Tag Archives: aging

  
By Ted Boscia
Reprinted from the Cornell Chronicle, July 1, 2011.
  
Pillemer

Pillemer

 The federal government is pushing doctors and hospitals to convert to electronic medical records by 2015, touting reductions in costs, increased patient safety and greater efficiencies in the U.S. health care system.

What's largely unknown is how the widespread adoption of computer technology affects the quality of medical care, particularly in nursing homes and other long-term care settings. If nurses and physicians trade pens and charts for handheld devices and laptops, will they lose their personal touch with residents? 

Cornell gerontologists, led by Karl Pillemer, the Hazel E. Reed Professor of Human Development in the College of Human Ecology, have produced the first study to examine how nursing home residents perceive electronic health information technology. They also measured its effect on such key health outcomes as the frequency of falls, resident behaviors and performance of everyday tasks. 

The findings, published online June 6 in the Journal of Aging and Health, report no negative effects on resident care from electronic health information technology in nursing homes. In fact, residents were generally amenable to new technologies; about three-quarters agreed that "handheld devices help staff to better manage my care." 

"Overall, these findings are encouraging for the wider implementation of electronic health information technology in nursing homes," said Pillemer, who is also a professor of gerontology in medicine at Weill Cornell Medical College. "Our primary concern for any new innovation in long-term care, where there are highly vulnerable populations, is whether it harms residents. This study finds no consistent negative effects, with most residents positive about its uses. Therefore, the use of electronic health information technologies in nursing homes would appear to be a net gain for residents." 

The Cornell team surveyed 761 residents at 10 long-term care facilities in the New York City area. Five of the facilities had equipped staff with personal digital assistants and laptops for recordkeeping; the others used traditional paper-based charts. They assessed residents twice over a span of nine months to gauge their reactions to the new technologies. 

During follow-up resident satisfaction surveys, only about half of the respondents at facilities with computer technologies even noticed the change, suggesting "minimal disruption" to residents, the authors write. Sixty-three percent said their care had stayed the same, with 30 percent rating it as better and 7 percent noting a decline. 

"If there are negative outcomes on patients," Pillemer said, "we would expect them to present early on when the new technologies would be most disruptive. That wasn't the case, and it could be that more positives would reveal themselves over time." 

Cornell co-authors on the paper, "Effects of Electronic Health Information Technology Implementation on Nursing Home Resident Outcomes," include Rhoda Meador, associate director of outreach and extension for the College of Human Ecology; Charles Henderson, senior research associate, Department of Human Development; Dr. Mark Lachs, professor of medicine and co-chief of the division of geriatrics and gerontology at Weill Cornell; and human development graduate student Emily K. Chen. Jeanne Teresi, director of research at the Hebrew Home for the Aged in the Bronx, is also a co-author. 

The study was funded by the New York Quality Care Oversight Committee, which formed in 2006 to produce a demonstration project of the adoption and implementation of health information technologies in a group of unionized, for-profit nursing homes. 

Ted Boscia is assistant director of communications for the College of Human Ecology. 

Related Links:
College of Human Ecology
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Karl Pillemer

By:  Aileen Costigan

CLAL members of the Alzheimer's project

CLAL members of the Alzheimer's project

A known side-effect of healthy aging is having trouble finding the right word to say. But some older adults experience more rapid decline or other language difficulties not typically found in healthy aging.

A pilot study led by Barbara Lust, professor of human development and director of the Cornell Language Acquisition Laboratory, with collaborators Dr. Janet Cohen Sherman at Massachusetts General Hospital, and Professor Suzanne Flynn at the Massachusetts Institute of Technology, suggests that older adults with early Alzheimer’s disease may be especially prone to difficulty constructing complex sentences as well as finding words. Such language problems make daily communication difficult and may also be an early marker for Alzheimer’s disease or other cognitive impairments. 

“There is a distinct gap in the research on language decline in those with clinical conditions,” said Lust.  “Several studies have raised the possibility that very early Alzheimer’s disease may be associated with deterioration in written language as seen in the works of popular authors such as Iris Murdoch. One unique contribution of our project is that we are looking at what is happening in spoken language.  Another is that we are looking at sentence formation.”

Lust and the other researchers in the Cornell Language Acquisition Lab (CLAL) and the Virtual Center for Language Acquisition (VCLA) are comparing language and cognitive abilities in three groups: healthy aging adults, adults with signs of mild cognitive impairment, and young college-aged controls. Participants are asked to repeat a series of sentences and are tested on the accuracy of their repetition. So far they have tested 40 participants and they plan to test more.

Preliminary results show that the declines found in language abilities may be separate from declines in overall cognition (e.g., memory). Specifically, those with mild cognitive impairment show particular challenges with vocabulary (e.g., word finding difficulties, word substitutions) and in certain types of complex sentence formation.

Results from this research, may shed light on the mechanisms of language decline and lead to techniques for early diagnosis and interventions for both healthy and cognitively impaired older adults.

“We are also planning to compare our findings in older adults to language development in young children,” said Aileen Costigan, project manager of the Alzheimer’s project. “If the results are the same in the young and older populations, this could help us determine how language decline is likely to occur with older adults and people with Alzheimer’s disease.  We may then know more about what to expect as the disease progresses.”

The Cornell Language Acquisition Lab, led by Lust and her collaborators, Dr. Cohen Sherman, Professor Flynn, and undergraduate Jordan Whitlock, is a collaborative, interdisciplinary group of researchers, educators, and students. Together with faculty, a talented group of undergraduate students from across the University is actively engaged in gathering and analyzing the pilot data and presenting the results in regional and national conferences.

“The Alzheimer’s language project has given me the opportunity to become deeply involved in the research process beyond what I expected as an undergraduate student. I expect to use the skills I’ve developed in data analysis, management, and interdisciplinary collaboration as I enter graduate school next year,” said Jordan Whitlock, a senior majoring in Linguistics and Cognitive Studies in the College of Arts & Sciences and planning to enter the Speech and Hearing Bioscience and Technology program at Harvard-MIT’s Division of Health Sciences & Technology.

This research is supported in part by the Cornell Bronfenbrenner Center for Life Course Development, Cornell Institute for Translational Research on Aging [CITRA] Pilot Study Program, Cornell University Cognitive Science program, Cornell University Institute for Social Sciences, and Hatch Grant/Federal Formula Funds.

Aileen Costigan, Ph.D., is the project manager of the Alzheimer’s language project and researcher in the Cornell Language Acquisition Laboratory. 

Reprinted with permission from Cornell Chronicle, April 1, 2011

Pillemer

Pillemer

Cornell researchers are calling on their colleagues around the world to focus on how aging global populations will intersect with climate change and calls for environmental sustainability.

In the article published in April's Journal of Aging and Health, professor of human development Karl Pillemer and four Cornell colleagues argue that environmental threats disproportionally affect the health of the aging.

"These risks are likely to increase as the effects of climate change are felt," the authors write. "The older population is at greater risk for adverse health effects from extreme temperatures, susceptibility to disease, stresses on the food and water supply, and reduced ability to mobilize quickly."

In addition to being affected by climate change, aging populations also might shape environmental change.

Older people now drive more than use mass transit less than they used to; take more medications, which need to be disposed of safely; and as they age and restructure their living arrangements, their residential energy efficiency changes and their independent and assisted living facilities are often built in environmentally sensitive areas, write the authors.

Older people may provide solutions to environmental problems, the researchers state, through their involvement in environmental volunteerism.

As our population ages, "studying the connections between environmental sustainability and aging is potentially of great importance," say the researchers, who propose a research agenda to examine the intersection of aging and environmental sustainability.

However, they add, older persons may also provide solutions to environmental problems through their becoming involved environmental volunteerism.

Few scientific studies, however, have focused on how aging and environmental sustainability intersect. The article offers various recommended topics for future research, including environmental threats to the health of older people, pro-environmental behavior and volunteerism in later life, and environmental impact of housing and living arrangements.

The article stems from the 2009 Cornell Conference on Aging and the Environment, co-sponsored by what is now called the Atkinson Center for a Sustainable Future as part of its 2008 Academic Venture Fund program. The conference included experts from across Cornell, partner and peer organizations, national experts, and the Environmental Protection Agency, and the format encouraged the development of a research agenda through a "consensus workshop" model, designed by Pillemer.

Co-authors of the new article include Nancy Wells, associate professor of design and environmental analysis; Rhoda Meador, associate director of extension and outreach, College of Human Ecology, and of the Bronfenbrenner Life Course Center; Jennifer Parise, graduate student, human development; and Linda Wagenet, former senior extension associate in development sociology, College of Agriculture and Life Sciences; all at Cornell.

By Karene Booker

Cary Reid

Reid

Anthony Ong

Ong

A person's outlook on life can minimize -- or aggravate -- a person's chronic pain, reports a new Cornell study.

"While pain is a fact of life for many," says Anthony Ong, assistant professor of human development at Cornell, "how people relate to their pain can either help or hinder healthy coping."

Ong and colleagues report that a person's habitual outlook on life and their ability to sustain positive emotions in the face of adversity or stress (what psychologists call psychological resilience) can make a dramatic difference in their experience of chronic pain, which afflicts millions of Americans, particularly the growing population of elderly.

The study, co-authored by M. Cary Reid, M.D., associate professor of medicine at Weill Cornell Medical College, and Alex Zautra, professor of health psychology at Arizona State University, is published in the September 2010 issue of Psychology and Aging (Vol. 25, No. 3).

The researchers studied 72 women and 23 men, ages 52 to 95, at Weill Cornell who were diagnosed with chronic pain -- the average duration of pain was about eight years. The patients completed daily diaries for two weeks containing information about their emotions and experience of pain each day.

The researchers found a link between the patients' resilience, positive emotions and how much they then "catastrophized" about their pain. Some people with chronic pain tend have an exaggerated negative view of the actual or anticipated pain. This so-called "pain catastrophizing" makes the experience of pain worse and contributes to increased pain severity, disability and emotional distress, Ong said. It exacerbates anxiety and worry. Such negative emotions can potentially stimulate neural systems that produce increased sensitivity to pain. It can become a vicious cycle.

On the other hand, the researchers found that high-resilient individuals reported less day-to-day pain catastrophizing, compared with the low-resilient individuals. The findings also suggest that the day-to-day experience of positive emotions represent an active ingredient in what it means to be "resilient," Ong said.

Interestingly, the researchers also found that women with chronic pain tended to catastrophize more than men; there was also a stronger effect of positive emotion on pain catastrophizing in women.

"Daily experiences of positive emotions have the potential to counteract the sense of helplessness and focus on negativity that can make chronic pain so devastating," Ong said. "Based on the gender differences we found, interventions for women in particular may benefit from greater attention to sources of positive emotion."

The study was supported, in part, by the John A. Hartford Foundation and the National Institute on Aging.

Positive outlook also influences widowhood

Higher levels of psychological resilience before the death of a spouse appears to buffer the potentially devastating negative impact of spousal loss, reports a new Cornell study.

Widows and widowers with higher levels of psychological resilience before their spouses died had little change in their positive emotion several years later, compared with those with lower levels of pre-loss psychological resilience, who experienced marked declines in positive emotion following spousal loss.

"Our analysis demonstrated that psychological resilience is a significant predictor of positive emotion in the face of major life challenges," said lead author Anthony Ong, assistant professor of human development, whose studied is published in Psychology and Aging (25:3). "And the maintenance of positive emotion has long-term consequences for well-being and health."

Ong and colleagues Thomas Fuller-Rowell, Ph.D. '10, and clinical psychologist George Bonanno of Columbia University studied a subsample of adults in a survey that included information at two points in time, 10 years apart. During that time, 52 individuals had been widowed and had not remarried. This group was compared with 156 continuously married individuals selected to match the widowed adults in age, gender and education.

The survey included measures of positive emotions (e.g., how much time they felt cheerful), psychological resilience (e.g., the ability to see the positive side of a difficult situation), spousal strain and depressive symptoms.

The researchers also found that widowed participants who had had more conflict with their spouses had higher positive emotion scores than their low-strain counterparts. And vice versa, widowed adults who reported lower levels of prior spousal strain exhibited greater declines in positive emotion.

"It's important to realize that the impact of spousal loss may vary widely based on personal characteristics and marital context," Ong said. "Contrary to historical beliefs, the experience of positive emotion during bereavement is not unusual, but relatively common and may be a signal of healthy adjustment."

The study was supported, in part, by the National Institute on Aging and National Institute of Mental Health. The original study was supported by the John D. and Catherine T. MacArthur Foundation.

-- Karene Booker

 

Positive emotions improve decision making, memory, and well-being of older adults.

For years, researchers have known that cognitive functions such as reasoning, memory, and problem solving decline with age. But a relatively new discovery is transforming conventional thinking about aging and cognition: as people age, their emotional wellbeing improves. 

“The processes that show decline are ones people need to navigate our everyday world— working memory, short-term memory, attention, the ability to represent visual images in our mind,” explained Joseph Mikels, assistant professor of human development. “All of the things we need to get around in life show significant decline starting in our 20s.” That is, except in one area: emotion. “Loss is ubiquitous across a number of cognitive domains, but older adults actually show an advantage over younger adults in the domain of emotion,” explained psychologist Anthony Ong, assistant professor of human development.  Read the full story

 

Human Ecology researchers aim to lessen aggression among residents, reduce staff turnover, and improve communication with families.

Last December, a 98-year-old Massachusetts woman became the oldest person charged with murder in state history for allegedly killing her centenarian roommate. The deadly assault followed a dispute over a piece of furniture the two nursing home residents shared.

Though an extreme case, the shocking incident brought to light a type of elder abuse that vexes nursing home residents, their families, and frontline caregivers: resident-to-resident elder mistreatment, a largely unstudied occurrence that takes the form of verbal attacks, physical violence, and, less commonly, sexual assault.

To better understand this issue, Human Ecology researchers, in collaboration with physicians at Weill Cornell Medical College, are midway through the first large-scale study of verbal and physical aggression among nursing home residents. Read the full story

 

QuoteOlder adults are likely at greater risk from climate change. Recognizing the urgency of this unstudied problem, researchers in the College of Human Ecology brought together experts in the both the social and natural sciences to begin to make recommendations.

When Hurricane Katrina engulfed New Orleans in 2005, catastrophic flood waters and fierce winds crippled the city’s infrastructure, caused billions in property damage, and killed an estimated 1,500 Louisiana residents. The death toll cut across all races, but one characteristic stood out among the storm’s victims: nearly three-quarters of the dead were aged 60 and older, with 50 percent of the victims aged 75 and older.

The stark difference in survival rates between young and old illustrates what scientists believe to be a greater vulnerability among seniors to environmental calamities like Katrina, where the elderly—many physically frail and with limited mobility—could not evacuate coastal areas ahead of the hurricane’s onslaught. Older adults also figure to have the most trouble coping with the predicted negative consequences of climate change, such as the accelerated spread of human diseases, declines in air and water quality, energy shortages, rising temperatures, food supply volatility, and loss of suitable habitats. Read the full story

 

Jordan WhitlockIs there a way to diagnosis Alzheimer’s disease before the symptoms start?

That is the question Jordan Whitlock, a senior working with Professor Barbara Lust’s research group, is trying to answer. If an earlier diagnosis were possible, then doctors could target this incurable disease in its beginning stages, prior to the onset of severe mental decline and brain damage. The goal of Whitlock’s research is to show if language dete­rioration can be an indicator of the early stages of Alzheimer’s. She says that the “loftiest ideal of this study is to learn about the progression of Alzheimer’s without any genetic testing.”

Professor Lust’s group uses several language testing methods while conducting this study. Whitlock focuses on a technique called Elicited Imitation, where she creates sentences that slightly vary in the specific part of speech she wishes to examine. Then, she will read these sentences aloud to a subject, who will repeat it back after a few moments. Subconsciously, the subject must reconstruct the sentence in their mind before answering.  Read the full story

By Ted Boscia, reprinted from Cornell Chronicle, November 19, 2010

Karl Pillemer, the Hazel E. Reed Professor in the Department of Human Development, will receive the M. Powell Lawton Award from the Gerontological Society of America (GSA) at its annual meeting Nov. 19-23 for his work on improving the lives of older adults in nursing homes and community settings.

The award recognizes Pillemer's work in three areas: preventing elder mistreatment by staff and other residents in nursing homes; improving the work life of qualified certified nursing assistants (CNAs); and strengthening relationships between the families of residents in long-term care and CNAs.

He has designed such interventions as workshops to ease communication between CNAs and families, a program to train and retain CNAs and epidemiological studies to determine the prevalence and causes of elder abuse.

"For people in nursing homes, the quality of relationships with staff and the care delivered defines the entire experience," said Pillemer, associate dean for extension and outreach in the College of Human Ecology. "If we can better support CNAs -- who deliver about 90 percent of the direct care -- and give families more tools to care for their loved ones, residents will have a better quality of life."

Pillemer is a GSA fellow, the society's highest class of membership, and serves as a member-at-large for its Behavioral and Social Sciences Section. At Cornell, he co-directs the Cornell Institute for Translational Research on Aging, a National Institutes of Health-funded center to work with community and academic partners to improve elder care.

For most older adults in long-term care, nursing homes are the last places they will ever live, and many give up hope on ever returning to home.

However, a Cornell evaluation project finds that a person-centered approach shows great promise in helping nursing home residents move back to the community, allowing nearly 60 percent of study participants to successfully return home.

Researchers in the College of Human Ecology evaluated Project Home, a pilot program in Syracuse, N.Y., funded by the New York State Department of Health. They report on their findings in an upcoming article in the Journal of Case Management.

"It's very common for older adults to express their desire to return home," said co-principal investigator Rhoda Meador, associate director of outreach and extension in the College of Human Ecology. "The idea with Project Home is that, with extra support and focus on an individual's unique needs, those wishes can become possible." Read the full story