bluuebunny/crossref_metadata_2025 huggingface dataset:
AGING BODY AS CONTEXT: THE ROLE OF INTEROCEPTIVE AGING IN MID- AND LATE-LIFE EMOTION
Authors: MacCormack Jennifer
Published: December 2022

Interoceptive sensations (e.g., racing heart, clenched gut) are often closely tied to emotion. Older adults tend to exhibit reduced sensitivity and awareness of their interoceptive sensations relative to younger adults (e.g., Khalsa et al., 2009; Mikkelsen et al., 2019; Murphy et al., 2019), yet the emotional implications of such interoceptive differences remain unclear. Herein, I present two behavioral cross-sectional studies (N=350) documenting age differences in how adults (18-75 yrs) link their interoceptive sensations to emotions (Study 1: cognitive behavioral task; Study 2: experience sampling). Results reveal that from midlife into late life, coherence between interoceptive sensations and emotions increasingly weakens, both behaviorally and in self-reports. Age effects are most prominent for high arousal sensations and states. These findings provide converging evidence with recent neuroimaging results (MacCormack et al., 2020) showing the importance of interoceptive aging and related shifts in physiological arousal as potential pathways by which emotions transform across adulthood.
DISCHARGE LOCATIONS AFTER HOSPITALIZATIONS INVOLVING OPIOID USE DISORDER AMONG MEDICARE ENROLLEES
Authors: Moyo Patience , Goodyear Kimberly , Jutkowitz Eric , Thomas Kali , Zullo Andrew
Published: December 2022

Hospitalizations involving opioid use disorder (OUD) are increasing in the Medicare population. Rising OUD-related acute care use emphasizes the need to understand where post-acute care is provided and opportunities to facilitate OUD treatment in those settings. We conducted a retrospective cohort study using 2016-2018 Medicare Provider Analysis and Review (MedPAR) files linked to enrollment data and the Residential History File (RHF) for 100% of Medicare fee-for-service beneficiaries aged ≥18 years. We used diagnostic codes for opioid dependence or “abuse” to identify OUD from MedPAR data. The RHF identified hospital discharge locations. Our analysis included 459,763 OUD-related hospitalizations. Overall, individuals < 65 years (60.3%), female (53.7%), or Medicare-Medicaid dually enrolled (59.1%) were the majority. The mean (standard deviation) length of stay was 5.5 (6.6) days and 31.3% of OUD-related hospitalizations required intensive care use. Seventy percent of patients with OUD-related hospitalizations were discharged home, 15.8% to skilled nursing facilities (SNFs), 9.6% to non-SNF institutional facilities, 2.5% home with home health services, and 1.8% died in-hospital. Within 30 days of hospital discharge, the range for 30-day all-cause readmissions was 27.7% (home) to 47.5% (non-SNF institutional setting). The 30-day all-cause mortality ranged from 3.1% (home without health) to 6.4% (non-SNF institutional settings). Given that over one-quarter of OUD-related hospitalizations resulted in discharge to locations other than home and that many institutional post-acute care settings cannot obtain OUD medications, modifying Drug Enforcement Administration regulations and expanding access to OUD medications for aging adults in post-acute and long-term care settings must be a near-term policy focus.
MEDICATIONS ASSOCIATED WITH GERIATRIC SYNDROMES AND HOSPITALIZATION RISK IN HOME HEALTHCARE PATIENTS
Authors: Wang Jinjiao , Shen Jenny , Yu Fang , Conwell Yeates , Li Yue , Caprio Thomas , Shah Avantika , Simmons Sandra
Published: December 2022

Polypharmacy is common in the home health care (HHC) setting. This study examined the prevalence, predictors, and impact of medications associated with geriatric syndromes (MAGS) use on subsequent hospitalization in HHC patients. Data from the HHC electronic medical records, the Outcome and Assessment Information Set (OASIS), and Medicare HHC claims of 6,882 adults ≥ 65 years old receiving HHC from a large, non-profit HH agency in New York State in CY 2019 were used. MAGS use was identified from active medications reconciled during HHC visits and defined as total count and in quartiles. Hospitalization during the HHC episode was operationalized as a time-to-event variable. Regression analyses were conducted to identify predictors of MAGS use, and survival analyses were conducted to examine the association between MAGS use and hospitalization. Nearly all (98%) of the HHC patients used at least one MAGS and 41% of all active medications were MAGS. A higher MAGS count was found among HHC patients who were non-white, community-referred, with more comorbidities, depressive symptoms, and functional limitations. A higher MAGS count was also related to increased risk for hospitalization. Moreover, higher quartiles of MAGS use combined with having ≥10 diagnoses predicted a 2.5-fold increase in hospitalization risk, relative to the lowest quartile of MAGS use and having < 10 diagnoses. In conclusion, over 40% of medications taken by HHC patients are MAGS, which, along with multimorbidity, increased hospitalization risk. HHC clinicians should identify MAGS use to inform deprescribing discussion with patients and their prescribers.
A SUCCESSFUL MODEL FOR AMPLIFYING THE VOICES OF OLDER ADULTS IN LONG-TERM CARE AND SERVICES AND SUPPORT RESEARCH
Authors: Lessem Rachel , Berman Rebecca , Eisenstein Amy
Published: December 2022

The experiential voice of older adults receiving long term services and supports (LTSS) is largely absent from health research hampering the development of effective interventions. While many have the capacity to participate in the design, development, and delivery of research, researchers traditionally do not recognize such capacity, may be unsure how to seek input, or may not appreciate the extent to which such input can improve the research enterprise. But the participation of these older adults can ensure that patient-centered research meaningfully addresses their care preferences and desired health outcomes, and can improve the effectiveness of care and patients’ quality of life. Through three PCORI-funded projects, we developed a successful model for addressing barriers to amplify these voices. We outline barriers to the dissemination and implementation of this model, and suggest next steps to test strategies to amplify the voices of older adults in long-term care.
PSYCHOSOCIAL AND BEHAVIORAL PREDICTORS OF HEALTH AND AGING
Authors: Graham Eileen , Turiano Nicholas
Published: December 2022

Crucial to understanding the aging process is to identify modifiable characteristics that can be targeted in hope of optimizing health across adulthood. This symposium brings together a diverse set of talks about the biopsychosocial and behavioral processes that influence aging outcomes. Turiano used a national sample to demonstrate that individuals with higher levels of neuroticism often use food to cope with stressors which ultimately results in a greater central adiposity and elevated glycated hemoglobin. Zavala used an epidemiological sample of long-banked frozen blood samples to successfully extract DNA and methylation biomarkers from 140 adults and found that stress measures are associated with accelerated biological aging. Luo used coordinated analysis to explore how correlations between personality traits and four health outcomes fluctuate over time, and found the associations between personality (level/change) and health increased in strength through middle adulthood and early stage of late adulthood but weakened in very old age. Jackson found that individuals who experienced high and increasing loneliness in older adulthood had worse cognitive function and steeper cognitive decline than expected given their observed post-mortem neuropathology (i.e., worse cognitive resilience). Lastly, Pfund investigated how personality and social support change together and found within and between person associations between personality and social support, and evidence that retirement was associated with an increase in social support. In sum, this symposium presents novel evidence for the associations among personality, stress, social support, and lonliness are associated with physical and cognitive health in old age.
PERSONALITY TRAITS PREDICT DIABETES RISK IN ADULTHOOD: THE MEDIATING EFFECTS OF USING FOOD TO COPE WITH STRESS
Authors: Turiano Nicholas , Alderson Jacob , Willard Meredith , King Sina , Súilleabháin Páraic Ó
Published: December 2022

Identifying the individual characteristics that predict which adults will develop obesity and diabetes is crucial. This study included national data from 902 participants (aged 25-75) in the Midlife Development in the U.S. (MIDUS) study. Participants completed the Big-5 personality trait measure in 1995-1996, and behavior/health variables between 2004-2009. We tested whether levels of certain personality traits would predict an elevated risk of diabetes via hemoglobin A1c (HbA1c) levels through eating behaviors. A structural equation modeling framework demonstrated good fit when testing indirect effects (CFI = 0.95; RMSEA = 0.05). Indirect effects revealed that higher levels of neuroticism predicted greater waist circumference and higher HbA1c levels due to an increased use of food to cope with problems (IE =0.10; p<0.05). Moreover, indirect effects were found for conscientiousness, albeit in a protective direction. Our findings suggest that personality traits may be an early predictor of behavior and thus long-term adverse health outcomes.
ASSESSING THE PSYCHOMETRIC PROPERTIES OF THE GERIATRIC SUICIDE IDEATION SCALE (GSIS) IN MIDDLE-AGED AND OLDER MEN
Authors: Heisel Marnin , Flett Gordon
Published: December 2022

Middle-aged and older men have high rates of suicide, necessitating focused risk detection. We developed the Geriatric Suicide Ideation Scale (GSIS; Heisel & Flett, 2006) as an age-specific, multidimensional suicide risk assessment tool. The GSIS has shown strong psychometric properties in clinical, community, and residential samples (see Heisel & Flett, 2016), yet research has lagged investigating its utility with middle-aged and older men. The purpose of the present study was thus to assess the psychometric properties of the GSIS administered to 82 men, 55 years and older (M=63.3, SD=4.6 years), who participated in a meaning-centered psychological intervention group for those concerned about or struggling with the transition to retirement (Heisel et al., 2020). Psychometric analyses included investigation of participant response characteristics, internal consistency, and construct validity. Findings demonstrated acceptable internal consistency for GSIS totals (α =.88) and for its Suicide Ideation, Death Ideation, Loss of Personal and Social Worth, and Perceived Meaning in Life subscales (α =.62-.81). Positive associations between the GSIS and negative psychological factors (depression, anxiety, hopelessness, loneliness, perceived lack of mattering to others, and history of suicidal behavior; r =.30 to .51) and negative associations with positive factors (life satisfaction, psychological well-being, perceived support, and meaning in life; r = -.21 to -.51) supported its construct validity. These and other findings will be discussed in the broader context of upstream population level approaches to suicide risk detection and prevention.
THE LANDSCAPE OF ALZHEIMER’S DISEASE AND RELATED DEMENTIAS CAREGIVER COMMUNICATION RESEARCH
Authors: Dobbs Debra , Yauk Jessica , Buck Harleah
Published: December 2022

Alzheimer’s Disease and Related Dementias (ADRD) affect one in nine adults aged 65 and over. Past research has demonstrated the need for services that improve quality of care for those with ADRD and their caregivers. Those with ADRD are at a greater risk for negative health outcomes. Therefore, it is crucial that those with ADRD receive care consistent with their preferences. However, more research is needed to shed light on effective tools available and patterns of advance care planning (ACP) when it comes to those with ADRD and their caregivers. This symposium highlights the landscape of ACP communication among those with ADRD and their caregivers. The session begins with a study that explored experiences of apathy and preferences for dyadic-communication via mobile health (mHealth) among adults with mild cognitive impairment and their care-partners. The second presentation demonstrates the feasibility and effectiveness of a palliative care education in assisted living program for nurses and administrators on increasing ACP discussions with family caregivers of residents with dementia. The third presentation investigates ACP among African Americans with ADRD and their caregivers and the critical role the community can play in facilitating communication. The final presentation explores how ACP differs by race, ethnicity and ADRD status using data from the 2018 Wave of the Health and Retirement Study. Future directions for implementation of these innovations for improving ACP communication among caregivers and persons with ADRD will be discussed.
EFFECTIVENESS OF A PC EDUCATION PROGRAM IN ASSISTED LIVING IN IMPROVING DISCUSSIONS WITH DEMENTIA FAMILY CAREGIVERS
Authors: Dobbs Debra , Yauk Jessica , Vogel Carlyn , Fanfan Dany , Buck Harleah , Haley William , Meng Hongdao
Published: December 2022

There is a need for improved communication in assisted living communities (ALCs) for staff and family caregivers of persons with dementia. This study is a cluster randomized trial in 10 ALCs (N=23 nurses and administrators; N= 122 residents with dementia) of a PC education (PCEAL) program for dementia care providers facilitated by hospice nurse educators. Baseline, 3- and 6-month data was collected for documentation of advance care planning (ACP) discussions. The PCEAL program had a moderate effect on ACP discussions at the 3-month follow in the treatment (N=17) compared to the control group (N= 6) (Cohen’s d = 0.72, 95% CI [0.25, 1.19]). The findings indicate that the PCEAL program potentially improves ACP discussions with family members of persons with dementia. We will discuss recommendations for tailoring the PCEAL program to include other direct and administrative staff and to elicit the perspective of families about quality of communication.
THE LEGACY OF HELEN KIVNICK: THE IMPACT OF VITAL INVOLVEMENT AND CREATIVITIES ON WELL-BEING IN LATE LIFE
Authors: Adams-Price Carolyn
Published: December 2022

Helen Kivnick was an extraordinary woman whose body of work strongly influenced and continues to influence the field of gerontology. Her classic work on vital involvement in late life, some of which was conducted with Erik and Joan Erikson, could be considered the foundation of current perspectives on positive gerontology, and creativity and aging. The current symposium will include both personal and theoretical takes on the legacy of Kivnick’s work, especially her interests in vital involvement and creativity. Kivnick emphasized the possibility for older adults to adapt to new situations, even in very late life, and while experiencing physical and cognitive decline. Two of the speakers will speak on their personal experiences with Kivnick, while two others will emphasize research and theory derived from Kivnick’s work. Dr. Adams-Price will introduce the symposium by addressing the significance of vital involvement as a concept in aging, as well as the ways creativity can improve well-being in late life. Dr. Wyatt-Brown will describe her long friendship with Dr. Kivnick, including Kivnick’s comments in their book with Ruth Karpen and Margaret Gullette. The Big Move, which describe Wyatt-Brown’s life with her husband in continuing care. Dr. Chee will discuss her research on patients with dementia who participated in a story-telling intervention, which increased their meaningful engagement in their environment. Finally, Ms. Linda Davis will recall her long partnership with Kivnick and the results of the national study they conducted on the benefits of creativity interventions for at risk- older adults in HUD housing.
IT COULD BE ANYTHING YOU WANT!: VITAL INVOLVEMENT OF PERSONS WITH DEMENTIA IN CREATIVE GROUP STORYTELLING
Authors: Chee Kyong Hee , Kim Seoyoun , Gerhart Olga
Published: December 2022

The benefit of vital involvement (VI) in dementia care is largely unknown. The purpose of this study is to demonstrate VI elements in a creative group storytelling program for persons living with dementia (TimeSlips). After offering 6 weekly storytelling sessions for 4 small groups in a memory care community, we interviewed participants (n = 21), family members (n = 2), and care associates (n = 6) to obtain feedback on the program. Themes from narratives in the audiorecorded and transcribed interviews suggest that participants enjoyed the program, enacting their personal values, strengths, and interests, and incorporating their past and current experiences, as supported by their sociospatial environment (e.g., facilitator, co-participants, researchers, shared table). When paired with the VI practice, creative group storytelling has potential to magnify favorable outcomes for participants with dementia, who may express more fully their meaningful engagement with their inner (psychological) and external (social and physical) world.
USING ANOCRITICISM AS AN ANALYTICAL FRAMEWORK: PERSPECTIVES FROM THE HUMANITIES
Authors: de Medeiros Kate , Maierhofer Roberta
Published: December 2022

To date, Gender Studies and Age Studies (predominantly humanities-based approaches to studying old age) have mostly remained two separate areas of research despite the ontological and epistemological similarities of both fields. As Maierhofer points out, “[a]ge/[a]geing studies would not have been established as a field without the theoretical and methodological approaches established through feminist theory.” Age studies research has largely focused on cultural representations (e.g., novels, films) and social manifestations of either age or gender but not both. Considering this limitation in research, this interdisciplinary panel discusses cultural and social intersections of age and gender from a theoretical as well as an empirical perspective. Taking Maierhofer’s analytical approach of ‘anocriticism’ as a starting point, the contributions of this panel explore intersections of age and gender in society, culture, and cultural representations. The first paper traces the historical development of anocriticism, from its feminist origins to its current application in Age Studies scholarship. The second paper presents research from two studies which used anocriticsm as an analytical framework. The third reports findings from an analysis of two novels. Here, an anocritical lens was used to deconstruct heteronormative assumptions about gender and age. The final paper presents an anocritical, qualitative analysis of narratives from five older men with regarding their performance of masculinities and power. As the papers demonstrated, anocriticism as theoretical framework, allows for a multi-dimensional yet nuanced analysis of cultural and social intersections of age and gender.
THE LONGITUDINAL ASSOCIATIONS BETWEEN SOCIAL NETWORK STRUCTURE AND SELF-ESTEEM
Authors: Hu Rita , Antonucci Toni
Published: December 2022

Based on the convoy model of social relations, the current study used Latent Growth Curve Modeling to examine the associations between overall network, closest, close and weak social tie trajectories across the lifespan and self-esteem later in life. Participants (N = 553) aged 13 to 77 in Wave 1 (1992) were surveyed again in 2005 (Wave 2) and 2015 (Wave 3). The overall network size increased significantly across the lifespan (β = 0.56, SE = 0.01, p < 0.001). The closet tie size trajectories were not significantly associated with self-esteem 23 years later. The growth of the close tie size was not significantly associated with self-esteem later. Weak-tie size growth was also significantly associated with higher self-esteem later (β = 0.14, SE = 0.00, p < 0.05). The findings highlight social network’s effects on self-esteem across the lifespan, as well as the critical role weak social ties play in development.
USING PHOTOVOICE TO UNDERSTAND THE LIVED EXPERIENCE AND ENVIRONMENT OF OLDER ADULTS AWAITING KIDNEY TRANSPLANT
Authors: Hladek Melissa , Wilson Deborah , Shanbhag Meera , Krasnansky Katie , Walston Jeremy , Xue Qian-Li , McAdams-DeMarco Mara , Szanton Sarah
Published: December 2022

End-stage renal disease (ESRD) causes age-accelerating disease and disproportionally affects older and minority patients; the preferred treatment is kidney transplantation (KT). Rates of KT have risen 5-fold for older adults since 1990 but there is great heterogeneity in KT outcomes by frailty and waitlist status. The person-environment fit theory posits that improving a person’s lived environment will facilitate optimal individual functioning. We recruited a balanced sample of 20 participants (mean age 60, range 35-82) with respect to their frail/ pre-frail and inactive/ active waitlist status to explore personal experience and the lived environment through the use of photovoice, gaining insight into the person-environment fit of those older adults awaiting KT. We will discuss IRB issues, recruitment and logistical tips with using Photovoice. This work will help to inform what vulnerable and marginalized older adults awaiting KT must be prepared for psychologically and physically, including modifications needed to their lived environments.
“WE WILL SURVIVE … BUT I JUST WANT MORE FOR US”: DISSEMINATING PHOTOVOICE FINDINGS TO ADVANCE FOOD POLICY AND EQUITY
Authors: Hines Anika , Brody Rebecca , Zhou Zehui , McDaniel Kennedy , Omenyi Chiazam , Miller, III Edgar , Cooper Lisa , Crews Deidra
Published: December 2022

Poor food environments and disproportionate food insecurity among African Americans (AAs) represent determinants of chronic disease disparities by race/ethnicity. We used PhotoVoice to explore the food environment in Baltimore, MD, through the perspectives of Black residents with hypertension. Findings illuminated structural racism and classism as root causes of “food desert” conditions. Respondents provided critical analysis of existing food access barriers, including problematic policies, and offered asset-based solutions. Using an exhibition of participants’ photographs to set the tone of the discussion, we will convene a stakeholder meeting including study participants, community advisory board members, local and state government agencies, civic organizations, community farmers, agricultural organizations, non-profit food providers, churches, local restauranteurs, convenience store owners, insurance payers, and transportation providers. Discussion will center on three areas of action informed by findings: systems level issues; individual activation, agency, and advocacy; and community-based solutions. Meeting proceedings will be disseminated through academic and lay publications.
CHRONIC PAIN’S PAINFUL IMPACT ON COGNITIVE FUNCTIONING
Authors: Azer Lilian , Skoblow Hanamori , Flores Eileen , Llaneza Danielle , Zhang Weiwei , D’Antonio Patricia
Published: December 2022

One in five Americans adults report experiencing chronic pain and stated it has negatively impacted their lives by limiting their engagement in activities. The magnitude of pain experienced is more severe in older adults, which may be due to age-related differences in pain perception pathways leaving older adults more vulnerable to the negative impact of pain. The most common type of chronic pain experienced by older adults involves musculoskeletal disorders, which is consistent with age-related declines muscle strength and mass. Declines in handgrip strength is associated with chronic pain perception and poor cognitive functioning. Older adults who experience severe chronic pain have worse working memory and attention. The experience of chronic pain is attentionally demanding on cognitive processes making it difficult for older adults to draw their attention away from pain perception during cognitively demanding tasks. Chronic pain is also associated with accelerated decline in cognition, dementia, and Alzheimer’s Disease pathogenesis. As a GSA policy intern, I represented GSA in the Protecting Access to Pain Relief Coalition to explore policy initiatives and recommendations in relation to chronic pain experienced by older adults. Research on chronic pains’ impact on cognitive and physical function is often conducted in isolation. However, they seldom occur in isolation during real-world tasks. Therefore, research on tasks that involve simultaneous physical and cognitive functioning in relation to chronic pain is imperative. In addition, handgrip strength should be considered as a useful cost-effective screening tool as a measure for cognitive decline in older adults with chronic pain.
THE INTERSECTIONS OF AGING BELIEFS AND POLICY
Authors: Skoblow Hanamori , Azer Lilian , Llaneza Danielle , Flores Eileen , D’Antonio Patricia
Published: December 2022

Ample evidence and stereotype embodiment theory indicate that older adults’ internalized beliefs about aging are related to their health and well-being over time. Aging beliefs are constructed and reinforced socioculturally, interpersonally, and structurally, the latter of which includes federal, state, and local policies. For instance, policies affect resource allocation for Older Americans Act programs, job security and safeguarding from workplace age discrimination, access to medical services or treatments, and financial well-being via tax and retirement law. Heterogeneity in community and organization-level public health policies during the first year of the COVID-19 pandemic also shaped and were shaped by beliefs about aging. Further, policies that acknowledge and address ageism not only promote positive health, social, and financial outcomes for older adults, but also allow all of the public to benefit from older adults’ participation in society. As a GSA policy intern, I tracked and analyzed legislation that is relevant for optimal aging outcomes, identified implicit age bias in policy, and framed policy recommendations that promote positive aging beliefs. Effective policies and collective action that reduce ageism, facilitate intergenerational contact, and ensure access to necessary services have the potential to benefit all of us as we age, not only directly, but also indirectly through beliefs about aging.
POLICY IMPLICATIONS ON CLINICAL PRACTICE: AN EXPLORATION
Authors: Llaneza Danielle , Flores Eileen , Azer Lilian , Skoblow Hanamori , D’Antonio Patricia
Published: December 2022

Clinical practice is direct and indirect work with and for patients to improve their wellbeing. Typically, clinical practice is specific to the discipline and institutional body in which providers work. Additionally, caring for older adults requires a review of the biological, psychological, and social aspects of their health to address their needs and diseases. Therefore, policy has significant albeit gradual effects on clinical practice. Health policies and legislation change clinical guidelines, options, and barriers. Federal and state-level policies influence clinical practice factors such as billing, provider knowledge, student training, treatment access, and availability of interventions. Understanding the needs of both patients and providers is imperative to creating clinical practices in line with policy. The collaboration between researchers, providers, and policymakers promotes inclusive and equitable recommendations for health care practices. Yet, often health policy at the federal level is a formidable dynamic that requires expertise and cooperation for all stakeholders that is often not readily accessible. A critical component of this work is reaching providers and patients where they are most often located with information dissemination and outreach efforts. As a GSA policy intern, I explored policy initiatives that directly and indirectly influenced clinical practice across disciplines from the Department of Health of Human Services, National Institute of Aging at NIH, Centers for Medicare & Medicaid Services, and other agencies and reviewed methods that promoted health equity in health care. We need better policy to improve our clinical practice to increase treatment options, expand access, and tailor delivery for our patients.
COGNITIVE FUNCTION AND HELP-SEEKING AMONG US CHINESE OLDER ADULTS WITH ELDER MISTREATMENT
Authors: Chao Ying-Yu , Yeh An-Yun , Zha Peijia , Dong XinQi
Published: December 2022

Purpose

Elder mistreatment (EM) in immigrants with cognitive decline is an understudied public health problem. Cognitive function plays an important role in individuals’ ability to seek help. This study aimed to examine the associations between cognitive function and help-seeking among U.S. Chinese older adults reported EM.

Methods

Data were from the Population Study of Chinese Elderly in Chicago (PINE). Five instruments were used to measure cognitive function, including the Mini-Mental State Examination, East Boston Memory Test Immediate Recall and Delayed Recall, Digit Span Backwards, and Symbol Digit Modalities Test. Informal/formal help-seeking intentions and behaviors were measured. Descriptive statistics, linear regression, and logistic regression were performed.

Results

A total of 450 participants reported EM. Most victims sought help from informal sources (53.48%), followed by any sources (11.42%) and formal sources (3.34%). About one-third of participants did not seek any help. Higher episodic memory was associated with an increase in help-seeking intentions among Chinese older adults with financial mistreatment (p < .05) and poly-victimization (p < .01). Lower working memory was associated with an increase in help-seeking intentions among those with caregiver neglect (p < .001). Compared to not seeking help, higher executive function was associated with a higher likelihood to seek help from any sources among Chinese older adults with psychological mistreatment (p < .05). Conclusion/implication: This study highlights the associations between cognitive function and help-seeking among this underserved population. Culturally tailored interventions are suggested to promote help-seeking for different types of cognitive impairment among Chinese older adults with EM.
TOXIC STRESS, RESILIENCY RESOURCES, AND TIME TO DEMENTIA DIAGNOSIS AMONG AMERICANS AGED ≥50 YEARS IN THE HRS 2006–2016
Authors: Nkwata Allan , Zhang Ming , Song Xiao , Giordani Bruno , Ezeamama Amara
Published: December 2022

Toxic stress (TS), resiliency-promoting factors (RPFs) and their interactions were investigated in relationship to incident dementia in a sample (n = 6516) of US adults ≥50 years old enrolled in the HRS between 2006-2016. TS included experiences of everyday discrimination and RPF included personal mastery. Race/ethnicity was self-reported as African American (AA), Caucasian, or Other. Multivariable Cox proportional hazards regression models estimated TS-, RPF- and race-associated hazard ratios (HR) for dementia diagnosis and 95% confidence intervals (CIs) with adjustment for comorbidity and socio-demographic factors. Discrimination-associated risk of dementia diagnosis on average increased with education level [discrimination x education, p = 0.032; HR = 1.75 (95% CI: 1.01–3.03) if < high school, HR = 5.67 (95% CI: 2.94–10.94) if high school completed and HR = 2.48 (95% CI: 1.53–4.00) if ≥some college education]. Likewise, AA vs. Caucasian race disparity in new-onset dementia was evident (HR = 2.12, 95% CI: 1.42–3.17) among adults with high-mastery while absent (HR = 1.35, 95% CI: 0.75–2.41) among adults with low mastery (Mastery x Race, p = 0.01). TS is a contextual driver of incident dementia that seemingly operates in a race and RPF-dependent manner. Heterogeneity pattern suggests that TS may overwhelm the cognitive reserve benefit of RPF particularly in status-inconsistent contexts including persons subjected to discrimination despite high education and in AA individuals despite high mastery. Policies that reduce discrimination and promote equitable treatment by race/ethnicity may support cognitive resiliency and reduce the risk of dementia diagnosis in adult Americans.
CONDUCTING COMMUNITY-BASED RESEARCH AS AN INSIDER AND OUTSIDER IN YOUR OWN COMMUNITY
Authors: Lewis Jordan
Published: December 2022

As an Alaska Native from the Bristol Bay region, this presentation will discuss being an insider and outsider in your own community and how it impacts research studies. Using case studies from my dissertation research, this presentation will discuss positionality and how to collect objective data, the lack of objectivity in getting, analyzing, and reporting data, and how research methods influenced my study. I will also discuss challenges and benefits of being an insider, including enhancing the validity of the research process, data collection, and analysis, understanding the group’s culture. The results include trusting relationships with communities, the Elders’ voices guiding the findings, an appreciation for the challenge of conducting research as an insider and outsider. This presentation will conclude with a discussion on how to obtain objective data and ensure the accuracy of findings through community-engagement principles and the benefits of working in your own community.
PERCEIVED DISCRIMINATION, DEPRESSIVE SYMPTOMS, AND COGNITIVE CONTROL AMONG MEXICAN-ORIGIN WOMEN
Authors: Muñoz Elizabeth , Tse Hin Wing (Florence) , Yan Jinjin , Kim Su Yeong
Published: December 2022

Mexican-origin adults comprise over 60% of the Latino population in the U.S., and are at greater risk for cognitive impairment compared to non-Latino Whites. Older Mexican-origin women are also disproportionally affected by cognitive impairment compared to their non-Latino White counterparts. Identifying early-life precursors for reduced cognitive function can inform prevention efforts. Perceived discrimination is a ubiquitous stressor with emergent evidence linking it to cognitive function and no studies testing mechanisms of this association among Mexican-origin women. Using data from a three-wave longitudinal study of Mexican-origin women spanning 8 years (n = 595, mean baseline age = 38.89 (5.74)) living in central Texas, we tested the longitudinal associations between baseline daily and ethnic discrimination on a task of cognitive control at Wave 3 and the mediating effects of Wave 2 depressive symptoms. We also tested the moderating effects of age, education, and financial difficulties on these links. Structural equation model results indicated that baseline daily discrimination was associated with slower reaction times at Wave 3 and that depressive symptoms at Wave 2 mediated this association; models controlled for age, education, and baseline depressive symptoms. Ethnic discrimination was positively associated with Wave 2 depressive symptoms, but not with cognitive control. Greater daily discrimination was associated with faster reaction times among those with lower financial difficulties. Findings show that greater daily discrimination is subsequently associated with lower cognitive control through increased depressive symptoms and highlight the need for future research to consider the socioeconomic context under which these links operate among Mexican-origin women.
AN INNOVATIVE MULTIDISCIPLINARY PAID APPRENTICESHIP PROGRAM TO DEVELOP A NEW WORKFORCE IN GERONTOLOGY
Authors: Sharma Anita
Published: December 2022

There is an acute need to develop new workforce talent in the Gerontology industry due to (a) a rapidly increasing older population; (b) new and evolving needs of older adults due to increased life spans and the long-term impact of COVID-19, and (c) high attrition rates of the current workforce due to death and retirement. One practical strategy to increase new talent is to develop paid apprenticeship opportunities for undergraduate students from different disciplines. The author developed multiple hybrid apprenticeship opportunities to create an "earn and learn" program through funds received from the Louisiana Board of Regents. The program was open to students from all majors because Gerontology is a multi-disciplinary field and there is a need to provide gerontological training to professionals from different disciplines to prepare them to serve older adults in different types of settings. As a pilot project, ten students were selected after an application process. Students in this project were required to complete two three-credit hour fully online courses in Gerontology with a grade of “B” or better. They were also required to complete an eight-hour orientation to help them develop soft skills to work with older adults during their apprenticeship period. They were then required to complete a 150-hour paid summer-apprenticeship in an organization that serves older adults and/or people with disabilities. The program was successful with a 100% completion rate. The students enrolled in this program completed the final step by presenting their apprenticeship experiences at a conference organized by the author.
FUNCTION FOCUSED CARE FOR ACUTE CARE: OVERCOMING RECRUITMENT, MEASUREMENT, AND IMPLEMENTATION POST-COVID-19
Authors: Resnick Barbara
Published: December 2022

To help patients spend more time engaged in physical activities and avoid the complications that occur Function Focused Care for Acute Care was developed (FFC-AC-EIT). FFC-AC-EIT includes the implementation of four steps: (1) Environment and policy assessments; (2) Education of staff; (3) Establishing patient goals; and (4) Mentoring and motivating of staff, patients, and families. A total of 600 patients from 12 hospitals will be included. Eligibility of patients is based on being 55 years of age and older, admitted for a medical reasons excluding COVID-19, and demonstrating evidence of dementia. Outcome measures are obtained at baseline, discharge, 1, 6 and 12 months post discharge and include physical function, physical activity, pain and pain management, psychological and behavioral symptoms associated with dementia, delirium and adverse events (falls, rehospitalizations, nursing home admissions). Due to COVID-19 innovative approaches were implemented to be able to initiate and continue with the study. These included: identifying potential participants that were COVID-19 free off site; transitioning some intervention activities with staff to online; completing verbal consent with proxies versus face to face; adjusting follow up MotionWatch 8 deliveries and placements to be done without face to face interaction; and adjusting recruitment time periods and intervention activities to fit with intermittently high periods of COVID-19. This symposium will describe intervention challenges, solutions and lessons learned, describe an effective process and measurement model for identification of participants with dementia; and provide optimal ways to measure pain and physical activity among older adults with dementia.
MEASUREMENT CHALLENGES AND SOLUTIONS WHEN EVALUATING PHYSICAL ACTIVITY AMONG HOSPITALIZED PATIENTS WITH DEMENTIA
Authors: Drazich Brittany
Published: December 2022

Obtaining subjective reports of physical activity from individuals is known to be biased. With increased creation, dissemination, and use of technology, approaches for objective measurement have improved. Although actigraphy is increasingly used, challenges include a lack of clearly established cut off levels for vigorous, moderate, and low level activity in older individuals, decreased arm movement with walking, and the impact of comorbidities (e.g., Parkinson’s Disease) on actigraphy readings. The advantages of the MotionWatch 8 over other devices will be discussed and our protocol for use shared. The findings from the first 200 participants will be described and challenges to interpretation addressed. The majority of the study participants were willing to wear the MotionWatch 8 during hospitalization. Using innovative approaches to avoid direct patient contact due to concerns related to COVID-19, follow up activity was obtained at 1 month post discharge. Lastly, recommendations for interpretation of findings will be provided.
HOME HEALTHCARE ACCESS AND UTILIZATION AMONG VULNERABLE POPULATIONS IN THE US AND PUERTO RICO
Authors: Rivera-Hernandez Maricruz
Published: December 2022

Home health (HH) care utilization among Medicare beneficiaries has exploded, serving over 3.3 million users (The Medicare Payment Advisory Commission, 2021). With the aging of the population and the preference for Home- and Community-Based Services and/or person-centered care delivered in the home, HH care use is expected to continue increasing. Prior research has highlighted inequitable access and use of HH rooted in structural and social determinants of health (Fashaw-Walters et al., 2022). However, more research is needed about disparities in timely access to quality of care and outcomes among racial and ethnic and rural populations. Furthermore, the literature regarding post-acute care has often excluded Puerto Rico HH beneficiaries (Rivera-Hernandez et al., 2020). Given the need to ensure equity of care post-pandemic, there is a pressing need to understand disparities in care and outcomes, specifically using representative data. This symposium will feature four presentations that provide novel insight regarding HH care utilization and outcomes among vulnerable populations. Individual presentations will describe 1) Home health care services utilization among Medicare beneficiaries in Puerto Rico; 2) Public reporting role in exacerbating disparities in access; 3) Differences in home healthcare latency following hospitalization for ADRD patients by race/ethnicity and rural and urban locations; 4) Racial disparity in the start of home healthcare in high-risk ADRD patients by the quality of home health and impact on rehospitalization. In addition, studies in this panel will discuss policy and clinical implications, as well as directions for future research regarding equitable access and health outcomes among HH users.
RACE AND RURAL-URBAN DIFFERENCES IN HOME HEALTHCARE LATENCY IN PATIENTS WITH DEMENTIA
Authors: Kumar Amit
Published: December 2022

Given the need to ensure equity of timely access to post-acute care among minority groups in rural areas, there is a pressing need to understand disparities in the start of home healthcare among minorities with Alzheimer's disease and Related Dementia (ADRD). This study investigates differences in the timing of initiation of home healthcare services following acute hospitalization for ADRD patients by race/ethnicity and rural and urban locations. A secondary analysis was conducted among older adults with ADRD using Medicare data, discharged to home following an episode of acute hospitalization in 2016-2017. The study outcome was a delay in the start of home healthcare after two days of hospital discharge, defined as a home health latency. Compared to non-Hispanic Whites residing in urban areas, Blacks living in urban areas and Hispanics living in rural areas have a significantly higher odd of home health latency 1.15 (95%CI;1.11-1.18) and 1.06 (95%CI;1.02-1.10), respectively.
INNOVATIONS IN REMOTE SUPPORT FOR DEMENTIA FAMILY CAREGIVERS
Authors: Meyer Kylie , Miller Lyndsey , Kaye Jeffrey
Published: December 2022

Remote delivery of dementia caregiver interventions can decrease delivery costs, and make it more feasible to provide evidence-based interventions to caregivers across the country. As the science behind remote delivery develops, new technologies and their applications can ensure preservation of important intervention components and principles, as well as novel forms of data collection. In this symposium, investigators will present on studies that demonstrate how technology can be used to improve delivery and assessment of remote caregiver interventions. Walter Dawson, D.Phil, will share findings from the Support via Technology: Living and Learning with Advancing Alzheimer’s disease and related dementia (STELLA) intervention. Using secondary data collected via weekly survey, he examined the association between costs of care and behavioral symptoms of dementia. Next, Allison Gibson, PhD, MSW, will present results from focus groups about caregivers’ experiences of the Harmony at HOME (H@H), a telehealth intervention to improve person-environment fit and limit behavioral symptoms of dementia. Kylie Meyer, PhD, will present results from the Learning Skills Together intervention, which uses teleconferencing to teach family caregivers how to provide complex care tasks while adhering to self-efficacy theory. Lastly, Shirin Hiatt, MPH, MS, RN, will present findings from the REmote Assessment and Dynamic Response (READyR) study, which tests the application of remote monitoring technology to assess adherence to value-based care (e.g., autonomy) among spousal family care partners. Each study was supported by the Emory University Roybal Center for Dementia Caregiving Mastery or Oregon Roybal Center for Care Support Translational Research Advantaged by Integrating Technology.
ASSOCIATION OF PLASMA LIPID METABOLITES WITH ANKLE-BRACHIAL INDEX IN THE LONG LIFE FAMILY STUDY
Authors: Kuipers Allison , Cvejkus Ryan , Thyagarajan Bharat , Patti Gary , Feitosa Mary , Mengel-From Jonas , Barinas-Mitchell Emma , Zmuda Joseph
Published: December 2022

We tested the association of lipid metabolites with ankle-brachial index (ABI) in the LLFS. Minimum ABI from doppler was used. Participants underwent phlebotomy after >8 hours fasting. Plasma metabolites were isolated via solid phase extraction. Lipid metabolites (N=193) were measured using RPLC-MS and corrected for batch effects in 948 participants. We used linear mixed models adjusted for age, sex, site, fasting, and relatedness. Twenty metabolites were associated with ABI (FDR P<0.05), of which 17/20 were triacyclglycerol (TAG) species, plus cholesterol ester (22:6), phosphatidylcholine (35:7), and phosphatidylethanolamine (38:7). After additional adjustment for traditional ABI risk factors, only two TAGs (50:1, 42:0) were significantly associated after multiple testing correction. While not significant in the base model, the metabolite lysophosphatidylcholine (18:3) demonstrated a marginally significant protective association after full adjustment (P=0.014). While triglycerides are known correlates of atherosclerotic deposition, these findings may identify novel metabolic correlates of peripheral vascular health in long-lived individuals.
REFRAME, REFORM, AND TRANSFORM: POLICY APPROACHES TO IMPROVE NURSING HOME QUALITY IN THE UNITED STATES
Authors: Perone Angela
Published: December 2022

Nursing homes (NHs) are one of the most heavily regulated industries in the United States. However, concerns about quality of care remain, especially for more vulnerable residents, including those with dementia. Concerns only increased during recent natural disasters and the COVID-19 pandemic. Community and industry advocates have suggested diverse reforms that prompted new federal policies. This study poses the following research questions: (1) How do federal policies compare with proposals by community (staff and patient advocates) and industry (NH) advocates to improve quality of care in NHs before and during the pandemic; and (2) How do federal policies address micro, mezzo, and macro level issues? To address these questions, this study employs a multi-level comparison case study design. Primary data includes systematically collected and analyzed federal bills, CMS regulations, and community and industry reports, press releases, and website data from 2018 through 2022. Findings revealed that policy proposals fell into three categories: reframe, reform, and transform. Reframe approaches included minimal transformation at the micro-level. Reform approaches involved more mezzo and macro-level changes. Transform approaches proposed significant structural changes at the macro-level. Community advocates presented far more transformative changes than industry advocates and federal policymakers. Federal policies focused on reframe and reform solutions at the micro level and rarely proposed transforming macro-level structures (e.g., workforce structural inequities). This study has important implications for research, policy, and practice by exposing limitations and strengths of proposed solutions for addressing resident care and concludes with suggestions for better aligning with community advocates.