bluuebunny/crossref_metadata_2025 huggingface dataset:
EDUCATION, ADULT LITERACY SKILLS, AND JOB AUTOMATION RISK IN THE OLDER US WORKFORCE
Authors: Narine Donnette , Yamashita Takashi , Chidebe Runcie , Cummins Phyllis , Kramer Jenna , Karam Rita
Published: December 2023

Despite the overall benefits of technological advancement, ongoing job automation has disrupted the U.S. workforce. Of particular concern is that increasing levels of job replacement—driven by job automation—is likely to be a risk factor for economic uncertainty, both for workers and the labor market. Older workers with lower educational attainment and basic adult literacy are known to face challenges in learning new knowledge and skills, which are currently required to be competitive in a technology-driven labor market. Thus, this study aimed to examine the relationship between educational attainment, literacy proficiency, and previously published job automation risk by occupations. Using the 2012/2014 Program for International Assessment of Adult Competencies (PIAAC) data, we analyzed a nationally representative sample of middle-aged and older workers (age 45-74 years; n = 1,484). The results of the linear regression indicated that higher educational attainment (college or higher vs. less than high school: b = -14.11, p < 0.05) and greater literacy proficiency (score 0-500 points: b = -0.06, p < 0.05) were associated with lower job automation risks (0-100 % replacement in the next decades) among middle-aged and older U.S. workers, accounting for the covariates (R-squared = 0.18). In alignment with the federal Workforce Innovation and Opportunity Act, these findings offer empirical support for policies and interventions that are purposefully designed to boost the human capital (i.e., knowledge and skills) of middle-aged and older workers through adult education and literacy training to lower their job automation risk, thereby increasing their level of job security.
INTENTION TO USE HOSPICE CARE FOR FAMILY AMONG OLDER RURAL BLACK AMERICANS IN ALABAMA
Authors: Csikai Ellen , Lee Hee Yun
Published: December 2023

Hospice usage overall continues to rise however, remains low among people of color, including by Black/African Americans. In 2020, 50.8% of White Medicare decedents and only 35.5% of Black decedents used hospice (NHPCO, 2022). Often reasons are connected to poor knowledge of and access to hospice resources that provide holistic support to those near end of life and their caregivers (Adrien, 2017). Little is known about the intention of older rural Black Americans’ to use hospice when caring for family members at home. In this study, older African Americans in Black Belt communities in Alabama were recruited to participate in a survey that addressed health literacy of problems with high prevalence in this rural area (diabetes, cardiovascular disease, stroke and cancer) (CDC Interactive Atlas, 2022). Guided by the Andersen’s Behavioral Model of Health Services Use, regression analysis was conducted to identify predisposing, enabling, and need factors influential in older rural African Americans’ intention to use hospice for family members. Among non-caregivers, who had heard of hospice (n=118 of 180), education, gathering with friends and social club participation, and PHQ-9 were found influential in predicting intention to use hospice for family members. However, among caregivers (n=107), female gender, education, health literacy, gathering with friends, social club participation, and PHQ-9 were influential. Results point to interventions to bolster health literacy regarding hospice among older rural Black Americans and that social clubs and other gathering places could be targeted with educational programs to increase intention to use hospice care for family members.
EMPOWERING ADULTS SEEKING RECOVERY FROM SUBSTANCE AND OPIOID USE DISORDER IN THE DEEP SOUTH
Authors: Buxton Michael , Allen Rebecca , Jacobs M Lindsey , Cox Brian , Holditch Sarah
Published: December 2023

Substance and opioid use disorder may be missed due to lack of consideration of physical, social, and emotional changes in midlife and later adulthood. This presentation uses data from a Graduate Psychology Education grant to examine predictors of alcohol use and misuse among treatment-seeking and primary care patients. Across three sites, 237 individuals completed behavioral health assessments; a rural (n = 54) and an urban federally qualified health center (n = 59), and a state-certified residential rehabilitation facility (n = 124). Participants ranged from 18 to 70 years of age (M = 40.05, SD = 1.75). Approximately 49.4% were female and 72.2% were non-Hispanic White, 23.3% African American, and 4.6% other. More than 28% of individuals had less than a high school education, and 38.4% reported a high school education or GED. Using the TAPS-II, 34.2% of participants reported alcohol use, and 13.5% reported prescription opioid misuse. Logistic regression analyses revealed that older age, prescription opioid misuse, and depression were significantly associated with alcohol use, χ2 (7) = 18.04, p = 0.12, while gender, report of adverse childhood experiences, and anxiety were not. Holding age, gender, and experiences constant, prescription opioid misuse had a significant effect on the probability of alcohol use, B = 1.092, SE = .429; Wald = 6.496, p = 0.01. The odds of alcohol use increased by a factor of 2.98 for individuals misusing prescription opioids. Treatment for problematic alcohol use must consider contextual influences including age, prescription opioids, and depression to implement effective evidence-based treatment.
IMPROVED NALOXONE PRESCRIBING IN RURAL PRIMARY CARE FOLLOWING ACADEMIC DETAILING FOR OPIOID OVERDOSE PREVENTION
Authors: Tobey Leah , Breckling Meghan , Ali Mohab , McAtee Robin
Published: December 2023

Performing opioid misuse screenings for older adults (OA) and reviewing high-risk medications are reliable screenings in preventing harm, especially accidental overdose. As one of the HRSA funded Geriatric Workforce Enhancement recipients, the AR Geriatric Education Collaborative (AGEC) worked with a rural federally qualified healthcare clinic system (ARcare) to reduce the likelihood of patient’s accidental overdose by co-prescribing Naloxone, when indicated. An Academic Detailing (AD) team of a PT, PharmD and MD, led this interactive training. AD is clinician-to-clinician support customized with the purpose to connect primary care providers to the best available evidence and most up-to-date clinical practice guidelines. A conversational needs assessment was stimulated where the provider shared their perspectives, knowledge deficits, and needs surrounding the AD topic of Naloxone. These AD interactions encouraged safer prescribing of high-risk medications while considering the use of hard reduction resources for patients, such as prescribing Naloxone. ARcare providers (n=22) attended AD on Preventing Opioid Overdose with Naloxone over 11 months. Of those, 9 had previously prescribed Naloxone 40 times pre-training then 107 times post-training; five providers had never prescribed Naloxone but prescribed it 46 times post-training. Eight providers, made no change, some of whom work in schools. Post-training data gathered from the 14 Naloxone prescribing providers showed a total of 153 Naloxone prescriptions after AD, a 283% increase. For primary care settings, age-friendly medication practices are critically important for OA safety, aging in place, and for OA and their caregivers to understand and utilize Naloxone if accidental overdose is suspected.
CULTURAL FACTORS PREDICT POSITIVE CAREGIVING APPRAISAL AMONG DIVERSE DEMENTIA FAMILY CAREGIVERS
Authors: McCarthy Michael , Remiker Mark , Garcia Y Evie , Williamson Heather , Baldwin Julie
Published: December 2023

Background and Objectives

Positive caregiving appraisal is strongly linked to health among caregivers of persons with Alzheimer’s Disease and Related Dementias (ADRD). Few studies have identified predictors of positive caregiving appraisal, although research suggests that cultural factors may play a role. This study hypothesized that self-identified race and ethnicity, as well as more nuanced cultural factors such as language spoken at home, culture-based values surrounding caregiving, and perceptions of provider cultural competence would predict positive caregiving appraisal.

Research Design and Methods

A cross-sectional survey was administered to 156 diverse, community dwelling ADRD caregivers. Data were analyzed according to a modified Sociocultural Model of Coping using sequential regression.

Results

In the final model, self-identified race and ethnicity did not predict positive appraisal. However, culture-based values around caregiving and provider cultural competence contributed significant variance to positive appraisal, after controlling for other factors in the model. Caregiving burden and perceptions that help was available were also linked to positive appraisal. Discussion and Implications: This study is among the first to identify cultural factors that contribute to positive appraisal in a diverse sample of ADRD caregivers, beyond race and ethnicity. Findings reinforce the need to assess and incorporate culture-based values in interventions for ADRD caregivers, as well as the importance of provider cultural competence when working with diverse ADRD family caregivers.
HEALTH INFORMATION–SEEKING BEHAVIORS, CONFIDENCE, AND CHALLENGES AMONG FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Chung Jane , Davidsson Rebecca
Published: December 2023

Family caregivers play a significant role in providing care for their loved ones with dementia, including communication with healthcare providers (HCP), treatment decision-making, and care coordination. These tasks require family caregivers’ ability to seek, manage, and interpret health information they have found or received during and outside clinical encounters. This study examined which sources family caregivers use for seeking dementia care information, how trustworthy and reliable they find these sources, and information seeking confidence and challenges. A survey designed to understand family caregivers’ information seeking was completed by 36 participants who provided at least 10 hours of dementia care weekly (mean age 63.4; 83% female). About 80% reported using the Internet to look for dementia information, and less than 20% used a smartphone app to exchange their loved one’s medical information with HCP through a protected portal. While family caregivers entrusted HCP, pharmacists, and dementia-related organizations as sources of dementia information, they were skeptical of radio and TV as sources of credible information. Other information sources were identified, including Alzheimer’s Association, support groups, books/documentaries, and research journals. Approximately 50% reported concerns about the quality of dementia-related information; 45% experienced difficulties accessing the information they needed; 44% sensed frustration while searching for dementia-related information; and 40% had difficulty understanding the information found. There should be efforts to develop strategies that help dementia caregivers better identify credible information sources to increase confidence and reduce the stress and burden of acquiring reliable information necessary to care for their loved ones.
ASSOCIATIONS BETWEEN FRAILTY AND SLEEP IN OLDER ADULTS WITH CANCER TREATED WITH CHEMOTHERAPY
Authors: Hoogland Aasha , Crowder Sylvia , Extermann Martine , Li Daneng , Carpenter Kristen , Fischer Stacy , Kinney Anita , Jim Heather
Published: December 2023

Little is known about the association between frailty and sleep after starting chemotherapy. The goal of this study was to examine frailty and sleep in older adults (65+ years old) with cancer. Patients newly diagnosed with cancer and starting chemotherapy were recruited to a multi-site study. Participants completed questionnaires before chemotherapy (i.e., baseline) and 5 days after their first infusion. A pre-treatment frailty score was derived using a 59-item deficit accumulation index and dichotomized (frail vs. robust). Sleep was assessed with the PROMIS Sleep Disturbance 8a (difficulty sleeping) and Sleep Impairment 8a (daytime sleepiness). Repeated measures ANOVAs adjusted for age, sex, cancer stage, and cancer type evaluated change in sleep over time. Participants were 402 older adults with cancer (M age=72, SD=5). Most were female (65%), non-Hispanic (96%), and married (67%). Difficulty sleeping was higher in frail participants (26%) than robust participants at baseline (p< 0.001). Over time, difficulty sleeping decreased in frail participants but increased in robust participants (p=0.02). Difficulty sleeping remained higher in frail participants post-infusion (p=0.01). Daytime sleepiness at baseline did not differ by frailty status (p=0.86) and was higher than population norms. Frail participants reported smaller reductions in daytime sleepiness over time (p< 0.01), and more daytime sleepiness after infusion (p< 0.0001) than robust participants. Despite improvements in sleep from pre-treatment to 5 days after infusion, frail participants reported more difficulty sleeping and daytime sleepiness than robust participants after infusion. Additional research is needed to better understand the association of frailty with health outcomes in older adults with cancer.
CLINICAL VERSUS SUBJECTIVE PREDICTORS OF DISTRESS AND HEALTH SATISFACTION AND THE MODERATING ROLE OF PERCEIVED CONTROL
Authors: Seckin Gul
Published: December 2023

Coping with cancer in old age and a general decline in physical health may result in a lack of control over health. Cancer diagnosis tends to be associated with fear, uncertainty, and loss. It also challenges one’s assumptions about the sense of the self and bodily image. This paper explores health perceptions (distress with somatic symptoms, treatment side effects, and satisfaction with health status) in a sample (N=350) of older individuals who reported being treated with cancer (M age=50.23, S.D. =10.91). Three models of hierarchical multiple regressions were performed to estimate the impact of sociodemographic, medical, and psychosocial variables and perceived control over health on subjective health indicators. The results indicated that lower income was associated with greater distress with physical symptoms (Slope = -.12; B= -.17, p =.002), older age was associated with less distress with cancer treatment side effects (Slope = -.01; B= -.12, p =.019) and gender (female) were negatively associated with satisfaction with health status (Slope = -.36; B= -.15, p =.002). Even though the higher stage of cancer was a significant covariate for greater distress with somatic symptoms (Slope = .12; B= .17, p =.001), it was not a significant covariate for distress with treatment side effects and satisfaction with health status. Perceived control over health significantly moderated the association between research covariates and satisfaction with health. These findings suggest that assessing differential aspects of self-rated health may provide health professionals with important information to supplement their diagnosis to understand the patient’s illness experience better.
FACTORS ASSOCIATED WITH LOW-DOSE COMPUTED TOMOGRAPHY LUNG CANCER SCREENING IN THE UNITED STATES
Authors: Tseng Tung-Sung , Li Chien-Ching , Lin Hui-Yi , Chiu Yu-wen
Published: December 2023

Low-dose computed tomography (LDCT) screening is recommended for high-risk smokers to decrease lung cancer-related mortality. In the US, the uptake of LDCT screening among eligible smokers is suboptimal. The impacts of social-environmental and individual factors on LDCT screening uptake are not clear. The current study investigated multi-level factors associated with the utilization of LDCT screening using national data. Methods: The 2017-2021 Behavioral Risk Factor Surveillance System (BRFSS) data and other state-level variables (Medicaid expansion status and the number of screening facilities) were applied. Our study outcome is the utilization of LDCT screening among study participants who met the US Preventive Services Task Force guidelines for lung cancer screening. The final study sample consisted of 15640 respondents from 29 states. All analyses were weighted to account for the complex sampling design applied in BRFSS. Results: The overall utilization rate of LDCT screening is only 18.4%. The LDCT utilization rate varied by state (6.2 -31.1%). Among the respondents, individuals who were employed, never married, had good health status, didn’t have personal physician, experienced cost problems, never had routine checkups, and did not experience certain chronic conditions (cancer, asthma, COPD) had a lower utilization rate of LDCT screening compare with their counterpart. Conclusion: Utilization of LDCT screening among eligible smokers remains low. Risk factors associated with LDCT screening identified from this study can be used to guide future lung cancer screening programs or revise the LDCT screening guidelines to meet the needs of high-risk smokers.
FAITH AND HEALTH: THE INTRICATE INTERPLAY OF MARITAL QUALITY, RELIGIOSITY, AND DIABETES
Authors: Case Rebekah , Yorgason Jeremy
Published: December 2023

Although chronic illness in later life can negatively affect marital quality and life satisfaction through increased stress and burden, religiosity and spirituality are known robust protective factors in relational and psychological outcomes. Stress theory suggests that religious behaviors can help moderate this negative relationship by providing patients with a sense of meaning in illness, external social support, and healthy coping mechanisms. Using data from the Life and Family Legacies Study, we analyzed cross-sectional data from 1,210 married participants around age 70 in 2016. Using an OLS linear regression model, we found main effects which showed that type 2 diabetes among older adults was predictive of lower positive marital quality and lower life satisfaction. When religious behaviors were included in the model as a moderator, religious behaviors interacted significantly with diabetes such that individuals with type 2 diabetes who reported high religiosity had high positive marital quality, while those with low religiosity reported significantly lower positive marital quality. Findings suggest that when persons with type 2 diabetes participate regularly in church services, prayer, and scripture study they experience more positive marital quality. This indicates that religiosity may be a significant protective factor and coping tool for marital quality when chronic illness is present.
PAIN INTENSITY AND PAIN CATASTROPHIZING ARE RELATED TO PHYSICAL PERFORMANCE IN OLDER ADULTS WITH BACK PAIN
Authors: Simon Corey , Knox Patrick , Goode Adam , Lentz Trevor , George Steven , Hicks Gregory , Colón-Emeric Cathleen , Keefe Francis
Published: December 2023

Back pain is highly prevalent in older adults and a risk factor for poor/declining physical performance. Back pain intensity and pain catastrophizing are two factors known to be associated with physical performance in younger adults; though a paucity of similar research exists in older adults. Thirty-nine older adults with back pain completed a battery of four standardized physical performance tests: 30-second chair rise, repetitive seated trunk rotation, repetitive standing functional reaching, and six-minute walk. Test scores were z-transformed and summated for a standardized physical performance score. We measured resting pain intensity and dispositional pain catastrophizing before the battery and movement-evoked pain intensity and situational pain catastrophizing during/after the battery. After accounting for age and biological sex, resting and movement-evoked pain intensity explained 14% and 39% unique variance in physical performance. In multivariable models, movement-evoked pain was the stronger factor. Similar modeling showed dispositional and situational pain catastrophizing explained 14% and 28% unique variance in physical performance. In multivariable models, situational pain catastrophizing was the stronger factor. Finally, path modeling showed situational pain catastrophizing mediated the total effect of movement-evoked pain on physical performance (21%). Findings suggest: 1) Factors with movement (i.e., movement-evoked pain, situational pain catastrophizing) are more strongly associated with physical performance than factors measured independent of movement (i.e., resting pain, dispositional pain catastrophizing); and 2) The impact of pain on physical performance is mediated by psychological distress. Importantly, neither movement-evoked pain nor situational pain catastrophizing are part of current standard of care for older adults with back pain.
PATTERNS OF USE, RISK FACTORS, AND ATTITUDES OF OLDER ADULT CANNABIS USERS
Authors: Anquillare Elizabeth , Gallegos Adrianna , Thayer Rachel
Published: December 2023

While cannabis use continues to increase among older adults (OA), research within this population is limited. This study aimed to describe OA patterns of use, risk factors, and subjective effects of cannabis use. OA cannabis users ages 60-79 (N=17, Mage=68.29, SD=5.61) were 94% White and 59% women, with an average education of 15.94 years (SD=2.38). Participants completed online questionnaires and semi-structured interviews regarding medical and mental health, subjective cognitive functioning, and cannabis use patterns and attitudes. Participants reported M=33.41 years of cannabis use (SD=20.15) with an average age of first use of 20.11 years (SD=10.40). Current use was reported as 4.29 days/week (SD=3.14). Current reasons for use were recreational (n=6), medical (n=2), or both (n=8). The most common medical conditions for which participants reported using cannabis were arthritis/joint pain (n=4) and disordered sleep (n=4). The most commonly reported benefits of cannabis use were relaxation (n=8), improved sleep (n=6), improved mood/anxiety (n=6), cognitive enhancement (n=5), and pain management (n=4). Common drawbacks included subjective cognitive decline (n=7), social hindrance (n=6), and health complications (n=5), whereas 5 participants reported no drawbacks. Most participants (76%) reported discussing cannabis use with their physician, although only 38% of those reported that discussion was helpful. Disconnect between OA cannabis users and their physicians could result in cannabis use that is contraindicated by preexisting medical conditions or medications. Emphasis should be placed on individualized psychoeducation regarding the potential risks/benefits of cannabis use as well as continuing education for physicians regarding cannabis use in OA.
PREVALENCE AND PREDICTORS OF DECISIONAL CONFLICT AMONG OLDER AFRICAN AMERICANS WITH ADVANCED KIDNEY DISEASE
Authors: Hamler Tyrone
Published: December 2023

Chronic kidney disease (CKD) is a major public health concern in the U.S., particularly among African Americans. African Americans are just under four more times likely to develop CKD than White individuals. Older African Americans are a vulnerable and understudied population in CKD literature, despite future projections of an increasingly diverse population of older adults. This study’s objectives were: (1) to determine the prevalence of decisional conflict for pre-dialysis older African Americans (2) whether perceived CKD knowledge, clinical characteristics (self-rated health, depression, anxiety, and number of comorbidities), and personal characteristics predicted decisional conflict. Study participants (N =125) were recruited from an outpatient nephrology clinic in a midwestern hospital and administered a telephone survey. Participants were African American, ≥ 50 years of age, pre-dialysis and diagnosed with Stage 4 or 5 CKD. A hierarchical ordinary least-squares (OLS) regression analysis was conducted to examine the relationship between variables. Participants reported mean scores of DC in the moderate range (M = 36.69). Approximately 42% (n =53) of patients’ decisional conflict scores were above 37.5, which is the cut-point for scores indicating uncertainty (O’Connor, 1995). Multivariate analyses indicated that DC was only significantly associated with perceived chronic kidney disease knowledge. Lower levels of perceived chronic kidney disease knowledge were associated with higher levels of DC. Findings indicated that DC is a critical area to continue to investigate among older African Americans with advanced CKD. Social workers are well-positioned to impact levels of knowledge in this population through working on interdisciplinary teams in medical settings.
SECONDARY ROLE STRAIN AND GRIEF OF DEMENTIA FAMILY CAREGIVING AS PREDICTORS OF BURDEN
Authors: Mason Hannah , Falzarano Francesca
Published: December 2023

Services often aim to improve caregiver experiences for dementia family caregivers by addressing challenges in daily care activities and enhancing care quality for care-recipients. Supporting caregivers should not exclusively focus on supporting activities related to direct care provision (e.g., primary stressors), but should also include services that holistically support the caregiver’s well-being. Identifying an individual’s unique needs beyond their caregiving role is crucial; the growing phenomenon of caregiver burnout, burden, and psychosocial struggle includes experiencing a loss of identity, increased desire to escape, and intense role captivity. While some services are more individualized, such as one-on-one therapy, there is an overall gap in caregiver support in secondary domains. The current study examined whether primary stressors (e.g., activities of daily living and everyday care tasks) or secondary stressors (e.g., strain on other relationships and responsibilities) were more predictive of burden in a sample of 46 participants who completed a mixed-method study examining the heterogenous experiences and unmet needs of dementia family caregivers. Analysis shows that interference of the care role with responsibilities to other family (i.e., secondary role strain) and feeling pre-loss grief over their loved one’s illness were significant predictors of greater burden compared to primary stressors. Results indicate the importance of addressing secondary stressors such as pre-loss grief and deterioration of one’s microenvironment (including social support, familial relationships, and identity) in intervention efforts to better enhance quality of life and well-being in dementia care.
SELF- AND PROXY-REPORTED MET NEEDS IN PERSONS WITH DEMENTIA ARE ASSOCIATIED WITH A LOWER HEALTH-RELATED QUALITY OF LIFE
Authors: Wammes Joost , Laws Holly , van Hout Hein , Vroomen Janet MacNeil , Monin Joan
Published: December 2023

This study examined the dyadic association of self and informal caregiver proxy-reported met needs in persons living with dementia on the health-related quality of life (HRQOL). A total of 237 dementia care dyads were included from the Case Management of Persons With Dementia and Their Caregivers Study. HRQOL was assessed by the EuroQol-5D and the number of met needs by the Camberwell Assessment of Needs for the Elderly. The Actor-Partner Interdependence Model framework was used to analyze the effect of an individual’s self or proxy-reported met needs on their own HRQOL (actor effects), and an individual’s self or proxy-reported met needs on the other dyad member’s HRQOL (partner effects). The number of self-reported met needs by persons living with dementia was negatively associated with their own HRQOL (actor effect b = -0.200, p < 0.001), and the HRQOL of informal caregivers (partner effect b = -0.114, p = 0.001). The number of proxy-reported met needs by informal caregivers was negatively associated with their own HRQOL (actor effect b = -0.105, p < 0.001) but not the person living with dementia’s HRQOL (-0.025, p = 0.375). Study findings suggest that both self-reported and informal caregiver proxy-reported met needs in persons living with dementia should be considered in research and practice because they have different implications for each dyad members’ HRQOL.
BRINGING COMMUNITY-BASED FALLS PREVENTION PROGRAM TO IMPROVE GLOBAL HEALTH (BRIGHT)
Authors: Thiamwong Ladda , Tongsiri Sirinart , Xie Rui , Ng Boon Peng , Park Joon-Hyuk , Li Wenjun , Eckstrom Elizabeth
Published: December 2023

Older adults in low- and middle-income countries (LMICs) experience a disparate burden of non-communicable diseases (NCDs) and barriers to accessing health care. Unintentional injuries are among the major NCDs, and falls are the second leading cause of these injuries and deaths. Falls were reported in up to 50% of older people living in Asia, including Thailand. There is a lack of community-based multifactorial fall prevention interventions that target both older adults and the primary care systems. We aimed to culturally adapt the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) for Thai older adults and explore the feasibility, appropriateness, and acceptability of using STEADI by trained community health workers (CHWs) and care managers (CMs). STEADI consists of three steps: screening, assessing, and intervening. In Step a, CHWs screened fall risk using three key questions and found that all of participants had fall risk, then CHWs screened with a Stay Independent questionnaire (range 0-14) and found that 100% have high fall risk (total scores 9.7± 2.4). In Step b, CMs assessed risk factors and CHWs assessed home hazards. They found that 50% had poor balance, 70% took 4+ medications, 75% fell on the walkway, and 70% had no bathroom modifications. In Step c, individual participants received fall prevention interventions and participants attended all sessions. Our results indicated that STEADI delivered by CHWs and CMs is feasible and acceptable for older adults. The mean scores of acceptability, appropriateness, and feasibility were 19.20,18.80, and 18.60 out of 20 totals, respectively.
RESULTS OF AN ONLINE CAREGIVING DURING CRISIS COURSE
Authors: Clevenger Carolyn , Epps Fayron , Higgins Melinda , Brewster Glenna , Raina Kirandeep , Hepburn Kenneth
Published: December 2023

Caregiving during Crisis (CDC) is an online, asynchronous, self-paced course for dementia family caregivers. The course was developed to enhance caregivers’ sense of mastery for their role as systems navigator with the secondary effects of improving their own and their person’s quality of life. CDC was drafted by subject matter experts and finalized by family caregivers. The final version focused on three main topics: Safe Home; Navigating the Healthcare System; and Managing the Day divided into 54 short interactive segments. One hundred caregivers were enrolled in a randomized waitlist control group design, with measures of mastery and quality of life at three timepoints over 16 weeks. We employed multi-level mixed effects models (MLM) with random (participant) and fixed (group) effects to test linear (or possibly non-linear) trajectories of change for the immediate and waitlist groups and model group X time and group*time interactions. Of 100 consented participants (50 in immediate and 50 in waitlisted group), 76 completed the midpoint study activities (38 in each group). For the immediate group, there was an increase in mastery such that by the midpoint at 2 months, the caregivers in the immediate group had significantly higher mastery scores (p=.039) than those in the waitlist group, with a moderate effect size (d=0.501) difference. Fourteen course participants completed semi-structured interviews. Their responses to the course were very positive, noting it was well organized, logical, and not too technical. They also indicated a need to include guidance for interactions with legal, regulatory, social service, and financial systems.
CULTIVATING AN ATTITUDE OF GRATITUDE: A BRIEF GRATITUDE INTERVENTION FOR OLDER ADULTS WITH CHRONIC PAIN
Authors: Condon Shelley , Cox Brian , Parmelee Patricia
Published: December 2023

Gratitude interventions have emerged as a promising approach to ameliorate the negative impact of pain and enhance quality of life. Despite the high prevalence of older adults with chronic pain, there are very few gratitude intervention studies in this population. The current study examined the feasibility and effectiveness of a two-week daily gratitude journaling intervention in a sample of 38 older adults (M=67.53 years) with chronic knee or hip pain. Participants were randomly assigned to the gratitude group (n=21), who wrote down three things they were grateful for every day, or the attention-matched control group, who did not journal. All participants completed pre- and post-intervention interviews and received 14 nightly phone calls, allowing for “global” (pre/post interviews) and “daily” (nightly calls) analyses of the study aims. Aim 1 examined the effects of gratitude on well-being using regression and multilevel model analyses, while Aim 2 examined the effects of the intervention on changes in well-being using repeated measures analyses of variance and multilevel model analyses. In Aim 1, significant associations were found between trait and state gratitude and well-being, supporting previous research and a multifaceted conceptualization and measurement of gratitude. In Aim 2, significant main effects for time emerged, suggesting that participants’ well-being improved regardless of their treatment group. Income level was also a consistent predictor of well-being, demonstrating disparities in chronic pain. The impact of small sample size, COVID-19, and methodological limitations will be discussed. Future research plans and recommendations will also be provided.
THE CURIOUS CASE OF CONSCIENTIOUSNESS AND DEPRESSION: FINDINGS FROM THE IOWA UNMARRIED SURVIVORS STUDY
Authors: Hensley Robert , Bishop Alexander , Martin Peter
Published: December 2023

The purpose of this study was to analyze the association between personality traits, coping, social support, stress, and loneliness relative to depression reported by N = 227 (M = 78.2, SD = 8.1) participants from the Iowa Unmarried Survivors Study. Using the Development Adaptation Model as a conceptual framework, a series of blocked multiple regression analyses were conducted. In the first block, age, gender, ethnicity, total years of education, and current marital status were included. The second block contained total life events and childhood poverty, whereas the third block included activities of daily living and total number of illnesses. The fourth block contained the aforementioned personality variables, and the fifth block included coping, social support, stress, and loneliness. Lifetime illnesses emerged as a significant predictor of depression, β = .158, p < .01. The more illnesses over one’s lifetime, the higher the levels of depression. In addition, both Neuroticism and Conscientiousness were significant predictors of depression, β = .453, p < .00, β = .139, p < .05 respectively. Finally, stress served as a significant predictor of depression, β = .200, p < .01. This model explained 58% of the variance in depression scores. Being unmarried and navigating through late adulthood presents a challenge to sustaining positive mental health. Results from this study have implications relative to how clinically trained counselors, geriatric social workers, and aging service providers develop interventions and programming to improve mental health and quality of life for persons who remain unmarried throughout later life.
THE NARRATIVES OF NURSING HOME RESIDENTS WITH PERSISTENT PAIN ABOUT THE PAINCQ-33
Authors: O’Connor Timothy
Published: December 2023

Problem

Persistent pain in older adults, often multimodal, remains poorly managed among nursing home residents. The resident’s perceptual barriers can interfere with how clinicians treat pain. Current pain instruments do not identify how older nursing home residents perceive interdisciplinary pain management care (IPMC). Purpose: This study explores the use of the Pain Care Quality (PainCQ-33) to measure how older nursing home residents with persistent pain perceive their IPMC and how these individuals communicate their persistent, multimodal pain to caregivers. Furthermore, this research determines how older residents prioritize their pain management expectations for maintaining their quality of life. Research design: A focus group design was used to explore residents’ viewpoints about the ability of the PainCQ-33 to accurately measure the perception of the quality of their pain management care. Data analysis: Transcripts and field notes from focus group discussions were analyzed using descriptive content analysis.

Results

The identified codes illustrate how pain interference affects the ratings an older resident assigns to their pain management care and expectations of whether their pain can be relieved. Additional codes demonstrate an older resident’s pain-relieving measures and who they identify as helping to alleviate their pain. A theme from the codes emerged, where the relevance of pain management was based on the caring nature for chronic pain, which is the underpinning of the PainCQ-33 instrument. Significance: Clinicians, including nurses, can benefit from having a pain assessment tool uniquely designed to assess how this population perceives the quality of their pain management care.
THE PREDICTIVE VALIDITY OF SUBJECTIVE SURVIVAL PROBABILITIES AMONG OLDER ADULTS WITH PAIN
Authors: Fennell Gillian
Published: December 2023

Chronic pain, which afflicts 20% of US adults, is associated with heightened mortality risk and lower subjective survival probabilities (SSPs) to advanced ages. However, the accuracy of SSPs for individuals with chronic pain is unknown. To assess whether individuals with and without pain and pain-related activity interference report SSPs that are veridical to their actual lifespans, we exploited multi-wave data from the Health and Retirement Study. Baseline SSPs and covariate data were obtained from the 2000 wave among respondents aged 57-89 with and without pain (N=7,075). SSP reports were then compared to the age at which respondents actually died (if they did) using mortality data from exit interviews in subsequent waves. We conducted a multinomial logistic regression using baseline pain and covariates to predict membership into one of four groups summarizing the accuracy and valence of SSP assessments. The groups were: (1)correctly pessimistic, (2)falsely optimistic, (3)falsely pessimistic, and (4)correctly optimistic. Findings suggest that individuals with baseline pain were significantly more likely to be correctly pessimistic about their longevity with low, but accurate SSPs (falsely optimistic (RRR=.56, p<.001), falsely pessimistic (RRR=.65, p<.001), or correctly optimistic (RRR=.44, p<.001)). This study highlights that chronic pain and associated disability are features of health that individuals use to estimate their own lifespans with greater accuracy. Future research should assess the extent to which this connection is due to self-fulfilling prophecy.
CAREGIVING THROUGH COVID: POSITIVE ASPECTS OF CAREGIVING AND CAREGIVER STRESS OVER TIME
Authors: Schneider Haley , Donohoe Maria , Thompson Lena , Ashida Sato
Published: December 2023

With an increase of age-related diseases due to population-aging, there are more caregivers in need of support services. Caregivers are known to experience poor health status due to caregiving burden, stress, and psychological impacts. Caregivers often experience care-related negative health consequences, and such experiences can be exacerbated during stressful times such as COVID-19 pandemic. The concepts of positive aspects of caregiving (PAC) help identify protective factors (sense of meaningfulness in role, familial cohesion, etc.) that have been shown to decrease negative health impacts and enhance caregiver satisfaction. This study included 43 caregivers of individuals diagnosed with Alzheimer’s Disease or related dementias (ADRDs) who participated in a randomized-controlled trial (2020-2021) to test an intervention that provides caregiver education and referral to community-based services. A regression model was built using the data from baseline and three-month post-intervention surveys. Controlling for baseline COVID-19 distress levels and gender, an increase in COVID-19 distress from baseline to three months was significantly associated with lower levels of PAC at baseline (b=-0.337, p-value=0.029); there was also a trend for a decrease in PAC over three months (b=-0.300, p-value=0.058). Understanding how lower levels of PAC leads caregivers to experience higher stress levels during the pandemic likely will help identify the opportunity to address caregiver stress. Future studies may explore the strategies to enhance caregiver PAC and investigate how changes in PAC may impact caregiver wellbeing. Future interventions may benefit from incorporating the concepts of PAC to support and empower caregivers during stressful events like the pandemic.
HOME CARE AND QUALITY OF LIFE AMONG COMMUNITY-DWELLING FRAIL OLDER ADULTS IN ISRAEL: A MULTIPLE MEDIATOR MODEL
Authors: Khalaila Rabia
Published: December 2023

The aim of the current study is to examine the association between two types of home care provision (combined formal and informal home care vs. family-only home care) and quality of life (QoL) of older adults, as well as the mediating effects of loneliness, social isolation and satisfaction with family relationships and support. A convenience sample of 360 Israeli adults aged 65+ responded to questionnaires. Using bootstrapping, we tested the strength and significance of the conditional indirect effects of the four simultaneous mediators. The results showed that combined formal and informal home care (vs. family-only home care) for older adults was associated with lower QoL of care-recipients, and was fully mediated by feelings of loneliness, social isolation, and low satisfaction with family support. Satisfaction with family relationships did not emerge as a mediator but was positively associated with QoL. Formal home care might reduce the QoL of care-recipients by increasing their feelings of loneliness, social isolation and reduced perceived family support. Practitioners should encourage family members to continue with family regular support and contact alongside the use of formal home care in order to maintain satisfaction and QoL of older relatives.
INTEGRATING PRIMARY CARE AND COMMUNITY-BASED PROVIDERS IN AN INTERPROFESSIONAL TEAM FOR OLDER ADULTS
Authors: Kropp Denise , Clay Danielle , Fosnight Susan , Drost Jennifer , Hughes Michelle , Warren Lorrie , Wilson Jess
Published: December 2023

The integration of healthcare and community-based providers has been long-recognized as the gold standard in the optimal care of older adults. Social determinants of health account for more than 80% of health outcomes. Therefore, optimal care requires meaningful collaboration between medical and community-based care providers. We present here a collaborative model of care integrating community providers and healthcare system. This is a long-standing collaborative approach where our Area Agency on Aging care managers present their complex cases to a team, which includes nursing, social work, geriatric medicine, and geriatric pharmacy. This team meets weekly for case presentations and interprofessional care planning. We have recently expanded these meetings to extend the reach of the team to remote Area Agencies on Aging, to ACO care managers, to a local FQHC, and to a local Habitat for Humanity affiliate for the Aging in Place initiative. Since September 2022 this expanded team reviewed 12 consumers. On average there were 4.25 medication issues identified (maximum=13, minimum=0). The team addressed the following in at least half of consumers: falls (58%), depression/anxiety (50%), advance care planning (67%), function (50%), caregiver support (58%), and dementia (50%). Additional issues included mobility (42%), finances (42%), pain, (33%), elder abuse (25%), safety (17%), behavioral health (17%), sleep (17%), spiritual care (17%), language barriers (17%), and substance abuse (8%). This team model has been shown to be replicable across provider settings. Expansion of this model extends the limited resources of geriatricians and geriatric pharmacists.
INTERVENTIONS FOR SENSE OF COHERENCE AMONG OLDER ADULTS WITH CHRONIC DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Liu Yaqian , Leung Angela Y M , Montayre Jed
Published: December 2023

Background

Sense of Coherence (SoC) is a core concept of “salutogenesis” in positive psychology, correlated with emotional distress and disease development in older adults with chronic disease (OACD). A diversity of interventions has been developed to enhance SOC, but research findings are conflicting and only a few studies have reviewed the effectiveness. Objective: This paper aimed to explore appropriate interventions and evaluate the effectiveness of these SoC interventions on OACD.

Methods

Search terms including ‘sense of coherence’, ‘older adult’ and ‘randomized controlled trial’ were performed in nine electronic databases and two grey literature sources. Publications were written in English from January 1979 to January 2023. A narrative synthesis was performed to determine intervention details, and classical meta-analysis was used to analyze available data on SoC using RevMan.

Results

27 RCT studies were identified, involving salutogenic-based program, cognitive behavior treatment, and self-management intervention. Meta-analysis was carried out with 21 RCTs involving 1,687 patients. It showed significant effects of all interventions on SoC, compared to usual care, among OACD (SMD=0.19, 95%CI [0.09, 0.28], p<0.001) and at 3-month follow-up (SMD=0.14, 95%CI [0.03, 0.24], p<0.001), but no significant difference was observed at 6-month or 12-month follow-up (SMD=0.12, 95%CI [-0.13, 0.43], p=0.07; SMD=0.15, 95%CI [-0.27, 0.47], p=0.09).

Conclusions

Interventions for SoC were shown to be effective right after the intervention and at 3 months. However, its effects were not sustained over a longer period. Further research is needed to explore optimal duration and components of interventions for SoC in this population.
THE NET ON THE RIVER WHERE VERY LITTLE HAS BEEN CAUGHT: DIFFERENCES IN MEMORY FOR DISCOURSE IN YOUNGER AND OLDER ADULTS
Authors: Getz Marjorie
Published: December 2023

Experiential learning is key for courses in a gerontology certificate program at a midwestern nursing and health science college. One curricular emphasis is the uniqueness of every older adult that the student will encounter as they move from a novice student role to professional role mastery several years into their careers. To assist in this transition, one course has a unit on memory for discourse, especially memory for printed materials—essential in support of understanding medical conditions and treatment follow-through. Our project had college students compare their memory for short stories with memories of “students” from an OLLI Program who attended this class. The project, in an adult development course, provides students with community service, direct contact with older adults and reflective practices to integrate course content with this activity. Qualitative analyses were used. Content analyses of reflective essays identified four themes (a) older adult focus on key story propositions as well as incidental propositions with tie-in to acquired knowledge on attention/memory from course work (b) frequent use of situational schema based on greater world knowledge held by older adults and implications of this type of discourse in clinical settings (c) differences, that favored older adults, between groups in memory for details in structured versus unstructured stories, and (d) differences in style of recall for stories between age groups. Reflections were encouraged to tie new age-related knowledge about memory processes into better client follow through. Students also reflected on ways to make memory more optimal in clinical settings.