bluuebunny/crossref_metadata_2025 huggingface dataset:
Elder Abuse Multidisciplinary Teams: Describing and Classifying a Key Collaborative Resource for APS Workers
Authors: Gassoumis Zachary , Galdamez Gerson , Rowan Julia , Wilber Kathleen
Published: December 2020

Elder abuse multidisciplinary teams (MDTs) are a key resource when APS workers address their most complex cases. MDTs promote coordination and information sharing, and provide access to highly specialized input and problem-solving from legal, health, social service, and financial fields. This paper characterizes the range of elder abuse MDTs across the U.S. We identified 324 MDTs in the U.S., which most frequently addressed cases of financial exploitation (90.8%), physical abuse (83.6%) and neglect (81.6%). Based on a follow-up survey, latent class analysis was used to determine closeness of a subset (n=91) to the elder abuse forensic center model, which has received much evaluation and policy attention. Twenty-six showed strong similarity to forensic centers, with 24 others showing partial similarity. Coupled with observations from site visits to 4 teams, findings can guide the development and evaluation of elder abuse MDTs to foster better interdisciplinary collaboration for APS workers. Part of a symposium sponsored by Abuse, Neglect and Exploitation of Elderly People Interest Group.
Lessons Learned in Research to Address Wicked Problems Facing the Care of Older Adults Across the Care Continuum
Authors: Dobbs Debra , Zimmerman Sheryl
Published: December 2020

A wicked problem, by definition, has innumerable causes, is tough to describe, and doesn’t necessarily have a right answer. This describes today’s health care for older adults across the long-term care continuum. Our interdisciplinary group has almost as many years (n=70) of experience as GSA conducting research in community-based groups across the continuum of care from skilled nursing facilities, assisted living communities, adult day care, to independent living. In this symposium we will discuss lessons learned in recruitment, intervention delivery, and unexpected outcomes. Peterson will discuss lessons learned in using large data sets to derive actionable information on staff license mix and SNF complaints. Dobbs will discuss the utility of using hospice nurses to train ALC nurses in delivering palliative care. Lee will discuss lessons in engaging direct care workers in their need for sleep. Meng will discuss learning to embrace an unexpected finding that friendships developed in a dementia family caregiver music and mindfulness intervention were as meaningful as positive health outcomes. Buck will discuss lessons learned in recruiting a hidden group – informal caregivers with complicated grief. Finally, Zimmerman, as expert long-term services and support discussant, will pull the pieces together across the studies to facilitate discussion. Enrich your future research related to addressing wicked problems in health care for older adults by learning from our experiences.
Brief Mindfulness Intervention for Family Caregivers of Persons With Dementia: A Pilot Study
Authors: Meng Hongdao , Dobbs Debra , Peterson Lindsay , Risal Punam , Veal Britney , Monaco William
Published: December 2020

Family caregivers (FCGs) play a crucial role in helping persons with dementia age-in-place. This pilot study is designed to test a group-based mindfulness intervention for FCGs to reduce stress and enhance wellbeing. We recruited two groups of FCGs (n=7), one from an assisted living community and another from an adult day service center. We used a mixed-methods pre-post study design. Quantitative outcome measures included stress, sleep quality, and quality of life. We conducted focus group interviews to gain an in-depth understanding of the intervention acceptability. Participants reported that they benefited from participating in the intervention sessions, and were more aware of their reactions to stressors. FCGs indicated that the mindfulness practice assignments were acceptable and feasible. An unexpected finding was that the majority of the participants intended to continue with informal meetings after the pilot study. Implications of the intervention benefits for FCGs in the community will be discussed.
Older Adult Fatality Reviews: A Powerful Tool to Improve Policies, Protections, and Services
Authors: Wilson Janet , Jackson Kimethria
Published: December 2020

Older adult maltreatment is a serious problem that can hasten mortality and cause fatality. Child and Domestic Violence Fatality Review teams have made a major impact to improve protections, services, and system responses for victims. There are over 1300 child fatality review teams in 50 US states and 200 domestic violence fatality teams in 45 states. Older adult fatality reviews, in contrast, have not proliferated across the country, missing opportunities to bring interdisciplinary expertise together to resolve policy, protection, and services needed to prevent older adult premature deaths due to violence and abuse. Method: A mini mock review of a fatality of an older adult woman will demonstrate the possibilities of beginning Older Adult Fatality Review Board as recommended by the American Bar Association. Conclusion: Interdisciplinary older adult fatality review teams have been an underutilized tool to make changes in older adult mistreatment protection services and systems.
Abuse of Vulnerable Older Adults by Designated Surrogate Decision Makers
Authors: Bolkan Cory , Teaster Pamela , Ramsey-Klawsnik Holly , Gerow Kenneth
Published: December 2020

Abuse perpetrated by designated surrogates has become highly visible nationally, yet no reliable data exist on its nature or extent. Because vulnerable older adults needing surrogate decision makers typically rely upon others for care, they may be unable to advocate for themselves and are susceptible to abuse. We prospectively gathered Adult Protective Services (APS) data from six geographically diverse counties on over 400 substantiated cases of abuse by perpetrators (53% non-surrogates; 47% documented or claimed surrogate) of vulnerable adults 65+ living in community settings. Most perpetrators (85%) were designated power of attorney, while approximately 8% were guardians, and 7% were representative payees; most perpetrators were family members. Polyabuse occurred frequently. Almost 25% of cases involved a prior substantiated APS report. This presentation highlights how surrogates perpetuate abuse and outcomes on older adult victims. Our findings inform practice and policy for better prevention, detection, investigation, and intervention in these challenging cases.
Person-Centered Health Care: An Approach That Integrates Acute and Long-Term Care
Authors: Young Yuchi , Chen Ye-Mei , Chung Kuo-Piao , Schumacher Patrick , Chen Hsiu-Hsi , Yeh Yen-Po
Published: December 2020

The concept of person-centered health care (PCHC) shifts from the individual’s diagnosis to the holistic health and individual social needs. PCHC is defined by WHO as “empowering people to take charge of their own health rather than being passive recipients of services.” This care strategy is based on the belief that if an individual is an equal partner in care planning and care decision making process, and that his/her view, input, and experiences can help improve overall health outcomes. PCHC requires a reconfiguration of the health care system. A vertical or/and horizontal integration of a variety of healthcare settings is necessary. A proposed 5-year PCHC pilot study in Taiwan’s Changhua county aims to reduce unnecessary hospitalizations by 15% in 4 years. Year one will focus on alignment of health care providers, baseline data collection, and assessment plans development. PCHC intervention will start in years two to five. Part of a symposium sponsored by International Comparisons of Healthy Aging Interest Group.
Promoting Aging in Place in Social Housing
Authors: Sheppard Christine , Perry Tam , Austen Andrea , Hitzig Sander
Published: December 2020

As cities around the globe plan for current and future older cohorts, there is a need to explore innovative housing models to help older adults age in place. This paper presents findings from an action-research academic/community partnership on a new service model at Toronto Community Housing, the second largest social housing landlord in North America and home to 27,000 older adults. As Toronto works to improve delivery of housing/support services, more knowledge was needed to understand the inadequate and inconsistent delivery of services to tenants. Interviews/focus groups with older tenants and service providers (N=116) identified challenges related to unit condition (e.g., pest control) and tenancy management (e.g., arrears), and that the fragmentation of housing and health services negatively impacts older tenants’ abilities to access supports and age in place. The presentation will conclude with discussion of planning and policy decision making approaches relevant to both Canadian and American contexts.
Integration and Implementation Challenges of State-Based Long-Term Services and Supports Financing Programs
Authors: Tell Eiileen , Cohen Marc , Veghte Ben , Bradley Alexandra
Published: December 2020

Several states are in the process of developing or implementing programs that use a social insurance approach to financing long-term services and supports (LTSS). The National Academy of Social Insurance developed a roadmap that highlights key design parameters for states to consider in crafting a program. It also outlines a range of vetted approaches states could adopt, and describes the building blocks and tradeoffs associated with a range of options. States that establish a new LTSS program will need to make decisions about the integration of the program with other payers and benefit programs as well as address concrete implementation challenges. This presentation summarizes these issues including coordination of benefits with other payers, Federal Medicaid funding issues, integration of LTSS and medical care, and challenges around program startup, administration and monitoring as well as evaluation and modification. Addressing such issues is critical to the success of these type of programs.
The 2019 National Nursing Home Social Services Directors Study
Authors: Bern-Klug Mercedes , Bonifas Robin
Published: December 2020

Psychosocial and emotional needs of nursing home (NH) residents can take the back seat to physical needs in NHs that do not employ staff with the appropriate educational and experience level to anticipate, identify and address these important issues. When present, professional licensed social workers can enhance the NH’s ability to address psychosocial issues. However, federal guidelines do not require licensed social workers in NHs, nor does it collect data that would reveal the extent to which licensed social workers are present. With financial support from the RRF Foundation for Aging the NNHSSD Study was undertaken in 2019 to build understanding of departmental staffing characteristics and involvement of the department in key activities and processes. The 924 respondents from around the country also answered questions about training needs, barriers to addressing resident needs, compensation, and job satisfaction. Findings reveal that about half of the nation’s NH social services directors have earned a bachelors or master’s degree in social work, and about half are licensed (although not all degreed social workers are licensed and not all licensed social workers have earned a social work degree). Half of all social services departments employ only one staff member, one-third have two staff members, and 9% have three staff. About 90% report enjoying their job, with over half reporting they are thriving (not just surviving) in their job. Respondents provided feedback that can be used to strengthen the role of the department and its ability to identity and address resident psychosocial needs.
The Experience of Working Family Caregivers: Implications for a National Paid Leave Policy
Authors: Washington Tiffany , Feinberg Lynn Friss
Published: December 2020

Family caregivers provide the bulk of unpaid care to older adults. The typical family caregiver is a 49-year-old woman who works full time and simultaneously provides an average of 24 hours of care per week for an older relative. Unfortunately, their caregiving duties places them at risk for lost wages and termination due to frequent interruptions at work, especially in the absence of a national paid family leave policy. It is possible that such a policy could mitigate these risks; however, the United States is the only developed nation that lacks a national paid family leave policy for all workers. This symposium will highlight the psychosocial, economic, and health issues experienced by working caregivers, and conclude by linking presenters’ findings to implications for a national paid leave policy. To start, presenter one will describe findings from a scoping review on workplace experiences of female family caregivers. Next, presenter two will describe findings from a systematic review to explore predictors of the adoption and implementation of state-level paid family leave policies. Presenter three’s study examines interest in supportive services among working and non-working Black caregivers in the Deep South. Presenter four will describe factors associated with healthcare utilization of working caregivers using data from the Regional Healthcare Partnership – Region 17 Health Assessment Survey. The final presenter, HHS Advisory Council to Support Grandparents Raising Grandchildren co-chair, will describe development of policy initiatives to identify, coordinate, and promote information, resources, and best practices for working grandparents raising grandchildren.
Beyond FMLA: Making the Case for State-Level Paid Family Leave, the Path to Policy Adoption
Authors: Stephenson Eugenie
Published: December 2020

The Family Medical Leave Act (FMLA) was established in 1993, and while limited in scope, it is the only national policy in place to support individuals that need to take time away from work to care for a sick family member. Paid Family Leave, a state-level mechanism of FMLA, creates a safety net to support these workers. Despite its potential impact, such programs currently exist in only 6 states and the District of Columbia. Further, even within these states, individuals are often unaware of the policy's existence. A systematic review of peer reviewed literature from 1994-2019 explores the predictors of the adoption and implementation of state-level Paid Family Leave and public awareness of Paid Family Leave programs in these states. This presentation will explore these findings and their implications on future state level adoption, implementation and awareness of Paid Family Leave.
Reframing Aging: A Generation's Work
Authors: D'Antonio Patricia
Published: December 2020

The Reframing Aging initiative, led by GSA on behalf of the Leaders of Aging Organizations, is a long-term, grant-funded social change endeavor designed to improve – or “reframe” the public's understanding of what aging means and the many contributions older people bring to society. Using evidence-based research, the initiative seeks to teach advocates how to tell an effective story about aging that will promote positive perceptions of aging and reduce ageism. This session will explore GSA's efforts to address ageism through Reframing Aging and the policy implications of this important initiative and will include lessons learned from experts who are utilizing reframing aging in their teaching and practice.
Negotiating the Gerontological Uncanny and Passing Tactics for Aging in Place
Authors: Yeh Jarmin , Fox Pat , Vlahov David , Pinderhughes Howard
Published: December 2020

Insisting people are equally worthy of aging in place is a radical but challenging idea. Scenes of homelessness texture the contemporary city, manifesting broader issues of inequality. This qualitative study explored material with twenty-two housed and unhoused San Franciscans born in 1950 or earlier, who participated in semi-structured in-depth interviews and chronicled their everyday lives using disposable cameras. Theoretical work on social and spatial practices was drawn upon to help understand their aging in place experiences. In interpreting themes, informants elucidated a moving tension between the daily interiority of identity and the negotiation of a changing environment that produces a sensation characterized as the uncanny. The vicissitudes of life and precariousness of their positionalities exposed tactics for “passing” as creative forms of resistance to their expulsion from society. Utilizing visual methods helped reveal assumptions and contributed to gerontological discourse and critical theorizations about aging in place inequalities. Part of a symposium sponsored by the Qualitative Research Interest Group.
Vulnerable Older Adults in Disasters: Effects of Hurricane Irma on Nursing Homes and Assisted Living
Authors: Peterson Lindsay , Dosa David , D’Antonio Patricia
Published: December 2020

Preparedness of residents in long-term care (LTC) in the face of hurricane emergencies is a contested and largely unanswered question. Our prior work involving the U.S. Gulf Coast hurricanes of 2005-08 showed that exposure to various storms on nursing home (NH) residents resulted in significantly more deaths than reported by health care officials. This work also highlighted that evacuation of NH residents, compared to sheltering in place, was independently associated with morbidity and mortality. Hurricane Irma struck Florida on Sept. 10, 2017, prompting the evacuation of thousands of NH and assisted living community (ALC) residents. This symposium will discuss the effects of Hurricane Irma on vulnerable older adults residing in NHs and ALCs using mixed quantitative and qualitative methodologies. The first presentation will discuss morbidity and mortality of NH residents exposed to Hurricane Irma and will stratify by long stay/short stay status and hospice enrollment. The second presentation will discuss improvements and continued barriers to NH preparedness based on interviews with 30 administrators following Hurricane Irma. Using a novel methodology to identify residents of ALCs using secondary data sources, the third presentation will document AL resident morbidity and mortality risk following Hurricane Irma. The final presentation will highlight results of interviews with 70 stakeholders from small and large ALCs concerning the hurricane experiences of residents, including those with dementia. This symposium offers a multi-faceted view of a disaster’s effects on LTC residents across Florida, including novel data from the NH environment and lesser-examined ALCs.
Metabolism and Aging: New Approaches to Nutrition and Diet in Aging
Authors: Rogina Blanka
Published: December 2020

Aging is associated with a functional decline in metabolic, physiological, proliferative, and tissue homeostasis leading to deterioration at an organismal level and increases risk for disease and death. Genetic, pharmacological and nutritional interventions have been successfully used to preserve metabolic health, which leads to preserved healthspan and extended longevity. This symposium will discuss new approaches to nutrition and diet and mechanisms underlying interventions such as calorie restriction and genetic CR. We will also discuss species-specific metabolic mechanisms based on longitudinal studies in mice, monkeys and humans.
Neurons Putting Out the Trash: A Novel Facet of Proteostasis and Mitochondrial Quality Control
Authors: Driscoll Monica
Published: December 2020

Toxicity of misfolded proteins and mitochondrial dysfunction are pivotal factors that promote age-associated functional neuronal decline and neurodegenerative disease across species. Although these neurotoxic challenges have long been considered to be cell-intrinsic, considerable evidence now supports that misfolded human disease proteins originating in one neuron can appear in neighboring cells, a phenomenon proposed to promote pathology spread in human neurodegenerative disease. We have found that C. elegans adult neurons that express aggregating proteins can extrude large (~5µM) membrane-surrounded vesicles that can include the aggregated proteins and damaged mitochondria. We speculate that throwing out the trash may correspond to a conserved mechanism that constitutes a fundamental, but formerly unrecognized, branch of neuronal proteostasis and mitochondrial quality control. I will discuss our current understanding of the mechanisms of neuronal trash elimination.
Senescence and Senolytics: State of the Art on Cellular Senescence, Senolytics, and Healthspan
Authors: Campisi Judith
Published: December 2020

Cellular senescence is a cell fate decision that is made by many mammalian cell types in response to damage, stress or certain physiological signals. Senescent cells arrest proliferation, essentially permanently, and develop a complex multi-component senescence-associated secretory phenotype (SASP). Recent studies using human and rodent cells, tissue samples and transgenic mouse models have defined a causal role for senescent cells, acting largely through the SASP, in a surprisingly large and diverse number of age-related diseases. Subsequently, several synthetic and natural compounds have been identified that have the ability to selectively kill senescent, but not non-senescent, cells. These compounds, termed senolytics, are now of intense interest to both basic research groups and biotechnology companies because they hold promise for postponing, ameliorating or, in some cases, reversing certain age-related pathologies. A related group of compounds, termed senomorphics, hold similar promise and act by selectively suppressing certain modules of the SASP. This symposium will feature presentations on some of the latest developments in the fields of cellular senescence and the SASP and how these cellular responses affect organismal health span. The symposium will particularly emphasize recent findings on the identification and activities of senolytic and senomorphic agents that have the potential to significantly extend the health span of mammalian organisms.
Cellular Senescence and Mammalian Healthspan
Authors: Campisi Judith
Published: December 2020

Cellular senescence is a complex cell fate, often induced by stress or damage, that can be beneficial or deleterious, depending on the physiological context and age of the organism. A prominent feature of senescent cells is a multi-faceted senescence-associated secretory phenotype (SASP), which includes growth factors, cytokine and chemokines, growth factors, proteases, bioactive lipids and metabolites. Senescent cells increase with age in most, if not all, mammalian tissues. Through the use of transgenic mouse models, senescent cells are now known to causally drive numerous age-related pathologies, largely through the SASP. Eliminating senescent cells, genetically or through the use of senolytic/senomorphic agents, can improve the health span, at least in mice, and hold promise for extension to humans in the near future.
The Epidemiology of Dementia in LGBTQ Older Adults
Authors: Flatt Jason
Published: December 2020

Over 3 million or more adults aged 60 + live in the US who identify as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ). Less is known about dementia risk in LGBTQ older adults. We will discuss dementia risk and related risk factors among LGBTQ adults from multiple population-based and cohort studies. We found higher rates of subjective memory problems among lesbian, bisexual and transgender adults compared to both gay men and heterosexual men and women. Using medical record data, 8% (343) of LGB adults aged 60+ were diagnosed with dementia. They were more likely to identify as male (63% vs. 44%), had a higher education level (college degree+ 63% vs. 40%) and were younger than their non-LGB counterparts. These findings highlight dementia risk and related problems among LGBTQ older adults. Future studies are needed to better understand dementia risk and recruiting, screening and improving dementia-related outcomes in LGBTQ older adults.
Changing Culture Around Serious Illness: The VA Life-Sustaining Treatment Decisions Initiative
Authors: Carpenter Joan , Burke Robert
Published: December 2020

Discussing and documenting goals of care and life-sustaining treatment decisions with seriously ill patients is a widely endorsed practice by healthcare and professional organizations. In 2018, The Veterans Health Administration (VA) initiated a new national policy to standardize such practices, the Life Sustaining Treatment Decisions Initiative (LSTDI), which included a coordinated set of evidence-based strategies and practice standards for conducting, documenting, and supporting high-quality goals of care conversations (GoCCs); staff training to enhance skills in conducting, documenting, and supporting GoCCs; standardized, durable electronic health record tools for documenting patients’ goals and preferences; and monitoring and information technology tools to support implementation and improvement. In this symposium, we will describe the first 20 months of implementing the LSTDI across the VA, the largest integrated healthcare system in the US. The first paper will focus on the factors associated with documentation of a GoCC and treatment preferences. The second paper will present findings describing facilitators and barriers to implementing the LSTDI and identifying factors that promote high rates of LSTDI documentation. The third paper examines patient level outcomes associated with a documented goal of comfort care, specifically the odds of receipt of hospice/palliative care, hospitalization, or ICU admission. This symposium will provide attendees with important information regarding a wide range of individual and system strategies to enhance the care of seriously ill older adults by engaging patients with serious illness in GoCCs and documenting their preferences for treatment in durable, easily accessible notes and orders.
Cultural and Institutional Issues in ACP for Care Home Residents: Perspectives of Loved Ones
Authors: de Vries Brian , Gutman Gloria , Kwan Helen , Jang Katrina , Soheilipour Shimae , Vashisht Avantika , Kaur Taranjot
Published: December 2020

Focus groups were held with family/decision makers of residents in an exclusively Chinese (EC; N=7) and a multi-ethnic (ME; N=8) care home, as well as South Asian (SA; n = 5) and lesbian, gay, bisexual and transgender caregivers (LGBT; n = 5) who had/have a loved one in a care home. Shared themes across groups included the role of the care home in Advance Care Planning (ACP) discussions, the timing of such discussions (i.e., at admission), and the extent to which another person was available and appropriate for such discussions. Issues unique to groups included superstition and the equation of ACP with funeral planning (EC), family history and regrets about not having planned (ME), gender differences and the need for education about ACP (SA) and the absence of traditional family among LGBT older adults. These themes highlight the challenges in ACP among diverse populations and the need for targeted interventions.
To Lie or Not to Lie: The Views of People With Dementia and Their Carers
Authors: Casey Dympna , Lynch Una , Cooney Adeline , Houghton Catherine , Smyth Siobhan , Jordan Fionnuala , Felzman Heike
Published: December 2020

In Ireland over 36,000 people with dementia live at home cared for by informal carers. Yet often these carers do not know how to deal with cognitive symptoms, including repeated questions wherein ‘truthful’responses cause distress. Carers face a dilemma, do they avoid, distract or ‘correct’ the person and tell the ‘truth’, or lie? This paper explores the concept of lying from the perspective of the carer and person with dementia. A descriptive qualitative methodology was used. Focus groups with a purposive sample of people with memory problems (n = 14) and carers (n = 18) were conducted. The results found that deliberate lying with the intention to deceive was deemed unacceptable by all. However, in certain circumstances telling a ‘good lie’ or ‘white lie’ was considered acceptable when the carer knew the person and the intention behind the ‘lie’ was to mitigate the distress of the person with dementia.
Effects of a Novel Approach to Reducing Costly Hospitalizations of Nursing Home Residents
Authors: Tappen Ruth , Wolf David , Southard Karen
Published: December 2020

The reduction of preventable hospitalizations from long term care facilities has been identified by CMS as an important measure of quality, both in terms of resident outcomes and nursing home performance. As many as one-quarter of individuals admitted to nursing homes from acute care are rehospitalized within the month placing them at high risk for increased falls, delirium, skin breakdown, nosocomial infection and the like and costing an estimate $4.3 billion annually. To address this well documented threat to care quality, CMS has imposed significant penalties for excessive readmissions on facilities with high rehospitalization rates. An important contributor to these preventable readmissions is resident and family insistence on the transfer. Early efforts to reduce potentially preventable hospitalization of nursing home residents focused on developing systems to identify and respond to acute changes in condition before hospitalization becomes necessary. Reports from facility staff, however, brought to our attention the additional problem of resident and family insistence on transfer despite provider recommendations to the contrary. A series of funded studies to understand this problem, develop a solution and test the effectiveness of this solution will be reported by an interdisciplinary team. We begin with description of the development and clinical trial of Go to the Hospital or Stay Here?, an evidence-based, patient-centered decision aid, with individual residents and families, followed by a pilot test of facility-wide implementation; then an eight state regional dissemination supported by CMS and participating states and finally a discussion of best practices for effective implementation of the Guide.
Go to the Hospital or Stay Here?: A Randomized Clinical Trial
Authors: Worch Sarah , Tappen Ruth
Published: December 2020

With the exception of guides for making end of life choices, there are very few if any patient decision aids created for residents of long-term care facilities. Further, only half of patient decision aids produced for any purpose have actually been field tested with patients and even fewer have been evaluated by providers other than the developers of the decision aid. Development of Go to the Hospital or Stay Here? was based on expert experience combined with extensive input from over 270 long-term care residents, their families and their caregivers. The initial clinical trial of this decision aid is reported in this presentation. Increased knowledge, reduced decisional conflict, increased preference for care in the nursing home when possible and a high rating of the helpfulness of the Guide were found in those who received the Guide (n=97) compared to those who did not (n=95).
CuidaTXT: A Text Message Dementia-Caregiver Intervention for Latinos
Authors: Puchalt Jaime Perales
Published: December 2020

Latino family caregivers of people with dementia have low access to caregiver support. Text messaging holds potential to dramatically enhance the reach of caregiver support interventions among Latinos. This presentation will describe the CuidaTXT Project, with a special emphasis on approach to recruitment and community engagement to achieve the objectives of designing and testing the first dementia caregiver-support text message intervention for Latinos. Based on the Stress Process Framework, CuidaTXT incorporates social support and coping components including AD education, problem-solving skills training, social network support, care management and referral to community resources via tailored two-way messaging. Engagement in CuidaTXT benefited from multi-source recruitment efforts in the Latino community-network built over a three-year period. The network is comprised of senior, religious and community centers, the local media, clinics, a Latino registry and a dementia health navigation service. This presentation will describe processes for assembling and engaging the network for CuidaTXT.
Choice Food Pantries in the Deep South: A Novel Approach to Addressing Food Insecurity in Older Adults
Authors: Buys David , Smith Masey , King Erin
Published: December 2020

Older adults in the deep south are living with high food insecurity rates; this is exacerbated by challenges with rural-living, like transportation limitations and no grocery stores. To address this, we must increase emergency food assistance offerings and adopt best practices for food pantries including choice food pantry approaches, which empowers clients with some autonomy in choosing the foods they receive as part of their pantry distribution. Coalitions in eight income-limited, aging, rural Mississippi Delta counties received support from a Centers for Disease Control and Prevention Grant to enhance the food-related infrastructure in their communities through technical assistance and economic investments. A detailed process evaluation was conducted on this effort. Each coalition adopted food pantry-related policies like adding new food pantries and adapting their existing food pantries with the choice model. Both aging volunteers and clients indicated positive outcomes from the process of adding pantries and adapting existing ones.
Are all homebound older adults frail?
Authors: Sheehan Orla , Bandeen-Roche Karen , Ritchie Christine , Chung Shang-En , Walston Jeremy , Roth David , Leff Bruce
Published: December 2020

Seven million adults in the United States are homebound and suffer the negative, powerful synergies of multiple chronic conditions, functional impairment, social stressors, and limited social capital. The prevalence of frailty in this vulnerable homebound population is unknown. Using representative data from the National Health and Aging Trends study (NHATS) study linked to Medicare claims (n=4756) we sought to assess the prevalence of frailty in the homebound population (n=361). Among the homebound, 68.5% met the frailty criteria compared to 12.3% of the non-homebound population. The frail homebound had lower educational attainment, were more likely to live alone, self-reported poorer health and more chronic physical and mental health conditions than the non-frail homebound (p<0.05 for all). Frail homebound older adults utilized more health services utilization than non-frail homebound and were twice as likely to be hospitalized (49.8% versus 28.0%, p=0.004).
Cognitive Reserve and Well-Being Among Centenarians
Authors: Martin Peter , Lee Gina , Gondo Yasuyuki , Poon Leonard
Published: December 2020

The purpose of this study was to assess cognitive reserve among centenarians and to evaluate whether reserve variables explain significantly more variance in cognitive functioning than education alone. Centenarians from the Georgia Centenarians Study were included. Results indicate that education, activity, social engagement, and engaged lifestyle significantly related to cognitive functioning. After adding cognitive reserve variables, the effect of education on cognitive functioning diminished. The overall model fit well, Χ2 (df=6) = 12.35, p = .06; CFI = .97, RMSEA = .067. Education indirectly related to cognitive functioning through occupational responsibility and engaged lifestyle. Social engagement directly related to cognitive functioning but also indirectly through activity levels. The four direct predictors (i.e., education, social engagement, activity, and engaged lifestyle) explained 33 percent of the variance in cognitive functioning. The results provide important information for cognitive reserve theories with implications for physical health and interventions that build cognitive reserves.
Correlates of Pain, Opioid Use, and Psychotropic Medications Among Older African Americans
Authors: Cobb Sharon , Bazargan Mohsen , Assari Shervin
Published: December 2020

Unrecognized and undertreated pain among older African Americans (AAs) is well-documented. This study explored the link between social, behavioral, and health correlates of pain and psychotropic as well as opioid-based medications in a sample of underserved 740 AA older adults. Almost 16% and 17% of participants used at least one psychotropic and opioid-based medications, respectively. Of those who use opioid-based medications, 73% used opioids only, 28% used opioids and at least one psychotropic medication. Use of opioid or psychotropic medications were associated with increased polypharmacy. Multivariate analysis showed different types of pain are predictors of opioid use, however, depressive symptoms and level of pain were associated with use of psychotropic medication. Moreover, the relationship of pain and psychotropic medications warrants more study due to emerging mental health crisis. These findings underscore the need for optimal concurrent management of pain and mental health for older AAs with potential inappropriate medication use.
Adapting the KAER Framework to Support Early Diagnosis and Treatment of Dementia in Asian Americans
Authors: Sadarangani Tina , Zanowiak Jennifer , Pan Janet , Salcedo Vanessa , Yi Stella , Kwon Simona , Chodosh Joshua , Trinh-Shevrin Chau
Published: December 2020

Asian Americans (AAs) are frequently diagnosed with dementia in advanced disease stages and have difficulty accessing services. The NYU Center for the Study of Asian American Health, set out to culturally adapt The Kickstart-Assess-Evaluate-Refer (KAER) framework to support earlier detection of dementia in AA communities. Working with Bangladeshi, Chinese, and Korean senior centers, we used a participatory action approach to assess cultural relevancy, usability and acceptability of KAER to improve timely diagnosis and access to care. We found that community-based organizations (CBOs), not physicians, were often “first responders” in identifying and managing dementia. However, CBO staff felt unprepared to “Kickstart” discussions, found certain KAER questions were not culturally appropriate, and encountered barriers in communicating their concerns to physicians. Adaptations to KAER can maximize its impact and reach in AA communities. Suggestions include group education, as opposed to individualized screening, and stronger linkages between physicians and CBOs to ensure care continuity.
Impacting Health Behaviors of Older Adults Through a Volunteer-Led Health Literacy Program
Authors: Cortes Tara , Seidel Liz , John Cinnamon St
Published: December 2020

A community based, peer volunteer-driven educational program was developed to empower older adults to improve health behaviors through health literacy. A community needs assessment determined the curricula which included classes on chronic disease management and issues impacting older adult health. Volunteers were recruited and trained on the curricula by health educators using a train-the-trainer module. 173 volunteers convened 302 workshops, and trained 2,065 unique older adults who account for 5000 attendees. Using a pretest posttest design, an outcome evaluation found statistically significant increases in knowledge among older adult workshop attendees on 6 of the 7 health topics (p<.01). Eighty-three percent of attendees reported positive health behavior changes at 3-month follow-up. The most commonly cited changes were increased physical activity and improved nutrition. Program challenges included volunteer scheduling and retention. Building a sustainable community-based, peer volunteer-driven health education program for older adults will be discussed.
A Patient Work Lens to Understanding and Supporting Health Care at Home
Authors: Werner Nicole
Published: December 2020

A majority of healthcare today occurs in private homes and is performed by older adults and their informal caregivers. However, only recently have we begun to understand more about the healthcare work of older adults and their caregivers and the home as a healthcare delivery system. Work science allows us to conceptualize the healthcare activities of older adults and their caregivers as a type of health-related work that has been conceptualized under the broad term, patient work. Applying a patient work lens can offer a unique perspective to addressing the persistent and pervasive challenges faced by older adults and their caregivers as they manage their healthcare at home and across healthcare settings. I will describe the historical development of the patient work approach and highlight recent efforts to use a patient work approach to understand and support the work of older adults and their caregivers providing care in the home.
Evidence for a Novel Care Management Program for Low-Income Older Adults
Authors: Lessem Rachel , Danilovich Margaret
Published: December 2020

The purpose of this study was to evaluate the implementation and effectiveness of a novel care management program for low income older adults in Chicago. Older adults (n=200) who had annual income below $31,225 but about the state level for home and community based services were received care management. Program participants completed a battery of assessments (UCLA Loneliness Scale, single item Quality of Life and Physical Health scales, and Nutritional assessment) at initial assessment and 1-year follow-up. We also conducted interviews with clients and care managers. We used a t-test to evaluate participant outcomes and coded qualitative data to identify themes. Results showed no significant differences between baseline and 1 year follow-up indicating that this care management program kept participants stable. Only 5 of 200 (2.5%) of clients transitioned to a nursing home. This study contributes important results on a novel program to sustain vulnerable older adults in the community.
Vision Impairment Among Late Mid-Life Women: Michigan Study of Women’s Health Across the Nation
Authors: Karvonen-Gutierrez Carrie , Kumar Navasuja , Moroi Sayoko , Musch David , Wood Sarah Dougherty , Ehrlich Joshua , Hood Michelle
Published: December 2020

There are few data on mid-life sensory health and its contribution to health and disability outcomes. The Study of Women’s Health Across the Nation—Michigan site (N=252 women, mean age=66.0 years) collected comprehensive data regarding ocular health to estimate the burden and correlates of vision impairment (VI) and unmet need for vision correction in this population. The prevalence of VI based on presenting and best-corrected visual acuity was 11.1% (95% CI 7.5,15.7) and 2.8% (95% CI 1.1,5.6), respectively. Thus, 75.0% of presenting VI was correctable, yet only 29.0% of women wore an appropriate eyeglass prescription. Black women and those with greater financial strain or less education were more likely to have presenting VI, but there were no differences in best-corrected VI. This presentation will include a discussion of the contributions of SWAN to the study of sensory aging, as well as methodological considerations for research from a mid-life aging cohort. Part of a symposium sponsored by Sensory Health Interest Group.
Value of Academic and Community Partnerships in Developing Age-Friendly Healthcare Systems Across Two Counties
Authors: Gupta Roopali , Greiner Phillip , Reichstadt Jennifer , Scott Kellie
Published: December 2020

The San Diego Imperial Geriatric Education Center is comprised of a robust partnership between two academic institutions, two County Area Agencies on Aging, three Federally Qualified Health Centers (FQHCs), three Programs of All-Inclusive Care for the Elderly (PACE), and several local community organizations providing older adult services across two large, diverse counties. Guiding the implementation of Age-Friendly and Dementia-Friendly Healthcare at our partner FQHC and PACE sites, and a large academic institution, has allowed us to review the similarities and unique qualities of each organization. We identified a common theme that providers would benefit from improved awareness and access to community resources (e.g., cognitive assessment and other ADRD (Alzheimer’s Disease and Related Dementias) support services), regardless of the specific health care system. The value of academic and community partnerships and the development of an infrastructure for information sharing and linking resources will be highlighted during this symposium presentation.
Older Adults-Friendly Multi-Modal Touch-Screen Platform Measures for Bilingual Cognitive Interventions
Authors: Yow W Quin , Lokanathan Tharshini , Chen Hui-Ching
Published: December 2020

There is an increasing interest in using touch-screen devices to conduct cognitive training and collect measurements of cognitive performance. However, older adults often have concerns such as anxiety about using these systems and poor comprehension of language instructions (Czaja & Lee, 2007). Given that Singapore is a multilingual society, we examined the deployment of an age-friendly multi-modal touch-screen platform (a game-based application on a tablet) in a cognitive intervention research. After modification of the platform to include features such as simplified instructions, multi-level prompts with a local accent, and four different instructional languages (including local dialects), participants were less reliant on the researchers and reported fewer difficulties in comprehending the instructions. The integrity and reliability of the data collected improved as a result. In sum, multilingual age-friendly touch-screen platform can be a novel yet effective method to study cognitive interventions in the Asian older adult populations.
The CoGenT3 Study: Cognition and Gender Trends in Three American Generations
Authors: Stites Shana
Published: December 2020

Many studies find gender differences in how older adults’ report on their memory, perform on cognitive testing, and manage functional impairments that can accompany cognitive impairment. Thus, understanding gender’s effects in aging and Alzheimer’s research is key for advancing methods to prevent, slow, manage, and diagnosis cognitive impairment. Our study, CoGenT3 – The study of Cognition and Gender in Three Generations – seeks to disambiguate the effects of gender on cognition in order to inform a conceptual model, guide innovations in measurement, and support future study. To accomplish this ambitious goal, we have gathered an interdisciplinary team with expertise in psychology, cognition, sexual and gender minorities, library science, measurement, quantitative methods, qualitative methods, and gender and women’s studies. The team benefits from the intersections of expertise in being able to build new research ideas, gain novel insights, and evaluate a wide-range of actions and re-actions but this novelty can also raise challenges.
Who Will Take Care of Me?: Older Parents’ Practice and Plans for Their Future
Authors: Toyokawa Noriko
Published: December 2020

The current study investigated older parents’ practices and plans to support their own autonomous lives with/without children’s living assistance and how these parents negotiate autonomous lives with their adult children among three racial/ethnic groups. The study participants were older parents who resided in the Southern California who were recruited through local senior centers (N = 15, Mage = 75, SD = 8.7; Caucasians 47%, Mexicans 40%, Filipinos 13%). Content analysis revealed that Caucasian American parents supported their autonomous lives by using friend networks and professional caregivers rather than depending on their children. Parents with Mexican origin emphasized that their children well took care of them and there were no conflicts with their children. Filipino parents planned to migrate to the Philippines where professional services were affordable so that they would not rely on their children’s care. Similarities and differences in older parents’ need among different racial/ethnic groups will be discussed.