bluuebunny/crossref_metadata_2025 huggingface dataset:
Seeking Information: When the Court Wants More
Authors: Rogol Natalie C. , Montgomery Matthew D.
Published: December 2020

The State of the Union represents an opportunity for the president to share policy goals with other political actors. Thus, the State of the Union can proxy how much information the Court has about executive preferences when receiving a case. We find that the less time a president devotes to a policy area, the more likely the Court is to issue a request for a brief in a case dealing with that issue area. This finding indicates that the Court is cognizant of presidential signals of policy preferences and actively seeks to supplement its understanding of the executive’s preferences.
Latinos’ Knowledge of the Supreme Court
Authors: Pedraza Francisco I. , Ura Joseph Daniel
Published: December 2020

There is convincing evidence that Americans have high, stable levels of knowledge about the Supreme Court. Yet, this conclusion masks variance in political knowledge associated with ethnicity. Using data from surveys of Latinos and non-Latinos fielded before and after the Supreme Court’s rulings in Arizona v. United States and National Federation of Independent Business v. Sebelius, we find Latinos know less about the Court than other Americans. However, Latinos’ knowledge of the Court increased significantly between the surveys, while others’ Supreme Court knowledge did not. We discuss the implications of this result for the Supreme Court’s legitimacy and civic education policy.
Improving subspace constrained radial fast spin echo MRI using block matching driven non-local low rank regularization
Authors: Mandava Sagar , Keerthivasan Mahesh B , Martin Diego R , Altbach Maria I , Bilgin Ali
Published: December 2020

Subspace-constrained reconstruction methods restrict the relaxation signals (of size M) in the scene to a pre-determined subspace (of size K≪M) and allow multi-contrast imaging and parameter mapping from accelerated acquisitions. However, these constraints yield poor image quality at some imaging contrasts, which can impact the parameter mapping performance. Additional regularization such as the use of joint-sparse (JS) or locally-low-rank (LLR) constraints can help improve the recovery of these images but are not sufficient when operating at high acceleration rates. We propose a method, non-local rank 3D (NLR3D), that is built on block matching and transform domain low rank constraints to allow high quality recovery of subspace-coefficient images (SCI) and subsequent multi-contrast imaging and parameter mapping. The performance of NLR3D was evaluated using Monte-Carlo (MC) simulations and compared against the JS and LLR methods. In vivo T
2 mapping results are presented on brain and knee datasets. MC results demonstrate improved bias, variance, and MSE behavior in both the multi-contrast images and parameter maps when compared to the JS and LLR methods. In vivo brain and knee results at moderate and high acceleration rates demonstrate improved recovery of high SNR early TE images as well as parameter maps. No significant difference was found in the T2 values measured in ROIs between the NLR3D reconstructions and the reference images (Wilcoxon signed rank test). The proposed method, NLR3D, enables recovery of high-quality SCI and, consequently, the associated multi-contrast images and parameter maps.
Sparse functional linear discriminant analysis
Authors: Park Juhyun , Ahn Jeongyoun , Jeon Yongho
Published: December 2020

Functional linear discriminant analysis provides a simple yet efficient method for classification, with the possibility of achieving perfect classification. Several methods have been proposed in the literature that mostly address the dimensionality of the problem. On the other hand, there is growing interest in interpretability of the analysis, which favours a simple and sparse solution. In this paper we propose a new approach that incorporates a type of sparsity that identifies nonzero subdomains in the functional setting, yielding a solution that is easier to interpret without compromising performance. Given the need to embed additional constraints in the solution, we reformulate functional linear discriminant analysis as a regularization problem with an appropriate penalty. Inspired by the success of $\ell_1$-type regularization at inducing zero coefficients for scalar variables, we develop a new regularization method for functional linear discriminant analysis that incorporates an $L^1$-type penalty, $\int |f|$, to induce zero regions. We demonstrate that our formulation has a well-defined solution that contains zero regions, achieving functional sparsity in the sense of domain selection. In addition, the misclassification probability of the regularized solution is shown to converge to the Bayes error if the data are Gaussian. Our method does not assume that the underlying function has zero regions in the domain, but it produces a sparse estimator that consistently estimates the true function whether or not the latter is sparse. Using both simulated and real data examples, we demonstrate this property of our method in finite samples through comparisons with existing methods.
Mobilizing Collective Action for Public Health Approaches to Dementia Education
Authors: Severance Jennifer , Luk-Jones Susanna , Melissa Griffin , Redeemer Glenda
Published: December 2020

Addressing increasing rates of Alzheimer’s disease and related dementias (ADRD) requires public health approaches including prevention, early detection and diagnosis, and outreach to low-income and minority communities facing higher risk and adverse health and economic outcomes. Communities are seeking ways to enhance cross-sector collaboration and overcome underdeveloped relationships and fragmentation that are barriers to effective public health responses. In this exploratory study, we evaluated outcomes of a community-wide effort to mobilize systems-level changes, build public awareness, and increase access to early detection services. A community-based organization, public health department, and academic institution in North Texas partnered to expand ADRD education programs and outreach for underserved communities. Nineteen community health workers were trained to provide brain health and ADRD education programs and refer to financial, legal, and social resources. Through collective action, 371 participants attended 26 education sessions delivered in English and Spanish. Forty-five percent of participants identified as non-white and 61% reported low educational attainment. Participants (n=314) completed post-surveys. As a result of training, 89% of trainees could recognize common warning signs of Alzheimer’s disease, 86% understood the importance of early detection and diagnosis, and 96% knew activities promoting cognitive health. Findings revealed strategies to increase collective action such as sharing data, establishing referral methods, and adopting dementia-friendly and age-friendly frameworks. Results show that collective action has the potential to build a community’s capacity for targeted ADRD education and improve access to early detection and brain health education for at-risk populations.
Preparing Students to Interact With Persons With Dementia in a Research Context
Authors: Peterson Roberta , Avent Elizabeth , Gassoumis Zachary , Cho Jeanine Yonashiro , Olsen Bonnie
Published: December 2020

By U.S. Centers for Disease Control and Prevention estimates, the number of older adults with Alzheimer’s Disease and related dementias (ADRD) is expected to increase 278% by 2060 to affect approximately 13.9 million individuals. Research is needed to not only improve understanding and treatment of ADRD but to also study its effect on the physical, emotional, and psychological well-being of persons with dementia (PWD) and their care partners (CP). However, due to the diminishing cognitive and functional capacities of PWDs associated with the progression of ADRD over time, research efforts are sometimes hampered by a plethora of potential scientific, logistical, ethical, and emotional barriers. This session will introduce an educational approach used to train students who are interested in conducting in-home research among PWDs and their CPs and share lessons learned through the program’s pilot training of undergraduate and graduate students (N=6). Through didactic training, role-playing exercises, and experiential learning processes, trainees are equipped to accompany research project interviewers into the homes of PWD and assist in implementing research protocols. Students receive extensive training in the disease trajectories of ADRD, the impacts of disease on PWDs and their CPs, ways to communicate and interact with PWDs, best practices in promoting the protection and autonomy of human subjects with dementia, and approaches to obtaining quality data for research.
A Longitudinal Aging and End-of-Life Care Curriculum for Medical Students Using the Geriatric 5Ms Framework
Authors: Schwartz Andrea , Schaefer Kristen
Published: December 2020

Medical student training in geriatrics and palliative care is critical to prepare them to care for older adults and those facing serious illness. We created a longitudinal Aging and End of Life Care Curriculum at Harvard Medical School, using Kern’s Curriculum Design Model. We conducted a focused needs assessment survey with course and clerkship directors, then implemented curricula based on the AAMC and Hartford Foundation’s 26 learning objectives in Geriatrics (Leipzig et al, Acad Med 2009), and “Raising the Bar for the care of seriously ill patients” which established competencies for medical students in palliative care (Schaefer at al, Acad Med 2014). We structured the curricular content to enable spaced learning, using the Geriatric 5Ms framework of Mobility, Mind, Medications, Multi-complexity and Matters Most (Tinetti at al, JAGS 2017), which aligns with the Age Friendly Health Systems Initiative priorities. Students participate in trainings on Delivering Serious News and Goals of Care Conversations, structured home visits with older adults, and clinical reasoning sessions focused on falls, delirium and polypharmacy risk reduction. The curriculum includes interactive, case based and jigsaw learning, as well as flipped classroom learning. Students are evaluated using a three part longitudinal Objective Structured Clinical Examination with an aging patient, which demonstrates an increase in medical student clinical skills in geriatrics. Individual sessions of the curriculum demonstrate increases in student knowledge of and attitude to geriatrics; longitudinal assessment is ongoing to ensure that students graduate ready to care for an aging society with competence, knowledge and compassion.
Huddle Up! A Comprehensive Approach to Improving Interdisciplinary Huddle in a VA Geriatric Primary Care Clinic
Authors: Wilking-Johnson Juliana , Sussman Joleen
Published: December 2020

Spending time in brief meetings or “huddles” is associated with greater job satisfaction and less burnout, especially when team members have mutually agreed upon goals and can participate in decision-making. However, huddles are often unproductive and may have opposite the intended effect if not tailored to the specific team involved. We sent a survey to all members of our VA Geriatric primary care team (including geriatric medicine fellows, social work, psychology, audiology, pharmacy, faculty and support staff) asking them to rate our huddle’s impact on their stress level, efficiency, learning, preparedness and feeling supported at work. Responders indicated if they received needed information and if they understood what information was needed from them. We then held a team meeting to establish mutually agreed upon goals, expectations and organization of huddle, which were then reinforced with visual and timer reminders. After 6 weeks utilizing the new format, we administered a post intervention survey assessing the impact of the change. The initial survey revealed that the geriatric medicine fellows had worse ratings than other trainees, staff, and faculty. Fellows were more likely to say that they did not know what information was needed from them; and they did not receive information needed from others. The follow up survey showed improvement in all scores among geriatrics medicine fellows and allied health professionals, including 100% of respondents indicating they receive needed information. Overall, comments regarding the intervention were positive, demonstrating that a structured, organized huddle tailored to a specific team, can be beneficial.
Diverse Family Caregivers, Diverse Experiences in Caring
Authors: Young Heather , Bell Janice , Choula Rita , Kilaberia Tina , Reinhard Susan
Published: December 2020

The Home Alone Revisited Study examined the experience of family caregivers including demands of caring for someone with physical, mental or behavioral health care needs, revealing a large proportion of caregivers managing medical/nursing tasks. The aim of this paper was to explicate racial/ethnic differences in the prevalence of tasks and the perceptions of caregivers regarding their responsibilities. The study was a nationally representative, population-based online survey that oversampled underrepresented groups. The sample included 2,089 diverse family caregivers (Hispanic, n=307; Black/African American, n = 231; Asian/Pacific Islander, n=196; White, n=1,284; multi-racial, n= 71), 57% women, ranging from 18 to 91 years of age. Overall, fifty-two percent of caregivers reported performing at least one medical/nursing task for their care recipient, with a greater percentage (p<0.01) engaged in these tasks in two groups: Asian/Pacific Islander (62%) and multiracial (62%). Across the five racial/ethnic groups, we found significant differences in having a choice, feeling pressure, and the influence of culture and religion on the decision to take on medical/nursing tasks. There were also significant differences in the prevalence of performing 17 specific tasks, reports of difficulty with the tasks, the extent to which respondents felt prepared, and the strain that they experienced in providing care. The findings reveal both commonalities and significant heterogeneity in the caregiving experience, suggesting the importance of advancing the dialogue among health and social service providers about providing culturally and linguistically appropriate care and developing responsive tools and resources to support family caregivers as they engage in complex care.
Feasibility and Acceptability of an mHealth Delivered Mindfulness Therapy for Caregivers
Authors: Kozlov Elissa , Dong XinQi
Published: December 2020

Decades of research have documented the profound, negative effects of caregiving on unpaid caregivers. Mindfulness Therapy (MT) is a promising, non-pharmacological technique with proven efficacy and effectiveness in managing stress, depression and anxiety in diverse populations. While the evidence-base for MT in caregiving is growing, traditional MT (8+ hours of face-to-face treatment with trained providers) is likely not a realistic treatment model for most caregivers due to lack of trained personnel, time constraints of the caregiver, and reimbursement issues. Therefore, in order to meet the unique needs of caregivers of older adults with cognitive impairment, an innovative delivery model is required. MHealth can be a useful tool to deliver behavioral interventions, as it overcomes barriers of traditional psychotherapy such as provider availability, scheduling conflicts, and cost. The objective of this paper is to report the feasibility, acceptability and preliminary efficacy of a pilot trial of mHealth delivered MT for stress and caregiver burden in caregivers of persons with dementia. The average age of participant was 63.2 years old. After two weeks, 93% of participants reported using the mindfulness app for an average of 48.38 minutes per week. At eight weeks, 88% of users reported using the mindfulness app for an average of 35 minutes per week. At 8 weeks, 100% of users reported practicing mindfulness without using the app for an average of 45.6 minutes per week. MHealth mindfulness therapy appears to be a feasible method of delivering mindfulness to caregivers of older adults with memory impairment.
Under the Digital Bridge: Investigating Trolling Behaviors in Baby Boomers
Authors: Hardin-Sigler Kristen , Deason Rebecca , Dailey Stephanie , Ceballos Natalie , Howard Krista
Published: December 2020

Internet trolling, or the intentional disturbance or upsetting of others on social media for personal amusement, has become increasingly prevalent in recent years (Howard et al., 2019). Current research focuses on these destructive social media behaviors in younger populations, therefore this study set out to investigate the gender differences of trolling behaviors in Baby Boomers. Participants (N = 140), ages 54 and older, were recruited from the Amazon Mechanical Turk and were compensated for their participation. Participants completed a survey investigating their likelihood to engage in trolling behaviors, the extent to which they enjoy trolling, and their feelings while trolling. Results indicated that while there were no significant differences between men and women in their need, intensity of use, or addiction to social media, men were significantly more likely to engage in trolling behaviors than women. Men reported posting to upset others (p = .018), as well as commenting to upset others (p = .053), more often than women. Furthermore, when engaging in these behaviors, men reported feeling intelligent (p = .013), confident (p = .024), superior (p = .053), and happy (p = .012), more often than women. However, these results could be indicative of a more sinister issue. Men also reported more often that their reasons for engaging in trolling behaviors were feelings of loneliness (p = .005) and anxiety (p = .010). This indicates that these trolling behaviors may then be a way for men to seek out some form of “social support” in the online community.
Voice Technologies to Support Aging in Place: Opportunities and Challenges
Authors: Pradhan Alisha , Lazar Amanda
Published: December 2020

Technology to support aging in place has been a topic of interest. Research indicates that older adults are increasingly using commercially available voice assistants in smart speakers. These devices enable non-visual interaction that does not require extensive expertise with traditional mobile or desktop computers, thus offering new possibilities of access to digital technology. We conducted two different studies with individuals aged 65 years old or above—a three week smart speaker deployment study with individuals who did not use computing devices regularly and a workshop on customizing internet of things technology with tech savvy individuals. Our findings indicate specific ways that these voice technologies might support aging in place, including ease of use and due to their not being identified with aging-specific technologies. We observed that participants consistently used their voice agent for finding online information, particularly health-related, emphasizing the need to revisit concerns about credibility of information with this new interaction medium. And, although features to support memory (e.g., setting timers, reminders) were initially perceived as useful, the actual usage was unexpectedly low due to reliability concerns. Our work provides a basis to understand older adults’ perceptions and usage of current voice technologies. We also identify opportunities for customizing voice technologies to better support aging in place.
The Impact of Memory Stereotype Threat on Memory and Memory Self-Efficacy in Older Adults
Authors: Fredriksen Lauren , Zucchero Renee’ , Partlow Brock , Infante Ruth , Taylor Janie , Washburn Haley
Published: December 2020

This study examined the impact of memory stereotype threat on memory duration (e.g., short-term and long-term) and modality (e.g., verbal and non-verbal), and memory self-efficacy in older adults who live independently (Mage = 77 years). Participants (N= 66) were randomly assigned to a group that received either neutral instructions or memory stereotype threat inducing instructions. All participants completed the California Verbal Memory Test-Second Edition (CVLT-2), the Rey Complex Figure Test (RCFT), a memory self-efficacy measure, and a demographics survey. An independent samples t-test indicated participants in the stereotype threat group reported significantly lower memory self-efficacy than participants in the neutral group. The main effect of the within-subjects factor of a 2x2 mixed analysis of variance (ANOVA) indicated that participants performed significantly better on short-term non-verbal memory than long-term non-verbal memory. There was no significant difference between the neutral and stereotype threat groups in memory modality or duration. These results may indicate that the instructions used to induce memory stereotype threat were not phrased strongly enough to elicit poorer performance on the CVLT-2 and RCFT in the memory stereotype threat group. Additionally, participants reported having a high level of education (i.e., a master’s degree was the modal educational level), which may have served as a buffer for memory stereotype threat. The findings call for future research to explore the impact of level of education on memory self-efficacy in older adults. Also, future research may focus on the impact of the strength of memory stereotype threat on memory performance.
Informing the Future: Cancer Prevention and Diagnosis Beliefs Among Older Latino Immigrants
Authors: Carrion Iraida , Neelamegam Malinee , Roberts Jane
Published: December 2020

Despite emerging research on Latinos and cancer (Carrion et al., 2018), there are no data regarding beliefs about cancer prevention and diagnosis in older Latinos residing in Central Florida. Similarly, to the US in general, Central Florida’s older Latino population is growing. Compared with other national samples, Latino immigrants in the southern U.S. report poorer health than in other regions (Siegel et al., 2015). Using convenience sampling (N = 168), univariate analysis was done to recognize the study population’s characteristics. Frequencies were assessed to understand participants’ responses to questions on cancer-related attitudes. The effects of age, country of origin, length of stay in the U.S., and marital status were assessed using logistic regression. Of the 168 individuals in the study, 34.5% were male with a mean age of 67.9, and a majority had at least a high school education and 25.8 years residing in the U.S. The participants were aware that tobacco use can cause cancer (93.5%) and that smoking affects the smoker as well as their family members (84.5%). They were also aware that mammograms facilitate early diagnosis of breast cancer (81.5%) and of the association between prolonged sun exposure and skin cancer (86.9%). However, specific knowledge about early diagnosis was low. Only 29.2% of participants knew that breast cancer can be diagnosed early, which was similar to the response toward early diagnosis of prostate cancer (24.4%). Among the participants, 26.2% were categorized as having poor knowledge of cancer prevention.
The Happy Campaign: Assessing the Effects of a Community-Wide Intervention on Older Adults Living in Public Housing
Authors: Gourley Amy , Montpetit Mignon , James-Smith LaKeesha
Published: December 2020

In the field of developmental psychology, the Stress-and-Coping model (Lazarus & Folkman, 1984) posits that individual differences in biological, psychological, and social risk and protective factors serve to increase or buffer the impact of stressful experiences on psychological well-being later in life. Importantly, research suggests that residents of public housing generally experience more risk factors than elders at large (Rabins, et al. 1996). The present study examines the impact of a programmatic intervention, The Happy Campaign, on individuals living in public housing in a small Midwestern city (aged 51-90 years; Mage= 63.3 years; SDage= 8.6 years). Goals of the Happy Campaign were to improve residents’ coping skills and increase perceived support. Results demonstrated significant improvement in key aspects of well-being post-intervention; these included significant increases in exercise (p = .04), self-reported health (p = .01), as well as decreases in negative affect (p= .008). Data also show a moderate increase in residents’ hope post-intervention (p = .06). Although future research is needed to account for confounding variables that arose in conducting research in this community setting, these data provide preliminary evidence that a broad-based, environmental intervention may offset the myriad risks faced by particularly vulnerable elders, and even augment well-being.
A Moderating Model of Self-Efficacy in Caregivers of Latina Breast Cancer Survivors
Authors: Hebdon Megan Thomas , Crane Tracy , Reed Pamela , Badger Terry
Published: December 2020

In caregivers of Latina breast cancer survivors, contextual factors such as informational support, Anglo-orientation, and spiritual well-being may affect physical and mental health. The purpose of this study was to test if caregiver self-efficacy moderated relationships between contextual factors and health outcomes. A model, derived from Bandura’s Social Cognitive Theory, included self-efficacy cancer knowledge (survivor) and self-efficacy symptom management (caregiver) as moderators of relationships between contextual factors and global health and depression. Secondary analysis of baseline caregiver data from an experimental study testing two psychoeducational interventions with Latina breast cancer survivors and their caregivers was conducted. Both self-efficacy measures were tested as moderators for relationships between contextual factors and health outcomes with fixed cutoffs (medium: mean, low/high: ±1 SD). Caregiver participants (N=233) were 43 years on average (SD=13), primarily women (70%), low-income (78%), and of Mexican-American ethnicity (55%). Anglo-orientation was significantly associated with global health (r(233)=.27, p<.001) and depression (r(233)=-.13, p=.05). High levels of self-efficacy cancer knowledge strengthened the negative relationship between depression and Anglo-orientation, while a slightly positive relationship was noted at low self-efficacy levels. Informational support was significantly related to global health (r(233)=.39, p<.001) and depression (r(233)=-.43, p<.001). Self-efficacy symptom management strengthened the negative relationship between informational support and depression. Correlational and moderation relationships were not significant for spiritual well-being. Both caregiver- and survivor-focused self-efficacy affected relationships between contextual factors and depression in caregivers of Latina breast cancer survivors. Further research should address both types of self-efficacy in caregiver health.
Age Differences in Engagement in Hong Kong Anti-Extradition Bill Protest: The Role of Self-Relevance
Authors: Wong Tze Kiu , Tse Dwight C K , Fung Nicole Long Ki , Fung Helene
Published: December 2020

Older adults were found to be less involved in non-institutional political actions than younger people did, and our previous work found that self-relevance mediated this age difference. In this study, we attempted to replicate the finding in a real-life social movement. We recruited 1037 participants (aged 18-84) during the anti-extradition bill movement in Hong Kong in September 2019. They responded to questions of how relevant and important the movement was to them, and whether they had taken part in a list of 8 political actions (e.g. signing petitions, joining rallies). Older adults indeed participated less in the movement compared with younger adults, and the age difference could partly be attributed to a lower perceived relevance of the movement. The finding suggested emphasizing on self-relevance as a potential way to promote political participation in older adults.
Creativity and Dementia: New Directions From Embodiment, Relationality, and Citizenship Discourse
Authors: Kontos Pia , Grigorovich Alisa , Colobong Romeo
Published: December 2020

There have been important advances in research on creativity that have provided a more inclusive view of everyday and ordinary creativity, including that of persons living with dementia. However, these developments are limited by a lack of engagement with scholarship on embodiment, relationality, and citizenship. We address these limitations by drawing on a relational model of citizenship that offers a critical rethinking of the nature of creativity and the imperative that these be supported in long-term dementia care. We draw on transcribed video-recorded interactions between elder-clowns and residents living with dementia in one long-term care home in central Canada. These are analyzed with reference to key theoretical tenets of the relational model of citizenship. Embodied selfhood (i.e., the primordial and socio-cultural dispositions of the body that are fundamental sources of self-expression and relationality), are identified as key to the creativity of persons living with dementia. We argue that creativity is not an individual cognitive trait but rather emerges from the complex intersection of enabling environments and the embodied intentionality of all involved. We conclude that creativity must be supported in everyday life through organizational practices and socio-political institutions that more fully support the relational, interpersonal, and affective dimensions of care.
Understanding the Impact of Pain Among Latinx Older Adults
Authors: Morais Calia , Robinson Michael , Fillingim Roger , Bartley Emily
Published: December 2020

Pain is the number one reason for seeking medical attention, and a top contributor to healthcare costs in the United States. Considerable evidence highlights racial/ethnic disparities in pain with Latinx communities being disproportionally affected at higher rates. Compared to other ethnic minority groups, Latinx older adults are more socioeconomically disadvantaged and experience higher rates of disability and frailty (Garcia, Downer, Crowe, & Markides, 2017). Given the rapidly growing population of Latinx, it is anticipated that the incidence of pain and its associated impact will adversely affect the quality of life of many older adults. The public health focus on improving pain management with non-opioid treatment options also highlights the need to provide culturally responsive care for Latinx older adults. However, limited efforts have addressed this important target for intervention. Following the biopsychosocial model of pain, this presentation will provide an overview of biological, psychosocial and cultural factors influencing pain disparities among older adults. Findings from experimental and clinical settings will be discussed. The presenter will also review current evidence highlighting the preference for self-management strategies for pain management among Latinxs, as well as the need to increase accessibility to psychosocial treatments for chronic pain, such as cognitive behavioral therapy for pain (CBT-pain). Furthermore, preliminary findings from a qualitative study will be presented to illustrate the need to offer culturally adapted treatments for pain management (Torres, Thorn, Kapoor, & DeMonte, 2017). Future research is needed to study sociocultural factors influencing pain disparities to help identify modifiable targets for intervention.
Expansion of Thailand’s Social Pension Policy and Its Implications for Family Support for Older Persons
Authors: Teerawichitchainan Bussarawan
Published: December 2020

Thailand is among few developing countries that have provided universal social pension for its older adults since 2009. Analyzing nationally-representative data from the Surveys of Older Persons in Thailand, we address the extent to which older Thais have benefited from the policy and describe the socio-demographic correlates of older persons who primarily rely on OAA as their main income source. Importantly, we examine how reliance on OAA may have implications for intergenerational exchanges between older parents and adult children as well as the well-being of older Thais. Results show significant changes over the last decade in the patterns of old-age income sources and filial economic support for older parents, particularly after the universalization of the OAA policy. We find the declining importance of children and rising significance of OAA as the primary income source. Older persons whose main income source was OAA were considered socially and economically vulnerable, although it was men rather than women who were more likely to depend on OAA as the main income source. Results further indicate that reliance of OAA as the main income source is not associated with a reduction in non-monetary familial support (intergenerational coresidence and social support) for aged parents. Nevertheless, we find that older parents whose main income was OAA were consistently less likely to report income adequacy and psychological well-being compared to others. This evidence suggests that while the OAA scheme may have tackled old-age poverty issues, it has little impact in dampening economic and social inequality among older Thais.
Experiences and Implications on Family Relationships for Grandmothers Raising Their Grandchildren
Authors: Musil Carol , Tracy Elizabeth , Braxton Rashon , Wallace McKenzie , Jeanblanc Alexandra
Published: December 2020

In the U.S., over 2.7 million grandparents are primary caregivers to grandchildren. It is critical to understand the experiences of grandparent caregivers to design tailored, supportive programs. Our aim was to analyze written journals of 129 grandmothers with respect to the impact of raising grandchildren on relationships with family members. As part of a national RCT study of grandmother caregivers, participants completed daily journals for 4 weeks. Employing thematic data analysis, three members of the research team coded using NVIVO 12 Plus. The research team met regularly to compare and resolve discrepancies in coding. Percent agreement was > 80%. Relationships with the grandchild’s mother were characterized by anger/tension, resentment, and the realization that the mother was incapable of parenting while at the same time expressing worry/concern for her. Relationships with the grandchild’s father mirrored these dynamics while also depicting the father as a distant figure, inconsistent, and financially absent. Spousal relationships were marked by challenges faced by the spouse, their shared role/influence as a grandparent, and the quality of their time spent together. The other relationships described were often focused on their other adult children, as well as their own adult siblings. Grandmother caregivers expressed stress or strain and frustration within these relationships. Caregivers also verbalized gratitude for support from family members within the context of familial and financial stress. Grandmother caregivers may need support in managing familial relationships and stress within these relationships, which may be a target for future interventions.
Evaluation Findings of a Community-Based Intervention for Older Adults With a History of Trauma
Authors: Rabin Carmel , Yoskowitz Karen Edell , Bedney Barbara
Published: December 2020

Between 70% and 90% of Americans aged 65 and older have experienced at least one traumatic event such as a sexual or physical assault, disaster, illness, or terrorism. Trauma exposure in older adult populations is linked to physical, mental, and cognitive decline. A new approach to improve outcomes of trauma-affected older adults is Person-Centered, Trauma-Informed (PCTI) Care, which promotes the dignity, strength, and empowerment of trauma-affected individuals by incorporating knowledge about trauma into agency programs, policies, and procedures. The Administration for Community Living/Administration on Aging has awarded The Jewish Federations of North America (JFNA) a grant to develop innovative PCTI interventions for Holocaust survivors. This includes a community-based intervention whereby local leadership councils are developed to identify Holocaust survivor needs, distribute grant funding, train caregivers in PCTI care, and forge partnerships to advance community-led Holocaust survivor care. This program has been implemented in eight major US cities where 168 community leaders dispersed 25 grants serving approximately 500 Holocaust survivors. JFNA conducted an evaluation of the first six of the eight cities to determine the impact of this community-based model on participants and Holocaust survivors and investigate the process by which a community-based model can be replicated. This evaluation used surveys and semi-structured interviews to collect data on variables including understanding of PCTI care, awareness of Holocaust survivor needs, strength of community partnerships, and leadership council sustainability. This session will review evaluation findings including best practices for community-based models of PCTI care, and applicability of findings to other older populations.
A Systematic Review of Interventions That Reduce Family and Friend Caregiving Time
Authors: Baker Zachary , Jutkowitz Eric , Gaugler Joseph
Published: December 2020

The decreasing number of family/friend caregivers available to help the rising number of older adults is creating a critical family care gap. For this reason, there is a growing need for interventions that reduce family/friend caregiving time. We systematically reviewed five electronic databases to identify randomized trials, case control, quasi-experimental, and cross-sectional studies that evaluated a modifiable element that could be targeted for interventions with care recipients 65+ and/or their family/friend caregivers and reported on an outcome of time spent caregiving. We excluded studies without a comparison, broadly defined. The initial search included 1,812 unique records. Following abstract and title screening 311 full-texts were reviewed. Fifty-five studies published between the years of 1990 and 2019 met inclusion criteria. Studies predominantly focused on care recipients with dementia (58%) and were largely conducted in western countries (91%). The categories of interventions reviewed included pharmaceuticals (25%), public long-term care financing (7%), case management (7%), care setting (16%), technology (7%), multi-component interventions (9%), skills building (15%), additional formal expertise/care (9%), and other (5%), with one study falling into multiple categories. Pharmaceuticals, case management, care setting, and multi-component interventions demonstrated promising evidence to reduce family/friend caregiving time. Methodologically, studies were inconsistent in measurement and ascertainment of caregiving time. Given the public health concerns of reduced availability of family/friend caregivers for older persons in the upcoming decades, caregiving interventions should consider measurements of caregiving time as key outcomes.
Recruiting Racially and Ethnically Diverse Dementia Family Caregivers for Survey Research
Authors: Mendez Kyra , Han Hae-Ra
Published: December 2020

Recruiting racially and ethnically diverse dementia family caregivers (FCGs) for research can be challenging. The purposes of this presentation are to describe methods of successfully recruiting racially and ethnically diverse dementia FCGs for survey research and to share lessons learned. This study aimed to recruit dementia FCGs who have a chronic health condition and access to a mobile device. FCGs were primarily recruited from the Baltimore-Washington Metropolitan area to complete an online or phone survey about their technology use. A variety of recruitment methods were used including: posting ads in a local newspaper targeting older adults, partnering with a local Alzheimer’s research center and memory treatment center, attending community events, using online research registries, and posting online advertisements. The most successful method of recruiting minorities was by attending community events for caregivers and talking directly with community members about the research study. Online recruitment methods were less successful, but yielded the greatest diversity of participants, including Asian, Native American, mixed race, and African American FCGs. Some challenges associated with recruiting minority FCGs were working with primarily immigrant communities; recruiting FCGs who do not speak English; and building trust among communities that have been negatively impacted by research. Suggestions for future research include using recruitment strategies that enable researchers to build rapport with FCGs, engaging community stakeholders to understand your source population, and using a variety of recruitment methods. Also, online recruiting through credible sources appears to be a somewhat feasible method of recruiting diverse FCGs for survey research.
The Patterns of Caregiving Activities for Family Caregivers of Older Adults: A Latent Class Analysis
Authors: Huang Jing , Chau Pui Hing , Choi Edmond Pui Hang , Wu Bei , Lou Vivian
Published: December 2020

The purposes of this study were to identify the patterns of caregiving activities among family caregivers in Hong Kong and to examine their associations with characteristic factors and caregiver burden. The data was from the cross-sectional survey on the profiles of family caregivers of older adults in Hong Kong. 932 family caregivers were classified into different classes by using the Latent class analysis (LCA) according to their engagements in the 17 daily caregiving activities: 6 activities of daily living (ADLs), 8 instrumental activities of daily living activities (IADLs), emotional support, decision-making, and financial support. Five classes were revealed and labeled “Total All-round Caregiving” (Class I: 19.5%), “Partial All-round Caregiving” (Class II: 8.2%), “ADLs Free Caregiving” (Class III: 23.8%), “ADLs & Partial IADLs Free Caregiving” (Class IV: 32.5%), “Financial Caregiving” (Class V: 16.0%), respectively. Results from multinomial logistic regression found that the following factors were associated with the class membership: care recipients’ age, medical diagnoses, and caregivers’ gender, job status, marital status, self-rated economic status, living with care recipients, and caring for ≥40 hours per week. Findings from multiple linear regression showed caregivers with different patterns of caregiving activities reported different levels of caregiver burden. Caregivers in Class I have been found with the highest caregiver burden. This is the first study that has applied LCA to capture the patterns of caregiving activities among family caregivers. Identification of caregiving activity patterns and examination of their characteristics and caregiver burden can help healthcare providers to shift to prioritized and targeted caregiver support.
Self-Efficacy Among Caregivers of People With Dementia and Its Impact on Caregivers’ Health
Authors: Cho Soyeon
Published: December 2020

Self-efficacy is construct which is associated with positive thinking. It has been examined in caregiving studies to alleviate caregivers’ negative health outcomes. However, little is known about Asian American caregivers’ self-efficacy on their psychological and physical outcomes, especially caregivers with people with dementia. Thus, the present study examined self-efficacy of caregivers as a potential mediator in the association between caregiving role captivity and depressive symptoms among older Korean Americans. Data were driven from a cross-sectional study of 175 community-dwelling Korean American older adults (aged 60 and older) in 2019. The direct significant relation between caregiving role captivity and depressive symptoms became insignificant after self-efficacy was introduced, which demonstrates a full mediation effect of self-efficacy. Results suggest that even in the presence of caregiving role captivity, mental well-being such as depression of caregivers can be maintained by having competence in self-management of their own health.
Comparing a Clinician Assisted and App-Supported Positive Psychiatry Behavioral Activation Intervention
Authors: Massie Ariane , Cassidy Keri-Leigh , Vallis Michael , Conn David , Parsons Daria , Mitchell Julie Spence , Checkland Claire , Rabheru Kiran
Published: December 2020

Positive psychiatry offers a unique approach to promote brain health and well-being in aging populations. Health interventions are increasingly becoming available using self-guided apps, however, little is known about the effectiveness of app technology or the difference between in-person versus self-guided app methodology for behavioural activation. The objective of this study was to investigate the difference in users and outcomes between two formats of a positive psychiatry intervention to promote brain health and well-being in later-life: (1) clinician-assisted, and (2) independent app use for self-management. As part of a larger national knowledge translation intervention two methods of a behavioural activation intervention (Clinician-assisted vs. Independent app use) were retrospectively compared. Main outcomes were patient characteristics (age, sex, and completion rate), psychological outcomes (health and resilience, and well-being), and behavioural outcomes (goal attainment, and items of goal SMART-ness). Clinician-assisted patients (n=254) were more likely to be male, older, and had lower health and resilience scores at baseline than Independent app users (n=333). Clinician-assisted patients had notably higher completion rates (99.2% vs. 10.8%). Psychological outcomes were similar regardless of intervention method for those who completed the intervention. Clinician-assisted patients had higher rates of goal attainment and goal SMART-ness. A preliminary goal setting methodology for effective behavioural activation, to promote brain health and wellness, is given. Clinician-patient relationships were found to be an important factor for intervention completion, caution is given for app use referral. Results indicate a need for further exploration to determine best practices for health app use in clinical practice.
Feasibility Test of a Customizable Relationship Intervention for Stroke Survivor-Family Caregiver Dyads
Authors: McCarthy Michael , Garcia Yolanda Evie , Lyons Karen , Sanchez Angelica , Bakas Tamilyn
Published: December 2020

A strong interpersonal relationship after stroke is important for the well-being of survivors and family caregivers. However, few interventions are designed to strengthen the relationship between members of the care dyad in order to prevent depression and other poor outcomes. The aim of this study was to feasibility test a quality of relationship intervention for stroke dyads called Hand in Hand (HiH). Sixteen survivor-caregiver dyads were recruited and randomized into either the HiH intervention group (n=8) or the Information, Support, and Referral (ISR) control group (n=8). HiH dyads received up to 8 sessions with a social worker in-person, by telephone, or by Zoom web conference, prioritized according to a 17-item screening tool with 17 corresponding HiH content areas. ISR dyads received up to 8 sessions that included information, active listening, and referrals as needed. Process, satisfaction, and pre/post outcomes data were collected for both groups. Seventy-five percent of HiH dyads completed over half the sessions which lasted, on average, 55 minutes (range 26-76). Sixty-two percent of ISR dyads completed over half the sessions which lasted, on average, 21 minutes (range 15-33). Dyads in both groups reported being satisfied with the program materials and processes. Survivors and caregivers in both groups experienced improvements in outcomes, particularly caregivers in the HiH group who showed improvements in communication, coping, subjective relationship quality, and depressive symptoms. Findings suggest that HiH is feasible to implement with stroke dyads and has promise for improving outcomes for participants. Additional research is needed to determine program efficacy.