bluuebunny/crossref_metadata_2025 huggingface dataset:
Supervisory Leaders in Aging: One-Year Practice Change Outcomes of Innovative Training Program
Authors: Kaplan Daniel , Silverstone Barbara , Chan Keith , Spishak-Thomas Amanda
Published: December 2020

Social services for older adults are instrumental in addressing vulnerabilities associated with aging. Yet, practitioners report needing expanded geriatric knowledge and enhanced supervision. Agency-based supervision is essential to skilled practice and staff retention, directly impacting the quality of services delivered by the teams they support. The Supervisory Leaders in Aging (SLA) program of the National Association of Social Workers (NASW) was designed to strengthen supervision of the social service workforce. The SLA program, adopted in four states (IL, FL, MD, and NY), trained 134 MSW supervisors who support 1,200 social service staff, aimed at enhancing the well-being of 264,000 clients annually. This paper reports newly available final outcomes data from the 3-year implementation study of SLA. Trainees self-rated use of relevant supervisory best-practices was measured with novel 30-item instrument which captured frequency in use of supervisory best practices. The measure was administered prior to the first session and at three and twelve months after the final session. Comparisons of ratings across time periods demonstrate a range of positive and significant increases at the end of program workshops (0.12–0.56; mean of 0.30 points) and after one year (0.18–0.53; mean of 0.34 points). Supervisory best practices were maintained by those who already engaged in these behaviors, and participants who previously underutilized best practices adopted and maintained these behaviors as a result of the workshops. Implications of this tested model for enhancing workforce capacity will be discussed, including variation of impacts by supervisor characteristics and retention of learning gains over time.
Which Seat at the Table? The Ways That Senior Service Organizations Are Engaged in Age-Friendly Community Efforts
Authors: Coyle Caitlin , Gleason Shayna
Published: December 2020

Senior centers across the nation continue to serve as important access and focal points for older adults to voice their desires, get basic needs met, and to engage in opportunities that support many of the key concepts of Age-Friendliness (i.e. social participation, respect and social inclusion, civic engagement, transportation, and community supports and health services). Senior centers are the front line of aging services and thus in a position to implement programs and raise public awareness about age-friendly initiatives. The purpose of this presentation is to present and discuss the involvement of senior centers or other senior service agencies, as well as to characterize the mobilization of a community after joining the movement. We will present 5 case studies of age-friendly communities who are in the implementation phase of their initiative, to illustrate the challenges, opportunities, and outcomes associated with placing a senior center at the forefront of the movement. Based on the results of this work, we will present a typology of age-friendly community initiatives as a mechanism for supporting other communities make this transition. We conclude with a discussion of how age-friendly communities are part of the paradigm shift of aging in community and the ways in which this work intersects with other health policy initiatives with which cities and towns engage.
Grandparenting and Health in Later Life: Intensity and Age, Gender, and Urbanicity Variations
Authors: Zeng Yue , Chen Yu-Chih
Published: December 2020

Grandparents play increasingly indispensable roles in providing family care. Although prior cross-sectional studies have shown a positive link between grandparenting and health, we know little about the optimal engagement level of grandparenting, its longitudinal implications, and variations on health outcomes. Guided by the role theory and social model of health promotion, we used propensity score analysis and multilevel analysis with three biennial waves of China Health and Retirement Longitudinal Study (2011-2015) to examine the longitudinal impacts of grandparenting intensity (no, low-, moderate-, and high-intensity) on health (mobility limitations, depressive symptoms, cognition, and self-rated health) among 4,925 older adults aged 45 and older, and how these impacts vary by age (45-59/60+), gender (male/female), and urbanicity (urban/rural). Controlling for the baseline sociodemographics (e.g., education and income), health limitations (e.g., ADLs and IADLs), and health behaviors (e.g., drinking and smoking), our results showed that, compared to no grandparenting, grandparenting provided at a moderate level was associated with fewer mobility limitations, lower depressive symptoms, and better cognition. Furthermore, grandparenting had a positive impact on physical, mental and cognitive health for 60+ older adults but not for the young-old. Both older males and females showed better physical health if they provided care at a low level, but older females showed better self-rated health. Older adults in the rural area showed better physical health; for the urban area older adults, better cognition. Findings suggest that policies aimed at supporting grandparents should consider the optimal threshold and variations by age, gender, and urbanicity.
Rural-Urban Differences in Social Connectedness Among Adult Foster Home Residents in Oregon
Authors: Tunalilar Ozcan
Published: December 2020

Social isolation has been linked to negative health outcomes, especially among older adults. Although ability to maintain social contact and existing ties to one’s community is a primary benefit of receiving long-term supports and services in a community-based setting, few studies explored how geography might shape these residents’ access to family members and friends. The current study explores this question in the context of adult foster homes (AFH), a type of family-style residential care licensed for five or fewer unrelated adults. Using cross-sectional data collected annually from 1,500 AFHs between 2015 and 2020, the study examines whether older adults residing in rural and urban AFHs in Oregon differ in terms of levels of distinct types of contact with their existing social networks. AFHs were designated as rural/urban at the zip code level using the definitions provided by the state coordinating organization for rural health. Results from negative binomial regression models show that rural residents were significantly less likely to receive help from their family members and friends in getting to medical appointments or outside activities (e.g., meals, walks, shopping) or receive social visits or phone calls compared to their urban counterparts. Rural and urban residents had similar levels of help with personal care and taking medications. These results remained unchanged after accounting for a set of home (e.g., Medicaid contract) and resident characteristics (e.g., acuity). These findings suggest important public health implications for improving rural residents’ social connectedness and interventions aiming at improving social participation in long-term care residents.
Age at Immigration and Depression in Old Age: The Mediating Role of Contemporary Relationships With Adult Children
Authors: Jang Heejung
Published: December 2020

For the growing population of older immigrants in the United States, both age at immigration and familial relationships are important factors affecting psychological well-being. This study explores how age at immigration and contemporary relationships with adult children combine to explain older immigrants’ depressive symptoms. This study uses 2014 Health and Retirement Study data from a sample of 759 immigrants age 65 and older who have at least one adult child age 21 or older. A series of ordinary least squares regressions and mediational analyses were conducted. Findings indicate that two aspects of familial relationships, associational solidarity and structural solidarity, significantly mediate the association between age at immigration and depressive symptoms. Specifically, immigrating in later-life was associated with a lower level of depressive symptoms through its relationship with structural solidarity. Immigrating in later-life was also associated with a higher level of depressive symptoms through its relationship with associational solidarity. In addition, giving monetary support to children and providing care for grandchildren may alleviate depressive symptoms for older immigrants. This study suggests that relationships with adult children may differ with age at immigration. The types of support that older immigrants provide to their adult children may be crucial because such support may instill a sense of obligation and reciprocity that may be beneficial to the psychological well-being of older immigrants.
Examining Racial and Ethnic Disparities Among Older Adults in Long-Term Care Facilities
Authors: Lee Kathy , Mauldin Rebecca , Connolly John , Tang Weizhou
Published: December 2020

Background: Nearly half-million older adults from minority racial and ethnic groups in long term care face disparities in quality of life and quality of care. However, there is little information about the associations between a resident’s race/ethnicity and the types of official complaints lodged. Methods: This project was a mixed methods study using a sequential explanatory design to examine ethnic and racial differences in types of complaints and rates of complaint resolution in a local Ombudsman Program. First, resident race/ethnicity and complaint data were collected from the Ombudsman Program and analyzed. Then, we conducted focus groups with Ombudsman Program staff and volunteers to provide a more complete interpretation of findings from the first phase. Results: Residents from ethnic/racial minority groups were less likely to generate Resident Care complaints and more likely to generate Resident Rights complaints, compared to non-Hispanic White residents (p<.05). Resident Rights, Quality of Life, and Administrative complaints were less likely to be disposed satisfactorily, compared to Resident Care complaints (p<.05). Themes emerged from our qualitative findings include language barriers and more efforts required for residents’ rights due to concerns raised more frequently among minority residents. Implications: Cultural competence training for Ombudsmen as well as care professionals should focus on skills and knowledge that value diversity, understand and respond to their unique concerns. Ombudsmen play an important role as they create an avenue for the residents to discuss their concerns. Implementation research may improve our understanding of the development and delivery of the Ombudsman Program.
Sex Difference in Self-Reported Sexual Functioning Among Frail Older Adults
Authors: Olivieri-Mui Brianne , Shi Sandra , McCarthy Ellen , Kim Dae
Published: December 2020

Frailty may differentially impact how older adult males and females perceive sexual functioning, an important part of well-being. We assessed the level of frailty (robust, pre-frail, frail) for anyone with data on 11 sexual functioning questions asked in wave 2 of the National Social Life, Health, and Aging Project, 2010-2011 (n=2060). Questions covered five domains: overall sexual function (OSF), sexual function anxiety (SFA), changes in sexual function (CSF), erectile/vaginal dysfunction (EVD), and masturbation. Logistic regression identified sex differences in frailty and reporting worse sexual functioning. Linear regression predicted the number of domains reported as worse. Among males (n=1057), pre-frailty meant higher odds of reporting SFA (OR 1.8 95%CI 1.2-6.6), CSF (OR 1.7 95%CI 1.1-2.7), and EVD (OR 1.5 95%CI 1.0-2.2). Among females (n=1003), there was no difference in reporting by frailty. Females were more likely to report worse OSF (Robust: OR 7.4, 95%CI 4.8-11.4; Pre-frail: OR 6.2, 95%CI 3.9-9.9; Frail: OR 3.4 95%CI 1.7-6.6), but less likely to report SFA (Robust OR .3, 95%CI .2-.5; Pre-frail OR .2, 95%CI .1-.3; Frail OR .2 95%CI .1-.3). Pre-frail and frail females reported fewer domains as worse (Pre-frail coefficient -0.21 SE 0.09, Frail -0.43 SE 0.14). As frailty worsened, males reported more domains as worse (Pre-frail 0.24 SE 0.07, Frail 0.29 SE 0.08). Self-reported sexual functioning differs by sex at all levels of frailty, and reporting by males, but not females, changes with frailty. Providers should be aware that sexual functioning is of importance to both sexes despite varying degrees of frailty.
Sexual Expression in Old Age: A Qualitative Study
Authors: von Humboldt Sofia , Ribeiro-Gonçalves José Alberto , Costa Andrea
Published: December 2020

Objective: This study aims to analyze how older adults express themselves sexually. For this purpose, a qualitative research was carried out, which analyzes their perspectives at a cross-national level. Methods: Four hundred and ninety five older participants aged 65 to 98 years, were interviewed. Participants were of three different nationalities and lived in the community. All the interviews went through the process of verbatim transcription and subsequent content analysis. Results: Results of content analysis produced nine themes: Tender and care (k = .91, p < .01); altruism and gratitude (k = .81, p < .01); attractiveness (k = 94, p < .01); positive communication (k = .89, p < .01); sexual activity (k = .88, p < .01); good health and physical condition (k = .96, p < .01); supportive relationship (k = .84, p < .01); eroticism (k = .94, p < .01); and feeling active and alive (k = .92, p < .01). Conclusions: This study stressed different ways on expressing sexuality in old age and underlined the importance of tender and care and eroticism for older adults who are sexually active. Keywords: Content analysis; older adults; qualitative study; sexual expression.
Exploring Application of Smart Companion Robots to Facilitate Faith-Based Ministries for Older Homebound Adults
Authors: Adebayo Christianah , Bishop Alex
Published: December 2020

This study examined perceptions regarding application of smart robot companions to facilitate homebound religious ministry programming to older adults. A total of N= 7 participants consisting of ministers, pastoral volunteers, and older adult members from Methodist, Presbyterian, and Roman Catholic traditions engaged in a 60-minute focus group. One key goal was to address the question: If you could design a robot for ministry to homebound older adults what would you want it to do? All responses were recorded, transcribed and coded for thematic content. Three core themes emerged relative to spiritual privacy, prospective intervention, and inclusive monitoring. Relative to spiritual privacy, participants expressed concern regarding robotic ability to maintain the spiritual privacy of the older homebound adult, especially when engaged in faith-based behaviors such as private prayer, confession, and pastoral counseling. Second, participants suggested that a robot companion serve as a memory aide for older homebound members. In particular, participants acknowledged a need for robot intervention relative to sending alerts concerning prayer requests, reminders of upcoming church-related events, and notices concerning future homebound ministry visitations. Finally, participants indicated an interest for the robot to actively monitor community inclusion, noting that many older homebound adults are left out of weekly church-related services or events and experience seclusion, yet most “retain a desire be included and remain an integral part of their faith community.” Results will be used to present a conceptual model for a smart robotic faith assistant designed for delivery of homebound ministries to older adults.
Long-Term Care Financing for an Aging Population: The Experience of Singapore
Authors: Chia Ngee Choon , Cynthia Chen Huijun
Published: December 2020

Singapore has a rapidly aging population. Long-term care (LTC) is one of the largest financial risks facing elderly in Singapore. Singapore implemented Eldershield, a long-term care insurance scheme which provided defined cash benefit payouts in the event of severe disability; but capped at a maximum of six years. Eldershield enrolled people at age 40, but offered an opt-out option. As of 2015, 65% of those aged 40 to 83 opted to be covered by Eldershield, making Singapore as having the highest voluntary LTC insurance rate in the world. This paper uses an actuarial multi-state disability model and calibrates the transition probabilities and duration-of-stay at various health (disability) states to assess the adequacy and comprehensiveness of Eldershield. The time-limited cash benefit design in Eldershield helped defray about 13% of LTC costs. Removing the time cap will help defray 23% and 26% of the LTC costs for elderly male and female respectively. Furthermore, the simulation results demonstrate that relaxing the trigger benefit and having staggered payouts will improve the adequacy of long-term care insurance. The experience of Singapore’s LTC insurance offers insights into the challenges of designing an insurance that tends to occur at higher age and insuring against a cost that could range from zero to a significantly large sum over a long period. Even with the enhanced Careshield Life, which provides cash payouts for life, other policy designs, for example caregiver grants, may be needed to ensure more adequate financing of long-term care.
Patterns of Internet Use, Loneliness, and Mental and Physical Health Among Korean Baby Boomers
Authors: Kim Jeehoon , Kim Jwakyum , Lee Ji Hyun , Han Gyounghae
Published: December 2020

Introduction. Korean Baby Boomers are more affluent and gained higher education than past generations. Their relatively younger age (born between 1955 and 1963), coupled with more personal resources can help the Boomers have easier access to digital devices, but little is known about their patterns of online activities and how diversity in online activities is associated with health status among Korean Boomers. Methods. Using data from the 2012 Korean Baby Boomers Panel Study (n=3,272), we conducted latent class analysis based on ten online activities. Three classes were identified with different patterns of online activities; namely, maximizers (n=315), selective users (n=1,435), and rare users (n=1,522). Multinomial logistic regression analysis was performed to examine factors associated with different groups. Ordered probit regression and multiple regression analysis were employed to predict depressive symptoms and self-reported health of Korean Boomers, respectively. Results. Selective users used the internet for information search, e-mail, SNS, streaming music, or gaming, whereas maximizers engaged actively on all activities. Rare users were minimally engaged in information search. Both selective users and maximizers were more actively engaged with social relationships and social group activities compared to rare users. Maximizers were more likely to experience loneliness than rare users. Selective users were less likely to report depressive symptoms and had better health than rare users. Discussion. Moderate engagement with digital technology supported Korean Boomers in maintaining social relationships and better health. Intervention strategies for alleviating loneliness and preventing social isolation for maximizers, thus helping them maintain better health, will be discussed.
Social Isolation and Its Related Factors in Participants of a Senior Citizens’ College in Japan
Authors: Uchida Hayato , Fujiwara Yoshinori , Matsuura Shinro
Published: December 2020

The aim of this study was to clarify the social isolation and its related factors of participants in senior citizen’s college in Japan. The participants were 104 persons (age 73.3+/-4.3) aged sixty-five years or over living in Hyogo Prefecture, Japan. They were the students of a senior citizens’ college established by Himeji City, Hyogo Prefecture in 1981. We conducted a cross- sectional study that included age, family structure, employment status, financial status, self-related health, presence of chronic disorders, instrumental activities of daily living, dietary variety score (1-10). The mental health well-being was assessed using the Japanese version of the World Health Organization Mental Health Well-being Index-five items (WHO-5). We defined social isolation as seeing friends or relatives less than two or three times a month. We carried out the survey in November in 2019. Selected variables were compared after dividing the participants into “socially isolated group” and “not socially isolated group”. A t-test, a chi-square test, and logistic regression analysis were conducted to examine the related factors of social isolation in this study. Of the 104 participants who were analyzed for social isolation, 21 (20.2%) were found to be socially isolated. From the results of multivariate logistic regression analysis, “lower mental health” (OR=4.013, 95%CI=1.745-10.435) and “lower self-related health” (OR=2.583, 95%CI=1.103-9.564) were independently associated with social isolation. These results suggest that, to prevent the social isolation of the participants in senior citizen’s college in Japan, it is necessary to develop and implement the approach which promote mental health and self-related health.
Associations Between Subjective Age, Contact With Older Adults, and Age Stereotypes Among Younger Adults
Authors: Kurth Maria , Intrieri Robert
Published: December 2020

Subjective aging (SA) has generally focused on middle-age and older adults in relation to physical and psychological health for the last 70 years (see Barak & Stern, 1986). Kornadt et al. (2019) recently called for more research examining: co-development of age stereotypes and SA, and this association across the lifespan. Literature examining SA and age stereotypes among younger adults is limited and suggests that age stereotypes are not directly associated with SA (Packer & Chasteen, 2006). Increased contact with older adults, however, is associated with less ageist attitudes (Bousfield & Hutchinson, 2010). This study examined SA and the associations between contact frequency and ageism. The sample consisted of 467 undergraduate students (Mage = 21.48, SDage = 2.63). Subjective age was assessed by asking How old do you feel compared with others your age?, and was scored on a 5-point scale from younger all the time (5) to older all the time (1). Ageism was assessed with the Aging Semantic Differential (ASD), which contains four factors. Results showed significant effects across felt age for contact frequency (F(4, 406) = 3.841, p = .004). Results for the ASD factors were mixed with Autonomy and Integrity showing significant effects for SA (F(4, 405) = 2.763, p = .027; F(4, 405) = 2.773, p = .027 respectively). Instrumentality and Acceptance were nonsignificant. Results suggested feeling older all the time is related to more contact, but more negative attitudes- this increased contact might providing priming for more ageist attitudes (Eibach et al., 2010).
Cross-Validation of a Scale to Measure Contact With Older Adults
Authors: Intrieri Robert , Kurth Maria
Published: December 2020

According to Allport (1954) intergroup contact would reduce prejudice that in-group members would experience toward out-group members. Allport also theorized that positive intergroup contact would follow after four conditions were met: (a) equal group status within the situation, (b) common goals, (c) intergroup cooperation, and (d) the support of authorities, law, or custom. While contact with older adults is a principal influence on attitudes toward older people, there is a paucity of adequate contact measures. This study assessed the cross-validity of the factor structure of an instrument to measure contact with older adults. The convenience sample consisted of 470 participants (61% male) from an undergraduate student subject pool (M = 20.67, SDtotal = 3.37). Participants were predominantly Caucasian (n=176, 48.9%), African American (n=103, 28.6%), and Hispanic/Latino/a (n=51, 14.2%). Results of a confirmatory factor analysis showed the three-factor model exhibited a reasonable fit to the data □□ (41, n = 360) = 191.797; p<.0001, CFI =.971; TLI =.961; RMSEA = .101 (90% CI, 0.087-0.116) SRMS = .042. An additional model examining the relationships between a single indicator of contact frequency and the three-factor COA scale revealed similar fit statistics □□ (41, n = 360) = 191.797; p<.0001, CFI =.967; TLI =.955; RMSEA = .092 (90% CI, 0.079-0.105) SRMS = .044. The findings provide clear and consistent evidence across independent samples that the covariances among the items are best explained through a latent structure that consists of three meaningful factors (“General Contact”, “Positive Experience, and “Negative Experience”).
Asian American Older Adults and Social Isolation: A Systematic Literature Review
Authors: Kwon Simona , Min Deborah , Chong Stella
Published: December 2020

Asian Americans are the fastest growing racial and ethnic minority group in the United States, whose population is aging considerably. Previous studies indicate that social isolation and loneliness disproportionately affects older adults and predicts greater physical, mental, and cognitive decline. A systematic literature review using PRISMA guidelines was conducted to address this emerging need to understand the scope of research focused on social isolation and loneliness among the disparity population of older Asian Americans. Four interdisciplinary databases were searched: PubMed, CINAHL, PsycINFO, and AgeLine; search terms included variations on social isolation, loneliness, Asian Americans, and older adults. Articles were reviewed based on six eligibility criteria: (1) research topic relevance, (2) study participants aged >60 years, (3) Asian immigrants as main participants, (4) conducted in the United States, (5) published between 1995-2019, and (6) printed in the English language. The search yielded 799 articles across the four databases and 61 duplicate articles were removed. Abstracts were screened for the 738 remaining studies, 107 of which underwent full-text review. A total of 56 articles met the eligibility criteria. Synthesis of our review indicates that existing research focuses heavily on Chinese and Korean American immigrant communities, despite the heterogeneity of the diverse Asian American population. Studies were largely observational and employed community-based sampling. Critical literature gaps exist surrounding social isolation and loneliness in Asian American older adults, including the lack of studies on South Asian populations. Future studies should prioritize health promotion intervention research and focus on diverse understudied Asian subgroups.
Pneumococcal Pneumonia Vaccination Among Older African American and Hispanic Men With Chronic Conditions
Authors: Smith Matthew , Sherman Ledric , Cauley Daunte , Badillo Brittany , Goidel R Kirby
Published: December 2020

The CDC estimates that 70% of adults ages 65 years and older received the pneumococcal pneumonia vaccination (PPV). However, documented PPV rates are substantially lower for men, especially non-white men. This study examined common and unique factors associated with PPV among racial/ethnic minority men age 65 and older with one or more chronic conditions. Data were analyzed from a national sample of 470 African American (n=267) and Hispanic (n=203) males using an internet-delivered questionnaire. Two binary logistic regression models were fitted to compare factors associated with PPV. On average, participants were age 70.1(±4.5) years and reported 3.9(±2.6) chronic conditions. PPV rates were 56.8% and 43.2% among African American and Hispanic males, respectively. Across models, men who received vaccines for influenza (P<0.001) and shingles (P<0.01) were more likely to receive the PPV; whereas, those who reported more disease self-care barriers were less likely to receive the PPV (P<0.05). Among African American males, those who were widowed (OR=3.80, P=0.022) and had an annual eye examination (OR=3.10, P=0.001) were more likely to receive the PPV; whereas, divorced/separated men were less likely to receive the PPV (OR=0.33, P=0.003). Among Hispanic males, those who took more medications daily (OR=1.36, P=0.005), reported higher disease self-management efficacy (OR=1.15, P=0.011), and had a colon cancer test in the past 12 months (OR=3.55, P=0.007) were more likely to receive the PPV. Findings suggest the need for culturally tailored education and self-management interventions to increase PPV and preventive healthcare service utilization among older racial/ethnic minority men.
Caregiver Relationships and Distress Moderated by Collectivism
Authors: Kim Eunbea , Rogers Mary , Szkody Erica , McKinney Cliff
Published: December 2020

The number of older populations raising their grandchildren has increased. Past research has indicated the distress custodial grandparents’ experience is related to their family relationships (Hayslip, Shore, & Emick, 2006). Family relationships are also influenced by a variety of factors such as social history, culture, family structure, and individual differences (Uhlenberg & Kirby, 1998). The current study evaluated the influence of culture on the relationship between caregiver relationship quality and mental health by examining 885 children (18-25 years; M=18.93). This study also compared the difference in cultural impact between custodial grandparents-grandchildren and biological parents-children. Measures included the Network of Relationships Inventory, Hofstede Cultural Questionnaire, and Adult Behavior Checklist. Path analysis was conducted using AMOS 26.0 which resulted in an interaction between relationship closeness and collectivism to predict custodial grandparent depressive symptoms. Custodial grandparents who reported a lower level of closeness with their grandchildren in a higher collectivistic culture reported a significantly higher level of depression symptoms than those in a more individualistic culture, particularly for custodial grandmothers. However, custodial grandparents who reported a higher level of closeness with their grandchildren in a higher collectivistic culture reported significantly lower levels of depressive symptoms than those in a more individualistic culture. Furthermore, compared to biological parents, custodial grandparents reported significantly lower levels of depressive symptoms when reporting higher collectivistic culture. These findings will inform the need for more research to assess factors of cultural features that reduce psychological problems and support family relationships to adapt psychological therapies in older adults.
Oregon's Behavioral Health Initiative for Older Adults and People With Disabilities at 5 Years: Where to From Here?
Authors: Dawson Walter , Stodola Allyson , Hasworth Serena , Kyler-Yano Jason , Winfree Jaclyn , Dreyer Linda
Published: December 2020

Oregon’s Behavioral Health Initiative for Older Adults and People with Disabilities is entering its fifth year. This novel state-level Initiative seeks to better coordinate services and resources for older adults and people with disabilities who have behavioral health needs by assigning a Behavioral Health Specialist (BHS) for every 60,000 adults 65 + and embedding them within local service agencies around Oregon. BHS primary job functions include improving coordination and collaboration between local service agencies, providing complex case consultations (CCC), and delivering workforce development training and community education. Five years of data from Portland State University’s Institute on Aging’s ongoing evaluation of the Initiative suggests significant impact in terms of workforce development trainings, community education, and new community partnerships. Data are collected from BHS and Initiative stakeholders (e.g., aging services agencies). Data collection tools include quarterly reports from the BHS, including a CCC reporting instrument; semi-structured interviews with stakeholders assessing Initiative involvement; and an electronic post-training survey (and two-month follow-up survey) for stakeholders attending BHS trainings. After five years, the evaluation appears to show the Initiative has delivered an abundance of innovative collaborations, workforce trainings, and educational opportunities aimed at better supporting the behavioral health of older Oregonians. It also highlights several persistent systemic barriers including a need for additional public funding of behavioral health, the challenges of accessing Medicare for behavioral health, and siloed agencies and organizations. Future evaluative efforts could explore adding outcomes-based assessments of the Initiative, including local-level quality improvement projects initiated by BHS within their communities.
Male Family Caregivers’ Well-Being: Balancing Work and Care for Parents in Japan
Authors: Umegaki-Costantini Hiroko
Published: December 2020

Despite substantial discussions on caregivers in policy making and academic research, a rapidly emerging new group of middle-aged male family caregivers who often also work are largely understudied. Inadequate understanding of male family caregivers jeopardises not only themselves but also care recipients, other family members and society: better care for older people depends on caregivers’ well-being. I address this gap by understanding how and why gender affects male family carers’ choices of care practices, and how male caregivers as ‘gendered beings’ sustain their well-being while reconciling work and care for their parents. Through in-depth-qualitative narrative interviews based on social anthropology of everyday life with 23 male working family carers in Tokyo in 2019, I find that men select care practices with priority given to familiar tasks deemed appropriately masculine. To perform ‘appropriate’ care for their parents, such men tend to approach care as they do their ‘work’: they ‘work-nise’ care. Such a gendered approach to care practices has important implications for addressing gender in public interventions. Also, I find that for male family working carers, achieving well-being does not mean balance in work, care and family. Rather, for them a source of well-being is from fulfilling filial duty as sons, which, however, requires making an appropriate effort and devoting themselves to some extent to support their parent(s). Thus, such men need to be embedded in a care and employment system that enables them to achieve such well being that, in turn, significantly impacts their care provision.
Partner Effects on Depressed Mood in Caregiving Dyads Are Most Pronounced in Cancer Caregiving, Partner Caregiving
Authors: Nassar Nadia Al , Litzelman Kristin
Published: December 2020

Theory and empirical evidence indicate that the well-being of caregivers and their care recipients is interrelated, although conflicting evidence has emerged across different caregiving populations. To establish a more nuanced understanding of this phenomenon, we used data from the National Health and Aging Trends Survey and the National Survey on Caregivers (2015 and 2017, n=759 dyads with complete longitudinal data) to construct actor-partner interdependence models assessing how spillover of depression varies by care recipient health condition (cancer, dementia, stroke, diabetes, or other conditions) and relationship type (spouse/partner, child, or other). Across condition types, the largest magnitude partner effects were observed in dyads with cancer, in which a one-point increase in caregiver depressed mood was associated with a 0.23-point increase in subsequent care recipient depressed mood (p=0.02) and a one-point increase in care recipient depressed mood was associated with a 0.33-point increase in subsequent caregiver depressed mood (p<0.01). Moderation by cancer status was statistically significant (pinteraction=0.03). Among spouse/partner caregivers, caregivers’ depressed mood was associated with subsequent depressed mood in the care recipient (p<0.05) but there was no evidence of spillover from the care recipient to the caregiver. Conversely, in both adult child caregivers and other caregivers, there was evidence for spillover from the care recipient to the caregiver (p<0.05) but not the reverse. The findings show that the interrelationship in the well-being of caregivers and care recipients varies by key caregiving characteristics, with implications for the development, dissemination, and implementation of interventions targeting caregiver, care recipient, and dyadic well-being.
Resilience and Service Needs Among African American Caregivers of People With Dementia: A Pilot Mixed-Methods Study
Authors: Moon Heehyul , Rote Sunshine , Decker Hallie , Kelsey Burton , Burton Chelsea , Moore Sharon , Babicka Tewsdaay
Published: December 2020

African American caregivers face unique challenges and strengths in addressing the needs of dementia care recipients. The purpose of the current study was to explore the roles of the familism and faith and service preferences and needs for African American dementia caregivers. Through collaborative partnerships among the research team, Alzheimer’s’ Association, Area Agency on Aging, and local churches, we obtained focus group and survey data (N=30) from African American dementia caregivers. Most caregivers were female (90%) and older than 51 years and had provided care more than 3 years. CGs showed strong cultural reasons (e.g., faith, duty, paying back) for providing care (range 0-40;M= 34.5; SD= 5.2). Focus groups data, which was audio taped, transcribed, and analyzed by three researchers using content analysis, revealed three major themes related to dementia care experiences and needs. First, caregivers explained positive aspects of caregiving for both the individual caregiver and family (growth in faith, sense of self -efficacy, feeling of gratefulness). Second, caregivers also described negative aspects that pose substantial challenges such as lack of services, lack of balance in life, family conflicts over care, and mistrust based on their previous experiences with existing health care systems. Third, caregivers described their knowledge of dementia and shared their self-care and coping strategies and a need for support group services. The findings show an urgent need to implement culturally responsive services, especially in undeserved areas and populations, for caregivers to maintain or improve their emotional well-being and quality of care as well as family relationships.
The Dyadic Effects of Perceived Support on Depression in Spousal Care Partners
Authors: Meyer Kylie , Patel Neela , White Carole
Published: December 2020

Relationship quality is an important factor affecting care partners’ health and wellbeing. Supportive marital relationships are associated with better physical and subjective health, whereas strain is associated with poorer health. Recent studies now indicate a dyadic effect of relationship quality on health outcomes, such that an individual’s perceptions of their relationship also affects their partner’s outcomes. Few studies have examined the dyadic effects of relationship quality on mental health among older cognitively intact caregiving couples. To address the lack of dyadic research about how perceived support from one’s spouse related to experiences of depression for individuals and their care partners, we apply cross-sectional actor partner interdependence models (APIMs) to data from the Health and Retirement Study (HRS) (N=490 dyads). APIM regression models controlled for participant demographic characteristics, relationship length, and care recipient functional ability. Findings showed that positive perceived support from a spouse had a stronger negative association with one’s own depression for care recipients than for caregivers. Similarly, greater negative perceived support from a partner was associated with higher levels of depression; whether the partner was the caregiver or care recipient did not make a difference in this model. Although there are hundreds of caregiver interventions to address caregivers’ mental health, few have demonstrated improvement in care recipient outcomes. Observation of both actor and partner effects in this study suggests there may be opportunities to improve care recipient and caregiver mental health by targeting interventions to promote high quality relationships with caregivers or both members of the care dyad.
The Association Between Caregiving Burden and Depressive Symptoms Among U.S. Chinese Adult Children
Authors: Liang Shuting , Dong XinQi
Published: December 2020

Existing research has showed the impact of caregiving burden on physical and psychological outcomes among adult children, but less have examined its association among Chinese immigrants in the US. This research will present the association between caregiving burden and depressive symptoms among U.S. Chinese adult children. Cross-sectional data were drawn from the PIETY study with 547 Chinese adult children aged over 21 years old in the greater Chicago area between 2012-2014. Caregiving burden was assessed by 24-item caregiver burden developed by Novak and Guest and is composed of five factors: time-dependence, developmental, physical, social, and emotional burden. Depressive symptoms were assessed by the nine-item Patient Health Questionnaire. Logistic regression analysis was conducted. In our sample, 241 (44%) adult children had depressive symptoms and 174 (72.2%) were female. In the result of multivariate analysis, after adjusting for covariates, developmental burden (Odds ratio [OR] 1.13 [1.05-1.21]), physical burden (OR 1.17 [1.06-1.28]), social burden (OR 1.20 [1.08-1.32]), and emotional burden (OR 1.22 [1.11-1.35]) were positively associated with reporting any depressive symptoms. However, the time-dependence burden was not associated with depressive symptoms. The findings highlight the potential impact of caregiving burden on depressive symptoms and how different domains of caregiving burden are associated with depressive symptoms among Chinese caregivers in the U.S. Future research should include multidimensional social supports or acculturation as underlying factors which might affect the relationship between caregiver burden and depressive symptoms across Chinese community in the US.
Age-Related Patterns in the Subjective Appraisal of Cognition
Authors: Jacova Claudia , Smith Samantha , Robertson Frank
Published: December 2020

Subjective cognitive decline (SCD) is a construct of high interest in aging and dementia because individuals endorsing it are at higher risk of developing cognitive problems. It is unclear how individuals arrive at the judgement that they have SCD. Here we aimed to understand which SCD symptoms give rise to the perception of decline as older adults age. Community-dwelling adults (N=494, mean age=63.6, SD=5.44), completed the Subjective Cognitive Decline Questionnaire (SCD-Q) online, using an online crowdsourcing site. The SCD-Q consists of one global question regarding self-perceived decline (yes/no) and 24 questions about everyday functioning which we utilized to form a memory, language, and executive functioning domain score, higher for greater perceived decline. Logistic regression revealed that memory and language domains predicted the likelihood of endorsing SCD for adults aged >64 (Memory: OR=1.76, CI=1.47-2.05; Language: OR=1.66, CI=1.30-2.02). Only the memory domain predicted the likelihood of endorsing SCD for adults <63 (OR=2.69, CI=2.35-3.02). Executive functioning domain scores did not play a role in the relationship between SCD likelihood in either age group. The higher the self-perceived memory or language decline, the more likely older adults are to conclude they have SCD. Our results suggest there is an age-related trajectory in how people evaluate their cognition, with younger people only considering memory and older people considering both memory and language. Clinicians should be aware of this trajectory when examining patients with SCD. Executive functions should be specifically queried because they may not emerge from older adults’ self-reported cognitive problems.
Weight Status Influences Carotid Intima-Media Thickness to Executive Function Among Older Adults
Authors: Bygrave Desiree , Wright Regina
Published: December 2020

Carotid atherosclerosis has emerged as an early predictor of reduced cognitive function. Underlying this association are risk factors, such as overweight and obesity, that promote carotid atherosclerosis and poor cognitive outcomes. Given the prevalence of overweight and obesity among older adults, there is a critical need to better understand how atherosclerosis influences cognitive function in the context of elevated weight. To address this gap, the current study examined relations between carotid atherosclerosis (carotid intima-media thickness [IMT]), and attention (Trailmaking Test) and executive function (Verbal Fluency Test) performance, and whether they varied as a function of weight status (body mass index [BMI] classification). Data were analyzed from 162 older adults (mean age = 68.43y, 34% male, 41% African American), free of major disease. Mutliple regression and analysis of variance analyses, adjusted for age, sex, education and mean arterial pressure, showed a statistically significant IMT x BMI interaction for Verbal Fluency performance (p=.04) and a trending IMT x BMI interaction for Trailmaking A performance (p=.05). Simple effects analysis of IMT and Verbal Fluency performance showed that this association was most pronounced among those who are obese. Findings suggest atherosclerosis may influence executive function in the context of obesity among older adults. As the development of carotid atherosclerosis is strongly related to aging, our findings suggest that maintaining a healthy weight may reduce its impact on executive function in older adulthood.
Are We Missing the Target When Measuring Quality of Life?
Authors: Janssen Leah , de Medeiros Kate
Published: December 2020

Over the last several decades, many instruments have been created to measure quality of life (QoL) in older adults, particularly for intervention research on individuals living with dementia. However, since definitions of QoL lack standardization across the research literature, the question of how to holistically capture an elusive and expansive concept such as QoL remain. This research uses qualitative content analysis to explore definitions and domains of QoL with an eye toward overlap and gaps. Definitions of QoL were extracted from gerontology encyclopedia entries and other peer-reviewed supplemental resources and analyzed for themes using Dedoose qualitative software. Results revealed three over-arching themes: no standardized or universal definition of QoL, use of subjective and objective factors for measurement, and varying domains of QoL. Additionally, we further distilled theme three to identify eight unique QoL domains: 1) economic/financial, 2) environment, 3) ADL/IADL function, 4) participation in activities, 5) personal resources, 6) physical health, 7) psychological well-being, and 8) social/relational, the total of which were only found in one of 15 definitions of QoL. Overall, findings led to an overarching definition of QoL that cuts across multiple dimensions and factors. We argue that by having all eight domains our understanding and measurement of QoL is enhanced, thereby improving our assessment of existing definitions of QoL, as well as the instruments used to measure QoL.