bluuebunny/crossref_metadata_2025 huggingface dataset:
Benchmarking Age-Friendly University Practices: AFU Inventory and Campus Climate Survey (ICCS) Study Insights
Authors: Montepare Joann , Silverstein Nina
Published: December 2021

The Age-Friendly University (AFU) initiative endorsed by GSA’s Academy for Gerontology in Higher Education (AGHE) provides institutions of higher education with guiding principles for addressing the needs of aging populations. Benchmarks are now needed for assessing age-friendly academic, workplace, and physical campus environments, perceptions of campus constituents, and recommendations for advancing age inclusivity. This symposium will discuss what the AFU Inventory and Campus Climate Survey (ICCS) administered to a national sample of colleges and universities is revealing about the study of age-friendliness in higher education. The sample includes data from over 10,000 faculty, staff, students, and older learners surveyed in 2020-21. Whitbourne will introduce the conceptual model that served as the foundation for the ICCS, with special attention to the need to assess and compare “objective” age-friendly practices with “subjective” perceptions of these practices. Bowen will describe the utility of examining age-friendliness across institutional units with different functions: outreach-engagement, personnel, physical environment, research, services-resources, student affairs, and teaching-learning. Beaulieu will present data demonstrating the importance of assessing perceptions of specific constituent groups including faculty, staff, students, and lifelong learners. Montepare will discuss insights gained about the definition and manifestation of what it means to be ageist, age-friendly, and age-inclusive in higher education. Silverstein will describe strengths and challenges observed across campuses along with recommendations and promising new directions for advancing age inclusivity in higher education.
Hypertensive Retinopathy Is Associated With Worse Cognitive Function in Women: The SWAN Study
Authors: Moroi Sayoko , Hood Michelle , Gutierrez Carrie Karvonen , Ehrlich Joshua , Gillespie Brenda , Wood Sarah Dougherty , Musch David
Published: December 2021

Based on the 2018 American Academy of Neurology guideline, the prevalence of mild cognitive impairment (CI) increases from 6.7% at 60-64 years to 25.2% at 80-84 years. There is interest to identify potential biomarkers in the retina for CI and dementia. The aims of this analysis was to test whether hypertensive retinopathy (HR) was associated with cognitive function using data from the Study of Women’s Health Across the Nation (SWAN), Michigan cohort. SWAN, launched in 1996/97, is a longitudinal study of women traversing midlife and into late adulthood. Starting in 2000, cognitive function tests were administered: East Boston Memory Test immediate (EBMTi) and 10-minute delay (EBMTd) for verbal episodic memory; digit span backwards (DSB) for working memory; and symbol digits modalities test (SDMT) for perception speed, motor speed, and visual scanning. Z-scores were calculated for EBMTi, EBMTd, DSB and SDMT and averaged at follow-up visit 15 (2015/16). Eye exams were performed on 255 women (66 + 2.6 years) at follow-up visit 16 (2016/17). HR was based on presence/absence of arteriovenous nicking. Logistic regression showed a statistically significant association of lower average cognitive Z-score with HR (p-value 0.03, beta=-0.21 [95% confidence interval: -0.40 to -0.02]) adjusting for measured hypertension or anti-hypertensive drugs, years of measured hypertension, race, education, and age. Preliminary results indicate that HR is associated with lower cognitive test scores in women in their 60s-70s. This association between a simple ophthalmic exam finding of systemic hypertension, i.e., arteriovenous nicking, and lower cognitive function is consistent with a cerebrovascular mechanism of CI.
Methodological Approaches to Transform, Develop, and Evaluate Cancer Care Interventions
Authors: Halpin Sean
Published: December 2021

Cancer diagnoses in older adults are often abrupt and unexpected, requiring patients to make quick therapy choices. Further, reflecting on traumatic therapy is often difficult. In our symposium, we bring together researchers from varied disciplines to report on patients’ cancer therapy choices. Carrion will discuss her mixed-methods approach to older Latino adults’ cancer therapy preferences. Next, Blackberry will present how patient-derived photographs (photovoice) can improve supportive care for older Australians in facilitating empowerment, patient-centered care, and shared decision making. Halpin, who will apply conversation analysis to examine how multiple myeloma patients interacted with supplemental material during in-person nurse-led education. Last, Seaman will use his work with head and neck cancer survivors to illustrate the conceptual and methodological challenges of investigating those who discontinue care. Understanding how patients from diverse populaces with various cancer diagnoses navigate their therapy may help inform future cancer-related health services’ approaches.
New Issues in Life Course Research: Which Early-Life Factors Matter for Late-Life Outcomes?
Authors: Smith Jacqui , Walsemann Katrina
Published: December 2021

The increased availability of retrospective information about the lives of participants in population panel studies has expanded the range of precursors to include in life course research. However, this also challenges researchers to select among many potential precursors to a late-life outcome and to determine the relative role of factors from different periods in the life course. Each paper in this symposium uses life course information from the Health and Retirement Study (HRS) to examine different late-life outcomes. Speakers will discuss what guided the particular selection of factors and outcome to examine in their study. Sonnega, Helppie-McFall, and Lee focus on indicators of childhood financial and social adversity as potential predictors of early retirement due to poor health. Park, Larkina, and Smith ask if decisions taken in early adulthood about how to balance work-and family-life by individuals and their partners are related to the categories of important life accomplishments older adults report in their life review. Two papers examine precursors of late-life health outcomes. Williams-Farrelly and Smith identified different profiles of physical activity in early- and mid-adulthood. They discuss associations between these profiles and cognitive aging. Whereas social losses, relocation, and multimorbidity are well-documented precursors of Major Depression in old age, Bergmans and Smith asked if poor health in childhood played a distal role. The session concludes with an integrative discussion of issues by Walsemann.
A Systematic Review of Interventions That Reduce Family Caregiving Time
Authors: Baker Zachary , Jutkowitz Eric , Gaugler Joseph
Published: December 2021

Due to multiple long-term sociodemographic and health trends contributing to the impending family care gap, there likely is no single policy or intervention that could increase the number of family caregivers in the U.S. to the levels required to fill such a gap. However, the amount of time that a family caregiver spends providing assistance is potentially mutable. Given the pressing concerns of the family care gap, identifying interventions or approaches that could reduce existing caregiving time is of considerable importance. This presentation provides the results of a systematic review of published research to identify the effects of interventions on the amount of time family caregivers spend on their caregiving tasks. Pharmaceutical approaches directed to care recipients, technology interventions, case management, multicomponent interventions, and care settings all appeared to reduce caregiving time. Improved operationalization, study design, and similar factors will help guide future intervention research to reduce caregiving time.
Identifying, Assessing, and Supporting Family Caregivers in Health and Long-Term Care: Progress and Opportunities
Authors: Riffin Catherine , Wolff Jennifer
Published: December 2021

Family caregivers are a largely hidden but vital workforce within medical and long-term care settings. Family caregivers are actively involved throughout care delivery systems and provide crucial assistance to people with chronic conditions. Building on the person- and family-centered care approach and recent recommendations from national organizations, this presentation sets forth a roadmap for research, policy, and practice that outlines practical solutions and opportunities to address existing barriers to systematic assessment and support of family caregivers in clinical practice. With the impending family care gap and projections for a steep decline in the availability of family caregivers in the coming decades, it is more important than ever to prepare health care systems for this shift. If put into action, the recommendations of this presentation can help to bridge the care gap by promoting sustainable solutions and infrastructure to ensure that families are recognized and adequately supported in care delivery settings.
Expanding the Scope of Administrative Health Records Through Advanced Statistical Methods
Authors: Akushevich Igor , Hill Carl V , Arbeev Konstantin
Published: December 2021

The objective of the Symposium is to expand familiarity of the application of advanced methods of modern statistical modeling and data management, to administrative health data by combining methodological innovations with practical hands-on demonstrations. Topics will cover a range of methodological and substantive topics including: i) decomposition and partitioning approaches in analysis of disparities and time trends in AD/ADRD; ii) new artificial intelligence technologies that allow us to enrich electronic health record datasets with self-report scores in geriatrics; iii) using administrative data to model adherence to disease management and health-related behavior; iv) the use of longitudinal extension of the average attributable fraction to study health disparities and multimorbidity; and v) the geographic and racial disparities in total and remaining life expectancies after diagnoses of AD/ADRD and other chronic conditions. The increasing availability of large-scale datasets based on electronic health records and administrative claims records provide an unprecedented opportunity for obtaining nationally representative results based on individual-level measures that reflect the real care-related and epidemiological processes. This makes the reduction of barriers to entry to the use of such data of vital importance to the community of geriatrics and health researchers.
Enhancing Active Engagement for Dementia Caregivers: A Synthesis of Interventions
Authors: Eaton Jacqueline
Published: December 2021

In a recent meta-analysis of interventions for dementia caregivers, psychoeducational interventions were found to be effective only if they required caregivers to apply knowledge and skills through active engagement. This emphasizes the importance of understanding which intervention components enhance application in order to improve caregiving interventions and the mechanisms by which they work. The purpose of this presentation is to identify and assess elements of active engagement within dementia caregiving interventions. Articles included in this review were published between 2009 and 2018 and identified as psychoeducational dementia caregiving interventions. Each intervention was assessed to describe: 1) how active engagement was defined, 2) the logistics for implementing the active engagement techniques, 3) and the process for evaluating active engagement components. Of 36 articles meeting inclusion criteria, 25 mentioned active engagement components of the intervention. Active components included discussion, problem-solving, practice, role-play, action plans, and homework. Only five articles provided partial descriptions of the active components, five mentioned assessing active engagement, and only one study examined the efficacy of an engagement technique. This demonstrates a significant gap in our understanding of interventions for dementia caregivers. Active engagement enhances outcomes, yet to our knowledge, the specific steps taken to engage caregivers actively and the mechanisms by which these work are unclear. This is a barrier to optimizing active engagement within intervention delivery. Clarifying processes and methods for testing mechanisms of action can further enhance caregiver engagement with interventions.
Improving Mood Promoting Access to Collaborative Treatment (IMPACT) Program in Geriatrics Primary Care
Authors: Baharlou Shahla , Hinrichsen Gregory , Munoz Lizette , Currey Katherine , Barton Sheila , Kahan Fay , MacKenzie Blair , Soleimani Laili
Published: December 2021

Improving Mood Promoting Access to Collaborative Treatment (IMPACT) is a well-established model for the treatment of depression in primary care. The COVID pandemic has caused increased distress and depression among the older patients in our New York City geriatric practice. This paper describes the establishment of a virtual IMPACT model during the pandemic in which IMPACT services have been provided via telephone. This effort was a multidisciplinary collaboration among geriatric medicine, geriatric psychiatry, social work, and geropsychology. Our IMPACT program uses a brief form of Interpersonal Psychotherapy (IPT) for depression as the psychosocial component instead of Problem Solving Treatment. Delivery of IMPACT by telephone appears to have enhanced engagement and sustained involvement in the program compared with prior efforts to deliver it by in-person meetings. IPT as a psychosocial modality was well-received by patients. To date, treatment outcomes have been favorable and will be reported in this presentation.
The Virtualization of a Movement and Social Group-Activity Intervention for Older Adults and Their Caregivers
Authors: Hugenschmidt Christina , Thumuluri Deepthi , Soriano Christina , Barnstaple Rebecca , Fanning Jason , Laurita-Spanglet Jessie , Ip Edward
Published: December 2021

COVID-related safety concerns mandated suspension of our ongoing trial testing the effects of movement and social engagement in older adults with early-stage dementia and their caregivers (dyads). Participant vulnerability and the requirement for group social interaction complicated intervention resumption. We present results from a successful pilot to rapidly and iteratively optimize study interventions for remote delivery targeting intervention mediators (social connection, movement) based on participant feedback. Three-dyad groups (n=6 individuals) completed cycles of intervention via Zoom immediately followed by an interview with open-ended and quantitative feedback. Cycles were repeated until no new information was solicited, then repeated with new participants. Optimization revealed needs for technological support, more intensive movement, and social connection. Specifically, the inability to make eye contact, see others’ full body, and technology-associated timing asynchronies impeded social connection in the movement group. We will present practical tips for crafting remote group interventions for caregiver/person living with dementia dyads.
Transition to Widowhood: Trajectories of Depressive Symptomatology Among Japanese Older Adults
Authors: Iida Masumi , Okamoto Shohei , Sugawara Ikuko , Kobayashi Erika
Published: December 2021

Spousal loss is one of the most consequential negative life events for the surviving partners. While there is abundant research on mental health and well-being of widows, most of these studies rely on the post-bereavement data. In this study, we use the data from the National Survey of Japanese Elderly (NSJE), which is a publicly available longitudinal data set collected from Japanese adults aged 60 years and older. The current study uses the first seven waves of data from 1987 to 2006, where participants were followed every three to four years. Using the NSJE advances our understanding of the bereavement process as it allows us to observe the levels and trajectories of depressive symptom before, during, and after the loss of their spouses. In our analyses, we selected 522 participants (average age at bereavement: 75.0 years; 27% male) who experienced spousal loss at some point during the seven waves. We examined the trajectories of depressive symptoms assessed using CES-D as these participants transition to widowhood. The results showed a small significant increase in depressive symptoms leading up to the time of the loss. There was also a significant increase in symptoms at the time of the loss, but we did not observe any decline in symptoms after the loss. In addition, we found that their age at bereavement significantly moderated the pattern, such that the increase in depressive symptoms at the time of the loss was attenuated for older participants. The implications of these findings will be discussed.
Rural Older Adults’ Experiences With Pain From Chronic Illnesses and Its Treatment
Authors: Noh Hyunjin , Suntai Zainab , Won Cho Rong
Published: December 2021

Although pain control is an essential factor in promoting quality of life, pain is undertreated among certain sub-populations, such as older adults and rural residents. The purpose of this study was to explore pain experiences and its treatment among rural older adults. A qualitative research design was adopted to capture the common essence of participants’ experiences through a phenomenological method. Purposeful sampling was used, and the participant criteria was: age 55+, have good thinking skills, resident of Alabama, have chronic/serious health conditions, and experienced pain or discomfort in the last 3 months. Twenty-three participants were recruited from rural counties of West and South Alabama through the local Area Agency on Aging and health and senior service centers. Individual semi-structured interviews were conducted via phone and were recorded and transcribed verbatim. Thematic analysis was conducted to identify emerging themes and repeated patterns from the data. Our results revealed themes in four categories: 1) impact of pain: physical limitations and coping strategies, 2) Impact of Covid-19: physical health, social, and mental health impact, 3) challenges in pain treatment: transportation (driver/time/cost/Covid-19 exposure) and non-transportation related problems (lacking resources/mistrust/limited health insurance coverage), and 4) suggestions: transportation-related (more transportation options/financial assistance) and non-transportation-related support (improved insurance coverage/non-pharmacological care) . Findings of this study highlight rural older adults’ unique needs in access to pain treatment, further amplified during the Covid-19 pandemic. Increase in sustainable, funded transportation programs and the supply of local pain specialists is critical to meet such needs and improve their quality of life.
Denture Use and Cognitive Decline in Chinese Older Adults: A Propensity Score Analysis
Authors: Wu Bei , Qi Xiang
Published: December 2021

Using data from the Chinese Longitudinal Healthy Longevity Survey (2011 to 2018), we examined the effect of denture use on cognitive decline (assessed by the Mini-Mental State Examination [MMSE]) among 1,316 cognitively normal older adults with severe tooth loss (≤9 remaining teeth) at baseline. We generated propensity scores for weighted and matched analyses using 18 covariates, classified as socio-demographics, health-related behaviors, health status, and oral health conditions. The results show that non-denture users had worse cognitive decline than denture users. In the kernel-based matched data, the difference in the declined score of cognitive function between denture and non-denture users was 2.25 (95%CI=1.37 to 3.13). In the weighted data, the difference in cognitive function score was 2.14 (95% CI=1.35 to 2.94). Using dentures is beneficial for cognitive health in older adults with severe tooth loss, suggesting that prosthodontic rehabilitation with dentures might have benefits beyond restoring oral functioning.
The Association Between Online Social Network Support and Fear of COVID-19 Among Older Adults
Authors: Steward Andrew , Schilz Matthew , Wang Kaipeng , Ingle M Pilar , De Fries Carson , Hasche Leslie
Published: December 2021

Public health concerns related to the COVID-19 health crisis are particularly salient among older adults. Fear surrounding COVID-19 has also been associated with increased spread, morbidity, and mortality of the disease. Prior to the pandemic, loneliness and social isolation were already a concern for older adults, and the pandemic further constrained how older adults may socially connect with others because of public health safety precautions. Social networks are a valuable form of support for older adults, and to our knowledge limited prior research has addressed whether social networks are associated with fear of COVID-19. Thus, the purpose of this study is to examine the association between social network and fear of COVID-19 among older adults. A convenience sample (n = 239) of adults 60+ years of age in the U.S. completed a 20-minute survey online or by phone. The independent variable was social network support measured by six items which asked about in-person and virtual contacts with members of the same and other generations. The dependent variable was measured by the Fear of COVID-19 scale (seven items). Results of ordinary least squares regression show that increased social network support was significantly associated with decreased fear of COVID-19 (p < 0.05), while holding constant age, sex, race, marital status, education, whether a respondent lives alone, and self-rated health. Findings highlight the importance of social networks for older adults during the COVID-19 crisis. Existing social networks which engage older adults should be expanded, with the knowledge that such efforts may also help reduce fear of COVID-19 for older adults.
Older Americans Act Meals Programs: Responding to the Pandemic
Authors: Jantzi Katie
Published: December 2021

This session provides insights into how the pandemic challenged the capabilities and ingenuity of the Older Americans Act (OAA) programs and the aging network. Speakers will include key aging network stakeholders, who will discuss the overnight evolution of programs serving often isolated older adults.
Social Relationships and Social Engagement Among African American Adults With a History of Incarceration
Authors: Sneed Rodlescia , Farmer Bridget , Johnson Jennifer
Published: December 2021

Strong social relationships and social engagement are crucial for both successful aging and successful community re-entry after incarceration. Here, we utilized a mixed methods approach to understand the impact of incarceration on social relationships and social engagement among formerly incarcerated community-dwelling African-American adults aged >50. Participants in the 2012 or 2014 waves of the Health and Retirement Study answered questions regarding prior incarceration, social relationships, and participation in social activities. Additionally, we utilized key informant interviews to further explore how incarceration might impact relationships and social engagement. This presentation will describe quantitative associations between prior incarceration and social relationship structure & function. Further, we will use our qualitative interview data to further explore possible explanations for our findings. Finally, we will describe how MCUAAAR Scientist/Faculty interactions facilitated this work.
The Rush Caregiver Initiative: A Model for Caregiver Health and Wellness in Age-Friendly Health Systems
Authors: Golden Robyn , Pelton Leslie , Carbonell Ellen
Published: December 2021

The Rush Caregiver Health and Well-Being Initiative (Caregiver Initiative) draws together evidence-based practices into a single framework to improve care for older adults and caregivers. The Caregiver Initiative has two components: system-level and caregiver level interventions. The complexities of system change take place within leadership, data management, and provider teams throughout the health care system, and solutions to resistance have been developed. Caregiver-level interventions start with an assessment using evidence-based tools, and offer an opportunity to participate in a Teach-Back Clinic, Family Care Planning sessions, and/or Goals of Medical Care meetings, all connected to the 4Ms of an Age-Friendly Health System. Contact and follow-up issues were addressed, and as of February 2021, 191 caregivers have enrolled. Outcomes to date show statistically and clinically significant reductions in depression, anxiety, and caregiver burden. This presentation will highlight lessons learned in the development of the model and caregiver outcomes to date.
Frailty in Preclinical Models: Impact of Healthspan on Disease Expression Over the Life Course
Authors: Howlett Susan
Published: December 2021

People age at different rates. This heterogeneity in aging has led to the concept of “frailty”, a state of heightened vulnerability to adverse health outcomes at any age. Frailty challenges health care providers, as frail patients are more likely than non-frail patients to experience diseases, hospitalization, and death. We showed that frailty occurs not only in humans, but also in aging rodents. It can be measured with a “frailty index” (FI) based on age-related health deficit accumulation as originally established in humans. We found that maladaptive changes in heart structure and function in late life are correlated more so with frailty than age and are closely graded by FI score, especially in male mice. Adverse effects of frailty originate at cellular/subcellular levels and scale up to organ and system levels, predisposing towards cardiovascular disease. Poor overall health, quantified with an FI, may drive maladaptive cardiac remodeling, especially in older males.
Examining Caregiver-Resident Communication and Apathy in Dementia in Nursing Homes During the COVID-19 Pandemic
Authors: Jao Ying-Ling , Berish Diane , Liao Yo-Jen , Boltz Marie
Published: December 2021

This presentation shares lessons learned from conducting a study examining the impact of staff caregivers’ communication approach on apathy in residents with dementia in nursing homes. Due to COVID-19 restrictions, this study had to be paused and required major revisions to continue, which resulted in significant delays and increased expenses. Additionally, this study required in-person data collection and video recordings to capture staff caregivers’ communication with residents with dementia during caregiving activities. However, due to the pandemic, nursing home residents’ daily routines have been significantly changed, making it challenging to capture the nature of caregiver-resident interactions. Furthermore, using masks created unforeseen barriers for capturing communication between staff caregivers and residents including difficulties in identifying residents’ facial expressions, which are a vital component of assessing apathy. The presentation describes approaches to communication with founders, collaborators, and clinical sites and discusses strategies to recruit participants and conduct data collection.
Recruiting Eligible and Interested Study Participants With Cognitive Impairment
Authors: Mattos Meghan , Lingler Jennifer
Published: December 2021

Recruiting and enrolling older adults with cognitive impairment is challenging under the best of circumstances. This symposium will begin with an introduction to best practices for recruitment of older adults living with cognitive impairment, followed by four presentations describing recruitment successes and challenges across multiple settings. The first presentation describes COVID-19 pandemic-related factors that have influenced recruitment and enrollment of older adults with cognitive impairment in an intervention study of a physical activity smartphone app. Strategies and procedural alterations to facilitate achievement of enrollment goals for technology-based interventions are discussed. The second presentation describes researchers’ recruiting experiences with older adults with mild cognitive impairment (oaMCI)-care partner dyads for a pilot, platform trial of biopsychosocial interventions. There were differences in study disinterest between oaMCI and study partners that may require specialized communication messaging and strategies for dyad engagement. The third presentation features recruitment adaptations for an Internet-delivered behavioral intervention study with oaMCI and insomnia. Anticipated concerns of oaMCI using technology or accessing the Internet were not significant barriers to recruitment, while fewer oaMCI endorsed sleep concerns than expected. The last presentation demonstrates the potential for telephone-based outreach to increase dementia knowledge and cognitive risk. Working with faith-based health educators to reach rural, ethnically-diverse older adults, researchers will describe how to promote inclusivity and successfully recruit oaMCI within the community. Presenters and participants are encouraged to dialogue on how recruitment and retention barriers may be avoided as well as to share success stories from their own research with oaMCI.
Links Between Early-Life Contextual Factors and Later-Life Cognition and the Role of Educational Attainment
Authors: Palms Jordan , Zahodne Laura
Published: December 2021

Educational attainment is a well-documented predictor of later-life cognition, but less is known about upstream contextual factors. This study aimed to identify which early-life contextual factors uniquely predict later-life global cognition and whether educational attainment mediates these relationships. Participants were drawn from the Michigan Cognitive Aging Project (N=461; Mage=63.51; SDage=3.13; 50% non-Hispanic Black). School-level contextual factors included U.S. region during elementary school (Midwest, South, Northeast), racial diversity of school (mostly White, mostly Black, diverse), self-reported education quality, and school type (public versus private). Household-level contextual factors included mother’s and/or father’s education, number of adults (1, 2, 3+), and number of children. Later-life global cognition was operationalized with a composite score derived from a comprehensive neuropsychological battery. A mediation model controlling for sociodemographics estimated total, direct, and indirect effects of contextual factors through educational attainment (years). Lower education quality, attending a mostly Black or diverse school, attending a public school, and reporting three or more adults in the household were each associated with lower cognition. After accounting for educational attainment, associations remained for education quality, school type, and reporting three or more adults in the household. Indirect effects through educational attainment were observed for elementary school region, education quality, racial diversity of school, and mother’s education. School context appears to more consistently predict later-life cognition than household context, highlighting the potential long-term benefits of school-level interventions for cognitive aging. Future research should consider causal relationships among household-level and school-level contextual factors, as well as additional mediators beyond educational attainment.
The Dyad Dilemma: Strategies to Recruit Study Partners for Mild Cognitive Impairment Clinical Trials
Authors: Gibson Allison , Pope Caitlin , Rhodus Elizabeth , Parsons Kelly , Johnson Julia , Oaks Dawn , Jicha Greg
Published: December 2021

Mild cognitive impairment (MCI) research faces challenges to successful enrollment, especially with clinical trial studies. This study explores researchers’ experiences recruiting from a U.S. Alzheimer’s Disease Center for a pilot, platform trial of biopsychosocial interventions for MCI dyads. Individuals with MCI that met the inclusion criteria for the study were invited to participate (n=39). Thematic analysis of recruitment case notes was utilized to track participants’ and study partners’ interest in participation. In most cases, participants with MCI were interested and willing to enroll and study partners were not. Recruiting persons with MCI and their study partners for clinical trials research may require specialized communication messaging such as education about how interventions address the needs of MCI, along with training on the relationship of MCI to cognitive decline. This presentation highlights effective strategies to engage study partners into recruitment for MCI research such as creating more flexible participation roles and offerings.
Early Intergenerational Relationships and Later Support Provided to Older Parents: Time-to-Death as a Contingency
Authors: Silverstein Merril , Zhang Wencheng , Wolf Douglas , Brown Maria
Published: December 2021

This paper focuses on whether stronger relationships with parents early in the family lifecycle results in adult children providing more support to them 45 years later, and whether this association is contingent on parents’ remaining years of life. We test time-to-death of parents as an indicator of vulnerability, an easy to ascertain and potentially powerful predictor of support. Data derived from the Longitudinal Study of Generations, a panel of three-generation families, originally fielded in 1971 and continuing to 2016. Focusing on the youngest generation (mean age = 19 in 1971), the analytic sample consists of 356 child-father relationships 473 child-mother relationships. We examined trajectories of instrumental support provided to parents over four waves between 1997 and 2016 as a function of each parent’s remaining years of life (mortality data from the National Death Index). We also examined variation in those trajectories based on frequency of shared activities and intensity of emotional closeness in 1971. Ordinal multi-level growth curve analysis revealed that proximity to death was a significant predictor of instrumental support provided over time. Only in child-father relationships did greater emotional closeness, as expressed in 1971, produce stronger associations between remaining years of life and provision of instrumental support. Findings are discussed in terms of understanding intergenerational dynamics that unfold over many decades and the utility of time-to-death as an alternative metric for assessing vulnerability. This research is timely in light of growing uncertainty about the family as a reliable source of care in later life, particularly for older men.
Dehumanization of Older Family Members: Novel Determinants of Elder Abuse Proclivity by Caregivers
Authors: Chang E-Shien , Monin Joan , Zelterman Daniel , Isenberg Naomi , Levy Becca
Published: December 2021

Elder abuse affects one in six older persons globally. Three limitations converge to impede progress in prevention: most research is victim- rather than perpetrator-based; the reliance on explicit, self-reported factors; and failure to account for psychological factors that motivate abuse in the first place. The current study will be the first to address these gaps by examining whether family caregivers’ dehumanization of older persons, or the denial of humanness to older persons as one of the most hateful age stereotypes, could explain elder abuse proclivity. Implicit dehumanization of older persons was measured by a novel implicit-association-test developed for this study. Explicit dehumanization was measured by a semantic differential question widely used in the literature. We used the reliable and validated 8-item Caregiver Abuse Screen to measure elder abuse proclivity. In the final survey of 585 caregivers, dehumanization was found to be prevalent with 51% of the caregivers implicitly and 31% explicitly dehumanizing older persons. As predicted, implicit and explicit dehumanization uniquely contributed to elder abuse proclivity (OR=1.23, 95% CI=1.02-1.50, p=.03) and (OR=1.26, 95% CI=1.05-1.51, p=.01), respectively, after adjusting for relevant covariates including caregiver burden, and caregivers’ and care-recipients' health. Also as predicted, implicit dehumanization improved the prediction of abuse proclivity above and beyond the explicit dehumanization of older persons and caregiver burden. Socio-etiological models of elder abuse perpetration and corresponding prevention design should consider the inclusion of dehumanization as a key risk factor for abuse proclivity in family caregivers.
Addressing the New Normal in Health Care Using an Interprofessional Model of Care Coordination
Authors: Cotton Sam , Faul Anna , Yankeelov Pamela
Published: December 2021

There has been significant discourse surrounding the widespread system failures within healthcare during COVID-19. Older, frailer, and poorer persons across the United States have been the most impacted by the pandemic. Given this, our FlourishCare team, received funding through the COVID Cares Act, as part of our Geriatric Workforce Enhancement Program (GWEP) grant, to create innovative programming for individuals that were the most impacted by the pandemic. Remote patient monitoring (RPM) is one intervention been shown as an effective way to assist persons in managing their conditions. Patients from our Optimal Aging Clinic were identified as struggling with hypertension, diabetes and/or COPD. Interprofessional teams of nursing and social work learners were assigned to work with patients. The kits contain all of the necessary technology and a virtual app platform that allows a patient to check their heart rate, blood pressure, oxygen levels, and glucose levels. This information was then disseminated to the team coordinating the patient’s care. The sample was mostly female (88%), African American (64%) and retired (70%). The mean age was 60 (SD=4), and 40% had less than a high school diploma. After 3 months in the program, we saw a significant improvement across all determinants of health, with a particular overall change in access to health services and individual health behaviors. This study showed the importance of providing patients with access to technology and the support of an interprofessional team can improve patient outcomes, lead to improvements in individual health behaviors and improve health literacy.
Person-Centered Care for Family Caregivers: Co-Designing an Education Program for the Healthcare Workforce
Authors: Parmar Jasneet , Anderson Sharon , Pollard Cheryl , Charles Lesley , Dobbs Bonnie , Leslie Myles , Marion Cecelia , McGhan Gwen
Published: December 2021

Background: Research recommends the healthcare workforce receive competency-based education to support family-caregivers [FCGs}. typically, education has been directed at FCG’s to increase their care skills rather that at healthcare providers to provide person-centered care to FCGs. Objectives: We present the co-design process used to create a competency-based education program for the healthcare workforce that ensures a person-centered focus on FCGs and introduce our Health Workforce Caregiver-Centered Care Education. Approach: Co-design is the act of creating with stakeholders to ensure useable results that meet stakeholder’s needs. We began by coining the concept “caregiver-centered care,” defined as a collaborative working relationship between families and healthcare providers aimed at supporting FCGs in their caregiving role, decisions about care management, and advocacy. From this definition we co-designed, then validated the Caregiver-Centered Care Competency Framework in a Delphi Process. Stakeholders (n= 101) including FCGs, providers, policy makers, community organizations, researchers, and educational designers then used effective practices for health workforce education to co-design the ‘foundational’ level of a Caregiver Centered Care education. Results: Teaching and learning resources include six competency-aligned educational modules with videos and interactive exercises that encourage reflection. With the COVID-19 pandemic, we moved the education online (caregivercare.ca). In the first four months online, 815healthcare providers completed the education. We continue to use mixed methods to evaluate the Caregiver-Centered Care Education, for acceptability and effectiveness, in five care contexts (primary, acute, home, supportive living, long-term care). Conclusion: We expect that our education will support caregiver-centered care in all healthcare settings.
Biological Aging Predicts Vulnerability to COVID-19 Severity in UK Biobank Participants
Authors: Kuo Chia-Ling , Pilling Luke , Atkins Janice , Masoli Jane , Delgado Joao , Kuchel George , Melzer David , Levine Morgan
Published: December 2021

Age and disease prevalence are the two biggest risk factors for COVID-19 symptom severity and death. We therefore hypothesized that increased biological age, beyond chronological age, may be driving disease-related trends in COVID-19 severity. Using the UK Biobank England data, we tested whether a biological age estimate (PhenoAge) measured more than a decade prior to the COVID-19 pandemic was predictive of two COVID-19 severity outcomes (inpatient test positivity and COVID-19 related mortality with inpatient test-confirmed COVID-19). Logistic regression models were used with adjustment for age at the pandemic, sex, ethnicity, baseline assessment centers, and pre-existing diseases/conditions. 613 participants tested positive at inpatient settings between March 16 and April 27, 2020, 154 of whom succumbed to COVID-19. PhenoAge was associated with increased risks of inpatient test positivity and COVID-19 related mortality (ORMortality=1.63 per 5 years, 95% CI: 1.43-1.86, p=4.7x10E-13) adjusting for demographics including age at the pandemic. Further adjustment for pre-existing disease s/conditions at baseline (OR_M=1.50, 95% CI: 1.30-1.73 per 5 years, p=3.1x10E-8) and at the early pandemic (OR_M=1.21, 95% CI: 1.04-1.40 per 5 years, p=0.011) decreased the association. PhenoAge measured in 2006-2010 was associated with COVID-19 severity outcomes more than 10 years later. These associations were partly accounted for by prevalent chronic diseases proximate to COVID-19 infection. Overall, our results suggest that aging biomarkers, like PhenoAge may capture long-term vulnerability to diseases like COVID-19, even before the accumulation of age-related comorbid conditions.
Antipsychotic Prescribing in VA-Contracted Community Nursing Homes and Incident Use Among Veterans
Authors: Moyo Patience , Corneau Emily , Cornell Portia , Mochel Amy , Magid Kate , Levy Cari , Mor Vincent
Published: December 2021

The Veterans Health Administration (VA) is increasingly purchasing long-term care for eligible Veterans from non-VA, community nursing homes (CNHs). Antipsychotics present safety risks for older adults, but it is unknown how the prevalent use of antipsychotics at CNHs influences whether newly admitted Veterans will initiate antipsychotic therapy. This study used 2013-2016 VA data, Medicare claims, Nursing Home Compare, and Minimum Data Set (MDS) assessments. We identified 10,531 long-stay CNH episodes for Veterans not prescribed antipsychotics 6 months before CNH admission. We categorized Veterans by whether, 12 months before admission, they were diagnosed with FDA-approved indications (including schizophrenia, Tourette’s syndrome, Huntington’s disease) for antipsychotic use. The exposure was the proportion of all CNH residents prescribed antipsychotics in the quarter preceding a Veteran’s admission. Using adjusted logistic regression, we analyzed two outcomes measured using MDS assessments collected ~100 days after CNH admission: 1) new antipsychotic use, and 2) new diagnosis for an FDA-approved indication among Veterans without these conditions at admission. Among antipsychotic-naïve Veterans admitted to CNHs, 7,924 (75.2%) lacked an antipsychotic indication. Prevalent antipsychotic use in CNHs ranged 0%-10.9% (quintile 1) and 25.7%-91.4% (quintile 5). The odds of initiating antipsychotic use increased with higher CNH antipsychotic use rates (OR=2.52, 95% CI:2.05-3.10, quintile 5 vs. 1), as did the odds of acquiring a new indication (OR=2.08, 95% CI:1.27-3.40, quintile 5 vs. 1). Provider practices may be influencing new diagnoses indicating antipsychotic use at CNHs with high antipsychotic use. It may be important for VA to consider antipsychotic use when contracting with CNHs.
Impact of Informal Care on Health Care Utilization Among Older People in China
Authors: Wang Yixiao
Published: December 2021

Population aging has become a challenge to long-term care and health care for the society. Using China as a case study, this paper assesses allocative efficiency of resources in informal care and health care, to explore the effectiveness of the policy, i.e., encouraging informal care as a more cost-effective way to reduce public health care spending. Drawing data from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey, this study examines the impact of informal care on utilization of health care as well as amount of health care expenditures among older people with functional limitations in China. Using random effects model with instrumental variable approach, our findings suggest that informal care significantly reduces the utilization of health care, primarily by reducing the utilization of outpatient care. However, informal care significantly increases the amount of inpatient care expenditures for inpatient care users. We do not observe significant association between informal care and amount of outpatient care expenditures for outpatient care users. This study highlights a pressing need for the Chinese government to support informal caregivers by taking economic values of informal caregiving into consideration, and to improve efficiency in inpatient care by a more integrated resource allocation mechanism
The Effectiveness of FFC-AL-EIT on Psychosocial Outcomes and Care Interactions
Authors: Galik Elizabeth
Published: December 2021

This study included a subset of 59 communities and 550 residents from the full FFC-AL-EIT study. Participants were mostly white (98%), female (69%) and had a mean age of 89.30 (SD=7.63). Sites were randomized to the four step FFC-AL-EIT intervention implemented by a function focused care nurse facilitator working with a facility champion over 12 months versus education only. Resident measures included depression, agitation, resistiveness to care and the quality of care interactions and were obtained at baseline, 4 and 12 months. There was a significant positive treatment effect related to depression, agitation, resistiveness to care and quality of care interactions with either less decline or some improvement in these behaviors and symptoms and improvement in the quality of care provided between the treatment versus control group. The study suggests there is some benefit to implementing FFC-AL-EIT for psychosocial outcomes and care interactions among residents in assisted living communities.
Understanding Resident, Family, and Staff Safety Priorities to Guide Development of an Engagement Toolkit
Authors: Cho Youngmin , Bartoldus Victoria , Chiong Cloie , Linville Tabitha , Palmertree Stephanie , Beeber Anna
Published: December 2021

Resident and family engagement (the desire, ability, and activation as a partner in care) is a necessary component of keeping assisted living (AL) residents safe. Barriers to engagement include differing priorities between the resident/family and staff. This presentation outlines the results of a content analysis of qualitative interviews with 105 AL staff, residents, and family members, in which we examined AL stakeholder priorities for safety. Qualitative interviews were analyzed to first identify safety priorities by stakeholder type (staff, resident, and families), and then compared across stakeholder group. Stakeholder-specific safety priorities were identified, including infection management (COVID-19 and others), medications errors, falls, elopement, lack of AL resources/staffing, conflict, adverse events, nutrition, physical hazards, building security, chemical agents, fire/natural disasters, and abuse/neglect – the importance of these priorities vary by stakeholder type. Presentation discussion will include implications for future intervention to address the top safety problems in AL.