bluuebunny/crossref_metadata_2025 huggingface dataset:
CUMULATIVE ADVANTAGE IN CHANGING ECONOMIC TIMES: STRESS, DISTRESS, AND FUTURE PROSPECTS FOR AGING COHORTS
Authors: Dannefer Dale , Crystal Stephen , O’Rand Angela
Published: November 2019

Processes of cumulative dis/advantage operate within cohorts and across historical time. In the ongoing dance of age, cohort and period, each cohort encounters distinctive social and economic environments at particular ages that may ameliorate or exacerbate the cumulative and systemic processes of inequality production that operate over its collective life course. We explore issues of current and future late-life inequality and its consequences. As overall income inequality has grown, what are the likely consequences for late-life outcomes? How have cohorts currently in midlife been affected by the Great Recession of 2008 and subsequent recovery? What are the mental and physical consequences of these developments, and to what extent can they be ameliorated by interventions in middle and later adulthood? This symposium addresses how variation in economic circumstances and social and psychological stresses may affect outcomes over the life course, and how these complex, interacting processes can be best conceptualized and examined. One paper examines the impact of the Great Recession and subsequent events on the intracohort distribution of income, suggesting inordinate setbacks during the Recession with likely long-term effects for economically vulnerable subpopulations. Another explores the role of psychosocial stressors in the process of cumulative dis/advantage, focusing on linkages between functional limitations and psychological well-being in later life, and how these linkages are amplified by diverse dimensions of disadvantage (e.g., education, employment; coping strategies; caregiving). A third paper examines the intergenerational dimensions of cumulative advantage processes. Finally, contrasting theoretical frameworks for apprehending life-course processes and historical change will be explored.
UNDERSTANDING THE ROLE OF STRESS PROCESSES IN CUMULATIVE DIS/ADVANTAGE PROCESSES
Authors: Carr Deborah
Published: November 2019

In my book Golden Years (2019), I argue that the psychosocial consequences of normal biological processes of aging are intensified for those who have had lives of disadvantage, just as the harmful consequences of life-course disadvantages are particularly acute for those experiencing age-related physical health declines. In this paper, I discuss the role of stress processes, including stress proliferation and amplification, as possible mechanisms contributing to cumulative dis/advantage. I evaluate these ideas empirically by focusing on the linkages between functional limitations (an indicator of normal biological aging) and psychological well-being in later life, and explore the extent to which these linkages are amplified diverse indicators of life course disadvantage including low education; poor-quality employment; avoidant coping strategies; and family-related strains including intensive caregiving. Analyses are based on data from the Midlife in the United States (MIDUS) study. I discuss the implications of incorporating stress process models in cumulative dis/advantage research.
A MULTI-COMPONENT HOME-BASED PHYSICAL THERAPY INTERVENTION FOR IMPROVING COMMUNITY AMBULATION AFTER HIP FRACTURE
Authors: Magaziner Jay S
Published: November 2019

Presented is a two-group RCT evaluating a multi-component exercise program for hip fracture patients to determine if it is effective in improving the ability to walk independently in the community. Hip fracture patients age ≥60 years (N=210) were assessed and randomized within 26 weeks of hospitalization, and reassessed 16 and 40 weeks later. The primary outcome was ability to walk 300m in six minutes. PUSH (active treatment) included aerobic conditioning, strengthening, balance and functional training. PULSE (attention control) included transcutaneous electrical nerve stimulation, flexibility and active range of motion exercises. Both groups received 2-3 visits per week for 16 weeks in their residences from a physical therapist. 22/96 in PUSH (22.9%) and 18/101 in PULSE (17.8%) (difference 5.1%; 95% CI: -6.1%, 16.3%; P=.37) became community ambulators. We conclude that advancing substantial proportions of hip fracture patients to community ambulation will require more than the intervention evaluated in this study.
IMPACT OF THE MULTI-COMPONENT HOME-BASED PHYSICAL THERAPY INTERVENTION ON COGNITIVE OUTCOMES IN THE CAP TRIAL
Authors: Gruber-Baldini Ann
Published: November 2019

Cognitive impairment after hip fracture influences recovery and some RCTs suggest aerobic and resistance exercise may improve cognition. This presentation examines differences in PUSH versus PULSE on cognition and the impact of cognition on community ambulation. In CAP, the Modified Mini-Mental State Examination (3MS) was pre-specified for subgroup (3MS<91 versus 3MS≥91) evaluation and as a tertiary outcome. The CAP Mechanistic Pathways ancillary study (subgroup n=40) included Hooper Visual Organization Test and Trails A&B as additional outcomes. At baseline, PUSH did not differ from PULSE on cognitive measures. Over 16 weeks, PUSH became faster on Trails A (Δ= 6.7(29.9)) while PULSE became slower (Δ=9.4(24.2)) (p<.05). Those with higher baseline cognition were more likely to become community ambulators (28.3% 3MS≥91 versus 8.8% 3MS<91), but PUSH versus PULSE effects didn’t differ by 3MS (no effect modification). Results suggest potential differences in recovery by cognition, but no treatment effect differences by level of cognition.
STARTING A TESTOSTERONE AND EXERCISE PROGRAM AFTER HIP INJURY (STEP-HI) TRIAL: RATIONALE, METHODS, AND FIDELITY
Authors: Binder Ellen
Published: November 2019

The STEP-HI study is an ongoing multi-center, randomized, controlled, double-blinded clinical trial that is evaluating whether six months of topical testosterone therapy combined with a supervised center-based exercise-training program can improve mobility, functional performance, and quality of life after hip fracture, compared to exercise training alone or Enhanced Usual Care. Female hip fracture patients ≥ 65 yrs. old who are living in the community or assisted living are being randomized within 16 weeks of surgical repair for the fracture, and re-evaluated 24 weeks later. Three hundred patients will be recruited from six clinical centers in the USA. This presentation discusses the rationale and study design, including innovative methods for fidelity monitoring of exercise procedures across the clinical sites. Strategies for recruitment and related challenges will be discussed. Preliminary enrollment and fidelity data will be presented.
EXAMINING PSYCHOSOCIAL FACTORS, HEALTH BEHAVIORS, AND WHITE MATTER LESIONS IN OLDER ADULTS
Authors: Bygrave Desiree , Wright Regina S
Published: November 2019

Prior to the onset of dementia, subclinical indices of brain pathology may reliably predict cognitive decline, even among older adults with high cognitive reserve. Evidence suggests that positive psychosocial experiences and healthy behaviors buffer cognitive decline. However, their relationship with brain outcomes in cognitively intact older adults is not well understood. Therefore, the current study examined the cross-sectional association between perceived social support, generalized anxiety, psychosocial stress, physical activity, sleep quality, and magnetic resonance imaging (MRI)-assessed white matter lesions (WML), among a diverse sample of older adults. We also examined sex and race as effect modifiers. Data were analyzed from 129 participants (mean age=67.40y, 69% female, 43% African American) enrolled in the Healthy Heart & Mind Study. Participants completed psychosocial and health behavior measures and MRI-assessed periventricular and deep WML were ascertained. Multiple regression analyses assessed relations of psychosocial responses and physical activity to WML, adjusting for known covariates. Significant general anxiety x sex interactions on deep WML (p<.05), significant physical activity x race interactions on total WML, frontal lobe WML and deep WML, respectively, and total sleep quality x race interactions on deep WML, were observed (p<.05). Conditional effects showed greater physical activity and sleep quality were associated with lower WML in African-American women; greater social belonging was associated with lower WML in American-American men; and lower anxiety was associated with lower WML in African-American women and White men. Results suggest positive psychosocial factors and health behaviors may influence subclinical brain pathology via unique pathways.
THE MEANINGS OF TRUST IN AFRICAN AMERICAN COMMUNITIES AND THEIR ASSOCIATION WITH PARTICIPATION IN DEMENTIA RESEARCH
Authors: Portacolone Elena , Lichtenberg Peter , Keiser Sahru , Vest Leah , Maloof Marsha , Johnson Julene
Published: November 2019

African American /Black American older adults’ low participation in research reduces the generalizability of research findings and hinders understanding of dementia mechanisms, further widening health disparities. Both the Alzheimer’s Association and the National Institutes of Health have identified recruitment of African Americans with cognitive impairment into dementia research as an area of high priority. Distrust of research and medical institutions is often cited as a barrier to participation of African Americans in dementia research. Therefore, the goal of this study is to better understand African American community members’ expectations associated with trust. We used focus groups and semi-structured interviews to examine the expectations associated with overall trust. We conducted 6 focus groups: 4 with African American older adults and 2 with caregivers of African American older adults with cognitive impairment. We also interviewed 5 African American older adults with cognitive impairment (total n=59). Data were analyzed with content analysis. Five themes emerged: 1) Importance of providing truthful help/information leading to trust; 2) Long relationships leading to trust; 3) Acting efficiently and consistently (e.g., “not fooling around”) leading to trust; 4) Transference of trust (e.g., I can likely trust someone trusted by a trusted person); 5) Difficult to trust because of a harsh social environment. To conclude, trust is a complex belief associated with multiple expectations and relationships. It is critical that researchers understand these expectations related to trust in order to increase recruitment of African American older adults into dementia research.
PRESIDENTIAL SYMPOSIUM: EDUCATION NETWORKS: STRENGTHENING GERONTOLOGY AND GERIATRICS THROUGH CONNECTIVITY
Authors: Howe Judith L , Hyer Kathryn
Published: November 2019

The AGHE Presidential Symposium, related to the theme of the annual scientific meeting, underscores the importance of networks, collaborations and partnerships in advancing education in gerontology and geriatrics. AGHE has been at the forefront of many innovative programs since it was founded in 1974, contributing to the growth of the field and the recognition of education as one pillar of the field of gerontology and geriatrics, along with research, policy and practice. This symposium highlights three ongoing initiatives that promote connections and collaborations. The first paper discusses the Age-Friendly University (AFU) network which is made of institutions around the globe who have committed themselves to becoming more age-friendly in their programs and policies. AGHE endorses the AFU principles and invites its members and affiliates to call upon their institutions become part of this pioneering initiative. The AFU initiative is one of several international activities that AGHE, global leaders in education on aging, has engaged in. The second paper describes international networking activities such as collaborations with international organizations including the World Health Organization and connecting international and US students. In the third paper, initiatives to connect disciplines and professions through competency-based education and curricula are discussed. For instance, the Gerontology Competencies for Undergraduate and Graduate Education and the Program of Merit promote competency-based gerontology education across disciplines and professions.
PERILS, PITFALLS, AND POTENTIALS OF NETWORKING IN INTERPROFESSIONAL EDUCATION: TAKING ON THE CHALLENGES
Authors: Clark Phillip
Published: November 2019

Gerontology and geriatrics are conceptualized as quintessential interdisciplinary fields. To understand aging and provide quality care to older adults, you need an interdisciplinary perspective and an interprofessional team. However, academic and clinical settings—with their vertical structures—require bridging strategies to connect the disciplinary dots. Implicit in this approach is the need for creating networks to support interdisciplinary education in both classroom and experiential settings. Taking on these challenges requires emphasizing the importance of key competencies for both gerontology and interprofessional practice with older adults, including foundational, interactional, and contextual dimensions. These competencies recognize the unique perspectives, contributions, and roles of different disciplines, and create the connections critical for promoting and sustaining interprofessional education. Strategies for developing and maintaining interprofessional networks include: (1) identifying forces driving and restraining change, (2) matching strategies for promoting networks to readiness for system change, and (3) enlisting external forces to make and maintain changes.
AGE-FRIENDLY UNIVERSITIES: POSSIBILITIES AND POWER IN CAMPUS CONNECTIONS
Authors: Montepare Joann M
Published: November 2019

Populations are aging locally, nationally, and globally – and challenging institutions of higher education to consider how they can respond to these changing demographics through new approaches to teaching, research, and community engagement. The Age-Friendly University (AFU) initiative was recently launched by an international team convened by Dublin City University, and endorsed by the Academy for Gerontology in Higher Education (AGHE). The AFU concept and 10 guiding principles provide a guiding campus-wide framework that colleges and universities can use for distinguishing and evaluating age-friendly programs and policies, as well as identifying institutional gaps and opportunities for growth. To date, over 45 institutions have joined the AFU global network. This presentation will describe how collaborations across aging-focused programs and campus units devoted to diversity, community engagement, professional studies, and related educational efforts offer prime opportunities to build and sustain an AFU vision.
THE EVOLUTION OF AGHE AS A GLOBAL LEADER IN EDUCATION ON AGING: HOW, WHY, AND WHAT’S NEXT
Authors: Perkinson Margaret A
Published: November 2019

The scope of AGHEʻs responsibility to gerontology and geriatrics extends worldwide, as reflected in its tag line, “Global Leaders in Education on Aging.” Optimal responses to worldwide demographic transitions can only come from persons well-versed in the dimensions of aging and trained and globally situated to translate that knowledge into effective and culturally-appropriate solutions. This presentation reviews the evolution of AGHE’s role in initiating and fostering global networks of educators in gerontology and geriatrics, including collaborative efforts with major international organizations (e.g., WHO, UN, IAGG) to increase the visibility and appreciation of aging-related issues among world leaders; sponsoring national and international meetings to promote exchange of ideas and refinement of teaching methodologies; initiating and adapting new models of gerontological training enhanced by advances in information and communication technology; and supporting world-wide cohorts of emerging scholars to assume leadership roles within the organization. Recommendations for next steps are considered.
BARRIERS AND OPPORTUNITIES TO HEALTHY AGING IN ANCHORAGE, ALASKA, USING CONCEPT MAPPING
Authors: Howell Britteny M , McLinden Daniel
Published: November 2019

Alaska currently has the fastest growing proportion of older adults than any state in the country, and seniors are choosing to age-in-place in Anchorage in record numbers. Research shows that including older adults with community-based professionals (aging advocates, researchers, service providers) in focus group activities can provide a rich and holistic model of aging that demonstrates a robust foundation for supporting aging and addressing health disparities. This paper presents the results of a project conducted with older adults (50+ years), advocates, and other stakeholders in Anchorage using Concept Mapping (CM) methodology, a technique not often used in the gerontology literature. CM is a mixed-method, participatory approach that uses brainstorming and unstructured card-sorting combined with multivariate statistics (multi-dimensional scaling, hierarchical cluster analysis) to create a data-driven visual representation of thoughts or ideas of a community. CM is well suited to integrating perspectives from multiple points of view. Participants were prompted to address the research question: how do we think about aging in Anchorage & what are the barriers and facilitators to aging well? Results indicate services for seniors should include culturally responsive health programming, low-cost opportunities for social engagement, inclusion of older adults with intellectual/developmental disabilities, transportation considerations, navigators to locate services in Anchorage, and more. CM allowed the researchers to identify how residents view healthy aging in this urban subarctic location and brainstorm practical solutions with stakeholders and local policy-makers. This presentation will also share lessons-learned regarding the use of this participatory approach with older adults.
EXISTING STRATEGIES FOR ELECTRONIC DATA COLLECTION BY ELDER ABUSE MULTI-DISCIPLINARY TEAMS
Authors: Rosen Tony , Burnes David , Kirchin Darin , Elman Alyssa , Breckman Risa , Lachs Mark
Published: November 2019

Elder abuse cases often require integrated responses from social services, medicine, civil legal, and criminal justice. Multi-disciplinary teams (MDTs), which meet periodically to discuss and coordinate interventions for complex cases, have developed in many communities. Little is known about how these MDTs collect case-level data. Our objective was to describe existing strategies of case-level electronic data collection conducted by MDTs across the United States as a preliminary step in developing a comprehensive database strategy. To identify MDTs currently collecting data electronically, we used a snowball sampling approach discussing with national leaders. We also sent an e-mail to the National Center for Elder Abuse listserv inviting participation. We identified and reviewed 11 databases from MDTs. Strategies for and comprehensiveness of data collection varied widely. Databases used ranged from a simple spreadsheet to a customized Microsoft Access database to large databases designed and managed by a third-party vendor. Total data fields collected ranged from 12-338. Types of data included intake/baseline case/client information, case tracking/follow-up, and case closure/outcomes. Information tracked by many MDTs, such as type of mistreatment, was not captured in a single standard fashion. Documentation about data entry processes varied from absent to detailed. We concluded that MDTs currently use widely varied strategies to track data electronically and are not capturing data in a standardized fashion. Many MDTs collect only minimal data. Based on this, we have developed recommendations for a minimum data set and optimal data structure. If widely adopted, this would potentially improve ability to conduct large-scale comparative research.
PROTECTIVE EFFECTS OF NEIGHBORHOOD SOCIAL COHESION ON ELDER ABUSE IN INDIAN OLDER ADULTS
Authors: Chang E-Shien , Levy Becca
Published: November 2019

It is estimated that elder abuse impacts 16% of older persons globally. There is a need to understand factors that protect older persons. In this study, we examined whether neighborhood social cohesion, or the mutual support, trust, and interaction among neighbors, could be such a factor. As it has been found to be protective of child abuse and domestic violence, we hypothesized that higher neighborhood social cohesion would extend to reduce the risks of elder abuse. Our cohort consisted of participants aged 60 and over in the Longitudinal Aging Study in India (LASI) pilot survey. Elder abuse was measured by asking participants if they experienced ill-treatment by family members. Neighborhood social cohesion was measured by a five-item instrument that captured perceived support and trust among neighbors. The final sample consisted of 541 participants with a mean age of 69 who largely (72.9%) resided in rural area. The hypothesis was supported. Compared to older persons with low neighborhood social cohesion, older persons with high neighborhood social cohesion were significantly less likely to experience elder abuse (OR= 0.57, 95% CI=0.35-0.92), after controlling for socio-demographics, health, and neighborhood contextual covariates. This study, for the first time, suggests that neighborhood social environment may exert a protective effect on risks of elder abuse. Neighborhood resources may both prevent family members from being abusive and may help older persons stop abuse. Incorporating structural factors such as neighborhood cohesion may be critical in devising elder abuse preventions that increase the safety and well-being of older persons.
FUTURE CARE PLANNING INTERVENTION WITH RURAL OLDER ADULTS
Authors: Lee Jeong Eun , Kim Dahee L , Peitz Louise , Kahana Eva , Kahana Boaz
Published: November 2019

To address their needs for proactive self-care and end of life planning, we implemented a community based educational program that promotes future care planning (FCP) for community residing older adults. Extension specialists from Iowa State University implemented two brief FCP program sessions with older adults. Topics included both short-term and long-term future care planning activities and strategies. Baseline and post program surveys were completed by 216 community dwelling older adults (M=78.21). The program was successful in getting older Iowans in the rural area start end of life care preparation as well as helping them to make changes in their health care decisions. The majority of participants (89.6 %) reported high satisfaction with the programs. We also found a high rate of change (62%) in opinion regarding future care. The implication of future care planning for is discussed with recommendations for future research.
INCOMPLETE ADVANCE CARE PLANNING? CORRELATES OF PLANNING WITHOUT PERSONAL CONVERSATIONS
Authors: Boerner Kathrin , Carr Deborah , Ornstein Katherine M , Moorman Sara
Published: November 2019

In the course of advance care planning (ACP), people may elect any of the following: a living will, a durable power of attorney for health care, and discussions with family members and health care providers. A small proportion of planners complete legal documents without discussing them with others (formal planning only, FPO). If people who have done FPO become incapacitated, their family and health care professionals may lack guidance on how to direct their care. To better understand this group, we drew on four large surveys of community-dwelling adults. Social isolation, measured by living alone and lack of a confidante, increased the odds of FPO across all studies. We also found some evidence that economic disadvantage and depressive symptoms were linked with FPO. We discuss implications for policy and practice, underscoring that ACP is yet another important domain affected by the crisis of social isolation in old age.
MEDIATORS OF GENETIC AND ENVIRONMENTAL MECHANISMS ON SELF-RATED HEALTH
Authors: Zavala Catalina M , Prescott Carol A , Lapham Susan
Published: November 2019

Self-rated health (SRH), an individual’s assessment of their own health status, is associated with older adults’ chronic and acute health conditions, as well as mortality. Assessments of SRH indicate individual’s global health is likely multifaceted. Level of education, particularly amount of post-secondary schooling, is associated with better SRH. Other indices of socioeconomic status (SES) such as income and wealth, have varying associations with SRH partly dependent on relative deprivation (e.g. Gini Index). The current study utilized data from 2,500 members of the Project Talent Twin and Sibling (PTTS) Study interviewed as adolescents in 1960 and followed up 54 years later. In 2014, participants were, on average, 70 years of age. Women comprised about 54% of the sample. We examined rearing family wealth, years of education, and functional independence as mediators of variance in SRH. Mean-level results indicated small positive associations between SES and SRH. Activities of Daily Living (ADL) accounted for about a quarter of variance in SRH, with higher functional independence predicting better SRH. Biometric analyses indicated that family wealth had small mediation effects on SRH via familial-environment (S) influences. Education mediated individual-specific (E) environmental influences. Functional independence (measured by ADL) mediated SRH via both additive genetic (A) and E influences. After adjusting for overall effects of sex, age, and specified mediators, a large portion of remaining variation in SRH was due to individual-specific (E) environmental influences. Current results suggest complex underlying genetic and environmental mechanisms contributing to an older adult’s assessment of their own health.
RACIAL-ETHNIC DISPARITIES IN ATTITUDES TOWARD PASSIVE AND ACTIVE EUTHANASIA
Authors: Moorman Sara M
Published: November 2019

This paper examined racial/ethnic differences in opinions about passive euthanasia (withdrawing or withholding treatment), suicide, and physician-assisted suicide. Data came from 1,832 participants in the 2013 Pew Religion and Public Life Project. Respondents from all racial/ethnic backgrounds were most likely to favor multiple forms of euthanasia. However, persons of color had a wider variety of opinions about euthanasia than did non-Hispanic whites. In multivariate multinomial logistic regressions, non-Hispanic whites had a 63% chance of approving broadly of euthanasia, while non-Hispanic blacks had a 40% chance, and Hispanics, a 49% chance. Opposition to euthanasia was most common among people with multiple disadvantages (e.g., educational attainment, immigrant status). Neither trust in health care providers nor recent experience with the death of a loved one explained these group differences. Results highlight large differences of opinion between the people who set policy and practice guidelines and those who lack this power and access.
MACHINE LEARNING APPROACHES TO ENHANCE CLAIMS DATA ANALYSES
Authors: Pietrobon Ricardo , Marcozzi David
Published: November 2019

This presentation will cover recent advances in machine learning applied to large claims databases involving medical disparities. First, we will describe methods involving the enrichment of existing claims data with social determinants of health from census data, where variables are imputed from one dataset to another, ultimately resulting in clinical models with enhanced predictive performance. Second, we will discuss the inclusion of variables representing imaging signs from MRI and CT exams, presenting large scalability and interobserver reliability, representing a method that can be used to enrich large state and national registries through the use of image recognition. Finally, we will discuss novel protocols for Natural Language Processing involving a combination of rule-based creation of corpora for radiology and discharge reports, with highly accurate deep learning methods for concept extraction and classification.
2009-2017 RACIAL AND ETHNIC DISPARITIES IN MEDICARE PATIENT EXPERIENCE AND INFLUENZA IMMUNIZATION
Authors: Elliott Marc N , Martino Steven , Hambarsoomian Katrin , Wilson-Frederick Shondelle , Dembosky Jacob , Gaillot Sarah , Weech-Maldonado Robert , Haviland Amelia
Published: November 2019

We sought to understand the extent to which racial and ethnic disparities in the immunization rates and case-mix adjusted patient experiences of access (getting needed care and getting care quickly) of Black, Hispanic, and non-Hispanic White Medicare beneficiaries have changed over time. Accordingly, we analyzed 2009-2017 CAHPS data from 2,725,614 Medicare beneficiaries. In 2009, flu immunization rates for Black and Hispanic beneficiaries were lower than non-Hispanic White beneficiaries by 17 and 14 percentage points, respectively. Over 9 years, these gaps were reduced to 12 and 8 points, respectively (p<.01 for all comparisons). In 2009, Black beneficiaries had 2-point and 5-point disparities on getting needed care and getting care quickly (on a 0-100 scale) respectively, relative to non-Hispanic Whites. For getting needed care, there was no significant change over time in the gap between Blacks and non-Hispanic Whites. For getting care quickly, the gap between Blacks and non-Hispanic Whites narrowed to 3 points in 2017. In 2009, Hispanic beneficiaries had 2-point and 5-point disparities on getting needed care and getting care quickly, respectively, compared to non-Hispanic Whites. The gap on getting needed care widened by 1 point to a 2017 disparity of 3 points. For getting care quickly, there was no significant change over time in the gap between Hispanics and non-Hispanic Whites. These findings suggest that flu immunization rates for Black and Hispanic Medicare beneficiaries have improved significantly relative to non-Hispanic Whites; however, substantial disparities remain. For the patient experience measures, the findings are more mixed.
HEALTHCARE EXPERIENCES OF NHOPI AND OTHER U.S. ASIAN MEDICARE BENEFICIARIES
Authors: Beckett Megan K , Elliott Marc N , Hambarsoomian Katrin , Dembosky Jacob , Wilson-Frederick Shondelle , Gaillot Sarah , Martino Steven
Published: November 2019

Native Hawaiians and Other Pacific Islanders (NHOPI) and Asians are the fastest-growing US racial and ethnic group. Differences in healthcare experiences may contribute to the better health outcomes of Asian-Only adults than NHOPIs, but little is known about NHOPI healthcare experiences. Using data from 1067 NHOPI and 9361 Asian-Only Medicare beneficiaries responding to the 2017 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, we investigated NHOPI and Asian-Only differences in flu vaccination and six case-mix adjusted composite measures of healthcare experiences (scaled 0-100), with and without adjustment for Medicare coverage type and state of residence. Compared with Asian-Only beneficiaries, NHOPI beneficiaries reported better experiences getting needed care (adjusted-difference of +7 points), customer service (+5 points), doctor communication (+5 points), getting care quickly (+4 points), care coordination (+4 points), and getting needed prescription drugs (+3 points). In contrast, NHOPI beneficiaries reported worse flu immunization (-7 points; p<0.05 for all reported differences). Adjustment for Medicare Advantage (MA) coverage and state of residence accounted for <25% of differences. NHOPI vs. Asian-Only care experience differences were similar for MA and Fee-for-Service beneficiaries. NHOPI were immunized for influenza less often than Asian-Only beneficiaries in MA (-15 points), but not Fee-for-Service; this did not differ by gender. NHOPI men reported better experiences than Asian-Only men for customer service (+11 points) and getting care quickly (+6 points). Patient experience does not explain worse health outcomes found elsewhere for NHOPI than Asian-Only. Further study may suggest means of improving Asian-Only healthcare experiences and NHOPI immunization.
MOBILITY AND PHYSICAL ACTIVITY IN OLDER ADULTS: OBSERVATIONAL AND INTERVENTION RESEARCH
Authors: Bamonti Patricia M , Bean Jonathan
Published: November 2019

Mobility disability is associated with considerable morbidity and mortality in late life. Physical activity [PA] is a modifiable behavior that can reduce mobility disability, as well as improve physical and mental health outcomes in older adults. However, only a minority of older adults meet the minimum PA requirements based on national guidelines. Research examining factors impacting PA and mobility in late life, as well as novel interventions to increase PA and improve mobility is essential to enhancing health and wellbeing. This symposium will provide an overview of observational and intervention research focused on understanding factors associated with PA and mobility, as well as intervention research designed to increase PA and improve mobility in older adults. First, Dr. Lien Quach will present research examining the impact of social engagement in reducing the risk of mobility decline among older adults with mild cognitive impairment. Second, Dr. Patricia Bamonti will examine psychological factors related to uptake and adherence of pulmonary rehabilitation in older Veterans. Third, Dr. Stephanie Robinson will explore engagement, feasibility, acceptability, and change in PA following a web-based intervention in middle-aged and older adult patients with COPD. Fourth, Dr. Elisa Ogawa will present research examining the feasibility and acceptability of an exergaming intervention compared to an exercise control condition among older adults at risk for falls. The symposium will conclude with discussion led by Jonathan Bean, MD, MPH, who will highlight implications of findings across studies and identify areas for future research.
NOVEL BIOMARKERS OF BIOLOGICAL AGE IN THE HEALTH AND RETIREMENT STUDY
Authors: Thyagarajan Bharat , Levine Morgan E
Published: November 2019

This symposium presents early results on epigenetic, transcriptomic and other aging biomarkers such as telomere length and mitochondrial DNA copy number from the Health and Retirement Study that allows a detailed examination of the biological pathways through which socioeconomic conditions influence the human aging process. In 2016 HRS collected 6 tubes of blood from people who completed the 2016 interview, had been in the sample at the prior wave and were not in a nursing home (n=9,973) to maintain a nationally-representative sample. These blood samples were analyzed for novel biomarkers of aging that included global methylation arrays, whole transcriptome sequencing, telomere length and mitochondrial DNA copy number among other biomarkers that were shown to be related to both social and economic circumstances and health outcomes at older ages. This level of integration of biological data to address social disparities hasn’t been accomplished before on a large nationally-representative sample of Americans and will provide a unique opportunity to understand the biological mechanisms through which social disparities affect human health. The symposium will describe the utility of measuring novel age related biomarkers in a nationally representative population study such as HRS and the potential research opportunities that can be pursued using this publicly available resource. It will provide an overview of the measurement and distribution of epigenetic, transcriptomic and telomere length and mitochondrial DNA copy number as novel aging biomarkers. It will also describe the utility of these biomarkers in further understanding the biological underpinnings of socioeconomic differences in health and mortality.
IADL DIFFICULTY AND MORTALITY IN ACTIVE: IMPLICATIONS FOR TRANSFER OF COGNITIVE TRAINING
Authors: Gross Alden L , Clay Olivio , Felix Cynthia , Unverzagt Fred , Marsiske Michael , Coe Norma
Published: November 2019

Objectives: Our goals were to externally scale an IADL difficulty scale to the more recognizable Functional Activities Questionnaire (FAQ), and test whether cognitive training attenuates the relationship between IADL difficulty and mortality. Method: We leveraged externally available FAQ data from NACC to scale questions about IADL activities administered in ACTIVE (N=2,802) using item response theory. We modeled time to death as a function of IADL difficulty in ACTIVE using survival analysis, testing whether ACTIVE intervention group status modified the association between FAQ and mortality. Results: IADL difficulty in ACTIVE, scaled to the FAQ, was associated with a higher risk of death (Hazard Ratio, HR, 1.01, 95% Confidence Interval, CI: 1.001, 1.02). The relationship did not differ by ACTIVE intervention status. Discussion: Cognitive training does not modify the relationship between IADL difficulty and mortality, consistent with a hypothesis that proposed relationships between cognitive ability and IADL difficulty are correlational, not causal.
ACTUARIAL CRITERIA FOR MCI DIAGNOSIS IN ACTIVE: IMPLICATIONS OF ADJUSTMENT FOR RACE
Authors: Thomas Kelsey , Cook Sarah , Unverzagt Fred , Bondi Mark W , Marsiske Michael
Published: November 2019

This study examined the baseline prevalence of mild cognitive impairment (MCI) in the ACTIVE study using actuarial criteria for MCI. Participants (n=2763; 26% Black) were classified as probable MCI cases if they had two observed test scores within the same cognitive domain (memory, reasoning, speed) that were >1SD below a demographically-adjusted expected score (based on the regression weights of a “robust” normal control group). Each score was adjusted using two approaches: Method 1 adjusted for age, sex, and education; Method 2 also adjusted for race. The estimated prevalence of MCI was 33.5% (n=925) in Method 1 and 32.1% (n=887) in Method 2. Adjusting for race reduced the proportion of Black participants classified as probable MCI from 42.3% to 34.9%. Future work will examine whether adjustment for social determinants of health (e.g., education quality, neighborhood/healthcare access) might further improve the utility of this classification method in diverse samples.
LONG-TERM BENEFITS OF REASONING TRAINING: A PREDICTED DIFFERENCE APPROACH
Authors: Marsiske Michael
Published: November 2019

In 928 ACTIVE participants, we investigated predictors of exceptional reasoning performance ten years post-enrollment. Participants had been randomized into a training arm (memory, reasoning, or speed of processing) or a no-contact control group. Each participant received an age- and education adjusted expected normative trajectory on a reasoning composite score, derived from the untrained control group. They were then classified as within- (n=467, 50%), above- (n=285, 31%), or below-normative expectation (n=176, 19%) ten years post-training. At a p<.001 significance criterion, reasoning training (b=, 0.632, OR =1.88) and younger age (b=-0.048/year, OR = 1.05) were associated with 10-year above-normative expectations. No other baseline factors considered (other training arms, education, cardiovascular risk, life space, mobility, locus of control, morale, motivation) predicted ten year status, nor did they interact with training arm. Reasoning training appears to have produced long term alterations in reasoning trajectory for many participants.
DEATH OF A CHILD AND MORTALITY RISK OVER THE LIFE COURSE: RACIAL DISADVANTAGE IN THE U.S.
Authors: Donnelly Rachel , Umberson Debra , Hummer Robert , Garcia Michael
Published: November 2019

Numerous studies show that bereavement, including bereavement following the death of a minor child, increases mortality risk in white populations. The death of a child prior to midlife has received much less attention. Moreover, recent research shows that black Americans are substantially more likely to lose a child compared to white Americans, but this racial disadvantage is largely unexplored. Losing a child is a traumatic event that may activate biopsychosocial and behavioral risk factors that add to mortality risk. We analyze longitudinal data from the Health and Retirement Study (1992-2014) to assess the association of child loss prior to midlife with mortality risk in mid to later life, and the possible biopsychosocial and behavioral covariates linking child death to mortality. The analytic sample includes 20,489 non-Hispanic white respondents and 5,328 non-Hispanic black respondents who have ever given birth to or fathered at least one child. Findings suggest that that the death of a child prior to midlife is associated with increased mortality risk, net of sociodemographic controls. Psychological (e.g., depressive symptoms), behavioral (e.g., alcohol use, smoking), and social (e.g., income, marital status) factors explain this heightened mortality risk. Although the heightened mortality risk for child loss is similar for black and white parents, black parents experience a greater disadvantage as they are almost twice as likely as white parents to lose a child prior to midlife. Child loss and the resulting health risks disproportionately burden black families, functioning as a unique source of disadvantage for black Americans.
RACIAL SIMILARITIES AND DIFFERENCES IN FUTURE CARE PLANNING
Authors: Peterson Natasha L , Lee Jeong Eun
Published: November 2019

Recent population trends for the United States show substantial increases in racial diversity as well as an increase in the older adult demographic. Accordingly, the expansion in minority older adults suggests the importance of recognizing how race affects future care planning (FCP) in late life. The aim of this paper is to investigate the racial similarities and differences in planning behavior and intentions related to end-of-life care planning. This study utilized data from the Future Care Planning intervention based on the initial assessment with 237 older adults in rural Iowa (Mage= 75.93, SD=11.14) with 73 non-White participants. Results indicated that both Whites and non-Whites had similar levels of intentions in terms of future care. However, non-Whites were less likely than Whites to engage in multiple areas of FCP including planning behavior and preparing for end-of-life (F=23.957, p<.000). These findings suggest a need for more targeted FCP assessments and interventions across race groups in rural contexts.
STRENGTHENING FAMILY CAREGIVING THROUGH INNOVATIVE TECHNOLOGY SOLUTIONS
Authors: Lindeman David , Kim Katherine K
Published: November 2019

Technology has the potential to enhance the repertoire of tools for family caregiving to address the complexities of caring for older adults. There are examples of technology-enabled interventions helping older adults remain independent and safe in their home; easing the financial, physical, and psychological challenges of family caregiving; assisting in the management of chronic illness; improving socialization and support; offering information and resources on a “just in time” basis; and improving the quality of care and quality of life for both older adults and their family caregivers. This session will review eight evidence-based, technology-enabled solutions for family caregivers, including technology solutions that address medication adherence, falls prevention, personal emergency response, remote monitoring, telehealth, dementia tracking, social engagement, and care training. Key drivers for successful application of these interventions (e.g., technology, analytics, user experience design) as well as barriers to scaling (e.g., accessibility, affordability, regulation) will be reviewed.
EVIDENCE-DRIVEN PROGRAMS IN THE HEALTHCARE SETTING: HOW CAREGIVERS CAN BENEFIT
Authors: Jensen Christine J , Jensen Christine J
Published: November 2019

How do family caregivers who interface with the healthcare system benefit from evidence-driven programs designed to support them? Education, training, and care coordination programs have all been found to significantly improve the well- being of caregivers. These programs include Operation Family Caregiver; Caring For You, Caring For Me; BRI Care Consultation; the New York University Caregiver Intervention; and patient and family advisory councils. Healthcare systems that host, translate and scale these programs make them more readily accessible for patients and their families, staff, and the larger community. Further, there is legislation, including the CARE Act, which recognizes the key role a family caregiver provides as a partner in their love one’s care. The CARE Act, now enacted in 36 states, states that family caregivers must be identified in the medical record and provided with the necessary resources to be able to care for their loved one after a hospital stay.
IMPLEMENTATION OF A MINDFULNESS BASED DEMENTIA-CARE PROGRAM WITHIN A HEALTHCARE SYSTEM
Authors: Hanson Leah , Kashyap Bhavani , Barclay Michelle P
Published: November 2019

The stress associated with caring for a loved one with Alzheimer’s disease or a related dementia can negatively affect mental and physical health. Mindfulness-based stress reduction (MBSR), teaching caregivers to focus on the present moment with non-judgmental awareness, has been shown to improve overall mental health, reduce perceived stress, and decrease depression. At HealthPartners, we implemented the Mindfulness Based Dementia-Care (MBDC) program, an 8-week program designed for family caregivers for those living with dementia. MBDC combines teaching of MBSR skills along with essential education for this chronic disease. Participants attend a 1-hour orientation session, 2-hour classes each week for 8 weeks, at-home practice between classes, and a 6-hour Saturday retreat. Secure electronic surveys are administered at baseline, program completion and follow-up for evaluation of the program. We will discuss barriers and learnings of implementation as well as preliminary results from the evaluation.
THE IMPORTANCE OF THE LONG-TERM CARE WORKFORCE ON QUALITY OUTCOMES FOR INDIVIDUALS RECEIVING SERVICES
Authors: Schwartz Lindsay , Degenholtz Howard , York Amy M
Published: November 2019

A strong, supported long-term care (LTC) workforce is vital to quality outcomes of individuals receiving LTC. With the sector facing issues around recruitment and retention, it is important to understand factors impacting the workforce. This symposium includes four presentations, a mix of both quantitative and qualitative research. First, Scales and colleagues will provide an overview of the workforce crisis using extensive policy analysis of home and community-based services (HCBS) in the US. Factors impacting the HCBS direct care workforce (DCW), including training, supply and demand, models of care and compensation, will be addressed. Next, Carder et al. will compare workforce recommendations from the 2003 Assisted Living Workgroup (ALW) report to current regulations. Many states have incorporated recommendations including criminal background checks and training while few have required staff performance evaluations and policies to improve retention. Morgan et al. examine AL residents’ care convoys’ impact on resident outcomes utilizing data from interviews with AL staff, external health care professionals, residents and family members (n=219). Policies, practices, work overload, time constraints, lack of training and turnover impacted DCW involvement in care convoys. Bender et al. analyze data from 14 DCWs and 16 executive directors from 4 ALs to examine how staff implement and understands end-of-life care policies and procedures. Limited training and communication around death present opportunities for improvement to support DCWs experiencing grief and bereavement. The discussant will address the importance of workforce as part of the network providing quality of care and improving quality of life of individuals receiving LTC.