bluuebunny/crossref_metadata_2025 huggingface dataset:
SOCIAL PARTICIPATION AMONG OLDER ADULTS WITH UNMET NEED CONSEQUENCES: FROM A DISABILITY PERSPECTIVE
Authors: Turner Natalie , Jones Brittany
Published: December 2023

This study examines the relationship between social participation and consequences arising from unmet ADL, IADL, and mobility needs using disability studies frameworks. The aging field has yet to fully incorporate theoretical perspectives from disability scholarship into our understanding of health, wellbeing, accessibility and inclusion. By situating the experience of aging, aging with care needs, and having unmet care needs within a disability studies lens we gain insight into the ways we are called to redesign the provision of supportive services to ensure meaningful inclusion in community. To illustrate this idea, we use Wave 5 from the National Health and Aging Trends Study (NHATS) (n=7,070) to examine the relationship between ADL, IADL, and mobility unmet need consequences and social participation. Both social participation and unmet need consequences among older adults have been explored from healthcare, quality of life, and economic perspectives. However, there is a lack of scholarship linking these two concepts using a disability lens. Preliminary results from a series of linear regressions show a significant, negative relationship between presence of unmet ADL and mobility need consequences and social participation (p < .001). These findings indicate that experiencing unmet care needs may not only have detrimental effects on health, but on overall adult wellbeing and may be infringing on the ability of older adults to engage with community to the extent they wish. By applying disability frameworks, aging researchers are called to reexamine the ways in which we consider accessibility and full inclusion of older adults with care needs.
SOCIAL RISKS AMONG PREDOMINANTLY AFRICAN AMERICAN/BLACK CAREGIVERS OF PERSONS LIVING WITH DEMENTIA
Authors: Winslow Victoria , Bernhardy Christina , Borson Soo , Lindau Stacy Tessler , Makelarski Jennifer , Thompson Katherine
Published: December 2023

Health-related social risk factors (HRSRs) are associated with poorer quality of life and higher caregiving burden and are more prevalent among women and in African American/Black communities due to structural inequities. Little is known about gender differences in HRSRs among dementia caregivers, especially AA/B dementia caregivers. Baseline data were obtained from 345 caregivers of PWD enrolled (17% at their own and 83% at their care recipient’s point of care) in a single-blind, randomized controlled trial of CommunityRx-Caregiver, a social care intervention delivered at the point of health care. Gender differences in HRSR rates (food, housing, safety, utilities, transportation, financial, and social support) were tested using chi-square tests. Most caregivers were women (78%) and non-Hispanic AA/B (80%). Female caregivers had significantly higher rates of having HRSRs (64% of women vs. 51% of men, p=0.04, 62% overall). Lack of social support (47% of women vs. 38% of men, 45% overall), financial strain (26% vs. 23%, 25% overall), and housing insecurity (23% vs. 14%, 21% overall) were also most prevalent among women. Thirty-one percent of women compared to 23% of men reported 2 or more HRSRs. Health-related social risks, especially lack of social support, were prevalent among women and men dementia caregivers in a predominantly AA/B community. By 2030, more than 9 million Americans and their families will be affected by dementia and dementia caregiving. Social care interventions should be designed to identify and support caregivers at the point of their own or their care recipient’s healthcare.
A GERIATRIC EDUCATION COURSE SPANNING COMMUNITY AND HEALTH CARE ENVIRONMENTS
Authors: Gareri Michele , Hazelett Susan , Kropp Denise , Sanders Margaret , Drost Jennifer , Kidd Lori , Fosnight Susan
Published: December 2023

To address gaps in the geriatrics-trained workforce, we implemented a Geriatric Resource Certificate (GRC) for interprofessional learners from healthcare and community provider settings. This program combines online self-paced didactics, real-time virtual lectures, and a real-world virtual team care planning experience. The education incorporates the 4Ms of the Age Friendly Framework and spans the geriatric experience from healthy aging through end-of-life. It includes Dementia Friends and ECHO sessions. The goal is to training people from a variety of care settings to be resource people regarding geriatric issues, much like the NICHE program in acute care. We had 37 learners who completed evaluations. Practice settings included ACO, Hospice, Emergency Department, nursing homes, hospitals, primary care, Area Agencies on Aging, and other community providers. Overall, the online didactics were rated an average of 4.53 on a 5 point Likert scale and the real-time lectures were rated an average of 4.41. The average score for “the GRC will help me provide care over the continuum” was 4.59. The average for the real team was 4.07, 4.26 for the ECHO, and 4.45 for Dementia Friends. All learners indicated they would refer others to the GRC. These results indicate that the GRC is an effective method to impart basic geriatric training into communities and raise awareness of resources available to assist older adults in maintaining their independence. In this era of high healthcare workforce turnover and staffing shortages, improving geriatric knowledge by training on-site geriatric resource staff is one way to improve care for older adults.
AGE-FRIENDLY PARTNER EVALUATION: REVIEWING FLORIDA ACTION PLANS
Authors: Swanson Helena
Published: December 2023

Understanding community collaboration is crucial to advance age-friendly community change (Greenfield, et al., 2022). This poster’s purpose is to provide evidence about age-friendly partner involvement to bring awareness to the extent that partnerships are collaborative and holistic at the age-friendly action plan stage. We conducted a qualitative, thematic analysis by reviewing Age-Friendly Florida Action Plans (N = 13) to code for partner involvement. The evaluation used the World Health Organization’s Age-Friendly Environments framework, which includes 4 cyclical steps: Engage and Understand, Plan, Act, and Measure. The evaluation questions were (1) How many partners are typically involved in action plans? and (2) Which types of partners are typically involved in action plans? The Florida Age-Friendly Communities evaluated have diverse characteristics in community type (e.g., rural, urban, and suburban), population size, and the percentage of the population that is 65+. After an iterative process was conducted between coders, a partner coding structure emerged. The partner coding structure included codes for government, businesses, non-profits, communities, and other partners. Partner themes for each sector (government, businesses, non-profit, community, and other partners) were identified and will be discussed. Overall, results concluded that there were an average of 16 partners involved in age-friendly action plans. On average, age-friendly partners were most involved in the Act step of the World Health Organization’s Age-Friendly Environments framework. Lastly, government sectors were the most frequent partner identified in age-friendly action plans. Considerations and recommendations for age-friendly partner involvement for creating collaborative and holistic age-friendly partners will be included.
DEVELOPING AN AGE-FRIENDLY ECOSYSTEM: A CASE STUDY FROM MINNESOTA’S MULTISECTOR BLUEPRINT ON AGING
Authors: Baig Farah , Moone Rajean , Graham Carrie
Published: December 2023

As age demographics continue to shift, age-friendly policy initiatives at the global, national, state, and local levels are rapidly evolving. These emerging age-friendly initiatives underscore a changing perception of aging and older adulthood. Many states, communities, academic institutions, health systems, and other organizations are embracing the demographic shift and leveraging age-friendly frameworks that seek to improve later life experiences. However, there is limited scholarly work that explores contextualized age-friendly policy development. Using qualitative case study and historiography methods, this study provides an overview of various age-friendly frameworks and outlines work in the State of Minnesota where intersections of the various frameworks are coalescing in an age-friendly ecosystem. Minnesota, rather than being a ‘best practices’ exemplar, serves as a model of an evolving system, led by the Age-friendly Minnesota Council in partnership with organizations such as the Minnesota Board on Aging and the Minnesota Department of Human Services, that are developing impactful policies to address the needs of a growing heterogeneous older adult population. The nuances and realities found within the Minnesota context underscore the need to develop fluid age-friendly ecosystems that can adapt to the uniqueness and complexity found in each state, region, or community. Going forward, it will be critical for Minnesota to evaluate their programs to determine their long term impact on the entire population — including today’s older adults as well as future older Minnesotans.
DISCRIMINATION AND PSYCHOLOGICAL WELL-BEING IN LATER LIFE: LONGITUDINAL EVIDENCE FROM CHINA
Authors: Zhou Shuai , Bai Xue
Published: December 2023

Although ample evidence shows a negative association between discrimination and well-being outcomes, yet few longitudinal studies have explored the prevalence and consequences of multiple forms of discrimination among older adults. This study investigated the effects of interpersonal and institutional discrimination on psychological well-being among Chinese older adults and whether such effects were conditioned on subjective socioeconomic status. Data were retrieved from the China Family Panel Studies, consisting of 9,356 older respondents aged 45 and older in 2010 with their follow-up observations during 2012–2016. Random-effects panel regression analyses were performed to examine the relationships between multiple forms of discrimination on psychological distress and life satisfaction, separately, as well as the moderating effects of subjective socioeconomic status. Results revealed that one in four older adults experienced at least one form of discrimination during the past 12 months. Most prevalent discriminatory experiences encompassed wealth-based discrimination, delay and stalling at government agencies, and unfair treatment by government officials. Experiences of discrimination were negatively associated with life satisfaction and positively associated with psychological distress. Subjective socioeconomic status ameliorated the negative effect of interpersonal discrimination on life satisfaction. Findings reveal the detrimental effects of discrimination on psychological well-being that both interpersonal and institutional discrimination could reduce satisfaction with life and exaggerate psychological distress. Findings imply that subjective socioeconomic status could protect older adults from harmful effects of interpersonal discrimination, but not institutional discrimination.
AMERICANS AND TAIWANESE: A COMPARISON OF BELIEFS IN AND PREFERENCES FOR ADVANCE DIRECTIVES BY SOCIODEMOGRAPHICS
Authors: Young Yuchi , Chen Duan-Rung , Shayya Ashley , Perre Taylor , Barnes Virgile , O’Grady Thomas
Published: December 2023

Introduction

Advance directives (ADs) are legal documents that allow individuals to express their end-of-life wishes. However, cultural differences related to collectivism and family values may impact AD beliefs and preferences. This study compares AD beliefs and preferences between American and Taiwanese adults.

Methods

A survey was used to collect data from adults in the US (n=166) and Taiwan (n=2000) to assess AD beliefs and preferences. Propensity score matching was used to compare the populations, and bivariate analyses were conducted to identify AD-specific differences between the two groups.

Results

Compared to the US, Taiwanese participants were younger (mean age = 45 vs. 50), higher percentage female (80% vs. 63%), and higher percentage married (50% vs. 48%). Taiwanese adults had a higher belief in preparing an AD (89.3% vs. 80.7%; p=0.02) and were more willing to complete one than American adults (85.6% vs. 63.1%; p< 0.01). 59.4% of Taiwanese adults preferred their family/loved ones make healthcare decisions, compared to 46.0% of Americans (p=0.01). However, only 50.8% of Taiwanese adults believed their loved ones’ decisions aligned with their wishes, while 79.5% of Americans held this belief (p< 0.001).

Conclusion

This study reveals noteworthy differences in AD beliefs and preferences between the two groups, with Taiwanese adults valuing AD preparation more and being more willing to complete them. Taiwanese adults also rely on their loved ones to make AD decisions, even though they believe these wishes may not align with their own. These differences likely stem from cultural norms of filial piety and collectivism in Taiwan.
SOCIODEMOGRAPHIC DIFFERENCES IN ADVANCE CARE PLANNING AMONG OLDER LESBIAN AND GAY ADULTS
Authors: Singleton Meki , Enguidanos Susan
Published: December 2023

Advance care planning (ACP) is a process that supports adults at any stage of health in ensuring that their values, goals, and wishes are met regarding future medical care. Factors associated with completing ACP include older age, being White, higher education, and higher socioeconomic status. However, scant research has investigated if these same characteristics are associated with ACP among lesbian and gay adults. Using data from an online survey (N=139), bivariate analyses were conducted to investigate predictors of ACP outcome measures. Being White (p<.01), older (p<.01), and employed (p<.05) were associated with having a higher level of comfort with medical decision making. Having a higher income (p<.01), being employed (p<.01), and having a health condition (p<.05) were associated with having completed a living will. Having a higher income (p<.01) and being employed (p<.05) were associated with having a durable power of attorney for healthcare. These outcomes demonstrate that while some variables were similar to previous findings, additional sociodemographic characteristics were found to have an influence on ACP among older lesbian and gay adults. Given that completing ACP has shown to improve quality of care at end of life, it is imperative to understand what factors influence ACP for older lesbian and gay adults. Understanding these within group differences will lead to future research and outreach efforts developed to inform and equip healthcare workers and community organizations with the means to better serve older gay and lesbian adults, a group that has been historically discriminated against by the healthcare system.
DOES NEIGHBORHOOD GENTRIFICATION AFFECT FOOD INSECURITY AMONG URBAN OLDER ADULTS? EVIDENCE FROM NEW YORK CITY
Authors: Cheung Ethan Siu Leung
Published: December 2023

Emerging studies have established that food insecurity is a prevalent public health problem among older adults, including those in urban areas. However, the relationship between neighborhood gentrification, an increasing trend in urban development, and food insecurity remains unclear. Using cross-sectional data from the Poverty Tracker Study, this study aimed to answer two research questions: 1) what is the association between living in gentrifying neighborhoods and food insecurity? 2) Do the food environment, public transportation, and social cohesion mediate the association? The sample consisted of 710 New York City residents aged 65 or older. Based on respondents’ census tracts, individual-level data were merged with neighborhood data obtained from the American Community Survey. local statistics were estimated by GeoDa 1.20 to examine the spatial distribution and significant clusters of generifying neighborhoods across New York City. ArcGIS 10.1 was then used to produce maps. To address both research questions, logistic regressions and mediation analyses were conducted. Regressions revealed that living in generifying neighborhoods was significantly associated with a greater risk of food insecurity, even after adjusting for demographic characteristics and socioeconomic status, such as income. Additionally, mediation analyses suggested that the association was significantly mediated by community social cohesion and the number of healthy food outlets. Findings suggest that neighborhood gentrification presents a salient risk factor for late-life food insecurity in urban areas. Community programs that foster social connections among neighbors and local food assistance programs may be particularly needed in gentrifying neighborhoods to mitigate and reduce the risk of late-life food insecurity.
SOCIAL CONNECTEDNESS RESOURCING OF OLDER PEOPLE IN ASSISTED LIVING IN THE UNITED STATES OF AMERICA: A SCOPING REVIEW
Authors: Pudur Rekha , Mpofu Elias , Prybutok Gayle
Published: December 2023

Abstract This PRISMA scoping review identifies the emerging evidence on social connectedness resources preferences and priorities of older adults in assisted living facilities. The searches in this scoping review were conducted in EBSCOhost. Eight studies were included from 134 articles published in English from January 2000 – September 2022. There are 2482 older adults from 233 assisted living facilities in the USA. Results organized by themes framed in the World Health Organization’s International Classification of Functioning, Disability, and Health (WHO-ICF) 1 provided evidence that older adults with or aging with or into chronic health conditions preferred facility based on community-based resources. Those from the larger enrollment assisted living facilities and limited physical mobility preferred facility-based resources more than community resources. Residents’ preferences and priorities for social connectedness in facility and community-based activities appear to serve different needs, suggesting that resident facilities should deliberately provide for social needs resources by the context of participation. Further research is needed to profile what residents preferred/prioritized in socially inclusive activities, either facility provided or community-based.
TRANSPORTATION-RELATED FACTORS AND THE LIKELIHOOD OF COMPANIONSHIPS AMONG SENIOR CENTER MEMBERS
Authors: Mauldin Rebecca , Parekh Rupal , Mattingly Stephen
Published: December 2023

Throughout the United States, a variety of programs focus on social engagement to reduce social isolation and loneliness for older adults. An ideal site for this is the senior center. This research takes place in a senior center serving older Hispanic/Latinx adults in an urban community in the northeast United States. Data were collected 9/21-12/21 from 38 of approximately 42 regular members. Cross-sectional social network analysis data were analyzed using exponential random graph modeling (ERGM) of the likelihood of companionship ties among 42 senior center members. Several transportation related factors were significantly associated with the likelihood of companionship ties. Controlling for demographics and frequency of attendance, having missed going to the senior center due to a lack of transportation was associated with a significantly lower likelihood of a companionship tie (p = .004). Companionships were also less likely for members who were transportation cost-burdened (p = .016). Companionships were less likely for those whose primary mode of transportation was driving compared to those who primarily relied on others for rides (p = .016). Results suggest that transportation experiences are significant factors in the social relationships among senior center members. Finding ways to reduce transportation cost burden and the frequency of missing going to the senior center due to lack of transportation should be considered in interventions to enhance social integration for senior center members. Understanding the role of driving oneself in having companionships for senior center members is an area to explore in future research.
APPLYING A TRAUMA-INFORMED DEI PRACTICE MODEL TO TRANSFORM CARE CULTURE
Authors: Morgan Jennifer , Jason Kendra , Royster Leigh-Anne
Published: December 2023

Collective trauma is a psychological distress experienced by large numbers of people or communities in response to shared trauma. It has been documented that the traumatic impacts of COVID-19 in concert with discrimination based on any marginalized identity (e.g., racialized, gender, and sexual minorities; poor, chronically-ill) leads to poorer health, work, and life outcomes. Marginalized older adults who have experienced discrimination over the life course are at increased risks for these challenges as they are more likely than any other group to experience infection, hospitalization, or death due to COVID-19. For older workers, they are more likely to remain unemployed or face more challenges at work than younger workers. Additionally, long-term care services and supports serving marginalized populations are more likely to have staff that have marginalized identities themselves and deal with similar challenges. We offer a conceptual model designed to transform care culture in ways that explicitly foster diversity, equity, inclusion and ultimately belonging and empowerment of individual community members. This conceptual model is guided by three founding principles: DEI (diversity, equity and inclusion), intersectionality, and trauma-informed care. This approach allows for care practitioners to address the intersecting structural and compounding challenges of COVID-19 and discrimination, instead of treating them as separate non-competing factors. By mapping out the evidence of collective trauma experienced by many minoritized and older workers; and those in aging services and long-term care sectors, we explain the principles of a trauma-informed approach and how retention and empowerment practices can support transformation of care culture.
COMPARING VARIED EFFECTS OF WORK AND PARTICIPATION ON DEVELOPMENT OF OLDER JAPANESE ACROSS GENDERS
Authors: Katagiri Keiko
Published: December 2023

Recently, the physical and cognitive status of older Japanese adults has improved on previous generations. Half of 60-year-old Japanese remain in the labor force. With extended life expectancy, improved health, and ability to remain productive into older age, some gerontologists now regard generativity as a developmental task for older adults before becoming frail, rather than for middle-aged people, as previously thought. These changes assume that older adults continue to develop, and this study examines the effects of work and active participation on development of older adults as a potential human resource for society. A 2019 random sampling survey was conducted with Tokyo and Hyogo Prefecture residents; the response rate was 43.0% (N = 1,063, aged 50-74). ANCOVA tests were conducted to gauge sense of community, interest in politics and generativity (all were positively affected by social and civic participation). Older people exhibited a higher sense of community than younger people. Females showed higher generativity and sense of community than males, while males scored higher than females for interest in politics. We observed interaction effects of work and civic participation. Working males in engaging civic activity exhibited greater positive change compared to non-working males with civic activity. Non-working females with active participation demonstrated greater positive change in generativity and interest in politics than working females with activity. This suggests older males enriched their experience by participating in civic activity while older females developed it through work. Both cases suggested that older adults can develop when they experience an unfamiliar diverse world.
DEVELOPMENT AND VALIDATION OF A U.S. AND GERMAN SHORT VERSION OF THE LATER LIFE WORKPLACE INDEX (LLWI-S)
Authors: Deller Juergen , Finsel Julia , Wöhrmann Anne , Oliveira Eduardo , Axelrad Hila , Vignoli Michela , Gu Xiuzhu , Van der Heijden Beatrice
Published: December 2023

Employment of older individuals becomes more important in demographic change. To identify organizational practices that foster the motivation, health, and performance of older employees in particular, an efficient holistic assessment of relevant organizational factors is needed. The 80-item Later Life Workplace Index (LLWI) provides such a measure for organizational practices for older employees by differentiating nine domains. The LLWI has been applied in emerging research in various research contexts and countries. However, it is quite a lengthy measure. Therefore, this paper describes the development and validation of the LLWI-S, a 29-item short measure covering all nine domains in order to achieve a more efficient instrument. The development of the short version was both, judgemental- and statistics-driven. A focus group consisting of the original LLWI-authors and several international scholars, whose research expertise lies in the field of employment and older employees, has developed the LLWI-S. A German- and an English-language version of the LLWI-S have been validated in Germany and the U.S. Reliability and model fit for the U.S. and the German version as well as multi-group CFA for measurement invariance will be presented. Results show that the measures have good internal reliability and model fit. We provide researchers and practitioners with a validated short measure to efficiently assess all nine relevant organizational domains for older employees. Researchers can utilize the LLWI-S to gain a comprehensive understanding of all relevant areas of organizational influences on later life work, while practitioners are able to assess their organizational readiness for an aging workforce.
TRAINING FOR CAREGIVER OF OLDER ADULTS IN ECUADOR: REPORT ON PRESENTIAL, DISTANCE, AND HYBRID MODALITIES
Authors: Guillemot Jonathan , Saenz Samantha , Landazuri Maria Augusta Vélez
Published: December 2023

Caregiving for older adults in Ecuador is provided by family members, professional caregivers as well as untrained domestic workers. All three groups lack access to theoretical and technical training. The accelerating care drain towards Europe and North America, the fast-paced aging in the region as well as increasing trends of North American older adults migration to Ecuador, increase the need for large scale, quality and affordable caregiver training. We report the methods and outcomes of three modalities of training for caregivers of older adults combining over 100 individuals trained over the course of four years: a traditional presential training, which was offered prior to the COVID-19 pandemic; an online modality via Zoom during the pandemic; and the early outcomes of a novel hybrid modality, combining presential and asynchronous video-based learning. We found that social interaction, including the sharing of personal experiences, was an essential part of the training experience, which translated into long-term social bonds and early stages of solidarity networks between participants. Online synchronous training allowed a broader geographical coverage but failed to contribute to socialization as well as generated challenges related to the learning experience and efficacy. The novel modality offered the broad geographical coverage, lowered the cost and allowed socialization. It however created technical and quality control challenges. Training of caregivers is a key component to promote aging in place and age-friendliness. Our experience and conclusion aim to contribute to the future of training in the Global South as well as in the Global North.
CARDIOVASCULAR DISEASE RISK SCORES AND INCIDENT DEMENTIA AND COGNITIVE DECLINE IN OLDER MEN AND WOMEN
Authors: Vishwanath Swarna , Hopper Ingrid , Tonkin Andrew , Murray Anne , Shah Raj , Woods Robyn , McNeil John , Ryan Joanne
Published: December 2023

Background

Risk factors for cardiovascular disease (CVD) also increase the risk of dementia. However, whether CVD risk scores are associated with dementia risk in older adults remains unclear. The aim of this study was to determine whether CVD risk scores are associated with dementia and cognitive decline in older men and women.

Methods

19,114 participants from a prospective cohort of individuals aged 65+ years. The Atherosclerotic Cardiovascular Disease risk score (ASCVDRS), Systematic Coronary Risk Evaluation 2 – Older Persons (SCORE2-OP) and the Framingham risk score (FRS) were calculated at baseline. Risk of dementia (DSM-IV criteria) and cognitive decline (>1.5 standard deviation (SD) decline from previous assessment in cognitive function) were assessed using hazard ratio.

Results

Over a median follow-up of 6.4 years, 850 individuals developed dementia and 4352 cognitive decline. Men and women in the highest ASCVDRS tertile had a 41% (95%CI 1.08,1.85) and 45% (1.11,1.89) increased risk of dementia compared to the lowest tertile respectively. Likewise, men and women in the highest SCORE2-OP tertile had a 64% (1.24,2.16) and 60% (1.22,2.11) increased risk of dementia. Findings were similar but the risk was slightly lesser when examining risk of cognitive decline for both ASCVDRS and SCORE2-OP. FRS was only associated with the risk of cognitive decline among women (highest vs. lowest tertiles: 1.13 [1.01-1.26]).

Conclusion

These findings suggest the utility of CVD risk scores in clinical practice, to not only assess future risk of CVD, but also as potential early indicators of cognitive impairment in older men and women.
CLINICIAN AND STAFF PERSPECTIVES IN TRANSITIONS OF CARE FOR DUAL-USE VETERANS LIVING WITH DEMENTIA
Authors: Ayele Roman , Albright Karen , Battaglia Catherine , Levy Cari
Published: December 2023

The Veterans Administration (VA) has partnered with non-VA hospitals to improve access to care. However, older Veterans living with dementia (VLWD) who use both VA and non-VA care may experience gaps in care, placing them at risk of adverse health outcomes during transitions. This research aims to understand the barriers and facilitators in transitions of care for VLWD following non-VA hospitalization. We conducted 23 interviews with VA and non-VA clinicians involved in transitions of care for VLWD. Snowball sampling was used to identify participants, and rapid analysis identified themes. VA Participants faced significant challenges in receiving timely discharge communication from non-VA stakeholders, relying on VLWD, who are poor historians, for information about their non-VA hospitalization. Inadequate staffing for care coordination was also a barrier to timely care, resulting in frustration for VLWD and their families when tests had to be redone due to a lack of appropriate documentation from non-VA hospitals. Both VA and non-VA stakeholders experienced similar care coordination challenges for VLWD, their families, and clinicians. Non-VA stakeholders described the VA as a “black box” due to a lack of communication and collaboration. However, stakeholders expressed a desire to provide quality care, improve care coordination, and give timely care to veterans. These findings highlight the barriers experienced by VA and non-VA stakeholders and provide opportunities for improvement in coordinating care for VLWD. Implementing care coordination programs and improving communication and collaboration between VA and non-VA stakeholders can improve the quality of care for VLWD and their families during transitions.
DEMENTIA AND MILD COGNITIVE IMPAIRMENT: PREVALENCE, CONVERSION RATES, AND LONGEVITY BETWEEN AGES 70 AND 95
Authors: Stessman Jochanan , Jacobs Jeremy
Published: December 2023

This study describes the prevalence and conversion rates of Mild Cognitive Impairment (MCI) and dementia between age 70-95, and the association between cognitive status and mortality. The Jerusalem Longitudinal Study (1990-2023) prospectively follows a representative community-dwelling cohort born 1920-21, assessed at home visit during 1990,1998, 2005, 2010, 2015 at ages 70, 78, 85, 90, and 95 (n=437, 806, 1170, 584, 468) respectively. Comprehensive assessment included Mini Mental State Examination (MMSE), defining normal cognition (29-30/30), MCI (24-28/30) and dementia (≤23/30). Mortality data were collected from the Ministry of Interior. Cox proportional hazards ratios (HR) were determined, adjusting for gender, education, self-rated health, physical activity, BADL status, diabetes, hypertension, ischemic heart disease. At ages 70, 78, 85, 85, 90, and 95 the prevalence of MCI was 13.5%, 21.5%, 38.7%, 37.0%, and 50%; prevalence of dementia was 3.2%, 4.2%, 24.3%, 31.3%, 35.7%. Between age 70-78, 78-85, 85-90, 90-95, conversion rates from MCI back to normal were 74.2%, 27.4%, 18.2%, 7.3%; MCI declining to dementia were 6.5%, 29.2%, 37.0%, 50.9%; MCI remaining MCI were 19.4%, 43.4%, 44.8%, 41.8%. Dementia was significantly associated with increased mortality throughout the entire study period: at age 70-78 Hazards Ratio=4.36 (CI 95%: 2.09-9.10), age 90-95 HR=1.5 (CI 95%: 1.01-2.21). In contrast, MCI was not associated with increased mortality, apart from at age 85: HR=1.38 (CI 95%: 1.04-1.82). Our findings show that conversion rates from MCI to dementia are age-dependent, with less than half of MCI subjects progressing to dementia. Unlike dementia, MCI was largely unassociated with mortality.
EMBEDDING A PHYSICIAN REFERRAL PATHWAY TO LINK PEOPLE WITH DEMENTIA TO COMMUNITY SERVICE PROGRAMS
Authors: Lepore Michael , Shivers Stephani , Curbeam Deanna
Published: December 2023

Dementia care quality and value can be enhanced by lateral integration between health systems (HS) and community-based organizations (CBOs), however clinical providers are often unaware of CBO programs. HS could heighten access to CBO programs among people living with dementia (PLWD) by recognizing CBOs as extended care teams, streamlining referrals, and facilitating information exchange through electronic health records (EHRs). Catalyzing CBO and HS integration, we piloted physician referral to a CBO for virtual delivery of Cognitive Stimulation Therapy (CST) in an embedded pragmatic trial. CST, a 14-session group intervention for PLWD, has been shown to benefit participant cognition and other outcomes, yet CST access is limited partially due to the risks and costs of in-person gathering. To enhance access, we trialed a version of virtual CST (vCST) and assessed patient follow-through on physician vCST referrals. Participating sites–one primary care clinic and one neurological specialty clinic—identified eligible PLWD via EHR (e.g., cognitive score indicating mild cognitive impairment to moderate dementia) and clinicians verified eligible PLWD appropriateness for vCST. Clinician-verified PLWD were randomized to intervention (referral, n=56) and control (no referral) groups, and clinicians provided vCST referrals. Results show the percentage of PLWD who followed through on (‘accepted’) the vCST referral. Similarities and differences—across demographics, cognitive scores, and referral sources—between PLWD who accepted versus declined referral are described. Future research will assess conversion rates from vCST referral to program completion, the completeness of outcome measures captured from EHRs, and the impact of vCST on cognitive scores.
MOTIVATIONS AND ROLE CAPTIVITY AMONG INFORMAL CAREGIVERS TO COMMUNITY-DWELLING PERSONS WITH DEMENTIA
Authors: Bloom Rachel , Osso Francesco , McCarthy Megan , Falzarano Francesca
Published: December 2023

There are 11 million informal (unpaid) caregivers currently assisting a person with dementia in the United States. Motivations for taking on this challenging role vary, with many citing their responsibility to family or a shared interpersonal history. Many caregivers do not feel as if they have a choice in taking on care responsibilities for relational and/or financial reasons and are held “captive” in this role. Prior research indicates role captivity as a key mediating force in the development of depression among dementia caregivers, but limited work has directly linked quantitative measures of role captivity with qualitative data surrounding motivations for providing care. The current mixed-methods study uses quantitative and qualitative data to explore this connection in a sample of 46 participants providing care to a community-dwelling person with dementia. Study findings show that role captivity was significantly associated with greater costs of care, feelings of grief, and depressive symptoms, as well as lower levels of self-efficacy and mutuality. These relationships were assessed alongside thematic analyses of interview data centered on motivations for providing care, familial and cultural expectations, and financial necessity. This research paints a detailed picture of the way in which dementia caregivers understand and relate to their role and can inform the design of effective psychological supports for this population.
NEUROPSYCHIATRIC SYMPTOMS OF DEMENTIA AND CAREGIVERS’ BURDEN
Authors: Paul Constanca , Sousa Susana , Teixeira Laetitia
Published: December 2023

Informal caregiving (IC) is a major health and social asset although simultaneously a potential burden and depression risk factor for those who care. Neuropsychiatric symptoms of dementia are disturbing and may contribute to a negative experience of care. To understand the neuropsychiatric symptoms of dementia in caregiving we have two objectives: to know the prevalence of neuropsychiatric symptoms perceived by ICs and if there is an association of neuropsychiatric symptoms and burden and depression of caregiver. We study a community-based sample (N=101) of primary care users with mental health concerns, referred by GPs. Instruments include sociodemographic information; Neuropsychiatric Inventory (NPI-Q), Caregiver Burden Scale (CBS) and Geriatric Depression Scale (ABCDS). The sample mean age was 79.4 (sd=7.7) years, 54 (53.5%) were female and 34 (33.7%) had no formal education. Half of the sample were married and 41 (41.90%) were widowed. The NPI-Q total score and the Distress dimension score were 10.1 (sd=5.6) and 11.9 (sd=9.1), respectively. The more reported symptoms were agitation/aggression (69.3%), and apathy/indifference (65.3%). We found a significant positive association between NPI-Q and caregivers’ burden (0.296) and depression (0.227) and between Distress and caregivers’ burden (0.417) and depression, 0.416. Conclusion: Neuropsychiatric symptoms of dementia appear associated with the burden and depression of informal caregivers. Training ICs to cope with care receiver symptoms is a priority to increase the quality of care and reduce burden and depression of caregivers.
NURSING HOME WORKFORCE EDUCATION: DOES ONE SIZE FIT ALL? EVIDENCE FROM THE CHATO NATIONAL TRIAL
Authors: Williams Kristine , Perkhounkova Yelena , Coleman Carissa , Hein Maria , Yang Frances , Shaw Clarissa
Published: December 2023

Educating the nursing home workforce to provide quality dementia care is a national priority. Staff education is usually provided to all staff in communities that vary in size, location, ownership, and resources with little consideration for diversity. To evaluate suitability for diverse staff, we compared learning outcomes for White, non-Hispanic staff and staff of diverse races and ethnicities who completed CHATO in year one. White non-Hispanic staff (N=402) scored higher on knowledge assessments than staff self-reporting other races and ethnicities (N=201) at baseline (mean=57.1% vs. 49.1%, p<.001). Both groups improved on post-assessment (by 19.0 and 23.1 percentage points, respectively, p<.001), Communication ratings indicated that at baseline White, non-Hispanic staff were more knowledgeable about effective (p<.001), appropriate (p=.008), and person-centered communication (p<.001) than diverse staff; while the latter recognized elderspeak better (p=.002). Both groups improved their communication ratings post-CHATO (p from .001 to <.001). While confidence in providing dementia care was similar between groups at baseline (p=.754), it improved only for White, non-Hispanic staff (p<.001). Intention to use learned skills in practice was higher for staff in the diverse group (p<.001). Diverse staff rated their satisfaction with the intervention lower (p <.001), suggesting that it was not tailored to their needs. These findings support the value of CHATO in increasing communication knowledge among diverse NH staff. However, lower satisfaction suggests the need to adapt CHATO to be more inclusive and culturally appropriate. Tailoring education may increase impact on outcomes and overcome disparities in dementia care common in NHs serving diverse populations.
PROTOCOLS FOR COLLECTING CONVERSATIONAL LANGUAGE IN PERSONS WITH DEMENTIA
Authors: Zaslavsky Oleg , Cohen Trevor , Wu Kuan-Ching , Jin Jessica , Chien Shao-Yun , Pakhomov Serguei
Published: December 2023

We describe first-of-its-kind protocols for collecting spontaneous conversations in persons with dementia living in a community through conversation elicitation tools twice a month over six months. We also describe the preliminary feasibility of the protocol deployment in the first enrolled participants over the first month of data collection. Participants were recruited from the University of Washington ADRC registry. The audio was captured using RODE wireless microphone system. Four conversational elicitation techniques were used: 1) reminiscence using personal photographs; 2) reminiscence using generic historical images; 3) picture description test from neurocognitive batteries; 4) open-ended questions about daily activities. Health measures included Cornell Scale for Depression in Dementia (CSDD), Clinical Dementia Rating (CDR), and Clinical Frailty Scale (CFS). Four male and two female participants (average age 75) were recruited. Average health measures at baseline were CDR = 2, suggesting moderate dementia; CSDD=7, suggesting depressive symptoms, CFS=5, suggesting mild frailty. At baseline, the tasks’ average conversation time in seconds was as follows: daily activities =528; personal reminiscence=443; historical reminiscence =227; picture description =192. The corresponding average times for the subsequent home visits were 917; 518; 474, and 280 at visit 1 and 525; 767; 629, and 311 at visit 2. We established the feasibility of collecting conversational speech in this population. Participants seemed more interested in conversations focused on daily activities and personal pictures than general topics. There was an increase in the duration of conversations over time, which might be related to participants’ greater familiarity with the study protocol and data collectors.
THE ASSOCIATION BETWEEN PSYCHOTROPIC DRUGS AND PHYSICAL FUNCTION IN HOSPITALIZED OLDER ADULTS WITH DEMENTIA
Authors: Kim Nayeon , Resnick Barbara
Published: December 2023

The aim of this study was to test if the use of psychotropic medications (antipsychotics, sedatives, antiseizure, antidepressants, and anxiolytics) was associated with physical function in hospitalized older adults living with dementia. This study was a secondary data analysis using baseline data from the Function Focused Care for Acute Care Using the Evidence Integration Triangle (FFC-AC-EIT) study. FFC-AC-EIT is an ongoing randomized controlled trial and this study included the first 290 participants. A path analysis was conducted to test the relationship between psychotropic drugs and physical function while controlling for age, gender, race, comorbidities, cognitive function, neuropsychiatric symptoms of dementia, and pain. Overall, 63.4% of participants took one or more psychotropic drugs, with the most used psychotropic drugs being antidepressants (39%), followed by antiseizure drugs (23.4%), antipsychotics (16.6%), anxiolytics (13.8%), and sedatives (4.1%). No significant association was found between the use of psychotropic medications and physical function. Cognitive function (β=1.489, SE 0.265, p< 0.001), comorbidities (β=-2.680, SE 1.093, p=0.014), and pain (β=-2.837, SE 0.865, p=0.001) were directly associated with physical function. Cognitive function was also indirectly associated with function through pain. The findings support prior research showing a lack of association between the use of psychotropic medications and physical function. Additional research may be needed to investigate the mediating effects of pain between cognition and physical function in older adults with dementia.
UNDERSTANDING CHALLENGES IN DEMENTIA CARE AMONG AFRICAN AMERICAN AND LATINX POPULATIONS
Authors: Alam Rifat , Sirdich Brianna , Schwingel Andiara
Published: December 2023

Addressing disparities in dementia care among minoritized populations in the US is obligatory. This qualitative study explores perspectives of healthcare providers and administrators about challenges in delivering dementia care among African American and Latinx populations. 12 healthcare providers and administrators from 5 organizations in Illinois and Indiana were interviewed virtually between October 4, 2022, and March 7, 2023, and transcribed verbatim. Interviews were coded and three emerging themes were identified inductively describing participants’ perspectives. Delays in treatment-seeking: Includes challenges of the communities to understand normal aging and dementia and trust healthcare system, lack of knowledge of available resources and perceived cost, tradition of informal caregiving and diminished insights of patients. Lack of a comprehensive support system: Describes areas hindering providers and administrators becoming a support for the patients, includes- communication barriers to understand language and vernaculars, lack of access to healthcare, insurance, and resources by the minoritized communities and needs for an efficient primary healthcare team. Difficulties in patient evaluation: Time constraints of the primary care providers and shortage of specialists affect proper evaluation of patients. Engaging patients from low-income groups and immigrants in the system is complex. Non-compliance due to unavailability of transportation and telemedicine and comorbidities of older patients leads to a failure of complete evaluation of patients’ cognitive function that needs multiple visits. Our study highlights prevailing challenges and areas of advancement of dementia care among African American and Latinx populations. Developing a roadmap for a policy-level change and cross-culturally valid interventions will help address dementia inequities.
COMPETENCY-BASED UNDERGRADUATE PALLIATIVE NURSING EDUCATION USING AN INTERPROFESSIONAL TEACHING APPROACH
Authors: Felderhoff Brandi , Mbango Catherine
Published: December 2023

The nursing workforce is expected to be “work ready” to address healthcare needs in diverse communities. Health inequities continue to persist, and access to healthcare services that promote well-being and improve quality of life is imperative. Nursing curricula that integrate competencies in palliative supportive care for patients with chronic complex illnesses are needed to improve health equity and promote global citizenship (AACN, 2021). The shift to competency-based learning is both an accreditation requirement, and essential to prepare nursing students for the NextGen NCLEX (Wolf, 2022). Through review of the AACN’s (2021) The Essentials: Core Competencies for Professional Nursing Education core competency of palliative and supportive care in the domain of population health for entry-level professional nurses, and framework from The Interprofessional Education Collaborative (IPEC) for team-based competencies to improve population health (IPEC, 2016), a nursing-social work education partnership is well-suited to address AACN’s Essentials utilizing IPEC’s four core competencies. This approach to teaching allows students to develop knowledge and competence in caring for patients with palliative or supportive care needs, effectively bridging the competency gap (Jones & West, 2017) with curricula developed through interprofessional collaboration (Gravina, 2017). Primary palliative nursing care is an interdisciplinary patient-centered approach that focuses on the management of physical, psychological, social, and spiritual care of patients and their families. The opportunity to learn through an interdisciplinary teaching approach better prepares students to examine their place within the team, and fully understand the related roles of their allied colleagues.