bluuebunny/crossref_metadata_2025 huggingface dataset:
BEST INTENTIONS OR BEST PRACTICE? HOW DO STAFF PERCEIVE BEST CARE FOR PEOPLE WITH DEMENTIA IN TAIWAN?
Authors: Liou Chih-ling
Published: November 2019

Care of people with dementia is a global issue, and the quality of dementia care in the long-term care facility is of concern internationally. The Taiwanese government seeks to expand the availability of adult day services (ADS) to meet the needs of an aging population with dementia; however, research about care in ADS in Taiwan is limited. This study aims to investigate how ADS staff perceptions of best care affected care delivery and clients’ quality of life. A focused ethnographic method was employed to collect data through 480 hours of participant observation and 31 staff interviews at three centers. Content analysis was used to analyze the data. The findings revealed a contradiction on how staff perceived best care and what they really performed at center. Thirteen staff members who were interviewed identified that in their view the best care is to “put yourself in the shoes of the client,” and another nine staff members chose “keep clients happy” as the best care. From the observation data, however, the staff performed the “good care” by forcing the clients to follow their orders absolutely unless the clients refused violently. Staff-led activities were structured as tasks to be completed rather than activities to be enjoyed. The clients complained about the bureaucratic management that shaped their lives at centers but could only endure or accept. To support clients’ quality of life and improve the care quality, ADS staff need to be educated more with the evidence-based best care for people with dementia.
FROM BEING ACTIVATED TO SELF-ORGANIZATION IN ELDER CARE: CONCEPTS OF AGING AND THEIR IMPACT ON RESIDENTS’ AGENCY
Authors: Strasser Irene , Hopfgartner Ines , Payer Carmen
Published: November 2019

In a research project together with an elder care facility in Austria, we were following a participatory approach to investigate important factors and processes to increase quality of life for residents with dementia. The aim was to better understand how we can foster participation, agency and freedom of choice within a care setting. Together with care workers, residents and relatives we were working on how to identify overall strategies and aims, as well as particular processes and procedures that allow for a higher involvement of all these groups of individuals. Doing research explicitly together with care workers we also aimed to trigger reflection of individual and organizational concepts of aging. We interviewed residents, relatives and care workers, conducted research workshops, and engaged in participant observation. In the talk the focus will be on care workers’ perspectives. We wanted to better understand the multiple stressors within daily routines in care work. Particularly, we wanted to find out more about the multifaceted processes of integrating one’s experiences into everyday care work, and integrating care work into one’s life story, to make meaning of the important work they are providing under constantly stressful working conditions. Finally, together with care workers, we developed a model for participation, that is explaining a wide range of residents’ possibilities for involvement: From activity orientation to actual participation and the realization of individually meaningful activities. What helps to initialize participation, and what we identified as obstacles in supporting residents’ autonomy will also be discussed in the talk.
LONG TERM CARE FEASIBILITY OF NURSING HOME LVNS USING AN ALGORITHM-GUIDED ASSESSMENT SUPPORT TOOL
Authors: Ashcraft Alyce S , Owen Donna C , Johnson Kyle , Song Huaxin
Published: November 2019

Licensed Vocational Nurses (LVNs) are the frontline staff communicating with off-site physicians to manage new or unexpected symptoms in nursing home (NH) residents. Care decisions following physician-LVN conversation impact Alzheimer’s disease (AD) resident quality of care. LVN difficulties using standardized communication forms (e.g. SBAR) spurred creation of an alternative not requiring high levels of RN supervision. The aim of this study was to examine the feasibility of an algorithm guided assessment support tool (AGAST) to help LVNs collect and cluster information using a simulated clinical scenario. A descriptive, participant observation design (video-taped) was used with ten practicing LVNs. AGAST was implemented in the Simulation Center in a clinical scenario of a NH resident with AD experiencing a urinary tract infection. The algorithm was placed within an online survey and participants were directed through a series of sequenced question and answer choices to identify and collect information pertinent to describing a change in resident condition. Duration of videos, description of AGAST-linked assessment behaviors, and content analysis of post-intervention transcripts were reported. AGAST prompts were seen with LVN physical assessment behavior and followed by questions about relevant day-to-day activity/level of performance. AGAST mean completion duration was 11.20 (SD=4.67) minutes. AGAST was rated as easy or very easy (90%). Major concerns included small font size on lab screens, insufficient open text space to add more information, and direct computer input. AGAST was a feasible alternative for assessment by LVNs. Further testing is needed in a variety of conditions.
EVALUATING AN INNOVATIVE USE OF CIVIL MONETARY PENALTY FUNDS: THE MA SUPPORTIVE PLANNING AND OPERATIONS TEAM (SPOT)
Authors: Bertrand Rosanna M , Katz Gabrielle R , Mota Teresa M , Moore Terry , Pettis Jennifer , Fillo Katherine T , Saunders Katherine C , Moore Chiara S
Published: November 2019

The Office of the Inspector General reported in 2014, that one in three NH residents experienced an adverse event within 35 days of admissions causing lasting or temporary harm. Thus, state departments of public health (DPH) were implored to invest in improving NH quality and safety. Using Civil Monetary Penalty funds, the Massachusetts DPH, developed the SPOT Initiative to innovatively provide NH teams with technical assistance and training to enhance their federally required Quality Assurance & Performance Improvement (QAPI) programs. Selection criteria included NH Compare 5-Star and MA scorecard ratings and geographic spread. To assess program effectiveness, the SPOT Team collected a range of data in each of the three SPOT years (e.g., QAPI assessments, leadership interviews and surveys, and training evaluations). Results demonstrated the success of the Initiative. Assessment data indicated an increase in QAPI readiness in each subsequent year overall and within of the each QAPI assessment domains (Design and Scope; Governance and Leadership; Feedback, Data Systems, and Monitoring/Systematic Analysis; Performance Improvement Projects and Systematic Analysis/Systemic Action). In Year 1, the overall data collected from the assessments demonstrated that 78% of the NHs that engaged with SPOT had “Not Started” or “Just Started” (1.8/5) implementation of the key QAPI measures. By Year 3, only 13% of NH teams rated themselves in these initial categories, whereas, 57% rated themselves as “Almost There” or “Doing Great” (3.92/5). Further, feedback from most SPOT NH teams was extremely positive as evidenced by high evaluation rankings following initiative learning sessions.
FACTORS ASSOCIATED WITH RESIDENTIAL CARE COMMUNITIES THAT HAVE RESIDENTS VISITING EMERGENCY DEPARTMENTS
Authors: Melekin Amanuel , Caffrey Christine , Rome Vincent
Published: November 2019

Emergency department (ED) visits are an important part of healthcare utilization. However, ED visits can be costly, lead to hospitalizations, and are sometimes unnecessary. Studies characterizing ED visits among long-term care settings have been largely focused on nursing homes where the unit of analysis is typically the resident. Facility- or community-level analyses describing residential care communities (RCCs) with ED visits are limited. Using RCCs as the unit of analysis, this study examines community-level factors associated with RCCs that have residents with ED visits. Community-level factors include ownership and chain affiliation, Medicaid participation, electronic health records use, service provision, nurse staffing, U.S. census region and metropolitan status. The study uses data from the 2016 National Study of Long-Term Care Providers conducted by the National Center for Health Statistics. In 2016, about 81% of RCCs had at least one resident visiting the ED in the past 90 days and around 19% of RCCs had no residents with ED visits in the past 90 days. Bivariate analyses indicated that ED visits varied by chain affiliation, ownership status, electronic health records use, and Medicaid participation. Logistic regression modeling to examine factors associated with whether or not RCCs had any residents with ED visits in the past 90 days will also be presented. Results may benefit efforts focused on implementing practices to reduce ED visits in RCCs.
THE SOCIAL DETERMINANTS OF LATE-LIFE MIGRATION IN THE U.S.: FINDINGS FROM THE NEW AMERICANS PROJECT
Authors: Maleku Arati , Espana Megan , Karandikar Sharvari , Kagotho Njeri , Parekh Rupal , Jarrott Shannon
Published: November 2019

Globally, late-life migration has been a growing phenomenon. Literature on aging and migration however, has primarily focused on immigrant populations who migrated early in life. To expand our conceptualization of aging and to plan for the care of growing older immigrant populations, it is crucial to understand the compounding effects of late-life migration and aging in new spaces. Drawing on the qualitative data (N=71) from a large-scale community-based participatory research project in a mid-western U.S. region, we examined the social determinants of late-life migration on the health and well-being of older immigrants by exploring: (a) barriers and facilitators of socio-cultural adaptation, (b) patterns of human service provision in a local context, and (c) societal patterns of caring for older immigrants in places of relocation. Life course and social convoy perspectives formed the conceptual basis of the study. Using Respondent Driven Sampling method, data collection included six focus group discussions (n=48) with immigrant communities and in-depth interviews with human service providers (n=23). Data analysis followed the Rapid and Rigorous Qualitative Data Analysis technique that generated six salient themes: cultural context of aging; challenges of late-life migration; broken convoy and social isolation; gender and age intersections; human services, and community efforts and solutions. Findings suggest that late-life migration is a conglomeration of losses and gains, contingent on complex determinants such as living arrangements, language, transportation, the built environment, inter-generational relationships, socio-economic status, and social convoys. We conclude with a call to develop age-friendly, culturally responsive human services and health policies.
GEROTRANSCENDENCE OF ALASKA NATIVE ELDERS AGING SUCCESSFULLY IN THE ALEUTIAN AND PRIBILOF ISLANDS
Authors: Lewis Jordan P , Wortman Eric
Published: November 2019

Meeting the healthcare needs of Alaska Native (AN) Elders in remote communities is critical to support successful aging and this study allows AN Elders from the Aleutian region to share their experiences and define successful aging, supporting the limited research on AN successful aging. This study interviewed 19 Elders in two communities from the Aleutian region of Alaska. Using a 20-item questionnaire based on Kleinman’s explanatory model to explore successful aging and experiences of being an Elder. Thematic analysis was employed to identify the characteristics and activities of Elders coping and adapting to aging-related changes. This study identified 5 core elements of successful aging, 4 of which formed Lewis’s AN model of successful aging (2011): Mental and Emotional Wellbeing, Spirituality, Purposefulness, and Physical Health and Mobility, and the new element of Gerotranscendence. The unique finding of this study that expands Lewis’s model is the change in mindset Elders experience as they self-reflect. Elders describe being more intentional in their relationships and a stronger connection to traditional cultural and spiritual activities, described by Tornstam (2005) as gerotranscendence. This research will be used locally to develop community specific health promotion and prevention programs to improve Elder services. These findings can also be used by health care providers to help Elders find meaningful activities that promote health and teach individuals to cope with aging-related changes.
EXPLORING FUNCTION OVER TIME IN OLDER ADULTS WITH ADVANCED HEART FAILURE
Authors: Floegel Theresa , Schoemann Alexander , Taylor Catherine
Published: November 2019

Heart failure contributes to functional limitation in older adults, which is associated with rehospitalization and poorer health. However little is known about the trajectory of function after hospitalization in this population or its’ association with readmission. Objective measurement over time to assess physical function trajectory in older adults with heart failure is needed. Purpose: To explore trajectory of function in older adults with heart failure who have history of hospitalization. Methods: Exploratory longitudinal design. Bi-weekly visits were conducted over 4 months with home-dwelling, ambulatory adults with heart failure (60+ years, NYHA classification III) who had a recent acute hospitalization. Function was assessed by Short Physical Performance Battery (SPPB) test and hand-grip strength (9 time-points). Descriptive analyses across time and groups comparison were performed. Results: Participants (N=10) were 75.3±4.6 years (2 female, 5 African American), with EF(%) 39±10 and 8.2±2.9 comorbidities. Half (n=5) were re-hospitalized during the study period. Those re-hospitalized scored an average 1.3 points lower on SPPB and had 2.03 kg less hand strength over time than those not re-hospitalized. An SPPB score <6 was observed across time in 51% of those re-hospitalized, compared to 31% of those remaining at home. Intra-individual function varied but did not decline over this time period. Conclusions: In a sample of older adults with heart failure, physical function ranged from some level of functional disability to functional dependence, with higher levels of disability observed in those re-hospitalized. A longer study period and larger sample may be needed to adequately assess physical function trajectory.
EFFECTS OF A SITTING REDUCTION INTERVENTION FOR OBESE OLDER ADULTS WITH DEPRESSION
Authors: Hemmady Sarita A , Rosenberg Dori , Hannon Peggy , Zhou Jing
Published: November 2019

Background: Little is known about the impact of sedentary behavior (SB) reduction interventions on older adults with obesity and depressed mood. An exploratory analysis examined behavioral and mental health effects of a SB reduction among participants with depressed moods. Methods: Participants were obese older adults (n=30, mean age=66, 77% female, 23% male, mean PHQ-8-Score=13.67) that were randomized to receive a sitting reduction intervention ( I-STAND); N=16) or a control condition (N=14) as part of a larger trial. Participants wore activPAL devices to assess sitting time at baseline and 12-weeks; they also completed the Patient-Health Questionnaire-8 (PHQ-8) to assess depressive symptoms. Linear regression models compared baseline and 12-week measures between groups adjusting for baseline values. A post-hoc qualitative analysis assessed ISTAND participant interview data. Results: I-STAND participants had greater reductions in sitting time than control participants by 57-minutes (p=0.04), as well as greater reductions in percent sitting time by 5.89-percent (p=0.03). Mean PHQ-8 scores were decreased by 0.14-points among the I-STAND group compared to the control (P=0.90). Qualitative themes included physical and social barriers to standing; varying perceptions of the presence of depression; physical health improvements (i.e. mood improvement) and perceptions of physical activity (i.e. feasibility to exercise). Conclusion: We found significant associations between sitting reduction and a SB intervention among older adults with obesity and depression, however this did not impact depressive symptoms. Further research should examine whether sitting reduction can improve mood or standing time among older adults with obesity and depressed mood.
THE RELATIONSHIP OF DAILY STEPS TO MOOD AND ENERGY: APPLICATION OF STEPMATE (MOBILE APP FOR TRACKING EXERCISE)
Authors: Bisson Alycia N , Sorrentino Victoria A , Lachman Margie E
Published: November 2019

Physical activity is one of the most promising and accessible strategies to promote healthy aging. Yet, the majority of middle-aged and older adults do not engage in the recommended amount of exercise despite awareness of its widespread benefits. Smartphone apps have the potential to be valuable tools in tracking and encouraging physical activity; however, few apps incorporate successful behavior change strategies. Drawing from interviews with older adults, we created a new smartphone app to encourage and track daily walking, StepMATE (Mobile App for Tracking Exercise). StepMATE uses behavior change strategies including action planning and social support to help users determine where, when, and with whom they will walk. The app records steps and also uses experience sampling to assess mood and energy levels twice a day. Adults ages 50 and over (N=58) participated in a one-month study where they used the app to set their own walking goals and track their daily walking. Using multilevel modeling, we found that on days in which adults take more steps than their average, they report higher mood and energy. We also found that on days in which participants achieve their step goal, they report higher mood and energy than on days when they do not achieve their goal. Discussion will center on motivational approaches to behavior change among sedentary older adults.
LIFE AFTER 100: IS GOD THE SECRET TO A SATISFYING AND PURPOSEFUL LIFE?
Authors: Firdauysa Nadia , Bhatta Jyoti , Bishop Alex J , Finchum Tanya , Grice James
Published: November 2019

Data from N = 111 centenarians (M = 100.88; SD = 1.48) residing in Oklahoma was used to examine patterns in the relationship between the God oriented vs. non-God oriented longevity secrets and subjective well-being. Observational Oriented Modeling (OOM) was then used to conduct an ordinal analysis using concatenated ordering to produce degree of fitness between data and underlying patterns in life satisfaction and purpose-in-life across three time points. OOM is a data analysis method used to evaluate fitness of proposed patterns to data called PCC. Results indicated that centenarians maintaining a God-oriented longevity secret fit a decreased pattern in life satisfaction (PCC = 25.00, c-value = .09); whereas centenarians not maintaining a God-oriented longevity secret fit the same pattern (PCC = 49.18, c-value = .06). Meanwhile, centenarians having a God-oriented longevity secret fit a decreased pattern of purpose-in-life (PCC = 71.43, c-value =.12); whereas centenarians having a non-God oriented longevity secret fit the same pattern (PCC = 53.45, c-value = .28). In comparison to centenarians who acknowledged something other than God as the secret to their longevity, those who cite God as the reason for longevity tend to proportionately maintain a more satisfying view of life, yet experience a deteriorating sense of purpose over time. Results indicate that longevity secrets reflect divergent patterns in subjective well-being among persons living beyond 100 years. This has implications relative to how geriatric practitioners design interventions, services, or programs to enhance quality-of-life for long-lived adults.
SUBJECTIVE HEARING IMPAIRMENT AND LONELINESS IN COMMUNITY-DWELLING OLDER ADULTS
Authors: Huang Alison , Deal Jennifer A , Rebok George W , Pinto Jay , Waite Linda J , Lin Frank
Published: November 2019

Loneliness in older adults is most often attributed to marital and living status, social life factors, and physical health. Hearing impairment, however, is an understudied, potentially modifiable risk factor for loneliness. Older adults with hearing impairment experience difficulties with communication and social functioning, which also could contribute to loneliness. For this analysis, we used data from Wave 2 of the National Social Life, Health, and Aging Project. Participants (N=3,174) were a nationally representative sample of community dwelling older adults aged 62 - 91 years. Poisson regression models with robust variance were used to model the cross-sectional relationship between self-reported hearing impairment and loneliness. We found a dose-response relationship such that individuals reporting very good/good and fair/poor hearing had a 9% [95% CI: 0.93 - 1.28] and 26% [95% CI: 1.10-1.46], respectively, higher prevalence of loneliness compared to individuals reporting excellent hearing, adjusting for chronic conditions, functional and cognitive ability, and demographic factors. Results were robust to exclusion of participants who reported hearing aid use. These findings suggest that self-reported hearing impairment is a strong factor associated with loneliness in older adults. Given the negative implications of loneliness on multiple facets of mental and physical health, functional ability, and premature mortality, efforts to further explore hearing impairment as a causal and modifiable risk factor for loneliness should be undertaken.
GENDER DIFFERENCES IN THE MECHANISM OF INVOLUNTARY RETIREMENT ON LONELINESS
Authors: Shin Oejin , Lee hyunjoo , Park Sojung , Kang Ji Young
Published: November 2019

Involuntary retirement is known to be associated with long-lasting negative effects on well-being compared to voluntary retirement. However, little is known about complex mechanism connecting the path from social contexts and psychological factors of retirees, especially involuntary retirees to later year well-being. Also, despite the well-known gendered pattern of preretirement employment histories over the life course in general, gender differences in the pathway on well-being after involuntary retirement is still unclear. Drawing on the stress process theory, this study examined gender difference on the pathway linking involuntary retirement (primary stressor) to loneliness through material/physical vulnerability (secondary stressor) and social support/self-efficacy (coping resources). Data are from the 2014 HRS with 2,087 retirees aged 65+. Two-step structural equation modeling (SEM) was utilized to examine the significance of the specific effects of multiple mediators (material/physical vulnerability, coping resources). For male retirees, involuntary retirement was associated with a higher level of loneliness mediated through physical vulnerability and social-efficacy. For female retirees, involuntary retirement was directly associated with loneliness as well as indirectly associated through 1) material vulnerability connected to low social support, and 2) physical vulnerability related to low social support and low social-efficacy. The different impact of involuntary retirement may be due to differences in work history, previous work quality, and accumulated financial condition across gender. The results suggest important gender specified implications for social policy and practice for involuntary retirees.
EXPLORING THE EFFECTS OF RURAL AND URBAN LIVING ON LONELINESS AND REINSTITUTIONALIZATION
Authors: Ligus Kaleigh , Grimaldi Alexandra , Robison Julie
Published: November 2019

The following study employs secondary data from the Money Follows the Person Rebalancing Demonstration (MFP) in Connecticut (CT) to assess relationships between rural and urban living on loneliness and reinstitutionalization among an older adult (65+) sample. MFP is a federal initiative to help states transition people from institutional settings to the community. Older adults (n=1,301) who transitioned from institutional care to the community between 2009 and 2015 were surveyed 6, 12 and 24 months after transition. Rurality was determined according to the CT State Office of Rural Health and US Census Bureau definitions: urban area (UA), urban cluster (UC) and rural, utilizing 2017 CT Population data. SPSS was used to conduct chi-square tests and one-way ANOVAs to examine relationships. Almost half of participants (48%) resided in UAs, another 43% lived in UCs and 8% lived in rural towns. A statistically significant relationship was found between rural and UC groups and loneliness, indicated by a three-item modified version of the R-UCLA loneliness scale. Rural residents reported lower rates of loneliness (3.84 out of 9) than did UC (4.61) or UA (4.64) residents. However, a significantly higher percentage of rural residents (44%) reported at least one instance of reinstitutionalization at 24 months compared to UC (36%) or UA (30%) residents. Multivariate analyses seek to clarify these contradictory results. The findings of this study have the potential to further inform the literature regarding loneliness and connections between reinstitutionalization among older adults living in rural and urban environments.
DOES A PERCEIVED CONNECTION TO A NEIGHBORHOOD REDUCE LONELINESS?
Authors: Johnson Kimberly J , Adeniji Dolapo O
Published: November 2019

This study investigated whether perceived neighborhood quality was associated with chronic loneliness for adults 60 and older in the United States. Although loneliness can be episodic and overcome, chronic loneliness has been identified as a social determinant of health. Utilizing ecological systems theory we hypothesized that higher levels of neighborhood social cohesiveness would be associated with lower odds of chronic loneliness. We postulated that the networks available to people in the proximal area where they live could provide social opportunities for reducing loneliness. This idea was consistent with prior findings indicating the salience of neighborhoods for retirees, but inconsistent with research indicating the importance of a confidant in reducing loneliness. Data from the 2008 and 2012 Health and Retirement Study Psychosocial Surveys were used (n = 3530). Loneliness was measured using the 3-item scale developed by Hughes and colleagues in 2004. Findings from unadjusted logistic regression indicated that loneliness was inversely related to neighborhood cohesion as measured by an index of the trustworthiness, friendliness and helpfulness of neighbors and cleanliness, occupancy, lack of graffiti, and sense of belonging in the area (OR = .73, p < .001). When demographic and health-related factors were entered into the model the odds of being lonely were significantly lower for those with higher ratings of social cohesion (OR = .83, p < .001). These findings were consistent with the idea that neighborhoods are an important social place for older persons and interventions at the neighborhood level may be more effective than individualized treatment plans.
PARTICIPATION AND SOCIAL CONNECTIONS IN A RECREATIONAL SENIOR SOFTBALL LEAGUE
Authors: Tarabochia Dawn S
Published: November 2019

Senior only communities have long been an option for adults over a certain age. A variety of activities and clubs are often available to residents of these communities. The purpose of this research project was to understand the lived experience of recreational softball players regarding players decision to play senior softball and to determine what social opportunities were associated with recreational senior softball leagues. A phenomenological research study was constructed to seek further inquiry into two research questions associated with this project. Participants were members of a senior living community and members of a recreational senior softball league. Convenience and snowball sampling techniques were utilized, and 25 interviews were conducted. The interview transcripts were analyzed for phenomenological themes by the research team. The researchers used Van Manen’s (1990) hermeneutical approach to analyze data. Trustworthiness was established by the use of a peer reviewer to assess the themes for accuracy. Themes associated with the first research question indicate that interviewees participated in softball for a variety of reasons, including having played softball as a younger adult, wanting to maintain a level of physical fitness, and for the social connections that participation in a softball league provided. Themes associated with the second research question found that participants enjoyed many social benefits from playing softball, including informal and formal social opportunities. In conclusion, the willingness and opportunity to play senior softball provided older adults the ability to maintain a certain level of physical activity and to engage in meaningful social interactions.
SERVICE LEARNING AS A MEANS TO ENHANCE CONNECTIONS TO OLDER ADULTS
Authors: Getz Marjorie A
Published: November 2019

Aging is a distinct part of the life cycle. College students enrolled in courses in gerontology often have difficulty relating to aging, that part of life not yet experienced. They may not fully appreciate that adults become more unique, not more similar, as they age. We describe courses in an undergraduate gerontology certificate program that incorporate experiential learning activities with older adults across a hierarchical sequence of courses. These courses feature service learning opportunities focused on increased understanding of course content, broader appreciation of the discipline and improved sense of civic responsibility. Much like the course content of the curriculum, the incorporated experiential learning opportunities for each course level fit a hierarchy leading to student competence and skills development needed for success in the final independent practicum. For the described courses, students provided community service, experienced direct contact with older adults and used reflective practices to integrate course content into service learning activities. We report on qualitative data obtained from students enrolled in the foundational course, Biophysical Aspects of Aging and the third level course, Aging and Mental Health. Content analyses of reflective essays identified five themes: (a) insights about the realities of aging in America (b) perceptions concerning personal negative stereotypes about older adults; (c) feelings of accomplishment/awareness of new skills in providing community services; (d) understandings related to the importance/value of community service; and (e) successes in integrating the course work on aging into service-learning experiences. Other experiential learning activities incorporated into this gerontology certificate program are highlighted.
UNDERGRADUATE EXERCISE AND AGING STUDENTS KNOWLEDGE AND PERCEPTIONS REGARDING OLDER ADULTS
Authors: Davis Tracy , Zechner Michelle
Published: November 2019

The aging population presents far ranging implications and opportunities for individuals, families, policy makers, and healthcare providers. The U.S. Census Bureau estimates an increase in the population aged 65+, which is projected to reach 83.7 million by 2050. With this changing demographic environment, human services and health care professionals with specialized training in aging are needed, regardless of career goals all students deserve exposure to aging education. Undergraduate students have varying knowledge and attitudes towards older adults. Many times undergraduate students have had limited interactions with older adults and their attitudes and perceptions are based on interactions with grandparents and other relatives. In order to better understand undergraduate student’s knowledge and attitudes regarding older adults we surveyed a group of 50 undergraduate students enrolled in an exercise and aging course offered through the Department of Kinesiology and Health. Students were surveyed using the Facts on Aging Quiz (Breytspraak & Bandura, 2015) and the Aging Semantic Differential (ASD) (Rosencranz & McNevin, 1969). Preliminary findings suggest that students have relatively low knowledge about older adults, as the average score of the Facts on Aging Quiz was 30.4 out of 50 (SD= 3.86). However, scores on the ASD indicate that the student have generally more positive attitudes towards older adults (M=74.29; SD=20.9). At the end of the semester the same students will be surveyed again to evaluate the impact of the course. Findings from this study will be used to augment course content to increase student knowledge and attitudes about older adults.
MAKING IT WORK: SECURING A GERONTOLOGY INTERNSHIP FOR THE NONTRADITIONAL DISTANCE EDUCATION LEARNER
Authors: Im Katherine
Published: November 2019

Some gerontology programs have required students to complete internships in order to satisfy the “interactional” Category II Competencies for gerontology as outlined by AGHE in 2014. For many non-traditional learners, a required internship in gerontology poses major challenges that may contribute to declines in enrollment and retention. Non-traditional learners are often older, employed, and have multiple responsibilities that compete for their time. This is especially true for students who attend university from a distance. This presentation reports the challenges faced by non-traditional, online students at a large state university who have an interest in gerontology. For these learners, the internship requirement is a deterrent to becoming a gerontology major. Challenges include student constraints, identifying potential placement sites in remote locations, and negotiating a complex administrative process. I review the programmatic measures taken to address these challenges and discuss the ways in which the internship process can be facilitated for non-traditional students. By developing a better process for securing internships, students have more freedom to focus on workplace learning. In addition, prospective gerontology students may come to regard the internship as an excellent opportunity for professional growth rather than a burden , thereby improving retention and interest in the major.
ADVANCE CARE PLANNING ASSIGNMENTS IN UNDERGRADUATE COURSES: EXAMINING STRESS APPRAISALS, COPING, AND RESPONSES
Authors: Templeman Maureen , Marino Victoria R , Dobbs Debra J , Haley William E
Published: November 2019

A common assignment in undergraduate aging courses requires students to consider or complete advance care plans for themselves. Due to the sensitive nature of this topic, it is important to consider student appraisals of such assignments. Using the transactional model of stress and coping, the current study used content analysis to examine student reactions to considering their own advance care planning. Participants included 151 students, diverse in race/ethnicity, in a Psychology of Aging undergraduate course at a large public university in the United States. Students were first exposed to course material related to death, dying, and bereavement, in addition to detailed advance directive forms, and were subsequently asked to discuss the importance of, and their preparedness for, their own advance care planning via a written assignment. Codes represented primary and secondary appraisals, coping efforts, and responses, and data was analyzed using ATLAS.ti software. Findings suggest that primary appraisals (perception of effect on well-being) ranged from positive to threatening, and secondary appraisals (perception of coping resources) focused on availability of internal and/or external resources. Themes such as traumatic experiences with death, feeling ill-prepared due to lack of knowledge or experience, and welcoming the opportunity to consider completing advance care plans emerged. Overall, results suggest that when designing assignments that require completion of advance care plans among undergraduate students, students should have the opportunity to discuss personal concerns first, and that some initial class activities should focus on preparatory tasks rather than just completion of advance care plans.
SERVICE LEARNING TO INCREASE EXERCISE IN OLDER ADULTS: TESTING A GROWTH MINDSET INTERVENTION
Authors: Coats Abby L Heckman , Wang Zhaoming , Miller Therese
Published: November 2019

Exercise is one of the best ways to maintain psychological and physical health in late life (Kohl et al., 2012). However, many older adults experience barriers to developing an exercise routine, such as fear/anxiety, limited perceived control, and lack of self-efficacy (Bock et al., 2014). Recently, successful psychological interventions to encourage exercise have been demonstrated (Brothers & Diehl, 2017; Lachman et al., 2018). Inspired by this success, we developed a service learning activity to address this community-based problem. Undergraduate psychology students visited local senior centers. During the visits, the students implemented an intervention to increase physical activity in older adults. Traditionally-aged undergraduate students ate lunch with the older adults and engaged in informal discussions. Then, after establishing rapport, they implemented an exercise-boosting intervention to the experimental group. (A control group did not receive the intervention.) The older adults in the experimental group heard quotes from peers explaining how they had overcome barriers to exercise. The peers’ stories included growth-mindset language (Yeager, Paunesku, Walton, & Dweck, 2013), such as an initial reluctance to exercise, followed by hard work and finally implementing a successful exercise regimen. Then the older adults wrote their own letters to a peer, explaining how they have overcome barriers in the past and how they could continue to do in the domain of exercise. This activity was helpful for both the older adults and the undergraduate students, as documented by qualitative interviews and questionnaire responses. The students reported more positive attitudes about aging after the activity.
DAILY FLUCTUATIONS IN SUBJECTIVE AGE AND MENTAL HEALTH: THE ROLES OF CHRONOLOGICAL AGE AND ATTITUDES TO AGING
Authors: Segel-Karpas Dikla , Shrira Amit , Bodner Ehud
Published: November 2019

Studies indicate that subjective age – individuals’ perception of their own age as older or younger than their chronological age, is related to their depressive symptoms. Less is known about the role that attitudes towards aging might play in this regard. 334 participants (age 30-90, M=58.15) reported their subjective age and depressive symptoms every day for a period of 14 days. Attitudes to aging were measured at baseline. Results indicated that daily subjective age was related to daily variation in depressive symptoms. Furthermore, we found that attitudes to aging (psychosocial losses, gains and physical changes) moderated the subjective age-depression relationship, such that it was stronger when psychosocial losses were high, and when physical changes and gains were low. The moderating effect of losses was especially prominent for older participants. This indicates that the general perception of aging moderates the toll that feeling old takes on mental health.
CO-OCCURRENCE OF ABUSE AND NEGLECT AS REPORTED BY DEMENTIA FAMILY CAREGIVERS
Authors: Pickering Carolyn E , Yefimova Maria , Maxwell Christopher
Published: November 2019

Understanding the co-occurrence or overlap among multiple forms of elder abuse and neglect (EAN) is important for designing effective interventions. This paper reports patterns of family caregiver’s daily behaviors related to physical assault, psychological mistreatment, and neglect. Majority of participants self-reported at least one EAN behavior (74%), with most reporting using multiple forms of EAN over the 21-day period (52%). On a given day, psychological mistreatment and neglect were more likely to happen in isolation, while physical assault was more likely to co-occur with psychological mistreatment. The mixed model’s intra-class coefficient suggests the daily context, rather than personal characteristics, explain the variance in the use of EAN. These findings highlight the importance of never minimizing a single event of EAN reported in clinical practice, give the high rate of polyvictimization, and reinforces the need to understand why caregivers use one form of EAN over another on a given day.
A MIXED-METHODS STUDY ON THE INFLUENCE OF CHINESE CULTURE ON CAREGIVING AND IMPACTS OF CSMP
Authors: Wu Jinli , Liu Mandong , Zhang Geng , Chi Iris
Published: November 2019

As a pilot study, the CSMP utilizes a mixed-methods design to tackle a lack of previous evidence and form a well-rounded perspective, using a randomized controlled trial with pre, post and 3-month follow-up assessments and focus group discussions. The CSMP not only targets cultural practices that exacerbates caregiving burden but also forms its basis upon Chinese culture and philosophies. New cultural factors together with previously-identified ones surfaced in discussions, including guanxi (Chinese relationship), renqing (favor), mianzi (self-esteem), social status, respect of authority, communication pattern, age respect, and more. The implications of cultural factors are discussed, together with corresponding areas for future improvement in CSMP and suggestions for professions working with this population. On the other side of the coin, participants who finished the CSMP achieved statistically significantly lower depression level, higher self-efficacy, and lower caregiver burden, compared to the control group.
THE IMPACT OF MEDICARE ADVANTAGE ON SKILLED NURSING FACILITY FINANCIAL PERFORMANCE, STAFFING, AND QUALITY
Authors: Bowblis John R , Huang Sean
Published: November 2019

Since the mid-2000s, skilled nursing facilities (SNFs) face an increasing percentage of post-acute care patients enrolled in Medicare Advantage (MA), yet our understanding the of how this affects SNFs is limited. Managed care may provide better coordination and continuous care that enhances SNF quality, but MA plans can also negotiate lower payments, providing SNFs with fewer financial resources to invest in staffing and quality. We use data from 2011-2015 from Medicare Beneficiary Summary File, Minimum Data Set, Certification and Survey Provider Enhanced Reporting, and Medicare Cost Reports to estimate linear fixed effect panel regressions with instrumental variables. We find that SNFs with greater MA share of post-acute care admissions have worse financial performance, lower nursing staff levels, and worse quality as measured by deficiency scores. Our finding favors the hypothesis that MA creates downward financial pressure and strong MA presence in local markets can potentially to spillover to non-MA residents.
IS BEING HOME GOOD FOR YOUR HEALTH? OUTCOMES OF MEDICAID HOME- AND COMMUNITY-BASED SERVICES
Authors: Konetzka R Tamara , Gorges Rebecca J , Jung Daniel H , Sanghavi Prachi H
Published: November 2019

Expanding home- and community-based services (HCBS) alternatives to nursing homes has become a priority for many state Medicaid programs. Dramatic policy changes affecting diverse patient and family populations are being made on the basis of surprisingly little evidence about the outcomes of HCBS relative to the alternatives. Our study is designed to address that gap, providing the first national estimates of plausibly causal health outcomes for recipients of Medicaid HCBS relative to nursing home care. We also examine heterogeneity of these effects by several important subgroups. Results indicate that HCBS users have rates of hospitalization similar to their nursing home counterparts, and rates are higher for those with dementia. Furthermore, disparities by race and ethnicity that have been well-documented in nursing homes also appear to extend to the HCBS setting. The costs of potentially poor outcomes need to be part of the policy equation.
EFFECTS OF MEDICAID MANAGED CARE ENROLLMENT ON HOSPITALIZATION RISK AMONG DUAL-ELIGIBLES
Authors: Gorges Rebecca
Published: November 2019

Many state Medicaid agencies have recently expanded Medicaid managed care (MMC) to include low-income older adults that are Medicare-Medicaid dually enrolled (duals). While little evidence exists regarding the effects of these expansions on health outcomes, duals may be especially vulnerable to low-quality or low-intensity care delivered by MMC due to their high use of services and the fragmentation inherent in the two-payer system. Using difference-in-differences (DID) and instrumental variables estimation, this study provides the first national examination of the impact of MMC on hospitalization for duals using claims data. DID results indicate that managed long-term services and supports (LTSS) expansions among duals are associated with increased rates of hospitalization while comprehensive managed care results in no change in hospital use. Further analyses exploring heterogeneity shed light on how these managed care payment models affect older adults and individuals using LTSS.
FORECASTING AND COPING WITH FUTURE STRESSORS PREDICTS DAILY SUBJECTIVE AGE
Authors: Neupert Shevaun D , Neupert Shevaun D , Zhu Xianghe
Published: November 2019

Stressors are associated with higher subjective ages, but the role of forecasting and coping with future stressors is unknown. 223 adults (107 aged 18-36, 116 aged 60-90) reported their subjective age, forecasts of next-day health stressors, and anticipatory coping with next-day health stressors each day for eight consecutive days. There was no main effect of forecasting, but increases in plan rehearsal coping were associated with increases in felt age. In contrast, increases in problem analysis coping were associated with decreases in felt age. Daily forecasting and coping also interacted with each other. On days with low plan rehearsal or low problem analysis, there was no association between forecasting of health stressors and subjective age. However, on days with high plan rehearsal or high problem analysis, increases in forecasting ratings were associated with increases in subjective age. Forecasting and coping with future stressors may play a role in subjective aging.
ENERGY EXPENDITURE AND PHYSICAL ACTIVITY AMONG OLDER PARTICIPANTS FROM THE MULTICENTER AIDS COHORT STUDY (MACS)
Authors: Schrack Jennifer A , Brown Todd T , Margolick Joseph B
Published: November 2019

Energy utilization becomes more inefficient with age and is linked to low physical activity and functional decline. Persons aging with HIV exhibit accelerated functional decline, but the effect of chronic HIV infection on energy utilization and free-living physical activity remains unclear. We investigated cross-sectional associations between age and: resting metabolic rate, peak walking energy (VO2), and 7-day physical activity by accelerometry in 100 men in the MACS (age: 60.8+/-6.8 years, 35% black, 46.1% HIV+, 94% virally suppressed). In multivariable regression models adjusted for age, BMI, race, chronic conditions, and HIV viral load, HIV+ men had a higher resting metabolic rate (β=103.2 kcals/day, p=0.03) and lower peak walking VO2 (β=-1.8 ml/kg/min, p<0.02) than HIV- men. Moreover, HIV+ men demonstrated lower physical activity, overall and by time of day (p<0.05). These results suggest that energy utilization differs by HIV serostatus, which may contribute to lower physical activity and function with aging.