bluuebunny/crossref_metadata_2025 huggingface dataset:
THE MEDIATING ROLE OF ADVANCE CARE PLANNING IN ACCULTURATION AND USE OF NURSING HOME AMONG KOREAN AMERICANS
Authors: Cho Soyeon
Published: November 2019

The study examined attitudes towards Advance Care Planning (ACP) as a potential mediator in the association between acculturation and willingness to use nursing home in Korean American older adults (aged 60 and older). Data were driven from a cross-sectional study of 235 community-dwelling Korean American older adults (aged 60 and older) in 2013. Multivariate regression models of willingness to use nursing home were entered in the following order: (1) demographics, (2) health, (3) acculturation, and (4) attitudes towards advance care planning. The mediation effect of attitudes towards ACP in the relationship between acculturation and willingness to use nursing home was separately examined using the bootstrapping method. Higher acculturation was associated with positive attitudes towards ACP and more likelihood of using nursing home. The proposed mediation model was fully supported: positive attitudes towards ACP served as an intervening step between acculturation and willingness to use nursing home. The mediating role of attitudes towards ACP yields implications for developing culturally sensitive advance care planning education program targeting older individuals.
FEELING AUTHENTIC DURING PLAYING PICKLEBALL IN LATER LIFE: PREDICTING POSITIVE PSYCHOLOGICAL FUNCTIONING
Authors: Ryu Jungsu , Heo Jinmoo , Lee Chungsup , Kim Amy Chan Hyung , Kim Kyung Min , Yang Hyunmin
Published: November 2019

Authenticity, being trustful with oneself, is regarded as a principle predictor of healthy functioning. However, the association between authenticity and psychological functioning has not been examined, even though leisure is an ideal context within which to experience authenticity. Therefore, this study examined the association between authenticity and psychological functioning in older adults playing pickleball. A convenience sample of 112 males and 96 females (64.11±6.56, 50 to 82yrs) was recruited from the 2017 U.S. Open Pickleball Championship which is an annual international pickleball tournament. The participants were asked to fill out a questionnaire primarily asking about their levels of authenticity (4-items) and psychological functioning measured by both perceived stress (4-items) and happiness (single item). The pearson correlation tests found higher levels of authenticity were significantly correlated with being less stressed (r = -.373, p < .01) and happier (r = .203, p < .01). A two-step hierarchical regression was used to determine the unique contribution of authenticity to either perceived stress or happiness, and found that authenticity uniquely contributed to 10% of the variance in perceived stress (F= 4.678, p <.001) and 2.3% of the variance in happiness (F= 3.046, p <.01). These results suggest that feeling authentic in older adults playing pickleball may play an important role in positive psychological functioning.
PREDICTING FUNCTIONAL DECLINE IN OLDER ADULTS: MORE ACTIVITY NOW EQUALS LESS DECLINE LATER
Authors: Whitehead Brenda
Published: November 2019

According to the Function Spiral Model (Whitehead, 2017), aging attitudes influence activity engagement, which impacts functional ability via physical conditioning (or deconditioning). This study tests the activity ♢ conditioning ♢ function segment of the model using 59 older adults aged 61-92 (Mage = 76 at Time 1) who participated in 2 in-person assessments of physical health, gait, and function, spaced 3 years apart. Participants also completed mail-in questionnaires, reporting engagement in activities (walking, gardening, household chores, social clubs, etc.) at each time point. Hypotheses were 1) a lower activity level at Time 1 would predict greater decline in physical function across the 3-year span, and 2) that this effect would be mediated by changes in physical conditioning. Dependent t-tests revealed that both physical function—as indicated by the timed Get Up and Go test—and physical conditioning—as indicated by peak respiratory flow—declined during the period. The regression model testing the effect of activity engagement at Time 1 on decline in physical function (controlling for age, baseline function, and activity change) supported hypothesis 1 (-0.43, p = .003): more activity at Time 1 predicted less decline in physical function over time. Instead of supporting the mediation hypothesis, the model including both activity and conditioning demonstrated the strength of the activity at Time 1 effect, which actually increased in magnitude (-0.48, p = .001). Although the hypothesized mediation was not supported, the findings highlight current activity engagement as an important mechanism for slowing the progression of future age-related functional decline.
FACTORS ASSOCIATED WITH LIFE-SPACE CONSTRICTION IN LATER LIFE: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY
Authors: Choi Moon , Mezuk Briana
Published: November 2019

This study aimed to examine factors associated with life-space constriction, using the data from the Health and Retirement Study, a nationally representative sample. We limited our analysis to those who were 65 years and older and answered to the 2012 experimental module on life-space (N=895; mean age=75.3; 59.4% women). Life-space was assessed with the modified version of the UAB Study of Aging Life-Space Assessment, ranging nine zones: room, home, own property, immediate neighborhood, town, community, county, state, and region. A series of logistic regression models were used to estimate odds ratios for life-space constriction by sociodemographic and health characteristics. The results showed that 3.0% and 6.7% of older adults reported that they had never been to places beyond their home and own property/apartment building for the past four weeks, i.e. the critical boundaries in terms of social isolation. The significant factor associated with the life-space constriction within home, immediate neighborhood, and town was physical mobility limitation (OR: 1.18, 1.09, 1.11, respectively), while the constriction within county was associated with education level (OR: 0.91). Driving a car was negatively associated with the life-space constriction within own property/apartment building and home (OR: 0.48 and 0.22, respectively). Policy makers need to pay more attention to social and environmental factors influencing social isolation among older adults such as transportation options and social class disparity.
ACTIGRAPH’S LOW-FREQUENCY EXTENSION FILTER FOR ESTIMATING WRIST-WORN PHYSICAL ACTIVITY IN OLDER ADULTS
Authors: Hicks Hilary J , Laffer Alex , Losinski Genna , Watts Amber
Published: November 2019

Advancements in body-worn activity devices make them valuable for objective physical activity measurement. Research-grade monitors utilize software algorithms developed with younger populations using waist-worn devices. ActiGraph offers the low frequency extension (LFE) filter which reduces the movement threshold to capture low acceleration activity that is more common in older adults. It is unclear how this filter changes activity variable calculations in older adults. We investigated the effects of the LFE filter on wrist-worn activity estimates in this population. Participants were 21 older adults who wore the GT9X on their non-dominant wrist for 7 days in a free-living environment. Activity counts were estimated both with and without the LFE filter. Paired samples t-tests revealed that the LFE estimated significantly higher number of counts than non-LFE calculated counts per minute on all three axes (p < .001). Step count estimates were higher with (M = 20,780.09, SD = 5300.85) vs. without (M = 10,896.54, SD = 3489.45) the LFE filter, (t (20) = -22.21, p < .001). These differences have implications for calculations based on axis counts (e.g., Axis-1 calculated steps, intensity level classifications) that rely on waist-worn standards. For example, even without the filter, the GT9X calculated an average of 10,897 steps, which is likely an overestimate in this population. This suggests that axes-based variables should be interpreted with caution when generated with wrist-worn data, and future studies should aim to develop separate wrist and waist-worn standard estimates of these variables in older adult populations.
INDEX OF RELATIVE RURALITY AS A PREDICTOR OF PHYSICAL ACTIVITY CORRELATES FOR OLDER ADULTS
Authors: Huffman Mary K , Amireault Steve
Published: November 2019

According to the ecological model, physical activity (PA) results from interactions between personal (e.g., intentions), social (e.g., autonomy support), and environmental factors (e.g., walkability, rurality). However, past research has commonly used dichotomous measures of rurality (i.e., rural versus urban), which has limited our understanding of the relationship between rurality and other PA correlates. Therefore, the purpose of this study was to investigate the associations between rurality and known correlates of PA among older adults. Ninety-one older adults aged ≥ 60 years, without severe cognitive impairment, completed a questionnaire assessing PA intentions (α = 0.89), autonomy support for PA (α = 0.91), and walkability (α = 0.76). The Index of Relative Rurality, a continuous, multidimensional measure of rurality, was used to evaluate the degree of rurality based on residential zip-code. Regression analyses revealed that the rurality-autonomy support association followed an inverted-U shape function (p = 0.01), whereas rurality was negatively associated with walkability (p = 0.02). Rurality was not associated with PA intentions; however, autonomy support was positively associated with PA intentions (p = 0.01). The use of non-dichotomous measures of rurality appears essential in our understanding of its association with other PA correlates. Failure to use such measures may result in incomplete portrayals of relationships.
ASSOCIATION OF RESTRICTED LIFE SPACE MOBILITY WITH COGNITIVE FUNCTION WITHIN OLDER BLACKS AND WHITES WITH DIABETES
Authors: Clay Olivio J , Bowen Pamela , Lee Loretta , McCaskill Gina , Affuso Olivia , Crowe Michael
Published: November 2019

The Centers for Disease Control and Prevention have reported that approximately one of every eight older adults self-report experiencing confusion or memory loss that is becoming more frequent or getting worse. Thus, identifying individuals who are at-risk for cognitive problems is essential. The purpose of this investigation was to assess the relationship between life space mobility and cognition within older Blacks and Whites with diabetes. Baseline data from the University of Alabama at Birmingham (UAB) Diabetes and Aging Study of Health (DASH) were utilized. Multiple regression models adjusted for age, education, income, gender, and race were utilized to assess the association between restricted life space (a score of less than 60 on the UAB Life Space Assessment) and cognitive function as assessed by the Telephone Interview for Cognitive Status (TICS-M). The analytic sample consisted of 224 older adults with diabetes (mean age = 73.52) with 54% being female and 53% White. Of the participants, 75 (32%) had a restricted life space and individuals with restricted life space on average had cognition scores that were over 2 points lower than participants categorized as not having restricted life space (B = -0.18, p < .01). Additionally, Black participants had lower levels of cognition when compared to Whites in the covariate-adjusted models (B = -0.23, p < .01). Results of this investigation provide additional evidence to support the relationship between mobility and cognition. Longitudinal investigations assessing the association between mobility and cognition within older adults with diabetes are needed.
CHRONIC KIDNEY DISEASE, MUSCLE WEAKNESS, AND MOBILITY LIMITATION
Authors: Latham-Mintus Kenzie , Doshi Simit , Moorthi Ranjani
Published: November 2019

Objectives: Chronic kidney disease (CKD) is associated with increased mobility limitation. Prior research has documented that peripheral nerve abnormalities occur early in CKD and progressively worsen. Loss of balance, impaired muscle strength, and slow gait predispose older adults to falls and frailty. However, the current literature is limited by a lack of nationally representative data that includes objective measures of kidney disease and physical functioning. Thus, this research examines whether CKD is associated with muscle strength, balance, gait, and self-reported mobility limitations. Methods: Data come from the 2016 Health and Retirement Study (HRS). Estimated GFR, a measure of kidney functioning derived from creatinine levels in the blood, was used to classify CKD (i.e, eGFR<45 or Stage 3b CKD). Logistic and linear regression models were generated to examine the association of CKD with physical functioning, net of demographic characteristics (i.e., age, sex, race, and education) and comorbidities (i.e., obesity, pain, and number of diagnosed medical conditions). Results: In unadjusted models, CKD was significantly associated (p<0.05) with more mobility limitations, slower walking speeds, stronger grip strengths, and non-participation in balance tests. After adjusting for covariates, CKD (β=-1.43, p=0.01) was negatively associated with grip strength. In sex-stratified models, CKD was associated with slower walking speeds among men, whereas CKD was associated with more mobility limitations among women. Discussion: In a nationally representative sample of older adults, CKD was associated with poorer physical functioning on multiple measures. After adjusting for demographic characteristics and comorbidities, CKD was associated with increased muscle weakness.
PERCEIVED PHYSICAL LITERACY FOR CHINESE ELDERLY QUESTIONNAIRE DEVELOPMENT: PRELIMINARY VALIDITY AND RELIABILITY
Authors: Wang Haocen , King Barbara
Published: November 2019

Physical activity (PA) is an essential health prompting behavior. Unfortunately, in China, only about 12% to 40% of older adults met the PA recommendations. To guide the design of future PA interventions and policy-making, innovative solutions are needed to be introduced. Physical literacy, a relatively novel concept, has been recently introduced in the field of older adults’ PA. This concept takes a holistic view of PA behavior, which proposed that a person need to be motivationally, physically, strategically, effectively, socially, and knowledgeably prepared to be and stay physically active. The aim of this study was to develop the Perceived Physical literacy for Chinese Elderly (PPLCE) questionnaire and to establish its reliability and validity. An item pool for the PPLCE was generated from literature and interviews with Chinese older adults. Expert panel reviews and cognitive interviews were applied to establish the face and content validity of the questionnaire. A convenient sample of 388 Chinese older adults was recruited to assess the psychometric properties of the PPLCE. The item-level analysis and exploratory factor analysis resulted in a 46-item self-report measure, consisting with four factors: motivation, physical competence, interaction with environment, sense of self, interaction with others, and knowledge and understanding. The Cronbach’s alpha coefficient and test-retest reliability of the PPLCE were 0.88 and 0.79 respectively. A positive correlation between PPLCE and leisure-time PA was found (r=0.43). The PPLCE has the potential to be used as a valid and reliable measure to assess Chinese older adults’ perceived physical literacy.
EXCURSION FROM HOME AND ECOLOGICAL PAIN IN OLDER ADULTS WITH KNEE PAIN
Authors: Mardini Mamoun T , Rashidi Parisa , Nerella Subhash , Fullwood Dottington , Corbett Duane , Ranka Sanjay , Manini Todd M
Published: November 2019

Background: Pain is an essential factor in limiting life-space mobility. Ecological momentary assessment (EMA) is crucial to understanding pain intensity and frequency. This study evaluated a customized smartwatch app for daily ecological pain reporting and GPS (Global Positioning System) coordinates collection to understand the impact of pain on daily excursion from home in older adults who report knee pain. Methods: Participants (n=14, 73.2 +/- 5.4 yrs, 64% female) wore a smartwatch with a customized app called Patient Reported Outcome of Mood, Pain, and fatigue (PROMPT) for 6.5 (4.0) days. Participants were prompted in their free-living environment about their pain intensity (range 0-10) in the morning, afternoon and evening. Additionally, GPS data were collected at 15 min intervals throughout the day. Geodesic distance was used to calculate the distance from the home address. Daily pain values were binned into high and low levels to compare to maximum daily excursions. Results: Individuals with average daily pain > 2 traveled 4.1 fewer miles than those individuals reporting pain 2 exceeded a distance of 5 miles compared to 17.9% of those individuals reporting pain <= 2 (X2=6.89, p < 0.05). Conclusion: In older adults, higher level of knee pain is associated with a decline in life-space mobility. Using custom designed smartwatch applications provides new opportunity to investigate how pain impacts community mobility.
THE RELATIONSHIP BETWEEN GLOBAL AND DAILY LEVELS OF PAIN AND RELIGIOUS COPING
Authors: Cheesman Katherine L , Cox Brian , Smith Dylan M , Parmelee Patricia A
Published: November 2019

Objective: This research examines associations between global and daily levels of pain and the use of religious coping strategies among African American (AA) and non-Hispanic White (NHW) older adults with physician-confirmed knee osteoarthritis (OA). Methods: As part of a larger study of racial/ethnic differences in everyday quality of life with OA, 125 persons over the age of 50 completed a global measure of religious coping using the Brief RCOPE. Daily variability in pain and coping was assessed using a daily diary methodology consisting of 4 daily phone calls over 7 days. Hypotheses: Demographic characteristics (sex, race) were expected to predict religious coping at both the global and daily levels. Specifically, we expected women and AAs would use more religious coping than their male and NHW counterparts. Further, daily levels of pain were predicted to correlate with daily levels of coping. Results: AAs were found to engage in significantly more religious coping behaviors than NHWs at the global, but not daily, level. An intraclass correlation coefficient of .316 indicated sufficient within-person variability for the use of multi-level modeling to determine the association of daily pain and religious coping. Within individuals, pain was significantly lower on days when religious coping was not used. Implications: Results contribute to a growing understanding of how individuals use their religious beliefs to cope with daily pain and perhaps, to the formulation of more targeted therapies for individuals living with chronic illness. (Supported by R01-AG041655 D. Smith and P. Parmelee, PIs.)
RELIGIOSITY AND HEALTH AMONG CHINESE OLDER ADULTS IN MAINLAND CHINA, HONG KONG, AND TAIWAN: A META-ANALYTIC REVIEW
Authors: Li Jia , Wang Qi
Published: November 2019

Abstract: Religion plays an important role in people’s later life. However, most existing studies on health and religiosity focused on Western settings. China has the largest aging population in the world and distinct contexts of religion. This study aims to examine the relationship between religiosity and health of Chinese older adults through a meta-analysis. We conducted a comprehensive database (English and Chinese) and gray literature searching. Two researchers independently extracted the studies and evaluated the quality of the eligible ones. A random-effect model was adopted to combine the results. Hedges’ g was computed as a standardized measure of the effect size. Subgroup analysis was conducted to examine the potential moderators. From the 3776 potentially eligible papers, 74 were eventually included. The results showed that, having a religious belief or ever attending religious activities was significantly related to a higher level of anxiety (Hedges’ g= 0.392, 95% CI[0.230, 0.556]), escape acceptance of death (0.477[ 0.154, 0.801]), death avoidance (0.498 [0.127, 0.870]), death anxiety (0.448[0.122, 0.774]), more positive coping practices (0.581[0.073, 1.094]), and subjective social support (0.313[0.143, 0.483]). However, the subgroup analysis did not conclude any significant moderators. Religiosity is significantly related to a variety of psychosocial characteristics of older adults, including both negative and positive traits. It calls for more future studies to investigate the competing mechanisms regarding how religiosity can influence older adults’ health and vice versa.
RAMBLE ON: LONELINESS AND OFF-TOPIC VERBOSITY IN OLDER ADULTS
Authors: Smith Leah N , Helphrey Jessica H , Sawyer Jennifer , Fierro Leigh A , Mokhtari Ben K , Moore Jenna M , Rodriguez Daniel , Barnett Michael D
Published: November 2019

Numerous studies have found off-topic verbosity occurs more frequently in older adults than younger adults. Previous theories have attributed this to age-related decline, emotion recognition, and communication style. Previous research has linked lower loneliness with more off-topic verbosity; however, the precise nature of this relationship remains unclear. Loneliness has been defined as an inconsistency between an individual’s actual and desired social relationships, and previous research has found that loneliness is associated with lower cognitive and social outcomes among diverse populations including older adults. The purpose of this study was to investigate the relationship between loneliness and off-topic verbosity among older adults. Healthy, community dwelling older adult participants (N = 82; age 60-99, M = 76.66, SD = 8.52) completed the Three-Item Loneliness Scale and provided a verbal sample in which they recounted an autobiographical memory (a vacation) and a procedural memory (how to make a breakfast); the verbal samples were transcribed and rated by three independent judges. In contrast with previous research, results found that loneliness was associated with a greater tendency to engage in tangential verbal topics. This suggests that social factors such as loneliness may impact the way some older adults express themselves verbally.
HOPE AND RESILIENCE AMONG VULNERABLE, COMMUNITY-DWELLING OLDER PERSONS
Authors: Myers Dennis R , Polson Clay , McGee Jocelyn S , Gillespie Rachel
Published: November 2019

Community-dwelling older adults in the U.S. are at risk for experiencing a number of physical, emotional, and social issues including poverty, social isolation, and deteriorating health and daily functioning. Despite such challenges, research indicates that many older adults remain resilient and that factors such as social support, spirituality, and self-esteem contribute to resilience and improved outcomes. One factor that has been found to be particularly important for resilience among older adults is a sense of hopefulness. However, research has not looked specifically at the effects of hope on older adults experiencing severe economic and psychosocial challenges. Utilizing survey data drawn from a unique sample (n = 64) randomly drawn from 224 clients of a Meals on Wheels program, we explore the relationship between hope and resilience among a group of at-risk, community-dwelling older adults in one central Texas community. We find that hope, after accounting for the effects of social support, spiritual experience, health (ADL), and ethnicity, is a strong and significant predictor of resilience among at-risk older adults and that hope tends to mediate the effect of spiritual experience on resilience. Drawing on these findings, we discuss potential implications for social workers and congregational leaders working with older adults and for future scholarship on hope and resilience.
THE EXTREME FACE OF SOCIAL ISOLATION: A COHORT STUDY OF UNBEFRIENDED INDIVIDUALS IN LONG-TERM CARE
Authors: Chamberlain Stephanie , Duggleby Wendy , Teaster Pamela B , Fast Janet , Estabrooks Carole
Published: November 2019

Even though social isolation is a significant predictor of poor health and mortality in older adults, very little is known about social isolation in long-term care (LTC) settings. The aim of this study was to describe the prevalence, demographic characteristics, health outcomes, and disease diagnoses of residents without family contact in Alberta LTC homes. Using data collected between April 2008 and March 2018, we conducted a retrospective cohort study using the Resident Assessment Instrument, Minimum Data Set, (RAI-MDS 2.0) data from 34 LTC facilities in Alberta. We identified individuals who had no contact with family or friends. Using descriptive statistics and binary logistic regression, we compared the characteristics, disease diagnoses, and functional status of individuals who had no contact with family and individuals who did have contact with family. We identified a cohort of 25,330 individuals, of whom 945 had no contact with family or friends. Different from residents who had family, the cohort with no contact was younger (81.47 years, SD=11.79), and had a longer length of stay (2.71 years, SD=3.63). For residents who had contact with family, residents with no contact had a greater number of mental health diagnoses, including depression (OR: 1.21, [95% CI: 1.06-1.39]), bipolar disorder (OR: 1.80, [95% CI: 1.22-2.68]), and schizophrenia (OR: 3.9, [95% CI: 2.96-5.14]). Interpretation: Residents without family contact had a number of unique care concerns, including mental health issues and poor health outcomes. These findings have implications for the training of staff and LTC services available to these vulnerable residents.
MAKING THE AGING EXPERIENCE WORTHWHILE: HOW SOCIAL INTERACTION CONTRIBUTES TO ACTIVE AGING
Authors: Doh Daniel , Adusei-Asante Kwadwo , Banham Vicki
Published: November 2019

In most parts of the world, people are now living longer lives, which presents both opportunities and concerns over how to make the ageing process a worthwhile experience. The World Health Organisation’s Active Ageing model became a prominent global policy response since 2002 and has evolved into different country-level ageing policies. While a considerable volume of literature exists on active ageing – testing the validity of its various components, there is limited empirical evidence of how social interaction contributes to active ageing for older people and how it can be promoted through policy. In this paper, we examine social interaction and how it contributes to lived experiences of active ageing among a sample of 30 older Ghanaians living in Australia and Ghana. Our findings confirm the significance of social interaction for active ageing, and shows that social interaction creates a sense of purpose for living, which leads to the ability of the individual to build resilience, which mitigates anxieties and pains associated with ill health (especially for frail older people); enhances self-motivation for play and fun; empowers the individual to explore opportunities for continuous activity including leisure, and improves the general feeling of happiness resulting in active ageing – quality of life. The paper’s main argument is that social interaction presents potentials for improving the quality of life (active ageing) for older people and needs to be carefully considered in policy, research and practice.
ADDRESSING SOCIAL ISOLATION OF OLDER ADULTS: THE COMMUNITY PERSPECTIVE AND CONTRIBUTION
Authors: Jeffery Bonnie , McIntosh Tom , Novik Nuelle
Published: November 2019

This presentation will discuss the Reducing Isolation of Seniors Collective (RISC), a collaboration of three organizations that have implemented nine projects to address social isolation for rural and urban older adults in Saskatchewan, Canada. A survey was completed with the purpose of identifying community-level awareness, knowledge and perspectives on the extent of social isolation of older adults in their communities. Key variables of interest included contributors to social isolation of older adults, barriers to overcoming social isolation, and community efforts and promising assets for addressing social isolation of older adults in their own communities. To develop an understanding of the extent to which respondents are involved with older adults, the survey asked respondents to report how often they supported, observed, advocated for, and/or interacted with seniors. The 271 respondents identified their roles in the community as human service professionals, healthcare professionals, program facilitators, community leaders, organization members, and community volunteers. Three-quarters of respondents reported that they were involved with seniors at least daily or weekly. While 75.3% believed that social isolation of older adults was “somewhat” or “very” common, almost one-half (41.2%) of respondents believed there was not general awareness of social isolation of older adults by other members in their community. Over one-half of the respondents mentioned community programming (55.7%), friends and neighbours (63.1%), and volunteers (57.2%) as community assets that can reduce isolation of older adults. Respondents reported examples of promising interventions in their communities: church support, library programs, transportation service, visiting programs, advocacy groups, and information sessions.
COUPLES LIVING WITH ADVANCED CANCER: RAMIFICATIONS OF SOCIAL ISOLATION AND BENEFITS OF AN EMBEDDED SOCIAL NETWORK
Authors: Raveis Victoria H , Pretter Sheindy , Carrero-Tagle Monique , Karus Daniel G , Shah Avani
Published: November 2019

Cancer remains a leading cause of death, especially among older adults. While spouses are commonly involved in the provision of emotional and practical assistance to their ill spouse, their caregiving is not without cost. Although knowledge of an impending death permits preparation for the loss, a long and protracted illness, or one marked by intense caregiving demands, can deplete the well spouse’s personal resources, increasing the risk of morbid bereavement outcomes. Well spouses (n=138), aged 50 and older (mean age 63.6), 41% male, providing 8+ hours of caregiving to a spouse with advanced cancer and a life expectancy of 6 months or less were followed over the terminal illness period. Caregiving spouses’ anticipatory grief, depression and anxiety were all significantly, inversely correlated with sufficiency of social support, specifically tangible, informational and emotional support (p<.05). At 2-3 months post-death (widowed subsample, n=82), the surviving spouses’ grief was inversely correlated with informational support (p<.01) and their social re-engagement post-death was directly correlated with sufficient tangible support (p<.05). Their narrative accounts about the illness and post-death period reveal various demands and negative social encounters they experienced with family members and others during this period, as well as, documenting support received. Spousal death presents a significant adaptive challenge, particularly to older adults who must adjust to the dissolution of longstanding bonds and altered life circumstances. Awareness of these complex relationship issues, i.e. problematic network relationships, will enable clinicians to attend to the needs and preferences of bereaved spouses during this period of heightened vulnerability.
A LIFE MORE ORDINARY: CREATING DEMENTIA-FRIENDLY SPACES THROUGH THE PERFORMATIVE ARTS
Authors: Milligan Christine
Published: November 2019

The concept of dementia friendly communities emerged from the ‘age-friendly’ movement that has been supported by the WHO for some time. This recognizes that like most older people, those with dementia desire to remain in their own homes, and their own communities, for as long as possible. But it also recognizes the significant socio-environmental challenges this can present. Transforming attitudes to dementia, supporting family and friend caregivers, and promoting meaningful participation for all in the community are essential to the success of any such movement. This paper draws on a qualitative evaluation of one such programme that has sought to develop innovative dementia friendly spaces through the arts and arts performance. Focusing on the Dukes Theatre in Lancaster, UK and its partner theatres and cinemas, I discuss how these venues have, over a three year period, developed spaces in which both people with dementia and their family carers can continue to meaningfully participate in ordinary everyday activities that can be crucial to maintaining the sense of belonging and partnership that is often lost as the dementia journey progresses. Whilst efforts to implement change at the city and community level are laudable, I suggest that it is perhaps at the micro-scale of individual places that we are most likely to successfully stimulate change.
HARNESSING THE POWER OF NETWORKS TO ADDRESS SOCIAL ISOLATION, LONELINESS, DEPRESSION, AND ELDER ABUSE
Authors: Abramson Tobi A , Jacquelin Berman , Sirey Jo Anne
Published: November 2019

Challenges to aging and risks to physical health and mortality arise when older adults have untreated mental health needs, experiences social isolation, loneliness, or is a victim of elder abuse. This symposium presents three innovative models that harness the power of networks and collaboration between aging services and an academic medical center to meet the needs of ethnically diverse community seniors. These model programs include: embedded mental health services on-site in community senior centers; Friendly Visiting to homebound seniors; and PROTECT intervention to treat elder abuse victims’ mental health needs. Research from these innovative, collaborative programs indicate that over 50% of senior center members screened positive for depression and anxiety (higher than the national average of 3-20%), social isolation, loneliness, and elder abuse. Of the 75% who engage in treatment, 37.3% and 41% showed a 3-month improvement of depression and anxiety, respectively. For seniors who have a friendly visitor, one-third also suffer from depression and/or anxiety. Three months after being visited by a friendly visitor, 42% and 53% see improvement in loneliness and social isolation, respectively. Among victims of elder mistreatment, 33% screened positive for depression or anxiety and 16% reported suicidal ideation. Clients receiving the PROTECT intervention had a greater decrease in depression, felt services were more useful, and reported greater improvement in the abuse. To find and build strength in age, it is essential that programs and policy be developed to support collaboration and provide the opportunities for building and utilizing networks across different domains of aging.
INTEREST GROUP SESSION—ABUSE, NEGLECT AND EXPLOITATION OF ELDERLY PEOPLE: DAILY REFLECTIONS OF DEMENTIA CAREGIVERS: MICRO-LONGITUDINAL APPROACHES TO UNDERSTANDING ELDER ABUSE AND NEGLECT
Authors: Pickering Carolyn E , Gassoumis Zach
Published: November 2019

Studies with clinic samples have found approximately 50% of family caregivers self-report engaging in abusive and neglectful acts towards the person with dementia whom they assist. Despite this, interventions to reduce and prevent elder abuse and neglect in dementia caregiving are lacking. To develop targeted interventions, the field still has much to learn about what happens during single incidents of elder abuse and neglect including (1) the types of tactics used (2) contextually-based risk/protective factors and (3) circumstances surrounding acts. This symposium will advance discussions on these topics through presentation of pilot data from a micro-longitudinal study on abuse and neglect within dementia family caregiving. Micro-longitudinal methods, such as daily diary studies, rely on intensive longitudinal measures over shorter periods of time. This approach can better ascertain ecologically-valid factors and identify temporal patterning between variables than traditional longitudinal and cross-sectional methods. First, we will provide an overview of the pilot project with family caregivers (N=50) completing diaries for 21 days. The second presenter will discuss data on the co-occurrence of different types of elder abuse and neglect as they manifest in daily lives of family caregivers, and lead discussion on measurement considerations. The next presenter will discuss data on contextually-based risk and protective factors for abuse and neglect that occur during daily caregiving activities. The final presentation will discuss findings on caregivers’ perceptions of the circumstances surrounding abusive and neglectful behaviors. Discussion will focus on how these findings, and methods, can be used to advance intervention development for the field.
RISK AND PROTECTIVE FACTORS FOR ABUSE AND NEGLECT IN DAILY CAREGIVING
Authors: Yefimova Maria , Pickering Carolyn , Maxwell Christopher , Puga Frank , Sullivan Tami
Published: November 2019

The stress-process model suggests a variety of factors related to the stress-experience as important in the formation of outcomes including elder abuse and neglect (EAN). Multi-level modeling with days (n=831) nested within caregivers (N=50) was used to evaluate relationships between theoretically-based risk and protective factors and odds of EAN. Disruptions in the daily routine are a significant risk factor for abuse and neglect. Participating in a meaningful activity at least twice a day with the care recipient is a significant protective factor for neglect (OR=0.19; CI=0.06-0.64; p=0.01), but not abuse. Hypotheses that spending the full day together would increase the risk of EAN, and receipt of instrumental support and caregiver participation in self-care would decrease risk, were not supported. Findings demonstrate that the risk of EAN varies from day-to-day in the presence and absence of contextual factors. Moreover, abuse and neglect may have different etiologic pathways.
TWELVE YEARS OF CHANGES IN STATES’ ASSISTED LIVING REQUIREMENTS FOR DEMENTIA-SPECIFIC STAFF TRAINING
Authors: Carder Paula , Smith Lindsey , Taylor Seamus , Kaskie Brian , Thomas Kali S
Published: November 2019

We describe two categories of dementia-specific AL requirements: staff training and admission/discharge criteria. We reviewed current requirements for all states and the District of Columbia, and amendments made over 12 years. Current and historic regulations were collected and analyzed using policy surveillance and qualitative coding. Twenty-three states currently require dementia-specific training, and 22 require continuing education. Nearly all states (49) require administrators to complete dementia-specific training. Of these, 13 states specified 7 to 120 hours of dementia care training. Some states added pre-admission screening for cognitive impairment; a few require a dementia diagnosis for admission. We describe state variation longitudinally in direct care staff training requirements, including: number of training hours, training content, and use of examinations or other tests of knowledge, skills and abilities. In addition, we categorize changes in admission/discharge criteria over time, including the use of medical versus behavioral health symptoms.
RESULTS FROM A 2019 SURVEY OF STATE AGENTS ON ASSISTED LIVING REGULATIONS AND TRENDS
Authors: Kaskie Brian P , Cornell Portia , Carder Paula , Thomas Kali
Published: November 2019

AL is regulated at the state level. Yet, little is known about the structure and function of state agencies that license and monitor AL. We fielded a 21-question survey among state agents with responsibility for AL in all 50 states. While licensure definitions of AL vary, state efforts appear uniform in regard to administrative alignment with departments of health as well as roles with facility licensing, renewal, and monitoring. However, we observed variability in the approaches used to monitor AL. While 80% of agents reported being able to issue fines for failures to meet regulatory standards, only 40% of states collected information concerning individual resident status. Only 20% issue separate licenses for providing care to persons with dementia, whereas 30% of state agents affirmed that non-licensed AL facilities were operating within their state. We consider how these varied regulatory approaches may shape facility operations and impact resident outcomes.
REFLECTIVE THINKING OF THE CSMP APP CO-DESIGN AND ALPHA-TESTING PROCESS
Authors: Yu Kexin , Wu Shinyi , Liu Mandong , Jiang Haojun , Chi Iris
Published: November 2019

Time and transportation barriers prevented caregivers with busy schedules to attend the CSMP. Developing a CSMP mobile application (app) and testing its feasibility was hypothesized to increase the accessibility of the CSMP to caregivers. Applying a user-participatory approach, seven caregivers who attended the CSMP in-person intervention participated in a 2-hour co-design session. A CSMP app prototype was developed based on the co-design interview results. The same seven caregivers and another five caregivers who were naïve to the CSMP intervention participated in a 2-hour alpha testing interview to provide feedback to the app prototype. Compared to co-design, participants were able to provide more constructive suggestions regarding app design when the app prototype was shown. The user participatory approach is a dialogue between researchers’ knowledge framework and users’ lived experience. Both agreement and disagreement regarding app design were identified, yet how to address the discrepancy has not been discussed in the literature.
INTEREST GROUP SESSION—ECONOMICS OF AGING: EVOLVING CARE SYSTEMS FOR OLDER ADULTS: UTILIZATION IMPACTS OF MEDICARE AND MEDICAID PAYMENT TRENDS
Authors: Bishop Christine E
Published: November 2019

With the promise of better care coordination, better member outcomes, and lower costs, Medicare and state Medicaid programs are implementing population-based payment systems for older adults. Medicare Advantage (MA) plans are responsible for Medicare services for their members, Medicaid managed long-term services and supports (MLTSS) programs cover a broad span of Medicaid benefits, and some state initiatives enroll beneficiaries dually eligible for both Medicaid and Medicare and integrate benefits from the two programs. Simultaneously, Medicaid programs are attempting to shift LTSS utilization away from nursing homes and toward home and community based services (HCBS). The presentations for this symposium address aspects of this changing landscape using Medicare and Medicaid claims and other data and causal econometric models. The first paper considers the effect of MA utilization on SNF staffing, quality, and financial health. The second paper compares medical care utilization outcomes, specifically risk of hospitalization, for Medicaid nursing home residents to outcomes for similar Medicaid members receiving HCBS. The third paper presents an MLTSS initiative in one state in the context of national developments and considers the challenges of evaluating its impact. The fourth paper compares hospitalization rates for MLTSS populations to rates for dually eligible-beneficiaries not enrolled in MLTSS. The discussion will bring findings together to assess early gains and costs as these systems of care evolve.
LONG-TERM EFFECTS OF CHILDHOOD SEXUAL ASSAULT AMONG OLDER PEOPLE WITH HIV
Authors: Brennan-Ing Mark , Seidel Liz , Erenrich Rebecca , Karpiak Stephen E
Published: November 2019

Research finds high rates of childhood sexual assault (CSA) among people with HIV (PWH). CSA is related to depression, post-traumatic stress disorder, substance abuse, and poor health. PWH age 50 and older account for the majority of this population in the U.S., but we have little information on the impact of CSA on these older adults. Data were obtained from the San Francisco arm of the Research on Older Adults with HIV 2.0 study (n=197). Fifty percent reported CSA. Cisgender women and transgender people were more likely to report CSA compared to other groups. PWH reporting CSA were more likely to meet the diagnostic criteria for PTSD (42% vs. 27%), and had higher mean PHQ-9 depression scores (9.3 vs. 6.8). Those reporting CSA had significantly more comorbid health conditions compared to their peers. Implications for using a trauma-informed care model with older adults living with HIV will be discussed.
TRAIT AND STATE SUBJECTIVE AGING INTERACT TO PREDICT DAILY CONTROL BELIEFS
Authors: Zhang Shenghao , Neupert Shevaun D
Published: November 2019

We examine trait and state subjective aging as antecedents of control beliefs in older adults with a daily diary design. Adults (n=116) ranging in age from 60 to 90 (M=64.71) completed a nine-day daily diary study online. Participants reported trait aging attitudes (Attitudes Towards Own Aging; ATOA) on Day 1 and daily Awareness of Age-Related Change (AARC) of loss and gain experiences and control beliefs (Locus of Control and Perceived Competence) on Days 2-9. Controlling for demographics and known antecedents of control beliefs (health, stressors, emotional well-being, and cognition), daily increases in AARC gain were associated with increases in both Locus of Control and Perceived Competence, and a cross-level interaction revealed that Locus of Control decreased for those with more positive ATOA on days when they reported more AARC losses. Discussion will focus on interpreting the interaction between trait and state subjective aging.
MAKING IT WORK: PEAK 2.0 PROGRAM EVALUATION RESEARCH
Authors: Syme Maggie , Doll Gayle , Cornelison Laci , Kaup Migette
Published: November 2019

Research opportunities from our organizational partnerships allow us to pursue answers to questions about PCC outcomes that have largely been out of reach for the field. Our program evaluation research agenda includes groundbreaking, short-term clinical outcomes from older Kansans living in nursing facilities implementing increasingly levels of PCC, including a 49% lower prevalence of depression for residents in strong PCC adopting homes (Hermer et al., 2017; Hermer et al., 2018). Yet there have been several challenges to achieving these goals that are atypical to the common academic research process. This presentation will further highlight the clinical outcomes association with PEAK 2.0, our continued research partnership with the state, and highlight some of the unique opportunities and challenges large-scale research with a state organization presents.
LONG-DISTANCE CAREGIVING: MENTAL HEALTH CONSEQUENCES AND USE OF RESOURCES
Authors: Cimarolli Verena R , Horowitz Amy , Pruchno Rachel
Published: November 2019

Long-distance caregiving (LDC) is a growing phenomenon and common experience for caregivers of frail older adults. In fact, 11% of family caregivers in the US live more than two hours distance from the care recipient (CR). Unfortunately, there is a paucity of research on unique experiences of LDCs and the impact of LDC on the mental health of LDCs. This symposium presents findings from the NIA funded Fordham Long-Distance Caregiving Study (R21AG050018) analyzing data of 304 long-distance caregivers (LDCs). The overall study goal was to better understand how LDCs deal with the structural constraint of distance, and to examine LDC consequences and resources. First, Horowitz presents the study background, characteristics of the sample, and provides a description of the unique experiences of LDCs. Next, Cimarolli concentrates on the Sociocultural Stress Process Model applied to LDC. Her study tested the impact of LDC on mental health and investigated resources (e.g., coping skills) which could mediate the association between caregiving stressors and mental health outcomes. The third paper (Falzarano) presents data related to satisfaction with formal service providers for four subgroups of LDCs based on CR residence and dementia status. Finally, Jimenez focuses on the characteristics of LDCs’ network of other informal caregivers (IC) providing assistance to the CR and factors are associated with more help received from other ICs. Dr. Pruchno, an expert in caregiving research, will discuss study findings. The symposium provides insights into unique experiences of LDCs, the impact of LDC on mental health, and resource use among LDCs.