bluuebunny/crossref_metadata_2025 huggingface dataset:
Grandparents and Parents: An Essential Partnership for Longevity Societies
Authors: Strom Paris
Published: December 2021

This presentation hypothesizes that an innovative collaboration by the adult generations will be necessary to enable conditions needed for family success in a longevity society. Unprecedented challenges of parents and grandparents are examined. Reasons why adults have to regard youth as a source of learning about their unique experiences in an age-separated society are explained. International curriculum development studies to support families of children from birth through adolescence are described. A curriculum that provides a common knowledge base about child and adolescent guidance is proposed to harmonize efforts of adults to support younger relatives. Curriculum for retirees should focus on continuing responsibilities other generations expect of them, learning about the lives of younger family members, and gaining awareness of parenting practices to reinforce lessons. Training volunteers in assisted living and long-term care facilities to be indigenous leaders of grandparent classes is discussed as a practical way to offer relevant learning and improve social support. Instruments are examined that assess ethnic relationships between adult generations, adults and adolescents, and track results of education intervention.
The Future of Aging in a Longevity Society: A Course for High School and College Students
Authors: Strom Paris
Published: December 2021

Americans, on average, can anticipate living 85 years or perhaps 100 if born in this millennium. This extension of the lifespan has introduced a new stage of human development presenting unfamiliar challenges to policy makers, health care providers, employers, religious institutions, families, individuals, and schools. Education about longevity should begin in adolescence (ages 10-20) with the merger of science, experiences of older generations, and imagination of youth. Content of this online course focuses on the years after adolescence: early adulthood, middle age, retirement, and old age. After reading each of the 16 lessons, cooperative learning teams conduct structured interviews with older relatives, friends or neighbors who are further along in life's journey. All the lessons are augmented by 'what do you think? tasks used to motivate discussions, structure interviews, decide on reasoning and problem-solving scenarios, identify key concepts to apply, group lesson reviews, and self-evaluation for comparison with peers. If society wants to encourage adolescents to appreciate their national and ethnic heritage, benefit from learning how older generations see situations and interpret current events, and acknowledge the common need for maturity and spiritual development, then older people should become resources for education about longevity.
Embalming, Viewing and the Social Construction of the Corpse: Time for Another Look
Authors: Finney Redmond , Shulman Lisa , Kheirbek Raya
Published: December 2021

Embalming of the dead is more common in the United States than anywhere else in the world. Battles far from home during the Civil War with concern for contagion from dead bodies being shipped home, compelled President Lincoln to direct the troops to use embalming to allow the return of the Union dead to their homes. Viewings were common with war heroes and culminated with the viewing of Lincoln himself. In the 20th century embalming became a tradition despite substantial evidence indicating environmental and occupational hazards related to embalming fluids and carbon dioxide generated from manufacturing steel coffins before placing in concrete burial vaults. Embalming is promoted and considered helpful to the grieving process when families are comforted by a the appearance of a peaceful death. Embalmers are expected to produce an illusion of rest, an image that in some ways disguises death for the benefit of mourners. The dead are carefully displayed in a condition of liminal repose where the 'true' condition is hidden, and death is removed from the actual event. In this paper we highlight the spiritual and cultural complexities of embalming related- issues. We also provide data on the lack of grieving families’ preparedness for the financial burden associated with the death of a loved one and the lack of knowledge of alternative options. We propose an innovative process to empower people facing serious illness, and their families to make shared and informed decisions, especially when death is the expected outcome.
Emotional Intelligence Skills Enhance Responsive Care of Hospitalized Older Patients
Authors: Kahana Eva , Ermoshkina Polina
Published: December 2021

Our previous research focused on the value of creative problem-solving in late life (Kahana, Kahana, & Ermoshkina, 2021). This paper considers the role of emotional intelligence in creative problem-solving for improving late-life medical care experiences. Emotional intelligence, which is situated at the intersection between the domains of intelligence and personality, can serve as a useful resource promoting personal and social adaptation to problems of old age. Our paper argues for the usefulness of emotional intelligence as older adults deal with challenges of the health care system. Emotional intelligence is rarely studied in gerontological research. Yet, it is required to overcome lack of attention to the patient experience and to provider–patient communication. Problems in communication with staff and in obtaining responsive care are prevalent for hospitalized older adults due to lack of continuity of care as unfamiliar “hospitalist” physicians typically offer care to frail elders. A key adaptive task of older patients involves securing investment by overworked health care providers. A friendly and extraverted self-presentation by older patients signals to the health care provider the social worth of the patient. Such demeanor can go a long way toward eliciting interest and caring responses from providers. Our paper offers a taxonomy of patient behaviors that can facilitate patient-centered care. Emotional intelligence shown by older patients reflected in expressions of appreciation for staff is likely to facilitate the interest of medical and nursing staff. Potential interventions to foster emotional intelligence among older patients will also be discussed.
Older Couples’ Advance Care Planning Engagement Patterns and Associations with Individual and Spousal Factors
Authors: Lee Hyo Jung , Kim Bon
Published: December 2021

This study examines older couples’ dyadic patterns of informal and formal advance care planning (ACP) and determines the associations of these patterns with their own and spousal characteristics. Using data from the 2014 and 2016 Health and Retirement Study, we performed a) latent class analysis to identify distinctive ACP engagement patterns and b) multinomial regression models to describe related characteristics of older couples (N = 1,545 couples). We identified four dyadic patterns of ACP engagement: a) high ACP engaging couple (45%); b) high engaging husband – low engaging wife (13%); c) high engaging wife – low engaging husband (11%); and d) low engaging couple (31%). Engagement in informal and formal ACP was associated with both individual and spousal factors: Older couples with advanced age or higher levels of education and wealth were more likely to engage in both informal and formal ACP, whereas only wife’s high level of constrain or husband’s greater number of depressive symptoms was associated with discordant ACP engagements. Couple-based approach to promote ACP merits older couples with limited resources or poorer psychological health in both or either spouse.
Trends in Dementia Prevalence in the United States, 1995-2019: An Age-Period-Cohort-Interaction Analysis
Authors: Lee Mark , Luo Liying
Published: December 2021

Previous studies have indicated that age-specific dementia prevalence has declined in the United States and other high-income countries. However, these studies have been limited by estimating temporal change in dementia rates on a strictly period basis, with little attention to possible cohort effects. Distinguishing age, period, and cohort effects is both methodologically and theoretically important for identifying the etiological factors driving dementia decline in the population. In this study, we apply the novel Age-Period-Cohort-Interaction (APC-I) model, which defines cohort effects as the interaction between age and period main effects. The APC-I model improves on earlier APC models (e.g., the accounting method) by solving the linear dependence between predictors through theoretical clarification instead of statistical manipulation. We use the APC-I model to estimate period and cohort trends in dementia prevalence using data from the Health and Retirement Study (HRS). Our analysis points to significant period and cohort effects. Dementia prevalence declined significantly between the periods 1995-1999 and 2015-2019. At the same time, cohorts born in the 1940s had significantly lower odds of dementia than would be expected given age and period main effects. This cohort’s unique protection from dementia has been relatively stable as they have aged. Our study identifies the periods during which and cohorts for whom dementia risk has declined in the United States. Further research is needed to specify the period factors (e.g., broad based improvements in nutrition) and cohort factors (e.g., increases in educational attainment) that are responsible for these trends.
The Effects of Exercise on Cognitive Function in Older Adults With Different Types of Dementia: A Meta-Analysis
Authors: Balbim Guilherme , Falck Ryan , Barha Cindy , Davis Jennifer , Starkey Samantha , Bullock Alexis , Liu-Ambrose Teresa
Published: December 2021

Combating dementia is a public health priority, and exercise training is one promising strategy for dementia prevention. However, its efficacy in promoting cognitive outcomes in different types of dementia remains unknown. We conducted a systematic review (N = 27) and meta-analysis (N = 24) of randomized controlled trials with cognitive function as a primary or secondary outcome. We aimed to assess the effect of exercise interventions on the cognitive function of older adults (>60 years) diagnosed with different types of dementia. We synthesized data from 2,441 older adults with dementia. Eleven trials included older adults with multiple types of dementia, eight with Alzheimer's disease, six with unspecified types of dementia, and two with vascular cognitive impairment. We performed random-effects models using robust variance estimation (RVE) and tested potential moderators using the approximate Hotelling-Zhang test (HTZ). Results suggest a small effect of exercise on cognitive function for all-cause dementia (g = 0.18; 95% CI: 0.04, 0.33; p = 0.016); however, the effects did not differ by type of dementia. Moderation analyses showed that trials that did not specify participants' severity of dementia, applied individual-level randomization, and had higher intervention adherence demonstrated larger exercise effects on cognitive function for all-cause dementia. We conclude that exercise promotes small improvements in the cognitive function of older adults with all-cause dementia. More research including different types of dementia is needed if we hope to determine the precise effects of exercise for each type of dementia.
Development of a Screening Tool for Feet/Footwear- Related Influences on Fall Risk
Authors: Wingood Mariana , Vincenzo Jennifer , Peterson Elizabeth , Neville Christopher
Published: December 2021

The effectiveness of multifactorial fall risk assessment and intervention strategies is well documented. Although identifying feet/footwear-related influences on fall risk is a vital fall risk assessment component, few evidence-based resources or screening tools are available. To address this need, we developed the Screening Tool for Feet/Footwear-Related Influences on Fall Risk. Our tool is designed for older adults who are identified as at risk for falling, based on the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Algorithm for Fall Risk Screening, Assessment, and Intervention. Tool development was informed by results of our systematic review of lower-limb factors associated with balance and falls. Our initial tool was evaluated by an external group of 9 interprofessional content experts. Those experts recommended modification of 8 items and rated the tool’s clarity as 81.2/100, appeal as 79.1/100, and clinical feasibility as 76.1/100. After incorporating recommended changes, we completed a modified Delphi study using 8 new interprofessional experts (average years of experience: 19.3). During Phase 1, Delphi participants recommended we combine items with similar treatment recommendations, add a question about orthoses, and increase the specificity of 9 items. This refinement resulted in a 20-item screening tool, which met approval after two rounds of consensus voting. Approval was defined based on the Item Content Validation Index, percentage of agreement > 80% on each item. The high level of agreement illustrates the tool’s content validity. Using our tool, an older adult’s feet/footwear-related risk factors can be identified and incorporated into an effective multifactorial fall prevention intervention.
Fall-related Injuries in Older Adults and Medications Prescribed within 30 Days Prior to the Injury
Authors: Ming Yu , Zecevic Aleksandra , Booth Richard , Hunter Susan , Johnson Andrew , Tirona Rommel
Published: December 2021

Fall-related injuries in older adults have serious consequences both for individuals and the public health care system. The purpose of this study was to identify medication classes prescribed within 30 days prior to the injury that were associated with fall-related injuries in older adults. This population-based, case-control study used secondary administrative health care data in Ontario, Canada. The cases were older adults, aged 66 years and older, who visited an emergency department for a fall-related injury. Controls were extracted from the Registered Person Database, and matched by same age, sex and residence area. Medication classes prescribed to both groups were recorded and logistic regression was conducted to examine the association between medications and fall-related injury. The case group included 255,270 older adults who experienced a fall-related injury over the five-year period (2010-2014). After adjustment for sex, age group, residence area, income level and number of medications prescribed, psychotropic medications (i.e., opioids, anti-epileptics, anti-Parkinson’s drugs, and antidepressants), drugs for treatment of constipation, infection and benign prostatic hyperplasia, antithrombotic agents, statins and bronchodilators were identified to be related to increased risk of fall-related injuries. In addition to medications already on the list of fall-risk increasing drugs or FRIDs, this study uncovered that drugs for benign prostatic hyperplasia, cephalosporins, biphosphates and bronchodilators increased the risk of fall-related injury in older adults. Well-designed prospective cohort studies considering prescription indication and drug-drug interactions are needed to provide more convincing evidence on medications that may be associated with increased risks of fall-related injury in older adults.
Intergenerational Conflict Among Asian Immigrant Families and Psychological Well-Being: Results from PIETY Study
Authors: Abdi Fatima , Bergren Stephanie , Lanza Lisa , Dong XinQi
Published: December 2021

Research suggests that stress from migration and cultural adjustment may lead to intergenerational conflict (IC) within Asian immigrant families. Current research reports management of IC but fails to acknowledge the consequences it may have on offspring. The PIETY study, a longitudinal study of Chinese adult children (n = 547) in the greater Chicago area, aims to examine the relationship between IC and psychological wellbeing in children of Asian immigrant families. IC is assessed by the sum of items on conflicting opinions with parents based on finances, health, parenting, and lifestyle. Psychological wellbeing was measured by the Perceived Stress Scale with a cutoff value greater than or equal to 14, R-UCLA Loneliness Instrument scored on a binary scale, and Hospital Anxiety and Depression Scale (HADS) Anxiety Subscale with a cutoff value greater than or equal to 8. Logistic regression was conducted and controlled for age, gender, education, income, marital status, and household composition. Every one-point higher conflict with parents was associated with being 2.31 times more likely to experience stress for the adult child (OR: 2.31, 95% CI: 1.49-3.57, p<.001) and being 4.56 times more likely to experience loneliness (OR: 4.56, 95% CI: 2.79-7.43, p<.001). IC, however, had a nonsignificant positive association with anxiety in adult children. The association between IC and psychological wellbeing suggests that conflict is a result of complex factors, for which interventions could be developed to improve psychological wellbeing and resiliency in families who continue to navigate cultural changes in a foreign land.
Intergenerational family leisure in the COVID-19 pandemic: Some potentials, pitfalls, and paradoxes
Authors: Rogers-Jarrell Tia , Vervaecke Deanna , Meisner Brad
Published: December 2021

COVID-19 has significantly changed the way we engage in leisure. The influence of public health measures and messaging on leisure put older and younger people alike at increased risk of stress, anxiety, loneliness, and isolation. Despite these similar experiences, ageism and tensions between generations intensified during the pandemic. Thus, it is imperative to encourage strategies that foster connections and solidarity between generations, such as participating in intergenerational family leisure. Intergenerational family leisure can both attenuate negative outcomes heightened or created by the pandemic (i.e., risk reduction) and increase positive experiences (i.e., wellness promotion). However, it is important to recognize that intergenerational family leisure may not be available, or ideal, for everyone, especially during the pandemic. There are longstanding and pandemic-specific pitfalls to engaging in intergenerational family leisure that need to be considered. Further, the conditions and handling of the COVID-19 pandemic have complicated family leisure in paradoxical ways. Many contradictions emerge as we navigate social systems and personal experiences when engaging in intergenerational family leisure during the pandemic. This paper critically presents some of the potentials, pitfalls, and paradoxes associated with connecting multiple generations in and through family leisure during the pandemic.
Family Caregiving Subtypes in the Caregiving Transitions Study: A Latent Class Analysis
Authors: Bentley John , Lupton-Smith Carly , Roth David
Published: December 2021

Family caregiving requires activities and experiences that have negative and positive features, producing stress but also providing benefits. The Caregiving Transitions Study (CTS) enrolled 283 caregivers from a national epidemiologic study, of which 32 were caregivers prior to enrollment in the parent study, and 251 became caregivers while participating in the parent study. Telephone interviewers were conducted after caregivers provided care for a minimum of 1.6 years (mean=7.7 years). Latent class analysis (LCA) was used to detect unobserved groups of caregivers. Number of problems (i.e., ADL, IADL, communication, emotional, disruptive behavior), average burden per problem, depressive symptoms, perceived stress, purpose in life, positive aspects of caregiving, hours of care, and duration providing care were used as indicators. Classes were subsequently compared on several external variables, including demographics, quality of life, leisure activities, and caregiving strain. The best-fitting model consisted of three classes (4.6% long-term, 27.6% high-distress, and 67.8% moderate-distress). Classes were similar with respect to sex, age, race, and primary caregiving status of the caregiver. Long-term caregivers had much longer caregiving durations and commonly provided care to a child. The high-distress class was noteworthy in terms of greater number of experienced patient problems; greater likelihood of caring for a person with dementia; higher levels of caregiving strain, depressive symptoms, perceived stress, and perceived burden; and lower levels of quality of life, purpose in life, positive aspects of caregiving, and leisure activities. These findings suggest that caregivers can be classified into distinct subtypes, with one subtype characterized as experiencing high distress.
Generation to Generation Project: Pairing Students With Older Adult Mentors During the COVID-19 Pandemic
Authors: Elfenbein Pamela
Published: December 2021

To meet the needs of older adults isolated in the midst of the COVID-19 pandemic, we began pairing Human Services and Gerontology students with community dwelling adults 55 years of age and older, recruited through senior centers and other organizations serving older adults.

Students paired with isolated older adults were tasked with building supportive relationships, assuring that basic needs were being met and that all available community resources were in place, and then documenting their mentor’s life stories with an emphasis on the resilience, strength and wisdom of their older adult mentors (to focus and build on their strengths, the older adults we engage with are referred to as our “mentors”). Oral histories and supporting artifacts are archived in the university’s library permanent repository.

The oral histories portray unique perspectives into life, strength, and resilience during the COVID-19 pandemic and quarantine. The older adult mentors participating in the Generation to Generation project reported feeling strengthened and connected through their participation in the Generation to Generation project.

To determine if social Isolation and loneliness can be ameliorated through participation in the Generation to Generation oral history project, researchers utilized the UCLA Loneliness Scale in pre- and post- participation interviews; findings will be shared.
Perceived Life Meaning and Purpose and Its Association with Mental and Physical Health among Family Caregivers
Authors: Chang Yu-Ping , Sessanna Loralee , Seo Young Sik
Published: December 2021

Evidence suggests that having a sense of life meaning and purpose is related to physical health. However, the association between life meaning and purpose and physical and mental health among family caregivers remains unclear. This study aimed to examine whether family caregivers’ perceived life meaning and purpose was associated with their physical and mental health (depression and anxiety). The National Study of Caregiving (NSOC) III cross-sectional survey (2017, N = 2,652) was utilized. One item was used to measure family caregivers’ perceived life meaning and purpose and two composite variables were generated to measure depression and anxiety. Physical health was assessed by questions including pain, breathing problems, limited arm/leg strength, low energy, and sleep problems. Weighted logistic regression analyses with covariate adjustments (i.e., caregiver’s age, sex, and race/ethnicity) were conducted to examine the association among family caregivers’ perceived life meaning and purpose, mental and physical health. Results indicated that family caregivers’ perceived life meaning and purpose was associated with a lower probability of having depressive symptoms (OR, .29, 95% Confidence Interval [CI], .15, .57) and anxiety (OR, .43, 95% CI, .23, .79). Furthermore, perceived life meaning and purpose was associated with a lower probability of having breathing problems (OR, .50, 95% CI [.25, .99]). Findings suggest that having a strong sense of life meaning and purpose is linked to better mental health and physical symptoms. Further research is needed to determine the mechanism regarding how life meaning and purpose may improve mental and physical health among family caregivers.
High Death Anxiety and Ambiguous Loss: Lessons Learned From Teaching Through the COVID-19 Pandemic
Authors: Weaver Raven , Bolkan Cory , Decker Autumn
Published: December 2021

For gerontological educators, topics such as mortality, loss, and end-of-life issues often emerge or are central in their courses. However, the COVID-19 pandemic has raised our awareness of loss and death on a global scale and teaching during the pandemic has raised questions about how educators, communities, or systems of higher education can support students’ learning while simultaneously experiencing losses during intense times of uncertainty. In this mixed-method study of 246 students enrolled in undergraduate thanatology courses, we explored their levels of death anxiety and their experiences with pandemic-related losses. We found that students’ death anxiety increased significantly during the pandemic, in comparison to the years prior (p < .001). We also conducted a content analysis in a subset of students’ written narratives (n = 44) regarding their pandemic experiences. We identified three themes. Participants desired: (a) more flexibility from instructors, no questions asked; (b) more compassion and understanding; and (c) specific, targeted support resources. The voices of students were filtered through the authors’ interpretation as educators to provide several teaching recommendations that support student learning during challenging times. The recommendations align with a trauma-informed approach, given the high rates of death anxiety and ambiguous loss among students, and have immediate implications for educators teaching during the pandemic, and for years to come. Finally, we also advocate for more university and community-based thanatology, and gerontology education offerings in general, to help normalize conversations about death, loss, and bereavement.
Caregiving Intensity and Psychosocial Impact of COVID-19 in Dementia and Non-Dementia Caregivers
Authors: Humber Marika , Truong Angeline , Suresh Madhuvanthi , Jacobs Josephine , Thomas Sam , Lee Trevor , Risbud Rashmi , Trivedi Ranak
Published: December 2021

COVID-19 has adversely impacted the well-being of informal caregivers (CG) due to infection risk, changes to the home environment, and changes to resource availability. CG of persons living with dementia (PLWD) may be especially vulnerable due to the intensity of care provided. We compared CG activities and well-being among CG who did and did not care for PLWD during COVID-19. We conducted an anonymous online survey from April 2020-present. Respondents self-identified as 18+ years and CG to a child or adult with mental health or medical conditions. CG answered questions regarding hours of care provision and caregiving activities, and completed measures of CG burden (Zarit Burden Inventory-4), loneliness (UCLA Loneliness Scale), depressive symptoms (Patient Health Questionnaire), and anxiety (Generalized Anxiety Disorder-2). Of the 258 respondents within the United States, 86 cared for PLWD (33%; 88% female; 56±12 years) while 172 did not (66%; 87% female; 49±14 years). Compared to non-dementia CGs, more CGs of PLWD provided 40+ hours of caregiving/week (36% vs. 49%, p<.05), performed more caregiving activities (8.5 vs. 10.5, p<.01), and assisted with more activities of daily living (55% vs. 73%, p<.01). Compared to non-dementia CG, more dementia CG reported CG burden (53% vs. 67%; p<.05) and loneliness (7.3 vs. 9.1, p<.05). No differences in depressive symptoms or anxiety were found. Results suggest that existing needs of CG of PLWD may be exacerbated by the stressors and concerns of the pandemic, necessitating higher levels of support.
Key Factors in Intervention Implementation, Fidelity, and Sustainability
Authors: Sherman Carey , Gordon Kate , Hepburn Kenneth
Published: December 2021

As part of an NIA-supported effort to develop an online course to train individuals to lead the evidence-based Savvy Caregiver program and to orient sponsoring organizations to the program, we conducted semi-structured interviews to assess success and sustainability “best practices”. Interviews were conducted with 17 leaders and trainers from eleven Savvy-providing organizations. Analysis of these interviews identified two main themes associated with successful program implementation: leadership commitment and trainer ownership. Paramount to success appears to be leaders’ clear understanding of and enthusiastic commitment to the value of the Savvy program to the organization’s constituents. This translated to careful selection, training, management and on-going development of Savvy program trainers. It contributed to leaders’ appreciation of Savvy as a gateway for clients to seek out other programs and services from the organization, while the gathering of meaningful evaluation data (using established outcome-assessment instruments) contributed, in several cases, to garnering more lasting support to deliver the program. Organizations’ commitment to the program was demonstrated by securing the kinds of adequate and appropriate training, typically involving both instruction and modeling, for Savvy program leaders. These efforts fostered a sense of ownership among the leaders – the sense that the program had positive value for the caregivers served. These findings should be of interest both to scholars engaged in the development of interventions and for organizations implementing them. Taken together, the themes highlight several factors for program implementation that maximize the chances of maintaining fidelity to core program principles and ensuring its sustainability.
Interdisciplinary Community-Based Support for Caregivers of Individuals Living with Dementia
Authors: Tucker-Roghi Gina , Escoubas Jamie , Tolliver Renee , Tucker Sarah
Published: December 2021

Evidence indicates family caregivers of individuals living with dementia (ILwD) are at risk for diminished physical and mental health; which may decrease their quality of life and directly impact their ability to provide care. An interdisciplinary approach to self-care and skill-building for caregivers is provided in a virtual support group offered by Council on Aging in Sonoma County, CA. As part of the nonprofit’s Adult Day Program, the group is offered to client caregivers and has two goals: First, creating a community-based, long-term support system for ILwD who are aging-in-place; second, fostering a safe and supportive community for family caregivers, by providing opportunities to collaborate with peers and an interdisciplinary team that includes a Marriage and Family Therapist (MFT), an Occupational Therapist (OT), and a Recreation Therapist (the day program manager). The closed group model established through eight weekly sessions builds trusting relationships in a frame that combines: the OT client-centered and collaborative approach to problem-solving everyday challenges of caregiving, the MFT skills of creating a safe space for discussion and deeper exploration, and program staff insights regarding the ILwD’s current interests and abilities exhibited during Day Program activities. Sessions include an emotional check-in by group members; a brief overview of best-practices and common caregiving concerns related to a weekly topic; and an opportunity for caregivers to explore the integration of best-practices into daily routines, while also attending to their well-being as caregivers. Program evaluation and results related to the program’s effectiveness and implications for scalability will be discussed.
The Relationship between Burden and Financial Factors for Help-Seeking Older Adult Caregivers
Authors: Qualls Sara , Yun Stacy , Weber Kendall , Ferszt Geffen
Published: December 2021

Older adult caregivers often experience unique financial challenges (Schultz & Eden, 2016). The purpose of the present study was to explore the relationship between caregiver finances and caregiver burden for this sample. A sample of 131 caregivers seeking counseling services completed questionnaires assessing demographics, care recipient functioning (ADLs/IADLs), and finances (yearly income, impact of caregiving on finances). A majority, 74.8% of caregivers, indicated financial burden since caregiving. A hierarchical multiple regression was computed to predict caregiver burden. The caregiving characteristics block explained 8.1% of the total variance in caregiver burden, F(7, 123) = 1.54, n.s. Specifically, being younger was significantly associated with more caregiver burden. Adding the care recipient functioning block explained an additional 6.9% of the variance in caregiver burden, Fchange(2, 121) = 4.93, p < .01. The caregiving characteristics and care recipient functioning model accounted for 15% of the total variance in caregiver burden, F(9, 121) = 1.55, p < .05. Again, younger age uniquely predicted greater caregiver burden. Lastly, caregiving finance factors contributed an additional 13.5% of the variance, Fchange(4, 117) = 5.54, p < .001. Thus, the final caregiver characteristics, care recipient functioning, and caregiving finances model accounted for 28.5% of the total variance in caregiving burden, F(13, 117) = 3.59, p < .001. Specifically, having less income and greater monthly expenses related to caregiving predicted higher levels of caregiver burden. These findings imply that those with fewer resources may benefit from intervention for the heavier burden they perceive compared to peers with more financial resources.
A Scoping Review of the Examination of Sandwiched Caregivers’ Psychological Well-being and Physical Health
Authors: Hodgdon Barbara , Wong Jen D , Pittman Patricia S
Published: December 2021

As numbers of sandwiched caregivers in the United States grow, it is essential to document the literature on the impact of dual care responsibilities on aspects of psychological well-being and physical health. This scoping review examined the literature on sandwiched caregivers’ psychological well-being and physical health, identified gaps in the literature, and provided suggestions for future studies to advance the literature on sandwiched caregivers in the United States. Guided by the Arksey and O’Malley (2005) framework, this scoping review comprised of 15 peer-reviewed articles between 1980 and 2019, that examined aspects of the psychological well-being (e.g., depression, affect) and physical health (e.g., health behaviors, chronic conditions) of sandwiched caregivers in the United States. Findings showed that there was ambiguity surrounding the conceptualization of sandwiched caregivers, specifically how older and younger care recipients were defined. Also, most studies examined psychological well-being while physical health was understudied. The findings of this review also showed that, compared to non-sandwiched caregivers (e.g., spousal, filial caregivers) and non-caregivers, sandwiched caregivers exhibited greater depressive symptoms and psychological distress as well as poorer health behaviors. Furthermore, sandwiched caregivers who were female and employed were more susceptible to greater depressive symptoms than their employed male counterparts or employed non-caregivers. In considering future directions, more work is needed that examines physical health. Additionally, sandwiched caregivers of minority status merit attention as multigenerational care occurs at greater rates in these populations. Finally, caregiving during the pandemic may have a detrimental impact on sandwiched caregivers’ lives which should be investigated.
Caregivers' Medical Care Provision at Patient End-of-Life: Associations with Emotional Difficulty and Gains
Authors: Leggett Amanda , Koo Hyun Jung , Baker Elaina , Lee Hannah
Published: December 2021

Family caregivers play crucial roles in patient care and medical decision making, especially at end-of-life (EOL). Yet, most research focuses on caregivers’ burden, with little attention to rewards that make for a fulfilling EOL care experience. We consider caregiver involvement at EOL and associations with caregiver stress and gains. Data are drawn from the 2017 National Study of Caregiving’s last month of life and core interviews which includes caregivers (n=283) for a nationally representative sample of Medicare eligible older adults, and questions caregivers about their care provision and EOL experience. We consider indicators of caregivers’ involvement in medical decision making and support received from providers as predictors of caregivers’ emotional difficulty and gains at EOL utilizing linear regressions controlling for demographic characteristics. Caregivers were 60.7 years of age on average, 72.5% female, 21.3% non-white, and 11% were spousal partners. Making medical decisions was associated with increased emotional difficulty at EOL (B=0.93, SE=0.24, p<.001). In contrast, more caregiving gains were associated with having care decisions align with the CG’s wishes (B=-0.64, SE=0.30, p<.05), being more informed by providers (B=0.41, SE=0.16, p<.05), helping the care recipient with anxiety or sadness (B=0.69, SE=0.28, p<. 05), and surprisingly, feeling that care decisions were made without their input (B=0.82, SE=0.29, p<.01). Being more involved and informed in care was associated with both positive and negative caregiver outcomes at EOL. Understanding caregiver emotional difficulty and gains at EOL are critical for identifying how clinicians can better support caregivers at EOL and improving the caregiving experience.
Prevalence of Binge Drinking by Caregivers of Persons with Alzheimer’s Disease or Related Dementia
Authors: Kunicki Zachary , Jones Richard
Published: December 2021

Some caregivers of persons with Alzheimer’s Disease and related dementias (ADRD) are known to be under high levels of burden, which is associated with higher levels of anxiety, depression, and stress. Previous research has established anxiety, depression, and stress are associated with binge drinking, but little research has examined binge drinking rates among ADRD caregivers. Binge drinking could influence the ability of ADRD caregivers to provide care. The purpose of this study was to explore the prevalence and prevalence correlates of binge drinking among ADRD caregivers using the 2019 Behavior Risk Factor Surveillance Survey (BRFSS). We identified N = 1,642 persons who were the primary informal caregivers of a person with ADRD. Among them, the prevalence of binge drinking was 14 per 100 persons. Bivariable analyses suggested male caregivers and caregivers with 14 or more days of poor mental health in the past 30 days had the highest prevalence of binge drinking at 18 per 100 persons. Caregivers who were 65 or older or had the lowest prevalence at 3 per 100 persons. Caregiving characteristics revealed providing 20 to 39 hours of care per week had the highest prevalence of binge drinking (17 per 100) whereas spousal caregivers (9 per 100) had the lowest prevalence. Smoking status and hours per week providing care were associated with higher odds of binge drinking in multivariable analyses. Future research should examine if binge drinking by ADRD caregivers is related caregiver burden and the quality of care provided to the persons with ADRD.
A Novel Electronic Frailty Index as a Predictor of Clinical Outcomes After Transcatheter Aortic Valve Implantation
Authors: Rangel Maria , Annabathula Rahul , Pajewski Nicholas , Williamson Jeff , Zhao David , Callahan Kathryn
Published: December 2021

Transcatheter aortic valve implantation (TAVI) is becoming the preferred therapeutic approach for older adults with severe aortic valve disease. Frailty portends increase mortality and adverse outcomes after TAVI. We sought to evaluate an electronic Frailty Index (eFI) as a predictor for increased healthcare utilization, adverse clinical and functional outcomes. We retrospective studied 302 adults older than 65 years that underwent TAVI at our institution between October 2017 and September 2020. The mean age of the cohort was 79 ±6.94 years old; 43% were female. Frail individuals (eFI >0.20), as compared to Fit (eFI <0.10) and Prefrail (0.10>eFI<0.20), were more likely to have a higher society of thoracic surgeons score and a greater burden of comorbidities. Subjects classified as Prefrail/Frail had longer intensive care unit stay post-TAVI than fit individuals (>24 hours: 17% vs 4%, respectively, p 0.02); and trended toward longer hospitalization time and discharge to a setting different than home. The Prefrail/Frail group also had a higher proportion of subjects with persistent New York Heart Association Class III heart failure symptoms 30 days post-TAVI as compared to Fit (14% vs 2%, p 0.04), however both groups demonstrated significant symptomatic improvement post-procedure. No significant differences in 30 day mortality, major adverse cardiovascular events or readmissions were found. TAVI is an effective treatment with a low incidence of early adverse clinical outcomes in older adults regardless of frailty status; eFI could help in identifying and targeting susceptible adults that may require additional resources to recover post-TAVI.
Outcomes of a Telephone-Based Frailty and Functional Assessment
Authors: Sison Stephanie Denise , Arias Karla Tejada , Newmeyer Natalie , Schoenburg Racheli , Valencia Carolina Fonseca , Kim Dae
Published: December 2021

With the goal of increasing the clinical use of frailty, we piloted a quality improvement project to determine the feasibility and utility of a telephone-based frailty and functional assessment. We identified 122 established patients with serious medical illness from an academic geriatrics clinic. A geriatric fellow assessed the functional status and conducted the Mini Nutritional Assessment, telephone-MoCA, and Geriatric Depression Scale to generate a deficit-accumulation frailty index (FI) score which was automatically calculated through the electronic medical record. A note was then generated to inform the providers of the details of the assessment and to provide recommendations based on the findings. From November 2020 to March 2021, 104 out of 122 (85.2%) established patients (mean [SD]: 83.4 [7.1], 66% female, 81% White, and mean [SD] FI: 0.32 [0.17]) agreed and proceeded with the assessment. One month after the call, we found that the assessment was included in the clinical decision-making of 55 out of 100 patients seen by their primary care provider. The top 3 incorporated recommendations were chronic disease management based on frailty status (n=56), lifestyle change and counseling to prevent frailty progression (n=44), and management of cognition and mood (n=18). Management of physical status including referral to PT and OT were incorporated in 15 encounters. Our results suggest that a telephone-based frailty and functional assessment is feasible and has value-added contributions in improving the care of older adults through providing a holistic view of their health status.
End of Life Virtual Reality Training: Medical Student Increased Empathic Ability
Authors: Gugliucci Marilyn , Manukhin Daniel , Dyer Elizabeth , Swartzlander Barbara
Published: December 2021

Introduction: It is unclear if medical student empathy declines by third year of clinical rotation trainings. Desensitization throughout the first two years may lead to decreases in empathy as a coping mechanism to avoid burnout in the clinical years. This study determined if self-assessed empathy increased after conducting an Embodied Labs, Inc. end of life virtual reality (VR) experience. Methods: Mixed methods, quantitative/qualitative, research were applied for University of New England (UNE) College of Osteopathic Medicine (COM) 2nd year medical students (N=174). They completed the 3-part 30 minute Clay Lab VR experience. UNE IRB approved pre/post-tests focused on empathy. Data were collected using RedCap. Closed questions were analyzed applying frequency analysis and paired-sample t-test through excel. Open-ended questions were analyzed through N-VIVO 12+. Results: The data included pre/post-tests from 146 students volunteers. Results indicated statistical significance (P=.01) in all closed questions except for question 7 (What is your view of conducting a full code on a patient with a DNR? (P=.14). The greatest difference seen between pre (23.97% agree or strongly agree) and post-test (64.38% agree or strongly agree) data was for question 3 (I gained knowledge about what hospice is by embodying Clay in this virtual reality lab); P= .00. Three qualitative themes included: Impact, Empathy, EOL Knowledge. Conclusion: This VR Lab experience increased self-assessed empathy at the time of Clay Lab completion; however, enduring empathy and learning about hospice/EOL has not been measured. Further research is suggested to determine the longitudinal impact of virtual reality education.
Effect of Baseline BMI and IL-6 on Gait Speed Response to Caloric Restriction in Older Adults
Authors: Hsieh Katherine , Neiberg Rebecca , Beavers Kristen , Beavers Daniel
Published: December 2021

We examined whether the effect of caloric restriction (CR) on gait speed change in older adults (67.3±5.27 years) varied by BMI and interleukin 6 (IL-6). Data from eight six-month randomized controlled trials were pooled, with 1268 participants randomized to CR (n=710) and non-CR (n=558) conditions. Baseline BMI/IL-6 subgroups were constructed using BMI≥35 kg/m2 and IL-6>2.5 pg/dL, and participants were jointly classified as high/high (n=395), high/low (n=208), low/high (n=271), or low/low (n=344). Overall treatment effects showed significant improvements in gait speed in CR versus non-CR [mean difference: 0.02 m/s (95% CI: 0.01, 0.04)]; however, CR assignment significantly interacted with BMI/IL-6 subgroup (p=0.03). Greatest gait speed improvement was observed in the high/high CR subgroup [+0.06 m/s (0.03, 0.09)] and appeared to be driven by no gait speed change among the high/high non-CR subgroup. Gait speed response to CR was greatest in older adults with elevated baseline BMI and IL-6.
Continue or not to continue? Attitudes towards deprescription among community-dwelling older adults in China
Authors: Tan Jie , Zhang Li , Wang Ying , Chen Lihui , Wu Chenkai
Published: December 2021

Inappropriate prescribing of medications and polypharmacy among older adults could lead to avoidable harms. It is hence vital to stop potentially inappropriate medications in this vulnerable group. An approach coined 'deprescribing' has been used to describe a patient-centerd process of optimizing medication regimens. But patient resistance to discontinuing medication use is a significant barrier to deprescribing. The present study aims to describe attitudes towards deprescribing and to examine individual-based characteristics that might be associated with these attitudes among community-dwelling older adults in China. We conducted a cross-sectional study through in-person interviews using the validated Patients’ Attitudes Towards Deprescribing questionnaire in two communities through the community-based physical examination platform. Participants were 65 years and older and had at least one chronic disease and one regular prescription medication. Of the 1,897 participants in the study, the average age was 74 years and 1,023 (53.9%) were women. The majority had one chronic disease (n=1,364 [71.9%]) and took 1-2 medications (n=1,483 [78.2%]). A total of 947 (50.0%) older adults reported being willing to stop taking one or more of their medicines if their physician said it was possible, and 1204 (63.5%) older adults wanted to stop a medicine been taking for a long time. Chronological age, marital status, number of chronic diseases, and self-rated health status were associated with the attitudes towards deprescribing. This study showed that half of the participants were willing to cease a medication that their physician though was no longer required. Individual-level factors were associated with attitudes towards deprescribing.