bluuebunny/crossref_metadata_2025 huggingface dataset:
CONFIDENCE IN HEALTH INSURANCE AFFORDABILITY AND DELAYED OR FORGONE HEALTH CARE AMONG ADULTS APPROACHING RETIREMENT
Authors: Luster Jamie , Tipirneni Renuka , Solway Erica , Malani Preeti , Kullgren Jeffrey , Kirch Matthias A , Singer Dianne , Scherer Aaron M
Published: November 2019

Recent challenges to the ACA may add uncertainties to decision-making about health insurance. We sought to determine if health insurance affordability concerns were associated with delayed/forgone health care among adults approaching retirement age. In October 2018, the NPHA conducted an online survey of US adults age 50-64. 45% of respondents had little/no confidence in ability to afford health insurance when they retire, and 27% little/no confidence in this over the next year. In the past year, 13% had not gotten medical care and 12% had not filled a prescription because of cost concerns. Controlling for demographic and health characteristics, having little/no confidence in health insurance affordability in retirement/within the next year was associated with delaying/forgoing health care (aOR 2.80, p<0.001). Despite the ACA’s coverage expansions and consumer protections, these findings suggest adults worry about the affordability of health insurance in retirement and may avoid needed health care for that reason.
OPTIMAL MEDICATION MANAGEMENT IN ALZHEIMER’S DISEASE AND DEMENTIA
Authors: Green Ariel
Published: November 2019

For older individuals with Alzheimer’s disease and related dementias (ADRD) and multiple chronic conditions (MCC), taking more medications is associated with greater risk of adverse drug events, drug interactions, treatment burden, and cognitive changes from medication side effects. Optimizing medication through deprescribing (the process of reducing or stopping the use of inappropriate medications or medications unlikely to be beneficial) can help avoid adverse drug effects and improve outcomes for MCC patients, particularly for those with ADRD. Findings to date are limited to primarily Caucasian patients. This talk will focus on work geared to elicit perspectives on medication use, communication about medication, and deprescribing among African American and Hispanic older adults with ADRD and MCC, their family members, and clinicians caring for these populations.
USE OF NEW HEPATITIS C DRUGS IN MEDICARE: PERSISTENT URBAN-RURAL DISPARITIES AND POTENTIAL INTERVENTIONS
Authors: Du Ping
Published: November 2019

Chronic hepatitis C virus (HCV) infection, whose prevalence is concentrated among older adults, can bring serious health impacts and high financial burden. With the availability of highly effective and well tolerated direct-acting antiviral (DAA) therapy, treatment of chronic HCV infection has rapidly evolved, making HCV treatment less burdensome. However, the high cost of DAA and lack of clinical expertise are still important barriers for providing DAA therapy to rural patients, highlighting the urban-rural disparities in managing many chronic diseases for aging populations. Telehealth could serve as effective care-model to improve management of HCV infection for older, rural populations. This talk will present work that examines multi-level factors affecting HCV DAA treatment (focusing on urban-rural disparities), evaluates changes in urban-rural disparities in DAA utilization over time, and explores the role of a telehealth-based intervention in reducing urban-rural disparities in HCV DAA treatment in Medicare patients.
INTERNET USE AND LONELINESS: CURE OR CAUSE? LONGITUDINAL ANALYSIS OF OLDER ADULTS’ INTERNET USE
Authors: Hees Elena , Tesch-Römer Clemens , Huxhold Oliver
Published: November 2019

The internet provides an indispensable platform for social interaction, entertainment and everyday tasks. Especially older adults might benefit from staying engaged online to counteract loneliness. Yet, current research on how internet use effects loneliness still paints a contradictory picture. The current study investigates the longitudinal influence of social internet use forms as opposed to general internet use on loneliness across three years (2014-2017) separately in two age groups (pre-retirement: 40-64 years and post-retirement: 65-85 years), using data from the German Ageing Survey (DEAS). Structural equation modelling shows, that general web use predicts an increase in loneliness in both age-groups. However, contacting friends and family online seems to protect against loneliness over and above the effect of overall internet use, at least for the younger age-group. Therefore, the current study underlines the importance of investigating what exactly people do online instead of seeing the internet as a homogenous tool.
SOCIAL ENGAGEMENT THROUGH VIDEO CHAT FOR OLDER INDIVIDUALS WITH AND WITHOUT COGNITIVE IMPAIRMENT
Authors: Rogers Wendy , Nie Qiong , Nguyen Lydia , Mudar Raksha , Myers Dillon , Gibson Alan , Kerssens Chantal
Published: November 2019

Social engagement is a fundamental component of health and quality-of-life outcomes. However, there is a prevailing view that older adults primarily want to engage socially with current family and friends – that they are not interested in developing new relationships. That is an overgeneralization. We have found that older adults are interested in the opportunity to engage in social interactions with people who have shared interests. Technology can facilitate these interactions. We will describe our research with OneClick.chat, a web-based video chat system. We explored potential benefits of use by adults aged 70-85, including those with mild cognitive impairment (MCI), as well as barriers and facilitators to adoption. Participants saw value of this online social engagement platform and were able to use it with some initial training. They envisioned using OneClick not only for conversations but also for learning and doing activities with like-minded individuals.
ONDRI: A PROVINCIAL INITIATIVE TO UNDERSTAND THE HEALTH SYSTEM IMPACT OF AGING AND NEURODEGENERATIVE DISEASES
Authors: Bronskill Susan E , Maxwell Colleen J , Jette Nathalie
Published: November 2019

As populations worldwide are living longer, the impact of neurodegenerative diseases on health resource utilization is expected to increase. Providing care to older adults with neurodegenerative diseases is challenging, and requires adequate supports across multiple health sectors including community, acute care and nursing home settings to allow individuals to maximize their quality of life. The Ontario Neurodegenerative Disease Research Initiative (ONDRI) is a collaborative research program that aims to improve diagnosis, treatment and management of neurodegenerative diseases including Alzheimer’s disease and related dementias, Parkinson’s disease, Amyotrophic Lateral Sclerosis (ALS), and Vascular Cognitive Impairment. Using population-based linked health administrative and clinical databases--covering over 14 million individuals residing in the province of Ontario, Canada-- the ONDRI health services research platform will address knowledge gaps regarding the health service utilization and outcomes of older adults with neurodegenerative diseases and impacts on family and care partners. Access to over two decades of historical health administrative data on a large population of older individuals uniquely positions our collaborative to examine trajectories of health system use as well as rare neurodegenerative diseases which have been previously understudied. The health services research platform is embedded within a larger ONDRI network of biomedical researchers, provincial decision-makers and health system stakeholders. Our research findings will inform health system planning and interventions to support older adults to live independently in the community. This session will explore how health administrative databases may be used to address knowledge gaps regarding health service utilization and outcomes in older persons with neurodegenerative diseases.
COMORBIDITY IN NEURODEGENERATIVE DISEASES AND MENTAL HEALTH CONDITIONS: IMPLICATIONS FOR HEALTH SYSTEM BURDEN
Authors: Maxwell Colleen J , Maclagan Laura C , Marrie Ruth Ann , Mondor Luke , Wodchis Walter , Hogan David B , Bronskill Susan E
Published: November 2019

Research suggests that older adults with neurodegenerative diseases are at increased risk of developing a subsequent neurodegenerative or comorbid psychiatric disorder or both. Depression and other psychiatric conditions, though prevalent, are often under-diagnosed and under-treated among those with neurodegenerative conditions potentially leading to more rapid disease progression, poorer health outcomes and increased health care use. Few population-based studies have comprehensively examined the risk and temporal ordering of common neurodegenerative and psychiatric conditions, including whether these associations differ by age or sex. Initial findings regarding the incidence of ordered pairs of neurological conditions (including dementia, Parkinson’s disease and stroke) and psychiatric disorders (including mood and anxiety disorders, and schizophrenia) will be summarized. This population-based retrospective cohort study will provide essential data to allow policymakers, planners and providers to better anticipate the prognosis and care needs of older adults with comorbid neurodegenerative and psychiatric conditions.
CHALLENGES IN IDENTIFYING PERSONS WITH NEURODEGENERATIVE DISEASES USING HEALTH ADMINISTRATIVE DATABASES
Authors: Maclagan Laura C , Soleimani Serena , Abrahao Agessandro , Zinman Lorne , Campitelli Michael A , Jaakkimainen Liisa , Maxwell Colleen J , Bronskill Susan E
Published: November 2019

Health administrative databases can be used to quantify prevalence and incidence of neurodegenerative diseases and their impact on health service utilization outcomes at the population level. Algorithms based on diagnosis codes and health service patterns can be used to identify persons suspected to have a neurodegenerative disease. Previous studies have developed and validated algorithms to identify persons with Alzheimer’s and related dementias using primary care medical records as the reference standard, however, little previous work has focused on developing algorithms for rare neurodegenerative diseases including amyotrophic lateral sclerosis (ALS). This session will discuss challenges in developing algorithms to identify persons with neurodegenerative diseases accurately and opportunities to improve existing definitions using novel data sources including electronic medical record databases. Preliminary findings regarding the development of an ALS algorithm will be presented.
UNDERSTANDING SEX DIFFERENCES IN OLDER PERSONS WITH NEURODEGENERATIVE DISEASES
Authors: Campitelli Michael A , Maclagan Laura C , Diong Christina , Fu Longdi , Yu Amy Y , Zinman Lorne , Swartz Rick , Bronskill Susan E
Published: November 2019

Sex differences in the incidence, prevalence, and clinical presentation of neurodegenerative diseases have been previously documented, however, sex differences in how individuals with neurodegenerative diseases access the health system remain understudied. Clinical trials and observational studies often do not report data stratified by sex, which limits the understanding of sex-related differences in persons with neurodegenerative diseases. This session will highlight both opportunities and methodological challenges researchers face when undertaking sex and gender research in persons with neurodegenerative diseases using two case studies: 1) sex differences in health service utilization prior to a diagnosis of Amyotrophic Lateral Sclerosis (ALS); and 2) sex differences in care needs and survival among persons who are admitted to a nursing home after a stroke. The findings of these studies may support the development of guidelines and care plans to meet the needs of men and women with neurodegenerative disorders in varied care settings.
PRODUCTIVE AND ACTIVE RURAL AGING: TOWARD CRITICAL PERSPECTIVES
Authors: Skinner Mark , Winterton Rachel , Walsh Kieran
Published: November 2019

Despite global trends in rural population ageing, relatively little attention within research and policy has been directed to understanding what it means for rural people, communities and institutions to be at the forefront of twenty-first century demographic change. To build understanding of rural ageing, this symposium draws together papers from four countries to provide insights in the gaps in rural ageing research – specifically the in context of productive and active rural ageing by examining rural work, retirement and volunteering through the critical perspectives of citizenship, contestation and complexity. Winterton and Warburton will explore how active citizenship trends among rural older adults support or hinder the capacity of rural settings to support health ageing. Colibaba and Skinner will discuss the contestation of rural ageing by examining a volunteer-based rural library and the emergent ‘contested spaces of older voluntarism’ whereby older volunteer negotiate their rights and responsibilities associated with ageing and volunteering in rural communities. Duvvury and Ni Leime will examine the interactions between the twin phenomena of feminisation of agriculture and the feminisation of ageing in the consequent implications for rural women’s work and retirement. Skinner and Joseph offer a critical perspective on voluntarism in ageing rural communities by examining volunteer leadership biographies as another means of understanding the contribution of older rural adults.
CRITICAL PERSPECTIVES ON VOLUNTARISM IN AGING RURAL COMMUNITIES: VOLUNTEER LEADERSHIP BIOGRAPHIES
Authors: Skinner Mark , Joseph Alun
Published: November 2019

Voluntarism has been portrayed as a productive and even transformative process whereby rural communities, households and older residents are able to meet the challenges of changing rural demographics. Yet, little attention has been paid to building a critical perspective on the complex and often-contested expectations placed on older rural volunteers. This paper focuses on the particular gap in understanding the contributions of older rural adults as a crucial resource in creating opportunities for aging in place and sustainable rural community development. Drawing on research into voluntarism in Canada’s aging resource communities, this paper presents qualitative findings from innovative ‘volunteer leadership biographies’ with older residents who were involved in key voluntary sector initiatives to improve community development. The findings show how older volunteer leadership is embedded in both place (residency) and time (life course), revealing new dimensions to the problem of understanding volunteer leadership in an era of rural population change.
RURAL LIBRARIES AS CONTESTED SPACES OF OLDER VOLUNTARISM IN AGING RURAL COMMUNITIES
Authors: Colibaba Amber , Skinner Mark
Published: November 2019

Recent efforts to better understand voluntarism as fundamental to how rural communities are meeting the challenges of population ageing have highlighted ageing rural volunteers, and the attendant burden of older voluntarism, as key issues for ageing in place of rural residents and ageing rural community sustainability. Drawing on a case study of a volunteer-based rural library in Ontario, Canada, this study examines the experiences of older volunteers, the challenges of sustaining volunteer programs, and the implications of older voluntarism for rural community development. Findings from interviews and focus groups with library volunteers, staff, board members and community stakeholders demonstrate how the experiences of older volunteers and challenges of older voluntarism affect rural community development. The results reveal how participation, well-being, conflict and territoriality associated with older voluntarism contributes to ‘contested spaces of older voluntarism’ whereby older volunteers negotiate their rights and responsibilities associated with ageing and volunteering in rural communities.
RURAL WOMEN AND AGING: IMPLICATIONS FOR WORK AND RETIREMENT OF OLDER WOMEN
Authors: Leime Aine Ni , Duvvury Nata , Watson Tanya
Published: November 2019

At least half of the world’s female population live in rural areas, and many are ageing. For these rural women, agriculture and informal rural livelihoods are the primary sources of employment, posing critical challenges for them with regard to work and retirement. This paper focuses on the interaction between the twin phenomena of the feminisation of agriculture and the feminisation of ageing and the consequent implications for rural women’s work and retirement. Drawing on qualitative interviews and focus groups with 48 older rural Irish women, the paper establishes the ‘invisibility’ of women’s economic contribution in agriculture, limiting their pension accumulation and constraining their retirement planning. The study found that even women property owners, and designated ‘farmers’, had uncertainty about their pension or retirement income. A key conclusion is that rural women’s pension rights are still not guaranteed posing increased risk of economic insecurity and wellbeing for older rural women.
PROGRAM CHARACTERISTICS ASSOCIATED WITH REDUCED FEAR OF FALLING: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RCTS
Authors: Kruisbrink Marlot , Delbaere Kim , Kempen Gertrudis , Crutzen Rik , Rixt Zijlstra G A
Published: November 2019

Fear of falling (FOF) is common among older people and can result in activity avoidance and decreased physical functioning. Different types of interventions have demonstrated significant small reductions in FOF. To optimize effect sizes, we sought to identify characteristics of interventions that were associated with a change in FOF. Five scientific databases were searched for articles using randomized controlled trial designs in community-dwelling older people without medical conditions. Data extraction included intervention type, setting, group format, type of supervision, provider, delivery format, duration, number of sessions, contact time, and risk of bias (assessed with the Cochrane Collaboration’s Risk of Bias Tool). After screening of titles, abstracts, and full texts, 55 unique studies – reporting on 68 interventions – were systematically reviewed. The majority of interventions focused on exercise (n=50). Interventions were performed at home (n=21) or in a community setting (n=23), were delivered in a group (n=26) or individual (n=30) format, and were often supervised (n=60) and delivered face-to-face (n=56). Duration ranged from 1 to 52 weeks and total contact time with the provider from 2 to 56 hours. Results of 42 interventions were suitable for meta-analysis. Univariate meta-regressions to evaluate associations between intervention characteristics and intervention effects directly after the intervention yielded no significant results. Due to self-reported outcomes and difficulties with blinding, risk of bias was high in all studies. To conclude, intervention characteristics were not associated with changes in FOF in this study. Possible reasons for an absence of associations and future research directions will be discussed.
ASSOCIATIONS OF PAIN INTENSITY WITH SEDENTARY BEHAVIOR AND PHYSICAL ACTIVITY IN OLDER ADULTS
Authors: Patel Kushang , LaCroix Andrea , Crane Paul , Walker Rod L , Richmire KatieRose , Larson Eric B , Rosenberg Dori E
Published: November 2019

Exercise is recommended for several painful, age-associated conditions; however, relationships between pain intensity and objectively measured sedentary behavior and physical activity have not been investigated in older adults. Accordingly, we analyzed cross-sectional data on 936 older adults in the ACT Study who self-reported their pain intensity on a 0-10 rating scale (0=no pain; 1-3=mild pain; and 4-10=moderate/severe pain) and wore an activPAL accelerometer. A total of 181 (19.3%) reported no pain, while 564 (60.3%) and 191 (20.4%) reported mild and moderate/severe pain, respectively. Linear regression models adjusted for age and sex estimated that compared to those with no pain, participants with moderate/severe pain walked significantly fewer steps/day (b-coefficient=-778 [95%CI: -1377, -179]) and had fewer sit-to-stand transitions/day (b-coefficient=-2.9 [95%CI: -5.6, -0.1]). In contrast, there were no significant differences in these outcomes comparing no pain versus mild pain. Future research will examine effects of pain treatments (opioids) and diagnoses on accelerometer-measured outcomes.
A BELGIAN VIEW ON BEING RETIRED BUT NOT OUT OF WORK
Authors: Dury Sarah
Published: November 2019

Retirement is no longer merely the end of a productive life. This changing nature of retirement challenges the common definitions of retirement – that define retirement primarily by what it is not (i.e. no longer working). The aim of this paper is to gain insight into the activity patterns of individuals who recently retired from a full-time job in relation with their well-being. We use data from a qualitative study in which we conducted semi-structured interviews with 45 individuals who retired one to two years ago in Belgium. We used a hybrid approach of inductive and deductive thematic analysis. Our findings demonstrate that most of the people who are retired from their full-time job remain active within society. First, productive activities, including work and civic engagement. Second, consumer-oriented activities comprising leisure and social contacts. The results suggest that being active, regardless of the type of activity, contributes to well-being.
PRIVATE PARTS: AGING, AI, AND THE ETHICS OF CONSENT IN SUBSCRIPTION-BASED ECONOMIES
Authors: Sawchuk Kim
Published: November 2019

This paper explores Artificial Intelligence (AI) as a technological design offered to assist elder-care based on tracking individual behavior amassed in data bases that are given predictive value through algorithm-identified normative patterns. Examples are drawn from ethnographic research conducted at the 2019 Consumer Electronics Show, including document analysis of product promotions and interviews conducted with company representatives, supplemented by interviews with older adults. The paper focuses on the ethical dilemmas of privacy, security, consent, and identity in home surveillance systems and financialization of personal data in AI subscription-based services. Theoretically the argument, informed by recent discussions on the datafication of self and quantified aging, emphasizes that such a subscription-based economy exploits older individuals by sharing their lifestyle profiles, health information, economic status, and consumer preferences within powerful corporate networks such as Google and Amazon. Conclusions question how the promise of AI is being tied to the future of population aging.
THE RISE OF ROBOT PETS AND DISCOURSES OF TECHNO-COMPANIONSHIP IN LATER LIFE
Authors: Lafontaine Constance
Published: November 2019

Robot pets of varying degrees of sophistication are advertised as ideal companions for older adults, with claims that they support their emotional and cognitive needs. A new generation of robot pets (e.g., Lovot) is emerging equipped with internet connections, recognition software, surveillance capacity, and AI platforms to mimic desired aspects of animal-human relationships. This paper draws upon promotional materials gathered at the Consumer Electronics Show 2019 and interviews with robot designers, to probe what the robotization of human-animal relationships tells us about shifting notions of companionship through the life course. The argument is that robot pets are inscribed within discourses that instrumentalize human-animal-technology entanglements and position digital technologies as idealized solutions to perceived age-related problems. Theoretical ideas from animals studies add a creative dimension to aging studies to explore what the societal enthusiasm for robot pets reveals about our understanding of the lived material and relational worlds of older adults.
REPRESENTATIONS OF OLD AGE IN THE CONSUMER ELECTRONICS WORLD
Authors: Ardèvol Mireia Fernández
Published: November 2019

This paper examines representations of old age at the Consumer Electronics Show 2019, identifying how explicit product discourses identify later life with Fourth Age dependency, fragility, decline, and care, as is the case with the home and companion-robot industry. While designers take a Fourth Age approach to the ‘senior market’, they liken their products with those for children, as both old and young are stereotyped as requiring surveillance based on their assumed weaknesses. Thus the technological depictions of old age neglect the diversities of older populations and reinforce dominant ageist and homogenizing narratives about older life as disempowering, passive, and digitally divided. Conclusions question why technological design aimed at helping older individuals are uninformed and misconceived about the realities of later life and what recommendations may be offered to resolve this resulting ageism.
ADULT-LIFE OCCUPATIONAL EXPOSURES: ENRICHED ENVIRONMENT OR A STRESSOR FOR THE AGING BRAIN?
Authors: Burzynska Agnieszka Z
Published: November 2019

The positive association between midlife occupational complexity and cognitive functioning in older age is well documented. Much less is known about the underlying neural mechanisms and whether occupational stress may accelerate neurocognitive aging. According to the BOSS model (Brain aging: Occupational Stimulation and Stress), occupational exposures may serve as long-term protective and risk factors that influence the rate and extent of neurocognitive decline in aging (Burzynska, Jiao & Ganster 2018). We present findings from three independent samples linking different occupational exposures (e.g. work physical demands, innovation, autonomy, employer control) with brain volume in cognitively healthy older adults. We discuss the findings in the context of cognitive reserve and brain maintenance. Our findings suggest that occupational activities need to be acknowledged as an important factor in lifespan cognitive and brain development and warrant further research, with a possible outcome of workplace interventions aimed at optimizing neurocognitive aging.
DOING AGING IN PLACE IN AN AGE-FRIENDLY CITY: AN APERTURE TO THE LIVED EXPERIENCES OF OLDER SAN FRANCISCANS
Authors: Yeh Jarmin C
Published: November 2019

Aging in place finds meaning through the quotidian. The mundanity of this work is the crux of its poignancy. This phenomenological study utilizes photovoice to explore how older adults manage to age in place in an age-friendly city. By interrogating micro- and macro-level realities, this study elicits the strategies seventeen informants use, including how their multiple identities and positionalities become implicated in the process of negotiating and navigating everyday environs, their acts of resistance and resilience, their articulations of hope or pressure to manage the future, as well as the risks and opportunities they encounter and the conditions shaping them, such as urbanization, discrimination, and distribution of resources between generations and groups. To "see" how informants do the “doing” of aging in place has implications for age-friendly community initiatives. It helps to capture the sociality of aging and demonstrates the way the materiality of inequality is sown through lived experience.
THE COURSE OF DEPRESSIVE SYMPTOMS IN OLDER ADULTS RECEIVING IN-HOME CARE
Authors: Helvik Anne-Sofie , Barca maria , Bergh Sverre , Šaltytė –Benth Jūratė , Borza Tom
Published: November 2019

The aim of the study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older people receiving in-home care, and to explore the association between cognitive function and the course of depressive symptoms. In all, 1001 older people (≥ 70 years) receiving in-home care were included in a longitudinal study over 36 months. Depressive symptoms, cognitive function, general medical health, activities of daily living, neuropsychiatric symptoms and use psychotropic drugs were assessed at three assessments. Dementia and mild cognitive impairment were diagnosed at all assessments. Baseline demographic characteristics and information on nursing home residency at follow-up were recorded. Linear mixed models were estimated. We found the prevalence and cumulative incidence of individual depressive symptoms to be higher in those with dementia at baseline than in those without. The persistence of depressive symptoms did not differ between those with or without dementia at baseline. The severity of cognitive decline and mean depressive symptom score assessed simultaneously were positively associated, but the strength of the association changed over time and was not significant at the last assessment. In conclusion: The differences in prevalence and cumulative incidence of depressive symptoms in those with and without dementia at baseline, and the association found between degree of cognitive decline and depressive symptoms over time shows that depression and dementia are interconnected. Nurses and clinicians should pay attention to cognitive status when observing or evaluating depression among older people receiving in-home care.
STRESS AND PSYCHOLOGICAL CHARACTERISTICS PREDICT CLUSTERED HEALTH TRAJECTORIES IN OLDER ADULTS
Authors: Thoma Myriam V , Höltge Jan , Gee Shauna L Mc , Maercker Andreas , Augsburger Mareike
Published: November 2019

The first aim of this study was the empirical identification of clustered health trajectories in older individuals, including an expected, more favorable or successful aging (SA) trajectory. The second aim was the identification and analysis of determinants useful for subgroup membership prediction. Particular focus was on early-life and chronic stress, as well as on a broad set of psychological characteristics, such as resilience, personality traits and general affect. A longitudinal survey study with two assessments one year apart has been conducted with older adults (N=224; mean age = 68 years; 72% women). The clustered health trajectories were identified using a longitudinal variant of k-means. For the prediction of subgroup allocation, random forests with conditional interferences were used. The applied machine learning-based approach revealed two latent clustered health trajectories: a ‘constant high health’ (66% of the sample) and a ‘maintaining low health’ trajectory (34%). Chronic stress and positive affect were found to be the most important predictors. Further predictors and their interactions were found to be important for predicting subgroup belonging, including resilience, self-esteem, social support, optimism, as well as negative affect and pessimism. Also, childhood adversities have to be included to predict subgroup belonging. With this study, we were able to show that individuals can be empirically allocated to two separate joint health trajectories in later life over the observation period of one year. In order to understand the current heterogeneity in health in older age, previous and current stress exposure and psychological characteristics have to be taken into account.
EFFECTS OF ENVIRONMENTAL FACTORS ON THE INCIDENCE OF DEPRESSION IN OLDER ADULTS IN TAIWAN: A MULTI-LEVEL ANALYSIS
Authors: Li Chia Chun , Li Der-Chiang , Hu Susan C
Published: November 2019

Depression is a common mental disorder worldwide, and also a leading cause of disability and global burden of disease. The risk factors of depression are multi-facets; however, past studies have focused more on individual factors than ecological factors. This study aims to use a health map framework with multi-level analysis to analyze the effects of environmental factors on the incidence of depression of older adults in Taiwan. We connected 3 national datasets, including the National Health Interview Survey (NHIS), Age-friendly Dataset at city-level, and the National Health Insurance Research Databases (NHRID), to examine the relationship between environmental factors and the incidence of depression in Taiwan. The dependent variable was the new cases of depression in older adults during 2010-2016. The study variables were environment factors including 5 build environments and 8 social environments. A total of 6494 valid participants aged 50 and over were recruited from the 2009 NHIS and were followed up to 2016. There were 292 (4.5%) new incident cases of depression during 2010-2016. Results of multi-level analysis showed that only one built environment (no. of heritage sites) was associated with the incidence of depression. No social factors was found significantly in the study. It seems that factors of individual-level appear more important than that of ecological-level as the determinants of depression. Results of this study could provide an exploratory information for future research regarding the relationships between depression and environments.
RACIAL RESIDENTIAL SEGREGATION AND COGNITIVE DECLINE AMONG OLDER ADULTS
Authors: Jang Joy Bohyun , Hicken Margaret T , Clarke Philippa J , Sol Ketlyne , Melendez Robert , Kim Min Hee , Mullins Megan , Judd Suzanne
Published: November 2019

Racial residential segregation may be a fundamental cause of health disparities in the U.S., and few studies employ objective measures of segregation to estimate its impacts on cognitive decline. Using data from 21,446 REGARDS participants in urban areas, we employed race-stratified growth curve models to examine how city racial segregation was associated with trajectories of cognitive decline over time. Controlling for demographics and health conditions/behaviors, higher segregation for blacks was marginally associated with lower cognitive function at baseline (b=-0.159, p<.10) while higher segregation for whites was associated with better cognitive function (b=0.158, p<.01). For both blacks and whites, there were no significant associations between segregation and rate of cognitive decline but neighborhood poverty was adversely related to cognitive function (b=-0.171, p<.01 for blacks, b=-0.289, p<.001 for whites). Further research into mechanisms that contributes to heterogeneity in associations between racial segregation and cognitive function is needed to develop effective prevention interventions.
WALKING THE TALK: ENGAGING PATIENTS AND CAREGIVERS AS COLLABORATORS IN PALLIATIVE CARE RESEARCH
Authors: Rahman Anna N , Enguidanos Susan
Published: November 2019

Palliative care is inherently patient directed and family oriented. Given this, it is especially important that patients and caregivers participate in developing new services intended to meet their needs. Our experience with conducting a controlled trial of home-based palliative care demonstrates this point. This poster will describe the implementation and dissemination decisions that patient and caregiver stakeholders guided during a comparative effectiveness trial of palliative care. It also will present strategies for engaging stakeholders and identify the impact of these strategies on continuous study improvement. For the study, we convened an advisory committee (AC), which included eight patients and caregivers among its 34 members. These eight partners in particular helped us identify meaningful patient- and caregiver-reported outcome measures, Throughout the study’s 2.5-year period, they offered suggestions that influenced the tone and topics addressed in quarterly AC meetings. They also helped refine the study’s patient and caregiver assessment instruments by roleplaying with our research assistants. When we launched a Google group to promote discussion among AC members, patient and caregiver stakeholders were especially forthcoming. They identified gaps in care and consumer understanding of palliative care that we otherwise would have overlooked. Of note, our stakeholders provided input on how to best to introduce a new palliative care program to patients. These engagement strategies create feedback loops that open new opportunities for continuously improving research. Moreover, engagement of patients and caregivers in research planning and implementation provides important and otherwise overlooked perspectives while ensuring a patient-centered focus, consistent with palliative care goals.
LIFE RESTORATION AND CARE PREPARATION AMONG OLDER PARENTS WHO LOST THEIR ONLY ADULT CHILD IN SHANGHAI
Authors: Chen Lin , Song Yajun , You Yixin
Published: November 2019

The combination of aging and losing an only adult child challenges an increasing number of older adults in China. Current literature primarily focuses on older parents’ bereavement but seldom examines how they restore their lives. Guided by the Dual Process Model, this study explores how older parents who lost their only adult child restore their lives and prepare for future care in Shanghai. Twenty-four older adults were purposively sampled and participated in face-to-face, in-depth interviews. The findings suggest that participants tried to restore their lives by rationalizing grief and expanding their social networks. Despite their losses, participants remained in favor of family caregiving and reluctantly prepared for future care. They showed ambivalent attitudes toward current government support while proposing their preferred services. This study informs social work practice to incorporate caregiving plan services and emotional support for this vulnerable group.
NAVIGATING DISASTERS: A CASE STUDY VA AND NON-VA HOME-BASED LONG-TERM CARE IN PUERTO RICO FOLLOWING HURRICANE MARIA
Authors: Haverhals Leah M , Hernandez-Lujan Deisy
Published: November 2019

This research describes how Department of Veterans Affairs (VA) and non-VA home-based long-term care (LTC) environments prepared for and secured the safety and wellbeing of elderly and disabled persons in the wake of Hurricane Maria, which struck Puerto Rico on September 20, 2017. In-person interviews, home visits, and field observations were conducted in Puerto Rico from January-March 2019. Staff from three of the VA’s Caribbean Healthcare System’s home-based LTC programs were interviewed, as well as caregivers in non-VA LTC environments. Veterans, family members of Veterans, family members of VA caregivers, and community members with expertise in disaster recovery were also interviewed for a total of N = 58 interviews and N = 12 home visits. Preliminary results of qualitative content analysis show VA and non-VA LTC environments prepared residents and caregivers for Hurricane Maria through providing education and recommendations in advance, including having enough medications and food on hand. Participants described Hurricane Maria not simply as a disaster but a “crisis” and a storm unlike any they had ever experienced. The interconnected nature of the VA seemed to provide a stronger support network compared to non-VA environments that were often independently run. Health of Veterans and non-Veterans was reported to be mostly stable during recovery. Perspectives from VA and non-VA entities allowed for a fuller picture to emerge around how Hurricane Maria impacted home-based LTC environments in Puerto Rico. This research can inform policies and procedures for such environments caring for elderly and disabled populations in areas prone to disasters.
COMPARISON OF NURSING HOME STAFF’S PERCEPTIONS OF NOISE TO MEASURED NOISE LEVELS
Authors: Ames April , Dubin Stacie , Valigosky Michael , Steiner Victoria
Published: November 2019

A noisy environment may affect the ability of healthcare staff in nursing facilities to effectively complete tasks and provide quality care to residents. Staff may also become irritable or annoyed due to their perception that noise levels are too loud. The purpose of this descriptive study was to examine the differences in nursing home staff’s perceptions of noise levels compared to measured noise levels in four nursing home facilities in Ohio. A questionnaire was also distributed to examine the perceptions of noise levels by staff and the effects of noise on their health. The majority of the respondents (n=90) were white females. They described all facilities as being moderately noisy which was consistent with the measured noise levels. The loudest perceived noise sources included door/patients alarms and floor cleaners, which was confirmed by measured noise levels. The majority of facilities identified the nurses station as one of the noisiest locations; however, this was inconsistent with measured noise levels. Overall, respondents at all facilities felt neutral or disagreed that the noise levels impacted themselves or the residents. However, some respondents agreed that in a noisy environment it is easier to make job errors, difficult to concentrate on work, and they find themselves irritable or agitated. Perceptions of noise should be considered along with measured noise levels because tolerance levels differ among individuals and mental activities involving memory or complex analysis are sensitive to noise which may affect job performance.
MEMORY FOR PICTURES AND WORDS AFTER A NATURAL DISASTER
Authors: Cherry Katie E , McKneely Katelyn , Nguyen Quyen , Yu Shui , Sampson Laura , Galea Sandro , Calamia Matthew R , Elliott Emily M
Published: November 2019

The pictorial superiority effect (PSE) is the finding that memory for pictures exceeds that of memory for matching words for people of all ages (Cherry et al., 2012). We examined free recall of line drawings and matching words in adults enrolled in the LSU Flood Study, an interdisciplinary study of disaster stress and cognition. We tested the hypothesis that disaster stress would be associated with deficits in memory for pictures and words. Participants were sampled from a three-parish (county) region of Baton Rouge, LA that was severely devastated by the 2016 flood (N = 202, age range: 18-88 years). They received multiple tests, including the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005), and self-report measures of executive function and functional impairment (Barkley, 2011). Three groups were compared: (1) non-flooded adults as controls, (2) once-flooded adults with structural damage to homes and property in 2016, and (3) twice-flooded adults who had relocated to Baton Rouge because of catastrophic losses in Hurricanes Katrina and Rita and flooded again in 2016. Results yielded a PSE in free recall for all disaster exposure groups (p < 0.001). Follow-up analyses by age group revealed that older adults showed the same memorial advantage of pictures relative to words as did their younger counterparts across all disaster exposure groups. These results imply that single and multiple disaster exposures do not appear to disrupt cognition assessed with traditional, laboratory-based measures. This research was supported by a grant from the National Science Foundation (Award Number 1708090).
NEIGHBORHOOD SOCIAL ENVIRONMENT AND PHYSICAL FUNCTION: EVIDENCE OF RACIAL AND ETHNIC DIFFERENCES
Authors: Millar Roberto J
Published: November 2019

Empirical and theoretical scholarship suggest that as individuals age and their physical, cognitive, and social needs change, their neighborhood environment becomes increasingly important to their health and well-being. Despite recent advances in this area of research, a number of critical gaps remain. Namely, few studies examine the associations between neighborhood social environments and performance-based physical function. Furthermore, racial and ethnic differences are widely understudied. The objectives of this study are (1) to examine the association between neighborhood social cohesion and physical disorder on physical function in older adults, and (2) to identify potential racial/ethnic differences in these associations. Data come from round five (collected in 2015) of the National Health and Aging Trends Study (NHATS; N=5,619). A series of adjusted linear regression models were used to predict performance-based physical function based on characteristics of the neighborhood social environment (i.e., cohesion, disorder). Results showed that only neighborhood physical disorder was statistically significantly associated with poorer physical function (p < 0.05). Similarly, when stratified by race/ethnicity, only neighborhood physical disorder was associated with poorer physical function in Whites (p < 0.05). There was no significant association for either neighborhood social environment characteristic and physical function for Black or Hispanic older adults. Racial and ethnic differences warrant closer investigation in studies of neighborhood effects on health. Community-level interventions, policy makers, and researchers should consider the interactions between minority membership and neighborhood social environments when addressing issues of health and physical function.
TRANSITIONING OUT OF GRANDCHILDREN CAREGIVING: EFFECTS ON GRANDPARENTS’ EMOTIONAL WELL-BEING
Authors: Hu Rita X , Li Lydia , Antonucci Toni C
Published: November 2019

Research has suggested that grandparents caring for grandchildren experience both psychological gains and loss. Less clear is what happens to these grandparents after they exit from the caregiving role. This study used the Health and Retirement Study (HRS) 2010 to 2014 data to examine the effects of transitioning out of caregiving on the psychological well-being of grandparents. Psychological well-being was measured by the Positive and Negative Affect Schedule. We defined caregiving grandparents as grandparents who provide 100+ hours of care per year to their grandchildren. In the first wave, 8,278 respondents in the HRS were identified as caregiving grandparents. Among them, 3,914 continued to be caregivers and 4,364 transitioned out of the caregiving role by indicating they are no longer providing care in the second wave. Grandparents who transitioned out of caregiving are more likely to be older in age, less educated and not married. Linear regression analysis was conducted to compare the two groups (continuing vs. exiting caregiving) on positive and negative affect, controlling for the first wave’s measures of the dependent variable, sociodemographic characteristics and health status of respondents. Results show that grandparents who continued caregiving had less decline in positive affect than grandparents who transitioned out of caregiving (b = -0.05, SE = 0.02, p<0.01), adjusting for covariates. But they were not significantly different in negative affect. These findings indicate that older adults may have fewer sources of joy after exiting the role of caregivers of their grandchildren.
BUILDING NETWORKS OF PROFESSIONALS TO SUPPORT KINSHIP CARE FAMILIES
Authors: Smith Andrea B
Published: November 2019

Numbers of American children being raised by relatives continue to rise. Over 7.8 million children, representing 10.5% of American children under age 18, lived in a relative-headed home. Of these, 2.5 million have no parent present in their home (Generations United, 2016). Kinship families’ needs are typically complex, needing prompt and sensitive responses. Varied professionals often serve kinship families but the majority report receiving little information or training related to kinship families. (Smith 2017 This pilot project surveyed professionals (n = 63) representing varied disciplines in a pre/post-test format to determine change in knowledge and strategies for working with kinship care family members. All respondents were enrolled in graduate courses specifically focused on kinship families. Respondents represented diverse fields including family therapists (n = 9), family service workers (n = 23), teachers (n = 16), school administrators (n = 4), child care providers (n = 2) and health care professionals (n = 7 ). Respondents completed a 17 question pre/post survey. Results demonstrated the majority (n = 59; 93%) had experience with kinship families but most (n = 47; 74%) had received little/no targeted professional training. Post-test results strongly indicated that completing any amount of kinship-related coursework positively impacted professionals’ knowledge, confidence, and readiness to utilize learned strategies in their work with kinship families. Additionally, post-test results of students completing the entire series of classes (9 credits) revealed significantly greater changes, demonstrating the importance of providing comprehensive information to enhance professional practices for working with kinship families.