bluuebunny/crossref_metadata_2025 huggingface dataset:
NO SILVER BULLET: ADDRESSING COGNITIVE HEALTH IN RACIALLY AND ETHNICALLY DIVERSE OLDER ADULTS
Authors: Muñoz Elizabeth
Published: December 2022

The growing racial and ethnic diversity of the older adult population, along with continued inequities in brain health outcomes highlight the need to examine risk-factors for reduced cognitive health in racial-ethnic minoritized adults. Stress is an important risk factor for reduced cognitive health, but the conditions under which stress operates among minoritized older adults is poorly understood. This presentation will discuss how studying sources of stress across multiple levels of analyses, including neighborhoods and interpersonal interactions, and the timing and duration of these experiences is needed. Further, addressing within group heterogeneity and shifting from between group comparison will enrich our understanding of risk-factors. Theoretical and empirical support for these propositions will be discussed, particularly as they relate to how neighborhood contexts and experiences with discrimination are associated with reduced cognitive health across multiple timescales.
REIMAGINING THE FUTURE OF ASSISTED LIVING TO PROMOTE QUALITY
Authors: Zimmerman Sheryl
Published: December 2022

Assisted living (AL) has existed in the U.S. for decades, evolving in response to older adults’ need for supportive care and distaste for nursing homes and older models of congregate care. Today, AL is the largest provider of residential long-term care in the country, with more than 996,000 AL beds in almost 29,000 AL communities. Unfortunately, that growth has spawned notable concern, with a recent report concluding that the initial key constructs of AL have become mired under key tensions such that “the current model of AL has been taken as far as it can go.” This symposium includes five presentations that respond to some of those tensions. The first two presentations respond to the increased acuity of AL residents: one addresses challenges and recommendations for residents’ palliative care needs based on numerous studies, and the other provides expert consensus panel recommendations for pragmatic medical and mental health care provision in AL. The next two presentations respond to concerns related to quality in AL, one focusing on frameworks, measures, and implementation of quality metrics, the other envisioning use of administrative data to study and promote quality. The final presentation speaks to the complexity of regulation, and how related research can be improved to better examine consequential differences between models of AL care. The discussant, a nationally recognized and highly regarded leader from the American Health Care Association/National Center for AL, will discuss how the presentations can be used to reimagine the future of AL to promote quality.
QUALITY METRICS IN ALFS: FRAMEWORK, MEASURES, AND IMPLEMENTATION
Authors: Shippee Tetyana , Bucy Taylor , Akosionu Odichinma , Skarphol Tricia
Published: December 2022

Concerns have surfaced regarding the quality of assisted living (AL) with calls for quality metrics reporting as essential for consumer choice and organizational accountability. This study presents a framework for quality metrics in ALs using a) results from literature review and environmental scan of existing domains and indicators used to assess quality in AL and 2) a survey of results from MN stakeholders (n=822) on their priorities regarding these quality measures. Our findings showed that consumer-reported measures (resident quality of life and family satisfaction) were rated as top priority, followed by staff-based measures (e.g., job satisfaction, turnover). Other domains included residents’ safety, resident health outcomes, care services and integration, and the environment of the ALs. These results have implications for states looking to develop and implement quality measures in ALs, especially in the context of rising AL resident acuity and the continued trend away from institutional models of long-term care.
THE FACES OF ELDER ABUSE: A CROSS-CULTURAL PERSPECTIVE
Authors: Teaster Pamela B Teaster , Anetzberger Georgia
Published: December 2022

This presentation gives a real world and compelling picture of the abuse of older adults, with authors representing three different World Health Regions (i.e., Regional Office for Africa, Regional Office for Southeast Asia, and the Regional Office for the Western Pacific) each locating the problem within an area’s historic and present societal treatment of older persons. An actual and emblematic case study of the abuse of an older adult will frame each presentation. Presenters will synthesize empirical data and research on the problem, explaining its usefulness and limitations as well as guiding frameworks utilized to address the problem, highlighting efforts of leading figures in each area or region who are addressing the problem and explaining existing policies and future initiatives to address the abuse of older adults. Dr. Eniola Cadmus will present perspectives on elder abuse in Nigeria. Drs. Noriko Tskudada and Asako Katsumata and will present perspectives from Japan. Drs. Farida Ejaz and Mala Shankardass will present perspectives from India. Dr. Georgia Anezberger will tie together the differences and commonalities within each region drawing upon a holistic and person-centered picture of the issue and problem of elder abuse.
MULTIMORBIDITY IN LATE LIFE: APPRAISAL, COPING, AND ANTICIPATING CARE NEEDS
Authors: Latimer Abigail , Wu Jia-Rong , McGuire Patricia
Published: December 2022

Older adults diagnosed with multiple chronic and serious illnesses are confronted with complex, at times unpredictable, and burdensome medical realities. We present a case study of a 76-year-old woman with heart failure, kidney disease, and arthritis early in her illness course. We use the Theory of Stress and Coping to guide our discussion of her coping appraisals and strategies that promote her psychological and emotional well-being. Although she dismissed her heart failure symptoms as “old age,” she identified pain and disability associated with her arthritis as more of an immediate and serious threat to her autonomy, control, and personal goals. As she is functioning independently and still working, we share her perspective on anticipated caregiving needs and expectations for the last decades of her life. Insights from this case study can inform future research directions and have implications for education and practice.
CROSSTALK BETWEEN UBIQUITINATION AND ADP-RIBOSYLATION IN THE MAINTENANCE OF MITOCHONDRIAL HOMEOSTASIS
Authors: Perissi Valentina
Published: December 2022

Oxidative stress and increased ROS production, as observed in aging and obesity, commonly lead to the accumulation of mitochondrial dysfunctions. This is met by the activation of a robust mitochondria-to-nucleus stress response promoting the rewiring of nuclear gene expression to limit cellular and tissue damage and promote organelle adaptation. Here we will review previous work uncovering the transcriptional cofactor G-Protein Pathway Suppressor 2 (GPS2) as a mediator of mitochondria retrograde signaling and a key nuclear regulator of nuclear-encoded mitochondrial genes, including mitochondrial chaperones/proteases, mitokines, and other protective enzymes such as the ADP-ribosyltransferase NEURL4. We will also discuss unpublished work showing that shuttling of GPS2 between organelles plays a role in coordinating the transcriptional and translational regulation of antioxidant factors and pro-apoptotic genes by promoting the ubiquitination of mitochondria-associated translation factors.
CHALLENGES AND SUPPORTS FOR VETERAN CAREGIVERS DURING THE COVID-19 PANDEMIC: A MIXED-METHODS STUDY
Authors: Penney Lauren , Noel Polly , Hernandez-Swift Karla , Leykum Luci , Trivedi Ranak , Dang Stuti , Kalvesmaki Andrea , Butler Jorie
Published: December 2022

Informal caregivers face challenges in supporting older or medically-complex Veterans, which could be exacerbated by the COVID-19 pandemic. Our mixed methods observational study explored Veteran caregivers’ supports, challenges, and self-identified impacts during the pandemic. Caregivers whose veterans needed help with at least one activity of daily living for the last year and received care at one of five Veterans Health Administration (VA) study sites were eligible. Survey participants (n=46) were 96% female, 32-83 years old (median 59); most (83%) cared for a spouse. A majority (67%, n=31) reported increased stress since the start of the pandemic. Top sources of increased stress included worry about COVID-19 infection, increased caregiving responsibility, delayed access to care, concerns about vaccine safety, and employment or financial concerns. Caregiver interviews (n=26) qualitatively analyzed using a rapid, templated approach identified the following themes: (1) the benefits and challenges of VA COVID precautions to Veteran care access (e.g. telehealth, getting care for new problems), (2) supports afforded by and limits of the expansion of the VA Caregiver Support Program, (3) declines in Veteran physical and cognitive functioning, (4) increased caregiver role in Veterans’ support and care, (5) changes in work and living situations to address increased caregiving needs and/or reduce risk of exposure, and (6) loss of and then return to more usual routines and social outlets amid ongoing COVID-related uncertainties. Recommendations include targeted, personalized outreach to engage caregivers in existing supports, removing barriers and streamlining processes for obtaining services, and creating durable caregiver-to-caregiver, peer support opportunities.
EMPLOYING DESIGN THINKING METHODS TO CREATE BEHAVIORAL INTERVENTIONS THAT SUPPORT AFRICAN AMERICAN CAREGIVERS
Authors: Aflatoony Leila , Hepburn Kenneth , Perkins Molly , Waldrop Drenna , Alexander Karah
Published: December 2022

Design Thinking provides an empathy-based creative problem-solving approach to intervention and/or patient-centered care design that seeks to articulate the right problem space and propose appropriate solutions to challenges encountered by individuals in specific contexts, such as healthcare. This abstract illustrates the application of the Design Thinking approach in the context of dementia caregiving. Emory’s Roybal Center for Caregiving Mastery conducted a three-part design studio workshop with African American dementia family caregivers to understand and identify prioritized solutions to their caregiving challenges. The workshops followed the Double-Diamond design process model that is divided into four phases (Discover, Define, Develop, and Deliver) and that emphasizes divergent and convergent modes of thinking. The process first encourages divergent thinking to explore a problem space and then employs convergent thinking to identify the salient problem and develop the right solution. The workshop’s Discover stage provided a broad and deep contextual understanding of the range of unmet needs African American caregivers experience in their interactions with healthcare personnel and systems. The Define phase enabled the convergent review and prioritization of the list of needs to be addressed. The Develop phase generated 17 intervention ideas. Finally, the Deliver phase focused on converging and validating the proposed interventions. The workshops concluded that having access to caregiver-focused resources supporting mental/physical self-care, such as support groups and peer programs, can be beneficial interventions to potentially improve knowledge, awareness, and caregiving mastery among African Americans American caregivers.
HEARING LOSS, HEARING AID USE, AND NEUROPSYCHIATRIC SYMPTOMS IN DEMENTIA: FINDINGS FROM NACC
Authors: Nieman Carrie , Morales Emmanuel Garcia , Leoutsakos Jeannie-Marie , Lyketsos Constantine , Oh Esther
Published: December 2022

Hearing loss is highly prevalent among persons living with dementia (PWD) and associated with an increased risk of neuropsychiatric symptoms (NPS), while hearing aid use may be protective. We analyzed data from the National Alzheimer’s Coordinating Center’s (NACC) uniform data set. We estimated the association between hearing loss and number or severity of NPS in a negative binomial regression adjusting for demographic and clinical characteristics. In the subsample with hearing loss, we estimated the association between hearing aid use and number or severity of NPS.10,054 participants were included with a mean age of 75 years. 2,416 (24%) self-reported hearing loss with 71% reporting 2+ NPS. In PWD and hearing loss, 1,325 (54.8%) reported hearing aid use. After a well-balanced matching, in adjusted models, hearing aid use was associated with fewer (IRR=0.82; 95%CI=0.77,0.87) and less severe NPS (IRR=0.74; 95%CI=0.69,0.80). Hearing aid use may represent an underutilized, non-pharmacological intervention to address NPS.
MIDLIFE PHYSICAL ACTIVITY AND HEARING IMPAIRMENT IN LATE LIFE: ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY
Authors: Martinez-Amezcua Pablo , Dooley Erin , Morales Emmanuel Garcia , Reed Nicholas , Lin Frank , Schrack Jennifer , Deal Jennifer , Palta Priya
Published: December 2022

Background

Cardiovascular risk factors are associated with worse hearing, but the role of mid-life physical activity (PA) on hearing loss at older ages is yet to be investigated.

Methods

Among 3,198 participants of the Atherosclerosis Risk in Communities study, we investigated the association between self-reported mid-life PA (meets PA recommendations [≥150 minutes of moderate-to-vigorous PA/week] vs. not) and hearing loss (audiometric battery [pure-tone and speech-in-noise]) at older ages. We estimated differences in hearing between those who met and did not meet PA recommendations at mid-life and at late life adjusting for demographics, medical conditions, and noise exposure.

Results

43.3% participants met PA recommendations at mid-life. These participants, compared to those who did not meet recommendations, had lower better hearing by 1.51 (0.46, 2.55) decibels, and 0.37 (0.01, 0.74) more words identified in the speech-in-noise test.

Conclusions

Meeting PA recommendations in mid-life was associated with better hearing at older ages.
A MIXED-METHODS, RANDOMIZED, CONTROLLED EVALUATION OF REMOTE ACTIVITY MONITORING FOR PERSONS LIVING WITH DEMENTIA
Authors: Gaugler Joseph , Rosebush Christina , Zmora Rachel , Albers Elizabeth
Published: December 2022

Remote activity monitoring (RAM) technology has the potential to allow at-home caregivers to track the behaviors and activities of persons with dementia in real-time, thus facilitating more proactive symptom management. The aim of the present study was to assess whether RAM technology was associated with reductions in negative health transitions and service utilization for persons with Alzheimer’s disease or related dementias (ADRD). An embedded experimental mixed methods design was used that included 179 caregivers who were followed over a 1.5 year study period. Participants were randomly assigned to receive the RAM technology system or usual care. Follow-up surveys were administered on a bi-annual basis over an 18-month period that collected information on dementia caregiver and care recipient characteristics and outcomes. We developed multilevel mixed effects models to estimate odds ratios for binary outcomes (falls, wandering, health care admissions) and categorical outcomes (frequency of falls and wandering). In adjusted models, RAM technology use was statistically and significantly associated with lower odds of emergency department visits (p<.05) and less frequent falls (p=.05) for people living with dementia over the 1.5 year study period. Technologies that prevent or delay the onset of negative health events via improved care management and monitoring may enhance the care of persons with dementia. As dementia continues to pose an array of challenges for someone living with ADRD, RAM or similar technologies may offer a solution to the conundrum of dementia care.
HOLISTIC WELLNESS COACHING INTERVENTION FOR OLDER ADULTS IN RESIDENTIAL COMMUNITIES
Authors: Clarke Philip , Fullen Matthew , Smith Jennifer
Published: December 2022

Many wellness programs for older adults focus on physical health or specific conditions, such as heart disease prevention or diabetes management. To supplement these efforts, there is a need for holistic wellness programming to enhance well-being in later life. We developed and piloted a novel wellness coaching program for residents of senior living communities to address this need. The theoretical framework of the program is based on a holistic, multidimensional wellness model and self-determination theory. Staff members from eight residential communities were trained on wellness coaching techniques, such as motivational interviewing, active listening, and group facilitation skills, before they led the 9-week resident wellness coaching program. A total of 79 residents, ages 71 to 97 (M = 84.3, SD = 6.5), completed the pilot program. The resident wellness coaching program included a mixture of individual and group coaching sessions. The coaching sessions provided wellness education, social support, and space to share progress on wellness goals. Participants completed surveys at three time points: pre-program, post-program, and 1-month follow-up. Residents reported high satisfaction with the overall program and its components. Repeated measures ANOVAs were conducted to examine changes in wellness over time. Comparison of pre- and post-test scores revealed significant improvements in health satisfaction, physical and psychological quality of life, purpose, loneliness, relatedness, and competence. Some of these changes, such as increases in psychological quality of life and decreases in loneliness, persisted at the one-month follow-up. These findings have implications for the development and implementation of wellness coaching programs with older adults.
ADULT CHILDREN'S EDUCATIONAL ATTAINMENT AND PARENT HEALTH IN MID- AND LATER LIFE
Authors: Dennison Christopher , Lee Kristen Schultz
Published: December 2022

While intergenerational models of adult health contend that children’s educational attainments influence the health of their parents, background characteristics that predict both can confound the results. Data from the National Longitudinal Study of Adolescent to Adult Health Parent Study are used to examine how having no children who completed college influences parents’ self-rated health and depressive symptoms. We use propensity scores to assess this relationship net of potential confounders and test for heterogeneity in the consequences associated with having no children who completed college. Having no children who completed college is negatively associated with parents’ self-rated health and positively associated with depressive symptoms. Among parents with the highest propensity for having no children who complete college, the consequences on depressive symptoms are greatest. These findings are important given the call for investments in children’s educational opportunities as a vehicle for promoting health among adults and their older parents.
A LONGITUDINAL INCREASE IN SLEEP HEALTH PROBLEMS IN MIDDLE ADULTHOOD PREDICTS EARLY MORTALITY
Authors: Lee Soomi , Mu Christina , Wallace Meredith , Andel Ross , Almeida David , Buxton Orfeu , Patel Sanjay
Published: December 2022

Negative consequences of sleep health problems are common in middle-age but poorly understood. This study investigated multidimensional sleep health in middle adulthood and mortality risk. Participants from the Midlife in the United States Study reported sleep characteristics in 2004-2006 (T1; n=9,640, Mage=52.72) and again in 2013-2016 (T2; n=4,334). Deaths since each survey were logged. Multidimensional sleep health composite captured Regularity, Satisfaction, Alertness, Efficiency, and Duration. Cox regression adjusted for sociodemographics and known risk factors (BMI, smoking, depression/anxiety, diabetes, and hypertension) indicated that each unit higher sleep health problems at T1 was associated with 245% and 324% increase in hazard rates for all-cause (Hazard Ratio; HR=3.45, p<.001) and heart disease (HR=4.24, p<.001) mortality, respectively. Those with an increase in sleep health problems at T2 compared to T1 had a 182% increase in all-cause mortality risk (HR=2.82, p<.05), but not heart disease mortality risk. Improving sleep health may reduce early mortality risk.
RESIDENT-TO-RESIDENT AGGRESSION: PREVALENCE AND RISK FACTORS
Authors: Yan Elsie , Lai Daniel W L , Lou Vivian Wei Qun , Chaudhury Habib , Pillemer Karl , Lachs Mark
Published: December 2022

This study examines the rates and risk factors of resident-to-resident aggression in long term care facilities in Hong Kong. A total of 800 personal care worker participated. Participants averaged 42.03 years of age (SD=7.63), were mostly female (92.7%), married (79.1%) and reported an average of 6.28 years of experience in long term care. 96.9 percent of the participants provided care to residents with dementia but 58.9% considered the training they received insufficient. Resident-to-resident aggression was common: All participants reported having witnessed verbal aggression (100%), 18% disruptive behaviors, 11.8% physical violence, and 3.1% sexual aggression.Resident-to-staff aggression was commonly reported with verbal aggression being the most common (97.6%) following by other disruptive behaviors (13.7%), physical violence (10.7%), and sexual aggression (8.5%). Logistic regression analysis indicated that disruptive behaviors and physical violence were associated with perpetrator male gender, dementia, and neuropsychiatry symptoms, as well as staff prior and current experience of taking care of persons with dementia, not having received training in dementia care, and perceived insufficiency of training. Sexual aggression was associated with perpetrator male gender and staff female gender. There is an urgent need to provide supportive services to prevent and intervene resident-to-resident aggression in long term care facilities. Improving management of behavioral and psychological symptoms of dementia through sufficient staff training and adequate staffing ration may be helpful in this aspect.
USE OF MOTIVATIONAL INTERVIEWING IN THE CONTEXT OF ELDER ABUSE INTERVENTION: THE RISE PROJECT
Authors: MacNeil Andie , Burnes David , Connolly Marie-Therese , Salvo Erin , Kimball Patricia , Rogers Geoff , Lewis Stuart
Published: December 2022

Despite the increasing number of elder abuse (EA) cases, many EA victims are reluctant to engage with formal support services, such as Adult Protective Services (APS). For EA interventions to be effective, it is important to overcome this client reluctance. This study examined the use of motivational interviewing (MI) by elder advocates, as a component of a larger EA intervention model, RISE (Repair Harm, Inspire Change, Support Connection, Empower Choice), developed in partnership with Maine APS and the Elder Abuse Institute of Maine. The advocate role was developed, in part, to increase service acceptance/utilization among EA victims. Advocates are trained in MI, a collaborative, client-centered approach designed to help individuals explore and resolve ambivalence around making a change. This study conducted qualitative interviews and a focus group interview with all advocates (n = 4) working within the RISE model to understand how MI is applied in the context of an EA intervention. Three domains were identified: (1) therapeutic relationship, which describes the importance of foundational relationship building to support EA victims; (2) techniques, which refers to the MI strategies that advocates apply and adapt in the context of EA intervention; and (3) implementation challenges, which discusses the difficulties that advocates encounter when using MI with victims of EA. Overall, the experiences of advocates suggest MI is a beneficial and amenable approach to help EA victims navigate feelings of ambivalence and explore their motivation for change. This study represents the first in-depth exploration of MI in the context of EA intervention.
STRUGGLES AND STRENGTH: A QUALITATIVE STUDY OF DIVERSE VOICES FROM THE COVID-19 COPING STUDY
Authors: Finlay Jessica , Eastman Marisa , Kobayashi Lindsay
Published: December 2022

This paper aims to explore complex realities and nuanced lived experiences in how diverse older adults are making sense of and dealing with the COVID-19 pandemic. We conducted semi-structured video and phone interviews with 57 COVID-19 Coping Study participants (average age 70.7 years, 44% female, 49% white) from May-July 2021. Qualitative thematic analysis identified physical, mental, social, and economic struggles. These included heightened COVID-19 risk given comorbidities, difficulties accessing healthcare, distressing political events, diminished sense of safety, distance to family and support networks, inability to collectively mourn, and exacerbated financial instability. Coping strategies included exercise, hobbies, spirituality, online activities, engaging with family and friends, and self-care practices. Community-level sources of resilience included vaccines, telemedicine, stimulus checks, and community groups/services. These results highlight profound resiliency and strength to cope with adversities of the pandemic and may inform strategies to support underrepresented and underserved older adults during and after the pandemic.
SUPPORTING DIVERSE FAMILY CAREGIVERS
Authors: Nadash Pamela
Published: December 2022

The RAISE Family Caregiving Advisory Council, created under the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act (2018) has been tasked to support the Secretary of Health and Human Services in developing a national family caregiving strategy. This presentation reports on research commissioned to support the activities of the Council, which aimed to engage a broad range of stakeholders in identifying concrete strategies to carry out the Goals identified as critical to supporting family caregivers. One priority was to engage with organizations representing the diversity of family caregivers, including groups working with Blacks, Indigenous people, Asian-Americans, Pacific Islanders, and other people of color, along with groups such as faith organizations that work with under-resourced communities. Respondents had much to say regarding mechanisms for ensuring access to services and supports among diverse family caregivers, most notably identifying support for “community ambassadors” as key, as well as targeted awareness campaigns.
REIMAGINING AGING WITH DISABILITY THROUGH TECHNOLOGY
Authors: Remillard Elena , Campbell Margaret
Published: December 2022

Individuals aging with long-term disabilities are likely to require support for managing challenges with everyday activities. To effectively promote independence and aging-in-place for this population, we must consider innovative technology solutions that go beyond traditional direct care services. This symposium will highlight technology research and development efforts from the Rehabilitation Engineering Research Center on Technologies to Support Aging-in-Place for People with Long-Term Disabilities (RERC TechSAge). TechSAge is an interdisciplinary collaboration between Georgia Tech, the University of Illinois Urbana-Champaign, and Georgia State University, dedicated to understanding the needs of, and developing supportive technologies for people aging with long-term vision, hearing, and mobility disabilities. First, Remillard et al., will present interview findings from individuals aging with long-term vision loss on challenges performing instrumental activities of daily living. Next, Mitzner et al., will describe TechSAge research-driven guidelines for designing and delivering wellness classes via video-conferencing to older adults with and without disabilities. Blocker et al., will highlight a field trial evaluating how digital home assistants (e.g., Amazon Echo devices) and smart home devices, along with user-friendly support guides, can support older adults with mobility disabilities at home. Finally, Jones et al., will describe the latest feature of the SmartBathroom laboratory – a SmartBathing Transfer Testbed prototype that will enable us to study of how different bathing environment configurations can impact transfer performance. Margaret Campbell (Retired Senior Scientist for Planning and Policy Support, National Institute on Disability, Independent Living, and Rehabilitation Research) will serve as the discussant for the symposium.
TECHSAGE TELEWELLNESS TOOL: GUIDELINES FOR DELIVERING INCLUSIVE WELLNESS CLASSES VIA VIDEO-CONFERENCING
Authors: Mitzner Tracy , Remillard Elena , Mumma Kara , Cochran Lelah
Published: December 2022

Many older adults, particularly those with mobility disabilities, experience barriers to participation in exercise classes, including lack of accessibility and transportation. Tele-technologies (e.g., Zoom) provide an opportunity to facilitate both physical and social wellness through remote group classes. We developed the TechSAge Telewellness tool to provide guidelines for designing wellness classes delivered via video-conferencing for older adults with and without disabilities. The protocols and guidelines presented within it have been tested for usability and acceptance with older adults with long-term mobility disabilities. Throughout the tool, we present examples from the TechSAge Tele Tai Chi study as a case study to provide helpful insights on developing a Telewellness program. The tool includes guidance on selecting a software, safety considerations, class organization and logistics, social time, and tech support. The contents of the tool provide insights for research and design regarding telehealth technology, as well as health and wellness interventions.
INITIAL EFFICACY OF AN APP-BASED MINDFULNESS MEDITATION FOR BEREAVED KOREAN OLDER ADULTS DURING THE PANDEMIC
Authors: Kwon Soonhyung , An Jaesung
Published: December 2022

Given the onset of COVID-19, older adults who recently lost their significant others feel more stressed. There yet exist a study utilizing smartphones for web-based delivery of mindfulness intervention among bereaved older adults. Therefore, this study aimed to test the initial efficacy of an app-based mindfulness-meditation (AMM) to alleviate stress and depressive symptoms and improve stress resistance, social support, and self-esteem in Korean older adults experiencing bereavement. Participants included 22 Korean older adults who had been bereaved within the preceding year. AMM involved sound therapy, breathing exercises, and narrated meditation sessions, and the program was conducted over eight weeks. The linear regression results showed that stress level among participants was significantly lower after the intervention, with decreased scores from the baseline. By confirming that AMM is an effective way of reducing stress, more active usage of devices like smartphones should be promoted to develop mental health interventions for older adults.
CONTEXT AND TRUST: DIRECT CARE WORKER RELATIONSHIPS, CARE PRACTICES, FACILITATION, AND IMPLEMENTATION OF INNOVATIONS
Authors: Perez Janelle , Wang Jing , Beeber Anna , Anderson Ruth , Berta Whitney , Lanham Holly , Estabrooks Carole
Published: December 2022

This paper examines the relationships between Direct Care Workers (DCW) and other nursing home (NH) staff. Specifically, we examine how trust, and the context in which trust exists, influences care practices and implementation of innovations in NHs. This secondary analysis of interviews and field observations from three separate NHs in different Canadian provinces shows differing levels of trust that between HCAs and other staff. We also analyze the organizational context can mediate trust in these relationships. Specifically, we analyzed trust DCWs have at the interpersonal, institutional, organizational levels and what ways they act as facilitators of programs aimed at improving care practices health outcomes of residents in NHs. Using the Alberta Context Tool’s dimensions of organizational context as a framework, this research shows how trust in the relationships between DCWs and other LTC staff influences caregiving practices and the uptake of new innovations.
ORGANIZATIONAL CONTEXT'S EFFECT ON CARE AIDES' PSYCHOLOGICAL EMPOWERMENT IN WESTERN CANADA
Authors: Iaconi Alba , Duan Yinfei , Song Yuting , Hoben Matthias , Hayduk Leslie , Norton Peter , Estabrooks Carole
Published: December 2022

This quantitative cross-sectional sub project investigated the effects of organizational context and individual characteristics on psychological empowerment of care aides working in nursing homes. We analyzed data collected from 3765 care aides from 91 nursing homes across Western Canada between 09/2019 and 03/2020. From the random-intercept mixed effects regression models we identified significant predictors at different levels for each component of psychological empowerment. At the organizational outer context level: region and home ownership model. At the inner context (care unit) level: formal interactions (β=-0.07, p=0.03; competence), evaluation (β=0.20, p<0.02; self-determination), culture (β=0.20, p<0.02; self-determination), communication (β=0.16, p<0.001; self-determination), and social capital (β=0.22, p=0.01; impact). At the individual level: care aides’ sex, language and job satisfaction.These findings suggest important ways in which contextual elements may influence staff quality of work life characteristics and underscore the need to consider context operating at different levels, as well as consider individual and contextual interaction.
GEROFIT STUDENT VOLUNTEERS: INTERGENERATIONAL APPROACH TO MOBILITY
Authors: Lee Cathy , Castle Steven , Hall Katherine , Morey Miriam
Published: December 2022

The Institute of Medicine (IOM) has reported that innovative models of care will need to be used to increase the workforce to care for an aging population and to encourage older adults “to be active partners in their own care” (IOM, 2008). Use of student volunteers in an intergenerational approach could be used to supplement the workforce to motivate older adults for self-care in clinical practice. Gerofit@UCLA is a student organization created to support Gerofit at the Greater Los Angeles VA. These students completed an Expectation Regarding Aging (ERA-12) Survey. ERA-12 is a 12-item survey that measures expectations regarding aging in physical health, mental health and cognitive function with scores ranging from 0-100, higher scores indicating higher expectations with aging. After volunteering in Gerofit, students indicated highest expectations for mental health (78.33 ± 5.9) compared to cognitive health (53.34 ± 5.3) and physical health (39.17 ± 3.7). Although these students recognize the physical changes with aging of this 80-102 year old group, they appreciate that group physical activity in a program like Gerofit has positive effects on mental health and cognition, for the patients and for themselves.
VETERANS VOICES: ACCEPTABILITY AND ENRICHING THE GEROFIT TO HOME EXPERIENCE FOR OLDER VETERANS
Authors: Parham Cheryl , Bettger Janet Prvu
Published: December 2022

The pandemic helped us overcome many of the barriers we had struggled with for group based exercise. Within six weeks, all of our sites had transitioned to group-based virtual classes, aptly called Gerofit to Home (GTH). Because of the rapid and continuously evolving changes in telehealth, we had near daily Veteran feedback on what was working and what was not working. Part of this planning included retaining a smaller group of Veterans on a regular basis who would serve as an ongoing Gerofit Veterans Advisory Panel (VAP). The VAP is a racially and geographically diverse group of 12 men and women Veterans from 7 different sites, with varying levels and duration of participation in Gerofit (some exclusively remote, some in-person then transition to remote with the pandemic). This presentation will feature a moderated discussion with VAP representatives, summarizing the perspectives provided on Veteran preferences, needs, and motivators to engage in GTH.
BUILDING CAPACITY FOR DEMENTIA CAREGIVER TOOLS AND PRAGMATIC TRIALS THROUGH STAKEHOLDER ENGAGEMENT
Authors: Lum Hillary
Published: December 2022

Caregivers face challenges communicating and coordinating health-related needs on behalf of persons living with dementia (PLWD). This presentation will highlight capacity building activities at UCHealth, a large academic health system in Colorado and Wyoming, to prepare for pragmatic clinical trials to test integrated health informatics tools to improve the care of PLWD and their family caregivers. We will describe foundational activities of: 1) convening diverse patient and family caregivers to identify communication priorities and refine health informatics tools, 2) engaging health system leaders to develop a system-based value proposition, and 3) partnering with health informatics teams to adapt tools (i.e., dementia registry, refined patient portal tools) and implement reports of pragmatic outcomes. Through support as an NIA IMPACT Health Care System Scholar, we will discuss lessons learned related to highlighting the preferences of diverse caregivers, especially related to use of health informatics tools in the context of dementia care.
CAPABLE IMPLEMENTATION: PROGRESS AND BARRIERS
Authors: Paone Deborah , Szanton Sarah
Published: December 2022

CAPABLE is an evidence-based 4-to-6-month program that improves daily function and the home environment based on the older adult’s goals. Study aims were to: (1) understand context and readiness factors in implementation, (2) identify barriers and facilitators, and (3) examine the utility of two frameworks. The unit of analysis was the organization. We employed the CFIR and RE-AIM frameworks for this qualitative study, using multiple data sources and traced the implementation of 40 organizations over 3 years. Leadership support, perceived value of the program, initial funding, strategic importance, and program champion were common supportive factors. Common challenges included difficulty with recruitment, staffing and infrastructure readiness and sustainability of funding. This study indicates readiness, technical support, and resources needed for implementation and sustainability of CAPABLE and suggests external environmental supports needed. It offers a practical way to monitor, evaluate, and report on ongoing implementation of evidence-based programs.
DRIVERS AND RESTRAINERS OF CAPABLE DISSEMINATION
Authors: Szanton Sarah , Paone Deborah
Published: December 2022

Using the technique of Force Field Analysis, the co-developer of CAPABLE examined drivers and restrainers of dissemination for the CAPABLE program. This generated 19 distinct drivers including robust research findings, demonstrated clinical and economic utility, and high value to older adults. The environmental shift toward value-based approaches in Medicare and Medicaid also increased the perceived value of CAPABLE. In addition, there were 8 restrainers, including component complexity, siloed health and housing sectors, and the operational lift needed to build the program. Lessons are offered from this case study to move from research to embedded practice.
TRANSLATION OF A MEDICARE CLAIMS-BASED FRAILTY ALGORITHM FROM ICD-9-CM TO ICD-10-CM
Authors: Faurot Keturah , Duchesneau Emilie , Shmuel Shahar , Park Jihye , Stürmer Til , Jonsson-Funk Michele L , Lund Jennifer L
Published: December 2022

Clinical trials often have insufficient power to estimate drug effects in older adult populations. Medicare claims data are a valuable resource for studying healthcare delivery for older adults. The Faurot frailty index (FFI) is a validated algorithm that uses demographic, enrollment, and ICD-9-CM-based claims information to predict ADL dependency as a proxy for frailty. The original FFI consists of 20 constructs, including those related to geriatric syndromes, of which 16 are based on ICD-9-CM diagnosis codes (e.g., arthritis, dementia). In October 2015, the US healthcare system transitioned to ICD-10-CM. In this study, we updated and validated the FFI for the ICD-10-CM era . We used General Equivalence Mapping (GEM) to translate the ICD-9-CM codes to ICD-10-CM. For each construct, we manually reviewed the ICD-10-CM codes after GEM, assessed the suitability, and plotted the monthly prevalence before and after the transition (2013-2017). Code lists for all but 1 construct required editing after translation using GEM (adding and/or removing codes). We observed increasing monthly prevalence for several constructs, although trend lines were consistent across the ICD-9-CM and ICD-10-CM eras: bladder dysfunction (1.8-2.5%), weakness (2.7-3.9%), and psychiatric illnesses (6.9-9.1%). Rehabilitation services did not translate well using diagnosis codes, however, adding CPT codes improved capture. The updated FFI was strongly associated with frailty-related geriatric outcomes (1-year mortality, hospitalization, SNF admission). Studies of drug effects in older adults should use validated indices, such as the FFI, to reduce bias. Thorough evaluation of claims-based algorithms is essential to support healthcare services research using these measures.
STATE USE OF VALUE-BASED PAYMENT IN NURSING FACILITIES
Authors: Tyler Denise , Porter Kristie , Hunter Melissa , Oliveira Iara , Squillace Marie , Dey Judith
Published: December 2022

Some states use value-based payment (VBP) programs as part of their nursing facility Medicaid payment systems. The purpose of this study was to determine which states use these programs, their goals, the measures used and other elements of these programs. An environmental scan was conducted to identify states that have VBP programs for nursing facilities, the key design elements of those programs, and the goals that states are aiming to achieve. Interviews with seven stakeholders were also conducted. We found that 20 states and the District of Columbia use VBP for nursing facilities with the goals of improving quality and increasing efficiency. However, due to lack of evaluation, it is not known if these programs are achieving their goals. Additional research is needed to determine which state programs are most successful. The results of such research would help in the development of future VBP programs.
THE COVID-19 PANDEMIC MAY HAVE EXACERBATED NURSE STAFFING DISPARITIES IN NURSING FACILITIES
Authors: Porter Kristie , Gasdaska Angela , Squillace Marie , Dey Judith , Oliviera Iara , Feng Zhanlian , Segelman Micah
Published: December 2022

Nursing facilities (NFs) have historically struggled to maintain adequate nurse staffing. We used PBJ data linked with other publicly available sources and conducted stakeholder interviews to understand nurse staffing between 2019 and 2020. We found large declines in the population of NF residents and in staffing hours. Measured in hours per resident day (HPRD) to account for the size of the NF resident population, there were slight increases in staffing. Staffing was nonetheless a major challenge for NFs because they required increased staffing due to the impact of the pandemic. NFs in higher quartiles of percentage of minority residents lost nurse staffing HPRD relative to NFs in the lowest quartile of minority residents. Stakeholders explained that NFs with more minority residents were likely to employ staff who live in more vulnerable communities with a greater concentration of minorities, who were more impacted by COVID.
GERIATRIC PRACTICE LEADERSHIP INSTITUTE—AN INTERPROFESSIONAL TEAM APPROACH USING THE IHI AGE-FRIENDLY MODEL
Authors: Knebl Janice , Severance Jennifer , Murphy Sara , Camp Kathlene , Roach James , Fairchild Thomas
Published: December 2022

According to the Institute of Medicine, immediate steps must be taken to educate and train both the current and future health care workforce to work collaboratively in addressing the diverse needs of the growing older adult population.1 Most healthcare professionals had very little education or clinical training in the care of older adults nor the most effective ways to work as a clinical team. The Geriatric Practice Leadership Institute (GPLI) is a collaboration between two universities providing inter-professional teams of early and mid-career professionals the skills and knowledge needed to leverage leadership skills to effectively work within interdisciplinary teams to provide age-friendly care to older adults. The GPLI incorporates the Institute for Healthcare Improvement (IHI) Age-Friendly Health Systems 4Ms’ Framework into the training. The GPLI is an on-line, team-based program which engages 5-7 teams each session. Module topics include Age-Friendly Health Systems, organizational culture, leading self, leading inter-professional teams, and quality improvement. Additionally, teams select and completes a quality improvement project based on the Age-Friendly Health Systems 4Ms and submits a final report and presentation. The teams are also assigned a coach for support. Continuing education credits and a micro-credential are available to participants. The GPLI has trained over 175 health care professionals during the past 7 years with teams representing ambulatory to emergency responder organizations. The GPLI has been funded by the Health Resources and Services Administration (HRSA) Geriatrics Workforce Enhancement Program grant (numberU1QHP2873), which currently covers all costs for participants.
MENTAL HEALTH IMPACT OF DISCRIMINATION: THE PROTECTIVE FUNCTION OF SOCIAL CAPITAL IN DIVERSE GROUPS OF OLDER ADULTS
Authors: Yan Mengzhao , Jang Yuri , Wilber Kathleen
Published: December 2022

Discrimination occurs in complex social contexts leading to various levels and types of outcomes. Although the negative health impact of discrimination is well-documented, there is a need to investigate patterns among discrimination, social factors, and health outcomes in diverse racial/ethnic groups of older adults to inform interventions. For example, social capital, such as social cohesion, social ties, and safety, is anticipated to be directly associated with mental health and also to modify the impact of discrimination. In the present study, we examined (1) racial/ethnic differences in perceived discrimination, social capital, and depressive symptoms and (2) the direct effect of perceived discrimination and social capital, as well as their interactions, on depressive symptoms among different racial/ethnic groups. Data were drawn from the National Social Life, Health, and Aging Project (NSHAP) Round 3 (2,988 non-Hispanic Whites, 719 non-Hispanic Blacks, and 499 Hispanics; 68 mean age). Compared to non-Hispanic Whites, non-Hispanic Blacks had a significantly higher level of perceived discrimination, lower social capital, and more depressive symptoms. Findings from multivariate linear regression models demonstrated that, in all racial/ethnic groups, frequent experiences of discrimination and low levels of social capital were associated with increased symptoms of depression. A significant interaction between discrimination and social cohesion was observed in non-Hispanic Whites and Hispanics. In both groups, the negative impact of discrimination was lower among those with higher levels of social cohesion. Our findings support efforts such as improving well-being for older adults by promoting age-friendly communities to build greater social cohesion.