bluuebunny/crossref_metadata_2025 huggingface dataset:
REACHING THE SOCIALLY ISOLATED OLDER ADULTS IN DEMENTIA RESEARCH
Authors: Emlet Charles , Goldsen Karen Fredriksen , Kim Hyun-Jun , Teri Linda , Jung Hailey , Jones Brittany
Published: December 2022

Sexual and gender minority (SGM) older adults are at greater risk for dementia and social isolation compared to their heterosexual peers. Lack of an available caregiver is of major concern. Yet, most dementia interventions to date have been designed primarily for caregiver-care recipient dyads or solely caregivers. A pilot study evaluated a 9-session virtual program designed to address social isolation, physical functioning and quality of life among SGM older adults living with dementia without a caregiver. Participants in the experimental group (n = 14) showed high attendance (75%) and retention rates. Social support was associated with intervention adherence. Compared to controls, the experimental group showed a significant increase in physical functioning and quality of life and decrease in depressive symptomatology and perceived stress. To meet the needs of this population without adequate social resources, research must address the different configurations of resources to better serve socially isolated SGM older adults.
CO-CREATING A GUIDELINE FOR MANAGING CHALLENGING BEHAVIOR OF MIGRANTS WITH DEMENTIA AT HOME
Authors: van de Ven Leontine Groen- , van der Kaaij Serena , Visser Geraldine , Veld Judith Huis in het , Gobbens Robbert , de Bruin Simone
Published: December 2022

Challenging behaviour is common in people with dementia at home. Nurses guide people with dementia and their informal caregivers managing challenging behaviour. However, common nursing guidelines for challenging behaviour in home care are unsuitable to the situation of migrants with dementia. We started a co-creation project with home care nurses, dementia case managers, informal caregivers of migrant background and student nurses as co-researchers that aims to develop an appropriate guideline. Semi-structured interviews at the start explored the current experiences with challenging behaviour. Interview results informed several working sessions where we discussed the results and used creative working methods such as role play to develop a first prototype of the guideline. The prototype was implemented in the daily practice of six home care teams and followed up during reflection meetings with our co-researchers. Our guideline puts special attention to getting familiar with each other before taking steps in managing challenging behaviour.
BSS Flash Poster Session 2: The Power of Purpose and Personal Ties in Late Life
Authors: Nelson Niccole , Bergeman Cindy
Published: December 2022

This study examined (1) the time-varying relationship between purpose in life and perceived stress reactivity, (2) the trajectory of perceived stress reactivity as it relates to both within- and between-person purpose in life, as well as (3) the predictive utility of perceived stress reactivity and its rate of change on cognitive ability and allostatic load. The sample comprised 933 participants from the Notre Dame Study of Health & Well-being, a 10-year study of annual questionnaire packets and biennial daily diary bursts. Analyses included three-level multilevel models from which random effects were extracted and used to predict allostatic load and cognitive ability. Results indicated that individuals were affectively reactive to perceived stress, and that perceived stress reactivity declined over time. Considering the effects of purpose in life on these processes, there were two cross-level interaction effects indicating (1) more purposeful individuals were less stress reactive than less purposeful individuals, and (2) more purposeful individuals declined less in negative affect over time than less purposeful individuals. There was also preliminary evidence for a within-person interaction effect between yearly purpose in life and daily affective reactivity such that when individuals felt particularly purposeful, they also tended to be less stress reactive. Finally, higher perceived stress reactivity, as well as less decline in this construct, was predictive of better cognitive ability. These findings indicate purpose in life buffers against environmental and maturational effects on negative affect, and that perceived stress reactivity may indicate a different, more adaptive process than affective reactivity to experienced stressors.
OLDER ADULTS SHARE CHALLENGES IN THEIR LIFE STORY: SENSE OF PURPOSE AS A RESOURCE FOR RESILIENCE
Authors: Habib Semper , Narine Ameesha , Bluck Susan , Sharma Shubam
Published: December 2022

Maintaining a sense of purpose promotes mental and physical well-being in older adults (Musich et al., 2018). Drawing on one’s sense of purpose is thus important for late life resilience. How older adults’ sense of purpose manifests in their everyday lives remains understudied. This study used qualitative methods to amplify older adults’ voices regarding purpose and resilience through analysis of their life stories. This study 1) explored what factors contribute to maintaining purpose in older adulthood, and 2) identified how older adults draw on their purpose during major challenges, particularly in the context of the COVID-19 pandemic. Eighteen older men and women (Mage = 79.1; including the young-old, old-old, and oldest-old) participated in semi-structured life story interviews that asked about participants’ individual interpretations of purpose in their lives and their experiences navigating the COVID-19 pandemic. Thematic analysis was conducted using established methods (Braun & Clarke, 2012). To address the first research question, analyses revealed that older individuals largely maintain their purpose through engaging in acts of service to others, fostering connections with close others, and actively setting and achieving goals. Regarding the second question, older adults described how drawing on purpose through acts of service and connections with others fostered resilience through the COVID-19 pandemic. Overall, older adults’ own expressions of their life stories illuminated how they are guided by purpose. Findings demonstrate the functionality of purpose in late life and how purpose can be practically fostered, specifically within the context of universally challenging experiences such as the COVID-19 pandemic.
COMPASSIONATE LOVE AND LONELINESS: LATER LIFE MENTAL HEALTH IN THE UNITED STATES
Authors: Lekhak Nirmala , Bhatta Tirth , Kahana Eva , Synder Joel
Published: December 2022

Loneliness is a serious public health problem that affects over 25% of older adults and is associated with an increased risk of depression, cognitive decline, and premature death. Previous research on social support mechanisms that contribute to loneliness has consistently illustrated the role of emotional support in reducing loneliness. However, the importance of compassionate love in reducing loneliness and, as a consequence, improving psychological well-being in later life has received little attention. Neurobiology indicates that the brain regions associated with loneliness and compassion overlap, suggesting that increasing compassion-related emotions may help alleviate loneliness. Using data from a nationwide web-based survey (n=1,861), we examined the influence of compassionate love on loneliness and assessed whether loneliness mediates the relationship between compassionate love and mental health outcomes. Even after controlling for emotional support, estimates from an ordinary least squares regression (OLS) model suggest that older adults who felt loved had significantly lower levels of loneliness (b=-0.84, p< 0.001). Feeling of love also contributed to significantly fewer depressive symptoms (b=-2.03, p< 0.001) and anxiety (b=-1.07, p< 0.001). Loneliness completely mediated the effect of compassionate love on anxiety (b=-0.82, p< 0.001) and significantly mediated its influence on depressive symptoms (b=-1.18, p< 0.001). Our findings underscore the need to design interventions that increase compassionate love to reduce loneliness and improve psychological wellbeing among older adults.
INTERACTIONS BETWEEN SLEEP AND BIOLOGICAL MARKERS OF AGING
Authors: Kaufmann Christopher , Stone Katie
Published: December 2022

There is well documented evidence that sleep architecture and circadian patterns change as people age in part due to accumulation of comorbidities, polypharmacy, and other factors inherent to the aging process. While a number of studies have examined sleep in the context of these factors, recent advances in the assessment of biological aging (including epigenetic age, metabolomics, and measurement of inflammatory biomarkers) have made it possible to identify potential mechanisms by which sleep impacts the aging course. In this symposium, we will highlight research that investigates the link between sleep disturbances and biological factors in order to identify whether sleep could be a modifiable risk factor for accelerated aging. Our first presentation will examine the association between insomnia symptoms and short sleep duration with epigenetic age acceleration using data from the Health and Retirement Study. Second, we will describe whether objectively measured sleep characteristics are associated with a number of metabolomic markers of aging. The third presentation will center around the extent to which social disparities in presence of inflammatory biomarkers may be mediated by sleep quality. Finally, we will examine how daytime sleepiness may be associated with longitudinal BMI trajectories. These presentations will, as a whole, highlight the importance of sleep as a contributor to healthy aging and longevity, and inform the development of interventional approaches targeting biological mechanisms to promote successful aging more broadly.
ASSOCIATION BETWEEN AEROBIC CAPACITY AND PERCEIVED FATIGABILITY: THE STUDY OF MUSCLE, MOBILITY, AND AGING (SOMMA)
Authors: Moffit Reagan , Forman Daniel , Coen Paul , Nicklas Barbara , Moored Kyle , Qiao Yujia (Susanna) , Cawthon Peggy , Glynn Nancy W
Published: December 2022

Peak aerobic capacity declines with age concomitant with greater fatigability and slower gait speed. We explored these relationships with cross-sectional SOMMA data (N=422, age=76.7±5.1, 57.4% women, gait speed= 0.97±0.18 m/s from a 4m walk). Participants completed a treadmill peak oxygen consumption test (VO2peak) and the self-administered Pittsburgh Fatigability Scale (PFS, range: 0-50; higher=greater fatigability). Mean VO2peak was 19.4±4.2 ml/kg/min, PFS Physical score was 16.9±8.5 points, and PFS Mental score was 8.1±8.2 points. Pearson correlations between VO2peak and PFS Physical and Mental scores were r=-0.36 and r=-0.23, respectively. For every one standard deviation higher VO2peak, PFS Physical and Mental scores were lower by 2.07 points (CI: -3.00, -1.13) and 1.10 points (CI: -2.07, -0.17), respectively, when adjusted for clinic site, age, race, sex, and self-reported physical activity. Future SOMMA analyses will evaluate a likely bidirectional association between VO2peak and fatigability, as well as examine their potential mediating effects on physical function.
PRESIDENTIAL SYMPOSIUM: BUILDING AND LEVERAGING COMMUNITY PARTNERSHIPS THAT EMBRACE DIVERSITY, ENRICH DISCOVERY, AND REIMAGINE AGING
Authors: Johnson Kalisha Bonds , Morgan Brianna , Abbott Katherine
Published: December 2022

Are you an ESPO member or early careerist who is interested in creating meaningful and engaging partnerships with different stakeholders? Want to learn how to leverage partnerships across diverse research settings and make impactful change? Or are you unsure of all the “hype” surrounding engaging communities and key stakeholders? If you answered “yes” to any of these questions, this symposium is for you. The ESPO Presidential Symposium will highlight three speakers who will share their career stories and a discussant with expertise in building and keeping important collaborations that influence aging research. Speakers include Drs. Christopher G. Engeland, Andrea Gilmore-Bykovskyi, and Martina Roes. Dr. Katherine Abbott will serve as the discussant. Starting at the basic science end of the research spectrum, Dr. Engeland will focus on communicating and collaborating at the intersections between research settings to carry science from the bench to the bedside. Next, moving to research that focuses on aging older adults in clinical research, Dr. Gilmore-Bykovskyi will discuss how she has established, maintained, and evolved her career in Alzheimer’s disease and related dementias across diverse research paradigms. Lastly, Dr. Roes will provide and international perspective and shares how she builds trust with the co-creation of research with persons living with dementia and their significant others.
GENERATIONAL TRANSMISSION OF SOCIAL RELATIONS: FINDINGS FROM MULTIPLE US LONGITUDINAL STUDIES
Authors: Hu Rita , Antonucci Toni , Neupert Shevaun
Published: December 2022

This symposium provides diverse findings documenting the long reach of social relations over generations. Ali and Rohner examine data from 41 adult offspring showing that recalled perception of rejection of parents during childhood are associated with fewer positive caregiving behaviors and social interactions with their now aging parents. Using three waves of longitudinal data over 23 years, Manalel, Cleary & Antonucci examine changes in composition, proximity, and contact frequency in social relations among 193 participants who were 8-12 years old at wave 1 (1992). Findings indicate increased diversity from wave 1 to 2 and increased stability from Wave 2 to 3, reflecting normative life transitions. Gender and race differences were also evident. Suitor, Gilligan, Frase & Stepniak examine 725 adult (aged 30-60) children’s experience of their mother’s advice concerning experienced depression and whether these differ by race, age, and gender. While there were no age differences, men, regardless of race and black daughters receiving advice had higher levels of depression but this had little effect white daughters. Finally, Hu and Antonucci use the Social Relations Study to examine the longitudinal association between social ties and self-esteem. They examined 553 people who were 13-77 at Wave 1 in 1992. Findings indicate that network closeness matters with increases in weak and close, but not closest network size related to increase in self-esteem 23 years later. In sum, this symposium offers multiple and diverse perspectives of generations in social relations and their association with well-being over the life span.
ANOCRITICISM: THEORIZING AND DISCOVERING INTERSECTIONS OF AGE AND GENDER
Authors: Maierhofer Roberta
Published: December 2022

This paper presents historical research on the theoretical foundations and application of ‘anocriticism’ as a method to trace portrayals of female aging in American literary texts to understand what it means to be “aged by culture” (Gullette 2004). Originally developed in the 1990s in context of American Studies as an analytical framework for the analysis of cultural representations of intersections of age and gender in literature, anocriticism brings together the feminist tradition of Elaine Showalter’s (1985) “gynocriticism” – a study of women writers and of the history, styles, themes, genres and structures of writing by women – through analysis of narratives and Germaine Greer’s (1992) use of “anophobia” (from Latin “anus” for “old woman”) to describe the fear of old women. The paper presents examples of anocriticism in practice in age studies and gerontology and highlights its potential for future multidisciplinary and interdisciplinary application.
PHOTOVOICE STUDY TO EXPLORE THE PHYSICAL DISABILITY EXPERIENCE IN OLDER ADULTS WITH MCI/EARLY DEMENTIA
Authors: Jenkins Emerald , Taylor Janiece , Evelyn-Gustave Allyson , Hornstein Erika , Wolff Jennifer , Rebok George , Szanton Sarah
Published: December 2022

Adults aging with mild cognitive impairment (MCI)/early dementia often experience physical disability, yet most research is focused on cognitive or physical disability rather than both. Understanding the experiences of this population and their care partners will help identify unmet needs and potential solutions. The purpose of this study is to explore perceptions of daily experiences relevant to aging in place in this population. We used human-centered design, critical ethnography, photos, written narratives, and semi-structured interviews with community-dwelling care partners (mean age: 63 years (SD= 7.48)) and older adults with MCI/early dementia and physical disability (mean age: 84.5 years (SD =2.60)) (total n= 9). Example participant insights included: preferred nonpharmacological remedies for pain, environmental constraints resulting in further isolation, systems of reminders relevant to the older adults’ preferences, and the importance of shared dyadic activities. This study demonstrates participants’ lived experiences and challenges faced and informs tailoring of an evidenced-based intervention.
EXPLORING THE USE OF MACHINE LEARNING TO IMPROVE DEMENTIA DETECTION: AUTOMATING CODING OF THE CLOCK-DRAWING TEST
Authors: Hu Mengyao , Murphey Yi Lu , Wang Song , Qin Tian , Zhao Zixuan , Gonzalez Richard , Freedman Vicki , Zahodne Laura
Published: December 2022

Alzheimer’s disease and related dementias, a leading cause of disability among older adults, has become a critical public health concern. The clock-drawing test (CDT), which asks subjects to draw a clock, typically with hands showing 11:10, has been widely used as a screening tool to detect dementia in clinical research and surveys. The clock-drawings are often coded into binary (e.g., normal vs. abnormal) or ordinal scores. A limitation in large-scale studies is that the manual-coding of CDT could result in biases if coders interpret and implement coding rules differently. Several small-scale studies have explored the use of machine learning methods to automate CDT coding. Such studies either have had limited success with ordinal coding or have used methods that are not designed specifically for complex images. This study aims to create and evaluate an intelligent CDT-scoring system that automatically codes ordinal CDT scores using deep learning neural networks (DLNN) methods including resnet101, EfficientNet-B3, and Visual Transformer. We used a large repository of CDT images from the 2011-2019 National Health and Aging Trends Study, a panel study of Medicare beneficiaries ages 65 and older. Results show that 1) DLNN has achieved a high scoring accuracy; 2) DLNN generates more consistent and accurate scores than trained lay coders, compared to expert coders with a neuropsychology background; 3) DLNN-coded CDT scores are highly correlated with self-reported dementia diagnosis and performance-based assessments of memory. This study offers a model for automating coding of other drawing tests used to evaluate a variety of cognitive functions.
PSYCHOMETRIC PROPERTIES OF THE NEUROPSYCHIATRIC INVENTORY QUESTIONNAIRE FOR THAI OLDER ADULTS WITH DEMENTIA
Authors: Wang Kaipeng , Hinton Ladson , Levkoff Sue , Sihapark Siranee , Chuengsatiansup Komatra , Chen Hongtu
Published: December 2022

Psychiatric and behavioral symptoms are highly prevalent among persons living with dementia. Clinical evaluation of those symptoms is critical for assessment of dementia progression and development of effective treatment. The Neuropsychiatric Inventory Questionnaire (NPI-Q) is a brief informant-based instrument to assess the severity of 12 types of neuropsychiatric symptoms among persons with dementia and associated caregiver distress. Although Thailand is experiencing a rapid increase in the prevalence with dementia, there is no validated instrument to assess neuropsychiatric symptoms in Thailand. This study aims to examine the psychometric properties of the NPI-Q instrument among older adults with dementia in Thailand. Data were collected from 353 participants aged 60 and over with probable dementia, at least one neuropsychiatric symptom, and an adult family caregiver willing to participate in the study. We examined the internal consistency, factorial validity, and criterion validity of the NPI-Q instrument. NPI-Q has acceptable internal consistency (Cronbach’s α=0.77). Principal component analysis yielded a five-factor solution, which accounted for 63% of the variance. The five factors included (1) agitation, anxiety, and irritability, (2) delusions, hallucinations, apathy, and disinhibition, (3) euphoria, motor disturbance, and night disturbance, (4) depression, and (5) abnormal appetite. We found that higher NPI-Q severity score was significantly associated with higher geriatric depression, associated caregiver distress, caregiver burden, and caregiver depression and lower quality of life among older adults and their caregivers, which confirmed the criterion validity of the instrument. Findings provide support for use of the NPI-Q among older adults with dementia in Thailand.
COMPLEXITY IN PSYCHOSOCIAL INTERVENTIONS: CASE STUDIES FROM A STROKE TRANSITIONS TRIAL
Authors: Chima Emmanuel , Woodward Amanda , Hughes Anne , Fritz Michele , Freddolino Paul , Swierenga Sarah , Coursaris Constantinos , Reeves Mathew
Published: December 2022

The Michigan Stroke Transitions Trial (MISTT) tested whether in-home social work case management (SWCM) or SWCM combined with access to a website providing stoke-related information improved outcomes relative to usual care for patients discharged home post-stroke and their caregivers. The aims of this secondary analysis are 1) to describe the actual support social work case managers (SWCM) provided to MISTT participants and 2) use select case studies to illustrate the relationship between SWCM and quantitative patient and caregiver outcomes. Data for the study were derived from SWCM case notes on 157 patients and their caregivers who received the MISTT intervention. Case notes were coded in two steps with a subset of cases coded by two researchers and reviewed for interrater reliability in each step. The first round of coding was guided by primary SWCM intervention goals. The second round of coding identified SWCM sub-themes within each primary goal. Key themes indicate SWCMs aided with understanding the post-hospitalization period, helped patients navigate a range of systems and services, identified needs and supported patient goals, provided psychosocial support, and centered support on stroke recovery and prevention. Case studies illustrate ways in which SWCM were key supports during the transition period, but that support does not cleanly align with quantitative findings from patient-reported outcomes. This study aligns with a growing body of work documenting the complexity of transitions of care and has implications for how we support patients and caregivers as they move from inpatient to outpatient care and measure outcomes.
STICK TO THE THEORY: FINDINGS FROM A COMPLEX CARE INTERVENTION FOLLOWING TRANSITION TO DIGITAL DELIVERY
Authors: Meyer Kylie , White Carole
Published: December 2022

Two thirds of family caregivers to persons living with dementia provide complex care tasks, including medical/nursing tasks, and nearly half worry about making a mistake. Learning Skills Together (LST) was designed to prepare caregivers to provide complex care through hands-on instruction (e.g., practice using a gait belt). Consistent with self-efficacy theory, the in-person intervention integrated behavioral modeling, strengths-based feedback, and knowledge-building. COVID-19 prompted a transition to digital delivery of LST over Zoom. Intervention content was modified to accommodate a digital approach while continuing to adhere to self-efficacy theory. Results from a pre- and post-test pilot study (N=35) indicate improvement in self-efficacy on (mean difference (MD)=1.0, SD= 1.6, p-value=0.004). Caregiver comments during qualitative interviews affirm intervention objectives were met. For example, caregivers described the importance of peer learning (modeling) during discussion. Results indicate that complex care intervention can be digitally delivered to family caregivers to improve self-efficacy surrounding complex care.
INCREASING DEMENTIA CARE MASTERY FOR RURAL CAREGIVERS: LESSONS FROM ADAPTING THE HARMONY @ HOME INTERVENTION
Authors: Gibson Allison , Henley Laura , Fairchild Vickie , Goss David , Baum Carolyn , Jicha Gregory , Rhodus Elizabeth
Published: December 2022

Providing care support to rural Alzheimer’s disease and related dementia (ADRD) caregivers has always been challenging, but particularly with the COVID-19 pandemic, new barriers have emerged for families in accessing care support. Delivered via telehealth, Harmony at HOME (H@H) provides dementia care mastery for caregivers of persons with ADRD in the skills of assessing and modifying the home environment to promote "person-environment fit," whereby increasing functional activity engagement and minimizing maladaptive behaviors. To enhance care supports specific to the needs of rural communities, this study reports the findings of two focus groups with rural caregivers who participated in the H@H intervention. Focus groups were aimed to identify the needs of caregivers in rural communities to guide adaptation approaches for future implementation of the H@H intervention in these underserved areas. Additional studies to assess real-world efficacy of the adaptations to H@H are needed as a next step toward implementing this intervention in clinical, home care settings.
NURSING HOME SOCIAL SERVICES DIRECTORS' ROLE AND RESPONSIBILITIES
Authors: Bern-Klug Mercedes , Galambos Colleen
Published: December 2022

While most of the nursing home literature focuses on residents and nurses, there is a growing literature on social services staff and family members of nursing home residents. Social services staff include social workers as well as non-social workers with responsibility for assessing and care planning for resident psychosocial issues, as well as a host of other responsibilities including working with families. This symposium presents findings from the National Nursing Home Social Services Directors Survey (NNHSSDS), a cross-sectional (2019) nationally representative study (n=924) that collected data on social services staff characteristics, departmental role responsibilities, and training needs. In this session three papers developed from these data are presented to document the extent to which social services staff are involved with family members, their interest in receiving training on how they can support other staff in understanding resident abuse and exploitation (at the hands of family, fellow residents, or staff), and neglect. As demanding as the social services role is, many holding the position of social services director report they are thriving (not just surviving) in the role. A final paper describes which variables help to distinguish those who report they are thriving versus those who do not. Implications to be discussed include what administrators could do to make the social services director’s job more attractive. The RRF Foundation for Aging provided data collection support for the NNHSSDS.
POSITIVE AFFECT IN DEMENTIA CARE DYADS
Authors: Monin Joan , Haase Claudia
Published: December 2022

Positive affect is important for physical health, well-being, and relationships. Yet, most studies of dementia care dyads have focused on negative outcomes, such as depression and caregiver burden. We present findings from studies that address this important research gap. The first two speakers present findings from actor partner interdependence models using secondary data from a randomized controlled trial of persons with early-stage dementia (PWD) and their spouses. Specifically, Dr. Monin will show that actor quality of life is significantly related to positive affect cross-sectionally, controlling for functional status of each partner and PWD behavioral symptoms. Ms. Piechota will present longitudinal findings demonstrating that when spouses were high in difficulty regulating emotions, the PWD’s positive affect decreased over three months, controlling for intervention arm and covariates. The second two speakers will present findings from two different studies of persons living with behavioral-variant frontotemporal dementia (bvFTD), Alzheimer’s disease (AD), and controls that engaged in laboratory conflict discussions. Dr. Brown will show that caregivers of individuals with bvFTD reported greater decreases in positive emotion across the discussion relative to caregivers of individuals with AD and language variants. She will also discuss how caregivers who reported greater decreases in positive emotion had higher levels of depressive symptoms, controlling for their partner’s diagnosis and level of cognitive impairment. Finally, Dr. Chen will provide evidence that bvFTD caregivers had lower emotional well-being according to the SF-36 than AD caregivers and controls, and this effect was fully mediated by bvFTD caregivers' lower positive emotional connections.
ASSOCIATIONS BETWEEN HEALTH AND POSITIVE AFFECT IN SPOUSAL DEMENTIA CARE DYADS
Authors: Monin Joan , Johnson Kalisha Bonds
Published: December 2022

Little is known about the conditions that foster greater positive affect in the daily lives of spousal dementia care dyads in the early stages of dementia. This study aimed to examine the extent to which multiple indicators of health, including activities of daily living needs, quality of life, and the person with dementia’s behavioral symptoms were associated with each partner’s positive affect in daily life. Using secondary baseline data from a randomized controlled trial testing a stress reduction intervention in 63 couples (N=126), we examined whether individuals’ multiple health indicators were associated with their own positive affect (actor effects) and their partner’s positive affect (partner effects). Actor partner interdependence model results showed that for both persons with dementia and spouses, actor quality of life was the greatest predictor of positive affect, controlling for all other actor and partner health indicators (β=.04, SE=.01, t(67.1)=3.36, p=.001).
RELIEF, REGRETS, AND REINVENTION: LIFE AFTER GRAY DIVORCE
Authors: Benson Jacquelyn , Olivia Landon , Donehower Allison , Sanner Caroline
Published: December 2022

“Gray divorce,” or divorce which occurs in later life, is rapidly becoming more common in the United States. The purpose of this grounded theory study was to examine the lived experience of getting divorced in mid to later life. Data address the following research questions: 1) What are the divorcees’ expectations for the process of divorce and post-divorce life? 2) How do life phase factors and family relationships shape the divorce experience? Participants included 41 heterosexual men and women who legally divorced at the age of 55 or older and between 1-7 years from the time of the interview. Participants divorced from first and higher order marital unions. They included self-identified initiators, non-initiators, and co-initiators of the divorce. Results suggest that gray divorce is a complex experience marked by shifting feelings of ambivalence and certainty that are influenced by such factors as health and social networks, especially family.
REIMAGINING ALZHEIMER’S RESEARCH: ON THE ROAD TO NEW DISCOVERIES
Authors: Andersen Stacy , Smith Lenora , Gibson Allison
Published: December 2022

Organized by the Alzheimer's disease and related dementias (ADRD) Interest Group, this symposium aims to highlight unique approaches to address 1) ADRD risk reductions through social and biological factors, and 2) quality of life of those with dementia. The first two presentations introduce remote communication technologies used for behavioral interventions, one for preventing social isolation and the resultant cognitive decline using video-chats by recruiting socially isolated older adults with mild cognitive impairment (MCI). The results of the recently completed randomized controlled trial provide evidence of a positive effect on cognition suggesting enhanced cognitive reserve. Another is for delivering a behavioral symptom intervention for community-dwelling persons with ADRD using telehealth. Researchers will highlight the feasibility, opportunities, and challenges of remote behavioral interventions. The third presentation focuses on micro-level communication between persons living with dementia and their family caregivers. By examining video-recorded home care observations, findings suggest caregiver education on positive interactions could facilitate more meaningful interaction with persons with ADRD. The fourth presentation explores pain among those with ADRD, a multifaceted phenomenon with health and functional consequences. Using the NHATS dataset, researchers show a continued need to detect and address pain in clinical settings particularly among persons with ADRD. The symposium concludes with a presentation using the CHARLS study to investigate correlations between inflammation or kidney-related metabolic biomarkers and cognition. Results provide longitudinal evidence of an association of kidney function and inflammation with cognitive test scores supporting the need to broaden dementia etiology research beyond the amyloid-cascade theory.
IMPLEMENTATION OF THE ELDER MISTREATMENT EMERGENCY DEPARTMENT TOOLKIT AT LYNDON B. JOHNSON HOSPITAL
Authors: Plummer Sherry , Burnett Jason , Froberg Ruthann , Campetti Randi , Dash Kim
Published: December 2022

Lyndon B. Johnson Hospital (LBJ) has the busiest Level III trauma and emergency department (ED) in Texas. Located in the busiest Houston zip code for Adult Protective Services reports, LBJ staff routinely assess older adults for mistreatment with no formal screening and response protocol. An ED-wide staff assessment revealed formal training needs for elder mistreatment (EM) detection, management, and reporting. Between October and December 2019, 55% of ED bedside nurses were trained along with 75% of charge nurses, and 12 clinical and nurse case managers, resulting in improved knowledge regarding EM screening and response best practices. In January 2021, LBJ staff implemented the Elder Mistreatment Screening and Response Tool (EM-SART). This resulted in 1,218 complete screens, 23 cases of suspected EM (2%), and 4 confirmed EM cases. Despite the pandemic and other challenges, LBJ staff demonstrated resilience and dedication, and reported EM training, screening, and response protocol efficacy.
IMPLEMENTATION OF THE ELDER MISTREATMENT EMERGENCY DEPARTMENT TOOLKIT AT HEYWOOD HOSPITAL
Authors: Papa Carol-Lynne , Campetti Randi , Froberg Ruthann , Haggerty Kristin Lees , Dash Kim
Published: December 2022

Beginning in 2016, Heywood Hospital, a 134-bed community hospital located in Central Massachusetts, partnered with the National Collaboratory to Address Elder Mistreatment to design and test a care model for identifying and responding to elder mistreatment (EM) in hospital emergency departments (ED). In February 2020, Heywood Hospital began implementing the care model known as the Elder Mistreatment Emergency Department (EMED) Toolkit as part of a five-site feasibility study. This presentation shares local results from the feasibility study and strategies for implementing the EMED Toolkit. 95% of Heywood staff participated in an online training program and, over 9 months, 4,588 (84%) of all older ED patients were screened for EM. Of these, 19 screened positive and 11 were reported to Adult Protective Services, a more than 7-fold (annualized) increase over the prior year. Most of the remaining positive cases were connected with community-based resources through Heywood’s Social Services Program.
EMERGENCY DEPARTMENT: ADULT PROTECTIVE SERVICES RELATIONSHIP IN RESPONSE TO ELDER MISTREATMENT
Authors: Sivers-Teixeira Theresa , Thayer Erin , Van Den Heever Carmen , Olsen Bonnie
Published: December 2022

Universal screening of older adults in emergency departments (ED) effectively improves identification of elder mistreatment (EM). To realize improved response, collaboration between ED providers and staff and local Adult Protective Services (APS) is essential. Qualitative data was derived from transcribed and coded key informant interviews with 10 APS workers and 5 ED clinical providers from 6 states. Results indicate each entity approaches EM from a different global perspective which informs key strategies to build effective response. ED providers focus on acute medical needs while APS focuses on long-term psychosocial needs. Assignment of specific individuals in both entities to be liaisons between ED and APS would support improved communication and collaboration. Education should focus on 1) capabilities and limitations in EM response and 2) clarity regarding bilateral sharing of information. Both entities report participation in multidisciplinary teams is valuable to foster collaboration on effective interventions in EM cases.
DEMENTIA-RELATED STIGMA IS ALIVE AND NOT WELL AMONG UNREGULATED HOME CARE WORKERS
Authors: Savundranayagam Marie , Basque Shalane , Gruneberg Audrey
Published: December 2022

Dementia-related stigma is pervasive despite the growing rates of dementia globally. The social cognitive model of stigma contends that stigma is created and maintained through negative stereotypes, prejudice, and discrimination towards people who belong to a group. Research on dementia-related stigma highlights the prevalence of stigmatizing views among formal care providers. However, little is known about how stigma is created and maintained by the ways in which frontline care providers talk about persons living with dementia. Accordingly, this study aimed to identify ways in which stigmatizing language is used by home care workers when describing routine care interactions with clients living with dementia. Semi-structured interviews were conducted with 30 unregulated home care workers, who shared their experiences caring for clients with dementia. We used conventional content analysis to identify themes related to dementia-related stereotypes, prejudice, and discrimination. Under stereotypes, persons with dementia were portrayed as objects, infants, not engaging, and cognitively and behaviorally unstable. Under prejudice, persons with dementia invoked pity, fear, disdain, and emotional fatigue. Under discrimination, participants shared experiences of excluding/ignoring, controlling, and using patronizing communication with persons living with dementia. Uncovering common examples of stigmatizing language offers opportunities to train home care workers to use person-centered communication. It is noteworthy that stigmatizing language emerged, when not asked about directly. Our findings underscore the persistence of dementia-related stigma and the need for training to eliminate stigma.
EVALUATION OF COGNITION IN PRIMARY CARE (CPC): A PILOT STUDY TO INCREASE EARLY DETECTION AND MANAGEMENT OF DEMENTIA
Authors: Fitzpatrick Annette , Gaster Barak , Raetz Jaqueline , Belza Basia , Suchsland Monica Zigman , Tracy Karen , Olivari Benjamin , McGuire Lisa
Published: December 2022

Despite evidence that early detection of mild cognitive impairment and dementia leads to improved patient care, these conditions remain under-diagnosed in primary care. To address this gap at University of Washington Medicine, we have developed and pilot-tested a program to increase cognitive evaluations and improve dementia care by primary care providers (PCPs). The Cognition in Primary Care (CPC) program was designed utilizing stakeholder-selected components of the GSA KAER (Kickstart-Assess-Evaluate and Refer) Model and Toolkit (2020 Edition), developed by the Gerontological Society of America (GSA). In this presentation we will describe evaluation of the CPC Program including (a) education training; (b) use of assessment tools integrated within the electronic health record (e.g. potentially harmful medications, depressive symptoms, alcohol use, sleep apnea, etc.); (c) practice recommendations such as dedicated evaluation appointments, diagnoses and referrals, and (d) PCP use of community resources for post-diagnosis support. A total of 66 PCPs participated in the series of 3 CME educational seminars. Over 93% of participants reported the content to be highly relevant and expected to incorporate it into their practice; commitments to use specific tools were made. Analysis is underway to determine impact of the program by comparing the above metrics before and after the training as well as between trained and untrained PCPs. Results from this evaluation will inform modifications to increase utilization of the CPC Model within UW Medicine, will be used to package the program to share with other primary care systems, and will guide future enhancements to the GSA KAER Toolkit.
DEMENTIA CARE THROUGHOUT THE TRAJECTORY AND ACROSS SETTINGS: RESULTS FROM THE DEVELOP AD RESEARCH STUDY
Authors: Hunt Lauren , Ornstein Katherine , Massimo Lauren
Published: December 2022

About 1 in 8 older adults in the United States has dementia, making it one of the biggest public health issues facing society today. The impact of dementia ranges across health and social systems, yet consideration of these contexts--which are of great relevance to patients and families--has been underexplored in prior research. In this symposium, we will present findings from the Deploying High-Value Longitudinal Population-Based data in Dementia Research (DEVELOP AD Research) study. This multicenter collaboration leverages existing population-based data sources to examine the health and social impacts of dementia throughout the trajectory of decline and across acute, long-term, and community-based settings. Session one will describe how acute care utilization increases in the years before the onset of incident dementia. Session two will examine the association between dementia and increased mortality risk after disruptive medical events, including hip fracture and pneumonia. Session three will report on the prevalence and patterns of medication overuse and misuse in community-dwelling people with dementia. Session 4 will estimate how many community-dwelling individuals, including those with dementia, could benefit from home-based medical care. Session 5 will focus on hospice use patterns and hospice care quality rating in people admitted to hospice for dementia versus other conditions. Together, these presentations provide a wide lens on the health and social experiences and needs of people with dementia at the national level, leading to a better understanding of how society can better address the challenges of caring for this growing population.
RURAL HOSPICE SOCIAL WORK: SUPPORTING PRACTITIONERS IN END-OF-LIFE WORK WITH LIMITED RESOURCES
Authors: Felderhoff Brandi , Alvarado Angela , Alvarez Valerie
Published: December 2022

Rural areas and the agencies, including hospice, that serve them face immense challenges in terms of accessibility, and service delivery. Small hospices face an enigmatic combination of higher operating costs and lower reimbursement payments, forcing higher caseloads on staff, and straining already limited available resources. Multiple cost benefit studies indicate that Medicare hospice reimbursement rules are well suited to the expense structure of large volume hospices, usually in urban, population dense areas; however, it is not clear that they apply as abundantly to smaller volume, rural hospices. This study sought to garner a deeper understanding of the roles and challenges required for rural hospice social work practice. Individual interviews with 9 rural hospice social workers across organizations in Texas and New Mexico were conducted. A maximum variation sampling technique was used to purposefully sample social workers from hospice agencies in areas deemed as rural by the Association of Rural Communities in Texas, with fewer than 200,000 occupants in their counties. Using emergent thematic analysis, key themes materialized including the challenge of dual relationships, required tasks beyond the scope of practice, issues of autonomy, and meeting them (patients/families) where they are at. Results demonstrate the complexities of rural hospice social work practice, the culture of rural communities, and the need for research into evidence-based intervention strategies specific to rural hospice social work, that will guide practitioners through navigating these challenging conditions.
GEROFIT TO HOME (GTH) AS A NEW MODEL OF CARE
Authors: Harris Rebekah , Morey Miriam , Ogawa Elisa , Wesley Alan , Bean Jonathan , Hall Katherine
Published: December 2022

Gerofit, a facility-based program transitioned to GTH, a completely virtual structured exercise program, at the onset of the pandemic and previously demonstrated that Veterans already engaged sustained performance with this transition (In-Person vs GTH, n=46; arm curls 19.7 vs 19.0 reps; 30-second chair stand 14.3 vs 15.9 reps). This study investigated whether gains in performance are achieved and sustained in Veterans who participated in GTH only, as it is unknown if virtual programs are as robust as facility-based programs. Measures of performance (3-month mean change, n=45, Arm Curls +3.4 reps; 30-second chair stand +1.5 reps) and self-reported function (SF-36 + 1.8 points) will be assessed from baseline to 3,6, and 12 months. Pooled results from 14 sites have been accumulated and change scores, age and gender-based percentile changes and clinically meaningful thresholds will be presented. This knowledge can have implications to support programs for older adults aging in place.
TYPOLOGIES OF CAREGIVING NETWORKS AND OLDER ADULTS' QUALITY OF LIFE
Authors: Hu Mengyao , Freedman Vicki , Patterson Sarah
Published: December 2022

This study identifies typologies of caregiving networks of older adults and their effects on older adults’ well-being and unmet needs in late life using the National Health and Aging Trends Study (NHATS). NHATS identifies the entire care network of older adults, cataloguing all activities each respondent assists with and the amount of time they spend helping, providing a unique opportunity to evaluate caregiving networks. Using network analysis and cluster analysis, we find that older adults have different types of caregiving networks including large and small networks with a primary caregiver and networks where caregivers share caregiving responsibilities more evenly. Size and structure of the networks are significantly associated with older adults’ well-being and unmet needs. These findings highlight the importance of considering the full care network in developing policies and programs to support family caregivers.