bluuebunny/crossref_metadata_2025 huggingface dataset:
BETA-TESTING OF A CSMP APP: AN ASSESSMENT OF USABILITY, UTILITIES, AND CHALLENGES
Authors: Wu Shinyi , Yu Kexin , Liu Mandong , Jiang Haojun , Chi Iris
Published: November 2019

A beta-version of a CSMP app was designed to empower Chinese caregivers with the knowledge, skills, and self-efficacy needed for holistic health self-care at the convenience of using their mobile phone. The key app functions included interactive multi-media lessons and practice, scheduling of coaching sessions for problem solving, and extended readings. Four groups of 5 caregivers (totaling 20) sequentially participated in one-hour lab and one-week in-home testing of the app to identify usability, utilities and challenges of using the app. They also were invited to join a social media group chat to enable peer-to-peer communication for support and sharing. Using post-lab interviews and exit survey, the beta-testing allowed the research team to assess external user acceptance and feasibility of using the CSMP app in real-world settings, and helped the team explore the perceived training requirements, values, challenges, and improvement priorities to materialize learning CSMP curriculum in a mobile environment.
MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS: POLICY INNOVATION AND EVIDENCE GENERATION
Authors: Degenholtz Howard
Published: November 2019

Twenty-two states have turned to managed care organizations to finance and deliver long-term services and supports (LTSS) as a way to control costs, improve quality and shift the locus of care away from institutional settings. These programs, referred to as Managed Long-Term Services and Supports (MLTSS) have been undertaken under several CMS authorities, and vary in terms of the program design and populations covered. Some programs such as the financial alignment demonstration, have integrated Medicaid and Medicare financing, while others have used waiver authority and three-party agreements to achieve coordination. However, all efforts share the same goal of improving the linkage between LTSS and both physical and behavioral health care. This presentation will provide conceptual framework for understanding and assessing program impact using the example of the multi-method evaluation of the $4 billion Pennsylvania Community HealthChoices program, one of the largest transitions in Medicaid policy to date.
INTEREST GROUP SESSION—HIV, AIDS AND OLDER ADULTS: HIV AND AGING: IMPROVING BIOPSYCHOSOCIAL HEALTH AND FUNCTIONAL WELLNESS
Authors: Brown Monique J , Perkins Molly M
Published: November 2019

People living with HIV/AIDS (PLWH) are living longer due to the success of antiretroviral therapy. In 2016, approximately 50% of PLWH in the U.S. were age 50 and older and 17% of new infections were among this age group. One key factor that contributes to the HIV prevalence and incidence among older adults is the lack of sexual health discussion during healthcare visits. Among older (50+) PLWH, most are exhibiting signs of accelerated aging and declines in functional (physical, cognitive and psychosocial) wellness and little is known about the lasting impact of childhood sexual abuse (CSA). In this symposium, we present new research assessing the biopsychosocial challenges faced by older PLWH and older adults at risk for HIV. Dr. Robinson will present findings on the frequency, content and barriers and facilitators in provider communication with older patients on sexual health and HIV. Dr. Brennan-Ing will examine the association between CSA and psychosocial health among older PLWH. Dr. Schrack will assess the impact of energy utilization on physical activity and function among older HIV+ and HIV- men. Dr. Taylor will assess predictors of physical, cognitive and psychosocial wellness among older men with and without HIV. Dr. Sekhar will present findings from a trial on the impact of glycine and N-acetylcysteine supplementation on accelerated aging among older PLWH. Dr. Perkins, will discuss the public health implications of the presented research for HIV prevention and wellness interventions among older adults, and suggest future areas of inquiry to improve clinical outcomes for this population.
EXPLORING SEXUAL HEALTH AND HIV COMMUNICATION BETWEEN HEALTHCARE PROVIDERS AND OLDER PATIENTS
Authors: Robinson Erin L , Washington Karla , Park Geuhye , Conner Laneshia , Lusby Tara
Published: November 2019

While HIV and aging is a complex issue, healthcare providers can play a vital role in education and screening among older patients. Therefore, this study aimed to better understand the frequency, content, and barriers/facilitators of provider communication with older patients around sexual health and HIV. One-on-one interviews were conducted with healthcare providers (N=18) and analyzed using Nvivo12. Providers reported that approximately 1-30% of their older patients show risk factors for STI’s. The majority of providers tailor their communication to older patients regarding sex/HIV, however they were divided in who initiates such conversations (themselves or the patient). Providers stated that standardized/routine health assessments help facilitate those conversations. Results indicate several barriers to conversations, such as age/gender differentials and time. Additional results will be discussed. Study findings can help guide provider education and screening of older adults regarding sexual health/HIV.
FUNCTIONAL WELLNESS AND OLDER MEN WITH HIV
Authors: Taylor Tonya N , Weedon Jeremy , Silk Tarik
Published: November 2019

Aging-related stressors, such as changing physical function, poorly managed multimorbidity, increasing pill burden and social losses can diminish for some older adults with HIV the capacity for self-care. These challenges, however, can be improved by maintaining physical, cognitive and social function, or functional wellness. Using cross-sectional data from a men’s health study with younger and older men with and without HIV, we conducted general linear models to identify individual and clinical predictors for physical, cognitive, social and role function, as measured by the Medical Outcomes Study HIV Health Survey. We found that older HIV+ men had lower burdens of functional deficits compared to older HIV- men and younger HIV+ men and that across all models, depression, followed by diabetes, housing, and employment were predictive of functional wellness. Functional wellness for older HIV+ men is a multidimensional construct that includes optimizing internal and external resources to maintain healthy living and wellness.
HOME IS WHERE THE HEART IS: OPTIMIZING AND TAILORING HOME AND COMMUNITY-BASED SUPPORT FOR DEMENTIA CAREGIVERS
Authors: Samus Quincy M , Hodgson Nancy , Gaugler Joseph E
Published: November 2019

Family caregivers, often “de facto” members of the care team for persons with dementia, play a central role in ensuring safety, support, quality of life, and continuity of care. Most often, they provide this care for loved ones at home and over a long period of time, as the illness progresses and care need intensifies. This session will provide a unique understanding of potential ways to optimize support for family caregivers in provision of day-to-day care in the home by examining often-overlooked factors influential in the health and wellbeing for both caregiver and persons with dementia. Presentations will draw from three large community-based trials testing interventions to support dementia caregivers. Drs. Samus and Sloan will present on common unmet needs identified by family caregivers and explore how needs differ by disease stage and race. Dr. Fortinsky will present baseline caregiver care-related challenges in a diverse cohort of caregivers and the effects of a caregiver intervention designed to mitigate these challenges. Dr. Hodgson will present the common symptoms clusters among home-dwelling persons with dementia patients and how these are associated with caregiver distress. Dr. Jutkowitz will discuss factors influencing dementia caregiver’s willingness to pay for help at home. Findings from this session will help elucidate care needs that matter most to family caregivers in diverse community-living cohorts and how we might optimize and tailor supportive home-based interventions to target these needs and challenges.
COMMON UNMET NEEDS OF DEMENTIA CAREGIVERS AND HOW THESE DIFFER BY DISEASE STAGE AND RACE
Authors: Samus Quincy M , Sloan Danetta , Leoutsakos Jeannie-Marie , Black Betty , Johnston Deirdre
Published: November 2019

This presentation (co-presentation Samus and Sloan) will use combined cross-sectional, baseline data from two intervention studies (n=-642) conducted in Maryland evaluating the impact of dementia care coordination model (MIND at home) to provide a detailed description of common modifiable unmet care needs of family caregivers of community-living persons with dementia (PWD), explore how care needs may differ by the disease stage of the PWD, and presence of racial disparities in care needs. Unmet caregiver needs were identified based on comprehensive in-home assessments using a standardized tool (JHDCNA 2.0) with 6 care domains and 18 items covering caregiver needs. Family caregivers were 77% women; 63 years old (mean); 60% White; and 52% adult children. The most prevalent needs were for education/resources (98%), legal (74%), mental health (44%), and informal support (43%). Needs varied based on dementia severity. African American caregivers (vs. white) had significantly more unmet caregiver needs at baseline (p<.001).
EFFECTS OF AN ART GALLERY INTERVENTION IN PEOPLE LIVING WITH DEMENTIA: A PILOT STUDY
Authors: D'Cunha Nathan M , McKune Andrew J , Isbel Stephen , Georgousopoulou Ekavi N , Kellett Jane , Naumovski Nenad
Published: November 2019

Art gallery programs tailored to the needs of people living with dementia are becoming more popular worldwide. This study aimed to observe the effects of six consecutive weekly discussion-based small group visits to the National Gallery of Australia Art and Dementia program on the salivary cortisol (SC) diurnal rhythm, salivary interleukin-6, quality of life (QoL), depressive symptoms, and cognitive function. Twenty-five participants (17 female; mean age 84.6 ± 7.27 years) completed the study with data collection at baseline, post-intervention, and at a six-week follow-up. Statistical methods were selected based on data distribution. The waking to evening (WE) SC ratio was altered (p = 0.016) (Baseline: 1.35 (1.19, 1.64), Post-intervention: 1.72 (1.54, 1.96), Follow-up: 1.44 (1.22, 1.79)) in the 22 participants who provided viable saliva samples. The WE SC ratio was higher post-intervention compared with baseline (p = 0.011), indicating a more dynamic SC rhythm, but returned to baseline levels at follow-up (p = 0.020). Interleukin-6 levels were unchanged (p = 0.664). In the total sample, no improvements in QoL (Proxy) (p = 0.165) were observed. However, self-reported depressive symptoms differed (p = 0.006), decreasing post-intervention (2.00 (1.00, 2.00)) compared with baseline (3.00 (2.00, 4.50)) (p = 0.015), and verbal fluency was affected (p = 0.027), improving from baseline (2.00 (0.00, 3.00)) to post-intervention (2.00 (0.50, 4.00)) (p = 0.027). Art and Dementia programs appear to have quantifiable benefits, including improved hypothalamic-pituitary-adrenal axis function, justifying a longer controlled trial inclusive of physiological outcomes.
APPLICATIONS OF QUALITATIVE RESEARCH IN DESCRIBING PCC ENVIRONMENTS: THE STORY BEHIND THE STATISTIC
Authors: Kaup Migette , Poey Judith , Doll Gayle , Cornelison Laci
Published: November 2019

The goal of PCC is to enhance quality and bring meaning to the lived experience in long-term care. This requires attention to patterns of life, and the creation of residential experiences within the environment. Ten case studies of homes participating in a pay-for-performance PCC program in the Midwest reveals how environmental affordances may be critical in the implementation and sustainability of PCC. Data collected through an in-depth environmental assessment revealed multiple strategies and attributes related to organizational, operational, and environmental practices. This presentation will demonstrate a diagrammatic and empirical comparison of the environments of those early in the process and those who have fully implemented and sustained PCC practices. Specific features will be highlighted and patterns discussed.
WHAT DOES LONG-DISTANCE CAREGIVING LOOK LIKE?
Authors: Horowitz Amy , Jimenez Danielle , Cimarolli Verena , Falzarano Francesca , Minahan Jillian
Published: November 2019

Long-distance caregivers (LDCs) are defined by geography, with little known about what they actually do when visiting and from afar. Both quantitative and qualitative data were collected from 304 LDCs. Half of LDCs lived more than 500 miles away from the care receiver (CR); 38% visited at least 1x a month, another 53% visited several times a year. Visit length varied extensively, ranging from one to 90 days at a time, with a median of 3 days. A wide range of care management tasks were common both when visiting and from afar; and targeted both formal providers and other informal caregivers. Emotional support and help with ADLs and IADLs were common during in-person visits. Other examples of emerging themes include: building relationships with formal care providers; personalizing care through, for example, special foods and/or activities; and the role of resources in determining visit length and help provided.
LONG-DISTANCE CAREGIVERS’ SATISFACTION AND CHALLENGES WITH FORMAL CARE PROVIDERS
Authors: Falzarano Francesca , Minahan Jillian , Cimarolli Verena , Horowitz Amy , Jimenez Danielle
Published: November 2019

The purpose of this study (N=304) was to identify differences in LDCs’ experiences with their care recipient’s (CR) formal care providers (FCPs) among four LDC groups based on CR dementia status and residential setting (community/nursing home [NH]). Results show that LDCs of CRs without dementia living in a NH are less likely to be satisfied with information/communication provided by FCPs compared to LDCs of CRs with dementia in the community. FCP-related challenges were significantly greater among LDCs of CRs in a NH, with or without dementia, compared to LDCs of CRs without dementia living in the community. A significantly greater proportion of LDCs of CRs living in a NH, with or without dementia, reported dealing with inadequate care as a challenge compared to LDCs of CRs with dementia living in the community. This highlights LDCs’ unique experiences related to FCPs based on differences in CR dementia status and residential setting.
RELIABILITY AND VALIDITY OF THE KNOWLEDGE OF PERSON-CENTERED BEHAVIORAL APPROACHES FOR BPSD
Authors: Haitsma Kimberly Van , Madrigal Caroline , Kolanowski Ann M , Resnick Barb , Galik Beth , Ellis Jeanette , Eshraghi Karen
Published: November 2019

How behavioral and psychological symptoms of dementia (BPSD) are understood and managed is important to person-centered care. No knowledge tests associated with dementia specifically address staff knowledge of person-centered behavioral approaches to BPSD. The Knowledge of Person-Centered Behavioral Approaches for BPSD Test was developed by our team to fill that gap. We tested the reliability and validity of this measure using a Rasch analysis and additional psychometric testing. 1,071 nurses from 35 nursing homes participated in the study. Reliability was evident based on an item separation of 11.00 and item reliability of 0.99. Construct validity was evident in that all of the items fit the model with INFIT and OUTFIT statistics (0.6-1.4). Associations between test scores and observed positive and negative care interactions (r=.38, p=.03; r=-.26, p=.12), person-centered care approaches (r=-.25, p=.15), and resistance to care (r=-.31, p=.07) will be examined and implications for person-centered care discussed.
INVESTIGATING DYNAMICS OF AGE-ASSOCIATED TRANSCRIPTIONAL NETWORKS WITH INTERVENTIONS TARGETING AGING
Authors: Kulkarni Ameya S , Mar Jessica C , Barzilai Nir
Published: November 2019

Biological aging is characterized by a progressive decline in physiological function from molecular to organismal levels, manifesting through adaptive transcriptional networks. We present an overview of the complex regulation of transcriptional networks in species- and tissue-specific aging. We aimed to: 1) capture the age-associated changes in gene-gene connectivity, and 2) evaluate the effect of two interventions targeting biological aging (metformin, acarbose) on the regulation of gene networks. Aim 1) Using RNA-Seq we modeled co-expression networks and identified differentially co-expressed gene-pairs between young, middle-aged and older-aged groups. Aim 2) Using short-term clinical studies in older humans (metformin: MILES-trial; acarbose: SAIL-trial), and complementary mouse studies, we revealed the genes and novel pathways underlying the drugs’ effects on biological aging in muscle and adipose. Importantly, these interventions shifted transcripts to a more youthful expression. Overall, we provide evidence of age-associated gene-network topology changes and identify upstream transcriptional factors affected by age-targeting drugs.
INTEREST GROUP SESSION—AGING VETERANS: EFFECTS OF MILITARY SERVICE ACROSS THE LIFE COURSE: OPTIMIZING VETERAN AND CAREGIVER WELL-BEING THROUGH TECHNOLOGY
Authors: Gould Christine E , Loup Julia , Wray Laura O
Published: November 2019

Older Veterans account for more than half of Veterans receiving care through the VA. Many suffer from dementia, traumatic brain injuries, and mental health disorders, resulting in complex care needs, which may include need for caregiver support. Innovative approaches using technology have the potential to improve access to treatments that improve the well-being of older Veterans and their caregivers. This symposium will present data from three Veterans Health Administrative investigators who are examining the impacts of innovative technology-delivered interventions. First, Dr. Michelle Hilgeman will describe preliminary 6-month outcome findings from a telephone-delivered Care Consultation + Counseling (CC+C) intervention for Veterans with dementia and their caregivers. Second, Dr. Kaci Fairchild will detail the background, methodology, and preliminary results of The COACH Project (Combined Online Assistance for Caregiver Health). The COACH Project is a mobile-delivered intervention consisting of exercise and caregiver skills training designed to reduce caregiver burden in those caring for someone with cognitive impairment. Third, Dr. Christine Gould will describe the development and feasibility of the Geri-Mobile Health clinic, which helps older Veterans use VA mental health apps to meet their well-being and mental health goals. Dr. Gould will describe the clinic’s personalized coaching method to support Veterans unfamiliar with apps and will share findings regarding the program’s acceptance, feasibility, and preliminary outcomes. Dr. Laura Wray, the executive director of the VA Center for Integrated Healthcare, will serve as the discussant. She will comment on implementing these interventions in primary care settings and the potential barriers to their adoption.
TECHNOLOGY-BASED INTERVENTIONS TO IMPROVE CAREGIVER WELL-BEING
Authors: Fairchild Kaci , Kamil-Rosenberg Shirit , Taylor Heather , Louras Peter , Scanlon Blake , Myers Jonathon , Yesavage Jerome
Published: November 2019

Informal or unpaid care is the most common form of long-term care. Despite clear benefits for the care recipient, caregiving can have unintended physical and emotional consequences for caregivers. Traditional caregiver interventions are limited in scope, as they often focus on the emotional consequences of caregiving; however, the physiological effects of caregiving are equally deleterious to caregiver health. Exercise improves physical health, yet the demands of caregiving can limit participation in physical activity. Traditional gym-based interventions may not be feasible for many caregivers. Advances in technology present an opportunity to address these limitations, specifically in the areas of accessibility and acceptability. The Combined Online Assistance for Caregiver Health (COACH) program combines evidence-based skills training with physical exercise in a tablet-based intervention. Preliminary evidence for the physical and psychological benefits are promising; however, differential attrition rates are informative as to the acceptability of technology-based interventions among some caregivers.
CHARACTERIZING THE EFFECTS OF HOSTILE ARCHITECTURE ON THE HEALTH GOALS OF HOUSELESS ELDERS
Authors: Johnson Ian M
Published: November 2019

Over 12,000 residents of Seattle experienced houselessness in 2018—among them, 70% reported having health conditions, 17.5% were over 50, and over half do not access emergency housing services. Local governments increasingly use strategies aimed at deterring unhoused populations from using public space. This research aimed to characterize the effects of urban planning interventions on the health goals among older disabled adults experiencing houselessness. Agency-based focus groups were conducted with adults over 50 who self-identified as disabled and met the federal criteria for homelessness. Through participatory mapping methods, constituents identified places where opportunities and barriers toward achieving health goals were experienced. Findings indicate lived experiences of confinement, exclusion, and loss of autonomy as well as creative negotiation and reclamation of space. This research equips advocates and providers with spatial data to increase public awareness, enrich local advocacy efforts, and offer new methodologies for enhancing social work perspectives on place and aging.
THE EFFECT OF AN ARTIST-IN-RESIDENCE PROGRAM ON SELF-REPORTED LONELINESS IN OLDER ADULTS
Authors: Richmond-Cullen catherine
Published: November 2019

The study, funded by the Pennsylvania Council on the Arts and the Pennsylvania Department of Aging, measured the effect that an artist in residence program (conducted by state-vetted professional teaching artists) had on self-reported loneliness in older adult. All participants were aged sixty years or older and participated in programming in state-funded adult community centers located in fourteen sites throughout the Commonwealth of Pennsylvania. Artists offered 10 sessions in creating and critiquing art to older citizens in the artists’ respective art forms including performing arts, visual arts and multidisciplinary/interdisciplinary arts. Through pre and post-tests, changes in loneliness were measured using the Revised UCLA Loneliness Scale. The data revealed that there was a significant correlation between a self-reported decrease in feelings of loneliness and participation in a program conducted by professional artists. . It was proposed that findings from the study could influence the quality of programs provided by state-funded adult community centers in Pennsylvania and increase funding levels to adult community centers throughout the Commonwealth of Pennsylvania.
INTEREST GROUP SESSION—REMINISCENCE, LIFE STORY AND NARRATIVE: RESEARCH AND PRACTICE: WISDOM OF THE ELDERS: ART, MEDICINE, NARRATIVES, AND POETRY
Authors: Nwankwo Ifeoma , Ardelt Monika
Published: November 2019

The Wisdom of the Elders (WOE) is a series of autobiography production workshops conducted since 2012 through a collaboration among community, university, and municipal partners. Beginning in Murfreesboro, TN it has since been replicated in New Orleans, LA. The Wisdom of the Elders project has many elements, including life history interviews, creative writing workshops, and creative expressions that allowed elders to share their wisdom with younger generations. Our focus was to understand how personal characteristics and historical/environmental events interact to influence healthy aging. Later work extended to interviewing older hospitalized patients in order to gain insight into intergenerational themes. The interdisciplinary team has also used poetry and reflection to train healthcare professionals and caregivers to use active listening strategies to better understand how patients cope with life-changing illnesses, and how they incorporate the challenges of those illnesses into rich, fulfilling lives. WOE has been supported by the Mellon Foundation, the Meharry-Vanderbilt Community Engaged Research Core, and the Department of English, the College of Arts and Science Dean’s Office, and the Chancellor’s Higher Education Fellowship at Vanderbilt University. WOE has led to the formation of an interdisciplinary research and publication collaborative featuring distinguished clinicians, artists, and scholars from Creative Writing, Education, Geriatrics, Interprofessional Learning, Psychology, and Public Humanities.
A QUALITATIVE ANALYSIS OF NARRATIVES CONTRIBUTED BY OLDER AFRICAN AMERICANS
Authors: Schlundt David , Bonnet Kemberlee R
Published: November 2019

We analyzed 19 interviews of African Americans who came of age during desegregation. We approached the development of the coding system and analysis of coded transcripts using an iterative inductive/deductive approach guided theoretically by the social ecological framework and life course development theory. Major coding categories included time orientation, topics of discussion, emotions, habits and behaviors, family, community, race relations, and history. Analysis of the sorted and coded quotes led to the development of a conceptual framework for understanding how participants portrayed their life trajectories. Individuals’ lives occurred in the context of societal institutions, the larger society, and culture. Life trajectories involve a series of changes in life circumstances and social relationships during which individuals engage with life goals such as making a living, staying healthy, coping with stressors, and maintaining satisfactory interpersonal relationships. Important themes associated with healthy aging included resilience, faith, forgiveness, and family.
AGHE PROGRAM OF MERIT: GERONTOLOGY DEGREE PROGRAMS, MINORS, AND CERTIFICATES
Authors: Mathews Shannon D , Elfenbein Pamela
Published: November 2019

The Executive Committee of the Academy for Gerontology in Higher Education (AGHE), formerly known as the Association for Gerontology in Higher Education, approved a proposal to establish and implement a voluntary program of evaluation known as the Program of Merit (POM). The POM designation provides gerontology programs with an AGHE “stamp of approval,” which can be used to verify program quality to administrators, to lobby for additional resources to maintain a quality program, to market the program, and to recruit prospective students into the program. In 2014, AGHE Gerontology Competencies for Undergraduate and Graduate Education© were established and have been integrated into this process. This session will outline the Program of Merit process and present the opportunities for gerontology program leaders to advance gerontology education.
PROGRAM OF MERIT REVIEWS: THE REVIEWERS’ PERSPECTIVE
Authors: Weinreich Donna
Published: November 2019

Each Program of Merit Application goes through a process of review. It is the same regardless if the application is for a gerontology program or a health professions program. In this session, the reviewer perspective will be shared and tips for how to complete an application to provide information in a format that aids the review will be shared.
ASSOCIATIONS OF ADVERSE CHILDHOOD EXPERIENCES WITH DSM-5 DEPRESSIVE DISORDERS AND SUICIDE ATTEMPT IN OLDER ADULTS
Authors: Rhee Taeho Greg , Barry Lisa C , Kuchel George A , Steffens David C , Wilkinson Samuel
Published: November 2019

Adverse childhood experiences (ACEs) may have long-term effects on mental health. Using a life-course perspective, this study examines prevalence of ACEs and the associations of ACEs with depressive disorders and suicide attempt in US older adults. The study sample were those aged 65 and older who participated in the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III (n=5,806 unweighted). ACEs, the key independent variable, were assessed using validated measures and outcome variables included lifetime and past-year major depressive disorder (MDD) and dysthymia using DSM-5 criteria, and lifetime suicide attempt. We estimated national prevalence of ACEs in older adults and used multivariable-adjusted logistic regression analyses to assess the association between ACEs and the outcomes after adjusting for socio-demographics and clinical co-morbidities. Overall, 34.7% of older adults, representative of 14.3 million older adults nationwide, reported some form of ACEs. The most common type was parental psychopathology (20.8%), followed by neglect (14.8%), and physical/psychological abuse (8.4%) (non-mutually exclusive). Having experienced any ACEs was associated with higher odds of having a past-year MDD diagnosis (adjusted odds ratio [aOR]=1.77; 95% confidence intervals [CI]=1.36, 2.29). Similar results were found for other depressive disorders. ACEs were also associated with higher odds of having a lifetime suicide attempt (aOR=4.34; 95% CI=2.64, 7.14). In conclusion, ACEs may expose older adults to an increased risk for mood disorders and suicide attempts, even over long periods of time as seen in this sample. Reducing ACEs is an important public health goal that may yield long-term benefits.
CHRONIC CONDITIONS, FUNCTIONAL LIMITATIONS, AND DEPRESSION IN OLDER ADULTS: ANALYSIS OF A LONGITUDINAL STUDY
Authors: Parajuli Jyotsana , Berish Diane , Jao Ying-Ling
Published: November 2019

Background: Chronic conditions, functional limitations, and depression are highly prevalent in older adults. Evidence suggests the links between chronic conditions, functional limitations, and depressive symptoms separately. However, few studies have considered these three conditions together longitudinally. This study examined the longitudinal relationship between chronic conditions and depressive symptoms and evaluated the mediation effect of functional limitations on the relationship between chronic conditions and depressive symptoms in older adults. Methods: This study analyzed longitudinal data from the Health and Retirement Study collected in 2012 and 2014. Mediation analysis was used to examine the direct and indirect effects of chronic conditions and functional limitations measured at the year 2012 on depressive symptoms measured at the year 2014 controlling for demographics. Results: Results revealed that chronic conditions predicted depressive symptoms. Specifically, one additional chronic condition in 2012 corresponded to an increase of 0.35 in depressive symptoms in 2014 (p<.001). After adding functional limitations as a mediator, the direct effect was reduced to 0.26 and the indirect effect was .088 (p<.001). In other words, functional limitations explained approximately 25% of the direct effect of chronic diseases on depression. Discussion: Findings reveal the longitudinal impact of chronic conditions and functional limitations on depressive symptoms in older adults. Findings help identify the high-risk population of depressive symptoms and intervene early.
DESIGNING A STATE-BASED SOCIAL INSURANCE PROGRAM FOR LONG-TERM SERVICES AND SUPPORTS
Authors: Cohen Marc A , Veghte Benjamin , Tell Eileen J , Bradley Alexandra L
Published: November 2019

The fundamental LTSS financing problem today is the absence of an effective insurance mechanism. To achieve universal coverage, social insurance is required. This report identifies key design questions for states to consider in crafting an LTSS social insurance program, outlines a range of vetted approaches states could adopt, and describes the building blocks and tradeoffs associated with these options. This analysis was developed during a year of deliberations by a Study Panel of 15 experts in LTSS with a variety of perspectives. States must answer two critical first-order questions. First, who is the program seeking to help – only the elderly, or all people with disabilities? Only those who start paying into the program now, or current retirees as well? Second, how will the program be financed – through a payroll tax, an income tax, or some other dedicated revenue source? Additional considerations follow from these two overarching questions.
CAREGIVING ACROSS GENERATIONS AND CULTURES
Authors: Villa Valentine
Published: November 2019

Utilizing data from the California Health Interview Survey (CHIS) 2009, we examine caregiving activities among foreign born and US born Latinos, and US born Non-Hispanic whites ages 18 to 80 who are caring for an adult age 60 or older. Utilizing OLS regression, we first examine the relationship between race, ethnicity, nativity, and age and the amount of caregiving, types of caregiving, and use of long-term care (LTC) services among the population. Next we examine the health, mental health, and economic status of the three caregiver populations. The results find that middle aged and younger foreign born Latinos provide the greatest amount of care and also present with the greatest amount of economic challenges. US born middle- aged Latino caregivers also provide relatively high levels of care and also are more likely than other caregivers to experience health challenges including diabetes, obesity, depression and social isolation.
STROKE
Authors: Serra Monica C
Published: November 2019

Following stroke, the leading cause of disability in the United States, muscle alterations commonly occur. These alterations include gross atrophy and shift in fiber type, particularly in the paretic limb, which have lasting implications on gait ability. We will discuss the current evidence supporting a mechanism for these changes (i.e. physical inactivity, inflammation, oxidative stress, and decreased lower motor neuron activation) and how these factors differ between the paretic and non-paretic limbs. Further, we will discuss how various therapeutic exercise modalities can be used to modify or reverse skeletal muscle abnormalities and alter physical functioning post-stroke.
PARKINSON’S DISEASE
Authors: Hackney Madeleine
Published: November 2019

The risk of Parkinson’s Disease (PD) increases with age as over 90% of individuals are diagnosed after the age of 50. Older individuals with PD face a compounding burden of reduced muscle power, decreased muscular endurance, and weakness related to disease specific processes such as an altered pattern of motor unit activation, rigidity and bradykinesia. Individuals with PD demonstrate a tendency towards type I fiber hypertrophy, and a greater heterogeneity for type II fibers. Despite the disease specific burden of PD, exercise results in improved mobility, balance, and movement initiation. Interventions like resistance training have resulted in strength gains, and other interventions, such as tango dancing may be particularly useful for balance improvements, as the movement involves multi-directional perturbations and whole-body coordination. Here, we will discuss the use of novel exercise interventions, such as resistance training and tango, to improve the muscle and mobility function of older adults with PD.
DIABETES MELLITUS
Authors: Prior Steven J
Published: November 2019

Nearly three-fourths of adults over 65 year of age are affected by impaired glucose tolerance or type 2 diabetes. Both aging and inactivity contribute to the numerous skeletal muscle changes that occur with insulin resistance and type 2 diabetes. These changes include reduced capillarization that can impaired glucose uptake and substrate delivery, resulting in metabolic abnormalities and metabolic inflexibility. These changes may ultimately contribute to reduced delivery of oxygen, nutrients, and hormones to the muscles leading to impairments in metabolism, muscle mass, and function. We will discuss current research on the role of vascular impairments and reduced skeletal muscle capillarization in the development of impaired muscle metabolism, fitness and function. Finally, we will discuss how exercise training may reverse these declines.
EMOTIONS AND WELL-BEING IN LATER LIFE CHILDHOOD HAPPINESS, SELF-MASTERY, AND LATER-LIFE HEALTH
Authors: Lee Haena , Schafer Markus H
Published: November 2019

Considerable work has documented that positive childhood memories, especially childhood happiness, predict better health among young adults. However, it is not known whether growing up happy has enduring health consequences across the life course. Using two waves of the National Social Life, Health and Aging Project (2010-2011 and 2015-2016; N = 1,937), we investigate the relationship between childhood happiness and changes in physical, mental, and biological functioning in later life. Childhood happiness was retrospectively assessed using a question: “When I was growing up, my family life was always happy.” Self-rated health, depressive symptoms, and frailty over a five-year period were examined to reflect changes in functional status. Childhood SES and living arrangement were examined to assess childhood sociodemographic background. Educational attainment, family support and strain, and self-mastery were considered as potential mediators. We find that, among other childhood factors, childhood happiness significantly predicts older adult health. Specifically, childhood happiness was associated with better self-rated health and lower depressive symptoms at follow-up, net of baseline health conditions. We did not find a relationship between frailty and childhood happiness. Unlike prior work, we found no significant effect of childhood SES on the measured outcomes. Associations between childhood happiness and self-rated health and depression were mediated by psychosocial resources including self-mastery and perceived social support from family members. This implies that growing up in nurturing, cherished family environment has the potential to cultivate social relationships and build resilience which could provide an important pathway to successful aging.
RETIREMENT FINANCIAL LITERACY LEVELS AMONG JAMAICANS
Authors: Donaldson-Davis Kayon
Published: November 2019

Although the general literacy rate (ability to read and write at a 6th-grade level or higher) of Jamaicans is 89%, the number of people who are adequately prepared financially is not comparable. Dissertation research findings revealed that 52% (n=203) of respondents had not received any financial education. Approximately 71% of respondents who reported high levels of financial distress and low financial well-being, had not received financial information about retirement planning. Results from the 2012 Social Status on the Elderly in Jamaica showed that 60.5% (n=1,716) of respondents had no pension and of those receiving money from abroad, most (75.0%, n=813) indicated that they received it only occasionally. Those who were self-employed, women and rural residents were most likely not to have a pension. This paper describes financial literacy levels among Jamaicans using two separate data sets – the 2012 Social Status on the Elderly and the 2018 Financial Preparation Study.
PILOTING THE MONEY SMART FINANCIAL LITERACY PROGRAM IN JAMAICA
Authors: Willie-Tyndale Douladel
Published: November 2019

This paper describes the piloting of a culturally modified version of the FDIC Money Smart Peer-to-Peer Program. The pilot study examined the use of Mentorship Teams comprised of two persons one (60 years and over) and another (30 - 59 years) who collectively provided mentorship and financial education to four working-age adults. The pilot was designed with four (4) phases: Phase 1 included recruitment and training of Mentors, Phase 2 the assignment of Mentors and Mentees, Phase 3 application of the intervention, and Phase 4 the evaluation of outcomes. This paper will review the design and recruitment processes, modifications made to the existing Money Smart Peer-to-Peer Program for cultural sensitivity and financial system factors, implementation challenges (including barriers and facilitators) and lessons derived from initiation and program implementation.
UTILIZATION TRENDS OF NEWLY APPROVED GLUCOSE-LOWERING DRUGS FOR TYPE 2 DIABETES
Authors: Dave Chintan , Kim Dae , Patorno Elisabetta
Published: November 2019

Using Medicare fee-for-service data from 2013-2015, we identified 3.2 million patients per year (mean [SD] age, 74.7 years [standard deviation, 7.2]) who were treated with glucose-lowering drugs for type 2 diabetes. Between 2013 and 2015, the proportion of patients treated with sulfonylureas declined from 27.4% to 25.1%; those using DPP4is (11.5% to 12.0%) and GLP1-RAs (1.8% to 2.4%) remained unchanged; those using SGLT2is increased from 0.2% to 1.9%. In the subgroup of patients initiating a glucose-lowering drug without prior use of the same class agent, the proportion of patients starting sulfonylureas (18.7% to 17.2% of initiators), DPP4is (16.0% to 15.0% of initiators), and GLP1-RAs (3.4% to 4.2% of initiators) changed little between 2013 and 2015, while those starting SGLT2is increased from 0.7% to 6.5% of initiators. In the Medicare population, we observed a persistently high use of sulfonylureas and a rapid uptake of SGLT2is among the newer classes.
COLLECTING RESIDENT DATA FROM RESIDENTIAL CARE COMMUNITIES USING MAIL QUESTIONNAIRES: A NEW APPROACH
Authors: Tunalilar Ozcan , Carder Paula C , Dys Sarah , Elliott Sheryl
Published: November 2019

Researchers who collect resident-level data from RCCs face several challenges. Conducting face-to-face, on-site interviews with administrators is costly and presents scheduling difficulties. Contacting administrators by telephone requires multiple attempts. Even when they are reached, they have limited time and might not share resident-level data. To overcome these difficulties, the current survey of Oregon RCCs combines a mail questionnaire with a self-administered sampling tool that allowed communities to select a random sample of their residents (two from each community). Pilot interviews with administrators indicated they were able to select a random sample of their residents easily, quickly, and accurately using this method. The feasibility and validity of this method were further tested by comparing results to community-level aggregate data collected using traditional mail questionnaires from RCCs (n=392). The similarities and differences between resident- and community-level data are discussed within the context of sampling design and mode of data collection from RCCs.
LESSONS LEARNED FROM QUALITY IMPROVEMENT DATA COLLECTION FROM ASSISTED LIVING PROVIDERS
Authors: Schwartz Lindsay
Published: November 2019

In 2012, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) launched the Quality Initiative, which was focused on four measurable goals: reduce hospital readmissions; reduce off-label use of antipsychotics; improve staff stability; and improve customer satisfaction. With this initiative, assisted living providers required measures to track their progress. In 2015, to enable benchmarking and comprehensive tracking, these measures were added to LTC Trend Tracker, AHCA/NCAL’s online data collection portal. There have been challenges to getting providers to voluntarily submit data, including time, concerns about privacy, understanding the measures, and learning to use LTC Trend Tracker. We have worked consistently with providers to understand challenges of data submission and assist with lessening the burden such as enabling vendors to upload data. To increase participation, we have learned that measures should be easily understood; measures should be specific and important to providers and consumers; and education and training are important.
TAPPING NATURAL NETWORKS TO ADDRESS DEMENTIA IN A LATINO COMMUNITY
Authors: Gelman Caroline , Giunta Nancy
Published: November 2019

The need for health education regarding Alzheimer’s disease and related dementias (ADRD), specifically designed for Latinos, has been well-documented. Many Latino older adults and their families delay seeking formal help for ADRD symptoms due to lack of information and access to culturally sensitive services. This paper presents preliminary findings of community-based participatory research to develop El Barrio SHARE, a culturally-tailored intervention tapping natural helpers (NHs) to address a need identified by community members in East Harlem, NY. It trains people who often interact with elders in the course of their work (e.g., hairdressers, bodega clerks), and are well-positioned to observe and detect ADRD-related problems and potentially link elders to relevant services. Findings from a process evaluation developing the 10-module NH training suggest that (a) participants seek information that debunks myths and stigma surrounding ADRD, and (b) the need for culturally-tailored, participant-centered interventions in marginalized communities is critical.
SOCIOCULTURAL VARIABILITY IN SELF-REPORTED COGNITIVE IMPAIRMENT AMONG OLDER LATINOS IN THE UNITED STATES
Authors: Garcia Marc A , Warner David F , Garcia Catherine
Published: November 2019

Cognitive impairment is a major public health concern in the United States. Research indicates cognitive impairment is higher for older U.S. Latinos than non-Latino whites, due in part to Latinos having longer life expectancy, lower educational attainment, and a higher prevalence of diabetes and cardiovascular disease. Prior studies on cognition have largely examined “Latinos” as a monolithic group. However, Latinos are heterogeneous in composition with unique socio-cultural characteristics based on nativity and country of origin. Accordingly, we used data from the 1997-2017 National Health Interview Survey (NHIS) to document age-specific trends in in self-reported cognitive impairment among US-born Mexican, foreign-born Mexican, island-born Puerto Rican, foreign-born Cuban, and non-Latino white adults aged 60 and older. Given the repeated cross-sectional nature of these data, we estimated hierarchical age period–cohort (HAPC) cross-classified random-effects model (CCREM) to isolate age trends in self-reported cognitive impairment across Latino subgroups and non-Latino whites. Results indicate significant heterogeneity among Latino subgroups, with island-born Puerto Ricans exhibiting the highest rates of cognitive impairment and foreign-born Cubans the lowest. Conversely, US-born and foreign-born Mexicans exhibited rates in between these two. All Latino subgroups statistically differed from non-Latino whites. Socio-demographic controls account for approximately 33%-45% of the disparity, but fully account for foreign-born Cubans and non-Latino whites differences. These findings indicate the importance of considering nativity and country of origin when assessing cognitive outcomes among older Latinos. Understanding minority and immigrant differences in cognitive impairment has implications for the development and implementation of culture-appropriate programs to promote healthy brain aging.