program inception.

DISCUSSION

ACAD's traction indicates the feasibility of recruiting Asians for clinical research to enhance understanding of AD risk factors. ACAD will recruit > 5000 participants to identify genetic and non-genetic/lifestyle AD risk factors, establish blood biomarker levels for AD diagnosis, and facilitate clinical trial readiness.

HIGHLIGHTS

The Asian Cohort for Alzheimer's Disease (ACAD) promotes awareness of under-investment in clinical research for Asians. We are recruiting Asian Americans and Canadians for novel insights into Alzheimer's disease. We describe culturally appropriate recruitment strategies and data collection protocol. ACAD addresses challenges of recruitment from heterogeneous Asian subcommunities. We aim to implement a successful recruitment program that enrolls across three Asian subcommunities.

Accelerometer-assessed sleep and decline in physical function in older men

OBJECTIVES

Assess the prospective association of actigraphically measured sleep with self-report and objective measures of physical function among community-dwelling older men.

METHODS

Participants were (n = 1496) men aged ≥65 years from the Osteoporotic Fractures in Men Study and ancillary sleep study who were followed up at 4 years for physical function outcomes. Sleep predictors included baseline total sleep time (<6, 6-8 hours [reference], >8 hours), sleep efficiency (<80% or ≥80% [reference]), wake after sleep onset (<90 [reference] or ≥90 minutes), and sleep onset latency (<30 [reference] or ≥30 minutes), measured by wrist actigraphy. Outcomes included self-reported difficulties in mobility and instrumental activities of daily living and objective measures of physical performance (time to complete chair stands, gait speed, grip strength, best narrow walk pace). Multivariable regression models estimated associations between the sleep predictors and change in physical function at follow-up, adjusting for demographic and health-related variables.

RESULTS

Participants with short average baseline total sleep time (<6 hours) had significantly greater slowing in their walking speed from baseline to follow-up. Participants with long baseline sleep onset latency (≥30 minutes) had significant increases in mobility difficulties and time to complete chair stands. Sleep efficiency and wake after sleep onset were not significantly associated with any outcomes. No sleep predictors were associated with change in instrumental activities of daily living.

CONCLUSIONS

These findings add to the body of evidence showing links between poor sleep and subsequent declines in physical function. Further experimental research is needed to understand the mechanisms at play.

Asian Americans' and Pacific Islanders' preferences in recruitment strategies and messaging for participation in the CARE registry: A discrete choice experiment

INTRODUCTION

This discrete choice experiment (DCE) identified Asian American and Pacific Islander (AAPI) adults' preferences for recruitment strategies/messaging to enroll in the Collaborative Approach for AAPI Research and Education (CARE) registry for dementia-related research.

METHODS

DCE recruitment strategy/messaging options were developed in English, Chinese, Korean, and Vietnamese. AAPI participants 50 years and older selected (1) who, (2) what, and (3) how they would prefer hearing about CARE. Analyses utilized conditional logistic regression.

RESULTS

Participants self-identified as Asian Indian, Chinese, Filipino, Japanese, Korean, Samoan, or Vietnamese (N = 356). Overall, they preferred learning about CARE from the healthcare community (vs. community champions and faith-based organizations), joining CARE to advance research (vs. personal experiences), and hearing about CARE through social media/instant messaging (vs. flyer or workshop/seminar). Preferences varied by age, ethnic identity, and survey completion language.

DISCUSSION

DCE findings may inform tailoring recruitment strategies/messaging to engage diverse AAPI in an aging-focused research registry.

Associations Between Objectively Measured Sleep and Cognition: Main Effects and Interactions With Race in Adults Aged ≥50 Years

BACKGROUND

This study examined associations of actigraphy-estimated sleep parameters with concurrent and future cognitive performance in adults aged ≥ 50 years and explored interactions with race.

METHODS

Participants were 435 cognitively normal adults in the Baltimore Longitudinal Study of Aging who completed wrist actigraphy at baseline (mean = 6.6 nights) and underwent longitudinal testing of memory, attention, executive function, language, and visuospatial ability. On average, participants with follow-up data were followed for 3.1 years. Primary predictors were baseline mean total sleep time, sleep onset latency, sleep efficiency (SE), and wake after sleep onset (WASO). Fully adjusted linear mixed-effects models included demographics, baseline health-related characteristics, smoking status, sleep medication use, APOE e4 carrier status, and interactions of each covariate with time.

RESULTS

In adjusted models, higher SE (per 10%; B = 0.11, p = .012) and lower WASO (per 30 minutes; B = -0.12, p = .007) were associated with better memory cross-sectionally. In contrast, higher SE was associated with greater visuospatial ability decline longitudinally (B = -0.02, p = .004). Greater WASO was associated with poorer visuospatial ability cross-sectionally (B = -0.09, p = .019) but slower declines in visuospatial abilities longitudinally (B = 0.02, p = .002). Several sleep-cognition cross-sectional and longitudinal associations were stronger in, or limited to, Black participants (compared to White participants).

CONCLUSIONS

This study suggests cross-sectional sleep-cognition associations differ across distinct objective sleep parameters and cognitive domains. This study also provides preliminary evidence for racial differences across some sleep-cognition relationships. Unexpected directions of associations between baseline sleep and cognitive performance over time may be attributable to the significant proportion of participants without follow-up data and require further investigation.

The Collaborative Approach for Asian Americans and Pacific Islanders Research and Education (CARE): A recruitment registry for Alzheimer's disease and related dementias, aging, and caregiver-related research

INTRODUCTION

Clinical research focused on aging, Alzheimer's disease and related dementias (ADRD), and caregiving often does not recruit Asian Americans and Pacific Islanders (AAPIs).

METHODS

With funding from the National Institute on Aging, we designed and launched the Collaborative Approach for AAPIs Research and Education (CARE), a research recruitment registry to increase AAPIs' participation in ADRD, aging, and caregiving research. We present the design of this novel recruitment program.

RESULTS

CARE uses community-based participatory research methods that are culturally and linguistically appropriate. Since CARE's launch, it has enrolled >7000 AAPIs in a 1-year period. The majority enrolled in CARE via community organizations and reported never having participated in any kind of research before. CARE also engages researchers by establishing a recruitment referral request protocol.

DISCUSSION

CARE provides a promising venue to foster meaningful inclusion of AAPIs who are under-represented in aging and dementia-related research.

Social Support and Technology Use and Their Association With Mental and Physical Health During the COVID-19 Pandemic Among Asian Americans: The COMPASS Cross-sectional Study

BACKGROUND

The global COVID-19 pandemic disproportionately affected Asian Americans and Pacific Islanders (AAPIs) and revealed significant health disparities with reports of increased discrimination and xenophobia. Among AAPIs, the pandemic exacerbated their social, linguistic, and geographic isolation. Social support may be especially important for AAPIs given the salience of collectivism as a cultural value. Another mechanism for support among AAPIs was technology use, as it is generally widespread among this population. However, older adults may not perceive the same benefits.

OBJECTIVE

We examined social support and technology use and their relationships with mental and physical health outcomes through the COVID-19 pandemic among AAPIs.

METHODS

Data were drawn from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) for the time period of October 2020 to February 2021. COMPASS was a cross-sectional, multilingual, national survey conducted online, by phone, and in person with AAPI adults who were ≥18 years of age, in collaboration with academic and community partners in the United States. Data were analyzed using multivariable linear regression using the outcome variables of mental and physical health with various predictors such as social support and technology use. We tested for interactions specific to age and ethnicity.

RESULTS

Among 4631 AAPIs (mean age 45.9, SD 16.3 years; 2992/4631, 63.1% female), we found that (1) increased social support was associated with better physical health, (2) total social support was positively associated with better mental health, (3) higher technology use was associated with poorer mental health and inversely associated with poorer physical health, (4) the association of technology use with mental health was weaker among those with low social support (vs those with high social support), (5) adults younger than 60 years old (vs ≥60 years old) were more negatively affected with social support and mental health, and (6) Korean Americans appeared to be a high-risk group for poor physical health with increased technology use.

CONCLUSIONS

Our paper identified mental and physical health needs along with supportive therapies observed among AAPIs during the pandemic. Future research on how social support can be leveraged, especially among AAPIs younger than 60 years old, and how various types of technology are being utilized are important to guide the recovery efforts to address both mental and physical disparities across communities as a result of the COVID-19 pandemic.

Inclusion of hearing and vision impairments in cognitive training interventions

Introduction

Cognitive training can potentially reduce risk of cognitive decline and dementia in older adults. To support implementation of cognitive training in the broader population of older adults, it is critical to evaluate intervention implementation and efficacy among representative samples, particularly those at highest risk of cognitive decline. Hearing and vision impairments are highly prevalent among older adults and confer increased risk of cognitive decline/dementia. Whether cognitive training interventions enroll and are designed to include this important subgroup is unknown.

Methods

A scoping review of PubMed and PsycINFO was conducted to examine the inclusion of older adults with hearing and vision impairment in cognitive training interventions. Two independent reviewers completed a full-text review of eligible articles. Eligible articles included cognitive training and multimodal randomized controlled trials and a study population that was cognitively unimpaired, aged ≥55-years, and community dwelling. Articles were primary outcome papers published in English.

Results

Among the 130 articles included in the review, 103 were cognitive training interventions (79%) and 27 were multimodal interventions (21%). More than half the trials systematically excluded participants with hearing and/or vision impairment (n = 60, 58%). Few studies reported hearing and vision measurement (cognitive: n = 16, 16%; multimodal: n = 3, 11%) or incorporated universal design and accessibility into intervention design (cognitive: n = 7, 7%; multimodal: n = 0, 0%).

Discussion

Older adults with hearing and vision impairment are underrepresented in cognitive training interventions. Reporting of hearing and vision measurement, proper justification of exclusions, and inclusion of accessibility and universal intervention design are also lacking. These findings raise concerns about whether current trial findings apply to those with hearing and vision impairment and generalize to the broader population of older adults. It is critical to include more diverse study populations and integrate accessibility into intervention design to include and better represent older adults with hearing and vision impairment.

Highlights

Cognitive training interventions underrepresent hearing and vision impairment.Sensory measurement and proper justification of exclusions are rarely reported.Interventions lack inclusion of accessibility and universal intervention design.More diverse study populations are needed in cognitive training interventions.Integration of accessibility into cognitive training intervention design is needed.

Correction: Racial Bias Beliefs Related to COVID-19 Among Asian Americans, Native Hawaiians, and Pacific Islanders: Findings From the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS)

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Racial Bias Beliefs Related to COVID-19 Among Asian Americans, Native Hawaiians, and Pacific Islanders: Findings From the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS)

BACKGROUND

During the COVID-19 pandemic, there have been increased reports of racial biases against Asian American and Native Hawaiian and Pacific Islander individuals. However, the extent to which different Asian American and Native Hawaiian and Pacific Islander groups perceive and experience (firsthand or as a witness to such experiences) how COVID-19 has negatively affected people of their race has not received much attention.

OBJECTIVE

This study used data from the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS), a nationwide, multilingual survey, to empirically examine COVID-19-related racial bias beliefs among Asian American and Native Hawaiian and Pacific Islander individuals and the factors associated with these beliefs.

METHODS

COMPASS participants were Asian American and Native Hawaiian and Pacific Islander adults who were able to speak English, Chinese (Cantonese or Mandarin), Korean, Samoan, or Vietnamese and who resided in the United States during the time of the survey (October 2020 to May 2021). Participants completed the survey on the web, via phone, or in person. The Coronavirus Racial Bias Scale (CRBS) was used to assess COVID-19-related racial bias beliefs toward Asian American and Native Hawaiian and Pacific Islander individuals. Participants were asked to rate the degree to which they agreed with 9 statements on a 5-point Likert scale (ie, 1=strongly disagree to 5=strongly agree). Multivariable linear regression was used to examine the associations between demographic, health, and COVID-19-related characteristics and perceived racial bias.

RESULTS

A total of 5068 participants completed the survey (mean age 45.4, SD 16.4 years; range 18-97 years). Overall, 73.97% (3749/5068) agreed or strongly agreed with ≥1 COVID-19-related racial bias belief in the past 6 months (during the COVID-19 pandemic). Across the 9 racial bias beliefs, participants scored an average of 2.59 (SD 0.96, range 1-5). Adjusted analyses revealed that compared with Asian Indians, those who were ethnic Chinese, Filipino, Hmong, Japanese, Korean, Vietnamese, and other or multicultural had significantly higher mean CRBS scores, whereas no significant differences were found among Native Hawaiian and Pacific Islander individuals. Nonheterosexual participants had statistically significant and higher mean CRBS scores than heterosexual participants. Compared with participants aged ≥60 years, those who were younger (aged <30, 30-39, 40-49, and 50-59 years) had significantly higher mean CRBS scores. US-born participants had significantly higher mean CRBS scores than foreign-born participants, whereas those with limited English proficiency (relative to those reporting no limitation) had lower mean CRBS scores.

CONCLUSIONS

Many COMPASS participants reported racial bias beliefs because of the COVID-19 pandemic. Relevant sociodemographic contexts and pre-existing and COVID-19-specific factors across individual, community, and society levels were associated with the perceived racial bias of being Asian during the pandemic. The findings underscore the importance of addressing the burden of racial bias on Asian American and Native Hawaiian and Pacific Islander communities among other COVID-19-related sequelae.

Differences in COVID-19 Vaccine Concerns Among Asian Americans and Pacific Islanders: The COMPASS Survey

BACKGROUND

Understanding concerns for receiving COVID-19 vaccines is key to ensuring appropriately tailored health communications to increase vaccine uptake. However, limited data exists about vaccine concerns among Asian Americans and Pacific Islanders (AAPI).

METHODS

Data from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS), a cross-sectional, national survey for AAPI adults in the U.S. were used (N=1,646). Descriptive statistics were used to assess sample characteristics including proportions of AAPI with various COVID-19 vaccine concerns, categorized as none, side-effects only, unsafe only, and multiple reasons, and differences in vaccine concerns by socio-demographics. Ordinary multivariable logistic regression analyses were conducted to evaluate associations between a characteristic and having any vaccine concerns.

RESULTS

Overall, 76% of the respondents reported having at ≥1 concerns about the vaccine. The most common concern was side effects (65%). Vietnamese Americans reported less concerns (vs. Chinese Americans). Those who were 30-39 and 40-49 years old (vs. <30), females (vs. males), and experienced mild negative impacts from COVID-19 on family income/employment (vs. no change) reported more concerns about the vaccine. Those who had less vaccine concerns were those who reported higher (vs. low) health status, ≥60 years old (vs. <30), and separated/divorced/widowed (vs. single).

DISCUSSION

AAPI is a diverse population and this study revealed differences in vaccine concerns across AAPI groups. Findings revealed potential targets for patient education needs. Effective strategies to address various vaccine concerns across subgroups of AAPI will be crucial to ensure equity in vaccination uptake.

Discrimination Experiences during COVID-19 among a National, Multi-Lingual, Community-Based Sample of Asian Americans and Pacific Islanders: COMPASS Findings

Reports of escalated discrimination among Asian Americans and Pacific Islanders (AAPIs) due to COVID-19 are alarming, making this a public health priority. However, there are limited empirical studies on the scope and impact of COVID-19-related discrimination among AAPIs. Using the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) data (N = 4971; survey period: October 2020-February 2021), which is a U.S.-wide multi-lingual survey, we examined the prevalence of, and factors associated with discrimination experiences attributable to being an AAPI during the COVID-19 pandemic. Overall, 60.7% reported experiencing discrimination; the group prevalence ranged from 80.0% (Hmong) to 40.5% (Native Hawaiians and Pacific Islanders). Multivariable logistic regression models revealed that COVID-19-related factors were associated with many discrimination experiences: having a shelter-in-place order of ≥1 month, living in areas with perceived similar/higher COVID-19 severity, and negative impact in family income/employment due to COVID-19. Additionally, being Asian American (versus Native Hawaiians and Pacific Islanders), females, non-heterosexuals, younger, more severe effect on family income, living in the non-West, and poorer health were significantly correlated with discrimination experiences. Findings may assist in formulating anti-AAPI-discrimination policies and programs at the local, state, and federal levels. Culturally appropriate programs and policies to combat this are urgently needed.

Vaccine willingness: Findings from the COVID-19 effects on the mental and physical health of Asian Americans & Pacific Islanders survey study (COMPASS)

Willingness to get the COVID-19 vaccine is crucial to reduce the current strain on healthcare systems and increase herd immunity, but only 71% of the U.S. public said they would get the vaccine. It remains unclear whether Asian Americans and Pacific Islanders (AAPI), a population with existing inequalities in COVID-19 infection and mortality, are willing to get the vaccine, and the factors associated with vaccine willingness. Given this imperative, we used data from a national, cross-sectional, community-based survey called COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS), an ongoing survey study that is available in English and Asian languages (i.e., Simplified or Traditional Chinese, Korean, Vietnamese) to examine vaccine willingness among AAPI. A total of 1,646 U.S. adult AAPI participants completed the survey. Self-reported vaccine willingness showed the proportion who were "unsure" or "probably/definitely no" to getting the COVID-19 vaccine was 25.4%. The odds for vaccine willingness were significantly lower for were Native Hawaiians and Pacific Islanders (vs. Asian Americans), Korean Americans (vs. Chinese and Vietnamese Americans), women (vs. men), heterosexuals (vs. non-heterosexuals), those aged 30-39 and 50-59 (vs. aged < 30), and those who reported having any vaccine concerns (vs. no concerns). AAPIs' willingness to get COVID-19 vaccine varied by groups, which underscores the need for disaggregated AAPI data. A multi-pronged approach in culturally appropriate and tailored health communication and education with AAPI is critical to achieve the goal of health equity for AAPI as it pertains to COVID-19 mortality and morbidity.

Associations of insomnia symptoms with subsequent health services use among community-dwelling U.S. older adults

STUDY OBJECTIVES

Determine the association of insomnia symptoms with subsequent health services use, in a representative sample of U.S. older adults.

METHODS

Participants were 4,289 community-dwelling Medicare beneficiaries who had continuous fee-for-service Medicare coverage 30 days before, and 1 year after the National Health and Aging Trends Study (NHATS) Round 1 interview. Participants reported past-month insomnia symptoms (i.e. sleep onset latency >30 min, difficulty returning to sleep) which we categorized as 0, 1, or 2 symptoms. Outcomes were health services use within 1 year of interviews from linked Medicare claims: emergency department (ED) visits, hospitalizations, 30-day readmissions, home health care (all measured as yes/no), and number of hospitalizations and ED visits.

RESULTS

Overall, 18.5% of participants were hospitalized, 28.7% visited the ED, 2.5% had a 30-day readmission, and 11.3% used home health care. After adjustment for demographics, depressive and anxiety symptoms, medical comorbidities, and BMI, compared to participants with no insomnia symptoms, those with two insomnia symptoms had a higher odds of ED visits (odds ratio [OR) = 1.60, 95% confidence interval [CI] = 1.24-2.07, p < 0.001), hospitalizations (OR = 1.29, 95% CI = 1.01-1.65, p < 0.05), and 30-day readmissions (OR = 1.88, 95% CI = 1.88-3.29, p < 0.05). Reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits and hospitalizations (incidence rate ratio (IRR) = 1.52, 95% CI = 1.23-1.87, p < 0.001; IRR = 1.21, 95% CI = 1.02-1.44, p < 0.05, respectively) after adjusting for demographic and health characteristics.

CONCLUSIONS

Among older adults, insomnia symptoms are associated with greater health services use, including emergency department use, hospitalization, and 30-day readmission. Targeting insomnia may lower health services use.

Comparing Web-Based and Classroom-Based Memory Training for Older Adults: The ACTIVE Memory Works™ Study

OBJECTIVES

To compare the efficacy of a web-based versus a classroom-based memory training program in enhancing cognition and everyday functioning in older adults, and program satisfaction and acceptability.

METHOD

Participants (N = 208; mean age = 71.1) were randomly assigned to a web-based or classroom-based training, or to a wait-list control condition. Cognitive and everyday functioning measures were administered at baseline, immediate, and 6 months post-training; both training groups evaluated program satisfaction and acceptability at immediate post-training. Repeated-measures analyses of variance assessed training effects on cognitive and functioning outcomes; independent-samples t tests assessed group differences in program satisfaction and acceptability.

RESULTS

Compared to controls, neither training group showed a significant improvement on measures of memory or everyday functioning as assessed by dependence or difficulty on instrumental activities of daily living over time. Training effects did not transfer to non-trained cognitive abilities. The web-based group was as satisfied with the training as the classroom-based group (p > .05).

DISCUSSION

Although no significant training effects were found, we demonstrated that a web-based platform is an acceptable and feasible mode to provide memory training to healthy older adults. Further studies are needed to investigate the potential of web-based memory training programs for improving cognition and function in cognitively healthy older adults.

0843 Prospective Associations of Insomnia Symptoms With Health Services Use in Community-Dwelling Older Adults

Introduction

Limited research has examined links of insomnia with health services use, particularly using claims-based data. We investigated the association of insomnia symptoms with costly health services use, measured by Medicare claims, in a nationally representative sample of U.S. older adults.

Methods

Participants were 4,302 community-dwelling Medicare beneficiaries aged ≥65 years from Round 1 (2011) of the National Health and Aging Trends Study who had continuous fee-for-service Medicare coverage 1 year before and after the Round 1 interview. Participants reported past-month insomnia symptoms (i.e., sleep onset latency &gt;30 minutes, difficulty returning to sleep after early awakening) which we categorized as 0, 1, or 2 symptoms. Outcomes were linked Medicare claims occurring after Round 1 interviews: emergency department (ED) visits, all-cause hospitalizations, preventable hospitalizations, all-cause 30-day readmissions, home health care (all measured as yes/no); and number of hospitalizations and ED visits.

Results

Overall, 18.9% of participants were hospitalized, 29.3% visited the ED, 3.1% had a preventable hospitalization, 2.6% had a readmission, and 11.7% used home health care. After adjustment for demographics, compared to participants with no insomnia symptoms, those with 2 symptoms had a higher odds of ED visits (odds ratio (OR)=1.42, p&lt;0.001), all-cause hospitalizations (OR=1.30, p&lt;0.01), preventable hospitalizations (OR=1.83, p&lt;0.05), 30-day readmissions (OR=1.73, p&lt;0.05), and home health care use (OR=1.27, p&lt;0.05). These associations did not hold, however, upon further adjustment for health characteristics (i.e., depressive/anxiety symptoms, medical comorbidities and BMI). After full adjustment, reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits (Incidence Rate Ratio=1.16, p&lt;0.05).

Conclusion

Among older adults, a greater number of insomnia symptoms is associated with greater health services use. Insomnia symptoms may be a marker of, or exacerbate, health conditions. Targeting insomnia may lower health services use.

Support

National Institute on Aging: R01AG050507 & R01AG050507-02S (PI: Spira); F31-AG058389; U01AG032947 (PI: Kasper) for the National Health and Aging Trends Study. Johns Hopkins Center on Aging and Health Data Use Agreement (PI: Roth, Co-I: Sheehan) with Centers for Medicare & Medicaid Services titled, “Potentially modifiable factors influencing outcomes in NHATS.”

0844 Links of Napping With Subsequent All-Cause Hospitalizations and Emergency Department Visits in Older Adults

Introduction

Few studies have examined whether napping is associated with objective measures of health services use. We investigated links of napping characteristics with all-cause hospitalizations and emergency department (ED) visits in Medicare claims from a nationally representative sample of older adults.

Methods

Participants were 869 community-dwelling Medicare beneficiaries aged ≥65 years from Round 3 (2013) and Round 4 (2014) of the National Health and Aging Trends Study (NHATS) who had continuous fee-for-service coverage 1 year before and after the NHATS interview. Participants reported past-month napping frequency (re-categorized as non-nappers, infrequent nappers, frequent nappers), napping type (intentional, unintentional), and nap duration. Outcomes were from linked Medicare claims measured after napping assessment: all-cause ED visits and hospitalizations (yes vs. no), and number of hospitalizations and ED visits.

Results

Overall, 45.4% of participants were nappers, and 55.2% of the nappers reported taking unintentional naps. After adjustment for demographics, depressive/anxiety symptoms, medical comorbidities and BMI, compared with non-nappers, infrequent and frequent nappers had a higher odds of hospitalization (odds ratio (OR)=1.65 and 1.73, respectively, both p&lt;0.05), as did unintentional nappers (OR=1.85, p&lt;0.05). We found no significant adjusted associations of napping frequency with ED visits. However, compared with non-nappers, unintentional nappers had a higher odds of visiting the ED (OR=1.94, p&lt;0.01). Additionally, compared to nappers taking short naps (≤30 minutes), those with naps &gt;60 minutes had a greater number of ED visits (Incidence Rate Ratio=1.99, p&lt;0.05).

Conclusion

Among older adults, napping—and particularly unintentional napping—may be a modifiable risk factor for health services use. More studies that consider multiple napping characteristics (e.g., duration, frequency), and using objective measures (e.g., actigraphy), are needed to advance understanding of how napping might influence health services use.

Support

National Institute on Aging: R01AG050507 & R01AG050507-02S (PI: Spira); F31-AG058389; U01AG032947 (PI: Kasper) for the National Health and Aging Trends Study. Johns Hopkins Center on Aging and Health Data Use Agreement (PI: Roth, Co-I: Sheehan) with Centers for Medicare & Medicaid Services titled, “Potentially modifiable factors influencing outcomes in NHATS.”

Later-life sleep, cognition, and neuroimaging research: an update for 2020

This review summarizes recent studies of sleep and brain health in later life, focusing on cognitive and magnetic resonance imaging (MRI)-derived outcomes. The majority of older people report sleep problems, and over one-third have sleep-disordered breathing (SDB). The research described herein builds on work demonstrating that abnormal sleep duration, sleep fragmentation, and SDB are associated with memory impairment and executive dysfunction. Self-reported short sleep is linked with greater cortical thinning and lower white matter integrity, and objectively measured fragmentation and SDB are tied to gray matter atrophy and altered connectivity. Results suggest that brain changes mediate previously identified sleep-cognition associations. Additional clinical trials are needed to determine whether treating insomnia or SDB benefits cognition in this population.

Cognitive Training for Ethnic Minority Older Adults in the United States: A Review

Purpose of the Study

Interest in cognitive training for healthy older adults to reduce cognitive decline has grown considerably over the past few decades. Given the shift toward a more diverse society, the purpose of this review is to examine the extent of race/ethnic minority participation in cognitive training studies and characteristics of studies that included race/ethnic minority participants.

Design and Methods

This review considered peer-reviewed studies reporting cognitive training studies for cognitively healthy, community-dwelling older adults (age 55+) in the United States published in English before December 31, 2015. A total of 31 articles published between 1986 and 2015 meeting inclusion criteria were identified and included in the review.

Results

A total of 6,432 participants were recruited across all of the studies, and ranged in age from 55 to 99 years. Across all studies examined, 39% reported racial/ethnic background information. Only 3 of these studies included a substantial number of minorities (26.7% in the ACTIVE study; 28.4% in the SeniorWISE study; 22.7% in the TEAM study). Race/ethnic minority older adults were disproportionately underrepresented in cognitive training studies.

Implications

Further research should aim to enroll participants representative of various race/ethnic minority populations. Strategies for recruitment and retention of ethnic minority participants in cognitive training research are discussed, which could lead to the development of more culturally appropriate and perhaps more effective cognitive interventions.

Napping characteristics and cognitive performance in older adults

OBJECTIVES

To determine the association of napping intention, frequency, and duration with cognition in a nationally-representative sample of US older adults.

METHODS

We performed a cross-sectional analysis of community-dwelling Medicare beneficiaries aged ≥65 years from Rounds 3 or 4 (2013-2014) of the National Health and Aging Trends Study (N = 2549). Participants reported past-month napping intention (intentional/unintentional), napping frequency (rarely/never [non-nappers], some days [infrequent nappers], most days/every day [frequent nappers]), and average nap duration (we categorized as ≤30 minutes [short]; 31-60 minutes [moderate]; and > 60 minutes [long]). Cognitive outcomes were performance on immediate and delayed word recall tests (IWR and DWR, respectively), the Clock Drawing Test (CDT), and self-rated memory (score: 1[excellent]-5[very poor]).

RESULTS

After adjustment for potential confounders, unintentional nappers had poorer immediate word recall test performance than non-nappers (B = -0.23, P < 0.01) and intentional nappers (B = -0.26, P < 0.01). After further adjustment for daytime sleepiness, frequent nappers reported poorer self-rated memory than non-nappers (B = 0.14, P < 0.05). Compared with short nappers, long nappers had poorer IWR (B = -0.26, P < 0.05) and CDT scores (B = -0.17, P < 0.05). Except for the association of nap duration with IWR and CDT, these associations remained after excluding participants with dementia and/or proxy respondents. Among participants undiagnosed with dementia or proxies, moderate-duration naps were associated with better DWR than short naps (B = 0.24, P < 0.05). Neither napping intentionality nor frequency was associated with CDT performance.

CONCLUSIONS

Among older adults, distinct aspects of napping are associated with cognitive performance. Prospective research, with objective measures of napping, is needed to elucidate the link between napping and cognitive trajectories.

Napping Characteristics and Restricted Participation in Valued Activities Among Older Adults

Background

Napping is associated with both positive and negative health outcomes among older adults. However, the association between particular napping characteristics (eg, frequency, duration, and whether naps were intentional) and daytime function is unclear.

Methods

Participants were 2,739 community-dwelling Medicare beneficiaries aged ≥65 years from the nationally representative National Health and Aging Trends Study. Participants reported napping frequency, duration, and whether naps were intentional versus unintentional. Restricted participation in valued activities was measured by self-report.

Results

After adjusting for potential confounders and nighttime sleep duration, those who took intentional and unintentional naps had a greater odds of any valued activity restriction (ie, ≥1 valued activity restriction), compared to those who rarely/never napped (unintentional odds ratio [OR] = 1.34, 95% confidence interval [CI] 1.01, 1.79, intentional OR = 1.49, 95% CI 1.09, 2.04). There was no difference between unintentional napping and intentional napping with respect to any valued activity restriction after adjustment for demographics. Compared to participants napping "some days," those napping most days/every day had a greater odds of any valued activity restriction (OR = 1.68, 95% CI 1.30, 2.16). Moreover, each 30-minute increase in average nap duration was associated with a 25% greater odds of any valued activity restriction (OR = 1.25, 95% CI 1.10, 1.43).

Conclusion

Older adults who took more frequent or longer naps were more likely to report activity restrictions, as were those who took intentional or unintentional naps. Additional longitudinal studies with objective measures of sleep are needed to further our understanding of associations between napping characteristics and daytime dysfunction.

Using an Emic lens to understand how Latino families cope with dementia behavioral problems

Focus group data collected for a larger project to develop a fotonovela for Latino caregivers was used to conduct a meaning-centered thematic analysis in order to elicit Latino family caregiver perspectives on how behavior problems occurring in the context of dementia are perceived and managed. A sample of 42 Spanish-speaking Latino caregivers were recruited from organizations affiliated with the Alzheimer's Association near San Diego, California. Caregivers were queried on challenging behaviors, coping strategies, as well as other daily challenges. Focus group sessions were conducted in Spanish, translated and transcribed into English, and analyzed using qualitative, grounded anthropological methods. In addition to a range of behavior problems, five indigenous approaches to managing challenging behaviors were identified: acceptance, love, patience, adaptability, and establishing routines of care. Additionally, participants identified persistent challenges which deter effective coping. These include: issues with providers, problems with family members, limited knowledge of resources, emotional distress, and financial strain. To our knowledge, this is one of the few qualitative studies to report indigenous coping strategies for dementia behavioral problems. These findings have the potential to inform culturally-tailored intervention.

The impact of a faculty development program in health literacy and ethnogeriatrics

PROBLEM

A faculty development curriculum aimed at increasing health literacy and awareness of patient care issues in ethnogeriatrics is essential to address serious deficiencies in faculty and health professionals' training and to prepare future health care professionals to care for older adults.

APPROACH

Authors from the Stanford Geriatric Education Center developed and implemented a faculty development program in Health Literacy and Ethnogeriatrics (HLE). The goal was to enhance faculty and health professionals' knowledge, skills, and attitudes in HLE-related areas (e.g., health disparities, low health literacy, quality of care for ethnically diverse elders, patient/provider communication). The curriculum was implemented during an intensive weeklong program over a three-year period (2008-2010). The eight-module core curriculum was presented in a train-the-trainer format, supplemented by daily resource sessions.

OUTCOMES

Thirty-four faculty participants from 11 disciplines, including medicine, came from 19 institutions in 12 states. The curriculum positively affected participants' knowledge, skills, and attitudes related to topics in HLE. Participants rated the curriculum's usefulness highly, and they reported that over 57% of the content was new. The HLE curriculum provided a mechanism to increase the self-assessed knowledge, skills, and attitudes of participants. It also fostered local curricular change: Over 91% of the participants have either disseminated the HLE curriculum through seminars conducted at their home sites or implemented HLE-related projects in their local communities, reaching diverse patient populations.

NEXT STEPS

Next steps include measuring the impact on the participants' teaching skills and at their home sites through their trainees and patients.