bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of USA and Australian Mobility Device Users’ and Ambulant Bus Users’ Views of Restraints on Public Buses
Authors: Unsworth Carolyn
Published: December 2020

Many older people use powered wheelchairs and mobility scooters to access the community on buses but have increased injury risk if the mobility device tips or slides. Wheelchair tie-down and occupant restraint systems (WTORS) are mandated on USA transit buses, and their introduction investigated in Australia. This study examined the views of mobility device and ambulant bus users in the USA and Australia on WTORS. A Qualtrics survey with 448 respondents showed strong support for WTORS use and found the most important factors underpinning use were Safety, Comfort, and Transit time. US research indicates dwell time while fitting WTORS is 4 minutes, and participants reported 5.65(SD3.06) minutes is acceptable. There was no difference in USA and Australian participants who have slid or tipped in their device, despite being restrained in the USA: X2(1,n=220)=.053,p=.53,phi-.016). This research suggests all bus users are supportive of WTORs, but their effectiveness requires investigation.
Evaluating the Impact of State Policy Interventions for LGBT Aging: Comparative Case Study of New York and California
Authors: Oswald Austin , Giunta Nancy , Johnston Tim , Wayland Sherrill
Published: December 2020

The majority of aging network service providers are unprepared to deliver targeted services to lesbian, gay, bisexual, or transgender (LGBT) older adults. In 2017, California legislature mandated ongoing LGBT sensitivity training for congregate living providers. Services and Advocacy for GLBT Elders (SAGE) developed a specialized training, Creating Inclusive Communities, for congregate living staff to learn the unique needs of LGBT elders. This secondary data analysis compared pre-test knowledge and attitudes of training participants in two states, one mandating LGBT aging sensitivity training (California, N=328) and one without the mandate (New York, N=622). Preliminary results show that prior to receiving training, California participants demonstrate significantly less knowledge of LGBT aging issues compared to New York participants; t(948)=-3.808, p<.001. Attitudinal differences were also demonstrated. These results suggest that laws mandating LGBT sensitivity training may help reach providers with greater training needs. Policy and practice implications will be discussed. Part of a symposium sponsored by Rainbow Research Group Interest Group.
Spiritual and Religious Journeys Over the Lifecourse: Challenging Stereotypes
Authors: Anderson Keith , Garthwait Cynthia , Vielle Laurel
Published: December 2020

Spiritual and religious beliefs often evolve across the lifecourse and tend to be influenced by experience, time, and maturity. Despite this evolution, stereotypes persist of older adults as being inflexible in their views and resistant to new or alternative beliefs. To explore this notion, researchers surveyed a convenience sample of 152 older adults (n = 152) who identified as spiritual/religious. Over three-quarters (77.0%) reported that their relationship with God or a higher power had grown closer over time. Most reported becoming “more liberal” (32.2%), “more conservative” (23.0%), or “more moderate” (17.8%) in religious perspective over time. Almost three-quarters of participants (73.7%) reported that they were “more accepting” of other religions”, yet also “more certain” of their own beliefs (74.3%) in later life. These and other results challenge the stereotype of older adults as “set in their ways”, even in terms of spiritual and religious beliefs.
Reframing Aging in Contemporary Politics: Building Momentum
Authors: D'Antonio Patricia
Published: December 2020

Changing American culture is challenging and changing attitudes and behaviors around the universal experience of aging especially so. Unless the field of advocates who care about aging issues cultivates a more visible, more informed conversation on older people, it will remain difficult to advance the systemic changes needed to adjust to a society with increased and increasing longevity. Advocates will need to be vigilant to avoid cueing negative attitudes towards aging and aging policies. The Reframing Aging Initiative is a long-term, social change endeavor designed to improve the public’s understanding of what aging means and the many contributions older people bring to society. Using evidence-based research, the initiative seeks to teach advocates how to tell an effective story about aging that will promote positive perceptions of aging and reduce ageism. The time to change the conversation is now.
Developing Age-Friendly Programs in Greater Manchester, UK: Understanding the Role of Social Infrastructure
Authors: Yarker Sophie , Phillipson Chris
Published: December 2020

This paper considers the critical role of social infrastructure in building age-friendly communities. Drawing on two neighbourhood projects, the paper explores the benefits which different types of social connections bring for older people and the types of spaces in which these connections are produced. It provides support for the importance of ‘natural neighbourhood networks’(Gardner, 2011) by demonstrating how everyday encounters help promote informal networks of support. Following Klinenberg’s (2018) analysis of the importance of social infrastructure, the paper argues that the decline of local high streets, closure of libraries, and cuts to the maintenance of green spaces, reduce opportunities for face-to-face social interactions. The paper presents findings from two studies illustrating the importance of social infrastructure in supporting new forms of community action amongst older people. The paper concludes that that the value of social interactions that occur in everyday mundane spaces needs greater emphasis in public policy.
Exploring the Influence of Social Infrastructure on Experiences of Aging in Place in Dublin, Ireland
Authors: Grove Hannah
Published: December 2020

This paper presents results from a PhD project that has carried out interviews, mapping exercises and ‘go-along’ interviews with thirty-four people aged sixty-six and over, in an inner city and suburban study area within Dublin, Ireland. A key objective of this research was to identify places, activities and interactions of most importance to older people. Through qualitative and spatial data collection and analysis techniques, different types of ‘social infrastructure’ that individuals value and engage with, as part of their daily lives, are identified and presented using annotated maps. The interactions and types of activities that occur in these places, and why they are important, are also discussed. Results demonstrate the benefits of high quality social infrastructure (and the challenges associated with a lack of social infrastructure) through participant’s own experiences, and highlight the vital role this plays in supporting older people to age well in place.
Experiences of Racial Discrimination Among Community-Dwelling Older Adults of Color and Nursing Home Staff of Color
Authors: Nkimbeng Manka , LaFave Sarah , Szanton Sarah
Published: December 2020

This symposium will present results of three qualitative studies that explored experiences of racial discrimination among older adults and their professional caregivers. Our first study reports on interviews conducted with older community-dwelling African American adults about their perceptions of and experiences with structural racial discrimination. Participants reported exposure that has accumulated over the life course and across contexts, including through limited access to educational and employment opportunities and disproportionate exposure to neighborhood violence and unhealthy products. Our second study reports findings from interviews conducted with older community-dwelling African immigrants about their experiences with acculturation and racial discrimination. Older African immigrants reported several types of discrimination, had developed unique strategies to cope with perceived discrimination and described how it impacted domains of health and wellbeing. Our third study reports on experiences with discrimination among U.S-born and immigrant staff of color caring for residents in high minority proportion nursing homes. Findings indicate that although staff of color are valued for the diversity they contribute to the workforce, they are also exposed to discriminatory events. In addition, tensions exist between U.S. and non-U.S born staff of color. In this symposium, we will discuss differences in experiences between U.S.-born and immigrant participants, levels of discrimination experienced (interpersonal, institutional, structural), and discrimination across contexts. We will also discuss intersectionality of race, ethnicity, immigrant status, language, gender, age, and class in relation to experiences of discrimination. We will reflect on the clinical and policy implications of our findings.
Mental Health Among Employed Family Caregivers: A Gender-Based Analysis on the Role of Workplace Support
Authors: Li Lun , Lee Yeonjung , Lai Daniel W L
Published: December 2020

Compared to men, women undertake more family caregiving responsibilities, and thus take more toll in health and wellbeing when they are employed. The current study examined the gender difference in mental health among employed family caregivers, focusing on the role of workplace support in balancing work and caregiving roles. Guided by the social role theory and the moderated-mediation model of employment adjustment and mental health, we analyzed a nationally representative data from the 2012 Canada General Social Survey - Caregiving and Care Receiving with a sample of 2,426 participants selected. Moderated-mediation analysis based on the SPSS macro PROCESS 3.3 was used. Women employed family caregivers are more likely to undertake higher intensive caregiving, make more employment adjustment, and further report worse mental health status than their men counterparts. Gender difference was apparent in regards to the workplace support. For women, the moderating effect of workplace support is significant only when there are at least 5 different types of workplace support available at their workplaces, while for men, the moderating effect is significant when there are at least 2-3 different types of workplace support available. Women employed family caregivers experience worse mental health when employment adjustment is needed for their care responsibility. Findings have implications for providing workplace support for family caregivers given that women benefit less from workplace support compared to men. Further study is needed to explore the impact of various types of workplace support for women employed family caregivers, and to provide tailored support to them.
Repaying Student Loan Debt: Implications for Older Women’s Financial Well-Being and Retirement Planning
Authors: Miller Julie , Brady Samantha , Balmuth Alexa , D’Ambrosio Lisa , Coughlin Joseph
Published: December 2020

Previous research demonstrates that student loan debt disproportionately affects women and is being repaid increasingly by older adults. Utilizing data collected through a mixed methods study at the MIT AgeLab (involving focus groups and a large national survey), we examine the impacts of repaying student loans on older women’s financial wellbeing. Findings focus on multiple areas, including the timing in which older women repaying student loans were able to pay down other debts, change jobs, get married, and pursue further education. Analysis also revealed that student loans impacted the amount that 63% of older women in the study were able to contribute to their retirement savings. Findings from this study suggest that repaying student loan debt for oneself and/or a family member can compromise older women’s near-term and longer-term financial being. Policy reforms are needed to support older women repaying student loans.
Quantitative Study of Individual Creative Caregiving Sessions on Well-Being of Caregivers and Care Recipients
Authors: Wheaton Felicia , Cole Safiyyah , Kappari Sai Raj , Johnson Matilda
Published: December 2020

There were approximately 34.2 million unpaid caregivers of adults age 50+ in the United States in the last 12 months (NAC & AARP, 2015). These individuals provide important care for older adults with physical, psychological and cognitive problems. There is a growing awareness that caregivers are also at risk for physical and mental health problems and therefore also require support to reduce stress and maintain optimal health. Research suggests that engaging in creative and artistic activities may reduce stress and improve physical and mental health among caregivers. Researchers from Bethune-Cookman University partnered with the Atlantic Center for the Arts in New Smyrna Beach, FL to evaluate their Creative Caregiving program. Approximately 10 informal caregivers and their care partners met for 2 hours each week over the course of 6 weeks from February 3-March 9, 2020. Participants learned how to connect mind, body and spirit by using the arts as a tool of self-care, social interaction, and learning. At each session, participants were asked to rate their overall wellbeing on a scale from 1-10. Pre- and post-session data was analyzed using paired samples t-tests. Results indicate that there was significant improvement in wellbeing and participants reported improvements in their stress, mood and relationship with their caregiver or care partner. These findings were observed for both caregivers and care partners, suggesting that arts programs can benefit both. Such programs are a fun and cost-effective way to improve wellbeing, at least in the short-term.
Intersections of Gender and Cognition in Older Adults
Authors: Stites Shana , Flatt Jason , Derby Carol
Published: December 2020

The National Institutes of Health (NIH) is committed to supporting rigorous science that advances what is understood about the influences of sex and gender in health and disease in order to inform the development of prevention strategies and treatment interventions. In research on aging and Alzheimer’s disease, sex/gender disparities in key outcomes are common. But, much of this research hinges on asking a single question: Is the patient or research participant male or female, man or woman? This practice offers few options for disambiguating sociocultural effects associated with gender from those related to biologic sex. It also assumes that self-reports are a suitable proxy for social phenotypes and that a dichotomous variable adequately captures the wide-range of sociocultural effects attributable to gender. The premise of this symposium is to evaluate how gender interacts with cognitive outcomes in order to advance measurement. This symposium will review evidence from five distinct lines of research on associations between gender and cognition for individuals and for individual’s interactions with their family members: (1) effects of normative shifts in American education on cognition in older adults; (2) hospitalization as a risk factor for cognitive decline in racially diverse American men and women; (3) caregivers who identify as sexual and gender minorities (SGM or LGBTQ+) and care for persons with dementia; (4) correlates of cognitive function in SGM older adults; and (5) differences in adults’ cognition based on childhood exposure to women’s social empowerment in 30+ Organisation for Economic Co-operation and Development (OECD) countries.
Gender Differences in 30-Day Re-Hospitalization Among Medicare Beneficiaries With Alzheimer’s and Dementia
Authors: Gilmore-Bykovskyi Andrea
Published: December 2020

Hospitalization is associated with accelerated cognitive decline for persons with Alzheimer’s disease and related dementia (ADRD), which disproportionately impacts women. Persons with ADRD are also at higher risk for 30-day rehospitalization, which may compound the impact of hospitalization-related exposures that precipitate decline. Evidence surrounding the intersections between gender and rehospitalization risk among diverse, representative populations with ADRD are lacking. This retrospective cohort study used a 100% national sample of Medicare beneficiaries with a diagnosis of ADRD and qualifying index hospitalization in 2014 (n= 1,033,144 unique beneficiaries and 1,672,238 unique stays). The primary outcome was rate of 30-day rehospitalization by gender and race. Within each racial group, men have higher rehospitalization rates than women: 2.6% higher among white men, 1.7% among African American men, and 2.6% higher among other racial/ethnic minorities. Findings highlight the importance of elucidating mechanisms underlying gender differences in hospital utilization and subsequent impact on cognitive decline.
University-Community Partnerships to Develop a Mutually Beneficial Tool to Measure Age-Friendly Collaboration
Authors: Pestine-Stevens Althea , Greenfield Emily
Published: December 2020

Age-friendly community initiatives (AFCIs) are frequently described as community collaborations; the AARP program model encourages diverse stakeholder engagement to achieve its aims of improving the social and built environments for long lives. However, little is known empirically about how AFCIs function as collaborations and how these relationships and activities lead to community changes. This paper presents how we developed a social network analysis tool to measure collaboration in AFCIs, which emerged from multi-year, university-community partnerships on AFCIs in western New York and northern New Jersey. Iterative processes, including inductive analysis of qualitative interviews and facilitated meetings with local AFCI work-groups, provided opportunities to create survey items on collaboration with meaning specific to AFCIs. We describe this tool’s application as part of a survey of AFCI stakeholders, demonstrating how findings contribute both to advancing knowledge on AFCIs in general and directly informing the efforts of AFCI actors on the ground.
Lessons Learned in a Community-Based, Randomized Controlled Trial of a Complicated Grief Intervention
Authors: Buck Harleah , Cairns Paula , Emechebe Nnadozie , Hernandez Diego , Mason Tina , Bell Jesse , Kip Kevin , Tofthagen Cindy
Published: December 2020

Complicated grief (CG), severe, prolonged (>12 months) grieving, disproportionately affects older adults. A prospective two-group, waitlisted RCT examined whether four sessions of Accelerated Resolution Therapy (ART) was effective in informal caregivers by comparing pre-to-post ART changes and investigating variation in treatment response by baseline CG levels. Inclusion: ≥60 years, Inventory of Complicated Grief >25. Paired t-tests of mean (SD) differences compared pre- to post-ART; pre-ART to 8-week follow-up, and post-ART to 8-week follow-up; then stratified by median baseline level of CG. Mean (SD) age of 54 participants was 68.7 (7.2) years, 85% female, and 93% white. Significantly greater CG reduction (-22.8 (10.3)) vs. waitlist (-4.3 (6.0)) was found. Within-participant effect sizes from baseline to 8-weeks post treatment were 1.96 (95% CI: 1.45, 2.47; p<0.0001). Treatment effects did not substantially differ by baseline levels. Lesson learned was that it was possible to successfully recruit and treat CG in the community.
Self-Efficacy of Family Caregivers of Older Adults With Cognitive Impairment: A Concept Analysis
Authors: Khan Tarik , Hirschman Karen , McHugh Matthew D , Naylor Mary , Khan Tarik S
Published: December 2020

The purpose of this concept analysis is to address fundamental gaps in the understanding of self-efficacy in family caregivers of older adults with cognitive impairment, including updating the 26-year-old concept analysis with a contemporary definition. With the first of the baby boomers set to turn 75 in 2021, the growing number of Americans with Alzheimer’s disease is predicted to more than double over the next 30 years, while the pool of potential family caregivers is likely to diminish by half. Research demonstrates that increased self-efficacy can help family caregivers of older adults with Alzheimer’s and other types of cognitive impairment experience lower burden and depressive symptom severity. This study utilized Walker and Avant’s method of concept analysis, an eight-step iterative process that helps to clarify the meaning of ambiguous concepts. A literature review was conducted from July 1993 through March 2019 using PubMed/MEDLINE, Scopus, CINAHL, and Embase. Eight defining attributes of this concept were identified. The revised definition of self-efficacy in this population is “a family caregiver’s confidence in their ability to: manage behaviors and other caregiving stresses, control upsetting thoughts, acquire medical information, manage medical issues, obtain self-care, access community supports, assist with activities of daily living and other care, and maintain a good relationship with a relative, friend, or neighbor of an older adult with cognitive impairment.” Practice implications include tailoring interventions to improve family caregiver self-efficacy. Policy implications include fostering evidence-based health strategies through payment and delivery incentives that further support caregiver self-efficacy.
Self-Neglect: One Pathway to Surrogate Decision-Making
Authors: Ramsey-Klawsnik Holly , Burnett Jason
Published: December 2020

Self-neglect, the most frequently reported allegation to Adult Protective Services (APS), involves profoundly harmful behaviors often due to functional or cognitive limitations, health problems, and insufficient resources that result in older adults insufficiently meeting their basic needs. Outcomes include high risk of illness, hospitalization and readmission, hospice and nursing home use, early mortality, and placement under surrogate decision-making authority of either well-intended or opportunistic others. APS staff are charged with assessing self-neglect and intervening to reduce client danger. A nationwide APS survey revealed program policies, procedures, resources, and needs affecting the client welfare. For example, 92% of APS programs have provisions for seeking guardianship for self-neglecting individuals, in 25% of programs staff serve as court-appointed guardians, and a wide variety of tools are used within APS programs to assess clients’ mental capacity. Key study findings, implications, and recommendations will be presented.
Service-Specific Surveying to Support Person-Centered HCBS for Older Adults and Their Caregivers
Authors: Walsh Caitlyn , Tice Jessica
Published: December 2020

The Florida Department of Elder Affairs (DOEA) annually surveys clients receiving state funded home and community-based services (HCBS) to measure their satisfaction with services. Historically, the same survey instrument was used each year, to afford question-level comparisons across time. However, in 2015 internal contradictions were identified between individual-level satisfaction ratings and qualitative statements made by the respondents later in the survey. The high rates of satisfaction typical in survey responses were also contradicted by findings from a comprehensive program evaluation which revealed high percentages of clients who terminated their services and many caregivers reporting strain and varying types of personal crisis. To address these issues, the annual Client Satisfaction Survey and methodology was redesigned to be more specific regarding details about the delivery of direct services, and the sampling methodology was revised to constrain to the recipients of discreet service types. The results from these new service-level surveys will be presented for each of three direct services: case management, personal care, and homemaker. Findings revealed differences across regions in the state, and highlighted the frustration experienced by HCBS clients with high worker turnover and low training for special conditions, such as Alzheimer’s or related dementia. Complaints and suggestions collected from clients and caregivers were shared with program managers for consideration in changes to policies, training, and other areas of service improvement toward becoming more person-centered. Overall, this service-oriented approach to surveying has yielded more actionable results and has been adopted by DOEA as the preferred method for all client-level surveying.
Impact of Health Systems on Life Expectancy in Taiwan, Singapore, and the USA: Similarities and Differences
Authors: Chen Ya-Mei , Young Yuchi , Schumacher Patrick
Published: December 2020

Like Singapore, Taiwan has universal health care and universal long-term care (LTC). The USA has neither. Those who need LTC in the US pay out of pocket, buy private LTC insurance or spend down to qualify for Medicaid; there are inherent issues related to cost and quality. For example, nursing home care costs over US$100,000/year and only about 8% of the population has private LTC insurance. Many people become impoverished or struggle financially to qualify for Medicaid. Conversely, Taiwan has universal LTC insurance that offers comprehensive services for all, but it is relatively new and its impact remains to be seen. Similarities and differences related to LTC quality indicators such as functional independence, and the NCQA quality measures (e.g., effectiveness of care, access/availability) in Taiwan, Singapore and the US will be presented. The results of this comparison can inform policy makers and stakeholders leading to best practices. Part of a symposium sponsored by International Comparisons of Healthy Aging Interest Group.
Who Are the Heavy Users of Acute and Long-Term Care Services in Changhua County, Taiwan?
Authors: Young Yuchi , Chen Ye-Mei , Chen Kuo-Piao , Chen Hsiu-Hsi , Chang Wei-Jung , Hsu Wan-Hsiang , Yeh Yen-Po
Published: December 2020

Identification of heavy health care users among community-dwelling older adults can lead to strategic care planning and management that positively impacts health care use and costs. This study aims to identify risk factors associated with heavy users of acute care and long-term care (LTC) in Changhua County, Taiwan. Study participants (n=8,090) included residents (age 65+) of Changhua County. Data were collected from 4/1/2017-10/26/2018. Linked hospitalization and LTC use information was provided by the Changhua County Public Health Bureau. Hospitalization was grouped into 1 vs. 2+. Univariate and multivariate logistic models will be used to address the study aim. Preliminary results show the average age was 81 years ranging from 65-105. Of this population, 56% are female, and 10% live alone. The average length of hospital stay was 9.7 days. Risk factors associated with heavy health care users identified in multivariate analysis will be presented and intervention strategies will be discussed. Part of a symposium sponsored by International Comparisons of Healthy Aging Interest Group.
Stories of the Experience of Searching for Long-Term Care and Eldercare: Case Study and Narrative Perspectives
Authors: Corley Connie , McCarty Ryan
Published: December 2020

With over 40 million individuals aged 65 years and older in the US, and by 2050 rising to an estimated 89 million, age matters, driving an increased need for long-term care/eldercare. Coupled with the higher costs of care, the search for long-term care/eldercare services can be a difficult prospect for adult children decision-makers. We present the experiences of adult children decision-makers in the US, using two methodological approaches: narrative and case study using autoethnography. In a narrative inquiry of 9 caregivers responsible for making long-term care/eldercare decisions for their parent(s) the zoom model was applied to conduct the analysis. Findings suggest that decision-makers have a strong sense of duty towards helping their loved ones find long-term care solutions. Decision-makers searched for many types of care solutions ranging from home health care to nursing homes. The experiential response most consistently stated by the participants was stress. These results are augmented by an autoethnographic case study in “six acts” illustrating how sense of agency in the caregiving journey can be enhanced. Participants with industry experience had a minimal advantage over those with no experience when it came to navigating the search for long-term/eldercare. We highlight why stories of family search for long-term care/eldercare matter, and how they can be leveraged for fundraising, advocacy, and healing. Implications for policy, research, education and practice are highlighted.
Conceptualizing the Shelter and Housing Needs and Solutions of Older People Experiencing Homelessness
Authors: Canham Sarah , Humphries Joe
Published: December 2020

Newly and chronically homeless older adults have unique pathways into homelessness and distinct physical, mental, and social needs. Using a five-step process, we conducted a scoping review of primary research to investigate the needs and solutions for sheltering/housing older people experiencing homelessness (OPEH). Thematic analysis of data from 19 sources revealed 1) shelter/housing needs and challenges of newly vs. chronically homeless older adults; 2) existing shelter/housing solutions addressing the needs of OPEH, including Housing First, permanent supportive housing, and multiservice homelessness intervention programs; and 3) outcomes of rehousing OPEH. Following, we developed a conceptual model which outlines how unique health and psychosocial needs of newly and chronically homeless older adults can be met through appropriately-designed shelter/housing solutions with individualized levels of senior-specific support. Future shelter/housing initiatives and strategies should use a rights-based approach and prioritize matching diverse OPEH needs to appropriate shelter/housing options that will support their ability to age-in-the-right-place. Part of a symposium sponsored by the Environmental Gerontology Interest Group.
Shelter and Housing Options, Supports, and Interventions for Older People Experiencing Homelessness
Authors: Mahmood Atiya , Humphries Joe , Moore Piper , Burns Victoria , Canham Sarah
Published: December 2020

While older people experiencing homelessness (OPEH) can have life histories of homelessness or experience homelessness for the first time in later life, understandings of shelter/housing models that meet diverse needs of this population are limited. We conducted a scoping review of the international literature on shelter/housing models available to support OPEH. Through an iterative process of reading and rereading 24 sources (published 1999-2019), findings were organized into 5 categories of shelter/housing models that have been developed to support OPEH: 1) Permanent supportive housing (PSH), including PSH delivered through Housing First, 2) Transitional housing, 3) Shelter settings with medical supports, 4) Drop-in centers, and 5) Case management and outreach. Findings expand our understanding of how a continuum of shelter/housing options are needed to support distinct health and housing needs of diverse OPEH. Policy and practice implications related to integrating health and social care to support OPEH to age-in-the-right-place will be discussed. Part of a symposium sponsored by the Environmental Gerontology Interest Group.
Family Caregivers of Veterans Experience High Burden, Mental Health Distress, and Financial Strain
Authors: Shepherd-Banigan Megan , Sherman Sophia , Lindquist Jennifer , Miller Katherine , Tucker Matthew , Smith Valerie , Van Houtven Courtney
Published: December 2020

We describe the caregiving experiences and needs of family caregivers of older Veterans enrolled in the U.S. Department of Veterans Affairs (VA). We conducted telephone surveys with 1,509 caregivers to assess caregiver health and well-being. Caregivers were primarily female, <50 years old, white, and the Veterans’ spouse. Veterans had substantial functional limitations and required care for multiple conditions, commonly, mental illness, dementia, and heart disease. On average, caregivers provided care for 9.6 hours per day and 6.7 days per week. Burden and depressive symptoms were above clinical thresholds with average scores of 21.8 (Zarit burden) and 11.5 (CES-D 10). Levels of perceived loneliness and financial strain were high. As this population needs emotional support, respite care services, social engagement, and training to care for aging Veterans, the expansion of enhanced caregiver services and supports to this population (expected in 2020) through the VA Mission Act of 2018 will be beneficial.
Mortality and Health Outcomes for Older Adults Screened by an Area Agency on Aging Over a 4.5-Year Period
Authors: Gum Amber , Schonfeld Lawrence , Kip Kevin , Goldsworthy Mary , Bell Jesse , Conner Kyaien , Green Ohad , Parkinson Katie
Published: December 2020

Area Agencies on Aging (AAA) screen older adults and oversee delivery of a wide range of home- and community-based services (HCBS). We examined the assessment process, services, and mortality and health outcomes for older adults screened by an Area Agency on Aging in west-central Florida. Most were self/family referred (78.9%). Using data from July 2013-December 2018, 23,225 older adults were screened. Individuals had an average of 2.6 years follow-up in the dataset, during which time 63.6% received additional assessments: follow-up screening (50.6%), comprehensive assessment for enrollment in HCBS (35.7%), or assessments for congregate meals or other services (13.7%). Results revealed differences in mortality: 22.5% of clients receiving services died compared to 32.1% of clients prioritized as lower risk and on waiting lists for services. Long-term care placement and functional decline outcomes also will be reviewed, along with implications for service delivery and managing waitlists.
Social and Physical Contexts of Long-Term Services and Supports
Authors: Fabius Chanee , Clarke Philippa
Published: December 2020

In the coming years, inevitably growing numbers of older populations will yield more older Americans with extensive medical and long-term care needs. This will lead to an increasing need for long-term services and supports (LTSS) to assist older adults with routine daily activities (e.g., bathing, dressing, medication management). There is a growing interest in understanding how social and physical environments contribute to health outcomes and the provision of services and resources for older persons with disabilities requiring assistance from LTSS. Decisions about care and subsequent experiences are likely a result of factors that extend beyond personal preference or individual factors, such as neighborhood quality, housing context, and living situations (i.e., homebound status) among community-dwelling older adults. Given population aging and the shift of LTSS from nursing homes toward community settings, there is a pressing need for more information about contextual factors that might help better develop supports for vulnerable older adults. This symposium will feature four presentations that provide novel insight regarding social and physical contextual factors contributing to LTSS. Presentations leverage data from the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries aged 65 and older, and will describe: 1) associations between individual and home environment risk-factors, neighborhood-level social deprivation, and falls; 2) the relationship between neighborhood-level social deprivation and caregiving intensity (number of hours of caregiving per week) among community-dwelling older adults; 3) associations between living in single-family vs. multi-unit housing and social networks; and 4) community tenure among homebound older adults.
Social Isolation and Loneliness: Translating Current Research into Health Care Practices and Improving Awareness
Authors: Galambos Colleen
Published: December 2020

This paper examines the evidence to support the need to translate current research into health care practices about social isolation and loneliness (SIL) among older adults. The health care system may be in the best position to identify those at highest risk—namely, older adults, whose only interactions are with members of the health care system. This paper reviews recommendations related to periodic assessments, including the use of validated tools to identify those at highest risk. Through this identification, clinicians and health care researchers may be able to use these findings to better target meaningful clinical and public health interventions. Additionally, a critical step toward preventing, mitigating, or eliminating negative health impacts will be to improve awareness about the problem and impact of SIL within the older adult population. This paper reviews recommendations for improving overall awareness by including SIL in national health strategies and public campaigns. Part of a symposium sponsored by Loneliness and Social Isolation Interest Group.
Social Isolation and Loneliness: Strengthening Education and Training
Authors: Lustig Tracy
Published: December 2020

This paper reviews recommendations for a variety of opportunities to improve education and training of the health care workforce on the health impacts of SIL and clinical approaches for assessment as well as testing different approaches for such education and training. The fifth goal of the NASEM study is to “strengthen ties between the health care system and community-based networks and resources.” Similar to other social determinants of health, addressing SIL will require coordinated efforts among a variety of stakeholders. This paper reviews recommendations for improving coordination, including team-based care and promotion of tailored community-based services, as well as the creation of a centralized repository for new evidence and best practices. Finally, connections between this NASEM study and the 2019 report Integrating Social Care into the Delivery of Health Care are discussed. Part of a symposium sponsored by Loneliness and Social Isolation Interest Group.
Barriers to Meeting the Social and Emotional Needs of Nursing Home Residents
Authors: Roberts Amy Restorick , Bern-Klug Mercedes
Published: December 2020

Presenters will describe barriers to psychosocial care and identify which factors increase the odds of experiencing a psychosocial care barrier. Reported major barriers include: insufficient number of nurse aide staff (31%), having to do things other people could do (29%), lack of resources to provide residents with opportunities to leave the nursing home on outings (25%), pressure to admit and discharge post/sub-acute patients takes time away from attending to the social and emotional needs of long stay residents (23%), and not enough social service staff for the number of residents (21%). With data from the 2019 National Nursing Home Social Services Directors Survey, a series of logistic regressions found that significant predictors varied by specific barrier, although devoting more time to short-term residents predicted a greater likelihood of reporting a major barrier in four of the five outcomes. Strategies to address these structural and contextual factors will be discussed.
Reassessing the Aging Enterprise: New Perspectives on the Social Construction of Later Life
Authors: Phillipson Chris
Published: December 2020

Four decades on from the publication of 'The Ageing Enterprise', this paper provides a critical review of the relationship between social theory and social policies for later life. To what extent do current theoretical perspectives in gerontology bear the influence of ideas laid out in that pioneering book? How has the ‘ageing enterprise’ fared given the dominant ideology of neo-liberalism and the precarious lives faced by people moving through the life course? The paper considers these questions in the context of globalization processes, and the imposition of austerity policies. The paper will consider the continuing importance of ‘The Ageing Enterprise’ by reviewing three main themes: first, assessing the changing relationship between the state and social policy; second, through examining current perspectives within critical gerontology; third, highlighting new forms of empowerment developing amongst older people, and the relationship of these to the values and ideas expressed in ‘The Ageing Enterprise’. Part of a symposium sponsored by the Women's Issues Interest Group.
Elder Justice and Nursing Home Reforms 2020
Authors: Smetanka Lori
Published: December 2020

The presentation will provide perspective on the current state of care quality in long-term care facilities and the legislative discussions and actions of the 116th Congress.
Working While Caregiving: A Scoping Review of the Experiences of Employed Female Caregivers
Authors: McLaughlin Jessica King
Published: December 2020

The negative consequences of caregiving disproportionately impact women, as women make up the majority of informal caregivers and spend more time doing caregiving duties than men. The competing demands inherent in being a caregiver while working can increase levels of stress and burden that these individuals may experience. However, the nuances of the challenges of working female caregivers are still not salient. This review synthesizes the extant literature on working female caregivers to clarify the dilemmas they face and factors that impact their ordeals. Thirty studies on working female caregivers met inclusion criteria. Findings indicate common themes that emerged across the studies. These themes indicate the need to more comprehensively support the multifaceted nature of working female caregivers’ experiences in the workplace and outside of work. Furthermore, this review identifies areas in which informed policy can have a meaningful impact on working female caregivers’ lives.
Federal Advisory Councils Established to Assist Working Caregiving Families
Authors: Gibson Ethlyn McQueen
Published: December 2020

This presentation will describe the legislative charge of two advisory councils established in 2018 through the Recognize, Assist, Include, Support and Engage Family Caregivers Act and the Supporting Grandparents Raising Grandchildren Act to support working family caregivers. The advisory councils are charged with 1) providing recommendations on effective models of family caregiving 2) improving coordination across federal government programs; and 3) identifying, coordinating, and promoting information, resources, and 4) best practices for working grandparents raising grandchildren, while maintaining their own physical, mental, and emotional well-being. The experiences of working family caregivers will be the foundation for these recommendations that are being developed over the next two years to present to Congress. These recommendations will support the development and execution of a national family caregiving strategy.
Intersectionality and Cognitive Impairment Risk in Older Persons With HIV: Age, Ethnicity, and LGBT Status
Authors: Mindt Monica Rivera , Savin Micah , Summers Angela , Stiver Jordan , Slaughter Alex
Published: December 2020

The Latinx population is disproportionately affected by HIV-infection and older Latinx persons living with HIV (PLWH) are at greater risk for neurocognitive impairment (NCI). However, no studies have examined whether intersectionality (including Lesbian Gay Bisexual Transgender [LGBT] status) increases NCI risk. This study investigated whether LGBT status increases NCI risk in 126 PLWH (Ages 19-73 years; 74% Male; 66% Latinx, 34% NHW) who completed a comprehensive NC battery. Domain average T-scores were based on demographically-corrected norms. Multiple regressions revealed that after accounting for covariates (cocaine use, premorbid IQ) and other dimensions of intersectionality (age, ethnicity), LGBT status significantly contributed to NCI risk in attention/working memory (B=-4.50, p=.01) and executive functioning (trend-level; B=-3.67, p=.06). LGBT status, a key dimension of intersectionality, should be considered in NC assessment of PLWH. Future research is needed to identify factors (e.g., discrimination) that may confer increased NCI risk in this population.
Framing the Issue
Authors: Lindberg Brian
Published: December 2020

The GSA Public Policy Advisor will facilitate a discussion about the 2020 reauthorization of the Older Americans Act with key stakeholders from Washington, DC. Also, the presentation will include perspective on GSA's active role in policy development and the legislative process.
Implementing Oregon’s New Quality Measurement Program for Assisted Living Communities
Authors: Carder Paula , McQueen Ann , Tunalilar Ozcan
Published: December 2020

Oregon legislation requires assisted living (AL) communities to report selected quality measures to the state licensing agency. The Quality Measurement Program (QMP) includes five metrics that assess different areas of resident safety and wellbeing: falls, antipsychotic medication use, staff training, staff retention, and resident satisfaction. This paper describes findings based on our 2019 survey of AL communities and offers suggestions for stakeholders interested in public reporting and quality metrics. Assisted living providers reported 28% of AL residents and 38% of memory care (MC) residents fell at least once in the prior 90 days, with 39% and 45% reporting an injury, respectively. Antipsychotic medication use was 20% among AL and 44% among MC residents. These findings and the survey methods used to collect them, combined with stakeholder and state agency staff participation, informed the current QMP approach. We describe how to collect meaningful quality metrics within the AL context.
Resident Quality of Life and Family Satisfaction: Developing Measures for Minnesota Assisted Living Report Card
Authors: Wheatley Muriel , Cooke Valerie , Shippee Tetyana
Published: December 2020

The 2019 Minnesota Legislature requested the Department of Human Services (DHS) and Minnesota Board on Aging to develop and administer a report card for assisted living (AL), including conducting annual resident and family surveys in Minnesota AL settings. This presentation includes the perspectives of representatives from MN DHS and Vital Research, as well as the University of Minnesota team who worked together to develop survey items, carry out the cognitive testing, and conduct analyses. Survey items were developed from published literature and existing tools on assisted living quality and underwent testing with MN stakeholders and cognitive testing with MN AL residents. Pilot testing assessed any further changes that needed to take place for resident and family satisfaction with AL quality (n=400). Presenters will share lessons learned with implementing the new tools and different aspects of the of the report card development and implementation process as well as the survey findings.