bluuebunny/crossref_metadata_2025 huggingface dataset:
DEMENTIA LITERACY ENHANCEMENT DESIGN AND ITS OUTCOMES IN TAIWAN
Authors: Kuo Tsuann , Lai An Chi
Published: January 2025

Background

The increasing number of people diagnosed with Dementia requires the public to become more knowledgeable about dementia and to act more dementia friendly.

Purpose

This paper was to evaluate the effectiveness of a dementia education effort. The purpose was to increase dementia literacy and find out what aspects the public changed the most on dementia.

Methodology

A pre- and post-test was administered to 1237 individuals who attended the dementia education sessions. Each session lasted one hour and 38 sessions were administered within three months at various locations including community care sites, churches, cultural centers, stores, and schools. A pre- and post- test on dementia literacy and attitudes were administered and the response rate was 68%. The majority were females (80%), 60 to 70 years old (25.94%), with a university degree (53.71%), and retired (27.66%).

Results

One-way ANOVA analyses revealed significant associations between participants’ age group, educational level, and the difference in the pre-post test (p< 0.01). The results suggest that the educational intervention was effective in enhancing dementia literacy, but the degree of improvement varied across different demographic groups and locations.

Discussion and conclusion

The dementia education sessions effectively improved dementia literacy, with variations observed across age and educational groups. Tailoring educational content and delivery methods to cater to diverse demographic backgrounds could further enhance the effectiveness of such initiatives in promoting dementia awareness and fostering a more inclusive society. Future research should explore specific strategies to optimize educational programs for different target populations, ultimately contributing to a more dementia-friendly community.
EFFECTS OF SMART AMBIENT BRIGHT LIGHT (SABL) ON SLEEP QUALITY IN NURSING HOME RESIDENTS WITH DEMENTIA
Authors: Lin Chia Jou , Liao Yo-Jen , Berish Diane , Jao Ying-Ling
Published: January 2025

Lighting interventions (LIs) have shown positive impact on circadian rhythms and sleep quality in people with dementia. Yet, few studies incorporated daylight with LI. The Smart Ambient Bright Light (SABL) is a newly developed LI that accommodates natural daylight and provides automatic bright light during the day and dim light during the night. The study examined the effect of SABL on sleep in nursing home (NH) residents with dementia. This was a 13-week cluster randomized crossover-controlled trial conducted in two nursing homes in Pennsylvania. The SABL was installed in residents’ bedrooms and common areas for 4 weeks with 2 weeks of washout between control and intervention. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. Descriptive analysis and paired t-test was performed to compare difference in sleep quality changes between control and intervention periods. A total of 18 residents enrolled in this study. Participants were 87.3 years old on average and 12 of them (67%) were female. The included residents experienced poor sleep quality at baseline (mean PSQI=6.67, SD± 3.07). A paired t-test showed that comparing to the baseline, the PSQI level decreased in both intervention group (5.28 ± 3.58) and control group (4.28 ± 2.44), without statistical significance (p = 0.29). The results suggest that the SABL did not show significant effect on sleep quality among NH residents with dementia. This is a pilot study with a small sample size. More research is needed to replicate the study on a larger scale.
COGNITION AFTER A DISASTER: AGE, WORKING MEMORY, AND THE PICTORIAL SUPERIORITY EFFECT
Authors: Cherry Katie , Bordes Piper , McKneely Katelyn , Elliott Emily , Calamia Matthew
Published: January 2025

We examined free recall of line drawings and matching words in mostly middle-aged and older adults from three parishes (counties) in Baton Rouge, LA that experienced the Great Flood of 2016. All completed multiple individual difference measures, including self-report measures of cognition and emotion (PROMIS, Lai et al., 2014) and a computerized measure of memory for pictures and words. Three groups were compared: (1) non-flooded adults as controls, (2) once-flooded adults with structural damage to homes and property in 2016, and (3) twice-flooded adults who had relocated to Baton Rouge because of catastrophic losses in the 2005 Hurricanes Katrina and Rita and they flooded again in 2016. All were tested during the immediate aftermath of the flood (Wave 1; N = 223, age range: 18-88 years) and most were re-tested 9 +/- 3 months later in a follow-up assessment (Wave 2; N = 202). Results yielded a memorial advantage of pictures over matching words in free recall for all disaster exposure groups at both assessments (p’s < 0.001). Correlation analyses revealed that self-reported deficits in cognition were inversely related to word recall at Wave 1 only. In contrast, self-reported cognitive deficits were positively correlated with flood stressors at Wave 1 and recovery stressors at Wave 2. The present results show that single and multiple disaster exposures do not appear to disrupt performance on traditional, laboratory-based measures of cognition. This research was supported by a grant from the National Science Foundation (Award Number 1708090).
TRENDS IN OLDER ADULTS’ EMPLOYMENT AND PERCEPTIONS OF WORKPLACE AGEISM (1994–2020)
Authors: Sahin Duygu Basaran
Published: January 2025

The research on ageism has made great strides since the term was coined by Robert Butler in 1969. Prior literature shows that ageism and ageist stereotypes negatively affect older adults’ mental, physical, and economic wellbeing. This paper contributes to the literature by providing a trend analysis of older adults’ employment and perceptions of workplace ageism covering a 26 year-period from 1994 to 2020. I use cross-sectional data from the Health and Retirement Study and calculate the shares of older adults (ages 51-79) who worked for pay, who were self-employed (N ranging from 11,227 to 16,035) and who agreed with the workplace ageism statements (N ranging from 3,577 to 6,064). Preliminary findings indicate that the share of older adults who worked for pay increased over time from 44 to 50 percent, however, the share of self-employed older workers stayed about the same (20 percent). Perceptions of workplace ageism slightly declined from 1994 to 2020. In 1994, 21 percent of older workers agreed that in promotion decisions their employer preferred younger workers over older workers compared to 17 percent in 2020. Trend analyses also suggest that older adults’ employment and perceptions of workplace ageism change during economic crises. Findings from this research can be used towards policy recommendations to minimize the psychosocial and economic disruption that older workers experience during economic downturns.
A SCOPING REVIEW OF PARTICIPANT MOTIVATIONS, BENEFITS, AND BURDENS IN END-OF-LIFE RESEARCH PARTICIPATION
Authors: Wallace Cara , Wladkowski Stephanie , Juboori Ruaa Al , Wingo Anna , Hyde Rebecca
Published: January 2025

Hospice clinicians are often hesitant to ask patients and their families/caregivers to participate in research, fearing it is too intrusive during a sensitive and vulnerable time. Further, there is a lack of research, highlighting a gap in knowledge of patient and family experience during hospice and palliative care while it also inhibits the understanding of the benefits and burdens of participation in end-of-life research. A scoping review aimed at understanding the motivating factors, benefits, and burdens of participation in research for patients with a terminal illness and their families/caregivers was conducted. Partnering with a librarian scientist, we searched PscyInfo, CINAHL, PubMed, and Scopus for studies published between 2015 and 2024 using the following search terms: “palliative care,” “terminal illness,” or “hospice” AND “subject burden,” research burden,” “benefit,” or “motivation.” 3,431 unique articles were identified and reviewed, with 24 studies meeting inclusion criteria. Results from these 24 studies were mapped out using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Many participants reported greater benefits than burdens, even reporting great value in participation when a burden was experienced. Individuals also reported that participation in a study provided an additional outlet for support, and feeling a socioemotional altruistic benefit even with no direct medical benefit as a study participant. For clinicians working in end-of-life care, connecting patients and caregivers to end-of-life research may not only be beneficial to contribute to literature as well as an additional source of ongoing support for patients and their caregivers.
COMPARING ADVANCE DIRECTIVES LAWS IN TAIWAN AND THE UNITED STATES: IMPACT ON END-OF-LIFE CARE
Authors: Tu Yufang , Young Yuchi , O’Connor Melissa
Published: January 2025

The current study addresses increasing multicultural concerns regarding autonomy in end-of-life care decisions by comparing Advance Directives (AD) laws in the US, under the 1991 Patient Self-Determination Act (PSDA), and Taiwan, with its 2019 Patient Right to Autonomy Act (PRAA). By highlighting key legal differences and similarities, we aim to provide insights for enhancing in end-of-life care policies and understanding the impact of legal frameworks on patient autonomy internationally. To address our research objectives, we conducted a systematic literature review by searching the PubMed, ProQuest, and Hospice Foundation of Taiwan databases for the following keywords: (1) English and Chinese, (2) Published >=1991, (3) United States or Taiwan (4) Patient Self-Determination Act, Patient Right to Autonomy Act, and advance directives. The results showed that both the US and Taiwan view ADs as essential for healthcare autonomy, allowing healthcare agents to represent incapacitated individuals. However, their AD legal frameworks differ significantly in legal requirements, scope, completion processes, healthcare agent eligibility, AD portability, and the promotional efforts. In the US, there is a need for stricter regulations governing patient-healthcare agent interactions to align decisions with patient preferences. Furthermore, enhancing universal portability of AD, particularly in emergencies, via cross-state recognition or digital sharing is essential. For Taiwan, we recommend expanding ADs to include emotional and spiritual aspects, for more end-of-life preferences. Incorporating psychiatric AD into Taiwan’s PRAA could enrich end-of-life care. Cross-culturally, making advance care planning more affordable, along with enhancing AD awareness through active healthcare provider involvement, could strengthen patient autonomy.
DOES COGNITIVE MISPERCEPTION AFFECT THE TIMING OF COMPLETING ADVANCE DIRECTIVES?
Authors: Lou Yifan , Lin Zhuoer , Chen Xi
Published: January 2025

While there has been extensive research on improving advance directives (AD) completion rates, less attention has been paid to the early engagement of AD. Studying factors that may be related to the earlier AD timing is critical as the initiation of AD is often delayed until “too late to be useful”. This study investigates one potential sociopsychological mechanism – cognitive misperception – that may be linked to the timing of AD completion. Data were from 3,675 older adults from the Health and Retirement Study who died between wave 2002 to 2018, completed living will or Durable Power Attorney of Health Care (DPAHC) before death, and had cognition measures no later than they did AD. Cognitive misperception was measured by the quartiles of differences between standardized subjective (self-rated memory) and objective cognition (working memory tests): conservative, no misperception, optimistic, and overconfident. Linear and logistic regression models were used to evaluate the relationship between cognitive misperception and (1) months between filing living will (or DPAHC) and death and (2) whether living will (or DPAHC) was filed within one year of death, respectively, net of demographic, socioeconomic status, and health covariates. We found that being conservative on cognition motivated older adults to file living will 8.62 months earlier, and being overconfident delayed older adults to file living will by 7.25 months. Being overconfident in cognition also significantly increased the likelihood of filing living will and DPAHC by 34% and 40%, respectively. Interventions targeting cognitive misperception may be effective in promoting early AD completion.
EXAMINING AGE BIAS IN CHATGPT RESPONSES TO USER QUESTIONS ABOUT DECISION-MAKING IN ADVANCED CANCER
Authors: McDarby Meghan , Mroz Emily , Hahne Jessica , Carpenter Brian , Parker Patricia
Published: January 2025

ChatGPT is an online, AI-powered chat application that provides human-like responses to user input. There is concern about bias in ChatGPT responses based on user demographics, yet no existing research has examined age bias in ChatGPT responses to questions about decision making (DM) in advanced cancer. The current study examined the content of ChatGPT responses to a hypothetical patient question about DM in advanced cancer. Replicating Nastasi and colleagues’ (2023) approach, we posed a medical-advice-seeking vignette to ChatGPT with variations on four hypothetical patient characteristics: age (45/65/85 years), race (Black/White), ethnicity (Hispanic/Non-Hispanic), and insurance status (Insured/Not Insured). Each vignette ended with: “Should I look for other treatments or focus on my quality of life?” Three coders categorized responses (ICC=.95) for mentions of nine topics relevant to DM in advanced cancer (e.g., consideration of clinical trials, suggestion to pursue second opinions, descriptions of hospice and palliative care, and encouragement to talk to providers for DM support). ChatGPT responses more frequently mentioned consideration of clinical trials to patients who were 45 compared to patients who were 65 and 85 years old (X2(2,N=96)=8.6, p=.01). There was a non-significant trend toward ChatGPT responses suggesting pursuit of second opinions more frequently for younger patients (X2(2,N=96)=3.0 p=.22). There were no age differences in mentions of hospice care (p>.50), palliative care (p>.30), or talking to providers for DM support (p>.30). Findings indicate that ChatGPT responses to questions about advanced cancer DM may contain age bias. Future research should address how ChatGPT users navigate bias in responses.
EXPLORING END-OF-LIFE DEMENTIA CARE IN RESIDENTIAL CARE SETTINGS: TOWARD A RELATIONAL MODEL
Authors: Kontos Pia , Dupuis Sherry , Colobong Romeo , Delaney Erin , Gertin Robin , Engell Katia , MacTavish Erica
Published: January 2025

With the biomedicalization of death in Canada, and the stigma associated with both dementia and death, people living with dementia (PLwD) in Canada suffer painful and undignified end-of-life (EOL) experiences. There is growing evidence that relational approaches, which value relationships as complex and dynamic connections including broader social, cultural, political, and environmental forces, can reduce stigma and improve quality of care. Yet, these approaches have not been explored or implemented in EOL care. Further, despite that EOL care is a priority in a number of national dementia strategies, EOL research in Canada remains limited and has largely neglected the inclusion of PLwD. To address these limitations, we conducted arts-based research conversations with PLwD in residential care settings in Ontario, Canada. These sessions were guided by Liberation Arts (i.e., using the arts to challenge oppressive attitudes, policies and practices), co-facilitated by community artists and researchers, and focused on what compassionate, relational EOL care looks like from the perspectives and experiences of PLwD. Transcripts of the audio-recorded conversations and the art created with PLwD were analyzed using the participatory Critical and Creative Hermeneutic Analysis Framework. Our analysis highlights EOL as relational (i.e., a communal rather than an individual process), as demonstrated by prioritizing relationships (e.g., human, pets, biographical objects, place/space), honoring PLwD (e.g., cultural/religious traditions, contributions to life), and supporting living life until the end. Our analysis contributes to the nascent EOL research that is inclusive of PLwD and will importantly inform a new model of EOL care grounded in relational caring.
FAMILY PERCEPTIONS ABOUT ENGAGING IN PALLIATIVE CARE CONFERENCES FOR THEIR LOVED ONES WHO LIVE IN LONG-TERM CARE
Authors: Kaasalainen Sharon , Thompson Genevieve , Wickson-Griffiths Abigail , Hunter Paulette , McCleary Lynn , Sussman Tamara
Published: January 2025

Despite the high mortality rates in long term care (LTC), most LTC homes do not have a formalized palliative program. Communication with family members or care partners is critical to prepare them for end-of-life and promotes shared decision-making. The aim of this study was to explore family perceptions about engaging in Palliative Care Conferences (PCCs) which were held for their loved one who was dying in LTC. This study was conducted in four provinces in Canada (Ontario, Manitoba, Saskatchewan, Alberta) and utilized a qualitative description design. Of the 36 family members who were interviewed, 12 were bereaved and 24 were non-bereaved. Overall, they felt that PCCs provided a venue for learning and appreciated the interdisciplinary approach. It gave them some time and space to develop stronger, more caring relationships with staff that sometimes was difficult to do during normal day-to-day activities. Family stated the PCCs were informative and promoted quality communication. They also described how the timing of PCCs and other discussions is important so they don’t feel rushed and can ‘go at their own pace’, allowing them to receive the information that they need when they are ready for it. PCCs appear to feasible and support a family-centered approach to care, which relies on strong communication. Future work needs to include a more rigorous evaluation that builds PCCs into everyday practice.
HOW DO HEALTH CARE PROVIDERS VIEW HOSPICE CARE IN BINZHOU, CHINA?: A QUALITATIVE INQUIRY
Authors: Yu Heshuo , de Medeiros Kate
Published: January 2025

Although many large Chinese cities have begun hospice services, it is still a relatively new concept in many parts of the country, especially in smaller cities. The purpose of this study was to gain a better understanding of health care providers’ (physicians and nurses) attitudes toward hospice care, to include perceptions of barriers and facilitators of implementation in a fourth-tier city. Using a qualitative descriptive approach, semi-structured, open-ended interviews were conducted with 15 health care providers. Two major themes were identified: 1) barriers to developing hospice care and 2) prospective facilitators to develop hospice care. There is currently much ambiguity regarding what governmental agency would oversee hospice care if implemented, who would be responsible for payment, the importance of developing interdisciplinary care teams, and concerns about worker shortages. Future research is encouraged to investigate hospice attitudes across different local healthcare systems and to encourage the development of local hospice support.
WHAT MATTERS IN HEALTH CARE TO OLDER NATIVE HAWAIIANS?
Authors: Ibrao Miquela , Burrage Rachel , Muneoka Shelley , Kawakami Keilyn , Tanji Tarin , Tanoue Leslie , Braun Kathryn
Published: January 2025

The formal assessment of What Matters for older adults is often done in a medical setting through the acquisition of legal forms to prepare for end-of-life care. For many indigenous elders, however, these forms may appear impersonal or culturally insensitive. What Matters should go beyond end-of-life planning and include preferences for how older adults live their daily lives, which may include preferences for dwelling status and relationships, in addition to medical care. For Native Hawaiian elders, cultural differences exist that impact their aging values and priorities. A secondary qualitative analysis of 20 interviews was conducted in partnership with Hā Kūpuna National Resource Center for Native Hawaiian Elders using a transformative lens to explore themes on What Matters to Native Hawaiian kūpuna as they age. Deductive coding was informed by guidelines on What Matters according to the Institute of Healthcare Improvement’s 4Ms Framework. Inductive codes identified themes specific to Native Hawaiian kūpuna as part of their culture. NVIVO software was used. Themes identified on What Matters to Native Hawaiian older adults included: 1) incorporation of cultural traditions into healthcare routines; 2) a strong sense of family as part of the decision-making process; 3) a preference for home-based care at the end-of-life; and 4) the importance of provider relationship building. An infographic with education and recommendations for healthcare providers was developed using findings from the study. Our interview, coding, and dissemination processes may be of interest to researchers working with other minority groups.
ASSOCIATION BETWEEN WITHIN-DAY CALORIE INTAKE PATTERNS AND MORTALITY RISK AMONG US ADULTS
Authors: Mao Ziling , Newman Anne , Farsijani Samaneh
Published: January 2025

Nutritional research on longevity has historically prioritized quantity of intake, with low-calorie diets as a prime example. Yet the crucial effects of intake timing and distribution on circadian rhythm and health are largely unexplored. Here, we determined the association between 24-hour calorie intake patterns and all-cause mortality.

Methods

We included 33,094 nationally representative US adults (47.6±0.2y; 52.4% women) from NHANES. First, we calculated calorie intake at 6-hour intervals within a day via 24-hour food recalls. Then, group-based trajectory analysis was performed, and four distinct temporal patterns of daily calorie intake were identified: “Skewed-to-Morning”, “Skewed-to-Midday”, “Skewed-to-Evening”, and “Midday-Evening-Balance”. Mortality was ascertained through December 2019 using the National Death Index. Survey-weighted Cox hazard regression was used to determine the association between calorie intake patterns and all-cause mortality, adjusting for demographics, income, BMI, physical activity, smoking, alcohol, calorie intake, and diet quality.

Results

Among participants, 18% had morning-skewed, 22% midday-skewed, 22% evening-skewed calorie intake, and 38% had equal intake between midday and evening. During a median follow-up of 96 months, 4,162 participants died. In the unadjusted model, all skewed calorie intake patterns were associated with higher all-cause mortality compared to the Midday-Evening-Balance group (P< 0.05). After multivariable adjustment, Skewed-to-Morning (HR=1.18; 95%CI, 1.04-1.35) and Skewed-to-Evening (HR=1.20; 1.02-1.39) patterns remained significantly associated with higher mortality.

Conclusion

Calorie intake patterns skewed toward morning or evening may be associated with a higher mortality risk, independent of amount and quality of diet. This underscores the importance of considering both the quantity and the timing of daily calorie consumption.
RESILIENCE IN DIVERSE SOLO OLDER GRANDMOTHERS RAISING ADOLESCENT GRANDCHILDREN
Authors: Peterson Tina
Published: January 2025

Grandfamilies scholars often focus on shared caregiving responsibilities supported by a spouse or partner when parenting younger grandchildren. Less attention has been given to solo older grandparents raising adolescent grandchildren. This research will apply Dannison and colleagues’ (2011) framework of the 5 P’s (proud, positive, persistent, protective, problem-solvers) of Resilient Grandparent Caregivers to explore resiliency in solo older grandparents raising adolescent grandchildren. Solo grandparent caregivers (n=8) participated in a phenomenological study to examine Caregiving in Later Life by Grandparents Raising Adolescent Grandchildren. Participants were primary caregiver for a grandchild 12 or older; grandchild in home at least 3 days weekly; and grandparent 40 or older. Data collection via semi-structured interviews occurred across three states between March 2015 and June 2015. Interviews were audiotaped, transcribed verbatim, and analyzed using conventional content analysis. Racially and ethnically diverse grandmothers (100%) reported an average age of 61 years (range 56 to 67) with caregiving responsibility for grandchildren with a median age of 14 years. These solo older grandmothers described being proud (e.g. joy, energy, grandchildren’s talent, liveliness, etc.); positive (e.g. telling jokes, picking battles, reframing behavior, music, etc.); persistent (e.g. kinship foster care placement, most challenging role, navigating multiple responsibilities, etc.) protective (e.g. setting boundaries, honoring holiday celebrations, structure, etc.) and problem-solvers (e.g. seeking therapy, advocating within schools, generational gifts, resolving purchasing for multiple kids, instilling time management, etc.). Reflections on resilience from diverse solo older grandmothers raising adolescent grandchildren can promote strategies to support and advocate for underserved grandfamilies.
THE TROUBLE WITH FORGETTING: PROSPECTIVE AND RETROSPECTIVE MEMORY FAILURES AMONG CAREGIVERS
Authors: Turner Rachael , Sharma Anisha , Reese-Melancon Celinda
Published: January 2025

Caregivers serve a critical role in assisting their loved ones, though providing care can be associated with physical and cognitive decline. We investigated disparities in memory lapses and their perceived impact on daily functioning among caregivers and non-caregivers. We focused on lapses in prospective memory (PM; i.e., memory for future actions) and retrospective memory (RM; i.e., remembering information from the past). Participants included respondents of the Midlife in the United States Refresher 1: Daily Diary Project dataset (Ryff & Almeida, 2020). Individuals were identified as caregivers if they indicated assisting a spouse or parent with a disability or health condition throughout the week (n = 75). Self-report questionnaires measured instances of PM and RM forgetting, interference with daily routine resulting from forgetting, how bothered one is by forgetting, positive and negative affect, and time spent on caregiving tasks. Contrary to expectations, caregivers did not differ from non-caregivers on frequency of forgetting PM or RM tasks (ps >.05). Additional analyses investigated relationships between key variables and everyday forgetting and indicated that greater PM or RM forgetting among caregivers was associated with being more bothered by forgetting and more interference with daily routine (ps <.001). Further, negative affect and time spent caregiving significantly predicted caregivers’ PM forgetting with caregivers who reported greater negative affect and more time spent caregiving reporting more instances of PM forgetting. The present study highlights the subjective experiences of caregivers in managing their daily memory tasks.
THE ASSOCIATION BETWEEN PERCEIVED SOCIAL SUPPORT AND LIFE SATISFACTION: RACE/ETHNICITY DISPARITIES
Authors: Mbam Kingsley , Su Yan-Jhu , Dong Wuyi
Published: January 2025

Objective

Studies have shown an association between perceived social support and life satisfaction. However, fewer studies covered the racial/ethnic disparities in this association. This study looks to address this gap by assessing how perceived social support differs across racial and ethnic groups and their life satisfaction.

Methods

This cross-sectional study used data from the 2020 Health and Retirement Study (HRS). The respondents include individuals 55 and older without any missing survey responses (n=1,901). The perceived social support was assessed using the summary score of social integration, which included spousal/partner support, children support, friend support, and non-nuclear family support. Life satisfaction was assessed using Diener’s measure of life satisfaction. Control variables, including demographic characteristics, household income, and self-rated health, were added to this analysis. Ordinary least squared (OLS) regression was implemented to examine whether race/ethnicity moderates the association between perceived social support and life satisfaction.

Results

Adjusted models show results disclosing that people with more perceived social support had significantly higher life satisfaction (b = 0.32, p < 0.001), and interaction effects showed that the association among Hispanic people is significantly stronger compared to non-Hispanic Whites (b = 0.17, p = 0.03).

Discussion

These results suggest that improving social support for individuals age 55 and older across racial groups can enhance their life satisfaction, which is essential to improving their overall health and well-being. Furthermore, this study widens the understanding of the demographic factors that influence the association between perceived social support and life satisfaction.
THE EFFECT OF DIGITAL INTERACTION WITH FRIENDS AND FAMILY ON OLDER ADULTS’ WELL-BEING: A SYSTEMATIC REVIEW
Authors: He Ranran , Ogle Destiny , Ren Jinnan
Published: January 2025

Contacting friends and family using digital technologies has grown in popularity among older adults. Given the importance of social interaction across the life course, this novel form of interaction may substantially shape their well-being. Existing studies reviewing the effects of technology use on older adults’ well-being were mostly broad in scope, without specifying the age group or the relationships between interactants. This study aims to fill a gap in the literature by systematically reviewing how digital interaction with friends or family shapes older adults’ well-being. We sourced articles from six databases, and the last search was performed in February 2024. Studies were synthesized and analyzed using the narrative approach. All 21 qualifying studies were quantitative in their design. Most studies (10 articles) found positive impacts of digital interaction with family members on well-being, whereas some found negative (4), mixed (3), or null effects (2). Even more conflicting results were found in studies examining the effects of digital interaction with friends; four found positive benefits, five found adverse impacts, and two found no effects. Communication with family members was typically more predictive of well-being than communication with friends. The aggregated measurement of digital contact, the types of digital technology examined, the age range of survey respondents, the sociocultural context, and whether the studies were undertaken during the COVID-19 pandemic may explain these inconsistent findings. Therefore, we suggest that future research incorporate more precise measures of digital interaction with friends and family, more diverse study designs, and explore socio-structural and relational moderators.
THE MORE, THE MERRIER? OLDER ADULTS’ LEISURE WITH OTHERS AND ASSOCIATIONS WITH WELL-BEING OVER TIME
Authors: Rauer Amy , Stewart Meagan , Fiori Katherine , Marini Christina , Kanter Jeremy
Published: January 2025

The benefits of leisure for older adults are well-documented, as is the key role that social networks play in facilitating more opportunities for leisure. However, it is unclear if these opportunities are uniformly beneficial over time or if engaging in leisure with certain social ties (or alone) are more advantageous, particularly when barriers to social activities are greater (i.e., COVID-19 pandemic). Thus, we examined older adults’ leisure alone and with others and its links to well-being using a sample of 136 older adults in the U.S. (Mage = 68, range: 50-91; 69% females; 93% White; 72% partnered; 61% retired). Participants reported on leisure at three time points (Summer 2021/Fall 2021/Winter 2022) using a modified version of the Pittsburgh Enjoyable Activities Scale (Pressman et al., 2009). Older adults were most likely to do activities with romantic partners, followed by activities alone, with leisure with friends and family least likely. Although more leisure engagement overall was associated with better well-being (depressive symptoms, anxiety symptoms, loneliness, life satisfaction, perceived mattering), it was primarily leisure with others that appeared beneficial (romantic partner, friends, family). In fact, greater solitary leisure was linked to feeling less important (perceived mattering). Given that leisure with a romantic partner and with family declined when COVID-19 cases peaked (in contrast to the stability of overall leisure, solitary leisure, and leisure with friends), it appears that older adults were still able to do things they enjoyed, but the limitations on with whom they could engage in leisure were not without consequence.
EFFECTS OF A USER-CENTRED TECH-SUPPORTED TRANSITIONAL CARE MODEL ON REDUCING DEPENDENCY AMONG DISCHARGED PATIENTS
Authors: Xia Nan , Cheng Clio Yuen Man , Lou Vivian Weiqun
Published: January 2025

Many patients, especially those aged above 60, continue to have care needs after discharge. However, the existing professional-led services do not meet the growing service needs in Hong Kong, especially during the Covid-19 pandemic. To fulfil the needs of discharged patients, a standardised transitional care service delivery model was established through a user-centred approach. A comprehensive one-stop online platform was developed to empower patients and their carers by enabling a better understanding of their conditions. The tech-supported solution also enabled service providers to deliver high-quality services through data-informed service plans without contact. The current study aims to evaluate the effects of the novel service delivery model on reducing dependency among discharged patients dwelling in the community. The interRAI-Home Care v9.3 was applied to collect information on patients’ dependency by evaluating their care needs before and after receiving the services. 431 subjects were recruited from three local NGOs between July 2021 and June 2023, and 286 (66.4%) participants completed both pre- and post-evaluations. The overall mean number of Clinical Assessment Protocols (CAPs) decreased significantly, from 7.4 to 5.5 (p < 0.001). Patients’ care needs were reduced significantly (p < 0.001) in each of the three institutions after receiving services, with no significant differences observed across institutions. The current study provides evidence of the effects of a user-centered tech-supported transitional care model for discharged patients and their carers, which ensures that such a model could effectively provide remote services to patients and their carers, and can facilitate alleviating manpower shortages while facing unexpected obstacles.
EXPLORING REFERRAL PATTERNS AND PATIENT PROFILES IN A CLINICAL EXERCISE PROGRAM FOR OLDER ADULTS
Authors: Jennings Stephen , Giffuni Jamie , Gregor Neil , Mason Tyara , Pepin Marc , Hall Katherine
Published: January 2025

Gerofit is a supervised, outpatient clinical exercise program offered to Veterans aged ≥65 enrolled in Veterans Health Administration. Enrollment in the program is contingent on health care provider referral. This analysis seeks to examine the sources and characteristics of referrals, aiming to inform strategies to enhance accessibility and optimize program efficiency. Referrals (N=2511) to the program from 2014-24 across 3 of the largest Gerofit sites were assessed, and came from a multitude of providers (primary care-44%; nutrition & dietetics-14%; physical therapy-11%; mental health-5%; etc.). Referrals from specialty clinics and physical medicine & rehabilitation physicians had the lowest enrollment rate (22% and 10%, respectively), while referrals from physical therapy and nutrition & dietetics had the highest enrollment rate (51% and 46%, respectively). Compared to all Veterans enrolled at these sites during this timeframe, those referred by nutrition & dietetics and mental health tended to be younger and have better physical performance, while specialty clinics & geriatrics tended to refer older and more frail adults. Examination of participation rates at 1 year post-enrollment by referring provider type showed that nutrition & dietetics referrals had the highest 1-year attrition levels (21%). Increased recruitment from high performing providers, and education to providers on program eligibility targeting those with lower enrollment rates (< 25%), will result in improved staff efficiency and enhance timely enrollment of eligible Veterans by reducing bottlenecks in the referral stage.
FORMATIVE FACTORS INFLUENCING SOCIAL CARE SERVICES DEMAND AMONG OLDER ADULTS: A FORTITUDE PERSPECTIVE
Authors: Zhang Hengyuan , Li Xuena
Published: January 2025

Background

There is a serious mismatch between the supply and demand of social care services for older adults in China. The imprecise identification of formative factors leads to challenges for service providers in targeting the appropriate groups.

Methods

Adopting a fortitude perspective, a theoretical framework to analyze the formative factors of social care services demand was developed. Based on survey data from three cities and six counties, the impact of these formative factors was examined through binary logistic regression analysis.

Results

The demand for social care services among older adults is significantly influenced by their physical, familial and resource fortitude, following an overflow pattern of “individual-family-market-government”. Conclusions: Demand for social care services emerges only when the challenges faced surpass the physical, familial, and resource fortitude of older adults. Overprovision to those with high fortitude and overlooking individuals with low fortitude results in a supply-demand imbalance.
HEALTH CARE COSTS OF MEDICARE BENEFICIARIES WITH FRAILTY AND/OR DEMENTIA
Authors: Sison Stephanie Denise , Shi Sandra , Oh Gahee , Olivieri-Mui Brianne , Park Chan Mi , McCarthy Ellen , Kim Dae Hyun
Published: January 2025

Frailty and dementia predispose older adults to adverse health outcomes, resulting in increased health care utilization. In this study, we examined healthcare costs in a 5% sample of Medicare fee-for-service (FFS) beneficiaries using Medicare part A and B claims from 2016-2019. Using validated claims-based algorithms, we identified the presence of dementia and frailty (claims-based frailty index ≥0.25) in community-dwelling beneficiaries, 65 years or older, with continuous FFS enrollment 12 months prior to the start of each calendar year. Annual costs per beneficiary were calculated across 4 groups: a) those having dementia alone, b) frailty alone, c) both frailty and dementia, and d) neither. Having frailty alone incurred the highest total annual cost ($38,119), followed by frailty and dementia ($33,098) and then dementia alone ($16,622). The breakdown of costs revealed that inpatient costs (highest proportion of total costs) and carrier costs (e.g., provider fees, labs, imaging, procedures; second-highest proportion of total costs), followed a similar pattern as the total costs. This pattern persisted when examining preventable inpatient costs, with the frailty alone group having the highest costs ($2,517), followed by the frailty and dementia group ($1,610). SNF costs were highest in the frailty and dementia group ($5,338), followed by the frailty only group ($4,044), and then the dementia only group ($2,208). Our findings suggest that the presence of frailty, regardless of dementia status, drives healthcare cost. This highlights the need for a holistic patient-centered approach to optimize and reduce costs for frail older adults.
HOW DOES MEDICARE ELIGIBILITY AFFECT CHOICE AND UTILIZATION?: EVIDENCE FROM VETERANS
Authors: Aouad Marion , Rose Liam , Wagner Todd
Published: January 2025

Health insurance streamlines access to care, thereby improving well-being and health. In efforts to control costs, health insurers use selective contracting to limit the size of their provider networks. Regulators have focused on network adequacy rules, given concerns that overly restrictive networks may impede appropriate access. This raises an important question about what happens to patient behavior if a network expanded. We examine the effects of network expansions by focusing on veterans who receive care from the Veterans Health Administration (VHA). We exploit the change in their insurance network induced by Medicare eligibility at age 65 to examine changes in inpatient health care behaviors. Using regression discontinuity methods, we find that hospitalizations increase by approximately 3 percent at 65. Interestingly, there are large insurer reallocations – individuals increasingly choose the new Medicare option for hospitalizations once it is available (a 70 percent increase relative to the pre-65 share.) while the VHA and commercial insurers are used increasingly less, with an approximately 7 and 51 percent decline, compared to the pre-65 share, respectively. We also find larger reallocations toward Medicare for certain groups, particularly among individuals who live closest to a Medicare hospital and further from VHA hospitals, and among those who visit the hospital for elective medical procedures (e.g., knee replacement). The results show the link between network size and cost containment, with expansions resulting in greater use of elective inpatient care.
MEDICARE-MEDICAID DUAL ELIGIBLE SPECIAL NEEDS PLANS (D-SNPS): ENROLLMENT TRENDS (2007–2023)
Authors: Dahal Roshani
Published: January 2025

Dual-Eligible Special Needs Plans (D-SNPs), private Medicare Advantage plans, exclusively enroll Medicare-Medicaid dual enrollees. First operationalized in 2006 and popular among state Medicaid agencies, enrollment in integrated plans remains a challenge. CMS expects states to transition existing plans into D-SNPs by end of 2025. We used publicly available SNP monthly data (2007-2023) to examine enrollment growth. CMS began reporting on integration status (2022) of D-SNPs: Coordination-Only, Highly-Integrated (HIDE), and Fully-Integrated (FIDE). D-SNPs began with 0.67million duals (73.9% of SNP enrollment). A moratorium on SNPs (2008-2009) correlates with slight decline; however, Affordable Care Act (2010) lifted moratorium and legislation extended SNPs through 2018, resulting in higher enrollment (mean 81.7%). In February 2018, SNPs were permanently authorized and annual enrollment in D-SNPs has consistently increased (11% to 16%). As of December 2023, there were 5.69 million duals (+16.4%) in D-SNPs, representing 89.5% of SNP enrollment. Of 823 plans, 60.6% were Coordination-Only, 29.8% were HIDEs, and 8% were FIDEs. Only twelve states offered FIDE-SNPs. Percentage of integrated plans have declined in the last year, despite overall increase in all D-SNPs (Coordination-Only plans grew by 34%, FIDE 15.7%, HIDE 12.5%). D-SNP market has experienced consistent high growth rate, outpacing growth in Medicare Advantage (8%). Although designed to serve duals, focused on integrating Medicare-Medicaid benefits, less than 10% D-SNPs are fully integrated more than 15 years later. Although HIDE-SNPs (a higher level of integration) began only in 2021, almost 30% of duals are enrolled. Integration under D-SNPs is important for reducing fragmented care among duals.
UNMET NEEDS FOR MENTAL HEALTH CARE: ARE THERE RACIAL DISPARITIES AMONG OLDER AMERICANS IN NEW YORK?
Authors: Li Chien-Ching , Yen Pei-Shan , Chen Yi-Fan , Matthews Alicia
Published: January 2025

Racial and ethnic differences in mental health problems have been widely discussed in the existing literature. However, limited research examines the disparities in mental health care among older Americans, who have been found to face access barriers to care. This study aimed to examine the racial and ethnic disparities in unmet needs for mental health care among older Americans in New York. We analyzed data from the New York City Community Health Survey (NYC CHS; 2012-2020). Our study sample included participants aged 50 years and older from the NYC CHS. The dependent variable of interest was the unmet need for mental health care (yes, no), which was assessed through the question, “Did you need treatment for mental health but did not receive it?”. The independent variable was race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian/Pacific Islander, other non-Hispanic). Covariates measured at a multi-level, including demographics, access to care, and neighborhood factors, were included. Regression results indicated racial/ethnic disparities in unmet needs for mental health care. Individuals in other non-Hispanic group were more likely to report having unmet needs for mental health care. However, non-Hispanic Blacks and Asian/Pacific Islanders exhibited a higher likelihood of having unmet mental health care needs compared to Whites. More importantly, older individuals without a personal doctor and those residing in underprivileged neighborhoods were associated with a higher likelihood of having unmet mental health care needs. Further development of community-based interventions is needed to mitigate access barriers to mental health care among older Americans.
FEASIBILITY AND ACCEPTABILITY PILOT OF THE ENHANCING ACTIVE CAREGIVER TRAINING (ENACT) INTERVENTION
Authors: Eaton Jacqueline , Neller Sarah , Cajavilca Moroni Fernandez , Dayley Amber , Johnson Julene , Ellington Lee
Published: January 2025

The process of actively engaging dementia caregivers in interventions has been insufficiently studied. This limits our understanding on how best to improve interventions. Enhancing Active Caregiver Training (EnACT) was developed to facilitate active engagement using participant-informed vignettes that portray caregiving experiences. We conducted a randomized waitlist-controlled pilot study to test the feasibility and acceptability of EnACT with a group of 30 caregivers of persons living with dementia. Participants were randomly assigned to intervention (n=15) or control (n=15) groups. The intervention group received three EnACT sessions during the first 7 weeks, which was then repeated for the control. Sessions used the vignettes to facilitate small-group dialogue, exploration, and reflection. These were delivered by trained interventionists via Zoom and each session lasted 60 minutes. Feasibility and acceptability data were collected to assess 1) interventionist training and delivery, 2) acceptability of treatment conditions, 3) participant adherence, and 4) recruitment, randomization, and assessment protocols. Preliminary results suggest that EnACT is feasible and acceptable to caregivers and interventionists. Retention rates were high (97%) and twenty-nine participants (97%) completed all six outcome surveys. Levels of satisfaction improved across the intervention, with the highest satisfaction focused on interventionists, engagement, topics, length, and accessibility. Data from this pilot is being used to prepare and plan for a fully powered randomized controlled trial.