bluuebunny/crossref_metadata_2025 huggingface dataset:
Inequities in Palliative and Dementia Care and Health in Long-Term Supportive Services Settings
Authors: Brody Abraham
Published: December 2021

Most older adults with serious illness, including Alzheimer’s Disease and Related Dementias (ADRD) reside in community-based settings. These individuals and their care partners rely on Long Term Supportive Services (LTSS) including nursing home, home health, hospice, and adult day centers to provide support. LTSS are often under-resourced and reimbursed however, with significant regulatory restrictions on the care they can provide. These issues combined with other systemic factors in our healthcare system and society, including racism and poverty, lead to substantial inequities. Even preceding the use of LTSS, ADRD is diagnosed later in non-white individuals and access to high-quality services, including palliative care is severely limited. Moreover, few palliative care interventions address ADRD and even fewer have been specifically tailored to address the needs of our multi-cultural, racially and ethnically diverse society. This symposium will therefore utilize data from several nationwide data sets collected as part of routine care for clinical, billing, and/or regulatory purposes to assess inequities that exist across LTSS sites related to ADRD and palliative care. The individual abstracts show a clear pattern of inequities that stem from endemic systems failures towards people of color in the United States that must be addressed through a multipronged approach. This research shows that policies must be changed to require adequate collection of social determinants of health, to target policies that allow sub-standard or limited access to care, and research and clinical reform to produce a more culturally sensitive approach to care for those with ADRD and other serious illnesses.
Associations Between Dementia, Race-Ethnicity, and Intensive and Patient-Centered End-of-Life Care
Authors: Luth Elizabeth , Reich Amanda , Semco Robert , Prigerson Holly , Weissman Joel , Manful Adoma
Published: December 2021

A retrospective cohort analysis of Medicare administrative claims data from 2016-2018 compared intensive and patient-centered end-of-life care measures in persons with and without dementia, including the moderating effects of race/ethnicity. Over half (53%) of 485,209 Medicare decedents had a dementia diagnosis. Decedents with dementia were 31-34% less likely to receive intensive end-of-life care (hospital death 95%CI: 0.64-0.67; hospitalization in last 30 days 95%CI: 0.68-0.70) and 50% more likely to receive timely hospice care (95%CI: 1.48-1.52). The association between dementia and end-of-life care varied by decedent race/ethnicity. Compared to non-Hispanic white decedents without dementia, non-Hispanic Black, Hispanic and Asian decedents with dementia were significantly more likely to receive intensive end-of-life care. Non-Hispanic Black decedents with dementia were 23% more likely to receive timely hospice care (95%CI: 1.11-1.36). Additional research is needed to understand why persons with dementia receive less intensive end-of-life care and why differences exist based on racial/ethnic status.
Inequity in Health Among People Living With Alzheimer's Disease and Related Dementias in Adult Day Centers
Authors: Boafo Jonelle , Yu Gary , Wu Bei , Brody Abraham , Sadarangani Tina
Published: December 2021

In adult day centers (ADCs), 58% of clients identify as racial/ethnic minorities, and at least 30% have Alzheimer’s Disease and related dementias (ADRD). ADCs offer culturally and linguistically congruent care to clients, making them well-positioned to address potential health disparities affecting persons with ADRD. We used data from 53 California ADCs (n=3,053) to identify differences in clinical characteristics among ADC clients’ with ADRD based on demographics such as race and English proficiency. We found that, when compared to their respective counterparts, a significantly greater proportion of racial/ethnic minorities and non-English speakers (p<.001) had 5 or more chronic conditions in addition to ADRD. We noted considerable missing data on race, likely because ADCs in California are not mandated to report data on race/ethnicity. In order to identify inequities in care within this complex population, social determinants of health, including race, must be a standard component of client assessment.
Integrating Study Designs on Emotional Reactivity and Regulation in Old Age: New Evidence From the EMIL Study
Authors: Schilling Oliver , Luong Gloria
Published: December 2021

Key insights into emotional reactivity and regulation have been gained by studying how these dynamics evolve as older people are confronted with controlled stressors in the lab, go about their everyday routines, or develop across adulthood and old age. Yet, we are only beginning to understand how the dynamics on the different time scales observed in these study designs interact . Aiming for a comprehensive picture of the predictors, correlates, and consequences of emotional reactivity and regulation, the EMIL study integrates a lab-based study with ambulatory in-vivo assessments and a classic long-term longitudinal study. 130 young-old (65-69 years) and 59 very-old adults (83-89 years) from the ILSE study, contributing four waves of health, cognitive, and psycho-social data over almost 25 years, were tested in the lab and assessed six times a day over seven consecutive days. We provide an overview of and first across-design results from EMIL: Katzorreck et al. examined whether the frequency of exposure to daily stressors affects emotion regulation capacity as tested in the lab. Lücke et al. analyzed daily working memory performance, sleep, and its association with long-term change in cognitive functioning. Wieck et al. present differential effects of discrete negative emotions as induced in the lab and reported in daily life on social cognitive performance as indicated by empathic accuracy. Gerstorf et al. examined how long-term cognitive aging affects positive feelings and stressor reactivity in daily life. Gloria Luong will discuss the presentations, considering challenges and opportunities of integrating lab-based, ambulatory, and longitudinal study designs.
Linking Emotion Regulation Capacity and the Frequency of Daily Stressors in Old and Very Old Age
Authors: Katzorreck Martin , Gerstorf Denis , Lücke Anna , Wahl Hans-Werner , Schilling Oliver , Kunzmann Ute
Published: December 2021

Lifespan theories and lab-based research both suggest that the ability to downregulate negative emotions is often well preserved into old age, but becomes increasingly fragile in very old age. However, little is known about factors that may alleviate such age differences. Here, we ask whether exposure to daily stressors helps very old adults to maintain effective emotion regulation skills. We used data from 130 young-old (65-69 years, 48% women) and 59 very-old adults (83-89 years, 58% women) who watched negative emotion evoking film clips in the lab under emotion regulation instructions and also reported stress situations they experienced in everyday life (42 occasions across seven days). Initial results indicate that very-old adults were indeed less successful in regulating sadness than young-old adults, but those very-old adults who reported many daily stressful situations were as capable of emotion regulation as young-old adults. We discuss possible factors contributing to our age-differential findings.
Long-Term Cognitive Aging Trajectories as Predictors of Daily Affect
Authors: Gerstorf Denis , Schilling Oliver , Kunzmann Ute , Katzorreck Martin , Lücke Anna , Wahl Hans-Werner , Ram Nilam
Published: December 2021

Multiple-time scale studies provide new opportunities to examine how developmental processes evolving on different cadences are intertwined. Theories about age-related accumulation of stress suggest that long-term progressive loss of cognitive resources should manifest in and shape short-term daily affective experiences. Applying growth modeling and intraindividual variability methods to data obtained from 123 young-old (65-69 years, 51% women) and 47 very-old adults (85-88 years, 49% women) who provided 20+ year longitudinal data on Digit Symbol performance and 42-occasion momentary data about the emotions and stressors they experienced during everyday life (6 reports per day), we found that shallower long-term loss of cognitive performance was associated with less fluctuation in momentary positive affect, as well as less “spikiness” of and reactivity to stress. We discuss and present further results highlighting how mid-term processes surrounding age, gender roles, and health additionally contribute to and shape links between long-term and short-term dynamics of aging.
Sex Differences in Potentially Inappropriate Prescribing Among Older Adults With Multimorbidity
Authors: Ukhanova Maria , Markwardt Sheila , Furuno Jon , Davis Laura , Noble Brie , Quiñones Ana
Published: December 2021

Sex differences in prescribing potentially inappropriate medications (PIMs) for various multimorbidity patterns are not well understood. This study sought to identify sex specific risk of PIMs in older adults with cardiovascular-metabolic patterns. Secondary analysis of the Health and Retirement Study interview data (2004-2014; n=6,341, ≥65 y/o) linked to Medicare claims data was conducted. Four multimorbidity patterns were identified based on the list of 20 chronic conditions and included: ‘cardiovascular-metabolic only’, ‘cardiovascular-metabolic plus other physical conditions’, ‘cardiovascular-metabolic plus mental conditions’, and ‘no cardiovascular-metabolic disease’ patterns. Presence of PIM prescribing was identified using the 2015 American Geriatrics Society Beers Criteria, limited to the list of medications to avoid in older adults. Chi-square tests and logistic regressions were used to identify sex differences in prescribing PIMs across multimorbidity patterns: (1) for PIMs overall and (2) for each PIM drug class. Results indicate that on average women were prescribed PIMs more often than men (39.4% and 32.8%, respectively). Women with cardiovascular-metabolic plus other physical patterns (Adj.OR=1.25, 95% CI: 1.07-1.45) and cardiovascular-metabolic plus mental patterns (Adj.OR=1.25, 95% CI: 1.06-1.48) had higher odds of PIM compared to men, however, there were no sex differences in PIM prescribing in the cardiovascular-metabolic only patterns (Adj.OR=1.13, 95% CI: 0.79-1.62). There was variation by sex across different PIM drug classes. Our study emphasizes the need to further reduce PIM prescribing among older adults, and identifies target populations for potential interventions to improve medication prescribing practices.
Thyme and Oregano Terpenoids Activate Autophagy and Protect Against Hepatic Steatosis
Authors: Civiletto Gabriele , Jacot Guillaume Eric , Sizzano Federico , Muller Kamila , Hermant Aurélie , De Marchi Umberto , Feige Jerome , Gut Philipp
Published: December 2021

Caloric restriction has been shown to reduce chronic illness in aging and increase life expectancy in most living organisms including mammals. Autophagy, a ubiquitous catabolic pathway of cellular quality control, is a key mechanism mediating the benefits of caloric restriction. In addition, mutations in genes involved in autophagy have been associated with the early onset of age-related diseases such as neurodegeneration, highlighting autophagy as a potential therapeutic target. Here, we aimed to discover autophagy inducers from a library of edible molecules for potential use in food applications. To this end, we developed a novel in vivo high-content screening strategy using fluorescent reporter zebrafish that monitor autophagy flux in skeletal muscle. We identify the thyme and oregano constituent thymol as a novel potent autophagy inducer in zebrafish, human cells and mouse tissues. Mechanistically, thymol triggers an hormetic effect on mitochondria in synergism with a calcium-dependent autophagy response which, in turn, leads to mobilization of intracellular lipid stores. We tested the effects of chronic thymol supplementation in mice fed a high-fat diet and showed that thymol mobilizes fatty acids, reduces liver triglycerides and improves markers of liver damage. In sum, we validate the use of zebrafish screening as a discovery model for autophagy-based therapeutics and demonstrate that thymol is an autophagy inducer with potential for the prevention of chronic metabolic diseases and other age-related conditions.
Identification of Latent Sleep Profiles in Middle-Aged Adults and Connections to Well-Being
Authors: Smith Claire , Lee Soomi
Published: December 2021

For middle-aged adults, achieving adequate sleep is a challenge but essential for long-term health. The present study identified latent sleep profiles to clarify how multiple sleep variables (i.e., regularity, satisfaction, alertness, timing, efficiency, and duration) cooccur within middle-aged adults and the implications these holistic sleep experiences have for well-being. Three profiles emerged within the Midlife in the United States II dataset (MIDUS; N=4030, Mage=56.23 years): (i) good sleepers, (ii) nappers/poor night sleepers, and (iii) sufficient but irregular sleepers. Generally, good sleepers reported the best well-being, sufficient/irregular sleepers reported comparatively moderate well-being, and nappers/poor night sleepers reported the worst well-being across a variety of indicators (i.e., chronic health conditions, life satisfaction, positive affect, negative affect, and psychological well-being) after adjusting for sociodemographic characteristics. Age moderated these associations. Our findings advance understanding of sleep health as a multifaceted construct and of its connection to well-being in middle-aged adults.
Characterizing Component Activities of Older Adult Sedentary Time by Age, Gender, and Device-Based Sitting Patterns
Authors: Greenwood-Hickman Mikael Anne , Walker Rod , Bellettiere John , LaCroix Andrea , Rosenberg Dori
Published: December 2021

The activities that compose older adults’ considerable sedentary time are not well characterized. We described daily time spent in self-reported sedentary activities and explored differences by age, gender, and activPAL sitting patterns. Participants self-reported a total of 10.7 hours of sitting time and spent the most time watching TV (2.6 hrs/day), using the computer (1.7 hrs/day), and reading (1.6 hrs/day). Women spent more time watching TV, engaged in hobbies, and socializing and less time on the computer compared to men. Older participants spent more time watching TV, reading, and participating in group activities and less time on the computer than younger participants. Those with low activPAL sitting time and frequent activPAL sitting breaks (low mean bout duration) ~1 hr /day less watching TV than those with high activPAL sitting time. These findings help illuminate future intervention targets and lay the path to explore associations between different sedentary activities and health.
The Impact of FFC-AL-EIT on Resident and Setting Outcomes
Authors: Boltz Marie
Published: December 2021

FFC-AL-EIT was implemented by a Research Nurse Facilitator working with a community champion and stakeholder team for 12 months to increase function and physical activity among residents. FFC-AL-EIT included four steps: (Step I) Environment and Policy Assessments; (Step II) Education; (Step III) Establishing Resident Function Focused Care Service Plans; and (Step IV) Mentoring and Motivating. A total of 85 communities and 794 residents were included. The age of participants was 89.48 (SD=7.43), the majority was female (N=561, 71%) and white (N=771, 97%). Resident measures, obtained at baseline, four and 12 months, included function, physical activity, and performance of function focused care. Setting outcomes, obtained at baseline and 12 months, included environment and policy assessments and service plans. Effectiveness was based on less decline in function (p<.001), more function focused care (p=.012) and better environment (p=.032) and policy (p=.003) support for function focused care in treatment sites.
Diversity of Activities and Loneliness Among Heterosexual and LGBT Older Adults
Authors: Lee Jeongeun , Svec Joseph
Published: December 2021

The extant literature highlights the physiological and psychological benefits of active lifestyles among older adults, though there is a considerable gap in scholarship for sexual minority groups. Utilizing the Social Integration Model, we hypothesize that social activities enhance individual psychological well-being, but those effects differ by one’s social identities. Using a national AARP foundation survey of adults (45+), this study examines whether individuals’ activities predict loneliness and depressive symptoms of heterosexual (n=2905) and LGBTQ adults (n=318). We utilize an index of diverse activities, which includes, social technology use, meeting with friends, and volunteer activities. Multiple linear regression is used to study cross-sectional associations of loneliness and depressive symptoms on the diverse activity index. Results show that a wider array of activities correspond with higher psychological well-being and lower loneliness, and this association is higher for LGBTQ older adults. We discuss implications for counseling and wellness programming for LGBT older adults.
Engagement in Assisted Living During the COVID-19 Pandemic: Challenges and Promising Practices.
Authors: Bartoldus Victoria , Cho Youngmin , Perez Janelle , Wang Jing , Palmertree Stephanie , Beeber Anna
Published: December 2021

The “lockdown” in assisted living (AL) from the COVID-19 pandemic has physically isolated residents from the outside world and affected resident and family engagement in care. This presentation outlines a content analysis of qualitative semi-structured telephone interviews conducted from April 2020 with 105 AL staff, residents, and family members exploring COVID-19 experience/restrictions and engagement during the pandemic. Analysis revealed AL families and residents expressed difficulties with COVID-19 visiting and distancing restrictions, reduced family visitations, discontinuity of care, and worries about COVID-19 infection. Staff/administrators expressed uncertainty about lack of knowledge about COVID-19, worries about transmission, and if staff will get exposed outside of work. Promising factors include enhanced communication between staff and families regarding care, improved virtual communication, creative strategies to socially engage residents, and improved infection control practices and staff training. The presentation discusses the implications of the findings for future research, policy, and practice.
Approaching Multimorbidity From a Translational Geroscience Perspective
Authors: Newman Anne
Published: December 2021

Multimorbidity describes the accumulated burden of chronic disease. Multimorbidity erodes physiologic reserve, increasing the risk of frailty, disability and death. Most older adults have at least one chronic health condition by age 65. Once established, many age-related conditions progress and accumulate with age. Geroscience holds that there are key biologic pathways that explain the increase with age in multimorbidity, frailty and disability Translation of geroscience principles to human studies requires careful assessment of biomarkers of these pathways and multisystem outcomes. In this symposium, translational researchers in geriatric medicine and gerontology will present current work to elucidate biologic underpinnings of aging and potential intervention targets. We will address whether blood biomarkers of aging processes are prognostic using combinatorial techniques and explore the potential for proteomics to identify novel pathways for health aging. New insights into the role of inflammation will be discussed with an emphasis on its relationship to multimorbidity. Brain aging will be considered with respect to the interactions between external stressors and resilience evaluating the role of ketone bodies which have immunomodulatory effects particularly on innate immune cells. Finally, the role of multimorbidity as an intervention target and potential intermediate outcomes including biomarkers will be presented with discussion of next steps needed to realize the potential for translational geroscience clinical trials to improve health span.
Operationalizing Healthspan as an Outcome for Clinical Trials in Geroscience
Authors: Justice Jamie
Published: December 2021

Efforts targeting biological aging pathways are advancing interventions which could extend healthy lifespan. Design of clinical trials to test such interventions necessitates an operational definition of healthspan, such as slowed accumulation or progression of multiple chronic diseases, functional decline, and disability. In this talk we explore these composite measures of healthspan proposed as outcomes for clinical trials in aging. This will be examined in example cases including multimorbidity and deficit accumulation frailty indices in an 8-Year intensive lifestyle intervention trial, and an update on multimordbity, functional, and biomarker endpoints in the trial Targeting Aging with MEtformin (TAME). Through these examples we will explore issues related to effect sizes and statistical challenges related to composite endpoints. Finally, we will discuss the role existing and emerging biomarkers of aging in clinical trials in geroscience and summarize evidence linking biomarkers to clinically meaningful outcomes.
Behavioral Health, Social Engagement, and Long-Term Care Services Use Among Community Older Adults: USA vs. Taiwan
Authors: Hou Su-I , Li Chien-Ching , Liu Darren
Published: December 2021

As healthcare advances, older adults are living longer. While 90% of older adults prefer aging in their own homes and communities, it is important to examine key factors influencing healthy aging-in-community and community-based long-term care (LTC) services available in different countries. This symposium examines behavioral health, social engagement, and LTC services utilization among community-dwelling older adults in the USA and Taiwan. Lessons learned from older adults across countries will provide insights for tailored community-based LTC services and program development. Dr. Hou from The University of Central Florida (UCF) will highlight similarities and differences in behavioral health profiles and the topics that most interest community-dwelling older Americans participating in three aging-in-community programs in Central Florida. Dr. Wang from Case Western Reserve University will examine the impact of neighborhood social cohesion on mobility among community-dwelling older Americans aged 65 and older from the national Health and Retirement Study. Dr. Liu from National Cheng-Kung University in Taiwan will share results of healthy lifestyle on quality of life among community-dwelling older adults in southern Taiwan. Dr. Young from State University of New York at Albany will compare long-term care use among community-dwelling older adults with and without dementia in Central Taiwan. Finally, Drs. Cao and Hou from UCF will analyze home and community-based services in the USA versus Taiwan. This symposium will further discuss similarities and differences of key factors related to healthy aging-in-community, along with practical recommendations and lessons learned across countries and cultural environments to improve community-based long-term care services and programs.
Home and Community-Based Services Between the USA and Taiwan
Authors: Cao Xian , Hou Su-I
Published: December 2021

Home and community-based services (HCBS) are critical to support our rapidly growing and aging population around the world. This paper takes initial steps to compare HCBS between the USA and Taiwan from four perspectives: funding sources, service types, challenges, and recommendations. Peer-reviewed articles and governmental reports (both English and Chinese) in the U.S.A. and Taiwan were reviewed. Analyses showed both countries mainly use tax dollars to fund HCBS. Although both countries have similar service categories, USA lack a clear organization scheme whereas Taiwan has detailed and clear services provisions. Workforce quality and shortage were common challenges for both countries, especially from culture perceptive. Recommendations for USA include expanded funding pool, better coordination between agencies, and rebalancing HCBS and institutional care with limited budget. Recommendations for Taiwan include expanded service coverage and quality to reduce disparity in rural areas, and providing more support for informal caregivers.
Social Connection Planning for Lonely or Socially Isolated Older Adults
Authors: Bower Emily , Newman Aurora , Reohr Paige , Vandorden Kimberly
Published: December 2021

Social connections are important for maintaining health and well-being with age. Behavioral interventions to promote connectedness hold promise, but there is limited evidence to guide effective modifications in the context of physical distancing or quarantine restrictions, such as those required during the COVID-19 pandemic. We present evidence for a brief (1-2 session) social connection intervention, “Connections Planning,” to enhance social connectedness for older adults. We first describe a cognitive-behavioral model of loneliness, which served as the framework for developing the intervention. We then present two case examples to demonstrate the application of the intervention with older adults in a community mental health clinic during physical distancing restrictions. Finally, we present initial findings from a pilot study to examine the feasibility and acceptability of the intervention delivered remotely with up to 10 community-dwelling older adults who endorse clinically significant loneliness. Recommendations for adapting the intervention during physical distancing restrictions are provided.
Differences in Geriatric-Focused Education Preparation and Beliefs About Providing Care to Older Patients in Ghana
Authors: Karikari Grace , Asante Samuel
Published: December 2021

With the increasing growth rate of older persons and a rise in related illnesses in Ghana, it is vital that health practitioners are equipped with geriatric-oriented knowledge and expertise to provide the needed services to geriatric patients. The purpose of this study was to examine (i) the differences in the level of geriatric-focused educational preparation between graduating medical and nursing students in a Ghanaian public institution, and (ii) the association between educational preparation and students’ beliefs about providing care to geriatric patients. The study hypothesized that students with more positive beliefs will be linked to higher educational preparation. Descriptive and inferential statistics were conducted (n=136 students). Findings show significant differences in the educational preparation of medical and nursing students (t [134] = -3.790, p < .001). Graduating nursing students, comparatively, had higher educational preparation (M=23.14, SDe3.30) than medical students (M=21.14, SD=2.76). However, there was no significant association between students’ educational preparation and their beliefs about geriatric care. The findings underscore the need for extensive or more focused training. Further, the association between beliefs and educational preparation warrants further exploration. The need to examine the social cultural environment within which the research participants reside are discussed.
Online Gerontology Courses: Issues of Equity
Authors: Sharma Anita
Published: December 2021

The COVID-19 Pandemic changed higher education in several significant ways. The most significant impact was on methods of course delivery. In March 2020, all educational institutions changed their methods of instruction to fully online instruction. It happened almost overnight and left the students as well as the instructors unprepared for the unanticipated metamorphosis . The sudden and unanticipated change in the method of instruction and delivery of course contents also highlighted issues of equity. There appeared to be high levels of inequity in the use of technology across school and college campuses. A survey of students conducted by the author at the University of Louisiana at Monroe revealed different types of inequity such as, lack of finances to buy equipment, lack of training in the use of technology, and lack of personal space to study from home. A significant percentage of student population at ULM consists of first-generation college students. These students were impacted the most by the new methods of course delivery. Additionally, the author looked up similar surveys at other educational institutions and conducted a meta-analysis of published studies. This paper presents these findings.
The State of Gerontological Training in Ghana: Implications for a Specialized Workforce and the Aging Population
Authors: Asante Samuel , Karikari Grace
Published: December 2021

The rise in older population in Ghana is accompanied by several challenges that may require trained professionals with specialized knowledge in geriatrics and gerontology to help address. Extensive review of existing literature, however, indicates a lack of comprehensive geriatric focused training in Ghana’s education system. Unfortunately, the scope of this training deficiency, potential impact on the geriatric workforce, as well as the health and wellbeing of the aging population on the national level have not been extensively examined. With the older adult population set to increase over the next few years, the need for geriatric-trained human service professionals in diverse disciplines, including medicine, nursing, psychology, social work and public health has become more pronounced. This paper is a review of the current state of gerontological education in higher institutions in Ghana. Specifically, authors examined (1) current geriatric-focused training programs available to students in all public/government owned institutions, (2) existing national level programs, and policies addressing training deficiencies, and (3) the implications of findings for future geriatric workforce as well as the health and wellbeing of older Ghanaians. The findings call attention to the need for a nationwide geriatric-focused training system and policies aimed at prioritizing specialized care for the older population. Culturally appropriate recommendations for integrating gerontological training and education in tertiary institutions are discussed. Guidelines and standards based on the Academy for Gerontology in Higher Education (AGHE) Competencies for Undergraduate and Graduate Education are proposed.
Development of a Virtual Reality Platform to Promote Disaster Preparedness Among Older Adults
Authors: Cong Zhen , Kan Chen , Hagedorn Aaron , Thomas Sam , Yeager Reid
Published: December 2021

This project develops a tailored and adaptive virtual reality platform to innovatively promote older adults’ disaster preparation in a socially engaging environment. The platform serves the following purposes: 1) assist older adults to develop tailored household emergency preparedness plans, 2) simulate extreme weather conditions and warnings for older adults to practice disaster response and develop relevant knowledge and skills as well as test and revise their emergency preparedness plans, 3) use the process as a social engagement tool to reduce social isolation and promote a sense of community. The virtual environments are designed in Unity to simulate extreme weather conditions/natural disasters and older adults are guided to use the HTC VR headset and experience the selected disaster scenario. The pilot VR platform will be tested among community-dwelling older adults in the Dallas-Fort Worth Metropolitan Area.
COVID-19 and Older Adults: Coping With Long-Term Pandemic Precautions
Authors: Emerson Kerstin , Kim Deborah , Mois George , Beer Jenay
Published: December 2021

Studies conducted at the beginning of Covid-19 precautions suggested that older adults were stressed, but hopeful. Less is known how coping has changed for older adults after experiencing months-long pandemic precautions. We explore differences in coping between the initial pandemic declaration in March 2020, and 9 months later, via an internet survey fielded in November 2020 (n= 781). We present summary data, using chi-square tests for subgroup analyses. A majority of respondents (aged M=66 yrs, range 60-89) were women (64%) and White (94%). When asked to compare their feelings to the beginning of the pandemic, 44.8% were more frustrated, 38.7% were more stressed, and 32.7% were more anxious. However, 38.3% were more appreciative. Women were significantly more likely than men to report increases in feeling frustrated, angry, scared, stressed, sad, and hopeless. Introverts were significantly more likely than extroverts to report an increase in loneliness and stress. Since the first few weeks of the pandemic, respondents reported more communication through video calls (45.2%), texting (40.2%), and phone calls (28.8%). Additionally, 61.5% spent more time on computers/tablets, 47.2% spent more time watching TV, and 24.5% spent more time praying. Extroverts were significantly more likely than introverts to report an increase in time with TV, phones, and computers/tablets. Women were significantly more likely than men to report increased texting and praying. These data provide further understanding of the impact of long-term pandemic precautions on older adults and suggest particular subgroups of older adults may benefit from public health and mental health interventions.
The Effectiveness of a Caregiver Support and Education Intervention Designed for Caregivers of Veterans
Authors: Mavandadi Shahrzad , Eaker April , Van Treese Katherine , Jeffries-Silmon Brenda , Wray Laura
Published: December 2021

Veterans are at increased risk for dementia and multiple comorbid conditions, often making the family caregiving experience particularly challenging. The objective of this study was to examine the effectiveness of a telephone-based, collaborative dementia care program for improving caregiver (CG) outcomes in CGs of veterans with dementia. All CGs (n=107) received individual care management and were randomized to either individual intervention alone or individual plus group education and social support. CGs were on average 72.5 (+/-11.0) years old, and the majority were female, spouses/partners of the care recipient (CR), and providing care for ≥1 year. Pre-post analyses indicate that CGs experienced a significant reduction in both the frequency of CRs’ dementia-related symptoms (e.g. memory difficulties, disruptive behaviors, depressive affect) and their own distress in response to these symptoms. Our study adds to the literature on the development and evaluation of understudied CG populations, such as CGs of veterans with dementia.
Disparities in Financial Strain for Older Adults and People With Disabilities in California
Authors: Chen Lei , Kietzman Kathryn , Allen Rebecca
Published: December 2021

This study examines disparities in the experience of financial strain among older adults and people with disabilities by age, gender, race/ethnicity, poverty, and disability type. People with disabilities refer to those who report cognitive impairment, difficulties performing activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs). Financial strain includes challenges that participants incurred during the last 12 months in acquiring food, housing, health care, or income. This study uses the data from the 2019 California Long-Term Services and Supports (LTSS) survey that was merged with data from the omnibus California Health Interview Survey (CHIS) (N=1097). This is the most comprehensive population-level dataset to examine LTSS needs, unmet needs, and uses of LTSS in California. Initial findings show that 50% of participants report spending less on food, while 40% report cutting down on saving for retirement, receiving and borrowing money from others, and experiencing a decline in household income. More than 20% note that they could not make rent or mortgage payments, had debt due to medical bills, and had to spend less on prescription medications or medical care. We also find significant disparities in financial strain by age, gender, poverty, and disability type; however, no significant disparities by race/ethnicity. This study is among the first to examine disparities in various financial strain types for people who need LTSS in California. The findings have policy implications for the Master Plan for Aging (MPA), which serves as a blueprint to build environments that promote an age-friendly California.
Does the Health Insurance Program Reduce Health-Induced Poverty?: New Evidence From the China Household Income Project
Authors: Zhang Yalu , Gao Qin
Published: December 2021

The growing cost of healthcare services has been a concern for many countries in the world. In China, medical expenditures can account for as much as 65% of per capita income in some low-GDP counties in 2011. One of the primary goals of the New Rural Cooperative Medical Insurance (NRCMI) is to provide financial protection and alleviate the financial burdens of rural residents in China. This paper examined whether NRCMI participation impacted the incidence of catastrophic health expenditure (CHE) among middle-aged and older adults (45 years old and above) using the China Household Income Project 2007 rural data and an instrumental variable estimation method in two provinces where there was heterogeneity in NRCMI implementation schedule. The results show that NRCMI enrollment could not impact the likelihood of experiencing CHE among middle-aged and older adults. However, NRCMI participation increased the actual amount of medical expenses in one province but not in the other. Although none of the prior studies have used instruments and village fixed effects or take endogeneity issues into account to investigate the impact of NRCMI on relative financial burden among recipients, the results found in this study are generally aligned with the prior findings, especially with those using quasi-experimental studies. Findings from this study provide empirical evidence to the policymakers that the effect of NRCMI participation on financial protections is limited despite its broad population coverage. The limited effects are probably due to the low reimbursement rate and more utilization of expensive healthcare services.
Vietnamese Families' Strength and Resilience and Healthcare Professionals’ Role During the Pandemic
Authors: Miyawaki Christina , Liu Minhui , Markides Kyriakos
Published: December 2021

Traumatic escape from Vietnam in 1975 brought 1.3 million Vietnamese refugees to the U.S. Today, Vietnamese are the largest Asian subethnic group in Houston, Texas (81,000+), making Houston the 3rd largest Vietnamese-populated city in the U.S. Despite these numbers, health research on Vietnamese population is limited. To address this gap, we developed the Vietnamese Aging and Care Survey and collected data on Vietnamese older adults (≥65 years) and their caregivers (N=199). The purpose of this study was to examine the association between caregivers’ caregiving characteristics and care recipients’ mental health (N=58 dyads). Descriptive statistics and logistic regression models were used. Caregivers were on average 53 years-old, Vietnam-born (97%), and working (66%). The majority (84%) lived with their care recipients and provided care for 20+ hours/week (69%) in good/excellent health (76%). Care recipients were on average 75 years-old, Vietnam-born (100%) in fair/poor health (81%). Regression results showed stressed caregivers with more-depressed care recipients (OR=1.47, 95%CI:1.02, 2.13) but positive caregiving experiences (OR=0.85, 95%CI:0.74, 0.97) and burdened caregivers (OR=0.79, 95%CI:0.65, 0.96) with less-depressed care recipients. We found the association between stressed caregivers and depressed care recipients (Life Stress Paradigm), but care recipients becoming a “helpful company” reduces caregiver burden and care recipients’ depression (Social Exchange Theory). Vietnamese families live in multigenerational households within ethnic enclaves and remain a tightly-knit family unit showing resilience to their low socioeconomic status (≤25K, 91%). Leveraging a family as their strength, healthcare professionals should take a caregiver-care recipient dyad approach when planning COVID-19 pandemic interventions in Vietnamese communities.
Unspoiled Identities of People Living Alone With Dementia: Resisting Stigma by Helping Others
Authors: de Medeiros Kate , Girling Laura
Published: December 2021

Goffman (1963) described stigma as the shift from being viewed as a whole and usual person to one with a spoiled identity. People living with dementia (PLWD) often report feeling stigmatized. Many dementia stereotypes highlight losses (e.g., loss of self) and negatively position the person as a passive, dependent care recipient. Here, we present findings from a qualitative study of people living alone with dementia (N=10) in the community that challenge these stereotypes. Analysis of in-depth interviews revealed that many participants resisted the spoiled identity label through active engagement in the community such as participating in paid employment, providing care for neighbors and family members, and volunteering. Overall, findings underscore the need to rethink and challenge common perceptions of PLWD that are focused solely on care, to recognize their active and valuable role in the lives of others. How PLWD negotiate these identities should inform policies of dementia in community.
Global Publishing Opportunities in Gerontology: A View From the Editor's Desk
Authors: Miller Edward , Simpson Elizabeth
Published: December 2021

Global aging has proceeded at an unprecedented and accelerating rate. The aging of the population creates both opportunities and challenges for elders, their families, and society in general. Importantly, there is substantial variation in the effects of and response to global aging both within and across nations depending, in part, on prevailing cultural expectations and values, political and economic imperatives, and social and demographic characteristics. Thus, while some regions and countries have responded with innovative policies and programs to better enable the growing cohort of older adults to remain active and engaged in the community, other regions and countries have struggled with their response or barely begun to plan for the rising population of elders. This symposium assembles editors at five leading gerontological journals to demonstrate the role that peer-reviewed scholarship can play in disseminating knowledge that informs gerontological research, policy, and practice internationally. Editors include: Kyungmin Kim, PhD, Research on Aging; Jessica Kelley, PhD, Journal of Gerontology: Social Sciences; Edward Alan Miller, PhD, Journal of Aging & Social Policy; Julie Hicks Patrick, PhD, International Journal of Aging & Human Development; and Julie Robison, PhD, The Journal of Applied Gerontology. Each presenter will review the scope, content, and focus of their journals and the role and opportunities for international scholarship.
The Role of Global Scholarship in the Journal of Aging & Social Policy
Authors: Miller Edward , Simpson Elizabeth , Gusmano Michael , Nadash Pamela
Published: December 2021

Policymakers, practitioners, and researchers need a balanced, thoughtful, and analytical resource to meet the challenge of global aging at a rate that’s historically unprecedented. The Journal of Aging & Social Policy (JASP), which was founded in 1989, serves this role by drawing contributions from an international panel of policy analysts and scholars who assume an interdisciplinary perspective in examining and analyzing critical phenomena that affect aging and the development and implementation of programs for elders from a global perspective. Study settings extend beyond the United States to include Europe, the Middle East, Australia, Latin America, Asia, and the Asia-Pacific rim. This presentation will document the scope, content, and focus of JASP, including the rise of international submissions, which now account for approximately half of articles published. Opportunities for publishing in JASP will be discussed; so too will strategies for navigating the peer-review process successfully.
Research on Aging: The International View From the Editors’ Desks
Authors: Kim Kyungmin , Burr Jeffrey , Peng Changmin
Published: December 2021

We review the scope, content, and focus of the peer-reviewed journal, Research on Aging (SAGE), publishing its 422nd volume this year. We will discuss how scholarship produced from researchers around the globe has changed over the years. Data on submissions, acceptance rates, and the important role of an international editorial board will be presented. The review process will be described, along with suggestions on how to increase chances of success when submitting original research. Although Research on Aging is sometimes considered to focus primarily on social gerontology, the scope in recent years has widened considerably, with manuscripts in aging studies published from such fields as economics, psychology, demography, public health, and public policy, as well as from sociology, and social work, among others. One of several special issues forthcoming in the journal will be described to demonstrate the possibilities for international impact.
Chronic Disease Among Medicaid Beneficiaries Over 50: The Potential Impact of Medicaid Work Requirements
Authors: Sneed Rodlescia , Gardner Graham , Stubblefield Alexander , Mezuk Briana
Published: December 2021

Since 2018, several states have proposed requiring work or other community engagement activities as a condition of receiving Medicaid; however, there has been little inquiry into the impact of such policies on Medicaid recipients over 50. Here, we describe the prevalence and burden of chronic disease among Medicaid beneficiaries over 50 who might be impacted by Medicaid work requirements. We used data from the 2016 wave of the Health and Retirement Study, a large-scale population-based study of adults aged >50. Our sample included individuals over 50 who were not Medicare-eligible (<65 years old) and not receiving Social Security Income. We used logistic regression models to compare those working <20 hours per week (the minimal community engagement/work cutoff) to those working >=20 hours per week, adjusting for age, race/ethnicity, sex, education, and marital status. Individuals working <20 hours per week had greater prevalence of chronic health conditions, including greater odds of diabetes (OR: 2.06; 95% CI: 1.37-2.46), hypertension (OR:2.56; 95% CI: 1.69-3.89), arthritis (OR: 2.96; 95% CI: 2.06-4.62, and lung disease (OR: 4.11; 95% CI: 2.31-7.32). Further, among those with chronic health conditions, those working <20 hours per week reported more, medication use, more worsening of their conditions in the past 2 years, and more hospitalization than their counterparts. Taken together, these finding suggest that Medicaid work requirements in this population would have the most impact on the most medically vulnerable individuals. Policymakers should consider this as they propose policies impacting Medicaid coverage in this population.
The Division of Aging Biology on Basic Research in Health Disparities
Authors: Carrington-Lawrence Stacy , Kohanski Ronald
Published: December 2021

The core mission of the Division of Aging Biology is to explore the molecular and cellular mechanisms of aging. Work supported by the Division is best known for research using laboratory animals, but we have a less well-recognized program of research engaging human participants. With a goal expanding our presence in clinical research and the hope that we can have an impact on health disparities, this talk will provide an overview of how our grantees approach basic mechanistic questions of aging in human communities. In addition, a forward-looking but speculative presentation will be made on ways in which laboratory animals might be used to study health disparities from the perspective of hallmarks of aging.