bluuebunny/crossref_metadata_2025 huggingface dataset:
Supporting Caregivers of Older Adults Through Education in Mindful Gratitude Practice
Authors: Lee Sungsim
Published: December 2020

This presentation describes a supportive mindfulness practice for caregivers of older adults based on the principles of Won Buddhism (an integrative, a modernized Buddhism). As the aging population grows, there is a significant increase in recognition of the negative impact of caregiver stress on older adults’ quality of life. The ability for caregivers to deal compassionately with stress is essential, as caring for older adults can awaken feelings about one’s own vulnerability and mortality. The ‘Mindful Gratitude Practice’ offers a way to cope with stress, cultivate self-care, and improve the care of others. Relevant research will be summarized, which shows mindfulness and gratitude practice respectively benefit positive influence in both physical and emotional well-being. Mindful Gratitude Practice as a spiritual approach that fosters caregivers' emotional stability, reduces their stress and improves the relationship between older adults and their caregivers. In this presentation, three processes of Mindful Gratitude Practice will be described: 1. Understanding a mindfulness practice by establishing intention, attention, and attitude, 2. Learning the principles of a gratitude practice and implementation, and 3. Incorporating mindfulness into a gratitude practice. Research results have demonstrated that through this learning process, caregivers have acquired the concept of interconnectedness, experience grateful moments, and a deep feeling of appreciation in their caregiving relationships. The presenter will guide participants in a short experience of Mindfulness Gratitude Practice. Further readings and resources will be provided for those who are interested.
Development and Evaluation of the Caring Ahead: Preparing for End of Life in a Dementia Questionnaire
Authors: Durepos Pamela , Kaasalainen Sharon , Ploeg Jenny , Sussman Tamara , Akhtar-Danesh Noori
Published: December 2020

A palliative approach is recommended in long-term care to support persons with dementia and help families prepare for end-of-life. Despite this, 50% of family caregivers of persons with dementia report feeling unprepared for death. A questionnaire is needed to assess caregiver death preparedness as an outcome measure for strategies within palliative care. A mixed methods design with qualitative and quantitative phases was used to develop and evaluate the ‘Caring Ahead: Preparing for End-of-Life in Dementia’ questionnaire. The questionnaire has 30 items organized into Medical, Relationship/Personal, Spiritual and Practical subscales with a 7-pt Likert response scale. To date, the questionnaire has been tested with 117 participants who are 61 years old on average, female (86%), adult children (77%) caring for a person with dementia in long-term care. The mean item score is 5.61 (SD 0.71). Participants report limitations in preparedness related to: 1) communication with healthcare providers about traditions and preferences for end-of-life care; 2) knowledge of the dying process and; 3) life purpose after death. A test-retest with 32 participants demonstrates a high degree of reliability; Intraclass Correlation Coefficient 0.91 (CI95%: 0.31-0.97). A moderate positive correlation between participant total scores and a single global preparedness item suggests concurrent validity, r=.66 (CI95%: 0.51-0.80). These findings will be used to refine the questionnaire and contribute a valuable measurement tool for clinicians, researchers and policy-makers working in palliative care.
COVID-19 Infections in Long-Term Care Facilities in Wuhan, China: Challenges and Lessons
Authors: Cai Yi , Wang Jing , Wu Bei
Published: December 2020

The impact of the COVID-19 infection on older residents and the direct frontline workers in long-term care (LTC) facilities in Wuhan, China deserves close attention. The fatality rate for older residents infected by the COVID-19 is among the highest in China Viral outbreaks are likely to occur in LTC facilities due to group-living arrangements, lack of precautionary measures, and older residents’ vulnerability to diseases. In this study, we aimed to explore different stakeholders’ experiences and challenges in the midst of the spread of the virus in LTC facilities. We conducted telephone interviews with four groups from two LTC facilities and two hospitals: twelve older residents (Four suspected cases and two infected), ten family members, four direct frontline workers (two infected), two nursing home managers, and four health care professionals working in the two hospitals that infected older residents were transferred to. We found that the gap in the transition of care quality between LTC facilities and local hospitals was widened during the COVID-19 outbreak. LTC facilities were slow to take precautionary measures and underprepared to handle the crisis after the infections occurred. The wellbeing of older residents was significantly impacted during the transition, particularly for those with dementia. Health care professionals in local hospitals were under tremendous stress providing treatments for older residents while ensuring their safety. There is an urgent need to improve transitional care and the capacity in preventing and handling this type of crisis for older residents in LTC.
Post-Acute Care for Medicare Beneficiaries in Accountable Care Organizations
Authors: Colligan Erin , Branand Brittany
Published: December 2020

Post-acute care (PAC) is a component of health-care utilization and spending that is subject to the discretion of providers. Prior research has demonstrated that Accountable Care Organizations (ACOs) recognize PAC as a logical target for increased efficiency and cost savings. As part of the evaluation of the Centers for Medicare & Medicaid Services (CMS) Next Generation ACO (NGACO) Model, we investigated NGACOs’ approaches to PAC services and the impact of these efforts on utilization and cost using a mixed-methods study design. We conducted interviews and surveys with NGACO leadership and providers and performed a difference-in-differences analysis of utilization and spending based on Medicare claims data. We found that NGACOs focused specifically on establishing partnerships with skilled nursing facilities (SNF) to facilitate transitions in care by establishing new channels of communication, sharing performance data, embedding staff in SNFs, and (in some cases) sharing financial risk. We observed a statistically significant decrease in SNF spending, a trend toward fewer SNF days, and statistically significantly lower expenditures for other PAC settings (e.g., inpatient rehabilitation and long-term acute care facilities). These findings suggest that NGACOs have contributed to improving transitions in care and diverting beneficiaries from intensive PAC settings. Nonetheless, the reduction in PAC spending alone did not translate to a decline in total cost of care. Future ACOs may need to expand their focus to the inpatient utilization and spending that precedes PAC in order to impact total cost of care.
Geographic Distance and Social Isolation Among Family Caregivers Providing Care to Older Adults
Authors: Li Lun , Wister Andrew
Published: December 2020

Family caregiving is associated with social isolation, but the role of geographic distance between caregiver and receiver in caregiving experience is unclear with mixed research findings. This study examined the relationship between geographic distance and caregiver social isolation (CSI), and explored the interaction between geographic distance and caregiving intensity in association with CSI. Based on the Ecological Model of Caregiver Isolation, hierarchical linear regression and ANCOVA analyses were applied to conduct data analysis with the 2012 Canadian General Social Survey (N=2,881). Caregivers living a short distance from receivers reported the lowest CSI than coresident, moderate and long distance caregivers. Being involved in higher intensity caregiving as the primary caregiver, undertaking more caregiving tasks, and providing care more frequently resulted in higher CSI scores. Additionally, long and moderate distance caregivers reported greater CSI than coresident and short distance caregivers only when providing higher intensity caregiving. Geographic distance is a salient contextual factor affecting CSI, and longer distance creates environmental barriers for caregiving provision. Employing a granulated measure of geographic distance positioned within an ecological framework facilitates an understanding of the nuanced association between geographic proximity and CSI. Furthermore, the identified interactive effects between geographic distance and caregiving intensity on CSI further reveal the complexity of caregiving experience. The findings are relevant for programs supporting caregivers in different contexts, especially physical distance.
Measuring Childlessness Among Middle-Aged and Older Americans
Authors: Xu Xiao , Liang Jersey , Kim BoRin , Raymo James , Ofstedal Mary Beth
Published: December 2020

Existing literature on childlessness among middle-aged and older Americans is sparse, and measuring childlessness is not straightforward for those with complex family histories. To address this knowledge gap, we examined data on 19,929 respondents age ≥50 from the 2016 Health and Retirement Study. All analyses accounted for complex sample design to generate nationally representative estimates. The proportion of respondents without children differed significantly depending on how “childless” was defined: 1) 14.9% (95% confidence interval [CI]: 13.9-15.9%) having no biological children, versus 2) 10.4% (95% CI: 9.5-11.3%) having no children/step-children that were living and in-contact. When measured based on absence of biological children, the prevalence of childlessness was higher in younger cohorts (17.7%, 13.2%, and 9.0% for age 50-64, 65-74, and ≥75 years, respectively, p<0.001) and among more educated individuals (17.4%, 12.3%, and 9.6% for more than high school, high school, and less than high school education, respectively, p<0.001). The prevalence of childlessness was also higher among men (16.7%) than women (13.2%) (p<0.001) and among non-Hispanic whites (16.0%) than Hispanics (9.8%) (p<0.001). Similar patterns, but lower prevalence, were observed when measuring childlessness based on absence of children/step-children that were living and in-contact. Although non-Hispanic whites (16.0%) were more likely than non-Hispanic blacks (13.0%) to have no biological children (p=0.007), a similar proportion of them had no children/step-children that were living and in-contact (10.8% versus 10.6%, p=0.06). Given fertility decline and growing family complexity, these findings help inform the structure of social support and long-term care needs of middle-aged and older Americans.
Who Masturbates? It Depends: Predictors of Masturbation by Gender and Partnership of Older Adults
Authors: Barrett Patricia , Burgess Elisabeth
Published: December 2020

Studies on masturbation often exclude older adults. While the frequency of masturbation is known to decline over the life course, research has neglected masturbation in older adulthood. In the adult population, the connection between partnered sex and masturbation has been well established; this relationship is mediated by individual’s contentment with their sex life. Furthermore, the sex/masturbation relationship is distinct by gender. This study seeks to understand how these relationships exist and influence masturbation among older adults. Using data from the third wave of the National Social Life, Health and Aging Project (NSHAP) (N=2,006), we completed logistic regressions to examine how sexual thoughts, frequency and contentment with partnered sex predict older adult’s likelihood of masturbating. Preliminary analyses, controlling for partnership status, gender, age, race, mental and physical health, indicate that frequent sexual thoughts (OR 4.52) and discontentment with sex frequency (OR 1.46), rather than frequent partnered sex, are significantly associated with an increased likelihood of masturbating in the year prior. Employing separate regressions for gender, bothersome sexual dysfunctions and higher depression scores were significantly associated with increased odds of masturbating for women, but not men. For partnered older adults, only those who reported relationships that were both physically and emotionally satisfying were less likely to masturbate (OR 0.54). To our knowledge, this is the first study that considers masturbation as a sexual behavior with distinct predictors by gender and partnership status. We conclude by discussing the implications of nuanced and varying sexual desires and behaviors among the older adult population.
Does Ageism Widen the Digital Divide? And Does It Vary by Gender?
Authors: Choi Eun Young , Kim Youngsun , Chipalo Edson , Lee Hee Yun
Published: December 2020

Existing literature informed that ageism might affect Internet use among older adults, further widening the digital divide among age groups. However, little empirical studies have been conducted on this topic. Our study aims to investigate (1) the current use of the Internet by gender, (2) the association between ageism and Internet use, and (3) potential gender differences. A cross-sectional data drawn from the 2016 Health and Retirement Study (HRS) was analyzed. Separate multiple regression analyses were conducted by gender to determine the varying impact of ageism on Internet use. We used two types of ageism (1) internal ageism (ingroup discrimination) and (2) external ageism (discrimination from external entities) to observe each type’s contribution to Internet use. About half of the sample (52% male and 54% female) reported using the Internet “daily,” while a quarter (26% male and 25% female) responded, “never/not relevant.” No significant differences between gender were found in levels of Internet use, the rates of external ageism, or the degree of internal ageism. A higher level of ageism was associated with a lower level of Internet use. Interaction effects between age groups and ageism varied across gender: external ageism had interaction effects on men’s Internet use whereas internal ageism showed significant results for women. Our findings suggest that ageism may influence Internet use and its impact differs by gender. Gender-tailored intervention strategies should be developed to help older individuals to diminish the adverse effects of ageism on Internet use.
Education and Literacy in the Digital Divide: Cross-National Comparison of East Asia and the USA
Authors: Yamashita Taka , Kim Giyeon , Liou Chih-ling , Ando Takatoshi , Liu Darren , Bardo Anthony
Published: December 2020

The disproportionate access to, and utilization of, modern information, communication and computer technologies in later life (or Digital divide) is widely recognized as a major problem in economically developed nations. Extant research has established that the digital divide is largely contingent on advanced age and socioeconomic status (e.g., educational attainment). Yet, most studies have exclusively focused on Western populations. Thus, the objective of this study was to examine patterns in the digital divide by educational attainment, and identify the role that basic skills (i.e., literacy) play in shaping cross-national differences. Internationally representative data of adults aged 45 years and older from Japan, South Korea, and the US were obtained from the Program for International Assessment of Adult Competencies (PIAAC). The PIAAC data include information on everyday digital technology use (e.g., computer device, email, online information and transactions), sociodemographic characteristics, and systematic literacy assessments (score 1-500). Based on results from weighted binary logistic regression models that used the moderator function, the effects of education on email use were significantly weaker (odds-ratio = 0.78, p < 0.05) in Japan vs. US, but equivalent in Japan vs. South Korea (p > 0.05). Additionally, education (odds-ratio = 1.22, p < 0.05) and literacy (odds-ratio = 1.01, p < 0.05) were consistent predictors a digital divide, and the effects of literacy were similar across all three nations (p > 0.05). Theoretical explanations of findings and other results are discussed in cultural contexts.
The Moderating Impact of Attending Services on the Effect of Older Adults’ Discrimination Experiences on Loneliness
Authors: Kim Dahee , Lee Kyuho
Published: December 2020

Research has shown that perceived discriminations impact physical and mental health in later life. Discrimination experiences could make older adults consider themselves as a social misfit and decrease their social interactions, which finally increases their loneliness. Religious behaviors has been reported as a key factor of a lower sense of isolation. Considering that religious behaviors provide opportunities to engage in more extensive social networks and have supportive social ties with community members, attending religious services might decrease the impact of older adults’ perceived discrimination on loneliness. The current research aims to examine the moderating role of religious services attendance in the association between older adults’ perceived discrimination and loneliness. We used data of 4,488 adults aged 50 to 80 (M=66.27, SD=10.15) from the Health and Retirement Study (HRS) collected in 2012 and 2014. Linear regression analysis was performed to investigate whether older adults’ religious service attendance might decrease the impact of their perceived discriminations in daily life on the level of loneliness. The results indicated that more perceived discriminations older adults face on a daily basis were significantly associated with higher levels of loneliness. However, participants who frequently attended religious services showed a lower impact of perceived discriminations on their loneliness. These findings highlight the positive effects of engaging in religious activities on discriminated older adults’ social well-being. These findings also emphasize the role of the religious community as a social resource for socially marginalized older adults.
Distinctions on the Importance of Age-Friendly Services by Old Age Groups: A Comparative Study Between the USA and the EU
Authors: Bogataj David , Bogataj Marija , Hyer Kathryn , Black Kathy
Published: December 2020

Based on the initiative of the World Health Organization in 2007, when describing the global age-friendly cities by a guide to enhance active aging and the age-friendliness of communities, Black and Hyer (2019) presented generational distinctions on the importance of age-friendly community features by focusing efforts on the built, social, and service environment in USA. Their study aimed to examine the differential salience of community features by older generational age groups including Baby Boomers and younger persons 50 years and older, and older cohorts, born before and during WWII. They found that the Chi-square results indicate significant differences across the generational age groups in all domains. We wanted to compare the preference of the same age cohorts in Europe. The sizes of samples were half of the size of samples considered by Black and Hyer, therefore we used z+4 tests which also have shown the distinctions pertaining to preferences on housing and participation in social activities. The differences between ranking in importance of Age-Friendly Community Features by Older Age cohorts in USA and EU are presented and discussed.
Gender Differences in Attitudes Toward Aging and Its Longitudinal Impact on Psychological Health
Authors: Choi Eun Young , Franco Yujin , Zelinski Elizabeth
Published: December 2020

Individuals with negative attitudes towards own aging (ATOA) experience worse psychological health in later life. At the intersection of sexism and ageism, women are likely to have greater concerns about growing older and hold more negative views of aging than their men counterparts. However, the impact of gender on the relationship between ATOA and psychological health is unclear. Moving forward, the current study aims to examine 1) gender differences in longitudinal changes in ATOA and 2) whether gender moderates the association of ATOA with cognitive function and depressive symptoms. Using three waves (2008, 2012, and 2016) from the Health and Retirement Study, a total of 6,675 adults aged 50+ (60% female) were analyzed. A series of multilevel growth curve analyses were performed to investigate the 8-year changes in ATOA and within- and between-person effects of ATOA on cognitive function and depressive symptoms. The models controlled for demographic, socio-economic, and physical health characteristics. Women had more negative ATOA at baseline compared to men, but not in rates of change. When levels of ATOA were more negative, both cognitive performance and depressive symptoms were poorer over time between individuals as well as within-person. We found that the detrimental effects of negative ATOA on depressive symptoms were stronger for women, but there were no significant gender differences in relation to cognitive functioning. Our findings demonstrated that women view aging more unfavorably than men, and the effects of endorsing negative ATOA are more pronounced on women’s mental health.
How Growing Older With Their Best Friend Changes Older Adult Men’s Perspectives on Aging
Authors: Mueller Ranell
Published: December 2020

Knowledge of the deeper meaning of how growing older alongside companion animal dogs affects men’s perspectives of aging is limited. This study employed qualitative research methods utilizing individual interviews and panel discussions with older adult men in order to investigate the dynamic phenomenon of their personal experience of growing older alongside their aging companion animal dogs. Individual audio-recorded and in-depth interviews and repeated panel discussions with a sub-group of participants, convened as a panel over a three-month period, explored behavioral and emotional manifestations of aging along with a companion animal. Analysis involved open, axial, and selective coding of transcripts to reveal underlying patterns within the data. Outcomes included insight into the role of dogs in the men’s perspectives of attitudes toward aging, toward not only themselves as older adult men, but also toward their aging dogs. Findings reveal that the older adult men felt empathy for their aging dogs, which translated to feeling empathy for themselves as well as other older adults. The men revealed attitudes of being sympathetic and understanding of the aging process simply as a result of aging alongside their aging dogs. A prominent idea that emerged was a feeling of grace toward oneself, others and their aging dogs. This study offers insight into the deeper understanding of one effect caring for older companion animals has on older adult men’s attitudes toward aging. This study provides movement toward a theory of the role of dogs in the development of older adult men’s attitudes toward aging.
The Effect of Nonessentialist Beliefs About Aging on Health Behavior Intentions
Authors: Oh Ga-Eun (Grace)
Published: December 2020

Globally, as people expect the longer life expectancy than ever before, people have increasing concerns about their health and aging. Although what people believe regarding aging can affect their health behaviors, limited research has investigated which beliefs regarding aging influence health behaviors. Previous research has shown that essentialist beliefs about aging reflect beliefs that the aging process is fixed, while nonessentialist beliefs about aging reflect the beliefs that the aging process is rather malleable. Since beliefs in nonessentialism regarding aging imply the benefits of health-promoting behaviors, we examine if manipulating nonessentialist beliefs about aging could contribute to intentions to engage in health behaviors. We also investigate if age and income might moderate the effect of nonessentialist beliefs. We conducted an experiment with a sample of American participants of varied ages (n = 599). The results showed that compared to essentialist beliefs, nonessentialist beliefs regarding aging significantly increased an intention to eat healthy food but they did not improve intentions of other health-promoting behaviors in terms of regular exercise and consumption of fruits and vegetables. Income moderated the effect of essentialist beliefs on an intention to eat fruits and vegetables. Specifically, nonessentialist beliefs had a positive effect among high-income people but rendered a negative effect among low-income people. Together, the present findings provide initial evidence that nonessentialist beliefs have a potential to promote health behaviors and call for the further investigation of the effects of educating nonessentialist beliefs on actual health behaviors and the boundary conditions of the effects.
Ethnicity Moderating the Relationship of Cognition Function of Patients With Dementia on Caregiver Depression
Authors: Palmer Alan , Gomez Rowena , Taylor Eric , Steer Eliot , Frank Megan
Published: December 2020

The purpose of this study was to see if ethnicity (African-American and Caucasian) moderates the predictive effects of cognition functioning in patients with dementia on caregivers’ severity of depressive symptoms. Secondary data analyses were conducted from Resources for Enhancing Alzheimer’s Caregiver Health (REACH II; 2001-2004). The participants consisted of 214 African American and 321 Caucasian participants (N = 535). The assessment battery included the Center for Epidemiologic Depression Scale (CES-D) to measure depression severity, Mini-Mental State Exam (MMSE) to measure level of cognitive function, and demographic questionnaire to gain information about caregivers and care-recipients. ANOVAs and ANCOVAs were used to examine ethnic group differences in care-recipient cognitive functioning in predicting caregiver depression. Caucasian caregivers reported significantly higher levels of depression and care-recipients’ cognitive function compared to African American caregivers, ps<.05. A custom ANCOVA indicated a significant interaction between ethnicity and care-recipient cognitive functioning on caregiver depression with greater effects of care-recipient cognitive function on caregiver depression for the African American caregivers than for the Caucasian caregivers, p=.02. Descriptively, the depression severity for the Caucasian caregivers remained relatively high across levels of care-recipients’ cognition. The findings indicated that ethnicity moderated the effects of care-recipient cognitive functioning on caregiver self-report of depressive symptoms. These findings suggest greater resiliency in African -American caregivers supporting their dementia or dementia-related condition care-recipients (Dias et al., 2015). These findings support the need to develop cultural specific interventions to better support the wellbeing of caregivers of care-recipients with dementia or dementia-related conditions.
Race and Educational Disparities in Advance Directive Completion: Encouraging Trends in the United States
Authors: Koss Catheryn , Hensley Rebecca
Published: December 2020

Advance directives (AD) help to ensure patients’ wishes are honored and contribute to improved end-of- life care. Race and education disparities in advance directive completion have been extensively documented. This study examined five waves of U.S. Health and Retirement Study exit survey data (N = 7,067) to examine to what extent these disparities have expanded or diminished over the past decade. Overall, advance directive completion increased from about 63% among participants who died in 2005-06 to about 73% among those whose deaths occurred between 2015 and 2016. Non-Hispanic whites were almost four times as likely to have advance directives compared to Hispanics or African Americans across this time period (OR=3.90. p<.0001). However, the growth rate in advance directive completion among non-Hispanic whites was significantly slower than for non-whites (OR=.90, p<.01). Compared to those with a high school education or less, those with some college (OR=1.67, p<.0001) and those with at least a college degree (OR=2.02, p<.0001) were significantly more likely to have advance directives across the time period. There were no significant differences in growth rates of advance directive completion for the different educational categories. These results suggest that educational disparities in advance directive completion are fairly stable, but that race disparities may be diminishing.
The Influence of Work Status Preference, Health, and Gender on Informal Caregiving Status
Authors: Koreshi Shanika
Published: December 2020

Current, literature has found a negative relationship between caregiving responsibilities and paid employment. There are two possible causal explanations; people with low employment prospects self-select into care and caregiving is time-consuming therefore, it require carers to accommodate this by reducing work. While there is considerable work on the influences of caregiving on work, there is limited research investigating how employment influences informal caregiving decisions. We investigated longitudinal associations between work status preferences (over-employed, underemployed, satisfied) and informal caregiving among older adults in New Zealand. The present study also explored whether gender and perceived health moderated the relationship between work status preference and caregiving. The study used data provided by three waves of the New Zealand Health, Work and Retirement Study. The findings suggest that underemployed and overemployed participants were more prone to taking up caregiving compared to participants who were satisfied with their work status. Regression analyses revealed that females with poor self-reported health were most vulnerable to experience incongruent work status preferences. The direct effects of work status preference on willingness to care may imply conflict between policies promoting full time labour force participation and social welfare policies that are continuing to rely on family carers to support the community. This evidence has implications for care policy given the importance of informal care in sustaining ageing in place policies.
Perceptions of Caregiving: Racial Examinations of Resiliency and Stress
Authors: Koumoutzis Athena , Cichy Kelly
Published: December 2020

Adult children are at risk of emotional strain when parental caregiving needs emerge. Pearlin’s Stress Process Model (1990) and caregiver studies suggest minority caregivers report lower subjective caregiving burden, however, few studies simultaneously consider both the stresses and rewards of caregiving. Using data from Wave II of the Family Exchange Study (N = 243), we examine racial differences in midlife adults’ perceptions (i.e., stress and rewards) of assisting their parents with activities of daily living (ADLs) and the associations between perceptions of ADL assistance and emotional well-being among adults who help their parents with ADLs. Compared to non-minority caregivers (M = 4.18, SD = 0.91), minority caregivers (M = 4.45, SD = 0.84) found it more rewarding to help their mother (t(314) = -2.54, p < .05), whereas non-minority caregivers (M = 2.25, SD = .1.27) found it more stressful to help their father than did minority caregivers (M = 1.64, SD = 0.99), t(162) = 3.01, p < .01). After controlling for demographics and ADL needs, linear regression analyses revealed that the stress of helping parents predicted depression (F(6, 189) = 5.30, p < .001) and race moderated the association (p < .01); the association was only significant for minority caregivers (p < .05). Implications will be discussed.
The Impacts of Discrimination and Filial Caregivers’ Age on Aspects of Physical Health
Authors: Hodgdon Barbara , Wong Jen
Published: December 2020

Filial caregivers (e.g., individuals caring for a parent or parent-in-law) are a part of the growing number of family caregivers in midlife and late adulthood. The responsibilities that filial caregivers navigate in midlife and late adulthood may expose them to multiple types of discrimination that may decrease their physical health, though this relationship has been understudied. As numbers of family caregivers grow, it is important to examine the potential vulnerability of younger and older filial caregivers’ physical health in the context of discrimination. Informed by the life course perspective, this study compares the physical health of younger (aged 34-64) and older (aged 64-74) filial caregivers who experience discrimination. Filial caregivers (N=270; Mage=53; SD=9.37) from the Midlife in the United States (MIDUS-II) Survey reported on demographics, family caregiving, daily discrimination, self-rated physical health, and chronic conditions via questionnaires and phone interviews. Regression analyses showed no differences between younger and older adults’ self-rated physical health or average chronic conditions. However, moderation analyses revealed that younger filial caregivers who experienced greater discrimination reported poorer self-rated physical health than their older counter parts as well as younger and older filial caregivers who experienced less discrimination. Additionally, younger caregivers with greater discrimination exposure exhibited more number of chronic conditions as compared to other caregivers. The study results highlight the impact of the intersection between filial caregivers’ age and discrimination on physical health. Findings have the potential to inform programs that could promote the health of filial caregivers in the face of discrimination.
The Effects of Reading Engagement on Older Adults’ Resource Allocation in Reading and Cognition
Authors: McCall Giavanna , Hwang Sueyoun , George Takudzwa , Liu Xiaomei , Stine-Morrow Elizabeth A L
Published: December 2020

With aging, print exposure has been shown to predict effective resource allocation during reading, as well as to account for growth in certain abilities. To test the hypothesis that literacy engagement has causal effects on reading processes and the cognitive abilities on which they depend, we developed a home-based literacy intervention administered via iPads. Participants (64% female; 60-79 years of age; < 10hrs/week of reading at baseline) were randomly assigned to an 8-week reading intervention group (developed in collaboration with a Champaign Library adult literacy specialist) or to a puzzle control, both of which involved ~8hrs/week of activity engagement. At pretest and posttest, participants performed a self-paced reading task to assess resource allocation to word and conceptual processing, and completed a battery of cognitive measures assessing episodic memory, working memory, and verbal fluency (alphas ≥ .79). Based on one-tailed tests, results showed greater positive change in working memory, t(57)=1.69, p<.05, for the literacy group relative to the control, and a marginally significant difference in change in episodic memory, t(57)=1.62, p<.06, but not in verbal fluency, t< 1. In addition, there was a significant difference between conditions in change in resource allocation to conceptual processing, t(53)=1.75, p<.05. Changes in working memory and conceptual processing were positively correlated (r=.27, p=.02). These findings suggest that reading engagement may be beneficial for older adults’ growth in fluid ability, which impacts reading processes, so as to create a “virtuous spiral” of resilience between literacy engagement and ability.
Provider-Identified Deprescribing Facilitators and Strategies for Older Adults in Primary Care: A Team Alice Study
Authors: Brady Laura , LaValley Susan , Ranahan Molly , Clark Collin , Monte Scott , Jacobs David , Wahler Robert , Singh Ranjit
Published: December 2020

Potentially inappropriate medications (PIMs) may harm adults over the age of 65, yet PIMs are prescribed at high rates. The process of deprescribing PIMs is challenging in the primary care setting, particularly among older adult patients with multiple chronic conditions. While barriers to deprescribing are well known, less data are available on the facilitators and strategies that primary care providers consider key to successful deprescribing. This study examines providers’ perceptions and attitudes of deprescribing to identify individual and systems-level facilitators and strategies for successful deprescribing. Data were collected through semi-structured interviews with 20 providers recruited from primary care practices located in Western New York. Rapid thematic analysis was used to identify the facilitators and strategies providers perceived as important to successful deprescribing. Facilitators included providers adapting their approach to deprescribing PIMs based on their knowledge of the patient. Providers’ own characteristics were also important, as were those of their organization, including whether a clinical pharmacist was available to consult. Strategies for deprescribing were patient-focused (e.g., adapting to patient’s lifestyle), process-focused (e.g., patient education on polypharmacy), and medication-focused (e.g., tapering). It is clear that many of the primary care providers who treat a larger number of older adults are aware of the importance of deprescribing PIMs. However, deprescribing in a busy primary-care setting is challenging. Findings detailing providers’ perceptions of facilitators and strategies for deprescribing can guide future interventions and target support to reduce the risk of harm from PIMs in older adults.
Interpersonal Relationships in Assisted Living: Findings From a Survey of Family Members and Staff
Authors: Falzarano Francesca , Reid M Cary , Schultz Leslie , Pillemer Karl
Published: December 2020

In recent decades, assisted living facilities (ALFs) have grown dramatically as an alternative to nursing homes. Research in nursing homes has shed light on the nature of the relationships that exist between family members and staff. However, little is known about family-staff relations within ALFs. We present data from the first study to describe the prevalence of conflict and positive and negative family-staff interactions in ALFs and to examine whether positive and negative aspects of the relationship contribute to salient staff and family outcomes. We use data collected from 252 family members and 472 staff members across 20 ALFs from the Partners in Care in Assisted Living (PICAL) study. Participants completed measures including interpersonal conflict, depression, perception of treatment, and stress-related to caregiving. Results showed that conflict among family and staff members is relatively low in ALFs. For staff, interpersonal conflict and treatment by family members significantly predicted burnout and depression. For families, only gender significantly predicted burden. Subgroup analyses, however, indicated that the effect of interpersonal conflict was significantly associated with perceived caregiver burden among family members whose relative has dementia. Despite the relatively harmonious relationships identified among family members and staff in ALFs, sources of conflict and negative interactions were identified, revealing the influence these relationships have on both family and staff outcomes. These findings can inform intervention efforts targeting family-staff interactions within ALFs.
Psychosocial Reactions to Relocation to Nursing Homes in Chinese Older Adults
Authors: Lan Xiuyan , Xiao Huimin , Chen Ying
Published: December 2020

This study aimed to elicit psychosocial reactions to relocation to nursing homes from older adults’ perspectives with a qualitative interview design. Narratives from 23 Chinese nursing home residents from Fuzhou, China in a life review program were recorded, transcribed into sentences, and analyzed with the qualitative content analysis. It revealed five stages of psychosocial reactions to relocation to nursing homes as fear, struggle, compromise, acceptance, and contribution. The first stage resulted from negative labels attached to nursing homes, disconnection to the society, difficulties in establishing new relationships, and being abandoned by their families. The second stage described the behaviors of struggle: complain about family members, think of going back home, pray to have a change, and take action to leave. The third stage described the keys to compromise: choices between maintaining the harmony in family relation and companionship of relatives, choices between professional care and family care, and choices between costs and effects of family care and nursing home care. The fourth stage described how they accept nursing home life: accept the life and yet with worries, affirm benefits of living in nursing homes, and embrace the nursing home life. The last stage resulted from sense of ownership and giving full play to self-worth. This study generated new insights into the knowledge on psychosocial reactions to relocation to nursing homes and provided both family members and nursing home staff with a direction for how to promote a smoother relocation process.
NH Compare’s Health Deficiency 5-Star Rating: Do We Learn Different Things From Survey and Complaint Deficiencies?
Authors: Peterson Lindsay , Bowblis John , Hyer Kathryn
Published: December 2020

The Centers for Medicare and Medicaid Services (CMS) publishes a 5-star rating system for nursing homes (NH). Currently, the 5-star rating for health deficiencies weights deficiencies from annual recertification surveys and complaints equally. Complaint deficiencies may contain different information than survey deficiencies because complaint deficiencies originate with consumers and complaint inspections are less predictable than surveys. The objective of this study is to construct separate 5-star ratings for survey and complaint deficiencies, and to compare them to CMS’ 5-star rating for health deficiencies. Using CASPER and ASPEN Complaints/Incident Tracking System for all NHs in 2017 (N=15,373), we calculated the 5-star rating for health deficiencies as reported by CMS, and then decompose CMS’ rating into separate 5-star ratings for survey and complaint deficiencies. The overall distributions of the CMS’ deficiency rating and survey deficiency rating are similar. The distribution of the complaint deficiency rating is different from CMS’ deficiency rating. Using complaint deficiencies, more NHs have 5-stars (26.5% vs. 10.5%) and fewer facilities have 4-stars (11.2% vs. 23.3%). Comparing the ratings for each facility relative to CMS’ rating, 35.3% of NHs have a different survey deficiency rating while 54.4% have a different complaint deficiency rating. A 5-star rating based on survey and complaint deficiencies results in different ratings for NHs, indicating that complaint deficiency ratings contain different information from survey deficiency ratings. CMS should publish separate ratings based on survey and complaint deficiencies to provide different information.
Living With Dementia: Flipping Stigma on Its Ear
Authors: O'Connor Deborah , Phinney Alison , Mann Jim , Chaudhury Habib , Seetharaman Kishore , Landy Ania , Paulina Malcolm
Published: December 2020

The language of social citizenship has emerged in the academic literature as one way of shifting the discourse to counter persistent problems of stigma and social exclusion for people with dementia. What this means and how it is experienced however from the perspective of those with dementia remains unclear. As part of a larger Participatory Action Research (PAR) study, an Action group of people with dementia began meeting in June 2019. The group now consists of ten members and meets monthly. The first task of the Action group was to assist in developing a more refined and practical understanding of the construct of social citizenship. Facilitated discussions were guided by the following questions: What are experiences of social citizenship by people with dementia? What kinds of practices and relationships promote the capacity of people with dementia to experience themselves as social citizens? Emerging findings indicate that the stigma is readily identified as a dominant aspect of the experience of living with dementia which needs to be ‘flipped on its ears’. Strategies for countering stigma include recognizing how language can both facilitate and block change, acknowledging dementia as a time of both loss and significant growth, remaining visible as a whole person – equal and also different - and maintaining active participation in one’s own life. These themes tie directly to the components identified in the academic literature of citizenship. However, members of the Action group were clear that the language of social citizenship is neither empowering nor strategic.
Capitalizing on Shared Interests: Achieving Age-Friendly University Endorsement Through Partnership and Advocacy
Authors: Terhune Katherina , Graf Allyson , Kim Suk-Hee , Danzo Amy , Conwell Sara
Published: December 2020

Response to the lifelong educational needs and interests of the older adult population calls for new opportunities and innovative practices in teaching, research, and community engagement that universities need to be prepared to offer their students and community. This presentation provides information from an Age-Friendly University (AFU) that currently has no gerontology degree or certificate program, highlighting various campus wide programs and initiatives aligned with the AFU principles. In particular, collaborative strategies involving faculty and the Adult Learner Programs and Services to help promote campus buy-in and AFU endorsement will be emphasized. Practical strategies will be discussed to assist junior and senior level faculty and other university personnel wanting to achieve AFU endorsement at their institution of higher education in order to shape age-friendly programs and practices.
Curricula Innovation to Positively Influence Preference for Working With Older Adults: A Review of the Literature
Authors: Brewer Christine
Published: December 2020

Few nursing students show preference in working with older adults. The purpose of this study was to review the U.S. nursing education evidence-based literature to determine curricula innovation to positively influence preference for working with older adults. CINAHL, Medline, Ovid Emcare, PsychInfo, and PubMed databases were searched for relevant U.S studies published between 2009 and 2020 using the search terms “nursing students”, “geriatrics OR gerontology OR older adults OR elderly OR aging”, “career OR work”, and “choice OR preference OR attitude”. Nine studies were eligible for inclusion. Nursing education may play a role in influencing how students perceive and prefer to work with older adults. Promising interventions include stand-alone gerontology courses, intergenerational service-learning experiences, and clinical experiences with community dwelling older adults. More evidence-based research with larger sample sizes are needed to determine effective nursing education interventions to improve nursing students’ attitude and preference for working with older adults.
Engagement and Mentorship of Undergraduate Students in Aging Research
Authors: Danner Alyssa , Whitehouse Christina , O’Connor Melissa
Published: December 2020

Education and mentorship of undergraduate students extends beyond the classroom and clinical setting into research. This presentation will discuss the experience of the student and research mentor as well as provide findings from an important qualitative research study. Through a university funded grant, a student nurse partnered with faculty to investigate the needs and experience of caregivers of recently hospitalized older adults with diabetes. Caregivers play a vital role in caring for older adults, often they do not receive the education necessary to achieve optimal health outcomes. Qualitative interviews of 20 caregivers were conducted. The main themes that emerged from the data were: the role itself, challenges, preparation, and additional comorbid diagnoses. These findings provide an understanding of experience, tasks, and needs of caregivers for older adults with diabetes. This research experience provided exposure and education that is essential to developing future aging research scientists.