bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERGENERATIONAL FINANCIAL TRANSFER AND FAMILY STRUCTURE IN INDIA: EVIDENCE FROM LASI, 2017–2018
Authors: Nagargoje Varsha , R Dilip T , James K S
Published: December 2023

Understanding patterns of intergenerational support is critical within the context of demographic change, such as changing family structures and population aging. Existing research has analyzed the proportion of direct financial transfers between older parents and adult children and vice-versa. This study also examined the association between family structure and the direction of financial transfer in India. From the first wave of the Longitudinal Ageing Study in India, samples of 30,147 older adults aged 60+ years whose children alive were included. Bivariate analysis and logistic regression methods opted to fulfill the study objectives. Findings showed that the proportion of children-to-parent transfers (13.1%) was triple that of parents-to-children transfers (4.4%). No rural-urban disparity existed in the overall proportion of parents-to-children financial transfers. Conversely, children-to-parent financial transfers have shown marked variation among rural and urban parts of India. Older adults living alone received the most financial support from their children. While controlling sociodemographic and economic characteristics, family characteristics like having children up to eight were significantly associated with higher parents-to-children financial transfers. However, having more than eight children did not show significant effect. Having more children significantly increases the likelihood of financial transfer from children to older parents. Older adults living alone were more likely to receive financial support from children but were less likely to provide it. Filial piety is deeply rooted in India and is reflected through the bond of reciprocity among younger generations to provide financial support to their older parents, which helps older people to maintain better economic well-being.
ETHNIC DIFFERENCES IN DIET QUALITY AND COGNITION AMONG OLDER ADULTS
Authors: Arellanes Isabella , Crimmins Eileen , Ailshire Jennifer , Kim Jung Ki
Published: December 2023

Research indicates an association between diet quality and cognitive outcomes. However, the association across ethnicities is not well understood. This study identifies differences in diet quality using the Healthy Eating Index (HEI-2015) score by ethnicity and its relationship to cognitive outcomes within ethnic groups. The sample includes 6,845 older adults from the 2014 wave of the Health and Retirement Study and nutrition data from the 2013 supplemental Health Care and Nutrition Survey. Cognitive functioning was measured based on a scale ranging from 0-27. Overall, 11% of respondents had a good quality diet, indicated by a HEI-2015 score of 81-100. Diet quality was significantly better among Hispanics than either non-Hispanic Blacks or Whites (p< 0.001 in both comparisons). Diet quality was not significantly different between Whites and Blacks (p=0.82). In a regression model controlling for age, gender, and marital status, the association between diet quality and better cognition was significant among Whites (p< 0.001) and Blacks (p< 0.05), but not significant among Hispanics (p=0.11). A one unit increase in the Healthy Eating Index is associated with a 0.05 increase in cognitive score among Whites and a 0.03 increase among Blacks. These findings suggest significant differences in diet quality across ethnicities that may impact cognition among older adults; however, the impact may differ by ethnicity.
INCONSISTENT ESTIMATES OF POOR HEALTH BETWEEN EUROPEAN SURVEYS—A MATTER OF SURVEY DESIGN?
Authors: Kelfve Susanne , Enroth Linda
Published: December 2023

Several studies have reported about inconsistencies in survey estimates on health, both within and between countries. One potential source of inconsistency in results from population surveys is survey quality. In particular, the prevalence of poor health among older people is sensitive for survey design factors and the inclusion of older people with poor health. We aimed to explore the association between survey design factors and within-country differences (between EU-SILC and SHARE) in estimated prevalence of poor health (long-term illness and global activity limitation (GALI)) among older people. The analyses include people 65 years and older from 25 European countries with data collections both in SHARE and EU-SILC 2017. Results show substantial differences in sociodemographic factors and estimates of poor health, both between and within countries. The within-country differences in the prevalence of long-term illness ranged from -18 percentage points for men in Denmark (lower in EU-SILC compared with SHARE) to 42 percentage points for women in Cyprus (higher in EU-SILC compared with SHARE). The prevalence of GALI showed similar patterns. We conclude that estimates of poor health, measured by long-term illness and GALI, have great variation between surveys within the same country. Survey design factors, such as response rate and the type and number of survey mode seems to explain part of these inconsistencies. Population surveys are widely used for monitoring health and the results from these surveys are utilized in health policy planning. Thus, it is crucial to understand the possible impact of survey design on health estimates.
INTERGENERATIONAL BONDS ACROSS THE EARLY YEARS OF MARRIAGE
Authors: Joiner Raquael , Perez Jacqueline , Bradbury Thomas , Karney Benjamin
Published: December 2023

As adults embark upon marriage, forming their own new nuclear families, they often remain connected to their families of origin. Nevertheless, spouses’ relationships with their parents and in-laws are likely to change across the early years of marriage. Given that empirical studies to date are typically limited to only a couple of measurement occasions, however, the stability and impact of such changes are unclear. Using Repeated Measures Latent Class Analyses, the present study addresses this gap by identifying classes of spouses (N=375 dyads) experiencing different types of relationships with their parents and in-laws across the first 9 years of marriage. Further, correlates and consequences of spouses’ longitudinal sentiment profiles were also examined. Three sentiment profiles (i.e., Mostly Helpful, Mostly Ambivalent, Mostly Indifferent, Mostly Difficult) emerged when looking at spouse’s sentiments toward their own parents and for husbands’ sentiments towards their in-laws, whereas 4 profiles (i.e., Mostly Helpful, Mostly Ambivalent, Mostly Indifferent, Mostly Difficult) were found for wives’ sentiments towards their in-laws. Mostly Ambivalent sentiment profiles showed the least stability, and spouses showed significantly higher odds of being in the Mostly Ambivalent class if they were living in a multigenerational household and if the wife was a 2nd generation immigrant. Spouses whose marriages dissolved showed significantly higher odds of being in the Mostly Indifferent, Mostly Ambivalent, and Mostly Difficult classes, compared to the Mostly Helpful class. These results provide an important starting point for future research aiming to understand how intergenerational bonds may promote or hinder successful marriages.
EVALUATING A CO-DESIGNED EXERGAMING PLATFORM (MOUVMAT) FOR OLDER ADULTS LIVING IN LONG-TERM CARE HOMES
Authors: Chu Charlene , Biss Renée , Bharucha Haniya , Matulis Henrique
Published: December 2023

MouvMat is an exergaming technology with an interactive digital gaming surface that was co-designed with a user-centered design approach for older adults (OA) living in long term care homes. The purpose of the study was to evaluate the acceptability and efficacy of MouvMat to improve mobility, cognitive function and psychosocial wellbeing among OAs. The study was conducted as a multi-site pilot randomised controlled trial where OAs in the intervention group attended 1-hour group sessions 3 times per week for 6 weeks. The control group received standard recreational programing. All participants underwent assessments (TUG, 2MW test, UCLA Loneliness Scale, Cornell Scale of Depression, digit span, TMT-A, TMT-B, alternating sequences, and verbal fluency) at baseline, mid-intervention, and end of intervention. Participant ratings indicated that the MouvMat was acceptable and OAs with a range of comorbid health conditions were able to attend sessions and engage with the intervention. Efficacy findings were varied and should be interpreted in the context of the heterogeneous physical and cognitive abilities of participants living in a long-term care setting. Future studies will focus on larger sample size and improvement in MouvMat’s design and interface.
THE BLUES AND OLDER MINORITY MUSICIANS: MORE THAN JUST MUSIC XXX
Authors: Migliaccio John
Published: December 2023

That’s right! This GSA Annual Scientific Meeting celebrates 30 years of the ever popular “‘Bo Diddley’ Track” providing insights into the older performers who have pioneered and preserved this uniquely American musical genre and distinctive cultural treasure. Tampa was, and remains, a significant location in its history. When Hudson Woodbridge (Whittaker), a.k.a. “Tampa Red”, had learned all he could of the popular “race records” featuring legendary blues performers like Ma Rainey, Bessie Smith, and Ida Cox and moved to Chicago in 1925 in his early 20s, he brought with him a prolific expertise on the slide guitar and helped introduce multiple new forms of this music. He spread the popular bawdy and humorous “hokum” Blues style and created numerous classic tunes that are still covered by the most famous musicians of today. Tampa continues to nurture a thriving music scene, and this year’s GSA conference will take full advantage of the magic, music, and musicians of the Suncoast Blues. This year’s special celebration will start with the opening of the exhibit hall. Then continue with the popular traditional lecture, oral history, refreshments, photo op and mini-performance by the best and most resilient local older blues musicians. That evening, join the artist and band, and a multitude of fellow GSA members, for a lively music bash at a local club featuring dancing, local food and refreshments, swag, and one of the best parties at GSA. It’s a cornucopia of education and enjoyment like none other.
VIRTUAL RESPITE FOR FAMILY CAREGIVERS
Authors: Washington Tiffany , Rapowitz Jennifer
Published: December 2023

The COVID-19 pandemic was detrimental to the wellbeing of individuals everywhere, especially family caregivers. Over 20% of older caregivers reported difficulties finding time for self-care during the pandemic Respite is an avenue to self-care; however, virtual respite programs are nearly non-existent. In this proof of concept study, we examined the acceptability of a virtual respite program with eight family caregivers of individuals living with dementia. Virtual respite visits were delivered by graduate students who engaged the person with dementia in a tailored activity, thereby freeing time for the caregiver to have a respite break. Families received up to six weekly virtual respite visits totaling 122 to 295 minutes. Semi-structured interviews with participating caregivers were transcribed and coded using steps of thematic analysis. Caregivers expressed high acceptability for virtual respite because it was easily adaptable to their existing hardware (e.g., smart devices, laptops), accessible, and required little technological knowledge. They further expressed appreciation for tailored activities for care receivers that allowed respite time for their own self-care activity. Given the limited availability of respite services, there is a need to design and test new types of respite care. This virtual respite program is an opportunity to reach more caregivers.
A CULTURALLY-TAILORED INTERVENTION INFORMED BY CAREGIVER VOICES
Authors: Mage Susanna , Hazany Farnaz , Cohanim Niki , Benton Donna
Published: December 2023

The first wave of Iranian immigration to the United States occurred between 1950-1979. Now, as members of this cohort enter their 60’s, the risk of age-related dementia will increase, necessitating younger, bicultural/bilingual members of the community, often family, to take on caregiving roles. Iranian caregivers are aware of neglecting their own health due to their role and often feel sad and lonely. Despite this, they are reluctant to access community resources intended to support caregivers. This could be attributed to the desire to protect and preserve the expected family image: by not using services, the family can maintain a sense of normalcy. The Ghofetegou Koneem for Caring Families Intervention helps caregivers in Los Angeles -- home of the largest Iranian community outside of Iran -- taking care of a person with dementia. The goal is to build a network of support that is personalized, easily accessible, and addresses perceptions of available social services. To tailor the intervention for an Iranian population, investigators partnered with a local adult day health care center to conduct 1:1 interviews with caregivers and perform needs assessments to identify needs prior to development. Qualitative analysis guided by a thematic approach revealed three themes of greatest need: 1) respite/self-care, 2) advocacy, and 3) disease-specific education and training. The importance of helping caregivers self-identify was also stressed, as this may lead to increased comfort in accessing resources. Integrating the voices of Iranian caregivers will help develop a culturally-relevant intervention tailored to the needs of Iranian families.
EXAMINING SOCIAL AND CULTURAL FACTORS AMONG EAST ASIAN FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Cassidy Jessica , Lee Kathy , Lee Jihui , Seo Chang Hyun , Lomelin Alan Kunz , Shin Hye-Won , Grill Joshua
Published: December 2023

The purpose of this study was to examine how frequently Korean and Chinese American family caregivers of persons living with dementia utilized home- and community-based formal support services and to assess whether utilization of such services was associated with overall well-being. We collected and analyzed quantitative and qualitative data (N = 62) in effort to understand how cultural and social factors influenced their utilization of home- and community-based services and programs. A total of 36 Korean American and 26 Chinese American family caregivers completed online surveys and individual interviews over the phone. The most frequently used programs by family caregivers of both ethnic groups were in-home care services (33.9%), senior centers (32.3%), family caregiver support programs (24.2%), and transportation services (22.6%). Providing care longer than 108 months (p = 0.047), greater knowledge of information and resources available (p = 0.043) and being a Medicaid recipient (p = 0.008) were associated with utilization of in-home services. Those who utilized nutrition programs and case management were more likely to report higher overall well-being (p < 0.05). Four themes emerged from our qualitative analysis: (1) a lack of knowledge of formal services, (2) language barriers, (3) transportation barriers, and (4) a lack of culturally tailored formal supports. This study emphasizes community-level efforts to increase the utilization of formal support services by developing linguistically and culturally tailored programs, and offering transportation services in existing support programs and online-based education and resources that can be available in different languages.
HELP-SEEKING IN A FOREIGN COUNTRY: EXPERIENCES OF OLDER LATINO IMMIGRANTS NAVIGATING ASSISTANCE IN AMERICA
Authors: Campos Barbara Mendez , Waters Mary , Ramirez Saul , Hodges James , Calvo Rocio
Published: December 2023

Access and utilization of assistance programs for older Latino immigrants focus on familismo or heavy reliance on family for help-seeking. The purpose of this paper is to document the different experiences of navigating services, including healthcare, for immigrants without family support. We also investigate the role of immigration status and age at migration on immigrants’ strategies for accessing and using social services. We conducted 141 in-depth interviews with immigrants 60 and over from Cuba, Dominican Republic, El Salvador, Mexico, Puerto Rico, and Venezuela. We used a grounded theory approach to code and analyze the data. Three themes shaped the variation we found in the strategies used by older Latino immigrants without family support: formal assistance rooted in state and local policies; age at migration and the resulting patterns of individual agency and resources, and variation by country of origin that captured legal statuses as well as social networks. Our study provides a deeper understanding of a hard-to-reach population’s access to and utilization of social services. It highlights the heterogeneity of Latino immigrants and elucidates differences from culture-based frameworks to understand Latino immigrants’ underutilization of social services later in life. We argue for a shift to perspectives that address how multiple structural dimensions intersect to impact older immigrants’ use of social services.
OLDER MEDICARE BENEFICIARIES WITH KIDNEY FAILURE FROM PUERTO RICO MIGRATED AFTER HURRICANE MARIA
Authors: Rivera-Hernandez Maricruz
Published: December 2023

The vast majority of the literature regarding migration often focuses on younger and healthy migrants. However, recent studies have shown that older adults with complex chronic conditions are migrating to receive services and supports from family members, especially after natural disasters. After Hurricane Maria landed in Puerto Rico in 2017, health care facilities struggled to provide care. Patients with complex chronic conditions faced significant challenges to receive care. The objective of this study is to characterize migration rates among older Medicare beneficiaries with kidney failure after Hurricane Maria. We conducted a cross-sectional analysis of older Medicare beneficiaries (65 and over) with kidney failure from Puerto Rico from 2010 to 2020. We used data from the Master Beneficiary Summary File and the Chronic Conditions Data Warehouse (CCW) Chronic Conditions Segment. Beneficiaries with kidney failure were identified using the End-Stage Renal Disease Indicator from the CCW. Outmigration was defined as changing the state of residence the following year. There were 9450 which contributed 28445 person-years of information. About 537 (1.9%) older adults with kidney failure migrated to the US mainland during the study period. Migration rates before Maria were 1.5 (95% CI, 1.3 – 1.7), which increased by 3.6 percentage points (95% CI, 2.8 – 4.4). However, migration rates dropped to pre-Maria levels after 2017. Older migrants were more likely to be females, fee-for-service beneficiaries and younger compared to non-migrants. These findings suggest that older adults with kidney failure migrated to the US mainland to access care immediately after Hurricane Maria.
HEALTH AND WELL-BEING ACROSS ECOLOGICAL SYSTEMS AND TIME IN MID LIFE AND LATE ADULTHOOD
Authors: Cichy Kelly , Stawski Robert , Stawski Robert
Published: December 2023

Health and well-being are shaped by peoples’ experiences and ecological contexts (Bronfenbrenner, 2005), reflecting the influence of complex person-context relationships. For example, experiences (e.g., daily stressors, early childhood adversity) occur within microlevel (e.g., marital relationships, neighborhoods) and macrolevel (e.g., societal inequalities) contexts, impacting both daily well-being and healthy aging. Further, a robust literature highlights the significance of naturally occurring everyday experiences for a range of health outcomes, underscoring how daily experiences have immediate and lasting effects on individual physical and cognitive health and psychological well-being. Drawing on Bronfenbrenner’s Ecological Model, the current symposium features novel research examining health and well-being outcomes across diverse ecological systems and time scales across midlife and old age, with the goal of articulating how innovative approaches for studying person-context interactions can be leveraged to understand both proximal and long-term health and well-being. Polenick and colleagues will examine associations between daily negative and positive events and well-being among heterosexual married couples living with early-stage dementia. Cichy et al. will examine gender differences in the prospective effects of daily stress processes on long-term chronic disease risk in midlife and later life. Next, Turner and Mogle will examine how positive and negative affect mediate the associations between daily memory lapses and psychological well-being. Finally, Choi, Munoz, Scott, and Sliwinski will examine whether current positive (i.e., neighborhood cohesion) and negative (i.e., neighborhood violence) neighborhood contexts moderate the effect of childhood stress exposure on cognitive function in adulthood. Robert Stawski will synthesize the presentations and offer insights for future research.
AFFECTIVE RESPONSES TO DAILY MEMORY LAPSES IMPACT PSYCHOLOGICAL WELL-BEING IN MIDUS
Authors: Turner Jennifer , Mogle Jacqueline , Hill Nikki , Almeida David
Published: December 2023

Daily experiences have broad and far-reaching impacts on physical and mental health. Past work has linked micro-level experiences (e.g., daily stress) to macro-level processes (e.g., anxiety and depression; Charles et al., 2013) with a goal of understanding how day-to-day experiences influence development of physiological and psychological pathology. One mechanistic pathway for the link between daily experiences and longer-term outcomes are affective responses. This study extends previous work by examining mediation effects of positive and negative affect to a common daily experience: daily memory lapses on psychological well-being in a national sample of participants (N = 2,018; 56.6% Women, Mage = 56.92, SD = 13.37) from the MIDUS Refresher (2011-2014) and the MIDUS-3 (2013-2019). Each day participants reported on positive and negative affect and memory lapses. At the start of each wave, a comprehensive well-being assessment included different facets of psychological well-being (e.g., autonomy, environmental mastery). Daily memory lapses were significantly associated with increased negative affect and decreased positive affect on that same day. As expected, positive affect was associated with greater psychological well-being, while negative affect was associated with an inverse relationship. Importantly, significant indirect (mediation) effects were obtained for all models. This suggests that daily memory lapses have an impact on psychological well-being through their impacts on daily affect. This work provides increased evidence for the importance of emotional responses to daily stressors (such as memory lapses) being a determinate of distal health-related outcomes.
THE NEEDS OF FAMILY CAREGIVERS OF PERSONS LIVING WITH DEMENTIA CARED FOR IN PRIMARY CARE PRACTICES
Authors: Vetter Michael
Published: December 2023

Background

The proportion of persons living with dementia (PLWD) in the US is projected to increase; the majority will be cared for by family caregivers and primary care providers. Purpose: At baseline for intervention studies to support primary care practices caring for persons with dementia, we assessed caregiver self-efficacy to inform our interventions.

Methods

We conducted a survey of 143 caregivers of persons living with dementia receiving care from 34 primary care practices in a Medicare ACO. The survey was conducted by postal mail and telephone in English and Spanish and used 9-item caregiver self-efficacy scale.4 , analyzing variation by caregiver relationship and location. Results A majority of 143 respondents were female (70%), White Non-Hispanic (80.4%) and lived with person with dementia (65.7%). Caregivers agreed that their doctors understand how memory or behavioral problems complicate health (85.3%) and least likely to agree that they had a health professional who helped them work through dementia care problems (39.2%). Only 45% agreed that they received advice on what problems to expect in the future related to Alzheimer’s or dementia. Caregivers who lived with the care recipient were significantly less likely than those who did not to report getting advice about common behavioral problems (43.6% vs. 68.6%, P = .005) and how to access community services (63.8% vs. 81.3%, P = .03). Discussion System innovations to support caregivers should tailor information to help caregivers of and PLWD to prepare for course of illness including treatment and management of behavioral symptoms of dementia.
THE IMPACT OF THE COVID-19 PANDEMIC ON INFORMAL CAREGIVERS OF PERSONS WITH DEMENTIA IN THE POST-VACCINATION ERA
Authors: Bannon Sarah
Published: December 2023

The COVID-19 pandemic disproportionately impacted individuals living with dementia and their family care-partners. Prior to the pandemic, many family care-partners had insufficient support to manage stressors and experienced resultant negative physical and mental consequences. Systematic reviews of studies from the early pandemic suggest that circumstances dramatically worsened for family care-partners’, though it is unclear whether and how they were impacted by ongoing fluctuations in COVID-19 risk for infection and safety guidelines following the availability of vaccines. Using qualitative design informed by a stress-and-coping theoretical framework, our objective was to characterize the ongoing impact of the pandemic on family care-partners of persons living with dementia. We used purposive sampling to recruit participants from a larger survey study of dementia caregiving during the COVID-19 pandemic. Study participants (n=18) completed a 1-hour virtual interview with that was transcribed, de-identified, and analyzed using thematic analysis. We identified 4 overarching themes characterizing family caregivers’ stressors that included: 1) changes in care, routines, and support; 2) actual or feared COVID-19 infection; 3) changes in the functioning and health of care-partners and care-recipients; 4) experiences with care facilities care transitions. We also identified 4 overarching themes characterizing care-partners’ coping strategies, including: 1) care-partner resourcefulness; 2) participation in meaningful, enjoyable, and restorative activities; 3) personal outlook and attitudes to reduce distress; and 4) connection with specific formal and informal supports. Our findings underscore the continued challenges that family care-partners experience and highlight important skills, supports, and resources to mitigate negative health outcomes and other long-term consequences.
POLICY SERIES: DOCTORAL PROGRAMS IN GERONTOLOGY: PROVIDING LEADERSHIP IN POLICY AND AGING
Authors: Miller Edward , Kaskie Brian
Published: December 2023

Advancements in education, medicine, wealth, technology, and population health have increased individual life expectancies. Healthy aging is not just a function of healthy genes, however; aging is modified by the broader context, which, in turn, creates opportunities and challenges that must be addressed by society. Lack of organized responses to population aging exacerbate social inequities based on workplace discrimination, displacement, and impoverishment, and contribute to public health inequalities pertaining to disease and disability, isolation, and vulnerability among older adults. Public policy offers one of the most effective ways to address inequities and inequalities such as these. This symposium spotlights four doctoral programs that prepare gerontologists who possess subject matter expertise in aging policy, conduct reliable policy surveillance and sourcing, execute empirical evaluations of policy formation and implementation, and offer well-informed contributions to policy makers who are most involved with supporting and protecting older adults. These well-established academic programs at the University of Massachusetts Boston (Edward Alan Miller, PhD), University of South Florida (Lyndsay Peterson, PhD), University of Southern California (Kathleen Wilbur, PhD), and Miami University (Jennifer M. Kinney, PhD) offer classroom education, research, and service-learning opportunities for students to acquire expertise in aging and public policy. Together, these programs provide models for training a generation of leaders in gerontology who can contribute productively to policy development and debates, illuminate structures and processes of policy making and implementation, and deploy analytic skills needed to evaluate policies relative to multiple and often competing interests.
ENGAGING PEOPLE WITH DEMENTIA AND THEIR FAMILY IN ADVANCE CARE PLANNING: A 33 COUNTRY DELPHI STUDY
Authors: van der Steen Jenny , Korfage Ida
Published: December 2023

Reaching a consensus about a definitional framework of advance care planning in dementia was a main goal of an international Delphi study conducted by the European Association for Palliative Care. Four rounds with a panel of 107 experts from 33 countries were conducted between September 2021 and June 2022. The framework comprised a definition and three issues that are of particular importance in the case of dementia, which were capacity, family, and engagement and communication. Focusing on the latter, we provide recommendations that achieved a consensus in the Delphi study. We also interviewed persons with dementia and provide their recommendations for health care providers directly offered by them which the panel found eye-opening. The framework fits dementia and is unique in that it focuses on a communication process that continues independent of the level of capacity, beyond a focus on documenting specific current or end-of-life treatment preferences. It evolved in consensus with experts from western and non-western countries and it should promote inclusiveness of persons with dementia and their family caregivers. The more inclusive conceptualization of what advance care planning in dementia is, provides a much-needed basis for research and policy initiatives on advance care planning in dementia. Further, the work also highlights ambiguity such as about when family caregivers can act as proxies and when not, and the methods may be used as a template for developing frameworks on advance care planning with other specific conditions.
IMPROVING THE ENGAGEMENT OF RESIDENTS WITH DEMENTIA IN ADVANCE CARE PLANNING DISCUSSIONS IN LONG-TERM CARE
Authors: Kaasalainen Sharon , Wickson-Griffiths Abigail , Vellani Shirin , Sussman Tamara
Published: December 2023

As part of the Strengthening a Palliative Approach in Long Term Care (SPA-LTC), we have designed and evaluated a number of tools and resources to promote a palliative approach in dementia, including a Canadian version of the Conversation Starter Kit (CSK) booklet. We used participatory action research to design tools for use with care providers based on survey data and interviews. Data was analyzed using thematic analysis and descriptive statistics. We found that residents reported that they engaged in asking more questions to their care provider after completing the CSK booklet. However, care providers stated that they did not feel comfortable addressing questions and concerns raised by residents and their family members. Hence, we co-designed two tools to help build capacity among care providers to support ACP discussions with residents and families, including an e-learning module about ACP discussions for people with dementia and a Conversation Guide. Pilot findings of these tools suggest that staff appreciate the information and tools to enable them to initiate ACP discussions and address difficult conversations. Clearly, residents with dementia and their families need to be supported to engage in ACP discussions early on in their disease trajectory so that residents are afforded the opportunity to voice their values and wishes for end of life care. At the same time, care providers need to have the skills (e.g., listening, probing) and comfort to engage in these discussions to support and help prepare residents and families for important decisions that need to be made later on.
COMMUNITY-BASED RESEARCH ON GRIEF SUPPORT FOR OLDER ADULTS: FROM EXPLORATION TO IMPLEMENTATION
Authors: Stone-Bury Lisa , Weiskittle Rachel
Published: December 2023

Community-based research has initiated a shift from research existing in an ivory tower to being collected and then implemented for the direct benefit of the public. The social sciences continue to struggle with the balance between rigorous science and feasible interventions, creating a common disconnect between research and practice. This is particularly relevant to grief and bereavement, for which services are often under-utilized among older adults. This symposium will discuss a multidisciplinary team’s application of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, describing the development, findings, and service outcomes of a community-based research initiative within a mid-sized city. First, Lisa E. Stone will describe the challenges and successful strategies in the collaborative process of questionnaire development with multidisciplinary community stakeholders. She will also present on the methodology used to attain large community and grief professional samples, including recruitment strategies for adults across the lifespan. Second, Caroline Collins-Pisano will present key age-related findings from the community study, highlighting the lifespan factors that impact grief experiences and utilization of grief resources among older adults. Lastly, Rachel E. Weiskittle will present on the team’s process of implementing data-driven grief interventions, focusing on the translation of community-based findings to multifaceted grief services for older adults. In sum, this symposium presents a community-based application of the EPIS framework that focuses on direct, tailored, and immediate implementation of grief services, a consistent need for the aging population.
PARTICIPATION IN AND EXCLUSION FROM EXTENDED LATE WORKING LIFE DURING THE DEMOGRAPHIC, DIGITAL, AND GREEN TRANSITION
Authors: Motel-Klingebiel Andreas
Published: December 2023

Policies aim to extend working lives by investing in the capacity and employability of older workers, changing the regulatory framework, promoting innovative life-course policies, and advancing lifelong learning, which gains relevance under the impact of increasingly aging populations, digitalisation, and the green transition. However, as some national, branch, and company policies are counterproductive, encouraging early exit and perpetuating ageist training and recruitment practices, working longer may not be equally achievable and beneficial for all workers. This symposium presents research on exclusion and inequality in late working life, providing evidence for policy innovation towards inclusive extended work and sustainable working conditions. It combines comparative multi-level research based on registry and survey data as well as qualitative information. Contributions address the opportunities and limitations of equal and inclusive extended work under the impact of population aging, digitalisation, and the green transition. This includes a conceptual introduction to research and policy on extended late work in Europe during the triple demographic, digital and green transition, an analysis of age discrimination in company and branch policies based on expert interview data, an examination of the perceived significance of lifelong learning for exclusion risks, an analysis of risk experiences associated with extended work, and a commentary discussing the findings in the context of gerontological debates on exclusion and precarity in later life. The (co-)authors represent a mix of early career, mid-career, and senior scholars with interdisciplinary backgrounds from Europe and North America. The audience is invited to discuss concepts, analyses, and conclusions with the presenters.
INEQUALITIES IN THE FRAILTY-FREE LIFE EXPECTANCY OF ADULTS IN ENGLAND AGED OVER 50
Authors: Sinclair David , Maharani Asri , Matthews Fiona
Published: December 2023

Understanding how the onset of frailty differs between socio-economic groups will help health and care providers plan for increasing demand from an ageing population and highlight population groups to target interventions to reduce frailty. We aimed to calculate the frailty-free, frail and total life expectancies of adults aged over 50 using data from the English Longitudinal Study of Ageing (ELSA), and analyse associations with socio-economic characteristics. Survey data from ELSA waves 1-9 (2002-2019) was used to follow the frailty trajectories of individuals (n=11,423 at wave 1). Individuals were categorised into non-frail and frail states using a frailty index. A multistate model assessed the risk of individuals transitioning between states or dying. Transitions were associated with the participants’ socio-economic characteristics and converted to life expectancies. Increased wealth, reduced deprivation, more education, and marriage are all associated with increased frailty-free and total life expectancies, and reduced frail life expectancies. Wealth is the most important socio-economic indicator of frailty-free life expectancy. At age 50, large inequalities in frailty-free life expectancies exist between the wealthiest, least deprived population (females: 36.1 [35.1-37.0], males: 34.6 [33.7-35.4] years) and the least wealthy, most deprived population (females: 22.1 [21.3-22.7], males: 21.3 [20.4-22.0] years). This is the first study to investigate the associations between frailty-free life expectancies and socio-economic characteristics in Europe. Large inequalities in frailty-free and frail life expectancies exist between those with different socio-economic characteristics. This highlights the people most at risk of early frailty at younger ages.
DIGITALIZATION OF HEALTH SERVICES FOR OLDER ADULTS: HEALTH INEQUALITIES AND THE COVID-19 PANDEMIC
Authors: Hall Alex , Eost-Telling Charlotte , Beyer Fiona , Aminu Abodunrin , Sinclair David , Craig Dawn , Hanratty Barbara , Todd Chris
Published: December 2023

There is a growing role for digital technologies in society, but concerns that older adults may be disadvantaged and excluded with the growth of use of these technologies. The COVID-19 pandemic led governments across the world to mandate lockdowns and social restrictions. This was accompanied by rapid implementation of many digitalized services, including to access health and social care. This paper reports on a project to advance our understanding of how health and social care services for older adults (65+) have been digitalized during the COVID-19 pandemic, and to learn what has worked well and what has not, with a specific lens on health inequalities. We report main findings from three workstreams: (i) a mapping review, to identify (a) the types of evidence available on the digitalization of health and social care services for older adults during the COVID-19 pandemic, and (b) the extent to which factors related to health inequalities have been considered in this evidence; (ii) quantitative analysis of health care records to examine the impact of digitalization on access to primary care for older people in England during the COVID-19 pandemic, with a focus on incidence rate of consultation types (face-to-face, telephone and video) examined against age, gender, ethnicity and socioeconomic status; (iii) qualitative work to explore the experiences of UK older adults of South Asian and Black African or Caribbean descent of using digital technologies to access primary care. We consider how digitalization of health and social care services relates to health inequalities for older people.
PREFERENCES FOR NEW MODELS OF SOCIAL CARE FOR OLDER PEOPLE IN ENGLAND
Authors: Walbaum Magdalena
Published: December 2023

Ageing and increasing diversity of the population pose challenges for social care provision. England has implemented several initiatives to improve care quality and make it more personalised, informed, and connected. This study aimed to understand the preferences of older people, including those from diverse backgrounds, for different aspects and models of social care, and how they trade-off different features of care. The study included two workstreams with participants aged 50+: 1) A qualitative study that explored preferences across five themes: housing settings, community assets, technology use, provision of care, and control and dignity; 2) A quantitative survey that analysed variations in preferences by demographic, socioeconomic, and needs-related factors. A discrete choice experiment was also conducted to evaluate the strength of preferences for different attributes. Older people value their independence and control over their lives and prioritise access to community resources and social connections. Participants also emphasised the importance of building a positive relationship with their care provider, respecting their sexual identity and personal beliefs to receive good quality care. In this presentation, differences in preferences among demographic, socioeconomic, and ethnic groups will be highlighted, underscoring the need to ensure that care packages align with individual preferences, beliefs, and values and promote equitable access to care, and outcomes. This approach may ensure that older people from diverse backgrounds receive high-quality care that promotes their independence and dignity and produces equitable care outcomes.
INCREASING THE REPERTOIRE FOR DEPRESSION CARE: PEER SUPPORT AS DEPRESSION CARE FOR VULNERABLE OLDER ADULTS
Authors: Joo Jinhui , Davey-Rothwell Melissa , Choi Namkee , Gallo Joseph , Xie Alice
Published: December 2023

Despite facing greater risks for poorer health, low-income White and BIPOC older adults underutilize mental health services even when they have indicated need. Increasing the repertoire for depression care that is community-based and uses paraprofessionals has potential to increase access and engagement. We are testing the effectiveness of a peer support intervention called Peer Enhanced Depression Care (PEERS) which is an 8-week community-based intervention that uses trained peer mentors to deliver emotional, appraisal and informational support in addition to encouraging self-care skills to depressed low-income white and BIPOC older adults. Enrolled participants are randomized to either the peer support intervention (PEERS) or to the social interaction control and followed for 12 months. The primary outcome is depression and secondary outcomes include engagement, mental health service use, and social, emotional, and physical functioning. Challenges related to the onset of the COVID-19 pandemic and social isolation required a shift from recruitment initially focused on the health care system to community-based organizations serving older adults. Required contactless recruitment strategies eg. flyers and newspaper ads, led to self-referral of community-dwelling older adults to the study. Challenges to participant enrollment included barriers related to communication, stigma related to help-seeking, distrust and unfamiliarity with research. Recruitment of peer mentors was facilitated by a robust infrastructure supporting the employment of the peer support workforce. Continued PM supervision after initial training, review of skills and evaluation of performance were important in maintaining quality and fidelity to the intervention.
A STAKEHOLDER-PARTNERED APPROACH TO INEQUITIES AFFECTING HOME HEALTH CARE WORKERS, OLDER ADULTS, AND CAREGIVERS
Authors: Okereke Olivia , Eme Vivian Anable , Totten Keliane , Locascio Joseph , Simmons Alison , Carpenter Nancy , Weiner Anthony
Published: December 2023

Home health aides (HHAs) provide on-site support for homebound older adults with cognitive impairments, while lessening strain on familial caregivers. However, HHAs face structural challenges in work-related transportation. Massachusetts General Hospital (MGH) researchers partnered with community and corporate stakeholders to inform a study evaluating whether on-demand transportation for HHAs via Uber rides will: 1) Improve metrics among HHAs (total visits, total unique patients, hours/week and days/week worked, missed visit/no-show rates, work satisfaction); 2) Increase racial, ethnic, socioeconomic and geographic diversity of older adults with cognitive impairments receiving homecare. Community partner CCHERS (Center for Community Health Education Research Services) helps residents of public/publicly-assisted housing in high-need areas of Greater Boston gain training and entry-level employment in healthcare as HHAs. Through its collaborations with other groups (e.g., Mothers for Justice & Equality, HomeCare Aide Council, Mass HomeCare Alliance), CCHERS identified that lack of affordable, accessible, reliable transportation was among the most-cited barriers affecting HHAs and equitable homecare delivery. Corporate partner Uber Health, through work in preliminary social-impact case studies, identified the platform’s central ride-coordination approach as preferred by Black and Hispanic women in the 18-45y age group (~80% of the local HHA workforce). MGH researchers’ study goals and metrics were informed by input of partners. With its community-engaged approach, innovative partnerships, and focus on achieving equity objectives to benefit patients and homecare workers alike, this project has potential for strong local impacts and future implications for state and/or national policies to provide high-quality, equitable homecare by directly addressing employment transportation-related barriers.
ESPO and Biological Sciences Section Symposium: Highlighting the Future Leaders of Geroscience
Authors: Yousefzadeh Matt , Ghosh Bhaswati
Published: December 2023

The Emerging Scholars Symposium (ESPO) is organized by post-docs and PhD students from GSA’s BS ESPO Committee. The goal of this symposium is to foster the next generation of aging researchers by recruiting trainees and early career investigators as speakers from contributed abstracts.
INTRAINDIVIDUAL VARIABILITY IN SLEEP DURATION IS ASSOCIATED WITH HIPPOCAMPAL VOLUME IN MID LIFE
Authors: Diaz Jose , Almeida David
Published: December 2023

Sleep is associated with global cognition, consolidation of memories, and structural & functional integrity of areas of the brain that support healthy cognition. While there has been research on sleep in older adults that indicates associations between poor sleep, cognitive decline, memory performance, and changes in the brain, there has been comparatively little work assessing the impact of sleep on the structure of the brain during middle adulthood. Changes in the brain begin much earlier than older adulthood, with midlife seeing cortical thinning and a decrease in brain volume in areas that support healthy cognitive functioning and memory, such as the hippocampus. Understanding how sleep may contribute to hippocampal volume in midlife may help inform how changing poor sleep is important for supporting successful aging. The current study examines the associations between 7 days of actigraphy measured sleep and hippocampal volume (MRI) in 82 midlife adults (Mage = 49.13 years, SD = 11.74; 28-76 years old) who completed the Biomarker and Neuroscience projects in the Midlife in the United States Refresher study. Results indicated that bi-lateral hippocampal volume was negatively associated with high (vs low) intraindividual total sleep time variability (>= 60 min; mean average deviation), with a 280 and 252 mm3 (p’s = .006 & .035) volume reduction for left and right hemispheres respectively. This relationship was not seen for other measures of sleep quality and the analysis additionally controlled for age, sex, BMI, race, depression status, education, and subjective physical & mental/emotional health.