bluuebunny/crossref_metadata_2025 huggingface dataset:
DOES THE NUMBER OF DISEASES OR DISEASE SEVERITY AFFECT THE AGING ATTITUDES IN HEALTH RETIREMENT STUDY?
Authors: Da Chang Jung
Published: December 2022

The number of older adults is increasing worldwide, coupled with an increase in chronic disease. Evidence has shown a relationship between health conditions and changes in attitudes toward own aging (ATOA) and thus may contribute to a negative ATOA among older adults with more health conditions. Additionally, studies also show that ATOA can affect the health of older people and become a vicious circle. To promote a healthier life for older adults, it is important to assist them to maintain a more positive ATOA. Therefore, the purpose of this study wants to determine the relationship between the diseases number and ATOA for older adults (N = 6303). Although the relationship between the number of the diseases has been discussed in previous studies, this study will use 2012 and 2016 waves Health and Retirement Study data to update the relationship by using generalized estimating equation. To understand whether it is the disease severity that affects ATOA, this study uses Charlson Comorbidities Index to measure the burden of diseases and use structural equation models to understand the relationship between variables and do the model pathway analysis. The initial results show that an individual with a greater number of diseases (p < .01, r=-.039), and a higher score of CCI have more negative ATOA (p < .01, r=-.04). These findings suggest both the number and severity of diseases contribute to ATOA in older adults. Furthermore, the CCI provides a method to identify the disease severity and can be used in the national databases.
RACIAL AND ETHNIC DIFFERENCES IN PARTICIPANT EXPERIENCE OF HOME- AND COMMUNITY-BASED SERVICES
Authors: Degenholtz Howard
Published: December 2022

It is widely recognized that racial and ethnic minorities experience lower quality of care and worse health outcomes across a wide range of health services and long-term care settings. However, less is known about racial and ethnic differences in home and community-based services (HCBS). This study used the HCBS version of the Consumer Assessment of Health Providers Survey (CAHPS) to examine participant experience of care in a large, statewide Medicaid program. The CAHPS-HCBS is a validated measure of quality of HCBS that supplements measures of health outcomes and provides policy makers with critical data on system performance. As part of a larger evaluation of Pennsylvania’s transition to Managed care for users of HCBS, representative samples of older adults were interviewed before and after the program was implemented. This study takes advantage of the phased implementation of managed care to estimate the causal effect of the program on differences in participant experience by racial and ethnic group. In general, non-Hispanic whites rated their overall satisfaction with HCBS lower than non-Hispanic Black and Hispanic people. The implementation of Managed care was associated with improvements in non-Hispanic Black and Hispanic ratings of personal care and service coordination, but not that of non-Hispanic whites. One implication of these findings is that managed care organizations can have positive impact on participant experience. The CAHPS-HCBS instrument is publicly available and can be used by state agencies to monitor racial and ethnic disparities in participant experience.
ADAPTING PRIMARY CARE WORKFLOWS TO PROMOTE ADVANCE CARE PLANNING WITH AN EMPHASIS ON A DEDICATED ACP FACILITATOR
Authors: Valadares Kevin , Leahy Suzanne , Ehlman Katie , Arnold Robin
Published: December 2022

The COVID-19 pandemic has sharpened attention regarding the need to proactively plan for a future medical crisis. Advance Care Planning (ACP) has emerged in the last 30 years as a potential way to improve individuals’ end-of-life care by ensuring that patients explore and communicate personal values, goals, and preferences regarding future medical care to surrogate decision makers and medical providers. Elevating ACP as a core function of direct patient care, the University of Southern Indiana’s (USI) Geriatric Workforce Enhancement Program (GWEP) embedded a multi-modal ACP initiative in a primary care clinic, anchored by the Medicare Annual Wellness Visit (AWV). Within this initiative, the role of a dedicated ACP Facilitator embedded in the practice is highlighted to promote and bill (Medicare CPT codes 99494, 99498) for ACP conversations. The addition of an ACP Facilitator (who is a licensed clinical social worker) as part of the primary care team complements the efforts of the providers to focus on What Matters most to patients. This is particularly important to patients with serious illness. This presentation will summarize the re-alignment efforts of the primary care clinic to prioritize ACP conversations for older adults, amounting to 10,000 visits per year.
MOTIVATIONS TO VOLUNTEER: SURVEY OF A SERVICE AGENCY IN RURAL MICHIGAN
Authors: Hu Rita , Dunkle Ruth , Tarr Julie
Published: December 2022

While volunteers are the foundation of service agencies in rural communities, they are difficult to recruit. This study aims to understand the characteristics of volunteers in a rural community that could aid in recruitment. All volunteers (N=127) for an organization providing services to keep older adults in their homes in rural Michigan were approached to participate in the study. Data were gathered via telephone-interview survey (N=76) and in-person focus groups (N=14) in the summer of 2021 to understand demographic factors as well as benefits and community factors contributing to volunteer participation. Most volunteers were female (61%), married (71%), over age 70 (M=71), and lived with others (72%). In the past year, 49% volunteered 1-5 hours per week and with multiple organizations (70%). They identified the primary benefits from volunteering as getting to know new people (66%). Volunteers agreed that they feel they contribute to the community (97%), have a strong attachment to the community (91%), and have the ability to make a difference in the community (95%). Volunteers were less aware of what could be done to meet the needs in the community (54%) and understand the needs and problems facing the community (59%). Focus group data suggest that volunteers desire information about community needs and aging in place. Due to the lack of centralized locations, social and educational hot spots such as coffee shops could attract new volunteers. Having a sense of community is an important component of volunteering and should be fostered when recruiting new volunteers.
PRIORITIZING FUTURE RESEARCH ON NONDRUG DEMENTIA CARE INTERVENTIONS
Authors: Jutkowitz Eric , Shewmaker Peter , Alarid-Escudero Fernando
Published: December 2022

We previously used an evidence-based mathematical model to evaluate the cost-effectiveness of psychosocial interventions that reduce the risk of a nursing home admission for people with dementia from a healthcare payer perspective. We found the incremental cost-effectiveness of MIND, an in-home intervention for people with mild-moderate dementia, compared to usual care was $271,456 per quality-adjusted life-year (QALY). The incremental cost-effectiveness of NYU Caregiver Intervention (NYUCI), which is for people with moderate dementia, compared to usual care was $3,964/QALY. Here we quantify the uncertainty around our cost-effectiveness estimates. First, we calculated the expected value of partial perfect information (EVPPI), which is the value of eliminating uncertainty around the treatment effect (i.e., risk of entering a nursing home) of MIND and NYUCI, and represents the maximum willingness-to-pay for a study to inform these estimates. Given a willingness-to-pay of $110,000/QALY, population EVPPI for MIND and the NYUCI were $81,000,000 and $395,000,000, respectively. Second, we calculated the expected value of sample information (EVSI), the expected net benefit of sampling (ENBS) and the optimal sample size (OSS). EVSI is the amount of uncertainty reduced from a pragmatic trial evaluating the risk of entering a nursing home for people in the intervention compared to usual care. ENBS is the return of a pragmatic trial with a fixed ($1,050,000) and per person ($2,000) cost to conduct the study. The OSS is the sample size that maximizes ENBS and was 3,571 for MIND and 5,357 for NYUCI. There is value in conducting pragmatic trials on MIND and NYUCI.
FOOD INSECURITY AMONG OLDER ADULTS IN NEW YORK CITY: DOES LOCATION MATTER?
Authors: Cheung Ethan Siu Leung
Published: December 2022

Having access to adequate and appropriate food sources is essential to addressing food insecurity among older adults. However, the role of locational characteristics in explaining food insecurity remains unclear, especially in urban areas. This study investigated the association of distance to grocery stores, neighborhood disadvantage, and social cohesion with food insecurity among older adults in New York City. Individual-level data were drawn from a 2-year Poverty Tracker Study. The sample included New York City residents aged 65 or older (baseline N = 710). Based on the respondents’ residential address and neighborhood ZIP codes, the individual-level data were merged with two spatial datasets: American Community Survey and ReferenceUSA. ArcGIS 10 (near analysis) was used to manage spatial data and calculate the distance to grocery stores. Hierarchical logistic regression models were employed for analyses. Descriptive results show that more older adults in neighborhoods with economic disadvantage and lower level of social cohesion reported more food insecurity. Logistic regressions suggested that after controlling for individual-level characteristics (e.g., age, gender, race and ethnicity, and education), living farther (0.26–0.50 miles and 0.51–0.70 miles) from the nearest grocery store was positively associated with food insecurity. Residing in economically disadvantaged neighborhoods also increased the odds of food insecurity. Community social cohesion was a marginally significant protective factor against food insecurity. Findings suggest that locational characteristics play a significant role in predicting food insecurity in New York City, suggesting that community outreach and grocery delivery programs are needed to mitigate the risk.
INTEGRATED CARE POLICY AND PRACTICE IN THE US: THE SCENARIO OF AGING IN CHINATOWN
Authors: Hu Yuanyuan , Xu Qingwen
Published: December 2022

Background

Older Chinese adults, the fastest-growing population among older immigrants, experience multiple barriers to access quality physical and behavioral health care, including low English proficiency, low health literacy, and segregation between health care and social care sectors (Tsoh et al., 2016). While integrated care attempts to address these issues, there is still a lack of culturally sensitive integrated care practices to address the needs of older Chinese immigrants.

Methods

This article reviews the definition and history of integrated care policies in the U.S., and compares four integrated care models on the service user and community levels, including the Chronic Care Model (CCM), Program of All-Inclusive Care for the Elderly (PACE), Patient Navigation Model, and Delivery System Reform Incentive Payment (DSRIP) Program.

Results

Taking the community-dwelling older Chinese immigrants as the context, this article discusses factors that are essential to this group of older adults and proposes a framework to integrate social determinants of health in the development of integrated care practice with the infusion of cultural values and norms.

Conclusion

Integrated care for older immigrants asks for a complicated mass reconstruction of current care systems. We propose an innovative framework that fully takes advantage of CBO’s capacity in providing culturally appropriate services is proactive and preventive in nature by addressing social determinants of health directly, recognizes the role of family and community in older immigrants’ life and aging process, and provide equal attention to the older adults’ needs in health, mental health, and elderly care.
SOCIAL INTERACTIONS OF COMMUNITY SPACE ATTENDEES AND ANTICIPATED FUNCTION OF THE SPACE AMID THE COVID-19 PANDEMIC
Authors: Takase Mai , Ogino Ryogo , Nitanai Ryoichi , Nakayama Riko , Kim Hongjik , Kazembe Neo , Goto Jun , Iijima Katsuya
Published: December 2022

Introduction

A regional community space in Japan, Chiiki-Katsudokan, was founded to facilitate the social interactions of older adults through activities. Meanwhile, the COVID-19 pandemic occasionally forced this space to close or limited the volume of its participants. In this research, the operation of the space was reviewed by monitoring the changes in the social interactions of the attendees, and by investigating the anticipated function from the attendees' needs. Method: A semi-structured interview targeting the attendees of Chiiki-Katsudokan was conducted in December 2021 (N=19, main age:80s). The level of social interaction before and during the pandemic and the newly anticipated function of the space were examined.

Results

First, deep and light interactions were observed. Those with deep interactions initially had wide social connections and used Chiiki-Katsudokan to interact with friends. Meanwhile, those with light interactions only talked to other attendees while attending the space. During the quarantine, those with deep interactions stayed connected with others and met privately, while those with light interactions faced a higher risk of social isolation. Second, the most popular newly anticipated functions of the space were "Place to gather with friends (n=14)" and "Interaction with younger generation (n=14)." "Opportunity to learn about the new pandemic-lifestyle (n=11)" was also rated high, while need for "online events" was rated the lowest (n=7).

Conclusion

The pandemic re-emphasized older adults' need for direct interaction. Low interest in technology-based countermeasures suggested that community spaces should expand their operation method while considering offline methods (e.g., pen-pal system) that could enhance social interaction.
QUALITY OF LIFE AND ATTITUDES TOWARD AGING IN OLDER ADULTS DURING THE COVID-19 PANDEMIC
Authors: Inman Morgan , MacLean Maria , Bryanton Olive , Montelpare William , Strong Jessica
Published: December 2022

Research has shown that positive or negative views of aging are associated with quality of life. Prior research has found that community dwelling older adults aged 65 and older with more negative views of aging have lower scores on quality of life scales, whereas those with higher views of aging have higher scores on quality of life scales. A group of 264 community dwelling older adults (Mean age = 72.4 years, 62-92 years old) living in Prince Edward Island, Canada, completed a survey measuring attitudes towards aging and quality of life during the COVID-19 pandemic. The sample consisted of a majority of retired (n=206) older adults, living in an urban area (n=151), and approximately 55% receiving a household income of $26,000 to $75,000 per year. Regression analysis found that attitudes towards aging significantly predicted quality of life (F(1,127)=24.9, p< 0.01), with positive attitudes predicting higher quality of life scores and negative attitudes predicting lower quality of life scores. The model showed that the predictor, attitudes towards aging, explained 16.5% of the variance in quality of life (B=-2.7, t=-4.9, p< 0.01). This suggests that attitudes towards aging play a role in predicting quality of life in older adults during the COVID-19 pandemic.
AWARENESS OF AGE-RELATED GAINS AND LOSSES AND THEIR ASSOCIATIONS WITH PHYSICAL AND COGNITIVE FUNCTION
Authors: Barber Sarah , Lenis Vanessa Martinez , Hamel Kate
Published: December 2022

Awareness of age-related change (AARC) refers to people’s recognition of how aging has affected their performance, behavior, and ways of experiencing life. Sometimes these age-related changes are perceived as losses (AARC-Losses), such as when people notice declines in their health. However, other times these age-related changes are perceived as gains (AARC-Gains), such as when people notice they have developed a better sense of what is important to them. Past research has shown that higher AARC-Losses (and to a lesser extent lower AARC-Gains) are associated with poorer self-rated health. However, no research has yet examined whether AARC also relates to an objective performance-based measure of health. To address this, we examined the cross-sectional relationships between AARC-Losses and AARC-Gains with gait speed (i.e., a measure of physical function) in 164 community-dwelling older adults. Participants in this study also completed health-related questionnaires and the NIH Toolbox Cognition Battery. Results showed that AARC-Losses were most strongly predicted by depression levels, but higher AARC-Losses were also predicted by slower gait speeds. A different pattern emerged for AARC-Gains. After controlling for demographic factors, depression, and other self-reported measures of health, we found that higher AARC-Gains were predicted by poorer cognition and slower gait speed. The counterintuitive relationship between AARC-Gains and objective cognition has previously been reported in the literature. However, this study is the first to document that AARC-Gains are also associated with poorer performance on an objective measure of physical function. We discuss features of the AARC questionnaire that may lead to these paradoxical effects.
FUTURE SELF, PERCEIVED CONTROL, AND AGING PREPARATION BEFORE AND AFTER THE PANDEMIC: MODERATED MEDIATION EFFECT
Authors: Hu Yue , Lin Zhixuan , Fung Helene
Published: December 2022

Aging preparation, which can be seen as an adaptation to age-related challenges, is always oriented toward the future. The present study aims to explore how thinking about the future self and aging preparation are related. Domain-specific aging preparation was assessed in a longitudinal sample including 359 Hong Kong adults aged from 20 to 98 yrs. In both the pre- (2018) and during pandemic (2020) waves, perceived control fully mediated the positive relationship between thinking clarity on the near future self and aging preparation in the financial domain. However, the mediation effect of perceived control on aging preparation was moderated by age in the pre-pandemic wave, with a higher effect for older adults than for younger adults. Yet, these age differences were no longer significant during the pandemic. The present findings suggested the critical role of perceived control in preparation for the age-related changes and the age-equating effect of COVID-19 pandemic outbreak.
WHO PLANS FOR LATER LIFE? AN EXAMINATION OF MIDDLE-AGED AND OLDER FLORIDIANS
Authors: Barrett Anne , Mimbs Hope , Michael Cherish , Noblitt Jessica
Published: December 2022

The extension of life expectancy highlights the importance of understanding how people conceptualize – and plan for – their later years. We address this issue using data from an online survey of over 3,400 Floridians aged 50 and older that was conducted between December 2020 and March 2021 and funded by the Florida Department of Transportation. We examine five types of planning: for health care needs, financial well-being, living arrangements, driving retirement, and end-of-life care. We find that the likelihood of planning varies considerably across these types. Only 23 percent of respondents reported planning “some” or “a lot” for driving retirement, compared with 74 percent for health care needs, 76 percent for end-of-life care, 77 percent for living arrangements, and 83 percent for financial well-being. Likelihood of planning varied by age, gender, socioeconomic status, health, and race or ethnicity. Across all types of planning, older adults and those with at least a college degree and higher income were more likely to have planned. Women were more likely than men to plan for their financial future, living arrangements, driving retirement, and end-of-life care. Those in better health were more likely to plan for their financial future and end-of-life care. The effects of race or ethnicity were less consistent across the types of planning. White respondents were more likely than other race or ethnic groups to report planning for their living arrangements and end-of-life care, while Hispanic respondents were more likely than other groups to plan for driving retirement.
INVESTIGATION INTO THE PREDICTORS OF HELP-SEEKING BEHAVIOR IN OLDER ADULTS
Authors: Kann Michael , Chapman Silvia , Azar Martina , Joyce Jillian , Waltrip Leah , Shagalow Shaina , Rizer Sandra , Cosentino Stephanie
Published: December 2022

Early help seeking (HS) among patients with emerging Alzheimer’s disease and related dementias (AD/ADRD) can have considerable implications for treatment course, access to clinical trials, lifestyle, and future quality of life. Previous studies in older adults suggest cognitive impairment itself does not lead people to seek help; rather, HS appears to be driven by Subjective Cognitive Decline (SCD), personality, and mood. It is possible, however, that tests used to measure objective cognition were not sensitive to detect subtle cognitive impairments that may influence HS behavior. In this study of 142 cognitively healthy older adults, we examined if utilizing cognitive tasks sensitive to preclinical AD (i.e., short term memory binding, associative memory, and susceptibility to semantic interference) revealed an independent association between objective cognition and HS, or if SCD continued to be a primary driver. Participants were assessed for HS, SCD severity, personality traits (conscientiousness and neuroticism), depressive symptoms, and demographics (age, gender, education). Partially and fully adjusted regression models were conducted to examine the association between cognitive tests and HS whilst adjusting for demographics, personality, depressive symptoms, and SCD. Associative memory was the only cognitive marker significantly worse in those who help seek (B=- 0.07, SE=0.03, p=.031); however, it did not withstand adjustment for SCD. Only increased SCD (B=0.06, SE=0.02, p=.005) and educational attainment (B=0.42, SE=0.15, p=.005) had independent associations with HS. Ongoing work is establishing possible moderators of these associations to unravel the multifaceted influences on HS and to guide strategies to increase HS in older adults with SCD.
EARLY-LIFE EDUCATIONAL EXPERIENCES, TOXIC STRESS, AND RISK OF NEUROCOGNITIVE IMPAIRMENT AMONG US ADULTS OVER AGE 50
Authors: Nkwata Allan
Published: December 2022

Increasing evidence suggests that the risk of cognitive impairment in later life in the US has been declining in recent years. However, factors associated with this decline are not fully understood. This study aims to examine whether educational history, including college attainment and adverse childhood experiences (ACEs) are associated with neurocognitive impairment (NI) among midlife and older US adults. We will use data from the Health and Retirement Study (HRS) along with information on respondents' early educational experiences collected in the 2015 and 2017 HRS Life History Mail Survey to examine whether school context, educational content, academic ability, and ACEs are associated with NI. We will farther explore ACEs as potential modifiers/ mediators of the relationship between educational history and NI in our sample. Multivariable logistic regression models will estimate odds ratios (ORs) and 95% confidence intervals (CI) with adjustment for demographic factors, socio-economic status (SES) and lifestyle factors.
A VIRTUAL STAFF TRAINING TO IMPROVE COMMUNICATION FOR OLDER ADULTS DURING MASK WEARING
Authors: Mamo Sara , Garrity Katherine , Wheeler Kara
Published: December 2022

The need for masking protocols in care centers for older adults exacerbated communication challenges in an already difficult environment. The purpose of this study was to alleviate the burden of communicating while wearing masks by providing a virtual staff training that introduced a headset amplifier and communication tips. The training was delivered via Zoom to small groups of staff at three Programs for All-inclusive Care for the Elderly (PACE®) organizations. The training included education about the impact of age-related hearing loss, instructions for using a headset amplifier, and communication tips. Staff were encouraged to use the amplifier with as many participants as possible to ease communication while wearing masks—rather than targeting participants based on hearing status. A pre/post quasi-experimental approach was undertaken. Fifty-one staff members completed the training and immediate pre/post questionnaires to measure knowledge gain. Follow-up questionnaires (including open-ended responses) were collected at 2- (n = 29), 4- (n = 23), and 6-months (n = 23) post-training. In addition, we completed one focus group (n = 5) and one in-depth interview regarding the feasibility of participation in the research project and brainstorming to increase use of the amplifiers. By integrating quantitative and qualitative findings, we highlight communication improvements when using the amplifiers and tips for integrating amplifiers into group care programs. The findings from this study will contribute to the development of a large-scale intervention to address hearing loss and support communication for older adults in group care settings.
AN INNOVATIVE APPROACH TO ENHANCING COPD CARE AND MANAGEMENT IN A RURAL NORTHERN COMMUNITY
Authors: Freeman Shannon , Meyer Anthon , Skinner Kelly , Peach Laura
Published: December 2022

Background

COPD is the third leading cause of death worldwide. Rural communities often face challenges to provide high quality chronic disease care for aging populations. Despite these longstanding challenges, there was an intention to improve the care setting by developing and fostering a shared vision for quality care, as evidenced by enhancing COPD screening and care. To ensure consistent and longitudinal patient access to high quality of care as well and ongoing physician recruitment and retention a new rural program was developed. Objective-In this presentation we will describe a new rural community based COPD program from conceptualization and development through to current functioning highlighting areas of innovation. Methods-A process evaluation guided by Moore et al.’s framework to assess program implementation, mechanisms of impact, and context was conducted. Qualitative thematic analysis was undertaken of stakeholder interviews conducted in 2021 (n=11) and document review (n=60;~500 pages) of key clinic documents dated back to pre-program development.

Results

We describe five phases of program development: Survive; Reorganize and Stabilize; Assess and Respond; Build and Refine; and Sustain and Share. Outreach and localizing resources improved access to the program. Acquiring secured physician compensation, capturing quality data, and improving patient and provider self-efficacy built the capacity of the system and stakeholders within it. Finally, relationships were forged through building an integrated facility, collaborative networking, and patient engagement. The key elements of program implementation were the resources required to ensure its operation, categorized as hardware, software, organizational, and human.
AN INTERPROFESSIONAL APPROACH TO DEPRESCRIBING: A CURRICULAR FRAMEWORK
Authors: Sun Winnie , Sadowski Cheryl , Farrell Barb
Published: December 2022

Deprescribing is an important approach for managing polypharmacy and reducing harm from potentially inappropriate medications. Healthcare professionals identify barriers to deprescribing, including lack of knowledge and skill. This is not surprising as pre-licensure education does not consistently incorporate components of deprescribing into curricula. As such, there is a clear need to consider how to promote deprescribing competencies, teach related knowledge and skills and assess learning outcomes. The Canadian Deprescribing Network (CaDeN) Health Care Professional Committee undertook a consensus process to develop a proposed competency framework that describes essential knowledge, teaching strategies, and assessment protocols to promote deprescribing skills and advocate for consistent education about deprescribing principles and practices. The framework is informed by the deprescribing process, which includes gathering and interpreting patients’ medication history and clinical information within their context, using tools that help identify potentially inappropriate medications, weighing potential benefit and harm of continuing or deprescribing medications, using shared decision-making to make decisions about deprescribing, communicating deprescribing and monitoring plans, and monitoring progress and outcomes. The competency framework considers interprofessional learning and how to involve patients and care partners in deprescribing decisions. Integrating deprescribing competencies in healthcare curricula requires an intentional and structured approach across all years of the program, focusing on interprofessional collaboration. Learning activities should be active and practical, progressing from early to advanced learner skills and include integration of deprescribing during experiential education. This framework includes a review of the competencies, learning outcomes, and assessment strategies, with a discussion of strategies to incorporate interprofessional learning activities.
HIGH-RISK ELDERLY SCREENING IN MEDICAL INTENSIVE CARE UNIT
Authors: Gnanasekaran Gowrishankar , Alappan Narendrakumar
Published: December 2022

Geriatrics care in medical intensive care units (MICU) establishes a unique opportunity in early screening of High Risk Elderly (HRE) patients admitted for critical care. Many MICUs do not have a standard protocol to screen for HRE patients as part of their daily huddle. Our program is a quality improvement initiative to improve early identification of HRE patients in the MICU. HRE patients were identified based on nursing specific screening triggers at one of the Regional Hospitals of a large teaching hospital in Northeast Ohio.The program was designed as a part of geriatrics care expansion at regional hospital sites. Identified patients were discussed in daily huddles to determine unique geriatric needs in caring for these patients. A geriatrics co-management team was engaged in comprehensive geriatric assessments and care transition when it was needed. Geriatrics care in MICU demonstrates a unique opportunity in early identification of HRE patients. This helps to support a patient -centered approach in caring for critically ill elderly patients. The program would lay foundations in early screening for risk factors and optimizing elderly care in MICU.
DELIVERING FOOD RESOURCES AND KITCHEN SKILLS TO OLDER ADULTS WITH FOOD INSECURITY AND HYPERTENSION
Authors: Rivera Rebecca , Holden Richard , Adams Mariah , Dawkins Emily , Tu Wanzhu , Clark Daniel
Published: December 2022

Non-Hispanic Black adults experience higher rates of food insecurity, poor diet quality, and hypertension compared with their non-Hispanic White counterparts. Delivering Food Resources and Kitchen Skills (FoRKS) is an integrated intervention that concurrently addresses food insecurity, nutrition literacy, and chronic disease self-management among older patients at a Federally Qualified Health Center. Two clinical dietitians led virtual hypertension self-management, cooking skills, and nutrition education classes twice per week for 16 weeks. Participants registered for classes, ordered free meal ingredients, and received encouragement from the dietitians through the FoRKS mobile technology application. This study presents diet quality descriptive results from the FoRKS pilot intervention conducted at Eskenazi Health from September 2021 to January 2022 in Indianapolis, Indiana. Participants (n=13) with hypertension (systolic blood pressure ≥120 mm Hg) and who identified as food insecure per the 18-item US Household Food Security Survey Module completed the 2018-version of the National Cancer Institute’s Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool at baseline and post-intervention assessments. Healthy Eating Index (HEI)-2015 scores range from 0-100 and were calculated from ASA24 data. Participants were non-Hispanic Black (n=12) or non-Hispanic White (n=1) with mean age 58 years (range 53-65 years). Mean±SD HEI-2015 scores improved from 51.5±11.9 at baseline to 55.2±12.5 after the intervention. This preliminary data supports further investigation into the efficacy of integrated lifestyle interventions, i.e., FoRKS, using a randomized controlled study design. Addressing food and culinary skills can lead to improvements in diet quality that may translate to improved disease management among diverse older adults.
PSYCHONEUROLOGICAL SYMPTOMS IN CANCER SURVIVORS AND THEIR CAREGIVERS: A LONGITUDINAL PILOT STUDY
Authors: Litzelman Kristin , Stevens Jen , Berghoff Ashley , Balubaid Afnan , Kwekkeboom Kristine
Published: December 2022

In cancer patients, stress is associated with a psychoneurologic symptom cluster of depressed mood, anxiety, pain, fatigue, and sleep disturbance. The stress of caregiving may trigger similar symptoms among caregivers and warrants investigation. The purpose of this analysis was to characterize correlates of psychoneurologic symptoms in cancer caregivers. Cancer survivor-caregiver dyads (n=29) provided eight weekly symptom reports using a web-based assessment system. Symptom burden was calculated as the sum of symptom severity (mean=7.5, SD=8.1, range=0-41). Primary and secondary stressors of caregiving were also assessed. Mixed modeling was used, accounting for repeated measures. Models controlled for person-mean of time varying covariates, as well as sociodemographic, clinical, and care-related covariates. A secondary analysis assessed interdependence in survivor and caregiver symptoms using Actor-Partner Interdependence Models. In descriptive analyses, caregivers most frequently reported feeling anxious (44% on average across timepoints), sleep problems (31%), fatigue (25%), depressed mood (24%), and feeling irritable/angry (24%). Within caregivers, greater hours of care (beta=0.11, p<.01) and more patient symptoms (beta=0.10, p<.01) were associated with greater symptom burden. Between caregivers, higher baseline perceived stress was associated with greater symptom burden (beta=0.38, p=.04) and coresidence with the survivor was associated with lower symptom burden (beta=-12.8, p<.01). Caregivers experienced higher symptoms when patients specifically reported anxiety, lack of appetite, or pain (beta=1.4, 2,4, and 3.0, p<.05). Cross-lagged Actor-Partner Interdependence Models indicated interdependence among survivor and caregiver symptom burden. The findings provide preliminary evidence of the interrelationship of psychoneurologic symptoms in survivors and patients, with implications for symptom management and supportive care practice.
DEVELOPMENT OF A BRIEF MEASURE OF COMMUNICATION QUALITY: THE 5- AND 10-ITEM FAMILY INPATIENT COMMUNICATION SURVEYS
Authors: Burke Emily , Slaven James , Taylor Tracy , Monahan Patrick , Sachs Greg , Torke Alexia
Published: December 2022

Communication quality between clinical care teams and families impacts important outcomes like satisfaction, depression, and anxiety. Assessment tools must be efficient and reliable to be useful in the clinical environment. We report the development of 5 and 10-item versions of the validated 30-item Family Inpatient Communication Survey (FICS). Data were from 364 surrogate decision makers (SDMs) for incapacitated older adults in the ICU. Most SDMs were adult children (66.8%). SDMs were 70.9% female, 68.9% white, with a mean age of 58.3. Exploratory factor analysis revealed high internal reliability for the single-factor FICS5 (α= .88) and two-factor FICS10 (α= .93). The FICS10 reliably measures two subscales: information (α= .91) and emotional support (α=.81). Good discriminant and predictive validity were demonstrated when comparing total scores to outcomes at 6-8 weeks after hospital discharge, including anxiety (correlation coefficient (ρ)= -.13; p=.0234 ), depression (ρ =-.15; p=.0076), decision regret (ρ =--.15; p=.0066), and satisfaction (ρ =-..48; p<.0001). Repeating analysis with a new sample (n=188) revealed similar results with Cronbach’s alpha ranging from .81 to .93. The FICS5 revealed significant associations (p<.05) at 6-8 weeks after discharge with distress (-.22), while the FICS10 demonstrated significant associations with distress (-.28), anxiety (-.20), depression (-.19) and decision regret (-.27). Confirmatory factor analysis indicated adequate fit (CFI: FICS5= .994, FICS10= .994; RMSEA: FICS5= .093, FICS10= .103). The FICS provides clinicians and interventionists with a reliable, low burden tool to evaluate communication quality and respond quickly, which could impact satisfaction and other important outcomes for patients and families.
CARING FOR INDIVIDUALS WITH DEMENTIA AND COGNITIVE IMPAIRMENT IN LOS ANGELES: A CAREGIVER PROFILE
Authors: Thomas Ariane , Barragan Noel , Reyes Mariana , Kuo Tony
Published: December 2022

In 2020, the Los Angeles County Department of Public Health launched Healthy Brain LA (HBLA). HBLA is a multi-pronged project designed to promote cognitive health, reduce the risk of dementia, and help develop a dementia-focused strategic plan for Los Angeles County (LAC) that prioritizes the needs of those impacted by dementia and cognitive impairment and their caregivers. To support this effort, the HBLA team analyzed weighted data from the 2019 and 2020 California Health Interview Survey (CHIS) to better understand the profile of adult caregivers of individuals with dementia and cognitive impairment. CHIS is a publicly available, population-based, web and telephone survey that asks California residents about a wide range of health topics, yielding representative data on all 58 counties in the state. In 2019-2020, an estimated 1.6 million adults provided care to individuals aged 18 years or older in LAC. About 322,880 of those caregivers provided care for individuals with dementia and cognitive impairment, representing 2% of LAC’s adult population. Many of these caregivers were female (59%), Latino/Hispanic (44%), and between 50-64 years of age (32%). Most of them experienced challenges, such as financial stress (61%), physical/mental health problems (18%), or a change in job status (27%), due to caregiving. These data provide the first local estimate of dementia and cognitive impairment caregiving in nearly 15 years. Results offer critical information about this population that will be used by the HBLA team and its partners to guide efforts to effectively meet the needs of caregivers in LAC.
FORMAL CAREGIVER BURDEN IN NURSING ASSISTANTS IN NURSING HOMES: A FEASIBILITY STUDY
Authors: Kunkle Rachel , Chaperon Claudia , Berger Ann
Published: December 2022

Formal caregivers are the direct care workforce that aid residents in nursing homes. Providing care to residents is hazardous and physically demanding. Formal caregiver burden encompasses five attributes – perceived stress, caring for another, dependency of the older adult, responsibility, and competence. Exploring the five attributes of formal caregiver burden using a mixed-methods approach will determine if the attributes are present and how the nursing home setting contributes to formal caregiver burden. The purpose of this feasibility study is to describe formal caregiver burden of nursing assistants who provide direct care to residents in a nursing home setting in the Midwest United States. Study site one was only able to enroll three participants; therefore, results were limited. However, study site two was able to recruit and enroll the desired sample size (N=9). Interviews and self-report measures (Background/COVID-19 Questionnaire, Perceived Stress Scale, Caring Behaviors Inventory, and Nursing Home Staff Competency Assessment) were completed, and the PI compared integrated mixed methods results. Results suggest all the attributes of formal caregiver burden were present, and no additional attributes were identified. The feasibility of virtual recruitment, enrollment, and data collection procedures were confirmed. Multiple challenges played a role in the unsuccessful recruitment of this feasibility study at site one; however, virtual recruitment was successful at site two. Further exploration will inform identification and measurement of formal caregiver burden to ensure support for nursing assistants, continue the vitality of the nursing assistant workforce in nursing homes/long-term care, and improve the lives of nursing assistants.
ENGAGING AFRICAN AMERICAN FAMILY CAREGIVERS THROUGH ART AND CREATIVE ACTIVITIES: A CASE STUDY
Authors: Hazzan Afeez , Sheppard Luvon , Hazzan Joyce
Published: December 2022

Studies have shown that engaging family caregivers of people with dementia in creative activities can provide therapeutic benefits by relieving stress and promoting well-being. However, there is a dearth of studies focusing on the involvement of racial minority family caregivers of people with dementia in research involving art and creative activities. The purpose of this study is to present the results of a case study interview with an artist-educator-community collaborator who acted as a key facilitator for the ACTION ARTS study. The purpose of the ACTION ARTS study was to utilize mobile technology applications for facilitating creative activities to enhance health and well-being of African-American family caregivers and their loved ones in the middle-to-late stages of dementia. The study included activities such as memory stimulation, art viewing, art making, and other forms of creative expressions. The research question for the current case study was: What are the best practices for engaging African-American family caregivers of older adults in the middle-to-late stages of dementia in research involving art and creative activities? Thematic analysis of the qualitative data from the case study interview yielded the following recommendations/results (1) Design the program of art and/or creative activities in an easy way to facilitate interaction among participants; (2) Make the program as accessible and relevant as possible so everyone is able to relate to it; (3) Emphasize areas of commonality that could help in giving both the facilitators and participants food for thought.
IMPACTS OF SOCIAL RELATIONSHIPS ON CO-OCCURRING SYMPTOMS AND FUNCTIONING IN OLDER ADULTS WITH COGNITIVE IMPAIRMENT
Authors: Kang Bada , Wei Sijia , McConnell Eleanor , Corazzini Kirsten
Published: December 2022

Social relationships are crucial for well-being of older adults with cognitive impairment (CI), however, evidence is lacking on how social relationships may influence symptom experience and functioning among those living with CI. This study aimed to identify subgroups of older adults with CI with distinct symptom and functioning profiles and to examine the association between latent class membership and social relationships. The sample included 927 older adults who were screened as having moderate or severe CI from wave 2 of the National Social Life, Health and Aging Project. Symptom (i.e., pain, fatigue, sleep disturbance, depression, anxiety, and stress) and functioning (i.e., instrumental activities of daily living, activities of daily living, and urinary incontinence) variables were used to identify subgroups. Latent profile analyses identified five distinct groups: most (51.7%) belonged to the low-symptom-high-functioning; few (7%) belonged to the high-symptom-low-functioning; while two groups had average symptom burden, one group (25%) had frequent urinary incontinence and normal daily functioning (poor-urinary-functioning), and the other group (5%) had normal urinary functioning and the worst daily functioning (worst-daily-functioning); interestingly, 13% belonged to high-symptom-normal-functioning group. Multinomial logistic regression modeling showed that, among social networks, support, strain, and engagement, members in groups with worse symptom burden and daily functioning were significantly more likely to have social strain, after adjusting for covariates (p-values < 0.01). Only severe CI was associated with worst-daily-functioning (OR = 3.24, p-value = 0.002). Interventions that ameliorate social strain may benefit symptom management and promote independent daily living among older adults with CI.
CROSS-DISCIPLINE COLLABORATIVE INTERNSHIPS TO REDUCE FEAR OF FALLING CONTRIBUTE TO AGE-FRIENDLY INITIATIVES
Authors: June Andrea , Seifert Allison
Published: December 2022

The Age Friendly University (AFU) initiative provides a vision to inspire institutions of higher education to respond to the interests and needs of an aging population to promote well-being and quality of life. At Central Connecticut State University (CCSU), we have utilized multiple strategies to engage collaborators within our university and our community to further age-inclusive efforts. The purpose of this presentation is to describe the ongoing collaboration, through the Matter of Balance program, with the Connecticut Healthy Living Collective, an emerging hub of state, regional and local agencies and organizations dedicated to healthy aging in communities throughout our state. The Matter of Balance program is an empirically supported community-based treatment to reduce fear of falling among older adults. We will first discuss the pilot internship program offered within the Department of Psychological Science that trained students as program facilitators which was cut short in Spring 2020 due to COVID 19. We will then describe “Version 2.0” of the collaboration which was offered in the Spring 2022 semester. This time, it was grounded in a gerontology internship course that expanded to include research, faculty, and student collaboration with the Department of Physical Education and Human Performance. In addition to providing these overall descriptions, the presenters will review the strengths and challenges of each approach, share results about the students’ experiences, and highlight the multidimensional value this intentional effort offers.
ASSOCIATIONS BETWEEN NEIGHBORHOOD CHARACTERISTICS AND COGNITIVE FUNCTIONING TRAJECTORIES BY RACE/ETHNICITY
Authors: Thierry Amy , Farmer Heather
Published: December 2022

Older adults living in neighborhoods with high physical disorder and low social cohesion may be especially vulnerable to experiencing declining health. However, less is known about how neighborhoods may influence age-related patterns of cognitive functioning for different racial/ethnic groups. Therefore, we examine whether perceived neighborhood characteristics (safety, cleanliness, and social cohesion) are associated with trajectories of cognitive functioning across race/ethnicity. Using data from the 2006-2016 waves of the Health and Retirement Study, our study includes 11,870 non-Hispanic White, non-Hispanic Black, and Mexican adults 65 and older. We conducted linear mixed models stratified by race/ethnicity using an age-accelerated design to understand how neighborhood characteristics are related to trajectories of cognitive functioning (measured by the Telephone Interview for Cognitive Status; range: 0-35). We also explore if sociodemographic, behavioral, and health characteristics account for this association. Analyses revealed that cognitive functioning showed a quadratic change with age. Negative neighborhood perceptions were associated with declines in cognitive functioning with increasing age for each racial/ethnic group. Among White adults, all neighborhood characteristics were negatively associated with cognitive functioning in fully adjusted models. For Black adults, perceived uncleanliness was significantly associated with trajectories of cognitive functioning. In Mexican adults, perceptions of uncleanliness and lower cohesion were significantly associated with worse cognitive functioning, but not in fully adjusted models. These findings suggest that the perceived neighborhood context is an important social determinant of cognitive health for older adults, and distinct aspects of the neighborhood may be more correlated with cognitive functioning for certain racial/ethnic groups than others.