bluuebunny/crossref_metadata_2025 huggingface dataset:
RESULTS FROM A PILOT TRIAL COMPARING MODES OF MEAL DELIVERY TO HOMEBOUND OLDER ADULTS WITH DEMENTIA
Authors: Thomas Kali , Bunker Jennifer , McCreedy Ellen , Hilgeman Michelle , Gabois Emily , Gutman Roee
Published: December 2023

Home-delivered meals promote independence among homebound older adults. However, it is unclear which mode of meal delivery delays nursing home placement among homebound older adults with dementia. We conducted a pilot multisite, two-arm, pragmatic clinical trial in May 2021-May 2022 in which participants with dementia were randomized to receive either: 1) a lunch-time meal delivered 5 times per week or 2) 10 frozen meals that were mailed to participants every two weeks. We used the Minimum Data Set to examine time from randomization to nursing home placement (primary outcome). Our analytic sample included 225 individuals with self-reported dementia on waiting lists at three Meals on Wheels programs in Florida and Texas. 121 participants were randomized to daily-delivered meals and 104 to frozen, drop-shipped meals. At 6 months from randomization, 9(7%) who received daily-delivered meals were admitted to a nursing home, compared to 15(14%) who received frozen, drop-shipped meals p-value=0.14,95%CI(-0.02,0.16). The adjusted log hazard ratio of nursing home placement was -0.65(SE=0.42)p-value=0.12). While this pilot was not adequately powered to detect statistically significant differences between arms, results suggest that even with social distancing requirements and a reduction in the number of deliveries because of the COVID-19 pandemic, there is a trend toward lower nursing home placement among participants with dementia who received daily-delivered meals compared to frozen, drop-shipped meals.
ORAL HEALTH EQUITY, BELIEFS, PRACTICES, PERCEPTIONS AMONG OLDER DETROIT RESIDENTS
Authors: Luborsky Mark , Osika Jocie , Shay Kimberly , Shilbayeh Mariam , Simoni Anisa Anisa , Ziglor Candace , Byrappagari Divesh , Jones Judith
Published: December 2023

Oral health disparities are widespread among older and disadvantaged Detroit residents. While preventable, poor oral health is strongly associated with adverse health and social outcomes and increased risk of cognitive impairments. To address limitations in access and knowledge among older Detroit persons, the University of Detroit Mercy Oral Health Equity project is providing free drop-in clinics offering screenings and basic care at multiple local community centers. However, we need person-centered knowledge about the reasons for an individual’s current oral health status and to inform strategies to increase service uptake. We conducted interviews with attendees onsite after their services to learn oral health perceptions, wants, and practices. Findings are reported from a sample, n=62, of predominantly African American, median age 81, female 69%, 50% over two years without a dental visit, and 61% fair to poor self-reported oral health. Analyses used topic, theme, pattern, and critical case content analytic methods. Constructs comprising four key domains were identified: (a) Oral health care exists at the intersection of forces featuring societal, political, historical, local urban place, and economic dimensions beyond individual-level health and behaviors; (b) lifespan pathways into current oral health and care practices, including wishes for future oral health status; (c) barriers and resources to oral health care access and practices; and (d) personal knowledge gaps regarding signs and mechanisms of oral health. Discussion will focus on strategies to reduce disparities and increase utilization, community and person-level knowledge gaps, and training dental students to engage older disadvantaged persons effectively.
EFFECTS OF SELF-PERCEPTIONS OF AGING ON COGNITIVE HEALTH: MEDIATING ROLE OF SOCIAL ISOLATION AND LONELINESS
Authors: Hu Rita , Li Lydia , Antonucci Toni , Dunkle Ruth , Smith Jacqui , Crampton Alexandra
Published: December 2023

Cognitive decline is one of the most common age-related stereotypes. The stereotype embodiment theory suggests that negative age stereotypes can be internalized through socialization and become negative self-perceptions of aging (SPA). However, the potential mediating role social relationships play between SPA and cognitive health remains unclear. Using three-wave data spanning eight years (2008/2010 – 2016/2018) from the Health and Retirement Study, this study aims to examine (1) SPA’s long-term effects on changes in cognitive health; and (2) the mediating role of social isolation and loneliness (N = 3,569, Mage = 72.30). SPA was measured by an 8-item scale. Cognitive health was measured by immediate and delayed word list recall. Social isolation was measured using network size, network diversity, frequency of contact with networks, and frequency of social participation. Loneliness was measured using the 11-item UCLA Loneliness scale. We controlled for baseline measures of the dependent variables and health-related and sociodemographic covariates. We found that negative SPA at baseline was associated with memory decline eight years later (b = -0.03, SE = 0.02, p < 0.05). The path analysis revealed that social isolation and loneliness were mediators between SPA and cognitive health, with social isolation accounting for 15% and loneliness accounting for another 32% of the total effects. The results suggest that social isolation and loneliness are pathways by which SPA exerts adverse effects on memory among older adults. Negative SPA should be a target for intervention. In addition, social relationship building could alleviate the impact of SPA on cognitive health.
TRAJECTORIES OF DEPRESSIVE SYMPTOMS BEFORE THE ONSET OF DEMENTIA: EXAMINING RACIAL/ETHNIC DISPARITIES
Authors: Lee Ji Hyun , Maher Amanda Cook , Palms Jordan , Mudrazija Stipica , Chopik William , Zahodne Laura
Published: December 2023

Biological and cognitive changes can often be detected up to 16 years prior to a formal diagnosis of Alzheimer’s disease (AD). Psychological symptoms of AD (e.g., depression) may also start to develop during this prodromal phase. Depressive symptoms may be an early marker of neurodegeneration and/or a reaction to early cognitive decline. Higher levels of depressive symptoms could create additional burdens for individuals with preclinical AD and their families. Unfortunately, little is known about the trajectory of depression during the preclinical phase of AD. Using the Langa-Weir method for algorithmic classification, a sample of incident dementia cases (n=2168) was identified from longitudinal data from the Health and Retirement Study (2000-2018). Depressive symptoms were measured with eight dichotomous items from the Center for Epidemiologic Studies Depression (CES-D). Latent growth curve models estimated the trajectory of depressive symptoms over up to 10 waves prior to dementia classification, and disparities across racial/ethnic groups were examined. Results show that depressive symptoms increased slightly over time throughout the preclinical phase of AD, following a quadratic trajectory. Older Hispanic adults reported consistently higher levels of depressive symptoms across timepoints, followed by older non-Hispanic Black and older non-Hispanic White adults. These findings highlight the importance of examining the psychological changes occurring during the preclinical phase of dementia for understanding the disease progression of AD and racial/ethnic disparities in psychological burden. The implications of using algorithmic dementia classifications in studying cognitive race/ethnic disparities will also be discussed.
THE IMPACT OF CHANGES IN COGNITIVE FUNCTIONING ON SOCIAL ISOLATION
Authors: Kayser Jay , Li Lydia
Published: December 2023

This study examines if transitioning from normal to impaired cognitive functioning is associated with changes in social isolation among community-dwelling older adults without cognitive impairment at baseline. This study uses nine waves (2011-2019) of data from the National Health and Aging Trends Study (NHATS). The sample (N=8,245) was representative of Medicare beneficiary at baseline. Social isolation was measured using a seven-item index that captures a range of social activities and network characteristics. Cognitive status was assessed through self-report of having Alzheimer’s disease, the Dementia Screening Interview (AD8), and cognitive testing. Based on pre-determined criteria, participants were grouped as either cognitively intact or impaired. Fixed effect linear modeling with robust standard errors was used to examine the impact of transitioning from intact to impaired cognitive functioning on social isolation. At baseline 5,575 Participants were cognitively intact. At each successive wave, between 12% and 16% of the sample was cognitively impaired. After controlling for time-varying covariates, transitioning from intact to cognitive impairment was associated with a statistically significant increase in social isolation (β=.18, SE=.03, p <.001). Gender and educational attainment did not impact this association. These findings underscore the need for policies and interventions to increase social connection among older adults, particularly during early stages of cognitive impairment.
DYNAMICS OF PSYCHOLOGICAL WELL-BEING ACROSS THE TRANSITION TO WIDOWHOOD
Authors: Li Lydia , Hu Rita , Kayser Jay , Cho Joonyoung
Published: December 2023

The present study examines within-person changes in psychological well-being (PWB) associated with the transition to widowhood. We analyzed 9-wave data collected annually from a probability sample of Medicare beneficiaries. The analyzed sample included married respondents at baseline (N=3,711). Five hundred ten respondents, 208 men and 202 women, became widowed in the survey period. We created variables to indicate widowhood status, the time before and the time since widowhood. Depressive symptoms measured by the PHQ9 and positive well-being assessed by a 6-items scale (e.g., My life has meaning and purpose) were dependent variables. Fixed-effect linear regression, which uses only within-person change over time in the panel data, was used. Results show that immediately after the spouse’s death, depressive symptoms increased and positive well-being decreased. There is a curvilinear relationship between time since widowhood and both depressive symptoms and positive well-being. Specifically, after the widowhood transition year, depressive symptoms began to decline, positive well-being began to increase, up to about four years after widowhood when depressive symptoms slightly rose and positive well-being slightly declined. Men and women have similar patterns. The findings suggest that right after spousal loss is challenging for older adults; some may need counseling and extra support. About two years after the spouse’s death, they return to the pre-loss level of PWB and continue improving until about four years after widowhood. Improvement in depressive symptoms and positive well-being shows older adults’ resilience and potential for personal growth after adversity.
AGING AND CIRCADIAN CLOCK
Authors: Hurley Jennifer
Published: December 2023

Circadian rhythms are highly conserved, 24-hour, oscillations that tune physiology to the day/night cycle, enhancing fitness by ensuring that appropriate activities occur at biologically advantageous times. Disruption of proper circadian timing negatively impacts organismal fitness, making understanding the mechanism underlying circadian regulation over cellular physiology critical to appreciating a fundamental rule of life on earth. As we age, our bodies circadian rhythms change due to stress, chronic disruption of our clocks, neurodegeneration, and a host of other reasons, which can have a profound effect on our systems. Therefore, understanding the aging circadian clock is important to promote longevity and healthy aging. In this session, we will investigate some of the research going on that links the clock to aging. Topics will include the investigation of the role of the clock in timing immunometabolic regulation in the context of inflammation and Alzheimer’s disease, the optimization of the timing of exercise in the effort to maintain homeostasis and decrease risk, the connection between aging and the reduction of the number of rhythmically expressed genes and the weakening of circadian control, and the effect of dietary restriction on the circadian clock. The take home message of this session will be the importance of factoring daily time into research, preventative measures, and treatment regimens, to maximize overall health as we age.
CIRCADIAN TIMING OF THE IMMUNOMETABOLIC RESPONSE AFFECTS ALZHEIMER’S DISEASE PATHOLOGY
Authors: Hurley Jennifer
Published: December 2023

Though the predominant model of the biological mechanisms underlying ADRDs is based on the beta-amyloid (Aβ) hypothesis, evidence suggests that inflammation from resident immune cells is also a key component of the development of ADRD pathophysiology. A major biological regulator of inflammation is the circadian clock, the 24-hour molecular timekeeper that broadly regulates gene expression throughout mammalian tissues to synchronize biology to the Earth’s day/night cycle. Concordantly, chronic disruption of the circadian clock (CD) increases the risk for and severity of ADRDs. Our research has revealed that the circadian clock times metabolism, with the clock timing mitochondrial division which in turn times the response of mammalian macrophages to ADRD pathological factors. We show that subunits of the enzyme NOX2, a driver in the creation of reactive oxygen species (ROS) that uses metabolites to impart inflammation, are driven to oscillate in a 24 hr rhythm by the circadian clock in macrophages and microglia. Notably, oscillations in these NOX2 subunits are dysregulated when an organism undergoes CD, leading to an increase in the levels of ROS released by macrophages and microglia and elevating overall levels of inflammation. Given the apparent interconnection between inflammation, circadian rhythms, and ADRDs, an understanding of the circadian timing of the immune system could be exploited to develop treatments that alleviate ADRD symptoms, contribute to a potential cure, and prevent a population-wide increase in neurodegeneration due to a societal surge in CD.
AGE-ASSOCIATED DECLINE IN TISSUE CIRCADIAN CLOCK FUNCTION
Authors: Esser Karyn
Published: December 2023

Cellular circadian clocks direct a daily transcriptional program that supports homeostasis and resilience. Emerging evidence has demonstrated age-associated changes in circadian functions. To define age-dependent changes at the systems level, we profile the circadian transcriptome in the hypothalamus, lung, heart, kidney, skeletal muscle, and adrenal gland in three age groups. We find age-dependent and tissue-specific clock output changes but these changes exhibit tissue specific patterns. In general, aging reduces the number of rhythmically expressed genes (REGs), indicative of weakened circadian control. These REGs are enriched for the hallmarks of aging, adding another dimension to our understanding of aging. We determined there were tissue specific changes in the phase distribution of REGs with the hypothalamus and skeletal muscle tissues of the old mice showing a large reduction with REG peak expression at only one phase of the day. Analyzing all expressed genes within a tissue for differences at four distinct times of day identified unique clusters of differentially expressed genes (DEGs). These outcomes identify non-circadian but temporally distinct age associated changes in gene expression. This analysis extends the landscape for understanding aging and highlights the impact of aging on circadian clock function and temporal changes in gene expression.
DIETARY RESTRICTION AND THE TRANSCRIPTION FACTOR CLOCK DELAY EYE AGING TO EXTEND LIFESPAN IN DROSOPHILA MELANOGASTER
Authors: Kapahi Pankaj
Published: December 2023

Many vital processes in the eye are under circadian regulation, and circadian dysfunction has emerged as a potential driver of eye aging. Dietary restriction (DR) is one of the most robust lifespan-extending therapies and amplifies circadian rhythms with age. We have previously shown that lifespan extension upon DR requires the presence of circadian clocks for maximal benefits. Herein, we demonstrate that dietary restriction extends lifespan in Drosophila melanogaster by promoting circadian homeostatic processes that protect the visual system from age- and light-associated damage. Altering the positive limb core molecular clock transcription factor, CLOCK, or CLOCK-output genes, accelerates visual senescence, induces a systemic immune response, and shortens lifespan. Flies subjected to dietary restriction are protected from the lifespan-shortening effects of photoreceptor activation. Inversely, photoreceptor inactivation, achieved via mutating rhodopsin or housing flies in constant darkness, primarily extends the lifespan of flies reared on a high-nutrient diet. Our findings establish the eye as a diet-sensitive modulator of lifespan and indicates that vision is an antagonistically pleiotropic process that contributes to organismal aging.
CONNECTING THE DOTS: SUPPORTING OLDER ADULTS LIVING WITH HIV-ASSOCIATED NEUROCOGNITIVE DISORDERS
Authors: Weinstein Elliott , Jimenez Daniel , Gouse Hetta
Published: December 2023

Although people living with HIV are living longer than ever before, significant HIV-related physical and mental health disparities remain among older adults living with HIV (OALWH) due to issues related to advanced aging. HIV-associated neurocognitive disorders (HAND) are becoming increasingly common and have the potential to negatively impact the cognitive, motor, and psychological well-being of OALWH. However, more research on both predictors of HAND and interventions to support cognitively impaired OALWH is needed. This symposium offers insights along the spectrum of intervention development. Two presentations will focus on best identifying predictors of HAND among groups most at-risk up while the other three discuss tailoring and evaluating interventions to alleviate HAND-related symptoms within diverse samples of OALWH from across the country. The first presentation centers on how cerebrospinal fluid markers of Alzheimer’s-related pathology can disentangle diagnosing HAND and amnestic mild cognitive impairment among OALWH in Southern California while the second highlights the role of grip strength in predicting frailty and cognitive impairment among OALWH living in South Florida. The third presentation assesses the feasibility, acceptability, and preliminary intervention effects of a physical activity intervention on cognition adapted for Latino OALWH in South Florida while the fourth examines qualitative feedback from several focus groups on adapting cognitive remediation group therapy as a hybrid group intervention for OALWH with cognitive concerns living in two Canadian provinces. Finally, the last presentation reviews findings of a 2-year randomized clinical trial examining speed of processing training on everyday functioning among OALWH in the U.S. Deep South.
A TWO-YEAR RCT EXAMINING SPEED OF PROCESSING TRAINING ON EVERYDAY FUNCTIONING IN ADULTS WITH HAND IN THE US DEEP SOUTH
Authors: Vance David , Fazeli Pariya , Azuero Andres , Khalidi Sarah , Frank Jennifer , Wadely Virgina , Raper James , Pope Caitlin
Published: December 2023

Approximately 44% of people living with HIV (PLWH) experience HIV-associated neurocognitive disorders (HAND). Cognitive training approaches, such as speed of processing (SOP) training, may reduce the detrimental impact of HAND on everyday functioning. In this experimental design study, 216 participants 40 and older with HAND or borderline HAND (82% Black) were randomized to one of three groups: 1) 10 hours of SOP training (n=70); 2) 20 hours of SOP training (n=73), or 3) 10 hours of Internet Navigation Control Training (a contact control group; n=73). Participants completed several everyday functioning measures at baseline, posttest, and year 1 and year 2 follow ups. Everyday functioning measures included: 1) Modified Lawton and Brody Activities of Daily Living (ADL) Questionnaire; 2) Timed Instrumental Activities of Daily Living (TIADL) Test; 3) Patient’s Assessment of Own Functioning (PAOFI); 4) Medication Adherence Questionnaire (MAQ); and 5) Medication Adherence Visual Analog Scale (VAS). Linear mixed-effect models and generalized estimating equation models were fitted to estimate between group differences at all follow-up time points. At follow-up timepoints, those in the 10-hour and 20-hour training groups performed better on medication adherence measures (MAQ and VAS) than those in the control group, with effects (Cohen’s d) ranging from 0.13 to 0.41 for MAQ and 0.02 to 0.43 for VAS. In conclusion, SOP training improved some indicators of everyday functioning, specifically medication adherence; however, the therapeutic effects diminished over time. This is an interesting finding given the importance of medication adherence in viral suppression and overall survival in PLWH.
HEALTH CARE EMPLOYERS’ PERSPECTIVES ON SKILLS REQUIRED FOR STUDENT SUCCESS IN THE WORKPLACE
Authors: Cummins Phyllis , Chidebe Runcie , Karam Rita , Kramer Jenna
Published: December 2023

Community colleges (CCs) play a critical role in educating healthcare workers that are important to an aging population. This study investigated the role literacy, numeracy, and problem-solving skills play in CC student success in the classroom and the workplace. Semi-structured virtual and in-person interviews were completed with CC administrators (n=9) and faculty (n=6), along with employers (n=10) who hire students from CCs. We focus on healthcare employers (i.e., home healthcare, nursing homes and hospitals) and the skills they value along with skills that are lacking in CC hires. Examples of health care occupations filled by CC students include certified nursing assistants, qualified medication aides, licensed practical nurses (LPNs), and registered nurses (RNs). Employers reported working closely with CCs, including providing opportunities for clinical rotations, serving on program advisory councils, and providing input into program development. Numeracy skills, such as measuring medication dosages, critical thinking skills, and problem-solving skills, including conflict resolution, are important and expected by employers. Communication skills are also highly valued, especially the ability to communicate on the level of the nursing home resident or hospital patient, along with their family members. Employers noted that LPNs and RNs sometimes have limited leadership and supervisory skills and remarked they are working with CC faculty and administrators to identify mechanisms (e.g., role playing, case studies) to improve those skills. Findings from this project will inform both CC administrators and employers regarding skills that are necessary to succeed as students and healthcare workers to meet the needs of an aging population.
MEDICAL LABORATORY SCIENTISTS’ ROLE IN THE CARE OF AN AGING POPULATION
Authors: Kaur Tripat
Published: December 2023

Medical Laboratory Scientists (MLS) are a group of highly skilled professionals in the healthcare industry who are responsible for working on specimens and providing results that are accurate in diagnosing medical disorders and monitoring treatments. These heroes work behind the scenes and face a critical shortage of personnel required to meet the needs of an ageing population. The number of clinical tests has increased 388% since 1993, from 12,683 to nearly 62,000. In addition, the Centers for Disease Control reports that for the >500 million primary care patient visits each year, one out of three patient encounters result in the ordering of at least one laboratory test. To meet these high testing volumes medical and clinical laboratories are highly automated with instrumentation utilized in all aspects of testing to improve the turnaround time for reporting results. Programs that offer medical laboratory science programs often must prepare the students for this highly technical field. To assist in the shortages that the laboratories faced, 6 years ago, BayCare Health System approached Hillsborough Community College Health Science division about setting up a post-baccalaureate medical laboratory science program. The program has now had approximately 100 graduates who have jobs around the Tampa Bay hospitals. Educational institutions face challenges in meeting current needs because of the lack of visibility of the medical laboratory science profession, a drop in the total enrollment in colleges over the last 5 years, and a rise in the national median age of the current population.
IMPLEMENTATION OF A COMMUNITY WALKING PROGRAM FOR OLDER ADULTS WITH MOBILITY CHALLENGES—WALK-ON!
Authors: Nicklas Barb , Hughes Jaime , Starr Kathryn Porter
Published: December 2023

Clinical trials in controlled settings show walking interventions improve function and reduce mobility loss in older adults. In the NIA-funded LIFE study, participants with more compromised function derived the most benefit, yet improvements were not sustained. Based on this research, clinicians often prescribe walking for older patients. However, few communities provide accessible opportunities for those with limited function to engage in safe, ability-appropriate, walking. Additionally, no evidence-based National Council on Aging exercise programs emphasize ambulation over longer distances in supervised and social settings. In collaboration with community partners, we developed and initiated Walk On!, a group-based, facilitator-led program designed to improve walking endurance, balance, confidence, and social connectedness in older adults with mobility challenges. In addition to walking, the program incorporates balance, gait, and flexibility components, and follows a safe progression based on individual ability. Sessions take place for one-hour, twice/week, over 12 weeks. The program is currently offered at four sites in Winston-Salem and Charlotte, NC (two churches-one primarily black membership and one primarily white, a YWCA, and a community fitness center). This symposium provides an overview of Walk On! and initial implementation. Both quantitative and qualitative program data on feasibility, satisfaction, and effectiveness for improving physical and psychosocial outcomes will be presented. Based on these early data, we believe there are countless underserved older adults who may be socially isolated due to limited mobility, yet are willing and would benefit from incorporating more ambulation in a safe and accessible environment.
LOOK AHEAD SLEEP: STUDY DESIGN AND BASELINE CHARACTERISTICS
Authors: Spira Adam , Bertisch Suzanne , Chen Haiying , Ding Jingzhong , Redline Susan , St-Onge Marie-Pierre , Hayden Kathleen
Published: December 2023

Older adults with obesity and type 2 diabetes (T2D) are at elevated risk for mild cognitive impairment (MCI) and dementia. Compared with younger persons, older adults are more likely to have sleep-disordered breathing (SDB), which is also common among adults with T2D and obesity and is associated with higher risk of dementia. The Look AHEAD Sleep (LA-Sleep) study investigates links of SDB and circadian rest/activity rhythms with cognitive performance, MCI, and dementia in older adults with T2D and obesity/overweight enrolled in Look AHEAD Aging (LA-A). LA-Sleep participants completed cognitive measures at baseline and were randomized to sleep measurement in the first (2022-2023) or second year (2023-2024). Sleep measures include assessments of SDB (WatchPAT), circadian rest/activity rhythms (ActiGraph) and daily sleep diary. Of those who enrolled in LA-A, 62.8% consented to LA-Sleep. To date in 203 participants have provided data from WatchPAT and 107 provided actigraphy data. Participants were a mean (±SD) age of 76.1±5.4 y, had a mean BMI of 34.2±6.7 kg/m2, 56.7% identified as female, and 75.4% were Non-Hispanic White, 12.3% Non-Hispanic Black, and 6.9% Hispanic. Approximately 90.2% had >high school education. Of participants with obesity in 2018-2020, 27.9% (41/147) had an apnea hypopnea index (AHI) of ≥15 to <30/h (moderate SDB) and 20.4% (30/147) had ≥30 events/h (severe SDB). Mean actigraphy-estimated total sleep time was 7.1±1.4 h, and mean wake after sleep onset was 62.5±31.0 min/night. Among adults with T2D and overweight/obesity, a high proportion have SDB and sleep fragmentation, potentially increasing risk for dementia.
EFFECT OF AN INTENSIVE LIFESTYLE INTERVENTION IN ADULTS WITH TYPE 2 DIABETES ON LONG-TERM HEALTH CARE SPENDING AND USE
Authors: Davis Ian , Frenier Christopher , Huckfeldt Peter , Harada Ann , Pajewski Nicholas , Espeland Mark , Goldman Dana
Published: December 2023

This study investigates the impact of the Look AHEAD intensive lifestyle intervention (ILI) on long-term health care spending. We investigated self-reported health care use and spending from 2002-2012 (during the intervention) and 2013-2019 (after the intervention). Lasso regressions, trained in Medicare data, were used to predict outpatient, inpatient, prescription drug, and total healthcare spending based on self-reported health care use. Other outcomes included self-reported outpatient visits, unique prescription drugs, and inpatient hospitalizations. Regressions comparing spending and use outcomes for the ILI and diabetes support and education (DSE) control groups were adjusted for baseline demographic characteristics, clinical status, and study site. We included 3957 participants (1997 ILI, 1960 DSE) who had at least one interview during the post-intervention period. Similar to prior work, we found that the ILI group had lower inpatient, outpatient, and prescription drug spending relative to the DSE group during the intervention period, resulting in lower total spending (adjusted difference: -$715: [95% CI: -$1178 to -$252]; P<0.001). However, most of the intervention’s effects on spending and use did not persist beyond the intervention period, except for prescription drug spending (adjusted difference: -$189: [95% CI: -$364 to -$14]; P=0.03) and unique prescriptions (adjusted difference: -0.3: [95% CI: -0.5 to -0.1]; P<0.001). Our results imply that an intensive lifestyle intervention can reduce health care spending for adults with type 2 diabetes, but interventions may need to be continued to maintain spending reductions.
EXPLORING THE UTILIZATION OF MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) PROGRAMS IN WORKFORCE DEVELOPMENT
Authors: Cotton Sam , Faul Anna
Published: December 2023

Measuring patient outcomes is a critical component of the HRSA funded Geriatric Workforce Enhancement Programs (GWEPs), which aim to improve the quality of care for older adult patients. In 2019, GWEPs were tasked with aligning patient outcomes with the CMS Merit-based Incentive Payment System (MIPS) program, which incentivizes quality care and patient outcomes. Collecting and using MIPS data effectively can be a challenging task, particularly when done across multiple levels of care. To address these challenges, the National Association of Geriatric Education Centers (NAGEC) created a workgroup to develop advocacy and solutions for patient outcomes. This symposium will discuss the utilization of MIPS as performance metrics across three GWEPs, the challenges in reporting these outcomes, and implications for future policy changes. This symposium’s primary objective is to explore how GWEPs can effectively measure patient outcomes, despite the challenges involved in collecting and utilizing MIPS data. By discussing these challenges and proposing potential solutions, this symposium aims to improve the effectiveness and sustainability of GWEPs, ultimately leading to better outcomes for older adult patients. Overall, measuring patient outcomes is critical for ensuring that older adult patients receive high-quality care that is tailored to their individual needs and preferences. Despite the challenges involved in collecting and utilizing MIPS data, our symposium provides an opportunity to explore potential solutions and advocate for policies that support improved patient outcomes in geriatric care.
RURAL HEALTH, FAMILY CAREGIVING, AND DEMENTIA: CHARACTERISTICS AND NEEDS ACROSS POPULATIONS
Authors: Stephens Caroline , Goodwin Rebecca , Ornstein Katherine
Published: December 2023

The rural population in the US is aging faster, more likely to live alone, and has more comorbidities than the overall aging population. Despite the greater need for long-term care services, rural residents may experience the most barriers to formal services (hospital, home health) and availability of family caregivers. Unfortunately, there is a dearth of research on aging and end-of-life care in rural areas. This symposium includes 4 presentations focused on rural health, family caregiving and dementia and the characteristics and needs across these diverse populations. The first presentation examines rural disparities in use of family and formal caregiving for older adults with disabilities using data from the Health and Retirement Study. The second presentation describes the unmet services needs among people with dementia and their caregivers living in rural Appalachia, and highlights contextual factors that shape service access and utilization. The last two presentations use data from the Utah Population Caregiving Database to examine the characteristics of families of nursing home (NH) residents who die with dementia and of those who die in rural NHs. Understanding the unique characteristics and needs of these underserved populations will help inform rural health practice and policy considerations to better serve this population, especially as we continue to see changes in the hospital and NH landscape across the US. Moreover, it is critical that even as federal and state policies rebalance long-term care from institutional settings to home- and community-based settings, the unique needs of those living in more rural areas are considered.
RURAL DISPARITIES IN THE USE OF FAMILY AND FORMAL CAREGIVING FOR OLDER ADULTS WITH DISABILITIES
Authors: Miller Katherine , Ornstein Katherine , Coe Norma
Published: December 2023

As federal and state policies rebalance long-term care from institutional settings to home- and community-based settings, reliance on formal (paid) and family (unpaid) caregivers for support at home nationally has increased in recent years. Yet, it’s unknown if use of formal and family care varies by rurality as a disproportional share of the aging population reside in rural areas. Using the Health and Retirement Study, we describe patterns in receipt of combinations of formal and family home care by rurality among community-dwelling adults aged 65+ with functional limitations from 2004-2016. Compared to older adults in urban areas, older adults in rural areas are more likely to receive any family care than those in urban areas and less likely to receive any formal care (2.4 and -4.4 percentage points respectively, p<0.05). From 2004 to 2016, a growing proportion of older adults in rural areas receive care from family caregivers exclusively while a decreasing proportion receive care from formal caregivers exclusively. When examining older adults in urban areas, we find the opposite trend — a growing proportion of urban adults rely exclusively on formal care and a decreasing proportion rely exclusively on family care. We find that national estimates of sources of caregiving and their trends mask significant heterogeneity in uptake by rurality. Understanding how older adults in rural areas are, or are not, receiving home-based care compared to their urban peers and how these patterns are changing over time is the first step to informing supports for family and formal caregivers.
UNMET SERVICE NEEDS AMONG RURAL APPALACHIAN CAREGIVERS OF PEOPLE WITH ALZHEIMER’S AND DEMENTIA
Authors: Russell David , Miyawaki Christina , Bouldin Erin
Published: December 2023

Risk factors for Alzheimer’s disease and related dementias (ADRD) are higher in rural areas than urban areas, and home- and community-based services (services) are less accessible. This study sought to identify unmet services needs among people with ADRD and their caregivers living in rural Appalachia, and highlight contextual factors that shape service access and utilization. We interviewed 22 caregivers and persons with ADRD living in Western North Carolina between August 2021 and April 2022 with recruitment assistance from local agencies and organizations. Themes were identified across domains of our conceptual model informed by theories of health services use, family caregiving, and sociocultural contexts. Family caregivers communicated multiple unmet needs, foremost of which included fragile and insufficient support systems or imbalances between family and paid caregiving support, a lack of clarity about their services options, and feeling behind in preparing for the future. In the presence of unmet care needs, family caregivers made decisions (or not) to use services in aiding them with caring for persons with ADRD. These decisions were shaped by illness-level (e.g. ADRD symptoms and progression), predisposing (e.g. work experiences), and enabling factors (e.g. family support). The sociocultural contexts in which family caregivers and the persons they cared for with ADRD were embedded within, including their culture, beliefs and family norms, also shaped perceptions and use of services. These contexts should be better understood and considered when developing and implementing acceptable services for people with ADRD in rural areas.
WHO DIES IN A RURAL NURSING HOME WITH AND WITHOUT FAMILY? EVIDENCE FROM THE UTAH POPULATION DATABASE
Authors: Goodwin Rebecca , Ornstein Katherine , Iacob Eli , Hollingshaus Michael , Smith Ken , Tay Djin , Utz Rebecca , Stephens Caroline
Published: December 2023

Rural nursing homes (NHs) are an increasingly important focus for policy makers given the lack of available post-acute and long-term care services in these areas. Families often play a critical role in filling this void in services and supporting NH residents at the end of life (EOL). No population-based studies to date, however, have documented the characteristics of families of persons who die in rural NHs. This study aimed to describe the size and composition of first-degree families (FDF) of Utah NH residents who died in rural/frontier NHs 1998-2016 (n=10,567). Using the Utah Population Caregiving Database, we linked rural/frontier NH decedents to their FDF (n=31,118; children=53.7%; siblings=33.8%; spouses=11.3%; parents=1.1%) and compared characteristics of those with and without FDF. Compared to rural/frontier NH decedents with FDF (77.5%), those without (22.5%) were more likely to be older (median 85.7 vs 84.8), female (61.3% vs 56.8%), Hispanic or Non-White Non-Hispanic (6.8% vs 3.7%), and less educated (<9th grade; 45.9% vs 37.4%), all p<0.001. There were no differences in diagnosis of dementia, Charlson Comorbidity Index, or hospitalizations in the last 6 months of life. Persons who live and die in rural NHs without FDF may be in double jeopardy, if you will, given the lack of family support and few to no options for care. Understanding the impact of family, or lack thereof, on rural NH resident EOL care trajectories is an important next step.
CLINICAL NOTES AND CARE COORDINATION CALLS AS IMPORTANT PREDICTORS OF EMERGENCY CARE UTILIZATION IN HOME HEALTH CARE
Authors: Evans Lauren
Published: December 2023

Home care patients experience a high illness burden and a heightened risk of negative health outcomes. There is a need to understand how clinician behaviors, including notetaking and care coordination activities, can be better integrated into risk modelling in home care settings. This study predicted hospitalization/ED visits using data from 86,866 home care episodes from an agency in the Northeastern United States. We began our analysis with nearly 200 variables, including patient-related factors (e.g., comorbidities, types of medications taken, functional status), and factors relating to clinician behavior, such as problems documented in clinical notes, and calling patterns to the patient or medical care providers. We used least absolute shrinkage and selection operator (LASSO) to aid in the selection of the best subset of variables. In our preliminary analysis, we found that two clinician behavior-related factors were the strongest risk factors for experiencing hospitalization/ED visits, specifically the proportion of concerning notes generated during the care episode (OR 8.97, 95% CI 7.64, 10.52), and a measure reflecting frequent calls to the patient’s family (OR 4.51, 95% CI 3.80, 5.37). Clinician documentation of specific problems, and the clinician’s decision to conduct a medication review were also risk factors. Patient risk factors included prior hospitalization, health conditions such as cancer and renal disease), functional limitations, certain medication classes (e.g., anticoagulants, diuretics), the use of oxygen, and the use of a urinary catheter. This study demonstrates that clinician behaviors and documentation patterns can be incorporated in risk models to yield important insights.
ENGAGEMENT OF FAMILY IN ASSISTED LIVING: SECONDARY QUALITATIVE ANALYSIS USING THE ADAPTIVE LEADERSHIP FRAMEWORK
Authors: Cho Youngmin , Crowder Victoria , Bankole Ayomide , Song Lixin , Wu Bei , Anderson Ruth , Beeber Anna
Published: December 2023

Assisted living (AL) residents are at high risk for safety issues (e.g., falls) and poor quality of life (QoL) because they can lose their personal preferences and autonomy in personal care or social activities once they enter AL. Family engagement (FE) plays a significant role in addressing these challenges while considering residents’ needs and preferences. The purpose of this study was to explore family caregivers’ perspectives about FE strategies in AL and contextual factors influencing FE. This study used a secondary analysis of the interview data from a larger study investigating 34 family caregivers’ opinions on AL safety and strategies to increase FE. The Adaptive Leadership Framework guided our directed content analyses to identify how family caregivers address the challenges with AL residents and staff. Family caregivers described adaptive leadership strategies pertaining to getting the residents to recognize the seriousness of their health status, finding available resources to support them, and planning for potential challenges. Family caregivers also described adaptive and collaborative work (with AL residents or staff) strategies such as advocating for resident needs, involvement in direct care or social activities, shared understanding of care plan, and making decisions together. We also found that contextual factors such as fear of speaking up and retaliation, previous experiences in FE, influenced family caregivers’ engagement in AL safety. These findings highlight the important role of family caregivers in addressing AL resident safety challenges. Also, our study provides the rationale for developing practical FE strategies to enhance residents’ safety and QoL.
PERCEIVED FEASIBILITY TO IMPLEMENT A TASK-ORIENTED EXERCISE PROGRAM BY FITNESS STAFF AT SENIOR LIVING COMMUNITIES
Authors: Liu Chiung-ju , Mansuy Lauren
Published: December 2023

Older adults who relocate to senior living communities have a desire to maintain their independence. The fitness infrastructure within these communities is a great platform to deliver evidence-based exercise programs to support residents’ independence, especially for those who have experienced activity limitations. Task-oriented exercise incorporates daily activities into exercise strategies and has been recommended as an approach to reduce late-life disability. The current study used an interview research design to determine the feasibility of implementing 3-Step Workout for Life, a task-oriented program, in senior living communities. The 3-Step Workout for Life program consists of gym-based group resistance exercise and home-based one-on-one activity exercise. Fourteen fitness instructors from different communities, with independent living units, in the state of Florida completed the study. Interviews were transcribed, coded, and underwent thematic analysis. Instructors perceived the screening procedure to select and enroll residents in this program could help match residents to the right fitness program. The gym-based group resistance exercise is compatible with existing instructor-led fitness programs. Although instructors perceived the home-based one-on-one activity exercise positively, such as the potential benefits for frail residents who do not attend the gym, they acknowledged several barriers to implementing this exercise. Major barriers include their job responsibility restricting them from working in the resident’s home, their belief that activity exercise should be better delivered by a rehabilitation professional, and limited staff to support the one-on-one format. The next step is to collaborate with community stakeholders to address these barriers and build capacity to implement task-oriented exercise programs.
UNCOVERING THE HIDDEN WORKFORCE: A STUDY OF DIRECT CARE WORKERS IN ASSISTED LIVING HOMES
Authors: Wyles Christina , Shea Kimberly
Published: December 2023

A growing number of 4.5 million U.S. direct care workers (DCWs) provide hands-on care to older adult residents in assisted living homes (ALHs) -- the smallest type of assisted living residences that require employment of DCWs. These homes typically have capacity for 8-10 residents, and they no longer resemble the original non-medical, home-like environment. With an aging population, increasing complexity of residents’ medical and functional needs, and increasing closure of nursing homes, demand for DCWs in ALHs continues to grow. Better information on this growing workforce segment, federal oversight, and consistent licensure are needed. The few available studies indicate high resident acuity and quality of care issues. To address this knowledge gap, a study explored and described the learning interests and needs and technology use of ALH DCWs. Guided by a human factors framework and an interpersonal perspective, DCWs (N = 14/ median age 41) were interviewed one-on-one using semi-structured questions. Data analysis involved qualitative content analysis of transcribed taped interviews. Findings revealed DCWs are interested in work-related topics and acknowledge the complexity of their residents. They use various health-related technologies in the care they provide, but need more access to educational opportunities that accommodate their long work hours and low salaries. The study also noted the expanded scope of practice, high risk of injury, and underrepresentation of DCWs in the literature. This study highlights learning and technology needs of DCWs in ALHs, emphasizing the need for more recognition and support for this vital segment of the long-term care workforce.