bluuebunny/crossref_metadata_2025 huggingface dataset:
HOME AWAY FROM HOME: SOCIODEMOGRAPHIC AND HUMAN CAPITAL PREDICTORS OF NURSING HOME USAGE
Authors: Ryan Cayley , Luo Liying
Published: December 2022

The U.S. is experiencing a demographic shift characterized by a significant segment of the population entering older age groups and beginning to require specialized eldercare, however little is known about the influence of demographic characteristics on individuals’ involvement with long-term care institutions. I use data from the Health and Retirement Study and logistic regression models to examine how the identities and resources people bring to the later stages of their lives influence their use of nursing homes. I find that individuals’ levels of human capital – measured through their educational attainment – have the strongest influence on their use of nursing homes, with individuals with college degrees having significant increases in the odds of ​reporting any nursing home stay and in the expected count of nursing home stays. I posit multiple pathways by which education could increase the likelihood of using institutionalized care, including through the social mobility of other family members as well as the ability to navigate healthcare resources and evaluate eldercare options. This detailed examination of the intersection between older ages, individual characteristics, the accumulation of different kinds of capital over the life course, and the involvement with formal care facilities provides valuable insight into the relationship between individuals and institutions across older ages and can inform policies attempting to prepare the landscape of formal care institutions for the influx of possible consumers.
A CLINICAL-COMMUNITY PARTNERSHIP TO ADDRESS OLDER ADULTS’ SOCIAL DETERMINANTS OF HEALTH NEEDS
Authors: Bolkan Cory , Weaver Raven , Geissal Erik , Wise-Swanson Breanne
Published: December 2022

Social determinants of health (SDH) are non-medical social needs key to reducing health disparities and improving health outcomes. Adequately identifying patients’ unmet SDH needs in primary care (PC) is a critical first step in addressing them, yet many questions remain regarding feasibility and implementation of screenings and how to effectively meet patients’ needs and improve their outcomes. With formative and process evaluation analyses, we report on the development and implementation of a community-based pilot study to proactively target high-risk, low-income, older patients with SDH needs. Over a six-month planning period, leadership from a PC clinic and a community based aging services organization (CBO) collaboratively created a shared infrastructure for in-office SDH screening by clinicians with direct referral to CBO for SDH support. The research team addressed challenges of workflow and barriers to sharing/accessing electronic health records. The pilot program will cover a 2-year period (12-month enrollment; 12-month follow-up) in which patients are screened at annual visits and followed-up in the community. In the first 6 months, 286 patients were screened, from which 34 (12%) CBO referrals were made, and nine patients were receptive to receiving more information, suggesting a need to explore patient barriers and receptiveness to services/supports. We report on lessons learned, adaptations to the pilot, efforts to increase identification of eligible patients, and strategies to enhance uptake of services beyond the traditional health care setting. Investment in health and aging services partnerships is a viable pathway to reducing health care use and spending, especially for older adult populations
ATTITUDES TOWARD AGING AMONG COLLEGE STUDENTS: RESULTS FROM THE INTERGENERATIONAL CONNECTIONS PROJECT
Authors: Xu Ling , Fields Noelle , Lomelin Alan Adolfo Kunz , Daniel Kathryn , Cipher Daisha , Troutman Brooke
Published: December 2022

To improve college students’ attitudes toward aging, an intergenerational intervention was implemented to connect them with community-dwelling older adults with cognitive impairment. College students were trained to make weekly phone calls to Meals on Wheels clients (age 65+). This study was an investigation of changes in college students’ attitudes toward aging over the course of study participation.College students aged 18 to 30 from a large public university in North Texas were recruited. Participants (n = 41) completed surveys through QuestionPro at baseline, midway, and at the end of the study. The Fraboni Scale of Ageism was used to measure attitudes toward aging. Friedman tests and one-way repeated measures ANOVAs were computed. Results indicated that college students’ total ageism scores significantly improved over time (F(2, 76)=4.491, p=.014), as well as their antilocution ageism scores (F(2, 76)=5.075, p=.007), and their avoidance ageism scores (F(2, 76)=3.844, p=.026). In addition, scores on six specific items significantly improved after participating in the study: “Many old people are stingy and hoard their money and possessions”, “Many old people are not interested in making new friends‚”, “Many old people just live in the past”, “I personally would not want to spend much time with an old person”, “Most old people should not be trusted to take care of infants”, and “Most old people would be considered to have poor personal hygiene”. Results suggest that weekly engagement with older adults offers promise for improving attitudes towards aging among college students. Implications for research and practice are discussed.
IS ACTIVE AGING POSSIBLE IN ETHIOPIA? PERCEPTIONS OF RURAL OLDER ADULTS
Authors: Teshome Abraham , Kotecho Messay , Adamek Margaret
Published: December 2022

Despite historical veneration of elders, older adults are increasingly viewed as a burden in many Sub Saharan African nations. Using a hermeneutic phenomenological approach, in-depth interviews were conducted to explore the aging experiences of 20 adults aged 70 and older in rural Ethiopia. Themes that emerged from the interviews were analyzed in light of the three pillars of the World Health Organization’s Active Aging Framework: health, security, and participation. Despite facing multiple barriers to active aging including lack of health care, financial hardship, ageism, and social exclusion, study participants were determined not to withdraw from activities in an effort to retain their autonomy, independence, and sense of dignity. As one participant shared, "the government does not care about us because it considers us as a useless segment of the society." Three themes reflected their major struggles: dwindling health and lack of access to health care, financial hardship, and social exclusion tied to ageism. The fourth theme--willful and purposive engagement--reflects the older adults’ response to these struggles. Contrary to myths about rural aging, study participants faced multifaceted challenges that kept them from realizing active ageing as they were not provided with sustained opportunities for health, security, and participation. Study findings point to the need for policymakers and other concerned bodies to develop supportive policies and programs to promote older adults’ well-being. The study calls for a paradigm shift that involves adopting the WHO’s Active Aging Framework, developing rights-based policies and programs, popularizing active aging, and revitalizing intergenerational solidarity.
CENTENARIANS IN SWEDISH MASS MEDIA: IS IT REVERSE AGEISM?
Authors: Torgé Cristina , Nyman Rosita
Published: December 2022

Studies on ageism often deal with negative stereotypes due to increasing age. Seldom studied is the increase in status that seems to occur at the turning point of 100 years. This study explores how centenarians are portrayed in Swedish media texts and relates this to mechanisms of ageism and age coding. We used Retriever database, which is the biggest Nordic database containing news media, to search for press articles concerning 100- to 105-year-olds. Our search resulted in 1468 articles, consisting of both news articles and feature articles. Excluding articles that did not deal with persons, articles with a paywall and redundant articles resulted in 235 articles. We analyzed (1) the contexts in which centenarians appeared, (2) the relevance of the persons’ age to the event and (3) feelings and values evoked in the articles. On the one hand, news reports evoke how centenarians ought to be shielded from harm and emphasize the indignity of even small wrongdoings. On the other hand, feature articles often use superhuman adjectives to describe centenarians, and emphasize their “youthfulness”. In birthday features, there was also an expectation for centenarians to publicize their celebrations and there was a recurrent trope was that centenarians held well-kept secrets about ageing well. Portrayals of centenarians show that they are an esteemed group. However, we also interpret that these portrayals can hide other forms of ageism, particularly compassionate ageism, and a stereotyping of centenarians that play down ill health and emphasize youthfulness at the extremes of old age.
CONTINUING BONDS OR UNBREAKABLE VOWS?: CONJUGALLY BEREAVED WOMEN'S PERCEPTIONS ABOUT REPARTNERING
Authors: Hackett Sara
Published: December 2022

The death of a romantic partner is regarded as one of life's most traumatic events. Despite established benefits from repartnering, women are typically less likely to repartner than men. Women oftentimes live longer than men and carry their grief into old age, but little is known about their integration of their loss into their lives going forward. Twenty conjugally bereaved women (Mean age = 78) participated in one 90-minute semi-structured interview to discuss their grief and their perceptions of their futures without their deceased partner. Thematic analysis revealed that participants viewed the deceased as an integral member of their present-day social convoy. Furthermore, participants expressed that they were averse to entering new romantic relationships because of either allegiance to the deceased, hesitancy about their age, or disinterest in caregiving for a subsequent partner. By exploring the reasons behind women’s resistance to repartnering, interventions may be developed to better support them.
THE IMPACT OF COGNITIVE BEHAVIORAL THERAPY ON RELIEVING NURSES' AGEISM TOWARD OLDER ADULTS
Authors: Rababa Mohammad
Published: December 2022

Background

Previous research has approved the effectiveness of cognitive-behavioural therapy (CBT) in managing some psychological problems. However, no previous has examined its impact on nurses’ death anxiety and ageism.

Methods

A randomized controlled trial was conducted on a total of 110 nurses who were randomly assigned to the study groups to test the effectiveness of CBT to reduce nurses’ death anxiety and ageism. The intervention was comprised of multiple training sessions delivered in five modules with the incorporation of several CBT exercises which are guided by the principles of Terror Management Theory.

Results

Overall, using CBT revealed a significant improvement in nurses’ level of death anxiety and ageism among the intervention group compared to the control group. CBT nurses had lower levels of ageism and death anxiety than those in the control group.

Conclusions

the use of CBT is very effective in relieving nurses’ death anxiety and ageism. The findings of the study have proved CBT is an innovative and creative psychological intervention that improves nurses’ psychological well-being and relieves stress and anxiety experiences associated with caring for older adults such as death anxiety which is the precursor of ageism. Future studies are recommended to examine the impact of CBT on other types of prejudices, including sexism and racism among nurses.Relevance to clinical practice: These findings could contribute to improved quality of life and healthcare provided to older adults. CBT could be a crucial component of the ongoing training program for gerontological nurses to target their ageism.
PERCEIVED WORKPLACE AGEISM AND OLDER WORKERS DURING THE GREAT RECESSION
Authors: Sahin Duygu Basaran
Published: December 2022

Age discrimination claims filed with the U.S. Equal Employment Opportunity Commission increased sharply at the beginning of the Great Recession (GR) and stayed elevated. Moreover, despite having lower unemployment rates compared to younger workers, older workers' unemployment lasted longer. Previous studies suggest that age discrimination might have extended the unemployment duration for older workers. However, no study has examined the role of perceived workplace ageism in older workers’ employment outcomes during the GR. This paper uses longitudinal data from the Health and Retirement Study to answer the following question: Were older workers who reported to perceive workplace ageism more likely to be unemployed or quit the labor force during the Great Recession? The baseline sample consists of workers aged 51 or older in 2006 (N=4,176). Multinomial logistic regression results show that older workers who agreed that in decisions about promotion, their employer gives younger people preference over older people, were more likely (RRR 2.05, p=0.01) to lose employment in 2008 than being employed, controlling for age, gender, race, education, health, marital status and job characteristics. Older workers who agreed that their co-workers make older workers feel that they have to retire before age 65, were more likely (RRR 1.63, p=0.002) to quit the labor force in 2008 than being employed, controlling for the aforementioned variables. These findings shine light on the important role that perceived workplace ageism played in older workers' employment outcomes during the GR.
COMMON NONCARDIOVASCULAR MULTIMORBIDITY PATTERNS AND OUTCOMES IN OLDER ADULTS WITH MAJOR CARDIOVASCULAR DISEASE
Authors: Sison Stephanie Denise , Lin Joshua K , Najafzadeh Mehdi , Patorno Elisabetta , Bessette Lily G , Zakoul Heidi , Kim Dae
Published: December 2022

Non-cardiovascular multimorbidity often coexists in older adults with cardiovascular disease (CVD), but their clinical significance is uncertain. Using Medicare data, we examined common non-cardiovascular comorbidity patterns and their association with clinical outcomes in beneficiaries with congestive heart failure (CHF), acute myocardial infarction (AMI), or atrial fibrillation (AF). We created 3 CVD cohorts of beneficiaries diagnosed with CHF (n=57,285), AMI (n=24,808), and AF (n=36,277) before January 1, 2016. Within each cohort, we applied latent class analysis to classify beneficiaries based on 7 non-cardiovascular comorbidities, including dementia, cancer, chronic kidney disease (CKD), chronic lung disease, depression, diabetes, and musculoskeletal disease. Mortality, cardiovascular and non-cardiovascular hospitalization, and home time lost until December 31, 2016 were compared across non-cardiovascular multimorbidity classes. Similar non-cardiovascular multimorbidity classes emerged from 3 CVD cohorts: 1) minimal, 2) depression (or lung-depression in AMI cohort), 3) diabetes-CKD, and 4) multi-system class. Compared to minimal class, multi-system class had the highest risk of mortality (hazard ratio [HR], 3.0 to 3.7), cardiovascular hospitalization (HR, 1.6 to 3.4) and non-cardiovascular hospitalization (HR, 2.8 to 6.0), and home time lost (rate ratio, 2.8 to 4.8), followed by lung-depression/depression or diabetes-CKD classes. In CHF and AF cohorts, multimorbidity classes were associated with greater increase in non-cardiovascular hospitalizations than cardiovascular hospitalizations. Our findings emphasize that improving health of older adults with CVD requires attention to non-cardiovascular multimorbidity.
ELDERLY MOUSE DETRUSOR MAINTAINS ITS PEAK FORCE OF CONTRACTION OVER TIME
Authors: Mortman Nadav , Ramasamy Ramalakshmi , Smith Phillip
Published: December 2022

Aging is a risk factor for urinary dysfunction. Detrusor weakening has been thought to contribute to the old bladder phenotype. Animal detrusor strips have been used to study bladder function. Strength of contraction in detrusor strips depends on length. This is referred to as the “length-tension relationship.” The aim of our study was to investigate this relationship in a mouse model by comparing the length-tension relationship in old and mature mice. We hypothesize that aging is associated with no change in active detrusor tension capability, however maximal tension will occur at longer lengths.We used two groups of male C57/Bl6 mice for this study, mature 11-12 month old mice and old 22-23 month old mice. Longitudinal intact bladder strips were harvested and placed in a vertical tissue bath between tension recording transducer hooks. Passive tensions and KCl induced contraction tensions for step-wise increments of stretch were observed.In the old group, normalized strip length at the point of maximum active tension was increased by ~13% on average as compared to the mature group with a statistically significant difference (P value 0.0171). Interestingly, the maximum active tension between groups did not differ by age. In conclusion, detrusor from old mice achieve similar maximum active tensions as that from mature mice, however at an increased length. This finding argues against a common belief that the bladder weakens with age. Instead, the aging bladder may adapt to increased filling volumes with an ability to operate at a similar strength of a younger bladder.
OBESITY MAY UNDERLIE SKELETAL MUSCLE AUTOIMMUNITY IN OLDER ADULTS
Authors: Zhang Tan , Feng Xin , Dong Juan , Beavers Kristen , Kritchevsky Stephen , Nicklas Barbara
Published: December 2022

A mechanistic understanding of the biological basis for sarcopenia could lead to novel biomarkers and intervention targets. We recently reported a novel role of autoimmunity in sarcopenia, which is potentially mediated through cardiac troponin T (cTnT) and its autoantibody. Given the known role of obesity in both autoimmunity and sarcopenia, we further explored the association between circulating cTnT or skeletal muscle IgG and obesity in older adults. We found that, in 37 older adults (NCT01049698, BMI: 30.8 ± 2.3 kg/m²; Age: 69 ± 3.5 yrs) without any cardiac abnormality, serum cTnT was negatively correlated with skeletal muscle volume (r = -0.37, p = 0.02) and leg extension strength (r = -0.38, p = 0.02), but positively correlated with body fat/muscle volume ratio (r = 0.37, p = 0.03). In two other studies including older adults (n = 11 & 12) from a subset of subjects (NCT01049698 & NCT01298817), skeletal muscle IgG1 (GAPDH normalized level by immunoblot) was found to be positively associated with BMI or dual-energy X-ray absorptiometry derived regional fat measurements, including fat mass, abdominal subcutaneous fat, abdominal fat, or thigh fat. We also found that subjects with higher skeletal muscle IgG1 protein levels have significantly higher BMI but lower knee extensor strength. Our finding suggests that obesity may underlie increased circulating cTnT and skeletal muscle IgG infiltration. It also warrants additional investigation into its role in skeletal muscle autoimmunity in older adults.
APPLYING STRESS AND COPING THEORY TO UNDERSTAND DIURETIC ADHERENCE EXPERIENCES IN THOSE WITH HEART FAILURE
Authors: Meraz Rebecca , Osteen Kathryn , McGee Jocelyn , Noblitt Paul , Viejo Henry
Published: December 2022

Heart failure (HF) is a chronic and costly condition, affecting at least 6 million Americans. The ventricular dysfunction associated with HF results in fluid volume overload, which is commonly managed with diuretics. Despite the benefits of diuretics, some individuals with HF report bothersome and stressful side effects and intentionally do not adhere. Positive intrinsic motivators, such as positive emotions, may benefit individuals in their adaptation to medication-related stress. However, there has been limited study of these potential motivators in older adults with HF. The purpose of this descriptive qualitative study was to understand intrinsic factors underlying diuretic adherence in adults with HF using the transaction theory of stress and coping. Using a descriptive qualitative approach, 82 adults who were hospitalized for HF and prescribed home diuretics were interviewed. The findings of the current study revealed the ways participants appraised diuretics and how they overcame the perceived medication effects so they could adhere to the medication. Data analysis revealed three themes: (1) diuretics are bothersome (2) staying positive in the midst of hardship, and (3) adapting to endure. Adherent participants stayed positive amid the perceived medication-related hardship, maintaining resilient and grateful attitudes. Adherent participants adapted to bothersome diuretic effects and utilized creative strategies for adherence. More research is needed to understand the relationships between resilience, adaptive coping, and adherence to diuretics.
STRUCTURAL DISCRIMINATORY FACTORS RELATED TO COGNITIVE FUNCTIONING AMONG OLDER HISPANICS: RESULTS FROM HRS
Authors: Gonzales Ernest , Whetung Cliff
Published: December 2022

A growing body of research reveals how interpersonal and structural discriminatory factors undermine cognitive functioning among older Black and White adults, yet few studies have focused on older Hispanics in the United States. We examined cognitive health trajectories among 1,513 Hispanic men and women in the Health and Retirement Study (2008-2020) with mixed-effects regression. The majority (71%) of older Hispanics reported less than a college education. This older Hispanic sample often attributed everyday and major discrimination to nativity, race, age, and gender. In multivariate analyses, education, marital status, total household assets, mental health (depression), physical activity (regular vigorous exercise), and multi-morbidity (a weighted index) were all associated with cognitive functioning and in the expected directions. Surprisingly, cognitive functioning did not vary by gender. Living in neighborhoods characterized by physical disorder and social cohesion by respondents, were associated with cognitive functioning at the bivariate level, but only neighborhood physical disorder held association at the multivariate level. Perceived everyday and major discriminatory experiences were not associated with total cognition at the bivariate or multi-variate levels. Results from this study suggest interventions that target access to higher education, as well as chronic health conditions and neighborhood factors, can optimize cognitive functioning. Stratified analyses and interaction effects are needed to tease out the diversity of older Hispanic adults by nativity, acculturation, interpersonal discrimination, and cognitive health.
DOES SOCIAL ENGAGEMENT FOSTER GENERATIVITY AND GOOD CITIZENSHIP AMONG THE THIRD AGERS IN JAPAN?
Authors: Katagiri Keiko
Published: December 2022

The labor force rate of those in their sixties have been increasing in Japan. Active Theory assumes that continuing activity is good for their well-being. Several researches also elucidate positive effects of work on older adults. Further, Japan has a mandatory retirement age of 60 years; though, persons can restart their work under contract labor. Katagiri proposed a social engagement model for third agers, which assumes that work for third agers cannot be the purpose in life and suggests three activities social participation, civic activities and work. This study examines the effect of the three activities on third agers. Random sampling survey was conducted in 2019 on people living in Tokyo and Hyogo prefecture. The response rate was 43.0% (N = 665, aged 60-74). Hierarchical multiple regressions were conducted to examine the effect of the three activities on generativity, sense of community, social contribution orientation, interest in politics by gender, and the robust positive effects of social and civic activities for male and civic activities for female. Though no effect of work existed, interaction effects of work and other activities were observed. Those working with social or civic activities had higher generativity. Among people with civic activity, working males showed higher sense of community while working females showed higher interest in politics. Males engaged only in work showed no such sense. The results suggest engaging only in work do not foster their development and engagement in social and civic activities are required to enrich their lives.
AGING ON THE JOB? THE ASSOCIATION BETWEEN OCCUPATIONAL CHARACTERISTICS AND ACCELERATED BIOLOGICAL AGING
Authors: Andrasfay Theresa , Kim Jung Ki , Ailshire Jennifer , Crimmins Eileen
Published: December 2022

There is a common saying that demanding jobs can make workers age faster, but there is little empirical evidence linking occupational characteristics to accelerated biological aging. We examine how occupational category (professional/managerial, sales/clerical, service, and manual) and occupational characteristics (e.g., psychosocial stressors, physical demands) are associated with a novel measure of physiologic aging, expanded biological age, that incorporates 22 biomarkers and captures physiologic dysregulation throughout several bodily systems. We assess how occupational characteristics for working individuals aged 51-60 in 2010 Health and Retirement Study (HRS) are associated with expanded biological age in the 2016 Venous Blood Study (VBS). We find that, compared to same-age individuals working in professional or managerial positions, those working in manual occupations appear 0.96-years older biologically while those in service jobs appear 2.8-years older biologically. Individuals whose jobs are high-stress, physically demanding, or require long working hours are nearly one year older biologically than their same-age peers without these adverse working conditions. These findings largely persisted after adjustment for educational attainment. Together these findings suggest that occupational characteristics may be an independent social determinant of accelerated aging.
EXPLORING ADJUSTMENT TO RETIREMENT: LEISURE IN THE LIVES OF FIRST-GENERATION KOREAN IMMIGRANT MEN
Authors: Chung Wonock , Liechty Toni
Published: December 2022

Baby boomers, born between 1946 and 1964, comprise a significant portion of the United States’ older adult population. Retirement is also a hallmark of their current life stage. While a body of literature points to the benefits of leisure activities in later life, the roles and relevance of leisure during the retirement transition among first-generation immigrant baby boomers are not well understood. The purpose of this study was to explore leisure throughout the lifespan among first-generation Korean immigrant men (N = 19) and how their cultural values and leisure involvement played out during the retirement transition. Guided by continuity theory of normal aging (Atchley, 1989) and leisure innovation theory (Nimrod, 2008), findings from interview data through interpretive phenomenological analysis (Smith et al., 1995) indicated that (1) perceptions and definition of leisure is shaped by their cultural backgrounds; (2) leisure in the working years mostly involved family leisure activities with an emphasis on providing their children with educational values; (3) leisure activities such as golf and fishing were a particular interest for this demographic, but meanings changed over time; (3) leisure provided continuity during the retirement; and (4) retirement was viewed as an opportunity for new leisure activities, but limited availability of sport and recreation programs was perceived as a barrier. These findings yield meaningful implications in that (a) leisure engagement can provide continuity in maintaining their social roles over the lifespan; and (b) more community-based sport and recreation programs targeting older adults would help them successfully transition to retirement.
STICKING WITH THE UNION? LABOR UNION MEMBERSHIP, WORKING CONDITIONS, AND POSTRETIREMENT HEALTH IN THE MIDWEST
Authors: Engelman Michal , Qin Yue
Published: December 2022

American Employment experiences over the past five decades have been shaped by growing prevalence of bad jobs – those that are precarious and offer few pension or health insurance benefits – and a marked decline in unionization. Previous health research has highlighted the deleterious implications of bad jobs and yielded mixed or inconclusive findings about union membership. However, most of this research focused on working-age adults, and few studies have examined the long-term impacts of working conditions and union membership. We fill this gap via data from the Wisconsin Longitudinal Study – a sample of men and women who graduated from Wisconsin high schools in 1957 and have been followed through their working years, past retirement, and into oldest-old ages. We estimated regression models examining the impact of union participation in 1975 on subsequent self-rated health and depressive symptoms (measured in 1993, 2004, and 2011). Our findings suggest that union participation was associated with poorer self-rated health in 1993 (OR=0.67, 95% CI (0.48, 0.96)), with a stronger negative effect for more active union members (OR=0.58, 95% CI (0.36, 0.96)), even after controlling for socioeconomic status in childhood and adulthood. This effect dissipated by 2004, when most WLS participants were nearing retirement and further diminished by 2011, when participants were in their 70s. We found no significant effects of union activity on depressive symptoms. Job characteristics and the historical decline in the prevalence and power of unions over the cohort’s lifetime provide important contexts for interpreting these results.
TOWARD AGE-FRIENDLY WORKPLACES: IDENTIFYING FACTORS THAT SUPPORT COGNITIVE FUNCTION IN OLDER WORKERS
Authors: Price Ashley , Lee Soomi
Published: December 2022

Older adults in the workforce face natural age-related decline that may impede their work performance. Sleep and cognitive function, both of which are degraded with age, may affect work performance in older workers. Workplace demands and support may also play roles in older workers’ performance. Yet there remains a lack of effort in identifying modifiable factors that contribute to older workers’ performance. This review compiled previous studies on modifiable factors across personal and workplace domains that support or impede older workers’ performance at work. Databases utilized for this systematic review include Google Scholar, AgeLine, and APA PsycINFO. Inclusion criteria were empirical studies conducted in developed countries, published in 2000 or later, that focused on older adults (age >55) working full-time (≥ 35 hours/week). Keywords included: sleep, older adults, workforce, cognition, aging, work performance, aging workforce, workplace support, management strategies. Of the 32 studies initially identified, 13 qualified for this analysis. In 6 studies, poorer sleep (measured by actigraphy) was prevalent in older workers and was negatively associated with their cognitive performance at work. Across 7 studies, demanding and non-supportive workplace characteristics (i.e., greater job demands, lower supervisor support, and higher agism) were identified as common risk factors for poorer sleep, poorer cognitive function, and lower work performance in older workers. Bridging this information together may help identify specific factors that may be modifiable by workplace interventions to support optimal performance in workers and promote more age-friendly work environments.
TO TELL OR NOT TO TELL: TYPOLOGIES OF OLDER ADULTS PREFERENCES ON DIAGNOSIS DISCLOSURE OF CRITICAL ILLNESS IN CHINA
Authors: Lou Yifan , Liu Jinyu
Published: December 2022

Background

A priori of advance care planning, that older adults should know their diagnosis, is not guaranteed nor legally supported in China. Typically, doctors will inform the family members of the diagnosis and prognosis of critical illness and let family members decide whether to inform or not. This study aims to explore how older Chinese prefer diagnosis disclosure of their critical illness and the factors related to each typology of desired roles.

Methods

We surveyed 571 older adults in Shanghai from late-2021. We included 7 items measuring values of diagnosis disclosure on three levels: to self, to significant others, and regarding physician disclosure approach. We characterized preference types using latent class analysis. Multinomial regression models on class memberships were used with cultural, sociodemographic, and healthcare experiences predictors.

Results

Three latent classes were identified: 34% of respondents preferred control over own diagnosis and respected significant others’ rights to know their own diagnosis (“transparent”). 50% of respondents has conflicted values. They preferred to know own diagnosis and to discuss with physicians privately, but chose to conceal others’ diagnoses if their significant others have serious illness (“contradictory”). 16% preferred to delegate control over diagnosis to others and assumes that their families hold the same value (“avoidant”). Increased familism is significantly related to contradictory type. People with experience of hospitalization and making medical decisions for family members were more likely to be transparent. Discussions: We discussed research, practice, and policy implications on culturally-appropriate approaches to honor patients’ autonomy with serious illness in China.
NORTH AMERICAN CONTEXTS USING COMPUTERIZED NETWORKS TO IMPROVE CARE DELIVERY FOR OLDER ADULTS
Authors: Alexander Gregory
Published: December 2022

Evidence shows that technology provides a means to improve communication and quality of care, through greater efficiencies in information management. However, research demonstrates that technology use does not consistently improve care. Therefore, there is a continuing need globally to evaluate and discuss the impact of technology in clinical care, especially in settings where older people have higher care needs. The panel includes five interdisciplinary experts with backgrounds in care delivery systems for older adults, engineering, informatics, health systems, quality improvement, mobile health, medicine, and nursing from the U.S. and Canada. This expert panel has three objectives: 1) Describe informatics research initiatives using computerized networks to improve care delivery for older adults, 2) Contrast information technologies used to manage information in health systems caring for older adults, and 3) Explain opportunities to improve health information technology systems used in care delivery for older adults.
MEDICAL AID IN DYING: DOES POLICY PREVENT SUFFERING AT THE END OF LIFE?
Authors: Becker Todd , Kusmaul Nancy , Gibson Allison , Wallace Cara L
Published: December 2022

Medical aid in dying (MAID) reflects the legal provision for qualifying, terminally ill individuals to receive a prescription from their medical provider for self-ingestion to hasten death. This policy analysis examines current MAID policy with a focus on MAID’s intended relief of suffering. Using Wallace’s (2015) policy model, we evaluated MAID on: policy description, historical context, development of the policy, efficiency, alternative programs, effectiveness, and unintended consequences. Policy description: Currently legal in 10 jurisdictions (nine states and Washington, DC), common goals include relieving suffering and promoting self-determination. Historical context: Following a failed attempt at federal legalization, the U.S. adopted an incremental, jurisdiction-based approach to legalization beginning in Oregon (1994). Development of the policy: Although all statutes imitate Oregon’s model, subtle differences exist. Efficiency: Although each policy includes waiting periods that vary in sequential order and duration, revisions have targeted waiting periods to improve efficiency. Alternative programs: Frequently considered an alternative to MAID, existing statutes encourage providers to discuss palliative options. Effectiveness: Despite appearing effective in promoting self-determination, MAID-related complications (e.g., vomiting) may exacerbate suffering. Unintended consequences: MAID’s requirement of clinician participation may place providers in situations that challenge their self-determination and provoke distress. In sum, many questions remain unanswered regarding MAID’s effectiveness and efficiency. Thus, more data are needed. Ethical implications will continue to be debated, though policy implications (e.g., who uses MAID, the number of unique providers, the emergence of complications, those present during death) greatly impact implementation and overall choices to limit suffering at the end of life.
DO DIFFERENT ADVANCE DIRECTIVES CREATE CONFUSION ON A PATIENT'S WISHES? (MOLST VERSUS FIVE WISHES)
Authors: Perre Taylor , Young Yuchi
Published: December 2022

Introduction. The objective of this study is to compare perspectives of young adults toward advance directives (ADs) and their preferences for life-sustaining treatment and care options. Methods. Participants include graduate students (n=30) attending a New York State university. Data were collected using a structured survey questionnaire, the Medical Orders for Life-Sustaining Treatment (MOLST) form and the Five Wishes form. Summary statistics were performed to address the study aim. Results. Of the participants, the average age was 24 years (60% were female, 60% White, and 27% Black). In Five Wishes, participants who are close to death, 70% wanted all or some forms of life support; when in a coma (47%), or with permanent and severe brain damage (36.6%) chose similar options. In MOLST, without pulse and/or breathing, 87% want CPR; while with pulse and breathing, 96% want artificially administered fluids and nutrition, 90% want mechanical ventilation, 67% want to be hospitalized, 67% want antibiotics, and 53% want unlimited interventions. Conclusion. (1) The majority of participants had not previously completed an AD; however, they were capable of making decisions about their life-sustaining treatments. (2) The discrepancies in treatment preferences may be due to the language of advance directives. Further studies in this respect are warranted.
EXPLORING FIVE WISHES AND END-OF-LIFE CARE PLANNING IN YOUNG ADULTS
Authors: Perre Taylor , Stone Arianna , Young Yuchi
Published: December 2022

Introduction. Advance care planning (ACP) allows individuals to plan ahead and express their preferences for medical treatment and care options to health care providers, family, and loved ones before they are no longer able to make or voice decisions due to the event of a serious illness or injury. Advance directives (ADs) allow individuals to record their preferences. While unintentional injuries are the leading cause of death among young adults, limited studies focus on ACP, ADs, and end-of-life treatment and care. Our study aims to (1) examine the perspectives of young adults towards Five Wishes, and (2) measure their preferences related to personal, emotional, spiritual, and medical values in end-of-life care planning. Methods. Data were collected using Five Wishes and a one-time questionnaire. Participants include graduate students (n=30) at a New York State university. The average age was 24 years old (60% were female, 60% White, and 27% Black). Results. In the case of permanent and severe brain damage without expectation to wake up or recover, 63% do not want life-support treatment. In the event of coma without expectation to wake up or recover, 53% do not want life-support treatment. When close to death, 80% want to have religious or spiritual readings and well-loved - poems read aloud. Conclusions. Young adults are capable of making their decisions regarding appointing a health care proxy and giving specific instructions for personal, emotional, spiritual, and medical care. The present findings intend to make contributions in promoting population-based healthcare decision-making, education, and awareness.
ACCESS TO HOSPITAL-BASED PALLIATIVE CARE SERVICES FOR OLDER ADULTS IN IOWA
Authors: Yeo Hyesu , Childs Elisa
Published: December 2022

Background

U.S. Medicare covers many palliative services; however, Iowa’s rurality and high rate of older adults (OAs) aged 65 or over make it unclear whether older Iowans have equitable service access. Hospital-based palliative care services (HBPCSs) include curative treatment, whereas other providers of palliative care may not. Thus, this study only examined OAs’ geographic access to HBPCSs in Iowa.

Methods

This study used the American Hospital Association and U.S. Census Bureau estimate in 2017. The geographical distribution of hospitals and HBPCSs was examined using a county-level approach, considering rural/urban status (using the Office of Management and Budget’s definitions) and OA population proportion.

Results

Of the 99 counties in Iowa, 89 were rural. Of the 116 hospitals statewide, one urban county and nine rural counties had no hospital. A total of 52 hospitals provided HBPCSs in 43 counties across nine urban and 34 rural counties. HBPCSs were primarily located in central Iowa, with northern and southern Iowa having the lowest access to HBPCSs. The OA population ratio was higher in counties without HBPCSs (19%) than HBPCSs (15.7%). All 54 counties with over a 20% OA population were concentrated in rural counties, while only 37% of these rural counties had HBPCSs.

Conclusion

This study suggests a regional imbalance of HBPCS providers for OAs in Iowa. Results showed that rural communities with a high ratio of OAs lack HBPCSs and suggest HBPCSs should be expanded at hospitals in northern and southern Iowa counties where many OAs live.
STARTING THE CONVERSATION: FINDINGS FROM AN ADVANCE CARE DIRECTIVE WORKSHOP
Authors: Parsons Kelly , Barber Justin , Gibson Allison , Jicha Gregory , White Renee
Published: December 2022

Every adult that enters a hospital is asked about an advance care directive (ACD) document. The completion rates of care directives started to grow in 2016, when Medicare provided a reimbursement benefit in the annual wellness exam. Previous data shows only 37% of older Americans have an ACD, of that 64% are white. Previous studies report data from medical visits, however, advance directive discussions conducted in a community setting has not yet been explored. This pilot study examines readiness to have discussions with your appointed decision-maker, primary care provider, and complete ACD document. This was a community workshop with a physician-led presentation regarding medical choices, followed by break-out groups with trained moderators reviewing ACD materials. Data from pre/posttest along with qualitative comments addressing information seeking (pre) and additional comments (post) are included. The workshop increased participants readiness to identify an individual to make medical decisions and put into writing the type of medical care they desire. It also showed resistance to having conversations with a person's primary care provider and chosen health care agent. Challenges included the pre/posttest completion rate and the inability to compare a control group. Viewing advance directive completion within the self-determination theory assists in understanding the need for a novel setting to promote relatedness. Further research needs to be done on community setting ACD workshops to provide a space for participants to be better informed in the ACD process. Community workshops need to be examined to have a broader spectrum of inclusion within historically marginalized communities.
A QUALITATIVE EVALUATION OF A POSITIVE REAPPRAISAL INTERVENTION FOR HOSPICE CAREGIVERS
Authors: Cho HanNah , Demiris George , Oliver Debra Parker , Washington Karla
Published: December 2022

For older adults who receive hospice services in the United States, family members often become their primary caregivers playing an essential role in delivering care. Nearly 25% of hospice patients and families report the need for improved communication and additional emotional support. However, there are few interventions targeting specifically caregivers. Whereas the term caregiving implies a unidirectional flow of benefits from the caregiver to the care recipient, caregivers also experience emotional, cognitive, behavioral, or interpersonal rewards from caring for a loved one. Research has demonstrated that positive gains are common among caregivers, often manifested with negative experiences. Positive reappraisal, a form of emotion-focused coping, is especially relevant when dealing with intractable stressors. Positive reappraisal is supplemental to problem-solving therapy interventions, yet this component has never been tested in a hospice setting. In this study, we wanted to understand hospice caregivers’ impressions of a problem-solving therapy intervention enhanced with positive reappraisal modules (called PISCESplus). We conducted a qualitative study examining hospice caregivers’ perceptions of positive reappraisal. Participants received the intervention (as part of a larger clinical trial). Caregivers’ exit interviews were audio-recorded and transcribed. Thirty hospice caregivers’ interviews were analyzed. Many participants reported a paradigm shift in their thought processes. Positive reappraisal helped them reframe negative emotions to positive ones, declutter their minds, and acknowledge that caregiving required work and effort. Study findings demonstrate the potential of this intervention to improve the coping skills of caregivers in the hospice setting.
INTERPROFESSIONAL TEAM MEMBERS’ PERCEPTIONS OF PALLIATIVE SOCIAL WORKERS’ CONTRIBUTIONS TO PATIENT-CENTERED CARE
Authors: O'Donnell Arden , Gonyea Judith
Published: December 2022

Interprofessional collaborative practice (IPCP) is fundamental to the delivery of high-quality patient-centered care. An IPCP core tenet is that efficient and effective teams are crucial for the delivery of care that achieves patient satisfaction as well as positive patient-level outcomes. Although a growing number of IPCP studies explore how IPCP professionals work collaboratively, the vast majority focus on the interactions of physicians and nurses, few consider other professions or simply lump them into an “other” category. This qualitative study addresses this knowledge gap through the exploration of how hospital palliative care teams utilize the skills of advanced hospice and palliative care certified (APHSW-C) social workers to increase teams’ overall effectiveness. A two-step recruitment process was used to create matched samples of 17 palliative social workers and 24 interprofessional team members (i.e., physicians, nurses, physician assistants, chaplains). Using a constructivist grounded theory approach, semi-structured interviews were conducted, recorded, and transcribed. Analysis revealed six themes surrounding other profession's perceptions of social workers’ contributions: 1) providing continuity during and across admissions, 2) assessing and promoting the patient’s bio-psychosocial needs, 3) offering clinical expertise and support to patients with complex psychosocial needs, 4) allocating time to initiate, process and revisit difficult conversations with patients and families, 5) modulating the pace and intensity of emotionally laden conversations, and 6) supporting team well-being. Findings underscore that interprofessional team members view social workers as playing a significant role in developing, building, and sustaining a therapeutic alliance between the patient and the team.