bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Participation Restriction in Midlife Caregivers: An Exploratory Study
Authors: Klinedinst Tara , Beach Scott , Donovan Heidi , Campbell Grace
Published: December 2021

Mid-life family caregivers (CGs) are at risk for participation restrictions (reduced engagement in valued roles and activities) due to competing demands of work, parenting, and family caregiving responsibilities. When CGs experience participation restrictions, quality of care for care recipients (CR) decreases, yet CG burden and risk for poor health increases. The purpose of this study was to identify the factors contributing to decreased participation in mid-life CGs. Participants were CGs aged 45-64 years (n = 677) from the National Study of Caregiving/National Health and Aging Trends Study. We used multivariate logistic regression to determine attributes of CGs, CRs, and the care situation that independently contribute to participation restrictions. We found that negative aspects of caregiving (OR = 1.51, 95% CI = 1.33, 1.71) and CR depression and anxiety (OR = 0.90, 95% CI = 0.83, 0.99) significantly predicted participation restrictions (p < 0.05). Positive aspects of care (OR = 0.87, 95% CI = 0.74, 1.01), frequency of helping with chores (OR = 1.30, 95% CI = 0.98, 1.70), frequency of providing personal care (OR = 1.24, 95% CI = 0.97, 1.59), and frequency of providing help getting around the home (OR = 1.30, 95% CI = 0.97, 1.75) showed trends for association with participation restrictions (p < 0.10). We identified factors that are related to participation restriction in mid-life CGs. Some of these factors (e.g., positive and negative aspects of caregiving, frequency of assistance provided) are potentially modifiable intervention targets that could bolster participation in this at-risk group.
Optimism and Health: Resource or Delusion
Authors: Chopik William
Published: December 2021

There is a general, widely-held belief that optimism is always a good thing. While there is much previous research suggesting that optimists enjoy several health and wellness benefits, there is also a large body of research suggesting that optimism is not always advantageous. Examining how optimism develops and changes across the lifespan may give us insight into how we use optimism and allow us to determine if and when optimism is helpful or maladaptive. In this talk, I will review evidence debating the efficacy of optimism, as well as examine how optimism develops across the lifespan. I also discuss how life events may or may not impact the developmental trajectory of optimism. Lastly, I address currently unanswered questions and emphasize the contextual nature of optimism’s advantages. Ultimately, being persistently optimistic about the future is a nearly universal human trait. But the exact contexts in which this positive thinking is helpful--if ever--is an intriguing question that speaks to how we think about ourselves, how we think about others, and how we think about our many possible futures.
Marital Strain and Support and Subjective Well-Being in Later Life: Ascribing a Role to Early-Life Conditions
Authors: Upenieks Laura , Liu Yingling
Published: December 2021

Decades of research have the beneficial effects of marital support and the detrimental consequences of marital strain on health and well-being. However, we know relatively less about how circumstances in childhood—a key developmental period of the life course—influence the relational structure in which later life is embedded and any implications this may hold for well-being. We integrate the life course perspective with the stress process model to offer a framework for how childhood conditions (childhood happiness, family structure, and financial strain) moderate the relationship between marital support/strain and subjective well-being in older adulthood in potentially different ways for men and women. The consequences of marital strain may be more severe and the benefits of marital support may not be as strongly felt for those adults who experienced greater adversity during childhood. Drawing on longitudinal data from Waves 2 (2010-2011) and 3 (2015-2016) of the NSHAP project (N = 1,376), results from lagged dependent variable models suggest that marital support buffers the effect of not living with both parents in childhood on subjective well-being for men. Meanwhile, women raised in families that experienced financial hardship reported lower subjective well-being in the context of marital strain in later life. No significant interaction effects were obtained for childhood happiness. Taken together, our findings suggest that adverse experiences in childhood can be scarring, particularly in the context of strained intimate relationships. However, a supportive marriage can, in some cases, offset the effects of childhood hardship on subjective well-being in later life.
Disparities of Mental Health Service Needs and Utilization Among Older Adults
Authors: Hu Yuanyuan , Xu Qingwen
Published: December 2021

Prior studies have examined mental health disparities, however, without adequate attention to the older adult population. Framed by the Andersen Behavioral Model of Health Service Use, this study was to examine the prevalence of depression and anxiety and the mental health service use among older adults of different race/ethnicity; and to investigate factors associated with mental health services use(counseling and psychotropic medication). Data from the National Health Interview Survey 2019 were analyzed by bivariate tests and logistic regression analyses. Hispanic older adults have the highest rates of depressive and anxious symptoms, followed by Whites, Blacks, and Asians. Non-Hispanic Asians and Blacks reported significantly lower rates of taking medication. The severity of depression and anxiety was consistently associated with mental health service use across all groups. Education was positively associated with counseling use in white and black groups. For older whites, better general health, male and foreign-born were significantly predicting less medication use. Older blacks with better general health were significantly less likely to use medication. For Hispanic older adults, female and being single were associated with anxiety medication use. Results suggest that older adults, despite different perceptions and cultural understandings of mental health, use mental health services for severe conditions. This study also highlights the important role that education and health literacy could have played in the use of counseling services. For the medication use, the result—that general health status was important for both black and white older adults, but not Hispanics—could suggest a few directions for further exploration.
Adaptation and Coping Among Rural Older Adults Throughout the COVID-19 Pandemic
Authors: Fuller Heather , Huseth-Zosel Andrea
Published: December 2021

In the past year, older adults have faced challenges due to COVID-19, yet many have also shown great resilience. This qualitative study explores older adults’ experiences and perceptions of adaptation, social connection, and coping across the first six months of the COVID-19 pandemic, with a particular focus on unique resilience factors among rural older adults. A Midwestern sample (35% rural) of 70 older adults aged 70-97 completed three phone interviews (April, June, and October 2020) about their experiences with social distancing due to COVID-19. Thematic analysis of qualitative responses identified themes of resilience including: 1) purposeful and flexible social connections, 2) positive psychological mindset, and 3) hardiness and life experience. Strains related to the loss of community connections were evident, yet older adults demonstrated signs of adaptability and coping as compensation. Implications and future directions will be discussed in the context of change over time and geographic variation.
Educational Experiences Within the Learning Community: ECHO Effects on Participants and Clients
Authors: Shirai Yumi , Bishop Kathleen
Published: December 2021

Although Project ECHO is a well-established, effective model to promote quality care in the general healthcare field, this project is the first attempt to implement the model with community care providers of individuals with IDD who are affected by dementia. In order to capture spokes’ (community providers and NTG-Affiliated Regional Trainers) experiences and explore potential benefits, we conducted a content analysis of qualitative data gathered from a spoke feedback session and follow-up surveys from the same group (n = 20). Our findings indicated that spokes appreciated (1) didactic sessions by gaining new knowledge; (2) in-depth, mutual discussion about their cases; (3) experts taking time and ensuring their good practices; and (4) the ability to apply this gained knowledge to their day-to-day practices to improve quality of life for individuals with IDD and their families. We will discuss specific examples that inform future practices.
Caregiving During COVID-19: A Multi-State Qualitative Study of Family Caregiver Experiences and Decision Making
Authors: Sadler Tonie , Yan Kevin , Brauner Daniel , Pollack Harold , Konetzka R Tamara
Published: December 2021

COVID-19 poses unique challenges to family caregivers. This study explores how family caregivers for older adults with cognitive impairments experience and make decisions about caregiving during a global pandemic. Using purposive sampling, 63 family caregivers across eight states participated in open-ended qualitative interviews (2019-2020), until thematic saturation was reached. Questions broadly examined caregivers’ experiences and decisions, focusing on decisions made around type of care setting. Questions about responses to the Pandemic were added as events unfolded. States were selected to represent variation in Home and Community Based Service (HCBS) expenditures as a percentage of total Medicaid long-term services and supports expenditures. Family caregivers experienced significant concern about COVID-19 itself, and about the indirect consequences of caregiving caused by the pandemic. Caregivers also displayed flexibility and adaptability in ceasing selected services, contingently continuing services, and utilizing telemedicine and other remote healthcare interventions to protect their loved ones. Many family caregivers utilized remote health care tools such telemedicine, no-contact prescription and grocery delivery. Such measures improved service access and reduced caregiver workload. Given the persistent challenges posed by COVID-19, long-term service organizations have an opportunity to enhance their policies to meet the needs of caregivers and those they care for. There is a need to expand telemedicine and other remote healthcare tools, while adapting these technologies to the needs of families. Also, procedures are needed for safe pathways to utilize HCBS and nursing care during a pandemic including communication supports, sufficient PPE, increased staffing, and utilization of evidence-based protocols.
Emerging Biotechnology Markers of Cognitive Impairment
Authors: Huisingh-Scheetz Megan , Schrack Jennifer
Published: December 2021

The early detection of cognitive impairment is among the National Institute on Aging’s (NIA) current research priorities. Sensor-based technologies have exploded in recent years allowing remote, continuous measurement of older adults’ free-living activity. This highly granular data has stimulated exciting new research exploring how change in health can be detected remotely using novel “biotechnology” markers. Yet, this area of research is in its infancy as it relates to predicting cognitive function. This symposium will provide an overview of the sensor-cognition research landscape and will feature 5 new studies exploring the relationship between biotechnology markers and cognitive function, each with unique sensors, cognitive measures and samples. The first three presentations will report associations between accelerometry-based activity measures (chest or wrist devices) and cognitive function (assessed by diagnosis, a neurocognitive assessment, or microstructural changes on DTI) in the Baltimore Longitudinal Study on Aging, a large, NIA-funded epidemiologic dataset. The fourth presentation will report the significance of free-living hip accelerometry activity measures beyond clinically-available information in a random forest prediction model of 1-year change in Montreal Cognitive Assessment scores among urban, predominantly African-American older adults without moderate-severe dementia residing in the community. The final presentation will report associations between room-to-room transitions as detected by in-home, infrared motion sensors and mild cognitive impairment using data from a community-dwelling sample of older adults residing alone. This symposium will provide a substantial expansion of current knowledge in this research space and will be relevant to clinicians or researchers with an interest in sensor technology or dementia.
Predictors of Falls in Older Adults With and Without Dementia
Authors: Okoye Safiyyah , Fabius Chanee , Wolff Jennifer
Published: December 2021

Persons living with dementia (PLWD) have up to twice the risk for falling and three-times the risk of serious fall-related injuries as those without dementia. Falls are a leading cause of hospitalizations among PLWD, who are more likely to incur high costs and experience negative health consequences (e.g, delirium, in-hospital falls) than persons without dementia. Few studies have examined risk factors for falls comparing Americans with and without dementia. We used data from the 2015 and 2016 rounds of the National Health and Aging Trends Study (n=5,581) to prospectively identify risk factors for a single fall and recurrent (2+) falls over a 12-month period among community-living older adults ≥65 years with and without dementia in a series of bivariate logistic regressions. Overall, we identified fewer predictors of single or recurrent falls among PLWD compared to persons without dementia. For example, socioeconomic indicators (e.g., income, financial hardship) predicted recurrent falls in persons without dementia, but not in PLWD. Among PLWD, falling in the previous year was associated with both single (odds ratio (OR): 3.38, 95% confidence interval (CI): 1.77, 6.49) and recurrent falls (OR: 6.19, 95% CI: 3.50, 10.93). PLWD who experienced recurrent falls were also more likely to be identified as having a fear of falling (OR: 2.17, 95% CI: 1.33, 3.54), physical function impairments, depression symptoms (OR: 2.23, 95% CI: 1.34, 3.71), and anxiety symptoms (OR: 1.73, 95% CI: 1.14, 2.62). Further study of fall-risk factors could inform screening, caregiver education and support, and prevention strategies for PLWD.
Transitions in Adherence Trajectories From Intervention to Maintenance of a Falls Prevention Exercise Program
Authors: Sung Pildoo , Lee May-Ling June , Tan Kok Yang , Malhotra Rahul , Chan Angelique
Published: December 2021

The successful implementation of a falls prevention exercise program for older adults hinges on self-maintenance after active intervention. However, little is known about the pattern of adherence from the intervention to the maintenance phase of such programs, and the factors influencing adherence. We investigate transitions in exercise adherence trajectories from the active intervention to the maintenance phase of a falls prevention exercise program in Singapore, and whether exercise self-efficacy is associated with adherence in the maintenance phase. We analyze data of 143 older adults who participated in a 12-week, group-based falls prevention exercise program, followed by a 6-month maintenance phase, in 2018-2019. Sequential process latent class growth modeling identifies the distinct exercise adherence trajectories in the active intervention and the maintenance phase separately and their transition patterns. Multivariable regression examines whether baseline and change in self-efficacy during the active intervention predict adherence during the maintenance phase. The analysis reveals three exercise adherence trajectories— adherent (40% of participants), intermittent (38%), and disengaged (22%)—in the active intervention phase, and two trajectories—adherent (33%) and disengaged (67%)—in the maintenance phase. Those adherent in the maintenance phase comprise participants who were adherent (42%) or intermittent (58%) in the active intervention phase. Baseline and increase in exercise self-efficacy during the active intervention are positively associated with adherence in the maintenance phase. The findings capture the heterogeneity in exercise adherence patterns within and across the active intervention and maintenance phases of falls prevention exercise program, and the importance of exercise self-efficacy in continued adherence to exercise.
Delivery of Home and Community Based Services During a Pandemic: Unexpected Consequences
Authors: Cherlin Emily , Ayedun Adeola , Straker Jane , Wilson Traci , Brewster Amanda , Rubeo Chris , Curry Leslie
Published: December 2021

The COVID-19 pandemic required AAAs to pause essential services, serving as a catalyst for innovation. We examined such innovations as part of an explanatory mixed-methods, positive deviance study of AAA partnerships with health and social service organizations. We identified 8 AAAs with many partners serving areas with lower levels of health care use, and 3 AAAs with few partners serving areas with higher levels of health care use. We interviewed AAA and partners, (total = 123). Using the constant comparative method, we identified recurrent themes: 1) AAAs adapted to increased demand for services by developing new ways to deliver services, 2) the pandemic raised awareness of unmet needs such as social connection, 3) changes in delivery of services included embracing technology, and 4) AAAs and their partners identified resources to rapidly pivot services. AAAs and partners demonstrated resiliency to not only to sustain programs, but to innovate throughout the pandemic.
Associations Between Endogenous Estrogen, Postmenopausal Hormone Therapy, and Cognitive Changes in Older Women
Authors: Espeland Mark , Hugenschmidt Christina
Published: December 2021

How markers of brain health are associated with endogenous estrogen and use of postmenopausal hormone therapy (HT) varies depending on women’s years from menopause and metabolic health status, ranging from potential benefit to harm. The Women’s Health Initiative (WHI) included 7,233 women age 65-80 who underwent a randomized clinical trial of various HT preparations for an average of 5.9 years. Over up to 18 years of post-trial follow-up, diabetes (DM2) increased the risk of dementia (hazard ratio [HR] 1.54 [95% CI 1.16–2.06]). Having DM2 and also treatment with unopposed conjugated equine estrogens increased the risk to HR=2.12 [1.47-3.06]. We hypothesize that the metabolic effects of estrogen in the brain drives this interaction. In support of this, the metabolic transition following menopause may alter the impact of other treatments on cognition, for example behavioral weight loss therapy to treat obesity in women with type 2 diabetes (interaction p=0.02 for executive function).
Neighborhood Environment and Social Support Received: An Examination of Race and Gender in Baltimore City
Authors: Baik Sol , Mair Christine , Lehning Amanda , Cheon Ji Hyang , Waldstein Shari , Evans Michele , Zonderman Alan
Published: December 2021

Social support in urban settings is likely shaped by the context of the neighborhood environment. Patterns of support may also differ by the type of support received as well as characteristics of the person receiving support. For example, women and Black residents may have stronger support networks compared to men and white individuals, and variation by gender and race in social support may have important implications for promoting well-being in disadvantaged neighborhoods. To investigate the presence of these potential patterns in a disadvantaged urban environment, we analyzed 2,553 Baltimore City residents (ages 30-64) from the baseline wave (2004-2009) of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. We tested associations between self-assessed neighborhood environment (disorder, cohesion, and control) and social support (from partners, children, and/or friends) and further explored variation by intersections of race and gender using multi-group structural equation modeling. Our results suggest that individuals are more likely to receive support when they perceive their neighborhood to have higher social control and cohesion, particularly in terms of support from friends. Although interactions by race and sex were not statistically significant, a descriptive pattern emerged wherein Black women are particularly likely to receive support from multiple sources when they report more social control in their neighborhood. On the other hand, there is almost no association between neighborhood environment and social support for Black men. We discuss these findings in light of potential neighborhood inequities in informal support access in Baltimore City and similar urban settings.
Residence in HUD Housing Associated With Greater Benefit From HCBS Services for Medicaid Enrollees in Pennsylvania
Authors: Da Costa Damian , Degenholtz Howard
Published: December 2021

State Medicaid programs seek to shift the delivery of long-term care services away from institutional settings and toward community-based settings by expanding access to home-and-community-based services (HCBS). HCBS are hypothesized to prevent or delay the need for protracted nursing home stays. This study explores the question of which types of community residence maximize this protective effect of HCBS. We used a probabilistic matching technique to identify whether waiver-eligible Medicaid enrollees were likely to reside in project-based HUD housing in 2013. We applied multinomial logistic regression to observe the risk of long-stay nursing home admission (>100 days) relative to persistent community residence in the subsequent four years. Our model controlled for age, race, gender, urban status, and receipt of home-and-community based services. Our predictor of interest was the interaction between receipt of home and community based services (HCBS) and residence in HUD housing. The eligible baseline population included 152,632 community-residing Pennsylvania Medicaid enrollees in 2013. The analytic sample excluded individuals who died during 2013 or who were no longer waiver-eligible after 2013. Residence in HUD project-based housing while receiving HCBS is independently associated with a 27% percent reduction in risk of long-stay nursing home admission (p = .01) when controlling for individual-level demographics. No significant association was observed between the predictor of interest and risk of death during the follow-up period, suggesting that this finding is not likely confounded by individual health status. Further research should test whether this association is causal and specify possible mechanisms.
Developing a Shared Language to Describe the Age-Friendly Ecosystem
Authors: Dash Kim , Shue Jody , Driver Tim , Bonner Alice , Pelton Leslie , Snyder Rani , Fulmer Terry
Published: December 2021

While multiple sectors—cities and communities, education, employment, health, and public health—have identified and implemented strategies to promote age-friendly systems, their efforts have mainly advanced in siloes. Each sector has met goals specific to its constituents, however, the major transformations required to realize systemic inclusivity and well-being among diverse groups of older adults remains indefinable. To begin to address this gap, we have engaged age-friendly sectors in a process of coordinated planning to define and operationalize an age-friendly ecosystem (AFE) that advances cross-sector and age-friendly solutions to meet the needs of all older adults. Our process borrows from Kania and Kramer (2011) who describe conditions to achieve substantial collective impact when coordinating efforts across sectors: a common agenda, shared measurement systems, mutually reinforcing activities, and continuous communication. In this presentation, we describe our stepwise process to set a common agenda, by engaging older adults and working with experts across sectors, to agree on a series of characteristics that define an AFE. Specifically, we surveyed older adults about their perceptions of an age-friendly ecosystem as well as conducted a review and analysis of relevant activities (i.e., policies, programs, and practices) associated with five age-friendly sectors. Next, activities were organized by common and defining characteristics. We then convened more than 40 international experts representing diverse age-friendly sectors to review and revise the AFE characteristics. Through structured and facilitated group processes, we worked with experts to identify and define six critical AFE characteristics as well as examples of corresponding activities.
Leveraging Partnerships for a Nursing Home COVID Learning Community
Authors: Ross Sarah , Severance Jennifer , Knebl Janice , Luk-Jones Susanna
Published: December 2021

The rapid and uncertain trajectory of community spread in nursing homes statewide spurred action by the University of North Texas Health Science Center to create a nursing home (NH) COVID learning community. As an existing ECHO hub, we assembled an interdisciplinary team leveraging local NH partnerships, a regional Quality Improvement Organization (QIO), and a regional emergency response task force to rapidly scale up delivery. Specialist teams include a geriatrician and NH medical director, administrator, nursing administration, infection control expert, and a QIO specialist. With the IHI curriculum as a road map for essential training elements, we adapt each week’s agenda based on the interests and concerns of the participating nursing facilities and the incidence rate in our community. At this time, we have two more sessions before completion of phase 1. The three cohorts are engaging 151 participants from 68 nursing facilities with a total attendance of 747.
Intensity of Grandparent Caregiving and Well-Being in a Cultural Context: A Systematic Review
Authors: Chan Athena Chung Yin , Lee Sun-Kyung , Zhang Jingchen , Banegas Jasmine , Marsalis Scott , Gewirtz Abigail
Published: December 2021

With improved longevity and changes in family structure, grandparents are key resources in providing care for grandchildren. However, mixed findings indicate that multiple role engagement may enhance well-being or bring demands on grandparents raising grandchildren. Little is known about how the intensity of grandparent caregiving is associated with their well-being in different family contexts (i.e., structures, cultures/regions, and reasons of care). This systematic review examines the association between the intensity of grandparent caregiving and their well-being. Peer-reviewed articles published after 1990 were identified in five electronic databases. A keyword search was performed for keywords associated with: (a) grandparent caregivers raising grandchildren, and (2) well-being (i.e., physical, mental, cognitive, and life satisfaction). Only quantitative studies were included. Fifty-six articles from 28 countries/regions were included. Findings suggested that the well-being of grandparents is optimal when they provide caregiving of moderate intensity, with optimal amounts varying across sociocultural contexts. In Europe and Australia, providing supplementary care seems beneficial for grandparents’ well-being, especially supporting dual-earner families. In Asia, economic resources buffer the adverse effect of primary care on grandparents’ well-being. In the U.S., findings vary across ethnicity/race. White grandparents enjoy health benefits providing supplementary care with support from adult children. However, Hispanic grandparent caregivers in multigenerational households have better well-being than those in skipped-generation households, whereas Black custodial caregivers have better well-being than supplemental caregivers. Collectively, the intensity of grandparent caregiving and well-being is complicated by their roles in the family and cultural differences. This systematic review calls for culturally-tailored family interventions.
Successes and Lessons Learned From Age-Friendly Community Collaborations: Baystate Health GWEP
Authors: Brennan Maura , Dobert Rebecca
Published: December 2021

Baystate is the largest health system in Western Massachusetts with 4 hospitals, 3 Community Health Centers (CHCs) and a large primary care network. Baystate Medical Center (BMC) is in Springfield, Massachusetts. BMC and the CHCs were the first health care sites nationally to be recognized by the Institute for Healthcare Improvement as “Committed to Care Excellence” in the age friendly movement. Collaboration with a city-wide coalition of community-based organizations led to simultaneous recognition of Baystate as “age friendly” and recognition of the city as both dementia and age friendly. The 3 awards were presented at a Springfield senior center with media coverage and the participation of the mayor and other political leaders. This collaboration persists and the GWEP and coalition partners continue to participate in multiple joint educational and community outreach projects. As a result, the city coalition has added health care to its initial focus on housing and transportation.
Household Structure and Older Persons
Authors: Zhang Sainan , Simelane Sandile , Jhamba Tapiwa , Snow Rachel
Published: December 2021

This research explores the life circumstances of older persons (aged 60 years and above), focusing on the sociodemographic and socioeconomic conditions of those who live alone. We situate the living arrangements of older persons within the global context of changing household structures in 76 countries from all regions of the world. Older persons who live alone are among those most likely to need governmental and other forms of social support. The analysis presented here is crucial for supporting policy responses to the needs of older persons, including the special attention they require during the current COVID-19 crisis. It also supports the operationalization of the Madrid International Plan of Action on Ageing (MIPAA)(United Nations, 2002), the realization of United Nations Principles for Older Persons (United Nations, 1991), and the broader framework of the Programme of Action of the International Conference on Population and Development(ICPA-POA).
Community Options to Fund Aging Services: A National Study to Track Local Initiatives
Authors: Koumoutzis Athena , Heston-Mullins Jennifer , Mayberry Pamela , Applebaum Robert
Published: December 2021

The majority of federal support for older people needing in-home services and supports comes from the Medicaid program. However, less than 10% of older people are eligible for Medicaid and to receive long-term services, a person must have a severe disability. Many older people with moderate levels of disability or those who are not impoverished are not eligible. In response to these system limitations, some counties across the nation have developed alternative funding strategies, such as property tax levies, to better serve older members of their communities. After identifying 15 states with such initiatives, a survey was distributed to 414 contacts within these states, with a response rate of 55%. Respondents included organizations such as area agencies on aging, councils on aging, and county departments on aging. Local funding varied within and across states, with annual funding ranging from $8,000-$47 million. Most commonly provided services with local funds include home-delivered (81%) and congregate (73%) meals, transportation (61%), and homemaker services (49%). A majority of programs (63%) indicated that local funds are used to provide at least one family or friend caregiver service. This study is the first compilation and description of locally-funded elder service initiatives in the U.S. Locally-funded initiatives can help older people with long-term services needs continue to live in their own homes and communities. On the other hand, some have raised questions about whether this is a good approach to funding aging services, raising concerns that this will lead to further inequities across states and communities.
Use of Community-Based Participatory Research in Mental Health Studies With Older Adults: A Systematic Review
Authors: Yau Jessie Ho-Yin , Au Walker Siu Hong , Liu Tianyin , Zhang Anna Y , Wong Gloria H Y , Lum Terry Y S
Published: December 2021

Community-based participatory research (CBPR), a bottom-up approach that community stakeholders and academics are involved equitably, is an effective approach for enhancing relevance and value in public health research and has gained popularity in recent decades. However, little is known about how CBPR can be used in mental health studies with older adults. This systematic review examined the current state of knowledge about how CBPR approach has been adopted in mental health research among older adults in different societies. According to the PRISMA guidelines, we searched five major databases and screened the literature using these criteria: 1) journal articles reporting use of CBPR in mental health research among older adults, 2) articles published in English language, 3) studies conducted in any settings with any mental health research. Initial search found 3,227 articles and preliminary screening identified 23 eligible articles. We found that around 90% of studies were conducted in the West. Most studies adopted CBPR to develop community-based mental health interventions or to revise current interventions or models while addressing the cultural needs of their studied population. Few studies adopted CBPR to evaluate existing mental health workshops or programmes. The extent of involvement of older adults in the CBPR approach varied across studies, from questionnaire design to programme evaluation. Our review uncovered ways of CBPR implementation across different societies and elements of successful implementation in CBPR practices in mental health research among older adults.
Creating Dementia-Inclusive Communities Using a Geriatric Workforce Enhancement Program Framework
Authors: Drost Jennifer , Sanders Margaret
Published: December 2021

The Geriatric Workforce Enhancement Program (GWEP) sponsored by HRSA provides an organizing framework around which dementia inclusive community initiatives can be successfully implemented and sustained. The overarching goal of all GWEPs is to improve outcomes for older adults by promoting evidence-based education that spans the continuum of care. This includes integration of academic, clinical, and community-based providers. By their very nature, all GWEPs partner across agencies throughout the state to deliver interprofessional education that will impact people living with dementia and their caregivers at the community, primary care, and acute care levels. Dementia inclusive community initiatives must have this kind of high-level interagency coordination. Our GWEP has successfully implemented Dementia Friends sessions across multiple sectors (Veterans, EMS, clergy, libraries, developmentally disabled, living alone) both in-person and virtually due to COVID-19. This symposium will share the methods to organize at the community level to deliver a unified message community-wide.
Gaps in the System: Supporting People Living With Dementia and Their Caregivers
Authors: King Madeline , Peckham Allie , Roerig Monika , Marani Husayn , Marchildon Gregory
Published: December 2021

As individuals are living longer, the prevalence of older adults living with dementia and other complex health and social care needs is on the rise (Alzheimer’s Association, 2020; CIHI, 2020). Correspondingly, efforts to develop supportive programming and policies for persons living with dementia (PLWDs) are of paramount importance (CIHR, 2019). The challenges faced by PLWDs and other complex health and social needs are widely known (CIHR, 2019), however, a systematic understanding of how and if current and long-standing efforts are adequately meeting the needs of these individuals remains elusive. This research sought to understand how program administrators, decision makers, PLWD, and caregivers across five North American jurisdictions (British Columbia, Ontario, Newfoundland and Labrador, New York State, and Vermont) perceived specific dementia care programs and support services within their respective jurisdictions. We performed an inductive analysis of semi-structured interviews (N=37) and identified on-going care gaps experienced by participants. We present three main gaps: 1) disconnected and uncoordinated system infrastructure, 2) lack of comprehensive services to meet the diverse needs of PLWD and their caregivers, and 3) inconsistency in how dementia is understood; with associated perceived remedies. The results suggest that even when attempts to address the needs of PLWD and their caregivers are put in place there remains significant limitations of systems. The perspectives of decision makers, program administrators and individuals with lived experience offer unique insight into how these experiences may be improved to better support the complex needs of PLWD and their caregivers.
Disparities in COVID-19 Mortality in High-Minority Nursing Homes
Authors: Lord Justin , Weech-Maldonado Robert , Davlyatov Ganisher , Ghiasi Akbar , Orewa Gregory
Published: December 2021

Racial/ethnic disparities in healthcare have been highlighted by the recent COVID-19 pandemic. Minorities continue to utilize nursing home services at a higher rate than White residents, contributing to existing health inequity concerns. This study examined the relationship between nursing home racial/ethnic mix and COVID-19 resident mortality using the CMS Nursing Home COVID-19 Public File. As of October 25, 2020, high minority nursing homes reported 6.5 COVID-19 deaths as compared to 2.6 deaths for nursing homes that had no racial/ethnic minorities. Four nested sequential negative binomial regressions were used to model the relationship between racial/ethnic disparities in COVID-19 deaths and the separate contributions of facility-level resident characteristics (percent of females, percent of residents 65 years and older, percent of residents with congestive heart failure, hypertension, and obesity, and the average level of residents’ acuity), resource availability (nursing homes’ payer-mix, occupancy rate, county-level Social Deprivation Index, and nursing home location), and other organizational characteristics (nursing home for-profit status, chain affiliation, and self-reported nursing, clinical, aides, and other staff shortages). After controlling for interstate differences, facility-level resident characteristics, resource availability, and organizational characteristics, high-minority nursing homes had 61% more COVID-19 deaths (Incidence Rate Ratio [IRR] = 1.61; p < 0.001) as compared to nursing facilities with no minorities. From a policy perspective, nursing homes, that serve primarily minority populations, may need additional resources, such as, funding for staffing and equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the long-term care.
The Intersection of Older Students and Disability: How Age-Friendly Universities Can Boost Visibility and Accessibility
Authors: Barragan Cassandra , Walsh Sarah
Published: December 2021

The needs of older learners differ from traditional students, and many services and resources available at higher education institutions are geared towards students aged 18-25 (Silverstein, Choi, & Bulot, 2001). Age Friendly University (AFU) principles highlight the need to consider older learners at a university. Older learners face various barriers to education including balancing schoolwork with responsibilities and accessibility of campus resources (Silverstein et al., 2001). This study examined how an AFU designated university is working to better understand their older students. Methods: A web-based pilot survey of older learners (N=248) asked all students ages 40 and older a series of questions regarding motivation to attend school, barriers and supports, campus environment, and connection with AFU principles. Analysis: A t-test analysis explored differences in motivation, barriers and challenges, and connection to campus between students who identified as having a disability and those who did not. Findings: We found there were significant differences between the groups in how health impacted their education (p=.001), being able to physically access campus (p=.014), the availability of online classes (p=.047), and the hours of operation of student support services (p=.045). There were also differences between groups in how connected they felt to campus based on feeling welcomed by faculty (p = .033) and feeling satisfied with their level of engagement at the university (p = .002). Discussion: Our results demonstrate the need to fully engage older learners with a disability as part of diversity and inclusion efforts to facilitate connection to the campus community.
Provider Perceptions of Video Telehealth in Home-Based Primary Care During COVID-19
Authors: Gorbenko Ksenia , Franzosa Emily , Brody Abraham , Leff Bruce , Ritchie Christine , Kinosian Bruce , Federman Alex , Ornstein Katherine
Published: December 2021

The COVID-19 pandemic accelerated the adoption of virtual care. In this qualitative study, we sought to determine provider perceptions of video telehealth during the first wave of COVID-19 in NYC to inform practice for home-based primary care providers nationwide. We conducted semi-structured interviews with clinical directors, program managers, nurse practitioners, nurse managers, and social workers at 6 NYC practices (N=13) in spring 2020. We used combined open and focused coding to identify themes. Participants employed both hospital-supported and commercial technological platforms to maintain care during COVID-19. Benefits of video telehealth included improved efficiency, capacity and collaboration between providers. Barriers included patients’ physical, cognitive or technological abilities, dependence on caregivers and aides to facilitate video visits, challenges establishing trust with new patients and addressing sensitive topics over video, and concerns over missing important patient information. Considering patient, clinical, and technological conditions can help optimize telehealth implementation among older homebound adults.
Barriers to Sustained Implementation of STAR-VA and Strategies to Overcome Them
Authors: Sullivan Jennifer , Adjognon Omonyele , Pendergast Jacquelyn , Wray Laura , Karel Michele , Curyto Kimberly
Published: December 2021

STAR-VA is an evidence-based, interdisciplinary program helping CLC teams effectively manage DBD. We conducted interviews with 42 key informants involved with STAR-VA implementation in 20 CLCs, guided by a sustainment framework, to understand facilitators and barriers to sustained implementation. We used directed content analysis to identify barriers and mapped them to the CFIR-ERIC Mapping Tool to identify associated implementation strategies. We identified six barriers: 1) staffing issues, 2) lack of written policies, 3) staff buy-in, 4) limited leadership support, 5) exclusion of STAR-VA criteria in performance evaluations, and 6) service line silos. We identified six strategies to overcome these barriers, three strategies most frequently mapped to reported barriers to STAR-VA sustainment: 1) assessing local CLC readiness, facilitators and addressable barriers; 2) identifying and preparing new champions; and 3) altering incentive/allowance structures. The identified strategies can be packaged to further integrate STAR-VA into usual CLC care processes to optimize program sustainability.
Social Connectedness Risk Among Middle-Aged and Older Black Men With Chronic Conditions
Authors: Smith Matthew , Sherman Ledric , Goidel Kirby , Cudjoe Thomas
Published: December 2021

Social connectedness is a multi-factorial concept encompassing structural, functional, and quality aspects. For those with chronic conditions, threats to social connectedness can exacerbate illness symptomology and impose barriers to disease self-management. This study identified factors associated social connectedness risk among Black men ages 40+ years with one or more chronic conditions. Data from 2019 were analyzed from a national sample of 1,200 Black males collected with an internet-delivered questionnaire. Three logistic regression models were fitted to assess factors associated with not having enough people to call for help (structural), feeling isolated from others (functional), and not being content with friendships/relationships (quality). All regression models were adjusted for age, education, marital status, number of chronic conditions, self-reported barriers to disease self-management, and having cut-down or skipped social activities because of health problems. On average, participants were age 56.7 (±9.7) years and self-reported 4.0 (±2.9) chronic conditions. Approximately 23% were ages 65+ years, 45.4% cut-down or skipped social activities because of health problems, 25.2% did not have enough people to call for help, 26.0% felt isolated from others, and 23.8% were not content with friendships/relationships. Across the three regression models, men who were middle-aged (P<0.05), never married (P<0.01), cut-down or skipped social activities because of health problems (P<0.001), and reported more barriers to disease self-management (P<0.001) were significantly more likely to report social connectedness risk. Findings suggest that efforts to improve the self-management of illness symptomology may mitigate threats to structural, functional, and quality aspects of social connectedness among this male population.
The Impact of Structural and Functional Social Resources on Loneliness Among Americans Age 50 Years and Older
Authors: Zucchetto Jillian Minahan
Published: December 2021

Social isolation and loneliness have many negative consequences (e.g., Cacioppo et al., 2006; Griffin et al., 2018; Uchino, 2006), especially among older adults (Perissinotto et al., 2012). According to the cognitive discrepancy theory (CDT), loneliness is the negative psychological state resulting from the perceived discrepancy between one’s desired level of social resources and one’s actual level of social resources (Peplau & Perlman, 1982; Perlman & Peplau, 1998). Social resources have both structural (e.g., objective) and functional (e.g., perceptions of the quality) aspects (Holt-Lunstad, 2017). The relationship between structural and functional social resources has been described as a filtration process in which functional aspects mediate the association between structural aspects and loneliness (Cacioppo et al., 2016; Hawkley et al., 2008, Hawkley & Kocherginsky, 2018). However, this filtration model has not been empirically tested within the CDT. This study examined the relationship among structural social resources (SSR), functional social resources (FSR), and loneliness cross-sectionally and longitudinally using a sample of 3,345 Americans aged 50 years and older from the 2008 and 2012 waves of the Health and Retirement Study. Results showed that there was a significant indirect effect both cross-sectionally (β = -.07) and longitudinally (β = -.06) such that FSR mediated the relationship between SSR and loneliness. Ultimately, the CDT is useful in explaining the complex relationship between structural and functional aspects of one’s social resources with loneliness, and interventions may seek to target the functional aspects of one’s social network to improve loneliness, rather than focusing solely on structural aspects.