bluuebunny/crossref_metadata_2025 huggingface dataset:
MANAGEMENT OF DEPRESSION IN OLDER ADULTS RECEIVING CARE IN MEDICAL SETTINGS
Authors: Poon Cecilia
Published: December 2022

Although rates of major depressive disorder are lower among older adults, depressive symptoms are a common presentation for aging individuals in medical settings. Unique challenges arise when treating depressive symptoms co-occurring with brain health concerns in older adults with a complex medical history. This presentation reviews how cognitive behavioral interventions for later-life depression are relevant for mental health practitioners who work in primary care and general medical settings. Specific clinical and multicultural considerations will be highlighted to support clinicians and interdisciplinary teams to work effectively with older adults who have co-existing depressive symptoms and cognitive concerns.
PREVALENCE AND PREDICTORS OF INCREASED VERBAL/PHYSICAL CONFLICT DURING COVID-19: CLSA FINDINGS
Authors: Gutman Gloria , Karbakhsh Mojgan , Stewart Heather
Published: December 2022

Child and spousal abuse rates have been shown to increase during various types of disasters. This study sought to determine the prevalence and determinants of older adults’ experiences of increased verbal or physical conflict (+VPC), as a proxy for elder abuse, during the COVID-19 pandemic. Data are from the Canadian Longitudinal Study on Aging (CLSA), a cohort study of 51,338 Canadians aged 45–85 at enrollment (2012-15) with follow-up every 3 years until 2033.. We analyzed data of participants aged 65 or above at follow-up1 who took part in a COVID-19 sub-study (n=24,306). Experiencing +VPC was the main outcome variable; explanatory variables included gender identity, sexual orientation, age group, race/ethnicity, educational attainment, marital status, household income, working status, living alone, social support availability, cohesion with community, self-rated physical and mental health, anxiety, depression, and previous history of elder abuse. The overall weighted prevalence of +VPC was 7.4%. Gay/bisexual men, 55-64 age-group, not living alone, low social support, poor social cohesion, low self-rated health, poor mental health, and past history of psychological or physical abuse were all significantly associated with +VPC. Weighted multivariable logistic regression revealed gender, not living alone, higher scores of depression and anxiety, and past history of psychological abuse to be independent predictors of +VPC. Implications for post-pandemic recovery and for prevention strategies during future disasters include targeted outreach programs for the most vulnerable group which includes males, persons age 55-64, those with self-rated poor mental health and/or history of elder psychological abuse.
ETHNIC AND NEIGHBORHOOD DIFFERENCES IN POVERTY AND DISABILITY AMONG OLDER ASIAN AMERICANS IN NEW YORK CITY
Authors: Chan Keith , Marsack-Topolewski Christina
Published: December 2022

Asian Americans are the fastest growing and aging U.S. population, and occupy both extremes of socioeconomic and health indices. Using the 2016 NYC.gov dataset, multilevel logistic regression analyses were conducted to examine the relationship of poverty, acculturation and neighborhood-level variables with disability for different ethnic groups of Asian older adults (Chinese, South Asian, Filipino, Japanese, Korean and Vietnamese) in New York City. Findings indicated that South Asian older adults had higher odds for disability compared to other ethnic groups. Living in a neighborhood with higher percentages of persons of the same ethnicity was protective for Chinese older adults only. There is an important opportunity for interprofessional collaborations through education, awareness, screening and intervening to enhance systems of care for Asian older adults. Social workers can play a pivotal role in providing key linkages to form interprofessional solutions and shared efforts to address the needs of this understudied and under-resourced population.
NEIGHBORHOOD CHARACTERISTICS AND TRAJECTORIES OF DEPRESSIVE SYMPTOMS AND ANXIETY
Authors: Qin Weidi
Published: December 2022

This study aims to identify the trajectories of mental health among older adults and to examine the association between neighborhood characteristics (i.e. social cohesion and physical disorder) and the identified trajectories. Data came from nine waves of the National Health and Aging Trend Study (N=6,951). Group-based trajectory modeling was used to identify the trajectories of depressive symptoms and anxiety respectively. Multinomial logistic regressions were used to examine the relationship between neighborhood and trajectories. Four trajectories were identified, namely “constantly low” “increasing” “decreasing” and “constantly high”. Results show that higher levels of social cohesion and the absence of physical disorder in the neighborhood demonstrated beneficial and protective effects on older adults’ mental health trajectories. The findings suggest that social cohesion may be an important social capital to cope with negative mental health experiences. On the contrary, negative physical features may be a stressor that adversely affect older adults’ mental health trajectories.
ORAL HEALTH AND DENTAL CARE AMONG OLDER ADULTS IN DIVERSE POPULATIONS: ANALYSES OF LARGE COHORT DATA
Authors: Wu Bei , Shuman Stephen , Saunders Michele
Published: December 2022

Using large cohort surveys, this symposium includes five studies examining the linkages between oral health and systemic conditions, and social and behaviors factors affecting oral health and dental care utilization in older adults. The first study used the English Longitudinal Study of Ageing (ELSA) and analyzed the effect of changes in self-rated dental conditions on memory among adults age 51+. This study also examined the mediation effect of stroke on this relationship. Using the same data (ELSA), the second study examined the longitudinal relationships between cognitive function and changes in diabetes and oral health status. Results showed that participants with co-occurrence of diabetes and poor oral health had an accelerated decline in cognitive function over the study period. The third study was conducted among 8,744 adults age 51+ using data from the Health and Retirement Study over a 10-year period. The authors found that social isolation had a significant effect on dementia onset and that both dental visits and tooth status had a mediating effect on the association. The fourth study analyzed the Medical Expenditure Panel Survey from 2009-2016 and found that individuals with cognitive impairment had a significantly lower probability of annual dental visits. Using data from the Population Study of Chinese Elderly in Chicago collected between 2017-2019, the fifth study found that spousal support was significantly associated with a lower likelihood of having any dental visit. Findings illustrate the importance of understanding how different aspects of social relationships might play a role in dental care use.
THE IMPACTS OF CHANGES IN DIABETES AND ORAL HEALTH CONDITIONS ON COGNITIVE TRAJECTORIES
Authors: Wu Bei , Tan Chenxin , Luo Huabin , Qi Xiang
Published: December 2022

Despite the emerging research studying the relationship between diabetes mellitus (DM), oral health problems, and cognitive function, little is known about how changes in DM and oral health status affected the trajectories of cognitive decline. Using data of 12,802 participants aged 51+ from the 2006-2018 English Longitudinal Study of Ageing, this study examined the longitudinal relationships of cognitive functions with time-varying DM and oral health status – measured by edentulism, self-rated dental condition, and oral impact on daily performance (OIDP) scale at five time-points from 2006 to 2018. Results showed that participants had DM and edentulism throughout the study period had an accelerated decline in verbal fluency (mean=20.9; b=-0.17, 95% CI=-0.28, -0.07); and those had both DM and OIDP-problem had an accelerated decline in memory function (mean=10.4; b=-0.09, 95% CI=-0.15, -0.03). Prevention and treatment of multiple chronic conditions are essential for cognitive health in later life.
UNDERSTANDING THE USE OF FLEXIBLE WORK ARRANGEMENTS AMONG OLDER INFORMAL CAREGIVERS
Authors: Koreshi Shanika , Alpass Fiona
Published: December 2022

The increasing provision of informal caregiving and the extension of working lives will result in many older workers combining paid work and informal caregiving responsibilities. Specific flexible work arrangement policies have been enacted in many countries to support working caregivers. Flexibility in the workplace has been suggested to promote prolonged employment among older workers. This study primarily focuses on the question of whether use of flexible work arrangements differs between caregivers and non-caregivers and how potential differences can be explained. Participants were 296 carers and 1611 non-carers (aged 55–70 years) who completed wave 8 of the New Zealand Health, Work and Retirement survey. The use of flexible work arrangements was analyzed based on five categories; Flexibility in number of work hours, flexible schedule, flexible place, options for time off, and other options. Hierarchical regressions were used to investigate caregiving as an independent predictor of use of flexible work arrangements after controlling for demographic and work characteristics. Results indicate that the studied informal caregivers on average used more workplace flexible arrangements than non-caregivers, both in flexible work hours, flexible schedules, and time off. The caregiver status difference in use of the three significant categories of flexible work arrangements can be explained by differences in socio-demographic and work characteristics. This difference in use of FWAs among older caregivers and non-caregivers warrants attention in discussions about prolonged employment and reconciliation of care and paid work.
REIMAGINING POLICY-INFORMED RESEARCH FOR THE FUTURE OF ASSISTED LIVING
Authors: Carder Paula , Thomas Kali , Smith Lindsey , Zimmerman Sheryl
Published: December 2022

Researchers have long known that states are responsible for licensing assisted living (AL). Recent analyses indicate that the regulatory landscape is more complex, as states have numerous license classifications that can be combined in multiple ways through various subtypes and designations applied to settings under the AL umbrella. Other sources of complexity include within-state policy variation in terms of affordability and access, person-directed care, emergency preparedness, workforce, and diversity and inclusion. This presentation describes a vision and framework for future research informed by this complex policy landscape. We describe how researchers can better conceptualize types of ALs, and provide guidance for how and why AL researchers might shift from the current practice of analyzing AL settings by the “state” versus by license type, among other categorizations.
WHAT CAN WE LEARN FROM THE THREE MURDER CASE IN A FEE-BASED NURSING HOME IN JAPAN?
Authors: Tsukada Noriko , Katsumata Asako
Published: December 2022

Japan enacted “The Act on the Prevention of Elder Abuse, Support for Caregivers of Elderly Persons and Other Related Matters” on 2006 April 1. Although the Act enabled the implementation of new programs and procedures to address abuse, elder abuse remains a cause of concern, particularly in institutional settings. This paper presents an elder abuse case that occurred in 2014 in a fee-based nursing home where a staff member murdered three residents. Although extreme, we chose to present this case because there is minimal research focused on fee-based nursing homes. Moreover, this case provides an opportunity to look broadly at factors that need to be addressed to reduce the likelihood of elder abuse in institutional settings. This paper first introduces facts about this case and discusses what can be learned to help increase an understanding about preventing future elder abuse cases in institutional settings.
THE ROLE OF CARE PARTNERS IN SUPPORTING INNER STRENGTH OF PERSONS NEWLY DIAGNOSED WITH MILD COGNITIVE IMPAIRMENT
Authors: Morgan Brianna , Massimo Lauren , Ravitch Sharon , Karlawish Jason , Hodgson Nancy
Published: December 2022

Inner strength is one’s internal process of facing challenging circumstances, like receiving a mild cognitive impairment (MCI) diagnosis. However, the role of care partners in this process is unknown. This study explores the role of care partners in supporting inner strength at the time of diagnosis using qualitative methodologies. We interviewed persons diagnosed with MCI (N=5) at a Memory Center within 12 months and their care partners (N=5). We analyzed data in NVivo using reflexive thematic analysis methods. Trustworthiness was maintained through vetted semi-structured interview guides, verbatim transcription, field notes, peer analysis, and audit trails. Care partners supplant cognitive losses (e.g., redistribution of self, organizing and coordinating) to allow the person with MCI to thrive, which is built on a foundation of the care partner’s personal resources and the nature of their relationship with the person with MCI. Implications include incorporating care partners into diagnostic processes and tailoring caregiving supports.
DOES HIGHER WORKER RETENTION BUFFER AGAINST CONSUMER COMPLAINTS? EVIDENCE FROM OHIO NURSING HOMES
Authors: Kennedy Katherine , Bowblis John
Published: December 2022

This study examined the relationship between nursing home (NH) quality using consumer complaints and certified nursing assistant (CNA) annual retention rates among Ohio freestanding NHs with complete data (n = 691). Core variables came from the 2017 Ohio Biennial Survey of Long-term Care Facilities and CMS Automated Survey Processing Environment Complaints/Incidents Tracking System. Four quartiles were created to compare NHs on their CNA retention rates: low (0-48%), medium (49-60%), high (61-72%), and very high retention (73-100%). Negative binomial regressions were estimated on total, substantiated, and unsubstantiated counts of allegations and complaints. All regressions controlled for facility and county-level factors and clustered facilities by county. Controlling for other factors, NHs in the top 50% (high and very high) of retention received 1.92 fewer allegations than those in the bottom 50%, representing a 19% difference; this trend was significant and negative across all outcomes. Using quartiles revealed a non-linear pattern: high retention NHs received the fewest number of allegations and complaints. The difference between high and low retention on total allegations, substantiated allegations, and unsubstantied allegations were 33% (3.73 fewer), 34% (0.51 fewer), and 32% (3.12 fewer) respectively. Unexpectedly, very high retention NHs received more unsubstantiated allegations than high retention NHs controlling for other variables. Research, policy, and practice efforts are critical to increase CNA retention for better consumer experiences by substantively improving CNA job quality through career advancement, high wages, and benefits. Given some turnover is desirable, effective strategies for recruitment are also needed.
DOES THE ENERGETIC COST OF STRESS ACCELERATE BIOLOGICAL AGING AND SHORTEN LIFESPAN?
Authors: Picard Martin
Published: December 2022

In humans, chronic activation of cellular stress responses predict functional decline, accelerate aging, and increase mortality, but the cellular basis for the stress-aging cascade remains unclear. Here we induced chronic stress in primary human fibroblasts from multiple donors with constant i) ATP-synthase inhibition (Oligomycin-1nM) or i) glucocorticoid stimulation (Dexamethasone-100nM) cultured for up to 10 months. Stressors triggered mtDNA instability and activated integrated stress responses resulting in both transcriptional activation and secretion of cytokines and metabokines. In parallel, chronic stress increased cellular energy expenditure or the “cost of living” by 62–108% (Ps<0.001). Thus, chronically stressed cells considerably expend more energy to undergo each cell division. This severe state of hypermetabolism led to faster rates of telomere shortening and of genome-wide DNA methylation-based epigenetic aging monitored across the cellular lifespan, reflecting mito-nuclear signaling. This accelerated aging phenotype culminated in 20–40% fewer maximal cell divisions (i.e., Hayflick limit). Based on findings that hypermetabolism and increased energy flux through mitochondria may shorten lifespan, we pharmacologically inhibited carbon entry (glutamine, pyruvate, long-chain fatty acids) into the Krebs cycle across the entire cellular lifespan. While this manipulation successfully decreased OxPhos activity, it increased glycolysis-derived ATP synthesis and total energy expenditure, exacerbating the accelerated aging phenotype. Combined, our longitudinal bioenergetic and multi-omic profiling of primary human cells show that chronic heterotypic stressors converge on an acceleration of metabolism (i.e., hypermetabolism), and commensurately accelerate the progression of multiple aging hallmarks. These findings also implicate long-term mito-nuclear signaling in the stress-aging cascade in a human model.
A SIMPLIFIED APPROACH FOR CLASSIFYING PHYSICAL RESILIENCE AMONG OLDER ADULTS: THE HEALTH ABC STUDY
Authors: Wu Chenkai , Lin Tianze
Published: December 2022

Physical resilience is an emerging concept within the context of aging and geriatric medicine, and we previously developed and validated one such measure based on the mismatch between persons’ frailty level and comorbidity burden. We sought to develop a simplified version for classifying physical resilience. We also examined the agreement between the simplified version and the original approach and evaluated its predictive validity. We included 2,457 older adults from the Health, Aging, and Body Composition Study. We constructed a simplified version for quantifying physical resilience based on the comorbidity burden and level of frailty (score: 0-10). Participants were grouped by the number of diseases and classified into three groups—adapters, expected agers, and premature frailers—based on the mean and SD of frailty score (less than, within, or above one standard deviation of the mean). The Cohen’s kappa between the novel resilience classification and the original approach was 0.70, and the percentage of absolute agreement was 85.4%. We observed a steep increase in years of healthy and able life from premature frailers to adapters in the simplified resilience classifications. We developed a simplified version for quantifying physical resilience in a cohort of initially well-functioning older Black and White adults. The agreement between the simplified version and the original approach is high. Adapters had a longer healthy lifespan than expected agers and premature frailers. This user-friendly measure could help assess patients’ physical resilience in clinical settings.
CHANGES IN FUNCTIONAL STATUS AMONG US ADULTS IN LATE MID-LIFE FROM THE HEALTH AND RETIREMENT STUDY 2004–2016
Authors: Doza Adit , Mahmoudi Elham , Tarraf Wassim
Published: December 2022

Reducing racial/ethnic disparities in health and functioning among older adults are salient key goals in the U.S. health policy. This study examined whether and how the functioning have progressed between White and minority populations in late midlife in recent years. We analyzed the Health and Retirement Study (HRS) among adults ages 45-64 years across two time periods (2004-2010 and 2010-2016). Using generalized linear regression, we modeled changes in activities of daily living (ADL) and changes in instrumental activities of daily living (IADL) as a function of race/ethnicity and sequentially adjusted for period specific risk factors including sociodemographic factors, health insurance, health behaviors and social networks. Oaxaca-Blinder Regression Decomposition (OBRD) techniques are used to assess the contributions of these factors to the observed trends in ADL/IADL. We find changes in ADL is significantly higher for Blacks (Odds Ratios of 1.23, CI 1.01-1.48) and US-born Hispanics (Odd Ratios of 1.54, CI 1.12-2.12) after adjusting for all the risk factors in the second period. About two-thirds of the disparity in functional status of adults is explained in our OBRD model and more than 70% of these explained differences among minorities is related to socio-demographic factors. This probably occurred due to the differences in income and net wealth which began to widen during the time of 2008 financial crisis. Although recently there is a decline in disability trends for older adults in U.S., our findings point to an increase in racial/ethnic disparities in functional status for adults in late midlife.
IMPACT OF AN ONLINE SOCIAL INTELLIGENCE TRAINING PROGRAM ON CUSTODIAL GRANDMOTHERS’ WELL-BEING
Authors: Dolbin-MacNab Megan , Smith Gregory , Infurna Frank , Webster Britney , Hu Luxin , Castro Saul , Crowley Max , Musil Carol
Published: December 2022

Despite widespread evidence that the circumstances leading to care, combined with the stress of full-time parenting, have profound effects on psychological, physical, and social functioning of custodial grandmothers (CGM) and their adolescent grandchildren (GC), evidence-based interventions for these families are scarce. To address this gap, we conducted a randomized clinical trial (RCT) with 349 nationally recruited CGMs which compared an online social intelligence training intervention (SIT; n=185) to an attention-control (AC; n=164) condition. The SIT focused on enhancing CGMs’ capacity to develop and sustain positive social ties; an important goal since working models of attachment and caregiving are challenged and re-shaped by the off-time and demanding nature of parenting a GC. To investigate initial impact of SIT, we conducted multi-domain latent difference score models (Mplus 8) on a full intent-to-treat basis comparing the two RCT conditions on changes across key outcomes from baseline to immediate post-intervention. In comparison to AC, SIT yielded statistically significant improvement in CGMs’ depressed affect, self-esteem, relationship quality with the GC, and attachment avoidance and attachment anxiety with GC. Contrary to expectations, no significant differences were found between the two conditions on outcomes indicative of social competence (e.g., perspective taking, social awareness, social information processing, social self-monitoring). We conclude that CGMs may have applied information obtained from the SIT primarily to their relationship with GC. Our findings point to the potential benefits of the self-guided SIT, given that it can be delivered online and therefore has widespread reach to a vulnerable population. [Funded by R01AG054571]
MEASURING OLDER ADULT LONELINESS ACROSS COUNTRIES
Authors: Newmyer Lauren , Verdery Ashton , Margolis Rachel , Pessin Lea
Published: December 2022

The topic of older adult loneliness commands increasing media and policy attention around the world. Are surveys of aging equipped to measure it? We assess the measurement of loneliness in large-scale aging studies in 31 countries. In each country, we document available loneliness measures, examine correlations between different measures, and assess how these correlations differ by gender and age group. There is substantial heterogeneity in available measures of loneliness across countries. Within countries with multiple measures, the correlations between measures are high (range .38-.78). Differences by age and gender group are relatively small. Correlations between loneliness measures and living alone and being without a spouse are positive and similar in magnitude across countries, supporting construct validity. We establish that even single-item measures of loneliness contribute meaningful information in diverse contexts, with reliable and consistent measurement properties within many countries.
MULTIDIMENSIONAL SLEEP HEALTH AND RECURRENT FALLS: THE OSTEOPOROTIC FRACTURES IN MEN STUDY (MROS)
Authors: Cauley Jane , Harrison Stephanie , Cawthon Peggy , Kubala Andrew , Ensrud Kristine , Crandall Carolyn , Buysse Daniel , Stone Katie
Published: December 2022

Prospective studies have reported associations between individual dimensions of sleep and subsequent falls. Considering sleep as a multidimensional construct may provide a more comprehensive assessment. Using data from the MrOS Sleep study, we calculated a multidimensional index of sleep, operationalized as the number of disturbances in 5 dimensions of sleep (self-reported “poor”: satisfaction, duration, daytime sleepiness, latency and sleep midpoint) and categorized as: 0, 1-2, >=3. A total of 3111 men, mean age 76.4 years, were studied. Logistic regression generalized estimating equations were used to model repeated measures of annually self-reported recurrent falls (≥2 falls) over 4 years of follow-up. Compared to men with no poor sleep dimensions, the Odds Ratio (OR) of recurrent falls in men with scores of 1 or 2 was 1.13 (95% Confidence Intervals, 0.96, 1.34), and in men with scores >3, the OR was 1.46(1.15, 1.84). Worse multidimensional sleep health was associated with recurrent falls.
DOES RESILIENCE OR SES PREDICT OLDER ADULTS FINDING A SILVER LINING DURING THE COVID-19 PANDEMIC?
Authors: Wilder Jocelyn , Lauderdale Diane , Finch Laura , Hawkley Louise
Published: December 2022

The COVID-19 pandemic has stretched our limits physically, mentally, and economically; however, some older adults report that it led to a positive life change. We used data from the NSHAP COVID-19 supplement to understand whether resilience and SES (both measured in 2015-16) are predictors of older adults’ likelihood of endorsing a positive change during the pandemic. Additionally, we examined whether resilience and SES predict specific positive changes described in open-ended responses. Higher education significantly predicted reporting a positive change during the pandemic. Adjusting for resilience (OR 1.0, p= 0.185), the odds of endorsing any positive change were 1.9 times higher for those with an associate degree (p=0.027) and 3.3 times higher for those with a bachelor’s degree or higher (p<0.001) compared to those who did not complete high school. Specific positive change domains also differed by SES. Additional research is needed to understand how SES and benefit-finding contribute to well-being.
FINANCIAL SCAMS TARGETING OLDER ADULTS DURING COVID-19
Authors: Beach Scott , Czaja Sara , Schulz Richard , Loewenstein David , Lichtenberg Peter
Published: December 2022

The COVID pandemic afforded financial scammers with new opportunities to target older adults. This paper presents data from a telephone survey conducted June–September, 2020 with 380 participants from a larger National Institute of Aging study examining financial exploitation among older adults. The survey assessed COVID-related scams in three areas: (1) products, testing, treatments; (2) financial assistance (e.g., stimulus checks); and (3) charities. Questions focused on scam exposure / attempts, mode of contact, responses, and whether the older adult reported it to someone. The sample (284 Pittsburgh; 96 New York City) was 64% female; mean age = 73.6; and 47% White, 41% African American, 12% Hispanic. Across all scam types, 18.4% reported scam attempts / exposure; 24% of those exposed engaged / responded without getting scammed (11%); or were actually scammed (13%); and 40% told someone about it. The most frequent modes of contact were: telephone (54%), internet / email (40%), or mail (29%). Controlling for socio-demographics, participants from NYC were more likely to be exposed (OR = 1.91; p=.036); as were those reporting more loneliness (8-item UCLA scale; OR = 1.06; p=.042); and those reporting that COVID had worsened their emotional well-being to a greater extent (OR = 1.57; p=.032). Older adults who were more socially isolated / lonely were also more likely to have been scammed and less like to tell anyone about it. Psychosocial factors play an important role in exposure and response to scams during pandemics. Implications for policy, intervention, and general scam susceptibility are discussed.
CHARACTERIZING AVOIDABILITY OF NURSING HOME RESIDENTS: COMPARING THE CLAIMS-BASED ALGORITHM AND NURSE ASSESSMENT
Authors: Blackburn Justin , Carnahan Jennifer , Hickman Susan , Sachs Greg , Unroe Kathleen
Published: December 2022

The elevated risks associated with transferring nursing home residents to the hospital are problematic, but identifying which transfers can be avoided is complex. Using billing claims to determine “avoidability” based on hospital discharge diagnostic codes ignores resource constraints, clinical comorbidities, and asymmetrical information between nursing home staff making the transfer decision at the onset of clinical changes and hospital billing departments following treatment and diagnostic procedures. Conversely, relying on clinical staff assessments at the time of transfer may be an impractical and resource-intensive strategy to drive payment reform and improve quality. Using Medicare claims data representing emergency department and hospitalization transfers from 38 nursing facilities in Indiana from 2016-2020, we compared classification of transfers using a claims-based algorithm and trained nurse assessments of avoidability. Among 960 transfers, nurses judged 48.4% were potentially avoidable while 30.8% were classified as such using claims data. Of concordant assessments, 15.3% were avoidable and 36.0% as not avoidable. Of discordant assessments, 33.1% were judged avoidable by nurses only and 15.5% via the claims-based algorithm (Kappa=0.0153). Discordance was most frequent among transfers with heart failure (64%, n=42), psychosis (74.5%, n=34), acute renal disease (50%, n=28); and lowest among urinary tract infections (31.3%, n=64). No resident demographic or clinical characteristics were associated with discordance (age, race, sex, cognitive function scale, activities of daily living, or CHESS scale). High discordance in determining avoidability may be driven by presentation of symptoms or other condition-specific factors. Policies to reduce avoidable hospitalizations must not rely on overly simplistic approaches for identification.
HEALTH RISKS AMONG OLDER ADULTS ACCORDING TO PRIMARY LANGUAGE: EVIDENCE FROM MEDICARE ANNUAL WELLNESS VISITS
Authors: Alsulaily Amjed , Berg Kristen , Luezas-Shamakian Lorella , Einstadter Douglas , Perzynski Adam
Published: December 2022

Emerging evidence suggests that older adults benefit from the Medicare Annual Wellness Visit (AWV). Lind and colleagues found that between 2011 and 2016, utilization of the AWV increased from 8.1% to 23.0%. However, compared with non-Hispanic whites, AWV utilization is 11.6% points lower for Hispanic/Latinos and 10.2% lower for non-Hispanic Blacks. AWV differences by primary language have not been previously reported. We examined the rate of AWV utilization for older adults with English vs. Limited English Proficiency (LEP) among patients seen at a large urban health system in northeastern Ohio. Using Bonferroni-corrected chi-square and t-tests, we also evaluated the association between LEP and health risks (e.g., depression, falls, activities of daily living, cognitive status) assessed during the AWV. Using the electronic health record, we identified 41,262 Medicare patients aged 65+ who were eligible for the AWV. Of those identified, 42.8% completed an AWV between 2019 to 2021. Persons who were white (41.7%), Hispanic (37%), male (39.9%), Spanish-speaking (37.2%) or other LEP (41.2%) had lower utilization of AWVs (p<.001). Pain and fatigue ratings, depressive symptoms, and oral health problems and were similar between language groups, while cognitive impairment (p<.001), functional independence (p<.001), and self-rated health (p<.001) were substantially worse among non-English speakers. LEP is associated with a lower rate of AWV utilization and worse self-rated health. A clearer understanding of how speaking a different language from that in which the AWV is conducted is important for clarifying discrepancies and disparities in minority population health.
TRENDS IN FALL-RELATED EMERGENCY DEPARTMENT VISITS INVOLVING ALCOHOL AMONG OLDER ADULTS: 2011–2020
Authors: Haddad Yara , Bergen Gwen , Shakya Iju , Yuan Keming , Law Royal , Moreland Briana , Haileyesus Tadesse
Published: December 2022

Falls disproportionately affect older adults (≥65) resulting in three million emergency department (ED) visits annually. The relationship between alcohol and falls is unclear, but side effects of alcohol consumption include gait and balance impairments, which are risk factors for falls. This study examined trends of older adult fall-related ED visits involving alcohol from 2011-2020. Alcohol data are not routinely collected during ED visits. Alcohol involvement was identified from National Electronic Injury Surveillance System-All Injury Program free-text narratives using natural language processing and text analytic techniques. Joinpoint regression was used and cross-validated with SAS to determine significant older adult fall changes from 2011-2020 by sex and to compare older adult trends to adults < 65 (20-34, 35-54, 55-64). From 2011-2020, 2.2% of all ED visits for older adult falls involved alcohol. Alcohol-involved fall ED visit rates for older adults increased annually by 7.2% (95%CI:6.1%-8.4%). These older adult ED visit rates increased by 6.8% (95%CI:5.4%-8.2%) for males and 7.4% (95%CI:6.0%-8.9%) for females annually. For adults aged 20-34 and 35-54, alcohol-involved fall ED visit rates increased annually by 1.3% (95%CI:0.1%-2.6%) and 3.8% (95%CI:2.7%-5.0%), respectively, until 2017 and then decreased by 4.4% (95%CI:1.2%-7.5%) and 4.0% (95%CI:0.3%-7.5%). For adults aged 55-64, ED visit rates increased annually by 8.5% (95%CI:6.8%-10.2%) until 2018 and then stabilized. Documenting alcohol use when treating falls is important for monitoring trends. Assessing alcohol use in conjunction with assessments for other fall risk factors can inform healthcare providers on effective strategies to recommend to reduce fall risk.
OLDER ADULTS' WORK DISRUPTIONS IN APRIL/MAY 2020: IMPLICATIONS FOR WORK STATUS AND MENTAL HEALTH OVER 6 MONTHS
Authors: Abrams Leah , Finlay Jessica , Kobayashi Lindsay
Published: December 2022

Using the COVID-19 Coping Study, we sought to determine how work disruptions for older adults in April/May 2020 related to labor force status in September/October 2020 and mental health throughout those six months (N=2,367). One-third of respondents who lost their job in April/May were unemployed at the end of follow-up, while 15% were unemployed after furloughs and 9% after reduced hours/income. One-quarter of those furloughed in April/May were out of the labor force at follow-up – evidence of a potential pathway from furloughs into retirement. Being employed at follow-up was most common after work-from-home in April/May (90%). Multi-level models revealed differences in mental health trajectories over six months according to baseline work disruptions, including persistently high anxiety following job loss and delayed upticks in anxiety and depressive symptoms when working from home. This research provides insights into longer-term economic and mental health ramifications of pandemic-related work disruptions among older workers.
SOCIAL PLACES: SHIFTING NEIGHBORHOOD PERCEPTIONS AMONG AGING AMERICANS DURING COVID-19
Authors: Meltzer Gabriella , O'Shea Brendan , Esposito Michael , Kobayashi Lindsay , Westrick Ashly , Finlay Jessica
Published: December 2022

This study examines individual and community factors related to older adults’ perceived losses in places to socialize with people of similar and different ages in their neighborhoods during COVID-19. In the 11-month wave of the COVID-19 Coping Study from March-April 2021, responses to perceived availability were “Less,” “About the Same,” or “More.” Most respondents reported less availability in places to socialize with those of similar (68.0%) or different (68.4%) ages. Ordinal logistic regressions showed respondents who lived alone perceived less availability in places to socialize with those of similar or different ages than those living with others (ORs 0.67, 95% CI 0.47, 0.97). Those living in metropolitan compared to non-metropolitan areas also perceived less availability in places to socialize with those of similar ages (OR 0.62, 95% CI 0.39, 0.98). These findings enhance our understanding of COVID-19-related losses in community resources that facilitate healthy aging in place.
PRESIDENTIAL SYMPOSIUM: RACIAL AND ETHNIC HEALTH DISPARITIES ACROSS THE LONG-TERM SERVICES AND SUPPORTS CONTINUUM: NEED FOR POLICY AND ACTION
Authors: Dobbs Debra , Polivka Larry
Published: December 2022

The pandemic further exacerbated racial and ethnic health disparities with BIPOC (Black, Indigenous and People of Color) communities experiencing significantly higher infection rates and higher hospitalization rates compared to White populations. Underlying medical conditions that disproportionately affect BIPOC populations (e.g., cardiovascular disease, diabetes, COPD) and social determinants of health (income, community and environmental factors, access to health care and job security) can account in large part for increased rates of morbidity and mortality. Within the long term services and supports (LTSS) continuum, health disparities exist in both who receives and provides care. The four papers in this Social Research Policy and Practice Presidential Symposium will highlight factors that result in health disparities across the LTSS continuum and propose possible policy and practice solutions to address the disparities. The first paper presented will be an overview of existing nursing home workforce issues that continue to impact disparities in the quality of resident care. The second paper presented examines nursing home resident quality of life disparities from a measurement perspective. The third paper will highlight issues on elder abuse and mistreatment of rural elders, American Indian and Alaskan Natives. The fourth paper will present recommendations from key stakeholders of the RAISE Family Caregiving Advisory Council on how to meet the needs of underrepresented groups (AAPI, BIPOC, Indigenous peoples) of family caregivers. Policy and practice solutions to reduce disparities will be discussed.
MECHANISMS TO ADDRESS RACIAL/ETHNIC DISPARITIES IN NURSING HOME QUALITY OF LIFE
Authors: Shippee Tetyana
Published: December 2022

Evidence documents racial/ethnic disparities in access, quality of care, and quality of life (QoL) among nursing home (NH) residents who are Black, Indigenous and persons of color. Yet, little is known about mechanisms for these disparities. This presentation examines the mechanisms for racial/ethnic disparities in QoL in high-proportion BIPOC facilities while highlighting variability in QoL disparities across these facilities. The presentation uses data from a 5 year mixed-methods project involving 96 resident interviews; 61 staff interviews; and 614 hours of observations in high proportion BIPOC facilities in MN, coupled with resident clinical Minimum Dataset assessments linked with survey data on residents’ QoL. The findings show significant racial/ethnic disparities in QoL with need for system level changes. Given the increasing racial/ethnic diversity of NHs, ensuring equity in QoL for BIPOC residents is an urgent priority for NHs to remain relevant in the future.
EXAMINING PHYSICAL HEALTH AMONG COHORTS OF CENTENARIAN SURVIVORS IN THE HEALTH AND RETIREMENT STUDY
Authors: Arieli Rotem
Published: December 2022

This research highlights cohort differences in physical health among centenarians/near-centenarians in the Health and Retirement Study. Across 14 waves, participants aged 98 or older (n=494) were compared by three cohorts (i.e., 1890-1900, 1901-1910, and 1911-1920). Cohorts were examined at respective waves where participants were 96, 98, and 100 years of age. One-way ANOVA results presented significant differences in functional health at age 96 (F[2,324]=5.01, p<.01), subjective health at age 98 (F[2,212]=7.94, p<.001), and health conditions at ages 98 (F[2,213]=12.52, p<.001) and 100 (F[2,115]=3.45, p<.05). The oldest cohort had significantly better functional health than the youngest cohort (age 96), better subjective health than the two younger cohorts (age 98), and fewer health conditions than the youngest cohort (ages 98 and 100). Consistently, the oldest cohort performed better on subjective and objective health markers, providing implications for health care, disease prevention, and policy related to the shrinking “healthspan” among exceptional agers.
FOCUSING ON DIVERSITY: UTMB RECRUITMENT STRATEGY FOR THE D-CARE STUDY
Authors: Samper-Ternent Rafael , Williams Alice , Hirst Roxana , Galloway Rebecca , Volpi Elena
Published: December 2022

The University of Texas Medical Branch (UTMB) is the main healthcare system in Galveston County where about 15% of older adults identify as Hispanic. Our recruitment efforts for the Dementia (D-CARE) study included adapting and translating in Spanish the screening, recruitment, and intervention materials. The study is being conducted by a bilingual team, and actively engages a highly diverse Local Patient and Stakeholder Council. After obtaining a partial HIPAA waiver from the Institutional Review Board, we created a dementia registry in the UTMB Epic (TM) electronic health record which captured patients diagnosed with ICD-9/10 codes of dementia. Referral letters from UTMB primary care and neurology providers authorized us to contact eligible patients. We utilized outpatient clinic appointment schedules, direct referrals, and community outreach to meet our enrollment goal. This recruitment strategy resulted in inclusion of 478 patient-caregiver dyads with 27.4% of participants identifying as Hispanic and 17% as Black.
WHEN LOVE HURTS: AMBIVALENT TIES INFLUENCE THE LINK BETWEEN FUNCTIONAL LIMITATIONS AND WELL-BEING
Authors: Haghighat Misha , Huo Meng
Published: December 2022

Functional limitations may co-occur with worse emotional well-being in older adulthood. Research has found that this association likely varies by social factors, with social support buffering well-being from physical declines, and strain exacerbating it. Yet, older adults’ functional limitations may contribute to more ambivalence in their social relationships, which involves both support and strain. Such ambivalence may exacerbate older adults’ emotional well-being in the face of physical limitations, but we know little about whether and how this occurs. The current study innovatively examined how older adults’ overall ambivalence moderates the association between functional limitations and depressive symptoms, and captured emotional mood among older adults with functional limitations when they had encounters with ambivalent partners throughout the day. Study participants (N = 313; ages 65+) were from the Daily Experiences and Well-being Study. Participants reported on functional limitations, depressive symptoms, and relationship quality with each social partner in a 2-hour in person interview, followed by reports of social encounters every 3-hours across 5-6 days. We observed a significant moderating effect of overall ambivalence on the association between functional limitations and depressive symptoms, such that this association was more salient among older adults with more ambivalent social networks. Further, only unpleasant encounters with ambivalent social partners, but not those with non-ambivalent social partners, compromised mood among older adults with functional limitations. These findings may advance our understanding of older adults’ ambivalent ties in the context of physical declines, and help identify therapies that may enhance well-being for older adults with health limitations.
NONE OF THEM ARE REALLY FRIENDS: STAFF PERCEPTIONS OF THE SOCIAL WORLD OF PEOPLE LIVING WITH DEMENTIA IN LONG-TERM CARE
Authors: de Medeiros Kate
Published: December 2022

Nursing homes are charged with the care and protection of residents. Consequently, staff exercise tremendous control over residents’ day-to-day lives, including their social worlds. This is especially true for people living with dementia who may have challenges with communication. This paper examined how staff viewed friendships among dementia residents. Eleven staff members were asked to describe the friendship among the 20 residents in their charge to include who was friends with whom and what were the key features of the friendships. Results revealed that nearly all staff viewed residents as incapable of forming friendships among other residents. One exception was that many staff viewed felts that the male residents enjoyed a level of friendship that female residents did not. Overall, the findings point to the need to help staff move beyond a limited view of residents’ capabilities and discover ways to help foster a rich social environment
THE BALTIMORE LONGITUDINAL STUDY OF AGING: READY TO SHARE
Authors: Simonsick Eleanor , Ferrucci Luigi
Published: December 2022

Beginning January 2023, the new National Institutes of Health (NIH) Data Sharing Policy for NIH-funded and conducted research is scheduled to go into effect. In anticipation of this requirement, scientists and staff of the Baltimore Longitudinal Study of Aging (BLSA) launched a comprehensive effort to create a user friendly well-documented accessible database scheduled for a “soft” release just in time for GSA. The BLSA, established in 1958 to study normative aging, continues to advance knowledge and understanding of aging mechanisms and their impact on and response to disease processes. During a 3-day clinic visit, the 1200+ BLSA participants undergo comprehensive evaluation covering the full range of physical functional and cognitive performance capacity as well as extensive imaging studies, biological sample collection and clinical examination. In this symposium, Dr. Griswold will introduce the data sharing platform and demonstrate its facility. Dr. Simonsick will elaborate on development of a fitness percentile-based approach to define exceptional aging and the factors associated with maintaining exceptional status. Dr. Moore will provide findings on life-course physical activity and CT derived muscle parameters and homeostatic regulation in later life. Dr. Tian will share her ongoing work aimed at identifying metabolomic signatures of brain atrophy and Alzheimer’s disease risk. Dr. Tanaka will report on her work analyzing the metabolomic profile of different dietary patterns and their association with frailty. Our Discussant, Dr. Ferrucci will briefly share future directions for the BLSA and then invite attendees to comment on the BLSA data sharing platform and scientific priorities.