bluuebunny/crossref_metadata_2025 huggingface dataset:
BEHAVIORAL ACTIVATION FOR FAMILY CAREGIVERS OF PEOPLE WITH DEMENTIA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Xu Xinyi , Kwan Rick , Leung Angela Y M
Published: November 2019

Behavioural activation (BA) aims to increase positive response-contingent environmental reinforcement and help caregivers to engage in pleasant and constructive activities, and therefore improve psychological and physical health among family caregivers of people with dementia (PWD). However, knowledge of the effectiveness of BA in this population remains limited. The current study applied a systematic review and meta-analysis in order to determine the effectiveness of BA among family caregivers of PWD. Literature was searched in PubMed, Medline, CINAHL, Cochrane, Embase and PsycINFO published from March 1988 to March 2018. Seven Randomized Control Trials (RCT)s evaluating the effects of BA in family caregivers of PWD were eligible to be included in this review. Cochrane’s guideline was used in order to measure risk of bias and extract data. A random effects model was used to pool the effect size. Family caregivers of PWD receiving BA that only for caregivers demonstrated a statistically significant reduction in depression (n=3; 311 participants; Cohen’d=0.55; 95% CI: 0.30 to 0.81; P<0.001). BA also had a positive impact on interlukin-6, negative affect of caregiving, relationship satisfaction, dysfunctional thoughts and distress related to neuropsychiatric symptoms of PWD for family caregivers. The available evidence suggests that future studies are needed to focus on better ways of administering BA to family caregivers of PWD, to improve their physical and psychological health. Meanwhile, more RCTs to investigate the effects of BA on psychological and physical health for family caregivers of PWD is needed.
EVALUATION OF THE RESCUE PROGRAM FOR REDUCING STROKE CAREGIVER STRESS AND IMPROVING PROBLEM-SOLVING ABILITIES
Authors: Jordan Meggan , Freytes I Magaly , Orozco Tatiana , Dang Stuti , Uphold Constance R
Published: November 2019

Research shows that caregiver interventions that combine problem-solving with psycho-education are the most effective for addressing stroke caregiver concerns. The Resources and Education for Stroke Caregivers’ Understanding and Empowerment (RESCUE) program, designed to reduce caregiver stress, depression, and burden, developed as a result of this evidence. A 4-week telephone and web-based clinical demonstration project led by registered nurses was established as part of the VHA Office of Geriatrics and Extended Care’s Non-Institutional Long Term Care Initiative. The goals of this clinical demonstration were to improve problem-solving skills and provide individualized support for stroke caregivers. A single-group pre and post-test design was used and 72 caregivers of veterans with stroke completed the intervention; qualitative and quantitative methods were used for evaluation. The outcome variables were caregiver depressive symptoms, problem-solving abilities, burden, health-related quality of life and care recipient functional abilities. Post-tests were conducted 2-6 weeks after the intervention. The evaluation found that there were statistically-significant decreases in caregiver depressive symptoms and burden from pre- to post-test assessments. Caregivers’ negative problem orientation significantly decreased. The other components of problem-solving abilities did not change. Qualitative data revealed how the program increased caregivers’ confidence in problem-solving which led to new strategies to relieve stress. Interviews also revealed how the intervention affected caregivers in unexpected ways, such as improved intimate relationships and new perspectives on caregiving. The preliminary effectiveness and barriers and facilitators of implementing a stroke caregiver program will be discussed.
DYADIC INTERVENTION FOR PEOPLE WITH DEMENTIA AND THEIR FAMILY CARERS AFTER THE DIAGNOSIS
Authors: Prins Marleen , Veerbeek Marjolein , van der Velden Claudia , Willemse Bernadette
Published: November 2019

Adaptation to and coping with the diagnosis dementia is a complex process. The right support in this phase is important to find the right care and to (self-)manage future care wishes. However, people with dementia (PWD) and their family carers (FC) often experience support directly after the diagnosis as inadequate. Support is not provided until problems start to accumulate and available support is not focused on continuation of their life and the emotional impact of the diagnosis. Therefore, the intervention SHARE [Support, Health, Activities, Resources, Education] was developed and studied in the US and adjusted to and pilot-tested in the Netherlands with positive results. SHARE is innovative because it is designed for dyads dealing with early-stage dementia to enhance communication between PWD and their FC and to prepare them for the future. In this study, the Dutch SHARE intervention was adjusted because of new insights and an RCT is being conducted to evaluate the (cost)effectiveness of this version of the Dutch SHARE. The primary outcome measurement for the PWD is quality of life and self-efficacy for the FC. Secondary outcomes are stress, communication in the relationship and perspective taking (only FC). The design and procedures of the RCT will be presented in this poster session as well as the demographic characteristics of participating dyads. This study contributes to knowledge about psychosocial interventions for PWD and FC with special attention for preventive empowerment of the ability to cope with the disease and the capacity to deal with the situation.
NEEDS AND EXPERIENCES OF CAREGIVERS TO PERSONS WITH DEMENTIA WHO HAVE LOST THEIR DRIVING PRIVILEGES
Authors: Yamin Stephanie , Gratton Cassandre
Published: November 2019

The ability to drive a motor vehicle for most older adults is associated with a sense of independence, well-being, quality of life and identity. For many older adults, driving cessation eventually becomes inevitable. This is especially the case for older adults with a diagnosis of dementia. Driving cessation has been shown to negatively impact individuals’ mobility and, consequently, quality of life. Informal caregivers (i.e., family caregivers) can mitigate the negative consequences associated with driving cessation in persons with dementia (PWD) by meeting their mobility needs and by offering emotional support. The purpose of this study was to examine the experience and needs of informal caregivers of PWD who had recently lost their driving privileges. Ten informal caregivers of PWD were recruited from a tertiary memory disorders clinic. Semi-structured interviews were conducted and transcribed. Transcripts of interviews were thematically analyzed using a grounded theory approach. The major themes emerging from the experience of caregivers included being overwhelmed by responsibility, overwhelmed by the emotional response of their care recipient and feeling resentment towards their care recipient. Similarly, the major themes emerging from the needs of caregivers included having the need for mobility training, psychoeducation on how to best attend to the emotional needs of their care recipient and the need for coping strategies. These experiences and needs expressed by caregivers indicate that driving cessation of the care recipient is a difficult experience for caregivers and that a therapeutic intervention based on the reported needs may be beneficial.
BRIDGING THE GAP BETWEEN COGNITIVE HEALTH AND FINANCIAL CAPACITY IN OLDER ADULTS: A SCOPING REVIEW
Authors: McLaughlin Jessica B King , Taeckens Ashley , Greenfield Jennifer C , Chess Eric
Published: November 2019

Significant declines in everyday functioning are often indicators of cognitive impairment. Although researchers agree that a diminished ability to carry out a variety of instrumental activities of daily living (IADL) tasks is a harbinger of cognitive impairment (CI), studies have repeatedly found that a compromised ability to successfully complete financial management tasks may be one of the initial IADLs affected by prodromal CI. Due to the combination of compromised financial functioning and the increased prevalence of CI, older adults as group are, therefore, put at a greater risk for financial abuse and exploitation. The aims of this scoping review were two-fold: 1) to synthesize current literature on CI as it relates to financial decision-making (FDM) and 2) to analyze the measures and instruments used to assess FDM in older adults. In a review of four databases, 39 studies were identified that met inclusion criteria. These studies used 22 different instruments to measure and assess financial functioning. Across the 39 studies, consistent themes emerged relevant to factors that impacted cognitive impairment and financial functioning. These themes included participants’ education levels, premorbid financial literacy, and age. White participants were overrepresented in research samples from these studies. Future research should investigate how FDM and early signs of CI may interact in people of color. Additionally, research should be focused on how to make instrumentation more accessible and feasible for the general public to administer without extensive training. This would enable the lay population to more easily identify early signs of cognitive impairment.
THE RELATIONSHIP BETWEEN IMMIGRANT STATUS AND UNDIAGNOSED DEMENTIA
Authors: Franco Yujin , Choi Eun Young
Published: November 2019

In the U.S., the immigrant population is rising, and immigrants are more likely to develop dementia than the U.S.-born population. However, little is known about the rate of undiagnosed dementia among immigrants. This study investigates the relationship between immigrant status and undiagnosed dementia, using 2011 data from the National Health and Aging Trends Study. Data from 7,347 older adults aged 65 years and older (6,531 U.S.-born and 816 immigrants) were included in the analysis. Study participants were divided based on whether they had or had not been diagnosed with dementia, respectively. The results of binary logistic regression showed that being an immigrant was associated with two times higher odds (odds ratio [OR]: 2.00, 95% CI: 1.38-2.92) of undiagnosed dementia compared to US-born participants. Among immigrants, undiagnosed participants had significantly lower levels of depression (t(166)=-2.60, p=.01). Moreover, although marginally significant, the latter were younger (t(166)=-1.90, p=.06) and immigrated at an older age (t(159)=1.87, p=.06) than the diagnosed group. Thus, it is important to tailor dementia education and interventions to the immigrant population, as this may contribute to reducing health disparities in dementia outcomes within the older population.
ALZHEIMER’S DISEASE AND RELATED DEMENTIAS IN MEXICAN AMERICAN MEDICARE BENEFICIARIES
Authors: Snih Soham Al , Chou Lin-Na , Downer Brian , Raji Mukaila , Kuo Yong-fang , Markides Kyriakos , Ottenbacher Kenneth
Published: November 2019

Objective: To determine the prevalence and incidence of Alzheimer’s Disease and Related Dementias (ADRD), and to identify the socio-demographic and health characteristics of Mexican-American older adults with ADRD. Methods: Data are from wave 5 (2004/05) of the Hispanic Established Population for the Epidemiological Study of the Elderly linked with Centers for Medicare and Medicaid Services files. We studied 1166 participants of which 927 did not have an ADRD diagnosis before wave 5 interview and followed until 2016. Measures included socio-demographics, medical conditions, depression, physical function, Mini-Mental-State- Examination (MMSE), body mass index (BMI), disability, and ICD-9-CM codes for ADRD. Results: A total of 424 participants had an index diagnosis of ADRD during 11-years. The total prevalence rate ranged from 31.6% in 2006 to 72.8% in 2016, and the total incidence rate ranged from 9.3% in 2006 to 15.8% in 2016. The prevalence rate ranged from 30.3% to 69.7% in men and 32.5% to 74.1% in women. The incidence rate ranged from 8.5% to 12.9% in men and 9.8% to 12.9% in women. Those with ADRD were significantly more likely to be older (82.1 versus 81.6 years; p-value=0.024) and to have a lower score in the MMSE (21.1 versus 21.7; p-value=0.013) compared with whole sample (N=927). Non-significant differences were observed by sex, education, medical conditions, BMI, depression, physical function or disability compared with whole sample. Conclusions: The prevalence and incidence rates of ADRD in Mexican-American Beneficiaries is high. These findings underscore the need for clinical services and caregiving resources in this population.
IDENTIFYING PATIENTS WITH PROBABLE DELIRIUM AND DEMENTIA FROM ROUTINE HOME HEALTH CARE ASSESSMENTS
Authors: Jarrín Olga F , Nyandege Abner , Rosati Robert J , Videon Tami J
Published: November 2019

Timely education of patients and their family caregivers on dementia disease management and health behavior changes and referral to additional resources is an essential part of age-friendly and high quality care. Nearly one out-of-three home health care patients has been diagnosed with dementia, however, family members and front-line health care providers are frequently unaware that a diagnosis of dementia has made, and what to do. The aim of this study was to identify a small set of questions that are routinely collected during home health care assessment which can be used to rapidly identify patients with suspected dementia, who may benefit from additional screening and services. We developed the preliminary model from 100% national home health care assessment data from 2014 (4.1 million people). We validated the model with a sample of nearly 27,000 patients who received a new (start-of-care) home health assessment in 2016, from four home health agencies that share a common data warehouse. The final model consisting of five questions, performed well in national data (AUC 0.85) predicting any diagnosis of dementia contained in the Medicare Chronic Conditions warehouse or home health record. The final model performed similarly (AUC 0.87) in the validation sample, predicting a diagnosis of dementia or history of dementia medication during a 3-year window of time from clinical data warehouse. The potential applications of this model have the potential to accelerate timely identification of patients with probable dementia or delirium, patient and family caregiver education, and referral to rehabilitative and supportive services.
CHOOSE TO MOVE: IMPLEMENTATION OF A PHYSICAL ACTIVITY INTERVENTION AT SCALE ACROSS BRITISH COLUMBIA, CANADA
Authors: Gould Joanie Sims , McKay Heather , Gray Samantha , Bauman Adrian , Nettlefold Lindsay , Hoy Christa
Published: November 2019

Despite the many benefits of physical activity (PA), older adults remain among the least active Canadians. Regular PA effectively enhances social connectedness which in turn, is linked to positive health benefits. PA also promotes older adult’s physical mobility which is “the best guarantee of retaining independence and being able to cope” in later years. Although effective PA interventions exist, all but five were conducted at small scale. None were effectively scaled up and sustained over the longer term. To improve population health, effective interventions must be scaled-up. In 2015, BC Ministry of Health released a PA strategy and action plan--older adults were identified as one priority area. In partnership with government and community stakeholders we were entrusted to co-design, implement and evaluate a 6 month, evidence- and choice-based PA intervention (Choose to Move; CTM) across BC, Canada. Implementation and adaptation frameworks and processes we adopted were embedded within socioecological models. We evaluated CTM at scale-up in 26 communities with 458 low active older adults. Our implementation evaluation showed that relationships and infrastructure were key facilitators to delivering CTM at scale. Our impact evaluation showed that PA and social connectedness were enhanced; mental health (loneliness/happiness), grip strength and mobility all improved following participation in CTM. A flexible, adaptable PA model, designed with scalability in mind is key to enhance health indicators in low active older adults. Effectively engaging stakeholders at multiple levels in the implementation process is essential to success.
DEBT AMONG OLDER ADULTS: DATA FROM AN EXPLORING STUDY IN SOUTH BRAZIL
Authors: Doll Johannes , Conte Francieli , Lima Karen
Published: November 2019

In recent years, Brazil has experienced significant increase in indebtedness rates amongst older adults. This is partly due to prominent forms of credit such as credit cards and payroll deductible credit, a type of credit that accounts for up to 35% of pensions. In addition, indebtedness is aggravated by high interest rates which are charged in Brazil. Exploratory study on the propensity for indebtedness amongst older people in Rio Grande do Sul, Southern Brazil (n = 406; age 46-97 years old; average 68,7 years old) aims to analyze reasons and factors which interfere in the financial-related issue. In general, indebtedness is a complex process that is often triggered by critical life events such as illness, death, separation, accident and unemployment. And, it is mediated by a number of behavioral and sociodemographic factors. The present work aims to analyze the relation between financial problems, income, schooling, age, materialism, consuming habits as well as altruism in two different social groups: a middle class (SESC) and a lower middle-class (FASC). Concerning theoretical reference, data discussion is based on Ronald Inglehart’s theory on Materialism and Postmaterialism. Data analysis has shown differences in factors and relations among the two social groups. Consuming habits and altruism have a significant correlation with financial problems in both groups. However, income, education and materialism has shown a significant correlation only in the lower middle-class group. In the middle-class group, no relation between income, education, materialism and financial problems has been found.
HETEROGENEITY IN PROGRESSION OF COGNITIVE IMPAIRMENT AND VARIATIONS IN HEALTH EXPENDITURES AND HEALTH SERVICES USE
Authors: Tarraf Wassim , González Hector M
Published: November 2019

Cognitive aging and disease (e.g. dementia) are leading public health issues as longevity increases and the US population ages. We fit generalized linear models using data from the longitudinal Health and Retirement Study (2008-2014) on (Unweighted N=1,884) participants 70-years and older who met criteria for cognitive impairment not dementia (CIND), based on Aging, Demographics, and Memory Study specification, at baseline (2008) to test how impairment reversion, stability, and transition to dementia over 8-years affect change in biennial hospitalizations, nursing-home use, and out-of-pocket expenditures (OOP). Over 8-years, 13% reverted to normal cognition, 20% remained as CIND, 21% transitioned to dementia, and 46% died. In these groups, average OOP spending at baseline was $2311 (SE=$225), $2722 (SE=$278), $2180 (SE=$228), and $3653 (SE=$322), respectively. Average OOP spending increased to $3,095, $4,720, and $11,548 by the 8th year for those that reverted, stayed stable, and transitioned, respectively. Average OOP spending at the wave preceding death was $11,600. We observed substantial increases in nursing home use that were particularly pronounced among those that transitioned to dementia (Baseline Probability=0.04 increasing to 0.37 over 8-years) or died (0.09 increasing to 0.35 over 6-years), and similar but less pronounced differences in patterns of inpatient hospitalizations. Estimates were only slightly modified through adjustments to sociodemographic characteristics and comorbid conditions. We discuss how healthcare policy and clinical interventions focusing on early identification of impairment can potentially lead to improved and more efficient healthcare if better understanding of heterogeneities in impairment and cognitive disease progression is achieved.
WHO ANSWERS THE HOUSEHOLD FINANCIAL QUESTIONS: ANALYSIS OF STABILITY AND CHANGE
Authors: Curl Angela L , Mudzonga Chido
Published: November 2019

There is limited research on who acts as household financial respondents (FR) for couples who are responding to surveys. The purpose of this study was to determine the amount of stability and change in FR, as well as predictors of FR status and change of FR status. Methodology: This study analyzed data from Health Retirement Study from 2006 to 2014. The sample comprised of 6,755 households of couples over the age of 50. Data were analyzed using Hierarchical Linear Modeling (HLM). Results: The results indicated that 18.13% households experienced one or more transitions of the financial respondent. Black non-Hispanics, males, those with higher education, earning a greater percent of the household’s income and those with higher cognitive ability were more likely to be the financial respondent than their counterparts. Higher depression (OR=1.22, p< .01) and lower cognitive ability (OR= 1.06, p<.01) were factors that predicted changes in the household’s financial respondent. Health (number of chronic conditions, self-rated health) and percentage of the household earnings are not significant in the change of financial respondent. Discussion: Change of respondent may result in differences in reporting of household financial resources in longitudinal studies. Changes in respondent may also be indicative of a more Egalitarian household, or serve as an early sign of changes in family dynamics or roles. As changes in mental health and cognitive ability may prompt a change of financial respondent, this highlights the importance of both spouses being financially literate and aware of the family’s economic resources, investments and obligations.
PHASED RETIREMENT IN OLDER AMERICAN WORKERS
Authors: Choi Shinae , Smith Genevieve
Published: November 2019

Older workers are engaging in “phased retirement” in which they transition from full-time working status to part-time working and eventually retire at a later age. This study investigated whether phased retirement was financially and psychologically beneficial for middle-aged and older adults in the United States. The current study examined data on financial and psychological well-being and retirement transitions (i.e., immediate retirement and phased retirement) from the Health and Retirement Study (HRS) at two time points, four years apart. We analyzed 5,106 middle-aged and older adults from the 2010 and 2014 waves of the HRS data set using chi-square and one-way analysis of variance tests. Our results showed that 66.8% of respondents remained full-time working, while 12.7% of respondents chose phased retirement and 15.2% of respondents jumped straight into retirement. Our findings suggest that phased retirement is beneficial for older Americans financially and psychologically. Specifically, the level of total household financial wealth was significantly higher for those who chose phased retirement than immediate retirees from workforce. In terms of psychological perspectives, immediate retirees experienced more depressive symptoms than those who chose phased retirement. Our findings could help individuals and households to be better equipped when preparing for retirement. Our findings could also provide a basis for further research into phased retirement and its impact on well-being in middle-aged and older Americans. Furthermore, policymakers could be better informed about retirement trends and create policies based on our findings to better help older individuals and households be financially and psychologically prepared for retirement.
WORKING LONGER FOR ACADEMICS IN THE U.S. AND IRELAND: A GENDERED LIFECOURSE ANALYSIS
Authors: Leime Aine Ni
Published: November 2019

Many governments including the US and Ireland have been advocating longer working lives for all workers to ensure pension sustainability in the light of population ageing. Policy changes encouraging increased social security/state pensions age reflect this. However, there has been limited investigation of how the gender implications of these policy changes. While longer working lives may be attractive for some workers, there is evidence that women and men have profoundly different work-life trajectories and women may be more financially disadvantaged approaching retirement age. There is a need to explore how this affects their ability and/or desire to continue working past traditional retirement age and their financial security. This presentation is based on analysis of evidence from an EU-funded cross-national research project involving work-life history interviews conducted with forty older workers in academia in the US and Ireland in 2016 and 2017. A lifecourse approach is used to analyse interview data from ten male and ten female academics in Ireland and ten male and ten female academics in the US, aged 50 or over. Participants discussed early influences, work-life history and health concerns. The paper uses a cumulative disadvantage perspective to analyse how gender, family and health trajectories across the life course affect and can limit options around late work and retirement. It concludes that gender differences regarding norms of care-giving are important and that extending working life is more likely to be caused by financial necessity for women. The implications for future research and policy are discussed.
CONSEQUENCES OF AGE DISCRIMINATION IN THE WORKPLACE
Authors: Yeung Dannii
Published: November 2019

Despite a growing number of middle-aged employees in the workforce, Hong Kong still lags behind other developed countries in implementing age-friendly policies to protect older workers from being discriminated in recruitment, performance appraisal, and other personnel decisions. This paper therefore aims to investigate the effects of age discrimination on work-related outcomes and well-being. A total of 333 Hong Kong Chinese employees aged 40 years and above (Mage = 46.6 years, SD = 6.21, Range = 40-68; 60% female) completed an online survey on work experiences. Self-perceived age discrimination in the workplace (Furunes & Mykletun, 2010), perception of occupational future time (Ho & Yeung, 2017; Zacher & Frese, 2009), work engagement (Schaufeli et al., 2017), work stress (Cohen et al., 1983), and psychological distress (Shek, 1989) were measured. Almost 53% of the participants reported that older workers were less likely to get the same training opportunity for new technology as their younger peers, and 46.8% perceived that older workers did not get the same promotion opportunity as their younger peers. Regression analyses further revealed that employees’ perceived age discrimination in the workplace indirectly influenced their levels of work engagement (B = -.038, SE = .017), work stress (B = .016, SE = .005), and psychological distress (B = .008, SE = .005) through perception of occupational future time. The findings of this study unveil the severity of workplace age discrimination in Hong Kong and the negative impacts of age discrimination on work-related outcomes. Recommendations for organizational practices will be discussed.
A HOSPICE COLLABORATIVE NETWORK TO IMPROVE SERIOUS ILLNESS CARE IN A LARGE HEALTHCARE SYSTEM
Authors: Leiter Richard E , Pu Charles T , Mazzola Emanuele , Bernacki Rachelle E
Published: November 2019

The quality of hospice care in the United States varies significantly, yet healthcare systems lack methods to comprehensively evaluate and stimulate quality improvement in organizations that serve their patients. Partners HealthCare, an integrated healthcare system located in Eastern Massachusetts, sought to create a high-quality hospice collaborative network based on objective and quantitative criteria obtained from public reporting as well as the hospice itself. Through a modified Delphi procedure, clinicians, administrators, and data scientists developed a set of criteria and a scoring system focused on three areas: organizational information, clinical care quality indicators, and training and satisfaction. All Medicare-certified hospices in good-standing in Massachusetts were eligible to participate in a request for information (RFI) process. We blinded all hospice data prior to scoring and invited hospices scoring above the 15th percentile to join the collaborative for a 2-year initial term. Of 72 eligible hospices, the majority (53%) responded to the RFI, of which 60% submitted completed surveys. Hospices could receive up to 23.75 points with scores ranging from 2.25 to 19.5. The median score was 13.62 (IQR: 10.5-16.75). For the 19 hospices scoring above the 15th percentile, scores ranged from 10.0-19.5 (median: 14, IQR: 11.1-16.9). There was no association between quality score and continuous (Spearman’s correlation 0.24, p=0.27) or dichotomous (Wilcoxon rank sum test p=0.13) measures of hospice size. The hospice collaborative network is one healthcare system’s initial attempt to effectively leverage its influence and relationships to improve hospice quality for the benefit of its seriously ill patients and their families.
TRENDS AND FACTORS ASSOCIATED WITH PLACE OF DEATH AMONG INDIVIDUALS WITH CARDIOVASCULAR DISEASE IN THE UNITED STATES
Authors: Cross Sarah H , Kaufman Brystana G , Warraich Haider
Published: November 2019

While most patients prefer to die at home, trends and factors associated with place of death for patients dying of cardiovascular disease (CVD) remain unknown. Using data from the National Center for Health Statistics from 2003-2017, we described trends and conducted multivariable logistic regression to evaluate associations between demographic characteristics and place of death among CVD patients in the United States. From 2003-2017, the rate of CVD deaths occurring at home increased from 21.3% to 30.9%, and rate of hospice facility deaths increased from practically none to 6.0%. Over the same period, the rate of hospital deaths decreased from 36.5% to 27.3%, and nursing facility deaths decreased from 25.1% to 20.6%. With the exception of conduction disorders, temporal trends in place of death were consistent across CVD diagnosis subgroups: ischemic heart disease, hypertensive heart disease, heart failure/cardiomyopathy, cerebrovascular disease, aortic stenosis, and all other CVDs. Differences between demographic groups persisted over the study period, with reduced odds of home death among Hispanic versus non-Hispanic (OR=.942; 95% CI .929-.955) decedents, Black versus White (OR=.837; CI .809-.866) decedents and greater odds of home death among decedents with some college education or more (OR=1.08; CI 1.06-1.09) versus decedents with a high-school education or less. In 2014, home surpassed hospital as the most common place of death for CVD patients. CVD patients often have acute and intense needs at the end of life that are challenging to manage in the home and the quality of care these patients receive should be further investigated.
ETHNIC AND DEMOGRAPHIC DIFFERENCES IN THE UTILIZATION OF ANCILLARY HOSPICE SERVICES
Authors: Halli-Tierney Anne D , Bell Gregg , Allen Rebecca S
Published: November 2019

Background: Research shows that ethnic differences exist in hospice service election, with fewer African American patients enrolling in hospice and having lower satisfaction with care compared to Non-Hispanic Whites. Hospice is interdisciplinary, with nursing care and “ancillary” services (social work, chaplain, nurses’ aide, volunteer). Little research exists about whether disparities exist in ancillary service election, and if patient demographics correlate with service utilization. We examined if ethnic or demographic differences exist among hospice beneficiaries in utilization of hospice services. Methods: Mixed-methods data collection took place from two community hospices. The quantitative arm involved retrospective chart review on new admissions from 2012 to 2016: acceptance of ancillary services and demographic data were collected as well as code status and outcome of hospice admission. The qualitative arm collected interview data from hospice personnel about thoughts on hospice care, which patients they think might decline ancillary services, and why. Results: Chart review was completed on 491 patient charts: interviews of hospice staff are ongoing. Sample was 55% female, 77% white, average age 77.8 years. Initial analysis on demographic data did not show statistical significance in utilization. Declination was lowest for social work (3.4% declined) and highest for hospice volunteer (88.9% declined). Initial interview themes involved need for patient education and role of health literacy. Discussion: Initial research does not show statistical ethnic or demographic differences in ancillary service utilization. However, broad utilization differences exist between services. Data can identify areas where hospices can improve care accessibility through patient education and personalization of services.
IDENTITY AND RESPONSIBILITY: WHAT IT MEANS TO BE A CAREGIVER AND ITS IMPLICATIONS FOR POLICY AND HEALTH CARE
Authors: Raj Minakshi , Platt Jodyn , Fitzgerald Tom , Anthony Denise , Daniel Lee Shoou-Yih
Published: November 2019

Improving health care and quality of life for older adults in the U.S. requires increased attention to the informal caregivers supporting aging relatives. Studies estimate that over 40 million unpaid caregivers provide more than $400 billion of unpaid care; however, there is little research examining the scope and variety of support caregivers provide. Less research has examined how caregivers conceptualize their experience beyond “caregiver burden”. A more comprehensive understanding of the types of support caregivers provide and caregiver perceptions of their role and purpose are critical to enhancing policies, e.g., the Family and Medical Leave Act, to be more responsive to caregiver needs. This study seeks to (a) identify the ways informal caregivers provide support and (b) describe what it means to be a caregiver from the perspective of informal caregivers. We conducted four focus groups with informal caregivers (relatives or partners) in Southeastern Michigan (n=18) and conducted qualitative thematic analyses. Support that caregivers provide ranges from financial planning to medical decision-making to social engagement. While caregivers face frustration and isolation consistent with “caregiver burden,” they also recognize positive attributes of being a caregiver such as overcoming adversity and helping elderly relatives maintain dignity. These attributes contribute to their identity of what it means to be a caregiver and perceived capacity to improve their relative’s health. Our findings suggest that we are underestimating the scope of work involved in care-giving and that a wider range of activities should be considered when developing workplace policies and resources to promote caregiver wellness.
INTERNET USE, MENTAL HEALTH, SOCIAL SUPPORT, AND CARE BURDEN OF INFORMAL CAREGIVERS
Authors: Yi Eun-Hye G , Adamek Margaret E
Published: November 2019

Given the psychological stress and health difficulties that stem from caregiver burden and lack of support, various technology-based supports have been introduced. This study aimed to understand the relationships of internet and social network use on informal caregivers’ health status, social support, and care burden. Outcomes were compared for three groups: Alzheimer’s caregivers (AC), other types of caregivers (OC), and non-caregivers (NC). A secondary data analysis of national data from the Health Information National Trends Survey 5-cycle for 2018 was conducted (N=3,297; NC= 2,918, OC=443; AC=113). Using Stata SE 15.1, various statistical analyses (Chi-square, ANOVA, logistic regression) with jackknife bias correction were used to compare the 3 groups. In general, OC experienced the most serious depression/anxiety. More OC (32%) were diagnosed with depression/anxiety by health professionals than NC (22.64%) and AC (19.82%) (F(2,48)=5.58, p<.001). The Other Caregiver group also had higher scores in PHQ-4 (M=2.42, SD=3.07) than NC (M=1.75, SD=2.71) and AC (M=1.63, SD=2.42) (F(2,48)=3.97, p<.05). Regarding care burden, AC provided more support for their care recipients for ADLs (M=2.93, SD=1.65) and IADLs (M=3.75, SD=2.00 for AC) than OC (F(1,49)=4.39, p<.05 for ADLs; F(1,49)=3.17, p<.10 for IADLs). OC (M=2.57, SD=2.43) and AC (2.96, SD=2.39) had fewer social supports than NC (M=3.41, SD=2.38) who can instantly assist them (F=11.60, p<.001). OC (21.68%) and AC (29.00%) more frequently than NC (12.01%) participated in social network (F(2,48)=5.72, p<.01) and online support groups (OC: 13.68%; AC=12.73%; NC=4.68%) (F(2,48)=9.84, p<.001). Developing practical online approaches for informal caregivers can supplement their limited in-person social support.
WHAT SHAPES ADULT SONS’ INCENTIVE FOR PARENT CARE IN JAPAN? EFFECTS OF WORK AND FAMILY CIRCUMSTANCES
Authors: Wakui Tomoko , Hirayama Ryo , Agree Emily M , Kai Ichiro
Published: November 2019

In Japan, because of marked sociodemographic shifts such as a growing number of older adults in need of care and fewer siblings in younger generations, adult sons are increasingly likely to be called upon to meet parental care needs while at working age. Using data from 1,183 employed men (M age = 44.6), our aim in this study was to explore work- and family-related factors that affect their incentives for parental caregiving, a potential component of their psychological preparedness for fulfilling care responsibility. Specifically, focusing on these sons’ workplace environment, living arrangements, and the quality of relationship with parents, we sought to identify whether and how these factors influenced their desire to provide different types of care (e.g., domestic help, ADL assistance). Regression analysis revealed differential associations between work- and family-related factors and sons’ desire for parental caregiving depending on type of care and parents’ gender. For their desire to provide domestic help and attend parents when seeing a doctor, live-in sons were more likely to desire to provide care regardless of parents’ gender. Whereas the quality of parent-child relationships was significantly associated with their desire to care for both parents, whether they had a supervisor to talk with about family issues had a significant effect only on that for their mother. On the basis of these findings, we discuss workplace needs for support to help sons continue work when they need to provide care.
TRANSLATIONAL ADVISORY BOARDS IN RESEARCH: EXPERIENCES FROM A PRAGMATIC RESEARCH TRIAL
Authors: Anderson Keith A , Dabelko-Schoeny Holly , Gitlin Laura N , Gaugler Joseph E , Koeuth Sokha , Marx Katherine A
Published: November 2019

Translational Advisory Boards (TABs) are select groups of researchers, practitioners, and, in some cases, service recipients (e.g., patients, caregivers) that convene regularly to advise researchers on ongoing studies. TABs provide direction and support, knowledge and insight, alternative points of view, and suggestions for overcoming obstacles and improving research functions. TABs are especially valuable in applied research in which “real world” conditions create challenges ranging from the anticipated (e.g., participant drop out) to the unanticipated (e.g., government shutdown). In this presentation, the researchers evaluate one TAB involved with an ongoing pragmatic research trial of Adult Day Services Plus (ADS Plus), an intervention for family caregivers to persons with dementia. Including individuals with diverse points of view was critical in the composition of the TAB. The TAB consisted of four seasoned researchers, four ADS industry professionals, and six program directors from the ADS Plus treatment and control groups. Creating meetings that were productive was imperative. TAB sessions were held bi-annually and had highly structured agendas soliciting guidance on specific issues. Qualitative analysis of the TAB sessions revealed three themes: assistance with recruitment; fidelity of the intervention; and sustainability of the intervention. This guidance helped the researchers to shift directions in recruitment and to consider further refinement of the intervention to increase sustainability. In looking at costs, the annual research personnel, TAB personnel, and overhead expenses were estimated at $2,500-$3,000 and $4,000-$5,500, respectively. In conclusion, TABs can be an effective tool to support research and should be considered for use in large-scale projects.
CONSIDERING AN INTERDISCIPLINARY DEMENTIA INTERVENTION, COMBINING BEHAVIORAL AND OCCUPATIONAL THERAPY
Authors: Frankenstein Lou
Published: November 2019

Behavioral therapy for people diagnosed with dementia and their informal caregivers can enhance the quality of life and the accomplishment of daily routines. The effectiveness of occupational therapy in dementia has also been proven several times. Still those therapies are often not part of the regular treatment. Through literature analyses and three focus group discussions with experts of both professions four occupational (ESP, WHEDA, Ergodem and HED-I) and two behavioral interventions (CBTAC, cordial-program) were compared to clarify how much and in what ways behavioral and occupational therapy in dementia overlap and differ. The interventions are similar with respect to intervention characteristics: They are non-pharmacological, client-centered, put a major emphasis on involving the caregivers and are similarly structured. Whilst occupational programs focus on practical issues, such as empowerment to perform daily activities or adjustment of the environment, cognitive-behavioral interventions specialize on planning activities, communication and reminiscence. These differences result from the theoretical basis and the primary goals of the professions. Behavioral therapy developed from learning theories and cognitive techniques. In contrast occupational therapy is based on environmental theories and the idea of empowerment. In addition two activating programs were included (CST, MAKS-active) to promote physical activity and social interactions since both positively influence the course of the disease. The focus group participants supported the idea of an interdisciplinary cooperation. The results suggest, that an intervention offered by both professions, ideally in cooperation, encompassing key elements identified in the studied programs would be an advance in dementia therapy.
PROMOTING OLDER ADULTS’ INTERGENERATIONAL COMMUNICATION AND MOTIVATION TO REGULAR EXERCISE THROUGH EXERGAMING
Authors: Li Jinhui , Li Chen , Chia Bing Xun , Chen Xinran , Pham Tan Phat , Salmon Charles T , Theng Yin Leng
Published: November 2019

Exergaming has become an important part of community programs to promote regular exercise and improve well-being for healthy aging. This study examines how different types of social playing and competitive information in exergaming affect older adults’ inter-generational communication with youth, as well as their motivation to regular exercise through exergaming. A 2 (time: pre-test vs. post-test) * 3 (social play: play alone vs. play with elderly vs. play with youth) * 2 (competition: competition informed vs. non-competition informed) mixed experiment with 319 Singaporean older adults conducted over six weeks in 2018, analyzed through a series of three-way repeated ANOVAs. Results show significant three-way interaction effects among time, social type, and competitive information on older adults’ inter-generation communication (F (2, 300) = 3.206, p = .042, η2 = .021), extrinsic motivation (F (2, 301) = 3.364, p = .036, η2 = .022) and intrinsic motivation (F (2, 303) = 4.528, p = .012, η2 = .029). The inter-generational communication of participants in play with youth shows significant improvement over time in both competition conditions, while those in play with elderly was only significantly improved in competitive informed condition. Social play is found to significantly affect the changes of both intrinsic and extrinsic motivation over time, while competitive information only affects intrinsic motivation significantly. The findings make contributions to aging research and understanding of potential factors that promote inter-generational communication and adherence to regular exercise via exergaming.
OLDER ADULT KIDNEY TRANSPLANT RECIPIENTS: THE LIVED EXPERIENCE OF ADAPTATION AND INTEGRATION
Authors: Kimberly Laura L , Burnette Denise , Lukens Ellen , Gelb Bruce
Published: November 2019

As the prevalence of end-stage renal disease increases in the United States, a growing number of adults aged 65 and over are receiving kidney transplants. While older adult recipients tend to fare well from a clinical standpoint, far less is known about their psychosocial wellbeing following transplantation. This study seeks to better understand the lived experience of older adult kidney transplant recipients, focusing on the ‘liminal’ period of adaptation following organ transplantation that has been reported elsewhere in the literature. Applying the hermeneutic phenomenology of philosopher Paul Ricoeur, the study explores the lived experience of 10 deceased donor kidney transplant recipients aged 65 and over. Guided by Ricoeur’s conceptual approach to identity as constituted through two forms, idem and ipse, preliminary findings suggest that despite expressing some distress around the ‘strangeness’ of integrating part of another into oneself (disruption of the idem sense of self), participants also constructed powerful narratives of resilience and coping that were rooted in the continuity of a deeply held ipse sense of identity over the life course. In particular, participants emphasized their ability to overcome adversity as an anchor of their ipse sense of self that enabled them to navigate the idem corporeal changes of transplantation. Moreover, they described kidney transplantation as a form of liberation, ultimately restoring their idem sense of self that had been profoundly disrupted by ‘machine life’ (time spent on dialysis). These findings will have significant implications for ensuring the provision of optimal support to older adult kidney transplant recipients.
THE IMPACT OF NEGATIVE SOCIAL EXCHANGES ON ADULT PHYSICAL AND MENTAL HEALTH
Authors: Nehrkorn-Bailey Abigail M , Patrick Julie Hicks , Marello Madeline M
Published: November 2019

As some health components may change across adulthood (CDC, 2019), social support for aging adults may be one way to optimize physical and mental health (U.S. Department of Health and Human Services, 2018). When social encounters are negative, however, physical and mental health may be negatively affected (Chen & Feeley, 2013; Hawkley & Cacioppo, 2010). Negative social exchanges (NSE) have been linked to an increase in negative affect and a decrease in positive affect (Newsom et al., 2003), along with an increase in physical symptoms (Edwards et al., 2001). In order to examine the relations between age, NSE, and two components of health (chronic health conditions and mental health) two moderated regression analyses were conducted using data from 848 adults (Mage = 32.5 years). Studying chronic health conditions, the overall model was significant, [F(3, 838) = 40.31, p < .001; R2 = .36]. Significant main effects emerged for NSE and age, along with a significant interaction between age and NSE (b = 0.010, p < 0.05). As NSE increased, the number of chronic health conditions increased, especially for older adults. For mental health, the overall model was significant [F(3, 845) = 52.96, p < .001; R2 = 0.16]. A significant main effect emerged for NSE, but neither the main effect for age nor the interaction were significant. Thus, although NSE can have deleterious effects on both mental and physical health, special attention needs to focus on the physical health of older adults who experience a higher number of NSE.