bluuebunny/crossref_metadata_2025 huggingface dataset:
A Retrospective Study of Retired Academics: Long-term Career Benefits of Past Mentoring Behaviors
Authors: Blanco Giovanna Garrido , Boeder Jordan , Fruiht Veronica , Erikson Kevin , Hwang Sarah , Chan Thomas
Published: December 2021

While there is extensive literature on the benefits of mentoring for mentees, less is known about the impact of those relationships on mentors, particularly, after mentors complete their careers (i.e., retirement). For academics, the time and energy spent mentoring students can either be beneficial or costly to productivity. This study explores the associations between past mentoring and present evaluations of retired academics’ careers, seeking to investigate the long-term career benefits of mentoring. Understanding the evaluation of older adults’ careers at retirement in relation to their prior engagement in mentoring is critical, as mentoring is an integral component of careers in academia. Survey data were collected from a national sample of 277 retired academics averaging 73.6 (SD=6.2) years old and 7.7 (SD=5.8) years post-retirement. Results from structural equation models demonstrated that retired academics who reported having more protegees (β=.19, p=.024) and engaged in more mentoring behaviors (β=.18, p=.027) exhibited increased objective career benefits. Providing more mentoring functions was also associated with higher subjective career achievement (β=.33, p<.001). Interestingly, the number of mentees and mentoring behaviors were not correlated to career satisfaction. Findings from the current study demonstrate the association between past mentoring experiences with career success. Examining the link between mentoring behaviors and overall assessments of career in retirement offers important insight into the long-term benefits of mentoring in higher education training prompting further research into the realization of these benefits in later life.
Agree to Disagree: Generational Differences in Ideological Values and the Impact on Depressive Symptoms
Authors: Scott Rachel , Lopez Acacia , Nadorff Danielle
Published: December 2021

Family Systems Theory states that values are transmitted between generations within families and, while many of these values are similar between immediate generations, there may be more differentiation in values between generation gaps. Ideological differences between generations may potentially cause subsequent tension and fluctuations in well-being. The current study sought to examine the moderating effect of generation on the relation between ideological values (political and religious) and depressive symptoms. Participants included 419 grandparents (age: M = 76, SD = 5.18) and 638 adult grandchildren (age: M = 29, SD = 5.57) from the 8th wave of the Longitudinal Study of Generations (LSOG) data set, collected in 2005. While violations in assumptions for the testing of religious ideology prevented additional analyses with that variable, significant mean differences were found between grandparents and grandchildren in political ideology scores, with grandparents expressing more conservative views. Generation also moderated the relation between political ideation levels and depressive symptoms. These relations trended in opposite directions for each generation (with non-significant conditional effects), such that when grandparents endorsed more conservative values, depressive symptoms decreased. Conversely, when grandchildren endorsed more conservative values, depressive symptoms increased. These findings indicate that while the older generation found a conservative viewpoint to be a protective factor for mental health, this was not true of younger generations, and indicates a need for age-specific cultural factors to be included in clinical intervention plans. Further implications for these findings will be discussed.
The Effects of Social Support on the Psychological Well-Being of Older Parents: A Longitudinal Study
Authors: Blanco Erik
Published: December 2021

This study examines whether parental support (the provision of social support by older parents to adult children) and filial support (older parents’ receipt of social support from adult children) influence two orthogonal dimensions of older adults’ psychological wellbeing: positive feelings and negative feelings. This study also highlights the importance of accounting for parental need as a mediator of social support. A longitudinal design is used to examine the effects of social support on the psychological wellbeing of older adults at Wave 6 (1998) and Wave 8 (2004) of the Longitudinal Study of Generations. Parental support significantly increases parents’ positive feelings, which suggests that, when it comes to positive feelings, it is better to give support than to receive it. Filial support findings indicate that older adults with greater level of disability demonstrate a decrease in negative feelings when they received filial support. However, this effect does not hold for older adults with lesser levels of disability, suggesting that, when it comes to older adults’ negative feelings, it is better to receive support (rather than to give it) when parents are in need. Although parental and filial support have the potential to buffer stressful life transitions in old age, most parents wish to remain independent, even in later life, making them reluctant to accept filial support. The parent-adult child relationship is crucial for psychological wellbeing, especially because of increased life expectancy.
Development and Initial Evaluation of the Caring Through COVID-19 Psychotherapy Group for Family Care Partners
Authors: Plys Evan , Williams Kadija N , Tyrrell Caitlin J , Weiskittle Rachel
Published: December 2021

This project details the development and initial evaluation of a manualized psychotherapy support group for family care partners of persons living with dementia, specially designed to address pandemic-related stressors. The authorship team, consisting of clinical geropsychologists, developed a treatment manual based on existing protocols, such as: cognitive behavioral therapy for pandemic-related stress, grief management and ambiguous loss, and caregiver family therapy. The resulting 8-week Caring Through COVID-19 psychotherapy group was piloted in an outpatient mental health clinic via tele-mental health with six family care partners of persons living with dementia. All participants were women and spouses or partners of the care recipient; mean age was 70.5 (SD = 9.07). Preliminary data showed a non-significant and small reduction in depression (d = .22) and non-significant moderate reductions in caregiver burden (d = .52) and pandemic-related stress (d = .64). Moderate non-significant improvements were observed in general caregiver self-efficacy (d = .62) and self-efficacy for emotional regulation (d = .67). The majority of participants reported that the content of the group was novel (83%) and relevant (83%); the most utilized topics outside of the group were accepting emotions (100%) and challenging negative cognitions (83%). Overall, most participants were very or extremely satisfied with the group (67%). Additional data is currently being collected with another cycle of the group (n = 4). Preliminary findings suggest that the Caring Through COVID-19 group may be beneficial for supporting family care partners during the pandemic. Considerations for implementation and future plans for dissemination will be discussed.
ACT-related Processes: Value-based Living Attenuates Meditating Relationships in Caregiver Stress Outcomes
Authors: Fauth Elizabeth Braungart , Novak Joshua , Aller Ty , Kelley Heather , Levin Michael
Published: December 2021

Associations between behavioral and psychological symptoms of dementia (BPSD), caregiver burden, and depressive symptoms are well-established, and these constructs are often targeted in interventions. Increasingly, dementia caregiver interventions are informed by mindfulness- and acceptance-based approaches, such as Acceptance and Commitment Therapy (ACT). In addition to standard outcomes, like burden and depressive symptoms, these interventions/therapies seek improvements in individuals’ psychological flexibility (e.g., cognitive defusion, present moment awareness, values-based living). Less is known how these constructs interact within well-established caregiver stress processes. We examined a moderated mediation model (N=161 dementia caregivers; PROCESS Procedure; SPSS Release 2.16.1), with BPSD frequency (Revised Memory and Behavior Problems Checklist) predicting depressive symptoms (10-item CES-D), mediated via caregiver burden (short Burden inventory). The moderator was the Values Questionnaire (Progress scale), and we controlled for gender, caregiver duration, age, income, and education. Results revealed that the indirect effect of BPSD on depressive symptoms through caregiver burden was weakened through higher progress toward values (moderated mediation significant at p<.05). In essence, greater levels of living according to values dampened the effect of BPSD on depressive symptoms, through care-related burden. These findings are important because caregivers often cannot leave this role, requiring them to learn to live with the caregiving role in healthy ways. Value-based living and committed action toward values signify caregivers’ success at balancing care-related stress with other priorities, and psychologically adjusting to difficulties. Interventions that emphasize values-based living, like ACT, have promise for caregivers, offering healthy ways to psychologically adjust to, and live with, the experience.
Caregiving in Older Adulthood and Meaning in Life
Authors: Suntai Zainab
Published: December 2021

While most of the literature on caregiving in adulthood focuses on grandparenting, there is an increasing trend of older adults providing care to an adult care recipient. Older caregivers are often females who are providing care to a spouse with medical conditions and are often doing so while coping with their own functional limitations, with limited support. Within the older adult literature, studies have captured the strain experienced by caregivers of older adults, who are often burdened by the loss of time and opportunity as a result of caregiving. For caregivers in older adulthood however, caregiving may be an avenue to remain engaged and active, and a way to have purpose in life. Therefore, the purpose of this study was to examine the association between caregiving in older adulthood and meaning in life. Data from the 2018 National Health and Aging Trends study were used, which is an annual longitudinal panel survey of Medicare beneficiaries in the United States. Chi square tests were used for bivariate analyses and a logistic regression model was used to predict meaning in life based on caregiving status. After accounting for all other explanatory variables, caregivers were 50% more likely to have meaning in life compared to non-caregivers (OR=1.501, CI= 1.493-1.510). This indicates that caregiving can be a form of meaningful/productive engagement for older adults and interventions should focus on providing adequate emotional and financial support to older caregivers.
Resilience in Family Caregivers of Adults With Autism Spectrum Disorder: An Integrative Review of the Literature
Authors: Chakurian Daphne
Published: December 2021

Care of adults with Autism Spectrum Disorder (ASD) is a public health priority and costs are projected to be 549 billion US dollars by 2025. Middle and older adult FCGs of adults with ASD often provide lifelong care, experience chronic stress, consequently, are at risk of poor mental health and QOL. An integrative review examined factors associated with resilience in studies of middle and older adult FCGs of adults with ASD. A comprehensive literature search found 10 reports of 8 studies published in peer-reviewed scholarly journals before October 13, 2020. Studies and/or reports of factors associated with resilience in middle and older adult FCGs of adults with ASD were examined using PRISMA, and quality checklists. Some 340 articles met search criteria, 14 were fully reviewed, and 10 were included. Findings suggest FCGs of adults with ASD show capacity for resilience consistent with research on FCGs of children with ASD significant chronic stress. A broad range of resilience factors were studied, and resilience was associated with positive social support, higher QOL, self-efficacy, and problem and meaning-focused coping styles. There is a dearth of research on middle and older adult FCGs of adults with ASD. Increased reporting of social determinants of health and participation of underrepresented groups is needed. Future research must address FGC heterogeneity and specify theoretically grounded conceptual and operational definitions of resilience. Identifying resilience factors is necessary for intervention studies to enhance resilience.
Effectiveness of Transitional Care from Hospital to Home in Frail Older Adults: A Systematic Review
Authors: Lee Ji Yeon , Yang Yong Sook , Cho Eunhee
Published: December 2021

Frail older adults are at high risk of negative consequences from hospitalization and are discharged without completely returning to their pre-existing health status. Transitional care is needed to maintain care continuity from hospital to home. This systematic review aimed to examine transitional care for frail older adults and its effectiveness. The Cochrane guidelines were followed, and search terms were determined by PICO: (P) frail older adults, not disease-specified; (I) transitional care initiated before discharge; (C) usual care; and (O) all health outcomes. Four databases were searched for English-written randomized controlled trials (inception to 2020), and eight trials were ultimately included. Frail older adults in eight trials (1996–2019) totaled 2,785, with a mean sample size of 310. The intervention components varied from hospital care (e.g., geriatric assessment, discharge planning, rehabilitation) to follow-up care after discharge (e.g., home visit, phone follow-up, community service). Most measured outcomes were readmission (n = 7), function (n = 4), quality of life (n = 4), self-rated health (n = 3), and mortality (n = 3). Statistical significance was reported in the following number of trials: readmission (n = 2), function (n = 2), quality of life (n = 1), self-rated health (n = 3), and mortality (n = 0). The effectiveness of the intervention on each outcome was inconsistent across the trials. Varied transitional care between hospital and home was implemented to improve health status; however, its effectiveness was controversial. A novel, yet evidence-based approach is needed to develop transitional care interventions for these vulnerable populations.
Older cancer survivors living with financial hardship in China: The Influence of Confucian Family Values
Authors: Su Mingzhu , Liu Li , Yue Hanlin , Zhang Jiajun , Yao Nengliang
Published: December 2021

Background: Financial hardship has not been well studied among older cancer survivors, despite its debilitating effects on their health and well-being. Aim: To describe the lived experience of older Chinese cancer survivors and explore the financial impacts following a cancer diagnosis. Design: A qualitative study conducted using semi-structured interviews with patients and family caregivers. Methods: We individually interviewed twenty-one cancer survivors (aged □ 60) with financial hardship and twenty family caregivers in Shandong province between August 2020 and January 2021. A content analysis was performed by multiple coders. Findings: Confucianism culture and the Chinese health system considerably impact the construct of financial hardship and its components. Four main categories were revealed:(1) healthcare providers were reluctant to discuss the diagnosis and costs of care with cancer patients; (2) financial transfer from adult children to older parents became prevalent after a cancer diagnosis;(3) cancer-related financial worries and stress spilled out into children's family; (4) coping and adjustment strategies were taken by the extended family. Conclusion: Both older cancer survivors and their adult children experienced financial distress mediating through filial piety in China. Instruments are needed to screen for cancer-related financial hardship adapted to the healthcare system and Confucian family values. Key words: Cancer survivors; older; financial hardship; qualitative; China
Policy Design and Consumer Direction: Cross-country Comparisons on Consumer-directed Care Programs
Authors: ZHANG Jinbao , WANG Julia Shu-Huah , Chen Yu-Chih
Published: December 2021

Objectives: The consumer-directed care (CDC) program aims to maximize health outcomes by offering older adults more control, choice, and flexibility over the care services they received. However, countries may operate CDC programs in different ways based on heterogenous sociostructural systems. We proposed a comparative framework to evaluate three dimensions of CDC—control and direct services, variety of service options, and information and support—and analyzed how countries varied in their policy design to achieve consumer direction. Methods: Using cross-national document analysis, we analyzed eleven CDC programs from seven selected countries (Netherlands, United States (US), United Kingdom (UK), Germany, China, Australia, and Spain) with five CDC care regimes. A total of fourteen indicators capturing three dimensions of CDC programs was developed. We further used these indicators to evaluate and compare similarities and differences of policy features across countries using descriptive statistics and graphical approaches. Results: CDC programs in the Netherlands, Arkansas, and the UK ranked at the top in consumer direction. All countries except Germany employed a “service-based” principle in determination of service type. Training care workers was in the most widespread use to assure quality of care. Merely the UK and Germany integrated CDC and conventional agency care without restrictions. Representative with relevant support was only available in the UK and Netherlands. Discussion and Implication: CDC models involve multi-faced aspects, rather than dichotomies and discrete entities. Implications include the need for a systematic reflection with our developed framework and enriching variety of service options to promote consumer direction.
Acceptance Commitment Therapy Intervention for Custodial Grandfamilies: A Virtual Implementation
Authors: Faulhaber Ella , Custis Meghan , Heupel Emily , Lee Jeongeun
Published: December 2021

Custodial grandfamilies often face challenges, such as psychological distress, parenting burden, and grandchildren showing internalizing and externalizing behaviors. Given their circumstances, effective training and education is critical to provide a supportive family environment for both custodial grandparents and custodial grandchildren. The aim of this study was to develop, pilot and evaluate a psychosocial intervention for custodial grandfamilies. The program, interACT, was implemented virtually due to restrictions related to COVID-19. It is an intervention for custodial grandparents (CGPs) and custodial grandchildren (CGC) to improve psychological wellbeing and life skills. Participant eligibility was determined by grandfamilies having Iowa residency and legal guardianship or custody of an 8-12 year old grandchild. The program utilizes the Acceptance and Commitment Therapy (ACT) framework, focusing on psychological flexibility, acceptance, and psychosocial resilience for CGPs and CGC. The program used techniques such as mindfulness, self-compassion, and decision-making skills. During the pilot program stage, participants were divided into CGPs and CGC groups, and completed self-paced weekly 45 minute long modules through a program website. To enhance online session experience, Extension staff facilitated hour-long Zoom calls to discuss module contents and foster peer connection for both groups. Findings will be available at the conclusion of the pilot program. We expect to find increased psychological well-being and improved life skills for both groups right after the implementation of the ACT. Findings and limitations will be discussed with practical implication for program implementation via virtual delivery for the current custodial families. Future studies could extend current curriculum to other populations.
Virtual Empowerment Training: Reaching Grandparent Caregivers During COVID19
Authors: Cox Carole
Published: December 2021

COVID-19 has had a devastating impact on minority populations in the United States who have disproportionately been at risk of getting the virus, having severe illness, and dying from it, with these risks most pronounced for older adults. The impact has been particularly severe on the more than on the more than 2, 7 million grandparents raising their grandchildren in the United States. Covid-19 has added profound strains to these families as they struggle with resources and isolation, frequently without assistance as well as the challenge of helping children to navigate online learning. The Virtual Empowerment Training Project, developed as a 7 session pilot program for low income grandparent caregivers in New York includes classes that strengthen parenting, communication, coping with loss and grief, and community empowerment. Participants were given ipads and computer training prior to classes, all conducted through Zoom. Initial data from the 56 participants (M age = 62, Race/ethnicity=Black, 79%, Hispanic, 16%, Income annual 41%<$15,K ) indicate improvement, i.e. a lessening of Negative Affect regarding the grandchild (p < .01) in the quality of their relationships with their grandchildren while also experiencing a decline (p < .01) in their sense of parental efficacy, possibly reflecting their becoming more critical of their own parental skills. Participant evaluations of the course were overwhelmingly positive, with more than 90% finding it extremely helpful, valuable, and eager to share it with others and to become more involved in improving the lives of grandfamilies..
Development of Online Child Support Activities by Older Adults; An Action Research During the COVID-19 Pandemic
Authors: Takase Mai , Ogino Ryogo , Nitanai Ryoichi , Goto Jun
Published: December 2021

Japanese communities have been attempting a novel type of childcare support, wherein community-dwelling older adults form a specialized group (support group) that aims to provide child support activities. Before the COVID-19 pandemic, the group gathered children and mothers in community spaces and conducted events. However, on-site support had to be halted due to the pandemic. In this study, we report a case of action research aimed at shifting the activities online. First, a suitable online support plan was explored by hosting several discussions with child-rearing mothers. A questionnaire survey was then conducted to determine the most-sought intervention contents (N=19). Finally, based on the results, an intervention was conducted. As a result of the discussions, the hosting of online programs was set as the main goal. Out of the ten activities studied, the three most popular activities were programming (n=17), English conversation (n=16), and science workshop (n=15). Based on the results, an online science workshop that built a Bottleium, a small aquarium using a bottle, was hosted. Eight children participated in the event. A post-activity survey revealed that all participants attended the online activity for the first time, and the parents were happy to have joined the activity that entertained their child during the quarantine period. Furthermore, focus group interviews were conducted with the support group; they reported being satisfied with the outcome and recognized the importance of their role as member of support group. The results suggest the positive effect of this project on both older adults and the children.
Do young adults see value in advance directives?
Authors: Stone Arianna , Young Yuchi , Perre Taylor , Chung Kuo-Piao , Chen Ya-Mei
Published: December 2021

Many Americans avoid end-of-life care planning; only 26% have completed an advance directive (AD). An AD promotes end-of-life care with dignity allowing individuals to make end-of-life treatment and care decisions before they are unable to do so. Previous studies related to ADs are focused on older adults with serious illness or people with functional/mental disability. The objective of this survey is to better understand young adults' knowledge of and attitude toward ADs and their preferences for ADs related to treatment and care options. Methods. Participants include graduate students (n=25) attending a state university in New York State (NYS). Data were collected using two ADs (Five Wishes; Medical Orders for Life-Sustaining Treatment (MOLST)) and one survey questionnaire. Summary statistics and multivariate models will be used to address the study aims. Results. Preliminary results show the average age was 23 years, 72% were female, 48% White, and 44% Black. The majority of young adults hadn’t completed an AD; however, their attitude toward ADs was positive; the majority believe it is important to have an AD prepared at their current age; and they believe young adults would willing to fill out ADs. Young adults can make difficult treatment and care decisions when the situation requires it. Conclusion. The study findings can be useful to policy makers, healthcare providers and other stakeholders in promoting population-based healthcare decision-making. Limitation. Participants were recruited from one university in NYS; thus, the study results may be generalized to a population sharing similar characteristics.
Cognitive Changes in Older Adults Following a Stepped Care Intervention for Late-life Depression
Authors: Zhang Anna Y , Lu Shiyu , Liu Tianyin , Leung Dara K Y , Wong Gloria H Y , Lum Terry Y S
Published: December 2021

Older adults with depression may manifest cognitive decline and treating depression may maintain or improve cognition. However, cognitive outcomes could be overlooked in non-pharmacological interventions for depression. This analysis investigated cognitive changes in a stepped-care intervention (Clinical Trial ID: NCT03593889) and the potential association with individual depressive symptom change. The community-dwelling older adults at risk of or with depressive symptoms without significant cognitive impairment (n=802) were assigned to intervention group (n=644) and control group (n=138). Depressive symptoms and cognitive functions were measured using Patient Health Questionnaire-9 and Cognitive Montreal Assessment-5 minutes protocol, respectively. Paired-t-Test showed significant improvements in overall cognition and attention in both intervention and control groups, but the improvements of language fluency (Intervention: MD=-0.51 p<0.01; control: MD=0.14, p=0.500) and orientation (Intervention: MD=-0.22 p<0.05; control: MD=-0.11, p=0.229) only displayed in intervention group. As control group had better cognition at baseline, linear mixed-effects model analysis was used to compare between-group difference. Intervention group had no significant cognitive improvement after adjusting the covariates but a potential improvement in language fluency (Coef. =0.442, SE=0.247, p=0.074). A linear regression analysis in intervention group indicated that reduction of concentration problem (β=0.106, p<0.05) and retardedness (β=0.117, p<0.01) under the symptomatology of depression were associated with the improvement of language fluency. In this group of older persons without significant cognitive impairment, there is no clear evidence of global cognitive benefits in a stepped care depression intervention, although there may be improvements in certain cognitive domains, which may be related to improvements in cognitive aspects of depression.
Emotion regulation profiles of development of depressive symptomatology: a longitudinal study.
Authors: Paniagua Teresa , Fernández-Fernández Virginia , Molina Martínez MªÁngeles
Published: December 2021

Introduction:COVID-19 pandemic has had a psychological impact on the eldest population. The aim is to analyse whether there are differences depending on the emotional regulation profile shown by a group of older people 6 months before the pandemic and the depressive symptomatology of these people at the same time, during home confinement and 8 months later. Method:Longitudinal study, sample of people over 65, three evaluation measures: WAVE1 (6 months before COVID-19,N=305;M=73.63;58.9% women), WAVE2 (house confinement;N=151;M=73.14;59.6% women) and WAVE3 (8 months later;N=91;M=72.62;64.70% women). We measured depressive symptomatology (CES-D; Radloff, 1977) and nine emotional regulation strategies (CERQ-S; Garnefski et al., 2001; Carvajal et al., 2020), with which 3 clusters were preset (after dendogram inspection and K means analysis). Three mean difference analyses (one-factor ANOVA) were performed taking as factor profiles and as outcomes variables depression in each wave. Results:profile 1, people use adaptive cognitive-emotional regulation strategies; profile 2, those with low levels of strategies (adaptive and maladaptive); profile 3, high scores in maladaptive strategies. Statistically significant differences between profiles 1 and 3, in the pre-confinement depression variable (F'2,91=6.18;p=.00) and during confinement (F'2,91=4.02;p=.02). Profile 3 higher depressive symptomatology (x̄1=17.16;x̄2=16.80) than 1 (x̄1=8.41;x̄2=9.65). Differences between profile 1 and 2 and 3 in depression 8 months after confinement (F’2,91=4.02;p=.02). Profile 1 lower levels of depression (x̄3=98.00) than 2 (x̄3=15.78) and 3 (x̄3=14.20). Profiles explain 12.3%, 8.4% and 12.5% of the depression variance in each wave. Conclusions:a "protected profile" (1), a "medium-term vulnerable profile" (2) and a "vulnerable profile" (3) to the development of depressive symptomatology.
Time Use, Gender, and Mental Health of Older Adults in Rural China
Authors: Lin Zhiyong , Chen Feinian
Published: December 2021

Time use is considered a valuable descriptor of people’s lifestyles, and studying how people spend their time is critical for understanding the determinants and consequences of individual well-being. In this study, we first develop a time use typology to characterize how older adults in rural Chinese families allocate their time in later life, and then examined how older adults’ time allocation influenced their mental health, with a special focus on differential implications for older women and men. Data derived from 2015 and 2018 waves of a longitudinal study of 1,007 older adults, aged 60 and older, living in rural areas of Anhui Province, China. We specifically focused on how social and solitary dimensions of time use, as well as time spent within and outside households, impacted depressive symptoms of older adults. Using the K-means cluster analysis, we identified four time use categories: “work-oriented,” “socially-active,” “homemaker/ caretaker,” and “socially-isolated.” Results from fixed-effects regression analysis demonstrated that older women involved in “socially-active” time-use category tended to report better mental than those in other time-use types, while the time spent on housework and caregiving was harmful to their mental health. For older men, more time spent on paid activities outside households (“work-oriented”) was associated with better psychological outcomes while solitary leisure time (“socially-isolated”) was associated with higher levels of depressive symptoms. These findings will be helpful for health policymakers and practitioners who seek to better identify vulnerable subpopulations and to design effective intervention strategies to reduce mental health problems.
Experiences of Black and White Family Hospice Caregivers: Anxiety, Depression, QOL, Burden, Hospice Communication
Authors: Starr Lauren , Washington Karla , Aryal Subhash , Oliver Debra Parker , Demiris George
Published: December 2021

Although hospice care benefits seriously ill patients and their families, growing evidence suggests anxiety, depression, and altered quality of life are prevalent among family hospice caregivers. It is unknown if Black and white family hospice caregivers experience differences in mental health, quality of life, caregiver burden, or quality of hospice communication. In this secondary analysis of baseline data collected from 717 family hospice caregivers in two randomized clinical trials, we compared anxiety (GAD-7), depression (PHQ-9), quality of life (CQLI-R), caregiver burden (Zarit), and caregiver-reported quality of hospice team communication (CCCQ) between Black and white caregivers. Black and white caregivers differed demographically across multiple variables. In bivariate analysis, we found no differences in depression (P=0.3536), anxiety (P=0.0733), caregiver burden (P=0.6680), and perceptions of caregiver-centered hospice communication (P=0.4549). White caregivers reported lower quality of life than Blacks (P=0.0386), specifically in emotional (P=0.0321) and social (P=0.0002) domains. Financial and physical quality of life did not differ. In multivariate regression analyses controlling for caregiver and patient factors, we found no racial differences in depression (P= 0.5071), anxiety (P = 0.7288), quality of life (P=0.0584), caregiver burden (P=0.9465), or hospice communication (P=0.8779). Variables explained 7.7% to 20% of variability in outcomes, suggesting research is needed to understand which other factors contribute to hospice caregiver coping and communication experiences. Results suggest Black and white informal hospice caregivers experience similar levels of anxiety, depression, burden, and perceptions of hospice team communication quality. Interventions to support hospice caregivers across racial groups are needed.
Does Level of Equality in State of Residence Relate to LGBT Health? An Analysis of Adults Aged 50+ Years from 34 US States
Authors: Nelson Christi , Andel Ross
Published: December 2021

Lesbian, gay, bisexual, and transgender (LGBT) health disparities have been well documented in previous research. This study examined whether the level of equality in state of residence (high, medium, fair, poor, or negative), determined by tallied LGBT-related laws and policies, was associated with health outcomes for LGBT adults. This study consisted of 3486 LGB and 959 transgender adults ages 50+ as well as 1:1 propensity matched heterosexual and cisgender participants from the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Separate logistic regression analyses for the LGB, transgender, heterosexual, and cisgender groups were conducted to assess health differences by state equality ranking. Results indicated that LGB participants in fair ranked states were more likely to report fair/poor general health (aOR=1.4, 95% CI=1.1-1.8) and 14 or more days of poor mental health in the past 30 days (aOR=1.4, 95% CI=1.1-1.9) compared to LGB in high ranked states. LGB participants in a low or negative ranked state were more likely to report fair/poor health (aOR=1.6, 95% CI=1.3-2.0), 14 days or more of poor physical health (aOR=1.5, 95% CI=1.1-1.8), and 14 or more days of poor mental health (aOR=1.3, 95% CI=1.0-1.7) in the past 30 days. Transgender participants in medium and low/negative ranked states were more likely to report fair/poor health (lowest aOR=1.75, 95% CI=1.3-2.5) compared to transgender individuals in high equality states. Similar results were not found for the matched heterosexual and cisgender groups. These results suggest that LGBT-related laws and policies may play a role in LGBT health.
Using Existing Software Systems to Collect Outcome Data in Adult Day Services
Authors: Anderson Keith , Peters-Beumer Lisa , Duff Laurie
Published: December 2021

Recently, there has been a resounding call for standardized outcome data collection in adult day services (ADS). Outcome data have the potential to demonstrate the effectiveness of ADS, aid in program development, and help leverage funding opportunities. Unfortunately, many ADS centers do not collect outcome data for several reasons, including the cost of data collection software and systems. In this presentation, we present one effort to utilize an existing multiuse ‘off the shelf’ software solution to collect ADS outcome data for a network of ADS providers. The researchers collaborated with software developers and ADS providers to adapt the software to incorporate outcome measures and reporting functionality on both the individual and program levels. Adaptation and adoption required attention to HIPAA compliance, workflow integration, measurement fidelity, and data management processes. Despite these challenges, adapting existing software systems may be a cost-effective way to enable expanded outcome data collection in ADS.
Inter- and Intra-racial Differences in Pain and Performance-Based Function in Older Adults With Osteoarthritis
Authors: Booker Staja , Fillingim Roger
Published: December 2021

Osteoarthritis (OA) contributes to movement-evoked pain, impaired function and mobility, and reduced quality of life among older adults. Assessment of pain has not traditionally considered the dynamic changes that occur with gross motor movement, and thus self-reports of pain often reflect static or resting pain. This case-control pilot study examined inter- and intra-racial differences in movement-evoked pain and performance-based function in older adults (N= 28) with knee OA. Cases consisted of Blacks and Whites with OA; controls included Blacks without OA. The Biodex Pro System 4, an isokinetic and isometric dynamometer commonly used in rehabilitative medicine, measured knee muscle function. Pain intensity was assessed pre-, ante-, and post- completion of 2 repetition sets of five alternating knee flexion and extension maximum voluntary contractions at angular velocities of 90° (greater resistance) and 180° (lower resistance). Repeated Measures Analysis of Variance with Bonferroni correction identified statistically significant differences in pain for within- and between-subjects at 90° and 180°. Pain increased during the repetitions and decreased after completion of both repetition sets; this non-linear relationship was significant (p= .004). One-way ANOVA demonstrated peak torque (extension), a muscle’s maximum strength capability, was significantly higher in White cases and Blacks controls compared to Blacks cases. Novel findings revealed that baseline pain is much higher and functional performance is significantly lower in Blacks with OA compared to White cases and Black controls. This research advances precision pain measurement and our understanding of the biological mechanisms uniquely involved in the experience of knee OA and mobility.
The Medicare Current Beneficiary Survey (MCBS): Providing Unique Access to Data on the Medicare Population
Authors: Cohen Hildie , Hoyt Sarah , Navin Sara , Titus Jennifer , Ibrahim Mia
Published: December 2021

The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a nationally representative sample of the Medicare population, conducted by the Centers for Medicare & Medicaid Services (CMS). It collects data on demographics, health insurance, health status, health care expenditures, satisfaction with care, and access to care for Medicare beneficiaries. The MCBS provides a unique source of information regarding beneficiaries aged 65 and over and beneficiaries aged 64 and below with disabilities residing in the United States that cannot be obtained solely through CMS administrative sources. For researchers interested in issues of health care utilization and cost, CMS releases two Limited Data Set (LDS) files for each data year and a Public Use File (PUF) freely available for download and use. Also, special topic based PUFs have been released on the impact of COVID-19 on Medicare beneficiaries. This presentation will demonstrate the importance of the MCBS for research on the Medicare population, discuss how researchers can access the data, where researchers can find published MCBS estimates, what content areas have recently been added, such as food insecurity, limited English proficiency, and COVID-19 vaccination uptake and what new content is on the horizon. The presentation will also discuss the operational challenges posed by the COVID-19 pandemic, and the content enhancement opportunities created by the public health emergency. It will conclude with a review of the suite of materials and documentation available for data users to enhance their research and utilize more timely data.
The Effect of Behavioral Activation on Older Adults' Engagement and Wellbeing: A Randomized Control Trial Protocol
Authors: Scott Julia Turner , Luszcz Mary , Mazzucchelli Trevor , Walker Ruth , Windsor Tim
Published: December 2021

Meaningful activity engagement in later life is widely recognized as crucial for ageing well, but age-related changes and transitions can impede such participation. A behavioral activation framework can provide a person-centred, value-consistent therapeutic approach to increasing activity engagement that is both easy to administer, cost effective and accessible to a broad audience. Although there is evidence supporting the utility of behavioral activation as a treatment for depression in older adults, this study will be the first to examine whether a behavioral activation is more effective in increasing activity engagement and psychological wellbeing among a non-clinical sample of older adults, compared to a multi component positive psychology intervention. This randomized controlled trial will examine the impact of two therapeutic approaches on activity engagement and wellbeing among older adults. One hundred and fifty adults aged 65+ who have relatively lower scores on a measure of engagement with life will be randomized to either a behavioral activation-based intervention, or a multi-component positive psychology intervention. The interventions will involve six individual weekly sessions conducted via telephone or video conference. Participants will be assessed pre-, post-intervention, and at three months follow-up. Outcome measures will include activity engagement, positive affect, and psychological wellbeing. Intra-individual variability will also be assessed via micro-longitudinal data in the behavioral activation condition. This study will be the first to provide evidence to the effectiveness of behavioral activation as an intervention to increase activity engagement and wellbeing among older adults, compared to other therapeutic approaches to increase psychological wellbeing.
The Moderation Role of Acculturation on Dietary Patterns and Stress among U.S. Chinese Immigrants
Authors: Dong XinQi , Le Qun
Published: December 2021

Studies have demonstrated that healthy dietary patterns are related to diminished stress. However, the potential moderation role of acculturation on dietary patterns and stress is unclear among the those whose eating habits are impacted by immigration. The aim of this study is to explore the moderation role of acculturation on dietary patterns and stress among Chinese elder immigrants in the United States. Data were conducted from the PINE Study with 3053 Chinese adults aged over 60 years in the Great Chicago area. Dietary patterns were measured via a 48-items Food-frequency questionnaire with frequency and size weighted. Items were identified into different food groups based on Dietary Guidelines. Acculturation was assessed by a 12-item short-scale among the population. Stress was measured via a 10-item Perceived Stress Scale with cutoff 14 indicating either low or high stress. Multiple logistic regression was used to examine the moderation effects on the associations with demographic characteristics, medical comorbidities, and BMI adjusted. After controlling covariates, one unit increasing in fruit consumption (OR: 0.61 (95%CI: 0.52 -0.72)) or coffee (OR: 0.49 (95%CI: 0.36 - 0.67)) was associated with lower odds of stress. However, after adding acculturation as an interaction term, the negative relationship between fruit or coffee consumption with stress was moderated by a higher level of acculturation (fruit: OR: 1.05 (95%CI: 1.02 - 1.08), coffee: OR: 1.05 (95%CI: 1.01 - 1.09) respectively). The associations between dietary patterns and stress may differentiate based on acculturation level among the elder immigrants. Further longitudinal studies should investigate potential causality.
The Association between Subjective and Objective Financial Knowledge: Path Analysis to Investor Behavior by Age
Authors: Lee Rain , Sil Jin , Jung Euijin
Published: December 2021

Financial literacy affects stock market participation, as well as individuals’ age, gender, income, and education level. However, measuring financial literacy is more appropriate to identify individuals with strong knowledge of finance rather than average individuals with general knowledge. This could be problematic to identify general participation of the stock market and investment as more individuals are now participating without having to have such knowledge. This study explored how individuals’ subjective financial skills and well-being affect investment participation by age. Overall, males are likely to participate more in both retirement and non-retirement investment. In between the boomer generation and younger group, the younger generation who reported participating in a non-retirement investment, such as stock market were having a higher score on subjective financial well-being (STDYX = .052, 95% CI [.07, .08]; p < .05). Importantly, among the older group, subjective financial skill score becomes a predictor of participating stock market (STDYX = .09, 95% CI [.01, .17]; p < .05). As the result suggest, while younger participants focus more on financial well-being, such as having security on finances, when they are participating in a non-retirement investment, whereas older adults are likely to invest based on their beliefs on financial skills regardless of secured finances. A retirement plan has shifted toward less on savings and more on investing. Older adults are now interested more in participating in investments, such as the stock market than the young population, and the proper preparedness for those older adults in participating in the investment is needed.
Engaging Stakeholders in a Pragmatic Trial of Home-Delivered Meals for Persons with Dementia
Authors: Harrison Jill , McAuliff Kathleen , Thomas Kali
Published: December 2021

Gathering stakeholder feedback is essential to designing and implementing relevant and actionable research. Additionally, stakeholders, particularly those directly impacted by an intervention, bring unique insights and experiences. This paper presents the process and findings of a research endeavor to co-design a pragmatic clinical trial with a Stakeholder Advisory Panel (SAP) in an effort to understand facilitators and barriers to conducting the research and implementing study findings. The proposed trial compares the impact of frozen, drop-shipped meals versus daily home-delivered meals provided by Meals on Wheels (MOW) programs on the ability of individuals living with dementia to age in place. We recruited nine SAP members, who were compensated for their time. The SAP is composed of a) MOW clients with dementia, b) family members of MOW clients with dementia, c) paid or volunteer MOW drivers, and d) MOW staff. A research team member facilitated two 90-minute meetings with the SAP members via Zoom. The topics of the meetings included potential benefits and challenges with each mode of meal delivery, the importance of the primary outcome (time to nursing home placement), topics of interest to include in interviews with clients and caregivers, and how participants would explain the study to a friend. Audio of the Zoom meetings was transcribed, and meeting summaries were shared with the SAP. Benefits of forming and engaging a SAP, as well as key lessons learned from SAP members and how recommendations were reflected in changes to the study protocol will be discussed.