Novel Approaches to Teaching Aging and Disability: Active Learning Through Design and Exploration.

Active learning emphasizes student engagement and collaboration instead of more passive learning, which involves primarily listening to lectures in the classroom setting. The benefits of active learning are many with an emphasis on the expansion of higher-order processing and critical thinking skills. Active learning can be found in many best practice approaches in the Medicine, Science, Engineering, and Mathematics (MSTEM) fields. Hack-a-thon and hack events are examples of active learning. These are gaining popularity in research institutes, and specifically in engineering, computer science, business, and healthcare settings. Wikipedia defines hack-a-thon as the blending of the words "hack," referring to exploratory programming, and "marathon," referring to a timed event. This article describes a hack-a-thon approach for active learning in the classroom setting.

"I want to focus on something that I feel really good about every day": Career development in established adulthood.

In developed countries, education and career experimentation typically extends into people's twenties (Arnett, 2000, 2015; Mehta et al., 2020). Thus, people are not committing to a career path in which they can build expertise, take on increasing responsibilities, and climb an organizational ladder (Day et al., 2012) until they reach established adulthood, the period of development from 30 to 45. As the conceptualization of established adulthood is relatively new, little is known about career development during this period. As such, in the present study, we aimed to provide a better understanding of career development in established adulthood by interviewing participants (n = 100) aged 30-45 from across the United States about their career development. Some participants described Career Exploration in established adulthood, sharing how they were still searching for a good career fit, and how a sense of diminishing time related to how they explore career paths. Participants also described Career Stability in established adulthood, including feeling committed to a career path, noting that there were some drawbacks to this stability, but also benefits in terms of feeling confident in their roles. Finally, participants described Career Growth, and shared their experiences of climbing the career ladder as well as planning for the future and possible "second acts". Taken together, our results suggest that established adulthood, at least in the USA, brings some stability in terms of career paths and development but that it may also be a period of career reflection for some.

The relationship between perceived discrimination and coronary artery obstruction.

BACKGROUND: Chronic stressors such as perceived discrimination might underlie race disparities in cardiovascular disease. This study focused on the relationship between perceived discrimination and risk of severe coronary obstruction while also accounting for multiple psychosocial variables and clinical factors. METHODS: Data from 793 (629 white and 164 black) male veterans with positive nuclear imaging studies were analyzed. Participants were categorized as being at low/moderate or high risk for severe coronary obstruction based on results of their nuclear imaging studies. Hierarchical logistic regression models were tested separately for blacks and whites. The first step of the models included clinical factors. The second step included the psychosocial variables of optimism, religiosity, negative affect, and social support. The final step included perceived discrimination. RESULTS: Perceived discrimination was positively related to risk of severe obstruction among blacks but not among whites after controlling for clinical and psychosocial variables. Similar results were found in patients who underwent coronary angiography (n = 311). CONCLUSIONS: Perceived discrimination was associated with risk of severe coronary obstruction among black male veterans and could be an important target for future interventions.

Understanding within-group variability of everyday cognition in aging Black/African American adults: a mimic (multiple indicators, multiple causes) model approach.

UNLABELLED: BACKGROUND/STUDY CONTEXT: Everyday cognition represents the ability to solve problems within domains that are representative of issues faced by adults on a daily basis. The current study examined individual differences in everyday cognitive ability among aging Black/African American adults. METHODS: Demographic data on age, gender, education, physical functioning, chronic illnesses, self-reported health, and depression were collected from 248 African American adults (mean age = 67.8 years, standard deviation = 8.47 years). A multiple indicators, multiple causes (MIMIC) modeling approach was used to examine the associations of individual characteristics with latent everyday cognitive ability and composite score indicators. RESULTS: Age, depressive symptoms, and number of chronic illnesses were negatively related to latent everyday cognition. The individual characteristics of age, depressive symptoms, self-rated health, and education were directly associated with composite indicators of latent everyday cognition. This suggests that within this sample of older Black/African American adults that certain composite scores (i.e., telephone use, food preparation, and finances) may be particularly sensitive to these individual characteristics. CONCLUSION: These results identify specific sources of variability in everyday cognitive ability among aging Blacks/African Americans. These individual differences should be accounted for when studying everyday cognition among Blacks/African Americans and when comparing the everyday cognitive ability of Blacks/African Americans with other groups.

PTSD Symptoms and Functional Impairment among Nurses Treating COVID-19 Patients.

INTRODUCTION: Nurses providing direct care for patients with COVID-19 may be at particular risk for developing symptoms of post-traumatic stress disorder (PTSD). However, little is known about how these symptoms are related to workplace and non-workplace impairment. OBJECTIVE: We examined if PTSD symptoms mediated the relationship between treating patients with COVID-19 and functional impairment. METHODS: An online survey collected data regarding demographic and workplace variables, PTSD symptoms, functional impairment, distracted practice, and if the nurse treated patients with confirmed COVID-19. Data collected in November 2020 from 218 primarily White and female nurses were analyzed. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines in reporting the methods and results. RESULTS: Analyses involved two steps: (a) calculating descriptive statistics, conducting univariate tests, and examining correlations among study variables; and (b) conducting a path analysis examining the mediating role of PTSD symptoms in the relationship between treating patients with COVID-19 and functional outcomes. Univariate tests found that nurses who had a diploma/associate's/bachelor's and nurses who treated patients with COVID-19 reported more PTSD symptoms, functional impairment, and distracted practice compared to nurses with graduate degrees and those who did not treat patients with COVID-19. Compared to nurses who reported having access to adequate PPE, nurses who reported not having access to adequate PPE reported more PTSD symptoms but lower functional impairment and distracted practice. Men reported lower distracted practice scores than women. In step two of the analyses, the path model suggested that treating patients with COVID-19 was indirectly related to both distracted practice and functional impairment through PTSD symptoms. CONCLUSION: The probable PTSD symptoms and work- and non-work-related functional impairment of nurses working with patients with COVID-19 highlight the importance of developing interventions that help these essential workers address vulnerabilities associated with working during the COVID-19 pandemic.

Subjective memory in older African Americans.

The current analysis examined (a) if measures of psychological well-being predict subjective memory, and (b) if subjective memory is consistent with actual memory. Five hundred seventy-nine older African Americans from the Baltimore Study of Black Aging completed measures assessing subjective memory, depressive symptomatology, perceived stress, locus of control, and verbal and working memory. Higher levels of perceived stress and greater externalized locus of control predicted poorer subjective memory, but subjective memory did not predict objective verbal or working memory. Results suggest that subjective memory is influenced by aspects of psychological well-being but is unrelated to objective memory in older African Americans.

Moderating Roles of Resilience and Social Support on Psychiatric and Practice Outcomes in Nurses Working During the COVID-19 Pandemic.

INTRODUCTION: Staff and equipment shortages and an easily transmissible virus make working in the COVID-19 pandemic demanding physically and psychologically. Nurses on the frontlines are particularly vulnerable to the adversity of working under these conditions, particularly with regard to mental health. Thus, understanding risk and protective factors for this vulnerable and essential group is critical for identifying potential targets of interventions. We had two aims for the current study: (a) to examine work functioning and symptoms of depression, anxiety, and posttraumatic stress (PTSD) among nurses who did and did not care for patients with COVID-19; and (b) to determine if resilience and social support moderate these relationships. METHODS: For three weeks in July 2020, nurses across the United States were invited to participate in an online survey collecting data on demographics, resilience, social support, and screening measures of depression, PTSD, anxiety, and distracted practice. Data were analyzed using descriptive statistics and hierarchical regression for each outcome measure. CONCLUSIONS: Our findings support a growing body of research reporting that nurses are experiencing mental health sequelae during the COVID-19 pandemic, especially those providing direct care to patients with the virus. We found that compared to nurses who did not care for patients with COVID-19, those who did reported increased symptoms of PTSD, depression, and anxiety. A novel contribution is our finding that nurses providing direct COVID-19 care also experienced increased levels of distracted practice, a behavioral measure of distraction linking to a potential impact on patient care. We also found that resilience and social support acted as moderators of some of these relationships. Fostering resilience and social support may help buffer the effects of providing care to patients with COVID-19 and could potentially decrease nurse vulnerability to developing psychological symptoms and impairment on the job.

"All of this was awful:" Exploring the experience of nurses caring for patients with COVID-19 in the United States.

INTRODUCTION: Little research documents the experience of nurses caring for patients with COVID-19 in the United States. This article explores the experience of nurses providing direct care to COVID-19 patients to understand the working conditions and emotional impact of working in this pandemic on nurses. METHODS: Data were gathered through an online survey distributed via snowball sampling in July 2020. The survey included an open-ended question asking nurses to describe a personal experience providing care to a COVID-19 patient. Researchers analyzed 118 responses using content analysis. RESULTS: The experience of nurses providing care to patients with COVID-19 was summarized into six themes: (1) feeling overwhelmed with the quantity of work (33.1%), (2) patient death (30.5%), (3) helplessness (23.7%), (4) absence of patient family presence and need for additional support (22.9%), (5) personal protective equipment (PPE) concerns regarding safety and how PPE can impair the nursing role (20.3%), and (6) lack of preparedness for the pandemic (16.9%). CONCLUSIONS: These findings suggest working directly with COVID-19 patients is a significant psychological strain on nurses. Adequate personal and institutional support for nurses is needed to prevent and treat mental distress from working under these conditions.

Race differences in cardiac catheterization: the role of social contextual variables.

BACKGROUND: Race differences in the receipt of invasive cardiac procedures are well-documented but the etiology remains poorly understood. OBJECTIVE: We examined how social contextual variables were related to race differences in the likelihood of receiving cardiac catheterization in a sample of veterans who were recommended to undergo the procedure by a physician. DESIGN: Prospective observational cohort study. PARTICIPANTS: A subsample from a study examining race disparities in cardiac catheterization of 48 Black/African American and 189 White veterans who were recommended by a physician to undergo cardiac catheterization. MEASURES: We assessed social contextual variables (e.g., knowing somebody who had the procedure, being encouraged by family or friends), clinical variables (e.g., hypertension, maximal medical therapy), and if participants received cardiac catheterization at any point during the study. KEY RESULTS: Blacks/African Americans were less likely to undergo cardiac catheterization compared to Whites even after controlling for age, education, and clinical variables (OR = 0.31; 95% CI, 0.13, 0.75). After controlling for demographic and clinical variables, three social contextual variables were significantly related to increased likelihood of receiving catheterization: knowing someone who had undergone the procedure (OR = 3.14; 95% CI, 1.70, 8.74), social support (OR = 2.05; 95% CI, 1.17, 2.78), and being encouraged by family to have procedure (OR = 1.45; 95% CI, 1.08, 1.90). After adding the social contextual variables, race was no longer significantly related to the likelihood of receiving catheterization, thus suggesting that social context plays an important role in the relationship between race and cardiac catheterization. CONCLUSIONS: Our results suggest that social contextual factors are related to the likelihood of receiving recommended care. In addition, accounting for these relationships attenuated the observed race disparities between Whites and Blacks/African Americans who were recommended to undergo cardiac catheterization by their physicians.

The moderating role of personality factors in the relationship between depression and neuropsychological functioning among older adults.

OBJECTIVE: Depression is often associated with decreased cognitive performance among older adults. The current study focused on the association of neuropsychological functioning and personality traits in depressed and non-depressed older adults. METHODS: Data from 75 depressed and 103 non-depressed adults over the age of 60 were analyzed. All participants underwent standardized clinical assessment for depression prior to participation and completed the NEO-PI-R and a series of neuropsychological assessments. RESULTS: A series of multiple linear regressions were conducted to examine the relationships between personality and neuropsychological performance among depressed and non-depressed older adults. Results indicated that higher Openness to Experience was related to better performance on Parts A and B of the Trail Making Test among depressed older adults, and to better Digit Span Backward performance among all participants. Higher levels of neuroticism were related to poorer performance on Digit Span Backward, but only among depressed older adults. Depressed participants performed more poorly on the Symbol Digit Modalities Test and the Controlled Oral Word Association Test. CONCLUSIONS: Personality characteristics, particularly Openness to Experience, modified the relationship between depression and neuropsychological functioning among older adults. Results indicate that interventions aimed at increasing one's Openness to Experience could potentially attenuate some of the neuropsychological impairments that are associated with depression.

Racial differences in hypertension knowledge: effects of differential item functioning.

Health-related knowledge is an important component in the self-management of chronic illnesses. The objective of this study was to more accurately assess racial differences in hypertension knowledge by using a latent variable modeling approach that controlled for sociodemographic factors and accounted for measurement issues in the assessment of hypertension knowledge. Cross-sectional data from 1,177 participants (45% African American; 35% female) were analyzed using a multiple indicator multiple causes (MIMIC) modeling approach. Available sociodemographic data included race, education, sex, financial status, and age. All participants completed six items on a hypertension knowledge questionnaire. Overall, the final model suggested that females, Whites, and patients with at least a high school diploma had higher latent knowledge scores than males, African Americans, and patients with less than a high school diploma, respectively. The model also detected differential item functioning (DIF) based on race for two of the items. Specifically, the error rate for African Americans was lower than would be expected given the lower level of latent knowledge on the items, on the questions related to: (a) the association between high blood pressure and kidney disease, and (b) the increased risk African Americans have for developing hypertension. Not accounting for DIF resulted in the difference between Whites and African Americans to be underestimated. These results are discussed in the context of the need for careful measurement of health-related constructs, and how measurement-related issues can result in an inaccurate estimation of racial differences in hypertension knowledge.

Patient characteristics associated with receipt of lifestyle behavior advice.

BACKGROUND: Lifestyle behaviors such as reducing weight if overweight or obese, reducing salt intake, exercising, reducing alcohol intake, quitting smoking, and eating a healthy diet are related to the prevention and control of chronic diseases. However the amount of lifestyle advice provided by clinicians has been declining over the last decade. METHODS: In 2002, a telephone survey was conducted to assess the quality of preventive care offered by health care providers. The study was a cross-sectional observational study of a randomly selected sample of 516 diverse individuals in Durham County, North Carolina. Information regarding age, sex, race, education, health conditions, and self-reported receipt of lifestyle advice was examined in the study. RESULTS: The odds of receiving advice to engage in preventive lifestyle behaviors were significantly higher for those with a pre-existing diagnosis of diabetes or hypertension and for participants reporting poor health status. For example, the odds of receiving advice to control or lose weight was 8.32 (95% CI, 2.65, 26.75) among individuals reporting a diagnosis of diabetes. Similarly, the odds of reporting "receiving advice to reduce salt intake" was 6.97 (95% CI, 3.74, 13.00) among subjects reporting a diagnosis of hypertension. LIMITATIONS: The results are from a cross-sectional study of a sample of individuals in only one county. Additionally, the results are based on patient self-reported information, which could be subject to recall and social desirability bias. CONCLUSION: Patients with identified health problems were more likely than others to report being advised to adopt healthy lifestyle recommendations. Future research should examine methods to encourage health care providers to offer lifestyle advice to those without pre-existing illness.

Social support, physical functioning, and cognitive functioning among older African American adults.

Social support and functional ability are related to a number of outcomes in later life among African Americans, including cognitive performance. This study examined how providing and receiving social support was related to fluid and crystallized cognitive abilities among aging African American adults after accounting for functional limitations, age, education, sex, income, and self-reported health. Data from 602 African American adults (M = 69.08, SD = 9.74; 25% male) were analyzed using latent variable modeling. Fluid ability was a second-order factor indicated by measures that assessed verbal memory, working memory, perceptual speed, and inductive reasoning. Crystallized ability was a first-order factor indicated by three measures that assessed vocabulary (Shipley Verbal Meaning Test and parts A and B of the ETS Vocabulary Test). Results indicated that the receipt of social support was negatively related to both fluid and crystallized abilities, while the provision of support was positively related to fluid and crystallized ability. Follow-up tests found that the receipt of support was more strongly related to fluid ability than crystallized ability. There was no significant difference regarding the relationship of provision of support with fluid ability compared to crystallized ability. Results discuss the importance of considering the social context of older adults when examining cognitive ability.

Dyadic analysis of self-efficacy and perceived support: the relationship of individual and spousal characteristics with physical activity among middle-aged and young-older adults.

The purpose of this study was to examine the associations among self-efficacy, perceived support, and physical activity in middle-aged and older married couples. A total of 116 middle-aged and older couples (M = 58.86 years, SD = 7.16, range 50-74) participated in the study. A dyadic approach to path modeling was taken. The final model indicated that for both husbands and wives, one's own self-efficacy was directly related to physical activity. In addition, husband self-efficacy was positively related to wive physical activity and indirectly related to wife physical activity through wife self-efficacy. Wife self-efficacy was indirectly related to husband physical activity via the level of husband perceived support. These results provide evidence for the importance of incorporating spousal characteristics in addition to individual characteristics when investigating physical activity during middle and later married life.

Physical activity in middle-aged and young-old adults: the roles of self-efficacy, barriers, outcome expectancies, self-regulatory behaviors and social support.

This study tests the associations of self-efficacy, outcome expectancies, perceived barriers, self-regulatory behaviors and social support with physical activity. Data from 116 married community-dwelling middle-aged and young-old couples (M = 58.86 years, SD = 7.16, range = 50 to 75) were collected via mail-in survey. The model indicated that self-efficacy was directly and indirectly related to physical activity through outcome expectancies, perceived barriers and self-regulatory behaviors. The results clarify the associations among the social cognitive constructs and physical activity, and suggest that interventions targeting multiple social cognitive constructs could increase the activity levels of middle-aged and young-old adults.

Physical health and depression: a dyadic study of chronic health conditions and depressive symptomatology in older adult couples.

This study examined the associations among chronic health conditions, sociodemographic factors, and depressive symptomatology in older married couples. Data from the 2004 wave of the Health and Retirement Study (n = 2,184 couples) were analyzed. Results indicated a reciprocal relationship in depressive symptoms between spouses. Additionally, post hoc analyses indicated that husbands' stroke and high blood pressure were related to increased depressive symptomatology among wives. Beyond the reciprocal relationship, husbands were unaffected by wives' health. These results suggest sex differences underlying psychological distress in the context of physical health among older adults and that older women with husbands who have high levels of depressive symptomatology, high blood pressure, or a history of stroke may be at particular risk of experiencing depressive symptoms.

Is there a nonadherent subtype of hypertensive patient? A latent class analysis approach.

To determine subtypes of adherence, 636 hypertensive patients (48% White, 34% male) reported adherence to medications, diet, exercise, smoking, and home blood pressure monitoring. A latent class analysis approach was used to identify subgroups that adhere to these five self-management behaviors. Fit statistics suggested two latent classes. The first class (labeled "more adherent") included patients with greater probability of adhering to recommendations compared with the second class (labeled "less adherent") with regard to nonsmoking (97.7% versus 76.3%), medications (75.5% versus 49.5%), diet (70.7% versus 46.9%), exercise (63.4% versus 27.2%), and blood pressure monitoring (32% versus 3.4%). Logistic regression analyses used to characterize the two classes showed that "more adherent" participants were more likely to report full-time employment, adequate income, and better emotional and physical well-being. Results suggest the presence of a less adherent subtype of hypertensive patients. Behavioral interventions designed to improve adherence might best target these at-risk patients for greater treatment efficiency.

The associations of patient demographic characteristics and health information recall: the mediating role of health literacy.

We examined the mediating role of health literacy in the relationships between participant demographic characteristics and health information recall. Baseline data from two studies that focused on hypertensive adults (N = 1190; M = 62.28 years, SD = 11.98; 35.5% female; 45.9% African-American) were analyzed. The final model, which adjusted for recruitment site, indicated that financial status, race, and education were indirectly related to health information recall through health literacy. Increasing education was also directly related to better health information recall. Increasing age was not related to health literacy, but was related to poorer health information recall. The final model fit the data very well, chi(2)(3) = 0.69, p = .36, RMSEA = .000 (90% CI = .000 to .024), CFI = 1.00. The results suggest that health literacy might be one of the mechanisms underlying the relationships between participant demographic characteristics and poor health outcomes due to inaccurate recall of instructions.

Mild cognitive impairment and objective instrumental everyday functioning: the everyday cognition battery memory test.

OBJECTIVES: To examine the performance subjects with and without mild cognitive impairment (MCI) on an objective measure of everyday or real-world memory and subjective items assessing competency within the same instrumental domains; to determine whether the Everyday Cognition Battery (ECB) can uniquely predict MCI status. DESIGN: Cross-sectional. SETTING: Independent-living sample of urban dwelling elders in Baltimore Maryland. PARTICIPANTS: The sample consisted of 555 subjects ranging in age from 50 to 95 (mean 68.8 +/- 9.6). MEASUREMENTS: Objective performance in three instrumental domains (medication use, financial management, nutrition and food preparation) was assessed using the ECB Memory Test. Subjective performance within the same instrumental domains was also assessed. RESULTS: No difference was found between elderly subjects with and without MCI on the subjective items of instrumental activity of daily living (IADL) competency. A significant multivariate effect for cognitive status group (F(3, 507)=21.88, P<.05, eta(2)=.12) was observed for the objective measure, with participants with MCI performing, on average, significantly worse than those without on all thee instrumental domain subscales. The medicine use (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94-0.99) and financial management (OR=0.93, 95% CI=0.91-0.96) subscales of the ECB Memory Test were unique and significant predictors of MCI. CONCLUSION: This study adds to the growing body of literature suggesting that cognitively complex IADLs might be compromised in elderly people with MCI. Moreover, the ECB Memory Test might be a clinically useful tool in evaluating real-world competency.