bluuebunny/crossref_metadata_2025 huggingface dataset:
EXPERIENCES OF DISTRICT NURSES WITH MAKING DECISIONS ABOUT THE USAGE OF INVOLUNTARY TREATMENT
Authors: Moermans Vincent , Bleijlevens Michel , Verbeek Hilde , de Casterlé Bernadette Dierckx , Milisen Koen , Hamers Jan
Published: December 2022

District nurses play a key role in care of older Persons Living with Dementia (PLWD) who still live in their own home environment. Studies show that they often have to deal with decision-making about and the usage of involuntary treatment. Involuntary treatment is care provided that they resist to and/or have not given consent to, such physical restraints, psychotropic medication. This study aimed to describe district nurses’ experiences regarding the decision-making processes about and the usage of involuntary treatment among PLWD. A qualitative study design with a grounded theory approach was used. During semi-structured interviews, 16 district nurses shared experiences in 31 different cases of involuntary treatment use among PLWD. Results show that district nurses were often not involved in the decision-making process. In most cases, family caregivers decided solely to use involuntary treatment, and district nurses were asked to do also. District nurses experienced these situations as difficult to deal with. They felt that they were torn between providing “good care”, wishes of PLWD, and meeting the expectations of family caregivers. Their experiences were negatively affected if PLWD verbally rejected the care provided, they were unable to enter into a dialogue with the caregivers about the care provided, and if they did not have sufficient knowledge about how to deal with PLWD. These findings indicate the importance, of proactive case management in dementia care at home. District nurses can facilitate this by going into dialogue between PLWD and his caregivers, in order to provide person-centered dementia care at home.
NJGWEP RESUSCITATING THE VA COGNITIVE CLINIC: REBUILDING COMMUNITY PARTNERSHIPS DURING A PANDEMIC
Authors: Bodenheimer Lisa , Overbeck Kevin , Perweiler Elyse , DeGennaro Jennifer , Chopra Anita , Toplyn Lavona , Cetkowski Richard , Berna Renee
Published: December 2022

The New Jersey Geriatrics Workforce Enhancement Program (NJGWEP), in collaboration with the Wilmington Veteran’s Administration Community-Based Outpatient Clinic (VA-CBOC) in Vineland, NJ, implemented a multi-disciplinary comprehensive, evidence-based geriatric care program to assess cognitive health and geriatric syndromes as well as offer caregiver support, dementia disease education and referrals to VA and community resources. The “Cognitive Clinic” evaluated 15 veterans during a 3-month pilot phase before suspension due to COVID-19 in March 2020. To maintain momentum established prior to COVID-19, NJGWEP/VA clinical providers routinely met virtually to update each other on their organizations’ status, policies, and progress providing clinical care during the pandemic. These meetings offered opportunities to retain rapport and brainstorm strategies to modify the cognitive clinic.NJGWEP/VA providers successfully pivoted to include a telehealth model of care when appropriate and feasible; also helping to reduce barriers that limited the number of in-person contacts allowed on any given day. Implementation of telehealth proved successful at capturing caregivers who otherwise cannot attend appointments. The VA suggested de-coupling the back-to-back social work/physician appointments to ease scheduling concerns for VA providers. The Cognitive Clinic resumed employing a hybrid model of in-person physician assessments with referrals to social work for caregiver support offered via telehealth. From 1/19/22-3/2/22, 10 veterans were evaluated by a physician; 5 were diagnosed with dementia, all of whom identified a caregiver and received education, resources and referrals. In the upcoming year, the plan is to evaluate 4 veterans per month and train a VA geriatric APN to support program sustainability.
ASSOCIATION BETWEEN QUALITY OF LIFE AND DEPRESSION IN DYADS OF OLDER PRIMARY CARE PATIENTS AND FAMILY MEMBERS
Authors: Fowler Nicole , Perkins Anthony , Park Seho , Schroeder Matthew , Boustani Malaz
Published: December 2022

Familial dyads experience illness as an interdependent unit. We evaluate the association of quality of life (QOL), as measured by physical (PCS) and mental health component (MCS) scores, with depression in dyads of older primary care patients and a family member. This is a cross sectional, descriptive study where QOL and depression were measured concurrently in the dyad using baseline data from 1809 dyads enrolled in a trial testing the benefits and harms of Alzheimer’s disease and related dementias (ADRD) screening. QOL was measured with the SF-36, depression was measured with the PHQ-9, and the association of depression with QOL was examined using an actor-partner interdependence model with distinguishable dyads. Patient mean (SD) age was 73.7 (5.7) years; 53.1% women; 85.1% white; 13.4% black. Family member mean (SD) age was 64.2 (13) years; 67.7% women; 13.4% black. A patient’s spouse/partner were 64.8% of family members. After controlling for dyadic relationship and gender, significant actor effects of depression on PCS for patient (β= -1.39; p< 0.001) and family member (β =-0.954; p< 0.001), and significant partner effects of depression on PCS for patient (β=-0.15, p< 0.05) and family member (β =-0.18; p< 0.01). There were significant actor effects of depression on MCS for patient (β =-1.2; p< 0.001) and family member (β=-1.2; p< 0.001), but depression had a significant partner effect on MCS only for patient (β = -0.08; p< 0.05). Among dyads participating in an ADRD screening trial, dyads with higher depression had lower QOL. Family member depression was associated with decreased family member and patient QOL.
OPPORTUNITIES, FEASIBILITY, AND CHALLENGES OF USING IMMERSIVE VIRTUAL REALITY IN AGING RESEARCH
Authors: Wrzus Cornelia
Published: December 2022

Immersive virtual reality (iVR), that is, 3D-scenarios presented in head-mounted displays, is rarely used in aging research, although it gained much popularity recently in medical, educational, consumer, and gaming contexts and offers advantages such as real-life scenarios under experimental control. Still, iVR might be less suited for older adults, if they do not experience realism (i.e., presence) or feel strong cyber-sickness (e.g., nausea, headaches). The current preregistered project (osf.io/ryz2c) examined the opportunities, feasibility, and challenges of immersive Virtual Reality for studying age differences in socio-emotional processes. Up to now, 50 younger (age M = 23.5) and 50 older adults (age M = 67.9) saw different socio-emotional situations in iVR using a HTCvive headset, which included eye tracking, and then rated experiences of presence and cyber-sickness. Results showed that feelings of being present in the virtual reality were moderate to high, while cyber-sickness was generally low, and did not differ significantly between younger and older adults. Further analyses explore associations with technology acceptance, health, and personality. The findings suggest that using iVR with older adults is feasible, and creates similar levels of realism and low cyber-sickness as among young adults. The discussion highlights the opportunities and challenges of using iVR for studying age differences in cognitive, emotional, or social processes in experimentally controlled, real-life scenarios.
LIFE AFTER LOSS: EMERGING INSIGHTS ON GRIEF ADJUSTMENT AND HEALTH IN LATE LIFE
Authors: Mroz Emily , Hackett Sara , Carr Deborah
Published: December 2022

Recent scholarship recognizes that grief adjustment is not a staged, linear process. In late life, the loss of close others is common and dynamic. However, little is known about the ‘ripple effects’ from loss experiences. As people are living longer, it is important to gain insight regarding how loss is processed, carried, and used for self-direction. This symposium responds to GSA’s 2022 meeting theme of “Reimagining Aging” by presenting emerging research which reimagines grief adjustment across diverse populations. To begin, Sara Hackett, PhD will share her work on the continuing bonds of older conjugally bereaved women and how they shape perceptions about repartnering. Following, Emily Mroz, PhD will present on affective sequences in final memories from past spousal loss and demonstrate how sequences predict future caregiving confidence in these widowed older adults. Danielle McDuffie, MA will add to this rich discussion by shedding light on predictors of bereavement and grief outcomes specific to Black adults. Last, Holly Prigerson, PhD will outline unmet psychological needs of family caregivers of patients who die in ICU settings and present her work on EMPOWER, an intervention aimed to reduce psychological distress and foster caregiver adjustment across the loss experience in this setting. Stephanie Wladkowski, PhD, our discussant, will tie these perspectives together, facilitating an important dialogue regarding classic and newly-considered impacts of grief in late life. Further, she will discuss how through more closely examining peoples’ experiences during and after loss, we can recognize late-life bereavement as shaping self-perceptions, relationships, and mental health.
OBJECTIVE AND SUBJECTIVE POVERTY AMONG OLDER PEOPLE AND ITS ASSOCIATION WITH HEALTH, FUNCTION, AND MORTALITY
Authors: Jacobs Jeremy , Stessman Jochanan
Published: December 2022

We examined objective and subjective poverty between ages 70-95, comparing and contrasting frequency, associated subsequent medical, functional, psychosocial impairment, and mortality. Data collection by the Jerusalem Longitudinal Study, following a representative community dwelling sample (born 1920-1921), assessed at ages 70, 78, 85, 90, and 95. We defined "objective poverty" as sole income from "national old-age pension" necessitating "supplemental income benefit" from the National Institute for Social Security; "subjective poverty" as "financial difficulty getting through each month". Subjective and objective poverty differed: frequency of objective poverty remained 13% throughout follow-up period, while subjective poverty was more frequent at younger age, decreasing from 24% at ages 70-85, to 14% at ages 90-95. Subjective poverty was significantly associated with depression at all ages (from HR=3.2, CI 95%:1.73-5.93 at age 70, to HR=2.45, CI 95%:1.32-4.54 at age 95), and poor self-rated health (from HR=2.69, CI 95%:1.63-4.46 at age 70, to HR=1.96, CI 95%:1.11-3.43 at age 95), however no consistent associations with objective poverty was observed. Both objective and subjective poverty were associated with low levels of physical activity, impaired functional and cognitive status. Mortality was significantly increased among subjects with subjective poverty at ages 70, 85, and 90 (ranging from HR=1.33, CI 95%: 1.02-1.74 to HR=1.50, CI 95%:1.11-2.03), while objective poverty was significantly associated with increased mortality at ages 78 and 85 (HR=1.43, CI 95%:1.01-2.03, and HR=1.55, CI 95%:1.16-2.07 respectively). In conclusion, subjective and objective poverty differ in their association with health, functional and psychosocial status, and mortality between ages 70-95.
THE RELATIONSHIP BETWEEN RELIGIOSITY AND NURSING HOME SERVICE UTILIZATION: A LONGITUDINAL ANALYSIS
Authors: Ronneberg Corina , Miller Edward
Published: December 2022

On any given day 3.9% to 4.2% of the US population receives nursing home (NH) care. Given the critical role NHs play in caring for older adults, research has identified various demographic, biological, psychological, and social factors associated with NH utilization. Few studies, however, have explored religiosity as a predictor; none, longitudinally. This study thus aims to examine how one’s religiosity (organizational, non-organizational, intrinsic) affects NH use. A total of n=7,564 respondents (>51 years) from the 2006 wave of the Health and Retirement Study, with no prior NH use, were assessed every two years, until 2014. Hierarchical modeling techniques (i.e., Generalized Estimating Equations Multinomial Logistic Regression) were used to model the relationship between religiosity and subsequent NH use, while controlling for other factors. Results indicate that high levels of organizational religiosity (i.e., service attendance) is associated with higher rates of NH utilization (B= 0.13, p < 0.001). Conversely, they indicate that higher non-organizational religiosity (i.e., private prayer) is associated with a lower likelihood of NH care use (B= -0.03, p < 0.05). Sex and race served as moderators in these relationships. The association between higher levels of service attendance and higher rates of NH utilization may reflect the sharing of information about available resources such as long-term care through one’s social support networks, including congregations. In contrast, individuals who were more likely to pray on their own, may lack the social support provided by congregations, and as a result, experienced more limited knowledge transfer about available resources such as NHs.
TESTING A PORTION OF THE OKLAHOMA AGING INMATE FORGIVENESS MODEL
Authors: Randall George , Bishop Alex , Bellah Sydney
Published: December 2022

The study assessed the viability of the published Oklahoma Aging Forgiveness Model on women in custody using cross-sectional data collected from females, violent and non-violent, in custody in Oklahoma. The theoretical model led to a hierarchical regression of a measure of positive mental health (Positive Evaluation of Life) on a block of control variables (age, education, and crime type), a block consisting of items from the Duke Religiosity measure, and a final block utilizing forgiveness of self, others, and situation (Heartland Forgiveness Scale). Results from the complete sample, N=447, explained 36% of the variance in the outcome. Significant individual predictors included in the final model were crime type, religiosity, and forgiveness of self and situations. We split the sample on crime type and found that for the violent offenders (N=228), 39% of the variance in the outcome was explained; in addition to religiosity, all three assessments of forgiveness were significant predictors. For the non-violent offenders (N=209), 35% of the outcome’s variability was explained. Religiosity, forgiveness of self and situation were significant predictors for this sub-sample. Discussion will focus on the Oklahoma Aging Forgiveness Model and how it works similarly for men in custody (published) and for women in custody. Further, the discussion will focus on the significant role played both by religiosity and forgiveness for those in custody. Findings from this study and that of studies with men clearly demonstrate that religiosity and forgiveness are important aspects of a prisoner’s life.
FAITH, HOPE, AND LOVE: UNDERSTANDING RELIGIOSITY AND HOPE AMONG OLDER AFRICAN AMERICAN COUPLES
Authors: Skipper Antonius , Rose Andrew
Published: December 2022

Older African Americans frequently turn to their religion or spiritual faith as a source of coping and resilience. Disproportionately burdened by numerous disparities and stressors, many African American utilize religion as a source hope for the future. Existing studies suggest that higher levels of positive religious coping are associated with higher levels of hope, and more frequent experiences with negative religious coping are associated with lower levels of hope. However, the relationship between religious coping and hope is underexamined among one of the most religious dyads in the U.S., older African American couples. This study utilizes data from 194 older African American couples (146 married and 48 cohabiting), with each partner between the age of 50 and 86 years, to examine the dyadic relationship between religious coping and hope. Actor Partner Interdependence Models revealed that men’s religious coping was associated with their own hope, and women’s religious coping was associated with their own hope. One unexpected partner effect was identified and found that women’s positive religious coping was negatively associated with men’s hope. Given the dearth of research on older African American couples, along with the need to better understand religious significance in psychosocial dyadic outcomes, this study offers several implications for engaging African American couples in relational counseling and therapy across the life course.
FAMILY SUPPORT AS A MEDIATOR OF COGNITIVE FUNCTIONING AMONG HISPANIC OLDER ADULTS WITH SENSORY IMPAIRMENTS
Authors: Tanner Corinna Trujillo , Yorgason Jeremy , White Avalon , Ehrlich Joshua , Cash Antonia
Published: December 2022

Background

Understanding the intersection of age, ethnicity, and disability will become increasingly important as the U.S. population ages and becomes more diverse. By 2060, Hispanics, the largest ethnic minority, will comprise 28% of the population. Although a heterogeneous group, originating from a variety of countries, Hispanics may share common cultural values. These familistic values may act as a buffer against social isolation and cognitive decline, commonly associated with sensory disabilities including vision, hearing, and dual sensory disabilities.

Methods

Our sample consisted of 557 Hispanic older adults that participated in the National Health and Aging Trends Study. Longitudinal mediation models across a three-year span were estimated using Mplus with vision, hearing, and dual sensory disabilities predicting cognitive decline directly and indirectly through social isolation. Bootstrapping with 5,000 draws adjusted the standard errors of indirect effects. Results and Discussion: Results suggest that vision disability and dual sensory disability were associated with declines in various cognitive functioning scores. Social isolation was linked with declines in some concurrent and some longitudinal cognitive measures. Although dual sensory disability (i.e., both vision and hearing disability) were linked with social isolation, individual vision or individual hearing disability were not associated with social isolation in this sample. Historically, vision and hearing disabilities have been associated with social isolation, yet in Hispanic cultures, social connections between generations may provide a buffer to this common result of sensory disabilities. Findings from this research suggest that Hispanic older adults experiencing dual sensory disabilities may benefit from interventions that foster social support.
IMMIGRATION EXPERIENCES AND COGNITIVE TRAJECTORIES AMONG OLDER CHINESE IMMIGRANTS
Authors: Tang Fengyan , Li Ke , Rauktis Mary , Chi Iris
Published: December 2022

Some studies have documented cognitive health among older immigrants in the United States; however, little is known about how the life-course immigration experiences were associated with cognitive trajectories among older Chinese immigrants. This study filled the research gap by identifying the patterns of cognitive change trajectory among older Chinese immigrants and examining the associations of immigration experiences (that is, age at migration, reasons for migration, acculturation, perceived discrimination, and preferred dialects) with cognitive trajectories. The sample comprised 2,075 participants from the Population Study of Chinese Elderly (PINE), who completed a battery of cognitive tests at four time points (2011-2019). Latent class growth analysis and multinomial logistic regression were utilized. Three latent classes of cognitive trajectories were identified: the low functioning with the fastest decline (LCF, 12%), the moderate functioning with a medium decline rate (MCF, 39%), and the high functioning with the slowest decline (HCF, 48%). Perceiving more discrimination reduced, while speaking Taishanese increased the odds of being in the LCF and MCF. High acculturation only distinguished MCF from HCF after controlling for the known factors of cognition such as age, education, and social engagement. This study identifies a group of older Chinese immigrants who are especially vulnerable to cognitive impairment, and indicates that the immigration-related risks for cognitive decline, such as late-life migration and lower acculturation, could be buffered by education in early life and social engagement post immigration. Practice and policy efforts are needed to increase socioeconomic and cultural opportunities for social integration among older immigrants.
SOCIAL NETWORK AND MENTAL HEALTH OF OLDER CHINESE IMMIGRANTS IN AFFORDABLE SENIOR HOUSING DURING THE COVID-19 PANDEMIC
Authors: Yu Kexin , Liang Jiaming , Tung Yi-Hsuan , Zhang Mutian , Yang Luyan , Wu Shinyi , Chi Iris
Published: December 2022

Chinese older immigrants who live in senior housing communities are at high risks of experiencing discrimination and social isolation during the COVID-19 pandemic. This study examines how and to what extent the pandemic has affected this population’s social network and mental health. Participants reported a decrease in social contact with their family and friends. Before the pandemic, many paid regular visits back to the home country and could not do so in the past two years. The loss of connection left some feeling despaired and expressed uncertainty on whether they could ever go back “home” before death. Participants also reported being in a low mood and feeling bored constantly. Participants reported resilience generated from their religious beliefs, having neighbors as role models, and wisdom learned from past life experiences. Knowledge produced in this project can inform the planning for responding to future crises in affordable senior housing.
LONGITUDINAL INVESTIGATION OF FACTORS PREDICTING RETIREMENT ADJUSTMENT AMONG RETIREES IN TAIWAN
Authors: Chao Shiau-Fang , Ye Wei , Liu Wei-Cheng
Published: December 2022

BackgroundRetirement can substantially affect one's lifestyle and self-identity. However, little research has focused on how pre-retirement conditions are associated with retirement adjustment.MethodThis study utilized data from 1989 to 2015 Taiwan Longitudinal Study on Aging. A total of 1,471 cases who experienced retirement between waves and completed the subsequent four year and eight year follow-up surveys after retirement were included for analyses. High life satisfaction and low depressive symptoms represented good retirement adjustment. Multiple regression analysis was applied to test the hypothesized relationships. ResultsThe findings were as follows: 1. Retirees experienced increased depressive symptoms and worsened family relationships when transiting from pre-retirement to post-retirement.2. High cognition functioning, ideal family relationships and sufficient financial resources before retirement were consistently associated with few depressive symptoms and high life satisfaction, both at four and eight year follow-ups. 3. Of the 10 different leisure activities investigated, physically active leisure activities such as walking and participating group exercise before retirement predicted few depressive symptoms and high life satisfaction four years after retirement, but not eight year follow-up. DiscussionCognitive functioning, financial status, and family relationship before retirement can significantly affect both short-term (four years) and long-term (eight years) retirement adjustment, whereas physically active leisure activities only link to short-term retirement adjustment. At policy level, pre-retirement financial security should be addressed and well-prepared. At practitioner level, maintaining ideal cognition level, positive family relationship, and engaging physically active leisure activities should be the central intervention target when serving employees who are approaching retirement.
JOB SEPARATION OF LONG-TERM CARE FRONTLINE STAFF IN ENGLAND
Authors: Vadean Florin , Saloniki Eirini-Christina
Published: December 2022

Staff turnover in the long-term care (LTC) sector in England is perceived to be relatively high. Most job leavers do not leave the sector, but rather move to other LTC employers. Nevertheless, there are concerns that the high ‘churn’ has a negative impact on continuity and quality of care, care providers’ recruitment and training costs, and the remaining staff workload and motivation. This study aimed to provide missing quantitative evidence on the drivers of LTC staff retention in England, with a focus on job quality. We used yearly data (2016 to 2019) from a large, employer-employee dataset covering about half of England’s LTC market: the Adult Social Care Workforce Dataset. After controlling for observed individual, organisational, and local market characteristics as well as unobserved worker and employer heterogeneity, we found that, everything else being equal, wages and employment conditions (i.e. full time contracts and contracts with guaranteed working hours) significantly reduce job separation. For example, a 10 per cent wage increase from the sample mean would have reduced the job separation rate by about 3 ppt. Our results also show that the wage effect was substantially downward biased (i.e. closer to zero) when not accounting for unobserved effects: the estimated reduction in job separation rate of a 10 per cent wage increase was only 1 to 1.5 ppt. Our findings show that improving pay and employment conditions for LTC staff can improve staff retention in LTC and stress the importance of accounting for unobserved variable bias.
DISCRIMINATION AND COPING AMONG OLDER CHINESE IMMIGRANTS DURING THE COVID-19 PANDEMIC: A QUALITATIVE STUDY
Authors: Liang Jiaming , Yu Kexin , Tung Yi-Hsuan , Li Choi Ha , Wu Shinyi , Chi Iris
Published: December 2022

Discriminatory events against Asians, especially Chinese, became rampant during the COVID-19 pandemic. It is difficult for older Chinese immigrants to effectively protect themselves from racism-related attacks due to their personal and social disadvantages. This study explored older Chinese immigrants’ experience of discrimination and coping strategies, as well as factors that influence their perceptions, attitudes, and coping preferences. Among 27 interviewees, 11 experienced discriminatory incidents themselves or known people around had been discriminated against during the pandemic. Thematic analysis revealed negative psychological impact of discrimination risk or experience. Most participants tended to adopt disengagement coping styles, such as avoidance, rationalization, and reducing social participation. Three primary influencing factors are: (1) perceived unkindness from government and public opinions; (2) concern for own health; (3) limited acculturation. Our findings suggest needing efforts to protect the safety of older Chinese immigrants, and raise their awareness and ability to defend themselves from racism and discrimination.
WHO GETS HOSPICE VISITS AT THE END OF LIFE: A LOOK AT MEDICARE'S HOSPICE SERVICE INTENSITY ADD-ON POLICY
Authors: Plotzke Michael , Christian Thomas
Published: December 2022

In 2016, the Centers for Medicare & Medicaid Services (CMS) implemented the Service Intensity Add-on (SIA) payment for the Medicare Hospice Benefit. The SIA incentivizes direct patient care by registered nurses and medical social workers during the last seven days of life through additional payments to hospices. We examined 100% of Fee-for-Service Medicare hospice claims in Fiscal Year 2020 to determine whether SIA utilization varies by patient and hospice characteristics. Using hospice level fixed-effects regression, we examine the associations between SIA utilization and various beneficiary and hospice characteristics. Relative to beneficiaries with cancer as a principal diagnosis, we find that other diagnoses are associated with only a slight reduction in SIA utilization (a reduction between 0.6 and 1.1 percentage points - where the average SIA utilization overall is equal to 85.3%). Those identifying as black had a reduction in SIA of 1.3 percentage points compared to those identifying as white. Compared to a patient dying on a Sunday, a patient’s death on Tuesday through Friday was associated with a higher likelihood of SIA (between 9.7 and 11.6 percentage points more likely) and more SIA minutes (between 29.9 minutes and 36 minutes). All reported results were statistically significant at the 0.1% level. Based on these results, we find that SIA utilization varied by certain characteristics. As a result, CMS should continue to monitor rates of SIA utilization to better understand whether any patient groups appear to be underserved at the end of life.
LIVE DISCHARGE FROM HOSPICE WITH DEMENTIA: CHALLENGES TO SUPPORTING THE PATIENT-CAREGIVER DYAD
Authors: Wladkowski Stephanie P , Wallace Cara L , Washington Karla
Published: December 2022

A live discharge from hospice disrupts care continuity and results in burdensome transitions for individuals with a life-limiting illness and their caregivers. In 2019, hospices served more than 1.6 million people across the United States, with nearly 63% of Medicare decedents age 85 or older. Of these patients, nearly 350,000 (20.9%) had a principal diagnosis of Alzheimer’s Disease/Dementia/Parkinson’s Disease. Research demonstrates that hospice care improves end-of-life outcomes for adults with Alzheimer’s Disease and related dementias (ADRD), yet with eligibility limited to a six-month prognosis, hospice is not structured to meet longer-term needs. The result is a live discharge from hospice. In 2019, 17.4% of hospice patients were discharged alive from hospice, with 6.5% discharged due to being ‘no longer terminally ill.’ The majority of live discharges are either hospice-initiated due to patient stabilization (extended prognosis resulting in a situation in which a patient no longer meets the life expectancy hospice eligibility criteria) or are patient-initiated (revocation) where a patient or proxy chooses to leave hospice care, typically to access disease-directed therapies or inpatient hospitalization. Both present unique challenges and opportunities for hospice providers. Informed by over 10 years of practice experience and research, this presentation will discuss the impact of live discharge from hospice and the unique impact for patients and primary caregivers of individuals with ADRD, the service gaps that exist for this population, and our recommendations for policy reform.
MULTISENSORY IMPAIRMENTS AND BRAIN VOLUMES IN MID-TO-LATE LIFE
Authors: Wanigatunga Amal , Tian Chenxin , An Yang , Cai Yurun , Gross Alden , Simonsick Eleanor , Schrack Jennifer , Agrawal Yuri
Published: December 2022

Age-related sensory impairment, such as loss in vision or hearing, have been linked to poor brain health. Yet, the relationship between co-occurring sensory impairments and brain volumes remains unclear. We used cross-sectional sensory and brain imaging data from 208 cognitively normal participants of the Baltimore Longitudinal Study of Aging (mean age 72 years; 59% women). Sensory impairments were separately identified with vision, hearing, smell, proprioception, and vestibular function testing. Brain imaging volumes were derived using an automated multi-atlas approach. Multiple linear regression models were used to estimate brain volumetric differences by number of sensory impairments (0-5) or by multisensory impairment status (MSI; ≥2 impairments). For every one additional sensory impairment, there was lower volume in the orbitofrontal gyrus (beta=0.35 cc [SE=0.17], p=0.04) but higher volumes in the caudate (0.14 cc [0.05], p=0.006) and putamen (0.13 cc [0.06], p=0.043). Participants with MSI (versus no MSI) had lower volumes in superior frontal gyrus (-1.01 cc [=0.34], p=0.003), lower orbitofrontal gyrus (-0.91 cc [0.38], p=0.018), superior parietal lobe (0.68 cc [0.27], p=0.011), and precuneus (-0.74 cc [0.35], p=0.038), but similar volumes in the caudate (p=0.12) and putamen (p=0.14). A negative relationship between MSI and brain volume across multiple regions was largely observed yet our exploratory findings raise the possibility that MSI is associated with compensatory maintenance of brain volume structures in the basal ganglia. Future directions include replication of these findings in other studies and longitudinal analyses to determine how MSI relates to brain atrophy.
EFFECTS OF ASSISTIVE TENNIS SHOES ON GROUND REACTION FORCE FOR PATIENTS WITH PERIPHERAL ARTERY DISEASE DURING WALKING
Authors: Evans Nathaniel , Rahman Hafizur , Pipinos Iraklis , Johanning Jason , Hassan Mahdi , Myers Sara
Published: December 2022

Peripheral artery disease (PAD) is caused due to buildup of atherosclerotic plaques, typically in the leg arteries, preventing adequate blood circulation and ultimately claudication. A previous study showed that the vertical ground reaction force (VGRF) curve is significantly flatter in claudicating patients, resulting in a lower and less fluctuant center of mass when ambulating. Patients with PAD also demonstrate significantly decreased propulsion forces in the anterior– posterior direction. Assistive tennis shoes (carbon fiber: CF, and spring-loaded: SL) can potentially assist push-off by substituting for muscle forces using energy stored in a carbon fiber plate or metal spring within the shoe. This study aims to examine how the CF and SL shoes impact walking performance in patients with PAD. A total of ten patients with PAD performed a progressive treadmill test using a pressure-instrumented treadmill for each shoe type: i) standard shoes, ii) CF shoes, and iii) SL shoes. We calculated the peak VGRF for three subjects to date as an average of ten stance phases for the beginning of the walking condition (pain free condition). Preliminary results from three subjects showed that patients with PAD generated a greater peak VGRF wearing CF and SL shoes compared to normal shoes during the heel contact (normal: 0.97±0.10BW, CF: 1.03±0.08BW, and SL: 1.09±0.10BW) and push-off (normal: 0.97±0.06BW, CF: 0.99±0.04BW, and SL: 1.03±0.05BW). In future, we will calculate the VGRF for the remaining patients in pain free and pain conditions and conduct statistical analysis to identify significant differences among shoe types.
A NATIONAL SNAPSHOT OF INFORMATION SHARING DURING CARE TRANSITIONS BETWEEN HOSPITALS AND SNFS
Authors: Adler-Milstein Julia
Published: December 2022

Prof. Adler-Milstein will present national survey results about skilled nursing facilities (SNFs) information sharing with referring hospitals. The survey, which garnered a 53% response rate, found significant gaps in information sharing. Of 471 hospital-SNF pairs, 64 (13.5%) reported excellent performance on 3 dimensions of information sharing (completeness, timeliness, and usability), whereas 141 (30.0%) were at or below the mean performance. Having a hospital clinician on site at the SNF was associated with more complete (odds ratio, 1.72; P = .03), timely (odds ratio, 1.76; P = .02), and usable (odds ratio, 1.64; P = .04) information sharing. Hospital accountable care organization participation was associated with more timely information sharing (odds ratio, 1.88; P = .02). Despite significant federal investment in hospital health IT infrastructure, we conclude that hospitals are not tailoring information sharing processes to ensure that SNFs receive timely, complete, and usable information.
MULTIMORBIDITY PROGRESSION AMONG MEDICARE BENEFICIARIES IN THE HEALTH AND RETIREMENT STUDY (1991–2015)
Authors: Quiñones Ana , Markwardt Sheila , Bobo Michelle , Allore Heather , Newsom Jason , Nagel Corey , Botoseneanu Anda , Dorr David
Published: December 2022

Older adults are at greater risk for developing and accumulating multimorbidity (2+ chronic conditions). This study describes the characteristics of older adults with multimorbidity using Medicare claims over a 24-year period. The HRS-Medicare data (1991-2015, N=17,199, age 67+ years) were used in descriptive analyses. We identified 8,800 (51%) beneficiaries who did not have multimorbidity at first observation (no multimorbidity), 6,270 (36%) with 2-4 conditions at the first observation (low multimorbidity), and 2,129 (12%) with 5+ conditions at the first observation (high multimorbidity). Older respondents (80+ years) had lower levels of multimorbidity at baseline compared with younger respondents (< 70 years); this appeared to be related to differences by birth cohort. Higher proportions of minoritized groups had high multimorbidity (15% non-Hispanic Black; 20% Hispanic; 11% non-Hispanic White). Despite only being 22% of the entire sample, persons with obese body mass index (>30) represented 41% of the high multimorbidity group. Higher incidence rates of disease accumulation were noted for Black (89/1,000 person years [py]) and Hispanic (94/1,000 py) compared with White respondents (82/1,000 py) in the high multimorbidity group. Hospitalization and ED rates increased linearly between the low and high multimorbidity groups. Functional loss was more prevalent in the high multimorbidity group compared with the no multimorbidity group; no difference was observed between no and low multimorbidity. Results highlight sociodemographic differences between Medicare fee-for-service beneficiaries with differing levels of multimorbidity, allowing new insights to guide interventions that address burdensome changes in late life.
LONG-TERM CARE STAFF DECISION-MAKING PROCESSES IN DETERMINING DAILY WELL-BEING OF RESIDENTS
Authors: Bowen Mary (Libbey) , Shin Ju Young , Rowe Meredeth
Published: December 2022

Much of the care provided to residents in long term care (LTC) comes from staff with minimal training, particularly in the area of the assessment of complex clinical presentations. This study utilized semi-structured focus group techniques with 25 clinical staff to understand how they determine whether a resident is functioning within or outside their daily “norm” and how they follow-up on these determinations. The overall finding was that each staff member develops an internally stored phenotype of each resident’s norm. Three primary themes emerged: 1) the staff’s phenotype becomes the ‘gold standard’ to determine whether there is a change and/or a cause for concern; 2) staff include sleep routines, fatigue, participation in usual activities, physical and mental status, and social interactions with others in their phenotypes. Staff reflect in what seems like a random manner through these comparisons, and, from this process, 3) a judgement emerges that helps inform clinical decision-making and potential action of the staff member. In most scenarios, staff decided there was no cause for concern. The identified weakness in this strategy was that staff rarely mentioned or used complementary and confirmatory formal assessment or referral mechanisms to ensure their judgment was correct. Thus, staff utilize complex multidimensional thinking and memory in decision-making but lack the skills or institutional structure to augment this with more formal and reliable techniques. This represents an interesting opportunity to build on existing assessment skills with additional types of assessment, technology-based information and formal referral mechanisms.
STAFFS’ PSYCHOSOCIAL WORK ENVIRONMENT IN RELATION TO RECIPIENT SATISFACTION IN HOME CARE SERVICES
Authors: Kåreholt Ingemar , Lundgren Dan , Kabir Zarina Nasar , Boström Anne-Marie
Published: December 2022

In accordance with ‘aging in place’ policy, older persons in Sweden are increasingly encouraged to continue living at home and if necessary be supported by home care service (HCS). Studies have examined whether the work environment of staff has an impact on the experiences and the wellbeing of the older persons in nursing homes, but few have examined such associations in HCS. The setting was 16 HCS work units. Two surveys were sent, one to staff on psychosocial working conditions, one to care recipients on care satisfaction. For each work unit, data on individual recipient satisfaction was matched to average values on psychosocial work conditions. Outcomes analyzed with linear regressions were overall recipient satisfaction, based on one question, and indexes on: assessment of implementation of services, contact with staff, and sense of security. Index on treatment by staff was analyzed with ordered logistic regressions due to skewed distribution. We used cluster correlated standard errors (clustering on work units). Results showed that good working conditions are important for recipient satisfaction, specifically overall recipient satisfaction, treatment by staff, and sense of security. Psychosocial work factors most important were work group climate, overall job strain, sense of mastery, job control, frustrated empathy, balancing competing needs, balancing emotional involvement, and lack of recognition. Having more home help hours was associated to stronger relation between working conditions and recipient satisfaction, especially with overall recipient satisfaction and treatment by staff as outcomes.
CARE WORKERS’ ADMINISTRATIVE BURDEN IN SWISS NURSING HOMES: A MULTICENTER CROSS-SECTIONAL STUDY
Authors: Ausserhofer Dietmar , Tappeiner Waltraud , Wieser Heike , Favez Lauriane , Zúñiga Franziska
Published: December 2022

Apart from ‘direct’ resident care, care workers in nursing homes also perform tasks that are related to organizational or management activities. ‘Indirect’ care activities, such as administrative tasks, are often considered as burdensome, as they increase overall workload and keep care workers away from caring for their residents. So far, there is little investigation on care workers’ administrative burden. The multicenter cross-sectional Swiss Nursing Homes Human Resources Project (2018) study included a convenience sample of 118 Swiss nursing homes and 2207 care workers (i.e., registered nurses and licensed practical nurses). Care workers completed questionnaires assessing the administrative burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied 2-level binomial generalized linear mixed models. Overall, 73.91% (n=1561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n=787) reporting to spend 2h or more during a "normal" day performing administrative tasks. Ratings ranged from 42.6% (n=884; ordering supplies and managing stocks) to 75.3% (n=1621; filling out the patient’s medical record). One out of four care workers (25.5%, n=561) intended to leave the profession, whereby care workers reporting higher administrative burden (OR=1.24; 95%CI: 1.02-1.50) were more likely to leave the profession. This study provides first insights on care workers’ administrative burden in nursing homes, which can inform the development of interventions to reduce the workload related to ‘indirect care activities’ and to improve care workers’ job satisfaction and retention in the profession.
CAN THE PUBLIC LONG-TERM CARE INSURANCE SERVICES IN JAPAN PREVENT THE DETERIORATION OF CARE LEVELS?
Authors: Sugiura Aki , Kanaya Reiko , Takeya Yasushi , Toki Hiroshi , Yamamoto Ryohei , Yamakawa Miyae
Published: December 2022

In Japan, the public long-term care insurance system supports a super-aged society. The long-term care service (LTCS) system is designed to prevent deterioration of care levels. We conducted a retrospective cohort study to clarify whether using LTCS prevents the deterioration of care levels. We use anonymized data of the Osaka National Health Insurance Database. We analyzed 16,469 subjects who were 65–74 years of age and certified at the mild care level from 2012 to 2015 at the time of initial certification. A baseline measurement was conducted 1 year after initial certification, and observation was continued until the subject’s care level deteriorated. Statistical analysis was performed using the Kaplan-Meier method and the Cox proportional hazards model. The results revealed that the period until the deterioration of care level (which occurred in 25% of subjects) was 6 months in the service use group and 22 months in the service non-use group. Although we included sex, care level, dementia, and Parkinson’s disease as variables in the statistical analysis, service users were more likely to deteriorate than non-service users (Hazard Risks: 1.89; 95% confidence interval: 1.79–2.00). It is likely that other factors, such as heart disease, may also be involved, and there may be a bias related to family caregiver factors. In conclusion, the current findings suggest that using LTCS cannot prevent the deterioration of care levels. Future studies should verify the effectiveness of LTCS by adding further variables and data regarding family caregivers and changes in outcomes.
RELATIONSHIPS OF CEREBRAL PERFUSION WITH GAIT SPEED ACROSS AGE AND SYSTOLIC BLOOD PRESSURE LEVELS
Authors: Windham Beverly Gwen , Griswold Michael , Sullivan Kevin , Mosley Thomas , Mielke Michelle , Knopman David , Petersen Ron , Vemuri Prashanthi
Published: December 2022

We hypothesized that poorer cerebral perfusion could impair mobility, particularly at lower systolic blood pressure (SBP). Cerebral perfusion was measured via arterial spin-labelled (ASL)-MRI in community-dwelling adults of the Mayo Clinic Study of Aging. Usual-pace gait speed was assessed over 5.6 meters on an electronic mat. Linear regression models estimated cross-sectional gait speed associations with ASL and modifying effects of age and SBP, adjusting for sex and body mass index. Results report differences in gait speed (meter/second) per standard deviation (SD) lower ASL or SBP (mean=139.1 mmHg, SD=19.7 mmHg). Among 479 participants (aged 31-94 years; mean age 67.6 years; 44% women; mean gait speed 1.17m/s), relationships of ASL with gait speed varied by age and SBP (ASL-x-age interaction: p<.007; ASL-x-SBP interaction: p<.007). At age 65, 75 or 85 years and a SBP of 120mmHg, each SD lower ASL was associated with a 0.04 m/s (0.01,0.07), 0.07 m/s (0.04,0.10), and 0.09 m/s (0.05,0.13) slower gait speed at respective ages. At age 65, 75 or 85 years with low ASL (1 SD below the mean), each SD lower SBP was associated with 0.06 (0.02,0.09) m/s, 0.03 (0.01,0.06) m/s or .01 (-0.02,0.04) m/s slower gait speed, respectively. With high ASL (mean ASL+1SD), lower SBP trended towards faster gait at older age, e.g. estimated gait speed was 0.04 m/s (0.00,0.09) faster for each SD lower SBP at age 85years. Poorer cerebral perfusion may contribute to slower gait, particularly with lower SBP. The interrelations of cerebral perfusion, SBP, and age with mobility merit further study.
LONELINESS AND DEPRESSION: EXAMINING THE MODERATING EFFECTS OF RESILIENCE RESOURCES
Authors: Zhang Xiaoyan , Silverstein Merril
Published: December 2022

Loneliness is highly prevalent among older adults and can negatively influence their mental health. However, less is known about the factors that might mitigate the effects of loneliness on mental health outcomes such as depression. We propose that resilience resources may serve as potential protective factors that buffer the impact of loneliness on depressive symptoms. This study aimed to (a) test the effects of loneliness, as well as resilience factors of perceived family support and optimism, on depressive symptoms, and (b) examine resilience factors as moderators of the relationship between loneliness and depressive symptoms. Participants derived from the Health and Retirement Study (HRS), a nationally representative sample of the population aged 50 years and older. The analytic sample was selected with baseline measurements in either 2006 or 2008 and two follow-ups across four-year intervals (N= 7,336). Structural equation modeling with latent variables and interaction terms was used to investigate study aims. Results revealed that (a) loneliness was significantly related to an increase in depressive symptoms; both perceived family support and optimism significantly reduced depressive symptoms, and (b) the link between loneliness and depressive symptoms was weaker when older adults reported higher levels of perceived family support and greater optimism. This study highlights the important protective roles played by perceived family support and optimism in reducing the adverse impact of loneliness on depression. Results suggest that strengthening family support and fostering optimism might be promising avenues for improving mental health in older adults particularly among those experiencing loneliness.