bluuebunny/crossref_metadata_2025 huggingface dataset:
INTEREST GROUP SESSION—ALZHEIMER'S DISEASE AND RELATED DIMENTIAS: OPPORTUNITIES AND CHALLENGES TO DEVELOPING AND TESTING PRAGMATIC ADRD INTERVENTIONS
Authors: Brody Abraham A , Gitlin Laura N
Published: November 2019

Many clinical trials have been performed to develop the evidence for caring for persons with Alzheimer’s Disease and Related Disorders (ADRD) in tightly controlled settings. These trials have found efficacy of a wide spectrum of interventions to address issues from advanced care planning to behavioral and psychological symptoms of dementia (BPSD). However, few ADRD interventions have been tested in wide-scale pragmatic fashion in long term supportive settings (LTSS) such as nursing homes, primary care clinics, hospices, or community based organizations. This is due to a variety factors, principle amongst them are the difficulty in implementing pragmatic trials, and that many of the interventions developed in tightly controlled settings are not directly translatable to real-world settings. Without translating and testing interventions in real world settings, the evidence base remains largely inaccessible to the end user, the persons with ADRD and their caregivers. Moreover, effectiveness remains unclear. The lack of pragmatic trials in ADRD exists despite significant recent investment from the NIH Office of the Director in a health systems collaboratory to support pragmatic clinical trials. In 2018, NIA therefore released a call for 2-phase intervention development and pragmatic trial testing via an R61-R33 mechanism (PAR-18-585). Four proposals were funded in September 2018 from this PAR. This symposium will explore the opportunities and challenges present in developing and testing pragmatic interventions in ADRD in LTSS. The speakers will also share specific scientific methodological and implementation questions that need to be addressed in applying for pragmatic trial awards.
CHALLENGES FOR IMPLEMENTING PRAGMATIC COMMUNICATION INTERVENTIONS IN NURSING HOME SETTINGS
Authors: Williams Kristine N , Shaw Clarissa , Coleman Carissa K
Published: November 2019

Interventions to improve nursing home care have been developed and tested. However readily disseminated interventions are lacking. Barriers include low staffing levels contributing to limited time for education and high turnover of direct care and administrative staff. Educational interventions must be accessible to accommodate busy staff. Meaningful outcome measures are needed and interventions must fit varied nursing home sizes, ownership, resident population, and regions. Changing Talk Online (CHATO) was adapted from the effective, yet time-intensive, Changing Talk program addressing nursing home staff communication. The original classroom-based program significantly improved staff communication with residents and resulted in subsequent reductions in resident behavioral and psychological symptoms of dementia. Strategies for marketing and recruiting nursing homes and to engage administrators and staff will be discussed as implemented in the Changing Talk Online (CHATO) R61 trial. Approaches addressing unique nursing home challenges to implementation are essential for successful dissemination to improve care.
SUCCESSFUL AGING SCALE DEVELOPMENT FOR COMMUNITY-DWELLING OLD-OLD (75+) IN CHINA: A PRELIMINARY ANALYSIS
Authors: Ye Minzhi , Chen Lin , Gu Lin
Published: November 2019

Thousands of articles have discussed the concept of successful aging, yet no existed scale to measure its components among old-old (age 75+) in urban China. This study used a mixed method to develop a valid scale in Shanghai from July 2016 to Nov 2018. We first conducted 97 semi-structured, in-depth interviews on community-dwelling old-old and listed 70 items based on the findings and previous studies (e.g., Lubben, 1988). Ten multidisciplinary professionals and eight old-old had focus groups to evaluate the content validity of the scale. We used the final 22 items to survey 208 community-dwelling old-old in twelve neighborhoods. The mean age is 81, with 40% females. The principal component analysis showed a 13-item scale representing four domains (self-reliant, aging attitude, self-value expression, and social support), with 0.67 total reliability (Cronbach's Alpha). This study provided a set of quality indicators to evaluate old-old’s life in urban China.
BARRIERS TO TRANSIT MOBILITY AND WELL-BEING AMONG LATE-LIFE ASIAN INDIAN IMMIGRANTS
Authors: Parekh Rupal
Published: November 2019

Using qualitative interpretative phenomenological analysis and semi-structured interviews, we explored transit mobility needs and its impact on well-being and quality of life among late-life Asian Indian immigrants. Using inductive and deductive methods, we analyzed qualitative data collected from 18 participants. Four themes emerged specific to the influence of contextual factors on transportation mobility barriers among participants. Findings suggest that cultural and individual attitudes combined with the ‘built environment’ hinder participation at the temple and other cultural and religious activities and increase dependence on adult children. The reciprocal fit between transit mobility needs, access to culturally familiar environments and the built environment is critical to freedom, independence, and healthy aging for diverse older adults. Research at the intersection of global aging and transportation mobility requires equal grounding in a range of justice principles (environmental, social, and economic) in the pursuit of sustainable transportation options for diverse older adult populations.
LENGTH OF STAY IN U.S. AN ANOMALY: PREVENTIVE HEALTHCARE UTILIZATION AMONG FAITH-BASED FIRST-GENERATION CHINESE
Authors: Hou Su-I
Published: November 2019

Limited knowledge exists on preventive healthcare services utilization (PHSU) among Chinese immigrants. This study examined factors related to PHSU among faith-based first-generation Chinese. A self-administered survey was conducted in five Chinese churches in southeastern US.(n=184). Mean age was 43 (SD=14) and 50% were males. Comparing with recent immigrants (<10 years), those who lived in the US for more than 10 years were more likely to be married (94.6% vs. 50.0%), have annual exams (74.5% vs. 39.6%), report doctors recommending cancer screenings (35.3% vs. 12.5%), have talked to doctors about screenings (25.5% vs. 4.2%), and perceive higher cancer knowledge (20.0% vs. 2.1%) (all p<.05). Considering all factors together, regressions showed perceived knowledge was the only significant predictor on having talked to doctors (OR=3.11) and doctor recommending screening (OR=2.15). Married status was the only strong predictor on annual exam (OR=29.13). Our findings highlight the urgent need for promoting PHSU in this population.
ALZHEIMER’S DISEASE IN AI/AN COMMUNITIES: THE NEED FOR A CULTURALLY TAILORED ROAD MAP FOR ACTION
Authors: Benson William F
Published: November 2019

Although little is known about Alzheimer’s disease and other dementias among our American Indian and Alaska Native (AIAN) population, the numbers of AIAN elders is growing rapidly as is the overall AIAN population. As noted in The Gerontologist, the number of AIAN elders 65 and older will triple by 2030. Between 2014–2060, the number of AIAN people aged 65 and older living with dementia is projected to grow over 475%. This poses challenges for tribal officials, health/social service providers and families. Among these are limited awareness/knowledge about Alzheimer’s disease, inadequate services and resources, and limited experience in providing proven responses to the needs of those with Alzheimer’s and their families. To help tribes and others serving the AIAN population to respond to such challenges, it was important to develop a menu of options for tribal communities and leaders to consider appropriate to their needs, circumstances and values.
LISTENING AND LEARNING TO FORM THE HBI ROAD MAP FOR INDIAN COUNTRY
Authors: French Molly , Splaine Michael , Shean John , Holt Heidi
Published: November 2019

American Indian and Alaska Native (AI/AN) communities are establishing new paths as more older adults develop Alzheimer’s and other dementias along with other co-morbidities. To offer a flexible framework of public health strategies that proactively address the growing issue of dementia among AI/ANs, Alzheimer’s Association and Centers for Disease Control and Prevention (CDC) developed the first-ever Healthy Brain Initiative Road Map for Indian Country. Partnering with International Association for Indigenous Aging supported Road Map development through virtual listening sessions and written comments from regional Native health experts, tribal aging service leaders, and tribal government officials. Many additional discussions, engagement of a cultural guide, and an additional partnership with National Indian Health Board further informed Road Map contents, graphic design, and marketing. Presenter will describe rationale for the process, themes from the consultations, and lessons learned by the Association and CDC that can apply to similar initiatives.
SOCIAL ISOLATION AND NETWORKS DO DENSE URBAN CENTERS PROVIDE LARGE SUPPORTIVE SOCIAL NETWORK TO OLDER ADULTS? A CROSS-COUNTRY COMPARATIVE STUDY
Authors: Palmarini Nicola , Cominato Monica , Luppi Francesca , Ruggeri Margherita , Pais Ivana , Schino Rosalba , Soto Mark
Published: November 2019

The urban-rural dichotomy underpins the common approach in studying environmental conditions influencing older adults’ lives characterized by post-Second World War urban migration in both Italy and the United States (US). However, the traditional opposition urban-rural dichotomy is inadequate to study how the environmental characteristics of a geographical area can account for the heterogeneous profile of its populations and its age distribution. This study aims to overcome the traditional mobility theories as an explanatory dichotomy for understanding the distribution of the age structure of a given population. The extent of a supportive network, and the connection between the place of residence to the proximity of other residential centres can be seen as potential resources for understanding the attractiveness of certain areas for older adults. A large harmonized set of demographic and socio-economic data were collected from the Italian National Institute of Statistics (ISTAT) and the American Community Survey (ACS). An analysis at the Italian municipality- and US county-level finds the population over 75 years old are overrepresented in rural areas of both countries as would be expected by available employment opportunities, but considerable heterogeneity among both urban and rural areas exist. In particular, rural more than urban settings are based on an informal support network that is argued to rely on human proximity to produce successful aging in the community. The variation in population of older adults in rural areas, therefore, might have implications on how to achieve age-friendly communities, aside from population’s traditional mobility theories and formal support network.
TARGETING THE MTOR NETWORK TO MAXIMIZE HEALTHSPAN
Authors: Perez Viviana I
Published: November 2019

The mechanistic target of rapamycin (mTOR) is a key nutrient and growth factor-responsive pathway that has emerged as a central regulator of aging. Inhibition of mTOR complex I in particular has been found to increase lifespan and improve functional declines during aging in yeast, worms, flies, and mice. Recently clinical studies have provided the first evidence that similar effects may be achievable in pet dogs and in elderly people. This session will focus on new discoveries related to mTOR signaling and aging.
MODERNIZING EXERCISE WITH TELE-VIDEO TO REACH A RURAL GERIATRIC POPULATION OF VETERANS
Authors: Jennings Stephen C , Manning Kenneth , Massey Oliver , Bettger Janet Prvu , Brown Candace S , Morey Miriam C
Published: November 2019

Rural Veterans often lack access to health care. Veterans Affairs (VA) supports telehealth technologies to provide services remotely that are comparable to onsite in-person care. We piloted VA Video Connect (VVC), to deliver an interactive exercise program for Veterans modeled on the VA Gerofit Program, a successful facility-based exercise program. VVC connects an exercise physiologist directly to the home with smart devices. Invitations to join Gerofit were mailed to 216 rural Veterans. Of 17 respondents, 7 (mean age 68) agreed to VVC tele-exercise 1x week for 12 weeks. Two Veterans were lost to follow-up prior to enrollment. Baseline VVC assessments (N=5) were indicative of high functional impairment in comparison to age-based norms: 2-minute step test (67.2 steps, 5th%tile), 30-second chair stands (12.4 stands, 26th%tile), and 30-second arm curls (15.3 curls, 25th%tile). Feasibility, barriers, and program impact will be discussed. Functional impairment indicates need for telehealth to reach Rural Veterans.
LOW TRANSLATION DOWNSTREAM OF TOR ACTIVATES MYOGENE EXPRESSION AND ENHANCES HEALTH OF BODY MUSCLE IN C. ELEGANS
Authors: Shim Juyoung K , Snow Santina , Howard Amber , Horrocks Jordan , Kelley Joshua , Sayed Hussein , Rogers Aric
Published: November 2019

Previous studies reported that DR or low nutrient signaling reduces translation and extends lifespan, while attenuating growth and reproduction. In this study using C. elegans as a model organism, we found that reduced translation in neurons or germ tissues increases survival and primes the HSR against unfolded protein stress in adult animals. Surprisingly, lowering translation in these tissues significantly upregulates transcription of several key muscle maintenance genes, including those encoding the myogenic response factor HLH-1 and heavy myosin chain factor UNC-54 and MYO-3. It also improves muscle maintenance according to motility assays. However, reduced translation in muscle tissue does not activate the same level of myogenic gene expression. Instead, lowering translation in striated body muscle results in increased reproduction and accelerated development. To further investigate, we examined maintenance of muscle health via deconvolution fluorescent microscopy and immunostaining. Using computational analyses involving Fiji ImageJ and MATLAB program, we discovered that lowering translation delays decrepitude in body muscle structure, resulting in improved mitochondrial morphology and increased thermotolerance. Here we report that, combining physiological, molecular, and microscopic technique, muscle is protected during low translation, low TOR signaling, or DR. We hypothesize that results reflect evolutionary responses that preserve function required for foraging during nutrient scarcity and accelerate development during times low energy usage and high nutrient abundance.
IN-HOME MONITORING AND PRIVACY CONCERNS AMONG OLDER ADULTS
Authors: Choi Moon
Published: November 2019

This study aimed to contribute to understanding older adults’ perspectives on privacy related to in-home monitoring by analyzing factors influencing the willingness to share their information collected by in-home monitoring systems. Study participants were interviewed at local senior centers in South Korea (N=170; mean age=77; 45.9% women). One out of eight (13.5%) participants did not want to share their information with anyone. Participants were more inclined to share their information with family and hospitals than with researchers, government agencies or insurance companies. The logistic regression results showed that participants living with others were more likely to share their information of vital signs, medication, and toileting compared to those living alone (ORs=20.5, 5.3, 4.5, respectively). Younger age and advanced ability to use the Internet were negatively associated with the willingness to share, overall. Information granularity and socioeconomic characteristics are important factors to consider when developing in-home monitoring systems for older adults.
POLICY SERIES: THE HRSA GERIATRICS EDUCATION INITIATIVES: A POLICY AND PROGRAM UPDATE
Authors: Carrico Catherine , Hyer Kathryn , Lindberg Brian W
Published: November 2019

This session will address the evolving work of Geriatric Workforce Enhancement Programs (GWEP) to educate and train the primary care workforce and partner with community based organizations to address gaps in healthcare. The inaugural GWEP awardees were announced at the 2015 White House Conference on Aging. In November 2018 the Health Resources and Services Administration (HRSA), released the second GWEP Notice of Funding Opportunity (NoFO). The new funding opportunity reflects current policy priorities. In addition, for the first time in 9 years a Notice of Funding Opportunity was released for the Geriatric Academic Career Award (GACA) program. The return of the GACA program indicates the success of advocacy efforts to increase programs to support geriatric training and the development of geriatric academic professionals. Individual symposiums will explore the policy priorities reflected in the GWEP NoFO including the use of technology for training and care delivery, the age-friendly healthcare and dementia-friendly community initiatives, and value-based care including improving partnership with community based organizations. Additionally, an individual symposium will present the GACA program and discuss the advocacy process leading to the reintroduction of this program. During the last congress advocates of the GWEP and GACA programs supported authorization and funding of geriatric programs. Geriatrics programs describing the work of the GWEPs and GACAs were reinserted into the legislative process, although this reauthorization was not completed. This advocacy process garnered strong bipartisan and agency support. The session will describe these efforts and will conclude with an update on current authorization and appropriation status.
THE IMPACT OF 3 MONTHS OF SUPERVISED EXERCISE ON CHANGE IN FUNCTION: COMPARISONS BY ARTHRITIS STATUS
Authors: Abbate Lauren M , Hall Katherine , Pearson Megan , Sloane Richard , Allen Kelli D , Kohrt Wendy M , Morey Miriam C
Published: November 2019

Physical activity is an established intervention for the management of arthritis. This study evaluated the effect of 3 months of participation in Gerofit on physical function by arthritis status. Participants, 519 Veterans aged ≥ 65 years self-reported either no arthritis (NA) (49%), upper body arthritis (UB) (8.2%), lower body arthritis (LB) (12.7%), or both upper and lower body arthritis (UB&LB) (30.4%) upon enrollment. Physical function measures [10-meter usual gait speed (m/s) (GS), arm curls (AC), chair stands (CS), and 6-minute walk (yards) (SMW)] were assessed at baseline and follow-up. Mean differences between time points were calculated. At baseline, compared to NA, LB and UB&LB had slower GS (1.10 and 1.06 vs 1.13) and shorter SMW distance (468.8 and 448.8 vs 490.7). All groups tended to increase physical function, with greatest improvement among LB (GS=0.27, AC=2.06, CS=2.52, SMW=42.53). Participation in Gerofit is associated with functional gains, regardless of burden of disease.
FOSTERING DEMENTIA-FRIENDLY COMMUNITIES AND SUPPORTING CAREGIVERS THROUGH THE GWEP PROGRAMS
Authors: Severance Jennifer J , O’Neil Lisa , Fain Mindy
Published: November 2019

As the number of people affected by dementia increases, it is essential that caregivers are provided resources and communities educated on how to engage and support people living with dementia. Supporting caregivers and providing education about dementia-friendly communities are key components of the Geriatric Workforce Enhancement Programs. This symposium will provide examples of GWEP projects which foster dementia-friendly communities and support caregivers. Additionally, recent and current legislation targeting dementia and caregivers will be presented.
HUBS OF INNOVATION: GWEP UTILIZATION OF TECHNOLOGY AND INNOVATION FOR TRAINING AND SERVICE DELIVERY
Authors: Caprio Thomas V , Bennett Katherine A , O’Barr Greg , Carrico Catherine P , McKibbin Christine
Published: November 2019

Technology offers powerful tools for meeting the increasing needs of older adults and caregivers. The Geriatric Workforce Enhancement Program recognizes the important role technology will play in service delivery and training by fostering innovation to meet local training and healthcare needs. This symposium will review the innovative models and strategies GWEPs are utilizing to improve care including Project ECHO, remote monitoring, and telehealth. The policy implications of these models will be presented, including current legislative action to support technology and innovation in the care of older adults.
INTEREST GROUP SESSION—LONELINESS AND SOCIAL ISOLATION: THE LANGUAGE(S) OF LONELINESS
Authors: Victor Christina , Smith Kimberley
Published: November 2019

We offer a novel perspective on the burgeoning literature focused on loneliness later life by examining the language(s) used to describe, define and depict loneliness. We have an extensive body of work describing the prevalence of , ‘vulnerability factors’ and consequences of loneliness in later life. These activities start with pre-defined concepts of what loneliness is and often use scales and questions which may/may not use the term loneliness. How well does the contemporary language of loneliness used in research, policy, practice and the media really capture the depth and complexity of what people are experiencing? Do the terms and words use in our measurement scales and quantitative research resonate with this vocabulary? In qualitative research interviews how do older adults talk (or avoid talking) about loneliness? How does the media talk about loneliness and what images does this convey about later life? We will address these three issues in our seminar. Using data from qualitative interviews undertaken as part of a mixed methods study of temporal variations in loneliness, Thomas uncovers the strategies participants used to talk or avoid talking about loneliness. Victor uses qualitative data from 12,000 adults aged 60+ collected as part of the BBC loneliness experiment to examine the terms used to describe loneliness and to identify both the opposite of loneliness and the positive aspects of loneliness. Sullivan exposes how loneliness is constructed in print and digital media over a 10-year period in the UK and Canada and its role in framing the loneliness problem.
THE ENCORE FELLOWSHIPS PROGRAM: FINDINGS FROM HOST AND FELLOW FOLLOW-UP EVALUATIONS
Authors: Halvorsen Cal J , Emerman Jim
Published: November 2019

The Encore Fellowships Network (EFN) began as a pilot program in 2009 to match mid- and late-career for-profit employees in the San Francisco Bay Area to non-profit organizations seeking their skills and experience. After a successful pilot, the EFN expanded nationally, reaching 26 states and placing close to 2,000 Fellows in 10 years. This presentation will reveal analysis from more than 1,400 linked surveys of fellows and their organizational hosts both pre- and post-fellowship, totaling more than 350 observations. Results indicate a high sense of program satisfaction and enduring impact on the work of the non-profits. Further, the efficiency of the matching process was positively associated with fellows’ recommendation of the program to friends or colleagues and a higher sense of enduring impact among fellows was positively associated with the likelihood of pursuing post-fellowship non-profit work. Implications for the EFN and the broader nonprofit sector will be discussed.
WHY DO WE NEED AN INTERNATIONAL CONVENTION ON THE RIGHTS OF OLDER PEOPLE?
Authors: Marumoto Mika
Published: November 2019

This presentation discusses the increasing need for an international convention on the rights of older people. Such a convention would contextualize global, regional and national demographic shifts and identify gaps in existing international human rights laws, so as to better protect older persons’ rights to health and well-being. Persons aged 60 or above are expected to more than double from 2015 to reach 2 billion in 2050, with their proportion of the world population rising from 12% to 21%. By 2050, 80% of older persons are expected to live in societies that are currently labeled developing countries. Existing international human rights instruments fall short regarding pensions and protection from poverty. The presentation demonstrates ongoing global efforts, specifically through the UN Open-ended Working Group on Ageing, to set global rights-based standards, and the roles played by civil society organizations that use network approaches in advocating for the rights of older people.
PROFESSIONAL CAREGIVERS’ PERCEPTIONS OF PEOPLE WITH DEMENTIA AT ADULT DAY SERVICES IN TAIWAN: THE EFFECTS ON CLIENTS
Authors: Liou Chih-ling
Published: November 2019

This study aims to explore staff perception of their clients with dementia in five ADS centers in Taiwan. Focused ethnography was used to collect data from 45 individual interviews with nurse’s aides, nurses, social workers, housekeepers, volunteers, bus drivers and centers’ directors and 600 hours of field observations. The findings from the content analysis revealed two themes reflecting ADS staff’s attitudes towards clients: (1) labeling the clients as “old” or “sick” to distance themselves from the clients and (2) viewing the clients as their aging relatives and over-helping them. Both attitudes not only affected staff-client relationships but also influenced how clients viewed themselves by inducing self-labeling of incompetent and dependent. More dementia-specific and communication training is needed for staff at ADS centers in Taiwan to change their attitudes and behavior toward clients with dementia. With a more positive attitude of people with dementia, the prerequisites for person-centered care will improve.
QUANTIFYING SENSITIVE DEPENDENCE OF INITIAL CONDITION USING STRUCTURAL EQUATION MODELING
Authors: Moulder Robert , Boker Steve
Published: November 2019

Human systems display sensitive dependence of initial condition. That is, even though two individuals may be similar in most regards, small differences between these individuals may have far reaching consequences later in life. In dynamical systems analysis, this sort of behavior is quantified with maximum Lyapunov exponents. These exponents quantify the degree to which small differences in initial condition between two systems affect trajectories of these systems later in time. Current methods for estimating maximum Lyapunov exponents are sensitive to noise and this sensitivity leads to estimation errors when researchers attempt to estimate these exponents on data obtained from human participants. Additionally, most current methods only allow for maximum Lyapunov exponent estimation using univariate time series. In this presentation, we present a method for using structural equation modeling for estimating latent maximum Lyapunov exponents from noisy multivariate time series and discuss applications of this method for analyzing human generated data.
DEMENTIA CARE AND BEHAVIORAL HEALTH WORKFORCE DEVELOPMENT: INNOVATIONS IN TRAINING ACROSS SETTINGS
Authors: Wyman Mary F , Cimarolli Verena R , Stone Robyn
Published: November 2019

It is well-established that there is a critical shortage of trained health care staff who can deliver high-quality behavioral health services to persons with dementia. The development of innovative professional training curricula, and effectively implementing and sustaining such programs, is a key element in addressing this workforce crisis. This symposium highlights cutting-edge efforts being conducted across the continuum of care, to train health care professionals to support optimal behavioral health for persons with dementia. In the outpatient setting, Wyman et al. present data from a survey of mental health clinicians on their perspectives about working with persons with dementia and caregivers, revealing critical gaps in knowledge and skills to target in continuing education programming. Wray and colleagues focus on integrated behavioral health in primary care, discussing how geriatric experts can most effectively contribute to improved assessment and treatment within this setting. Koepp presents an innovative program to transform outpatient mental health care for persons with dementia through provider training and consultation. In the residential care setting, Reinhardt and colleagues report on the implementation of a comprehensive approach to the alleviation of behavioral health problems through training direct care staff in person-directed care in nursing homes. Finally, Karel et al share how VA interprofessional nursing home teams learn and sustain an evidence-based program to address behavioral concerns among residents with dementia. The discussant will lend a deep expertise in research and policy related to the geriatric workforce to her remarks on the presentations.
BEHAVIORAL HEALTH WORKFORCE DEVELOPMENT TO IMPROVE DEMENTIA CARE IN INTEGRATED PRIMARY CARE
Authors: Wray Laura O , Vest Bonnie M , Brady Laura Levon , King Paul R
Published: November 2019

People with dementia (PwD) receive most of their health care in primary care, yet timely recognition and optimal management of dementia in that setting continues to be challenging. Implementation of primary care medical home models in the Veterans Health Administration (VHA) holds promise for improving quality and coordination of dementia care through interprofessional collaboration. Integrating behavioral health providers (BHPs) into primary care may help to support the care of people with dementia and their families. However, most integrated BHPs have a generalist training background and likely require professional education to address the unique needs of patients with dementia. We will describe findings from a national VHA education needs survey of integrated BHPs and an in-depth qualitative study examining primary care for PwD in two large VHA healthcare systems. We will discuss how geriatric experts can serve as trainers to address current gaps in primary care of PwD.
TRANSFORMING DEMENTIA SERVICE DELIVERY: THE MENTAL HEALTH GERO-CHAMPIONS PROGRAM
Authors: Koepp Regina M
Published: November 2019

In order to provide effective mental health care to older adults with major neurocognitive disorders (e.g., Alzheimer’s disease and related dementias) within outpatient mental health clinics, mental health practitioners must possess a basic understanding of these disorders, the needs of and challenges faced by people living with dementia and their families, and effective treatment approaches for this population. The Mental Health Gero-Champions Program was established in 2015 at a large Veterans Affairs medical center with the aim of providing clinical support and opportunities for training to multidisciplinary mental health providers to enhance skills in assessing and treating older adults with neurocognitive disorders. This presentation will provide an overview of the Mental Health Gero-Champions Program, describe the development and implementation of this program, and discuss challenges and successes in sustaining this transformative initiative over time.
INTEREST GROUP SESSION—SYSTEMS RESEARCH IN LONG TERM CARE: DEVELOPING AN EVIDENCE BASE FOR NURSING HOME STAFFING IN EUROPE AND BEYOND: MANY PATHS TO ONE GOAL?
Authors: Hamers Jan , Backhaus Ramona , Corazzini Kirsten
Published: November 2019

Despite heterogeneity across countries, nursing homes worldwide have to ensure the delivery of high quality care. At the same time, adequately staffing the homes remains a major concern in most countries. It is a significant challenge to determine the numbers and type of staff as well as staff’s competencies that are necessary to meet the complex needs of nursing home residents. While, especially in the US, research on the relationship between staffing and quality in nursing homes has received considerable attention, the research literature is contradictory. Evidence shows that employing more staff or more registered nurses instead of nurse assistants will not automatically lead to better nursing home quality. This inconsistency of evidence might be explained by a myriad of methodological and theoretical challenges. This symposium aims to provide an international perspective on how researchers from different European countries contribute to the development of an evidence base for nursing home staffing. The first presenter will draw on findings from a realist review conducted in the UK, focusing on the mechanisms (how, why and in what circumstances) under which staff influence care home quality. The second presenter will offer insights into a Swiss study, taking a broader perspective on measuring staffing and quality in nursing homes. The third presenter will present a new instrument to identify staffing ratios in German nursing homes and provide insight into its development process. The fourth presenter will discuss the results of a critical review on the evidence base of a Dutch nursing home staffing guideline.
IMPROVING PRIMARY CARE PROVIDER EDUCATION AND SATISFACTION VIA THE CATCH-ON LEARNING COMMUNITIES
Authors: Emery-Tiburcio Erin , Bednarcyzk Magdalena , Wallace Febe , Newman Michelle
Published: November 2019

Nationally, there is a shortage of geriatric trained healthcare providers caring for older adults. As the population of older adults grows, health care systems and primary care providers struggle to provide high quality, cost effective care for older adults. Time for training is also limited in busy community health centers. The CATCH-ON Learning Communities (LCs) are telehealth educational interventions based on the ECHO model, modified to be less time intensive, thus decreasing cost to participating clinics. In the LC, geriatric specialists provide evidence-based, best practice training utilizing case discussions to illustrate pertinent learning points via monthly one hour video conferences. Practical, specific behavioral recommendations are offered for immediate implementation in each session. LCs are provided to interprofessional primary care teams. The first LC with a federally-qualified health center (FQHC) yielded consistently high satisfaction from participants, along with a 17% decrease in high risk medication prescriptions and 22% increase in falls screenings. Training the primary care workforce in evidence based geriatric interventions can improve the care of all older adults within each health system, improving healthcare access to help mitigate healthcare inequalities, slow adoption of best practices and rising costs of caring for complex older adults. The CATCH-ON Learning Community is an effective, low cost model of training the primary care work force without geographical or financial constraints that frequently limit access to specialized care.
PATTERNS OF WEALTH TRAJECTORY IN LATER LIFE: CRITICAL PERIOD, ACCUMULATION, AND SOCIAL MOBILITY MODELS
Authors: Chen Yu-Chih , Park Sojung , Morrow-Howell Nancy
Published: November 2019

Wealth, an important financial cushion for older adults to buffer economic stress, requires a longer time to accumulate and develop in one’s course of life. However, little is known about the trajectories of wealth in later life, and how the life course socioeconomic status (SES) may contribute to the development of wealth at old-age. This study investigated longitudinal patterns of wealth trajectory and whether SES across the life course affects these trajectories using critical period, accumulation, and social mobility models. Using data from 16,189 adults aged 51 and older from the 2004-2014 Health and Retirement Study, a growth mixture model was used to explore distinct wealth trajectories. Impacts of life course models were studied using multinomial logistic regression. Results showed that four heterogeneous latent classes of wealth were identified: Stable high (reference group), Low and increasing, Stable low, and High but decline. Disadvantaged adulthood SES, accumulated exposure to socioeconomic risks, and downward or persistent socioeconomic disadvantage over the life course were associated with Stable low, Low and increasing, and High but decline, supporting all three life course mechanisms on wealth development in later life. Evidence suggests that wealth development is heterogeneous across individuals, and a strong gradient effect of life-course SES on wealth trajectories are clearly observed. Programs and policies should address the effects of life course on wealth development to strengthen the economic well-being in later life.
CAREGIVER DEPRESSIVE SYMPTOM SEVERITY AMONG OLDER ADULTS WITH COGNITIVE VULNERABILITY
Authors: Fortinsky Richard H , Wakefield Dorothy
Published: November 2019

While caregivers of older adults with dementia often report considerable levels of depressive symptoms, much less is known about depressive symptoms among family members of older adults with depression or recent delirium. As part of an ongoing randomized clinical trial testing an in-home multidisciplinary team intervention for older adults with cognitive vulnerability due to dementia, depression, and/or delirium (care recipients, or CR) and their caregivers, in this presentation we report baseline data from the first 211 dyads enrolled in the trial to determine how caregiver depressive symptom severity is related to: CR diagnoses; CR cognitive impairment severity; and CR depressive symptom severity. CR diagnostic groups: Depression Only (n=49); Dementia Only (n=61); Depression and Dementia Only (n=47); Delirium Plus (n=54). Depressive symptom severity was measured using the Center for Epidemiologic Studies Depression Scale; CR cognitive symptom severity was measured using the Telephone Interview for Cognitive Status. Among CR, 57% were female, mean/sd age=77/6.9, 93% White; among caregivers, 64% were female, mean/sd age=66/13.7, 91% White, 55% spouses, 25% daughters, 9% sons. In multivariate linear regression models, which included covariates caregiver gender, relationship to CR, and number of hours/week providing care, we found that caregiver depressive symptom severity was less severe among caregivers of CR with Dementia Only compared to CR with Depression Only (b=-3.32; p=0.06); not associated with CR cognitive symptom severity; and significantly associated with CR depressive symptom severity (b=0.14; p<0.01). We conclude that family members of older adults with depression deserve greater attention to address their own depressive symptoms.
FACTORS ASSOCIATED WITH UNMET NEED AMONG FAMILY CAREGIVERS
Authors: Campione Joanne R , Zebrak Katarzyna
Published: November 2019

This study investigates the relationship between caregiver demographics, caregiving intensity, caregiver support use, and aspects of the caregiving situation with perceived unmet need. The data source was survey response data from 1,558 informal caregivers caring for older adults (age 60+) or caring for any adult with Alzheimer’s disease or related dementia (ADRD). Participants were randomly recruited through U.S. Area Agencies on Aging client lists of any service and interviewed in December 2016. Caregivers were asked, “Are you receiving all the help you need?” Twenty-two percent (n=345) said “Definitely No” and were classified as having unmet need. We placed caregivers in tertiles based on their Zarit burden score; unmet need was 14% among low burden, 20% among medium, and 34% among high. The mean age of the care recipient (CR) was 81 years. Caregivers were 70% non-Hispanic White, 52% caring for CR with ADRD, and 43% spouse of CR. A multivariable logistic regression found two predictive factors (odds ratio p-value < 0.01) that increased the likelihood of reporting unmet need: daily intensity of caregiving and not feeling appreciated by CR. Usage of caregiver education, counseling or support group services in the past 6 months decreased the likelihood of reporting unmet need. In the high burden subgroup, Black caregivers were more likely to report unmet need than White caregivers. Understanding the relationship between caregiver demographics, self-reported burden level, service use, and the caregiver’s need for more help can assist caregiver support programs in assessing, measuring, and addressing the ongoing needs of caregivers.
WHOM DO WE SERVE? DIVERSITY OF OLDER COMMUNITY CARE RECIPIENTS’ FUNCTIONING ACROSS EUROPE
Authors: Stoop Annerieke , Lette Manon , de Bruin Simone , Nijpels Giel , van Hout Hein
Published: November 2019

Across Europe, an increasing number of older people with multiple health and social care needs stay in their own homes until old age. Community care aims to support them to live at home for as long as possible. Comparative studies showed that population characteristics of older community care recipients differ between European countries. This is due to differences in financing, delivery and governance of community care. However, little is known about differences in health, including physical, cognitive, mental and social functioning, of older community care recipients served across European countries. The aim of this study was to provide insight into these differences. We used data of the IBenC study, which was collected using the interRAI HC-Assessment among 2884 older community care recipients from six European countries: Belgium, Finland, Germany, Iceland, Italy and the Netherlands. We found that prevalences of impairments in different health domains were highest among Italian community care recipients followed by the Belgian population, and lowest among community care recipients from the Netherlands. Feelings of loneliness were lowest among the Italian and highest among the Dutch population. This variation between European countries may be explained by differences in eligibility for and access to formal community services and informal care provision as well as cultural diversity. Insight in these differences supports understanding of community care across Europe among European and national policy-makers and researchers.
FROM BIG DATA TO COMMUNITY SETTINGS: HOW CAN EXERCISE IMPROVE HEALTH OUTCOMES IN OLDER CANCER SURVIVORS?
Authors: Bluethmann Shirley M , Leach Corinne
Published: November 2019

Current guidelines recommend that survivors achieve regular physical activity and reduced inactivity to attenuate cancer and mortality risk and to promote quality of life. Optimal ways of obtaining physical activity or measuring how much exercise has been achieved continues to be a challenge, especially among older adults and cancer survivors. Our symposium will provide insights using big data to understand population level patterns of activity and potential benefits for survivors, examining implications for survival and key health outcomes, including multimorbidity and functional limitations. We will also discuss social and environmental determinants that may be important for older survivors in designing community interventions, especially in rural communities. These include considerations related to the built environment and social support to promote leisure-time physical activity in older survivors.
GAPS AND OPPORTUNITIES TO IMPROVE ACCESS TO HEALTHCARE FOR OLDER RURAL VETERANS
Authors: Hicken Bret , Seaman Aaron T , Moo Lauren
Published: November 2019

Almost 25% of US military veterans live in rural areas and over 70% of these are age 55 years or older. The physical, cognitive, and functional declines common to aging coupled with accumulated physical and psychological traumas often incurred through military service make caring for older Veterans an especially difficult challenge. Furthermore, the geographic distances associated with rural living pose a significant barrier to timely access to care for aging Veterans and caregivers living in remote communities. Significant gaps remain in VA’s understanding of the needs of this population, which is essential for developing adequate models of care. This symposium highlights various aspects of the rural older Veteran experience and will suggest opportunities for improving access to care for this population. The first presentation estimates the differential impact of rural status on mortality rates among older Veterans using mortality data from the General Social Survey (Wilmoth et al). A second study is an analysis of urban/rural differences in PTSD symptoms as function of multiple co-factors and accounting for geographic location (Kurth et al). Seaman et al present qualitative data regarding the experience of Veterans with head and neck cancer to understand how rurality impacts cancer survival (Seaman et al). The final presentation will highlight a model to address mental health problems in older Veterans in primary care (Geri-PACT [Kube et al]) and will specifically highlight how this VA program may be adapted to address such needs the needs of older Veterans in rural areas.
PTSD SYMPTOMS AMONG VIETNAM, PERSIAN GULF, AND OEF/OIF/OND VETERANS: A RURAL/URBAN COMPARISON
Authors: Kurth Maria , Choun Soyoung , Lee Dylan , Rothwell David , aldwin Carolyn
Published: November 2019

There are mixed results in studies examining rural/urban differences in PTSD symptoms among veterans; however, many of these studies failed to consider possible confounds with geographic location. This study examined rural/urban differences in PTSD symptoms by combat exposure, war cohort, and gender. The VALOR (Veterans Aging: Longitudinal studies in Oregon) pilot study sampled Vietnam, Persian Gulf, and OEF/OIF/OND war cohorts using an online survey. The sample (N=237, Mage=57.84, SD=12.68) was mainly male (65%), White (85%), and urban (75.95%); most reported combat exposure (71%). Participants completed measures of PTSD, combat exposure, and demographics. Results indicate no effect of cohort or rural/urban status on PTSD symptoms. There was a significant effect of combat exposure, F(1,224)=4.58, p=.03, and gender, F(1,224)=4.13, p =.04, with males reporting higher levels of PTSD symptoms and combat exposure. Contrary to our expectations, there were no effects of cohort or geographic location on PTSD symptoms.
THE ROLE OF COMMUNITY ENGAGEMENT IN HURRICANE PREPAREDNESS AS PERCEIVED BY ASSISTED LIVING ADMINISTRATORS
Authors: Dobbs Debra J , June Joseph , Peterson Lindsay J , Dosa David , Jester Dylan , Hyer Kathyrn
Published: November 2019

The importance of communities in disasters has been well established since Hurricane Katrina. Smit and Wandel’s bottom-up approach to assess risks during a disaster involves community stakeholders. Administrators of assisted living (AL) environments increasingly have to assess the risks of hurricane evacuation for vulnerable older adults. The current study examines intersections between social networks, communication and preparedness during a hurricane for AL administrators. We conducted focus groups and interviews with AL administrators (N=60) in Florida about communication patterns with community associations, emergency management officials, AL staff, residents and their families during Hurricane Irma (2017) and about their perceptions of preparedness. A content analysis approach was used. Atlas.ti v7 was used for initial and axial coding. Co-occurrences were found among communication and preparedness themes. Some prevalent themes included “social capital”, “high versus low tech strategies” and “leadership effectiveness”. Themes intersected with individual administrator and AL organizational characteristics.
CONTROVERSIES AND CHALLENGES IN DEFINING SARCOPENIC OBESITY
Authors: Batsis John A
Published: November 2019

Sarcopenia is defined as the loss of muscle mass, strength and physical function with aging and in conjunction with obesity, leads to incrementally adverse outcomes. There is no current consensus for defining this disease entity, making an accurate evaluation challenging in both the research and clinical settings. We will review the definitions put forth by the Sarcopenia Definition and Outcomes Consortium and the European Working Group for the Study of Sarcopenia. We will present data highlighting the different diagnostic criteria of sarcopenic obesity and the diagnostic accuracy of common anthropometric measures in measuring adiposity using data from the National Health and Nutrition Examination surveys. The advantages and disadvantages of the different modalities of assessing body composition will be discussed, including body impedance analysis, dual energy x-ray absorptiometry, computer tomography and magnetic resonance imaging in addition to simple, novel clinical screening tools for obesity sarcopenia will be presented.