bluuebunny/crossref_metadata_2025 huggingface dataset:
SACCADES TO SCREEN AND ASSESS COGNITIVE IMPAIRMENT IN OLDER ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Wan Qiaoqin , Zhang Shifang , Huang Xiuxiu , Zhao Xiaoyan
Published: December 2022

Objective

To systematically summarize the evidence of saccade as a screening and assessing for patients with mild cognitive impairment (MCI) and dementia.

Methods

English databases including PubMed, EMBASE, the Cochrane Library, Web of science, and PsycINFO and Chinese databases including CNKI, Wanfang and VIP were searched. Studies that analyzed the metrics of saccade in people with health cognition, MCI, or dementia were included. The quality of the included studies was evaluated with Cross-sectional/ Prevalence Study Quality from Agency for Healthcare Research and Quality (AHRQ). Study characteristics, participants' characteristics, sample size, saccade procedure, and metrics were extracted from the included studies.

Results

Twenty-two studies involving 1595 participants were included. Meta-analysis showed that peak velocity (SMD= -0.27°/s, 95% CI (-0.44, -0.11), latency (SMD=-0.36ms , 95%CI (-0.51,-0.20), and accuracy rate (SMD=0.42%, 95%CI (0.17,0.68) of prosaccade between older adults with and without cognitive impairment had significant difference. The performance in latency (SMD=-0.56ms, 95%CI(-0.72,-0.39), accuracy rate (SMD=1.32%, 95%CI(1.07,1.56), and corrected errors (SMD=1.23%, 95%CI(0.98,1.47) of antisaccade in people with health cognition was better than that in older adults with cognitive impairment. The results of subgroup analysis revealed that the accuracy rate of prosaccade, latency and accuracy rate of antisaccade demonstrated crucial difference between health older adults and people with MCI, while only accuracy rate of antisaccade showed significant difference between people with MCI and dementia.

Conclusions

The metrics of saccade, especially antisaccade, can be a potential screening and assessing tool for MCI and dementia in elderly persons.
STIFLED UTILIZATION OF DEMENTIA-RELATED HEALTHCARE SERVICES DUE TO STIGMA IN RURAL APPALACHIA
Authors: Rhodus Elizabeth , Gibson Allison , Gross David , Sprang Rob , Parsons Kelly , Johnston Julia , Jicha Gregory
Published: December 2022

Residency in rural Appalachia is linked with heightened morbidity and mortality due to a myriad of conditions, many of which are associated with increased risk and prevalence of Alzheimer’s disease and related dementias (ADRD). Despite this, access to and utilization of dementia-specific healthcare services in the region are limited. This study presents community-based stigma associated with enrollment in healthcare clinical research offered in rural Appalachia. Additional data from focus groups with care partners of people with memory impairment in rural Appalachia discuss implications of stigma in their communities. Findings elaborate on recruitment challenges associated with terminology, such as caregiver and dementia, as well as availability of diagnosticians. This study illustrates unique characteristics needed for community-based education programs tailored to the culture and customs of rural regions in order to increase utilization of healthcare for older adults at risk or living with ADRD.
DEVELOPMENT AND VALIDATION OF THE LEISURE EUSTRESS-DISTRESS SCALE
Authors: An Jaesung , Payne Laura , Liechty Toni
Published: December 2022

Encountering stressors is a part of everyday life and can even occur when people engage in leisure activities. This is more prevalent among older adults due to the onset of chronic condition(s), lack of resources, and social isolation. Therefore, leisure related stressors could provoke complex emotions derived by positive and/or negative responses to stressors before, during, and after older adults engage in leisure activities. Different from the concept of leisure constraints, which emphasizes causes of stress that prevents leisure engagement in the first place, the concepts of leisure eustress and distress are associated with the emotional experience of stress in the context of leisure. Despite the presence of leisure-based eustress and/or distress among older adults, there is no measurement scale that assesses this phenomenon. Therefore, the purpose of this study was to develop and validate a leisure eustress-distress scale (LEDS). Phase one of this study included in-depth interviews, expert panelists review, and a pilot study to develop and refine items. In the second phase, a target study was conducted to examine the factor structure using exploratory and confirmatory factor analysis. For validity, LEDS showed partial support for construct and criterion validity. Strategies to strengthen the scale’s validity will be discussed as well as future recommendations and practical implications of the LEDS.
SOURCES OF STIGMA AND THEIR IMPACT ON ALASKA NATIVE ADRD CAREGIVERS' WELLBEING
Authors: Kim Steffi
Published: December 2022

Challenges such as isolation, scarce resources, and limited knowledge of the disease are often the result of stigmatizing experiences from multiple systemic sources. No studies have investigated the impact of sources of stigma on the quality of life in Alaska Native (AN) ADRD caregivers. This exploratory, mixed-method study within a community-based participatory research framework assessed the experience of family stigma among 40 AN caregivers of people with ADRD across Alaska by administering a measure of systemic stigma and describes the impact of stigmatizing experiences on AN caregivers’ quality of life to develop preliminary data-driven stigma-reducing initiatives. AN caregivers completed the Family Stigma – Alzheimer’s Disease Scale (FS-ADS), assessing caregiver stigma, layperson stigma, and structural stigma. Quality of Life was assessed with the Goodness of Life for Every Alaska Native (GLEAN) scale. Preliminary data on structural stigma and its impact on caregiver quality of life will be presented.
GRANDPARENTING AND DEPRESSIVE SYMPTOMS IN URBAN CHINA: LIVING ARRANGEMENTS AND WORK STATUS AS MODERATING EFFECTS
Authors: Ma Luyan , Cheng Zhaowen
Published: December 2022

Scholars worldwide are divided as to whether grandparenting can benefit to older adults’ well-being. Evidence from rural China supports that custodial grandparenting worsens grandparents’ psychological well-being. However, given the great urban-rural gap, the situation in urban China might be different. To clarify this, we use CHARLS 2011-2013 (900 respondents) and examine the association between length and intensity of grandchild care and depressive symptoms among older adults living in urban China. We also explore the moderating effect of grandparents’ living arrangements and work status. Multiple linear regression with interaction analysis is applied in our analysis. We find that moderate levels of grandchild care, without distinguishing between living arrangements and work status, are associated with reduced depressive symptoms (β = -1.146，p < .05). Grandparents are likely to have more depressive symptoms when working full-time and providing care at the same time. Comparing with not living with grandchildren, living with grandchildren is beneficial to grandparents’ mental health. Findings suggest that psychological counseling services and economic support policies should be launched to relieve the work pressure of grandparents in financial difficulties.
AGE DIFFERENCES IN EXPOSURE TO NOVEL SITUATIONS IN DAILY LIFE AND ASSOCIATED EMOTIONAL EXPERIENCE
Authors: Chu Li , Shavit Yochai , Ram Nilam , Carstensen Laura
Published: December 2022

Exposures to novelties are cognitively beneficial in later adulthood, but their impact on emotional well-being is still unknown. Novel situations may bring excitement as well as anxiety, and this may be different across ages According to socioemotional selectivity theory, older adults prioritize familiar and positive experiences that likely contribute to better emotional well-being over novel and negative ones, suggesting that older adults may be motivated to avoid novel situations, especially if these experiences are associated with negative emotions. This study examined age differences in novelty experienced in daily life and the associated emotions. We utilized experience sampling data collected five times a day for one week from 375 participants (age range=18-94). Contrary to the hypothesis, older age exhibited a quadratic association with novel daily experiences such that situation novelty was lowest in middle adulthood. Results from multilevel models suggested that people with higher overall exposure to novel situations had higher overall levels of negative emotions, and that when in more novel situations the prototypical individual experienced more negative emotions in general. However, consistent with SST postulates, one of these associations were moderated by age; older adults experienced lower positive emotions during novel situations than younger individuals. In contrast, the association between situation novelty and negative emotions did not differ with age. Together, these findings suggest that older adults do often find themselves in novel situations but may experience them less positively than younger adults. Implications on learning-related programs and interventions designed to expose older adults to novelties will be discussed.
RACIAL DIFFERENCES IN THE ASSOCIATION BETWEEN LONELINESS AND COGNITIVE STATUS AMONG BLACK AND WHITE MEN
Authors: Bruce Marino , Beech Bettina , Marshall Gillian , Thorpe, Jr. Roland J
Published: December 2022

Background

Loneliness is a stressor that has been found to increase the likelihood of poor health and dementia. Few studies have focused on this association among men and even fewer studies have examined racial disparities in loneliness and cognitive functioning among this group. The purpose of this study was to examine racial differences in the association between loneliness and cognitive functioning among national sample of men aged 50 years and older.

Methods

Data were drawn from Black and White men in the 2016 Health and Retirement Study who completed the Leave Behind Questionnaire (n=2226). Cognitive function was the primary outcome and was measured by a dichotomous variable derived from a modified version of the Telephone Interview for Cognitive Status. Loneliness was the primary independent variable and was derived from the 3-item UCLA Loneliness Scale.

Results

Black men made up 18.5% of the study sample; however, the proportion of this group with scores indicating cognitive impairment or dementia (35.9%) doubled the corresponding percent of white men (17.6%). Findings from race-stratified modified Poisson regression models indicated that loneliness was associated with a higher prevalence of cognitive impairment or dementia for White men (PR=1.24, CI:1.05-1.47), but Black men (PR=0.92, CI:0.73-1.16).

Conclusions

Results from this study raise important questions about the salience of pooled analyses and suggest a need for tailored approaches to mitigate cognitive decline. Additional studies focusing on Black men are needed to develop effective interventions preserving cognitive functioning among this population.
IS ETHNIC HERITAGE MEANINGFUL IN ADULTHOOD? ETHNIC IDENTITY AND WELL-BEING IN MEXICAN-ORIGIN FEMALE ADULTS
Authors: Tse Hin Wing (Florence) , Song Jiaxiu , Muñoz Elizabeth , Kim Su Yeong
Published: December 2022

Being the largest immigrant group in the U.S., the process of exploring, forming, and retaining ethnic identity is a critical component to Mexican immigrants’ successful adaptation and wellbeing. Despite recognizing the dynamic nature of ethnic identity development, extant research has predominantly focused on adolescence, overlooking the development and impact of ethnic identity in adulthood, when individuals’ experiences are continuously shaped by critical life events (e.g., moving to a new country). Additionally, there is a lack of longitudinal research on mid-late adulthood. Filling these gaps, this study utilized a three-wave longitudinal dataset of 595 Mexican-origin female adults (Mage.wave1 = 38.39) to examine their initial levels and trajectories of ethnic identity development (i.e., exploration, centrality, and resolution) and understand how these individuals’ initial levels and trajectories of ethnic identity are associated with their wellbeing (i.e., life meaning, resilience, and depressive symptoms) at Wave 3. Using latent growth curve modeling, unconditional models revealed that initial levels of ethnic identity in Mexican-origin female adults were moderately high, and that their centrality and resolution of ethnic identity remained stable while their exploration of heritage identity increased over time. The conditional model also showed that Mexican-origin female adults’ higher initial levels of centrality and resolution were associated with a greater sense of life meaning (and resiliency, only true for resolution levels) but not with depressive symptoms. These findings suggest that ethnic heritage is associated with more positive perception in life and may inform interventions on developing a positive ethnic identity that is related to better wellbeing.
HOW IS MENTAL HEALTH IN LATE LIFE SHAPED BY STRUCTURAL RACISM?
Authors: DeAngelis Reed , Homan Patricia , Brown Tyson
Published: December 2022

Less than one percent of studies on the link between race and health have focused on structural racism. Empirical research on how structural racism affects health in later life is especially rare. Moreover, the conceptualization of structural racism in the race theory literature has often differed from the measurement strategies used in aging and health research. This study advances the field by 1) utilizing a novel, theory-informed latent measure of structural racism in states across multiple domains, including political participation, education, economics, housing, and the judicial system, 2) mapping structural racism across states, and 3) quantifying the association between structural racism and mental health outcomes (depressive symptoms and frequency of poor mental health days) among Black and White older adults. We use administrative data measuring state-level racial stratification linked to geocoded individual-level demographic and health data from the HRS (N=9,126) and the BRFSS (N=308,029). Results show that, whereas structural racism is consistently associated with worse mental health for Black people, it is either unrelated to health or predictive of better health among Whites. Findings highlight the utility of rigorously conceptualizing and measuring structural racism and its impact on health among older adults.
RACIAL/ETHNIC DISPARITIES IN THE RISK OF DEMENTIA: THE ROLE OF STRESS EXPOSURE IN LATE LIFE
Authors: Lai Wen-Hua
Published: December 2022

The number of individuals with Alzheimer's disease and related dementias is expected to triple from 5 million to 13.7 million by 2050 in the US. Current studies suggest that older Black and Latinx adults experience poorer cognitive health; their dementia prevalence is 1.5 to 2 times higher than their white counterparts. Excessive stress exposure (e.g., traumatic experiences and discrimination) may serve as contributors to the cognitive health inequalities faced by racial/ethnic minorities. However, extant studies on cognitive health in diverse aging populations remained limited. In particular, little is known about how the level and effect of stress exposure account for cognitive health disparities across racial/ethnic groups. This study examines whether racial/ethnic differences in stress exposure (traumatic events, stressful life events, perceived everyday discrimination, lifetime discrimination, and financial strain) shape cognitive health disparities by race/ethnicity. Data from the 2006-2012 Health and Retirement Study are used to address the research question (N=9,251). Preliminary results based on ordinal logit regression models and moderation analyses suggest that all racial/ethnic minority older adults, especially Blacks, were more exposed to stressors and experienced poorer cognitive health than their White peers. However, even though some stressors are associated with adverse cognitive health, greater stress exposure among minority older adults explains little cognitive disparities faced by them. Moreover, the magnitude of the stressor effects on cognitive health is smaller for Blacks and Latinxs than for Whites. This study will discuss the implication of these unexpected findings and areas of promising future research.
THE NEIGHBORHOOD CONTEXT AND ALL-CAUSE MORTALITY AMONG OLDER ADULTS IN PUERTO RICO
Authors: Garcia Catherine , McEniry Mary , Crowe Michael
Published: December 2022

The neighborhood contexts in which older adults live are increasingly being recognized for their role in influencing disease processes and risk of death among the U.S. population. However, few studies have focused on neighborhood impacts among older populations residing in Puerto Rico– a U.S. territory –who are especially vulnerable to the effects of the environment as they “age in place” in the context of a budget crisis, the great recession, the debt crisis, and Hurricanes Irma and María. The combination of these events can obstruct access to neighborhood resources, services, and contexts considered necessary for promoting healthy aging. Thus, it is warranted to understand the effects of place on mortality in Puerto Rico, whose social and economic contexts differ from the U.S. and are more similar to that of other Latin American and Hispanic-Caribbean countries. We used 2000 U.S. Census data at the block-group level linked to the 2002 Puerto Rican Elderly Health Conditions Project with mortality follow-up to 2021 to examine neighborhood characteristics that are conceptualized as influencing mortality (e.g., residents without a high school degree; households receiving public assistance income; residents living below the poverty level; unemployed residents; residential stability; age structure). Multilevel mixed-effects parametric survival models with a Weibull distribution were estimated. Overall, results show that neighborhood socioeconomic disadvantage is associated with an increased risk of mortality among older Puerto Ricans. This suggests that older Puerto Ricans clustered in disadvantaged communities are more likely to experience a cumulative burden of social disadvantages that adversely impacts their longevity.
ARE PERCEIVED NEIGHBORHOOD CHARACTERISTICS ASSOCIATED WITH CHRONIC PAIN IN MIDDLE-AGED AND OLDER ADULTS?
Authors: Yang Yulin
Published: December 2022

Neighborhoods predict many health outcomes including functional limitations and disability; however, how neighborhoods are associated with chronic pain remains poorly understood. This study uses examined the association between four perceived neighborhood characteristics (social cohesion, physical disorder, safety, and social ties) and chronic pain in a nationally representative sample of adults aged 51+ in the US. Among 14,069 participants (58.65% women; mean age 68.81) in the Health and Retirement Study (2006-2008), we investigate whether neighborhood social cohesion, neighborhood physical disorder, neighborhood safety, and neighborhood social ties were associated with odds of having moderate-severe and limiting pain using adjusted logistic regression. After adjusting socio-demographic factors (age, gender, race/ethnicity, education, wealth, marital status), residence in neighborhoods with high perceived social cohesion, safety, and more social ties were associated with lower odds of having moderate-severe and limiting pain. Perceived neighborhood physical disorder did not predict whether respondents have moderate-severe and limiting pain or not.
TRAJECTORIES OF ANXIETY SYMPTOMS DURING THE COVID-19 PANDEMIC AMONG OLDER ADULTS
Authors: Choun Soyoung , Lee Dylan , Kurth Maria , Lee Hye Soo , Igarashi Heidi , Aldwin Carolyn
Published: December 2022

Older adults face particular challenges during the COVID-19 pandemic, including increased risk for morbidity and mortality (CDC, 2021). Social distancing and lockdown to prevent contagion may create social isolation and loneliness, adversely affecting mental and physical health. We examined anxiety symptom trajectories of older adults and identified risk and protective factors during the early months of the COVID-19 pandemic. We also examined how anxiety symptoms were associated with both between- and within-person variations in loneliness, social contacts, and physical problems. We sampled 247 older adults (Mage = 71.1, SD = 7.3, range = 51 - 95), who participated in eight weekly longitudinal online surveys from April 28 to June 23, 2020. Multilevel modeling analysis controlling for age, gender, marital status, and education showed that anxiety symptoms significantly decreased in the first few weeks, but then increased around week 6 of the study period. At the between-person level, individuals with higher levels of both loneliness and physical problems were at risk for experiencing higher levels of anxiety, but social contacts were not significant. Middle-aged participants reported higher anxiety symptoms than older participants. Women experienced higher anxiety symptoms than men. As a protective factor, individuals who were high in resilience had significantly lower anxiety symptoms over time, compared to those with low in resilience. In the within-person level, anxiety symptoms were positively coupled with both loneliness and physical symptoms over time. We conclude that lonely individuals and those in poor health were at greater risk of poor mental health during the pandemic.
SOCIAL CONNECTION IN OLDER ARKANSANS DURING COVID-19: CHANGES AND SATISFACTION
Authors: McAtee Robin , Peszka Jennifer , Goldberg Anne , Spradley Laura , Musallam Noura , Allen Lauren , Vogle Sophie , Simpson Luke
Published: December 2022

Social support is important to the health and well-being of older adults. Changes in social support (both frequency and satisfaction with) and barriers to social support during the pandemic remain unknown. During Spring 2021 an automated phone survey of adults 65 and older in Arkansas was completed. Calls were placed to 27,296 households where 8,745 individuals answered, and 867 (N=723 White, non-Hispanic) older Arkansans completed the 18 question self-report survey. Results indicated that: 41% had curtailed their in-person interactions significantly; 61% continued to engage in in-person social interactions outside of their home once a week or more; and social group activities decreased from 52% to 41%. Additionally, it was reported that 88% used technology for social interactions once a week or more and 60% reported technology interactions made them feel socially connected. Despite this, only 67% reported being satisfied with their social connection during the pandemic compared to 93% prior to the pandemic. While many participants continued in-person social interactions, social activity and satisfaction decreased during the pandemic. Social technology alternatives were used by many and for some, social connection was reported to be satisfactory. The value of what was learned from this survey has application outside pandemic times. Understanding and acknowledging that social isolation exists for older adults in normal times and improving technological access to social activities has great value. This knowledge can be used to substantiate the expansion and improvement of older adult friendly virtual platforms therefore contributing to reducing social isolation.
COLLABORATIVE PARTNERSHIP BETWEEN STATE AGENCIES AND ACADEMIA ADDRESSING LONG-TERM CARE WORKFORCE NEEDS
Authors: Ehlman Katie , Diekemper Karla , Valadares Kevin
Published: December 2022

The rural areas of southwestern Indiana are challenged with insufficient healthcare workers in the long-term care industry. The University of Southern Indiana (USI) Geriatric Workforce Enhancement Program (GWEP) is collaborating with state agencies to address shortages in licensed administrators, activity professionals and social service designees. These roles, vital in the nursing facility, hold educational requirements through the Indiana State Department of Health (ISDH) and the Indiana Professional Licensing Agency (IPLA). USI gerontology faculty addressed workforce challenges in five phases: 1) Evaluation of state educational requirement and comparison to current USI gerontology courses; 2) Development of new coursework to support state requirements; 3) Expansion of preceptor pool; 4) Proposal to state agencies; 5) USI curriculum modifications. Faculty evaluated the educational and training requirements for these roles and compared the requirements with current courses. Preceptors were needed for students’ field experiences; a preceptor pool was developed through funded training. The requirements and course alignment were included in the program proposal to the state agencies. Upon ISDH, IPLA and University New Program Development Committee approval, additional instructors were recruited. Results of this initiative include a: 1) Fully approved and launched Administrator-in-Training (AIT) residency embedded in curriculum at undergraduate and graduate level; 2) Fully approved Activity Professional Certificate Program; 3) Pool of 10 certified preceptors; and 4) Onset of the social service designee certificate program. This collaborative partnership developed between USI, ISDH and IPLA ensure state agency requirements are met academically for students entering the long-term care workforce.
UTILIZING COMMUNITY ANALYSIS TO INCREASE AWARENESS OF HEALTH DISPARITIES IN OLDER OKLAHOMANS
Authors: Sylvester Donna
Published: December 2022

Where we live affects us. The state of Oklahoma consistently ranks in the bottom ten percent for health outcomes, health policies, and health behaviors of older adults. Physical therapy students in Oklahoma must recognize the impact that social determinants of health have on older adults in order to fully meet the needs of their future patients. Prior to final clinical experiences, third-year Doctor of Physical Therapy students explore these concepts through individual community analysis projects in urban and rural communities across the state. The students visit their chosen community to assess access to transportation services, food, housing, and healthcare-specific to older adults. Additionally, students explore opportunities for exercise classes targeted toward older adults and the walkability of the community. Students come away with a better understanding of the wide array of social determinants of health experienced by older adults in Oklahoma and learn of opportunities to advocate for future patients in their communities.
CRAFTING AN UNDERGRADUATE CONCENTRATION IN AGING ACROSS THE UNIVERSITY AND ASSESSING COMPETENCIES
Authors: Mulhorn Kristine
Published: December 2022

In the last few years, our Health Administration Department has grown its undergraduate offerings in aging and now is promoting those courses as a concentration available for any major. A recent collaborative effort between our college and the honors college, our university has created a university-wide set of courses across all majors related to topics in aging. In our university, students can pursue a concentration with as few as three courses that are relevant to their majors. Usually, the courses in a concentration are taught by those in the major. However, the global issue of aging can be taught as a specialty area for many majors. To ensure students meet the learning objectives, the following assessment plan was developed for three key courses offered by the Health Administration Department—Healthy Aging, Aging and the Law and either Aging in a Global Context or Aging Services Management. First, a curricular map of the areas of competency within our program are outlined and then the content and areas of assessment are considered based on whether the competencies are “Introduced”, “Reinforced,” and “Mastered.” Next, the key assignments in each course within the concentration were aligned with the Program Objectives for the Health Administration bachelor’s program to assess student achievement of key competencies. In the process of offering the concentration in Aging across multiple majors, it is important for various departments to understand how courses in aging add valuable competencies regardless of their major.
RACIAL AND ETHNIC DISPARITIES IN COGNITIVE DIFFICULTY AMONG OLDER ADULTS: EVIDENCE FROM NEW YORK CITY
Authors: Cheung Ethan Siu Leung , Liu Jinyu
Published: December 2022

This study examined racial and ethnic disparities in cognitive difficulty among older adults in New York City (NYC). Also, we tested whether physical health, family structure, individual socioeconomic status (SES), and neighborhood SES explained the disparities. Based on community districts, individual-level data from the 2019 American Community Survey were merged with neighborhood data from NYC Community District Profile. A sample of 5,622 NYC residents aged 60 or older was included across 55 community districts. The outcome variable, cognitive difficulty, was measured by a binary variable in which respondents’ self-reported challenges with cognitive health (1=having challenge, 0=no). Racial and ethnic groups included Whites, Blacks, Latinos/Hispanics, and Asians. We used multilevel logistic regressions for analysis. Results show that Latinos/Hispanics had the highest odds of reporting cognitive difficulty across groups. Physical health, marital status, individual SES, and access to parks were significantly associated with cognitive difficulty. Physical health, family structure, and multilevel SES partially explained or influenced the racial and ethnic disparity in cognitive difficulty. However, such influence varied by race and ethnicity. Physical health and individual SES contributed to the disparities for Latinos/Hispanics and Blacks, compared to Whites. Neighborhood SES attenuated the disparity in cognitive difficulty between Latinos/Hispanics and Whites. Also, family structure uniquely explained the disparity for Blacks. No significant disparity was identified between Asians and Whites. This study shed light on the important roles of multilevel factors in predicting racial and ethnic disparities in cognitive difficulty. Findings provide direction for interventions to reduce racial and ethnic disparities in cognitive difficulty.
CONNECTING RURAL OLDER ADULTS WITH DISABILITIES TO HOME MODIFICATIONS WITH A REMOTE HOME ASSESSMENT
Authors: Nabors Emily , Garell Catia , Pynoos Jon
Published: December 2022

Older adults living in rural areas have particular challenges to accessing critical supportive services such as home modifications to promote functioning and safety. Conducting remote home assessments through telehealth has the potential to reduce time spent and overall cost that occur in conducting in-person assessments. During the pandemic, providers turned to telehealth to preserve continuity of assessment services with few research-based practices to guide them. With support from a NIDLRR SBIR grant, Thrive for Life LLC in partnership with the USC Leonard Davis School of Gerontology conducted research to develop a remote home assessment that aims to connect health and home modification providers with rural older adults (65+) with disabilities, a population that may not receive home modifications otherwise. Research included a literature review, key informant interviews with five experts in the field, and individual phone interviews with 30 rural older adults who have disabilities. The literature was analyzed and used to inform the interview questions. Key informant interview responses were analyzed for models, potential challenges, lessons learned, and opportunities to impact priority needs. Consumer interview responses were analyzed for needs, preferences, concerns, and challenges related to technology use. Findings demonstrate common barriers such as lack of access to broadband and smart technology; circumstances in which remote assessments are, and are not, likely to be successful; and the potential value of conducting remote home assessments in rural areas to ensure equity of access to home modifications for older adults with disabilities during the pandemic and beyond.
AGING IN PLACE: TURNING TO THE VOICES OF EXTENSION EDUCATORS
Authors: Koerner Susan , Anderson Brianna , Ju Sehyun
Published: December 2022

Most adults report a preference for aging-in-place (AIP) – remaining safely in their own home and community as they age, even as they become more dependent on others. When attempting to determine options and feasibility for AIP, older adults and/or their families – especially those living in non-metropolitan rural areas and small towns, may turn to Extension educators for information and guidance. For the current study we interviewed seven family-focused Extension educators responsible for 25 counties throughout a Midwestern state to explore the challenges, supports, patterns of experience, and service/policy recommendations that these professionals find relevant to AIP in their regions. The principal investigator (PI) conducted each semi-structured interview by phone; each audio-recorded interview lasted approximately 60 minutes. Two trained research assistants and the PI applied combined deductive-inductive thematic analyses to the transcribed interview data following Braun and Clarke (2012), utilizing MAXQDA, and ensuring trustworthiness during the coding process. Five major categories with sub-themes emerged: Challenges to AIP (e.g., transportation), Supports to AIP (e.g., churches), Most-Challenged Populations (e.g., middle-income families who neither can afford in-home assistance nor are eligible for government aid), Attitudes Toward AIP (e.g., caution against social isolation), and Recommendations for Services/Policies to Facilitate AIP (e.g., government funding, in-home technology assistance). Some variation across counties was apparent with, for example, one county making concerted efforts to retain young adults in its communities (i.e., reducing out-migration), thus enhancing family presence making AIP more feasible, non-isolating. Our findings will be especially noteworthy to social service providers and aging-focused public policymakers.
GEOGRAPHIC PROXIMITY TO NEIGHBORHOOD RESOURCES AND DEPRESSIVE SYMPTOMS AMONG KOREAN OLDER ADULTS
Authors: Lee JuHyeong , Shin Donghee , Kim Yeoju , Kim Giyeon
Published: December 2022

Given the importance of geographic proximity to neighborhood resources especially during the COVID-19 pandemic, this study examine whether the relationship between geographic proximity to neighborhood resources (e.g. hospitals, public transportation, etc.) and depressive symptoms varied by geographic location (i.e., rural vs. urban areas) among older adults in South Korea and whether this relationship was mediated by participation in social activities (e.g. education, club, community, etc.). The nationally representative samples, Korean older adults aged 65 or older, were drawn from the 2020 Survey of Living Conditions and Welfare Needs of Korean Older Persons (N=9,732, Urban=6,975, Rural=2,757). Hierarchical regression models, Baron and Kenny’s steps, and Sobel Test for the mediation effect were conducted. Results showed that geographic proximity was negatively associated with depressive symptoms in urban areas (B=-.041, p<.001), while positively associated in rural areas (B=.034, p<.01). Participation in social activities partially mediated the relationship in urban areas (Z=-2.162, p<.05), while there was no significant mediation effect in rural areas. Additionally, geographic proximity to hospitals or public transportation was significantly associated with depressive symptoms in rural areas. The findings suggest that geographic proximity to neighborhood resources helps older adults reduce social isolation, which may improve mental health of older adults living in urban areas during the pandemic. However, geographic proximity to neighborhood resources could make older adults living in rural areas become depressed, emphasizing that the characteristics of the urban and rural areas need to be considered to create an aged-friendly environment.
NEIGHBORHOOD PREDICTORS OF MENTAL HEALTH OF OLDER AMERICANS: EVIDENCE FROM A 5-YEAR LONGITUDINAL STUDY
Authors: Orekoya Afolabi , Egbuchiem Henry , Olanisa Olawale , Arisoyin Abimbola , Ebili Ujunwa , Adaralegbe Adeleye , Abbasi Khuzeman
Published: December 2022

With increasing dependence on other people in old age, environmental resources become an important asset for older adults to experience healthy aging. Data on the longitudinal relationship between neighborhood and mental health in late life is scanty. This study utilized hierarchical multiple regression model analysis to investigate whether and which neighborhood factors predicted depression and anxiety among older Americans followed up for over five years within the same neighborhood. Two waves of data containing a cohort of 1,731 older adults from the NSHAP project were used. Outcome measures were depression and anxiety. Predictors were four neighborhood factors: Social cohesion (NSC), social ties (NSC), neighborhood problems (NP), and perceived neighborhood danger (PND). We adjusted for demographic and physical health characteristics. The mean age of the respondents was 71.4 ± 6.5 years and were mostly females (55.5%). Lower NSC and a higher PND significantly predicted depression. However, the model only explained 2.8% of the variance in depression. In the covariate-adjusted model, none of the neighborhood factors predicted depression, but the model significantly improved to 32.5%. NP was the only significant predictor of anxiety in the final model and explained 27.8% of the variance in anxiety. Covariates, which are primary determinants of mental health disparity, have a much larger role to play. This study sheds some light on the complexity of the relationship between neighborhood and mental health in older adults. Future policy development and interventions should target improving both physical and social environments to enhancing the mental wellbeing of older adults.
EARLY-LIFE EDUCATION AND COGNITIVE AGING: DOES CONTENT, LOCATION, AND HISTORICAL CONTEXT MATTER?
Authors: Smith Jacqui , Zahodne Laura
Published: December 2022

Life course and cognitive aging theories about the sources of subgroup and individual differences in susceptibility to cognitive impairment frequently highlight the significance of early-life education, defined in research by total years of school and highest degree. A more nuanced approach could shed light on why and for whom education matters for brain aging processes. For example, one year of school in the 1930s may not be the same as one year in the 1960s, or in different school types and states in this historical period. In addition, post- high school training and degrees differ in content. Each paper in this symposium uses early-life education history and late-life cognitive data from the Health and Retirement Study (HRS). Speakers discuss what guided their selection of specific education content, location, contexts and analytic strategy. Williams-Farrelly asks how individuals characterized by privileged high school educational experiences in the period from 1930 to the 1960s benefited in terms of social mobility and later-life cognitive functioning. Nkwata, in contrast, focuses on early-life education experiences that potentially limit the skills acquired together with exposure to family adversity and stress. Yu utilizes sequence analysis to identify and examine the association between late-life cognition and variations in patterns of K-12 education defined by duration and order of racial/ethnic composition. Walsemann and colleagues ask if state-level differences in the timing and implementation of school desegregation policies explain Black-White disparities in the transition to cognitive impairment in the US South. The session concludes with an integrative discussion by Zahodne.
SENIOR HOUSINGS’ ROLE FOR AGING IN PLACE: FOCUSING ON THE NATIONAL PROFILE OF INDEPENDENT LIVING FACILITIES IN KOREA
Authors: Park Sojung , Ryu ByeongJu
Published: December 2022

Understanding the changing preference for alternative housing arrangements is important due to the confluence of a global population aging, increasing cost concern for long-term care, and the desire of older people for aging in place (AIP). To date, little is known about to what extent the current housing models meets the needs of AIP for older people. Guided by the Person-Environment fit perspective, we examined the South Korean case using the first national data on independent living facilities (ILF) for older adults. Employing a convergent mixed-method design, we conducted a quantitative analysis of 277 ILFs and qualitative interviews with executive directors and managers from 10 facilities. We found the majority of the housings serve the low-income, and the residents' health status varies widely (i.e., ranging from fully independent to those homebound). However, the characteristics and nature of services available and staff composition are not adequate to meet the needs of the residents. Notably, privacy issues (i.e., a shared restroom and bedroom) in congregate settings stood out, decreasing the occupancy rate. Our findings suggest that the housing model needs to be diversified corresponding to the resident's needs for health and social care and economic affordability and should respect their privacy needs. We discussed ways to reform the current policy governing the ILFs, including strengthening service coordination programs to alleviate gaps between the residents' needs and the service availability. Our findings provide implications for improving and reforming the existing housing model to age in place in Korea and potentially other aging societies.
LONGITUDINAL ASSOCIATIONS OF SOCIAL CONNECTEDNESS, SOCIAL CONTRIBUTION, SOCIAL ENGAGEMENT, AND LATE-LIFE DRUG USE
Authors: De Main Atami , Powers Daniel , Xie Bo
Published: December 2022

Substance misuse among older adults is a growing and complex problem with implications for society, aging adults, and their families. It is understudied in research and clinical practice. Limited and mixed evidence exists that suggests relationships between changes in older adults’ social environment and their drug use over time. This study addressed this gap by examining potential associations between social environment and drug use among community-dwelling older adults. Data were drawn from 3-waves of the national longitudinal survey of Midlife Development in the United States (MIDUS) (N= 2,020; age range=55-94 years; Mean=63.10, SD=5.66 at Wave 1). We estimated multilevel logistic growth models to assess the relationships between social environment indicators (social connectedness, social contribution, social engagement) and drug use, controlling for age, marital status, race/ethnicity, education level, household income, employment status, and number of chronic conditions. Our findings showed significant odds of drug use over the 20-year period of study, which were increased among older adults with multiple chronic conditions with a 59.5% risk of drug-related problems. Social contribution (feelings of being valued by society) negatively predicted older adults’ drug use whereas social connectedness and social engagement were not significant predictors over time. The models also indicated a moderating effect of social contribution on drug use, showing low changes in drug use over time with low social contribution. Our findings illuminate the differential roles of social environment indicators in drug use. Future research, policy, and practice may particularly focus on the role of social contribution in late-life drug use.
ADDRESSING GAPS IN PRIMARY CARE DIAGNOSIS OF COGNITIVE IMPAIRMENT VIA A NURSE CONSULTATION
Authors: Shin So Young , Bui Nhat Minh , Kiekhofer Rachel , Goode Collette , Dulaney Sarah , Possin Katherine
Published: December 2022

Purpose

This study aimed to identify the concerns and unmet needs of patients and care partners after incident primary care diagnosis of cognitive impairment.

Methods

Primary care providers referred older adults who had newly diagnosed with cognitive impairment for a telephone encounter, the ‘Brain Health Consultation’ (BHC), with a dementia expert nurse. The nurse assessed for questions or concerns regarding immediate needs, cognitive, neuropsychiatric, functional, or other symptoms; cognitive assessment results and the diagnosis; care planning including safety, prognosis, treatments, advance care planning, and community services.

Results

Patients (N=37) and care partners (N=30) completed the BHC. The patients were racially/ethnically diverse; 51% Asian, 18% Non-Hispanic White, 10% Hispanic, 10% Black, 11% other). Most patients (70%) and caregivers (70%) endorsed cognitive concerns, and many patients endorsed mood (65%), sleep or fatigue (49%), and pain (10%) concerns. All patients and care partners had questions about the assessment results and diagnosis, and some patients (11%) and caregivers (13%) expressed concerns about disease progression. Few patients and caregivers expressed care planning needs.

Conclusion

Following incident cognitive impairment diagnosis in primary care, patients and families have unmet needs around understanding their assessment and diagnosis. Care planning may be reserved for a follow-up consultation after the patient and family have had time to understand and accept the diagnosis. While we used a dementia expert nurse to perform the BHC, given the types of concerns identified, a supervised, trained, unlicensed health professional (e.g., a care team navigator) may be appropriate to perform the BHC.
EFFECTS OF SPECIAL NURSING UNITS IN NURSING HOMES: FOCUSING ON HEALTH OUTCOMES AND SATISFACTION
Authors: Cho Eunhee , Yoon YeaSeul , Choi Seonhwa , Kim Eunkyo
Published: December 2022

This quasi-experimental study aimed to evaluate the effectiveness of special nursing units in nursing homes by comparing health outcomes and satisfaction between the general nursing units and special nursing units across nursing homes in South Korea. Surveys—paper, phone, and online—were conducted five times (March, August, and November 2019; June and October 2020) for health outcomes (health pattern changes and the number of residents with new health problems) and four times (March and August–November 2019; June and October 2020) for satisfaction. Descriptive analysis, χ²-test, paired t-test, and McNemar test were performed using the SPSS 25.0 program. The results showed an improvement in the health outcomes of residents in the special nursing units. Regarding health pattern changes, there was a decrease in the number of residents facing problems related to consciousness, cardiovascular function, urination, defecation, and pain and of those with new health problems such as aches, falls, pressure sores, and urinary incontinence. Furthermore, caregivers’ satisfaction in the special nursing units was higher than that of their counterparts in the general nursing units. The results of this study will be used as evidence to expand this special nursing unit’s services in the future.