bluuebunny/crossref_metadata_2025 huggingface dataset:
FEASIBILITY AND ACCEPTABILITY OF IMPLEMENTING DEPRESCRIBING IN POST-ACUTE HOME HEALTH CARE
Authors: Wang Jinjiao , Shen Jenny , Yu Fang , Nathan Kobi , Conwell Yeates , Simmons Sandra , Mixon Amanda , Caprio Thomas
Published: January 2025

Polypharmacy is common in home health care (HHC), but no deprescribing intervention has been tested in HHC. In a prior study, we identified essential components of deprescribing by interviewing patients, primary, acute and post-acute care providers, pharmacists, and HHC nurses in 12 U.S. states. This study assessed the feasibility and acceptability of deprescribing in HHC through the collaboration of an HHC nurse and a pharmacist to conduct home medication review, deprescribing assessment, primary care provider discussion, patient education, deprescribing implementation, and safety monitoring. In 11 patients who received HHC following hospital discharge, we assessed feasibility and acceptability of deprescribing through surveys and qualitative interviews with patients, providers, and study interventionists. Patients received deprescribing components over 3-4 home visits. On average, the HHC nurse spent 1 hour/home visit/patient, the pharmacist spent 1 hour on deprescribing assessment/patient, and the provider spent 5 minutes / patient to review and implement deprescribing recommendations. Over 70% of deprescribing recommendations were accepted by providers, with 30% not accepted mostly due to patient preference. Providers found deprescribing “very feasible,” but noted barriers such as time constraints and patient preferences. The HHC nurse found deprescribing components “very feasible,” citing the multidisciplinary approach as a facilitator but noting communication challenges with providers. Providers and patients both generally reported that deprescribing components were helpful and led to patients feeling empowered. In conclusion, deprescribing components were feasible in HHC and highly acceptable to patients and providers. Effective communication between patients, HHC nurses, and providers is crucial for deprescribing in HHC.
INTEGRATING CERTIFIED NURSING ASSISTANTS INTO INTERDISCIPLINARY CARE TEAM AND RESIDENT CARE PLANNING
Authors: Raval Aasha , Ermolenko Mia , Jimenez Andreina , Balaji Anisha , Shenoy Shivani , Bergh Marissa , Travers Jasmine
Published: January 2025

Integrating certified nursing assistants (CNAs) into interdisciplinary care team (IDT) and resident care planning is essential for delivering person-centered care in nursing homes. In 2016, the Centers for Medicare and Medicaid Services mandated this integration, but the lack of clear guidelines made implementation challenging. As a result, a specific road map is needed for nursing homes to optimize how best to integrate CNAs into IDT and resident care planning. This qualitative study, guided by Donabedian’s Quality of Care Model, explored the barriers and facilitators in integrating CNAs into IDT and resident care planning. Seventeen participants including CNAs, directors of nursing, social workers, nursing home surveyors, ombudsmen, and physicians were recruited from across the United States using the State Survey Agency Directory, LinkedIn, and a referral program initiated by our research team. One-on-one, 30-minute virtual Zoom interviews were conducted between June-2022 and June-2023. Interview data were analyzed using directed content and thematic analyses. Five key themes emerged from the data and included: recognition of challenges for CNA Integration, nursing home leadership and structure, integration of CNAs, care coordination and communication, and care integrity. The findings led to the development of two INTEGRATE guides in August 2024: one for nursing home executive leadership which offers strategies for effectively integrating CNAs into IDT and resident care planning, and another for CNAs, which provides practical guidance on contributing to IDT meetings and care planning processes. The next steps of this work involve testing the efficacy and acceptability of the INTEGRATE guides in nursing homes.
MEALTIME EXPERIENCES DURING AML/MDS TREATMENT: LONGITUDINAL QUALITATIVE STUDY PRELIMINARY RESULTS
Authors: Crowder Victoria , Cho Youngmin , Teng Chiao-Hsin , Batchelor Melissa , Beeber Anna , Coombs Lorinda , Richardson Daniel , Bryant Ashley
Published: January 2025

Older adults (aged ≥60) with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) face varied experiences related to eating and mealtimes during treatment with hypomethylating agents and Venetoclax (HMA+VEN). Family/friend carepartners may provide extensive support to patients during this time and undergo challenges of their own. A gap exists in our understanding of eating and mealtime experiences over time, and how this affects quality of life (QOL); further information is crucial to guide patients, clinicians and carepartners in their management. We aimed to understand patient’s eating and mealtime experiences with AML/MDS and their carepartners during Cycles 1 and 2 of HMA+VEN treatment, the efforts made to address challenges, and the impacts on QOL. We conducted semi-structured interviews with 11 older adult patients and ten carepartners at Cycles 1 and 2 and conducted directed content analysis with the Adaptive Leadership Framework for Chronic Illness. We identified five preliminary categories: (1) adaptive challenges for patients in eating and mealtimes, (2) changes with eating and mealtimes over Cycles 1 and 2, (3) adaptive challenges for carepartners in care of patients, (4) how they collaboratively address challenges, and (5) the impact of experiences or changes in eating and mealtimes on QOL. Findings highlight and expand our knowledge of eating/mealtime experiences during chemotherapy for patients with AML/MDS and carepartners, including their experiences with appetite loss, adaptations of meals, and the extensive involvement of carepartners. These findings may guide future intervention development to support symptom management, enhance support and services, and maintain QOL.
UNDERSTANDING AND ADDRESSING COMMUNITY-BASED PALLIATIVE CARE REFUSALS: A MULTI-PERSPECTIVE STUDY
Authors: Sheldon Kira , Luth Elizabeth
Published: January 2025

More than half of older adults have multimorbid chronic conditions, resulting in disability, functional limitations, and reduced quality of life. Community-based palliative care, increasingly part of Medicare Advantage value-based care plans, supports seriously ill individuals and their caregivers to improve symptom management and satisfaction and reduce acute care use. Yet, many potentially eligible individuals decline free services when offered. To understand why eligible individuals refuse palliative care, we conducted semi-structured interviews and focus groups with 22 Medicare Advantage plan members and caregivers who refused palliative care and five palliative care team members at a non-profit healthcare agency. Transcripts were analyzed to identify reasons for refusal. We identified three overarching reasons plan members and caregivers declined palliative care: (mis)associating it with end of life, unclear benefit of palliative care, and not wanting to change current care. Palliative care team members confirmed these findings and contributed additional insights. Medicare Advantage plan members and families who refused palliative care represent a key resource for understanding how to better explain services and increase acceptance of palliative care. Palliative care team members’ perspectives provide insights from interactions with seriously ill individuals who may be disinclined or unable to engage in research. In clinical practice, clearly differentiating palliative care from hospice, providing an individualized explanation for how it will address an individual’s particular needs, and emphasizing integration of palliative care with existing care teams may improve engagement in palliative care among seriously ill older adults.
IN-HOME ASSISTIVE TECHNOLOGY PROTECTS DEMENTIA CAREGIVERS FROM WORSENING SLEEP EFFICIENCY
Authors: Scheffer Julian , Levan Darius , Wells Jenna , Gallagher-Thompson Dolores , Grimm Kevin , Chen Kuan-Hua , Wang Gene , Levenson Robert
Published: January 2025

Caregivers for people with dementia or mild cognitive impairment often report sleep problems due to heightened vigilance concerning worrisome behaviors (e.g., falls, wandering) by their care recipients (CRs). Interventions are needed to help alleviate these issues and the associated sleep troubles for caregivers. One promising approach is to utilize scalable and affordable in-home technologies that monitor CR behaviors round-the-clock and alert caregivers to potentially dangerous situations. We conducted two randomized controlled trials with independent samples to determine whether People Power Caregiver (PPCg), a newly developed in-home monitoring and alerting system, benefitted caregivers’ sleep over a six-month period. Combining the two studies, a total of 162 primary caregivers of the CRs were randomly assigned to either an active condition (PPCg system fully activated) or a control condition (Study 1: water leak detection only; Study 2: waitlist control procedure). Caregivers self-reported their sleep quality using the Pittsburgh Sleep Quality Index at baseline, three-months, and six-months. Using latent growth modeling, caregivers in the control conditions reported significantly worsening sleep efficiency compared to caregivers in the active condition (Active: B = -0.30, SE(B) = 0.14; Control: B = 0.74, SE(B) = 0.12; Condition Effect on Linear Slope: p =.038). We observed a similar pattern with PPCg benefitting caregivers’ sleep duration; however, this result was not statistically significant (Condition Effect on Linear Slope: p =.105). These results suggest that in-home technologies such as PPCg may offer an effective way to help caregivers achieve healthy sleep as they contend with the demands of caregiving.
DISPARITIES AMONG LONG-TERM AND SHORT-TERM USERS OF MEALS ON WHEELS SERVICES
Authors: Weaver France , Chubinski Jennifer , Walsh Sarah
Published: January 2025

Home-delivered meal programs for older adults, commonly known as Meals on Wheels (MOW) services, provide nutritional benefits and are valued by clients, but most studies capture use over a short period of time, typically a few months. This study is the first to focus on duration of use and identify disparities in the long-term and short-term MOW users. It uses 35,756 observations from the 2013-2022 National Health and Aging Trends Study (NHATS), an annual survey of Medicare enrollees aged 65+. A fixed effect multinomial logit model, with complex survey design, predicts the probabilities of being a short-term or long-term MOW user across lagged sociodemographic and health characteristics. Short-term users are defined as reporting MOW use once (12.4% of the sample) and the long-term users indicate use for 2+ years (8.6%). Persons who are Black are statistically more likely to be long-term MOW users (13.7%) than non-Black (8.0%), similarly for those on Medicaid (15.7%), having 2+ instrumental activity of daily living limitations (10.9%), and pre-frail (9.5%). In contrast, no racial or health differences are found for short-term MOW users, except for those on Medicaid (18.7%). These results identify the populations more likely to be long-term MOW users, but further research is needed to determine if prolonged MOW use is an indicator of sustained independence or a consequence of barriers to additional services. This study helps to better understand the role played by MOW and the federal Older Americans Act Nutrition Program, which funds those services, at serving diverse populations.
REVIEWING DATA DISAGGREGATION IN AGING HEALTH RESEARCH: NIA GRANTS AND RECOMMENDATIONS FOR EQUITY
Authors: Cajavilca Moroni Fernandez , Lee Matthew , Doan Lan
Published: January 2025

Current federal minimum standards for collecting and reporting race and ethnicity data often group diverse individuals into broad, monolithic categories. Despite advances in policy and practice and calls for inclusive research, data equity remains a significant issue in aging-related health research. Racially and ethnically diverse older adults are underrepresented in health research and rarely disaggregated by ethnicity in data collection, analysis, and reporting of aging-related health outcomes. Data disaggregation offers a promising approach to advancing data equity in aging research. We reviewed the National Institutes of Health Research Portfolio Online Reporting Tools Expenditures and Results (NIH RePORTER) database to identify extramural National Institute on Aging (NIA) grants from 1985 to 2024 that proposed disaggregating race and ethnicity data for aging research. We found only 12 NIH-funded awards, demonstrating the limited focus on this issue. Most grants that explicitly mentioned data disaggregation were awarded from 2015 onwards (n=11, 92%). Proposed data disaggregation by ethnicity in NIA-funded grants included Latino and Hispanic, Asian, Pacific Islander, and Arab ethnic groups. Grant funding mechanisms included investigator-initiated grants such as R01 grants (n=5, 42%) and predoctoral training grants/awards such as the F31 and R36 (n=3, 25%). Enhancing cultural congruence and methodological rigor in data collection and reporting that is reflective of the diversifying aging population is crucial for meaningfully addressing health equity. We provide recommendations to advance aging-related health research and highlight data disaggregation considerations for racially and ethnically minoritized communities that are historically under-engaged and underrepresented in aging health research.
THE RELATIONSHIP BETWEEN RETIREMENT AND CARDIOVASCULAR DISEASE: A MEDIATION ANALYSIS IN THE U.S. AND SOUTH KOREA
Authors: Choi Gayoung , Chen Ruijia , Park Hee Man , Lee Harold
Published: January 2025

Retirement has been linked to increased risk for cardiovascular disease (CVD), but little is known about the pathways underlying the association. Moreover, most studies have been conducted in Western countries, and their findings might be less generalizable to Eastern countries due to different social contexts and labor and employment environment. We examined 1) whether retirement status is associated with a higher risk of CVD in South Korea and the U.S., and 2) whether health (e.g., hypertension, diabetes, and obesity), behavioral (e.g., physical activity, alcohol consumption, and smoking), and psychological factors (e.g., loneliness, depressive symptoms, and quality of life) mediate these associations. Data were drawn from the Health and Retirement Study (HRS, 2002–2014; n=11,855) and the Korean Longitudinal Study of Aging (KLoSA, 2006–2018; n=4,908). We analyzed the data using cox proportional hazard model, controlling for socio-demographic factors, health conditions, health behavior, and social isolation. We also performed causal mediation analyses based on counterfactual framework. After adjusting for all covariates, retirement (vs. employment) was associated with an increased likelihood of developing CVD (Hazard Ratio (HR): 1.22, 95% CI: 1.00-1.49) in Korea but not in the U.S. Regarding potential mediators, several physical health factors accounted for a proportion of the association in KLoSA: hypertension (17.7%, p< 0.01), diabetes (12.1%, p< 0.05), and obesity (3.7%, p=0.01). The psychological pathway, specifically quality of life, also mediated the association (4.8%, p< 0.05). Our findings highlight that public health interventions targeting physical and mental health could be an important strategy for preventing CVD among retirees, especially in Korea.
IGESS: A CO-CREATIVE INTERGENERATIONAL STRATEGY FOR ENHANCING POSITIVE INTERGENERATIONAL OUTCOMES
Authors: Wong Alice C , Lai Daniel W L , Ou Alison Y T , Bai Xue
Published: January 2025

Intergenerational interaction is crucial for promoting social cohesion and mutual understanding. The Inter-Generational Engagement in Secondary Schools (i-GESS) program was created to engage older adults and university students in co-creating learning activities for students in secondary schools to enhance positive intergenerational interactions, attitude, knowledge, and skills. This study examined the changes using a quasi-experimental pre-post survey design in 129 older adults (age 60+), 110 university students (age 18 to 22), and 470 secondary school students (age 13 - 16). The results demonstrated substantial improvements in attitudes towards different age groups, as measured by the 34-item Kogan’s scale. Secondary school students showed a significant 13.7% improvement in attitudes towards older adults, while university students and older adults noted increases of 4.2% and 5%, respectively, in their views towards youth. Additionally, self-rated communication skills saw notable gains, with secondary school students and university students recording increases of 7.9% and 9.5%, respectively. Trust in communication also increased substantially, evidenced by a 12.1% rise among secondary school students and a 5% improvement among older adults. The most pronounced enhancements were in the attitudes of secondary school students towards older adults and the communication skills of university students, indicating major impacts in these areas. The i-GESS initiative successfully bridged generational divides, fostering meaningful relationships across age groups via the application of the co-creation strategy. The positive outcomes further reinforce the benefits of this intergenerational approach for enhancing mutual cooperation and respect.
INTERGENERATIONAL SOLIDARITY AND MENTAL HEALTH IN CHINESE AMERICAN FAMILIES: A DYADIC APPROACH
Authors: Li Mengting , Le Qun , Guo Man , Peng Changmin , Tang Fengyan , Da Wendi , Jiang Yanping
Published: January 2025

Existing family and caregiving studies have focused on mental health of either older adults or adult children, while less is known about the effect of intergenerational relations on mental outcomes for both generations using a dyadic approach. This study examined the association between intergenerational solidarity and mental health among older Chinese Americans and their middle-aged adult children with dyadic analysis, while considering the gendered nature of these relationships. This study included 216 father-child and 337 mother-child dyads. Three indicators of intergenerational solidarity (emotional closeness, contact frequency, and upward support) were assessed by both parents and children. Mental health of both generations was assessed with anxiety, depression, and loneliness. Actor–Partner Interdependence Models were used for dyadic analysis. In father-child dyads, lower contact frequency perceived by children and greater upward support perceived by older fathers were associated with older fathers’ lower levels of anxiety and loneliness; and higher emotional closeness perceived by adult children was associated with adult children’s lower levels of anxiety. In mother-child dyads, higher emotional closeness and upward support perceived by older mothers were associated with older mothers’ lower levels of anxiety, depression, and loneliness, while higher emotional closeness and upward support perceived by adult children were associated with adult children’s lower levels of loneliness. The findings suggest that dyadic intervention promoting emotional closeness and upward support may benefit mental health for both generations and achieve optimal caregiving outcomes. The gendered pattern in intergenerational relations should also be considered in dyadic interventions.
SOCIAL NETWORK TYPES TRANSITIONS, HEALTH AND WELL-BEING-A PERSON-CENTERED APPROACH AMONG CHINESE OLDER ADULTS
Authors: Dai Shuting
Published: January 2025

The social networks of older individuals reﬂect personal life history and cultural factors. However, little is known about stability and change in social network types over time in China. The purposes of this study were to (1) investigate transitions in social network types of Chinese older adults; and (2) examine the transitions of the relationship of the social network types to the measures of health and well-being. Data were drawn from ﬁve waves of the China Health and Retirement Longitudinal Study to examine the changes in social network heterogeneity in old Chinese cohort. Data from 19395 observations of 7321 older adults (65 years and older) were considered. Latent transition analysis (LTA) was conducted using seven social network-related variables. The identified typologies were then regressed on the indicators of health and well-being. We found 5 social network types at both waves, representing the most to the least diverse types–diverse, unmarried and diverse, extended family, immediate family, and restricted. About 68% of respondents between waves retained their social network type, whereas 19% transitioned into more diverse types and 13% into less diverse types. Compared with the restricted network, older adults in all other networks were more likely to report higher self-rated health, higher life satisfaction, and lower depressive symptoms at both waves. The findings capture the dynamics in social network composition among older adults in China. A person-centered approach is recommended for policymakers to understand social network transitions, and promoting social network diversity in later life may contribute to healthy aging.
A NOVEL DNA METHYLATION-BASED SURROGATE BIOMARKER FOR LATENT SYSTEMIC INFLAMMATION
Authors: Meier Helen , Klopack Eric , Farina Mateo , Hernández Belinda , Mitchell Colter , Faul Jessica , McCrory Cathal , Crimmins Eileen
Published: January 2025

Chronic low-grade systemic inflammation is a risk factor for chronic diseases and mortality and is an important biomarker in health research. DNA methylation (DNAm) surrogate biomarkers are valuable exposure, risk factor and health outcome predictors in population studies. We generated a DNAm surrogate biomarker for chronic, systemic inflammation from a previously identified systemic inflammation latent variable derived from seven inflammatory markers and evaluated its performance relative to measured inflammatory biomarkers in predicting several age-associated outcomes of interest, including mortality, activities of daily living and multimorbidity in the Health and Retirement Study. The DNAm surrogate, Inflammation Latent Variable Methylation Surrogate (InfLaMeS), strongly correlated with individual inflammation markers and performed similarly to the latent systemic inflammation when predicting multimorbidity, disability, and 4-year mortality. These results suggest that InfLaMeS provides a robust alternative to blood-chemistry measures of inflammation that can be used for further scientific insight into understanding the role of inflammation in aging and health.
THE IMPACT OF HIIT ON MUSCULAR, ENDURANCE, AND QUALITY OF LIFE METRICS IN OLDER ADULTS
Authors: Hoffman Rashelle , Murphy Blake , Krywe April , Stoffel Devon , Magrini Mitchel
Published: January 2025

High-intensity interval training (HIIT) can mitigate age-related declines in muscle mass and strength that lead to decreased functional ability and loss of independence. However, previous HIIT protocols are often treadmill or recumbent bike-based with limited whole-body functional exercises and often do not include older adults (OA) beyond 70 years of age. The aim of this study was to examine the effects of a 12-week, Total Body HIIT (TB-HIIT) protocol on muscle size (cross-sectional area [CSA] of the rectus femoris [RF], vastus lateralis [VL], and vastus medialis [VM]), muscle strength (peak toque [pT] and rate of torque development [pRTD]), muscle activation (peak electromyography [pEMG] and rate of EMG rise [pRER]), cardiovascular endurance (6-minute walk test [6MWT]), and quality of life (QOL, 36-Item Short Form [SF-36]) in OA. Older adults, 65-95 years of age, were recruited and completed all outcomes at baseline and following the 12-weeks of TB-HIIT. The TB-HIIT protocol progressively increased the exercise-to-rest ratio every four weeks (20sec:40sec, 30sec:30sec, 40sec:20sec) with target intensity being 85-95% of participants’ heart rate max. Twenty-four OA (74.8□6.37 years, range=65-89) completed this study. Results showed significant increases in VL-CSA (p=0.02, g=-0.77), VM-CSA (p< 0.001, g=-1.03), cardiovascular endurance (p< 0.001, g=-0.95), and health-related QOL (p=0.012, g=-0.47). No significance was revealed in RF-CSA (p=0.068, g=-0.4), pT (p=0.78, g=-0.17), pRTD: p=0.91, g=-0.07), pEMG (p=0.77, g=-0.17) or pRER (p=0.51, g=-0.39). Future research should continue to explore the benefits of TB-HIIT with consideration towards OA subpopulations with comorbidities and greater physical impairment to advance exercise prescription and function for this population.
COMPARISON OF MULTIDIMENSIONAL AGING TRAJECTORIES BETWEEN PEOPLE AGING WITH AND WITHOUT DISABILITIES
Authors: Park Seeun , Bratzke Lisa
Published: January 2025

Background

The aging trajectories of people aging with disabilities (PAwD) may involve distinct life experiences compared to those of people without disabilities (PWoD). However, the extent to which aging trajectories vary between the two groups remains unclear. This study investigates these differences, analyzing the impact of long-term disability at phenotypic and functional levels, and examining social disparities across various demographic factors using data from the 2006-2020 waves of the Health and Retirement Study.

Methods

Phenotypic aging was measured by the metabolic dysfunction risk score (MDRS), and functional aging was assessed through limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Growth-curve modeling was used.

Results

A total of 7,234 participants were included. PAwD exhibited significantly higher baseline MDRS and ADLs/IADLs scores, with more rapid escalation over time, indicating premature and accelerated aging. Significant social disparities in aging were observed across cohort, gender, race/ethnicity, and educational attainment. Recent cohorts of PAwD showed more rapid increases in MDRS. Women and racial minorities, especially non-Hispanic Blacks and Hispanics, had higher MDRS. Across all race/ethnicity groups, PAwD exhibited higher MDRS and functional limitations. Lower educational attainment was associated with both higher MDRS and ADLs/IADLs.

Conclusion

PAwD experience an accelerated and unequal aging process compared to PWoD, with significant social disparities. These findings suggest the need for tailored health interventions and policies that address the distinct aging trajectories and vulnerabilities of PAwD, emphasizing early detection and targeted support to mitigate the compounded effects of disability and sociodemographic factors.
COGNITIVE DECLINE AMONG OLDER ADULTS FOLLOWING TRAUMATIC BRAIN INJURY
Authors: Albrecht Jennifer
Published: January 2025

Traumatic brain injury (TBI) is a risk factor for Alzheimer’s disease and related dementias. However, evidence for this association among older adults is less robust, and further studies are needed to better understand cognitive recovery following TBI in this population. Retro-TBI is an ongoing prospective cohort study of adults aged 65+ diagnosed with TBI at a Level 1 trauma center. In the current study, we assessed four cognitive domains (memory, language, attention, and visuospatial/constructional) at 2 weeks, 3 and 6 months post-TBI using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). We calculated the slope of the RBANS total age-adjusted scaled scores for each participant with ≥2 assessments (n=42) over days since TBI. Participants with a negative slope were considered to have cognitive decline. We compared participant characteristics between those with and without cognitive decline using Student’s t-test or Fisher’s exact test. Average age was 73.9 (standard deviation 7.8) years and 47.6% were female. Findings indicated that 31.0% (13/42) of participants had cognitive decline and were more likely to report a history of depression (61.5% vs. 13.8%, p=.003) and live alone (76.9% vs 34.5%, p=.02) than those without cognitive decline. The cognitive decline group was also more likely to experience decline in visuospatial/constructional (61.5% vs. 24.1%, p=.04) and immediate memory skills (61.5% vs. 27.6%, p=.047) compared to those without cognitive decline. Preliminary findings from this ongoing study suggest that one-third of older adults experience cognitive decline over 6 months post-TBI, with immediate memory and visuospatial skills particularly impacted.
SELF-FUNDED PERSONAL CARE IS COMMON AND COSTLY FOR PEOPLE WITH DEMENTIA ACROSS THE INCOME SPECTRUM
Authors: Reckrey Jennifer , Shen Karen , Yang Yang
Published: January 2025

remain in the community; those without Medicaid coverage or long-term care insurance must self-fund this care (i.e., pay for privately or out-of-pocket). Using data from the Health and Retirement Study (2002-2018), we identified the prevalence and financial burden of self-funded paid care among community-dwelling people ≥65 who received help with ≥1 activity of daily living (n=4666). Dementia status, receipt of paid care, and financial information (income, cost of self-funded paid care) were determined by survey responses. One-quarter of PLWD (versus 14% without dementia) used self-funded care. Among PLWD, the probability of self-funding care increased with income, but was significant for all income groups: 15%, 23%, 32%, and 48% of those with incomes 100%, 100-200%, 200-400%, and ≥400 of the federal poverty level respectively self-funded paid care. The amount and cost of this self-funded care was high, particularly for PLWD: 45% of PLWD (versus 22% without dementia) received ≥40 hours/week of self-funded care and nearly half spent ≥$1000/month self-funding paid care. The median PLWD that self-funded care spent 45% of their monthly income on self-funded care; in the lowest-income group, the median PLWD spent nearly 75% of their monthly income on self-funded paid care. Given self-funded paid care is common and costly throughout the income spectrum, programs and policies aimed at easing the financial burden of self-funded paid care (e.g., expanded access to Medicaid home and community-based services) are essential, particularly for low-income individuals and families.
UNMET NEEDS & AVOIDABLE NURSING HOME PLACEMENTS AMONG BLACK, LATINO, AND WHITE PEOPLE LIVING WITH DEMENTIA
Authors: Travers Jasmine , Shenoy Shivani , Bergh Marissa , Raval Aasha , Jimenez Andreina
Published: January 2025

Many nursing home (NH) placements are avoidable considering equivalent care can be provided in the community setting. Preventing avoidable NH placements and enabling aging in the home and community has been prioritized by federal, state, and local entities. Guided by Diwan and Moriarty’s conceptual frame for Identifying Unmet Healthcare Needs of Community Dwelling Older Adults, this qualitative descriptive study explored the unmet needs and related barriers that drive avoidable NH placements among Black, Hispanic/Latino, and White people living with dementia (PLWD). One-on-one semi-structured interviews were conducted March-November 2022. Participants including PLWD, family care partners (FCP), and NH staff, were recruited from two New York NHs. Policy experts were recruited from aging organizations across the country. Data were analyzed using a directed content and thematic analysis approach. Sixty-one individuals were interviewed, 19 PLWD, 17 FCP, 15 NH staff, and 10 aging policy experts. Seven distinct themes specific to unmet needs emerged from the data and included 1) support with activities of daily living and basic home maintenance; 2) resources and services; 3) treatment; 4) socialization; 5) individual preferences; 6) function of the home; and 7) equipped, available, and supported family. Related barriers that contribute to unmet needs defined within our guiding framework included awareness, knowledge, availability, affordability, and acceptability of resources and services. Participants described multifaceted factors that contribute to the unmet needs driving avoidable NH placements. Strategies to address these unmet needs and improve the understanding of the complex home and community-based services landscape may help reduce these placements.
WHAT FAMILY CAREGIVERS FEEL UNPREPARED FOR: DIFFERENCES BETWEEN DEMENTIA AND NON-DEMENTIA CAREGIVERS
Authors: Singh Roshni , Munoz Richard , Garcia-Davis Sandra , Lamba Saanvi , Dang Stuti , Ruiz Diana , Leykum Luci , Desir Marianne
Published: January 2025

This study identified tasks for which informal caregivers feel insufficiently prepared, stratified by Veterans’ dementia status. Using the Veterans Affairs’ HERO CARE Survey data, we analyzed caregivers’ responses to one open-ended question: “Out of all the tasks that you help the Veteran with, is there anything specific you would like to be better prepared for?” Responses were coded thematically into ten domains and differences in reported domains between caregivers of Veterans with and without dementia were compared. 296 dementia and 426 non-dementia caregivers were included. On average, caregivers were female (87.3%), non-Hispanic white (71.4%), primary caregivers (85.9%), and had provided over five years of care (54.2%). Dementia and non-dementia caregivers were demographically similar except in age (70.9 vs 65.9 years, p< 0.001); spouses (69.1% vs 58.2%, p=0.004); working at-least part-time (18.3% vs 25.9%, p=0.003), and hours of care-provision per week (94.7 vs 74.5, p< 0.001). Preparedness concerns for both dementia and non-dementia caregivers respectively included care-coordination (24.3% vs 25.1%, p=0.81), nursing/medical tasks (19.3% vs 21.6%, p=0.44), advance planning (16.6% vs 15.7%, p=0.77), and assistance with Instrumental Activities of Daily Living (IADLs) (11.5% vs 9.4%, p=0.36) and ADLs (11.5% vs 7.3%, p=0.05). Dementia caregivers expressed significantly more concerns about caregiver self-care (7.4% vs 3.1%, p=0.007), and less about handling emergencies (1.7% vs 4.7%, p=0.03) than non-dementia caregivers. Informal caregivers may need additional training in several domains of care tasks ranging from direct care to service coordination to improve caregiving competency. Dementia caregivers may particularly benefit from learning self-care strategies.
CONTENT ANALYSIS - NURSING HOME (NH) STATEMENTS OF DEFICIENCIES (SODS) AS QUALITY IMPROVEMENT INNOVATION
Authors: Dellefield Mary , Madrigal Caroline
Published: January 2025

The Centers for Medicare and Medicaid (CMS) issue Statements of Deficiency (SODs) collected by trained observers detailing practices that pose harm or ‘immediate jeopardy’ to nursing home residents. SODs document nursing home compliance failures, such as F-tag 0678, which addresses non-compliance with federal cardiopulmonary resuscitation (CPR) requirements, a critical indicator of resident autonomy and self-determination. This study aimed to describe practice patterns and organizational characteristics linked to F-tag 0678 immediate jeopardy citations in 80 nursing homes across CMS Region 5 (Michigan [17], Minnesota [30], Ohio [22], Wisconsin [11]} from 2019-2022. An a-priori code book was developed, based on previous SOD research and American Heart Association guidelines. Content analysis was applied to SODs to identify practice patterns and organizational characteristics. Sampled nursing homes were for-profit (69%), with a mean bed size of 93 (range= 26-212) and an average star rating of 2.4 (range=1-5). Major practice pattern failures included: early detection (identifying code status/initiating CPR); logistics (communication failures; failures to follow policy/procedures); documentation (lack of clarify about code status/inaccurate documentation of CPR event); staff performance (lack of familiarity with nursing home operations); and delay in initiating CPR (13 minutes to 4 hours). Structured analysis of SODs offers a novel, efficient approach to leverage existing CMS data to drive quality improvement efforts and inform policy decisions. This research has the potential to inform the development of evidence-based interventions, enhance regulatory oversight, improve the quality of care, and protect the rights of vulnerable nursing home residents.
EXAMINING THE COMPLETENESS OF MEDICARE ADVANTAGE ENCOUNTER DATA FOR MEASURING POST-ACUTE CARE UTILIZATION
Authors: Yun Hyunkyung , Kosar Cyrus
Published: January 2025

Given the rapid growth of Medicare Advantage (MA) program, the degree to which the newly-released MA encounter data reliably capture care utilization has serious implications for the ability to evaluate MA-related policies accurately and conduct rigorous academic research. However, little is known about the quality of MA encounter data outside of the acute care setting. We assessed how well the encounter data captured post-acute skilled nursing facility (SNF) and home health (HH) utilization overall and across MA contracts. We identified 2016-2019 Minimum Data Set (MDS) and the Outcome and Assessment Information Set (OASIS) admission assessments preceded by inpatient claims and calculated the proportion of assessments matched to a SNF or HH encounter record within 7 days of the assessment’s admission date. In 2019, there were 871,101 MDS assessments and 812,002 OASIS assessments following an MA inpatient stay. About 82% of MDS assessments could be matched to a SNF encounter records (up from 75% in 2016) while 63% of OASIS assessments matched to a HH encounter record (52% in 2016). There was substantial contract-level variation in match rates and a lack of correlation across services. Only 21% of contracts that had high SNF encounter completeness (match rates of 90% and above) also had high HH completeness, and 68% of contracts with high HH completeness also had high SNF completeness. Efforts to improve the quality of MA encounter data are needed as CMS prioritizes this data as a source for program oversight and payment.
IMMERSIVE GREEN SPACE AND EMOTIONAL BENEFITS FOR OLDER PEOPLE LIVING IN RESIDENTIAL CARE HOMES FOR ELDERLY (RCHES)
Authors: Yung Hiu Kwan , Ogungbile Adedayo , Ohene Eric , Fan Yujun , Wang Siqiang , Yim Cynthia
Published: January 2025

In densely populated cities like Hong Kong where land is scare, elderly residents in care homes often do not have access to natural gardens. However, previous research has proofed that natural gardens are beneficial to people’s psychological and social well-being. To address this problem, our study explores the use of a portable Cave Automatic Virtual Environments (CAVE) to simulate therapeutic effects of physical gardens, with the aim of providing elderly residents of RCHEs with the healing elements of nature, and potentially reducing stress and enhance emotional health. 18 residents living in two RCHEs were recruited to participate in the virtual garden experiments bi-weekly over two months. Questionnaire surveys were conducted to elicit their evaluation and feelings on the different features of the virtual gardens. We collected respondents’ skin conductance levels by using the Shimmer wearable sensors to analyze changes in heart rates, stress levels and emotional states. The results show that the virtual garden is able to make older people feel more relax and recall the nostalgic feelings of the built environment. This study has won the award organized by the National Academy of Medicine of the United States which recognizes its contribution in catalyzing innovations to promote people’s lifelong physical, mental, and social health and well-being.
COUNTY JAIL AS A SITE OF CARE AND CONTROL FOR OLDER HOMELESS SEATTLELITES
Authors: Johnson Ian
Published: January 2025

An estimated 1.2% of people over age 50 living in community settings have been recently involved in the criminal-legal system. County jails detain people who have yet to face trial, have been sentenced to misdemeanors with short sentences, or who violated parole. Much of the attention to aging within the criminal-legal system has focused on long-term institutions such as prisons; this gap limits our understanding and ability to respond to the need of older adults in the homeless-jail cycle. Using electronic medical record data from a specialty street-based palliative care team and key informant interviews, this presentation will present preliminary findings from a reflexive thematic analysis. Findings include: (1) entangled health and behavioral health precedents for criminal-legal involvement; (2) jail healthcare designed for high acuity and low complexity; (3) discretionary and subjective compassion for aging issues; and (4) ageism’s role in driving institutionalization of older people experiencing homelessness. Implications include guiding future abolitionist research in gerontology, workforce preparation within homeless response systems and correctional programs, and interventions to reduce jail use by older people.
HEALTH EFFECTS OF EXTENDED WORKING LIFE AMONG OLDER ADULTS
Authors: Zhan Rongfang , Mpofu Elias
Published: January 2025

Objectives

To examine health benefits of working beyond the age of 66 in addition to the impact of socioeconomic status (SES) on potential health effects.

Methods

This longitudinal study utilized data from 4,492 respondents, aged 50 years and over, from 6 waves (2004 - 2014) of the Health and Retirement Study. Measures included physical activities of daily living, mental health and the prevalence of chronic diseases in older adults.

Results

Remaining in the workforce was associated with a reduced risk of mental illness. Socioeconomic disparities were apparent: extended working life had a beneficial effect on physical health and independence of older adults with lower SES and enhanced mental wellbeing of those with higher SES. No significant group differences in prevalence of chronic conditions was noted.

Discussion

The current findings provide support for public policies aimed at increasing retirement age and have implications for how best to protect older worker’s health. Keywords: Older workers, retirement, socioeconomic status, health.
SAFETY OF PUBLIC BUSES IN NATURALLY OCCURRING RETIREMENT COMMUNITIES
Authors: Chippendale Tracy , Sangrar Ruheena , Rotenberg Shlomit , Curl Angela , Suzuki Lisa
Published: January 2025

Community mobility is critical to support aging-in-place. For older adults living in low-and moderate-income urban communities, driving may not be an option due to costs associated with car ownership, impracticalities of cars in urban settings, or a lack of driving history. Some older adults must retire from driving due to changes in their functional status. Safe public transportation is therefore paramount to equity in community mobility. The purpose of this Ecological theory informed study was to explore supports and limitations regarding safe public bus use in naturally occurring retirement communities (NORC). A multiple qualitative case study design was used with purposive sampling of representative cases, including four bus routes in NORC neighborhoods, two in Toronto, Canada, and two in NYC. Field observations and in-depth semi-structed interviews were conducted. Inclusion criteria for participants were: 1) Age 60 and older 2) Resident of one of the four NORC neighborhoods 3) Ride the bus on average 2 or more times per month 4) Ambulatory with or without a walking aid (e.g. cane, rollator) and 5) English speaking. A descriptive, thematic approach was used for data coding and analyses, and data was organized according to the Framework Method. Approximately 45 hours of field observations were conducted, and N=17 NORC residents participated in interviews. Results revealed four major themes: Impact of other people’s behavior, Problematic passageways: obstructions, Personal impact on safety, and Space & time orientation. Several subthemes also emerged. Results suggest implications for policy and education to increase safety for older adult bus users.
“IT TAKES A SPECIAL PERSON”: EXPLORING NURSING STUDENTS’ END-OF-LIFE CARE EXPERIENCES AND ITS INFLUENCE ON EMOTIONS
Authors: Kowalchik Kalei
Published: January 2025

Navigating end-of-life care as a nursing student can results in intense emotions such as grief and despair and there is limited research on undergraduate nursing students’ thoughts and experiences on the need for emotional support resources when caring for patients and families at the end of life. To explore to explore and understand what end-of- life care experiences influence undergraduate nursing students’ emotions. A qualitative descriptive design study was used to interview third- and fourth-year nursing students. Purposive sampling techniques were used to recruit participants. Demographic data was collected via Qualtrics, and interviews were held via face-to-face (n=4) and Zoom (n=17). Data were transcribed verbatim, de-identified, and analyzed for themes. Results show that providing care to dying patients and their families is emotionally impactful to students and creates self-awareness about death and mortality. Students’ personal, educational, occupational, and clinical experiences caring for dying patients influences how they process and regulate their emotions when professionally caring for dying patients and their families. Additionally, these experiences are influential to how they interact with death and dying topics in their personal lives. Caring for dying patients and exposure to death as a nursing student is emotionally impactful to students as an emerging professional and as a person. Nurse educators should integrate supportive resources for students caring for dying patients to help develop students’ resilience, emotional intelligence, and self-awareness when providing EOL care.
MEDIA REPRESENTATION OF OLDER WOMEN DURING WAR CONFLICT: CASE OF UKRAINE AND ISRAEL
Authors: Shulyaev Ksenya , Band-Winterstein Tova
Published: January 2025

Media reportage of war conflicts tends to underrepresent women, especially older women, and distort their involvement in wars through narrow role characterizations. Women are often cast less as political actors and more as helpless victims. This backdrop sets the stage for our study, which examines the media portrayal of older women during wartime, focusing on conflicts in Ukraine and Israel. By content-analyzing news from Ukraine and Israel, we identify recurring themes and highlight the roles and experiences of older women as depicted in media from the onset of the full-scale war in Ukraine (February 2022) and the “Iron Swords” in Israel (October 2022). The findings revealed five key portrayals of older women (1) Older Women as Victims: symbolizing the enemy’s inhumanity and brutality (2) Older Women as Enablers of Family Continuity: guardians of family bonds with warriors, maintaining household rituals and caring for grandchildren amidst chaos (3) Older Women as Resilient Heroines: Symbols of Hope, Survival and Legacy. (4) Older Women as Bearers of Wisdom: transmitting wisdom and stability during times of conflict. (5) Older Women as Symbols of Patriotism: Volunteers, donators, symbolizing endurance and national pride. The media’s portrayal of older women during wartime underscores their multifaceted roles and the profound impact of conflict on their lives and conveys symbolic messages to society to serve broader societal and political purposes. This study aims to contribute to reframing aging representation in media by enhancing knowledge, improving ageistic attitudes toward older women, and supporting addressing aging issues during wartime.