bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Change Predict Change in the CHANGE Intervention Study?
Authors: Maitland Scott , Brauer Paula , Mutch David , Royall Dawna , Klein Doug , Tremblay Angelo , Rhéaume Caroline , Jeejeebhoy Khursheed
Published: December 2020

Does change in one lifestyle factor (e.g., exercise/fitness) help explain change in another factor or process (i.e., dietary behavior or cardiovascular risk)? The current modeling was a secondary analysis of a primary care feasibility study of individualized lifestyle (diet and exercise) treatment of metabolic syndrome (n=293; mean age = 59yrs) that achieved 19% reversal over one year. Diet quality was assessed by the Healthy Eating Index (HEI) (2005 Canada); while fitness was assessed by several measures (VO2max, flexibility, curl-ups, push-ups). Three occasions (i.e., baseline, 3-, and 12-month) were examined using latent change score and latent growth curve models (in AMOS) to assess whether changes in one domain predicted changes in the remaining domains: (1) diet (measured by HEI or latent construct); (2) fitness (measured by VO2max percentiles or latent construct); and, (3) 10-year risk of cardiovascular disease (by Procam Risk score). Results showed significant improvement in all three domains separately during the intervention, with greater change between baseline and 3-month assessment and continued change between 3- and 12-months. Initial status variables on observed constructs were moderately positively correlated and change in dietary behavior was significantly related to change in fitness levels, but neither were significantly related to change in the 10-year risk of cardiovascular disease. In addition, the associations between change in diet and changes in fitness were inconsistent baseline to 3 months, and 3-12 months. These results offered new insight on relationships among interventions in a behavioural counselling program which can inform future programming.
Weight Change and All-Cause Mortality in Later Life: Findings From the National Survey of the Japanese Elderly
Authors: Murayama Hiroshi , Liang Jersey , Shaw Benjamin , Botoseneanu Anda , Kobayashi Erika , Fukaya Taro , Shinkai Shoji
Published: December 2020

Recent studies predominantly in Western populations suggest that both weight gain and weight loss are associated with increased mortality risk in old age. However, evidence on this topic in Asian populations remains sparse. We examined the association between weight change and all-cause mortality in a nationally-representative sample of community-dwelling older Japanese. Data came from the National Survey of the Japanese Elderly (N = 4,869, age ≥ 60 years). Participants were followed for up to 30 years. Short-term (3 years) and medium-term (6 years) weight changes were classified as “loss ≥ 5%,” “loss 2.5%–4.9%,” “stable,” “gain 2.5%–4.9%,” and “gain ≥ 5%.” Cox proportional hazards models were used to assess the relative (stable weight as reference) mortality risk associated with weight change categories. Short-term weight loss ≥ 5% was associated with higher mortality compared to the stable category, after adjusting for sociodemographic factors, health behaviors, and health conditions (hazard ratio = 1.36; 95% confidence interval = 1.22–1.51). The other weight change categories had no significant association with mortality. This was observed both among males and females. Moreover, the same pattern of results was observed when we used the medium-term weight change indicator. In conclusion, we found that both short- and medium-term weight loss greater than 5% increased the risk of dying among older Japanese; however, other types of weight change did not. This finding could inform clinical and public health approaches to body-weight management aimed to improve the health and survival of older adults, particularly in Asian populations.
Future Care Plan at the Contemplation Stage Among Older Adults
Authors: Oladimeji Abolade , Kahana Eva , Kahana Boaz , Lee Jeongeun
Published: December 2020

Previous studies have shown that making future care planning often involves several steps. This is consistent with the transtheoretical model of behavior change which identified stages in which behavior changes over time and progresses through a series of six stages (Prochaska & Norcross, 2001). Although most studies on future care planning among older adults have examined the progression from the pre-contemplation stage to an action stage, little is known about the unique characteristics of older adults at the contemplation stage. Our sample included 409 randomly selected older adults in Cleveland, Ohio who were in the first wave of a longitudinal study of successful aging (µage = 78.8, SD=5.74). We used multivariate logistic regression to predict older adults who are more likely to have thought of their future care plans (contemplation stage). Results indicate several individual and relationship factors such as marital status, engaging in health behaviors (not smoking), being young old, and having personal transportation (OR=.42, .63, 2.81, and 1.73) account for contemplating future care. These findings underscore that several individual resources, as well as relationship status, are associated with contemplation stage of future care planning. The results reinforce the idea that future care planning is a stage-based behavior that people engage in, rather than a stand-alone activity.
Do Volunteers Make a Difference on Nursing Home Quality Measures?
Authors: Falkowski Paul , Kelly Christopher , Kelley Nancy
Published: December 2020

The purpose of this study was to explore the relationship between nursing home volunteer programming and quality measures and increase the knowledge base of nursing home volunteer programming in various settings. Fifty-two nursing homes were surveyed using electronic surveys and personal interviews. Questions focused on the organization of the nursing home, characteristics of the volunteer program and volunteer activities. Of the 52 facilities surveyed, 19 were not part of a chain, 37 were in urban settings, and 24 were for-profit entities. Volunteers were used in 46 nursing homes with a mean number of volunteers of 51.7 onsite an average of 4.9 days per week. Bivariate analysis revealed statistically significant correlations (p<.05) between organizational and volunteer programming characteristics and six quality measures (pressure sores, urinary tract infections, depression, use of restraints, falls, use of antipsychotic and hypnotic drugs). Statistically significant (p<.05) inverse relationships were found between volunteers providing individualized activities (e.g., feeding assistance, combing hair, doing nails, and letter writing) and the incidence of urinary tract infections and the use of psychotropic drugs. Multiple regression analysis revealed a statistically significant (p<.05) inverse relationship between personal volunteer services such as combing hair and doing nails and the use of hypnotic drugs and antipsychotic drugs. This study indicates a significant correlation between volunteer programming and quality measure scores. A larger study of these relationships is indicated.
Expectations Regarding Aging After Relocation to an Assisted Living Community
Authors: Plys Evan
Published: December 2020

This study adds to the growing literature on attitudes toward aging in older adulthood by using a multidimensional measure to assess heterogeneous profiles of expectations regarding aging (ERA) in a sample of assisted living (AL) residents. The author analyzed secondary data from a cross-sectional quantitative study consisting of 202 residents of 21 ALs. Participants were mostly female (72%), white (90%), and widowed (59%); ages ranged from 51 to 100 (M = 83.05, SD = 10.32). Hierarchical Cluster Analysis identified four subgroups: (1) “healthy agers”, n = 54, 27%, characterized by high physical, emotional, and cognitive ERA; (2) “cognitively intact”, n = 41, 20%, characterized by low physical, low emotional, and high cognitive ERA; (3) “coping with decline”, n = 56, 28%, characterized by moderate physical, high emotional, and low cognitive ERA; and (4) “unhealthy agers”, n = 51, 25%, characterized by low physical, emotional, and cognitive ERA. Subgroups varied by mental health (healthy agers > unhealthy agers), cognitive ability (cognitively intact > coping with decline), and activity participation (coping with decline > unhealthy agers). Surprisingly, groups did not differ based on social support from co-residents, staff, or family. Results demonstrate that distinct subgroups of ERA exist among AL residents, supporting the utility of assessing ERA as a multidimensional construct in this setting. In addition, findings suggest that expecting to retain health and ability in at least one domain may protect against behavioral consequences of negative ERA. The author also discusses implications for future research and clinical practice in AL.
Nursing Home Staff’s Perceptions of Healthcare Decision Making for Unbefriended Residents
Authors: Kim Hyejin , Perkins Molly , Pope Thaddeus , Comer Patricia , Song Mi-Kyung
Published: December 2020

‘Unbefriended’ adults are those who lack decision-making capacity and have no surrogates or advance care plans. Little data exist on nursing homes (NHs)’ healthcare decision-making practices for unbefriended residents. This study aimed to describe NH staff’s perceptions of healthcare decision making on behalf of unbefriended residents. Sixty-six staff including administrators, physicians, nurses, and social workers from three NHs in one geographic area of Georgia, USA participated in a 31-item survey. Their responses were analyzed using descriptive statistics and conventional content analysis. Of 66 participants, eleven had been involved in healthcare decision-making for unbefriended residents. The most common decision was do-not-resuscitate orders. Decisions primarily were made by relying on the resident’s primary care physician and/or discussing within a facility interdisciplinary team. Key considerations in the decision-making process included “evidence that the resident would not have wanted further treatment” and the perception that “further treatment would not be in the resident’s best interest”. Compared with decision making for residents with surrogates, participants perceived decision making for unbefriended residents to be equally-more difficult. Key barriers to making decisions included uncertainty regarding what the resident would have wanted in the given situation and concerns regarding the ethically and legally right course of action. Facilitators (reported by 52 participants) included some information/knowledge about the resident, an understanding regarding decision-making-related law/policy, and facility-level support. The findings highlight the complexity and difficulty of healthcare decision making for unbefriended residents and suggest more discussions among all key stakeholders to develop practical strategies to support decision-making practices in NHs.
Predicting Change in Depressive Symptoms in the Nursing Home
Authors: Reinhardt Joann , Burack Orah , Cimarolli Verena , Weiner Audrey
Published: December 2020

Depressive symptoms are common among nursing home (NH) residents. Important predictors of depression to tease apart include demographic characteristics, physical status, functional ability, and chronic pain. A challenge to addressing depression is that a majority of NH residents have some level of dementia. Nonpharmacological management of depression in the NH is a recommended first line of treatment including: personalized activities, music therapy, repositioning, and attention to personal care needs (toileting, resting, and hydration). A holistic approach to the well-being of NH residents is the adoption of person directed (PDC) care models. In this study, predictors of decreased depression over time was examined in residents (N=144) living in two communities featuring PDC models, and those living in traditional care communities within the same NH. Care in the two PDC communities focused on provision of comfort care for persons with advancing dementia at-risk of not having their care needs met largely due to their inability to clearly communicate these needs. Care practices focused on knowing each elder deeply, and anticipating their needs. Care practices also included an emphasis on staff empowerment and meaningful life activities for residents. Traditional communities are those where PDC practices had not yet been incorporated. Data on demographic characteristics, cognitive status, physical and functional status, behavioral symptoms, and pain were extracted from the MDS. Results showed that being in the PDC group, less time in the nursing home, having less pain, and fewer behavioral symptoms were significant predictors of decreased depressive symptoms over a six-month period.
Profiling Nursing Home Care Specialization Groups
Authors: Wang Xiao (Joyce) , Burr Jeffrey , Hefele Jennifer , Wang Joyce
Published: December 2020

The nursing home (NH) industry has experienced a shift toward care specialization. This study used NH-level panel data from 2011 to 2017 to describe unique care specialization groups in urban areas using latent profile analysis (LPA) (N= 64695, with 12,143 unique NHs). We focused on urban NHs because NHs specialize in care due to competition and memetic pressure, more likely to be the case for urban NHs. To identify care specialization profiles, LPA was applied using different types of specialist staffing levels (physical therapist, occupational therapist, physicians, and dietitians) and the share of special care units aimed at chronic conditions like Alzheimer’s Disease and AIDs. Model diagnostics and information criterion guided selection of the best fitting model. Model stability over time, interpretability of results, and parsimony were also taken into consideration. The final results indicated a 4-profile model fit the underlying data best and the patterns remained comparatively stable over seven years. The 4-classes are uniquely identified as: high use of specialists of all types (3%), moderate use of specialists of all types (7%), mixed use of specialists and special care units (26%), and low specialization use (64%). From 2011 to 2017, the size of the ‘low specialization’ group became smaller, whereas the high and moderate groups grew larger. In addition to describing a clear trend towards increased care specialization, our findings indicated great heterogeneity in NHs’ care specialization patterns in urban areas. Future studies should examine market and organizational characteristics, as well as performance outcomes for different specialization groups.
Are the Self-Employed Mentally Healthier Than Salaried Workers? Evidence From Korea, Mexico, and the United States
Authors: Jun Hankyung
Published: December 2020

Self-employed workers are often reported to have better health than salaried workers. Whether this is because self-employment has health benefits or healthier workers are self-employed is not clear. Self-employed workers may have higher job satisfaction due to higher levels of self-efficacy and autonomy, but may also experience higher job stress, uncertainty, and lack of health insurance leading to mental health problems. Self-employed workers in the U.S. may have different characteristics than those in Mexico and Korea given different working and living environments as well as different institutional arrangements. This study will examine the association between self-employment and mental and cognitive health for older adults in the U.S., Mexico, and South Korea. It uses harmonized panel data from the Health and Retirement Study, the Korean Longitudinal Study of Aging, and the Mexican Health and Aging Study. We compare the health and selection effect of self-employment using a pooled logistic model, fixed-effects model, and a bivariate probit model. In addition to comparing self-employed and salaried workers, we analyze differences between self-employed with and without employees. By using rich data and various models, we address reverse causality and estimate the relationship between self-employment and health. We show that the positive health effects of self-employed workers in the U.S. disappear once controlled for unobserved heterogeneity, indicating the possibility of healthier workers selecting into self-employment. Interestingly, for Korea and Mexico, healthier individuals seem to select into wage work which reflects the difference in working conditions across countries. Further analysis will show effects by business size.
Factors Influencing Practitioner Choice in Nonparticipation in Medical Assistance in Dying
Authors: Brown Janine , Goodridge Donna , Thorpe Lilian
Published: December 2020

Canadians aged 65 and older compromised 79% of the individuals who chose a medically assisted death between January 1 – October 31, 2018. Despite public approval for MAID, and positive professional reception, few practitioners are participating in MAID care and the underlying factors influencing this require exploration. What are the factors considered by practitioners when contemplating MAID participation? Interpretive Description guided a qualitative, exploratory project. Data included semi-structured interviews with 35 practitioners who currently did not participate in MAID, interviewer field notes and reflective content. Data was analyzed through open coding, a constant comparative approach and thematic analysis. Participants are contemplating numerous endogenous and exogenous factors in determining care participation. The endogenous factors included philosophy of care, MAID/faith/spirituality congruence, the conceptualization of duty, comfort with death and previous life experiences. Within these factors, participants described knowing if MAID participation was, or was not, possible through a process of self-reconciliation. Those who thought MAID care participation may be possible, but yet were not participating, intentionally contemplated numerous exogenous factors including risk, time and practice factors, patient, family and community considerations, system structures, and visibility. Non-participation in MAID care is important to understand to support the self-determination of older adults who may consider MAID. Contemplating involvement in MAID care is complex with both numerous factors influencing practitioner choice. Practitioners require care options, safe passage, respect, model of care clarity, removal of practice barriers, open conversations, enhanced education opportunities and time to facilitate safe, supportive work environments and client care.
Meaning Making as a Central Mechanism of Dignity Therapy for Older Adults With Cancer
Authors: Mroz Emily , Bylund-Lincoln Carma , Wisolmerski Rachel , Wilkie Diana , Fitchett George , Handzo George , Chochinov Harvey , Bluck Susan
Published: December 2020

Nearly 500,000 older Americans die a cancer-related death each year (National Vital Statistics Report, 2018). Following a diagnosis of a serious illness like cancer, maintaining a sense of dignity is central to a patient’s wellbeing. Dignity Therapy (DT) was recently introduced as an intervention to enhance dignity for terminally ill patients (Chochinov et al., 2005). This therapy provides patients opportunities to foster a sense of dignity though making meaning of their lives (Hack et al., 2010). To date, whether meaning-making actually occurs as a central mechanism of effective DT has not been tested. The current study investigates (i) how often and in what forms meaning-making occurs during DT, and (ii) how patients’ baseline feelings of dignity relate to meaning-making during DT. Participants were 25 male and female cancer outpatients (M age = 63.08; SD = 5.72). They completed the Patient Dignity Inventory (Chochinov et al., 2008) and then participated in Dignity Therapy with a trained provider. Sessions were audio recorded, transcribed, and reliably content-analyzed for meaning-making using an established coding scheme (Park & Folkman, 1997). Content-analysis revealed that all patients made meaning of past life events at least once (range: 1-12 occurrences). Multiple forms of meaning-making emerged, with Finding Benefit and Personal Growth most common. Patients reporting more dignity-related distress prior to DT showed greater meaning-making during the DT session (r = .46, p < 0.05). This study provides foundational evidence that meaning-making is a key mechanism of Dignity Therapy, helping older adults with cancer enhance dignity at end-of-life.
Association Between Frailty and Development of Alzheimer's Disease–Related Dementias
Authors: Li Chih-Ying Cynthia , Downer Brian , Chou Lin-Na , Ottenbacher Kenneth , Markides Kyriakos S , Snih Soham Al
Published: December 2020

Frailty is associated with an increased risk for Alzheimer’s disease and related dementias (ADRD). However, this association has not been investigated in older Mexican Americans; a population that is high-risk for frailty and ADRD. This study investigated the association between frailty and the development of ADRD over 9-year period. We analyzed 860 Mexican Americans ≥76 years old of the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) who have been linked with Medicare claims data. Survey data from Wave 6 (2007/08) was used to categorize participants as frail (either pre-frail or frail) or non-frail according to the Fried phenotype. The main outcome was ADRD diagnosis after Wave 6 interview. ADRD status was determined using the Chronic Conditions Segment of the Master Beneficiary Summary File. We estimated ADRD disease-free probability during 2007-2016 using midpoint of interval data method stratified by frailty status. Mean age of the study sample was 83.2 years (SD=4.4) and 59.3% were female. We found individuals who were frail had less ADRD-free months (46.5; SD= 36.5-52) compared to those who were non-frail (66.0; SD= 47.5-120). Individuals with a score of less than 21 points on the Mini Mental Status Exam had greater risks of ADRD development (Odds Ratio=1.35, 95% CI= 1.05-1.74) compared to their counterpart, after controlling mortality as a competing risk. Our results suggest being pre-frail, frail or cognitively impaired are risk factors for ADRD in community-dwelling older Mexican Americans.
Retirement Without God: Activism and Community Among Secular People Over 60
Authors: Blankholm Joseph
Published: December 2020

There are more than 1,400 nonbeliever communities in the United States and well over a dozen organizations that advocate for secular people on the national level. Together, these local and national groups comprise a social movement that includes atheists, agnostics, humanists, freethinkers, and other kinds of nonbelievers. Despite the fact that retired people over 60 dedicate most of the money and energy needed to run these groups, the increasingly vast literature on secular people and secularism has paid them almost no attention. Relying on more than one hundred interviews (including dozens with people over 60), several years of ethnographic research, and a survey of organized nonbelievers, this paper demonstrates the crucial role that people over 60 play in the American secular movement today. It also considers the reasons older adults are so important to these groups, the challenges they face in trying to recruit younger members and combat stereotypes about aging leadership, and generational differences that structure how various types of nonbeliever groups look and feel. This paper reframes scholarly understandings of very secular Americans by focusing on people over 60 and charts a new path in secular studies.
Effects of Personality and Emotion Regulation in Depressed Older Adult Inpatients
Authors: Mak Wing Jin , Yenko Ira , Aronov Avner , Park Hyunyoung , Geramian Helene , Ho Jennifer , Francois Dimitry , Zweig Richard
Published: December 2020

Personality pathology and emotion dysregulation are associated with impaired psychological and functional outcomes in adults. However, much less is known about their relationship with depression, social functioning, and suicidal behaviors among older clinical samples. The aim of this study was to examine how the two impact depression, social adjustment, and suicidal behavior in an inpatient sample of depressed adults 55 to 89 years of age (N=52). Personality (agreeableness and neuroticism) and suppression strategies (expressive and thought suppression) were first investigated individually and then jointly as a combined predictive model. Results found lower agreeableness predicted poorer social adjustment (β = -2.871, p < .01), while higher neuroticism (β = 0.426, p<.01) and greater use expressive suppression (β =.253, p <.05) each predicted more severe depressive symptoms. Individuals high in neuroticism also evidenced greater use of both thought suppression and expressive suppression, while those who were more depressed endorsed poorer social functioning. Although not reaching the point of statistical significance, lower agreeableness, higher use of suppression strategies, and poor social functioning were found to be moderately associated with experience of recent suicidal ideation. Our findings demonstrated personality pathology and ineffective emotion regulation are promising potential pathways in the detection and intervention of psychological and functional impairments in depressed older adults. Our study also highlighted the need for more research examining the effects of personality pathology and emotional dysregulation from a functional perspective, which could enhance the focus of target problem areas in interventions for severely depressed older adults.
Turning 75: Why Age Matters for Victims of Assaultive Violence Reported to Police
Authors: Addington Lynn
Published: December 2020

Americans are able to age in more active and engaged ways than previous generations. These changes bring many positive opportunities, but also might affect the risk of criminal victimization for older adults. In considering these risks, an initial question is how best to identify older adults. One common default is to use age 65 and older, which suggests older individuals are part of a homogenous group. The Census Bureau’s multiple category approach illustrates another option, which captures variations as Americans age. This study explores the risk and characteristics of non-fatal assaultive violence using a multiple-category age definition and uses police data from the Federal Bureau of Investigation’s 2016 National Incident-Based Reporting System (NIBRS). These data were collected from 34 states and cover a range of crimes including aggravated and simple assaults. NIBRS data are well suited for this study as they collect details about the crime including victim and offender demographics and incident details such as victim-offender relationship, weapons, location and arrest. Preliminary results indicate that 34,689 assault victims were adults over the age of 65. Using a generic measure of older adult (age 65 and above) masks important variations in these assaults. Distinct patterns are observed between those aged 65 to 74, 75 to 84 and 85 and above. Within these age categories, differences also occur across racial and sex groups. The patterns observed can provide more nuanced guidance to challenge traditional assumptions about older adult crime victims and inform policies tailored to support these victims.
A Qualitative Study of Healthcare Experience Among Chinese Homebound Adults Receiving Home-Based Medical Care
Authors: Zhou Rui , Cheng Joyce , Wang Shuangshuang , Yao Nengliang (Aaron)
Published: December 2020

Home-based medical care (HBMC) is emerging in China, but research understanding the efficiency and effectiveness of this new care model is rare. In this study, researchers interviewed 17 Chinese homebound adults aged 45 and older (53% females, mean age=76) who have received HBMC, and collected detailed information regarding their experiences and attitudes toward HBMC. Participants were recruited from healthcare institutions in Shanghai, Jinan, and Zhangqiu of China. The evaluation of patients’ experiences with HBMC yielded both positive and negative aspects. Positive experiences included 1) the delivery method was convenient for homebound patients; 2) health problems could be detected timely because doctors visited patients regularly; 3) home care providers had better bedside manners and professional skills than hospital-based providers; 4) the medical insurance covered the cost of home care services. Negative experiences related to the supply and quality of care, including 1) the scope of current HBMC services was too limited to meet the needs of homebound patients; 2) the visit time was too short; 3) healthcare providers’ professional skills varied greatly. Findings from this study suggest that the HBMC model benefited Chinese older adults, primarily homebound adults, in terms of convenience and affordability. There are opportunities to expand the scope of home care services and improve the quality of care. Policymakers may consider providing more resources and incentives to enhance HBMC in China. Educational programs may be created to train more HBMC providers and improve their professional skills.
Older Adults and Opioid Education: Lessons Learned From Experiences in Rural Arkansas
Authors: McAtee Robin , Tobey Leah , Hayes Corey , Spradley Laura , Kumpuris Sajni
Published: December 2020

Nearly one-third of all Medicare participants were prescribed an opioid by their physician in 2015 (AARP, 2017) and in 2017, Arkansas had the 2nd highest opioid prescribing rate in the nation (CDC, 2019). Approaching older adults (OA) about opioids and pain management can be a sensitive topic. Educating and altering long-term treatment with opioids is especially challenging in rural areas where literacy, especially health literacy, is suboptimal. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve health outcomes including an emphasis to decrease the misuse and abuse of opioids among older Arkansans. To address this crisis, the AGEC partnered with local leaders such as the AR Drug Director, academia, Department of Health and Human Services, and multiple community based organizations to create age-tailored educational programs. Unique aspects of approaching and educating rural OA about opioids and pain management will be reviewed. Outcomes will be discussed such as their lack of knowledge about: what is an opioid, why they were prescribed, and what are viable alternatives. Also discussed will be lessons learned that resulted in more effective methods of reaching and teaching rural OA. Partnering with the AR Farm Bureau helped the AGEC reach 100’s of farmers in the extremely rural and mostly agricultural areas. Learning to not use the word opioid resulted in more participants and in a more positive attitude and outlook on attempts to change the culture of opioid use, misuse and abuse among older Arkansans.
Innovations in Gerontology Education: A Multifaceted Approach
Authors: O’Connor Melissa , O’Connor Melissa
Published: December 2020

By 2030, older adults are projected to outnumber children. This growth among older adults presents both opportunities and challenges on how to care for this unprecedented older adult population. In 2010, there were 7.2 family caregivers for every person 80 and older; this is expected to fall to 3 by 2050. Many older adults are at risk of becoming an elder orphan - someone aging alone with no family available to address their caregiving needs. This underscores the urgent need for the education of nurses who are prepared to care for older adults with complex social and health needs, many of whom are suffering from three to five chronic conditions. This symposium highlights cutting-edge research designed to transform nursing education to better prepare students to advance the health of older adults. Our first presentation describes ageism among undergraduate students and innovative curricula to positively influence their preference for working with older adults. Next, the groundbreaking tool-kit that encourages self-reflection on beliefs about aging and reframes how students view older adults. Third, the qualitative results of a collaborative learning experience designed to introduce students earlier and more often to older adults. Finally, findings from a student-led study investigating the unique needs of caregivers of older adults with diabetes highlights the importance of funding students to conduct research related to older adults. Our symposium ends with a discussion of how these approaches are transforming nursing education to adequately prepare nurses to improve the health and health care of older adults.
Providing Experience for Undergraduate Nursing Students to Care for Older Adults: A Qualitative Study
Authors: Pariseault Christine , Whitehouse Christina , O’Connor Melissa
Published: December 2020

Care of the older adult can be complex and frequently influenced by ageism. Nursing students do not have the frequent opportunity to provide care for older adults. The purpose of this pilot study was to expose sophomore nursing students to older adults earlier and more often in the undergraduate curriculum by providing a unique clinical experience at St. Thomas of Villanova Monastery, a residential facility for retired Augustinian priests. This study examines the experience of students’ participation in this clinical experience. Qualitative content analysis of 12 student logs was conducted. Themes that emerged included: age-related changes, environmental considerations, psychosocial needs and changes, and consideration of gerontology as a career choice and existing bias. Students gained a valuable understanding of the unique age-related changes that older adults are experiencing. Early experiences are vital in the curriculum and provide enhanced engagement in gerontology.
Adapting Resources for Enhancing Alzheimer's Caregiver Health for Dementia-Capable Services
Authors: Spencer Mindi , Miller Maggi , Jahries Diana , Davis James , Spencer S Melinda
Published: December 2020

The overall goal of the PRISMA Health - REACH (PH-REACH) project was to reduce caregiver burden and improve caregiving skills among caregivers of community-living Alzheimer's disease and related dementia patients and, as a result, improve care and quality of life for both the patients and their caregivers. This evidence-based, person-centered program emphasizes positive aspects of caregiving and provides tools to improve stress management, caregiver self-care, and coping skills for managing problem behaviors. PH-REACH provided in-home caregiver training, support, and service referral to 126 caregivers in the Greenville area. Trained coaches delivered the program to caregivers of persons with moderate to severe dementia in its original format but later adapted it to better fit the caregivers’ needs. Analysis of pre- and post-test data showed that both the standard and adapted interventions provided benefits across multiple caregiver outcomes, including reduced caregiver burden, ability to manage disruptive behaviors of the care recipient, increased caregiver self-efficacy, reduced depression, and a slight improvement in the number of chronic health conditions. This supports and expands on previous research that has demonstrated the ability of this program to translate across different community-based and clinical settings. The tailored version of PH-REACH succeeded in assisting these caregivers, meeting them where they were in their caregiving journey, and provided measurable benefits to both their mental and physical health. Overall, this project provided evidence of the utility of the PH-REACH intervention and laid the groundwork to extend caregiver training and support to other institutions, both inside and outside the health system.
Are Quality-of-Life Scores Stable and Sensitive Over Time for Nursing Home Residents With and Without Dementia?
Authors: Shippee Tetyana , Qin Xuanzi , Baker Zachary , Jarosek Stephanie , Woodhouse Mark
Published: December 2020

The proportion of older adults with Alzheimer’s Disease and Related Dementias (ADRD) in nursing homes (NHs) has been increasing over time and creates a mandate to meaningfully examine their care. There is also a growing recognition that person-centered measures are important for dementia care, and consensus about the need to maximize residents’ quality of life (QoL). Yet, because QoL is fundamentally subjective, and residents with ADRD experience declines in cognitive function, their ability to make complex judgements about QoL has been questioned. This presentation will longitudinally assess whether QoL scores for residents with ADRD are stable and sensitive over time compared to those without ADRD. We use 2012-2015 Minnesota Resident Quality of Life and Satisfaction with Care Survey data, which contain in-person resident responses from a random sample of residents of all Medicare/Medicaid certified NHs in the state, about 40% of whom have AD/ADRD. These data were linked to the Minimum Data Set (MDS) 3.0. and facility characteristics data. The final sample contained 12,949 cohort-resident pairs, 8,803 unique residents, and 3,120 residents participated in more than two surveys. QoL scores of residents with and without ADRD were similarly stable over time and sensitive to health status change. We also found that stability of QoL scores may be driven by cognitive impairment as opposed to ADRD diagnoses. Thus, self-report QoL scores can also represent the QoL status for nursing home residents with ADRD diagnoses, and residents with ADRD diagnoses shouldn’t be excluded from quality of life surveys based on ADRD diagnoses.
Building Community Space for Supporting Residents Living With Dementia in a Housing Complex District in Tokyo, Japan
Authors: Sugiyama Mika , Okamura Tsuyoshi , Miyamae Fumiko , Edahiro Ayako , Ogawa Madoka , Inagaki Hiroki , Ura Chiaki , Awata Shuichi
Published: December 2020

It is estimated that by 2025 the number of people with dementia will reach around 600 thousand, approximately one out of five in the older population in Tokyo, Japan. At the same time, the number of older people living in a single, couple household is expected to increase. We built a community space for older people in the largest housing complex district in Tokyo, and with the goal of creating a dementia friendly community (DFCs). In this study, we used the community-based participatory research approach to create a model of an inclusive community space with a human-rights-based approach, which is embodied in the PANEL framework by the Alzheimer Scotland organization. The community space where everyone, regardless of with or without dementia, can freely spend their time, and seek consultation on healthcare and older care. It also serves as a Dementia Café, where people with dementia can get together and chat. Places open 3 days a week. Those users can casually seek consultation by physicians, health nurses and psychologists. From April 1, 2017 to March 30, 2018, the average number of visitors was 11.6. Number of consultation was 182 times (female 81.3%, 80s’ =31.3%; 70s’ =23.1%). Historically, service delivery for the people with dementia was hospital-based in japan, but our community space established a new method to provide consultation to people with dementia, from a professional perspective, and to cooperate with appropriate social resources and related organizations as needed.
The Influence of Verbatim Versus Gist Formatting on Younger and Older Adults’ Information Acquisition
Authors: Nolte Julia , Loeckenhoff Corinna , Reyna Valerie
Published: December 2020

It is well-established that pre-decisional information seeking decreases with age (Mata & Nunes, 2010). However, it is still unknown whether age differences in information acquisition are influenced by the type of information provided. Fuzzy-trace theory suggests that decision makers prefer gist-based over verbatim-based processing, and that this preference increases across the lifespan. Therefore, we hypothesized that age differences arise when presenting participants with verbatim details (such as exact numbers) but not gist information (such as ”extremely poor” or “good”). In a lab-based experiment, 68 younger adults and 66 older adults completed a gist-based and a verbatim-based search task before making health insurance choices. Younger and older adults reviewed similar amounts of information in either condition. In line with Fuzzy-trace theory, however, older adults sought more information when presented with gist rather than verbatim information. The role of age-associated covariates and implications for decision-making will be discussed.
Evolution of Public Knowledge About Dementia Causes and Symptoms: A Gender Perspective
Authors: Santos Pedro , Paul Constanca , Silva Cláudia
Published: December 2020

The research objective is to monitor the evolution of public knowledge about dementia causes and symptoms, over a three-year period and by gender. The survey was made available at the Directorate-General of Health website and disseminated by email to relevant health and social stakeholders and through social networks, in 2015 and 2018. Respondents (n=1478 and 1716, respectively), included mostly women (79.4% and 83.3%). In both years, respondents showed a higher knowledge on symptoms than on causes. Total knowledge about symptoms and combined knowledge scores were higher in 2018 compared to 2015 (p=.012 and p=.0.2), respectively). “Neurological brain changes" were considered the main causes of dementia, by both genders in 2015 and in 2018 (>80% of respondents), with an increase in relative frequency being observed only for women (p=.039). “Psychiatric disease” and "drug consumption" are now less regarded as causes of dementia by both genders, with significant change over time also among women (p=.006 p=.001). On the contrary, in the last survey more women (+3.7%; p=.049) and men (+9.3%; p=.022) considered “stress” as main cause of dementia. “Confusion and disorientation”, “wandering and getting lost”, “difficulty managing and paying bills”, ”difficulty remembering things from the day before”, and “difficulty managing daily tasks”, were considered the most common symptoms, but only the last two significantly increased in 2018 (p=.018 and p=.000). Women knowledge increased regarding more causes and more symptoms compared to men. These findings will help to inform public debate and decision-making on gender-based policies to address awareness and stigma about dementia.
Decade Review of Social Support in Family Gerontology: Methods, Theories, and Directions for Future Research
Authors: Seidel Amber , Yorgason Jeremy , Humble Áine , Humphris Roxanne
Published: December 2020

Social support has a rich foundation in family gerontology benefiting older adults, such as bolstering mental health, decreasing social isolation, and connecting them in families and communities. This study draws from a decade review of 995 empirical articles focusing on family gerontology from 13 of the top journals in gerontology, family, and relationships. Of the 995 articles, 86 were coded as social support or social network. Of these 86 articles, less than 3% included dyadic analyses, 95% were quantitative with just over 30% longitudinal. Over 30 different theories were identified with many building their work off multiple theories. Two key theories appear in over 30% of the articles, social support and socioemotional selectivity. Only 4% did not cite any theoretical framework. Overall, this presentation will review the methods, theories, and key findings of the social network/social support subtheme of a decade review of family gerontology and identify related gaps.
Aging in Rural Communities: Advocacy Does Matter
Authors: Wiese Lisa , Holley Lyn , Guest M Aaron
Published: December 2020

Disparities in health care information and access often experienced by rural residents exacerbate health risks of older adults. The purpose of this symposium is to highlight efforts in varied rural settings to develop new information that contributes to identifying, assessing, and addressing the causes of these disparities, thus informing and strengthening advocacy and intervention. Mi and Ma address an unmet need for the description of challenges related to the extensive migration of Chinese rural workers and their families (46 million increase since 2011) that has exacerbated disparity of Social Security access. They describe barriers to establishing eligibility of these newly urban families for social services as they change from rural farmers to urban householders. Asman and Sisofo discuss barriers to working successfully with an alliance of diverse city, county, and state organizations to meet perceived needs of three categories of rural older adults: 1)active but denies aging, 2)adapting to aging and achieving satisfaction; and 3)dependent aging. Using a novel measure to determine true needs of their rural older communities resulted in benchmarks, which the alliance used in creating their strategic plan. Ford and colleagues tested a church-based program in a rural African American setting to facilitate chronic disease management. They tested the efficacy of utilizing online resources in underserved settings. Wiese and Williams investigated stakeholder perceptions/knowledge regarding dementia at six diverse rural sites. Although 71% of participants believed heart disease and poor diet increased dementia risk and were willing to be screened, only 15% had been tested for memory loss.
Social Security Access Challenges for Chinese Farmers Migrating to Urban Settings
Authors: Mi Hong , Ma Qiyini
Published: December 2020

In 2018, China had 564 million rural people, accounting for 40% of the total population. However in 2018, the total number of rural workers immigrating to urban areas related to economic need reached 288 million. This represents an increase of 46 million since 2011. The Chinese government piloted a new rural insurance as an answer to pushing urbanization forward to support rural immigrants. Consequently since 2009, the number of urban and rural residents participating in the basic old-age insurance has been kept above 500 million, making it the largest basic old-age insurance system, covering the largest number of persons in the world. Due to this insurance, an estimated 515 million people were lifted out of poverty, of which 27.41 million were older adults. Challenges for the Chinese government include transforming the Chinese situation of absolute poverty to relative poverty, and improving the living standard of older adults.
Openness and Transparency Promotion With Existing Longitudinal Data: A Worked Example of a Coordinated Analysis
Authors: Mroczek Daniel , Graham Eileen , Willroth Emily
Published: December 2020

The application of openness and transparency principles is challenging when using existing or ongoing long-term longitudinal data. One technique that promotes replicability and also is consistent with openness and transparency principles is coordinated analysis. Such analyses, especially when done with a large number of extant longitudinal datasets, tend to draw upon values of data sharing, revelation of code and scripts, and pre-registration. Thus coordinated analyses often provide good examples of how multiple transparency and openness values can come together. We will demonstrate this by presenting two recent large-scale coordinated analyses. One was a 15-study investigation of personality and mortality risk (Graham et al., 2017). The second is a new 16-study investigation of personality trajectories (Graham et al., under revision). We show how multi-study designs are congruent with open science and transparency ideas in the context of longitudinal and other secondary data.