bluuebunny/crossref_metadata_2025 huggingface dataset:
BE EPIC-VR: TRANSLATING AN IN-PERSON, PERSON-CENTERED COMMUNICATION TRAINING PROGRAM INTO VIRTUAL REALITY
Authors: Savundranayagam Marie , Chen Allison , Norris Grace , Schumann Annette , Kaur Simran , Campos Jennifer , Orange Joseph
Published: December 2023

Be EPIC is a dementia-specific, person-centered communication training program for frontline healthcare workers that uses simulations with trained actors, reflection, and feedback. Scaling Be EPIC is limited by resource and methodology demands of recruiting and training actors and consistency of delivery across sites. Virtual reality (VR) is a promising solution to the problem of scaling Be EPIC because it provides interactive, realistic, and consistent simulations. However, there is limited research on implementing VR to train frontline healthcare workers. Guided by the Consolidated Framework for Implementation Research, the current study used an effectiveness-implementation hybrid design to compare simulation experiences of Be EPIC-VR with Be EPIC-in person and real-world clinical encounters. The study also explored factors that can influence the future implementation of Be EPIC-VR in long-term care home settings during the pre-implementation period. Six frontline healthcare workers who completed the Be EPIC in-person version with trained actors also completed the same assessment simulation in VR, followed by an interview. Thematic analyses revealed two themes that contributed to the simulation’s realism: the immersive nature of the virtual environment and the accuracy of the avatar’s visual, verbal, and behavioral characteristics. Moreover, the factors influencing the successful implementation of VR simulations in long-term care home settings include sufficient technological infrastructure and workplace personnel who can assist with Be EPIC-VR implementation. The findings highlight the potential to scale Be EPIC using VR and provides insights into the iterative process involved in translating an in-person training into a VR training program.
SOLITUDE LINKS WITH INDIVIDUAL AND RELATIONAL WELL-BEING: EVIDENCE FROM DYADIC DAILY LIFE ASSESSMENTS
Authors: Garza Elizabeth Zambrano , Murphy Rachel , Ashe Maureen , Madden Kenneth , Gerstorf Denis , Hoppmann Christiane , Pauly Theresa
Published: December 2023

Solitude, defined as physical aloneness or the absence of social interactions, has been associated with both positive and negative outcomes. Older adults spend a significant amount of their waking time by themselves (exacerbated during the pandemic), but they may be better equipped to regulate the negative emotions that are often linked with being alone. Additionally, solitude may provide a balance between social connectedness and autonomous needs. Using pandemic, end-of-day daily diary data across 10 days from 136 older Canadian adults and a close other of their choice (59% spouses, M = 66.49 years, SD = 13.26 range: 18-87 years, 88% White, 62% women), this project aims to examine associations of actor and partner solitude with relationship quality and daily affect. Multilevel models revealed that participants who reported more voluntary solitude experienced more daily positive affect and those who reported more negative solitude experienced both more negative affect and less positive affect at both daily and overall levels. We also found daily partner effects such that more voluntary solitude of the partner was associated with less actor negative affect and negative solitude of the partner being associated with less actor positive affect and more negative affect over and above actor effects. Finally, when partners reported more voluntary solitude, participants reported higher relationship support. Findings shed light on the benefits and drawbacks of how solitude is experienced in older adulthood, highlighting the influence social partners affect quality and relationship satisfaction.
INCLUSION OF HEARING AND VISION IMPAIRMENTS IN COGNITIVE TRAINING INTERVENTIONS WITH OLDER ADULTS
Authors: Marino Francesca , Jiang Kening , Smith Jason , Chen Diefei , Deal Jennifer , Rebok George , Huang Alison
Published: December 2023

Cognitive training intervention implementation and efficacy should be evaluated among representative samples, including those at highest risk of cognitive decline. Hearing and vision impairments are prevalent among older adults and confer an increased risk of cognitive decline/dementia. Whether cognitive training interventions enroll and are designed to include this important subgroup is unknown. A scoping review of PubMed and PsycINFO was conducted to examine the inclusion of older adults with hearing and/or vision impairment in cognitive training interventions. Eligible articles included English-language cognitive training randomized controlled trials and a study population that was cognitively unimpaired, aged ≥55-years, and community-dwelling. Among the 130 articles in the review, 103(79%) were cognitive training and 27(21%) were multimodal interventions that included cognitive training. Over half the trials systematically excluded participants with hearing and/or vision impairment (n=60, 58%). Few studies measured and reported participant hearing and/or vision impairment (cognitive: n=16, 16%; multimodal: n=3, 11%) or reported incorporating low hearing/vision accessibility features into intervention design (cognitive: n=7, 7%; multimodal: n=0, 0%). Greater representation of older adults with hearing and/or vision impairment in cognitive training interventions is needed and can be achieved by strengthening measurement and reporting of participant hearing and vision, minimizing barriers to participation by increasing accessibility in recruitment and intervention design, and intentional inclusion of older adults with hearing and/or vision impairment. With greater representation of older adults with hearing and/or vision impairment, studies can better evaluate group-specific differences in training effect and begin to tailor interventions to potentially maximize benefit.
PEER SUPPORT FOR CAREGIVERS OF AFRICAN AMERICANS LIVING WITH DEMENTIA: A PHASE 1 BEHAVIORAL INTERVENTION PROTOCOL
Authors: Moss Karen , Happ Mary Beth , Brody Abraham , Will Celia , Tan Alai , Brill Seuli Bose , Bullock Karen
Published: December 2023

African American caregivers of older adults living with Alzheimer’s disease or a related dementia are at high risk for physical, spiritual, and psychosocial challenges. Peer mentorship, a relationship-centered person-to-person approach may reduce healthcare decision-making burden among African American caregivers through cultural tailoring by promoting oral traditions, personal contact, and storytelling. The purpose of this Stage 1 intervention study is to use a stakeholder-informed approach in further developing and pilot testing the co-created Peer Support for Caregivers of African Americans Living with Alzheimer’s Disease and Related Dementias (Pair2Care), a culturally sensitive caregiver peer support program. Pair2Care feasibility and acceptability will be evaluated in current (n=15) and trained former (n=15) African American Alzheimer’s and related dementia caregivers. Pair2Care will be deemed feasible and acceptable by evaluating eligibility criteria, recruitment and retention data, protocol adherence, satisfaction, and feedback on program appropriateness for broader dissemination. Preliminary intervention outcomes of caregiver anxiety, depression, quality-of-life, social support, self-efficacy for surrogate decision-making, and intent to use palliative care or hospice services will be assessed to evaluate intervention effectiveness. At 6 months as compared to baseline, current caregivers will report less anxiety and depression, improved quality-of-life, social support, and self-efficacy for surrogate decision-making, as well as intent to use palliative care or hospice services as part of healthcare and advance care planning decision- making. Pair2Care poses an innovative strategy with the potential to address advance care planning and healthcare decision-making, a significant health disparity problem and thereby promote health equity.
LIFELONG LEARNING FOR THE OLDER POPULATION—TECHNOLOGY WITH THE OLDER LEARNERS
Authors: Su Yan-Jhu , Alberth Andrew
Published: December 2023

Advances in digital information technology and population aging are two hallmarks of the 21st century. Modern students are increasingly dependent on digital technology in their education. However, how to make digital technology less exclusive to young students remains an important issue. The COVID-19 pandemic has also popularized remote learning and the use of communication software among all ages. Teaching remotely has broadened access to education for all ages. Therefore, how to use technology to help older people achieve the goal of lifelong learning remains critical. This presentation will review the literature to explore the relationship between technology and older adults, as well as share the author’s experience leading older adults to use technology for online learning in Taiwan. The key takeaways from this presentation will help educators understand the benefits and challenges of technology use among older adults, and highlight ways to bridge the digital divide between older and younger learners in the classroom.
UNFAIR TREATMENT, SOCIAL COHESION, AND COGNITION IN BLACK ADULTS LIVING IN URBAN NEIGHBORHOODS
Authors: Fan Erica , Dubowitz Tamara , Troxel Wendy , Weinstein Andrea , Gary-Webb Tiffany , Ghosh-Dastidar Bonnie , Manly Jennifer , Rosso Andrea
Published: December 2023

Exposure to discrimination has been associated with poorer cognitive function but this association may be influenced by broader social factors, such as neighborhood social cohesion. We investigated the associations between unfair treatment, social cohesion, and cognitive function in 234 participants ≥50 years, recruited from urban, primarily Black neighborhoods in Pittsburgh, PA. Neuropsychological assessments were conducted in 2018 to create six cognitive domain z-scores, adjusted for age, sex, and education level. Social cohesion was assessed in 2013 and 2018. Change in social cohesion scores over time categorized participants into four groups: consistently high, consistently low, increasing, and decreasing scores. Unfair treatment was assessed via questionnaire in 2018. Adjusted generalized linear models assessed associations between unfair treatment and cognition. Unfair treatment was significantly associated with executive function (β=-0.041, p=0.01) and marginally associated with language (β=-0.030, p=0.07). Associations persisted with change in social cohesion in the models and we found that social cohesion moderated the association between unfair treatment and executive function (p=.06). In those with consistently low social cohesion, more unfair treatment was associated with worse executive function (β=-0.085, p=0.02). Both increasing and decreasing social cohesion showed a similar negative association between unfair treatment and executive function at a trend level (β=-0.122, p=0.08 and β=-0.082, p=0.10 respectively). There was no association for those with consistently high social cohesion. Individuals experiencing unfair treatment and consistently low levels of neighborhood social cohesion had lower executive function. These findings highlight the importance of intervening at multiple levels and addressing both interpersonal discrimination and structural sources.
LESSONS LEARNED DEVELOPING A NUTRITIONAL ADHERENCE INTERVENTION FOR DEMENTIA PREVENTION: A QUALITATIVE ANALYSIS
Authors: Sheffler Julia , Patel Juhi , Kiosses Dimitris , Naar Sylvie
Published: December 2023

Lifestyle interventions show considerable promise in delaying the onset and reducing risk for Alzheimer’s disease and related dementias (ADRD). Unfortunately, scalable interventions that address issues of long-term adherence have not been adequately developed or disseminated. Especially important for this effort is iterative evaluation and adaptation of interventions using participant feedback throughout the development process. Using the NIH ORBIT model for behavioral intervention development, our team has established the proof-of-concept (N=9) and pilot tested (N=58) a Mediterranean ketogenic nutrition (MKN) adherence program for older adults at risk for ADRD. This program incorporates motivational interviewing strategies and cognitive behavioral skills training to enhance uptake and long-term adherence to MKN. For each of these pilots, participants completed exit interviews at the conclusion of the 6-week, group intervention and 3-months post-intervention. Qualitative and quantitative data on the acceptability of the program, as well as detailed participant feedback about their experience and recommendations for improvements were collected. While quantitative data demonstrate high acceptability, thematic analysis of qualitative interviews demonstrate a range of recommendations for enhancing and refining important components of the intervention that will be necessary for future scaling and dissemination. We discuss important themes, future directions of this work, and implications for lifestyle intervention development more broadly.
A TOOL TO SUPPORT FAMILY AND PAID CAREGIVERS PROVIDE DAILY ORAL CARE TO PERSONS LIVING WITH DEMENTIA
Authors: Ashida Sato , Beachy Tim , Donohoe Maria , Schneider Haley , Pinho Hianca , Wilson Haley , Marchini Leonardo
Published: December 2023

Persons living with dementia often receive daily oral care from family caregivers or paid caregivers such as nurse aides. However, these caregivers report limited knowledge about and confidence in providing daily oral care. This study used stakeholder engaged processes to develop an app that provides information and guidance to caregivers to support their oral care provision. Contents to support oral care for persons living with dementia were developed through a collaboration between the College of Dentistry and College of Public Health based on prior research. In-depth interviews were conducted with key stakeholders including dental professionals, family caregivers, nursing home administrators, and nurse aides. Participants identified many benefits of this support tool to improve their oral care provision. Dental professionals confirmed the accuracy and importance of the information and provided additional suggestions. Family caregivers appreciated the detailed information and guidance on how to provide daily care, how to identify oral health problems, and what to do if they identify problems. Photos especially helped caregivers identify the nature of the problem to determine action steps. For paid caregivers, the app served as a good reminder and reference guide. Nursing home administrators wanted to use the app as a training tool to standardize and improve the overall care. The app was well-accepted and provided an easily accessible tool for caregivers during care provision. Additional qualitative data and pilot test results will be presented.
DOES BECOMING FRAIL MEAN THE END? SOCIAL, LIFESTYLE, AND HEALTH SURROGATES OF RESILIENCE IN THE MOST VULNERABLE
Authors: Wu Chenkai , Xue Qianli
Published: December 2023

Frailty is a prevalent geriatric syndrome characterized by reduced reserve to stressors and increased vulnerability to adverse outcomes. Despite many efforts, reversing the frail status remains difficult, primarily due to a lack of understanding of its etiology. Intervention efforts have primarily focused on improving functions and alleviating symptoms instead of targeting frailty-causing biology and treating the syndrome. Although no magic pill exists for treating frailty, becoming frail doesn’t mean the end of life. Frail individuals are a socioeconomically, behaviorally, and clinically diverse group. Identifying socioeconomic, lifestyle, and health features that could mitigate the frailty-induced health risks and promote resilience is critical for guiding patient-centered management of frailty. This symposium has a collection of four studies focusing on different ways to promote health and reduce risks among the most vulnerable. The first study suggested that adherence to a healthy lifestyle may provide an excellent opportunity to decrease the risk of adverse outcomes among the frail, especially those living in an unfavorable social environment. The second study found frailty to be associated with higher healthcare expenditure only among persons with poor self-rated health, suggesting individuals reporting good health are resilient to frailty-induced health risks. The third study found that physical frailty and self-rated health were overlapping but distinct constructs. Good self-rated health was predictive of low mortality among frail individuals, and the association was stronger among the frail than the non-frail. In the fourth study, intrinsic capacity, assessed by a validated, multidimensional tool, provided prognostic value for healthcare utilization beyond multi-morbidity.
ENGAGE UNDERREPRESENTED GROUPS IN TECHNOLOGY AND AGING RESEARCH: LIVED EXPERIENCE AT GEOGRAPHICALLY DIVERSE SITES
Authors: Kaye Jeffrey , Beattie Zach
Published: December 2023

Minoritized and marginalized older adults face multifaceted barriers that could prevent them from participating in aging research, including but not limited to not having access to research opportunities, time and transportation constraints, lack of trust with health care providers and researchers, and language barriers. When the research projects involve technology, whether as a tool for engagement or recruitment, intervention delivery, or outcome monitoring and assessment, additional challenges exist in recruiting underrepresented groups. The technology adoption gap has been widely reported. Minoritized and marginalized older adults are less likely to have internet access or feel less confident in using technology compared to their more privileged counterparts. This symposium introduces the lived experience and lessons learned from engagement and recruitment of underrepresented populations at multiple Alzheimer’s Disease Research Centers. The first presentation presents outreach and recruitment efforts at the Oregon Outreach, Recruitment & Education Core. The authors will discuss strategies and benefits to engage people of underrepresented backgrounds in the research workforce. The following two presentations focus on recruitment efforts for installing an in-home monitoring technology platform for diverse older adult populations, including African Americans in Chicago, IL, and Hispanic/Latino immigrants in San Antonio, TX. The fourth presentation describes the response, retention, and enrollment rate of an online dementia research registry and the effort to adapt the registry and build capacity in recruiting Asian American immigrants with limited English proficiency. Sharing successes and lessons learned at multiple sites will contribute to developing more effective recruitment strategies for future aging research involving technology.
FINDING COMMON GROUND: IMPROVING RESEARCHER-PRACTITIONER COLLABORATION IN ADULT MALTREATMENT RESEARCH
Authors: DeLiema Marguerite , Wilber Kathleen
Published: December 2023

The work of adult protection is inherently multidisciplinary–involving health care professions, social services agencies, law enforcement, criminal and civil justice systems, and the broader aging services network. Researchers seeking to develop and evaluate screening tools and interventions for elder abuse and neglect must cultivate partnerships with state and local agencies that are responsible for adult protection. In this symposium, early career researchers will share the unique challenges they have faced when collaborating with adult protective services (APS), healthcare organizations, and other state agencies on research to improve adult maltreatment outcomes. First, Reynolds and colleagues will summarize three collaborative projects involving a large healthcare system in Texas and APS agencies in Oklahoma. They will share how the research team adapted protocols to pandemic-related disruptions to data collection, and how they created new systems to standardize documentation. Liu interviewed state agencies in Montana and analyzed transcripts using thematic analysis. She will share the challenges and strategies that surfaced and relate to improving state-level collaboration in addressing the needs of mistreatment victims and survivors. DeLiema will present on planning for and navigating administrative barriers to cross-sector collaborations, including contracts and legal agreements that are part and parcel to university-government research partnerships. Last, Burnes will introduce the RISE project and share how he and his colleagues managed expectations to co-create a new outcomes measurement tool with adult protection workers. Reaching consensus necessitated honesty, openness, humor, and patience, but ultimately strengthened the collaboration to yield a more valid outcomes measurement assessment.
PARTNERING TO ADDRESS ADULT MALTREATMENT: HARD-EARNED LESSONS AND WISDOM GAINED BY APPLIED RESEARCHERS
Authors: Reynolds Courtney , Tuft Samantha , Ejaz Farida
Published: December 2023

We focus on three projects in which applied researchers collaborated with community-based and government partners to address adult maltreatment. In our first study with Texas, we partnered with a large healthcare system and Adult Protective Services (APS). Two APS workers served as consultants to clinicians and 529 patients were reported to APS. Researchers struggled with quantifying case notes on the consultations, pointing to the importance of creating a systematic method to document case notes for future studies. In the second grant, the same partners evaluated a case management intervention to prevent self-neglect among at-risk, adult primary care patients. A total of 477 randomly selected participants completed a baseline interview. Lessons learned included revising language in how to discuss self-neglect, particularly in consent forms and becoming more flexible in where to conduct interviews. Other challenges encountered included the time and effort it took to develop data use agreements that allowed us to access APS administrative data. Our third study with Oklahoma APS was conducted in the midst of a pandemic, requiring us to change study protocols from home to telephone-based interviews. Despite these challenges, we interviewed 188 clients over the phone. Drawing on the experiences across all three projects, we will discuss challenges – from contracting to IT issues, to recruitment and data collection – and how each one has presented an opportunity for growth and wisdom that can be applied to future research activities.
MENTAL HEALTH AND TECHNOLOGY UTILIZATION AMONG MEXICAN AMERICAN INFORMAL CAREGIVERS FOR PATIENTS WITH ADRD
Authors: Jiang Lin , Garcia-Andres Adelaido , Sarmiento Cassandra , Nasr Lubna , Moreno Isis Macias , Escobar Romeo , Longoria Denise , Gonzalez John
Published: December 2023

Background

The number of Latinos with Alzheimer’s disease and related dementia (ADRD) is expected to rise to 1.3 million by 2050. Mexican Americans with ADRD rely heavily on unpaid informal care. The use of information communication technology (ICT) among caregivers is associated with significant improvements in mental health and social support. However, current ICT studies focus mainly on White American caregivers. This study fills the gap. Method: From November 2021 to November 2022, we collected 115 surveys, of which 11 were collected from in-person interviews at a clinic and 104 were collected online. The survey included the UCLA Loneliness Scale version 3, the Center for Epidemiologic Studies Depression (CES-D), and the Online Social Support Scale.

Results

The participants, aged from 18 to 82 and have cared for their family members with ADRD for two years on average. About 70.4% of them use the internet daily. The results indicated that the more time spent on Instagram, YikYak, and first-person shooter online games, the higher depression the participants had. Also, the more first-person shooter online games they use, the higher is their loneliness. Other social media use is not related to loneliness or depression.

Conclusion

This study suggests that it is necessary to explore an appropriate internet-based ICT for Mexican American informal caregivers to reduce their loneliness and depression. Future research needs to examine their feelings and reflections on using internet-based ICT and discern how their caregiver’s role and Latino culture affect the utilization of technology.
ACCESS AND USAGE OF CARE AMONG OLDER MIGRANTS: CHALLENGES AND OPPORTUNITIES
Authors: Khan Mushira
Published: December 2023

Equitable access to care is critical to support healthy aging in underserved groups. Recent global demographic trends such as the rapid aging of the population in developing and developed countries, the growing proportion of migrants from the Global South to the Global North over the past 50 years, and increasing health inequalities between and within countries reflect a continued need to address the underlying pathways and causal mechanisms that determine access to and usage of care among migrants. This paper reviews the current state of knowledge on the micro-, meso-, and macro-level determinants that intersect and shape access to and usage of care services and programs among older migrants. It makes the case that foreign-born older adults are more likely to experience challenges accessing services and programs due to cultural and language barriers and factors related to their socio-economic status, race/ethnicity, gender, and time since immigration. Next, the paper provides a deeper exploration of the interface of structure and agency and an interrogation of how access and usage of care among older migrants may be conditioned, not simply by individual socio-economic circumstances and life course events, but also by macro-level factors like the distribution of power relationships and neoliberal public policies. The paper concludes with a call for sustained efforts to acquire a more profound understanding of individual-level, socio-economic and socio-political forces that influence access and usage of care. Finally, it provides directions for future research with the ultimate goal of supporting healthy aging among older migrants.
ADDRESSING THE CHALLENGES OF MIPS WITHIN THE GWEP PROGRAM: A CALL TO CO-CREATE MEANINGFUL WAYS TO SHOW IMPACT
Authors: Faul Anna
Published: December 2023

To address the challenges that unique challenges that the GWEP programs had in collecting and using MIPS data to show meaningful and quality work with older adult patients, we created a collaboration between NAGEC and the GWEP MIPS workgroup. Our primary goal was to develop a collective understanding of how GWEPs perceived MIPS as main outcomes. To better understand the collective challenges, a survey was created to examine the diversity in the sites across all GWEPs where MIPS data was collected and to quantify the types of challenges that GWEPs faced in collecting this type of patient data. From this survey we found the following issues were most prominent: 1.) Most GWEPs had primary care sites that had a difficult time pulling date from their electronic health records; 2.) Providers at participating primary care sites struggled to enter MIPS datapoints into the EHRs; 3.) Some of the participating primary sites did not collect MIPS data; 4.) Some of the participating primary care sites do not have the time to provide us with MIPS data in a timely fashion; and 5.) Some of our participating primary care sites are different than the traditional primary care sites (eg. skilled nursing facility, hospice, emergency departments), making MIPS measures irrelevant. From this survey, we were able to develop a solution focused statement to present to HRSA and to start the conversation about the difficulties and challenges in collecting MIPS data.
SLEEP AND SEXUALITY AMONG CAREGIVERS AND THEIR PARTNERS
Authors: Proulx Christine , Skoblow Hanamori , Rauer Amy
Published: December 2023

Older adult caregivers have increased risk of disturbed sleep, which is associated with declines in sexual frequency. Spousal caregivers engage in less sexual activity than caregivers of non-spouses. We examined whether the associations between sleep behaviors (duration, napping frequency, feeling rested) and couples’ sexual frequency, quality, and pleasure were similar among dyads in which one spouse was providing care to a spouse (n = 146) or a parent or other care recipient (n = 211). Using Wave 2 of the NSHAP and actor-partner interdependence models, we found significant differences (p <.01) between dyads. For all spouses, only frequency of sharing a bed was related to frequency of sexual activity in the previous 12 months. Sleep duration was not associated with any outcomes. In both groups, frequency of sharing a bed was positively associated with reports of physical pleasure (b’s ranged from .20 to .50). In spousal caregiver couples, caregivers’ greater napping frequency was negatively associated (b = -.29, p <.01) with their partner’s reports of a physically pleasurable relationship, and their reports of feeling rested were positively (b = .17, p < .01) associated with their own reports of pleasure. For couples in which the caregiver was caring for a non-spouse, there were actor effects for caregivers’ and noncaregivers’ napping frequency on lower reports of sexual relationship quality (b = .19 and .49, respectively), and a partner effect for non-caregivers (b = .25). These results point to the importance of understanding the context of caregiving, sleep behaviors, and sexual relationships.
INTERPROFESSIONAL CO-LEARNING AT MULTIPLE LEVELS OF LTSS: PRO-HOME PROGRAMS AND RESEARCH
Authors: Skowronski Jordan , Zanoni Joseph , Caceres Maria
Published: December 2023

Promoting Seniors’ Health with Home Care Aides (Pro-Home), a randomized controlled trial (RCT) of a gentle physical activity program delivered by home care aides (HCAs) for their older clients in English or Spanish, provided unprecedented opportunities for collaboration and co-learning across multiple disciplines and professions (public health, health services research, sociology, medicine, physical/occupational therapy, kinesiology, social work, psychology, economics, medicine, nursing; frontline care workers, leaders and staff members of state and home care agencies, , social service agencies, researchers, undergraduate and graduate students). The turbulent long-term services and supports (LTSS) environment, which culminated in the COVID-19 pandemic, provided the study participants (HCAs and their older clients), multiple levels of LTSS stakeholders and the research team with rapidly evolving new contexts for the RCT. This paper presents how the Pro-Home project developed into a learning organization where individuals and organizations learn from each other to pivot at every new turn in the environment, focusing on the development of a novel interactive training for HCAs in-person or remotely. The initial training activities were conducted in-person. After adapting the material for remote delivery, we provided the latter sessions via phone with digital and physical tools. For each training session, we assessed outcome quality using an exit survey and other methods capturing HCAs’ program delivery. The presentation concludes with implications for research and practice in LTSS.
DIFFERENCES IN END-OF-LIFE OUTCOMES BETWEEN IMMIGRANT AND NONIMMIGRANT OLDER ADULTS
Authors: Suntai Zainab , Chipalo Edson , Beltran Susanny
Published: December 2023

Although the number of immigrants in the United States has continued to grow, few research studies have focused on the experiences of older immigrants at the end life. Research on the immigration experience shows that there are long-lasting physical, mental, and psychological symptoms that continue to affect immigrants even long after arriving in a new country. To better understand how the immigration experience may influence outcomes in late life, this study examined differences between immigrant and non-immigrant older adults in the following end-of-life outcomes: being alone at death, being in pain at the end of life, having anxiety and/or depression in their final months of life, and the quality of care received at the end of life. Data were taken from the combined 2012 to 2020 National Health and Aging Trends study, which is an annual longitudinal study of Medicare beneficiaries aged 65 and older. Chi-square tests were used for bivariate analysis, and multivariate logistic regression models were used to assess differences between immigrant and non-immigrant older adults. The results showed that immigrant older adults were more likely to die alone at the end of life, more likely to be in pain at the end of life, more likely to experience anxiety and/or depression at the end of life, and less likely to receive good quality care at the end of life. Implications for practice, policy, and research are provided.
RECESSION EXPERIENCES AND SELF-REPORTED DAILY SLEEP QUALITY IN MID-LIFE AND AGING ADULTS
Authors: Bhat Aarti , Lee Sun Ah , Diaz Jose , Almeida David
Published: December 2023

Adverse economic events can negatively impact various indicators of health, including sleep quality. Sleep quality issues are associated with chronic physical health conditions and poor mental health. While there has been a more established body of work on stress and global indicators of sleep, assessing sleep quality at the daily level can contribute to further understanding how stress can impact everyday life. Given that midlife and older adults are a fast-growing demographic in the United States, who have experienced economic events such as the 2007-2009 Great Recession as well as the COVID-19 pandemic, it becomes critical to study how such economic experiences affect markers of wellbeing, such as daily sleep, for aging adults. This study examines the effect of recession hardships on daily sleep quality in aging adults using the Midlife in the United States Refresher study. This study will combine the MIDUS Refresher Survey project with the MIDUS Refresher Biomarker project (n=863) to assess the contribution of adverse Recession events across financial, job, and housing experiences (86% of participants reported at least one adverse Recession experience) on quality of sleep (e.g., time to fall asleep, wakefulness during night) using the Daily Sleep Diary component of the MIDUS Refresher Biomarker project, in which participants self-reported on their sleep quality for seven days. This study will provide insight into how certain types of Recession events may differentially affect daily sleep patterns for aging adults; and provide information of within and between person differences in how Recession events impact daily sleep.
A SYSTEMATIC REVIEW OF ENABLERS AND BARRIERS TO CANCER SURVIVORSHIP IN NIGERIA
Authors: Nwakasi Candidus , Mahmoud Kafayat , Esiaka Darlingtina
Published: December 2023

Background

Nigeria is benefitting from public health and healthcare advancement which is increasing cancer care in the country. As a result, more people are surviving cancer. However, this should not mask the fact that Nigeria, a rapidly aging country which an increased risk of cancer incidence, bears a heavy health burden of about 72,000 cancer deaths per year — this underscores cancer as a leading cause of death among Nigerians. The purpose of this study was to identify and synthesize factors that are enablers or barriers to cancer survivorship in Nigeria and add to the body of knowledge on cancer survivorship in the global south. Method. Using PRISMA guidelines, we conducted a systematic review across Scopus, PubMed, and databases. Given that cancer survivorship covers periods from diagnoses, to treatment, and end of life, we identified 31 peer-reviewed studies that assessed cancer treatment, management, care, and survivorship in Nigeria.

Results

Eight themes emerged from our review of 31 peer-reviewed studies that examined factors that are enablers of barriers to cancer survivorship among Nigerians. Some of the themes include a desire to survive, the availability of treatment options, self-management, and the availability of pseudo-healthcare providers. We later grouped the themes under three categories, healthcare, economic, and psychological factors.

Conclusion

Cancer survivors in Nigeria are confronted with several issues that affect their quality of life and health outcomes. This highlights the need for studies on cancer survivorship to inform the design of tailored health improvement interventions for cancer survivors in Nigeria.
THE ROLE OF PERSON- AND FAMILY-ORIENTED LONG-TERM SERVICES AND SUPPORTS
Authors: Fabius Chanee , Okoye Safiyyah , Wu Mingche , Jopson Andrew , Burdgorf Julia , Ballreich Jeromie , Scerpella Daniel , Wolff Jennifer
Published: December 2023

Long-term services and supports (LTSS) in the United States are defined by its patchwork and unequal nature. Data constraints obscure our understanding of inequities in LTSS care experiences and factors that may attenuate them. We advance a conceptual framework of LTSS-relevant environmental domains. We then link measures from public use datasets to person-reported care experiences from the 2015 National Health and Aging Trends Study. We assess relationships between domains of LTSS-relevant environmental characteristics and three LTSS care experiences: 1) adverse consequences due to unmet need, 2) participation restrictions in valued activities, and 3) subjective well-being. We examine 2,411 older adults with disabilities, and key subgroups by race, dementia, and Medicaid enrollment status. We find that for the roughly 10.4 million older adults with disabilities in the community, the LTSS environment is associated with care experiences, but the direction of the relationship varies by domain. Measures of neighborhood social and economic deprivation (e.g., poverty, social cohesion) are associated with experiencing adverse consequences due to unmet needs. Measures of the health care and social services delivery environment (e.g., Medicaid Home and Community-Based Service Generosity, average direct care worker wage, paid family leave) are inversely associated with experiencing participation restrictions. Select measures of the built and natural environment (e.g., housing affordability) are associated with participation restrictions and low subjective well-being. Relationships between measures of LTSS-relevant environmental characteristics and care experiences generally held in directionality but were attenuated for key subpopulations. Results reinforce the importance of strengthening environmental policies that support aging in place.
CHILDHOOD FAMILY ENVIRONMENT, GENETIC RISK FOR ALZHEIMER’S DISEASE, AND LATE-LIFE COGNITIVE DECLINE
Authors: Zhang Shiyang , Han Sae Hwang
Published: December 2023

How genetic risks for Alzheimer’s disease (AD) interact with environmental factors to shape individuals’ cognitive trajectories across the lifespan is a burgeoning area of research. However, relatively little is known about the role childhood family environment plays in the relationship between genetic risk factors for AD and cognitive decline in later life. This study examined whether and how early-life family environments may modify cognitive decline associated with genetic AD risks. Using longitudinal data from the Health and Retirement Study (HRS; 1998-2018), we followed over 9,000 individuals aged 51 and older during the observation period spanning nearly two decades. Cognitive functioning was assessed with the full cognitive battery from the HRS. Childhood family environment was evaluated separately with the relationship quality with one’s mother and the number of household adults before the age of 16. We estimated a series of multilevel models to assess the association between polygenic risk score for AD (PGS-AD) and changes in cognitive functioning, and whether the association was moderated by the two measures of childhood social capital. Findings indicated that childhood maternal relationship quality, but not the number of household adults, protected against cognitive decline accelerated by PGS-AD. That is, the associations between higher PGS-AD and accelerated cognitive decline were attenuated for individuals who reported a better childhood maternal relationship. Findings are in line with the biopsychosocial model of health and suggest that a better quality of maternal relationships in childhood may have a protective effect on cognitive functioning across the lifespan.
COVARIATE-ADJUSTED ASSOCIATIONS OF COGNITION, DEPRESSIVE SYMPTOMS, AND SOCIAL SUPPORT WITH LIFE SPACE MOBILITY
Authors: Armah Henrietta , Clay Olivio
Published: December 2023

Diabetes mellitus is one of the most common chronic diseases among older adults and can affect their movement, participation, and all aspects of daily living, thus restricting life space mobility. Life space mobility reflects individuals’ ability to move independently and engage in social activities. This study examines covariate-adjusted associations of cognition, depressive symptoms, amount of support received and satisfaction with support with life space mobility. The study included 247 older adults aged 65 and above from the University of Alabama at Birmingham (UAB) Diabetes and Aging Study of Health (DASH). Average age was 73, 45% of the sample were Black/African American, 53% were female, and 47% were married. Results from multiple covariate-adjusted regression analyses revealed that being Black/African American, older, female, and higher depressive symptoms significantly predicted lower life space mobility (all p’s < .05) while being married, educated, and reporting better health significantly predicted greater life space mobility. Similarly, higher cognitive function was a significant predictor of greater life space mobility (B = .140, p < .05). Results remained significant even when adjusted for covariates. Amount of support received and satisfaction with support did not predict life space mobility. Findings from this investigation identify individuals who are at risk for restricted life space mobility and suggest protective factors. Establishing these associations with life space mobility within a health disparities framework would be important as it would draw attention to functioning in later life for socially disadvantaged groups and help inform interventions.
SOCIAL CONNECTIONS AND SUICIDE DESIRE AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: Mize Mary Chase
Published: December 2023

As the population of older adults in the U.S. continues to increase, so will the prevalence of critical mental health concerns such as suicide (CDC, 2020). The Interpersonal Theory of Suicide posits desire for suicide develops from the simultaneous presence of thwarted belongingness and perceived burdensomeness (Joiner, 2005). Low social connection and perceptions of low social support can result in feelings of thwarted belongingness and perceived burdensomeness among older adults (Van Orden et al., 2012). The purpose of this study was to understand the relationship between social connections (frequency of contact with others, both synchronous or “real-time” and/or asynchronous) and suicide desire among community-dwelling older adults who received home-delivered meals (HDM) during Covid-19. This cross-sectional study was part of a grant-funded project by the Administration for Community Living. Among a sample of 320 older adults in a large southeast metropolitan area, we identified 25 participants who had no social connections of any type within the past week. These individuals had the highest levels of suicide desire and loneliness, and had the lowest levels of perceived social support. Implications for practice and future research include: a) recognition of the social connections HDM volunteers provide to older adults who may be lonely and at risk of suicide, b) an understanding of suicide desire among older adults during the Covid-19 pandemic, and c) opportunities for nutrition service providers to invest in equipping HDM volunteers to respond to suicide.
SOCIAL NETWORK BARRIERS AND FACILITATORS TO RHEUMATOID ARTHRITIS MANAGEMENT IN HISPANIC/LATINX FAMILIES
Authors: Wilson Kamryn , Dalpe Sara , Waldman Zoe , Koehly Laura , Lin Jielu
Published: December 2023

Compared to their non-Hispanic White counterparts, individuals of Hispanic/Latinx heritage are more likely to develop disabilities from comorbidity and remain disabled for longer periods over the life course. Among chronic conditions, rheumatoid arthritis (RA) is very common, affecting at least 1% of the U.S. population. Evidence suggests that RA is more active and severe among Hispanic/Latinx individuals, characterized by more flare-ups, greater inflammation, higher tender/swollen joint counts, and more self-reported pain, due in part to their underuse of health services, delay in initiating treatment, and difficulty in adhering to treatment plan. In this study, we sought to identify social network factors relevant to managing RA pain and RA-attributable functional limitations, in a sample of Hispanic/Latinx families residing in the Washington DC region. We analyzed network structure and patterns of interpersonal health communication and assessed how these factors may facilitate or impede proactive healthcare, independent of individual and system-level barriers. The findings are three-fold: First, there is substantial heterogeneity in social network structure in the families examined, likely due to different immigration experiences. Second, severely contracted personal networks (e.g., isolate or singe-edge) were observed among older, foreign-born individuals who spoke Spanish and had less schooling. This was a major barrier to RA management. Finally, more health communication, closeness, and advice-seeking ties in one’s personal network facilitated use of health services which was positively correlated with health outcomes. We discuss the implications of the findings in the context of developing family network-based health education interventions.
FINANCIAL DIFFICULTY, HEALTH BEHAVIORS, AND MENTAL HEALTH OF FAMILY CAREGIVERS DURING THE COVID-19 PANDEMIC
Authors: Liu Yujun , Hughes M Courtney , Wang Heng
Published: December 2023

The COVID-19 pandemic greatly burdened family caregivers in the United States and across the globe as they and their family members often suffered from the COVID-19 virus and its societal implications, like social isolation and a shift to remote healthcare. This study examines the impact of the COVID-19 pandemic on financial difficulty, health behavior, and mental health outcomes among family caregivers for older adults across the intersectionality of gender and race. Using the 2020 National Health and Aging Trends Study (NHATS) COVID-19 supplement for Family Members and Friends, our sample included adult family or friend caregivers of Medicare beneficiaries aged 65 or older in the US (N = 2,062). We modeled the interrelationships between financial difficulty, health behaviors, and mental health outcomes using a structural equation model. The results indicate that within the intersectionality framework, during the pandemic, female caregivers reported less vigorous activity, more changes in walking and sleeping patterns, and more eating and watching TV than before the pandemic compared to male counterparts. Compared to white caregivers, during the pandemic, non-white caregivers showed less vigorous activity and more changes in walking, sleeping, I eating, and TV watching patterns than before the pandemic. Financial difficulty was significantly and positively associated with negative mental health. Active behavior was significantly and negatively associated with negative mental health. Health professionals should consider the interrelationships between sociodemographic factors, physical activity levels, and financial difficulties that have come to light during the pandemic when designing future programs and policies to improve family caregiver health.