bluuebunny/crossref_metadata_2025 huggingface dataset:
THE HEART OF DAILY LIFE: THE INTERPLAY BETWEEN EVERYDAY AFFECTIVE STATES, DAILY EVENTS, AND SUBJECTIVE BELIEFS
Authors: Klaiber Patrick , Pauly Theresa , Scott Stacey
Published: January 2025

Affective experiences profoundly shape well-being and quality of life throughout adulthood. They are intricately intertwined with social engagement and daily experiences like stressors and positive events. Individuals’ internal beliefs regarding aging and emotions can either facilitate or impede their engagement with daily events, and further impact emotional responses and regulation. Moreover, fluctuations in affect resulting from these daily experiences may cumulatively influence long-term mental and cognitive health outcomes. This symposium illuminates these dynamics by utilizing a set of daily diary studies using lifespan and older adult samples. The first presentation by Witzel et al. connects experiencing more frequent positive events and more favorable affective reactions to these events with better cognitive health. Klaiber and Pauly find that on days on which people feel older than usual, they experience more stressors, and fewer positive events, but also tend to show more favorable affective responses to these positive events. Thirdly, Pauly shows that positive affect mediates the association between social interaction time and decreased subjective age. Finally, Rutledge and Barlow shed light on differential associations between emotion beliefs and affect in younger vs. older individuals. Together, these studies offer valuable insights into the complex interplay between daily experiences, beliefs, affective fluctuations, and long-term health outcomes in adulthood. Stacey Scott will integrate the insights gained from these four papers, discuss their potential and limitations, and consider directions for future research.
THE INTERPLAY OF SOCIAL INTERACTION, POSITIVE AFFECT, AND SUBJECTIVE AGE IN OLDER ADULTS
Authors: Pauly Theresa
Published: January 2025

How old people feel compared to their actual age, their so-called “subjective age” (SA), is a central predictor of health and well-being across the life span. Felt age can influence lifestyle choices such as attending a social gathering. On the other hand, spending time with other people can elicit feelings of engagement and positive emotions, which could in turn, make people feel younger. The current study aimed to examine the reciprocal association between everyday time spent in social interaction and subjective age in old age. For this purpose, a sample of 108 older adults aged 65–92 years took part in a daily diary study. Over 14 days, participants reported daily social interaction time, positive affect, and subjective age. Multi-level models showed that previous day social interaction time was related to next day subjective age, whereas previous-day subjective age was not related to next-day social interaction time. In addition, the same-day association between social interaction time and subjective age was fully mediated by positive affect. Findings suggest that social connections might foster a sense of feeling young in older adulthood. Further research in this area may offer valuable insights into developing interventions aimed at enhancing subjective well-being and quality of life among older populations.
HELPING OR HINDERING: ASSOCIATIONS BETWEEN DAILY POSITIVE EXPERIENCES AND COGNITIVE PERFORMANCE
Authors: Witzel Dakota , Taylor Zachary , Cerino Eric , Stawski Robert , Almeida David
Published: January 2025

Daily stressors have significant effects on cognitive health across the lifespan, but little is known about how daily positive experiences may facilitate better cognitive performance. Leveraging the third wave of a publicly available adult lifespan sample who completed a telephone assessment of cognitive function (i.e., executive function, episodic memory) and an eight-day daily diary protocol (n=1,172; 55.76%Women, Mage=62.71), we examined how the exposure, number of, and affective reactivity to daily positive experiences were related to executive function and episodic memory. Models adjusted for daily stressor exposure, age, education, marital status, and gender. Person means for exposure and number of positive experiences, as well as negative (NAR) and positive (PAR) affective reactivity (decreases or increases in negative or positive affect, respectively) were calculated across eight days. Linear regressions suggest that having a higher proportion of days with positive experiences, and a higher number of positive experiences were related to better executive function and episodic memory (ps<.05). Higher NAR to the exposure to and number of daily positive experiences was related to better executive function; only NAR to the exposure to daily positive experiences were related to better episodic memory (ps<.05). Higher PAR to the exposure to and number of daily positive experiences was related to poorer episodic memory only (ps<.05). Discussion will focus on the complex differential associations among affective reactions to positive experiences and cognitive function. Future directions should evaluate possible non-linear effects of reactivity and mechanisms underlying associations between daily positive experiences and cognitive health across the lifespan.
A TECHNOLOGY-BASED TRANSITIONAL PALLIATIVE CARE INTERVENTION FOR FAMILY CAREGIVERS IN RURAL OR UNDERSERVED AREAS
Authors: Griffin Joan , Holland Diane , Vanderboom Catherine , Mandrekar Jay , Kaufman Brystana , Gustavson Allison , Ingram Cory
Published: January 2025

In this presentation, Dr. Griffin will describe the Technology-Enhanced Transitional Palliative Care (TPC) study, a randomized controlled trial testing the efficacy and cost-effectiveness of an intervention to address FCGs’ unmet needs in order to improve their health and well-being. Nurse interventionists use video visits to teach, guide and counsel FCGs in rural areas caring for someone receiving palliative care and transitioning form hospital to home. In addition to providing background on the importance of addressing unmet family caregiver needs during care transitions for patients receiving palliative care, she will describe the study design, sample, intervention and control group procedures, including the use of video visits, and outcomes assessed. This presentation will provide necessary context for the remaining presentations.
RECRUITING FAMILY CAREGIVERS FOR INTERVENTIONS DESIGNED TO OPTIMIZE TRANSITIONS FROM HOSPITAL TO HOME
Authors: Gustavson Allison , Griffin Joan , Horstman Molly , Kaufman Brystana , Mandrekar Jay , Vanderboom Catherine , Ingram Cory , Holland Diane
Published: January 2025

Recruiting family caregivers to participate in research, especially caregivers of people with severe or life limiting illnesses transitioning from hospital to home, is challenging. Traditional approaches for recruitment, including recruitment done on site at clinics or hospitals, became impracticable during the COVID-19 pandemic, leading to shifts toward virtual or remote recruitment and consent. In this presentation, Dr. Gustavson will compare the success of these two methodological approaches, in-person and remote recruitment and consent, used in the Technology-Enhanced Transitional Palliative Care (TPC) study. She found that the rate of recruitment and consent done in-person was 28% and the rate of remote recruitment and consent was 23%. Those recruited and consented remotely were more likely to be younger, white, have greater than high school education, and were children of or had another non-spousal relationship to the care recipient. She discusses the limitations and benefits of each recruitment modality, including the impact on representativeness of the study sample.
LAYERING THE IMPACTS OF STRUCTURAL RACISM ON HEALTHY AGING TRAJECTORIES IN A LONGITUDINAL COHORT
Authors: Sadler Richard
Published: January 2025

African Americans are more at risk for earlier and more pronounced cognitive and functional decline. Direct impacts of racism are responsible for disparities in medical quality, access, and treatment are documented drivers of these racial disparities in aging health inequities. But largely understudied is the role of the built and social environment as a foundational determinant of health. In particular, a web of elements of structural racism in the built environment (STRAßE) work together to create environments where amenities are scarce and disamenities proliferate. While many studies are keen to include redlining as one such measure, emerging evidence suggests that additional STRAßE variables (i.e. blockbusting, urban renewal, freeway construction) may be key in illuminating health linkages. Here we build such measures for the city of Baltimore for use in an expanded dataset of the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) epidemiological cohort study. Our team has proposed work with HANDLS to collect complete residential histories for ~800 midlife to older Baltimore-born men and women (ages 30-64 at baseline), tracked up to 13 years across three waves. We will illustrate spatial-temporal specific exposures of STRAßE and establish a framework for future work. We use GIS to digitize and geocode the extent of STRAßE and identify spatial-temporal overlaps. Initial findings show interesting links between key STRAßE measures (i.e. redlining lacking overlap with blockbusting, gentrification co-occurring with redlining and urban renewal), illustrating the importance of considering a wider range of measures than has been examined to date.
NATIVE AMERICAN CAREGIVING PREFERENCES: HEARING THEIR VOICES
Authors: Monaghan-Geernaert Pamela
Published: January 2025

American Indian and Alaska Native elders have the shortest life expectancy of all non-white groups in the USA (CDC, 2022). Despite this disparity, Native elders experience higher rates of morbidity, often necessitating skilled care. Previous research has indicated that enhancing treatment for AI/AN elders must incorporate cultural considerations (Willging et al. 2021). This study utilized focus group data collected at the National Indian Council on Aging (NICOA) biennial conference for American Indian and Alaska Native elders. Elders from all Indian Health Service Units across the nation participated in the focus groups, sharing their desires for caregiving when they can no longer care for themselves. Thematic analysis of the data revealed that elders wish to have their voices heard and to play a role in guiding their own care to the best of their abilities. When external caregivers are necessary, elders prefer family members as their first choice, followed by tribal members, with culturally trained caregivers considered as a last resort. Additionally, elders expressed a desire for the incorporation of Native teachings, storytelling, and traditional medicines, such as herbal remedies, into their care. They also emphasized the importance of streamlining the care process between Indian Health Services (IHS), tribes, and families and removing barriers to ensure respective care during periods of illness and frailty. As the Native elderly population continues to age, it is crucial that we actively listen to their stories and preferences regarding elderly care.
EXPLORING IKIGAI AND LIVING WELL WITH DEMENTIA AMONG JAPANESE CANADIANS: A NARRATIVE AND ARTS-BASED RESEARCH STUDY
Authors: Ito Hiro , Cox Susan , Phinney Alison , Ho Anita
Published: January 2025

Like many ethnocultural minority populations, Japanese Canadians have been underrepresented in research pertaining to experiences of living with dementia. Representation of how diverse populations experience living with dementia is necessary to further scholarship on the intersections of dementia and culture. Thus, we aim to explore how Japanese Canadians live well with dementia through the conceptual lens of ikigai, a Japanese wellbeing construct. In this two-phase study, we took a relational approach and recruited 4 people living with dementia and 3 of their care partners from the Japanese Canadian community. In the first phase, we conducted individual and dyadic narrative interviews to understand experiences of living well with dementia. In the second phase, we gathered in a group art-making workshop to enable participants to identify and express what they wanted others to know about how they live well with dementia. To ensure that individuals could participate meaningfully in their preferred language, the study was conducted in English and Japanese. Audio recordings from both phases were transcribed and analyzed through narrative inquiry. Through our study, we identified several ways Japanese Canadians maintained their ikigai to live well with dementia, including notions of balance, continuity, and gratitude. Our findings offer insights into the integral role of culture in living well with dementia, as well as the value of culturally nuanced and inclusive research.
IMPACT OF RESPITE SERVICES ON DEMENTIA CAREGIVERS’ NEUROCOGNITIVE AND PREDEATH GRIEF OUTCOMES: A PILOT STUDY
Authors: Schneider Sydnie , Elliott Lauren , McLean Elisabeth , Neugebauer Volker , Diehl Keegan , Singer Jonathan
Published: January 2025

Caring for individuals with dementia presents a significant challenge, often placing caregivers under immense stress. Research has consistently highlighted that caregivers of individuals with dementia face an elevated risk of experiencing health concerns themselves due to the high stress and burden. This burden extends beyond psychological strain, with studies indicating higher rates of neurocognitive decline and pre-death grief (PDG) among family caregivers. Despite growing recognition of these health risks, there is currently a lack of interventions that target the family caregivers of persons with dementia. This study implemented 12-weeks of 3-hours of respite. We assessed overall neurocognitive functioning and PDG in caregivers at baseline and follow-up. Pilot data from 8 caregivers were analyzed. Assessments comprised of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; i.e., attention, language, visuospatial ability, and immediate/delayed recall) and the PG-12 (i.e., pre-death grief). The individual reliable change index (RCI) for each participant was calculated as the difference in overall scores on the RBANS and PG-12 scores at baseline and follow up. Average PG-12 scores decreased (RCI = -0.88) at intervention, indicating a decrease in PDG. Further, RBANS (RCI = 1.2), immediate memory index (RCI = 4.58), language index (RCI = 3.16), attention index (RCI = 1.58), and delayed memory index (RCI = 2.33) scores increased. However, average visuospatial/constructional index (RCI = -8.04) scores decreased. These preliminary results suggest that only 3 hours of respite a week has the potential to reduce PDG and improve neurocognitive functioning among family caregivers of persons with dementia.
SUPPORTING SAFE AND HEALTHY SEXUAL EXPRESSION IN LONG-TERM CARE: A REVIEW OF CANADIAN RESOURCES
Authors: Grigorovich Alisa , Brassolotto Julia , Manduca-Barone Alessandro , Colobong Romeo , Martin Lori Schindel , Iaboni Andrea , Feldman Sid , Kontos Pia
Published: January 2025

Little is known about what educational resources are available to practitioners in Canada for supporting the safe and healthy sexual expressions of persons living with dementia in long-term care (LTC). To address this gap, we conducted a critical review of publicly available online resources in Canada. Our objectives were to identify existing resources, describe key content areas and modalities, and assess strengths and weaknesses. To find resources, we conducted a systematic Google search, targeted websites searches, and contacted experts. Resources were included if they were in English, publicly accessible (e.g., not behind a paywall), focused on support of sexual expression of persons living with dementia in LTC, and informed action at the micro level of practice and/or meso level of organizational policy. We identified 9 resources, the majority of which were text-based and aimed at supporting staff or organizations in developing policies or practices regarding assessment and intervention in non-consensual sexual behavior. Guidance on consent was narrowly focused on bioethical principles, often neglecting fluctuating capacity, assent, and the role of substitute decision-makers. Although some acknowledged that healthy sexual expression in the context of dementia should be supported, the focus was primarily on support of non-erotic intimacy (e.g., hugging vs. stroking/kissing). We also found stigmatizing language (e.g., “demented”), and cursory attention to sexual and gender diversity, and ethnically and culturally diverse content. Although the available resources provide an important foundation, there is a pressing need to develop additional resources to better support sexual expression for persons living with dementia in LTC.
EXPLORING THE FEASIBILITY AND UTILIZATION OF CLARE: A MOBILE APPLICATION FOR CAREGIVERS AFTER HOSPITAL DISCHARGE
Authors: Wang Dingyue , Matters Doreen , Hendrix Cristina
Published: January 2025

CLARE is the first mobile application tailored to enhance discharge education and teaching practices in hospital settings. This mixed-method study aimed to assess the feasibility of CLARE in providing caregiving training and support immediately following hospital discharge. Additionally, the study sought to apply the Unified Theory of Acceptance and Use of Technology (UTAUT) framework to identify factors that promote or hinder the intent and use of CLARE among caregivers. Caregivers included in the study were primary caregivers assisting patients post-discharge, aged at least 35 years, and caring for patients aged at least 55 years. Data from application usage was analyzed alongside caregiver interviews. CLARE areas of teaching encompassed discharge preparation (e.g., early mobility instruction), COVID-19 care protocols (e.g., isolation; quarantine; home sanitization; monitoring shortness of breath), and caregiver self-care strategies (e.g., managing anxiety and stress). Preliminary findings from the 23 enrolled caregivers (with a target enrollment of 50) revealed that 65.2% were female, and the majority (78.3%) were between 50 and 80 years old. Usage statistics indicated that 17.4% of caregivers completed all tasks, 34.8% completed over 80% of tasks, and 52.2% completed more than half of the tasks in CLARE. Survey and interview responses showed that CLARE is a user-friendly, time-efficient, and informative app that facilitates awareness of caregiver needs. Caregivers appreciated the clear and real-time information in CLARE. Our findings suggest a need for ongoing development and updates to CLARE, alongside comprehensive interventions addressing the diverse hospital discharge needs of caregivers.
AGING SINGLE PARENTS: PSYCHOSOCIAL OUTCOMES AND WELL-BEING AMONG A MARGINALIZED POPULATION
Authors: Hanes Douglas
Published: January 2025

Objective Over the last 50 years, single parents—in particular, single mothers—have received much popular and political attention. And yet, their aging experiences remain unresearched. This paper analyzes aging among single parents, including their sex/gender and racial/ethnic composition, as well as their psychosocial well-being, in a population-based aging study. Method Using Health and Retirement Study data (N = 38,785), we identify single parents as participants who were never married at baseline and have children (n = 680), 1.80% of participants with children. Multilevel regressions analyzed psychosocial outcomes: discrimination experiences, subjective social status, and social support. Results Odds of single parenthood increased for each subsequent birth cohort (OR = 1.89, p < 0.001). Women (□2 = 85.192, p < 0.001) and people of color (□2 = 802.32, p < 0.001) were more likely to be single parents, who also had lower education levels and wealth. Single parents were more likely to report discrimination due to race (OR: 1.522, p = 0.047), with single mothers of color more likely to report discrimination due to financial status (OR = 1.575, p = 0.049). Single parents received less positive social support and more negative support from their children; they were also more likely to experience depression, have lower self-rated health, and smaller social networks. Discussion Aging single parents are more likely to belong to already-marginalized groups, and face further and ongoing discrimination, known risk factors for adverse later-life health and well-being. These results indicate the need for greater attention to this marginalized group.
LONG-TERM AND INTERGENERATIONAL EFFECTS OF EARLY-LIFE EXPOSURE TO THE 1959–1961 CHINESE FAMINE ON HEALTH
Authors: Cheng Mengling , Sommet Nicolas , Kerac Marko , Spini Dario
Published: January 2025

Undernutrition in early life is associated with increased risk of poor health and mortality in later life. Less is known if the health effects of early-life undernutrition transmit across generations. This study examined the associations between early-life famine exposure and self-rated health in the first generation (F1) and the subsequent generation (F2). We used data from the China Health and Retirement Longitudinal Study (2011-2020, 11,000 participants). We classified F1 participants by famine exposure (exposed/unexposed) and timing at famine exposure (exposed in utero, infancy, pre-school, primary school, or adolescence); we classified F2 offspring by their parents’ famine exposure status. We performed growth curve models to investigate the associations between early-life famine exposure and self-rated health in F1 and F2. The first generation (F1) exposed to famine in utero, infancy, pre-school, primary school, or adolescence had poorer self-rated health than those unexposed (IRR=1.06, 95% CI [1.04 – 1.07], p <.001). The offspring generation (F2) whose parents were exposed to famine also had poorer self-rated health than those of unexposed parents (IRR=1.05, 95% CI [1.01 – 1.10], p <.05). Findings of this study show the long-term and intergenerational effects of early-life famine exposure on health, indicating cumulative advantage and disadvantage over the life course and across generations. Our study highlights the need to prevent and treat child/adolescent undernutrition to improve health in the long run.
HOME HEALTH CARE ACCESS AND OUTCOMES AMONG VULNERABLE OLDER POPULATIONS: CHALLENGES AND OPPORTUNITIES
Authors: Gadbois Emily , Johnson Michael
Published: January 2025

Home health care (HHC) provides skilled nursing (e.g., wound care, medication management), therapies (e.g., physical, occupational, speech), and aide services (e.g. bathing, grooming, dressing), which are key supports necessary to regain function, restore health, and maintain independence in the community. This panel presents five studies examining factors that challenge equitable access and high quality outcomes associated with skilled HHC among vulnerable older populations (i.e., Veterans, people living with dementia, patients needing post-acute care). The first panelist will discuss findings using national-level HHC quality data demonstrating that access to high-quality HHC varies widely across the country for people with dementia. The second panelist will share findings from a novel data linkage using Medicare Advantage (MA) and traditional Medicare claims to understand variation in use of HHC among people living with dementia. The third panelist’s presentation will focus on a particularly vulnerable population - hospitalized older Veterans - and how payer source shapes the use of post-acute HHC. The fourth panelist will discuss results from a qualitative study with MA plans about how they design and manage post-acute HHC benefits. The final presenter will share results from an analysis of national standardized HHC assessment data to identify failures in information transfer that impact care delivery and quality for HHC patients living with dementia. The discussant, a national industry leader with over two decades of experience working in the delivery of HHC, will contextualize findings and discuss how they can inform national policy discussions around improving access and quality of HHC.
ACCESS TO HIGH-QUALITY HOME HEALTH CARE FOR PERSONS WITH DEMENTIA
Authors: Mather Harriet
Published: January 2025

While prior research has demonstrated variation in access to high quality home health agencies among older Medicare beneficiaries, access among persons with dementia - a population with increased need of skilled care delivered in the home - has not been explored. This study examined availability of high-quality home health agencies by dementia prevalence in the US using a cross-sectional analysis of county-level data on availability and quality of home health agencies indexed to number of FFS Medicare beneficiaries with Alzheimer’s disease and related dementia (ADRD). Using multiple Medicare Public Use Files (PUF), including star ratings for home health quality of patient care (QoPC), home health care CAHPS survey (HHCAHPS), county-level ADRD prevalence, and Medicare FFS enrollment, we found that the median county-level number of home health agencies was 15 (IQR 8-29), star rating was 3.4 (IQR 3.1-3.7) for QoPC and 3.8 (IQR 3.5-4.0) for HHCAHPS. Higher prevalence of persons with ADRD was moderately correlated with total number of home health agencies in a county (Spearman’s r=0.36, p<0.05), with weaker positive correlations with high-quality home health agencies via QoPC (r=.2, p<0.05) and HHCAHPS quality ratings (r=.17, p<0.05). There is wide variation in access to high quality home health care among persons with dementia. To meet the needs of a growing population living at home with dementia, we must address inequities in access to high quality home health care.
MISSING DEMENTIA DIAGNOSIS INFORMATION DURING HOME HEALTH: PREVALENCE AND IMPACTS
Authors: Burgdorf Julia
Published: January 2025

Medicare-funded Home Health Care (HHC) delivers skilled health care services through visits to patients’ homes. Poor information transfer between HHC and other care settings is a perennial issue; HHC providers rarely have reliable and complete information regarding patients’ clinical history or needs. One-third of HHC patients have dementia, but lack of visibility into a patient’s dementia status could negatively impact HHC providers’ ability to appropriately tailor care to these individuals. We examined a national sample of 426,606 older adults (65+) who received Medicare HHC in 2018 and had diagnosed dementia, as reported in the Medicare Beneficiary Summary File. The majority (68.3%) did not have their dementia diagnosis captured in the HHC claims or assessment files. We fit multilevel logistic models clustering at the HH agency-level and adjusting for patient sociodemographic characteristics and clinical status and HHC agency characteristics. Patients whose dementia diagnosis was not captured during HHC were less likely to receive Speech-Language Pathology (aOR: 0.63; 95% CI: 0.61-0.64), social work (aOR: 0.70; 0.69-.72), or aide visits (aOR: 0.81, 95% CI: 0.80-0.82). Patients whose dementia diagnosis was not captured were also more likely to be hospitalized (aOR: 1.69; 1.65-1.73) or to visit the Emergency Department (aOR: 1.47; 95% CI: 1.44-1.50) during HHC, and less likely to have their Activities of Daily Living (ADL) limitations stabilize or improve by HHC discharge (aOR: 0.70; 95% CI: 0.68-0.72). Results suggest HHC providers often lack pertinent information regarding patients’ dementia status, contributing to reduced access to relevant services and increased risk for negative outcomes.
INNOVATING LONG-TERM CARE DURING COVID-19 ACROSS FOUR NATIONS: INNOVATIONS, BARRIERS, AND FACILITATORS
Authors: Chu Charlene , Melo Ruth , Bowers Barbara
Published: January 2025

The COVID-19 pandemic has starkly highlighted the vulnerabilities of older adults in residential long-Term Care Homes (LTCHs), amplifying calls to “reimagine” the LTC sector. Active engagement and inclusion of older adults, their families, and staff in the development and implementation of LTC innovations have been recommended by the United Nations and the World Health Organization, but little is known about such engagement in innovations. This symposium presents a comprehensive scoping review aimed at understanding innovations implemented in LTCHs in four countries (Brazil, Canada, Switzerland, United States) since 2020, and the practices of inclusion within innovation processes within LTCHs. The first paper outlines the scoping review methodology and summarizes national-level results, including the number of studies per country and types of studies (e.g., observational, experimental). The second paper presents an analysis of interventions deployed across different countries. The third paper focuses on the types and goals of technology-based innovations implemented in LTCHs during COVID-19 and summarizes the extent to which perspectives of residents, staff, and family caregivers were considered regarding technology-based innovations. The final paper examines the barriers and facilitators of the innovation process during COVID-19. This international symposium contributes to the reimagining and transformation of LTCHs into more resilient, inclusive, and high-quality living environments.
INNOVATIONS IN LONG-TERM CARE SECTOR DURING COVID-19: A SCOPING REVIEW
Authors: Melo Ruth , Santos Suzanne , Bhatti Sumaya , Duan Yanjun , Chu Charlene , Zuniga Franziska , Cranley Lisa , Lepore Michael
Published: January 2025

Different innovations were implemented in Long-Term Care (LTC) homes during COVID-19. Although designed to support stakeholders, innovations also have the potential to exacerbate disparities and inequalities in this sector. This scoping review aims to analyze innovations implemented in the residential LTC sector during the pandemic in four countries: Canada, USA, Brazil, and Switzerland. Potential studies were searched in six databases. Search strategy and eligibility criteria followed the mnemonic “PCC” (i.e., Population: residents, family members/caregivers, and other stakeholders, Concept: innovation, and Context: residential LTC sector). The studies retrieved from databases were screened by two independent reviewers. Discordances between reviewers were solved by consensus or by a third reviewer. A customized spreadsheet was used for data extraction. The search identified 4,056 registers. After excluding duplicate studies, 3,122 records were screened. From them, 98 studies fulfilled the eligibility criteria and were included. Half of the studies were conducted in the USA (51.0%), followed by Canada (39.8%). Few studies were conducted in Switzerland (n=3) and Brazil (n=1). Included studies have different design

methods

qualitative (18.4%), observational (17.3%), experimental (17.3%) and mixed methods (10.2%). Other types of design methods (opinion, commentary, experience reports, editorial, etc.) and literature reviews accounted for 28.6% and 8.2%, respectively. The innovations presented in the studies were classified according to type, level, and setting. Stakeholder engagement with innovation was categorized as active, passive, and co-designed. results of studies that involved stakeholders are presented in the following papers.
TECHNOLOGY-BASED INNOVATIONS IN LONG-TERM CARE HOMES DURING COVID-19 AND RELATED INCLUSION PRACTICES
Authors: Chu Charlene , Bhatti Sumaya , Duan Yanjun , Santos Suzanne , Lepore Michael , Melo Ruth , Zuniga Franziska , Cranley Lisa
Published: January 2025

The COVID-19 pandemic has magnified challenges in Long-Term Care Homes (LTCHs), driving the adoption of technology-based solutions. The scoping review to explore technology-based innovations into a LTCH during COVID-19 in Canada, the US, Brazil and Switzerland produced 60 studies. The most reported technologies were use of telemedicine/virtual medical care tools that allowed for remote delivery of health care (n=16) within LTCHs, and robotics for clinical tasks and social interaction (n=14). Less frequently reported technologies were: wearables for health monitoring (n=2), mobile apps to improve residents’ mental well-being (n=2), and call light systems (n=1) between residents and staff. Most technologies were introduced by researchers (n=38) which primarily engaged with staff (n=30) and residents (n=24). Studies with telemedicine and robotics (n=30) focused on exploring the feasibility and acceptability of technology with the aim to improve optimal resident care and increase social connectedness. Notably, the most common goals of the technology-based innovations were to provide virtual medical care and to engage residents socially. The majority of the papers had active engagement (n=24) which relies on stakeholder’s actions (i.e. video calls). We also examined the level of inclusion and engagement of residents, their families, and staff and found varying levels of engagement. the term “co-design” was explicitly used (n=7) where the innovation was designed together with the stakeholders (for example, stakeholder opinions were considered during the process). This paper describes the engagement of stakeholders of these technological innovations, and points to the need for future research in this area.
PROJECT ECHO-GERIATRICS EXPANDS CAPACITY FOR STUDENT INTERPROFESSIONAL EDUCATION
Authors: Bennett Katherine , Brazg Tracy , McPeak Ashley , Willgerodt Mayumi , Cochrane Barbara , Mike Leigh Ann , Phelan Elizabeth
Published: January 2025

Interprofessional collaborative practice training is important for all health professions trainees, particularly for those who will care for older adults. However, clinical interprofessional training opportunities are limited. The Extension for Community Healthcare Outcomes (ECHO) model trains health professionals in specialty care via case-based sessions with a virtual learning community. We sought to determine whether integration of health professions students into an existing Project ECHO-Geriatrics would be a feasible and effective way to deliver training on age-friendly and interprofessional care. Our novel Age-Friendly Healthcare Interprofessional Training Program used Project ECHO as the platform for longitudinal, interprofessional health professions student education. Students were recruited from health professions schools across the University of Washington. After a brief introduction to age-friendly care and Project ECHO, participants attended at least 3 ECHO sessions and post-session debriefs. In its first two years, the program trained 44 students from 9 health professions programs (e.g. nursing, medicine, pharmacy, physical therapy, social work, dentistry). One hundred percent of participants reported the program was meaningful and worth their time. All competency items (5-point scale, 5 high, 1 low) improved, with the greatest improvements in understanding roles on an interprofessional team (3.1 pre, 4.0 post, p<.001) and confidence for providing age-friendly care (2.2 pre, 4.0 post, p<.001). Participants reported an increased likelihood of focusing on geriatrics in their careers. Open-ended feedback highlighted increased geriatrics knowledge as well as the importance of interprofessional teamwork. Project ECHO is a feasible and effective approach to rapidly expand age-friendly, interprofessional training for health professions students.
BECOMING DEMENTIA CAPABLE: AN INNOVATIVE EDUCATIONAL STRATEGY FOR EMS PROVIDERS
Authors: Davis Kimberly , Jensen Christy , Waters Leland
Published: January 2025

There is an identified need to provide Emergency Medical Services (EMS) providers with foundational knowledge and skills in care of older adults living with dementia. EMS providers are uniquely positioned to recognize, intervene, and connect older adults and caregivers to community resources. Further, they can provide invaluable information and referrals to primary care providers (PCP), including partnering for long-term management. However, focus groups revealed they receive little to no formal training in best practices for care of older adults. This ongoing HRSA-funded project incorporates a two-pronged approach to training EMS providers: (1) training on the challenges of living with dementia from both the patient and caregiver perspectives including disease progression, management, communication skills, and community resources; and (2) training in advance care planning needs including introduction of the Physician Orders for Scope of Treatment, medical-ethical conversations in end of life, and patient advocacy. Content aligns with goals in the “Dementia State Plan 2020-2024: Building a Dementia Capable Virginia” which seeks to incorporate a public health approach to mitigate the impact of dementia. Training was provided in 7 regions of Virginia and has so far reached 275 EMS providers, first responders, and “hidden responders” (i.e. SW, behavioral health, elder law, etc.). Preliminary evaluation data reveals intention to change practice as a result of the educational strategy and will be shared at the symposium. As front-line workers, EMS providers are poised to help with early identification for older adults who would benefit from referral and early treatment, thereby reducing disease and disability.
“I DON’T USE ANYTHING SPECIAL”: DIETARY SELF-MANAGEMENT AMONG BLIND AND VISION-IMPAIRED PERSONS WITH TYPE 2 DIABETES
Authors: Nicklett Emily , Crowley Julia , Perez Rene , Fears Vanessa , Hernandez Beatriz Morales , Burgos-Melendez Yesenia
Published: January 2025

Diabetic retinopathy, a common complication of type 2 diabetes (T2D), is a leading cause of blindness and vision impairment (BVI) among middle-aged and older adults. Diabetes self-management is critical for maintaining eyesight and reducing the risk of further diabetes-related complications; however, those with BVI likely face additional challenges in managing diabetes, including following a diabetes-friendly diet. This study explores barriers and facilitators to maintaining a diabetes-friendly diet among BVI persons with T2D and examines how these experiences may influence their dietary behaviors. In collaboration with Vibrant Works—a community-based organization in San Antonio, Texas offering employment, independent living, and well-being services to the blind and low-vision community—phone-based questionnaires were fielded in January-March 2023 (n=18, ages 42-70). The questionnaires included validated measures of dietary adherence, followed by an open-ended, semi-structured interview about challenges and strategies for diabetes self-management. Quantitative data were entered directly into a database and qualitative data were transcribed and coded with themes emerging directly from the data. Six themes emerged that characterize barriers and facilitators to dietary behaviors: (a) vision status and comorbidities; (b) prior knowledge and experience in food preparation; (c) habits and routines; (d) access/accessibility (i.e., transportation, BVI-friendly cooking tools, accessibility of food stores; (e) support (i.e., social and tangible support); and (f) neighborhood and community factors (i.e., walkability, sidewalk quality, food store availability). Findings from this study can inform more equitable strategies for dietary self-management among populations experiencing both T2D and vision loss through direct practice, future research, and policy approaches.
EVALUATION OF EQUITY IN HOSPICE CARE UTILIZATION AMONG MEDICARE-ENROLLED AUTISTIC OLDER ADULTS
Authors: Bishop Lauren , Nikahd Melica , Hyer J Madison , Hand Brittany
Published: January 2025

Better identification and increased life expectancy of autistic people has given rise to a need to better understand their end-of-life care. The purpose of this study was to compare hospice utilization of autistic older adults to non-autistic older adults using hospice claims from Medicare and examine if known inequities in hospice utilization among the general population are exacerbated among autistic older adults. Our sample included 5,468 autistic older adults and 10,934 matched population comparison older adults who died between 2013-2021. We used multivariable logistic regression to compare these groups on the odds of any, early (at least 28 days before death), intermediate (4-27 days before death), and late (within 3 days of death) hospice utilization. Interaction terms were used to assess whether effects were modified by beneficiary’s sex, race, or rurality. In a sensitivity analysis, we repeated our analyses in unmatched samples. The autistic older adult and matched population comparison groups had similar odds of any hospice utilization (OR: 1.05; 95% CI: 0.98-1.13), early (OR: 1.01; 95% CI: 0.91-1.11), intermediate (OR: 1.03; 95% CI: 0.95-1.13), and late hospice (OR: 1.07; 95% CI: 0.96-1.19). In our models evaluating the impact of other known inequities, we did not find significant interactions between autism diagnostic status and sex, race, or rurality. Results were similar in the unmatched samples. Our findings suggest that autistic older adults experience similar receipt and timing of hospice as non-autistic peers, highlighting the potential power of zero cost, universal health policies in reducing healthcare utilization disparities among autistic people.
DISABILITY: INDEPENDENT OR DEPENDENT VARIABLE IN GERONTOLOGICAL RESEARCH?
Authors: Putnam Michelle , Stark Susan
Published: January 2025

A critical issue for bridging aging and disability research is developing a shared understanding of when disability should be employed as an independent or a dependent variable. To date, this discussion has rarely been had across researchers. Is disability a dependent variable, an outcome? Or does it contribute to outcomes as an independent variable? Or both? How disability is conceptualized, measured, analyzed, and interpreted matters for how we understand the role disability plays over the life course. Disability status is used as both an independent and a dependent variable in gerontological and disability/rehabilitation research. Research in both fields often focuses on reducing likelihood, duration, and severity of disability. A key distinction between fields is how each conceptualize disability – what it is and what it means – particularly given age of onset and type of disability. For example, in gerontological research, often positions disability as an individual trait that mediates the ability to live independently (typically reducing independence). However, disability/rehabilitation research commonly positions disability as a situational trait, or moderating variable associated with difficulty of living independently, but not causing inability to live independently. NIH’s recent inclusion of disability as a social determinant of health provides an opportunity for gerontologists to more deeply consider how disability is employed in research designs and why. We discuss how more consistent use of disability as an independent and/or dependent variable can help bridge aging and disability research and provide greater understanding of the role disability plays over the life course.
MANAGING MULTIPLE CHRONIC CONDITIONS: FINDINGS BY NATIONAL CLAUDE D. PEPPER OLDER AMERICANS INDEPENDENCE CENTERS
Authors: Graham Eileen , O’Conor Rachel , Wolf Michael
Published: January 2025

Multimorbidity is an increasing concern among clinicians, as older adults accumulate chronic conditions that require complex coordination of care. There is an increasing interest among research and clinical communities to understand the impacts of multimorbidity on individuals and how quality of care can be optimized to improve quality of life in the aging population. The primary objective of the Claude D. Pepper Older Americans Independence Centers national network is to advance scientific knowledge that will help older adults maintain function, independence, and quality of life. The current symposium highlights recent work put forth by three of the 15 National ‘Pepper’ Centers (Northwestern, Mt. Sinai, UCSF). Graham will present recent findings on how multimorbidity is longitudinally related to physical and mental health-related quality of life, and their cognitive, psychological, social, and health-related determinants. The next three presentations explore the role of caregivers in supporting the health and quality of life of older adults with multimorbidity. O’Conor will discuss complexity of family care dyads management of MCC, by reviewing patient and caregiver perspectives on challenges of successful management at home. Allison will discuss the interplay of care support structures and dementia care needs in the home. Reckrey will discuss results from a qualitative analysis exploring perspectives of geriatricians on the importance of paid caregivers of older adults with MCC. In sum, this symposium will present novel evidence showing the importance of understanding of how multimorbidity and dementia impact caregiving considerations, primary care decisions, and health related quality of life for older adults.
CASCADING BURDEN OF UNCONTROLLED CHRONIC CONDITIONS AMONG PERSONS LIVING WITH DEMENTIA
Authors: O’Conor Rachel , Pack Allison , Russell Andrea , Oladejo Dianne , Morhardt Darby , Lindquist Lee , Wolf Michael
Published: January 2025

Half of all potentially avoidable hospitalizations among persons living with dementia (PLWD) are due to poorly controlled chronic conditions. Yet little is known about how PLWD and their caregivers manage the multiple chronic conditions (MCC) and polypharmacy they often contend with, or how these health management behaviors impact PLWD and caregiver well-being. We conducted qualitative interviews with patient-caregiver dyads exploring capacity to manage MCC. PLWD were eligible if they had mild or moderate dementia, ≥3 chronic conditions, ≥5 medicines, and a caregiver. Three coders applied a priori and emergent codes to transcripts. We interviewed 68 participants (PLWD: mean age 78 years, 65% female, 53% white, 32% Black; Caregivers: mean age 65 years, 73% female, 56% spouse, 38% adult child). PLWD were managing 5 chronic conditions and took 9 medicines on average. PLWD recalled instances of difficulty managing MCC and subsequent hospitalization, while emphasizing they had recovered. Following errors in health management behaviors, they expressed gratitude for additional caregiver support. In contrast, caregivers described a cascading burden of uncontrolled chronic conditions among PLWD. Many reported feeling overwhelmed managing the complexity of MCC, including multi-drug regimens, for the PLWD. Caregivers cited difficulties achieving adequate control for numerous chronic conditions (e.g. hypertension, diabetes, heart disease). Consequences included hospitalizations and increased regimen complexity; in turn, these increased caregiver responsibilities, emotional strain, and financial costs. Findings suggest management of MCC compounds caregiving responsibilities and contributes to caregiving burden. Supporting caregivers’ practical skills for managing MCC may promote PLWD and caregiver well-being.