bluuebunny/crossref_metadata_2025 huggingface dataset:
CAREGIVING AND COGNITIVE IMPAIRMENT IN MEXICO AND THE US
Authors: Cantu Phillip , Rote Sunshine , Gaugler Joseph
Published: December 2022

Dementia is one of the most common causes of disability and dependence in the world. The growing dementia population in Mexico is exemplary of many low- and middle-income countries (LMICs). While the U.S. has a highly developed formal long-term care system, the use of institutional care among Latinos has been low. Mexico lacks a publicly financed long-term care system, and it does not have a national-level mandatory registry of institutions, compulsory standards of care, nor a regulatory body to oversee management, quality of care standards for services, or the accreditation and evaluation of service providers. There are no policies, public programs, or services to provide dependency care, including support for people living with dementia and their family caregivers. As in other LMIC’s, there is limited public support for the aging population in Mexico, leaving families with the main responsibility of providing care and economic security for older adults. “Informal” and family caregivers for older adults with cognitive impairment are critical components of how older adults with cognitive impairment are able to remain in the community. This symposium will reflect the broad spectrum of caregivers and care context in the U.S. and Mexico to shed light on sources of care for older adults living with cognitive impairment.
CLARK TIBBITTS AWARD AND HIRAM J. FRIEDSAM AWARD PRESENTATIONS AND LECTURES
Authors: Dassel Kara
Published: December 2022

The Clark Tibbitts Award Lecture will feature an address by the 2022 award recipient Laura M.K. Donorfio, PhD, FAGHE, of The University of Connecticut. AGHE's Clark Tibbitts Award was established in 1980 and named for an architect of the field of gerontological education. The award is given each year to an individual or organization that has made an outstanding contribution to the advancement of gerontology and geriatrics education. The Hiram J. Friedsam Award Lecture will feature an address by the 2022 award recipient Rona J. Karasik, PhD, FGSA, FAGHE, of Saint Cloud State University. Hiram J. Friedsam was the professor, co-founder, and director of the Center for Studies in Aging and dean of the School of Community Service at the University of Northern Texas. Dr. Friedsam was an outstanding teacher, researcher, colleague, and mentor to students, faculty, and administrators, as well as a past president of AGHE. The purpose of this award is to recognize those who emulate Dr. Friedsam's excellence in mentorship.
COGNITIVE AGING IN LOW- AND MIDDLE-INCOME COUNTRIES
Authors: Zhang Yuan , Saenz Joseph
Published: December 2022

Cognitive aging is a highly complex, dynamic, and context-dependent process; and is influenced by individual and community characteristics and experiences across the life course. Low- and middle-income countries (LMICs) are critical components of the international dementia research community because the burden of dementia is rapidly rising in LMICs, and low-resource settings may have unique social and economic determinants of cognitive health. However, little population-based research focuses on these regions. The papers in this symposium use high-quality population survey data from Mexico, Brazil, South Africa, and China to study critical social determinants of cognitive function in countries across the globe. These papers cover a range of social and economic factors, including food insecurity, education, household material resources, and urban-rural settings and policy. First, Saenz will present findings on how food insecurity, throughout life, relates with cognitive function among older Mexican adults. Next, Farina will present evidence on both indirect and direct pathways from education to cognitive function among older Brazilians. Third, Kobayashi will present longitudinal data evaluating level and change in household resources in relation to subsequent cognitive function in South Africa. Finally, Zhang will present evidence on the interplay of rural/urban residence and household registration system across the life-course in creating cumulative advantage/disadvantage in cognitive aging using longitudinal data from China. The papers in this symposium provide new insights into social determinants of cognitive health in diverse contexts and have significant policy implications for improving cognitive health in LMICs across the globe.
TRENDS IN HOUSEHOLD MATERIAL RESOURCES AND COGNITIVE HEALTH IN A LONGITUDINAL COHORT STUDY OF AGING IN SOUTH AFRICA
Authors: Kobayashi Lindsay , Kabudula Chodziwadziwa , Kabeto Mohammed , Yu Xuexin , Tollman Stephen , Kahn Kathleen , Berkman Lisa , Rosenberg Molly
Published: December 2022

Material resources that affect daily living conditions may be salient for cognitive aging in low-income settings, but evidence is limited on this topic. We investigated relationships between long-term trends in household material resources and subsequent cognitive function among 4,580 adults aged ≥40 in a population-representative cohort in Agincourt sub-district, South Africa, from 2001-2015. Household material resources (dwelling materials, water, sanitation, sources of power, modern amenities, and livestock) were assessed biennially from 2001-2013. We evaluated mean resources, volatility in resources, and change in resources over this period in relation to cognitive function in 2014/2015. Higher mean household resources and larger improvements over time in resources were positively associated with subsequent cognitive function, independent of confounders. Findings were largely driven by modern amenities for food preparation, transportation, and communication outside of the household. Access to these amenities may support cognitive aging through boosting nutrition and cognitive reserve and should be investigated further.
DEVELOPING AND RAPIDLY SCALING AN MHEALTH APP IN A 25-SITE PRAGMATIC TRIAL OF ALIVIADO DEMENTIA CARE IN HOSPICE
Authors: Brody Abraham , Durga Aditi , Ford Ariel , Lin Shih-Yin
Published: December 2022

Following stakeholder engagement in our pilot phase of a large-scale 2-phase NIA funded pragmatic clinical trial in hospice (HAS-QOL Trial) of Aliviado Dementia Care, we utilized a co-design process to develop over a 6-month period and rapidly scale an mHealth application to assist clinicians in performing best practices in care for persons living with dementia receiving hospice. Throughout the 36 months of intervention period, the app has been utilized by at least 6,580 hospice team members, both to complete training, receive mobile push notification nudges, and: 1) perform 6,682 clinical assessment such as the PAINAD for pain and NPI-Q for behavioral symptoms; 2) develop 2,204 symptom specific care plans; and 3) Review specially developed education materials to 15,128 caregivers and send them to 671 directly. This session will also discuss the process of implementation and scaling, including the technological hurdles in working with a workforce with sometimes limited technical skills.
DIVERSITY MATTERS: INTERSECTIONAL INEQUITIES IN HEALTH AND WELL-BEING THROUGH AGING
Authors: Koffer Rachel , Drewelies Johanna , Carr Deborah
Published: December 2022

Different positions within social hierarchies receive unequal access to resources, leading to health disparities in later life (Agenor, 2020). Research addressing inequities must increasingly account for the many social categorizations (e.g., race, gender, socioeconomic status) that affect individuals‘ lived experiences. This symposium examines the role of intersecting social contexts on health and well-being across the life course. Surachman and colleagues use the U.S.-based National Growth and Health Study to examine the intersectionality between early life socioeconomic context and race on women’s metabolic syndrome severity. Their findings have implications for societal factors leading to accelerated aging across young adulthood and early midlife. Koffer and colleagues use the U.S.-based Study of Women’s Health Across the Nation to demonstrate differential midlife exposure to types and number of major life events across race/ethnicity and education. They subsequently find that major life events increase risk of cardiovascular disease events, indicating the importance of studying the life experiences of diverse women across midlife. Drewelies and colleagues use the Germany-based Berlin Aging Study II to look at the associations among multidomain identity and social background factors on physical, cognitive, and psychological aging. Implications from their work demonstrate the interplay of diversity on health and well-being in older adulthood. Conjointly, findings indicate that intersectional identities play an important role in shaping key outcomes of human functioning across adulthood and aging. Dr. Deborah Carr will critically discuss the three contributions from a life course perspective and provide considerations for future research and policy promoting equity for diverse older adults.
USING ADJUSTED MULTIPLE CORRESPONDENCE ANALYSIS TO EXPLORE LATENT VARIABLES FOR THE DEMPOL-Q
Authors: Hoffmann Anna-Louisa , Bergmann Johannes-Michael , Holle Bernhard , Roes Martina , Palm Rebecca
Published: December 2022

Nursing home administrators are responsible to operationalize dementia-specific person-centred care into their care practice, e.g. by internal policies. To assess the degree of existence of internal policies on person-centred care for dementia-specific care in German nursing homes, we developed the Dementia Policy Questionnaire (DemPol-Q). After pretesting, the instrument consists of 19 dichotomous items. We aimed to explore the construct validity of the DemPol-Q. We used a secondary data set of a national survey with a representative sample of 134 nursing homes. For data analysis we conducted an Adjusted Multiple Correspondence Analysis. Results show that nine items of the DemPol-Q were significantly assigned to two latent variables. Since the items per latent variable vary in their content, they cannot be explicit denominated with a specific sub-dimension of dementia-specific person-centred care. Nonetheless, Adjusted Multiple Correspondence Analysis is an uncommon but appropriate exploratory data reduction procedure for nursing science.
A MIXED METHODS EVALUATION OF PROJECT TRIP: KEY FINDINGS AND EXPANSION
Authors: Schwartz Abby , Richman Alice , Scott Mallary , Liu Haiyong , White Weyling , Doherty Caroline
Published: December 2022

Project TRIP is an innovative individualized transportation program for low-income adults in rural eastern North Carolina (eNC), that aims to increase access to healthcare and reduce health disparities. This paper presents results from a 3-year grant which sought to evaluate TRIP and expand it to a neighboring eNC county. The concurrent mixed methods findings from the process/implementation, outcome/effectiveness, and economic evaluation, and qualitative interview data with TRIP stakeholders (N=40) will be presented. Findings include relationships between pre and post TRIP enrollment health data indicating improvements in health outcomes and decreases in health care utilization, including estimated costs savings of Project TRIP. Qualitative interview data will be discussed in substantiating the quantitative evaluation data. Interviews with stakeholders in the TRIP replication and expansion county site will also be presented including pilot test data in that county. The presentation will conclude with implications for sustainability and further expansion of TRIP.
TIME TO EMBRACE HETEROGENEITY IN INTERVENTIONAL STUDIES OF OLDER ADULTS
Authors: Xue Qian-Li
Published: December 2022

Adopting evidence-based medicine in clinical care of older patients is challenging because the “best” evidence available may not be directly applicable due to exclusion or underrepresentation of older adults in clinical trials. Interventions shown to be beneficial in trial populations therefore often exhibit heterogeneous treatment effects (HTEs) in older adults, particularly among the most vulnerable. This talk will review the concept, causes, and estimation of HTEs. We distinguish clinical heterogeneity from methodologic heterogeneity, defined respectively as the variation in biological mechanisms leading to similar aging phenotypes and variation in study design, measurement, and analysis. We use examples drawn from geriatric medicine to introduce novel study designs and data analytics used to study HTEs. This talk highlights the importance of moving beyond post-hoc subgroup analysis to an approach that integrates theories, observational and experimental data, and data science in the study of HTEs.
THE LOOMING POST-ACUTE REORGANIZATION: IMPLICATIONS FOR OLDER ADULTS TRANSITIONING FROM THE HOSPITAL
Authors: Bucy Taylor , McHugh John , Cross Dori
Published: December 2022

Post-acute volume plays an important role in the care of millions of older adults transitioning from a hospital stay. To help reduce the total cost of care, many hospitals have been shifting more volume from institutional skilled nursing care to less expensive home health care. In fact, in 2017, home health volume eclipsed skilled nursing facility volume as the preferred post-acute destination for the first time. The COVID-19 pandemic further exacerbated this trend with many older adults preferring to avoid institutional care. Using 2016-2019 MedPAR data, we explored changes over time in hospital discharges to skilled nursing facilities versus to home health. We regress the ratio of home health to skilled nursing facility volume on a month-year variable. We find that the ratio of discharges to home health versus to skilled nursing facility increases by .07 percentage points per month (coefficient = .00073, 95% CI [.00063 to .00084]). This translates to a nearly one percentage point change in the ratio of home health to skilled nursing volume per year. These trends vary by patient characteristics (e.g. hospital diagnosis), organizational characteristics (e.g. hospital market relationships), and indicators of market capacity of post-acute services. This growing trend has implications on vulnerable older adults; health system leaders need policy guidance and incentives to invest in value-oriented care practices across this changing post-acute landscape.
PHYSICAL INTIMACY IN DAILY LIVES OF OLDER ROMANTIC COUPLES: LINKS WITH MOMENTARY AFFECT AND DAILY CORTISOL LEVELS
Authors: Kolodziejczak Karolina , Drewelies Johanna , Pauly Theresa , Ram Nilam , Hoppmann Christiane , Gerstorf Denis
Published: December 2022

Physical intimacy is assumed to benefit well-being through stress-buffering and mood-improving processes. Although partnered older adults often report wishing for and experiencing physical intimacy, inquiries about how intimacy is linked to affect and stress in older couples’ daily lives remain scarce. We examined self-report and salivary cortisol data from 120 German couples (Mage= 71.6, SDage= 5.94) obtained up to seven times per day over seven consecutive days. In moments when participants experienced more physical intimacy, women reported less negative affect, and men more positive affect. Experiencing more overall physical intimacy was associated with more positive affect and less negative affect in women, and lower daily cortisol in men. More overall intimacy wished was related to more negative affect in women and men, and to higher daily cortisol in men. We conclude that physical intimacy relates to indicators of well-being in older couples’ daily lives and consider routes for future inquiry.
FEELING BLUE WITH YOU: AGING COUPLES' REACTIVITY TO UPSETTING PERSONAL MEMORIES AND MARITAL CONFLICT
Authors: Wilson Stephanie , Shrout M Rosie , Kiecolt-Glaser Janice K
Published: December 2022

Reactivity to marital conflict has long been considered a critical mechanism linking marriage to health and well-being. Yet, developmental theories suggest conflict may subside with age. To compare mood and cardiovascular responses to two novel contexts—both partners’ upsetting personal experiences—with marital conflict reactivity, 107 couples ages 40-87 recounted a difficult personal memory to the partner, discussed a marital problem, and provided baseline and post-task mood, blood pressure (BP), and heart rate (HR). Although older adults relived their upsetting personal memories with less emotional intensity, negative mood and systolic BP increased most after this task. Compared to disagreement, the spouse’s upsetting memory triggered larger increases in negative mood, HR, and among older adults, SBP. Results suggest that both partners’ upsetting personal experiences are as relevant for mood and cardiovascular activity as marital conflict in aging couples, and that spousal distress may grow increasingly important with older age.
EMOTION WORD USE AND CARDIOVASCULAR REACTIVITY DURING MARITAL INTERACTIONS
Authors: Meier Tabea , Stephens Jacquelyn , Haase Claudia
Published: December 2022

Cardiovascular reactivity in midlife may predict health problems in later life, but few studies have examined cardiovascular reactivity during marital interactions, as an important interpersonal context, and potentially modifiable linguistic correlates. This laboratory-based study examined emotion word use (i.e., positive and negative emotion words derived using automated language analysis) and cardiovascular reactivity (i.e., heart rate changes from baseline) across two marital interaction contexts (i.e., positive and conflict conversation) in 46 married couples (92 individuals; age: M = 42.6, SD = 8.5). Results showed that (1) spouses who used more negative emotion words during conflict showed higher cardiovascular reactivity. Moreover, (2) when husbands used a more diverse negative emotion word vocabulary during positive conversations, their wives showed higher cardiovascular reactivity and (3) when wives used a more diverse positive emotion vocabulary, their husbands showed lower cardiovascular reactivity. Findings highlight the relevance of couples’ emotion word use for cardiovascular reactivity in midlife.
ANTIPSYCHOTIC MEDICATION USE IN ASSISTED LIVING/RESIDENTIAL CARE: DO ORGANIZATIONAL CHARACTERISTICS MATTER?
Authors: Dys Sarah , Tunalilar Ozcan , Carder Paula
Published: December 2022

This study investigates how assisted living/residential care (AL/RC) and memory care (MC) contexts are associated with the prevalence of antipsychotic medication use (APU). Primary data were collected from a statewide representative sample of AL/RC settings through the Oregon Community-Based Care study from 2017-2019 and combined with publicly available administrative data. Framed by Donabedian’s model of care quality, we examine associations among 90-day prevalence of APU, organizational, care process, and AL/RC resident population characteristics using random intercepts regression models. Every licensed AL/RC setting in Oregon receives an annual mailed survey to provide aggregate resident demographics, health acuity, health service use, payment type and organizational policies. Organizational measures (e.g., profit status, license type, geographic designation) were collected from state websites. The average 90-day prevalence of APU among all Oregon AL/RC settings is 30.7%, though rates differ by MC endorsement (23.9% in AL/RC and 42.7% in MC). Compared to care processes and resident population characteristics, organizational characteristics were associated with larger magnitudes of difference in rates of APU. Nonprofit settings were associated with lower rates of APU in both AL/RC (β= -4.4 percentage points, [95% CI: -8.4, -0.4]) and MC (β= -12.4, [95% CI: -21.2, -3.6]. Compared to low-Medicaid settings, settings with very high proportions of Medicaid residents were associated with higher prevalence of APU, +8.9 in AL/RC (95% CI: 1.7, 16.1) and +11.0 in MC (95% CI: 2.3, 19.8). Policymakers might consider how organizational resource capacity influences APU in AL/RC settings, especially if APU prevalence is treated as a quality indicator.
KEY CONSIDERATIONS FOR EVALUATING REAL-WORLD EVIDENCE IN SUPPORT OF FDA REGULATORY DECISION-MAKING
Authors: Li Jie (Jenni)
Published: December 2022

For decades, FDA has been using RWE to monitor and evaluate the safety of drug products in the post-marketing setting. Under the FDA RWE Program, FDA has accepted RWE in support of effectiveness claims. For example, the approval of tacrolimus (Prograf) for the prophylaxis of organ rejection after lung transplant was based on RWD from a national transplant registry. The key considerations for evaluating RWE for safety and effectiveness assessments include: (1) whether the RWE are fit for use (e.g., data relevance and reliability); (2) whether the study design can provide adequate scientific evidence to answer the regulatory question of interest (e.g., whether the lack of blinding impacts the reporting of the outcome events); and (3) whether the study conduct meets FDA regulatory requirements (e.g., study monitoring and standardization of data collection). FDA has issued draft guidances on EHR/Claims data, registries, data standards, and regulatory considerations, respectively, to detail these key considerations. Carefully designed and analyzed RWE studies can be used to support safety and effectiveness claims.
CAREGIVING NETWORKS OF DIVERSE FAMILIES: CONTEXT AND CULTURE INFLUENCES ON DEMENTIA CARE
Authors: Roberto Karen , Savla Jyoti
Published: December 2022

Older adults living with dementia and their primary caregivers are embedded within larger family and formal care networks that are shaped by cultural and contextual influences. Yet information about diverse caregiving networks is sparse. This symposium focuses on the composition, structure, responsibilities, and influences of caregiving networks in supporting persons living with dementia and their primary family caregivers. Savla and colleagues identify six distinct care networks among dementia family caregivers living in economically diverse areas of rural Appalachia. Networks varied by caregivers’ emotional connectivity with family/friends, caregiver strain, role overload, loneliness, and service attitudes and utilization. Ashida and colleagues focus on changes in rural and urban dementia family caregiving networks during the COVID-19 pandemic. Network members engaging in negative social interactions increased while those engaging in uplifting interactions decreased over time, especially among urban caregivers. Bonds Johnson and colleagues examine shared decision making between African American caregivers and their relative living with dementia. Dyadic analysis revealed that while care recipients were involved in the decision-making processes, their care network’s level of the involvement varied. Angel and colleagues explore the role of caregiver characteristics, stressors, and resources for Mexican American caregivers. Depressive symptoms were significantly associated with dementia caregiver turnover, with adult children and grandchildren caregivers more likely to experience turnover than spouses. Collectively, the findings presented extend prior research on community-based dementia caregiving, broadening the focus from a single caregiver to a network of caregivers and capturing the complexities of place-based context and culture variations in care provision.
TURNOVER AND DEPRESSIVE SYMPTOMS AMONG MEXICAN AMERICAN CAREGIVERS OF PERSONS LIVING WITH DEMENTIA
Authors: Angel Jacqueline , Rote Sunshine , Markides Kyriakos
Published: December 2022

This study explored the role of caregiver background, stressors, and resources for Mexican American caregiver turnover and depressive symptoms. Using two waves of the Hispanic Established Epidemiologic Study of the Elderly (H-EPESE, 2010/2011-2016 N=333) Caregiver Supplement and informed by the sociocultural caregiver stress process model, we estimate logistic and OLS regressions of change in dementia and change in caregiver over five years. Neuropsychiatric expressions were significantly associated with caregiver turnover. Adult children and grandchildren caregivers were more likely to experience caregiver turnover than spouses. While depressive symptoms were relatively low at both waves, there was a greater increase in depressive symptoms occurred for caregivers who completed the interview in Spanish rather than English, which was partially explained by greater perceived stress at baseline. Findings demonstrate the need to provide dementia care supports for Mexican American caregivers, reduce stress for Spanish-speaking caregivers, and support Mexican American grandchildren who unexpectedly become caregivers.
ENDOGENOUS DNA DAMAGE AS A DRIVER OF AGING AND TISSUE DYSFUNCTION
Authors: Yousefzadeh Matt
Published: December 2022

Aging is a complex multifactorial process that enhances stress or impairs the ability to cope with it, whereby increasing the risk of morbidity and mortality. Many factors can contribute to aging, such as macromolecular damage (including DNA damage) that accumulates in a time-dependent manner. DNA damage is also known to induce cellular senescence, a cell fate that is known to play a causal role in aging. To investigate the effects of DNA damage and cellular senescence on aging, animal models lacking Ercc1, an important DNA repair gene, were utilized. Ercc1-deficient mice age faster than wild-type littermates and exhibit the senescent cell burdens that are comparable to that of a naturally aged mouse. To investigate cell autonomous and non-autonomous effects of DNA repair deficiency on senescence and aging, Ercc1 was deleted in mice in a tissue-specific manner. Increased senescent cell burden and dysfunction were present in tissues specifically targeted for Ercc1 deletion. However, enhanced senescence was also present in some non-targeted tissues, suggesting that these occur through cell non-autonomous mechanisms.
COGNITIVE RESERVE AND RISK OF MOBILITY DISABILITY IN OLDER ADULTS
Authors: Holtzer Roee , Zhu Xiaonan , Rosso Andrea , Rosano Caterina
Published: December 2022

Background

Cognitive Reserve (CR) protects against cognitive decline and dementia but its relation to mobility disability has not been established. To address this important gap in the literature, we conducted a longitudinal investigation to test the hypothesis that higher baseline CR was associated with a lower risk of developing mobility disability in older adults.

Methods

Participants were dementia-free older adults who received a brain magnetic resonance imaging and had gait speed assessments during follow-up. Using the residuals approach, CR was derived from the modified-Mini-Mental Status Examination (3MS) total score by removing variance accounted for by measures of structural brain integrity, education and race. Mobility disability was defined using a validated cutoff score in gait speed of 0.8 m/s. Logistic regression models using General Estimating Equations (GEE) were utilized to examine longitudinal associations between baseline CR and the risk of developing of mobility disability across repeated assessments.

Results

Of the participants (n=237; mean age=82ys; %female=56%) who were free of mobility disability at baseline, 103 developed mobility disability during follow-up (mean=3.1ys). Higher CR at baseline was associated with lower risk of developing incident mobility/disability [odds ratio (OR)=.819, 0.67 to 0.98, p=.038 (unadjusted); OR=.815, 0.67 to 0.99, p=.04 (adjusted for socio-demographic variables and depression); OR=.819, 0.68 to 0.88, p=.035 (adjusted for illness history); OR=.824, 0.68 to 0.99, p=.045 (adjusted for white matter hyperintensities); OR= .795, 0.65 to 0.95, p=.016 (adjusted falls history)].

Conclusion

We provided first evidence that higher CR was associated with lower risk of developing mobilitydisability in older adults.
APA GUIDELINES FOR THE EVALUATION OF DEMENTIA AND AGE-RELATED COGNITIVE CHANGE: OVERVIEW AND CLINICAL APPLICATION
Authors: Mast Benjamin , Lichtenberg Peter
Published: December 2022

Dementia is a leading cause of cognitive and functional decline and the number of people living with dementia or involved in caring for another person with dementia continues to rise. There is a growing need for health professionals who are well trained in dementia assessment and intervention. In 2021, the American Psychological Association and its Committee on Aging (CONA) published a revision of the APA Guidelines for the Evaluation of Dementia and Age-Related Cognitive Change with the goal of promoting proficiency and expertise in this growing practice area. This symposium presents an overview of the APA Guidelines and their clinical application in various practice situations and settings. The first presentation (Mast) provides an overview of the guidelines and highlights areas of significant revision, including greater attention to multicultural competence, person-centered principles, and assessment of family caregivers. The second presentation (Steffen) presents the application of the APA Guidelines to working with older adults before formal assessment and diagnosis has been initiated. The third presentation (Allen) describes use of the APA Guidelines in the post-evaluation period and integrates GSA’s revised KAER Toolkit for Primary Care Teams. The final presentation (Bush) presents ethical considerations before, during, and after dementia assessment.
APA GUIDELINES FOR THE EVALUATION OF DEMENTIA: OVERVIEW AND KEY UPDATES
Authors: Mast Benjamin , Levy Shellie-Anne
Published: December 2022

This presentation will provide a historical background and a broad overview of the APA Guidelines for the Evaluation of Dementia and Age-Related Cognitive Change. This will begin with an overview of general and procedural guidelines pertaining to dementia assessment and will be followed by an in-depth discussion of key updates in the 2021 revision. The newly revised guidelines recognize racial and cultural disparities in dementia outcomes, and emphasize the importance of multicultural competence in all aspects of dementia assessment. The revised guidelines also integrate person-centered principles into the assessment process and place greater emphasis on understanding the person living with dementia. New guidelines were included to address (1) the assessment of behavioral and psychological changes in the context of dementia, and (2) the importance of assessing the health and well-being of family caregivers.
AFTER A NEUROCOGNITIVE EVALUATION: ROLES AND COMPETENCIES OF BEHAVIORAL HEALTH PROVIDERS
Authors: Allen Rebecca , Steffen Ann
Published: December 2022

GSA’s revised KAER Toolkit for Primary Care Teams (Fall, 2020) provides useful information for referring individuals and families to community resources following a neurocognitive disorder diagnosis. Mental health practitioners must develop competencies and professional identities within integrated care teams to facilitate this process. This presentation outlines post-assessment suggestions for clinicians across disciplines (psychology, social work, nursing, medicine, pharmacy, +) in building such teams. There may be needs for serial assessment of specific individual capacities, treatment plans to facilitate shared decision-making between individuals and family care partners, and evaluations of the family care partner’s capacity to provide care. Behavioral health providers assist patients, families, and health care teams across a range of residential settings in understanding and implementing treatment recommendations. Emerging science indicates the value of initiating planning discussions with lifestyle modifications to enhance functioning within dyads. Culturally responsive strategies will be suggested for engagement in planning for future care.
AGE AS ONE OF THE DETERMINANTS OF RESILIENCE TO THE COVID-19 PANDEMIC AND ITS IMPACTS ON SEX LIFE
Authors: Berdychevsky Liza
Published: December 2022

Recent research started exploring the impacts of the COVID-19 pandemic on sex life. However, there is a dearth of research on the roles of age in the overall adjustment to the pandemic and its impacts on sex life. The purpose of this study was to address this gap. Data collection was based on the online survey methodology (N=675, age range:18-76yo). Data analysis included one-way ANOVA and multivariate multiple regression. Age differences were found in the participants’ overall ability to adjust to the pandemic-related lockdown conditions, with older adults (51+yo group) adjusting better than the rest of the sample and young adults (18-30yo group) adjusting significantly worse. Resilience to the impacts of COVID-19 on sex life also varied by age. Sexual desire deteriorated the worst among middle-aged participants (31-50yo group); likely, due to increased childcare responsibilities. However, the issues with physical sexual difficulties have worsened the most among older adults. Regression results also showed that age had negative effects on the frequencies of intimate and sexual behaviors (sexual touching and caressing, sexual intercourse, and oral sex) and sexual desire and satisfaction with sex life during the pandemic. While older adults’ overall adjustment capacity to the pandemic’s conditions was the highest in the sample, the pandemic’s impacts on their sex lives and sexual health were the worst. The pandemic has exacerbated existing vulnerabilities and further jeopardized older adults’ sexual wellbeing. This study provides age-specific insights for sexual counseling and age-targeted sexual health education for older adults during the pandemic and its aftermath.
TRENDS IN RISK FACTORS FOR DISABILITY AND REDUCED PHYSICAL FUNCTIONING AMONG US ADULTS DURING THE COVID-19 PANDEMIC
Authors: Andrasfay Theresa , Crimmins Eileen
Published: December 2022

The COVID-19 pandemic has caused widespread societal disruptions that may have impacted risk factors for disability and functional limitations. Current research suggests that physical inactivity, BMI, and smoking increased during the early phase of the pandemic, but less is known about whether these risk factors remained elevated as the pandemic progressed and mitigation measures were less disruptive. In this study, we assess trends in exercise frequency, BMI, and smoking among American adults aged 45 and over during the first year of the COVID-19 pandemic. We use data from the Understanding America Study (UAS) Coronavirus in America study, a nationally representative online survey that followed American adults from March 2020 to July 2021. We find that exercise frequency was highly seasonal throughout the pandemic, increasing during warmer months and decreasing during the colder winter months. Throughout this period, exercise frequency was highest among those with more education and those who were retired. Average BMI remained similar throughout this period, but less educated individuals and those working away from home and those who were unemployed experienced increases in BMI. Consistent with media reports suggesting increased interest in quitting smoking during the pandemic, we find decreases in smoking prevalence and frequency of smoking over this period. Decreases in smoking prevalence were concentrated among less educated individuals, who had higher prevalence of smoking to begin with. In sum, changes in risk factors for disability and reduced physical functioning during the pandemic were mixed and varied by education and employment status.
BLACK PLACEMAKING: THE BODY, HOME, AND PUBLIC SPACE THROUGH THE LENS OF OLDER WOMEN
Authors: Reyes Laurent , Yeh Jarmin , Versey H Shellae
Published: December 2022

African American communities are frequently depicted as victims of urban conditions. However, a rich culture of grassroots community development and organizing, often led and stewarded by Black women, exists. Many of these efforts involve enhancing economic, political, and educational opportunities and centering ethics of care and caregiving. This is the notion of Black placemaking, which is explicitly community-focused, shaping the social fabric of everyday life and allowing for the development of Black vernacular spaces that became vital to African-American culture. This paper examines how Black older women engage in placemaking by presenting three select case studies. Using a narrative inquiry approach, we conducted secondary data analysis of interviews drawn from larger qualitative studies about aging in communities that took place in San Francisco and New York City. Black feminist spatial imagination, embodiment, and intersectionality theory were our guiding frameworks. Our analysis revealed how the aging Black body is a site that is subjected to socio-political regulation and violence and illuminates how Black women are agents of community resilience, creativity, and transformation. Creating and holding space (i.e., placemaking) with bodies and physical structures that center the Black community is an act of care, self-determination, and resistance to white supremacy. These embodied processes of placemaking have wide-ranging implications for the ways Black neighborhoods are framed and discussed in popular media, empirical research, and policy. Furthermore, they invite a shift in our current approach to placemaking in later life, one that centers the strengths, history, and traditions of the Black community.
HOW DO INTERGENERATIONAL RELATIONSHIPS IMPACT THE HEALTH OF ASIAN AMERICAN OLDER ADULTS?
Authors: Nguyen Duy , Lee Yookyong , Liu Rui
Published: December 2022

Intergenerational relationships and filial piety are important values common to many Asian-ethnic groups. While a limited literature exists examining the health outcomes of older adults living with grandchildren in Asian countries, Asians in America have received less attention from researchers and policymakers. This study fills the knowledge gap by using data from the 2015-2019 American Community Surveys to examine the relationship between Asian ethnicity and living with grandchildren on health outcomes. This analysis focuses on respondents aged 65 and over from the six most populous Asian American groups: Chinese, Filipino, Indian, Japanese, Korean, and Vietnamese (n=100,538). Roughly half the sample lived with grandchildren. Weighted, adjusted logistic regression analyses tested for the effects of Asian ethnicity and living with grandchildren on 4 health outcomes: ambulatory, independent living, hearing, and vision difficulties. Multivariate analyses showed Filipino and Vietnamese older adults were more likely than Chinese to report difficulties across health outcomes. Additionally, individuals living with grandchildren were less likely to report ambulatory, independent living, and hearing difficulties. Joint effect analyses revealed Indian, Filipino, and Japanese Americans living with grandchildren reported more difficulties compared to the reference group. Overall, the results suggest that living with grandchildren can be a protective factor for the health outcomes of older Asian Americans, while having different impacts depending on ethnic origin. Future research needs to differentiate the impact of living with grandchildren across Asian ethnic groups. Further, culturally appropriate policy and practices are needed to promote successful aging among older Asian Americans living with grandchildren.
KEEPING COMMUNITY DURING A PANDEMIC: LGBTQ+ OLDER ADULTS AND THE VIRTUAL SENIOR CENTER
Authors: Marmo Suzanne , Pardasani Manoj , Vincent David
Published: December 2022

During the initial stages of the pandemic, 96% of all senior centers ceased in-person programming, leaving many older adults without resources for meals, socialization, and critical services (NCOA, 2020). As a result of this shutdown, risk factors such as being a member of the underserved LGBTQ+ community, identifying as part of a racial or ethnic minoritized group, and/or experiencing poverty contributed to an increased likelihood of experiencing difficulties in meeting basic needs, reduced immunity to COVID and experiencing isolation (Berg-Weger and Morley, 2020; Kuehn, 2021). Despite the closure of many senior centers, some organizations were well positioned to strategically utilize pre-existing resources to help the community (Pendergrast, 2021). One organization, SAGE Advocacy and Services for LGBTQ+ Elders, the first publicly funded senior advocacy organization for LGBTQ+ older adults in the US, was one of the first to effectively transition to becoming a virtual senior center within days after the start of the pandemic (NYC DOA, 2020). Having a group of front-line workers who were highly embedded in their community, helped facilitate effective organizational adaptation and transition to a virtual senior center. This presentation seeks to describe how staff and program facilitators became vital resources for maintaining connection to the community of LGBTQ+ older adults. Focus groups with SAGE senior center employees and program facilitators were conducted in summer of 2021. Data identified resiliencies and barriers for maintaining community, providing vital services, and mitigating isolation with LGBTQ+ elders. Lessons learned and implications for organizations facing crises will be shared.
DESIGNING INTERVENTIONS FOR OLDER ADULTS WITH LOW- AND MIDDLE-INCOME COUNTRIES SETTINGS IN MIND
Authors: Baker Zachary , Nkimbeng Manka , Cuevas Pearl G , Quiñones Ana , Kang Karmeet , Gaugler Joseph , Hinton Ladson , Shippee Tetyana
Published: December 2022

Most people living with dementia (PLWD) live in low- and middle-income countries (LMIC) and the proportion in LMICs is poised to continue growing. But 99.9% of dementia funding is awarded to researchers in high-income countries (HIC). Our team of scientists from India, Cameroon, the Philippines, the USA, Ukraine, and Germany draw on our involvement in interventions in 12 countries to suggest one way to help meet the needs of PLWD living in LMICs. We suggest that researchers in HICs who are developing new interventions might consider the needs of LMICs during intervention development. By thinking through implementation scenarios in different settings or countries where barriers and facilitators to implementation vary in type, or in importance, it might speed future adaptation of those interventions to LMICs. We outline anticipated challenges, case studies from our own work, benefits for individual researchers, benefits for public health, and recommendations for employing this strategy.
INTEGRATING HOUSING, HEALTH, AND SUPPORTIVE CARE IN AFFORDABLE SENIOR HOUSING: EVALUATION OF THE R3 PROGRAM
Authors: Miller Edward , Cohen Marc
Published: December 2022

This symposium reports evaluation findings from the Right Care, Right Place, Right Time (R3) program. The initiative is designed to integrate housing, health, and supportive care to residents of affordable senior housing using a wellness team (nurse and social worker). The embedded team works directly with residents to address health-related, educational, and informational needs and access to services - focusing on proactive outreach and prevention, coordination with providers, constant contact with residents, and targeting high-risk residents. The initiative aims to create a replicable, scalable, and sustainable model of housing with supportive services that enables independent living while reducing health care costs. Two wellness teams served approximately 400 participants at seven Boston-area buildings. The R3 program was implemented in two phases. The 18-month pre-intervention period was January 2016-March 2017, while the 18-month Phase 1 intervention period was July 2017-December 2018. The 21-month Phase 2 implementation period (known R32), which introduced a targeting strategy to identify high risk residents, was January 2019-September 2020. Evaluation activities included quantitative and qualitative components. Program participants and non-participants at intervention and comparison sites were surveyed on program-related experiences. Program, housing, and community partners were interviewed. Key performance indicators were tracked. Medicare claims data were analyzed using comparison groups. Focus groups were completed with payers, housing providers, and community stakeholders. The purpose of this symposium is to identify the experiences of program participants and key stakeholders with the R3 program, and to assess program impact. Edward Miller and Marc Cohen will serve as chair and co-chair, respectively.
THE EXPERIENCES OF PROGRAM PARTICIPANTS WITH THE R3 PROGRAM
Authors: Simpson Elizabeth , Miller Edward , Lin Yan , Nadash Pamela , Cohen Marc
Published: December 2022

The voluntary nature of the R3 program means that the experiences of residents who enroll in the program are critical to program success. Surveys were distributed to participants and non-participants in the intervention and control buildings during R32. Findings indicate that most enrollees are interacting with R32 staff; they trust them and feel that they provide important information; and they feel safer, less alone, and healthier because of their participation in the program. Roughly nine-in-ten are satisfied with the program and three in five would recommend it to a friend. Fully one-third believe that the program is helping them avoid medical emergencies necessitating a trip to the emergency room. When faced with a serious medical concern, residents in R32 buildings are far less likely to view calling 911 or going to the emergency room for treatment as a way to address their issue compared to individuals living in control buildings.
INTEGRATION OF DIGITAL TECHNOLOGY IN RESEARCH INVOLVING OLDER ADULTS: LESSONS FROM COMMUNITY-BASED TRIALS
Authors: Han Hae-Ra
Published: December 2022

Working with study participants in community-based clinical trials during COVID-19 pandemic has created diverse challenges to study teams. Globally, COVID-related restrictions were implemented including country-wide lockdowns and social distancing, and study teams had to quickly adjust their study protocols to work in a virtual environment. Meeting virtually for recruitment activities or intervention delivery may be particularly challenging when the target group is older adults—one of the vulnerable populations to experience the digital divide due to limited digital access and limited digital literacyThis symposium covers the lessons learned related to use of digital technology in participant recruitment and intervention delivery across a range of populations, including community-dwelling Korean American older adults to African American older women living with pain and low mood, caregivers of persons living with heart failure, and low-income cancer survivors with multiple chronic conditions. The discussion will include 1) findings from screening over 1,000 older Korean Americans to enroll them into a multi-site community-based trial, 2) lessons in diversifying intervention delivery methods to African American older women, 3) the integration of virtual modality into a self-care and social support intervention for caregivers of persons with heart failure, and 4) the deployment of mHealth to deliver a home-based exercise program to ethnically diverse low-income cancer survivors with co-morbid conditions in the setting of the COVID-19 pandemic. This symposium seeks to build the evidence related to recruitment and intervention delivery targeting diverse groups of older adults in community settings using technology by sharing common challenges, experiences, and opportunities.