bluuebunny/crossref_metadata_2025 huggingface dataset:
Adapting an Advance Care Planning Website for Persons With Dementia in Nursing Homes During the COVID-19 Pandemic
Authors: Morgan Brianna , Behrens Liza , Talwar Sonia , Summerhayes Emily , Ersek Mary , Hodgson Nancy
Published: December 2021

We partnered with a national for-profit nursing home (NH) organization to test the acceptability and use of an advance care planning (ACP) website for people living with dementia using a randomized controlled trial (RCT) design. Concurrently, the COVID-19 pandemic disproportionately impacted NHs and halted in-person research. We will present challenges, opportunities, and adaptations in site engagement, recruitment, and data collection. Initially, NHs were overwhelmed by pandemic efforts and research staff were unable to enter sites. We capitalized on time and available resources by beta-testing the website in a comparable population and designing surveys to elicit COVID-19’s impact on ACP. Once able, NH staff took on recruitment and data collection efforts intended for research staff. We supported NHs by pivoting to remote data collection, providing technology on site, and offering flexible communication. Flexibility is key in supporting site engagement, recruitment, and data collection and has implications for designing pragmatic RCTs.
Conducting a Cluster RCT on Medication Safety in Nursing Units Overtaxed by the COVID-19 Pandemic
Authors: Nuckols Teryl , Seferian Ed , Coleman Bernice , Berdahl Carl , Cohen Tara , Henreid Andrew
Published: December 2021

Medication errors continue to harm many hospitalized patients. In other high-risk industries, voluntary incident reporting is widely used to improve safety. Reporting is widely used in hospitals, but not as effectively. This AHRQ-funded cluster RCT will assess the effects of the SAFE Loop, which includes five enhancements in incident reporting implemented on hospital nursing units. Analyses will compare changes in nurses’ attitudes toward reporting, event reporting rates, report quality, and medication event rates between intervention and control arms. The COVID-19 pandemic has created both obstacles and opportunities. The intervention requires study staff to engage nursing unit directors, attend daily nursing “huddles”, and train overtaxed front-line nurses in a geographic area greatly impacted by COVID-19 surges. This created uncertainty around the best time to start the trial. Conversely, we have collected unique data on the implications of COVID-19 for medication safety while testing our instruments during the trial preparation phase.
Addressing COVID-19 Barriers to Clinical Trial Enrollment and Implementation in the PHARM-DC Study
Authors: Pevnick Joshua , Keller Michelle , Kennelty Korey , Ko Michelle , Murry Logan , Nguyen An , Henreid Andrew , Schnipper Jeffrey
Published: December 2021

Recent hospitalization puts older adults at higher risk of experiencing adverse drug events (ADEs) that are a common cause of hospital readmission. Yet, most ADEs are preventable. The PHARMacist Discharge Care (PHARM-DC) study is a multi-site randomized controlled trial that seeks to evaluate the effect of pharmacist-led peri- and post-discharge interventions on 30-day hospital readmissions among older adults taking ≥10 medications or ≥3 high-risk medications. The PHARM-DC intervention includes pharmacist-led patient counseling, medication reconciliation at discharge, and a follow-up phone call post-discharge. We will highlight study protocol adaptations undertaken during the COVID-19 pandemic to address challenges to enrollment and to minimize risk of COVID-19 exposure for study participants and research personnel. Additionally, we will share insights from focus groups and semi-structured interviews with pharmacist interventionists and pharmacy leaders on barriers and facilitators to implementation due to the pandemic and strategies for future clinical trials to overcome barriers.
IPE in LTC Immersion Experience: Creating a Bridge to Careers in Long-Term Care
Authors: Hebdon Megan Thomas , Wilson Christina , Bernier-Carney Catherine , Telonidis Jacqueline , Chase-Cantarini susan
Published: December 2021

The Utah Geriatric Education Consortium seeks to enhance healthcare provider workforce capacity. The purpose of our interprofessional education (IPE) in Long Term Care (LTC) course is to enhance students’ understanding of team-based care for older adults, presenting avenues for career opportunities. The course was offered via distance learning technology to adapt to the COVID-19 pandemic. Health sciences students (n=55) enrolled in the course and completed pre- and post-course work asynchronously. The course also included a two-hour virtual session in partnership with a LTC interprofessional team with a resident case study and discussion using the 4M’s Framework. We will discuss the a) COVID-19 course adaptations, b) IPE case study using the 4M’s Framework to help students conceptualize older adult care, and c) student pre- and post-course discussion responses demonstrating their prior experience with older adults and course impact on their views about caring for older adults in LTC settings.
The Perks of Doing Housework: Its Impacts on Physical Health, Mental Well-Being, Cognitive Performance, and Survival
Authors: Chu Li , Gong Xianmin , Lay Jennifer , Zhang Fan , Kwok Timothy , Fung Helene
Published: December 2021

Previous research has shown mixed results regarding the effects of doing housework. While some earlier studies have found no association between performing heavy housework and health, other studies have found various benefits of doing housework, including body leanness and lower mortality rate. This study examined the effects of housework on older adults’ survival over a period of 14 years, and investigated the underlying mechanisms. A total of 2,768 older adults in Hong Kong (female: 47.29%; age: 65-98) from a longitudinal survey study were included in the current analyses. Linear regression analysis revealed that doing more housework was significantly associated with surviving more days (β = 45.36, SE = 6.40, p < .001). We then examined whether the association between housework and survival was mediated by physical health, mental health and/or cognitive functioning using a parallel mediation model with multiple mediators. Results showed a significant partial mediating effect of physical health (β = 1.20, SE = .53, p = .003), a marginally significant partial mediating effect of cognitive functioning (β = 1.35, SE = .70, p = .054) and no mediating effect of mental health. All the analyses remained consistent after controlling for sex, education, marital status, subjective social status and living arrangement. These results suggest that doing housework may benefit survival by improving physical and cognitive functioning. Our findings have implications for better understanding factors that influence mortality, developing accessible physical activity interventions for older adults, and supporting aging in place.
Heterogeneity in Vulnerability and Resilience Among Centenarians
Authors: Jopp Daniela , Lampraki Charikleia , Spini Dario
Published: December 2021

Given their exceptional longevity, centenarians have long been considered as examples of successful aging. Yet, with increases in empirical studies, findings suggest that they may show vulnerability and resilience at the same time. This symposium offers a more in-depth perspective on both constructs in centenarians. Zaccaria and colleagues investigated the link between social isolation and loneliness within the Fordham Centenarian Study. Results indicate the existence of four subgroups combining expressions of isolation and loneliness, suggesting different vulnerability patterns in centenarians. Uittenhove and colleagues analyzed patterns of coping strategies in the Second Heidelberg Centenarian Study. Cluster analysis identified two coping profiles, one characterized by a wide coping repertoire including problem-directed and internal strategies, while the other showed low problem-solving. Lampraki and Jopp examined the effects of (lacking) resources and psychological strengths (optimism) on depressive symptoms in the Fordham Centenarian Study. Findings suggest that the effect of resources is mediated by psychological strengths, demonstrating their beneficial value in very old age. Jopp and colleagues report findings from the ongoing SWISS100 Study. Based on telephone interviews conducted during the COVID-19 pandemic, they found that centenarians did not feel vulnerable. While half of the centenarians and their proxies reported no changes in everyday life, the other half experienced substantial challenges due to lack of activities and absence of social contacts due to governmental regulations. In sum, centenarians are vulnerable and resilient at the same time, highlighting the future research needs on its predictors, and the application of this knowledge within the context of crisis.
Loneliness and Social Isolation Among Centenarians and Near-Centenarians: Results From the Fordham Centenarian Study
Authors: Zaccaria Daniele , Cavalli Stefano , Masotti Barbara , Jopp Daniela
Published: December 2021

Although loneliness and social isolation are often discussed together, they are mainly examined separately. The few studies examining both concepts simultaneously focus usually on the wider category of older people (65+), with no or little attention to very old age. Our main aim was to investigate loneliness and social isolation in combination among near-centenarians and centenarians. Analyzing data from the Fordham Centenarian Study (N=94; MAge=99.2; range=95-107), we found no or very weak associations between loneliness and social isolation. Combining measures of loneliness (UCLA Loneliness scale) and social isolation (Lubben Scale) we built a typology with four different groups (Not lonely or isolated; Lonely and isolated; Lonely but not isolated; Isolated but not lonely). The factors that most strongly predicted the distribution among these four groups were gender, widowhood, education, and self-rated health. Findings highlight the importance of jointly studying both concepts to better understand social risks in very old age.
Implications of the COVID-19 Pandemic on Adult Day Services
Authors: Marx Katherine , Gitlin Laura , Sadarangani Tina
Published: December 2021

Adult day service (ADS) centers serve an important role in care provision for people living with dementia (PLWD). These programs provide socialization, activities, and access to many therapies for PLWD. Additionally, they offer respite to family caregivers so they can work, run errands, and recharge. In March 2020, like much of the nation, ADS sites across the nation were shut down. This left many PLWD and their caregivers without access to the services they depended on to manage day to day care. It also left many sites without a revenue source to pay employees and maintain buildings. Almost a year later, many states have still not reopened ADS and sites that have reopened have done so with a lower census, increased costs, and the lingering fear of a second closure. Much focus has been on the care of older adults in nursing homes or other residential long-term care settings but the challenges of ADS and the people they serve has been mostly ignored. The purpose of this symposium is to highlight the implications of the COVID-19 pandemic on ADS centers. Holly Dabelko-Schoeny will present data gathered from ADS Centers across Ohio. Lauren Parker, will then present data from ADS sites across the United States that examines the effect of COVID-19 on closures and programming during the closures. Katherine Marx will present the effect of ADS closures on family caregivers of persons living with dementia. Finally, Joseph Gaugler will explore this from a policy perspective and provide recommendations moving forward.
Innovative Population and Intervention Research for LGBTQ+ Older Adults With Dementia in a COVID World
Authors: Emlet Charles , Goldsen Karen Fredriksen
Published: December 2021

This past year, the lives of vulnerable older adults, including those within the older LGBTQ+ community have been disrupted dramatically, as has the research agendas designed to improve their lives. Older people, including LGBTQ+ older adults with dementia, have been placed at increased risk for social isolation and mental health issues during COVID, making viable interventions even more crucial. Additionally, how research is conducted within these communities needed to be adjusted in order to preserve viability. This symposium draws upon data from the National Health Aging and Sexuality/Gender study, the first longitudinal study of LGBTQ+ older adults in the United States, as well as data from Aging with Pride: IDEA (Innovations in Dementia Empowerment and Action), the first randomized controlled trial (RCT) designed to improve quality of life of LGBTQ+ adults living with dementia and their care partners. (1) Kim and Fredriksen Goldsen examine modifiable behavioral and social factors that can improve quality of life among LGBTQ+ older adults with cognitive impairment. (2) Fredriksen Goldsen, Teri, Emlet and colleagues present initial efficacy findings from the IDEA study and how the intervention needed to be altered to be viable in a COVID world. (3) The importance of Motivational Interviewing (MI) as part of a LGBTQ+ sensitive intervention designed for LGBTQ+ older adults with dementia and their care partners is discussed by Petros, Fredriksen Goldsen and Teri. As COVID continues to impact vulnerable populations as well as research and service delivery, identifying new and innovative strategies will become increasingly important.
Pileup of Insufficient Sleep and Day-to-Day Trajectories of Affective and Physical Well-Being
Authors: Lee Soomi
Published: December 2021

This study examined whether and how pileup of insufficient sleep is associated with day-to-day trajectories of affective and physical well-being. Participants from the Midlife in the United States Study (N=1,795) provided diary data for eight days. Pileup of insufficient sleep was operationalized as the number of consecutive nights with <6 hours of sleep. Multilevel models evaluated the linear, quadratic, and cubic effects of pileup of insufficient sleep on daily well-being, adjusting for sociodemographic covariates. Daily negative affect increased and positive affect decreased in curvilinear fashion as the pileup of insufficient sleep increased. For example, daily negative affect increased, but the rate of increase decelerated as the pileup of insufficient sleep increased. In the days most distal to baseline, the rate of increase in negative affect accelerated again. Results were consistent for physical symptoms. Findings suggest that making efforts to break the vicious cycle of insufficient sleep may protect daily well-being.
Associations of Daily Sleep and Stress With Rumination: An Ecological Momentary Assessment and Actigraphy Study
Authors: Vigoureux Taylor , Lee Soomi
Published: December 2021

Unconstructive repetitive thoughts are indicative of rumination about daily experiences. Given that poor sleep is associated with greater reactivity to daily stressors, we examined joint associations of daily sleep and stress with daily rumination. 143 nurses completed 14 days of ecological momentary assessments (EMA; assessments of daily sleep, stress, and rumination) and actigraphy. After controlling for age, sex, education, income, inpatient vs. outpatient nurse, workday, and day vs. night shift, there were significant joint associations of sleep and stress with daily rumination. Daily rumination was lowest when lower (-1SD) stressor severity or stressor frequency were paired with longer (+1SD) EMA or actigraphy sleep duration. Daily rumination was highest when higher stressor frequency was paired with higher actigraphy wake after sleep onset (i.e., poorer sleep quality). Future studies should assess whether rumination about daily experiences is associated with quality of patient care provided by nurses in a hospital setting.
Acceptance of Tele-Technology-Based Mind-Body Classes for Individuals With Mild Cognitive Impairment
Authors: Cohen Kara , Griffiths Patricia , Mitzner Tracy
Published: December 2021

Individuals with Mild Cognitive Impairment (MCI) face many challenges, including cognitive declines and reduced independence which are associated with poor health outcomes. Although there is no cure for MCI, mind-body exercise classes may improve cognitive function and reduce risk of falls (Wayne, Yeh, & Mehta, 2018). However, such classes are often not accessible for individuals with MCI due to lack of transportation, fear of being stigmatized, or inability to find instructors who have experience working with individuals with MCI (Hobson & Middleton, 2008; Rimmer, 2005). Tele-technology, such as video-conferencing software, has the potential to remove barriers to participation by allowing individuals to attend classes from home. The goal of this study was to assess the feasibility of using tele-technology to deliver mind-body classes to individuals with MCI. We evaluated technology acceptance and usability for OneClick.chat, a web-based video-conferencing platform designed for older adults. Stakeholders (4 subject matter experts, 2 individuals with MCI, and 2 care partners) participated in a user study that included questionnaires and a short interview. The technology acceptance data indicate that OneClick.chat was perceived as easy to use. Some individuals expressed privacy and security concerns which could be addressed with additional education and support. These findings have implications for interface design, education, and training for deployment of tele-technology delivered mind-body classes for those with MCI.
Body Mass Index Trajectory and Incident Mild Cognitive Impairment Among African American Older Adults
Authors: Morgan Adrienne Aiken , Capuano Ana , Wilson Robert , Barnes Lisa
Published: December 2021

Previous research suggests a decline in body mass index (BMI) among older adults is associated with negative health outcomes, including mild cognitive impairment (MCI) and incident dementia (Gao et al., 2011). However, few studies have examined BMI longitudinal trajectories and how they change after MCI diagnosis among older African Americans. To characterize trajectories of change in BMI among older African American participants with no cognitive impairment at baseline we used data from the Minority Aging Research Study, MARS (N=408, 76.5% women, mean age = 73.5, mean education = 15.0). We constructed piecewise linear mixed-effects models that included a random intercept and two random slopes. The first slope began at baseline. The second slope began at MCI diagnosis allowing for acceleration in the rate of decline after the diagnosis. The results showed BMI declined over time (B=-0.19, SE=0.04, p<.001), and there was a faster decline after MCI (additional decline, B=-0.18, SE=0.068, p=.007). In a second model controlling for age, higher education was associated with a lower BMI at baseline (B=-0.36, SE=0.092, p<.001) but slower decline before MCI (B=0.02, SE=0.006, p=.001). However, after MCI the decline of participants with higher education was faster (B=-0.06, SE=0.022, p=.003). These results suggest an accelerated decline in BMI following MCI diagnosis, with higher education related to an even faster BMI decline, possibly a consequence of cognitive reserve.
Intermittent Fasting: From Calories to Time Restriction
Authors: de Cabo Rafael
Published: December 2021

Classic implementation of calorie restriction (CR) in laboratory animals increases health and longevity in most model organisms. Traditionally, chronic CR is the reduction of daily energy intake without malnutrition. Recently, paradigms have emerged that recapitulate some of the beneficial aspects of this intervention, avoiding some of its challenges. The length of daily fasting length and periodicity have emerged as potential drivers behind CR’s beneficial health effects. Numerous strategies and eating patterns, including prolonged periods of fasting, have been successfully developed to mimic many of CR’s benefits without its austerity. These new feeding protocols range from short mealtimes designed to interact with our circadian system (daily time-restricted feeding) to more extended fasting regimens known as intermittent fasting. We will discuss the current status of knowledge on different strategies to reap the benefits of CR on metabolic health in rodent models and humans without the rigor of chronic reductions in caloric intake.
Dementia Care Involvement and Training Needs of Social Services Directors in U.S. Nursing Homes
Authors: Kwak Jung , Smith Kevin , Bern-Klug Mercedes
Published: December 2021

This study describes social services directors’ involvement in dementia care in U.S. nursing homes, focusing on interest in and needs for dementia care training. Respondents were 841 social service directors from U.S. nursing homes. We found that 87% of social service departments engaged in cognitive assessment; 59% of social services directors were strongly interested in dementia care training, and 23% would need up to 10 hours of preparation time or would not be able to train staff on dementia-related care. Racial minority background, fewer years of experience in nursing homes, and barriers to staffing predicted strong interest in dementia care training. These findings demonstrate social services directors’ active involvement in dementia care and need for training.
The Integral Role of CBOCs in Rural Healthcare: Promises and Challenges
Authors: Pimentel Camilla , Nearing Kathryn , Kernan Laura , Dryden Eileen , Moo Lauren
Published: December 2021

Community-based outpatient clinics are critical to extending the geographic reach of VA’s healthcare delivery system. Nationwide, 733 CBOCs provide outpatient care to nearly half of the VA’s patient population. The 13 rural CBOCs in the study sample provide outpatient primary care, mental health care, and a limited number of specialty care services. Located 1–3.5 hours away from their closest VA Medical Center, these CBOCs have a wide—sometimes interstate—service catchment area. To effectively serve increasingly older and medically complex patient populations, they rely heavily on partnerships with larger VA Medical Centers and local community providers for inpatient, residential, and additional outpatient services. CBOCs experience myriad staffing challenges, including staff turnover, “access providers” working at multiple CBOCs, and highly variable training in rural health and geriatrics. While some CBOCs have robust telehealth offerings, others cannot currently grow their telehealth capacity owing to constraints in clinic space and provider schedules.
Loneliness, Stress, and Depressive Symptoms Among Older Immigrants: A Moderating Role of Familial Relationships
Authors: Jang Heejung
Published: December 2021

Objectives: Immigration is a stressful life event, and immigrants commonly experience loneliness, a risk factor for depression. However, little is known about how and whether older immigrants’ perceived stress exposure/appraisals mediate the association between loneliness and depressive symptoms. Further, this study explores whether familial relationships moderate the indirect or direct effects of the mediation models. Method: This study uses the 2012 Health and Retirement Study from a sample of 719 immigrants age 57 and older. A series of moderated mediation analyses were conducted across the total number of stress exposure and eight stress appraisal domains. Results: The findings indicate that the total number of stress exposure and five domains of stress appraisals (health problems in self, physical/emotional problems in spouse/child, financial strain, housing problems, and close relationships in others) mediate the association between loneliness and depressive symptoms. In addition, the perceived negative strain from family moderated the mediating effect of health problems and housing problems in the relationship between loneliness and depressive symptoms. Discussion: This study suggests that negative relationships with family may increase upsetting in stress appraisals on health and housing problems, which turn in increased depressive symptoms for lonely older immigrants. Practitioners need to assess older immigrants’ stressors and family relationships to understand their loneliness and depressive symptoms.
Cultural Humility: The Bias Checker
Authors: Moore-Bembry Natalie
Published: December 2021

Historically we have been taught to understand and embrace cultural competency, however, this focus has often led to a superficial understanding of others and seldom required one to better understand themselves. Cultural humility is based on one’s ability to engage in individual accountability and institutional accountability. Individual accountability is based on critical self-reflection and critique, lifelong learning, and the challenging of power imbalances. Institutional accountability requires one to challenge structural power. This session will: (1) explore ways to engage in critical self-reflection and critique; (2) describe how values and beliefs impact the interactions of our personal and professional lives; and (3) strategize ways to collectively model and practice in cultural humility in one’s personal and professional life.
The Study of Muscle, Mobility, and Aging (SOMMA): An Overview
Authors: Cummings Steve , Cawthon Peggy , Hepple Russell
Published: December 2021

SOMMA is an NIA-funded cohort study to identify biological determinants of mobility and fitness. The overall aim of SOMMA is to use biopsies, novel biomarkers, advanced imaging, and intensive physical and cognitive assessments to elucidate the biological processes that contribute to changes in mobility and physical fitness with aging. SOMMA will recruit 875 people age 70+ (of whom about 200 have been enrolled.) We take biopsies of the vastus lateralis muscle to quantify mitochondrial content and function of the electron transport chain. We use 31PMR spectroscopy to quantify mitochondrial capacity to generate ATP in quadriceps muscle (ATPmax). We will quantify other biological properties in biopsies including denervation, autophagy and accumulated biochemical damage and use gene expression to discover pathways that contribute to mobility and fitness. SOMMA uses MR for quadriceps volume and D3Cr dilution for total skeletal muscle mass, cardiopulmonary exercise testing to measure fitness (VO2 peak). We are also making many other intensive assessments of physical and cognitive function. Mobility endpoints include baseline and three year change in 400 m and 4 meter gait speed and fitness. SOMMA is building a large biobank of muscle, adipose blood, and urine specimens that will be available for ancillary studies. In this Symposium, we will present results from analyses of associations between muscle mitochondrial function and strength, muscle mass, cognitive performance, gait speed, and fitness. The symposium will also preview opportunities for collaborations and ancillary studies with SOMMA.
Associations of Body Composition and Mitochondrial Function in Older Adults
Authors: Cawthon Peggy , Coen Paul , Goodpaster Bret , Hepple Russell , Kritchevsky Stephen , Newman Anne , Cummings Steve
Published: December 2021

SOMMA assessed body composition by whole body magnetic resonance imaging (MRI) scans analyzed by AMRA (fat-to-weight ratio, mean: 57% ± 0.1; thigh muscle volume, mean: 8.9L ± 2.4; weight-to-muscle volume ratio, mean: 9.0 kg/L ± 1.6). Deuterated creatine dilution (D3Cr muscle mass, mean: 21.8kg ± 6.8) was used to measure muscle mass. Mitochondrial function was measured in fresh muscle tissue by respirometry (maximum OXPHOS and maximum ETS) and non-invasively by 31PMRS (ATPmax). Maximum OXPHOS and maximum ETS capacity were positively correlated with thigh muscle volume (r=0.42 and 0.44, respectively; p<.001) and D3Cr muscle mass (r=0.37 and 0.33, respectively; p<.001) and negatively correlated with fat-to-weight ratio (r=-0.36 and 0.26, respectively; p<.001) and weight-to-muscle volume ratio (r=-0.42 and -0.37, respectively; p<.001). Stratified analyses suggest that some associations may differ by sex. Associations between ATPmax and these body composition measures were more modest.
Engaging Isolated Hispanic and Latino Older Adult Caregivers in Remote Behavioral Interventions
Authors: Silva Caroline
Published: December 2021

Recruiting Hispanic/Latino older adults for behavioral clinical trials is challenging, particularly those who are isolated. This presentation describes the recruitment process and feasibility/acceptability outcomes for the adaptation of two interventions (Connect for Caregivers and Engage Coaching) aimed at improving the social relationships and supports of older adult Hispanic/Latino caregivers of a family member with dementia. We compare online and community-based recruitment methods for English and Spanish-speaking Hispanic/Latino caregivers across the United States and present recruitment challenges during COVID-19. Of eligible participants, 82% were identified via online (e.g., research registry) and 18% via community-based (including snowball sampling) methods. Of participants recruited via online methods, 22% were Spanish-speaking, versus 100% of those recruited by community-based methods. Overall, 91% of all eligible/interested participants enrolled in at least one of the interventions. We discuss further the feasibility/acceptability of study procedures and the interventions, as the study was conducted remotely (via phone/Zoom) due to COVID-19.
Voices in Motion: How Social Singing Can Facilitate Psychological Health for Persons With Dementia and Caregivers
Authors: MacDonald Stuart , Sheets Debra , Allison Theresa
Published: December 2021

Dementia is a global public health priority that exerts significant impact on individuals, families, healthcare systems, and society. Worldwide, over 35 million individuals are estimated to have some subtype of dementia – a projection expected to triple by 2050. Despite progress, a cure for dementia remains elusive, and approved pharmacotherapies are selectively effective for but a limited duration. Increasingly, arts-based interventions for persons with dementia (PwD) and their caregivers are being recognized as inexpensive, non-invasive, and non-pharmacological lifestyle interventions with the potential to improve psychological function as well as reduce healthcare costs. This symposium overviews the Voices in Motion (ViM) study – a sociocognitive intervention exploring the impact of participation in an intergenerational choir on psychological, social, and cognitive function for PwD and their caregivers (n=32 dyads). PwD, caregivers, and local high school students sang in a professionally-conducted choir for as many as three seasons (each ~12 weeks long), spanning up to 18 months of follow-up. Employing an intensive repeated measures design, psychosocial, physiological, and cognitive function was measured every four to six weeks (up to 9 total assessments). The symposium papers provide a representative overview of the broad impact that this novel, non-pharmacological lifestyle intervention can offer vis-à-vis mitigating dementia symptoms and facilitating the psychological health of caregivers. Choir participation has important and significant impacts on psychosocial well-being and quality of life. Discussion focuses on policy implications and the need for community-based programs that reflect a social model for dementia and support living well through engaging and meaningful activities.
Loneliness, Social Contact, and Health Among Older Adults During the COVID-19 Pandemic
Authors: Choun Soyoung , Aldwin Carolyn , Lee Dylan
Published: December 2021

The COVID-19 pandemic is a challenging situation for many older adults at elevated risk for mortality. Social distancing and lockdown to prevent contagion may result in social isolation and feelings of loneliness, which can have adverse effects on health. We examined how depressive symptoms were associated with between-person differences and within-person variations in loneliness, social contacts, and daily physical problems during 8 weeks. We sampled 247 older adults (Mage = 71.1, SD = 7.3, range = 51 - 95), who participated at micro-longitudinal online surveys (baseline and 7 weekly follow-ups) from April 28 to June 23. Multilevel modeling analysis controlling age, gender, marital status, and education showed that depressive symptoms were significantly decreased during 8 weeks. Further, depressive symptoms were positively coupled with both loneliness and physical problems for both the within-and between-person levels. Increase in social contact was related to decreases in depressive symptoms only at the between-person level.
Self-Transcendent Wisdom Mediates the Association Between Spirituality and Well-Being in Six Nations
Authors: Ardelt Monika , Kim Juensung , Ferrari Michel
Published: December 2021

Distraught individuals sometimes turn to religion for solace, particularly in old age, so spirituality is not necessarily positively related to well-being. However, spirituality might lead to greater well-being if it promotes self-transcendent wisdom. Using a sample of 307 respondents from six nations (USA, Canada, Serbia, Ukraine, Iran, and China), ranging in age from 59 to 99 years (M=73.00, SD=8.13), this study tested the generalizability of the hypothesized mediated pathway. Results showed only weak correlations between spirituality and well-being measures in the whole sample. Yet, as predicted, spirituality, mediated by self-transcendent wisdom, was indirectly related to greater well-being in all six nations, despite significant differences by nation in variable means. Spirituality had additional direct positive effects on life satisfaction in Canada, Iran, and China and on general well-being in Iran and China. These findings suggest that spirituality likely results in greater well-being when it transcends egocentric concerns.
When the Professional Turns Personal: Healthcare Providers and Their Own Advance Care Planning During the Pandemic
Authors: Carpenter Brian
Published: December 2021

As healthcare professionals counseled patients and care partners during the pandemic about treatment options, clinical probabilities, and preparations for death, they had opportunities to reflect on how they themselves would want to be treated if they fell ill. We conducted a survey with healthcare professionals who were caring for patients during the pandemic and asked their work had affected their own advance care planning. Based on their clinical observations, 28% revised their personal interest in life-prolonging medical interventions. Substantial proportions had initiated conversations with partners (45%), parents (46%), and their primary care physician (29%) about their medical preferences. Similarly high percentages had encouraged family members and friends to update or complete their advance care plans, and 26% intended to initiate planning in the near future. Interest in advance care planning is high among healthcare professionals, who may benefit from tailored resources that acknowledge their clinical experience.
Advance Care Planning in the Time of COVID: Real-World Case Discussions
Authors: Frechman Erica , Buck Harleah
Published: December 2021

COVID has accelerated the science and practice of palliative care while creating a sense of urgency in advance care planning (ACP). Past palliative care principles and practices have been stressed to the breaking point, causing the need for new ACP approaches to elicit patient-and-family goals/values/preferences. In this presentation, two cases will be used to discuss pragmatic implications and real-world implementation strategies in the trenches of the major health care system disruptor of this generation. We will discuss access to documentation, immediacy and complexity of the decision-making process, provider impacts, role of the family, and even an upside to this crisis. This will include questions of ethics and equity. The first case involves an older man whose family disregarded his wishes, while the second case discusses the pitfalls and pearls when family cannot visit. These two cases highlight COVID’s impact on ACP and cause us to re-think its process and delivery.
Ageist Policies That Favor Older People: What Do Older People Think?
Authors: Jonson Hakan , Harnett Tove
Published: December 2021

Policies on supportive services have frequently used chronological age to determine rights and needs of people within the adult population. Such policies have been described as ageist, but could also be regarded as favoring older people in cases where chronological age is used as a proxy for needs. In Sweden, municipalities have recently been allowed to grant people above a certain age some home care services without individual needs testing, and several political parties have suggested that a nursing home guarantee at the age of 85 should be introduced. The aim of the study that this presentation reports on was to investigate views among older people on age as an organizing principle for distributing eldercare services. Data was collected through an online surveys to members of pensioners’ organisations (N=1540). Respondents were asked about their views on a number of age-related policies that are used or proposed as part of the eldercare system in Sweden. The analysis revealed a general support for the use of chronological age as a proxy for needs. This suggest that respondents used an interest groups perspective and supported stereotypical arrangements that favored older people. When free-text answers were included in the analysis, it became evident that the use of chronological age was not related to the problem of ageism. In the presentation we will discuss the potential gap between anti-ageism and views of older people and what a framework on ageism brings into the moral economy of eldercare.
The Othering of Older People in Disability Policies
Authors: Jonson Hakan
Published: December 2021

Disability policies in Sweden rest on the idea that all humans have equal value and a goal of policies has been to enable persons with disabilities to be able to live like other members of society, but older people do not seem to be included as part of this goal. The presentation concerns the Swedish support system’s legal discourse, and investigates the rationale for excluding people over the age of 65 from services that younger people with disabilities may obtain. Data consists of government texts and court decisions under the Severe Disability Act about services for people over the age of 65. It was found that little in the legal discourse concerns the needs and rights of older people, and the general belief is that the Severe Disability Act is primarily intended for children, young people, and adults of working age. The legal discourse contained a type of “residual ageism” that was justified through the indirect construction of older people as different. Othering of older people was present in assumptions about differences in categorizations (people with disabilities vs older people with support needs), needs (active age vs not active age), and comparisons (with people without disabilities of the same age vs with others receiving eldercare). The presentation outlines potential changes of these policies.
Resources Within: Between Resident Ties and Links to Health Among Older Subsidized Housing Residents
Authors: Webster Noah
Published: December 2021

Increasing evidence points to the importance of non-family ties in promoting health among older adults. Less is known though about these ties within the context of subsidized housing. In this study we examine prevalence of social ties between residents and examine links to health. Data were collected through interviews conducted with 39 residents age 62 and older living in a subsidized housing community in Southeast Michigan. Residents reported knowing on average 10 (SD=6.5) other residents, and nominated three (SD=4.2) residents into their close social networks. Residents who reported getting out of the community less often and those with one or more health limitations nominated significantly more residents into their network. Also, getting out of one’s apartment more often was associated with knowing more residents in the community. Findings highlight between resident ties may serve as an important resource for those geographically restricted and may be useful to integrate into interventions.
Social Isolation and Healthcare Utilization Among Older Adults Living in Subsidized Housing
Authors: Cudjoe Thomas , Prichett Laura , Runge Katherine , Andes Laura , Latkin Carl , Boyd Cynthia
Published: December 2021

Older adults living in subsidized housing are often at high risk for having multiple chronic conditions and nursing home placement. Previous studies in this population have not examined the relationship between social isolation and healthcare utilization. We examine this using Lubben Social Network Scale-6 and self-reported healthcare utilization. Utilizing data from a multi-state non-profit subsidized housing provider, we performed descriptive and multivariate analyses on a sample of older adults (N=3,822). Overall, 95 % reported having a checkup within the last 12 months and an average of less than one emergency room visits (mean= 0.58) or hospitalizations (mean= 0.34). In adjusted models, Socially isolated older adults had lower levels of routine checkup (OR=0.50, CI 0.36,0.70) and higher levels of hospitalizations (IRR=1.30, CI 1.10,1.54) compared to older adults who were not socially isolated. Efforts to address healthcare utilization should identify social isolation and explore strategies to promote social connectedness to improve health.
Kathryn Hyer's Lasting Legacy in Gerontology Education and Aging Policy Research
Authors: Dobbs Debra
Published: December 2021

Kathy Hyer, our dear friend, colleague, former Gerontological Society of America President and Professor and Director of the Florida Policy Exchange Center on Aging, University of South Florida posthumously has been awarded the Clark Tibbett's Award for her achievements in the advancement of the field of gerontological education in higher education. This lecture will reflect on some of her decades of accomplishments including her dedication to AGHE's mission to train and educate students in gerontology. Her greatest achievement is in the area of training and education of long-term care administration and aging studies undergraduate students to be nursing home and assisted living administrators. This lecture will also highlight several initiatives of Dr. Hyer's that involved undergraduate, graduate students, and junior faculty who she mentored including the Geriatric Workforce Enhancement Project, NIA SAFEHAVEN and COVID research on disasters, the Dementia Training Academy, Age Friendly Initiatives both nationally and internationally and student mentorship for graduate assistantships through the USF Center for End of Life Care.
Common Data Elements for Workforce and Staffing Measurements in Long-Term Care
Authors: Chu Charlene , Zúñiga Franziska , Corazzini Kirsten
Published: December 2021

The workforce in residential long-term care (LTC) is key in providing high-quality, person-centered care for residents. However, low staffing and adverse staffing outcomes such as turnover or job dissatisfaction hinder the provision of high-quality care. International research can add valuable insights for policy and practice by learning from different settings and cultures. The initiative “To Harmonize Research In long-term care liVing Environments (WE-THRIVE)”, is led by an international group of LTC researchers to identify common data elements (CDE) for cross-comparative research that support older adults thriving in LTC. In this symposium, we will present an overview of the WE-THRIVE initiative with a specific focus on CDEs and measurement. The first talk will provide the context for the WE-THRIVE initiative, and discuss the collaborative and iterative processes required to develop the initial CDEs in the area of workforce and staffing. In the second talk, we will discuss which staff should be “in the house” to meet the needs of residents during and after a pandemic, and what type of workforce data system should be available to ensure the best quality outcomes for residents and carers. Next, current issues in the measurement of staffing in LTC based on a review of reviews of staffing’s relationship to quality of care will be discussed. Finally, we extend the debate to consider theoretical and empirical explanations for the relationship between staffing and quality in LTC and the promotion of person-centred care outcomes.
COVID-19 Vaccine Intentions Within the Medicare Population
Authors: Swenson Tami
Published: December 2021

COVID-19 vaccine intentions by older adults reflect individual care seeking behavior and medical system trust and broader systemic cultural shifts related to vaccine hesitancy. The purpose of this paper is to examine the October wave of the rapid response panel survey fielded by the Centers for Medicare and Medicaid Services (CMS) to track and monitor the effects of the pandemic within the Medicare population. With a sample size of 9686 Medicare beneficiaries, the calculated statistics use replicate weights to adjust for the complex survey sample design and balanced repeated replication using Fay’s adjustment of 0.3 for variance estimation. When asked about the likelihood of getting the COVID-19 vaccine if one were available, 58 percent of the Medicare population definitely or probably intended to get the vaccine, 16 percent expressed they would probably or definitely not, and 26 percent were not sure. Black or Hispanic Medicare beneficiaries were significantly more likely to express they would probably not or definitely not get the vaccine than White, non-Hispanic Medicare beneficiaries. Distrust of what government says about the vaccine and concern about the safety or side effects were the most common reasons for not intending to get the vaccine. Those expressing intentions to not get the COVID-19 vaccine in the October 2020 survey wave were more likely to lack access to the internet, which is a potential systematic barrier if they changed their intentions following the FDA approvals of the COVID-19 vaccines and more information became available in the winter and spring of 2021.
Immigration-Related Factors and Depression Help-Seeking Among Older Chinese Americans
Authors: Kong Dexia , Guo Man , Simon Melissa , Dong XinQi
Published: December 2021

Asian Americans have the lowest mental health service utilization rate among all racial/ethnic groups. One important yet understudied aspect of this group’s mental health service use is its potential associations with immigration-related factors such as migration reasons, years in U.S., acculturation, and ethnic enclave residence. Using data from the Population-based Study of Chinese Elderly in Chicago (collected 2013-2015, N=3,123), this study investigates whether and how immigration-related factors shape mental health service utilization. Four categories of help-seeking behaviors for depressive symptoms were examined, including not seeking help (23.5%), seeking help from informal source(s) only (40%), seeking help from both informal and formal sources (28.7%), and seeking help from formal source(s) only (8.8%). Results of logistic regressions showed that U.S. Chinese older adults who migrated for family reasons were less likely to seek help from informal sources only than those who migrated for other reasons [Odds Ratio (OR)=0.64, 95% Confidence Interval (CI)=0.42-0.99). Less acculturated older immigrants (OR = 0.88, 95% CI = 0.79-0.97) and those who lived in Chinatown (OR = 2.34, 95% CI = 1.21-4.52) were more likely to seek help from formal sources only (relative to not seeking any help). Our findings showed that majority of the older Chinese Americans with depressive symptoms either did not seek help or sought help from informal sources only. Their help-seeking behaviors were shaped by their migration and acculturation experiences. Leveraging informal support networks and ethnicity-specific resources in Chinatown represent a culturally appropriate approach to facilitate mental health help-seeking among U.S. Chinese older adults.