bluuebunny/crossref_metadata_2025 huggingface dataset:
MEASURING EFFECT OF PERSONALIZED MUSIC TO REDUCE BEHAVIORS IN NURSING HOME RESIDENTS WITH DEMENTIA
Authors: McCreedy Ellen , Yang Xiaofei , Baier Rosa , Thomas Kali S , Rudolph James , Mor Vincent
Published: November 2019

The purpose of this six-month pilot study was to identify an optimal measurement strategy for assessing the effects of a personalized music program, MUSIC & MEMORY, on agitated and aggressive behaviors among 45 nursing home residents with moderate to severe dementia. Dementia-related behaviors were measured before and after the intervention with three methods 1) observationally using the Agitation Behavior Mapping Instrument (ABMI); 2) staff report using the Cohen-Mansfield Agitation Inventory (CMAI); and 3) administratively using Minimum Data Set - Aggressive Behavior Scale (MDS-ABS). ABMI score was 4.4 (standard deviation, SD: 2.3) while not listening to the music and 1.6 (SD: 1.5) while listening to music (p<.01). CMAI score was 61.24 (SD: 16.32) before the music and 51.24 (SD: 16.05) after the music (p<.01). MDS-ABS score was .8 (SD: 1.6) before music and .7 (SD: 1.4) after music (p=.59). Direct observations were most likely to capture behavioral responses, followed by staff interviews. No effect was found using exclusively available administrative data. There is growing interest in identifying and testing non-pharmaceutical alternatives to managing agitated and aggressive behaviors in nursing home residents with dementia. Measurement occurring closest in time to the intervention was most likely to capture responses, but was also most costly, least pragmatic, and most subject to confirmation bias. These findings will inform a large pragmatic trial, beginning Spring 2019.
PEAK RESIDENT SATISFACTION OUTCOMES AND RESEARCH
Authors: Poey Judy , Cornelison Laci
Published: November 2019

Outcomes related to person-centered care in nursing homes have been difficult to ascertain. Much of the extant literature has suffered from differing definitions of what it means to be person-centered, variation in the levels of implementation of person-centered care that an organization has achieved, and small sample sizes. The PEAK program provides a unique opportunity to control for these variables across a large sample of nursing homes throughout the state of Kansas. This presentation will discuss the methodological advantages of evaluating the PEAK program and the findings from an evaluation of resident satisfaction in nursing homes at varying levels of implementation of person-centeredness.
PARTNERSHIPS THAT WORK: AN ACADEMIC AND STATE COLLABORATION IN KANSAS
Authors: Doll Gayle , Kaup Migette , Cornelison Laci
Published: November 2019

Academic partnership with state government may be a researcher’s dream or a tremendous burden. This presentation demonstrates the perspectives of university personnel as well as government leaders when contracts and grants are issued for the provision of research and services. Opportunities and barriers for researchers will be discussed.
THE SOCIOCULTURAL STRESS PROCESS MODEL APPLIED TO LONG-DISTANCE CAREGIVING
Authors: Cimarolli Verena R , Horowitz Amy , Jimenez Danielle , Shi Xiaomei , Falzarano Francesca , Minahan Jillian
Published: November 2019

This study investigated the impact of LDC on mental health utilizing the Sociocultural Stress Process Model as a conceptual framework. A path analytic model tested the impact of caregiving stressors (i.e. distance, frequencies of visits, hours spent helping, burden) and sociocultural values (i.e. familialism) on LDCs’ mental health outcomes (i.e. depression, anxiety), and resources (i.e. coping strategies, social support) which can mediate the association between stressors and mental health outcomes while controlling for socio-demographics. Results show that resources did not mediate the effects of stressors on the mental health outcomes. However, both higher depression and anxiety were associated with living closer to the care recipient (CR), less frequent visits, higher burden, being younger, being female, and less optimal income adequacy. In addition, higher depression was associated with lower use of coping strategies and higher education. Higher anxiety was also associated with lower levels of social support and higher familialism.
LONG-DISTANCE CAREGIVERS’ INFORMAL CARE NETWORKS
Authors: Jimenez Danielle , Falzarano Francesca , Horowitz Amy , Cimarolli Verena , Minahan Jillian
Published: November 2019

The purpose of this study (N=304) was to examine the characteristics of LDCs’ informal caregiver (IC) network (Co-caregivers [Co-CG], other informal helpers) providing assistance to the care recipient (CR), and factors associated with more help received from ICs. The majority of LDCs in the sample reported working with at least one IC (81.9%) indicating the existence of a secondary care network. LDCs and Co-CGs were often siblings in comparison to other informal helpers that were more likely to be the CR’s friend. Results also show that CRs with children, living in the community, receiving no formal services, and lower levels of cognitive impairment receive more hours of help from ICs. In addition, more hours of help by ICs were associated with LDCs’ having higher scores of depression and anxiety, spending more hours per month helping the CR, and more frequent contact with CR. These seemingly discrepant findings are discussed.
PET OWNERSHIP HISTORY AND SUCCESSFUL AGING OUTCOMES IN COMMUNITY-LIVING OLDER ADULTS
Authors: Friedmann Erika , Gee Nancy R , Simonsick Eleanor M , Studenski Stephanie , Barr Erik , Resnick Barbara , Kitner-Triolo Melissa H , Hackney Alisha
Published: November 2019

Diminishing cognitive and physical function, worsening psychological symptoms and increased mortality risk and morbidity typically accompany aging. Health needs of the aging population will continue to increase as the proportion of the population aged 50 years and older increases. Pet ownership (PO) has been linked to better health outcomes in older adults, particularly those with chronic health conditions. However, much of the evidence is weak with little known about the contribution of PO to successful aging in community living older adults. This study examines associations between PO and cognitive performance, physical functioning, and psychological status in community living older adults. Participants in the Baltimore Longitudinal Study of Aging (>50 years old, N=378) completed physical functioning, cognitive and psychological testing, and a ten-year PO history. Most participants (89%) had owned pets at some point and 24% currently have pets. Fourteen percent have 1-4 dogs, 12% have 1-4 cats, and 3% have others. PO was lower with older age (p<.001). In regression analysis controlling for age decade, pet ownership within the past 10 years (PO10) independently predicted cognitive function [total verbal learning (p=.04), and short (p=.015) and long (p=.031) delay free recall, ] but not physical function or psychological status. PO was lower in older age groups as was cognitive, physical functional, and psychological status, while PO within the past 10 years was associated with better verbal learning and memory independent of age. Longitudinal analysis is required to disentangle the sequential associations between PO and change in health status over time..
INTEREST GROUP SESSION—NURSING CARE OF OLDER ADULTS: MAKING IT HAPPEN: PERSON-CENTERED DEMENTIA CARE FOR BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS
Authors: Kolanowski Ann M , Bowers Barbara
Published: November 2019

Person-centered care is the standard of practice in communal living sites, yet many facilities struggle to make this a reality. Both direct care staff and administrators find residents’ behavioral and psychological symptoms of dementia (BPSD) particularly challenging. Our research team is conducting a pragmatic trial, the goal of which is to help staff use person-centered, non-pharmacological approaches for these symptoms. During the past three years we have gained insights into what may affect the ability of staff to deliver high quality person-centered care. We share these insights in this symposium. In the first paper, the investigators present data indicating that a high rate of psychotropic drug use among residents with dementia persists despite little association to BPSD, and bring into question the need for education around de-prescribing practices. In the second paper, the investigators discuss the conceptual basis and empirical evidence for using affect balance, in addition to symptom reduction, as an important and meaningful outcome for residents. The third paper examines gender differences in the expression of BPSD and how these differences may work to limit staff ability to identify treatment approaches for women who, nonetheless, have significant symptoms. In the final paper the psychometric properties and results of a new Knowledge of Person-centered Approaches for BPSD Test, that was developed by the team and given to staff, are examined and the implications of the findings for the delivery of person-centered care are considered. The discussant will reflect on these findings and provide direction for future research and practice.
RESIDENT, STAFF, AND FACILITY FACTORS ASSOCIATED WITH AFFECT BALANCE
Authors: Kolanowski Ann M , Behrens Liza , Haitsma Kimberly Van , Resnick Barbara
Published: November 2019

Affect balance is a concept that is measured by comparing the relative frequency of experiencing positive affect versus negative affect. A higher ratio of positive to negative affect has been associated with greater well-being, improved function and resilience. Baseline data from an ongoing pragmatic trial were used to determine the resident, staff and facility factors associated with affect balance in 325 nursing home residents with moderate to severe cognitive impairments. Measures of resident demographics, cognitive status (BIMS), function (Barthel Index), staff hours, staff knowledge of person-centered care approaches, facility policies and the facility environment were taken. Affect balance was measured using items from the Quality of Life in AD scale. Initial correlational analyses indicate that affect balance is associated with being male (p=0.03), having better function (P=0.04) and receiving a greater number of RN and CNA hours of care (p=0.003 and P=0.02 respectively).
FACTORS THAT INFLUENCE PSYCHOTROPIC MEDICATION USE
Authors: Resnick Barbara , Galik Elizabeth
Published: November 2019

Understanding the factors that influence psychotropic can guide reduction in use of these medications. This study described predictors of psychotropics use among residents with moderate to severe cognitive impairment. This was a secondary data analysis using baseline data from the first 341 residents in the EIT-4-BPSD trial. Predictive measures included demographics, agitation, resistiveness to care, depression, cognition, pain, facility factors and state. Overall 63% (n=211) received at least one psychotropic medication, 16% (n=52) an anti-seizure medication, 23% (n=77) an anxiolytic, 30% (n=99) an antidepressant, 2% (n=8) a sedative hypnotic, 28% (n=93) an antipsychotic medication, and 9% (n=29) an opioid. Model testing explained 9 to 15% of psychotropic medication use. There were high rates of psychotropic medication use and a limited association between demographic factors, behavioral symptoms, and psychotropic medication use. Continued research is needed to explore additional factors associated with psychotropic medication use such as beliefs of providers.
THE INTEGRATED MEMORY CARE CLINIC AS A HEALTHCARE NETWORK
Authors: Kovaleva Mariya A , Higgins Melinda , Jennings Bonnie Mowinski , Song Mi-Kyung , Clevenger Carolyn K , Griffiths Patricia C , Hepburn Kenneth W
Published: November 2019

The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses (APRNs) who provide dementia and primary care. This presentation describes the experiences of persons living with dementia and their caregivers during their first year at the IMCC, through the lens of the IMCC as a healthcare network. Forty-two caregivers were evaluated in three survey-based assessments over nine months. Twelve caregivers completed qualitative interviews about their experience at the IMCC. Severity of depression and delusions and total symptom severity improved significantly for persons living with dementia. Caregivers described their sense of belonging to the IMCC healthcare team and valued direct telephone access to APRNs. By enhancing care access and engaging clients in their care, the IMCC serves as a reliable and professional healthcare network for patient-caregiver dyads who often receive suboptimal dementia care in mainstream healthcare.
ONE-TWO PUNCH OF HIGH WAGES AND EMPOWERING PRACTICES FOR MAINTAINING CARE NETWORKS IN NURSING HOMES
Authors: Kennedy Katherine , Bowblis John R , Abbott Katherine M
Published: November 2019

Stabilizing certified nursing assistant (CNA) employment is necessary for maintaining care networks and providing high quality of care for nursing home (NH) residents. This study’s objective was to examine the relationship of high wages and empowerment practices on CNA retention. We used the 2015 Ohio Biennial Survey to construct a facility-level dataset of 547 NHs and estimated multivariable linear regressions. NHs that provided both high wages and high empowerment were associated with a 12.95 percentage-point improvement in the CNA retention rate (SE = 4.53, t-value = 2.86, p = 0.0045). High wages and a high empowerment score did not have significant effects individually (p > .05). Retention rates were similar between NHs that lacked high wages and scored low on the empowerment scale, and NHs that provided one at a high level but not the other. Implications for better retaining CNAs require multiple empowerment practices combined with high hourly wages.
PETS PROVIDE SIGNIFICANT SUPPORT TO OLDER ADULTS LIVING ALONE: RESULTS FROM THE NATIONAL POLL ON HEALTHY AGING
Authors: Connell Cathleen M , Solway Erica , Malani Preeti , Singer Dianne , Kirch Matthias , Kullgren Jeff , Janevic Mary R
Published: November 2019

Human-animal interaction has been linked to health and social benefits for older adults. While pets can play a positive role in healthy aging, not all pet owners experience the same benefits. The present study uses data on how pets impact the well-being of older adults, including those living alone from the National Poll on Healthy Aging (NPHA), a nationally representative household survey conducted in October 2018. A randomly selected, stratified sample of adults age 50 to 80 (n=2,051) completed the survey online. Over half reported having a pet; the majority had dogs (70%) and cats (50%). Companionship was the main reason for getting a pet (52%); the majority believed their pets helped them enjoy life, reduce stress, and connect with others. Pet owners living alone were significantly more likely than pet owners living with others to report that their pet helps them cope with physical or emotional symptoms (72% vs. 58%), feel loved (94% vs. 85%), stick to a routine (76% vs. 60%), take their mind off pain (43% vs. 32%), and have a sense of purpose (82% vs. 72%; all p<.05). Respondents living alone were also more likely to report that pet care strains their budget (26% vs. 17%) and that their pet’s needs take priority over their own (22% vs. 14%; p<.05). Given the important role that pets play in the lives of older adults, efforts to support this relationship (e.g., pet-friendly housing policies, low-cost and mobile veterinary clinics, pet walking and pet sitting services) are warranted.
MULTIDISCIPLINARY EMERGING PERSPECTIVES ON BUILDING AND MAINTAINING NETWORKS IN AGING
Authors: Stephenson Eugenie
Published: November 2019

This presentation is a reflective piece on developing and staging of the inaugural Gerontology Student Workforce Day at the Georgia Capitol held in January 2016 through coordination with the state-level Council on Aging (GCOA: Georgia-Council-on-Aging). The aims of this initiative focused on bridging students’ gerontology education and career aims with current legislative concerns for older adults at the state level through networking and advocacy efforts. We also sought out to highlight to state legislators the necessity to support gerontology education. Results of this networking engagement included educating state legislators on both the role of gerontology education to support the needs of older residents at the community-level and highlighting to both parties the impact of gerontology professionals on the state’s workforce. As a result, we engaged gerontology students and early career aging professionals in high-impact networking opportunities focused on service and policy efforts with state legislators and local AAAs (area-agencies-on-aging).
GERI-MOBILE HEALTH: DEVELOPMENT AND FEASIBILITY OF A PROGRAM TO HELP OLDER VETERANS USE VA MENTAL HEALTH MOBILE APPS
Authors: Gould Christine E , Ma Flora , Scales Ashley N , Juang Christine , Carlson Chalise , Loup Julia , Sakai Erin
Published: November 2019

VA mental health self-management mobile applications (apps) teach evidence-based skills such as mindfulness and behavior activation. Older Veterans are likely to benefit from learning these skills, but many need assistance learning to use their mobile devices. To bridge this knowledge gap, we developed a clinical program (Geri-Mobile Health) and accompanying patient education materials to help older Veterans use apps to meet their mental health and well-being goals. The program provides personalized coaching support consisting of (1) teaching basic mobile device use; (2) selecting a goal-consistent app; and (3) encouraging behavior change using the app. The presentation will describe the preliminary outcomes and implementation process. Initial results suggest that the program is feasible, acceptable, and may increase mobile device proficiency for novice users. Additionally, we disseminated 1,418 sets of education materials to providers in 21 states. Challenges and successes at the local and national levels will be discussed.
ADAPTING MINDFULNESS-BASED COUNSELING FOR THE TELEPHONE: A PILOT STUDY FOR CAREGIVERS AND VETERANS WITH DEMENTIA
Authors: Hilgeman Michelle M , Block Phoebe R , Bishop Teddy K , Alexander Kimberly , Snow A Lynn
Published: November 2019

Optimizing Dementia Care in Veterans with Dementia is a randomized, controlled, pilot study examining outcomes for Veterans and their caregivers at 6- and 12-months for two telephone-based interventions: a) Benjamin Rose Institute’s (BRI) Care Consultation (CC), and b) CC + Counseling (CC+C). Counseling modules are integrated into the existing BRI CC framework using guided mindfulness-based skill-building exercises on various content domains (e.g., grief, identity, intimacy, stress management). Sixty-four caregivers and 47 Veterans (M = 74.3 years, MOCA Score M = 15.5) have been randomized in this ongoing pilot study. Caregivers are 91% female, 32% Black/African American, and 72% spouses. Preliminary implementation and 6-month outcome data is discussed (e.g., reaction to behavioral distress, mindfulness, depression, quality of life) using within-group paired samples t-tests for the 32 dyads randomized to CC+C. Lessons learned include strategies for adapting mindfulness-based approaches over the telephone to enhance access for Veterans and caregivers across geographic regions.
OLDER ADULT DISASTER RECOVERY FOLLOWING HURRICANE KATRINA
Authors: Merdjanoff Alexis , Abramson David , Piltch-Loeb Rachael , Park Yoon Soo
Published: November 2019

This study explores the effects of environmental disruption on older adult well-being, recovery and resilience following Hurricane Katrina. It is based upon the Gulf Coast Child and Family Health Study, a longitudinal cohort of 1,079 residents from Louisiana and Mississippi highly affected by the storm. Using five waves of data collected over the last 12 years, analyses examine the drivers of long-term recovery by age group, including factors such as household income, physical health, mental health, stable housing and social support. Path analyses compare the influence of these drivers on recovery among younger adults (18-54), the young-old (55-64), mid-old (65-74) and old-old (75+). Results demonstrate that each age group relies on specific factors to improve their recovery, and that only a small number of factors are critical for older adult recovery. Results can help identify points of intervention for disaster recovery planning that can facilitate long-term recovery for older adults.
WISDOM OF THE ELDERS, VOICES FROM OUR AMERICA
Authors: Nwankwo Ifeoma
Published: November 2019

The fundamental goal of WOE was to determine whether and how autobiography production can enhance and provide valuable data about African American seniors’ mental health, past and present. The second goal of WOE was to determine whether and how project partners could use the findings from WOE, particularly those about resilience and strategies for coping with challenging situations, as the basis for new interventions, studies, publications, curricula, and educational programs for learners across contexts, generations, levels, and disciplines. Outcomes are illustrated by rich examples of the genesis, history, products and pedagogy of the project.
ILLNESS AND THE LANGUAGE OF POETRY
Authors: Birdsong Destiny
Published: November 2019

Two interactive workshops were conducted: one for training healthcare professionals in nursing, PT, and pharmacy, and another for the continuing education for caregivers of HIV-positive patients. Active Listening and Visual Learning Strategies for Healthcare Professionals discussed the importance of using active listening skills to better hear, understand, and treat patients. Activities included viewing one WOE respondent’s artwork and hearing a clip of the respondent’s interview, followed by a facilitated discussion of how the respondent’s story about her childhood shed light on her art. Additionally two published poems about bodies and illness were shared, with discussion of how each poem’s circuitous narrative nature offered clues about the speaker’s illness and outlook on life. Cultural Humility’s activities focused on utilizing poetry to discuss how caregivers can use active listening strategies to better understand how patients cope with life-changing illnesses, and how they incorporate the challenges of those illnesses into rich, fulfilling lives.
DISCORDANCE IN GOALS OF CARE BETWEEN PATIENTS WITH ADVANCED CANCER AND THEIR CAREGIVERS: DOES AGE PLAY A ROLE?
Authors: Lipson Amy R , Douglas Sara
Published: November 2019

Cancer is considered a family disease as the caregivers (CG’s) role extends beyond providing care as they can also help facilitate treatment decisions. While much has been reported in the literature about patient (PT) goals of care (GoC), little is known about discordance between PT and CG GoC and the impact of PT age. The variables of interest were PT and CG identified GoC using a 100-point visual analog scale (VAS) with anchors of quality of life (0) and survival (100). Discordance was defined as a > 40 point difference on the VAS. The GoC data reported here were those obtained at enrollment and prior to subject’s death. A sample of 235 PTs and CGs of PTs diagnosed with advanced cancers were included in the study. Mean age for the PTs was 64.7 (SD=10.5, range =21-88) with 54% being > 65. At enrollment, 28.7% of the PT-CG pairs of those PTs 65 years (X2 (1)=1.06, p=.304). At death, 61.8% (X2 (1)=31.04 <.001, Φ=.49) with discord at enrollment had discord at death. For patients who were older, 66.7% who had discord at enrollment also had discord at death and for patients
INTEREST GROUP SESSION—GERIATRIC EDUCATION: AGHE PROGRAM OF MERIT: PRACTICAL AND TECHNICAL APPLICATION INFORMATION AND ASSISTANCE
Authors: Gugliucci Marilyn R , Mathews Shannon D , Elfenbein Pamela
Published: November 2019

At a time in education when it is important for programs at colleges and universities to be productive in teaching, student recruitment, and income generation, the AGHE Program of Merit review process can aid in advancing gerontology/geriatrics programs. The Program of Merit has expanded its review now Colleges of Osteopathic Medicine and any Health Professions program may apply for Program of Merit status – your institution need not be an AGHE member to apply. The POM designation provides gerontology programs and those health disciplines that include geriatrics/gerontology content in the curriculum with an AGHE “stamp of approval” which can be used to verify program quality to administrators, to lobby for additional resources, to maintain a quality program, to market the program, and to recruit prospective students into the program. This session will begin with the “Why,” “What” and “How” of applying for Program of Merit and then provide time for small group consultation regarding the Program of Merit application. Preparation of the self-study document will be detailed by the experienced faculty members followed by the review process and timelines associated with application process. Free consultation available!
FAMILY CAREGIVERS’ COMMUNICATION NEEDS AT THE END OF LIFE OF OLDER PATIENTS AT GERIATRIC FACILITIES
Authors: Cohen Rinat , Maydan Gal , Brill Shai , Cohen-Mansfield Jiska
Published: November 2019

Current literature on end-of-life communication (EOLC) between family caregivers (FCs) and health professionals (HPs) lacks reference to FCs’ communication needs and primarily addresses its formal aspects of communication such as offering advance directives. We explored FC’s communication needs and developed a questionnaire to evaluate the quality of EOLC. Interviews were conducted with 152 Israeli FCs of patients from nursing care, skilled nursing care, assisted ventilation, and dementia units within four facilities (nursing homes and geriatric medical centers). Most participants were women (61%), married (78%), and were children of the patients (77%), with a mean age of 57.5 (S.D.=12.01, range: 29-88). Qualitative analysis yielded several themes: FCs’ concerns about the availability and accessibility of all types of HPs, information needs (e.g., the need for regular updates initiated by HPs), FCs’ need for emotional support, and difficulties stemming from differences in language and culture. The need for improved communication in these spheres extended to all stages of hospitalization. Based on these needs, we developed a questionnaire to evaluate the quality of EOLC. Reliability was measured in a different sample, and ranged from Cronbach alpha of .916 (41 items; 41 FCs) to .937 (41 items with discrimination index greater than .3; 78 FCs). Factor analysis yielded factors similar to the themes that emerged from the qualitative analysis. The findings highlight aspects of EOLC between FCs and HPs which should be addressed and improved. Thus, this study is a crucial first step toward improving the quality of care at the end-of-life.
STRENGTHENING LATE-LIFE DEPRESSION COLLABORATIVE CARE THROUGH COMMUNITY ENGAGEMENT: CARE PARTNERS INITIATIVE
Authors: Hinton Ladson , Hoeft Theresa J , Henderson Stuart , Gosdin Melissa M , Rath Laura , Unutzer Jurgen
Published: November 2019

Despite the availability of effective treatments for late life depression, many older adults with depression either do not access or fully engage in treatment. The goal of this study was to examine the feasibility and two-year outcomes from an Archstone Foundation funded Care Partners Initiative to strengthen depression care for adults 65 years of age and older. Seven sites throughout California implemented evidence-based collaborative care through partnerships between primary care organizations, community-based organizations (CBOs), and families of older adults with depression. Evaluation used a mixed-methods approach incorporating both qualitative and quantitative data. Of the seven sites, six formed partnerships between primary care clinics and CBOs and one site only focused on engaging family members in treatment. In the first two years, 274 patients were enrolled and rates of depression improvement were comparable to prior depression care effectiveness trials. Overall, 49% of patients at CBO sites interacted 3+ times with CBO staff/clinicians, while at the family site, 79% of patients had 3+ contacts including a family member. Using data from key informant interviews, focus groups, and site progress documents, seven core components were identified that facilitated successful implementation and delivery of partnered collaborative care, including three foundational components: strong stakeholder buy-in, effective patient engagement, and the promotion of depression treatment as a core value across organizations. Multiple complexities of partnering between primary care clinics and CBOs or families were identified. Challenges and lessons learned from this initiative will also be discussed.
DESIGNING STATE-BASED LTSS PROGRAMS IN CONTEXT OF UNIVERSAL FAMILY CARE AND EMANCIPATORY GERONTOLOGY
Authors: Veghte Benjamin , Estes Carroll , Torres Stacy
Published: November 2019

This symposium will present findings from a National Academy of Social Insurance study panel on Designing State-Based Social Insurance Programs for Long-Term Services and Supports, Paid Leave, and Affordable Child Care. The risk of needing to provide or receive care is universal. Policymakers in several states are now weighing the enactment of new social insurance programs to address the risk of needing long-term services and supports. The study panel has mapped out the key design choices such states would need to consider with regard to program structure, financing, integration with Medicaid, and implementation, and the implications of these choices for elders, people with disabilities, families, providers, and states. The symposium will also present the study panel’s findings with regard to how long-term care benefits could be provided in the context of an integrated care program addressing three often interrelated caregiving risks: long-term services and supports, paid family and medical leave, and early child care and education: Universal Family Care. Finally, implications for emancipatory gerontology, including the impact of the current gaps in our care infrastructure on family caregivers and the care workforce, will be considered.
EFFECTS OF MUSCLE ALTERATIONS AND REHABILITATION ON MOBILITY IN CHRONIC CONDITIONS OF AGING
Authors: Serra Monica C
Published: November 2019

Age-related changes in muscle morphology and composition are associated with the development of mobility impairments, an increased risk for institutionalization, and mortality. While primary aging may account for some of these changes, the presence of aging related co-morbid conditions such as frailty, stroke, diabetes, and Parkinson’s disease is associated with muscle fiber atrophy, increased intramuscular fat, changes in muscle fiber distribution, and vascular dysfunction that occurs in both large and small vessels. These changes ultimately result in impaired substrate delivery to the muscle, reduced capacity for muscle regeneration, and anabolic resistance leading to declines in balance, strength, and endurance. It is important to understand the biological underpinnings of the changes in muscle following each of these conditions to develop effective preventive measures and maximize restorative rehabilitation protocols. This session will discuss the changes in muscle from the fiber level (i.e., changes in innervation and muscle fiber type proportion) to the systemic level (i.e., changes in specific postural and locomotor muscles), and their relationship to mobility, balance, and function. We will describe techniques (i.e., imaging, EMG, and muscle biopsies) used to assess muscle changes and their applicability in rehabilitation research. Further, we will discuss clinical recommendations for exercise to preserve and enhance skeletal muscle in the aging adult.
A UNIQUE MODEL TO ADDRESS ELDER ABUSE: THE OHIO ATTORNEY GENERAL’S ELDER ABUSE COMMISSION
Authors: Anetzberger Georgia , Roberts Amy Restorick
Published: November 2019

This presentation will highlight Ohio’s innovative model to address the prevalence, risk factors, and consequences of elder abuse and neglect. We will begin with an overview of the mission and duties of the recently codified Ohio Attorney General’s Elder Abuse Commission. These include: (1) to raise awareness, improve education, and boost the level of research regarding elder abuse in Ohio, (2) to provide a forum for improving the elder justice system, and (3) to identify policy, funding, and programming recommendations to address elder abuse. Next, we will share findings from the Research Committee’s first statewide survey on elder abuse research priorities. Completed by frontline practitioners, program administrators, advocates, researchers, and policy makers, the online survey received 459 responses from individuals across the state. Findings reflect gaps in the elder abuse literature, as respondents prioritized funding for research in how elder abuse can be prevented, and what programs/policies can best serve victims and their families after elder abuse has begun. We will conclude with recommendations regarding how the Elder Abuse Commission model may be adapted or modified to elevate awareness of elder abuse and elder abuse research in other parts of the country.
SAFEGUARDING OLDER PEOPLE FROM FINANCIAL ABUSE: EXPERIENCES OF IRISH BANKS
Authors: Phelan Amanda A , O’Donnell Deirdre , McCarthy Sandra
Published: November 2019

Financial abuse is a significant issue for older populations and was identified as that most common form of maltreatment in a 2010 Irish prevalence study (Naughton et al. 2010). This study examined how abuse was experienced and responded to by staff in five Irish banks. A mixed method approach was used: online survey (n=898) amd semi structured interviews (n=25) Findings from the survey data demonstrate that more than half of the respondents (66.5%) had previously suspected a customer to be experiencing some form of financial abuse. There was a high index of suspicion to the five scenarios presented to the staff. Findings from the interviews demonstrate the complexity and wide variations of case experiences of bank managers and the National Safeguarding Committee. These include being financially abused in the context of undue influence, scams, fraud and some cases described the naivety or potential naivety of some customers who may have capacity challenges, engage with strangers through social engineering scams, share PINs or open bank accounts without fully understanding the consequences. All staff had some experience of a suspicion of financial abuse in older people and employed various strategies to respond to their suspicions. We focused our recommendations in two areas: Bank level responses-inter-sectorial collaboration, education and training, a vulnerable adult champion, having a choice of banking methods of engagement, direct client communication and enhancements within the Central bank of Ireland. Macro level responses were increasing public awareness, raising the profile of financial abuse as a crime and enhancing safeguarding legislation
THE EXPERIENCE OF HAPPINESS IN LATE-LIFE REPARTNERING: SURPRISE AND DISAPPOINTMENT
Authors: Koren Chaya
Published: November 2019

Late life repartnering among those aged 65 and older is a phenomenon developing along with the increase in life expectancy. Although research indicates that older people are happier than adults at other life phases, the common lay person perception among the young as well as the old is that old age is associated with less happiness. Late life repartnering in Israel, culturally located between tradition and modernity, is not officially recognized as an option in old age. Exploring the experience of happiness within a social context that perceives late-life repartnering as the exception, using a naturalistic paradigm, has the potential for understanding lay persons perceptions of happiness. The aim of this qualitative research is to explore the experience of happiness in late-life repartnering relationships from a dyadic perspective of each and both partners. 20 couples (40 participants) functionally independent, aged 66-92 who entered their late-life repartnership at old age (men aged 65+; women aged 60+) after widowhood or divorce from a lifelong marriage raising a family, were interviewed separately. Interviews were recorded and transcribed verbatim. Data was analyzed using a dyadic interview analysis method. Findings indicate that happiness in late-life repartnering relationships include experiences of surprise and disappointment in three sub-themes: a. “A gift from heaven”: Surprised of being happy; b. Disappointment not being happy; c. No surprise – No disappointment. Findings are discussed based on disappointment theory, and empirical literature on expectations and happiness. Implications are addressed.
COMPUTERIZED COGNITIVE TRAINING, WITH OR WITHOUT EXERCISE, TO PROMOTE COGNITIVE FUNCTION: A RANDOMIZED TRIAL
Authors: ten Brinke Lisanne F , Best John R , Chan Joey L , Ghag Cheyenne , Erickson Kirk I , Handy Todd C , Liu-Ambrose Teresa
Published: November 2019

Given the world’s aging population, it is important to identify strategies that promote healthy cognitive aging. Computerized cognitive training (CCT) may be a promising method to combat cognitive decline in older adults. Moreover, physical exercise immediately prior to CCT might provide additional cognitive benefits. We conducted a randomized controlled trial to examine the effect of a CCT intervention, alone or preceded by physical exercise, on memory and executive functions in older adults. 124 community-dwelling older adults aged 65-85 years were randomly assigned to either 8-weeks of: 1) 3x/week group-based CCT plus 3x/week CCT sessions at home; 2) 3x/week group-based CCT combined with a 15-minute brisk walk (Ex-CCT) plus 3x/week Ex-CCT sessions at home; or 3)3x/week group-based sham exercise and education sessions (CON). At baseline and 8-weeks standard neuropsychological tests of verbal memory and learning and executive functions were administered, including the Rey Auditory Verbal Learning Test (RAVLT), Stroop test, Flanker test, Trail Making Tests (TMT B-A), and Dimensional Change Card Sort (DCCS) Test. At trial completion, there were no differences in RAVLT performance. Compared with CON, FBT and Ex-FBT participants significantly improved performance on the Stroop test (p = .001 and p = .023, respectively). Additionally, those randomized to Ex-CCT improved performance on the Flanker test (p = .002), TMT B-A (p = .047), and the DCCS Test (p = .023) compared with BAT. These findings suggest that an 8-week CCT program could benefit executive functions, and that implementing exercise immediately prior to CCT could provide broader benefits.
APPLYING THE DIME APPROACH TO A FINANCIAL LITERACY PROGRAM
Authors: Brown Lisa M
Published: November 2019

Financial literacy is defined as “the ability to use knowledge and skills to manage financial resources effectively for a lifetime of financial well-being.” The Money Smart Peer-to-Peer Program (MSP) was developed by the FDIC for use with diverse populations. MSP was culturally adapted for use in Jamaica using the Johns Hopkins DIME process. Peer counselling programs consistently demonstrate that they are acceptable and effective with adults who have limited education and low-income by overcoming barriers that are typically encountered when people attempt to access unfamiliar services or guidance from a professional. Research conducted with the MSP program reveals that program participants were more likely to open and save using deposit accounts, use and adhere to a budget, and have increased confidence in their financial abilities 6 to 12 months after completing the course. Implementation of MSP increases the likelihood that people can retire with dignity and financial security.
FRAILTY AND THE EFFECTIVENESS AND SAFETY OF NEW GLUCOSE-LOWERING DRUGS IN OLDER ADULTS WITH TYPE 2 DIABETES
Authors: Kim Dae H , Patorno Elisabetta , Munshi Medha
Published: November 2019

Recently, several classes of non-insulin glucose-lowering drugs, such as dipeptidyl peptidase-4 inhibitors (DPP4i), glucagon-like peptide-1 receptor agonists (GLP1-RA), and sodium glucose co-transporter-2 inhibitors (SGLT2i), have been approved to treat type 2 diabetes. Clinical trials have shown that GLP1RA and SGLT2i confer cardiovascular benefit, while DPP4i do not have such benefit; these drugs do not seem to increase the risk of hypoglycemia. However, due to underrepresentation of older adults with frailty and lack of frailty assessment in clinical trials, little is known about how the effectiveness and safety of these drugs change across different levels of frailty. In this symposium, we present the real-world evidence from Medicare data April 2013-December 2016 on the utilization trends of newly approved diabetes drugs (Dr. Dave) and comparative effectiveness and safety of SGLT2i vs sulfonylurea (Dr. Pawar), SGLT2i vs DPP4i (Dr. Kim), and SGLT2i vs GLP1-RA (Dr. Patorno). The outcomes were 1) composite cardiovascular endpoint of mortality, myocardial infarction, stroke, or heart failure; and 2) severe hypoglycemia, defined as emergency department visits or hospitalizations due to hypoglycemia. We applied a validated claims-based frailty index (CFI) to estimate the treatment effectiveness and safety in non-frail (CFI<0.10), pre-frail (CFI 0.10-0.19), or frail individuals (CFI≥0.20). Following individual presentations, Dr. Munshi and presenters will lead an interactive discussion about clinical implications and methodological challenges in conducting geriatric pharmacoepidemiologic studies using Medicare data. This symposium will demonstrate the utility of CFI in claims-based pharmacoepidemiologic studies and provide health care providers with new evidence to tailor diabetes pharmacotherapy based on frailty.
FRAILTY AND THE COMPARATIVE EFFECTIVENESS AND SAFETY OF SGLT2I AND DPP4I IN OLDER ADULTS WITH TYPE 2 DIABETES
Authors: Kim Dae H , Pawar Ajinkya , Kim Seoyoung , Patorno Elisabetta
Published: November 2019

We conducted a 1:1 propensity score-matched retrospective cohort study of 83,432 patients with type 2 diabetes (mean age, 71.5 years [standard deviation, 5.0]) initiating a SGLT2i or a DPP4i in Medicare data. We estimated HRs (95% CIs) for a composite cardiovascular endpoint and severe hypoglycemia comparing the two treatments in the entire population and by the CFI-based frailty subgroups. Compared with DPP4i, SGLT2i were associated with a lower rate of the composite cardiovascular endpoint (HR, 0.70 [95% CI, 0.64-0.77]) and a similar rate of severe hypoglycemia (0.88 [0.71-1.07]) over a mean follow-up of 8.8 months. The rate of composite cardiovascular endpoint for SGLT2i vs DPP4i was consistently lower in pre-frail (0.71 [0.64-0.79]) and frail (0.67 [0.55-0.80]) subjects, but not in non-frail patients (0.98 [0.62-1.54]). The rate of severe hypoglycemia was not meaningfully different between SGLT2i and DPP4i (non-frail, 0.39 [0.12-1.16]; pre-frail, 0.83 [0.65-1.07]; frail, 1.13 [0.78-1.64]).
GETTING TO YES . . . I WILL RESPOND: CHALLENGES AND SUCCESSES SURVEYING AGING SERVICES PROVIDERS TO PRODUCE QUALITY DATA
Authors: Harris-Kojetin Lauren
Published: November 2019

Voluntary surveys of aging services providers are important data sources for research, quality improvement, and program evaluation efforts to inform evidence-based decision making. Ideally, provider surveys—a type of establishment survey—offer valuable information on providers and services users. However, decreasing survey response rates in recent years raise data quality concerns. This symposium highlights challenges leading to lower response rates (e.g., time constraints, skepticism, confidentiality concerns, getting to the correct respondent); specific data collection techniques tested, what did and did not work, and lessons learned. Although the surveys focus on long-term services and supports (LTSS) providers (e.g., assisted living) and services users (e.g., residents), the session is generalizable to other establishment surveys. Presenters bring extensive survey experience and diverse organizational perspectives—academic research center, national provider association, federal statistical agency, and research contractor. Over the years, the presenters have used their research network to share challenges and lessons learned with each other, which addresses the GSA conference theme, “Strength in Age: Harnessing the Power of Networks.” The first presentation describes test results of a state survey protocol to obtain sampled resident information from assisted living providers. The second presentation examines approaches to increase provider participation in a quality improvement initiative. The third presentation discusses efforts to address response challenges in an on-going national survey of providers in two LTSS sectors. The session allows time for and facilitates interaction with audience members to share their insights and lessons learned.
EVALUATING ENHANCEMENTS TO ADDRESS SAMPLE DIVERSITY, RESPONDENT BURDEN, AND DIFFICULTY REACHING RESPONDENTS
Authors: Hobbs Melissa , Hobbs Melissa , Greene Angela , Caffrey Christine , Sengupta Manisha , Harris-Kojetin Lauren
Published: November 2019

Every two years since 2012, the National Study of Long-Term Care Providers includes provider surveys with residential care communities (RCCs) and adult day services centers (ADSCs), via a multi-mode approach using Web, hard-copy questionnaires, and computer-assisted telephone interviewing. In each wave, we struggled to achieve target response rates. First, diversity among providers surveyed—e.g. RCC size, type of ADSC—presents unique challenges. For RCCs, small communities have lower response compared to larger ones. For ADSCs, how they define themselves (medically vs socially oriented) influenced their decision to participate. Second, respondents’ perceived burden, particularly the time required to complete the survey, is a recurring concern especially for directors of multiple RCCs and ADSCs. Finally, reaching target respondents—directors, administrators or operators—is problematic. These challenges affect data quality. In this presentation, we share results of our efforts to enhance contacting and interviewing protocols intended to address low participation associated with these challenges.
PRESIDENTIAL SYMPOSIUM: HARNESSING SOCIAL NETWORKS TO OPTIMIZE ENVIRONMENTAL CONTEXTS FOR DIVERSE AGING EXPERIENCES
Authors: Rozario Philip A , Greenfield Emily , Kusmaul Nancy
Published: November 2019

Social networks provide opportunities for engagement with others and structure the receipt and provision of emotional, instrumental, informational and appraisal support. Indeed scholars in this field have documented the importance of having strong social networks in influencing older adults’ well-being and quality of life. The three papers in this symposium draw on the convoy model of social relations and ecological model to examine and better understand the micro, mezzo, macro contexts that shape and influence how older people engage with and benefit from their networks in three areas: low-income senior housing communities, urban areas specifically targeting older Latinos with dementia, and disaster preparedness in micropolitan counties in eastern Iowa. The first paper, a cross-sectional study focusing on social connections in senior housing communities, examines levels of social networks, engagement, support and loneliness and their relationship with well-being outcomes. The second paper, a community-based participatory research project, reports an intervention that seeks to train natural helpers in a predominantly Latino urban neighborhood to identify and refer older Latinos with dementia to bilingual assessment services. The third paper, synthesizing findings from interventions targeting network building at the individual and state levels as well as a community-based network analysis, presents ways to strengthen networks at the mezzo and macro levels as well as environmental contexts that enable better disaster preparedness for community-based older adults. These papers will consider practice, policy and research implications in strengthening social networks and engagement to optimize older adults’ well-being in various settings.