bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral Health and Dental Care in Older Korean Immigrants: A Qualitative Study
Authors: Jang Yuri , Rhee Min-Kyoung , Hyeon Jeong Chung , Choi Eun Young , Park Juyoung , Park Nan Sook
Published: December 2020

Many segments of the U.S. population continue to experience a disproportionate burden of oral disease and inequities in dental care, and older Asian immigrant populations are among those at high risk. Responding to the needs to attend to ethnic and geographic variations among older Asian Americans and to better understand contextual factors that shape their experiences of oral health and dental care, the present study conducted in-depth interviews with eighteen older Korean immigrants in the Los Angeles Greater area. The qualitative inquiries were theoretically guided by the three core categories of the Andersen’s (1968, 1997) health service model: oral health needs, service barriers, and service outcomes. Using the constant comparison method, themes and sub-themes within each category were derived. The eight themes emerged from the qualitative data were: (1) oral health problems, (2) perceived need, (3) insurance and finance, (4) language barriers, (5) social support, (6) knowledge and belief, (7) satisfaction with service, and (8) areas of improvement. The findings demonstrated varied experiences associated with oral health and dental care of older Korean immigrants and informed the development of services and programs responsive to the identified needs and barriers.
Physical Health Constraints and Psychological Distress in Older Asian Americans: The Role of Perceived Health
Authors: Yoon Hyunwoo , Jang Yuri , Kim Seoyoun
Published: December 2020

Given the importance of understanding the underlying dynamics of physical and mental health in old age, the present study explored the roles of physical health constraints in predicting subjective health perception and psychological distress among older Asian Americans. Guided by the Health Belief Model, we also examined whether subjective health perception would function as a mediator in the link between physical health constraints and psychological distress. Using data from 533 Asian Americans aged 60 and over (mean age=69.4, SD=6.88) in the 2016 Asian American Quality of Life Study, the direct and indirect effect models were tested with multivariate linear regressions and the PROCESS macro. Advanced age, unmarried status, lower levels of acculturation, and more chronic physical conditions were significant predictors of psychological distress. When subjective health perception was added to the model, an additional 5% of the variance was accounted for, resulting in 25% of the total variance explained by the estimated model. Negative health perception was a significant predictor of increased level of psychological distress. Supporting the mediation hypothesis, all direct paths among physical health constraints, subjective health perception, and psychological distress were significant. The indirect effect of physical health constraints on psychological distress through subjective health perception status was significant, as evidenced by the 95% bootstrap confidence interval for the indirect effect not containing zero (.07, .28). The findings not only help better understand the psychological mechanisms that underlie physical health constraints and psychological distress but also suggest avenues for interventions.
Stress, Hope, and Depression Among Older Adults Living in Public Housing
Authors: Montpetit Mignon , James-Smith LaKeesha , Gourley Amy
Published: December 2020

Individuals living in public housing often experience myriad stressors related to poverty and mental illness. The current study explores how hope impacts the relationship between stress and depression in a sample of adults (aged 51-90 years; Mage= 63.3 years; SDage= 8.6 years) living in public housing. Questionnaire data were collected before and after running an intervention geared toward improving residents’ well-being. Results of the initial questionnaire study suggest that hope moderates the stress -> depression relationship (p = .001), with effects in the expected directions: individuals exhibiting higher-than-average levels of stress and below-average hope reported the highest levels of depression. Data further suggest modest increases in hope post-intervention (p = .06). Overall, results suggest that hope may be important in helping mitigate the impact of life stress on vulnerable individuals, and that it can be augmented in the context of a short-term, cost-effective intervention.
Traditional Cultural Practices Provide More Frequent Feelings of Happiness and Calm for Native American Elders
Authors: Adamsen Collette , Danielson Ramona
Published: December 2020

Though American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) elders are an understudied population, available data demonstrates higher rates of depressive symptoms among these elders. In addition, AI/AN/NH elders are a medically underserved population, with geographic isolation a common barrier to accessing emotional/mental health services. However, cultural practices are important sources of resilience for AI/AN/NH elders. Survey data from “Identifying our Needs: A Survey of Elders” Cycle VI (2014-2017), conducted by the National Resource Center on Native American Aging, were analyzed using ordinal logistic regression; N=18,134 adults age 55+ from 164 tribal survey sites. Respondents indicated how often (from none to all of the time) they participate in cultural practices (e.g., traditional food, music, customs). Frequency of participation varied; 27% of elders reported participating in traditional cultural practices a good bit of the time or more, 28% some of the time, 18% a little of the time, and 27% did not ever participate. We explored the relationship between frequency of cultural practices and frequency of feelings of happiness, calm/peacefulness, nervousness, and being downhearted/blue. A significant positive association was found between higher frequency of cultural participation and feelings of happiness and calm/peacefulness; no association was found with nervousness or depressive symptoms. While the frequency of participation by elders in cultural practices is directly related to better self-reported levels of happiness and peacefulness, nearly half (45%) never/almost never participated in these types of practices, which underscores the need to support availability of and elders’ participation in cultural practices.
Wicked Problems: An Exploration of Elder Mistreatment Complexity
Authors: Rowan Julia , Marnfeldt Kelly , Wilber Kathleen , Enguidanos Susan
Published: December 2020

Elder mistreatment (EM) complexity, while described anecdotally, lacks an empirical foundation for measurement. Improved knowledge on the range and nature of concurrent issues that complicate EM intervention would inform the development of more effective solutions and enable greater precision of evaluation research. The purpose of this qualitative study was to explore factors contributing to complexity in a sample of EM cases that was selected based on difficulty reaching resolution. The sample was drawn from those reviewed by an experienced EM Multidisciplinary team (MDT) and determined to require long-term case management (n=39) beyond the capacity of the MDT’s usual response. Case manager narrative documentation of ongoing assessment and social service records were qualitatively coded by two researchers. Inductive content analysis, with iterative code reconciliation, was used to identify issues and problems both related and concurrent to EM. Eighteen themes and 74 sub-themes emerged, with 93% initial coding agreement between researchers. The most frequent themes were problems with Caregiving (80%), Cognition (80%), Physical Health (80%), Behavioral Health (69%), Socialization (64%), and Finances (62%). Refusal of formal services was common (90%), yet all accepted visitation by the case manager, suggesting informal support may be effective. Diversity, interconnectedness, and emergence of issues along the duration of case management indicates a system approach to intervention design and evaluation is warranted. This research underscores the need for holistic intervention for highly complex EM, and lays the foundation for objective measure of complexity to standardize selection for specialized intervention.
Adult Children’s Education Attainment and Parents’ Subjective Well-Being in China
Authors: Chen Dan , Tong Yuying
Published: December 2020

Parent-child tie is important for parental later life due to insufficient old-age support in developing contexts. Parents often anticipate they would share the returns of children’s education for their early period investment. Previous studies show that adult children’s education is positively associated with parents’ survival and physical health in both low- and middle-income countries. What’s less discussed in literatures is the effect of adult children’s education on parental subjective wellbeing. Drawing the China Health and Retirement Longitudinal Study (CHARLS), this study intends to explore the effect of adult children’s education attainment on parents’ life satisfaction. This study uses information from baseline wave in 2011 and latest wave in 2015 of CHARLS. The analytic sample restricts to adult children aged between 25 and 49 with the highest education among all children of a parent who are aged between 50 and 84. To handle the reversed causality, this study adopts lagged effect model and controls for baseline subjective wellbeing. Instrumental variables (IV) are also used to handle the endogeneity issue existing between children’s education and parental wellbeing to conclude a causal effect. The preliminary results without IV reveal that association between children’s schooling years and parents’ life satisfaction is non-linear. However, results with IV show that adult children’s schooling years are negative associated with parents’ life satisfaction. This study firstly draws attention on negative sides of children’s education attainment on parental subjective wellbeing which implies more studies to unfold the mechanisms underlying the association.
Dyadic Patterns of Marital Quality During Later Life
Authors: Bulanda Jennifer , Yamashita Taka , Brown J Scott
Published: December 2020

Although earlier cross-sectional studies suggested a U-shaped curve in marital quality over the life course, recent longitudinal studies find stability or continual decline (Proulx, Ermer, & Kanter, 2017). It is important to better understand patterns of marital quality during later life, as marital quality is associated with older adults’ marital stability, health, and longevity. However, few studies have utilized couple-level data to examine marital quality trajectories, and only one has examined dyadic patterns during later life (Wickrama et al., 2020). We use nationally-representative data from the 2006-2016 waves of the Health and Retirement Study (HRS) to examine positive and negative dimensions of marital quality among a sample of continuously-married couples over age 50 in which both partners provided data on marital quality at three time points (n = 1,389 couples). A survey-weighted latent growth curve model simultaneously examines two marital quality trajectories: own and spouse’s. Preliminary results show that mean baseline positive and negative marital quality are similar for own and spouse’s trajectories. Although growth rates are statistically non-significant for positive marital quality, the variance of growth rate is statistically significant for spouse’s trajectory (0.001, p < 0.05), and greater baseline own positive marital quality is associated with negative growth of spouse’s positive marital quality. Growth rates are similar for own and spouse’s trajectories of negative marital quality, and variance of growth rate is statistically significant for spouse’s negative marital quality trajectory. Results point to stability in marital quality over time, and suggest the importance of using couple-level data.
Hearing the Unheard: Promoting Active and Healthy Aging With Family Leisure
Authors: Rogers-Jarrell Tia , Meisner Brad
Published: December 2020

Grandparents are playing an increasing role in the lives of their grandchildren. Participating in this role enriches grandparent’s well-being through feelings of enjoyment and satisfaction. Research also indicates participating in family leisure positively improves family communication, creates higher quality relationships, and enhances family cohesiveness and connectedness. However, the grandparent perspective, and their inclusion in family leisure, is often overlooked, rendering their voices invisible. Given the growing aging population, and the role grandparents play, their involvement in, and experience with, family leisure is becoming increasingly relevant. Therefore, the purpose of this paper was to critically review and explore the available literature on grandparents (ages 65+) experiences with family leisure. This paper critically reflected on benefits of family leisure participation according to the World Health Organizations active aging and healthy aging ideologies. Participation in family leisure provides grandparents with opportunities for social participation, remaining active and engaged through generativity and contribution to family, as well as building, maintaining and enhancing relationships. More research that is inclusive of grandparent’s perspective of, and experience with, family leisure is needed. By taking a socioecological approach to understanding the experiences of grandparents’ participation in family leisure, clear suggestions can be made on how to support grandparent’s involvement in family leisure at the interpersonal, organizational, institutional, community, and policy levels. In particular, future actions and initiatives should simultaneously support family leisure across and within these domains. Promoting family leisure is one way to support active and healthy aging not only among older adults, but among all individuals.
Key Components of Interventions for Grandparents Raising Grandchildren: A Systematic Review
Authors: Chan Athena Chung Yin , Piehler Timothy
Published: December 2020

Increasingly grandparents provide primary or supplementary care for their grandchildren globally. In view of the challenges faced by grandparent caregivers, a number of intervention programs were designed to act as a buffer to the potential negative impacts on their well-beings. A recent meta-analysis (Chan et al., 2019) shows that interventions for grandparent caregivers have small to moderate effect sizes for increases in social support and parenting skills. However, little is known how the multi-component interventions work. The aim of this review is to categorize the key components of intervention programs and determine the direct effect of components on grandparent caregivers’ outcomes (i.e., physical, mental health and well-being). A component-level approach is adopted to disentangle the ‘active ingredients’ of the interventions. Peer-reviewed articles were searched via five electronic database (published before January 2020). A keyword search was performed based on combinations of two groups of terms: (1) grandparent caregivers and (2) intervention, training, and support group. Studies adopting an experimental or pre/post design and reporting quantitative changes in grandparents’ outcomes were included. Studies focusing on the special needs of grandchildren were excluded. Fourteen interventions were identified from over 20 included studies. Preliminary analyses show that different physical and mental outcomes of grandparent caregivers were predicted from key components of education, skills training, relaxation and psychosocial support. With the goal of developing evidence-based interventions for grandparents raising grandchildren, this synthesis offers insight into the mechanisms of an intervention, which informs its generalizability or applicability to a new context.
Cycle of Disadvantages: An Exploration of Young and Older Female Dementia Caregivers’ Experiences
Authors: Mahmoud Kafayat , Nwakasi Candidus
Published: December 2020

Families play an essential role in providing care for older persons in Nigeria, a responsibility that is culturally assigned to women. Caregiving is made even more difficult given the increasing rates of older persons with dementia and the limited capacity of caregivers to provide adequate care. We explored the experiences of two female dementia caregivers and how they cope with other competing responsibilities. The research method employed a case study approach, which followed the lived experiences of two Nigerian women – a 75-year-old woman (Ada) who cares for her husband, and a 35-year old woman (Chika) who cared for her father. The research adopted the life course concept of ‘linked lives’ and the Family Stress Process model to explore and identify the continued embeddedness of persons within their family networks and relationships, which may have deleterious effects on the wellbeing of caregivers. This study revealed that married women providing care to older parents are exposed to domestic violence from their spouses who deem them uncommitted to their (husbands’) families. These women continue to remain in such abusive relationships due to financial dependence and unwillingness to leave their children. Older women caregivers, on the other hand, over time, begin to develop physical limitations, which limit their ability to provide care for their spouses and subsequently must depend on unemployed children who live close by. This study highlights the complicated cycle of exposure to socio-economic and health disadvantages which women experience as caregivers across two generations.
Millennials as Caregivers: Results From the BRFSS, 44 States, DC, and Puerto Rico, 2015-2018
Authors: Reed Nia , Bouldin Erin , Taylor Christopher , McGuire Lisa
Published: December 2020

Millennials (born 1981-1996), now outnumber Baby Boomers. Millennials have the unique task of potentially providing care for their own children, their aging parents, and grandparents, making them the first “club sandwich” generation. We utilized data from 44 states, the District of Columbia, and Puerto Rico from the 2015-2018 Behavioral Risk Factor Surveillance System to estimate the prevalence of informal caregiving among Millennials (based on age at the time of survey completion: 18-34 in 2015, 19-35 in 2016, 20-36 in 2017, and 21-37 in 2018). We conducted log-binomial regression analyses to compare mental and physical health among Millennials, adjusting for age, sex, education, and race/ethnicity. Among 37,780 Millennials included, 18.7% provided regular care/assistance to a friend/family member with a health problem, long-term illness, or disability in the past month. Of these caregivers, 36.3% provided the most care to a parent/parent-in-law and 21.8% to a grandparent. Half of Millennials had ≥1 children under age 18 in their home, regardless of caregiving status. In adjusted models, Millennial caregivers had higher prevalence of frequent mental distress [≥14 days in the past 30 days when mental health was not good] (prevalence ratio [PR]=1.72, 95% confidence interval [CI]: 1.50-2.00, p<0.001), higher prevalence of fair/poor health (PR=1.42, 95%CI: 1.20-1.68, p<0.001), and higher prevalence of ≥1 chronic health conditions [current asthma, arthritis, cancer, cardiovascular disease, diabetes, or COPD] (PR=1.69, 95%CI: 1.51-1.90, p<0.001) than non-caregivers. Nearly one in five Millennials was providing informal care, and Millennial caregivers reported significantly worse mental and physical health than their non-caregiving peers.
Psychological Well-Being and Positive Aspects of Caregiving: What’s the Relationship?
Authors: Malley Kelly O , Qualls Sara
Published: December 2020

Many family caregivers derive meaning and purpose from caring for a loved one. Research on the mechanisms underlying positive aspects of caregiving have explored appraisal, reciprocity, resilience, gratitude, mastery, and appreciation. This study aimed to explore how individual personality factors, using the framework of psychological well-being (i.e., autonomy, positive relationships, purpose, personal growth, self-acceptance, and environmental mastery) proposed by Ryff (1989), may influence positive aspects of caregiving. N = 452 family caregivers completed informed consent, provided demographic information, and completed study measures using an online research platform. Multiple regression equations were calculated to assess which aspects of psychological well-being predicted two positive aspects of caregiving: competence and personal gain. The model explained 22% of the variance in caregiving competence, F(6, 445) = 21.01, p < .001. Autonomy (β = .26, p < .001) and self-acceptance (β = .18, p = .02) contributed most significantly to feelings of competence. The model explained 14% of the variance in personal gain, F(6, 445) = 12.11, p < .001. Self-acceptance (β = .19, p = .02), personal growth (β = .18, p = .01) and autonomy (β = .13; p = .03) contributed most significantly feelings of personal gain. Psychological well-being, specifically feelings of autonomy and self-acceptance, are modest predictors of feelings of competence and gain, and psychological well-being appears to have an effect on positive aspects of caregiving. Interventions for family caregivers should consider ways of building autonomy, self-acceptance, and growth to increase feelings of competence and gain.
Unraveling the Health-Protective Effects of Sense of Coherence in Dementia Caregiving
Authors: Yu Doris
Published: December 2020

The health protective effects of sense of coherence in a stressful encounter is well recognized. Representing the extent an individual can comprehend, manage and make meaning out of a caregiving situation, little is known about how SOC shapes the dementia caregiving process in a way to benefit the carers’ health outcomes. This exploratory study recruited 401 family cares of dementia in Hong Kong. Over 30% of them reported moderate to severe depression, and those with low sense of coherence were most affected. Further analysis indicated that the health protective effects of SOC was mainly mediated through a higher level of perceived gain and more effective coping. In particular, those who can make meaning out of the caregiving situation were most benefited by such a mechanism. The study provides direction on ways to strengthen the health risk identification for family carers and enhance their role adaptation. After this presentation, the participants are able to: 1) Understand the role of sense of coherence in shaping the health of dementia family caregivers. 2) Understand the mediating pathways which explain the health benefit of sense of coherence for dementia family caregivers. □ Gain critical insights for developing health risk identification strategies and tailored interventions to protect the dementia family caregivers from depression.
The Influence of Dementia Caregiving Styles on Caregiver Distress and the Person With Dementia’s Quality of Life
Authors: Leggett Amanda , Connell Cathleen , Gitlin Laura , Kales Helen
Published: December 2020

Building vertically upon the Stress Process Model, dementia caregivers’ cognitive-behavioral management styles are an understudied area with implications for dyadic care outcomes and tailoring of care interventions. We consider whether membership in five previously classified caregiving styles (Externalizers, Individualists, Learners, Adapters, Nurturers- which vary in their adaptability, dementia understanding, and behavioral management practices) impacts caregivers’ experiences of care-related stress and the quality of life of the person with dementia (PWD). Participants included 100 primary family caregivers for PWDs who were 74% female, 18% non-White, and on average 64 years old. Utilizing linear regressions, each caregiving style was considered as a key predictor (reference: Externalizers- poor understanding, non-adaptable approach, and punitive behavioral strategies) of the Caregiver Assessment of Function and Upset (CAFU) upset score, Neuropsychiatric Inventory (NPI-C) distress scale, Zarit Burden Interview (ZBI), and PWD quality of life (QOL-AD) scale controlling for demographics, care duration, co-residency, and dementia severity. Relative to Externalizers, Nurturers (understanding, adaptability, positive engagements) had less CAFU upset (β=-0.4, p<.01), less NPI-C distress (β=-0.3, p<.05), and greater QOL-AD for the PWD (β=0.4, p<.01). Learners (recognize need to change care approach, attempting adaptability, trial-and-error behavioral care) also showed significantly lower NPI-C distress than Externalizers (β=-0.5, p<.01). Thus caregiving styles with more dementia understanding, adaptability and positive behavioral strategies showed less distress and better PWD QOL. Corresponding with recent dementia care summits calling for identification of caregivers at greatest risk for poor outcomes, targeting and tailoring interventions based on caregiving styles may lead to great public health impact.
5-Cog Study: Cross-Cultural Comparison of Subjective Cognitive Complaints in a Diverse Primary Care Population
Authors: Ayers Emmeline , Weiss Erica F , Verghese Joe
Published: December 2020

Subjective cognitive complaints (SCC) are risk factors for cognitive decline in older adults. A link between SCC and depressive symptoms has also been reported. These associations have not been much studied in non-White populations. We examined the relationship of SCC with cognitive function and depressive symptoms in adults aged 65 and older attending a primary care clinic in the Bronx. Five common SCC questions (four memory-related and one non-memory-related) were identified by literature review. Linear regressions, adjusted for age, sex and education years, were used to examine associations between individual SCC and cognitive function (Montreal Cognitive Assessment (MoCA) score and Hopkins Verbal Learning Test (HVLT) recall score) and depressive symptoms (Geriatric Depression Scale (GDS) score) for Hispanic (n=53) and non-Hispanic Black (n=47) adults. Mean number of SCC was similar for Blacks and Hispanics (2.3 vs. 2.4, p=0.752). Hispanics performed worse on the MoCA than Blacks (16.4 vs. 18.5, p=0.012), but education explained this difference. GDS and HVLT were similar across groups. For Hispanics only, a response of fair or poor to the question “how is your memory for a person your age?” was associated with worse MoCA scores (β -2.6; p=0.008). SCC were not associated with HVLT scores for either group. Four SCC for Blacks and two for Hispanics were associated with worse GDS scores. In an urban clinic population, SCC for Blacks and Hispanics were associated more with depressive symptoms than cognition. Further research is needed to identify SCC that better correlate with cognitive function in diverse populations.
Clinical Depression, Depressive Symptoms, and Depressed Cognition in Caregiving Grandmothers
Authors: Burant Christopher , Jeanblanc Alexandra , Musil Carol , Wallace McKenzie , Jaclene Zauszniewski
Published: December 2020

Grandmothers living with or raising grandchildren have elevated levels of depressive symptoms compared to grandmothers who do not provide care. While the CES-D measures the somatic, positive and negative affect, and interpersonal strain symptoms experienced with depression, the Depressive Cognitions Scale captures the change in cognitive thinking that often precedes clinical depression. Our aim was to compare depressive symptoms and depressed cognitions between grandmother caregivers with a diagnosis of depression and those without in a nationwide sample of 342 grandmother caregivers. In the questionnaire, participants were asked whether they had a diagnosis of depression amongst other health conditions and also completed the CES-D and the Depressed Cognitions Scale. A score of 16 or greater on the CESD or a score above 7 on the Depressed Cognitions Scale can be used to identify individuals who may be at risk for depression. Grandmothers who had a diagnosis of depression were more likely to have CES-D scores 16 and above (79.7 %) as compared to those who were not (39.2%) (Chi Square=54.55, p<.001); and more likely to have higher depressed cognition scores 7 and above (71.3 %) as compared to those who did not (42.9%) (Chi Square=26.68, p<.001). Additionally, grandmothers who had depressed cognitions were more likely to have CES-D scores 16 and above (74.1 %) as compared to those who were not (33.1%) (Chi Square=57.56, p<.001). The elevated scores in participants who already have a diagnosis of depression indicates the need for potential interventions to further address depressive symptoms in grandmother caregivers.
Innovative Strategies to Reach Diverse Elders: Using Age-Tastic to Improve Health and Well-Being
Authors: Berman Jacquelin , Pardasani Manoj , Gates Madison , Powell Mebane
Published: December 2020

This session will present the findings of a randomized control trial evaluating the impact Age-Tastic has on behavioral change. Age-Tastic is an eight-week intervention that uses game play, group facilitated discussion, and at home activities to promote positive behavioral change. There are five behavioral change domains: emotional well-being, nutrition, financial exploitation, falls prevention, and health literacy. A randomized control trial was conducted in New York City senior centers and include a diverse group of older adults. There were 98 older adults assigned to an experimental or control group. Participants in both groups completed a baseline survey, which was repeated at the end of the intervention and at week sixteen. The experimental (n = 64) and control (n = 34) groups did not significantly differ at baseline in regard to behaviors; however, upon completion of the intervention, the experimental group had significantly changed health behaviors (p < .05) compared to the control group. The behavior change reported by the experimental group was maintained at week sixteen (p < .001) with a medium effect size (ε2 = .17). In addition the experimental group also reported significant improvements at weeks eight (p < .001) and sixteen (p < .001) with large effect sizes (r2 = .62 and .52, respectively). This study found that Age-Tastic is an effective intervention for engaging older adults holistically about their health and wellness and for promoting positive behavioral change among diverse racial and ethnic populations.
Older Adult Refugees’ Roles in Creating Partnerships for Culturally Responsive Healthcare
Authors: Lewis Denise , Seponski Desiree , Kelley Amber
Published: December 2020

The aim of this presentation is to reveal the importance of engaging older refugee community members in creating partnerships with local healthcare providers to implement culturally responsive interventions. Such engagement invites older refugees’ participation and encourages continued connection to country of origin beliefs and culture, particularly within the sphere of healthcare and medical family therapy. Cambodian and Laotian refugee families in coastal Alabama were interviewed via qualitative community-based participatory research and ethnographic, in-depth interviews focused on familial and communal processes. Local healthcare providers engaged in focus group discussions regarding cultural processes associated with health beliefs and behaviors and in periodic outreach through culturally responsive health fairs. We found that older adults play important roles in refugee populations as community leaders, problem-solvers, and legacy-carriers upholding traditional values and cultural continuity. They also maintain and promote continuity by employing traditional, complementary, or alternative medicine (TCAM). Recursive processes also emerged as older individuals sought care from younger community members in times of sickness, including having younger generations provide language translation and transportation to local healthcare centers and hospitals and in navigating the United States healthcare system. In addition, community members joined with local healthcare providers to aide in health and healthcare literacy among refugees and to educate local physicians on culturally responsive interventions. Implications include the inclusion of older adults in health decisions and the promotion and maintenance of community partnerships with health agencies that both encourage TCAM utilization and also allow for access to ongoing, appropriate treatment within the US healthcare system.
Hum Along With the Silent Disco Headphones: Lessons Learned in Implementing the Headphone Program in a Hospital Unit
Authors: Hung Lillian
Published: December 2020

Silent disco headphones have been used among young people in concerts and parties; such headphones have extended distance coverage for broadcasting from a transmitter, features of noise cancelation, and three channels of music. Rather than using a speaker system, music is delivered by wireless headphones and facilitated by a DJ via a built-in microphone. No study has yet tested whether it is feasible to use such headphones to support well-being among older people in hospital settings. This study examined the feasibility of using silent disco headphones with older adults with dementia staying in a geriatric hospital unit. We employed a video-ethnographic design, including conversational interviews and observations, with video recording among ten patient participants in a hospital unit. Two focus groups were conducted with ten hospital staff across disciplines. Thematic analysis yielded three themes: (a) “it just made me feel happy, “(b) “it brings him back alive,” (c) “it unlocks dementia”. Delivering music and meditation programs via the silent disco headphones in the hospital unit has the potential to be a beneficial intervention that can enhance mood and energy, support self-expression, and promote wellness. Our findings suggested that witnessing the positive effects of headphones on patients changed the staff’s view of how music could be used in the clinical setting to support patients’ well-being. We identified enablers and barriers to implementing the headphone program in the hospital setting. Future research should further investigate how headphones may help to reduce stress and promote wellness for patients in the clinical environment.
How to Achieve the Desired Outcomes of a Complex Intervention in Nursing Homes: A Theory of Change
Authors: Dichter Martin , Hylla Jonas , Berg Almuth , Eggers Daniela , Möhler Ralph , Meyer Gabriele , Köpke Sascha , Halek Margareta
Published: December 2020

Background Recent systematic reviews suggest the effectiveness of complex psychosocial interventions to reduce sleep disturbances in people with dementia (PwD) living in nursing homes. However, it is unclear how and under which circumstances these interventions work and which components and processes are crucial determinants for effectiveness. Objectives To develop a Theory of Change (ToC) that describes a causal chain for the reduction of sleep disturbances. Design and Methods The ToC approach is a participatory method in intervention development to generate knowledge about how, why, and under which circumstances interventions are effective. We conducted two expert workshops, a subsequent expert survey (n=12), a systematic literature review, and expert interviews (day and night nurses). Results Necessary preconditions for the reduction of sleep disturbances were identified on staff, management and cultural levels of nursing homes. Intermediate goals like “individual knowledge on PwD is available”, “a specific institutional concept to promote sleep is implemented”, “person-centred care is implemented” and “sleep preferences of PwD are fulfilled” were defined. The intermediate goals, interventions, promoting and inhibiting factors as well as rationales were sorted into a causal chain. All intermediate goals were rated as relevant or highly relevant based on the expert survey. Conclusions The ToC model displays how a complex psychosocial intervention is likely to be effective in reducing sleep disturbances and meeting sleep preferences of PwD in nursing homes. The model is the basis for the development and evaluation of a planned complex psychosocial intervention to prevent and reduce sleep disturbances in PwD.
Social Relationships and Alcohol Abuse in Older Ages
Authors: Vogelsang Eric
Published: December 2020

In an aging world, researchers and practitioners often extol the health benefits of social relationships (e.g., family ties, social participation) for older adults. Yet, they generally ignore how these same bonds and activities may contribute to negative health behaviors, such as alcohol use and abuse. Using data from the Wisconsin Longitudinal Study (16,065 observations from a cohort of 7,007 respondents), I examine how family structure, family history, and participating in certain social activities predict alcohol consumption and symptoms of alcoholism between ages 53 and 71. I find that having children and taking part in two particular social activities (meeting friends and group exercise) are associated with problematic drinking behavior. Moreover, religious participation and ever living with alcoholics were associated with reporting negative alcohol consequences, but not with alcohol consumption itself. These findings contextualize the increasing rates of alcohol abuse among older adults.
What’s Driving SNF Readmission Rates? Exploring Differences in Processes Between High and Low Performing Hospitals
Authors: Manges Kirstin , Ayele Roman , Lee Marcie , Leonard Chelsea , Galenbeck Emily , Burke Robert
Published: December 2020

Despite the increasing national focus on improving post-acute care outcomes, best practices for reducing readmissions from skilled nursing facilities (SNFs) are unclear. The objective of this rapid ethnographic study was to observe processes used to prepare older patients for post-acute care in SNFs, and to explore differences between hospital-SNF pairs with high or low thirty-day readmission rates. We stratified hospitals according to readmission rates from SNF and used convenience sampling to identify two high and two low performing sites and associated SNFs (n=5). We conducted intensive multi-day observations (n=148 hours) and key informant interviews (n=30 clinicians) to describe hospital processes for discharging patients to SNF. We used thematic analysis of interviews and fieldnotes to identify differences in transitional care processes of hospitals discharging patients to SNFs. Hospitals used five major processes prior to SNF discharge that could affect care transitions for older adults: recognizing the need for post-acute care, deciding level of care, selecting SNF facility, negotiating patient fit, and coordinating care with SNF. During each stage, high-performing sites differed from low-performing sites by focusing on: 1) earlier, ongoing, systematic identification of high-risk patients; 2) discussing the decision to go to a SNF as an iterative team-based process; and 3) anticipating barriers with knowledge of transitional and SNF care processes. Identifying variations in processes used to prepare patients for SNF provides critical insight into the best-practices for transitioning patients to SNFs and areas to target for improving care of older adults.
Lessons From Whakapapa and Filial Piety: Can Social Work Capitalize on the Connection That Survives Death?
Authors: Park Hong-Jae
Published: December 2020

Ageing is part of life, and so is death. Although death will involve all of us over time, it is often regarded as a taboo topic, and bonds with the dead are seldom acknowledged in contemporary times. The paper presents selected insights on the connection that survives death, learned from a qualitative study on two indigenous knowledges—whakapapa (genealogical connections in Maori) and filial piety (respect/care for ancestors). Data were collected from interviews with 49 key informants (Maori=25; Korean=24) in 2018/19 in New Zealand and South Korea. The research findings indicate that the connectedness with ancestors or deceased loved ones is a significant part of the participants’ mental and social lives. Māori (the first nation people of New Zealand) have established the unwritten convention of whakapapa as the core value that places whānau (family) at the centre of social relationships. In Korean culture, its filial piety/ancestor veneration tradition has emphasised the connection between deceased and living family members. Criticism about the traditions of whakapapa and filial piety was also raised by a few participants. The significance of this study is situated in the innovative perspective that the post-mortem relationship can be embodied, not only by the living who practise memorial respect for the dead, but also by those older people who establish after-life legacy before death. To help capitalise on this whakapapa connection, the so-called concept of “memorial social work” is presented as a potential area of social work practice, which has critical implications in the ageing/end-of-life related fields.
Qualitative Interview Analysis: Unpacking Packed Interviews
Authors: Silver Michelle
Published: December 2020

Retirement is an ever-evolving, dynamic, and complex social construct we associate with the end of one’s career. Exploring what retirement means to different people can contribute to a better understanding of the implications of this important transition at the individual and societal level. However, sifting through participants stories is not always a straightforward endeavor, particularly in the case when participants have something to hide. This paper examines the value of qualitative research methods in unpacking complex personal narratives. As the landscape surrounding mature workers’ experiences continues to change, this paper extends policy debates about retirement, as well as scholarly conversations about the richness and complexity of qualitative research.
Association Between Medication-Related Problems and Emergency Room Visits Among Community-Dwelling Older Adults
Authors: Zhu YuJun , Meyer Marsha , Likar Denise , Enguidanos Susan
Published: December 2020

Medication-related problems (MRPs) remain one of the largest health risks for older adults, yet there are few studies that identify the complete myriad of problems associated with medication use among community-dwelling older adults with chronic diseases. The aim of this study is to identify the range and quantity of MRPs among community-dwelling older adults and determine the relationship between number of MRPs and emergency room (ER) visits. Primary data were collected from a community medication program for diverse older adults (N=206). A comprehensive medication review was conducted to identify MRPs including adverse drug reaction, inappropriate storage, and non-adherence. We conducted multivariate logistic regression to examine the relationship between the number of MRPs and ER visits controlling for health conditions and demographic information including age, gender and race. The mean age of participants was 74.2 (SD=8.8) and 65% were female. Racial groups include Whites (39%), Blacks (21%), Hispanics (29%) and Asian/Pacific Islanders (11%). On average, participants had 5.3 (SD=2.3) health conditions and 18.8 (SD=5.9) MRPs, among which adherence (36%) and coordination of care (28%) were most commonly identified. About 30% had at least 1 ER visit in the previous 6 months. The number of MRPs was significantly associated with ER visits (OR=1.08, p=.03). Older adults experienced a variety of MRPs and for each problem experienced, the odds of having an ER visit increased by 8%. Interventions are needed to assess the myriad of MRPs among community-dwelling older adults and address those potential risks.
Elder Abuse and Neglect: Training First Responders in Rural Arkansas to Recognize, Respond, and Report
Authors: McAtee Robin , Claar Valerie , Spradley Laura , Thomasson Whitney
Published: December 2020

As the incidence of elder abuse and neglect continue to rise and plague our country’s older adults, it is imperative that their plight is recognized, reported and elicits an appropriate response. At least 1 out of 10 older adults suffer from at least one type of abuse each year (DOJ, 2020) and only 1 in 24 cases of elder abuse is ever reported to authorities (National Center on Elder Abuse, 2019). Since 41% of Arkansas’ population live in rural areas, reaching and educating first responders who work in these areas is a priority, yet has been a challenge. It has been ascertained that virtually no elder abuse or neglect related training for first responders occurs in Arkansas. In 2015, the Arkansas Geriatric Education Collaborative (a HRSA Geriatric Workforce Enhancement Program) developed an education program and mobilized it to multiple first responder groups including the AR State Police, multiple city and county paramedics’ organizations, EMTs, local police officers and fire fighters. The program was further enhance late in 2019 when the training was made available on-line in conjunction with dementia training. The content and methods of training and test results revealing knowledge gained will be reviewed. Follow-up stories from first responders who have put their training into action in the field will be told as they reveal how they have used their training to identify potential abuse, neglect and self-neglect cases and how they have recognized, reported and addressed specific cases.
Piloting the Adult Protective Services’ Identification, Services, and Outcomes Matrix: Focus Group Findings
Authors: Yeh Jarmin , Liu Pi-Ju , Perkins Jacques , Butler Andrew , Stratton Sara , Conrad Kendon , Conrad Karen , Iris Madelyn
Published: December 2020

The historical lack of outcomes-related data in Adult Protective Services (APS) has affected funding coming to the program. Without data quantifying the effectiveness of APS services, policymakers have been unable to justify budget increases to improve wages for workers or professionalize the field. For the first time in APS history, the U.S. Administration for Community Living sponsored a pilot project to implement a novel evidence-based assessment tool into APS electronic systems, called the Identification, Services, and Outcomes (ISO) Matrix. The goal was to improve APS’ ability to reduce harm of abuse and neglect and maintain client’s independence to live in the community. APS workers in San Francisco and Napa Counties were trained and phased into using the ISO Matrix over a six-month implementation period. This poster presents findings from six focus groups conducted between February 13 and March 28, 2019, with 34 San Francisco and Napa County APS workers and supervisors. Utilizing semi-structured, in-depth interviewing techniques, APS workers and supervisors expressed their views and experiences. Facilitators and barriers of implementing the ISO Matrix were assessed and opportunities for improvements were identified. Findings revealed a tension between their hopefulness that the ISO Matrix could modernize APS data-tracking and yield evidence of improved client outcome to bolster the field, and their frustrations about new burdens the ISO Matrix placed on their labor and workflow. Understanding frontline perspectives of APS workers and supervisors has practical and policy implications for adopting the ISO Matrix in other counties and states across the U.S.