bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EFFECT OF COMMUNITY HEALTHCHOICES ON PARTICIPANT SATISFACTION WITH HOME AND COMMUNITY-BASED SERVICES
Authors: Bear Todd
Published: December 2022

A stratified random sample of participants was interviewed in each region of Pennsylvania during each phase of the implementation using the Consumer Assessment of Health Providers Survey – Home and Community Based Services (CAHPS-HCBS) version. In addition, comparison groups were interviewed from the third implementation region. These data were combined with surveys conducted by the three Community HealthChoices managed care organizations (MCOs). Data were weighted to create geographically representative estimates of participant experience across a range of composite measures. We found that participant ratings of their personal care attendants declined on three out of four measures, however measures of medical and non-medical transportation improved as a result of the implementation of Community HealthChoices. There were notable differences between people of different racial and ethnic groups, with non-Hispanic whites consistently reporting lower levels of satisfaction with person care.
EMERITUS PROFESSORS' PERCEPTIONS: QUALITATIVE RESEARCH EXPLORING AGE-FRIENDLY UNIVERSITY PRINCIPLES
Authors: Melillo Karen Devereaux , Gautam Ramraj , Sritan Sarawut , Khumrungsee Montri
Published: December 2022

In 2020, the UML AFU campus launched the AFU Inventory and Climate Surveys (in partnership with UMass Boston). The results identified a need for campus improvement related to “involving retired faculty in University activities’ (Principle 9) and “promoting intergenerational learning to facilitate the reciprocal sharing of expertise between learners of all ages” (Principle 4). An IRB-approved follow-up survey invited respondents to participate in one-hour virtual qualitative interviews to explore the research question: What are the perceptions of Emeritus Professors regarding AFU Principles 4 and 9? Emeritus Professor interviews (n=19) were held in 2021. Four researchers completed the content analyses, which revealed six major themes: promoting intergenerational learning activities; considering emeritus group; being proactive; supporting continued UML relationships; meaning of emeritus and preferred engagement; actual and perceived benefits. The findings will be discussed as to how AFU principles can benefit both Emeritus Professors and students through understanding of this untapped resource.
AGE-FRIENDLY LOWELL: INTERGENERATIONAL CONNECTION THROUGH EXPERIENTIAL LEARNING OPPORTUNITIES
Authors: Townsend Michelly , Cornell David , Hostetler Andrew , Toof Robin , Melillo Karen Devereaux , Noel Sabrina
Published: December 2022

The rapid growth of the aging demographic requires students entering the workforce to be adept at engaging with older adults in a professional capacity. The Age Friendly Community (AFC) and Age Friendly University (AFU) initiatives present an opportunity for researchers and students to work alongside older residents to improve Age Friendly practices, policies, and infrastructure in their local communities. Age Friendly Lowell developed an Action Group (AG) of 25 Lowell residents aged 50y+, who provide feedback and guidance for 12 graduate students, as they develop measurement tools for a comprehensive community assessment. Students work with AG members to identify, pilot test, and adapt evaluation tools and learn innovative strategies for recruitment. This experiential learning structure is mutually beneficial, as residents lend their expertise, while students learn to echo those concerns throughout their work. This structure serves as a unique and effective model for other communities pursuing AFC and AFU designations.
INNOVATIVE APPROACHES TO EVALUATING THE LIFESPAN ASSOCIATIONS OF STRESS, HEALTH, AND WELL-BEING
Authors: Lee Lewina
Published: December 2022

Despite widespread agreement on the importance of stress in health and aging, the mechanisms by which psychosocial stressors influence emotional and physical health are not fully understood. Thorough operationalization of stressor exposure and stress response can contribute to a “common language of stress” (Epel et al., 2018) across disciplines, and a lifespan approach can inform the developmental timing of stress-health mechanisms. Guided by these considerations, this symposium presents five studies led by early-career researchers to delineate stress-health associations across the lifespan. Dr. Olivia Atherton will leverage father-offspring data over 25+ years to examine domains of early life stressors that are susceptible to intergenerational transmission and modifiers of such transmission. Drawing from daily diary bursts embedded within a longitudinal study, Dr. Emily Willroth will report on the role of affective reactivity to daily stressors as potential mediators of the association between childhood psychosocial stressors and all-cause mortality risk. Dr. Meaghan Barlow will present on a novel emotion construct – emotion globalizing – by considering the extent to which emotional response to daily stressors influences global assessment of well-being and age differences in these processes. Dr. Soomi Lee will consider job characteristics linked to 10-year stability and change in sleep health profiles in a national adult sample. Dr. Victoria Marino will illustrate a novel approach to assess the flexibility with which individuals select strategies for coping with stressors and describe its association with mortality. Altogether, this symposium contributes evidence on how psychosocial stressors may shape health and well-being across the lifespan.
TO WHAT EXTENT IS THERE INTERGENERATIONAL CONTINUITY IN EARLY-LIFE STRESSORS?
Authors: Atherton Olivia , Graham Eileen , Spiro Avron , Schulz Marc , Waldinger Robert , Mroczek Daniel , Lee Lewina
Published: December 2022

Prior work has investigated the correlates and consequences of early life stress within a person’s lifetime, but less is known about whether early life stressors are sustained across generations. Using multi-generational data from 1,312 offspring and their fathers (N = 518 families), we examined the extent to which there is intergenerational continuity in childhood social class, childhood home atmosphere, parent-child relationship quality, and childhood health, as well as whether person-level and family-level factors strengthen (or weaken) intergenerational continuity. Results suggest notable intergenerational continuity in childhood social class, but no continuity in childhood home atmosphere, parent-child relationship quality, or childhood health. Moreover, the intergenerational continuity of early life stressors was modified by father education level and education mobility, such that low education level conferred risks, and upward education mobility conferred benefits, for offspring adverse experiences. We discuss broader implications of the findings for future research, clinical interventions, and social policy.
EARLY-LIFE STRESSORS, ADULT AFFECTIVE REACTIVITY TO DAILY STRESSORS, AND MORTALITY RISK
Authors: Willroth Emily , Luo Jing , Graham Eileen , Antic Mina , Lopes Maria , Spiro Avron , Mroczek Daniel , Lee Lewina
Published: December 2022

Exposure to stressors in childhood is theorized to sensitize individuals to stressors experienced later in life. One way that stress sensitization might manifest is through greater affective reactivity to daily stressors. In turn, greater affective reactivity to daily stressors has been associated with poorer health and increased mortality risk. The present pre-registered investigation tested greater affective reactivity to daily stressors in later life as a potential mediator of the association between early life stressors and mortality risk in a sample of 144 men from the VA Normative Aging Study. Partially consistent with our hypotheses, greater early life psychosocial stressors were associated with greater positive (but not negative) affective reactivity to daily stressors in later life. However, neither early life psychosocial stressors nor affective reactivity to daily stressors were significant predictors of mortality risk. We will discuss implications of these findings for theories of stress experience across the lifespan.
COPING VARIABILITY AND ITS ASSOCIATION WITH ALL-CAUSE MORTALITY
Authors: Marino Victoria , Spiro Avron , Lee Lewina
Published: December 2022

Coping strategies – cognitive, behavioral, and emotional tactics used to manage stressors – are associated with morbidity and mortality. Between-strategy coping variability, defined as (un)evenness in usage across coping strategies, may reflect context-specific coping and account for additional variance in health outcomes beyond mean strategy use. This study examined prospective associations of mean coping strategy use and between-strategy coping variability with time to death in 823 men from the Normative Aging Study. In Cox proportional hazard models, 1-SD higher in mean usage of positive action, negative action, prayer, withdrawal, and substance use strategies was associated with 17-32% greater risk of all-cause mortality over 27 years, after adjusting for baseline demographics, health status, and depression. Contrary to prior research, mortality risk did not differ by coping variability. We will consider findings within the stress and coping framework and discuss implications for biobehavioral pathways linking coping to all-cause mortality.
M. POWELL LAWTON AWARD PRESENTATION AND LECTURE
Authors: Washington Tiffany
Published: December 2022

The M. Powell Lawton Award Lecture will feature an address by the 2021 recipient David L. Roth, PhD, FGSA, of Johns Hopkins University. This session will also include the presentation of the 2022 M. Powell Lawton Award to recipient Jon Pynoos, PhD, FGSA, FAGHE, of the University of Southern California. The M. Powell Lawton Award is presented annually to an individual who has made outstanding contributions from applied research that has benefited older people and their care. The Lawton Award is generously funded by the Polisher Research Institute of Abramson Senior Care.
ASSESSING CANCER SCREENING DISPARITIES USING SECONDARY SURVEYS: CHALLENGES AND OPPORTUNITIES
Authors: Zanwar Preeti
Published: December 2022

According to the WHO, cervical cancer is the fourth common cancer in women, with 90% each of the 604,000 new cases and 342,000 deaths in 2020 occurring in low-and middle-income countries. Cervical cancer can be cured if diagnosed early and treated promptly. Cervical cancer screenings by Pap-tests are evidence-based secondary prevention which are important in diagnosis and for receiving timely treatment for pre-cancerous lesions. I will present intersectional disparities in compliance with the U.S. Preventive Services Task Force guidelines for Pap testing in age-eligible women with disabilities by race/ethnicity using nationally representative Medical Expenditure Panel Survey. I find overall the proportion of women current with Pap testing is significantly lower among women with versus without disability. Additionally, I will provide example of other survey data such as the Behavioral Risk Factor Surveillance System that can be used for cancer screening and prevention and opportunities and challenges for using survey data.
THE ROLE OF A MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE DIAGNOSIS IN HEALTHCARE UTILIZATION
Authors: Castaneda-Avila Maira , Lapane Kate , Epstein Mara
Published: December 2022

Monoclonal Gammopathy of Undetermined Significance (MGUS) is an understudied precursor of multiple myeloma (MM), the second most prevalent hematologic malignancy in the US. MGUS is incidentally diagnosed, and its significance is unclear as only 1% per year transition to MM. MGUS is highly prevalent among adults aged ≥ 50 years. In this presentation, we will review mixed-method approaches. Using healthcare claims and electronic health records from patients in central Massachusetts, we applied group-based trajectory modeling and conditional Poisson regression. These analyses were complemented by a qualitative analysis of in-depth interviews with providers and MGUS patients. Together, these methodologies provided a comprehensive evaluation of the impact of MGUS on healthcare utilization in older adults. The qualitative analysis provided a better understanding of the patient and provider factors influencing healthcare utilization after an MGUS diagnosis. The presentation will highlight how the use of these methodologies provide different perspectives among understudied premalignant conditions.
NARROWING THE DISPARITIES GAP IN LTSS: POLICY AND PRACTICE
Authors: Choula Rita
Published: December 2022

Access to and the quality of long-term supports and services (LTSS) are not equitable for all older Americans. Disparities have been documented qualitatively and quantitatively for marginalized racial and ethnic communities and LGBTQI+ communities but the specific causes of gaps in equity differ by community, locality, and state. To be effective, policy solutions must be grounded in the lived experiences of Black, Latino, Asian American and Pacific Islander, and LGBTQI+ older adults in those communities. This symposium showcases how community-based research can be employed to understand the root causes of inequities in LTSS access and care affecting older adults of color and LTGBTQI+-identifying older adults and presents community-grounded policy solutions to remedy those inequities. Papers 1 and 2 use participatory research methods to understand barriers to equitable LTSS care access and quality and develop locally grounded solutions to those barriers. Caldera (Paper 1) shares results from a study of Cook County, IL nursing home residents and their caregivers focused on racial and ethnic disparities in access to and experiences with nursing home care. Hado (Paper 2) presents findings from research in Georgia and New York examining disparities in access to and experiences with HCBS for older racial and ethnic and LGBTQI+ communities. Fashaw-Walters (Paper 3) discusses the how systemic racism is at the root of inequities in LTSS access for communities of color and shares actionable recommendations aimed at ending racial and ethnic inequities in LTSS policies.
NARROWING RACIAL AND ETHNIC DISPARITIES IN HOME AND COMMUNITY-BASED SERVICES
Authors: Hado Edem
Published: December 2022

Older adults overwhelmingly prefer to age at home and in their community, yet research shows uneven access to quality home and community-based services (HCBS), especially among diverse racial and ethnic groups. Our research in Georgia and New York employs participatory research methods, including key informant interviews and focus groups conducted in 2021 and 2022, to identify root causes of disparities in access to, quality of, and experience with HCBS for older racial and ethnic and LGBTQI+ communities. Some root causes identified include: complexity in and lack of funding, tension between equal versus equitable service provision, and meaningful community outreach, particularly in Latino communities. We then identify scalable opportunities policy and programmatic interventions to improve care and service equity for older adults in those communities.
ADDRESSING SYSTEMIC RACISM ACROSS LONG-TERM SERVICES AND SUPPORTS
Authors: Fashaw-Walters Shekinah , Shippee Tetyana , Travers Jasmine
Published: December 2022

Long-term services and supports (LTSS) are some of the most racially segregated healthcare services in the U.S. today. Marginalized users (e.g., Black and Latino older adults) have disproportionate access to high-quality care and subsequently report poorer health outcomes when compared to White users. It is important to acknowledge racism as a fundamental cause of these inequities to LTSS access. As the U.S. works to expand LTSS, it is critical to diversify and strengthen the LTSS workforce, increase Medicaid reimbursements along with efforts to improve accountability and transparency, reconsider payment models and the use of public reporting, improve quality metrics, implement effective support systems for patients of color, expand access to care, and increase promotion of integrated care. Health equity researchers, Drs. Tetyana Shippee, Shekina Fashaw-Walters, and Jasmine Travers will share 7 actionable evidence-based recommendations for LTSS policy change aimed to dismantle racism and advance health equity.
RE-EXAMINING PATIENT-CENTERED CARE THROUGH DESIGN PROCESS
Authors: Mulhorn Kristine , Yoshinaga Shushi
Published: December 2022

Service design is the adoption of design process to healthcare and other service sectors. This was a transdisciplinary research project in which investigators were faculty members from Graphic Design and Health Administration. In addition, two student research assistants were recruited from undergraduate Graphic Design and Health Science majors. The objective of service design is to involve consumers, designers, and businesspeople in an integrative process, which can be applied to post-acute rehabilitation hospital settings focusing specifically on the experience of those who are 65 and older. The aim of this pilot study was to explore “designing with people rather than just for them”, an approach to improve the patient experience. Our first step involved on-site interviews. The patient narratives raised challenges and positive aspects of their interactions with the facility. On our initial site visit, we interviewed five members of clinicians and administrative staff. During the two follow-up visits, our student research assistants interviewed seven patients. Based on our staff member interview findings, we developed a revised set of questions for patients. The questionnaire was divided into three sections related to appointments: pre-arrival, during the visit, and after their appointments. Interview results were summarized in a visual data format and collaborative recommendations were made during the final presentation such as interior layout, wayfinding, online portal and their functionalities. Our findings also confirmed that the interior signage created confusion, promoting frequent questions to staff. These results will engage stakeholders and contribute to a co-designing process that will ultimately improve the patient journey.
GAINS AND LOSSES OF OLDER ADULTS LIVING IN SUBSIDIZED HOUSING DURING THE COVID-19 PANDEMIC
Authors: Blinka Marcela , Grieb Suzanne , Runge Katherine , Andes Laura , Latkin Carl , Boyd Cynthia , Cudjoe Thomas
Published: December 2022

Social isolation is prevalent among community dwelling older adults. Low income older adults living in subsidized housing may have increased risk for social isolation. To examine resident experiences and perspectives relating to their social connections during the COVID-19 pandemic, we conducted semi-structured interviews with 13 older adults (62+) who are English, Spanish, and Mandarin speaking recruited from a large non-profit affordable housing organization with communities in 22 states. Twelve housing communities were identified based on distributions of socio-demographic factors and prevalence of self-reported social isolation l in the housing community’s annual survey of residents in order to maximize site diversity. We used qualitative thematic analysis methods to examined participants’ views about their social connections before and during the COVID-19 pandemic, as well as their personal and the housing community’s strategies to mitigate experiences of social isolation. Emerging themes include loss of common facilities and opportunities to socialize with other residents due to COVID-19 restrictions, and increased use of technology to stay connected.
METHODOLOGICAL AND ETHICAL ISSUES OF RESEARCH WITH OLDER ADULTS IN PUERTO RICO DURING COVID-19
Authors: Cho Sunghwan , Camacho David , Buckley Thomas , Vazquez Julia , Carrasquillo-Sánchez Kiara
Published: December 2022

Engaging diverse groups of older adults is essential to addressing health disparities. In this presentation, we will describe how we used our research team’s networks and knowledge of the target population to engage key stakeholders in our KAP project. We will address our partnerships with clergy, NGO staff and administrators, housing authorities, colleagues at Puerto Rican universities, and older adults who serve as informal community and institutional gatekeepers. We will discuss how these partnerships facilitated our ability to identify and access study sites and participants; conduct telephone and in-person interviews; ensure data quality through training and monitoring; and, assure safety through adherence to COVID-19 protocols. Finally, we will describe key cultural and ethical issues of conducting research with older adults through community partnerships during a pandemic. The presentation has implications for developing beneficial partnerships with local community leaders and enhancing the representation of diverse groups of older adults in research.
KNOWLEDGE, ATTITUDES, AND PRACTICES TOWARD COVID-19 AMONG OLDER ADULTS IN PUERTO RICO
Authors: Becker Todd , Buckley Thomas , Burnette Denise
Published: December 2022

To better understand the dynamics of their health behaviors during the pandemic, we examined older adults’ COVID-related knowledge, attitudes, and practices (KAP). KAP theory postulates that individuals acquire knowledge about a health condition which influences their attitudes and beliefs and that these, in turn, lead to health practices. We used hierarchical regression to examine the influence of knowledge and attitudes (Step 1) on practices, controlling for health and relevant covariates (Step 2). The Step 1 association between increased knowledge and better practices (B = 0.14, p = .046) became nonsignificant in Step 2. Greater worry about contracting COVID-19 remained significant throughout (Step 2: B = 0.15, p = .043). We further explored subgroup differences within KAP measures via bivariate analyses. For instance, women had significantly higher overall knowledge (p = .013), while men had significantly better overall attitudes (p = .044). We will discuss implications of such subgroup differences for practice and policy interventions.
THE HEALTH OF THE DIRECT CARE WORKFORCE: EVIDENCE AND IMPLICATIONS ACROSS LONG-TERM CARE
Authors: Scales Kezia , Scales Kezia
Published: December 2022

Direct care workers play a key role in supporting the health and wellbeing of older adults and people with disabilities across care settings—yet their own health risks are largely overlooked. The four papers in this symposium address this critical knowledge gap. First, McCall and colleagues will present a comparative analysis of the health status, health insurance coverage, and healthcare experiences of direct care workers across long-term care using National Health Interview Survey data. Next, Lee et al. will present the trends and characteristics of occupational injuries and illnesses among California’s long-term care workers from 2019 to 2020 using California Workers’ Compensation data, assessing the impact of COVID-19 on their occupational health. Sterling will characterize the physical and mental health of the direct care workforce before and during COVID-19 using data from the CDC's Behavioral Risk Factor Surveillance Survey, as well as drawing on qualitative and survey-based studies of unionized, agency-employed home care workers in New York. Sterling will also present findings from a pilot feasibility study of an intervention aimed at improving home care workers’ well-being. Finally, Quinn et al. will synthesize findings on home care workers’ occupational hazards—including needlesticks, musculoskeletal strain, violence and infections—and examine how preventing these risks can improve safety for both workers and clients. The discussant will draw out themes and implications from across these complementary studies, highlighting the importance of safeguarding direct care workers’ health as a key step toward improving care quality and outcomes for older adults and people with disabilities.
THE ROLE OF CAREGIVERS DURING DISASTERS
Authors: Wyte-Lake Tamar , Haverhals Leah
Published: December 2022

The COVID-19 pandemic laid bare the critical role caregivers play in supporting the older adult population, and how easily care structures can fall apart under the stress of a disaster event. As our population rapidly ages, it is imperative to better understand how to support caregivers to ensure relationships between caregivers and older adults remain robust and guarantee everyone’s safety. Therefore, this symposium focuses on the roles of formal and informal caregivers during disasters, primarily the COVID-19 pandemic. Dr. Richard Chunga will present findings from a survey of homecare aides, exploring drivers of high turnover rates and describing how employers can improve job satisfaction. Dr. Lindsay Peterson will describe barriers and facilitators to disaster preparedness among caregivers, using interviews with caregivers from diverse backgrounds in Florida. Ms. Jessica McLaughlin (PhDc) will share experiences of informal female caregivers, derived from interviews across the United States (US). Chelsea Manheim (LCSW) will describe adaptations to care provision for rural Medical Foster Home (MFH) Veterans from interviews conducted with MFH care providers from across the US. Dr. Carrie Wendel-Hummell will share data around the strengths and challenges of the self-directed care model for home-based long-term care, drawing on interviews with consumers, caregivers, workers, and providers in Kansas. As a whole, these presenters will provide insights into experiences of caregivers as they navigated challenges associated with the COVID-19 pandemic and generate forward thinking on how to inform future disaster response. Sponsoring SIGs: Paid Caregiving, Family Caregiving, Assisted Living, Disaster and Older Adults
MOMENTARY VARIATION IN SUBJECTIVE AGE, PERCEIVED STRESS, AND PHYSIOLOGICAL REACTIVITY IN LATE MIDLIFE
Authors: Tingvold Maiken , Borgmann Lisa , Kornadt Anna
Published: December 2022

The age people feel, their subjective age, can vary on both daily and momentary levels. Previous longitudinal and daily-diary studies have shown that hormonal and self-reported measures of stress covary with subjective age. Our study aims at exploring momentary fluctuations in subjective age and their relation to objective and subjective measures of stress assessed in people’s daily lives. 54 participants aged 50 – 62 years (Mage = 56.1 yrs, 75% female) wore sensors recording their physiological reactivity and reported on perceived stress and subjective age six times per day for one week. We found that a lower subjective age was related to a greater heart rate variability and less perceived stress on a momentary level. Our findings confirm and expand studies showing the association of stress and subjective age and their importance for aging processes in late midlife.
2022 IRVING S. WRIGHT AWARD
Authors: Gill Thomas
Published: December 2022

Dr. Gill is a leading international authority on the epidemiology and prevention of disability among older persons. His nomination for the Wright Award lauded his groundbreaking research on the mechanisms underlying and interventions targeting functional decline and disability among community-living older persons., He collaborates with investigators throughout the country, is a leader of multisite clinical trials, and is a devoted mentor. He has published more than 350 original reports and has been continuously funded by the National Institutes of Health (NIH) and multiple foundations since 1997. Dr. Gill is the Humana Foundation Professor of Medicine (Geriatrics) and Professor of Epidemiology (Chronic Diseases) and of Investigative Medicine; Director, Yale Program on Aging; Director, Claude D. Pepper Older Americans Independence Center; Director, Yale Center for Disability and Disabling Disorders; and Director, Yale Training Program in Geriatric Clinical Epidemiology and Aging-Related Research.
DOES DISTANCE CARE MAKE A DIFFERENCE IN THE STATUS OF CARE RECIPIENTS OVER AN 18-MONTH PERIOD?
Authors: Wakui Tomoko , Kai Ichiro , Awata Shuichi
Published: December 2022

Aging in place is a priority for policy makers and individuals, and the continuity of care provided at home is one of the major concerns. Co-resident caregiving has been a dominant caregiving arrangement in Japan; however, the solitary residence of older care recipients has become more frequent. This study thus examined the impact of distance care on the status of care recipients over an 18-month period. Longitudinal data were collected from family caregivers of older adults in 17 municipalities of north-central Japan beginning in 2010. The status of care recipients after 18 months was categorized as receiving care at home, being institutionalized, deceased, hospitalized, moved out from the community, recovered, or untraceable. Care recipients’ age, gender, activities of daily living, dementia symptoms, and caregivers’ age, gender, health status, economic status, and caregiving burden were measured. We analyzed data of 2280 care recipients–caregiver dyads. Care recipients’ mean age was 84.7 (SD=7.3), and 66.7% were women. Of those, 65.0% had some dementia symptoms. Multivariate logistic regression models predicting the status of care recipients after 18 months showed that distance care had significant effects on care recipients’ status. Those who received distance care were more likely to be moved out, institutionalized, and deceased after 18 months, even after controlling for their care needs and caregiving situations. There were no significant effects on being hospitalized. This study suggests that the more difficult situation pertaining to staying at home is experienced by care recipients who received distance care, and support is required.
RACIAL AND ETHNIC DIFFERENCES IN HEALTH OF SPOUSES OF COGNITIVELY IMPAIRED OLDER ADULTS
Authors: Cantu Phillip , Samper-Ternent Rafael , Chen Lu
Published: December 2022

Introduction

A large body of research in the U.S. shows that non-Hispanic black (black) and Hispanic older adults have higher rates of cognitive impairment and dementia compared to Whites. Little research has examined how cognitive life courses differentially affect spouses of cognitively impaired older adults.

Objectives

This paper will describe the different life courses of spouses of cognitively impaired older adults by race and ethnicity in the U.S.

Methods

Using data from the 2010 Health and Retirement Survey, we examine differences in the health of spousal dyads where one partner becomes cognitively impaired over follow up, by 2016. Spousal dyads are limited to Hispanic (n=464 dyads), i black (n=345 dyads), or white (n=2,409 dyads) couples who were both cognitively normal at baseline and had cognition information at follow up.

Results

Hispanic and Black dyads were more likely to have at least one partner become cognitively impaired over the follow up period despite being younger than White dyads. A total of 23% of Hispanic dyads, 26% of Black dyads and 16% of White dyads were N/CI at follow up. Despite fewer chronic conditions at baseline, a higher proportion of Hispanic dyads with no chronic conditions had at least one member become cognitively impaired (20%) compared to Whites (6.28%).

Conclusion

Our results show that health of couples changes differently by race and ethnicity. A higher proportion of Hispanic and Black dyads have partners with cognitive impairment and the cognitive impairment happens earlier in life.
LONGITUDINAL CHANGE IN LIVING ARRANGEMENTS AND COGNITIVE IMPAIRMENT
Authors: Kim Jiwon , Cantu Phillip , Angel Jacqueline
Published: December 2022

Objective

To examine changes in living arrangements and cognition in the U.S. and Mexico.

Methods

Latent class analysis to document the joint progression of cognitive impairment and changes in living arrangements using the Hispanic -EPESE and the Mexican Health and Aging Study (MHAS)

Results

In the H-EPESE, vital status analyses reveal that those who died were more likely than survivors to report likely dementia and co-morbid physical conditions and one third of older adults lived alone. Almost one-fifth of the H-EPESE sample suffered a decline in cognition over time. Despite declines in cognitive function, there is a great deal of stability in living alone across waves. We expect even greater stability and change in living alone in the event of cognitive decline in the MHAS given cultural traditions and fewer options in care and a lower propensity to live alone in Mexico.
MHEALTH DESIGN AND IMPLEMENTATION IMPLICATIONS TO PROMOTE PHYSICAL ACTIVITY IN OLDER HISPANICS/LATINOS WITH MCI
Authors: Perez G Adriana
Published: December 2022

Addressing physical inactivity for older Hispanics/Latinos with mild cognitive impairment (MCI) is a public health priority, since MCI increases the risk of developing Alzheimer’s Disease and related dementias (ADRD). Compared to non-Latino Whites, Hispanics/Latinos are 2X more likely to develop ADRD. One promising approach to promoting physical activity includes use of mobile health (mHealth) strategies that may deliver Spanish-language information and culturally relevant motivational messages to enhance intrapersonal/interpersonal factors for health behavior change. The purpose of this study is to test mHealth strategies as a mechanism to deliver booster sessions for reinforcing physical activity goals/progress among older Latinos with MCI who complete the Tiempos Juntos intervention treatment. Our hypothesis is that culturally adapting mHealth strategies may improve efficacy and maintenance of physical activity effect; as well as cognitive health outcomes (6 months post-intervention). Results among the first wave of participants will be discussed, including challenges and opportunities for future research. While the use of mHealth is not new, these approaches commonly exclude individuals with limited-English proficiency and thus, designing interventions that center the needs of older Hispanics/Latinos with MCI/ADRD and other historically excluded communities, is an important first step in promoting physical activity and advancing cognitive health equity.
LIFE EVENTS AND CARDIOVASCULAR DISEASE EVENTS: THE STUDY OF WOMEN'S HEALTH ACROSS THE NATION
Authors: Koffer Rachel , Thurston Rebecca , Matthews Karen
Published: December 2022

Cardiovascular disease (CVD) is the number one cause of death for women, and major life events across midlife may contribute to CVD risk. The present study aimed to test whether greater exposure to major life events across nearly two decades of longitudinal follow-up would be associated with higher risk of clinical cardiovascular disease events. 3,222 middle-aged women from the multi-ethnic Study of Women’s Health Across the Nation reported and provided up to 15 years of major life events, non-fatal incident CVD events, traditional biobehavioral and sociodemographic factors, and death certificates. Cox proportional hazards models were used to test the association between average annual life events and incident fatal and nonfatal CVD events. Each additional major life event was associated with a 1.16-fold (95% CI: 1.08-1.23) increase in CVD events. CVD risk will be discussed considering evidence of racial/ethnic disparities in exposure to major life events.
PREDICTIVE MODEL OF 30-DAY HOSPITAL READMISSION FOR PATIENTS WITH ALZHEIMER’S DISEASE
Authors: Mahmoudi Elham , Najarian Cyrus , Wu Wenbo , Aikens James , Bynum Julie
Published: December 2022

Hospitals are insufficiently equipped for patients with Alzheimer’s disease and related dementia (ADRD). Thus, 30-day hospital readmission is higher and costlier among ADRD patients than the general population of older adults. Our objective was to develop a risk-assessment tool for hospitalized patients with ADRD. We used 2016-2019 electronic medical record (EMR) data from the University of Michigan health system and applied machine learning techniques to develop a readmission risk-assessment tool. We identified 2,899 individuals with ADRD who had at least one index hospital admission. All data features available in EMR – demographics, lab results, prior counts of healthcare use, and characteristics of index hospitalization – were included in our predictive models. Additionally, we geocoded the street address of patients using the National Neighborhood Data Archive using the U.S. Census tract-level information to include two composite measures of socioeconomic status: disadvantage and affluence. The readmission rate for ADRD patients was 22% versus 17% for the general population. The best predictive model was the Random Forest (area under the receiver operating characteristic curve=0.66; sensitivity=0.64; specificity=0.61). The accuracy of our model (0.61) was 42% higher than the LACE score (0.43), which is currently used by the hospital for all patients. The top 5 predictors of 30-day readmission among people with ADRD included length of hospital stay, frailty index, living in a disadvantaged neighborhood, and total prior-year healthcare charges. Our risk-assessment tool identifies ADRD patients at high risk of readmission and why they are at higher risk. The tool enables better decision-making before discharge.
THE INCREMENTAL EFFECTS OF DEMENTIA ON HEALTHCARE USE AND ECONOMIC STATUS IN THE US: A QUASI-EXPERIMENTAL APPROACH
Authors: Choi HwaJung , Langa Kenneth , Norton Edward , Cho Tsai-Chin , Connell Cathleen
Published: December 2022

This research is to assess the impact of dementia on healthcare use and economic status over the course of dementia. We used a nationally representative, longitudinal study of older adults, specifying two propensity-score matched samples: 1) 3,476 adults aged 55+ at baseline who would have dementia in two years (hereafter “dementia group”), and 2) 3,476 adults who had never transitioned to dementia but had similar baseline sociodemographic and health status (hereafter “control group”). In two-year follow-up, the total care hours from unpaid helpers (44 hours per month vs. 20) and other in-home medical care (24% vs. 15%) were substantially higher with vs. without dementia. In the dementia group, the percentage of using nursing homes increased from 4% at the baseline to 27% at 8-year follow-up, compared to the increase from 3% to 10% in the control group. There was little change in OOP costs in the control group but a substantial increase in the dementia group over time (from $4,443 at baseline to $11,806 in an 8-year follow-up). The percent having Medicaid increased from 17% at baseline to 33% in 8-year follow-up in the dementia group. By using a quasi-experimental approach with longitudinal data, the study clarifies the incremental effects of dementia on health care and economic status. The effects of dementia on both home-based and facility-based care are substantial, with major changes occurring at the onset. Dementia exacerbated financial resources with increasing OOP medical costs, which may have profound impacts on families and society.
PALLIATIVE CARE FOR NURSING HOME RESIDENTS: APPLYING LESSONS LEARNED FROM COVID-19
Authors: Unroe Kathleen
Published: December 2022

Many people receive care near or at the end of life in nursing homes, including 70% of people with Alzheimer’s Disease and Related Dementias (ADRD). Studies have documented unmet needs for symptom management and frequent transitions of care for nursing home residents. Despite this, access to palliative care for nursing home residents is inconsistent. The COVID-19 pandemic both highlighted and exacerbated inequities in access to care, including in US-based nursing homes, as well as globally. COVID-19 specific guidance for nursing homes at state and federal levels, while designed to protect residents, contributed to increased social isolation and functional decline. Drawing upon data from an ongoing study to advance palliative care for residents living with ADRD, this presentation will highlight promising practices and opportunities to deliver palliative care in this setting.
CAUSAL ANALYSES OF PALLIATIVE CARE OUTCOMES USING OBSERVATIONAL DATA: A REVIEW OF CURRENT LITERATURE
Authors: Kim Narae , Jiang Jingjing , Garrido Melissa , Jacobson Mireille , Mockler David , May Peter
Published: December 2022

People with serious medical illnesses disproportionately account for health care spending, and the last year of life is typically the most costly. Economic evidence to inform improvement efforts in care for this population is long recognized as thin relative to policy importance. Palliative care studies rely heavily on routinely collected data since conducting randomized controlled trials with subjects nearing the end of life is particularly challenging; however, observational studies face high risk of bias. We conducted a systematic review of the peer-reviewed and grey literature to identify quasi-experimental studies evaluating palliative care’s effect on costs and health care utilization. Eligible study designs were those that controlled for unobserved confounding using causal inference methods (e.g. difference-in-differences). Eligible outcomes were costs, health care use, and quality-of-life. Among 806 search results, we included 17 studies: seven used difference-in-differences methods, five used interrupted time series analysis, and five used instrumental variables. Reporting quality was variable. Studies reported a general pattern of improved outcomes associated with palliative care. However, the incidence of studies finding a significant difference was lower than cohort studies that don’t attempt to control for unobserved confounding. Studies that don’t control for unobserved confounding may be overestimating true effects due to bias. Given the large volume of routine data collection in end-of-life care, there exists clear potential to increase the application of the causal inference methods to palliative care research. Such studies would strengthen the evidence base on an understudied topic and potentially inform other types of economic analysis in palliative care.
PROFILE OF DECEDENTS FROM A NATIONAL COHORT OF ASSISTED LIVING RESIDENTS
Authors: Belanger Emma , Rosendaal Nicole , Wang Xiao (Joyce) , Teno Joan , Gozalo Pedro , Dosa David , Thomas Kali
Published: December 2022

An increasing number of older adults reside in assisted living (AL) toward the end of life, and it remains unclear if this trend represents an additional place of care and end-of-life transition before eventual nursing home admission. Our objective was to examine the characteristics and healthcare utilization of AL residents who died during a two-year follow-up. We conducted a prospective cohort study of Medicare beneficiaries residing in large AL communities (25+ beds) in January 2017, and followed them until the end of 2018 using a variety of administrative healthcare claims data. The national population of Medicare beneficiaries in AL included 273,722 fee-for-service (FFS) beneficiaries, and 143,258 Medicare Advantage beneficiaries. From 2017 to the end of 2018, 23.7% of residents died. Of the 66,605 FFS Medicare beneficiaries who died during follow-up, 77.0% were 85 years old or older, 72.2% were diagnosed with Alzheimer’s disease and related dementia (ADRD) and 80.8% were diagnosed with heart failure or chronic obstructive pulmonary disease. Most FFS decedents (97.3%) resided in AL during their last 12 months of life, with 23.0% leaving AL before the last month of life. Half of FFS decedents died in AL, while another 24.1% died in a nursing home. AL communities represent an increasingly common place of end-of-life care for dying Medicare beneficiaries. These findings point to the need for state and federal policies to protect a growing population of frail and vulnerable AL residents.
THE EXPERIENCES OF OLDER PEOPLE IN ENGLAND DURING THE COVID-19 PANDEMIC: EVIDENCE FROM ELSA
Authors: Zaninotto Paola
Published: December 2022

In this session we will present results from the English Longitudinal Study of Ageing (ELSA) Covid-19 substudy. Data were collected during the pandemic at two separate occasions to capture the experiences of older people and to compare them to pre-covid periods. The session will include results among people with cognitive impairment, people who contracted infections and explore the consequences on their mental health, well-being and health in general
UNDERSTANDING SOCIAL AND CULTURAL DIVERSITIES AND AGING FOR HEALTH AND WELL-BEING IN KOREAN AND KOREAN AMERICANS
Authors: Hong Seunghye , Hong Michin , Braun Kathryn
Published: December 2022

Guided by the socio-ecological model and the cultural diversity perspective, this symposium aims to enhance the understanding of critical issues in health and well-being among Koreans and Korean Americans with three primary focuses: aging, social-ecological and multilevel factors, and identifying social and cultural contexts. Five studies examined multilevel factors—individual, relational/interpersonal, community, and societal—that are associated with health and well-being, conducted in Korea as well as in the United States. Study 1 examined psychological well-being among older Koreans, specifically its association with intergenerational relationships and social support using longitudinal multilevel modeling to estimate depression trajectories. Study 2 examined childhood experiences and midlife cultural engagement associations among middle-aged Korean couples, considering the influences of their spouses’ experiences and cultural resources. Study 3 explored the experiences of the nature-based virtual reality program among older Korean Americans, using in-depth interviews and providing an innovative approach using technology as a therapeutic tool. Study 4 examined social determinants of health associated with Korean American immigrants’ willingness for end-of-life discussions and the factors affecting willingness (awareness of hospice, communication with family/doctors, and social isolation). Study 5 examined health insurance coverage and its association with immigration-related factors (English proficiency, generational status, and age at immigration) among Korean Americans using national data. The various health, mental health, and well-being issues in Koreans and Korean Americans will be discussed from contextually responsive approaches. This symposium will provide implications for practices, education, research, and policy to promote health, mental health, and well-being in the Korean and Korean American populations.
HEALTH INSURANCE COVERAGE, AGE, AND IMMIGRATION-RELATED FACTORS AMONG KOREAN AMERICANS
Authors: Hong Seunghye , Park Ki Tae , Lee Yeonjung , Park Mei Linn , Park Nan Sook
Published: December 2022

The purpose of this study was to examine health insurance coverage and its association with demographic and immigration-related factors (English proficiency, generational status, and age at immigration) among Korean Americans (KAs, n=11,462). Data were drawn from the 2017 American Community Survey. KA older adults aged 65+ had significantly higher odds of having any health insurance compared to those aged 41 to 64. KAs who speak English well or only speak English were more likely to have any health insurance compared to those with limited English proficiency (i.e., don’t speak English well or at all). First-generation KAs had lower odds of having any health insurance compared to those born in the U.S. Those who immigrated after 41 years of age were less likely to have health insurance compared to those born in the U.S. These findings underscore the need to consider immigration-related factors in efforts to increase healthcare accessibility for KAs.