bluuebunny/crossref_metadata_2025 huggingface dataset:
Do Family Caregivers of Dementia Patients Feel Competent in Pain Management?
Authors: Zhao Hui , Kulbok Pamela , Williams Ishan , Manning Carol , Romo Rafael
Published: December 2021

Older adults with dementia rely on others to recognize and treat their pain and will ultimately become dependent. Family caregivers (FCGs) play a crucial role in pain management, yet limited data is available regarding the factors that impact their abilities. This qualitative descriptive study sought a deep understanding of FCGs perception of their abilities to manage pain for a loved-one with dementia. A sample of 25 adult family caregivers of community-based older adults with dementia was recruited in central Virginia. Participants were 29 to 95 years old, predominantly white, married, female, and high school graduates. We conducted semi-structured interviews that were audio recorded and analyzed using constant comparative analysis. Participants’ who perceived greater competence with pain management reported less pain for their loved-one, and their level of confidence was influenced by 3 factors: progress and stage of dementia: this increases the complexity of care, affecting FCGs ability to manage pain and engendering a self-perception of incompetence; developing adaptive mechanisms: built self-efficacy and improved FCGs perceived competence;, and support from professionals: a greater degree of support alleviated FCGs concerns and instill new skills, Effective pain management depended on family caregivers’ belief in their own abilities, and perceived competence could be improved by learning new skills or making adaptations. Professional care givers need to routinely assess FCGs abilities and provide adequate interventions.
Effects of Non-pharmacological Interventions on Elderly in Nursing Homes with Sleep disorder: A Meta-Analysis
Authors: Jung Sunok , Choi Eunju , Kim Hyeyoung
Published: December 2021

Purpose: This study aimed to examine the effects of nonpharmacological sleep intervention programs to improve sleep quality among the elderly in long-term care facilities. Methods: A literature search and selection was performed on nine different databases using the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement. In total, 14 studies met the inclusion criteria and were systematically reviewed. For the meta-analysis, the effect size was estimated using the random-effects model on Review Manager (RevMan) desktop version 5.4 of the Cochrane Library. Result: The meta-analysis of nonpharmacological interventions obtained a total effect size of 1.0 (standardized mean difference [SMD] = 1.0, 95% confidence interval [CI]: 0.64–1.35), which was statistically significant (Z = 5.55, p < .001). The most frequent nonpharmacological interventions identified were the interventions using aroma; the effect size was 0.61 (SMD = 0.61, 95% CI: 0.14–1.08), which was statistically significant (Z = 2.55, p = .01). In subgroup analysis, group-specific interventions, interventions for >4 weeks, and untreated control studies were more effective. Conclusion: This study confirms that nonpharmacological interventions are effective in improving sleep quality among the elderly in long-term care facilities. However, the small sample size and risk of bias in assessing the interventions of individual studies are unclear or high, thereby limiting the generalizability of the results. Further studies based on randomized control trials and the development of evidence-based interventions that consider the elderly participants’ physical activity levels, intervention methods and duration, and control group selection are needed to obtain more conclusive evidence.
Engaging Underrepresented Older Adults in ADRD and Aging Research: A Scoping Review
Authors: Godbole Nisha , Beasley Jeannette , Kwon Simona , Roberts Timothy , Kranick Julie , Sherman Scott , Trinh-Shevrin Chau , Chodosh Joshua
Published: December 2021

The rapidly aging and diversifying U.S. population coincides with increases in prevalence of Alzheimer’s disease and related dementias (ADRD) and other aging-related disorders. Unfortunately, older adults and racial and ethnic minorities are often underrepresented in research studies. The differing barriers that underrepresented older adults face in research engagement indicate that results from studies conducted on younger and majority populations may not maintain external validity outside of those groups. Therefore, efforts to engage diverse older adults in research is imperative. The goal of this scoping review was to summarize findings of the current state of National Institute on Aging (NIA) sponsored research, identifying extant literature on engaging diverse older adult populations in aging and ADRD research. Among 566 articles screened for inclusion, 436 were included in the final analysis. Results showed that African Americans were represented in over half the studies (63.5%), but Native Hawaiian/Pacific Islander and American Indian or Alaska Native populations were not well represented. Community- and convenience-based recruitment and retention strategies that have demonstrated prior success in research engagement were widely utilized. Racial, ethnic, and income status breakdowns were not included in 30.0%, 57.1%, and 53.4% of studies respectively, making it difficult to assess the applicability of findings for particular groups. Inclusion of Alzheimer’s disease patients or those with mild cognitive impairments was also poorly defined in most studies. Findings highlight gaps in existing literature that can be used to inform future research, and recruitment and retention strategies for engaging racial and ethnic minority older adults in research.
Factors Influencing Implementation of eHealth Technologies to Support Informal Dementia Care: An Umbrella Review
Authors: Bastoni Sofia , Wrede Christian , da SIlva Marcia C , Sanderman Robbert , Gaggioli Andrea , Braakman-Jansen Annemarie , van Gemert-Pijnen Lisette
Published: December 2021

The increase of People with Dementia (PwD) living at home underscores the need for innovative eHealth technologies that support both patients and informal caregivers (IC). Sustainable implementation of eHealth technologies within this target group can, however, be difficult. Our study aims at providing an overview of (1) technologies employed in the context of informal dementia care (IDC) and (2) factors influencing the implementation of these technologies. Five databases were searched for (systematic) reviews. 21 reviews were included. A combination of deductive and inductive thematic analysis was performed, using the NASSS Framework to organize the findings. We identified technologies used “by IC”, “by PwD” and “with PwD”. Most represented technologies included: (i) devices for in-home monitoring (ii) technologies for supporting memory, orientation, and day structure, and (iii) communication technologies. Most factors influencing implementation related to the condition of dementia, characteristics of the technology, the expected/perceived value by users, and the characteristics of the IC. Considerably less has been reported on factors related to the implementing organization, the technology supplier, the wider institutional and sociocultural context of policy and regulations, and the adaptation of technology over time. Our study 1) created a comprehensive overview of eHealth technologies employed in the context of IDC and contributes to a better understanding of factors influencing their implementation, and 2) uncovered a knowledge gap regarding success factors for implementation related to the wider context. Although future research is needed, these findings can help researchers improving the development and implementation of eHealth technologies to support IDC.
Family Caregiving in the Somali-American Community During COVID-19
Authors: Moone Rajean , Suleiman Kamal , Lightfoot Elizabeth
Published: December 2021

This poster describes a study of Somali American family caregiving during the COVID-19 pandemic, specifically investing the unique caregiving challenges faced by Somali caregivers. The findings from this study, which was part of a larger study related to family caregiving, were drawn from in-depth interviews of ten Somali family caregivers in Minnesota. All interviews were conducted in Somali during the summer of 2020 and translated and transcribed by a certified translator and research assistant. The major themes that emerged from this study related to Visitation, Hospital Accompaniment, and Self Sacrifice. As Somali culture is centered around extended family connections, isolation places particular strain. Second, family members typically serve as advocates, translators and guides during hospital visits. The restrictions on hospital accompaniment due to COVID-19 caused increased stress and poorer care of family caregivers and their loved ones. Third, in the Somali community, family placement is a last resort. Caregivers reported great sacrifices in time, comfort and opportunities to care for family members during COVID-19. Most of the caregivers described their coping with these sacrifices in terms of radical acceptance and God consciousness. These findings have important implications for providing supports for Somali family caregivers.
Health and Financial Risk-Taking Propensity During the COVID-19 Pandemic: Differences by Age and Time
Authors: Sevi Barış , Shook Natalie
Published: December 2021

The COVID-19 pandemic has presented a global health threat of unprecedented magnitude and had a devastating impact on the world’s economy. Accordingly, the riskiness of decisions related to health and finance may have increased. However, health and financial threats have differentially affected different age groups. For example, COVID-19 posed a greater health threat to older adults (65+ years) than younger or middle-aged adults, whereas financial threat due to the pandemic affected younger and middle-aged adults more than older adults. This study examined differences in the levels of health and financial risk-taking propensity by time of the pandemic and age group: young (18-39 years), middle-aged (40-64 years), and older adults (65+ years). A sample of 488 individuals residing in the US (245 Woman; Mage = 51.07, SD = 15.99) completed three waves of surveys in March, April, and May 2020. We found that risk-taking propensity for both health and financial decisions decreased over time. The risk-taking propensity was significantly lower in April and May than March, but risk-taking propensity in April and May did not significantly differ. The three age groups were all significantly different than each other in both health and financial risk-taking propensity at all three waves. Younger adults reported higher risk-taking propensity than older and middle-aged adults, and middle-aged adults reported higher risk-taking propensity than older adults. The findings indicate that the pandemic may have influenced all individuals to take less risks in the fields of health and finance regardless of their age.
Impact of iN2L Tablets on Loneliness and Well-Being: Findings of an Innovative Industry-AAA Program
Authors: Nguyen Lydia , O'Hern Karen , Siak Adam , Stoglin Kristi , Mather-Tayor Charlotte
Published: December 2021

Area Agency on Aging (AAA) senior and adult day centers closed due to COVID-19, causing many older adults to lose an important source of connection and engagement, leading to social isolation. To combat negative consequences, iN2L and a Florida AAA partnered on an innovative program providing iN2L tablets to AAA-supported older adults to use at home. The tablets have a simple interface, content specifically designed for older adults (e.g., games; music; movies), and video call capability. Participants included 51 independent older adults (mean age 77) and 39 family caregivers (mean age 59) of people with dementia. Participants completed phone surveys with AAA case managers at baseline and 3 months, including UCLA Loneliness Scale (3 item) and questions about their tablet experiences. Findings show positive trends for loneliness and well-being in both groups. At 3 months, lonely participants decreased from baseline by 25% for independent older adults and 18% for family caregivers. Over 80% of independent older adults agreed the tablet engages them in meaningful activities, provides daily enjoyment, and helps with relaxation. For family caregivers, 79% agreed the tablet is another tool in their caregiver toolkit and about 70% agreed the tablet adds daily enjoyment, helps with relaxation, and provides engagement in meaningful activities for their family member. Approximately 50% of caregivers felt happier, less stressed, and less irritable since using the tablets. This work has implications for the utility of technology in promoting engagement and connection, alleviating negative effects of social isolation, and the effectiveness of industry-AAA partnerships.
Interventions Adopting Body-Mind-Spirit Model to Improve the Holistic Health of Older Adults: A Systematic Review
Authors: Hu Xinyue , Li Tongtong , Chi Iris
Published: December 2021

This systematic review aims to summarize 5 key information from non-pharmaceutical intervention studies which adopt Body-Mind-Spirit (BMS) model for older adults: (1) definition of BMS, (2) types and formats of the interventions, (3) background and BMS training of the interventionists, (4) activities included in the interventions, and (5) effect of these interventions on the holistic health of older adults. We conducted a systematic search of 9 databases (ProQuest, Web of Science, PsycINFO, PubMed, Cochrane, Wanfang, AIRITI, CADAL, CNKI) for studies published in English or Chinese through May 31, 2021. Inclusion criteria were: (1) Must be empirical studies; (2) Participants must be aged 55 and above; and (3) Must adopt the BMS model or contain BMS in full-text. We found 15 studies (7 RCTs, 1 cluster randomized trial, 3 mixed-method studies, and 4 qualitative studies). Ten studies (66.67%) adopted Chan’s BMS model. Thirteen studies (86.67%) adopted in-person group interventions. Only five studies (33.33%) provided BMS training to the interventionists. Six articles (40%) categorized the activities as body-, mind- or spirituality-related. Ten studies (66.67%) reported effectiveness in all 3 dimensions of BMS. Of the 7 RCTs, 5 were rated as medium-quality, and 2 were rated as low-quality according to the Cochrane’s Risk of Bias tool. Most interventions based on the BMS model claimed to be effective in improving the holistic health of older adults. In order to improve the internal validity, future RCT studies should be more prudent about the randomization process and adhere to the BMS model when designing the interventions.
Reflection Leading to Action on Diversity, Equity, and Inclusion at the Virginia GWEP
Authors: Alexander Chuck , Slattum Patricia , Williams Ishan , Waters Leland
Published: December 2021

Last year’s Black Lives Matter protests inspired the Virginia Geriatric Education Center (VGEC) GWEP’s plenary to engage in reflection and discussion on diversity, equity, and inclusion (DEI) in our work together. During each bi-monthly meeting, we dedicate time to generate ideas to improve our programming, how we work together, and how we partner and recruit for our programs. Champions for DEI on our plenary led an effort to develop a DEI newsletter clarifying DEI concepts and introducing resources thematically related to the monthly VGEC faculty development program curriculum. By incorporating these resources into our monthly curriculum, facilitators have a new access point to incorporate content on health equity and policy into our curriculum. The intentional focus on DEI is opening the door to deeper reflection and conversation with a goal of improving all our programming, cultivating a new social awareness, and bringing new voices and perspectives to the table.
Leveraging Medical Claims to Predict Long-term Care Transitions among Older Adults in the United States
Authors: Backhaus Megan , Jhuang An-Ting , Griffith Ben , Bangerter Lauren
Published: December 2021

Most older adults prefer to age in place rather than moving to a long-term care (LTC) facility, but little is known about the factors that predict entry into LTC. This study sought to utilize administrative claims data to understand the predictors of LTC transitions using de-identified claims data from Medicare Advantage members in the UnitedHealth Group Clinical Discovery Database. We investigated LTC transitions of 250,587 adults (Mean age = 77, standard deviation = 7.75) between January 1, 2016 and December 31, 2019. Types of predictors for these transitions include aggregated medical data surrounding chronic conditions and frailty indices, as well as healthcare utilization and demographics in 2016 and 2017. We then fit data of these types to an extreme gradient boosting (XGBoost) model to predict long-term care transitions in 2018 and 2019 (ROCAUC = 0.84, accuracy = 0.84, precision = 0.68, and recall = 0.42). Frailty indicators, such as falls and fractures, mobility problems, dementia, and delirium, as well as osteoporosis are strong predictors of LTC transitions. These findings can be used to design interventions aimed at preventing LTC transitions and enabling older adults to age in place.
Motivation to Learn and Multilingualism across the Adult Life Stages in the U.S.
Authors: Sahoo Shalini , Yamashita Takashi , Millar Roberto , Cummins Phyllis
Published: December 2021

Lifelong learning or continuing education over the life course has become necessary to navigate a rapidly changing technological landscape. Motivation to learn (MtL) is essential for facilitating lifelong learning. In the U.S., most of the educational opportunities are available in English. Moreover, little is known about associations between being multilingual and MtL across the life stages. This study analyzed nationally representative data from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) restricted use file (RUF). Using a previously established latent MtL construct, structural equation models were estimated by four age groups --- 25-34 (n = 2,310); 35-44 (n = 1,610); 45-54 (n = 1,670); and 55 and older (n = 2,620). Results showed that being multilingual was associated with greater MtL among younger age groups, including age 25-34 (b = 0.20, p = 0.01) and 35-44 (b = 0.28, p < 0.001), after adjusting for the demographic, socioeconomic and health characteristics of individuals. Multilingualism was not associated with MtL among older age groups, including 45-54 (b = 0.06, p = 0.50) and 55 and older (b = 0.13, p = 0.19). Findings suggest that education policies that target younger multilingual adults are likely to be effective while enhancing MtL of monolingual (i.e., English-speaking only) adults seems to be a necessary first step. Yet, a similar approach may not be effective for older adults, arguably due to more diverse life circumstances, educational needs, and learning style preferences. More detailed interpretations of empirical results and theoretical explanations are needed.
Motivations and Experiences of Older Adult Volunteers in a Telehealth Nursing Simulation Activity
Authors: Crittenden Jennifer , Thompson Kayla
Published: December 2021

The COVID-19 pandemic has posed challenges to safely engaging older adults in volunteer activities. This research explored a unique partnership between a Retired Senior and Volunteer Program (RSVP) and a school of nursing to administer a telehealth virtual simulation training for nurse practitioner students. Semi-structured interviews were carried out with nursing simulation coordinators and volunteers after the telehealth simulation exercise. The purpose of this research was to identify principles of successful virtual volunteer engagement for telehealth simulations. This initial pilot study encompassed debriefing interviews with volunteers (N = 3) and interviews with simulation coordinators (N = 2). Three major themes emerged within the response coding: 1) the benefits of virtual simulation volunteering, 2) technology as a facilitating factor and challenge, and 3) unique volunteer management considerations. Both volunteers and coordinators noted that volunteers derived positive emotional benefits and new insights from their participation. Coordinators discussed the “authenticity” factor that older adults brought to the simulation experience as a benefit to engaging older adult volunteers. Technology sub-themes included accessibility considerations, experience with the online format, and other logistical considerations in conducting telehealth simulation. Volunteer management sub-themes encompassed volunteer skills and motivations, the perceived successful aspects of training, and improvements for future simulations. Volunteers discussed an interest and connection to healthcare and education as a motivating factor for their participation in the telehealth simulation. This small scale pilot research will be expanded through future simulation activities to continue to identify principles of practice for engaging older adults in virtual volunteerism.
Older Adults Place Greater Importance on a Purposeful Retirement
Authors: Best Rachel , Pfund Gabrielle , Cardador M Teresa , Strecher Victor , Hill Patrick
Published: December 2021

Sense of purpose is associated with desirable health and well-being measures in older adults. Unfortunately, existing research points to complexity in the connection between purpose and retirement: some but not all people decline in sense of purpose following retirement, and some view it as nonessential to maintain a purpose specifically during retirement. These findings suggest there may be individual differences both in the importance placed on being purposeful specifically during retirement, and that there may be a discrepancy in purpose importance before retirement and during retirement. In this study, we examined whether perceived purpose importance correlates with age and personality, as well as working status. Data were collected from a U.S sample (N = 2,009), aged18-93 (M =48.51). Participants completed a survey assessing the Big Five personality traits and were asked to rate the importance of purpose before and after retirement. Findings suggest that, overall, people believe it wasrbe important to have a purpose and direction during retirement (M = 3.86). Perceived purpose importance during retirement was greater among older, conscientious, and less neurotic adults, but working status did not appear to play a role. Moreover, when comparing perceptions of purpose importance before and during retirement, age was the distinguishing factor differentiating who perceives during-retirement purpose as more important than before-retirement purpose, such that older adults placed greater importance on sense of purpose during retirement. Results indicate that older adults do value having a purpose during retirement, suggesting that purpose-focused interventions may be well-received by this population.
Paid Care Services and Transitioning Out of the Community among Diverse Older Adults with Dementia
Authors: Roche-Dean Maria , Baik Sol , Moon Heehyul , Coe Norma , Oh Anna , Zahodne Laura
Published: December 2021

Objectives: Paid care provided in the home or through community organizations includes important support services for older adults with dementia such as cleaning and personal care assistance. These services could delay the transition to long-term care, but access may differ across sociodemographic groups. This study examined the relationship between paid care and transitioning out of the community among diverse older adults with dementia. Methods: Using data from 303 participants (29.4% Black) with probable dementia in the National Health and Aging Trends Study (2011-2019), subdistribution hazard models estimated the association between receiving paid care at baseline and the probability of transitioning out of the community over the next eight years. Covariate selection was guided by the Andersen model of healthcare utilization. Results: Paid care was associated with lower risk of transitioning out of the community (SHR = 0.70, 95% CI [0.50, 0.98]). This effect was similar after controlling for predisposing factors and most prominent after controlling for enabling and need for services factors (SHR = 0.63, 95% CI [0.42, 0.94]) and was only evident among Whites. There were no racial differences in the use of paid care, but Black participants were less likely to transition out of the community than Whites despite evidencing greater care needs. Discussion: Paid care services may help delay transitions out of the community. Future research should seek to explain racial differences in access to and/or preferences for home-based, community-based, and residential care.
Respite Service Use among Dementia and Nondementia Caregivers: Findings from the Caregiving in the U.S. 2015 Survey
Authors: Lee Yura , Choi Wonchan , Park Min Sook
Published: December 2021

Caring for persons with dementia places a significant physical, emotional, and financial burden on caregivers. Although dementia caregivers may be exposed to more challenging caregiving environment than caregivers of those with other chronic conditions, little is known about how specific factors related to respite service use differ between dementia and nondementia caregivers. Thus, this study first examined factors related to respite service use among caregivers and further tested the moderating effect of dementia caregiver status in these relationships using nationally representative U.S. data. Logistic regression analyses were conducted among 1,203 caregivers (276 dementia and 927 nondementia caregivers) from the national Caregiving in the U.S. 2015 data. Caregivers’ race and ethnicity as a predisposing factor, caregivers’ self-rated health as an enabling factor, and care recipients’ living arrangement and functional limitations as need factors were significantly related to respite service use among caregivers. Moreover, dementia caregiver status moderated the association between enabling factors (i.e., household income, work status, and self-rated health) and respite service use. Our findings imply that dementia caregivers may be more in need of respite service use than nondementia caregivers when they have limited enabling factors (e.g., lower household income, nonworking status, poorer health). Policy and practice efforts that specifically support enabling factors are suggested to promote more respite service use among dementia caregivers.
Social Connectedness, Meals on Wheels Services and Healthcare Utilization Among High-Need Older Adults
Authors: Walsh Sarah , Chubinski Jennifer , Weaver France
Published: December 2021

Homebound vulnerable adults 65+ are at an increased risk for social isolation and loneliness. The adverse consequences of loneliness are profound – including increased health care utilization, burden of dementia, chronic diseases, and mortality. Meals on Wheels (MOW) is a familiar source of nutritional support for homebound individuals who wish to stay in their homes and has additional important benefits. A growing body of evidence demonstrates that MOW provides mental and social health benefits beyond nutrition, but less is known about the interplay between MOW, social cohesion, and health services use. This project will address this gap in the literature using data from the 2013-2020 National Health and Aging Trends Study (NHATS), a nationally-representative panel study of 65+ Medicare enrollees. Using matching and longitudinal multivariate techniques, the risks of hospitalization and permanent nursing home entry are compared between MOW users and non-users. Our longitudinal dataset includes 11,266 observations. Of those, 12.8% rely on MOW or other food assistance (N= 1,488) and 16.6% experience low social cohesion (N= 1,936). Some 6.6% of participants are nursing home residents (N= 748) and the 39.1% report an overnight hospital stay in the prior year (N= 4,560). MOW is a comparatively low-cost intervention to help homebound older adults retain their independence and limit costlier healthcare utilization. This work extends our understanding of MOW services beyond simple nutrition benefits to its potential impact on social health.
The (Un)Willingness to Keep Living at Very Advanced Ages
Authors: Ribeiro Oscar , Araujo Lia , Teixeira Laetitia , Afonso Rosa Marina
Published: December 2021

A long life is a general desire that will be reached by more and more people, particularly in developed countries. But the delay of mortality raises important questions about quality of life in the later years. Centenarians have received attention from different disciplines, particularly from demography and genetics, but a psychological approach on whether life at age 100 is perceived as worth living is still very limited. This study explores centenarians’ will to live and associated factors in a sample of 121 centenarians (mean age 101 years; SD 1.63 years; 84.3% female), who answered to a questionnaire comprising sociodemographic characteristics, health status, social functioning, and well-being as well as open questions on their will to live and end-of-life issues. Of the total sample, 31.4% expressed willingness to live longer, 30.6% did not, and 38% presented no clear positioning. From the qualitative thematic analysis, annoyance, uselessness, loss of meaning, disconnection, and loneliness were the most common justifications for being reluctant to live longer. Positive valuation of life and good self-rated health, followed by having a confidant and reduced pain frequency, were the reasons for being willing to live longer. From the quantitative analysis, associated factors of will to live include pain frequency, self-rated health, having a friend confidant and valuation of life. This study provides researchers suggestions for further investigation and highlight the importance of inquiring and understanding very old people’s values and views on their will to live, future wishes, and meaning in life.
The Financial and Operational Effects of COVID-19 on Ohio’s Long-Term Care Residential Settings
Authors: Kennedy Katherine , Applebaum Robert , Brod Kathryn
Published: December 2021

The COVID-19 pandemic has had a drastic impact on Ohio’s long-term care facilities. Yet, months into the crisis, the financial ramifications and workforce shortage were unknown. In partnership with the Scripps Gerontology Center at Miami University, LeadingAge Ohio and the Ohio Health Care Association developed an online survey that was launched in July 2021. Response rates were 46.4% for skilled nursing facilities (SNFs; N=446) and 35.8% for residential care facilities (RCFs; N=287). Core questions compared the first quarters of 2020 and 2021. Declines in operating revenues (-11.7% SNFs; -10% RCFs) and rising labor costs per patient day (17.9% SNFs; 16.1% RCFs) contributed to most providers experiencing a financial loss in the most recent month (78% SNFs; 66% RCFs). The increased documented use of agency staff is an important finding of this work; 62% of SNFs and 34% of RCFs spent money on agency staff. Despite increases in starting wages, the labor crisis remains severe. As of July 2021, SNFs had an average of 19.51 open positions, of which 9.82 were for state-tested nurse aides and 5.65 were for nurses. RCFs had an average of 8.83 open positions, of which 4.24 were for resident care assistants and 1.89 were for nurses. The challenges faced by the long-term care industry have rightly focused on the deleterious impacts of COVID on residents and staff. But these data also suggest that the financial impacts on the industry are serious and will likely shape access and provision of care in the future.
Antipsychotic and Psychopharmacological Medications: Care Transitions Among Nursing Home Residents
Authors: Holmes Sarah , Kuzucan Aida , Olopoenia Abisola , Brandt Nicole , Briesacher Becky , Qato Danya , Zarowitz Barbara , Wastila Linda
Published: December 2021

Nursing home residents are frequently prescribed antipsychotic and other psychopharmacologic medications (AP/PPM) to manage behavioral and psychological symptoms. Residents also experience care transitions between nursing homes and other healthcare institutions. Limited research exists on the relationship between AP/PPM use and care transitions in this population. The purpose of this study is to compare odds of care transitions among those with and without AP/PPM use, controlling for resident characteristics. This cross-sectional study used data from a 5% random sample of Medicare beneficiaries between 2011-2015 who resided in a nursing home and were continuously enrolled in Medicare Parts A, B, and D. Chi-square tests compared resident characteristics and AP/PPM use between those with <2 and ≥2 transitions. Multivariate logistic regression evaluated the odds of transitions in those with and without AP/PPM use during a one-year follow-up, including interaction effects among AP and PPM use. Among 132,263 eligible residents, the majority were female(68%), white(85%), and >75 years old(63%). Of residents who experienced ≥2 transitions, 17% received AP and 82% received PPM, compared to those with <2 transitions for which 9% and 66% received AP/PPM, respectively (p<.001). Logistic results showed that for residents with PPM use, those who take AP have 1.33 the odds of experiencing ≥2 transitions than PPM users who do not take AP (p<.001). Findings demonstrate a significant association between AP/PPM use and care transitions in nursing home residents. Prudent use of AP/PPM should thus be optimized with a goal of reducing care transitions and improving quality of care.
Acetylation of Tau Induces Alzheimer's Disease-Associated Tau in Transgenic Mice
Authors: Ali Addison , Pareja Kristeen , Tracy Tara
Published: December 2021

Alzheimer’s disease (AD) is a neurodegenerative disorder that is characterized by neurofibrillary tangles (NFTs) and amyloid beta plaques. These NFTs are made up of aggregated tau proteins. Tau is involved in stabilizing microtubules and does not usually display aggregation. Acetylation of tau protein causes an increase in tau aggregation but its role in AD progression is still not well understood. I hypothesized that enhanced acetylated tau results in an increase in AD-like tau pathology. To test this, a murine prion promoter-tauKQ transgene was injected into the mouse fertilized oocyte. The tauKQ mutation alters lysine to glutamine to mimic acetylation of tau. Nontransgenic mice were used as controls. AT8 and GT-38 antibodies were used in immunohistochemistry (IHC) to target phosphorylated tau and AD-associated tau, respectively. GT-38 is conformation-dependent and requires 3R and 4R tau isoforms which makes it specific to AD. Through immunofluorescence, increased phosphorylated tau was observed in the hippocampus of the tauKQ mice compared to the nontransgenic mice. I focused on the dentate gyrus, CA1 region, and the mossy fibers of the CA3 region since they are involved in many memory processes. Through chromogenic IHC, the tauKQ mice exhibited more 3R+4R tau isoform pathology in the mossy fibers than the nontransgenic mice. This data suggests that an acetylation mimic is sufficient to stimulate an abundance of AD-related tau pathology in transgenic mice which is consistent with my hypothesis. The tauKQ mouse model can assist in understanding the role of tau acetylation and tau progression for AD.
Assessing Cardiometabolic Health Risk in Children Living With Grandparent Primary Caregivers: Interim Analysis
Authors: Song MinKyoung , Hayman Laura , Lyons Karen , Bessette Hannah , Davis Mary Roberts , Winters-Stone Kerri , Musil Carol
Published: December 2021

Minimal research has been conducted on the effect that grandparents as primary caregivers have on the cardiometabolic health of children who live with them, even though a number of studies have examined the influence of parent caregivers. As a first step towards filling that gap, we examined physiological and behavioral indicators of cardiometabolic health risk among children (aged 7 to 12 years) living with grandparent primary caregivers in Oregon and Washington. We measured body mass index and total cholesterol/glycohemoglobin (HbA1c), as well as physical activity/sleep and diet. In this preliminary analysis of our findings with 10 dyads (mean age 64.2 ± 4.0 years for grandparents; 9.3 ± 1.9 years for grandchildren), we report that on most of the indicators - obesity, physical activity, sleep, and diet - these children’s levels were comparable to national averages across all household types (not differentiated by type of family structure). However, 25% of the grandchildren (n=2) participating in our study had a total cholesterol level ≥ 200, compared to 7.4% of children from a nationally representative dataset. Similarly, 14% of the grandchildren (n=1) participating in our study had HbA1c ≥ 6.5%, compared to < 0.5% of children from a nationally representative dataset. Our findings suggest that these children may be at higher cardiometabolic health risk (e.g., hyperlipidemia). Further investigations with a larger sample and more examination of cardiometabolic risk profiles including lipids/blood glucose assessment are required to validate our preliminary findings.
Associations Between HIV Stigma and Mental Health Among Older Hispanics and Whites Living With HIV
Authors: Karcher Kayle , Kamalyan Lily , Gonzalez Veronica , Brody Lilla , Heaton Robert , Moore Raeanne , Jeste Dilip , Marquine Maria
Published: December 2021

Hispanics/Latinos/as/x (henceforth Hispanics) have higher rates of HIV infection than non-Hispanic (NH) Whites, particularly in older age. People living with HIV (PWH) are at increased risk of stigma and poor mental health, but these associations have not been thoroughly examined in older PWH. We investigated ethnic differences in HIV stigma and its association with mental health in older Hispanic and NH White PWH. Participants included 116 PWH ages 50-75 (58 Hispanic and 58 NH White) from southern California (for the overall cohort: 82.7% male; 57.7% AIDS, 93.9% on antiretroviral therapy). Participants completed self-report measures of HIV-stigma, depression (Beck Depression Inventory-II; BDI-II), and cumulative alcohol use (i.e., lifetime total quantity/total days). Covariates examined included sociodemographic and HIV-disease characteristics. An independent sample t-test showed no significant ethnic differences in HIV stigma (p=.82). Separate multivariable linear regression models on mental health outcomes (adjusting for significant covariates) showed no significant interaction between HIV stigma and ethnicity on BDI-II scores (p=.83) or cumulative alcohol use (p=.51). Follow up models removing the interaction term, showed that increased HIV stigma was associated with higher BDI-II scores (B=0.34, 95% Cl=0.21-0.48; p<.001), but not with cumulative alcohol use (p=.49) in the overall sample. Findings indicate a significant link between HIV stigma and depression symptoms in older PWH, with comparable associations among Hispanics and NH Whites. Future studies examining factors that may moderate the link between HIV stigma and depression in diverse older PWH would help guide the development of interventions aimed at improving mental health in this population.
I’m the Only Son She Got Left: Male Caregivers’ Experiences Managing Older Adults’ Post-Acute Care
Authors: Bueno Michael , Russell David , Chase Jo-Ana
Published: December 2021

Family caregivers (FCGs) play an integral role supporting older adults transitioning to post-acute care following a hospitalization. FCGs function as advocates, information agents, and most importantly, care managers and providers. Although, caregiving has been traditionally seen as a female role, men are increasingly undertaking these roles and responsibilities. This research addresses a gap in the existing literature by exploring the subjective experiences of male FCGs of older adults in the post-acute setting. Using data from two parent qualitative studies on caregiving in the post-acute setting (N=40), we conducted a qualitative secondary analysis using conventional content analysis of male caregiver participants’ interview data (n=11). Interviews explored the subjective experiences of male caregivers’ interactions with home health care supportive personnel and conducting medical/nursing tasks for older adults. Five themes emerged: areas of abandonment, financial needs, masculinity, organization of care, and preparation. These themes highlighted areas of both confidence and struggle for male FCGs and captured their unique experiences managing the care of an older adult in the post-acute setting. Furthermore, the themes illustrate male FCGs’ feelings of guilt, financial impact, work disruptions, and the perceived effect of masculinity on their caregiving role. Findings can inform clinicians’ provision of focused and tailored resources to meet the specific needs of male FCGs. Future research should explore the evolving experiences of male FCGs over time, particularly those FCGs of older adults with chronic illnesses.
Conceptualizing the Value of Aging: What is it Like to Be An Older Woman in the 21st Century?
Authors: Shilvock-Cinefro Karen
Published: December 2021

The basis for this hermeneutic phenomenological research was to identify common themes in women 65 years of age and older and determine whether these women felt valued in ageing. The best description of this research becomes the study of the phenomena as real living or “entering the lifeworld “(Finlay, 2012). The research sought to increase the knowledge of how older women feel about their own ageing and the effect of society’s response to them. The participants covered a large age range of 66 to 93 years of age all of which experienced physical, emotional, and social changes involving age. The participants' response to these changes of ageing and society’s response to them ranged from very positive to very distressing. Twelve women were interviewed from a vast range of locations throughout the United States through zoom due to COVID 19. Their responses reflect four main categories: ageism, successful ageing, active engagement, and social support. The interviews focused on seven main questions: Tell me about being your age? Is there a time you can recall when you first felt older? Have you ever felt mistreated as an older adult? Have you ever felt you were discounted or ignored as being an older woman? Have you done anything to maintain your youth? Have you done anything to feel youthful? Have you ever felt dismissed related to your age? Utilizing seven questions and the conversation with these questions brought forth this study. This became a platform for these women to tell their stories.
Dementia Ready: Comparing Approaches for Building Caregiver Readiness and Knowledge of Dementia
Authors: Lepore Michael , Keefe Kate , DeFrancesco Erica , Robison Julie , Ohlheiser Alis , Bailey Christine , Kellett Kathy
Published: December 2021

Despite the rising prevalence of dementia and the high cost and complexity of care for people with dementia, most dementia care is provided at home by informal caregivers who are not clinically trained. Building caregiver readiness and knowledge of dementia is key to supporting quality care and desirable health outcomes, such as preventing falls and reducing nursing home admissions. We sought to determine and compare the impact of two interventions—Resilient Living with Dementia (RLWD) and Care of Persons with Dementia in their Environments (COPE)—and of their combined delivery (both RLWD and COPE) on increasing caregiver readiness and knowledge of dementia. Between January 2019 and March 2021, 77 caregivers of people with dementia in Connecticut participated in RLWD and/or COPE and completed the Alzheimer’s Disease Knowledge Scale (ADKS) and the Preparedness for Caregiving Scale (PCGS) at baseline and at four-month and ten-month follow-ups. Analyses were conducted to compare outcomes by intervention(s). From baseline to four months and to ten months, we observed statistically significant (p < .05) improvement on the ADKS among participants in RLWD, and on the PCGS among participants in COPE and among participants in RLWD. The most substantial impact on PCGS was observed among participants in both COPE and RLWD. No improvement in the ADKS was observed among participants in only COPE, but ADKS improvement was observed at four months among participants in COPE and RLWD. Findings suggest that the benefits of COPE and RLWD for building dementia caregiver readiness are complementary and mutually reinforcing.
Functional Status in Older Adults with Peripheral Artery Disease in Korea: A Cross-Sectional Study
Authors: Kim Yesol , Kim Mihui , Ryu Gi Wook , Choi Mona
Published: December 2021

Peripheral artery disease (PAD) is a chronic, progressive atherosclerotic disease resulting in worse functional status. It is an important factor that affects mobility and quality of life in older adults with PAD. This study aimed to identify the functional status and its associated factors of older adults diagnosed with PAD. We conducted a cross-sectional study among older adults aged 65 above diagnosed with PAD at a tertiary hospital in Seoul, Korea. Participants' functional status was measured using a Walking Impairment Questionnaire (WIQ) which consisted of distance, speed, and stair-climbing. We measured cardiac health behavior, social support, health perception, and clinical manifestation through self-administered questionnaires. Among 94 participants, the mean age was 74.98±6.21 years, and 91.5% were male. The mean score of WIQ was 0.59±0.30 out of 1; the mean scores for distance, speed, and stair-climbing of WIQ were 0.67±0.40, 0.45±0.27, and 0.64±0.37, respectively. Participants' functional status was significantly associated with age (β=-0.012, P=.002), sex (β=-0.284, P=.001), ulcers of the lower extremity (LE) (β=-0.242, P=.031), using a walking-assist device (β=-0.240, P=.002), walking difficulty due to pain of LE (β=-0.142, P=.006), and health behavior about physical activity (β=0.099, P=.021). This regression model predicted 53.5% of participants' functional status (F=8.63, P<.001). This study indicated that younger age, female, independent walking, no ulcers of LE, no walking difficulty, and higher physical activity behavior were significantly associated with better functional status in older adults with PAD. Therefore, healthcare professionals should develop and provide interventions to promote physical activity and alleviate symptoms to enhance functional status.